WorldWideScience

Sample records for generalized cost effectiveness

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

    Directory of Open Access Journals (Sweden)

    Johns Benjamin P

    2010-03-01

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

  2. A generalized concept for cost-effective structural design. [Statistical Decision Theory applied to aerospace systems

    Science.gov (United States)

    Thomas, J. M.; Hawk, J. D.

    1975-01-01

    A generalized concept for cost-effective structural design is introduced. It is assumed that decisions affecting the cost effectiveness of aerospace structures fall into three basic categories: design, verification, and operation. Within these basic categories, certain decisions concerning items such as design configuration, safety factors, testing methods, and operational constraints are to be made. All or some of the variables affecting these decisions may be treated probabilistically. Bayesian statistical decision theory is used as the tool for determining the cost optimum decisions. A special case of the general problem is derived herein, and some very useful parametric curves are developed and applied to several sample structures.

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

    Science.gov (United States)

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

    2009-10-09

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

  4. [Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis].

    Science.gov (United States)

    Fernández-Ordóñez, M; Tenías, J M; Picazo-Yeste, J

    2014-05-01

    To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001). Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  5. Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder.

    Science.gov (United States)

    Heuzenroeder, Louise; Donnelly, Marie; Haby, Michelle M; Mihalopoulos, Cathrine; Rossell, Ruth; Carter, Rob; Andrews, Gavin; Vos, Theo

    2004-08-01

    To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filter criteria ("equity", "strength of evidence", "feasibility" and "acceptability to stakeholders") is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

  6. Cost-effectiveness of physical therapy and general practitioner care for sciatica.

    NARCIS (Netherlands)

    Luijsterburg, P.A.; Lamers, L.M.; Verhagen, A.P.; Ostelo, R.W.J.G.; Hoogen, H.J.M. van den; Peul, W.C.; Avezaat, C.J.; Koes, B.W.

    2007-01-01

    STUDY DESIGN: An economic evaluation alongside a randomized clinical trial in primary care. A total of 135 patients were randomly allocated to physical therapy added to general practitioners' care (n = 67) or to general practitioners' care alone (n = 68). OBJECTIVE: To evaluate the cost-effectivenes

  7. Effectiveness and cost-effectiveness of general immunisation of infants and young children with the heptavalent conjugated pneumococcal vaccine

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    Stürzlinger, Heidi

    2005-11-01

    Full Text Available Background: The European Agency for the Evaluation of Medicinal Products (EMEA granted market authorisation to the heptavalent pneumococcal vaccine Prevenar (Wyeth in the year 2001. The indication of Prevenar is the active immunisation of infants and young children under the age of two against invasive disease caused by Streptococcus pneumonia serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. At the time of this study the German vaccination scheme advises the immunisation with Prevenar only for children at high risk. Objectives: The objective of the study is first to determine the efficacy and effectiveness of the immunisation of all children with the heptavalent conjugated pneumococcal vaccine in Germany and second, whether a general recommendation for vaccination of all children would be cost-effective. Methods: A systematic literature search was performed in 29 relevant databases for the period of January 1999 to June 2004. Thus 1,884 articles were identified which were then assessed according to predefined selection criteria. Results: There is evidence for the medical effectiveness of Prevenar against invasive pneumococcal disease caused by the covered serotypes from a major double-blinded RCT undertaken in California. The vaccine shows lower values of effectiveness against otitis media and pneumonia. The values for effectiveness of the vaccine in Germany are below the data for California because of the different incidence of Serotypes. The cost-effectiveness rates for an immunisation of all children with Prevenar vary across different countries. One reason - besides different Health Systems - can be seen in the uncertainty about the duration of protection, another in the assumption on regional serotype coverage of the vaccine. From the healthcare payers' perspective a general vaccination of all children in Germany is not cost-effective, from a societal perspective the benefits from vaccination could prevail the cost. The actual price of the

  8. [Can Topical Negative Pressure Therapy be Performed as a Cost-Effective General Surgery Procedure in the German DRG System?].

    Science.gov (United States)

    Hirche, Z; Xiong, L; Hirche, C; Willis, S

    2016-04-01

    Topical negative pressure therapy (TNPT) has been established for surgical wound therapy with different indications. Nevertheless, there is only sparse evidence regarding its therapeutic superiority or cost-effectiveness in the German DRG system (G-DRG). This study was designed to analyse the cost-effectiveness of TNPT in the G-DRG system with a focus on daily treatment costs and reimbursement in a general surgery care setting. In this retrospective study, we included 176 patients, who underwent TNPT between 2007 and 2011 for general surgery indications. Analysis of the cost-effectiveness involved 149 patients who underwent a simulation to calculate the reimbursement with or without TNPT by a virtual control group in which the TNP procedure was withdrawn for DRG calculation. This was followed by a calculation of costs for wound dressings and TNPT rent and material costs. Comparison between the "true" and the virtual group enabled calculation of the effective remaining surplus per case. Total reimbursement by included TNPT cases was 2,323 ,70.04 €. Costs for wound dressings and TNPT rent were 102,669.20 €. In 41 cases there was a cost-effectiveness (27.5%) with 607,422.03 € with TNP treatment, while the control group without TNP generated revenues of 442,015.10 €. Costs for wound dressings and TNPT rent were 47,376.68 €. In the final account we could generate a cost-effectiveness of 6759 € in 5 years per 149 patients by TNPT. In 108 cases there was no cost-effectiveness (72.5%). TNPT applied in a representative general surgery setting allows for wound therapy without a major financial burden. Based on the costs for wound dressings and TNPT rent, a primarily medically based decision when to use TNPT can be performed in a balanced product cost accounting. This study does not analyse the superiority of TNPT in wound care, so further prospective studies are required which focus on therapeutic superiority and cost-effectiveness. Georg Thieme

  9. Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free

    NARCIS (Netherlands)

    Zijlstra, T.R.; Braakman-Jansen, Louise Marie Antoinette; Taal, Erik; Rasker, Hans J.; van de Laar, Mart A F J

    2007-01-01

    Objectives: To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM). - Methods: 134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient

  10. Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures.

    Science.gov (United States)

    Burnett, Heather F; Lambley, Rosemary; West, Stephanie K; Ungar, Wendy J; Mireskandari, Kamiar

    2015-11-01

    The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA. An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged 68 successful procedures per child. The result was robust to varying the cost assumptions. Cross-over designs offer a powerful way to assess costs and effectiveness of two interventions because patients serve as their own control. This study demonstrated significant savings when ophthalmological exams were carried out in a hospital outpatient clinic, although with slightly fewer procedures completed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. The cost-effectiveness of point of care testing in a general practice setting: results from a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Briggs Nancy E

    2010-06-01

    Full Text Available Abstract Background While point of care testing (PoCT for general practitioners is becoming increasingly popular, few studies have investigated whether it represents value for money. This study aims to assess the relative cost-effectiveness of PoCT in general practice (GP compared to usual testing practice through a pathology laboratory. Methods A cost-effectiveness analysis based on a randomized controlled trial with 4,968 patients followed up for 18 months and fifty-three general practices in urban, rural and remote locations across three states in Australia. The incremental costs and health outcomes associated with a clinical strategy of PoCT for INR, HbA1c, lipids, and ACR were compared to those from pathology laboratory testing. Costs were expressed in year 2006 Australian dollars. Non-parametric bootstrapping was used to generate 95% confidence intervals. Results The point estimate of the total direct costs per patient to the health care sector for PoCT was less for ACR than for pathology laboratory testing, but greater for INR, HbA1c and Lipids, although none of these differences was statistically significant. PoCT led to significant cost savings to patients and their families. When uncertainty around the point estimates was taken into account, the incremental cost-effectiveness ratio (ICER for PoCT was found to be unfavourable for INR, but somewhat favourable for ACR, while substantial uncertainty still surrounds PoCT for HbA1c and Lipids. Conclusions The decision whether to fund PoCT will depend on the price society is willing to pay for achievement of the non-standard intermediate outcome indicator. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12605000272695

  12. A General Approach of Quality Cost Management Suitable for Effective Implementation in Software Systems

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    Stelian BRAD

    2010-01-01

    Full Text Available Investments in quality are best quantified by implementing and managing quality cost systems. A review of various opinions coming from practitioners and researchers about the existent quality cost models reveals a set of drawbacks (e.g. too theoretical and too close to ideal cases; too academic, with less practical impact; too much personalized to particular business processes, with difficulties in extrapolating to other cases; not comprising all dimensions of a business system. Using concepts and tools in quality management theory and practice and algorithms of innovative problem solving, this paper formulates a novel approach to improve practical usability, comprehensiveness, flexibility and customizability of a quality cost management system (QCMS when implementing it in a specific software application. Conclusions arising from the implementation in real industrial cases are also highlighted.

  13. Generalized cost-effectiveness analysis of a package of interventions to reduce cardiovascular disease in Buenos Aires, Argentina

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    Souto Alberto

    2009-05-01

    Full Text Available Abstract Background Chronic diseases, represented mainly by cardiovascular disease (CVD and cancer, are increasing in developing countries and account for 53% of chronic diseases in Argentina. There is strong evidence that a reduction of 50% of the deaths due to CVD can be attributed to a reduction in smoking, hypertension and hypercholesterolemia. Generalized cost-effectiveness analysis (GCE is a methodology designed by WHO to inform decision makers about the extent to which current or new interventions represent an efficient use of resources. We aimed to use GCE analysis to identify the most efficient interventions to decrease CVD. Methods Six individual interventions (treatment of hypertension, hypercholesterolemia, smoking cessation and combined clinical strategies to reduce the 10 year CVD Risk and two population-based interventions (cooperation between government, consumer associations and bakery chambers to reduce salt in bread, and mass education strategies to reduce hypertension, hypercholesterolemia and obesity were selected for analysis. Estimates of effectiveness were entered into age and sex specific models to predict their impact in terms of age-weighted and discounted DALYs saved (disability-adjusted life years. To translate the age- and sex-adjusted incidence of CVD events into health changes, we used risk model software developed by WHO (PopMod. Costs of services were measured in Argentine pesos, and discounted at an annual rate of 3%. Different budgetary impact scenarios were explored. Results The average cost-effectiveness ratio in argentine pesos (ARS$ per DALY for the different interventions were: (i less salt in bread $151; (ii mass media campaign $547; (iii combination drug therapy provided to subjects with a 20%, 10% and 5% global CVD risk, $3,599, $4,113 and $4,533, respectively; (iv high blood pressure (HBP lowering therapy $7,716; (v tobacco cessation with bupropion $ 33,563; and (iv high-cholesterol lowering therapy

  14. Cost effectiveness of a pharmacist-led information technology intervention for reducing rates of clinically important errors in medicines management in general practices (PINCER).

    Science.gov (United States)

    Elliott, Rachel A; Putman, Koen D; Franklin, Matthew; Annemans, Lieven; Verhaeghe, Nick; Eden, Martin; Hayre, Jasdeep; Rodgers, Sarah; Sheikh, Aziz; Avery, Anthony J

    2014-06-01

    We recently showed that a pharmacist-led information technology-based intervention (PINCER) was significantly more effective in reducing medication errors in general practices than providing simple feedback on errors, with cost per error avoided at £79 (US$131). We aimed to estimate cost effectiveness of the PINCER intervention by combining effectiveness in error reduction and intervention costs with the effect of the individual errors on patient outcomes and healthcare costs, to estimate the effect on costs and QALYs. We developed Markov models for each of six medication errors targeted by PINCER. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. A composite probabilistic model combined patient-level error models with practice-level error rates and intervention costs from the trial. Cost per extra QALY and cost-effectiveness acceptability curves were generated from the perspective of NHS England, with a 5-year time horizon. The PINCER intervention generated £2,679 less cost and 0.81 more QALYs per practice [incremental cost-effectiveness ratio (ICER): -£3,037 per QALY] in the deterministic analysis. In the probabilistic analysis, PINCER generated 0.001 extra QALYs per practice compared with simple feedback, at £4.20 less per practice. Despite this extremely small set of differences in costs and outcomes, PINCER dominated simple feedback with a mean ICER of -£3,936 (standard error £2,970). At a ceiling 'willingness-to-pay' of £20,000/QALY, PINCER reaches 59 % probability of being cost effective. PINCER produced marginal health gain at slightly reduced overall cost. Results are uncertain due to the poor quality of data to inform the effect of avoiding errors.

  15. COMPARATIVE STUDY OF HEMODYNAMIC STABILITY AND COST EFFECTIVENESS BETWEEN GENERAL AND SPINAL ANAESTHESIA IN PATIENTS AGE GROUP (0-5YEARS IN LOWER ABDOMINAL AND LOWER EXTREMITIES SURGERIES

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    Jaitawat

    2015-12-01

    Full Text Available BACKGROUND AND AIMS Aim of this study was to compare the changes in heart rate, blood pressure, oxygen saturation and cost effectiveness between general anaesthesia and spinal anaesthesia in pediatric patients undergoing lower abdominal and lower limb surgeries for the same duration. MATERIAL AND METHODS Fifty ASA1 patients in age group 0-5 years of either sex undergoing lower abdominal and lower limb surgeries were randomly divided in to two groups (Group-I GA group-n25 and Group-II SA group-n25. Group1 was given general anaesthesia and group-II was given spinal anaesthesia. Haemodynamic parameters and side effects during intra operative and immediate post-operative period were recorded and cost of GA and SA was calculated. RESULTS Patients in both the groups were comparable in surgical procedures and duration of surgery. Haemodynamically children in spinal group (Group-II remained more stable intra operatively and no untoward incidence was observed in group-II. Spinal Anaesthesia was much more cost effective as compared to general anaesthesia. CONCLUSION Pediatric spinal anaesthesia is a safe and effective anaesthetic technique for lower abdominal and lower limb surgeries. It is much more cost effective as compared to general anaesthesia.

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

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

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

  17. Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: design of a randomised clinical trial

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    Verhaar Jan AN

    2011-10-01

    Full Text Available Abstract Background Osteoarthritis (OA is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hip OA. Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare costs. However, studies evaluating cost-effectiveness of common exercise therapy in hip OA are lacking. Therefore, this randomised controlled trial is designed to investigate the cost-effectiveness of exercise therapy in conjunction with the general practitioner's (GP care, compared to GP care alone, for patients with hip OA. Methods/Design Patients aged ≥ 45 years with OA of the hip, who consulted the GP during the past year for hip complaints and who comply with the American College of Rheumatology criteria, are included. Patients are randomly assigned to either exercise therapy in addition to GP care, or to GP care alone. Exercise therapy consists of (maximally 12 treatment sessions with a physiotherapist, and home exercises. These are followed by three additional treatment sessions in the 5th, 7th and 9th month after the first treatment session. GP care consists of usual care for hip OA, such as general advice or prescribing pain medication. Primary outcomes are hip pain and hip-related activity limitations (measured with the Hip disability Osteoarthritis Outcome Score [HOOS], direct costs, and productivity costs (measured with the PROductivity and DISease Questionnaire. These parameters are measured at baseline, at 6 weeks, and at 3, 6, 9 and 12 months follow-up. To detect a 25% clinical difference in the HOOS pain score, with a power of 80% and an alpha 5%, 210 patients are required. Data are analysed according to the intention-to-treat principle. Effectiveness is evaluated using linear regression models with repeated measurements. An

  18. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial.

    Science.gov (United States)

    van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

    2016-04-02

    Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared

  19. Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

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    De Salas-Cansado M

    2012-06-01

    Full Text Available Marina De Salas-Cansado,1 José M Olivares,2 Enrique Álvarez,3 Jose L Carrasco,4 Andoni Barrueta,5 Javier Rejas,51Trial Form Support Spain, Madrid; 2Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo; 3Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona; 4Department of Psychiatry, Hospital Clínico San Carlos, Madrid; 5Health Outcomes Research Department, Medical Unit, Pfizer Spain, Alcobendas, Madrid, SpainBackground: Generalized anxiety disorder (GAD is a prevalent health condition which seriously affects both patient quality of life and the National Health System. The aim of this research was to carry out a post hoc cost-effectiveness analysis of the effect of pregabalin versus selective serotonin reuptake inhibitors (SSRIs/serotonin norepinephrine reuptake inhibitors (SNRIs in treated benzodiazepine-refractory outpatients with GAD.Methods: This post hoc cost-effectiveness analysis used secondary data extracted from the 6-month cohort, prospective, noninterventional ADAN study, which was conducted to ascertain the cost of illness in GAD subjects diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Benzodiazepine-refractory subjects were those who claimed persistent symptoms of anxiety and showed a suboptimal response (Hamilton Anxiety Rating Scale ≥16 to benzodiazepines, alone or in combination, over 6 months. Patients could switch to pregabalin (as monotherapy or addon or to an SSRI or SNRI, alone or in combination. Effectiveness was expressed as quality-adjusted life years gained, and the perspective was that of the National Health System in the year 2008. A sensitivity analysis was performed using bootstrapping techniques (10,000 resamples were obtained in order to obtain a cost-effectiveness plane and a corresponding acceptability curve.Results: A total of 282 subjects (mean Hamilton Anxiety Rating Scale score 25.8 were

  20. 34 CFR 76.530 - General cost principles.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false General cost principles. 76.530 Section 76.530... Be Met by the State and Its Subgrantees? Allowable Costs § 76.530 General cost principles. Both 34 CFR 74.27 and 34 CFR 80.22 reference the general cost principles that apply to grants, subgrants...

  1. Effectiveness and cost-effectiveness of telephone consultations for fever or gastroenteritis using a formalised procedure in general practice: study protocol of a cluster randomised controlled trial.

    Science.gov (United States)

    Reuter, Paul-Georges; Desmettre, Thibaut; Guinemer, Sabine; Ducros, Olivier; Begey, Stéphane; Ricard-Hibon, Agnès; Billier, Laurianne; Grignon, Océane; Megy-Michoux, Isabelle; Latouff, Jean-Noël; Sourbes, Adeline; Latier, Julien; Durand-Zaleski, Isabelle; Lapostolle, Frédéric; Vicaut, Eric; Adnet, Frédéric

    2016-09-22

    Telephone consultations in general practice are on the increase. However, data on their efficiency in terms of out-of-hours general practitioner (GP) workload, visits to hospital emergency departments (ED), cost, patient safety and satisfaction are relatively scant. The aim of this trial is to assess the effectiveness of telephone consultations provided by French emergency call centres in patients presenting with isolated fever or symptoms of gastroenteritis, mainly encountered diseases. This is a prospective, open-label, multicentre, pragmatic, cluster randomised clinical trial of an estimated 2880 patients making an out-of-hours call to one of six French emergency call centres for assistance with either fever or symptoms of gastroenteritis without seriousness criteria. Each call is handled by a call centre physician. Out-of-hours is 8 p.m. to 7.59 a.m. on weekdays, 1 p.m. to 7.59 a.m. on Saturdays and round-the-clock on Sundays and school holidays. Patients will be enrolled over 1 year. In the intervention arm, a telephone consultation based on a protocol, the formal Telephone Medical Advice (fTMA), is offered to each patient calling. This protocol aims to overcome a physical consultation during out-of-hours periods. It offers reassurance and explanations, advice on therapeutic management which may include, in addition to hygiene and diet measures, a telephone prescription of antipyretic, analgesic, rehydration medication or others, and recommendations on surveillance of the patient and any action to be taken. The patient is invited to call again if the condition worsens or new symptoms develop and to make an appointment with their family GP during office hours. In the control arm, the call centre physician handles calls as usual. This physician can carry out a telephone consultation with or without a telephone prescription, dispatch an on-duty GP, the fire brigade or an ambulance to the patient, or refer the patient to an on-duty physician or to the ED

  2. 34 CFR 75.530 - General cost principles.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false General cost principles. 75.530 Section 75.530 Education Office of the Secretary, Department of Education DIRECT GRANT PROGRAMS What Conditions Must Be Met by a Grantee? Allowable Costs § 75.530 General cost principles. The general principles to be used...

  3. 78 FR 7718 - Review of the General Purpose Costing System

    Science.gov (United States)

    2013-02-04

    ... Surface Transportation Board 49 CFR Parts 1247 and 1248 Review of the General Purpose Costing System... general purpose costing system, the Uniform Railroad Costing System (URCS). Specifically, the Board is..., 2013. ADDRESSES: Comments may be submitted either via the Board's e-filing format or in the traditional...

  4. Robotics in general surgery: A systematic cost assessment.

    Science.gov (United States)

    Gkegkes, Ioannis D; Mamais, Ioannis A; Iavazzo, Christos

    2016-12-21

    The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.

  5. Cost effective solar Inverter

    Directory of Open Access Journals (Sweden)

    Nagarathna M

    2015-06-01

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

  6. General medications utilization and cost patterns in hospitalized children

    Directory of Open Access Journals (Sweden)

    Kassis I

    2009-03-01

    Full Text Available Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults. Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital. Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription. Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient in A and 959 for 88 children (10.9 prescription/patient in B (p=0.02. The general medications defined daily dose (DDD and drug utilization 90% (DU90% index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS and B (6,269 NIS admission units were compared (p=0.04. Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in

  7. General View on Internal Audit of Production Costs

    Directory of Open Access Journals (Sweden)

    Yıldırım Ercan ÇALIŞ

    2013-06-01

    Full Text Available Identifying the costs correctly is primarily important for managerial objectives. An effective and efficient managerial policy is only possible through actual financial data setting the base of decisions to be made. Well defined and true calculated cost elements are essential to determine production costs properly. Considering any expense which is not related with manufacturing, will cause inaccurate cost computation. Aim of this study is to determine the necessary audit procedures to specify and define cost factors properly

  8. Cost accounting of radiological examinations. Cost analysis of radiological examinations of intermediate referral hospitals and general practice.

    Science.gov (United States)

    Lääperi, A L

    1996-01-01

    The purpose of this study was to analyse the cost structure of radiological procedures in the intermediary referral hospitals and general practice and to develop a cost accounting system for radiological examinations that takes into consideration all relevant cost factors and is suitable for management of radiology departments and regional planning of radiological resources. The material comprised 174,560 basic radiological examinations performed in 1991 at 5 intermediate referral hospitals and 13 public health centres in the Pirkanmaa Hospital District in Finland. All radiological departments in the hospitals were managed by a specialist in radiology. The radiology departments at the public health care centres operated on a self-referral basis by general practitioners. The data were extracted from examination lists, inventories and balance sheets; parts of the data were estimated or calculated. The radiological examinations were compiled according to the type of examination and equipment used: conventional, contrast medium, ultrasound, mammography and roentgen examinations with mobile equipment. The majority of the examinations (87%) comprised conventional radiography. For cost analysis the cost items were grouped into 5 cost factors: personnel, equipment, material, real estate and administration costs. The depreciation time used was 10 years for roentgen equipment, 5 years for ultrasound equipment and 5 to 10 years for other capital goods. An annual interest rate of 10% was applied. Standard average values based on a sample at 2 hospitals were used for the examination-specific radiologist time, radiographer time and material costs. Four cost accounting versions with varying allocation of the major cost items were designed. Two-way analysis of variance of the effect of different allocation methods on the costs and cost structure of the examination groups was performed. On the basis of the cost analysis a cost accounting program containing both monetary and

  9. Comparative effectiveness and costs of generic and brand-name gabapentin and venlafaxine in patients with neuropathic pain or generalized anxiety disorder in Spain

    Directory of Open Access Journals (Sweden)

    Sicras-Mainar A

    2015-06-01

    Full Text Available Antoni Sicras-Mainar,1 Javier Rejas-Gutiérrez,2 Ruth Navarro-Artieda3 1Planning Directorate, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain; 2Department of Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain; 3Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To explore adherence/persistence with generic gabapentin/venlafaxine versus brand-name gabapentin/venlafaxine (Neurontin®/Vandral® in peripheral neuropathic pain (pNP or generalized anxiety disorder (GAD, respectively, and whether it is translated into different costs and patient outcomes in routine medical practice. Methods: A retrospective, new-user cohort study was designed. Electronic medical records (EMR of patients included in the health plan of Badalona Serveis Assistencials SA, Barcelona, Spain were exhaustively extracted for analysis. Participants were beneficiaries aged 18+ years, followed between 2008 and 2012, with a pNP/GAD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM code, who initiated treatment with generic or brand-name gabapentin or venlafaxine. Assessments included 1-year treatment persistence and adherence (medication possession ratio, health care costs, and reduction in severity of pain and anxiety symptoms. Results: A total of 2,210 EMR were analyzed; 1,369 on gabapentin (brand 400; generic 969 and 841 on venlafaxine (brand 370 and generic 471. Brand-name gabapentin and venlafaxine were both significantly associated with longer persistence than generic: 7.3 versus 6.3 months, P<0.001; and 8.8 versus 8.1 months, P<0.05, respectively. Brand-name was associated with higher adherence: 86.5% versus 81.3%, P<0.001; and 82.1% versus 79.0%, P<0.05, respectively. Adjusted average costs were higher with generic compared with brand: €1,277 versus €1,057 (difference of €220 per patient; P<0.001 for gabapentin; and €1,110 versus €928

  10. A Deterministic Inventory/Production Model with General Inventory Cost Rate Function and Concave Production Costs

    NARCIS (Netherlands)

    S.I. Birbil (Ilker); J.B.G. Frenk (Hans); Z.P. Bayindir (Pelin)

    2004-01-01

    textabstractWe present a thorough analysis of the economic order quantity model with shortages under a general inventory cost rate function and concave production costs. By using some standard results from convex analysis, we show that the model exhibits a composite concave-convex structure.

  11. Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care.

    Science.gov (United States)

    Mousquès, Julien; Bourgueil, Yann; Le Fur, Philippe; Yilmaz, Engin

    2010-12-01

    To assess the efficacy and the cost of a French team work experiment between nurses and GPs for managing type 2 diabetes patients. Based on a case control study design we compare the evolution of process (standard follow-up procedures) and final (glycemic control) outcomes, and of cost, between two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group). After a 11 months of follow-up, patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 and 6.8, p≤5%) and under glycemic control (with OR comprise between 1.8 and 2.7, p≤5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled group. This experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiment to be launched by French health authorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  12. Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: Design of a randomised clinical trial

    NARCIS (Netherlands)

    P. van Es (Pauline); P.A.J. Luijsterburg (Pim); J. Dekker (Joost); M.A. Koopmanschap (Marc); A.M. Bohnen (Arthur); J.A.N. Verhaar (Jan); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2011-01-01

    textabstractBackground: Osteoarthritis (OA) is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hi

  13. 42 CFR 413.5 - Cost reimbursement: General.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Cost reimbursement: General. 413.5 Section 413.5 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... records of old assets, the principles provide an optional allowance in lieu of such depreciation...

  14. Cost-Effective Clustering

    CERN Document Server

    Gottlieb, S

    2001-01-01

    Small Beowulf clusters can effectively serve as personal or group supercomputers. In such an environment, a cluster can be optimally designed for a specific problem (or a small set of codes). We discuss how theoretical analysis of the code and benchmarking on similar hardware lead to optimal systems.

  15. A cost-effective treatment for severe generalized erosion and loss of vertical dimension of occlusion: laboratory-fabricated composite resin restorations.

    Science.gov (United States)

    Metz, Michael J; Stapleton, Brandon M; Harris, Bryan T; Lin, Wei-Shao

    2015-01-01

    This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

  16. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting – rationale, design and baseline characteristics

    Directory of Open Access Journals (Sweden)

    Glastonbury Briony

    2008-08-01

    Full Text Available Abstract Background Point of care testing (PoCT may be a useful adjunct in the management of chronic conditions in general practice (GP. The provision of pathology test results at the time of the consultation could lead to enhanced clinical management, better health outcomes, greater convenience and satisfaction for patients and general practitioners (GPs, and savings in costs and time. It could also result in inappropriate testing, increased consultations and poor health outcomes resulting from inaccurate results. Currently there are very few randomised controlled trials (RCTs in GP that have investigated these aspects of PoCT. Design/Methods The Point of Care Testing in General Practice Trial (PoCT Trial was an Australian Government funded multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost effectiveness and satisfaction of PoCT in a GP setting. The PoCT Trial covered an 18 month period with the intervention consisting of the use of PoCT for seven tests used in the management of patients with diabetes, hyperlipidaemia and patients on anticoagulant therapy. The primary outcome measure was the proportion of patients within target range, a measure of therapeutic control. In addition, the PoCT Trial investigated the safety of PoCT, impact of PoCT on patient compliance to medication, stakeholder satisfaction, cost effectiveness of PoCT versus laboratory testing, and influence of geographic location. Discussion The paper provides an overview of the Trial Design, the rationale for the research methodology chosen and how the Trial was implemented in a GP environment. The evaluation protocol and data collection processes took into account the large number of patients, the broad range of practice types distributed over a large geographic area, and the inclusion of pathology test results from multiple pathology laboratories. The evaluation protocol developed reflects the complexity of the Trial setting

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

    African Journals Online (AJOL)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-11-01

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

  19. School District Administrative Costs, Regional Series, and Telecommunications. Special Study. Report to the Arizona Legislature by the Auditor General.

    Science.gov (United States)

    Arizona State Dept. of Education, Phoenix.

    The Arizona Office of the Auditor General conducted a study of Arizona school district administrative costs, regional services, and telecommunications. In the area of administrative costs, the study found that larger, unified districts were more cost effective in terms of district administrative costs per student and students per administrator.…

  20. The effectiveness and cost-effectiveness of telephone triage of patients requesting same day consultations in general practice: study protocol for a cluster randomised controlled trial comparing nurse-led and GP-led management systems (ESTEEM).

    Science.gov (United States)

    Campbell, John L; Britten, Nicky; Green, Colin; Holt, Tim A; Lattimer, Valerie; Richards, Suzanne H; Richards, David A; Salisbury, Chris; Taylor, Rod S; Fletcher, Emily

    2013-01-04

    Recent years have seen an increase in primary care workload, especially following the introduction of a new General Medical Services contract in 2004. Telephone triage and telephone consultation with patients seeking health care represent initiatives aimed at improving access to care. Some evidence suggests that such approaches may be feasible but conclusions regarding GP workload, cost, and patients' experience of care, safety, and health status are equivocal. The ESTEEM trial aims to assess the clinical- and cost-effectiveness of nurse-led computer-supported telephone triage and GP-led telephone triage, compared to usual care, for patients requesting same-day consultations in general practice. ESTEEM is a pragmatic, multi-centre cluster randomised clinical trial with patients randomised at practice level to usual care, computer decision-supported nurse triage, or GP-led triage. Following triage of 350-550 patients per practice we anticipate estimating and comparing total primary care workload (volume and time), the economic cost to the NHS, and patient experience of care, safety, and health status in the 4-week period following the index same-day consultation request across the three trial conditions.We will recruit all patients seeking a non-emergency same-day appointment in primary care. Patients aged 12.0-15.9 years and temporary residents will be excluded from the study.The primary outcome is the number of healthcare contacts taking place in the 4-week period following (and including) the index same-day consultation request. A range of secondary outcomes will be examined including patient flow, primary care NHS resource use, patients' experience of care, safety, and health status.The estimated sample size required is 3,751 patients (11,253 total) in each of the three trial conditions, to detect a mean difference of 0.36 consultations per patient in the four week follow-up period between either intervention group and usual care 90% power, 5% alpha, and an

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

    Science.gov (United States)

    Fisher, P

    1993-12-01

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

  2. A Departmental Cost-Effectiveness Model.

    Science.gov (United States)

    Holleman, Thomas, Jr.

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

  3. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice : protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

    2016-01-01

    BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Off

  4. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice : Protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, T.; Lancee, J.; Slottje, P.; Bosmans, J.; Van Someren, E.; Reynolds, C.; Cuijpers, P.; van Straten, A.

    2016-01-01

    Background: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Off

  5. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice : protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

    2016-01-01

    BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Off

  6. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice : Protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, T.; Lancee, J.; Slottje, P.; Bosmans, J.; Van Someren, E.; Reynolds, C.; Cuijpers, P.; van Straten, A.

    2016-01-01

    Background: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Off

  7. Serial Cost Sharing with Many Goods and General Aggregation

    OpenAIRE

    2000-01-01

    The Serial Cost Sharing Rule has been conceived originally for problems where agents ask for different quantities of an homogeneous private good, the sum of which is produced by a single facility. In this context, it is endowed with a variety of desirable equity and coherency properties. This paper investigates the extension of this rule to the context where agents ask many goods that may be specific to some of them and where the aggregation rule may be very general. It begins with a systemat...

  8. Cost effectiveness in trauma care.

    Science.gov (United States)

    Elliott, D C; Rodriguez, A

    1996-02-01

    The above discussion brings together a vast body of data that together proclaim with fervent clarity: Traumatic injuries are expensive. The expense is paid in productive lives lost, in permanent disability, in pain and suffering, and in health care resources consumed. As local and regional trauma systems struggle for development and survival, competition for the health care dollar casts in the additional necessity of providing the service of trauma care with maximum efficiency. Despite the variety of cost-efficiency measures described above, a majority of trauma centers continue to operate "in the red." Such cannot continue indefinitely. Fiscal responsibility dictates that health care institutions must balance budgets in order to maintain operations. Four primary strategies for cost containment appear from the above discussion: 1. Improve reimbursement rates from trauma patients. 2. Increase outside funding from government sources. 3. Improve cost efficiency of diagnostic and therapeutic procedures used in trauma patient management. 4. Increase efforts aimed at primary prevention of intentional and unintentional injuries. In the final analysis, most authors agree that the last strategy offers the best hope. As stated in their article, "The Economic Impact of Injuries," Harlan and colleagues conclude that "the most effective medical and cost reduction strategy would be prevention." The same article goes on to detail how greater funding for research into optimal prevention modalities could reap societal and economic benefits far beyond the value of the initial outlay. Yet such research funding continues to be inadequate. For every dollar spent on medical care of cancer patients, nine cents is directed to research. For every dollar spent on trauma care, less than a penny is spent on research. Until the public recognizes the terrible toll trauma extracts in lives, livelihood, and money wasted and until it realizes the pre-eminent importance of prevention, care of the

  9. Pursuing Photovoltaic Cost-Effectiveness

    DEFF Research Database (Denmark)

    Yang, Yongheng; Koutroulis, Eftichios; Sangwongwanich, Ariya

    2017-01-01

    Countries with considerable PhotoVoltaic (PV) installations are facing a challenge of overloading their power grid during peak-power production hours if the power infrastructure remains the same. To address this, regulations have been imposed on PV systems, where more active power control should...... be flexibly performed. As an advanced control strategy, the Absolute Active Power Control (AAPC) can effectively solve the overloading issues by limiting the maximum possible PV power to a certain level (i.e., the power limitation), and also benefit the inverter reliability due to the reduction in the thermal...... loading of the power devices. However, its feasibility is challenged by the associated energy losses. An increase of the inverter lifetime and a reduction of the energy yield can alter the cost of energy, demanding an optimization of the power limitation. Therefore, aiming at minimizing the Levelized Cost...

  10. Cost-effectiveness analysis in markets with high fixed costs.

    Science.gov (United States)

    Cutler, David M; Ericson, Keith M Marzilli

    2010-01-01

    We consider how to conduct cost-effectiveness analysis when the social cost of a resource differs from the posted price. From the social perspective, the true cost of a medical intervention is the marginal cost of delivering another unit of a treatment, plus the social cost (deadweight loss) of raising the revenue to fund the treatment. We focus on pharmaceutical prices, which have high markups over marginal cost due to the monopoly power granted to pharmaceutical companies when drugs are under patent. We find that the social cost of a branded drug is approximately one-half the market price when the treatment is paid for by a public insurance plan and one-third the market price for mandated coverage by private insurance. We illustrate the importance of correctly accounting for social costs using two examples: coverage for statin drugs and approval for a drug to treat kidney cancer (sorafenib). In each case, we show that the correct social perspective for cost-effectiveness analysis would be more lenient than researcher recommendations.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  12. The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review

    Directory of Open Access Journals (Sweden)

    Michelle Remme

    2014-11-01

    Full Text Available Introduction: Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. Methods: Effective intervention models were identified from an existing evidence review (“what works for women”. Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. Results: Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. Conclusions: There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework.

  13. Adoption of robotics in a general surgery residency program: at what cost?

    Science.gov (United States)

    Mehaffey, J Hunter; Michaels, Alex D; Mullen, Matthew G; Yount, Kenan W; Meneveau, Max O; Smith, Philip W; Friel, Charles M; Schirmer, Bruce D

    2017-06-01

    Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program. All patients who underwent laparoscopic or robotic cholecystectomy, ventral hernia repair (VHR), and inguinal hernia repair (IHR) at our institution from 2011-2015 were identified. The effect of robotic surgery on laparoscopic case volume was assessed with linear regression analysis. Resident participation, operative time, hospital costs, and patient charges were also evaluated. We identified 2260 laparoscopic and 139 robotic operations. As the volume of robotic cases increased, the number of laparoscopic cases steadily decreased. Residents participated in all laparoscopic cases and 70% of robotic cases but operated from the robot console in only 21% of cases. Mean operative time was increased for robotic cholecystectomy (+22%), IHR (+55%), and VHR (+61%). Financial analysis revealed higher median hospital costs per case for robotic cholecystectomy (+$411), IHR (+$887), and VHR (+$1124) as well as substantial associated fixed costs. Introduction of robotic surgery had considerable negative impact on laparoscopic case volume and significantly decreased resident participation. Increased operative time and hospital costs are substantial. An institution must be cognizant of these effects when considering implementing robotics in departments with a general surgery residency program. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Should the surgeon or the general practitioner (GP follow up patients after surgery for colon cancer? A randomized controlled trial protocol focusing on quality of life, cost-effectiveness and serious clinical events

    Directory of Open Access Journals (Sweden)

    Ringberg Unni

    2008-06-01

    Full Text Available Abstract Background All patients who undergo surgery for colon cancer are followed up according to the guidelines of the Norwegian Gastrointestinal Cancer Group (NGICG. These guidelines state that the aims of follow-up after surgery are to perform quality assessment, provide support and improve survival. In Norway, most of these patients are followed up in a hospital setting. We describe a multi-centre randomized controlled trial to test whether these patients can be followed up by their general practitioner (GP without altering quality of life, cost effectiveness and/or the incidence of serious clinical events. Methods and Design Patients undergoing surgery for colon cancer with histological grade Dukes's Stage A, B or C and below 75 years of age are eligible for inclusion. They will be randomized after surgery to follow-up at the surgical outpatient clinic (control group or follow-up by the district GP (intervention group. Both study arms comply with the national NGICG guidelines. The primary endpoints will be quality of life (QoL (measured by the EORTC QLQ C-30 and the EQ-5D instruments, serious clinical events (SCEs, and costs. The follow-up period will be two years after surgery, and quality of life will be measured every three months. SCEs and costs will be estimated prospectively. The sample size was 170 patients. Discussion There is an ongoing debate on the best method of follow-up for patients with CRC. Due to a wide range of follow-up programmes and paucity of randomized trials, it is impossible to draw conclusions about the best combination and frequency of clinic (or family practice visits, blood tests, endoscopic procedures and radiological examinations that maximize the clinical outcome, quality of life and costs. Most studies on follow-up of CRC patients have been performed in a hospital outpatient setting. We hypothesize that postoperative follow-up of colon cancer patients (according to national guidelines by GPs will not have

  15. A General Model for Cost Estimation in an Exchange

    Directory of Open Access Journals (Sweden)

    Benzion Barlev

    2014-03-01

    Full Text Available Current Generally Accepted Accounting Principles (GAAP state that the cost of an asset acquired for cash is the fair value (FV of the amount surrendered, and that of an asset acquired in a non-monetary exchange is the FV of the asset surrendered or, if it is more “clearly evident,” the FV of the acquired asset. The measurement method prescribed for a non-monetary exchange ignores valuable information about the “less clearly evident” asset. Thus, we suggest that the FV in any exchange be measured by the weighted average of the exchanged assets’ FV estimations, where the weights are the inverse of the variances’ estimations. This alternative valuation process accounts for the uncertainty involved in estimating the FV of each of the asset in the exchange. The proposed method suits all types of exchanges: monetary and non-monetary. In a monetary transaction, the weighted average equals the cash paid because the variance of its FV is nil.

  16. Hip Fracture Prevention: Cost-Effective Strategies

    OpenAIRE

    Peter Vestergaard; Lars Rejnmark; Leif Mosekilde

    2001-01-01

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

  17. Costs and effects in lumbar spinal fusion

    DEFF Research Database (Denmark)

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

    2007-01-01

    ) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of Activity-Based-Costing. Clinical effects were measured by means...... of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted...... of the present investigation is a recommendation to focus further on determinants of cost-effectiveness. For example, patient characteristics that are modifiable at a relatively low expense may have greater influence on cost-effectiveness than the surgical technique itself--at least from an administrator...

  18. A general approach to total repair cost limit replacement policies

    Directory of Open Access Journals (Sweden)

    F. Beichelt

    2014-01-01

    Full Text Available A common replacement policy for technical systems consists in replacing a system by a new one after its economic lifetime, i.e. at that moment when its long-run maintenance cost rate is minimal. However, the strict application of the economic lifetime does not take into account the individual deviations of maintenance cost rates of single systems from the average cost development. Hence, Beichet proposed the total repair cost limit replacement policy: the system is replaced by a new one as soon as its total repair cost reaches or exceeds a given level. He modelled the repair cost development by functions of the Wiener process with drift. Here the same policy is considered under the assumption that the one-dimensional probability distribution of the process describing the repair cost development is given. In the examples analysed, applying the total repair cost limit replacement policy instead of the economic life-time leads to cost savings of between 4% and 30%. Finally, it is illustrated how to include the reliability aspect into the policy.

  19. 42 CFR 417.564 - Apportionment and allocation of administrative and general costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Apportionment and allocation of administrative and... Apportionment and allocation of administrative and general costs. (a) Costs not directly associated with... administrative and general costs that are not included in paragraph (a) of this section. (2) The allocation...

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

    OpenAIRE

    Roth, Dana L

    2004-01-01

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

  1. 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.)

  2. A review on cost-effectiveness and cost-utility of psychosocial care in cancer patients

    Directory of Open Access Journals (Sweden)

    Femke Jansen

    2016-01-01

    Full Text Available Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies, group interventions (four studies, individual psychological support (two studies, and individual psycho-education (one study. Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]. One study did both. Costs included were intervention costs (three studies, intervention and direct medical costs (five studies, or intervention, direct medical, and direct nonmedical costs (three studies. In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.

  3. LOW-COST LED LUMINAIRE FOR GENERAL ILLUMINATION

    Energy Technology Data Exchange (ETDEWEB)

    Lowes, Ted

    2014-07-31

    During this two-year Solid-State Lighting (SSL) Manufacturing R&D project Cree developed novel light emitting diode (LED) technologies contributing to a cost-optimized, efficient LED troffer luminaire platform emitting at ~3500K correlated color temperature (CCT) at a color rendering index (CRI) of >90. To successfully achieve program goals, Cree used a comprehensive approach to address cost reduction of the various optical, thermal and electrical subsystems in the luminaire without impacting performance. These developments built on Cree’s high- brightness, low-cost LED platforms to design a novel LED component architecture that will enable low-cost troffer luminaire designs with high total system efficacy. The project scope included cost reductions to nearly all major troffer subsystems as well as assembly costs. For example, no thermal management components were included in the troffer, owing to the optimized distribution of compact low- to mid-power LEDs. It is estimated that a significant manufacturing cost savings will result relative to Cree’s conventional troffers at the start of the project. A chief project accomplishment was the successful development of a new compact, high-efficacy LED component geometry with a broad far-field intensity distribution and even color point vs. emission angle. After further optimization and testing for production, the Cree XQ series of LEDs resulted. XQ LEDs are currently utilized in Cree’s AR series troffers, and they are being considered for use in other platforms. The XQ lens geometry influenced the independent development of Cree’s XB-E and XB-G high-voltage LEDs, which also have a broad intensity distribution at high efficacy, and are finding wide implementation in Cree’s omnidirectional A-lamps.

  4. The cost of swimming in generalized Newtonian fluids: experiments with C. elegans

    Science.gov (United States)

    Gagnon, D. A.; Arratia, P. E.

    2016-08-01

    Numerous natural processes are contingent on microorganisms' ability to swim through fluids with non-Newtonian rheology. Here, we use the model organism Caenorhabditis elegans and tracking methods to experimentally investigate the dynamics of undulatory swimming in shear-thinning fluids. Theory and simulation have proposed that the cost of swimming, or mechanical power, should be lower in a shear-thinning fluid compared to a Newtonian fluid of the same zero-shear viscosity. We aim to provide an experimental investigation into the cost of swimming in a shear-thinning fluid from (i) an estimate of the mechanical power of the swimmer and (ii) the viscous dissipation rate of the flow field, which should yield equivalent results for a self-propelled low Reynolds number swimmer. We find the cost of swimming in shear-thinning fluids is less than or equal to the cost of swimming in Newtonian fluids of the same zero-shear viscosity; furthermore, the cost of swimming in shear-thinning fluids scales with a fluid's effective viscosity and can be predicted using fluid rheology and simple swimming kinematics. Our results agree reasonably well with previous theoretical predictions and provide a framework for understanding the cost of swimming in generalized Newtonian fluids.

  5. Low-Cost Quality Control and Nondestructive Evaluation Technologies for General Aviation Structures

    Science.gov (United States)

    Cramer, K. Elliott; Gavinsky, Bob; Semanskee, Grant

    1998-01-01

    NASA's Advanced General Aviation Transport Experiments (AGATE) Program has as a goal to reduce the overall cost of producing private aviation aircraft while maintaining the safety of these aircraft. In order to successfully meet this goal, it is necessary to develop nondestructive inspection techniques which will facilitate the production of the materials used in these aircraft and assure the quality necessary to maintain airworthiness. This paper will discuss a particular class of general aviation materials and several nondestructive inspection techniques that have proven effective for making these inspections. Additionally, this paper will discuss the investigation and application of other commercially available quality control techniques applicable to these structures.

  6. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

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

  7. Cost-effectiveness thresholds: pros and cons.

    Science.gov (United States)

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

    2016-12-01

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

  8. [An analysis of cost and profit of a nursing unit using performance-based costing: case of a general surgical ward in a general hospital].

    Science.gov (United States)

    Lim, Ji Young

    2008-02-01

    The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.

  9. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Lue-Ping Zhao

    Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

  10. How cost effective is CHP

    Energy Technology Data Exchange (ETDEWEB)

    Bakker, D.; Huizinga, J.

    1989-04-01

    A critical review of the calculations and conclusions of the CHP (combined heat and power generation) Preconditions Working Group, on which an article was published in the November 1988 issue of this magazine. According to the review a correct assignment of costs avoided in the power generating area is more important than gas price reduction. In a postscript to the review the authors of the November article oppose this view. 2 figs., 1 tab.

  11. Nanoparticle risk management and cost evaluation: a general framework

    Energy Technology Data Exchange (ETDEWEB)

    Fleury, Dominique; Metz, Sebastien; Bouillard, Jacques X; Brignon, Jean-Marc [INERIS, Parc Technologique Alata BP2 - 60550 Verneuil-en-Halatte (France); Bomfim, Joao A S, E-mail: dominique.fleury@ineris.fr [Centro Ricerche Plast-optica (CRP), Via Jacopo Linussio 1 - 33020 Amaro (Italy)

    2011-07-06

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  12. Nanoparticle risk management and cost evaluation: a general framework

    Science.gov (United States)

    Fleury, Dominique; Bomfim, João A. S.; Metz, Sébastien; Bouillard, Jacques X.; Brignon, Jean-Marc

    2011-07-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  13. Cost-Effective Stress Management Training.

    Science.gov (United States)

    Shea, Gordon F.

    1980-01-01

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

  14. A cost study of a general practitioner hospital in the Netherlands.

    NARCIS (Netherlands)

    Hakkart-van Roijen, L.; Moll van Charante, E.P.; Bindels, P.J.E.; Yzermans, C.J.; Rutten, F.F.H.

    2004-01-01

    To perform a cost study of the first general practitioner (GP) hospital in the Netherlands. We conducted a cost study in a GP hospital in the Netherlands. Data on healthcare utilisation from 218 patients were collected for a period of one year. The costs of admission to the GP hosptial were compared

  15. A generalized gravitomagnetic clock effect

    CERN Document Server

    Hackmann, Eva

    2014-01-01

    In General Relativity the rotation of a gravitating body like the Earth influences the motion of orbiting test particles or satellites in a non-Newtonian way. This causes e.g. a precession of the orbital plane, known as the Lense-Thirring effect, and a precession of the spin of a gyroscope, known as the Schiff effect. Here we discuss a third effect, first introduced by Cohen and Mashhoon, called the gravitomagnetic clock effect. It describes the difference in proper time of counter revolving clocks after a revolution of $2\\pi$. For two clocks on counter rotating equatorial circular orbits around the Earth the effect is about $10^{-7}$ seconds per revolution, which is quite large. We introduce a general relativistic definition of the gravitomagnetic clock effect which is valid for arbitrary pairs of orbits. This includes rotations in the same direction and different initial conditions, which is crucial if the effect can be detected with existing satellites or with payloads on non-dedicated missions. We also de...

  16. 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 b

  17. Generalized cost-criterion-based learning algorithm for diagonal recurrent neural networks

    Science.gov (United States)

    Wang, Yongji; Wang, Hong

    2000-05-01

    A new generalized cost criterion based learning algorithm for diagonal recurrent neural networks is presented, which is with form of recursive prediction error (RPE) and has second convergent order. A guideline for the choice of the optimal learning rate is derived from convergence analysis. The application of this method to dynamic modeling of typical chemical processes shows that the generalized cost criterion RPE (QRPE) has higher modeling precision than BP trained MLP and quadratic cost criterion trained RPE (QRPE).

  18. Sampling: Making Electronic Discovery More Cost Effective

    Directory of Open Access Journals (Sweden)

    Milton Luoma

    2011-06-01

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

  19. Green Infrastructure Siting and Cost Effectiveness Analysis

    Data.gov (United States)

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

  20. The Stickiness of Selling, General, and Administrative Costs in the Indonesian Companies

    Directory of Open Access Journals (Sweden)

    Benny Armanto

    2014-04-01

    Full Text Available Selling, general and administration costs are the main components in the Income Statement. A large number of permanent staff in sales and marketing department will make the company dominated by the fixed costs. This fact could lead to sticky cost behavior. In addition, role of the manager can also cause the cost stickiness. When the company’s revenue decreases, manager may delay to decrease the cost or not even decrease cost at all. The objective of the study is to determine whether cost stickiness of selling, general and administrative in the Indonesian listed companies. This study applied log-linear data panel regression with 3605 firm years that is listed in Indonesian Stock Exchange (BEI from 1993 – 2013. This study finds that selling, general, and administrative costs are sticky only for the manufacturing companies. Furthermore, the results show that adjustment of sales, general, and administrative costs delayed by the manager when revenue decreases, yet the cost stickiness will be reduced in the next period.

  1. Treatment persistence and cost-effectiveness of latanoprost/latanoprost–timolol, bimatoprost/bimatoprost–timolol, and travoprost/travoprost–timolol in glaucoma: an analysis based on the United Kingdom general practitioner research database

    Directory of Open Access Journals (Sweden)

    Antoine Lafuma

    2011-03-01

    Full Text Available Antoine Lafuma1, John F Salmon2, Julien Robert1, Gilles Berdeaux31Cemka, Bourg-la-Reine, France; 2Oxford Eye Hospital, Oxford, UK; 3Conservatoire National des Arts et Métiers, Chaire Economie et Gestion des Services de Santé, Paris, FranceObjective: To compare treatment persistence and costs with 3 glaucoma treatment sequences (first-line/second-line: latanoprost/latanoprost–timolol (LLT, bimatoprost/bimatoprost–timolol (BBT, and travoprost/travoprost–timolol (TTT, derived from the UK General Practitioner Research Database (UK-GPRD.Methods: Patient records referring to ocular hypertension, topical glaucoma treatment, surgery, or laser therapy were extracted. Patients prescribed LLT, BBT, or TTT sequences were selected. Treatment failure was inferred from glaucoma prescription change (adding or removing a topical treatment, surgery, or laser therapy. Treatment durations preceding failure were compared by applying Wilcoxon’s test to survival curves. Adjustment on confounding variables was performed with a Cox model and a propensity score method. Unit costs were estimated from a UK National Health Service perspective.Results: A total of 1592 patients received LLT, 110 BBT, and 114 TTT. Their mean age was 68 years and the sex ratio almost 1 male:1 female. No significant demographic or comorbidity differences were observed between treatment sequences. Treatment persistence at 36 months was achieved in 60.0% of LLT, 55.5% of BBT, and 70.3% of TTT patients (P = 0.005. Resources consumed and associated monthly costs were significantly less for the TTT group (£17.74 compared with BBT (£21.30 and LLT (£22.37 groups.Conclusion: Analysis of data obtained from the UK-GPRD suggests that the TTT treatment sequence achieved longer treatment persistence at lower cost than LLT and BBT.Keywords: glaucoma, travoprost, timolol, latanoprost, bimatoprost, persistency, costs

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

    Science.gov (United States)

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

    1989-01-01

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

  3. Systematic Review of the Cost and Cost-Effectiveness of Rapid Endovascular Therapy for Acute Ischemic Stroke.

    Science.gov (United States)

    Sevick, Laura K; Ghali, Sarah; Hill, Michael D; Danthurebandara, Vishva; Lorenzetti, Diane L; Noseworthy, Tom; Spackman, Eldon; Clement, Fiona

    2017-09-01

    Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of EVT for ischemic stroke patients and to synthesize all the publicly available economic literature. A systematic review of the published literature was conducted to identify economic evaluations and cost analyses of EVT for acute ischemic stroke patients. Systematic review best practices were followed, and study quality was assessed. Four-hundred sixty-three articles were identified from electronic databases. After deduplication, abstract review, and full-text review, 17 studies were included. Seven of the studies were cost analyses, and 10 were cost-effectiveness studies. Generally, the cost analyses reported on the cost of the approach/procedure or the hospitalization costs associated with EVT. All of the cost-effectiveness studies reported a cost per quality-adjusted life year as the primary outcomes. Studies varied in regards to the costs considered, the perspective adopted, and the time horizon used. All the studies reported a cost per quality-adjusted life year of <$50 000 as the primary outcome. There is a robust body of evidence for the cost and cost-effectiveness of EVT. The cost analyses suggested that although EVT was associated with higher costs, it also resulted in improved patient outcomes. From the cost-effectiveness studies, EVT seems to be good value for money when a threshold of $50 000 per quality-adjusted life year gained is adopted. © 2017 American Heart Association, Inc.

  4. Optimal Policy for Brownian Inventory Models with General Convex Inventory Cost

    Institute of Scientific and Technical Information of China (English)

    Da-cheng YAO

    2013-01-01

    We study an inventory system in which products are ordered from outside to meet demands,and the cumulative demand is governed by a Brownian motion.Excessive demand is backlogged.We suppose that the shortage and holding costs associated with the inventory are given by a general convex function.The product ordering from outside incurs a linear ordering cost and a setup fee.There is a constant leadtime when placing an order.The optimal policy is established so as to minimize the discounted cost including the inventory cost and ordering cost.

  5. Is the societal approach wide enough to include relatives? Incorporating relatives' costs and effects in a cost-effectiveness analysis.

    Science.gov (United States)

    Davidson, Thomas; Levin, Lars-Ake

    2010-01-01

    It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives' costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives' costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives' effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives' QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient's QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives' costs and effects. Because cost-effectiveness analyses are used for

  6. Low-cost carriers fare competition effect

    OpenAIRE

    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 be operated by a low-cost carrier with better possibilities to subsist. The proposed model in this paper was set up by analyzing The United States domestic air transport market 2005 year database fr...

  7. Cost effectiveness of a medical digital library.

    Science.gov (United States)

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

    2001-01-01

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

  8. Cost effectiveness of new roadway lighting systems

    Directory of Open Access Journals (Sweden)

    Yi Jiang

    2015-06-01

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

  9. Groundwater remediation and the cost effectiveness of phytoremediation.

    Science.gov (United States)

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

    2012-10-01

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

  10. 29 CFR 531.3 - General determinations of “reasonable cost.”

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false General determinations of âreasonable cost.â 531.3 Section 531.3 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS WAGE PAYMENTS UNDER THE FAIR LABOR STANDARDS ACT OF 1938 Determinations of âReasonable Costâ and â...

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

    Science.gov (United States)

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

    1999-01-20

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

  12. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

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

    2014-12-01

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

  13. Decentralization for cost-effective conservation

    Science.gov (United States)

    Somanathan, E.; Prabhakar, R.; Mehta, Bhupendra Singh

    2009-01-01

    Since 1930, areas of state-managed forest in the central Himalayas of India have increasingly been devolved to management by local communities. This article studies the long-run effects of the devolution on the cost of forest management and on forest conservation. Village council-management costs an order of magnitude less per unit area and does no worse, and possibly better, at conservation than state management. Geographic proximity and historical and ecological information are used to separate the effects of management from those of possible confounding factors. PMID:19255440

  14. Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care : Quality of Life and Cost Utility in General Practice

    NARCIS (Netherlands)

    Spijker-Huiges, Antje; Vermeulen, Karin; Winters, Jan C.; van Wijhe, Marten; van der Meer, Klaas

    Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice. Design: A pragmatic randomized controlled trial. Results were

  15. Cost-effectiveness analysis and innovation.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

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

  16. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up.

    Science.gov (United States)

    Brooker, Simon; Kabatereine, Narcis B; Fleming, Fiona; Devlin, Nancy

    2008-01-01

    Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intra-country variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with district officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US$ per schoolchild treated, and an incremental cost-effectiveness ratio (cost in US$ per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US$0.54 and the cost-effectiveness was US$3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children who received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$0.41-0.91) and cost per anaemia case averted (US$1.70-9.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations.

  17. Cost effectiveness of robotic mitral valve surgery

    Science.gov (United States)

    2017-01-01

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

  18. GPACC program cost work breakdown structure-dictionary. General purpose aft cargo carrier study, volume 3

    Science.gov (United States)

    1985-01-01

    The results of detailed cost estimates and economic analysis performed on the updated Model 101 configuration of the general purpose Aft Cargo Carrier (ACC) are given. The objective of this economic analysis is to provide the National Aeronautics and Space Administration (NASA) with information on the economics of using the ACC on the Space Transportation System (STS). The detailed cost estimates for the ACC are presented by a work breakdown structure (WBS) to ensure that all elements of cost are considered in the economic analysis and related subsystem trades. Costs reported by WBS provide NASA with a basis for comparing competing designs and provide detailed cost information that can be used to forecast phase C/D planning for new projects or programs derived from preliminary conceptual design studies. The scope covers all STS and STS/ACC launch vehicle cost impacts for delivering payloads to a 160 NM low Earth orbit (LEO).

  19. A generalized cost Malmquist index in DEA for DMUs with negative data

    Directory of Open Access Journals (Sweden)

    Ghasem Tohidi

    2014-10-01

    Full Text Available In some data envelopment analysis (DEA applications, some inputs of DMUs have negative values with positive cost. This paper generalizes the global cost Malmquist productivity index to compare the productivity of different DMUs with negative inputs in any two periods of times under variable returns to scale (VRS technology, and then the generalized index is decomposed to several components. The obtained components are computed using the nonparametric linear programming models, known as DEA. To illustrate the generalized index and its components, a numerical example at three successive periods of time is given.

  20. Cost-effectiveness in reproductive medicine

    NARCIS (Netherlands)

    L.M. Moolenaar

    2013-01-01

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

  1. Utilization of information on costs and effects.

    NARCIS (Netherlands)

    2006-01-01

    In decision making, information about the costs and effects of road safety measures is only used to a limited extent. European research shows that about 35% of civil servants and politicians use this type of information. Furthermore, there are great differences between northern countries (58%) and c

  2. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

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

  3. [Cost effectiveness and health sector reform].

    Science.gov (United States)

    Musgrove, P

    1995-01-01

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

  4. Cost-effective ultrasound PACS solution

    Science.gov (United States)

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

    1995-05-01

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

  5. Cost effective campaigning in social networks

    Science.gov (United States)

    Kotnis, Bhushan; Kuri, Joy

    2016-05-01

    Campaigners are increasingly using online social networking platforms for promoting products, ideas and information. A popular method of promoting a product or even an idea is incentivizing individuals to evangelize the idea vigorously by providing them with referral rewards in the form of discounts, cash backs, or social recognition. Due to budget constraints on scarce resources such as money and manpower, it may not be possible to provide incentives for the entire population, and hence incentives need to be allocated judiciously to appropriate individuals for ensuring the highest possible outreach size. We aim to do the same by formulating and solving an optimization problem using percolation theory. In particular, we compute the set of individuals that are provided incentives for minimizing the expected cost while ensuring a given outreach size. We also solve the problem of computing the set of individuals to be incentivized for maximizing the outreach size for given cost budget. The optimization problem turns out to be non trivial; it involves quantities that need to be computed by numerically solving a fixed point equation. Our primary contribution is, that for a fairly general cost structure, we show that the optimization problems can be solved by solving a simple linear program. We believe that our approach of using percolation theory to formulate an optimization problem is the first of its kind.

  6. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

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

    2016-12-01

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

  7. Contractors and the Cost of War: Research into Economic and Cost-Effectiveness Arguments

    Science.gov (United States)

    2006-12-01

    32 Figure 4. Transaction Cost Economics Framework ........................................................50 x...the cost-effectiveness debate, there are a myriad of other issues that exist. For example, Transaction Cost Economics (TCE) yields key insights on...Perspectives on Public Choice. New York: Cambridge University Press, 455 – 480; qtd in Williamson, “Public and Private Bureaucracies: A Transaction Cost Economics

  8. Controlling Campylobacter in the chicken meat chain - Cost-effectiveness and cost-utility analysis

    NARCIS (Netherlands)

    Mangen MJJ; Havelaar AH; Nauta MJ; Koeijer AA de; Wit GA de; LEI; Animal Sciences Group; PZO; MGB

    2005-01-01

    The aim of this study was the estimation of cost-effectiveness and cost-utility of various interventions to control Campylobacter contamination of broiler meat. The relative risk, the intervention costs, the disease burden (expressed in Disability Adjusted Live Years (DALYs)) and the costs-of-illnes

  9. Do Cost Functions for Tracking Error Generalize across Tasks with Different Noise Levels?

    Science.gov (United States)

    Sensinger, Jonathon; Aleman-Zapata, Adrian; Englehart, Kevin

    2015-01-01

    Control of human-machine interfaces are well modeled by computational control models, which take into account the behavioral decisions people make in estimating task dynamics and state for a given control law. This control law is optimized according to a cost function, which for the sake of mathematical tractability is typically represented as a series of quadratic terms. Recent studies have found that people actually use cost functions for reaching tasks that are slightly different than a quadratic function, but it is unclear which of several cost functions best explain human behavior and if these cost functions generalize across tasks of similar nature but different scale. In this study, we used an inverse-decision-theory technique to reconstruct the cost function from empirical data collected on 24 able-bodied subjects controlling a myoelectric interface. Compared with previous studies, this experimental paradigm involved a different control source (myoelectric control, which has inherently large multiplicative noise), a different control interface (control signal was mapped to cursor velocity), and a different task (the tracking position dynamically moved on the screen throughout each trial). Several cost functions, including a linear-quadratic; an inverted Gaussian, and a power function, accurately described the behavior of subjects throughout this experiment better than a quadratic cost function or other explored candidate cost functions (p<0.05). Importantly, despite the differences in the experimental paradigm and a substantially larger scale of error, we found only one candidate cost function whose parameter was consistent with the previous studies: a power function (cost ∝ errorα) with a parameter value of α = 1.69 (1.53–1.78 interquartile range). This result suggests that a power-function is a representative function of user’s error cost over a range of noise amplitudes for pointing and tracking tasks. PMID:26313560

  10. Do Cost Functions for Tracking Error Generalize across Tasks with Different Noise Levels?

    Directory of Open Access Journals (Sweden)

    Jonathon Sensinger

    Full Text Available Control of human-machine interfaces are well modeled by computational control models, which take into account the behavioral decisions people make in estimating task dynamics and state for a given control law. This control law is optimized according to a cost function, which for the sake of mathematical tractability is typically represented as a series of quadratic terms. Recent studies have found that people actually use cost functions for reaching tasks that are slightly different than a quadratic function, but it is unclear which of several cost functions best explain human behavior and if these cost functions generalize across tasks of similar nature but different scale. In this study, we used an inverse-decision-theory technique to reconstruct the cost function from empirical data collected on 24 able-bodied subjects controlling a myoelectric interface. Compared with previous studies, this experimental paradigm involved a different control source (myoelectric control, which has inherently large multiplicative noise, a different control interface (control signal was mapped to cursor velocity, and a different task (the tracking position dynamically moved on the screen throughout each trial. Several cost functions, including a linear-quadratic; an inverted Gaussian, and a power function, accurately described the behavior of subjects throughout this experiment better than a quadratic cost function or other explored candidate cost functions (p<0.05. Importantly, despite the differences in the experimental paradigm and a substantially larger scale of error, we found only one candidate cost function whose parameter was consistent with the previous studies: a power function (cost ∝ errorα with a parameter value of α = 1.69 (1.53-1.78 interquartile range. This result suggests that a power-function is a representative function of user's error cost over a range of noise amplitudes for pointing and tracking tasks.

  11. Do Cost Functions for Tracking Error Generalize across Tasks with Different Noise Levels?

    Science.gov (United States)

    Sensinger, Jonathon; Aleman-Zapata, Adrian; Englehart, Kevin

    2015-01-01

    Control of human-machine interfaces are well modeled by computational control models, which take into account the behavioral decisions people make in estimating task dynamics and state for a given control law. This control law is optimized according to a cost function, which for the sake of mathematical tractability is typically represented as a series of quadratic terms. Recent studies have found that people actually use cost functions for reaching tasks that are slightly different than a quadratic function, but it is unclear which of several cost functions best explain human behavior and if these cost functions generalize across tasks of similar nature but different scale. In this study, we used an inverse-decision-theory technique to reconstruct the cost function from empirical data collected on 24 able-bodied subjects controlling a myoelectric interface. Compared with previous studies, this experimental paradigm involved a different control source (myoelectric control, which has inherently large multiplicative noise), a different control interface (control signal was mapped to cursor velocity), and a different task (the tracking position dynamically moved on the screen throughout each trial). Several cost functions, including a linear-quadratic; an inverted Gaussian, and a power function, accurately described the behavior of subjects throughout this experiment better than a quadratic cost function or other explored candidate cost functions (p<0.05). Importantly, despite the differences in the experimental paradigm and a substantially larger scale of error, we found only one candidate cost function whose parameter was consistent with the previous studies: a power function (cost ∝ errorα) with a parameter value of α = 1.69 (1.53-1.78 interquartile range). This result suggests that a power-function is a representative function of user's error cost over a range of noise amplitudes for pointing and tracking tasks.

  12. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    Friedman, S. N.

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

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

    Directory of Open Access Journals (Sweden)

    Ruggeri M

    2012-06-01

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

  14. An improved set of standards for finding cost for cost-effectiveness analysis.

    Science.gov (United States)

    Barnett, Paul G

    2009-07-01

    Guidelines have helped standardize methods of cost-effectiveness analysis, allowing different interventions to be compared and enhancing the generalizability of study findings. There is agreement that all relevant services be valued from the societal perspective using a long-term time horizon and that more exact methods be used to cost services most affected by the study intervention. Guidelines are not specific enough with respect to costing methods, however. The literature was reviewed to identify the problems associated with the 4 principal methods of cost determination. Microcosting requires direct measurement and is ordinarily reserved to cost novel interventions. Analysts should include nonwage labor cost, person-level and institutional overhead, and the cost of development, set-up activities, supplies, space, and screening. Activity-based cost systems have promise of finding accurate costs of all services provided, but are not widely adopted. Quality must be evaluated and the generalizability of cost estimates to other settings must be considered. Administrative cost estimates, chiefly cost-adjusted charges, are widely used, but the analyst must consider items excluded from the available system. Gross costing methods determine quantity of services used and employ a unit cost. If the intervention will affect the characteristics of a service, the method should not assume that the service is homogeneous. Questions are posed for future reviews of the quality of costing methods. The analyst must avoid inappropriate assumptions, especially those that bias the analysis by exclusion of costs that are affected by the intervention under study.

  15. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    , a scenario-part and a cost-benefit part. Air and sea modes are not analyzed. The model adopts a bottom-up approach to allow a detailed assessment of transport policy measures. Four generic areas of intervention were identified and the likely effect on CO2 emissions, socioeconomic efficiency and other...... concerns of the potential measures within those intervention areas: • Reductions in the need to travel • Improved efficiency of the transport system • Improved fuel efficiency of transport activities • Reduced CO2 intensity of the fuels Within each area a number of measures were analysed. The measures...

  16. Effective control of engineering cost measures

    Institute of Scientific and Technical Information of China (English)

    郑虹; 戚悦

    2013-01-01

    the civil engineering cost function mainly lies in the calculation of the required for the construction cost to the sum of al. Civil engineering cost throughout the project, the efective use of human, financial weakness, can beter benefit our investment, so the control of civil engineering cost measures is very necessary.

  17. Time Overrun and Cost Effectiveness in the Construction Industry

    Directory of Open Access Journals (Sweden)

    T.Subramani

    2014-06-01

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

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

    Science.gov (United States)

    Sinkey, Rachel G; Odibo, Anthony O

    2016-06-01

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

  19. A TRUST REGION ALGORITHM VIA BILEVEL LINEAR PROGRAMMING FOR SOLVING THE GENERAL MULTICOMMODITY MINIMAL COST FLOW PROBLEMS

    Institute of Scientific and Technical Information of China (English)

    ZhuDetong

    2004-01-01

    This paper proposes a nonmonotonic backtracking trust region algorithm via bilevel linear programming for solving the general multicommodity minimal cost flow problems. Using the duality theory of the linear programming and convex theory, the generalized directional derivative of the general multicommodity minimal cost flow problems is derived. The global convergence and superlinear convergence rate of the proposed algorithm are established under some mild conditions.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-07-01

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

  1. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jukes Matthew CH

    2008-09-01

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

  3. A Cost-Effectiveness Analysis of the Swedish Universal Parenting Program All Children in Focus.

    Directory of Open Access Journals (Sweden)

    Malin Ulfsdotter

    Full Text Available There are few health economic evaluations of parenting programs with quality-adjusted life-years (QALYs as the outcome measure. The objective of this study was, therefore, to conduct a cost-effectiveness analysis of the universal parenting program All Children in Focus (ABC. The goals were to estimate the costs of program implementation, investigate the health effects of the program, and examine its cost-effectiveness.A cost-effectiveness analysis was conducted. Costs included setup costs and operating costs. A parent proxy Visual Analog Scale was used to measure QALYs in children, whereas the General Health Questionnaire-12 was used for parents. A societal perspective was adopted, and the incremental cost-effectiveness ratio was calculated. To account for uncertainty in the estimate, the probability of cost-effectiveness was investigated, and sensitivity analyses were used to account for the uncertainty in cost data.The cost was € 326.3 per parent, of which € 53.7 represented setup costs under the assumption that group leaders on average run 10 groups, and € 272.6 was the operating costs. For health effects, the QALY gain was 0.0042 per child and 0.0027 per parent. These gains resulted in an incremental cost-effectiveness ratio for the base case of € 47 290 per gained QALY. The sensitivity analyses resulted in ratios from € 41 739 to € 55 072. With the common Swedish threshold value of € 55 000 per QALY, the probability of the ABC program being cost-effective was 50.8 percent.Our analysis of the ABC program demonstrates cost-effectiveness ratios below or just above the QALY threshold in Sweden. However, due to great uncertainty about the data, the health economic rationale for implementation should be further studied considering a longer time perspective, effects on siblings, and validated measuring techniques, before full scale implementation.

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

    NARCIS (Netherlands)

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

    1998-01-01

    textabstractSTUDY OBJECTIVE: Evaluating the costs, effects, and savings of several strategies for cystic fibrosis (CF) gene carrier screening. DESIGN: A general model for evaluating prenatal, preconceptional, school, and neonatal carrier screening was constructed. For p

  5. Economic costs of rotavirus gastroenteritis and cost-effectiveness of vaccination in developing countries.

    Science.gov (United States)

    Rheingans, Richard D; Antil, Lynn; Dreibelbis, Robert; Podewils, Laura Jean; Bresee, Joseph S; Parashar, Umesh D

    2009-11-01

    Rotavirus is the leading cause of severe gastroenteritis in children worldwide. We evaluated the economic burden of rotavirus and the cost-effectiveness of vaccination from the health care perspective. Estimates were based on existing epidemiological data, cost estimates, vaccine coverage, and efficacy data, as well as hypothetical vaccine prices. Outcome measures included health care and societal costs of rotavirus and benefits and incremental cost-effectiveness ratio of vaccination. Sensitivity analyses evaluated the impact of estimate uncertainty. Treatment costs increased with income level, and health burden decreased; however, burden varied across regions. On the basis of current vaccination coverage and timing, rotavirus vaccination would annually prevent 228,000 deaths, 13.7 million hospital visits, and 8.7 million disability-adjusted life-years, saving $188 million in treatment costs and $243 million in societal costs. At $5 per dose, the incremental cost-effectiveness ratio in low-, lower-middle-, and upper-middle-income countries was $88, $291, and $329 per disability-adjusted life-year averted, respectively, and $3,015, $9,951 and $11,296 per life saved, respectively. Vaccination would prevent approximately 45% of deaths and approximately 58% of associated medical visits and costs. Vaccination is a cost-effective strategy to reduce the health and economic burden of rotavirus. The cost-effectiveness of vaccination depends mostly on vaccine price and reaching children at highest risk of mortality.

  6. Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners : An example of a pragmatic trial

    NARCIS (Netherlands)

    Meeuwsen, E J; German, P; Melis, R J F; Adang, E M; Golüke-Willemse, G A; Krabbe, P F; de Leest, B J; van Raak, F H J M; Schölzel-Dorenbos, C J M; Visser, M C; Wolfs, C A; Vliek, S; Rikkert, M G M Olde

    2009-01-01

    BACKGROUND: With the rising number of dementia patients with associated costs and the recognition that there is room for improvement in the provision of dementia care, the question arises on how to efficiently provide high quality dementia care. OBJECTIVE: To describe the design of a study to determ

  7. Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial.

    NARCIS (Netherlands)

    Meeuwsen, E.J.; German, P.; Melis, R.J.F.; Adang, E.M.M.; Goluke-Willemse, G.A.; Krabbe, P.F.M.; Leest, B.J. de; Raak, F.H. van; Schölzel-Dorenbos, C.J.M.; Visser, M.C.; Wolfs, C.A.; Vliek, S.B.; Olde Rikkert, M.G.M.

    2009-01-01

    BACKGROUND: With the rising number of dementia patients with associated costs and the recognition that there is room for improvement in the provision of dementia care, the question arises on how to efficiently provide high quality dementia care. OBJECTIVE: To describe the design of a study to determ

  8. Design of low-cost general purpose microcontroller based neuromuscular stimulator.

    Science.gov (United States)

    Koçer, S; Rahmi Canal, M; Güler, I

    2000-04-01

    In this study, a general purpose, low-cost, programmable, portable and high performance stimulator is designed and implemented. For this purpose, a microcontroller is used in the design of the stimulator. The duty cycle and amplitude of the designed system can be controlled using a keyboard. The performance test of the system has shown that the results are reliable. The overall system can be used as the neuromuscular stimulator under safe conditions.

  9. Cost Effective Machining Of Ceramics (CEMOC)

    Energy Technology Data Exchange (ETDEWEB)

    Barkman, W.E.

    1997-04-18

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

  10. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database.

    Science.gov (United States)

    Salman, Muhammad; Bell, Theodore; Martin, Jennifer; Bhuva, Kalpesh; Grim, Rod; Ahuja, Vanita

    2013-06-01

    Since its introduction in 1997, robotic surgery has overcome many limitations, including setup costs and surgeon training. The use of robotics in general surgery remains unknown. This study evaluates robotic-assisted procedures in general surgery by comparing characteristics with its nonrobotic (laparoscopic and open) counterparts. Weighted Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (2008, 2009) were used to identify the top 12 procedures for robotic general surgery. Robotic cases were identified by Current Procedural Terminology codes 17.41 and 17.42. Procedures were grouped: esophagogastric, colorectal, adrenalectomy, lysis of adhesion, and cholecystectomy. Analyses were descriptive, t tests, χ(2)s, and logistic regression. Charges and length of stay were adjusted for gender, age, race, payer, hospital bed size, hospital location, hospital region, median household income, Charlson score, and procedure type. There were 1,389,235 (97.4%) nonrobotic and 37,270 (2.6%) robotic cases. Robotic cases increased from 0.8 per cent (2008) to 4.3 per cent (2009, P robotic surgery had significantly shorter lengths of stay (4.9 days) than open surgery (6.1 days) and lower charges (median $30,540) than laparoscopic ($34,537) and open ($46,704) surgery. Fewer complications were seen in robotic-assisted colorectal, adrenalectomy and lysis of adhesion; however, robotic cholecystectomy and esophagogastric procedures had higher complications than nonrobotic surgery (P robotic surgery had a lower mortality rate (0.097%) than nonrobotic surgeries per 10,000 procedures (laparoscopic 0.48%, open 0.92%; P robotic surgery is generally considered a prohibitive factor. In the present study, when overall cost was considered, including length of stay, robotic surgery appeared to be cost-effective and as safe as nonrobotic surgery except in cholecystectomy and esophagogastric procedures. Further study is needed to fully understand the long-term implications of

  11. Effectiveness of Multimedia Elements in Computer Supported Instruction: Analysis of Personalization Effects, Students' Performances and Costs

    Science.gov (United States)

    Zaidel, Mark; Luo, XiaoHui

    2010-01-01

    This study investigates the efficiency of multimedia instruction at the college level by comparing the effectiveness of multimedia elements used in the computer supported learning with the cost of their preparation. Among the various technologies that advance learning, instructors and students generally identify interactive multimedia elements as…

  12. Effectiveness of Multimedia Elements in Computer Supported Instruction: Analysis of Personalization Effects, Students' Performances and Costs

    Science.gov (United States)

    Zaidel, Mark; Luo, XiaoHui

    2010-01-01

    This study investigates the efficiency of multimedia instruction at the college level by comparing the effectiveness of multimedia elements used in the computer supported learning with the cost of their preparation. Among the various technologies that advance learning, instructors and students generally identify interactive multimedia elements as…

  13. Training general surgery residents in pediatric surgery: educational value vs time and cost.

    Science.gov (United States)

    Lee, Steven L; Sydorak, Roman M; Applebaum, Harry

    2009-01-01

    This study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery. A survey was administered to GS residents that evaluated the pediatric surgery rotation and anticipated practice intentions. A retrospective analysis (2005-2006) of operative times for unilateral inguinal hernia repair, bilateral inguinal hernia repair, and umbilical hernia repair was also performed. Procedure times were compared for operations performed by a pediatric surgeon with and without GS residents. Cost analysis was based on time differences. General surgery residents (n = 19) considered the pediatric surgery rotation to have high educational value (4.7 +/- 0.6 of 5) with extensive teaching (4.6 +/- 0.7) and operative experience (4.4 +/- 0.8). Residents listed pediatric surgery exposure, operative technique, and observed work ethic as most valuable. Upon graduation, residents expect to perform pediatric operations 2 to 3 times annually. Thirty-seven percent of residents felt competent to perform appendectomy (patients >5 years), 32% appendectomy (3-5 years), 21% gastrostomy (>1 year), and 11% inguinal herniorrhaphy (>1 year). Operative times and costs were significantly higher in operative procedures performed with a GS resident. General surgery residents considered pediatric surgery as a valuable educational experience. Residents anticipate performing pediatric operations a few times annually. Training GS residents in pediatric surgery increased operative time and cost. This information may be useful in determining the appropriate setting for resident education as well as budget planning for pediatric surgical practices.

  14. [The costs of physical inactivity in the world: a general review].

    Science.gov (United States)

    Bueno, Denise Rodrigues; Marucci, Maria de Fátima Nunes; Codogno, Jamile Sanches; Roediger, Manuela de Almeida

    2016-04-01

    There is convincing evidence in the scientific literature of the effectiveness of regular physical activity and physical exercise in the conservation of health and the prevention of various ailments. However, studies into the association between costs of medical services and physical inactivity have not been duly addressed. International studies have quantified these costs and revealed the association between physical activity and/or sedentary behavior. Therefore, this review sought to gather information available from several countries and analyze the global costs associated with physical inactivity over the past few decades. The results of twenty-four original and well-researched articles in nine countries, including Brazil, were analyzed. The results showed that physical inactivity, irrespective of the method of classification, is burdensome to the economy of health worldwide, and directly responsible for the high cost of medication, the incidence of hospitalization and the frequency of medical appointments. The costs of the group of the physically inactive population affected by chronic diseases feature among the major components of the total costs involved in public health.

  15. Impact of Generic Alendronate Cost on the Cost-Effectiveness of Osteoporosis Screening and Treatment

    OpenAIRE

    Smita Nayak; Roberts, Mark S.; Greenspan, Susan L.

    2012-01-01

    INTRODUCTION: Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women. METHODS: Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorp...

  16. Effective stability for generalized Hamiltonian systems

    Institute of Scientific and Technical Information of China (English)

    CONG; Fuzhong; LI; Yong

    2004-01-01

    An effective stability result for generalized Hamiltonian systems is obtained by applying the simultaneous approximation technique due to Lochak. Among these systems,dimensions of action variables and angle variables might be distinct.

  17. Cost-effectiveness of face-to-face smoking cessation interventions : a dynamic modeling study

    NARCIS (Netherlands)

    Feenstra, Talitha L; Hamberg-van Reenen, Heleen H; Hoogenveen, Rudolf T; Rutten-van Mölken, Maureen P M H

    2005-01-01

    OBJECTIVES: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs p

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

    Directory of Open Access Journals (Sweden)

    White Michael T

    2011-11-01

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

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

    African Journals Online (AJOL)

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

  20. The trAPP-study: Cost-effectiveness of an unsupervised e-health supported neuromuscular training program for the treatment of acute ankle sprains in general practice: Design of a randomized controlled trial

    NARCIS (Netherlands)

    A.K.E. Mailuhu (Adinda); E.A.L.M. Verhagen (Evert); J.M. van Ochten (John); P.J.E. Bindels (Patrick); S.M. Bierma-Zeinstra (Sita); M. van Middelkoop (Marienke)

    2015-01-01

    textabstractBackground: Ankle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in the Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a r

  1. The Geometric Nonlinear Generalized Brazier Effect

    DEFF Research Database (Denmark)

    Nikolajsen, Jan Ánike; Lauridsen, Peter Riddersholm; Damkilde, Lars

    2016-01-01

    denoted the generalized Brazier effect. The original work of Brazier dealt with very large deformations that changed the cross section significantly and hereby also the bending moment of inertia and the bending moment capacity. In this paper the aim is to describe the Brazier effect for smaller...... that the generalized Brazier effect is a local effect not influencing the overall mechanical behavior of the structure significantly. The offset is a nonlinear geometric beam-type Finite Element calculation, which takes into account the large displacements and rotations. The beam-type model defines the stresses which...... deformation not taking into account the change in moment of inertia. However, the generalized Brazier effect gives additional stresses directed perpendicular to the beam axis. In composite structures these extra stresses may influence the fatigue life significantly. The paper demonstrates a linearized method...

  2. Study of cost-effectiveness and cost-utility antihypertensive drugs used in hiperdia peaked - PI

    OpenAIRE

    NapoleÃo Moura Dias Neto

    2009-01-01

    Hypertension is a major cause of cardiovascular disease and study the costeffectiveness and cost-utility of anti-hypertensive drugs are rare in Brazil. This paper is a study of type pharmacoeconomic cost-effectiveness and cost-utility analysis of patients enrolled in the program HiperDia the municipality of Picos â PI in the period 20/8/2009 to 30/10/2009. We analyzed the direct costs of treatment, considering only the price of antiretroviral drugs, the effectiveness as measured by mean re...

  3. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology

    Directory of Open Access Journals (Sweden)

    Hanson Kara

    2006-05-01

    Full Text Available Abstract Background Insecticide-treated nets (ITNs are an effective and cost-effective means of malaria control. Scaling-up coverage of ITNs is challenging. It requires substantial resources and there are a number of strategies to choose from. Information on the cost of different strategies is still scarce. To guide the choice of a delivery strategy (or combination of strategies, reliable and standardized cost information for the different options is required. Methods The electronic online database PubMed was used for a systematic search of the published English literature on costing and economic evaluations of ITN distribution programmes. The keywords used were: net, bednet, insecticide, treated, ITN, cost, effectiveness, economic and evaluation. Identified papers were analysed to determine and evaluate the costing methods used. Methods were judged against existing standards of cost analysis to arrive at proposed standards for undertaking and presenting cost analyses. Results Cost estimates were often not readily comparable or could not be adjusted to a different context. This resulted from the wide range of methods applied and measures of output chosen. Most common shortcomings were the omission of certain costs and failure to adjust financial costs to generate economic costs. Generalisability was hampered by authors not reporting quantities and prices of resources separately and not examining the sensitivity of their results to variations in underlying assumptions. Conclusion The observed shortcomings have arisen despite the abundance of literature and guidelines on costing of health care interventions. This paper provides ITN specific recommendations in the hope that these will help to standardize future cost estimates.

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

    Science.gov (United States)

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

    2014-05-01

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

  5. Determination of chest x-ray cost using activity based costing approach at Penang General Hospital, Malaysia.

    Science.gov (United States)

    Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Saleem, Fahad; Ahmad, Nafees

    2012-01-01

    Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure. Human resource cost was calculated by multiplying the mean time spent by employees doing specific activity to their per-minute salaries. The costs of consumables and clinical equipments were obtained from the procurement section of the Radiology Department. The cost of the building was calculated by multiplying the area of space used by the chest X-ray facility with the unit cost of public building department. Moreover, straight-line deprecation with a discount rate of 3% was assumed for calculation of equivalent annual costs for building and machines. Cost of electricity was calculated by multiplying number of kilo watts used by electrical appliance in the year 2010 with electricity tariff for Malaysian commercial consumers (MYR 0.31 per kWh). Five activities were identified which were required to develop one chest X-ray film. Human resource, capital, consumable and electricity cost was MYR 1.48, MYR 1.98, MYR 2.15 and MYR 0.04, respectively. Total cost of single chest X-ray was MYR 5.65 (USD 1.75). By applying ABC approach, we can have more detailed and precise estimate of cost for specific activity or service. Choice of repeating a chest X-ray can be based on our findings, when cost is a limiting factor.

  6. An fMRI study on sunk cost effect.

    Science.gov (United States)

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

    2013-06-26

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

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

    Directory of Open Access Journals (Sweden)

    N. N. Climko

    2009-01-01

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

  8. Rewards, costs and challenges: the general practitioner's experience of teaching medical students.

    Science.gov (United States)

    Sturman, Nancy; Régo, Patricia; Dick, Marie-Louise

    2011-07-01

    Medical student attachments in general practices play an important role in undergraduate medical education internationally. The recruitment by universities of new teaching practices or an increase in the teaching commitment of existing practices will be necessary to address rising medical student numbers. General practitioners (GPs) are likely to weigh the perceived rewards of practice-based teaching against the perceived costs and challenges in deciding whether to accept a student placement and how to teach. These aspects of the 'lived experience' of the GP-teacher have not been adequately investigated. This study aims to enhance understanding of the GP clinical teacher experience in order to inform strategies for the recruitment, retention, training and support of teaching general practices. Sixty GP clinical teachers in Brisbane-based urban teaching general practices were interviewed individually face-to-face by the principal investigator, using a semi-structured interview plan. Representativeness was ensured through quota sampling. The interview data were analysed thematically by two of the investigators independently, following member checking of interview transcripts. The results demonstrate a number of key inter-related perceived rewards, costs and challenges of teaching, including intellectual stimulation, cognitive fatigue and student characteristics. The findings extend reports in the previous literature by offering a richer description of current GP-teacher experience. Participants identified teaching rewards in a manner largely consistent with previous research, with the exception of enhanced practice morale and teamwork. Findings confirm that reduced productivity and increased time pressures remain key perceived negative impacts of teaching, but also reveal a number of other important costs and challenges. They emphasise the diversity of GP experience and practice cultures, and the need for teaching to enhance both GP and patient perceptions of

  9. Systematic review of cost and cost-effectiveness of different TB-screening strategies

    Directory of Open Access Journals (Sweden)

    Costa José

    2011-09-01

    Full Text Available Abstract Background Interferon-γ release assays (IGRAs for TB have the potential to replace the tuberculin skin test (TST in screening for latent tuberculosis infection (LTBI. The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention, given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes. Methods Using Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs. Results The 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective. Conclusion The available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs

  10. Effects of electronic communication in general practice

    NARCIS (Netherlands)

    van der Kam, WJ; Moorman, PW; Koppejan-Mulder, MJ

    2000-01-01

    Objective: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. Methods: We retrieved all publications in the English language indexed in MEDLINE

  11. Developing Cost Effective Automation In Soap Manufacturing

    Directory of Open Access Journals (Sweden)

    Rajesh B. Salwe

    2014-01-01

    Full Text Available A low cost automation system for soap manufacturing is to be designed and developed. The setup consists of mixer in which the raw material is mixed for the process of soap making. The mixture is then carried into a tray to a stamping machine. The plunger embosses on raw material of soap to give desired shape and size to the soap in a low cost manner.

  12. Developing Cost Effective Automation In Soap Manufacturing

    OpenAIRE

    Rajesh B. Salwe; Prof.S.V.Dahake

    2014-01-01

    A low cost automation system for soap manufacturing is to be designed and developed. The setup consists of mixer in which the raw material is mixed for the process of soap making. The mixture is then carried into a tray to a stamping machine. The plunger embosses on raw material of soap to give desired shape and size to the soap in a low cost manner.

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

    Science.gov (United States)

    Warren, C G

    1993-01-01

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

  14. COST ANALYSIS OF THE PSYCHOLOGICAL EFFECTS OF WASTE DISPOSAL

    Directory of Open Access Journals (Sweden)

    S. A. Oke, K. O. Awofeso

    2006-01-01

    Full Text Available This paper quantifies the cost involved due to the psychological effect of waste disposal. The major costs are quantified as management and personnel costs. Management costs refer to those associated with awareness, recovery and recycling, taskforce and experimental. On the other hand, personnel costs are related to tax and health. The approach utilized is the algebraic sum of these component costs, since dimensional consistency of the formulation is observed. The results obtained indicate that the framework presented could beneficially add to the tool kit of the environmental decision makers. This would make it possible to generate scenarios that would give the decision maker adequate information before decisions are made. The implication of this research is that intuitive decision-making on cost is replaced with scientific backed up decision making. The idea proposed in this work is new since it provides a unique way of measuring cost of the effects of waste disposal on the stakeholders in the system.

  15. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis.

    Science.gov (United States)

    Tsiachristas, Apostolos; McDaid, David; Casey, Deborah; Brand, Fiona; Leal, Jose; Park, A-La; Geulayov, Galit; Hawton, Keith

    2017-09-07

    Self-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs. In a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm. Between April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; pCosts were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean costs of

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

    Science.gov (United States)

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

    2013-08-20

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

  17. A Generalized Minimum Cost Flow Model for Multiple Emergency Flow Routing

    Directory of Open Access Journals (Sweden)

    Jianxun Cui

    2014-01-01

    Full Text Available During real-life disasters, that is, earthquakes, floods, terrorist attacks, and other unexpected events, emergency evacuation and rescue are two primary operations that can save the lives and property of the affected population. It is unavoidable that evacuation flow and rescue flow will conflict with each other on the same spatial road network and within the same time window. Therefore, we propose a novel generalized minimum cost flow model to optimize the distribution pattern of these two types of flow on the same network by introducing the conflict cost. The travel time on each link is assumed to be subject to a bureau of public road (BPR function rather than a fixed cost. Additionally, we integrate contraflow operations into this model to redesign the network shared by those two types of flow. A nonconvex mixed-integer nonlinear programming model with bilinear, fractional, and power components is constructed, and GAMS/BARON is used to solve this programming model. A case study is conducted in the downtown area of Harbin city in China to verify the efficiency of proposed model, and several helpful findings and managerial insights are also presented.

  18. Message from the Director General Final costs to completion of LHC

    CERN Document Server

    Luciano Maiani

    2001-01-01

    In March this year a review of the costs for the LHC machine was started, which was completed by the end of August. This was a bottom-up review with each group concerned making a projection of the cost to completion of the project. Figures presented were worryingly high. In conjunction, the responses from industries to the calls for tender for essential machine components, especially the superconducting magnet assembly, were also higher than originally anticipated. A summary of this situation was presented to the Finance Committee last week and then to the Committee of Council. After the meetings a summary was prepared by the chairman of Committee of Council which I reprint below. CHAIRMAN'S SUMMARY In the 248th Meeting of the Committee of Council, the Director-General presented a preliminary estimate of the cost to completion of the LHC Project, approved in 1994 and scheduled for commissioning and operation in 2006. Repeating that the project is well advanced and technically sound, the figures presented, s...

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

    Science.gov (United States)

    Kolb, Gerald R

    2002-01-01

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

  20. Cost-effectiveness analysis of face-to-face smoking cessation interventions by professionals

    NARCIS (Netherlands)

    T.L. Feenstra (Talitha); H.H. Hamberg-van Reenen; R.T. Hoogenveen (Rudolf); M.P.M.H. Rutten-van Mölken (Maureen)

    2003-01-01

    textabstractObjectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions: 1) Telephone Counseling (TC), 2) Minimal counseling by a general practitioner (H-MIS), 3) Minimal counseling by a general practitioner combined with Nicotine Replacement Therapy (H-MIS+NR

  1. 45 CFR 95.515 - Effective date of a cost allocation plan amendment.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Effective date of a cost allocation plan amendment. 95.515 Section 95.515 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH...

  2. Cost-effectiveness of vaccination against herpes zoster.

    Science.gov (United States)

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

    2014-01-01

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

  3. The Kyoto Protocol Is Cost-effective

    Directory of Open Access Journals (Sweden)

    Giulio A. De Leo

    2002-06-01

    Full Text Available Despite recent advances, there is a high degree of uncertainty concerning the climate change that would result from increasing atmospheric greenhouse gas concentrations. Also, opponents of the Kyoto Protocol raised the key objection that reducing emissions would impose an unacceptable economic burden on businesses and consumers. Based on an analysis of alternative scenarios for electricity generation in Italy, we show that if the costs in terms of damage to human health, material goods, agriculture, and the environment caused by greenhouse gas emissions are included in the balance, the economic argument against Kyoto is untenable. Most importantly, the argument holds true even if we exclude global external costs (those due to global warming, and account for local external costs only (such as those due to acidic precipitation and lung diseases resulting from air pollution.

  4. Cost and Training Effectiveness Analysis Performance Guide

    Science.gov (United States)

    1980-07-23

    value is treated as a reduction in the cost of the alternative for wnioh the use of the assets is intended. The fair market value may be determined...imputed value of the facility should be used. These costs can be based on fair market value, scrap value, or alternative use. In any event, discuss this...1 MM 1 i l 1 1 SOFTIS 1X1 X XI 1 1 ’ 1 1 I Ml 1 1 1 i M 3SOFTA 1 1X 1 IX X i 1 1

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

    Science.gov (United States)

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    Objectives: To compare the cost-effectiveness of endoscopy and empirical proton pump inhibition (PPI) therapy for management of dyspepsia in primary care. Methods: A randomized controlled trial (RCT) including prospective collection of economic resource data was conducted in general practice from...... June 2000 to August 2002, Aarhus County, Denmark. We randomly assigned 368 dyspeptic patients from 32 general practices to treatment with omeprazol 40 mg for two weeks (n: 184) or endoscopy (n: 184). The study adopted a societal perspective, and the year of costing was 2006. Outcome measures: days free...... of dyspeptic symptoms and proportion of patients with dyspepsia after one year based on patients' and general practitioners' (GPs') assessment. Costs were estimated from patient and GP questionnaires and from medical records. Results: The incremental cost-effectiveness (CE) ratio for one day free of dyspeptic...

  7. The Faraday effect revisited: General theory

    DEFF Research Database (Denmark)

    Cornean, Horia Decebal; Nenciu, Gheorghe; Pedersen, Thomas Garm

    This paper is the first in a series revisiting the Faraday effect, or more generally, the theory of electronic quantum transport/optical response in bulk media in the presence of a constant magnetic field. The independent electron approximation is assumed. For free electrons, the transverse...

  8. The Faraday effect revisited: General theory

    DEFF Research Database (Denmark)

    Cornean, Horia Decebal; Nenciu, Gheorghe; Pedersen, Thomas Garm

    2006-01-01

    This paper is the first in a series revisiting the Faraday effect, or more generally, the theory of electronic quantum transport/optical response in bulk media in the presence of a constant magnetic field. The independent electron approximation is assumed. At zero temperature and zero frequency...

  9. General Relativistic Effects in Atom Interferometry

    Energy Technology Data Exchange (ETDEWEB)

    Dimopoulos, Savas; /Stanford U., Phys. Dept.; Graham, Peter W.; /SLAC /Stanford U., Phys. Dept.; Hogan, Jason M.; Kasevich, Mark A.; /Stanford U., Phys. Dept.

    2008-03-17

    Atom interferometry is now reaching sufficient precision to motivate laboratory tests of general relativity. We begin by explaining the non-relativistic calculation of the phase shift in an atom interferometer and deriving its range of validity. From this we develop a method for calculating the phase shift in general relativity. This formalism is then used to find the relativistic effects in an atom interferometer in a weak gravitational field for application to laboratory tests of general relativity. The potentially testable relativistic effects include the non-linear three-graviton coupling, the gravity of kinetic energy, and the falling of light. We propose experiments, one currently under construction, that could provide a test of the principle of equivalence to 1 part in 10{sup 15} (300 times better than the present limit), and general relativity at the 10% level, with many potential future improvements. We also consider applications to other metrics including the Lense-Thirring effect, the expansion of the universe, and preferred frame and location effects.

  10. Cost Effectiveness Analysis, A DTIC Bibliography.

    Science.gov (United States)

    1980-07-01

    Model for Estimating * 0 6 DUGAS. DORIS J. Software Life Cycle Costs (ModelGuidelines for Attracting Private *4Concept). Volume 1.Capital to Corp$ of...of Category It Test Program A0-A023 442 An Econometric Analysis of aitonance Data. VOlunteer Enlistments of service AD-AO21 258 HUMPHREYS . THOMAS H

  11. Atomoxetine's Effect on Societal Costs in Sweden

    Science.gov (United States)

    Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par

    2010-01-01

    Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization…

  12. Non-traditional settings for influenza vaccination of adults: costs and cost effectiveness.

    Science.gov (United States)

    Prosser, Lisa A; O'Brien, Megan A; Molinari, Noelle-Angelique M; Hohman, Katherine H; Nichol, Kristin L; Messonnier, Mark L; Lieu, Tracy A

    2008-01-01

    Influenza vaccination rates remain far below national goals in the US. Expanding influenza vaccination in non-traditional settings such as worksites and pharmacies may be a way to enhance vaccination coverage for adults, but scant data exist on the cost effectiveness of this strategy. The aims of this study were to (i) describe the costs of vaccination in non-traditional settings such as pharmacies and mass vaccination clinics; and (ii) evaluate the projected health benefits, costs and cost effectiveness of delivering influenza vaccination to adults of varying ages and risk groups in non-traditional settings compared with scheduled doctor's office visits. All analyses are from the US societal perspective. We evaluated the costs of influenza vaccination in non-traditional settings via detailed telephone interviews with representatives of organizations that conduct mass vaccination clinics and pharmacies that use pharmacists to deliver vaccinations. Next, we constructed a decision tree to compare the projected health benefits and costs of influenza vaccination delivered via non-traditional settings or during scheduled doctor's office visits with no vaccination. The target population was stratified by age (18-49, 50-64 and >or=65 years) and risk status (high or low risk for influenza-related complications). Probabilities and costs (direct and opportunity) for uncomplicated influenza illness, outpatient visits, hospitalizations, deaths, vaccination and vaccine adverse events were derived from primary data and from published and unpublished sources. The mean cost (year 2004 values) of vaccination was lower in mass vaccination (dollars US 17.04) and pharmacy (dollars US 11.57) settings than in scheduled doctor's office visits (dollars US 28.67). Vaccination in non-traditional settings was projected to be cost saving for healthy adults aged >or=50 years, and for high-risk adults of all ages. For healthy adults aged 18-49 years, preventing an episode of influenza would

  13. The effect of pediatric knowledge on hospice care costs.

    Science.gov (United States)

    Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J

    2014-05-01

    The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

  14. The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action.

    NARCIS (Netherlands)

    Bemelmans, W.; Baal, van P.; Wendel-Vos, G.C.W.; Schuit, J.; Feskens, E.J.M.; Ament, A.; Hoogenveen, R.

    2008-01-01

    Objectives. To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive life

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

    Science.gov (United States)

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

    2017-08-01

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

  16. Intervals in Generalized Effect Algebras and their Sub-generalized Effect Algebras

    Directory of Open Access Journals (Sweden)

    Zdenka Riečanová

    2013-01-01

    Full Text Available We consider subsets G of a generalized effect algebra E with 0∈G and such that every interval [0, q]G = [0, q]E ∩ G of G (q ∈ G , q ≠ 0 is a sub-effect algebra of the effect algebra [0, q]E. We give a condition on E and G under which every such G is a sub-generalized effect algebra of E.

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

    Science.gov (United States)

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

    2016-12-01

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

  18. Cost-effectiveness analysis of sandhill crane habitat management

    Science.gov (United States)

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

    2013-01-01

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

  19. Cost Effective Campaigning in Social Networks

    CERN Document Server

    Kotnis, Bhushan

    2016-01-01

    Campaigners are increasingly using online social networking platforms for promoting products, ideas and information. A popular method of promoting a product or even an idea is incentivizing individuals to evangelize the idea vigorously by providing them with referral rewards in the form of discounts, cash backs, or social recognition. Due to budget constraints on scarce resources such as money and manpower, it may not be possible to provide incentives for the entire population, and hence incentives need to be allocated judiciously to appropriate individuals for ensuring the highest possible outreach size. We aim to do the same by formulating and solving an optimization problem using percolation theory. In particular, we compute the set of individuals that are provided incentives for minimizing the expected cost while ensuring a given outreach size. We also solve the problem of computing the set of individuals to be incentivized for maximizing the outreach size for given cost budget. The optimization problem t...

  20. Implant marketing: cost effective implant dentistry.

    Science.gov (United States)

    Wohrle, P S; Levin, R P

    1996-01-01

    The application of the KAL-Technique to the field of implant dentistry allows both patients and dental practices to benefit. It is an exciting advance that decreases frustration and stress in providing implant procedures and lowers overall costs. Professionals using the KAL-Technique report significant predictability in achieving passive framework fit. They are also lowering overall cost of implant cases, which increases the number of patients who can accept implant treatment. It has been well established that the more individuals in a practice that receive implants, the more referrals a practice will gain. This is because implant patients find tremendous advances in the quality of life, and do not hesitate to tell others who can take advantage of this opportunity. Implant dentistry is one of the fastest growing fields in dentistry today. While some other areas of dentistry begin to decline in volume and need, implant dentistry provides the opportunity to keep practices strong and to insure long-term success.

  1. The cost-effectiveness of an intensive treatment protocol for severe dyslexia in children.

    Science.gov (United States)

    Hakkaart-van Roijen, Leona; Goettsch, Wim G; Ekkebus, Michel; Gerretsen, Patty; Stolk, Elly A

    2011-08-01

    Studies of interventions for dyslexia have focused entirely on outcomes related to literacy. In this study, we considered a broader picture assessing improved quality of life compared with costs. A model served as a tool to compare costs and effects of treatment according to a new protocol and care as usual. Quality of life was measured and valued by proxies using a general quality-of-life instrument (EQ-5D). We considered medical cost and non-medical cost (e.g. remedial teaching). The model computed cost per successful treatment and cost per quality adjusted life year (QALY) in time. About 75% of the total costs was related to diagnostic tests to distinguish between children with severe dyslexia and children who have reading difficulties for other reasons. The costs per successful treatment of severe dyslexia were €36 366. Successful treatment showed a quality-of-life gain of about 11%. At primary school, the average cost per QALY for severe dyslexia amounted to €58 647. In the long term, the cost per QALY decreased to €26 386 at secondary school and €17 663 thereafter. The results of this study provide evidence that treatment of severe dyslexia is cost-effective when the investigated protocol is followed.

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

    Science.gov (United States)

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

    2015-09-01

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

  3. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  5. A general model for the estimation of societal costs of lost production and informal care in Italy

    Directory of Open Access Journals (Sweden)

    Lorenzo Pradelli

    2017-02-01

    reported HRQoL data with demographically matched Italian norms. Our results will be useful for cost-effectiveness and budget impact analyses conducted from the perspective of the Italian society and we encourage the inclusion of these costs in economic evaluations to allow decision makers to be fully informed about the costs and consequences of their decisions on healthcare interventions.

  6. Development of cost effective nutrient management strategies for a watershed with the DSS FyrisCOST

    Science.gov (United States)

    Collentine, D.; Johnsson, H.; Larsson, P.; Markensten, H.; Widén Nilsson, E.

    2012-12-01

    This paper describes an application of the FyrisCOST model to calculate the cost efficiency of alternative scenarios for nitrogen management in a small agricultural catchment in Southern Sweden. The scenarios include the spatial distribution by sub-catchment of a set of nitrogen abatement measures that have been identified as eligible for financial support under the Swedish Rural Development Program (wetlands, catch crops, spring plowing and a combination of these) with alternative crop distributions. The model FyrisCOST is a catchment scale DSS that has been developed for the evaluation of alternative nutrient mitigation strategies. This model is able to evaluate a range of mitigation approaches for phosphorous and nitrogen from several sources (point and diffuse). This allows cost efficiency to be estimated for a catchment based on a combination of measures. The model is currently being used to develop a data base for the Swedish Water Authorities on the cost efficiency of buffer zones for all small catchments in Sweden. Hydrological flows in the FyrisCOST model are built on the dynamic model FyrisNP and nutrient losses are derived from simulations from the Nutrient Leaching Coefficient Calculation System (NLeCCS) which includes the ICECREAMDB model for estimating phosphorus losses and the SOILNDB model for soil nitrogen leaching. FyrisCOST calculates nitrogen concentrations in effluent water for each sub-catchment. The concentration of nitrogen is dependent on the current land use and geographical conditions. In order to evaluate agricultural scenarios in FyrisCOST a method for calculating N leaching from agricultural land was constructed. The calculation includes crop rotations and tillage systems and differentiates between annual and perennial crops. The model is able to take into account the probability that a primary crop is followed by a specific crop/tillage system and the effect on nutrient losses estimated using a specially developed leaching

  7. A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted

    Science.gov (United States)

    Neumann, Peter J.; Thorat, Teja; Zhong, Yue; Anderson, Jordan; Farquhar, Megan; Salem, Mark; Sandberg, Eileen; Saret, Cayla J.; Wilkinson, Colby; Cohen, Joshua T.

    2016-01-01

    Introduction Calculating the cost per disability-adjusted life years (DALYs) averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve population health. However, there has been no systematic attempt to characterize the literature and its evolution. Methods We conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA) Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases “disability-adjusted” or “DALY”. Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000–2009 and 2010–2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low) to 7 (high), and examined the correlation between diseases researched and the burden of disease in different world regions. Results We identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%), followed by non-communicable diseases (28%). A high proportion of studies evaluated primary prevention strategies (59%). Pharmaceutical interventions were commonly assessed (32%) followed by immunizations (28%). Adherence to good practices for conducting and reporting cost-effectiveness analysis varied

  8. Projected cost-effectiveness of new vaccines for adolescents in the United States.

    Science.gov (United States)

    Ortega-Sanchez, Ismael R; Lee, Grace M; Jacobs, R Jake; Prosser, Lisa A; Molinari, Noelle-Angelique; Zhang, Xinzhi; Baine, William B; McCauley, Mary M; Miller, Ted

    2008-01-01

    Economic assessments that guide policy making on immunizations are becoming increasingly important in light of new and anticipated vaccines for adolescents. However, important considerations that limit the utility of these assessments, such as the diversity of approaches used, are often overlooked and should be better understood. Our goal was to examine economic studies of adolescent vaccines and compare cost-effectiveness outcomes among studies on a particular vaccine, across adolescent vaccines, and between new adolescent vaccines versus vaccines that are recommended for young children. A systematic review of economic studies on immunizations for adolescents was conducted. Studies were identified by searching the Medline, Embase, and EconLit databases. Each study was reviewed for appropriateness of model design, baseline setup, sensitivity analyses, and input variables (ie, epidemiologic, clinical, cost, and quality-of-life impact). For comparison, the cost-effectiveness outcomes reported in key studies on vaccines for younger children were selected. Vaccines for healthy adolescents were consistently found to be more costly than the health care or societal cost savings they produced and, in general, were less cost-effective than vaccines for younger children. Among the new vaccines, pertussis and human papillomavirus vaccines were more cost-effective than meningococcal vaccines. Including herd-immunity benefits in studies significantly improved the cost-effectiveness estimates for new vaccines. Differences in measurements or assumptions limited further comparisons. Although using the new adolescent vaccines is unlikely to be cost-saving, vaccination programs will result in sizable health benefits.

  9. A comparison of side effects and cost for spinal andgeneral anesthesia in geriatric patients

    OpenAIRE

    E. Nasiri; R.Nemat; F. Sohail Arshadi; R.A.Mohammadpour

    2006-01-01

    AbstractBackground and purpose: There is still debate regarding advantages and disadvantages of regional versus general anesthesia techniques. Some studies suggested that regional anesthesia technique probably reduces postoperative morbidity and mortality.In this retrospective historical cohort study, we compared the cost-effectiveness for spinal and general anesthesia in elderly patients.Materials and methods : A total of 120 medical records of elderly participants whom underwent general or ...

  10. Societal Discounting of Health Effects in Cost-Effectiveness Analyses: The Influence of Life Expectancy

    OpenAIRE

    Suzanne Polinder; Willem Jan Meerding; Job van Exel; Werner Brouwer

    2005-01-01

    Background: Increasing life expectancy and decreasing marginal valuation of additional QALYs over time may serve as a basis for discounting future health effects from a societal perspective. Therefore, we tested the hypothesis that societal time preference for health is related to perceived future life expectancy. Methods: A sample of 223 people from the general population prioritised healthcare programmes with differential timing of health benefits and costs from a societal perspective. Furt...

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2007-03-01

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

  13. Effect of seed priming on agronomic performance and cost ...

    African Journals Online (AJOL)

    Effect of seed priming on agronomic performance and cost effectiveness of rainfed, dry-seeded nerica rice. ... Open Access DOWNLOAD FULL TEXT ... vitamin (Ascorbate) priming, hardening, osmohardening, and a non-primed control.

  14. Analysis of the cost-effectiveness and costs rationalization of antidepressants consumption in Lithuania

    OpenAIRE

    2013-01-01

    In recent years, there has been much debate regarding the rationality of consumption and cost effectiveness of antidepressants. The economic aspects of treating depression are becoming more frequently evaluated as newer antidepressants become available and as healthcare entities attempt to address increasing costs. The aim of the research. To investigate and assess the possibilities of a more rational use of the public and private funds of the Lithuanian population in the cases of medicam...

  15. Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeon – general practitioner Delphi approach

    Directory of Open Access Journals (Sweden)

    Augestad KM

    2014-09-01

    Full Text Available Knut Magne Augestad,1–3 Arthur Revhaug,1,3 Roar Johnsen,4 Stein-Olav Skrøvseth,2 Rolv-Ole Lindsetmo1,3 1Department of Gastrointestinal Surgery, 2Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway; 3Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 4Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Background: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines. Methods: Prospective observational survey of implementation of electronic medical record (EMR-supported guidelines for surgical treatment. Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £ to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670 and 37 (range 29–49 referred patients, respectively, were needed to provide a cost-effective service. Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to

  16. Cost effectiveness and cost utility of the noncoding blood glucose meter CONTOUR® TS

    Directory of Open Access Journals (Sweden)

    Przemyslaw Holko

    2011-02-01

    Full Text Available Przemyslaw Holko, Pawal KawalecHTA Centre, Kraków, PolandAims: This study assessed the cost efficacy and cost utility of the automatic blood glucose meter CONTOUR® TS from the public payer (National Health Fund [NHF] and payer (patient and NHF perspectives over a 26-year analysis horizon.Methods: Clinical effectiveness data were obtained from prior clinical studies of automatic versus manually coded blood glucose meters. Cost data were obtained from the NHF. The probability of procedure use related to diabetic complications was obtained from four medical centers in Poland. The incremental cost-effectiveness ratio related to 1 life year gained and the incremental cost-utility ratio related to 1 quality-adjusted life year gained were calculated.Results: Assuming co-funding from public funds, introduction of the CONTOUR® TS is associated with savings of Polish złoty (PLN 31,846.19 (€8916.93 and PLN 113,018.19 (€31,645.09 per life year gained from the payer and public payer perspectives, respectively. Cost utility analyses showed that the CONTOUR® TS is associated with savings of PLN 40,465.59 (€11,330.37 and PLN 11,434.82 (€3201.75 per quality-adjusted life year gained from the payer and the public payer perspectives, respectively.Conclusion: The CONTOUR® TS appears superior to manually coded meters available in Poland both from the payer and the public payer perspectives and may represent an improved strategy for glycemic control.Keywords: blood glucose self monitoring, costs and cost analysis, health care costs, diabetes mellitus, diabetes complications 

  17. Reliable and cost effective micro hydro power

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1998-03-01

    A 14 kW hydroelectric power plant in British Columbia that generates enough power to run a small farm was described. It was developed as an alternative to bringing in power from BC Hydro, which would have cost about the same initially, but would also have entailed about $300 per month of utility bills. The system operates at a fraction of its capacity at practically no operating cost and the capital outlay will have been recovered in six to seven years. The system uses a Lima generator directly coupled to a pelton turbine. Some 1,400 feet of five inch PCV pipe running down a hillside provides 136 psi of static pressure. The pressurized water in the pipeline squirts through a nozzle and the jet of water strikes the buckets of the pelton turbine. The energy in the water is transferred to the turbine and provides the shaft power to drive the generator. Two electrically heated dwellings, a workshop and a barn containing 300 pigs are supplied by the power plant.

  18. On a general Heisenberg exchange effective Hamiltonian

    Energy Technology Data Exchange (ETDEWEB)

    Blanco, J.A.; Prida Pidal, V.M. [Dept. de Fisica, Oviedo Univ. (Spain)

    1995-07-01

    A general Heisenberg exchange effective Hamiltonian is deduced in a straightforward way from the elemental quantum mechanical principles for the case of magnetic ions with non-orbital degeneracy in a crystalline lattice. Expressions for the high order direct exchange coupling constants or parameters are presented. The meaning of this effective Hamiltonian is important because extracting information from the Heisenberg Hamiltonian is a difficult task and is however taken as the starting point for many quite profound investigations of magnetism in solids and therefore could play an important role in an introductory course to solid state physics. (author)

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

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

  1. Cost-effectiveness of screening programs for Chlamydia trachomatis - A population-based dynamic approach

    NARCIS (Netherlands)

    Welte, R; Kretzschmar, M; Leidl, R; Van den Hoek, A; Jager, JC; Postma, MJ

    2000-01-01

    Background: Models commonly used for the economic assessment of chamydial screening programs do not consider population effects. Goal: To develop a novel dynamic approach for the economic evaluation of chlamydial prevention measures and to determine the cost-effectiveness of a general practitioner-b

  2. Cost-effectiveness of screening programs for Chlamydia trachomatis - A population-based dynamic approach

    NARCIS (Netherlands)

    Welte, R; Kretzschmar, M; Leidl, R; Van den Hoek, A; Jager, JC; Postma, MJ

    2000-01-01

    Background: Models commonly used for the economic assessment of chamydial screening programs do not consider population effects. Goal: To develop a novel dynamic approach for the economic evaluation of chlamydial prevention measures and to determine the cost-effectiveness of a general

  3. Cost-effectiveness analysis of scalp cooling to reduce chemotherapy-induced alopecia

    NARCIS (Netherlands)

    van den Hurk, C.J.; van den Akker-van Marle, E.M.; Breed, W.P.M.; van de Poll-Franse, L.V.; Nortier, J.; Coebergh, J.W.W.

    2014-01-01

    Background. Alopecia is a frequently occurring side effect of chemotherapy that often can be prevented by cooling the scalp during the infusion. This study compared effects and costs of scalp cooling with usual general oncological care, i.e. purchasing a wig or head cover. Material and methods.

  4. Economics of infection control surveillance technology: cost-effective or just cost?

    Science.gov (United States)

    Furuno, Jon P; Schweizer, Marin L; McGregor, Jessina C; Perencevich, Eli N

    2008-04-01

    Previous studies have suggested that informatics tools, such as automated alert and decision support systems, may increase the efficiency and quality of infection control surveillance. However, little is known about the cost-effectiveness of these tools. We focus on 2 types of economic analyses that have utility in assessing infection control interventions (cost-effectiveness analysis and business-case analysis) and review the available literature on the economics of computerized infection control surveillance systems. Previous studies on the effectiveness of computerized infection control surveillance have been limited to assessments of whether these tools increase the sensitivity and specificity of surveillance over traditional methods. Furthermore, we identified only 2 studies that assessed the costs associated with computerized infection control surveillance. Thus, it remains unknown whether computerized infection control surveillance systems are cost-effective and whether use of these systems improves patient outcomes. The existing data are insufficient to allow for a summary conclusion on the cost-effectiveness of infection control surveillance technology. All future studies of computerized infection control surveillance systems should aim to collect outcomes and economic data to inform decision making and assist hospitals with completing business-cases analyses.

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

    Science.gov (United States)

    Jayaratne, K. S. U.

    2015-01-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  7. Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico.

    Directory of Open Access Journals (Sweden)

    Jochen Profit

    Full Text Available BACKGROUND: Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. METHODS AND FINDINGS: A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs, and incremental cost-effectiveness ratios (ICERs for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in

  8. Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico

    Science.gov (United States)

    Profit, Jochen; Lee, Diana; Zupancic, John A.; Papile, LuAnn; Gutierrez, Cristina; Goldie, Sue J.; Gonzalez-Pier, Eduardo; Salomon, Joshua A.

    2010-01-01

    Background Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. Methods and Findings A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24–26, 27–29, and 30–33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24–26, 27–29, and 30–33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in

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

    Science.gov (United States)

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

    2016-09-16

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

  10. Cost-benefit and cost-effectiveness analysis of drug therapy.

    Science.gov (United States)

    Dao, T D

    1985-04-01

    A model for cost-benefit analysis and cost-effectiveness analysis (CBA-CEA) of pharmaceutical intervention is presented, and CBA-CEA research methods reported in the literature are reviewed. The cost versus benefit and the cost effectiveness of drug therapy can be analyzed in societal as well as private terms. Since CBA measures costs and outcomes in monetary terms, it can be used to compare net benefits of all types of interventions. CEA, however, can be used only in comparing alternative interventions that can produce a similar health outcome. Research activities needed for identification of treatment protocols, alternative therapies and their respective outcomes, and resource use are described. Quantification of benefits and costs is discussed and inherent strengths and weaknesses of CBA-CEA are summarized. For the wide variety of research activities involved in CBA-CEA, the expertise of economists, physicians, clinical pharmacists and pharmacologists, epidemiologists, sociologists, and psychologists is needed. Inherent in CBA-CEA for drug therapy are judgments, either by analysts or by policy decision makers, about how to value life, pain, anxiety, and happiness and how to distribute health-care resources. When results of CBA-CEA are presented and interpreted with care, this analysis can be an important tool for policy decision makers.

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

    Science.gov (United States)

    Hutchinson, Paul; Wheeler, Jennifer

    2006-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2002-12-13

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

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

    Science.gov (United States)

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

    2014-06-01

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

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

    African Journals Online (AJOL)

    USER

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

  16. Cost-Effectiveness of Training in Developing Countries.

    Science.gov (United States)

    Bas, Daniel

    1988-01-01

    The author defines the output and effectiveness of training and its monetary and psychological costs and discusses the cost-benefit implications of institution-based training, enterprise-based training, apprenticeships, self-instruction, and new educational technologies. He argues that an examination of these implications is indispensible for…

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

    Science.gov (United States)

    Young, Andrea

    2015-01-01

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

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

    Science.gov (United States)

    Young, Andrea

    2015-01-01

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

  19. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2004-05-01

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

  2. Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

    Directory of Open Access Journals (Sweden)

    Doug Coyle

    2012-01-01

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

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

    Science.gov (United States)

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

    2017-07-28

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

  4. Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community.

    Science.gov (United States)

    Lalloo, Ratilal; Kroon, Jeroen; Tut, Ohnmar; Kularatna, Sanjeewa; Jamieson, Lisa M; Wallace, Valda; Boase, Robyn; Fernando, Surani; Cadet-James, Yvonne; Scuffham, Paul A; Johnson, Newell W

    2015-08-29

    The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.

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

    Science.gov (United States)

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

    2011-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2007-09-01

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

  7. Cost-effective forensic image enhancement

    Science.gov (United States)

    Dalrymple, Brian E.

    1998-12-01

    In 1977, a paper was presented at the SPIE conference in Reston, Virginia, detailing the computer enhancement of the Zapruder film. The forensic value of this examination in a major homicide investigation was apparent to the viewer. Equally clear was the potential for extracting evidence which is beyond the reach of conventional detection techniques. The cost of this technology in 1976, however, was prohibitive, and well beyond the means of most police agencies. Twenty-two years later, a highly efficient means of image enhancement is easily within the grasp of most police agencies, not only for homicides but for any case application. A PC workstation combined with an enhancement software package allows a forensic investigator to fully exploit digital technology. The goal of this approach is the optimization of the signal to noise ratio in images. Obstructive backgrounds may be diminished or eliminated while weak signals are optimized by the use of algorithms including Fast Fourier Transform, Histogram Equalization and Image Subtraction. An added benefit is the speed with which these processes are completed and the results known. The efficacy of forensic image enhancement is illustrated through case applications.

  8. Cost Effective Rumor Containment in Social Networks

    CERN Document Server

    Kotnis, Bhushan

    2014-01-01

    The spread of rumors through social media and online social networks can not only disrupt the daily lives of citizens but also result in loss of life and property. A rumor spreads when individuals, who are unable decide the authenticity of the information, mistake the rumor as genuine information and pass it on to their acquaintances. We propose a solution where a set of individuals (based on their degree) in the social network are trained and provided resources to help them distinguish a rumor from genuine information. By formulating an optimization problem we calculate the optimum set of individuals, who must undergo training, and the quality of training that minimizes the expected training cost and ensures an upper bound on the size of the rumor outbreak. Our primary contribution is that although the optimization problem turns out to be non convex, we show that the problem is equivalent to solving a set of linear programs. This result also allows us to solve the problem of minimizing the size of rumor outb...

  9. Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010.

    LENUS (Irish Health Repository)

    Bennett, Kathleen

    2009-01-01

    OBJECTIVE: Coronary heart disease (CHD) is associated with a large burden of disease in Ireland and is responsible for more than 6000 deaths annually. This study examined the cost-effectiveness of specific CHD treatments in Ireland. METHODS: Irish epidemiological data on patient numbers and median survival in specific groups, plus the uptake, effectiveness, and costs of specific interventions, all stratified by age and sex, were incorporated into a previously validated CHD mortality model, the IMPACT model. This model calculates the number of life-years gained (LYGs) by specific cardiology interventions to generate incremental cost-effectiveness ratios (ICERs) per LYG for each intervention. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 1885 CHD deaths in patients aged 25 to 84 years, and thus generated approximately 14,505 extra life-years (minimum 7270, maximum 22,475). In general, all the cardiac interventions investigated were highly cost-effective in the Irish setting. Aspirin, beta-blockers, ACE inhibitors, spironolactone, and warfarin for specific conditions were the most cost-effective interventions (< euro 3000\\/LYG), followed by the statins for secondary prevention (< euro 6500\\/LYG). Revascularization for chronic angina and primary angioplasty for myocardial infarction, although still cost-effective, had the highest ICER (between euro 12,000 and euro 20,000\\/LYG). CONCLUSIONS: Using a comprehensive standardized methodology, cost-effectiveness ratios in this study clearly favored simple medical treatments for myocardial infarction, secondary prevention, angina, and heart failure.

  10. Cost-Effectiveness of a Community Pharmacist-Led Sleep Apnea Screening Program - A Markov Model.

    Directory of Open Access Journals (Sweden)

    Clémence Perraudin

    Full Text Available Despite the high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS remains underdiagnosed. In many developed countries, because community pharmacists (CP are easily accessible, they have been developing additional clinical services that integrate the services of and collaborate with other healthcare providers (general practitioners (GPs, nurses, etc.. Alternative strategies for primary care screening programs for OSAS involving the CP are discussed.To estimate the quality of life, costs, and cost-effectiveness of three screening strategies among patients who are at risk of having moderate to severe OSAS in primary care.Markov decision model.Published data.Hypothetical cohort of 50-year-old male patients with symptoms highly evocative of OSAS.The 5 years after initial evaluation for OSAS.Societal.Screening strategy with CP (CP-GP collaboration, screening strategy without CP (GP alone and no screening.Quality of life, survival and costs for each screening strategy.Under almost all modeled conditions, the involvement of CPs in OSAS screening was cost effective. The maximal incremental cost for "screening strategy with CP" was about 455€ per QALY gained.Our results were robust but primarily sensitive to the treatment costs by continuous positive airway pressure, and the costs of untreated OSAS. The probabilistic sensitivity analysis showed that the "screening strategy with CP" was dominant in 80% of cases. It was more effective and less costly in 47% of cases, and within the cost-effective range (maximum incremental cost effectiveness ratio at €6186.67/QALY in 33% of cases.CP involvement in OSAS screening is a cost-effective strategy. This proposal is consistent with the trend in Europe and the United States to extend the practices and responsibilities of the pharmacist in primary care.

  11. Generalized Efimov Effect in One Dimension

    Science.gov (United States)

    Moroz, Sergej; D'Incao, José P.; Petrov, Dmitry S.

    2015-10-01

    We study a one-dimensional quantum problem of two particles interacting with a third one via a scale-invariant subcritically attractive inverse square potential, which can be realized, for example, in a mixture of dipoles and charges confined to one dimension. We find that above a critical mass ratio, this version of the Calogero problem exhibits the generalized Efimov effect, the emergence of discrete scale invariance manifested by a geometric series of three-body bound states with an accumulation point at zero energy.

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

    Science.gov (United States)

    Zettler, Patricia J; Fuse Brown, Erin C

    2017-01-01

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

  13. Cost-effectiveness of HPV vaccination in Belize.

    Science.gov (United States)

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

    2015-05-07

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

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

    Science.gov (United States)

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

    2011-11-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Erin M Graybill

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

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

    Science.gov (United States)

    Lam, Hwai-Tai Chen

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

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

    Science.gov (United States)

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

    1999-01-01

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

  19. A General Low-Cost Indirect Branch Prediction Using Target Address Pointers

    Institute of Scientific and Technical Information of China (English)

    谢子超; 佟冬; 黄明凯

    2014-01-01

    Nowadays energy-efficiency becomes the first design metric in chip development. To pursue higher energy efficiency, the processor architects should reduce or eliminate those unnecessary energy dissipations. Indirect-branch pre-diction has become a performance bottleneck, especially for the applications written in object-oriented languages. Previous hardware-based indirect-branch predictors are generally inefficient, for they either require significant hardware storage or predict indirect-branch targets slowly. In this paper, we propose an energy-efficient indirect-branch prediction technique called TAP (target address pointer) prediction. Its key idea includes two parts: utilizing specific hardware pointers to accelerate the indirect branch prediction flow and reusing the existing processor components to reduce additional hardware costs and power consumption. When fetching an indirect branch, TAP prediction first gets the specific pointers called target address pointers from the conditional branch predictor, and then uses such pointers to generate virtual addresses which index the indirect-branch targets. This technique spends similar time compared to the dedicated storage techniques without requiring additional large amounts of storage. Our evaluation shows that TAP prediction with some representative state-of-the-art branch predictors can improve performance significantly over the baseline processor. Compared with those hardware-based indirect-branch predictors, the TAP-Perceptron scheme achieves performance improvement equivalent to that provided by an 8 K-entry TTC predictor, and also outperforms the VPC predictor.

  20. How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis.

    Science.gov (United States)

    Bojke, Laura; Manca, Andrea; Asaria, Miqdad; Mahon, Ronan; Ren, Shijie; Palmer, Stephen

    2017-05-03

    Costs and utilities are key inputs into any cost-effectiveness analysis. Their estimates are typically derived from individual patient-level data collected as part of clinical studies the follow-up duration of which is often too short to allow a robust quantification of the likely costs and benefits a technology will yield over the patient's entire lifetime. In the absence of long-term data, some form of temporal extrapolation-to project short-term evidence over a longer time horizon-is required. Temporal extrapolation inevitably involves assumptions regarding the behaviour of the quantities of interest beyond the time horizon supported by the clinical evidence. Unfortunately, the implications for decisions made on the basis of evidence derived following this practice and the degree of uncertainty surrounding the validity of any assumptions made are often not fully appreciated. The issue is compounded by the absence of methodological guidance concerning the extrapolation of non-time-to-event outcomes such as costs and utilities. This paper considers current approaches to predict long-term costs and utilities, highlights some of the challenges with the existing methods, and provides recommendations for future applications. It finds that, typically, economic evaluation models employ a simplistic approach to temporal extrapolation of costs and utilities. For instance, their parameters (e.g. mean) are typically assumed to be homogeneous with respect to both time and patients' characteristics. Furthermore, costs and utilities have often been modelled to follow the dynamics of the associated time-to-event outcomes. However, cost and utility estimates may be more nuanced, and it is important to ensure extrapolation is carried out appropriately for these parameters.

  1. Comparing the Mass, Energy, and Cost Effects of Lightweighting in Conventional and Electric Passenger Vehicles

    Directory of Open Access Journals (Sweden)

    Johannes Hofer

    2014-09-01

    Full Text Available In this work the effect of weight reduction using advanced lightweight materials on the mass, energy use, and cost of conventional and battery electric passenger vehicles is compared. Analytic vehicle simulation is coupled with cost assessment to find the optimal degree of weight reduction minimizing manufacturing and total costs. The results show a strong secondary weight and cost saving potential for the battery electric vehicles, but a higher sensitivity of vehicle energy use to mass reduction for the conventional vehicle. Generally, light weighting has the potential to lower vehicle costs, however, the results are very sensitive to parameters affecting lifetime fuel costs for conventional and battery costs for electric vehicles. Based on current technology cost estimates it is shown that the optimal amount of primary mass reduction minimizing total costs is similar for conventional and electric vehicles and ranges from 22% to 39%, depending on vehicle range and overall use patterns. The difference between the optimal solutions minimizing manufacturing versus total costs is higher for conventional than battery electric vehicles.

  2. Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention?

    Science.gov (United States)

    Van den Heede, Koen; Simoens, Steven; Diya, Luwis; Lesaffre, Emmanuel; Vleugels, Arthur; Sermeus, Walter

    2010-06-01

    This paper is a report of a cost-effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units. A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates. Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a 'do nothing' alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life-year gained. The analysis used 2007 costing data. The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to euro1,211,022. Such nurse staffing levels would avoid an estimated number of 45.9 (95% confidence interval: 22.0-69.4) patient deaths per year and generate 458.86 (95% confidence interval: 219.93-693.79) life-years gained annually. This corresponds with incremental cost-effectiveness ratios of euro26,372 per avoided death and euro2639 per life-year gained. Increasing nurse staffing levels appears to be a cost-effective intervention as compared with other cardiovascular interventions.

  3. EFFECTIVE SAVINGS IN PRODUCTION TIMES AND COST

    African Journals Online (AJOL)

    ES OBE

    THROUGH MONITORING OF THE EFFECT OF ADDITIVES AND ... planning, using the in-depth knowledge of gel times, can there be a saving in production times and prevention of material ..... production lines staff handlay-up laminators and ...

  4. Stimulating cost effective behavior in hospitals.

    Science.gov (United States)

    Neuhauser, D

    1987-04-01

    Types of influence on the delivery of medical care are divided into monetary and other. These incentives effect care at the system, hospital, care team, physician and patient levels. Selected examples, primarily from the USA, are discussed.

  5. Cost effectiveness analysis of hemiarthroplasty and total shoulder arthroplasty.

    Science.gov (United States)

    Mather, Richard C; Watters, Tyler S; Orlando, Lori A; Bolognesi, Michael P; Moorman, Claude T

    2010-04-01

    Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are two viable surgical treatment options for glenohumeral osteoarthritis. Recent systematic reviews and randomized trials suggest that TSA, while more costly initially, may have superior outcomes with regard to pain, function and quality of life with lower revision rates. This study compared the cost-effectiveness of TSA with HA. A Markov decision model was constructed for a cost-utility analysis of TSA compared to HA in a cohort of 64-year-old patients. Outcome probabilities and effectiveness were derived from the literature. Costs were estimated from the societal perspective using the national average Medicare reimbursement for the procedures in 2008 US dollars. Effectiveness was expressed in quality-adjusted life years (QALYs) gained. Principal outcome measures were average incremental costs, incremental effectiveness, incremental QALYs, and net health benefits. In the base case, HA resulted in a lower number of average QALYs gained at a higher average cost to society and was, therefore, dominated by the TSA strategy for the treatment of glenohumeral osteoarthritis. The cost effectiveness ratio for TSA and HA were $957/QALY and $1,194/QALY respectively. Sensitivity analysis revealed that if the utility of TSA is equal to, or revision rate lower than HA, TSA continues to be a dominant strategy. Total shoulder arthroplasty with a cemented glenoid is a cost-effective procedure, resulting in greater utility for the patient at a lower overall cost to the payer. These findings suggest that TSA is the preferred treatment for certain populations from both a patient and payer perspective. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  7. The clinical utility and cost effectiveness of routine thyroid screening ...

    African Journals Online (AJOL)

    depression, cognitive impairment, and psychosis, while ... the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at .... Antidepressants were prescribed to 302 (28%) of patients,.

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

  10. An Analysis of the Romanian General Accounting Plan. Opportunities for Adaptation to the Activity-Based Costing (ABC Method

    Directory of Open Access Journals (Sweden)

    Irina-Alina Preda

    2008-11-01

    Full Text Available In this article, we analyze the causes that have led to the improvement of the Romanian general accounting plan according to the Activity- Based Costing (ABC method. We explain the advantages presented by the dissociated organization of management accounting, in contrast with the tabular- statistical form. The article also describes the methodological steps to be taken in the process of recording book entries, according to the Activity-Based Costing (ABC method in Romania.

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

    Science.gov (United States)

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

    2009-10-01

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

  12. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

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

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

    Science.gov (United States)

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

    2001-09-26

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

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

    Science.gov (United States)

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

    2016-05-01

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

  15. Minimum Cost Design of Distributed Energy Resources with Studying the Effect of Capital Cost and Replacement Cost

    Directory of Open Access Journals (Sweden)

    Mehdi Nafar

    2012-02-01

    Full Text Available This study presents an optimized design of HPS in a distribution system including sources like, photovoltaic array, Diesel generator and battery bank.In this research, an algorithm has been developed for evaluation and cost optimization HPS. The costs include capital cost, replacement cost, operation and maintenance cost, fuel cost and production cost for HPS and DG power during different load profile. Then an objective function with aim to minimizing of total costs has been considered. A genetic algorithm approach is employed to obtain the best cost value of HPS construction. This study tested on case study network on Mardasht city in Iran.

  16. Cost-effective management alternatives for Snake river chinook salmon: A biological-economic synthesis

    Science.gov (United States)

    Halsing, D.L.; Moore, M.R.

    2008-01-01

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

  17. SINGLE MACHINE SCHEDULING WITH CONTROLLABLE PROCESSING TIMES AND COMPRESSION COSTS (Part Ⅱ Heuristics for the General Case)

    Institute of Scientific and Technical Information of China (English)

    Foulds,L.R.; TangGuochun

    1999-01-01

    A single machine scheduling problem with controllable processing times and compression costs is considered. The objective is to find an optimal sequence to minimize the cost ofcompletion times and the cost of compression. The complexity of this problem is still unknown.In Part Ⅱ of this paper,the authors have considered a special case where the compression timesand the compression costs are equal among all jobs. Such a problem appears polynomiafiy solvable by developing an O(n2) algorithm. In this part(Part Ⅱ ),a general case where the controllable processing times and the compression costs are not equal is discussed. Authors proposehere two heuristics with the first based on some previous work and the second based on the algorithm developed in Part Ⅱ . Computational results are presented to show the efficiency and therobustness of these heuristics.

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

    Science.gov (United States)

    John, Denny; Parikh, Rajul

    2017-07-01

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

  19. Costs and cost-effectiveness of family CBT versus individual CBT in clinically anxious children

    NARCIS (Netherlands)

    D.H.M. Bodden; C.D. Dirksen; S.M. Bögels; M.H. Nauta; E. de Haan; J. Ringrose; C. Appelboom; A.G. Brinkman; K.C.M.M.J. Appelboom-Geerts

    2008-01-01

    The objective of this study was to investigate the cost-effectiveness of family cognitive-behavioral therapy (CBT) compared with individual CBT in children with anxiety disorders. Clinically anxious children (aged 8—18 years) referred for treatment were randomly assigned to family or individual CBT

  20. Cost Effective Regional Ballistic Missile Defense

    Science.gov (United States)

    2016-02-16

    Defense Agency, Huntsville, AL; Chief, Materiel Fielding Team ( Automotive ), Materiel Fielding and Training Directorate, TACOM Life Cycle Management...Executive Office Ground Combat Systems, Detroit Arsenal, Michigan; Training With Industry Officer, EADS North America, Huntsville, Alabama; and Product...identify the ways and means to counter this imbalance or risk future erosion of our military effectiveness, diminished allied confidence, and unnecessarily

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-02-15

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

  3. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates – A Modeling Study

    Science.gov (United States)

    Kingsley, James; Karanth, Siddharth; Revere, Frances Lee

    2016-01-01

    Background Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20–60%. This increases the cost of colonoscopy for our society. Aim The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC). Methods A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT) every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers. Results At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society’s willingness to pay (<$50,000/QALY). Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy. Conclusions Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%. PMID:27936028

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

    Science.gov (United States)

    2012-01-01

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

  5. Effectiveness and cost of treatment with maraviroc in HIV infection

    Directory of Open Access Journals (Sweden)

    Viola Sacchi

    2009-12-01

    Full Text Available Since 1995, life expectancy and quality of life of HIV patients improved significantly due to the use of Highly Active Anti-Retroviral Therapy (HAART, consisting of different combinations of three classes of antiretroviral agents, nucleoside and non-nucleoside reverse transcriptase inhibitors, and protease inhibitors. Recently, new treatment options for individuals developing resistance to these drugs have become available, with the appearance of new drug classes like integrase inhibitors, fusion inhibitors and CCR5 antagonists. Maraviroc is the first antiretroviral agent belonging to the latter drug class approved for clinical use. CCR5 receptor antagonists act by blocking the interaction of the HIV virus with the CCR5 chemokine receptor, a co-receptor essential to the entry process of R5-tropic viruses. The drug is indicated, in combination with other antiretroviral products, for treatment-experienced adult patients infected with only CCR5-tropic HIV-1 detectable virus strains. Results of main phase III clinical trials indicate that maraviroc, in combination with optimized background therapy (OBT, causes significantly greater reductions in viral load and increases in CD4+ cell count, as compared to OBT alone in this kind of patients. In Italy, the monthly cost of maraviroc therapy is about € 780. A number of economic evaluations, performed for different settings, demonstrate that the therapy including maraviroc is cost-effective if compared to OBT alone, determining an ICER generally below the threshold of three times the GDP per capita. In the Italian context, the ICER determined by OBT + maraviroc vs OBT alone is approximately 45,000 €/LYG.

  6. Cost-effective technology advancement directions for electric propulsion transportation systems in earth-orbital missions

    Science.gov (United States)

    Regetz, J. D., Jr.; Terwilliger, C. H., Jr.

    1979-01-01

    This paper presents the results of a study to determine the directions that electric propulsion technology should take to meet the primary propulsion requirements for earth-orbital missions of the next three decades in the most cost-effective manner. Discussed are the mission set requirements, state-of-the-art electric propulsion technology and the baseline system characterized by it, adequacy of the baseline system to meet the mission set requirements, cost-optimum electric propulsion system characteristics for the mission set, and sensitivities of mission costs and design points to system-level electric propulsion parameters. It is found that the efficiency-specific impulse characteristic generally has a more significant impact on overall costs than specific masses or costs of propulsion and power systems.

  7. Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

    Directory of Open Access Journals (Sweden)

    Rosella Saulle

    2013-11-01

    Full Text Available The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs.

  8. Implications of ICU triage decisions on patient mortality : a cost-effectiveness analysis

    NARCIS (Netherlands)

    Edbrooke, David L.; Minelli, Cosetta; Mills, Gary H.; Iapichino, Gaetano; Pezzi, Angelo; Corbella, Davide; Jacobs, Philip; Lippert, Anne; Wiis, Joergen; Pesenti, Antonio; Patroniti, Nicolo; Pirracchio, Romain; Payen, Didier; Gurman, Gabriel; Bakker, Jan; Kesecioglu, Jozef; Hargreaves, Chris; Cohen, Simon L.; Baras, Mario; Artigas, Antonio; Sprung, Charles L.

    2011-01-01

    Introduction: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that d

  9. THE EARLY BIRD CATCHES THE WORM : EARLY COST-EFFECTIVENESS ANALYSIS OF NEW MEDICAL TESTS

    NARCIS (Netherlands)

    Buisman, Leander R; Rutten-van Mölken, Maureen P M H; Postmus, Douwe; Luime, Jolanda J; Uyl-de Groot, Carin A; Redekop, William K

    2016-01-01

    OBJECTIVES: There is little specific guidance on performing an early cost-effectiveness analysis (CEA) of medical tests. We developed a framework with general steps and applied it to two cases. METHODS: Step 1 is to narrow down the scope of analysis by defining the test's application, target populat

  10. Cost-effectiveness of face-to-face smoking cessation interventions: A dynamic modeling study

    NARCIS (Netherlands)

    T.L. Feenstra (Talitha); H.H. Hamberg-Van Reenen (Heleen); R.T. Hoogenveen (Rudolf); M.P.M.H. Rutten-van Mölken (Maureen)

    2005-01-01

    textabstractObjectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in term

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

    NARCIS (Netherlands)

    Wildhagen, MF; Hilderink, HBM; Verzijl, JG; Verheij, JBGM; Kooij, L; Tijmstra, T; ten Kate, LP; Habbema, JDF

    1998-01-01

    Study objective-Evaluating the costs, effects, and savings of several strategies for cystic fibrosis (CF) gene carrier screening. Design-A general model for evaluating prenatal, preconceptional, school, and neonatal carrier screening was constructed. For prenatal and preconceptional screening, two s

  12. Bariatric surgery: cost-effectiveness and budget impact.

    Science.gov (United States)

    Terranova, Lorenzo; Busetto, Luca; Vestri, Annarita; Zappa, Marco Antonio

    2012-04-01

    Bariatric surgery is to date the most effective treatment for morbid obesity and it has been proven to reduce obesity-related comorbidities and total mortality. As any medical treatment, bariatric surgery is costly and doubts about its affordability have been raised. On the other hand, bariatric surgery may reduce the direct and indirect costs of obesity and related comorbidities. The appreciation of the final balance between financial investments and savings is critical from a health economic perspective. In this paper, we try to provide a brief updated review of the most recent studies on the cost-efficacy of bariatric surgery, with particular emphasis on budget analysis. A brief overview of the economic costs of obesity will also be provided. The epidemic of obesity may cause a significant reduction in life expectancy and overwhelming direct and indirect costs for citizens and societies. Cost-efficacy analyses included in this review consistently demonstrated that the additional years of lives gained through bariatric surgery may be obtained at a reasonable and affordable cost. In groups of patients with very high obesity-related health costs, like patients with type 2 diabetes, the use of bariatric surgery required an initial economic investment, but may save money in a relatively short period of time.

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

    Science.gov (United States)

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

    2015-05-07

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

  14. Cost-effectiveness of gastrostomy placement for children with neurodevelopmental disability.

    Science.gov (United States)

    Townsend, J L; Craig, G; Lawson, M; Reilly, S; Spitz, L

    2008-10-01

    Malnutrition and growth deficiency are common in neurologically impaired children. Gastrostomy placement has been shown to result in significant catch-up growth, improved health of the child and reduction in family stress; its cost-effectiveness has not been investigated. Costs related to gastrostomy placement are estimated here from a prospective controlled study of children referred to a tertiary paediatric centre in the UK. Costs of inpatient stay, medication, tests, general practitioner consultations, community healthcare, equipment, and parents' indirect costs were estimated at baseline and follow-up. Costs of the different types of gastrostomy surgery are given. Results for both time periods were available for 54 of the 76 children recruited to the study. Five-day food diaries were kept at baseline and follow-up. Costs of food increased slightly but not significantly post surgery from pound sterling 33 to pound sterling 40 (Euro 44 to Euro 54, US$65 to US$78) per week. Variation in cost between cases was considerable but the mean net cost difference of pound sterling 20.80 (CI - pound sterling 43.79 to pound sterling 85.35) (Euro 28 (CI Euro-59 to Euro 115), US$41 (CI US$-86 to US$167)) per week per child including for food and surgery, was also not significant. Community service costs were significantly lower post surgery. Few parents reported personal costs at either time point, although many had reduced or stopped paid work to care for the child. As gastrostomy placement for these children resulted in significant clinical benefit at no significant extra cost, it is concluded that the procedure is cost-effective.

  15. Quantum Zeno effect by general measurements

    CERN Document Server

    Koshino, K

    2004-01-01

    It was predicted that frequently repeated measurements on an unstable state may alter the decay rate of the state. This is called the quantum Zeno effect (QZE) or the anti-Zeno effect (AZE), depending on whether the decay is suppressed or enhanced. In conventional theories of the QZE and AZE, effects of measurements are simply described by the projection postulate, assuming that each measurement is an instantaneous and ideal one. However, real measurements are not instantaneous and ideal. For the QZE and AZE by such general measurements, interesting and surprising features have recently been revealed, which we review in this article. The results are based on the quantum measurement theory, which is also reviewed briefly. As a typical model, we consider a continuous measurement of the decay of an excited atom by a photodetector that detects a photon emitted from the atom upon decay. This measurement is an indirect negative-result one, for which the curiosity of the QZE and AZE is emphasized. It is shown that t...

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

    Science.gov (United States)

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

    2017-02-01

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

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

    Science.gov (United States)

    Hale, Rachel; Giese, Jeannie

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

  18. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

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

    2017-09-15

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

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

    Science.gov (United States)

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

    2014-01-01

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

  20. Effect of Congestion Costs on Shortest Paths Through Complex Networks

    Science.gov (United States)

    Ashton, Douglas J.; Jarrett, Timothy C.; Johnson, Neil F.

    2005-02-01

    We analyze analytically the effect of congestion costs within a physically relevant, yet exactly solvable, network model featuring central hubs. These costs lead to a competition between centralized and decentralized transport pathways. In stark contrast to conventional no-cost networks, there now exists an optimal number of connections to the central hub in order to minimize the shortest path. Our results shed light on an open problem in biology, informatics, and sociology, concerning the extent to which decentralized versus centralized design benefits real-world complex networks.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  2. The Effect of Labor Supply Shortages on Asymmetric Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    This study examines the effect of shortages in labor supply on asymmetric cost behavior. Building on the labor demand literature, it is argued that labor supply shortages increase adjustment costs for hiring new employees. Consistent with this explanation, results provide evidence that companies...... facing restrictions in labor supply increase costs (and resources) less than companies operating with sufficient access to additional personnel. This leads to a more symmetrical cost behavior for increasing activity compared to decreasing activity. Additional analyses show that shortages in labor supply...... induce firms to increase selling prices but also to temporarily expect more effort from their current employees. The effect decreases with the length of the labor supply shock and is more pronounced for companies located in less populated regions. Results are robust to alternative explanations...

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

    Science.gov (United States)

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

    2015-04-01

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

  4. Costs and net health effects of contraceptive methods.

    Science.gov (United States)

    Sonnenberg, Frank A; Burkman, Ronald T; Hagerty, C Greg; Speroff, Leon; Speroff, Theodore

    2004-06-01

    Pregnancy and contraceptive methods both have important health effects that include risks and benefits. The net impact of contraception on women's health has not been reported previously. This is a cost-utility analysis using a Markov model evaluated by Monte Carlo simulation using the societal perspective for costs. The analysis compared 13 methods of contraception to nonuse of contraception with respect to healthcare costs and quality-adjusted life years (QALYs). Discounting was applied for future costs and health effects. The base-case analysis applies to women of average health and fertility, ranging from 15 to 50 years of age, who are sexually active in a mutually monogamous relationship; smoking rates observed in women of reproductive age were used. Sensitivity analysis extended the analysis to nonmonogamous status and smoking status. Compared with use of no contraception, contraceptive methods of all types result in substantial cost savings over 2 years, ranging from US$5907 per woman for tubal sterilization to US$9936 for vasectomy and health gains ranging from 0.088 QALYs for diaphragm to 0.147 QALYs for depot medroxyprogesterone acetate. Compared with nonuse, even with a time horizon as short as 1 year, use of any method other than sterilization results in financial savings and health gains. Most of the financial savings and health gains were due to contraceptive effects. In a population of patients, even modest increases in the use of the most effective methods result in financial savings and health gains. Every method of contraception dominates nonuse in most clinical settings. Increasing the use of more effective methods even modestly at the expense of less effective methods will improve health and reduce costs. Methods that require action by the user less frequently than daily are both less costly and more effective than methods requiring action on a daily basis. Copyright 2004 Elsevier Inc.

  5. 2 CFR Appendix A to Part 225 - General Principles for Determining Allowable Costs

    Science.gov (United States)

    2010-01-01

    ... applicable CAS requirements when estimating, accumulating and reporting costs under CAS-covered contracts... incorporated as a non-profit corporation under State law), any other regional or interstate government entity... concept of netting such credit items (including any amounts used to meet cost sharing or...

  6. Evidence for cost reduction based on pre-admission MRSA screening in general surgery

    NARCIS (Netherlands)

    Diller, Ricarda; Sonntag, Anne K; Mellmann, Alexander; Grevener, Knut; Senninger, Norbert; Kipp, Frank; Friedrich, Alexander W

    2008-01-01

    Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for MRSA infection causing increased costs in patient's care and treatment. To evaluate cost efficiency, pre-admission MRSA screening and subsequent MRSA decolonization of patients admitted to the Department of Gen

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

    Science.gov (United States)

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

    2016-01-01

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

  8. Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study.

    Science.gov (United States)

    Wiley-Exley, Elizabeth; Domino, Marisa Elena; Maxwell, James; Levkoff, Sue Ellen

    2009-12-01

    suggest some uncertainty about the cost-effectiveness of the intervention, more than 75% of the bootstrap draws were considered cost-effective due to a decrease in total costs for IC in the full Veteran's Affairs sample. The findings indicate that IC is likely to be a cost-effective intervention in contrast with ESR in the Veteran's Affairs setting. In the non-Veteran's Affairs settings, IC is not a more cost-effective intervention in comparison with ESR. In the VA setting, the greater clinical improvement associated with IC coupled with the variation in costs and outcomes were such that IC was determined to be more cost-effective than ESR with a probability of 73-80%. Among non-VA participants, the lower clinical outcomes combined with no discernable differences in costs translated with a low probability that IC was more cost-effective than ESR, at any of the estimated values of clinical improvements. This suggests the importance of clinical setting in determining the clinical and cost effectiveness of IC for mental health. Our analyses were restricted to a six-month period, based on self-report, and did not include societal costs related to lost productivity and future costs. These results suggest that general integration has its advantages and, when such integration exists, further integrating behavioral health care into primary care might be considered as one way to improve depression in elders. The finding that ESR may be cost effective in some settings is also policy relevant. Further research is needed to analyze the components of the costs of ESR in non-VA settings and the effectiveness of IC in VA settings.

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

    Directory of Open Access Journals (Sweden)

    Gabriel Otieno

    2016-03-01

    Full Text Available Malaria remains a leading cause of mortality and morbidity among the children under five and pregnant women in sub-Saharan Africa, but it is preventable and controllable provided current recommended interventions are properly implemented. Better utilization of malaria intervention strategies will ensure the gain for the value for money and producing health improvements in the most cost effective way. The purpose of the value for money drive is to develop a better understanding (and better articulation of costs and results so that more informed, evidence-based choices could be made. Cost effectiveness analysis is carried out to inform decision makers on how to determine where to allocate resources for malaria interventions. This study carries out cost effective analysis of one or all possible combinations of the optimal malaria control strategies (Insecticide Treated Bednets—ITNs, Treatment, Indoor Residual Spray—IRS and Intermittent Preventive Treatment for Pregnant Women—IPTp for the four different transmission settings in order to assess the extent to which the intervention strategies are beneficial and cost effective. For the four different transmission settings in Kenya the optimal solution for the 15 strategies and their associated effectiveness are computed. Cost-effective analysis using Incremental Cost Effectiveness Ratio (ICER was done after ranking the strategies in order of the increasing effectiveness (total infections averted. The findings shows that for the endemic regions the combination of ITNs, IRS, and IPTp was the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment and IRS; for seasonal areas is the use of ITNs plus treatment; and for the low risk areas is the use of treatment only. Malaria transmission in Kenya can be minimized through tailor-made intervention strategies for malaria control

  10. Robust Guaranteed Cost Observer Design for Singular Markovian Jump Time-Delay Systems with Generally Incomplete Transition Probability

    Directory of Open Access Journals (Sweden)

    Yanbo Li

    2014-01-01

    Full Text Available This paper is devoted to the investigation of the design of robust guaranteed cost observer for a class of linear singular Markovian jump time-delay systems with generally incomplete transition probability. In this singular model, each transition rate can be completely unknown or only its estimate value is known. Based on stability theory of stochastic differential equations and linear matrix inequality (LMI technique, we design an observer to ensure that, for all uncertainties, the resulting augmented system is regular, impulse free, and robust stochastically stable with the proposed guaranteed cost performance. Finally, a convex optimization problem with LMI constraints is formulated to design the suboptimal guaranteed cost filters for linear singular Markovian jump time-delay systems with generally incomplete transition probability.

  11. Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only.

    Science.gov (United States)

    Vijgen, Sylvia M C; Westerhuis, Michelle E M H; Opmeer, Brent C; Visser, Gerard H A; Moons, Karl G M; Porath, Martina M; Oei, Guid S; Van Geijn, Herman P; Bolte, Antoinette C; Willekes, Christine; Nijhuis, Jan G; Van Beek, Erik; Graziosi, Giuseppe C M; Schuitemaker, Nico W E; Van Lith, Jan M M; Van Den Akker, Eline S A; Drogtrop, Addy P; Van Dessel, Hendrikus J H M; Rijnders, Robbert J P; Oosterbaan, Herman P; Mol, Ben Willem J; Kwee, Anneke

    2011-07-01

    To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only. Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG. Obstetric departments of three academic and six general hospitals in The Netherlands. Population. Laboring women with a singleton high-risk pregnancy, a fetus in cephalic presentation, a gestational age >36 weeks and an indication for internal electronic fetal monitoring. A trial-based cost-effectiveness analysis was performed from a health-care provider perspective. Primary health outcome was the incidence of metabolic acidosis measured in the umbilical artery. Direct medical costs were estimated from start of labor to childbirth. Cost-effectiveness was expressed as costs to prevent one case of metabolic acidosis. The incidence of metabolic acidosis was 0.7% in the ST-analysis group and 1.0% in the CTG-only group (relative risk 0.70; 95% confidence interval 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST analysis (n= 2 827) were €1,345 vs. €1,316 for CTG only (n= 2 840), with a mean difference of €29 (95% confidence interval -€9 to €77) until childbirth. The incremental costs of ST analysis to prevent one case of metabolic acidosis were €9 667. The additional costs of monitoring by ST analysis of the fetal ECG are very limited when compared with monitoring by CTG only and very low compared with the total costs of delivery. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Costs without benefits? Methodological issues in assessing costs, benefits and effectiveness of water protection policies. Paper

    Energy Technology Data Exchange (ETDEWEB)

    Walz, R.; Schleich, J.

    2000-07-01

    In the last few years, the conditions for extending environmental policy in general and policy dealing with the prevention of water pollution in particular have undergone extensive changes. On the one hand, there has been indisputable considerable success in preventing water pollution which has led to less direct pressure for policy action. On the other hand, the rising sewage levies and the lower political priority assigned in general to environmental policy documented in, e. g. public opinion surveys, has led to water pollution control policy facing very different pressures of justification: more efficient use of funds, improved planning processes, proof of the achievable benefit, but also stopping the increase in levies or not hindering economic development, these or similar slogans are the objections brought against water pollution control. Regardless of how unambiguous these terms appear when used as slogans in this way, they become diffuse and unclear if regarded more closely. This paper therefore attempts to reveal the reasons for possible misunderstandings and misinterpretations on the one hand and, on the other, to reveal the basic problems and uncertainties which are necessarily linked with an assessment of costs and benefits. In order to do this, three areas are examined: level of actors and analysis, evaluation methods and assessment of costs and benefits. (orig.)

  13. Costs without benefits? Methodological issues in assessing costs, benefits and effectiveness of water protection policies. Paper

    Energy Technology Data Exchange (ETDEWEB)

    Walz, R.; Schleich, J.

    2000-07-01

    In the last few years, the conditions for extending environmental policy in general and policy dealing with the prevention of water pollution in particular have undergone extensive changes. On the one hand, there has been indisputable considerable success in preventing water pollution which has led to less direct pressure for policy action. On the other hand, the rising sewage levies and the lower political priority assigned in general to environmental policy documented in, e. g. public opinion surveys, has led to water pollution control policy facing very different pressures of justification: more efficient use of funds, improved planning processes, proof of the achievable benefit, but also stopping the increase in levies or not hindering economic development, these or similar slogans are the objections brought against water pollution control. Regardless of how unambiguous these terms appear when used as slogans in this way, they become diffuse and unclear if regarded more closely. This paper therefore attempts to reveal the reasons for possible misunderstandings and misinterpretations on the one hand and, on the other, to reveal the basic problems and uncertainties which are necessarily linked with an assessment of costs and benefits. In order to do this, three areas are examined: level of actors and analysis, evaluation methods and assessment of costs and benefits. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Jensen Lotte

    2008-11-01

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

  15. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

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

  16. An improved effective cost review process for value engineering.

    Science.gov (United States)

    Joo, D S; Park, J I

    2014-01-01

    Second-look value engineering (VE) is an approach that aims to lower the costs of products for which target costs are not being met during the production stage. Participants in second-look VE typically come up with a variety of ideas for cost cutting, but the outcomes often depend on their levels of experience, and not many good alternatives are available during the production stage. Nonetheless, good ideas have been consistently generated by VE experts. This paper investigates past second-look VE cases and the thinking processes of VE experts and proposes a cost review process as a systematic means of investigating cost-cutting ideas. This cost review process includes the use of an idea checklist and a specification review process. In addition to presenting the process, this paper reports on its feasibility, based on its introduction into a VE training course as part of a pilot study. The results indicate that the cost review process is effective in generating ideas for later analysis.

  17. Analysis of Defense Industry Consolidation Effects on Program Acquisition Costs

    Science.gov (United States)

    2007-12-01

    Industry Mergers. 15 April 1997. Suhan, Kensinger, Keown , and Martin , “Do Strategic Alliances Create Value,” Journal of Financial Economics, 46 2 (1997...aerospace and defense contractors (Lockheed- Martin , Northrop-Grumman, Boeing, Raytheon, and General Dynamics) (See the figures in the Appendix...overhead costs. Also in 1993, Norman R. Augustine, then CEO of Lockheed Martin , headed an effort involving other major defense industry executives

  18. The Production Effect: Costs and Benefits in Free Recall

    Science.gov (United States)

    Jones, Angela C.; Pyc, Mary A.

    2014-01-01

    The production effect, the memorial benefit for information read aloud versus silently, has been touted as a simple memory improvement tool. The current experiments were designed to evaluate the relative costs and benefits of production using a free recall paradigm. Results extend beyond prior work showing a production effect only when production…

  19. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service: Simulated Effects on Costs

    NARCIS (Netherlands)

    Moth, G.; Huibers, L.; Vedsted, P.

    2013-01-01

    Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We app

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

    Directory of Open Access Journals (Sweden)

    Soile Oinonen

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

  1. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2011-01-01

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

  2. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2016-01-01

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

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

    Science.gov (United States)

    Persad, Govind

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Relación costo-efectividad de las intervenciones preventivas contra el cáncer cervical en mujeres mexicanas Generalized cost-effectiveness of preventive interventions against cervical cancer in Mexican women: results of a Markov model from the public sector perspective

    Directory of Open Access Journals (Sweden)

    Cristina Gutiérrez-Delgado

    2008-04-01

    Full Text Available OBJETIVO: Realizar un análisis de la relación costo-efectividad generalizada (ACEG para la vacuna anti-VPH, el tamiz por captura de híbridos (CH y el tamiz por Papanicolaou en el caso mexicano. MATERIAL Y MÉTODOS: Entre abril y agosto de 2007 se desarrolló en México un ACEG de las intervenciones relacionadas con 10 posibles escenarios en un modelo markoviano, bajo la perspectiva del sector público como pagador. RESULTADOS: Los escenarios con cobertura universal muestran un cociente costo-efectividad por AVISA ganado para el Papanicolaou en mujeres de 25 a 64 años de 16 678 pesos, para el tamiz por CH en mujeres de 30 a 64 años de 17 285 pesos y para la vacuna en niñas de 12 años de 84 008 pesos. El financiamiento anual necesario para estas intervenciones es de 621, 741 y 2 255 millones de pesos, respectivamente. CONCLUSIONES: Se sugiere introducir una combinación selectiva de tamices (Papanicolaou y CH y considerar las ventajas comparativas de aplicación en distintas poblaciones y áreas geográficas. De manera complementaria, se aconseja introducir la vacuna con un precio umbral de 181 pesos por dosis, equiparable en términos del costo y la efectividad a la CH.OBJECTIVE: To develop a generalized cost-effectiveness analysis (GCEA of the HPV vaccine, hybrid capture screening (HC and Papanicolaou screening (Pap in the Mexican context. MATERIALS AND METHODS: From April to August 2007, in Mexico, a GCEA of the interventions was developed for 10 possible scenarios using a Markov model from the public sector perspective as payer. RESULTS: Scenarios considering 80% coverage show an ACER per DALY averted of $16678 pesos for Pap of women between ages 25 and 64, $17277 pesos for HC of women between ages 30 and 64, and $84008 pesos for vaccination of 12-year-old girls. Annual financing of $621, $741 and $2255 million pesos, respectively, is needed for these scenarios. CONCLUSIONS: A selective, combined introduction of Pap-HC screening that

  6. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Directory of Open Access Journals (Sweden)

    J Lennert Veerman

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

  7. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Science.gov (United States)

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

    2011-01-01

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

  8. The effects of age, gender, and crash types on drivers' injury-related health care costs.

    Science.gov (United States)

    Shen, Sijun; Neyens, David M

    2015-04-01

    There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-01

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

  10. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-05-01

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

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

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

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

  12. Cost-effectiveness and incidence of renewable energy promotion in Germany

    Energy Technology Data Exchange (ETDEWEB)

    Boehringer, Christoph [Oldenburg Univ. (Germany). Dept. of Economics; Landis, Florian [Eidgenoessische Technische Hochschule, Zurich (Switzerland); Tovar Reanos, Miguel Angel [Zentrum fuer Europaeische Wirtschaftsforschung GmbH (ZEW), Mannheim (Germany)

    2017-08-01

    Over the last decade Germany has boosted renewable energy in power production by means of massive subsidies. The flip side are very high electricity prices which raises concerns that the transition cost towards a renewable energy system will be mainly borne by poor households. In this paper, we combine computable general equilibrium and microsimulation analysis to investigate the cost-effectiveness and incidence of Germany's renewable energy promotion. We find that the regressive effects of renewable energy promotion could be ameliorated by alternative subsidy financing mechanisms which achieve the same level of electricity generation from renewable energy sources.

  13. Cost-effectiveness analysis of interventions for migraine in four low- and middle-income countries.

    Science.gov (United States)

    Linde, Mattias; Steiner, Timothy J; Chisholm, Dan

    2015-02-18

    Evidence of the cost and effects of interventions for reducing the global burden of migraine remains scarce. Our objective was to estimate the population-level cost-effectiveness of evidence-based migraine interventions and their contributions towards reducing current burden in low- and middle-income countries. Using a standard WHO approach to cost-effectiveness analysis (CHOICE), we modelled core set intervention strategies for migraine, taking account of coverage and efficacy as well as non-adherence. The setting was primary health care including pharmacies. We modelled 26 intervention strategies implemented during 10 years. These included first-line acute and prophylactic drugs, and the expected consequences of adding consumer-education and provider-training. Total population-level costs and effectiveness (healthy life years [HLY] gained) were combined to form average and incremental cost-effectiveness ratios. We executed runs of the model for the general populations of China, India, Russia and Zambia. Of the strategies considered, acute treatment of attacks with acetylsalicylic acid (ASA) was by far the most cost-effective and generated a HLY for less than US$ 100. Adding educational actions increased annual costs by 1-2 US cents per capita of the population. Cost-effectiveness ratios then became slightly less favourable but still less than US$ 100 per HLY gained for ASA. An incremental cost of > US$ 10,000 would have to be paid per extra HLY by adding a triptan in a stepped-care treatment paradigm. For prophylaxis, amitriptyline was more cost-effective than propranolol or topiramate. Self-management with simple analgesics was by far the most cost-effective strategy for migraine treatment in low- and middle-income countries and represents a highly efficient use of health resources. Consumer education and provider training are expected to accelerate progress towards desired levels of coverage and adherence, cost relatively little to implement, and can

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

    Science.gov (United States)

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

    2017-02-01

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

  15. Evaluation of the cost effectiveness model being developed for the component improvement programs of the Air Force and the Navy

    OpenAIRE

    Crowder, Gerald L.

    1992-01-01

    Approved for public release; distribution is unlimited This thesis examines the Cost Effectiveness Analysis (CEA) model used by the Air Force to assist with the decision making process of their Component Improvement Program (CIP). The emphasis was on studying the model for its use in the Naval Component Improvement Program. With an example provided by General Electric, a sensitivity analysis was performed to determine the cost drivers of the model. For the example, the major cost driver...

  16. Effects of cost reflective electricity tariffs in Namibia

    Energy Technology Data Exchange (ETDEWEB)

    2007-04-15

    The power balance in Southern Africa is changing. Namibia faces the choice between increased reliance on imports of electricity or expanding domestic generation. One option is to build a gas fired power plant at Kudu. This plant will have an average generation cost well above the projected import cost. The changing power balance in the region may warrant that Namibia incurs substantial costs to ensure energy security. If Kudu is not built, we project that real end user tariffs will peak in 2010/11 at a level 22 percent higher than in 2006, but then gradually revert towards the 2006 level. The effects of this tariff scenario on the economy should not be dramatic, and we would not recommend to subsidise electricity in this case. This forecast is based on an assumed 67 percent increase the real price of imports. In this and all other scenarios we assume that the unit costs of distribution in Namibia and local surcharges will decline. Namibia has experienced temporary halts in imports of electricity. As the balance in the Southern African power market is changing, the risks of capacity shortages appear to have increased. Frequent power outages could be very costly to the economy, and one may thus argue that Namibia should accept the higher costs of electricity to ensure stable supply. Building Kudu could be one, and possibly the only, viable option to reduce the risks of capacity shortages. The cost of generation at Kudu, if it is built, is uncertain. We have assumed a cost at 44 c/kWh. This can be viewed as an upper bound of the cost range. If Kudu is built at this cost, the end user tariff would have to increase by 85 per cent in real terms over the 2006-2011 period to finance Kudu in full, having factored in projected exports earnings. The real tariff will decline slowly after 2011. This appears a risky scenario, not least for the effects on investments in exports sectors and businesses facing international competition in the Namibian market. If Kudu is built at

  17. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

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

  18. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

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

  19. Examining the effectiveness of municipal solid waste management systems: an integrated cost-benefit analysis perspective with a financial cost modeling in Taiwan.

    Science.gov (United States)

    Weng, Yu-Chi; Fujiwara, Takeshi

    2011-06-01

    In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBA framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O&M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities.

  20. [Comparision of costs of secondary prevention and treatment of stroke--cost-effectiveness analysis].

    Science.gov (United States)

    Ceronja, Ivana; Sosić, Zvonko

    2011-01-01

    Cerebrovascular accident (CVA) is a serious complication of untreated arterial hypertension. The aim of this paper is to compare the cost of secondary prevention and treatment of CVA caused by untreated arterial hypertension. Cost-effectiveness analysis of diagnosis and therapy of arterial hypertension in comparison with CVA treatment. The cost of secondary prevention of CVA per patient per year in 2006. was 1.589,19 kunas, which comes to 15.107,75 kunas in thirty years of treatment (discount factor included), whereas a single CVA treatment was 17.207,54 kunas on average. In every 850 treatments of hypertension (NNT) comes a prevented CVA which is 1.350.811,5 kunas, and is therefore more expensive than a single CVA treatment. Secondary prevention has a long-term protective effect improving the patients' quality of life, inhibiting the potential post-CVA handicap and pre-retirement. Thus, the main advantage of both primary and secondary prevention is in their greater benefit for patients.

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

    Science.gov (United States)

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

    2015-10-01

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

  2. Pharmacotherapy in the management of early Parkinson’s disease: cost-effectiveness and patient acceptability

    Directory of Open Access Journals (Sweden)

    Esther Cubo

    2010-09-01

    Full Text Available Esther CuboNeurology Department, Hospital General Yagüe, Burgos, SpainAbstract: In the absence of a cure, the primary goals in managing Parkinson’s disease (PD are to preserve functionality and health-related quality of life (HRQoL. Current therapeutic strategies for PD include symptomatic treatment and are primarily focused on replacing dopamine in the brain. Dopamine agonists can be used as an alternative initial levodopa therapy, to delay the onset of motor complications, but at the expense of more dopaminergic adverse effects; poorer control of motor symptoms; and increased cost. In PD, treatment effects and costs accumulate over time; hence the choice of time horizon in cost-effectiveness analysis can be particularly important. Pharmaceutical expenditures have grown rapidly in recent decades and now total nearly 10% of all health care costs. The main approach to treat PD at the present time is to advance knowledge of the efficacy, to reduce long-term complications associated with treatment, and to improve patient HRQoL and society burden. The implementation of cost-effectiveness studies, including the societal perspective, should be considered as an outcome of new therapy strategies, which would be helpful to health care decision makers.Keywords: Parkinson’s disease, costs, health-related quality of life

  3. 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.

  4. 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.

  5. Modeling the economic costs of disasters and recovery: analysis using a dynamic computable general equilibrium model

    Science.gov (United States)

    Xie, W.; Li, N.; Wu, J.-D.; Hao, X.-L.

    2014-04-01

    Disaster damages have negative effects on the economy, whereas reconstruction investment has positive effects. The aim of this study is to model economic causes of disasters and recovery involving the positive effects of reconstruction activities. Computable general equilibrium (CGE) model is a promising approach because it can incorporate these two kinds of shocks into a unified framework and furthermore avoid the double-counting problem. In order to factor both shocks into the CGE model, direct loss is set as the amount of capital stock reduced on the supply side of the economy; a portion of investments restores the capital stock in an existing period; an investment-driven dynamic model is formulated according to available reconstruction data, and the rest of a given country's saving is set as an endogenous variable to balance the fixed investment. The 2008 Wenchuan Earthquake is selected as a case study to illustrate the model, and three scenarios are constructed: S0 (no disaster occurs), S1 (disaster occurs with reconstruction investment) and S2 (disaster occurs without reconstruction investment). S0 is taken as business as usual, and the differences between S1 and S0 and that between S2 and S0 can be interpreted as economic losses including reconstruction and excluding reconstruction, respectively. The study showed that output from S1 is found to be closer to real data than that from S2. Economic loss under S2 is roughly 1.5 times that under S1. The gap in the economic aggregate between S1 and S0 is reduced to 3% at the end of government-led reconstruction activity, a level that should take another four years to achieve under S2.

  6. The cost of swimming in generalized Newtonian fluids: Experiments with C. elegans

    CERN Document Server

    Gagnon, David A

    2016-01-01

    Numerous natural processes are contingent on microorganisms' ability to swim through fluids with non-Newtonian rheology. Here, we use the model organism Caenorhabditis elegans and tracking methods to experimentally investigate the dynamics of undulatory swimming in shear-thinning fluids. Theory and simulation have proposed that the cost of swimming, or mechanical power, should be lower in a shear-thinning fluid compared to a Newtonian fluid of the same zero-shear viscosity. We aim to provide an experimental investigation into the cost of swimming in a shear-thinning fluid from (i) an estimate of the mechanical power of the swimmer and (ii) the viscous dissipation rate of the flow field, which should yield equivalent results for a self-propelled low Reynolds number swimmer. We find the cost of swimming in shear-thinning fluids is less than or equal to the cost of swimming in Newtonian fluids of the same zero-shear viscosity; furthermore, the cost of swimming in shear-thinning fluids scales with a fluid's effec...

  7. Pipeline cost reduction through effective project management and applied technology

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, A. [TransCanada Pipeline Ltd., Alberta (Canada); Babuk, T. [Empress International Inc., Westwood, NJ (United States); Mohitpour, M. [Tempsys Pipeline Solutions Inc., Vancouver, BC (Canada); Murray, M.A. [National Energy Board of Canada (Canada)

    2005-07-01

    Pipelines are regarded by many as passive structures with the technology involved in their construction and operation being viewed as relatively simple and stable. If such is the case how can there be much room for cost improvement? In reality, there have been many technological and regulatory innovations required within the pipeline industry to meet the challenges posed by ever increasing consumer demand for hydrocarbons, the effects of aging infrastructure and a need to control operating and maintenance expenditures. The importance of technology management, as a subset of overall project management, is a key element of life cycle cost control. Assurance of public safety and the integrity of the system are other key elements in ensuring a successful pipeline project. The essentials of best practise project management from an owner/ operator's perspective are set out in the paper. Particular attention is paid to the appropriate introduction of new technology, strategic procurement practice and material selection, indicating that capital cost savings of up to 15% are achievable without harming life cycle cost. The value of partnering leading to technical innovation, cost savings and improved profitability for all the participants is described. Partnering also helps avoid duplicated effort through the use of common tools for design, planning schedule tracking and reporting. Investing in appropriate technology development has been a major source of cost reduction in recent years and the impact of a number of these recently introduced technologies in the areas of materials, construction processes and operation and maintenance are discussed in the paper. (author)

  8. Climate targets and cost-effective climate stabilization pathways

    Science.gov (United States)

    Held, H.

    2015-08-01

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

  9. Cost effective optical coupling for polymer optical fiber communication

    Science.gov (United States)

    Chandrappan, Jayakrishnan; Zhang, Jing; Mohan, Ramkumar V.; Gomez, Philbert Oliver; Aung, Than Aye; Xiao, Yongfei; Ramana, Pamidighantam V.; Lau, John Hon Shing; Kwong, Dim Lee

    2008-02-01

    Polymer Optical Fiber (POF) optical modules are gaining momentum due to their applications in short distance communications. POFs offer more flexibility for plug and play applications and provide cost advantages. They also offer significant weight advantage in automotive and avionic networks. One of the most interesting field of application is home networking. Low cost optical components are required, since cost is a major concern in local and home networks. In this publication, a fast and easy to install, low cost solution for efficient light coupling in and out of Step Index- POF is explored. The efficient coupling of light from a large core POF to a small area detector is the major challenge faced. We simulated direct coupling, lens coupling and bend losses for step index POF using ZEMAX R optical simulation software. Simulations show that a lensed fiber tip particularly at the receiver side improves the coupling efficiency. The design is optimized for 85% coupling efficiency and explored the low cost fabrication method to implement it in the system level. The two methods followed for lens fabrication is described here in detail. The fabricated fiber lenses are characterized using a beam analyzer. The fabrication process was reiterated to optimize the lens performance. It is observed that, the fabricated lenses converge the POF output spot size by one fourth, there by enabling a higher coupling efficiency. This low cost method proves to be highly efficient and effective optical coupling scheme in POF communications.

  10. (Correcting misdiagnoses of asthma: a cost effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Vandemheen Katherine

    2011-05-01

    Full Text Available Abstract Background The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective. Method Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars. Results Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37% did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278. Conclusion Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.

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

    Science.gov (United States)

    Glassman, Amanda; Cañón, Oscar; Silverman, Rachel

    2016-12-01

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

  12. The practical problems of applying cost-effectiveness analysis to joint finance programmes

    OpenAIRE

    Karen Gerard; Ken Wright

    1990-01-01

    Joint finance is money allocated by the Department of Health to NHS authorities to promote policies of inter-agency collaboration which prevent people being admitted to hospital or facilitate earlier discharge from hospital or save on NHS resources generally. Worries have been expressed that joint finance has not been used as effectively or efficiency as it might have been. This paper is concerned with the practical application of cost-effectiveness analysis to policies or schemes which typic...

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    A. M. Oliveira Filho

    1989-01-01

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

  15. Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain

    Directory of Open Access Journals (Sweden)

    E. Molina-Cuadrado

    2014-07-01

    Full Text Available Objective: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. Methods: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of lifeadjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental costeffectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macro-costs strategy based on published literature and the survival tables for the Spanish population. Results: Treatment with Ticagrelor was associated to an incremental cost of 1,228 per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 and the cost per one gained life year of 7,435 . The sensitivity analysis showed consistent results. Conclusions: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain.

  16. Update on the management of cirrhosis – focus on cost-effective preventative strategies

    Directory of Open Access Journals (Sweden)

    Neff GW

    2013-04-01

    Full Text Available Guy W Neff,1 Nyingi Kemmer,1 Christopher Duncan,2 Angel Alsina1 1Tampa General Medical Group, Tampa, FL, 2Highline Gastroenterology, Seattle, WA, USA Abstract: Cirrhosis is a chronic liver disease stage that encompasses a variety of etiologies resulting in liver damage. This damage may induce secondary complications such as portal hypertension, esophageal variceal bleeding, spontaneous bacterial peritonitis, and hepatic encephalopathy. Screening for and management of these complications incurs substantial health care costs; thus, determining the most economical and beneficial treatment strategies is essential. This article reviews the economic impact of a variety of prophylactic and treatment regimens employed for cirrhosis-related complications. Prophylactic use of ß-adrenergic blockers for portal hypertension and variceal bleeding appears to be cost-effective, but the most economical regimen for treatment of initial bleeding is unclear given that cost comparisons of pharmacologic and surgical regimens are lacking. In contrast, prophylaxis for spontaneous bacterial peritonitis cannot be recommended. Standard therapy for spontaneous bacterial peritonitis includes antibiotics, and the overall economic impact of these medications depends largely on their direct cost. However, the potential development of bacterial antibiotic resistance and resulting clinical failure should also be considered. Nonabsorbable disaccharides are standard therapies for hepatic encephalopathy; however, given their questionable efficacy, the nonsystemic antibiotic rifaximin may be a more cost-effective, long-term treatment for hepatic encephalopathy, despite its increased direct cost, because of its demonstrated efficacy and prevention of hospitalization. Further studies evaluating the cost burden of cirrhosis and cirrhosis-related complications, including screening costs, the cost of treatment and maintenance therapy, conveyance to liver transplantation, liver

  17. Optimizing bulk milk dioxin monitoring based on costs and effectiveness.

    Science.gov (United States)

    Lascano-Alcoser, V H; Velthuis, A G J; van der Fels-Klerx, H J; Hoogenboom, L A P; Oude Lansink, A G J M

    2013-07-01

    Dioxins are environmental pollutants, potentially present in milk products, which have negative consequences for human health and for the firms and farms involved in the dairy chain. Dioxin monitoring in feed and food has been implemented to detect their presence and estimate their levels in food chains. However, the costs and effectiveness of such programs have not been evaluated. In this study, the costs and effectiveness of bulk milk dioxin monitoring in milk trucks were estimated to optimize the sampling and pooling monitoring strategies aimed at detecting at least 1 contaminated dairy farm out of 20,000 at a target dioxin concentration level. Incidents of different proportions, in terms of the number of contaminated farms, and concentrations were simulated. A combined testing strategy, consisting of screening and confirmatory methods, was assumed as well as testing of pooled samples. Two optimization models were built using linear programming. The first model aimed to minimize monitoring costs subject to a minimum required effectiveness of finding an incident, whereas the second model aimed to maximize the effectiveness for a given monitoring budget. Our results show that a high level of effectiveness is possible, but at high costs. Given specific assumptions, monitoring with 95% effectiveness to detect an incident of 1 contaminated farm at a dioxin concentration of 2 pg of toxic equivalents/g of fat [European Commission's (EC) action level] costs €2.6 million per month. At the same level of effectiveness, a 73% cost reduction is possible when aiming to detect an incident where 2 farms are contaminated at a dioxin concentration of 3 pg of toxic equivalents/g of fat (EC maximum level). With a fixed budget of €40,000 per month, the probability of detecting an incident with a single contaminated farm at a dioxin concentration equal to the EC action level is 4.4%. This probability almost doubled (8.0%) when aiming to detect the same incident but with a dioxin

  18. Cost-effectiveness of systemic treatments for moderate-to-severe psoriasis in the German health care setting.

    Science.gov (United States)

    Küster, Denise; Nast, Alexander; Gerdes, Sascha; Weberschock, Tobias; Wozel, Gottfried; Gutknecht, Mandy; Schmitt, Jochen

    2016-05-01

    Systemic treatments of moderate-to-severe psoriasis differ substantially in terms of effectiveness and costs. Comprehensive economic-evaluations of all systemic treatments for psoriasis from a societal perspective are missing. The objective of our study was to compare the cost-effectiveness all systemic treatments approved for moderate-to-severe psoriasis from a societal perspective, by including all cost categories. An incremental cost-effectiveness-analysis was performed for all systemic treatments for psoriasis, currently recommended by the German S3-Guideline i.e. methotrexate, cyclosporine, fumaric acid esters, and retinoids, adalimumab, etanercept, infliximab and ustekinumab. We used a Markov model with time-dependent transition probabilities and a time horizon of 2 years to investigate incremental cost-effectiveness ratios. Both direct and indirect costs were considered to reflect the societal perspective. Effectiveness outcome was PASI-75 response. One-way and probabilistic sensitivity analyses explored the effect of treatment duration, discount rate, effectiveness, and the perspective (societal vs. healthcare system) on the findings. According to the base-case analysis a cost-effective treatment pathway for moderate-to-severe psoriasis starts with methotrexate, followed by ustekinumab 90 mg and infliximab, if methotrexate does not achieve or maintain PASI-75 response. Sensitivity analyses confirmed the general robustness of these findings with methotrexate being most cost-effective. However, from a third-party-payer perspective (without indirect cost) conventional therapies were generally more cost-effective than biologics. From a value-based healthcare perspective, methotrexate should be the systemic treatment of first choice, ustekinumab 90 mg second choice and infliximab third choice for patients with moderate-to-severe psoriasis. From a societal perspective, the other treatments are less efficient according to our model. From a third

  19. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis

    DEFF Research Database (Denmark)

    Edbrooke, David L; Minelli, Cosetta; Mills, Gary H

    2011-01-01

    of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account...... and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission......ABSTRACT: INTRODUCTION: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak...

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

    Science.gov (United States)

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

    2007-06-01

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

  1. Cost-effectiveness of interferon-gamma release assay for entry tuberculosis screening in prisons.

    Science.gov (United States)

    Kowada, A

    2013-10-01

    The incidence of active tuberculosis (TB) and latent tuberculosis infection (LTBI) in inmates and prison staff is higher than that in the general population. Mycobacterium tuberculosis-specific interferon-gamma release assays (IGRAs) provide more accurate diagnosis of M. tuberculosis infection with higher specificity than the tuberculin skin test (TST). To assess the cost effectiveness of QuantiFERON®-TB Gold In-Tube (QFT) compared to TST, TST followed by QFT and chest X-ray, we constructed Markov models using a societal perspective on the lifetime horizon. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness was compared. The QFT-alone strategy was the most cost-effective for entry TB screening in prisons in developed countries. Cost-effectiveness was not sensitive to the rates of BCG vaccination, LTBI, TB, HIV infection and multidrug-resistant TB. Entry TB screening using an IGRA in prisons should be considered on the basis of its cost-effectiveness by public health intervention.

  2. GMOtrack: generator of cost-effective GMO testing strategies.

    Science.gov (United States)

    Novak, Petra Krau; Gruden, Kristina; Morisset, Dany; Lavrac, Nada; Stebih, Dejan; Rotter, Ana; Zel, Jana

    2009-01-01

    Commercialization of numerous genetically modified organisms (GMOs) has already been approved worldwide, and several additional GMOs are in the approval process. Many countries have adopted legislation to deal with GMO-related issues such as food safety, environmental concerns, and consumers' right of choice, making GMO traceability a necessity. The growing extent of GMO testing makes it important to study optimal GMO detection and identification strategies. This paper formally defines the problem of routine laboratory-level GMO tracking as a cost optimization problem, thus proposing a shift from "the same strategy for all samples" to "sample-centered GMO testing strategies." An algorithm (GMOtrack) for finding optimal two-phase (screening-identification) testing strategies is proposed. The advantages of cost optimization with increasing GMO presence on the market are demonstrated, showing that optimization approaches to analytic GMO traceability can result in major cost reductions. The optimal testing strategies are laboratory-dependent, as the costs depend on prior probabilities of local GMO presence, which are exemplified on food and feed samples. The proposed GMOtrack approach, publicly available under the terms of the General Public License, can be extended to other domains where complex testing is involved, such as safety and quality assurance in the food supply chain.

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

    Directory of Open Access Journals (Sweden)

    Gialama F

    2013-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Ceri J Phillips

    2009-11-01

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

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

    Science.gov (United States)

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

    2015-07-07

    control in a number of studies in patients with different clinical profiles. The included trials were generally of poor quality and are therefore likely to be at high risk of bias. Art therapy appeared to be cost-effective versus wait-list but further studies are needed to confirm this finding in the target population. There was insufficient evidence to make an informed comparison of the cost-effectiveness of group art therapy with group verbal therapy. HTA project no. 12/27/16; PROSPERO registration no. CRD42013003957.

  6. Does a computerized price comparison module reduce prescribing costs in general practice?

    DEFF Research Database (Denmark)

    Vedsted, Peter; Nielsen, Jørgen Nørskov; Olesen, Frede

    1997-01-01

    OBJECTIVE: We aimed to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module into the computer record system of a defined group of GPs. The GPs' expectations for and experiences with the module were...

  7. Cost-effectiveness of hepatitis a vaccination in indonesia

    NARCIS (Netherlands)

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

    2014-01-01

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

  8. Cost-effectiveness of hepatitis A vaccination in Indonesia

    NARCIS (Netherlands)

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

    2014-01-01

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

  9. Cost-effectiveness of varenicline for smoking cessation

    DEFF Research Database (Denmark)

    Keiding, Hans

    2009-01-01

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

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

    Science.gov (United States)

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

    2003-01-01

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

  11. The Cost-Effectiveness of Atypicals in the UK

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    Science.gov (United States)

    Kaufer, Steve

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

  14. Cost-effectiveness of periconceptional supplementation of folic acid

    NARCIS (Netherlands)

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

    2002-01-01

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

  15. Lifetime health effects and costs of diabetes treatment

    NARCIS (Netherlands)

    L.W. Niessen (Louis Wilhelmus); R. Dijkstra; R.C.W. Hutubessy (Raymond); G.E.H.M. Rutten (Guy); A.F. Casparie (Anton)

    2003-01-01

    textabstractBACKGROUND: This article presents cost-effectiveness analyses of the major diabetes interventions as formulated in the revised Dutch guidelines for diabetes type 2 patients in primary and secondary care. The analyses consider two types of care: diabetes control and the

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

    African Journals Online (AJOL)

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

  17. Videoconferencing a Stroke Assessment Training Workshop: Effectiveness, Acceptability, and Cost

    Science.gov (United States)

    Miller, Patricia A.; Huijbregts, Maria; French, Esme; Taylor, Denise; Reinikka, Kirsti; Berezny, Laura; Fry, Sherri; Grunin, Anna; Harvey, Melissa

    2008-01-01

    Introduction: Videoconferencing (VC) is becoming a common method for the delivery of continuing education (CE) to clinicians in remote locations. The purpose of this study was to compare the effectiveness, acceptability, and costs of a full-day training workshop (TW) delivered through two different formats: face-to-face (FTF) and VC. The TW was…

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

    Science.gov (United States)

    Gallagher, Michael P.

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

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

    Science.gov (United States)

    Ashmole, R. F.; And Others

    1973-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-21

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Gerke, Oke; Hermansson, Ronnie; Hess, Søren

    2015-01-01

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

  3. Cost-effectiveness analysis of policy instruments for greenhouse gas emission mitigation in the agricultural sector.

    Science.gov (United States)

    Bakam, Innocent; Balana, Bedru Babulo; Matthews, Robin

    2012-12-15

    Market-based policy instruments to reduce greenhouse gas (GHG) emissions are generally considered more appropriate than command and control tools. However, the omission of transaction costs from policy evaluations and decision-making processes may result in inefficiency in public resource allocation and sub-optimal policy choices and outcomes. This paper aims to assess the relative cost-effectiveness of market-based GHG mitigation policy instruments in the agricultural sector by incorporating transaction costs. Assuming that farmers' responses to mitigation policies are economically rationale, an individual-based model is developed to study the relative performances of an emission tax, a nitrogen fertilizer tax, and a carbon trading scheme using farm data from the Scottish farm account survey (FAS) and emissions and transaction cost data from literature metadata survey. Model simulations show that none of the three schemes could be considered the most cost effective in all circumstances. The cost effectiveness depends both on the tax rate and the amount of free permits allocated to farmers. However, the emissions trading scheme appears to outperform both other policies in realistic scenarios.

  4. EFFECT OF WATER BORNE DISEASES ON INDIAN ECONOMY: A COST- BENEFIT ANALYSIS

    Directory of Open Access Journals (Sweden)

    PATHAK Hemant

    2015-06-01

    Full Text Available This paper expressed the effect of water borne diseases, risk assessment and potential consequences on Indian economy. In Indian sub-continent higher burden of waterborne diseases due to a deteriorating public drinking water distribution system, increasing numbers of unregulated private water systems, and a limited, passive waterborne disease surveillance system. This shows that degraded water quality can contribute to water scarcity as it limits its availability for both human use and for the ecosystem. It isn’t cheap to treat water so that it is safe to drink. But it also isn’t cheap to treat everyone who becomes ill during a waterborne illness outbreak. As the level of protection becomes more effective, the cost of water treatment generally rises, as well. Unfortunately, government agencies generally attempt to minimize costs while the health effects have not been properly assessed.

  5. Coste del cuidado informal del ictus en una población general no institucionalizada Cost of informal care for stroke victims in a non-institutionalized general population

    Directory of Open Access Journals (Sweden)

    Adolfo Hervás

    2007-12-01

    Full Text Available Antecedentes: El impacto social del ictus es importante por tratarse de una enfermedad invalidante, que causa dependencia y necesidad de cuidados informales. La importancia de la dependencia cada vez es mayor en la sociedad, pero no hay registros de los costes del cuidado informal, y se desconoce cómo valorarla. Objetivos: Calcular el coste del cuidado informal del ictus en una población general y analizarlo en función del grado de dependencia. Realizar un análisis de sensibilidad con la variable costes unitarios a partir de fuentes diversas. Material y métodos: Se estudian todos los casos diagnosticados de ictus a 31 de diciembre de 2004 (n = 95 pertenecientes a una zona básica de salud de Navarra, de los que 40 (44,4% precisan cuidados informales. Se valora la dependencia para las actividades de la vida diaria mediante los índices de Barthel (actividades básicas [ABVD] y Lawton-Brody (actividades instrumentales [AIVD]. La valoración del tiempo del cuidado informal se realiza con una aproximación de abajo a arriba (bottom-up, mediante un cuestionario de recogida de actividades diarias. Resultados: El coste del cuidado informal de los pacientes con ictus es de 21.551,28 €/año, con un rango, según el análisis de sensibilidad, entre 6.490,80 y 31.436,72 €/año. Hay diferencias estadísticamente significativas en el coste del cuidado informal según el grado de dependencia (ABVD: 24.865,2 €/año; AIVD: 10.442,9 €/año. Conclusiones: El coste del cuidado informal en la atención al ictus es elevado y crece con el nivel de dependencia.Background: Stroke has a strong social impact since it causes disability, leading to dependency and the need for informal care. Although awareness of the importance of dependency is increasing, registries of the cost of informal care are lacking and consequently the real value of this activity to society is still unknown. Objectives: To calculate the cost of informal care of stroke victims in a

  6. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  7. Cost Effective Polymer Solar Cells Research and Education

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-10-13

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Baum, J.W.

    1986-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  10. The cost effectiveness and cost utility of valsartan in chronic heart failure therapy in Italy: a probabilistic markov model.

    Science.gov (United States)

    Pradelli, Lorenzo; Iannazzo, Sergio; Zaniolo, Orietta

    2009-01-01

    To evaluate the cost effectiveness and cost utility of the use of valsartan in addition to standard therapy for the treatment of patients with chronic heart failure with low left ventricular ejection fraction (LVEF). The study was conducted by means of a cohort simulation based on a probabilistic Markov model and projecting the 23-month follow-up results of the Val-HeFT (Valsartan Heart Failure Trial) study over a 10-year time horizon. The model included four states (New York Heart Association [NYHA] classes II, III, IV, and death), and had a cycle duration of 1 month. Probabilistic simulations were performed using the WinBUGS software for Bayesian analysis. The distribution of patient parameters (sex, age, use of beta-adrenoceptor antagonists, and ACE inhibitors) in the simulated population were derived from the Italian heart failure patient population. Individual mortality data were derived from general mortality data by multiplying by a NYHA state-specific relative risk, while the probability of changing NYHA class was taken from the Val-HeFT data. Costs (2007 values) were calculated from the perspective of the Italian Health Service (IHS) and included costs for drugs and heart failure hospitalizations. Quality-of-life (QOL) weights were obtained by using published health-related QOL data for heart failure patients. A 3.5% annual discount rate was applied. Probabilistic sensitivity analysis was performed on each parameter using original-source 95% confidence interval (CI) values, or a +/-10% range when 95% CI values were unavailable. For the 10-year time horizon, patients were estimated to live for an average of 2.3 years or 1.7 quality-adjusted life-years (QALYs), with slight increases in the valsartan group. In this group, hospitalizations for worsening heart failure were predicted to be significantly reduced and overall treatment costs per patient to decrease by about and U20AC;550. In subgroup analyses, valsartan lost dominance in patients in NYHA II, and in

  11. Challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials

    Directory of Open Access Journals (Sweden)

    Yunbo Chu

    2016-10-01

    Full Text Available Economic evaluation in the form of cost-effectiveness analysis has become a popular means to inform decisions in healthcare. With multi-regional clinical trials in a global development program becoming a new venue for drug efficacy testing in recent decades, questions in methods for cost-effectiveness analysis in the multi-regional clinical trials setting also emerge. This paper addresses some challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials. Several discussion points are raised for further attention and a multi-regional clinical trial example is presented to illustrate the implications in industrial application. A general message is delivered to call for a depth discussion by all stakeholders to reach an agreement on a good practice in cost-effectiveness analysis in the multi-regional clinical trials. Meanwhile, we recommend an additional consideration of cost-effectiveness analysis results based on the clinical evidence from a certain homogeneous population as sensitivity or scenario analysis upon data availability.

  12. Cost effectiveness of ergonomic redesign of electronic motherboard.

    Science.gov (United States)

    Sen, Rabindra Nath; Yeow, Paul H P

    2003-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Dilawar Ali

    2013-02-01

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

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

    Science.gov (United States)

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

    2007-02-01

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

  15. Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India

    Directory of Open Access Journals (Sweden)

    Kumar G Anil

    2010-05-01

    Full Text Available Abstract Background Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India. Methods Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY saved as a measure of cost-effectiveness of each type of HIV prevention intervention. Results The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US $50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US $410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions. Conclusions The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.

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

    Directory of Open Access Journals (Sweden)

    Sarah J. Ronaldson

    2017-06-01

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

  17. Cost effectiveness of targeted HIV prevention interventions for female sex workers in India.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Rudra, Shalini; Gupta, Indrani; Kaur, Manmeet; Mehendale, S M; Chatterjee, Susmita; Panda, Samiran; Kumar, Rajesh

    2011-06-01

    To ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control Programme in India. A compartmental mathematical Markov state model was used over a 20-year time horizon (1995-2015) to estimate the cost effectiveness of FSW targeted interventions, with a health system perspective. The incremental costs and effects of FSW targeted interventions were compared against a baseline scenario of mass media for the general population alone. The incremental cost-effectiveness ratio was computed at a 3% discount rate using HIV infections averted and disability-adjusted life-years (DALY) as benefit measures. It was assumed that the transmission of the HIV virus moves from a high-risk group (FSW) to the client population and finally to the general population (partners of clients). Targeted interventions for FSW result in a reduction of 47% (1.6 million) prevalent and 36% (2.7 million) cumulative HIV cases, respectively, in 2015. Adult HIV prevalence in India, with and without (mass media only) FSW interventions, would be 0.25% and 0.48% in 2015. Indian government and development partners spend an average US $104 (INR4680) per HIV infection averted and US $10.7 (INR483) per DALY averted. Discounting at 3%, FSW targeted interventions cost US $105.5 (INR4748) and US $10.9 (INR490) per HIV case and DALY averted, respectively. At the current gross domestic product in India, targeted intervention is a cost-effective strategy for HIV prevention in India.

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

    Science.gov (United States)

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

    2017-09-01

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

  19. Antibiotic prescription and cost patterns in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Krivoy N

    2007-06-01

    Full Text Available Antibiotic prescription habits, cost pattern, and the prospective intervention in an Intensive Care Unit were analyzed. Methods: Data on antibiotic utilization and costs were collected prospectively from individual electronic charts from August 2003 to January 2004, and retrospectively from August to December 2002. Results: A total of 180 and 107 patients were surveyed in 2002 and 2003. In 2002, Piperacillin-Tazobactam (13.8% and Imipenem/Cilastin (11.2% were the most prescribed medications; while, in 2003, Vancomycin (12.6% and Imipenem/Cilastin (11.3% were prescribed, respectively. Total defined daily dose (DDD and Drug Utilization 90% (DU90% index for 2002 and 2003 were 2031.15 and 2325.90 DDDs (p>0.1 and 1777.57 and 2079.61 DU90%, respectively (p>0.1. The Median Total Cost /100 admission days (CI 95% were NIS13,310 (11,110;18,420 and NIS13,860 (6,710;18,020 (p=0.66, respectively. Conclusions: Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at minimizing the future emergence of bacterial resistance and futile expenses.

  20. Vaginal microbicides save money: a model of cost-effectiveness in South Africa and the USA.

    Science.gov (United States)

    Verguet, S; Walsh, J A

    2010-06-01

    To determine the hypothetical cost-effectiveness of vaginal microbicides preventing male to female HIV transmission. A mathematical epidemiological and cost-effectiveness model using data from South Africa and the USA was used. The prospective 1-year-long intervention targeted a general population of women in a city of 1,000,000 inhabitants in two very different epidemiological settings, South Africa with a male HIV prevalence of 18.80% and the USA with a male HIV prevalence of 0.72%. The base case scenario assumes a microbicide effective at 55%, used in 30% of sexual episodes at a retail price for the public sector in South Africa of US$0.51 per use and in the USA of US$2.23 per use. In South Africa, over 1 year, the intervention would prevent 1908 infections, save US$6712 per infection averted as compared with antiretroviral treatment. In the USA, it would be more costly: over 1 year, the intervention would prevent 21 infections, amounting to a net cost per infection averted of US$405,077. However, in the setting of Washington DC, with a higher HIV prevalence, the same intervention would prevent 93 infections and save US$91,176 per infection averted. Sensitivity analyses were conducted and even a microbicide with a low effectiveness of 30% would still save healthcare costs in South Africa. A microbicide intervention is likely to be very cost-effective in a country undergoing a high-level generalised epidemic such as South Africa, but is unlikely to be cost-effective in a developed country presenting epidemiological features similar to the USA unless the male HIV prevalence exceeds 2.4%.

  1. Techniques for Conducting Effective Concept Design and Design-to-Cost Trade Studies

    Science.gov (United States)

    Di Pietro, David A.

    2015-01-01

    Concept design plays a central role in project success as its product effectively locks the majority of system life cycle cost. Such extraordinary leverage presents a business case for conducting concept design in a credible fashion, particularly for first-of-a-kind systems that advance the state of the art and that have high design uncertainty. A key challenge, however, is to know when credible design convergence has been achieved in such systems. Using a space system example, this paper characterizes the level of convergence needed for concept design in the context of technical and programmatic resource margins available in preliminary design and highlights the importance of design and cost evaluation learning curves in determining credible convergence. It also provides techniques for selecting trade study cases that promote objective concept evaluation, help reveal unknowns, and expedite convergence within the trade space and conveys general practices for conducting effective concept design-to-cost studies.

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

    Directory of Open Access Journals (Sweden)

    Yolanda Hernández-Gago

    2017-03-01

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

  3. Effective Stiffness: Generalizing Effective Resistance Sampling to Finite Element Matrices

    CERN Document Server

    Avron, Haim

    2011-01-01

    We define the notion of effective stiffness and show that it can used to build sparsifiers, algorithms that sparsify linear systems arising from finite-element discretizations of PDEs. In particular, we show that sampling $O(n\\log n)$ elements according to probabilities derived from effective stiffnesses yields an high quality preconditioner that can be used to solve the linear system in a small number of iterations. Effective stiffness generalizes the notion of effective resistance, a key ingredient of recent progress in developing nearly linear symmetric diagonally dominant (SDD) linear solvers. Solving finite elements problems is of considerably more interest than the solution of SDD linear systems, since the finite element method is frequently used to numerically solve PDEs arising in scientific and engineering applications. Unlike SDD systems, which are relatively easy to precondition, there has been limited success in designing fast solvers for finite element systems, and previous algorithms usually tar...

  4. Social costs of robbery and the cost-effectiveness of substance abuse treatment.

    Science.gov (United States)

    Basu, Anirban; Paltiel, A David; Pollack, Harold A

    2008-08-01

    Reduced crime provides a key benefit associated with substance abuse treatment (SAT). Armed robbery is an especially costly and frequent crime committed by some drug-involved offenders. Many studies employ valuation methods that understate the true costs of robbery, and thus the true social benefits of SAT-related robbery reduction. At the same time, regression to the mean and self-report bias may lead pre-post comparisons to overstate crime reductions associated with SAT. Using 1992-1997 data from the National Treatment Improvement Evaluation Study (NTIES), we examined pre-post differences in self-reported robbery among clients in five residential and outpatient SAT modalities. Fixed-effect negative binomial regression was used to examine incidence rate reductions (IRR) in armed robbery. Published data on willingness to pay to avoid robbery were used to determine the social valuation of these effects. Differences in IRR across SAT modalities were explored to bound potential biases.All SAT modalities were associated with large and statistically significant reductions in robbery. The average number of self-reported robberies declined from 0.83/client/year pre-entry to 0.12/client/year following SAT (pcosts of these interventions. Conventional wisdom posits the economic benefits of SAT. We find that SAT is even more beneficial than is commonly assumed.

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

    Science.gov (United States)

    Russell, Louise B; Sinha, Anushua

    2016-05-01

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

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

    Science.gov (United States)

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

    2017-01-10

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

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

    Science.gov (United States)

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

    2013-06-01

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

  8. Assessing Cost-Effectiveness in Obesity (ACE-Obesity: an overview of the ACE approach, economic methods and cost results

    Directory of Open Access Journals (Sweden)

    Swinburn Boyd

    2009-11-01

    Full Text Available Abstract Background The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study. Methods The Assessing Cost Effectiveness (ACE approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'. Results The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum and when expressed as a 'cost per child' estimate (from Conclusion The use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and

  9. Cost-effectiveness of interventions to prevent disability in leprosy: a systematic review.

    Directory of Open Access Journals (Sweden)

    Natasja H J van Veen

    Full Text Available BACKGROUND: Prevention of disability (POD is one of the key objectives of leprosy programmes. Recently, coverage and access have been identified as the priority issues in POD. Assessing the cost-effectiveness of POD interventions is highly relevant to understanding the barriers and opportunities to achieving universal coverage and access with limited resources. The purpose of this study was to systematically review the quality of existing cost-effectiveness evidence and discuss implications for future research and strategies to prevent disability in leprosy and other disabling conditions. METHODOLOGY/PRINCIPAL FINDINGS: We searched electronic databases (NHS EED, MEDLINE, EMBASE, and LILACS and databases of ongoing trials (www.controlled-trials.com/mrct/, www.who.int/trialsearch. We checked reference lists and contacted experts for further relevant studies. We included studies that reported both cost and effectiveness outcomes of two or more alternative interventions to prevent disability in leprosy. We assessed the quality of the identified studies using a standard checklist for critical appraisal of economic evaluations of health care programmes. We found 66 citations to potentially relevant studies and three met our criteria. Two were randomised controlled trials (footwear, management of neuritis and one was a generic model-based study (cost per DALY. Generally, the studies were small in size, reported inadequately all relevant costs, uncertainties in estimates, and issues of concern and were based on limited data sources. No cost-effectiveness data on self-care, which is a key strategy in POD, was found. CONCLUSION/SIGNIFICANCE: Evidence for cost-effectiveness of POD interventions for leprosy is scarce. High quality research is needed to identify POD interventions that offer value for money where resources are very scarce, and to develop strategies aimed at available, affordable and sustainable quality POD services for leprosy. The findings

  10. Assessing Cost-effectiveness of Green Infrastructures in response to Large Storm Events at Household Scale

    Science.gov (United States)

    Chui, T. F. M.; Liu, X.; Zhan, W.

    2015-12-01

    Green infrastructures (GI) are becoming more important for urban stormwater control worldwide. However, relatively few studies focus on researching the specific designs of GI at household scale. This study assesses the hydrological performance and cost-effectiveness of different GI designs, namely green roofs, bioretention systems and porous pavements. It aims to generate generic insights by comparing the optimal designs of each GI in 2-year and 50-year storms of Hong Kong, China and Seattle, US. EPA SWMM is first used to simulate the hydrologic performance, in particular, the peak runoff reduction of thousands of GI designs. Then, life cycle costs of the designs are computed and their effectiveness, in terms of peak runoff reduction percentage per thousand dollars, is compared. The peak runoff reduction increases almost linearly with costs for green roofs. However, for bioretention systems and porous pavements, peak runoff reduction only increases significantly with costs in the mid values. For achieving the same peak runoff reduction percentage, the optimal soil depth of green roofs increases with the design storm, while surface area does not change significantly. On the other hand, for bioretention systems and porous pavements, the optimal surface area increases with the design storm, while thickness does not change significantly. In general, the cost effectiveness of porous pavements is highest, followed by bioretention systems and then green roofs. The cost effectiveness is higher for a smaller storm, and is thus higher for 2-year storm than 50-year storm, and is also higher for Seattle when compared to Hong Kong. This study allows us to better understand the hydrological performance and cost-effectiveness of different GI designs. It facilitates the implementation of optimal choice and design of each specific GI for stormwater mitigation.

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

    Science.gov (United States)

    Ong, A S H; Goh, S H

    2002-03-01

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

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Joakim Ramsberg

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

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

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

  17. Economic viewpoints in educational effectiveness : Cost-effectiveness analysis of an educational improvement project

    NARCIS (Netherlands)

    Creemers, B; van der Werf, G

    2000-01-01

    Cost-effectiveness analysis is not only important for decision making in educational policy and practice. Also within educational effectiveness research it is important to establish the costs of educational processes in relationship to their effects. The integrated multilevel educational effectivene

  18. Time and Cost Analysis: Pediatric Dental Rehabilitation with General Anesthesia in the Office and the Hospital Settings

    Science.gov (United States)

    Rashewsky, Stephanie; Parameswaran, Ashish; Sloane, Carole; Ferguson, Fred; Epstein, Ralph

    2012-01-01

    Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board–approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36–60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance. PMID:23241037

  19. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    Science.gov (United States)

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

    2015-10-01

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

  20. The Electoral Costs of Being a Woman in the 1979 British General Election.

    Science.gov (United States)

    Rasmussen, Jorgen S.

    An analysis of voting behavior toward women candidates in the 1979 general election in Great Britain determined whether public opinion has shifted against an equal political role for women. A total of 104 Labour, Liberal, and Conservative female candidates were measured against a control group of the same number of male candidates. The research…

  1. Bayesian Variable Selection in Cost-Effectiveness Analysis

    Directory of Open Access Journals (Sweden)

    Miguel A. Negrín

    2010-04-01

    Full Text Available Linear regression models are often used to represent the cost and effectiveness of medical treatment. The covariates used may include sociodemographic variables, such as age, gender or race; clinical variables, such as initial health status, years of treatment or the existence of concomitant illnesses; and a binary variable indicating the treatment received. However, most studies estimate only one model, which usually includes all the covariates. This procedure ignores the question of uncertainty in model selection. In this paper, we examine four alternative Bayesian variable selection methods that have been proposed. In this analysis, we estimate the inclusion probability of each covariate in the real model conditional on the data. Variable selection can be useful for estimating incremental effectiveness and incremental cost, through Bayesian model averaging, as well as for subgroup analysis.

  2. Density functional theory based generalized effective fragment potential method

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Kiet A., E-mail: kiet.nguyen@wpafb.af.mil, E-mail: ruth.pachter@wpafb.af.mil [Air Force Research Laboratory, Wright-Patterson Air Force Base, Ohio 45433 (United States); UES, Inc., Dayton, Ohio 45432 (United States); Pachter, Ruth, E-mail: kiet.nguyen@wpafb.af.mil, E-mail: ruth.pachter@wpafb.af.mil [Air Force Research Laboratory, Wright-Patterson Air Force Base, Ohio 45433 (United States); Day, Paul N. [Air Force Research Laboratory, Wright-Patterson Air Force Base, Ohio 45433 (United States); General Dynamics Information Technology, Inc., Dayton, Ohio 45431 (United States)

    2014-06-28

    We present a generalized Kohn-Sham (KS) density functional theory (DFT) based effective fragment potential (EFP2-DFT) method for the treatment of solvent effects. Similar to the original Hartree-Fock (HF) based potential with fitted parameters for water (EFP1) and the generalized HF based potential (EFP2-HF), EFP2-DFT includes electrostatic, exchange-repulsion, polarization, and dispersion potentials, which are generated for a chosen DFT functional for a given isolated molecule. The method does not have fitted parameters, except for implicit parameters within a chosen functional and the dispersion correction to the potential. The electrostatic potential is modeled with a multipolar expansion at each atomic center and bond midpoint using Stone's distributed multipolar analysis. The exchange-repulsion potential between two fragments is composed of the overlap and kinetic energy integrals and the nondiagonal KS matrices in the localized molecular orbital basis. The polarization potential is derived from the static molecular polarizability. The dispersion potential includes the intermolecular D3 dispersion correction of Grimme et al. [J. Chem. Phys. 132, 154104 (2010)]. The potential generated from the CAMB3LYP functional has mean unsigned errors (MUEs) with respect to results from coupled cluster singles, doubles, and perturbative triples with a complete basis set limit (CCSD(T)/CBS) extrapolation, of 1.7, 2.2, 2.0, and 0.5 kcal/mol, for the S22, water-benzene clusters, water clusters, and n-alkane dimers benchmark sets, respectively. The corresponding EFP2-HF errors for the respective benchmarks are 2.41, 3.1, 1.8, and 2.5 kcal/mol. Thus, the new EFP2-DFT-D3 method with the CAMB3LYP functional provides comparable or improved results at lower computational cost and, therefore, extends the range of applicability of EFP2 to larger system sizes.

  3. Cost Benefit Analysis: Cost Benefit Analysis for Human Effectiveness Research: Bioacoustic Protection

    Science.gov (United States)

    2007-11-02

    APPENDIX A. ACRONYMS ACCES Attenuating Custom Communication Earpiece System ACEIT Automated Cost estimating Integrated Tools AFSC Air Force...documented in the ACEIT cost estimating tool developed by Tecolote, Inc. The factor used was 14 percent of PMP. 1.3 System Engineering/ Program...The data source is the ASC Aeronautical Engineering Products Cost Factor Handbook which is documented in the ACEIT cost estimating tool developed

  4. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

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

  5. Evaluating the cost-effectiveness of preventive zinc supplementation

    OpenAIRE

    Fink, Günther; Heitner, Jesse

    2014-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

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

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

    OpenAIRE

    Clemmensen, Torkil; Vendelø, Morten

    2004-01-01

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

  9. Cost-effective wearable sensor to detect EMF

    OpenAIRE

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

    2009-01-01

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

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

    CERN Document Server

    Smith, Hubbert

    2011-01-01

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

  11. Cost effectiveness of GHG mitigation options and policy implication

    Energy Technology Data Exchange (ETDEWEB)

    Lim, K. S. [Korea Institute for Industrial Economics and Trade, Seoul (Korea, Republic of)

    1998-04-01

    This paper represents the summary findings and conclusions of several studies implemented about microeconomics and macroeconomics marginal costs of GHG abatement policies. Financial, economic, and, where possible, environmental microeconomics costs of reducing GHGs are estimated by a World Bank team. Six energy-related CO{sub 2} mitigation policy options are applied to estimate the macroeconomics costs of GHG emission reduction, the macroeconomics impacts on the Chinese economy. In terms of policy, conservation is a better option to cope with a restrictive mitigation constraint, assuming a developing country can achieve planned energy-saving targets. Without a CO{sub 2} emission constraint or with less restrictive CO{sub 2} emission constraints, however, the simulation results indicate that a conservation strategy may be less attractive than fuel substitution in a developing country, mainly due to the economic dampening effect of reduced production in the energy sectors. This finding suggests that an often-cited costless or negative-cost energy conservation policy may not be a better option when a less restrictive mitigation target is in force. This does not mean that the potential for energy efficiency improvements in a developing country is not worthwhile, but that the overall macroeconomics impacts should be considered before implementing the policy option. (author). 9 refs., 3 figs., 3 tabs.

  12. Large-scale system effectiveness analysis. Sub-problem 3: a conceptual framework for system cost. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Myers, D.R.; Lee, W.C.; Yabroff, I.W.

    1980-06-16

    The effectiveness of a large-scale electric power system can be measured by four factors: system performance, system availability, system cost, and system worth (from the user perspective). In response to the need for synergistic effectiveness measures. A broad, multi-contractor research project is being conducted to integrate those four categories. This report describes system cost at two levels: a conceptual framework for measuring the total cost of producing electricity under diverse system effectiveness measures, and a set of general cost inputs that relate the framework to specific utility types. In this report, Chapter II describes the general-level conceptual framework for assessing the cost of system effectivenss attributes. Chapter III shows how the actual costs of a power system can be disaggregated and then integrated into the broad-level conceptual framework. Chapter IV utilizes the conceptual framework and the concepts underlying its development to produce some concrete examples of measures of cost of system effectiveness. Appendix A is a more in-depth look at the cost of fuel, and illustrates the level of analytical detail necessary for putting the framework into practice.

  13. Analysis of cost outliers within APR-DRGs in a Belgian general hospital: two complementary approaches.

    Science.gov (United States)

    Pirson, Magali; Dramaix, Michèle; Leclercq, Pol; Jackson, Terri

    2006-03-01

    The objective of this study was to find factors that could explain high and low resource use outliers, by associating an explanatory analysis with a statistical analysis. High resource use outliers were selected according to the following rule: 75th percentile + 1.5* inter-quartile range. Low resource use outliers were selected according to: 25th percentile - 1.5* inter-quartile range. The statistical approach was based on a multivariate analysis using logistic regression. A decision tree approach using predictors from this analysis (intensive care unit (ICU) stay, high severity of illness and social factors associated with longer length of stay) was also tested as a more intuitive tool for use by hospitals in focussing review efforts on "not explained" cost outliers. High resource use outliers accounted for 6.31% of the hospital stays versus 1.07% for low resource use outliers. The probability of a patient being a high resource use outlier was higher with an increase in the length of stay (odds ratios (OR) = 1.08), when the patient was treated in an intensive care unit (OR = 3.02), with a major or extreme severity of illness (OR=1.46), and with the presence of social factors (OR = 1.44). The probability of being a low outlier is lower for older patients (OR = 0.98). The probability of being a low outlier is also lower without readmission within the year (OR = 0.55). The more intuitive decision tree method identified 92.26% of the cases identified through residuals of the regression model. One quarter of the high cost outliers were flagged for additional review ("not justified" on the basis of the model), with nearly three-quarters "justified" by clinical and social factors. The analysis of cost outliers can meet different aims (financing of justifiable outliers, improvement of the care process for the outliers not justifiable on medical or social grounds). The two methods are complementary, by proposing a statistical and a didactic approach to achieve the goal of

  14. A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischemic stroke.

    Science.gov (United States)

    Joo, Heesoo; Wang, Guijing; George, Mary G

    2017-01-01

    Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times. A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the key words acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving, and incremental cost-effectiveness analysis. The review is limited to original research articles published during 1995-2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 2 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective. The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.

  15. Cost-effectiveness of powered wheelchairs: findings of a study.

    Science.gov (United States)

    Andrich, Renzo; Salatino, Claudia; Converti, Rosa Maria; Saruggia, Maurizio

    2015-01-01

    This study surveyed a sample of 79 wheelchair users who had obtained powered wheelchairs from the National Health Service in an Italian Region in the period 2008-2013. The wheelchair prescriptions had been done on the basis of an assessment protocol agreed with the Local Health Authority. Follow-up interviews were carried out at the users' homes, in order to collect information about the wheelchair use and its effectiveness, usefulness and economic impact. The instruments used in the interviews included an introductory questionnaire (describing the wheelchair use), the QUEST (measuring the user's satisfaction), the PIADS (measuring the psychosocial impact, in terms of perceived changes in ability, adaptability and self-esteem), the FABS/M (detecting environmental facilitators and barriers) and the SCAI (estimating the economic impact). Overall, positive outcomes were detected for most users, especially in relation to their satisfaction and the psychosocial impact. A number of barriers were identified in various settings (at home, in public places, in natural spaces, in public transportation) that sometimes restrict the user mobility and thus may claim for corrective actions. Several environmental factors acting as facilitators were also identified. In relation to the economic impact, the provision of a powered wheelchair generated remarkable savings in social costs for most of the users, on average about 36.000 Euros per person on a projected 5-years span. This estimate results from the comparison between the social cost of the intervention (sum of the costs of all material and human resources involved in the provision and usage of the wheelchair) and the cost of non-intervention (the presumed social cost incurred in case no powered wheelchair had been provided and the user had to carry on with just a manual wheelchair). The study was also an opportunity to develop and try out a follow-up method that proved applicable within service delivery practice.

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

    Directory of Open Access Journals (Sweden)

    Matjaž J. Retelj

    2007-03-01

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

  17. Effectiveness of empathy in general practice: a systematic review

    OpenAIRE

    Derksen, F.; BENSING, J; Lagro-Janssen, A

    2013-01-01

    Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablemen...

  18. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perović Saša

    2009-01-01

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

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

    Science.gov (United States)

    Carman, Robert A.

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

  20. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

    Directory of Open Access Journals (Sweden)

    Leurent Baptiste E

    2011-02-01

    Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration isrctn.org Identifier: ISRCTN18271323

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

    Science.gov (United States)

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

    2017-08-01

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

  2. Relevant Costs for Decision in an Effective Controlling System

    Directory of Open Access Journals (Sweden)

    Mihaela TULVINSCHI

    2010-05-01

    Full Text Available Controlling is considered a leading concept in the sense of coordination, planning, control and automation, in order to produce the synthesis necessary in decision making. The purpose of article is to highlight the link between a dynamic accounting system and an effective controlling system. The research method used is based on the idea that the cost analysis in an efficient controlling system involves obtaining accounting information from within the entity which management then uses in decision making. In conclusion, we emphasize that an effective controlling system must provide managers the tools to meet their informational needs.

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

    Science.gov (United States)

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

    2015-03-01

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

  4. Cost-effectiveness of HIV screening for incarcerated pregnant women.

    Science.gov (United States)

    Resch, Stephen; Altice, Frederick L; Paltiel, A David

    2005-02-01

    Antiretroviral therapy (ART) initiated on a prenatal basis in HIV-infected pregnant women is a highly effective method for preventing mother-to-child HIV transmission. We developed a decision analytic model to project the clinical and economic outcomes of alternative HIV screening strategies (voluntary prenatal screening [VPS], routine prenatal screening [RPS], and mandatory newborn screening [MNS]) for a high-risk population of incarcerated pregnant women. Data for the decision model came from the HIV voluntary counseling and testing program at Connecticut's sole correctional facility for women and a comprehensive anonymously linked serosurvey of all inmates who entered the facility during the 2-year period beginning in October 1994. Based on serosurvey results, in the absence of any HIV screening program, 2.5 cases of pediatric HIV infection would be expected per 1000 pregnancies. Multiplied by the discounted lifetime cost per case of $247,000, this translates to a cost of $624 per testing-eligible prison entrant. Entrants were considered eligible if they were pregnant and their HIV status was unknown. MNS would save money, cost $364 per eligible entrant, and simultaneously reduce the rate of infections to 1.1 per 1000 pregnancies. Doing both MNS and RPS is most effective in reducing the rate of new infections (down to 0.2 per 1000 pregnancies). It would, however, increase costs to $430 per eligible entrant. This would result in an incremental cost of $73,603 per additional pediatric HIV case averted when compared with MNS alone. If mandatory newborn testing was not considered a feasible option, RPS would dominate VPS and would be cost-saving compared with no screening. RPS compares favorably with alternative uses of HIV prevention and treatment resources. In correctional facilities where voluntary newborn screening is already in place, our findings show that there remains a small marginal benefit to be realized from switching to RPS. In settings where HIV

  5. Cost-effectiveness analyses of training: a manager?s guide

    OpenAIRE

    O?Malley, Gabrielle; Marseille, Elliot; Weaver, Marcia R

    2013-01-01

    The evidence on the cost and cost-effectiveness of global training programs is sparse. This manager?s guide to cost-effectiveness analysis (CEA) is for professionals who want to recognize and support high quality CEA. It focuses on CEA of training in the context of program implementation or rapid program expansion. Cost analysis provides cost per output and CEA provides cost per outcome. The distinction between these two analyses is essential for making good decisions about value. A hypotheti...

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

    Directory of Open Access Journals (Sweden)

    Griffiths EA

    2015-08-01

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

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

    CERN Document Server

    Singla, Pradeep; 10.5120/5619-7911

    2012-01-01

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

  8. RTM: Cost-effective processing of composite structures

    Science.gov (United States)

    Hasko, Greg; Dexter, H. Benson

    1991-01-01

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

  9. Cost-effective lightweight mirrors for aerospace and defense

    Science.gov (United States)

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

    2015-05-01

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

  10. A general and simple method for obtaining R2 from generalized linear mixed‐effects models

    National Research Council Canada - National Science Library

    Nakagawa, Shinichi; Schielzeth, Holger; O'Hara, Robert B

    2013-01-01

    The use of both linear and generalized linear mixed‐effects models ( LMM s and GLMM s) has become popular not only in social and medical sciences, but also in biological sciences, especially in the field of ecology and evolution...

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

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

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

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Another failure to generalize the Mozart effect.

    Science.gov (United States)

    McCutcheon, L E

    2000-08-01

    Several studies have not replicated Rauscher, Shaw, and Ky's 1993 finding that 10 minutes of exposure to Mozart piano music temporarily enhanced performance on three spatial reasoning tasks. Later Rauscher and Shaw argued that enhanced performance is unlikely unless three conditions are met. The present study was designed to meet those three conditions. 36 adults were exposed to one of six listening orders and one of six test orders. Listening and test orders had no systematic effect on spatial reasoning performance. A one-factor, repeated-measures analysis of variance yielded no significant difference on spatial reasoning performance after listening to classical music, jazz, or silence. A reanalysis, using only those items most likely to tap spatial reasoning, fell short of significance, and mean scores were in the direction opposite to that hypothesized. These results were inconsistent with studies that have supported a Mozart effect.

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

    LENUS (Irish Health Repository)

    Slattery, E

    2012-02-01

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

  15. Renormalization and effective actions for general relativity

    Energy Technology Data Exchange (ETDEWEB)

    Neugebohrn, F.

    2007-05-15

    Quantum gravity is analyzed from the viewpoint of the renormalization group. The analysis is based on methods introduced by J. Polchinski concerning the perturbative renormalization with flow equations. In the first part of this work, the program of renormalization with flow equations is reviewed and then extended to effective field theories that have a finite UV cutoff. This is done for a scalar field theory by imposing additional renormalization conditions for some of the nonrenormalizable couplings. It turns out that one so obtains a statement on the predictivity of the effective theory at scales far below the UV cutoff. In particular, nonrenormalizable theories can be treated without problems in the proposed framework. In the second part, the standard covariant BRS quantization program for Euclidean Einstein gravity is applied. A momentum cutoff regularization is imposed and the resulting violation of the Slavnov-Taylor identities is discussed. Deriving Polchinski's renormalization group equation for Euclidean quantum gravity, the predictivity of effective quantum gravity at scales far below the Planck scale is investigated with flow equations. A fine-tuning procedure for restoring the violated Slavnov-Taylor identities is proposed and it is argued that in the effective quantum gravity context, the restoration will only be accomplished with finite accuracy. Finally, the no-cutoff limit of Euclidean quantum gravity is analyzed from the viewpoint of the Polchinski method. It is speculated whether a limit with nonvanishing gravitational constant might exist where the latter would ultimatively be determined by the cosmological constant and the masses of the elementary particles. (orig.)

  16. GENERALIZED p-VALUES AND GENERALIZED CONFIDENCE INTERVALS FOR VARIANCE COMPONENTS IN GENERAL RANDOM EFFECT MODEL WITH BALANCED DATA

    Institute of Scientific and Technical Information of China (English)

    Rendao YE; Songgui WANG

    2007-01-01

    Various random models with balanced data that are relevant for analyzing practical test data are described, along with several hypothesis testing and interval estimation problems concerning variance components. In this paper, we mainly consider these problems in general random effect model with balanced data. Exact tests and confidence intervals for a single variance component corresponding to random effect are developed by using generalized p-values and generalized confidence intervals.The resulting procedures are easy to compute and are applicable to small samples. Exact tests and confidence intervals are also established for comparing the random-effects variance components and the sum of random-effects variance components in two independent general random effect models with balanced data. Furthermore, we investigate the statistical properties of the resulting tests. Finally,some simulation results on the type Ⅰ error probability and power of the proposed test are reported.The simulation results indicate that exact test is extremely satisfactory for controlling type Ⅰ error probability.

  17. The effects of dependence and function on costs of care for Alzheimer's disease and mild cognitive impairment in Ireland.

    Science.gov (United States)

    Gillespie, P; O'Shea, E; Cullinan, J; Lacey, L; Gallagher, D; Ni Mhaolain, A

    2013-03-01

    To explore the incremental effects of patient dependence and function on costs of care for patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) in Ireland. Cost analysis based on reported resource use for a cross-section of 100 community-based people with AD and MCI. Formal care included general practice visits, hospitalizations, outpatient clinic consultations, accident and emergency visits, respite care, meals on wheels services and other health and social care professional consultations. Informal care included time input provided by caregivers. Resource unit costs were applied to value formal care and the opportunity cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale and patient functional capacity using the Disability Assessment for Dementia scale. Multivariate regression analysis was used to model the cost of care. Both dependence and function were independently and significantly associated with total formal and informal care cost: a one point increase in dependence was associated with a €796 increase in total cost and a one point improvement in function with a €417 reduction in total cost over 6 months. Patient function was significantly associated with formal care costs, whereas patient function and dependence were both significantly associated with informal care costs. The costs of care for patients with AD and MCI in Ireland are substantial. Interventions that reduce patient dependence on others and functional decline may be associated with important economic benefits. Copyright © 2012 John Wiley & Sons, Ltd.

  18. DEVELOPMENT THE GENERAL BUDGET COSTS AT AN ENTERPRISE OF EXPLOITATION OF MINERAL RESOURCES IN THE COAL

    Directory of Open Access Journals (Sweden)

    DINA IONELA CLAUDIA

    2015-03-01

    Full Text Available Considering the fact that the goal of any enterprise, and those that operate in the field of extracting coal, mineral resources aims at maintaining balance relationship between revenue and expenditure, the problem faced by the management of the companies is finding those methods which allow the sizing and control of this type of relationship. For this purpose it shall draw up a document of financial forecasting, namely "the budget of revenue and expenditure", emerged as "an instrument of harmonization and improvement of the relationship between revenue and expenditure", which due to its mining over a specific period of time, usually one year and broken down by quarters, financial revenue and expenditure, thus ensuring steady financial relationship. In the present work we, as starting from general considerations realiarea the budget, to introduce a new model of its întrocmirea taking into account the secificitatea of coal mining of ore extraction.

  19. Determinants and Effects of Logistics Costs in Container Ports: The Transaction Cost Economics Perspective

    National Research Council Canada - National Science Library

    Hyuk-soo Cho

    2014-01-01

    .... Based on country-level analysis, this study is designed to investigate empirically internal capabilities and external environments of logistics costs and traffic volumes in individual container ports...

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

    Energy Technology Data Exchange (ETDEWEB)

    2007-07-01

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

  1. 基于潮流追踪和广义发电分配因子的输电费用分摊方法研究%Transmission Cost Allocation Based on Power Flow Tracing and Generalized Generation Distribution Factors

    Institute of Scientific and Technical Information of China (English)

    岳建坤; 张粒子

    2012-01-01

    利用成本加收益的方法确定输电费用,然后借鉴优势潮流法的思想,将输电费用分为使用费用和安全费用。利用潮流追踪法和广义发电分配因子法进行输电费用分摊。利用5节点系统验证了该方法的有效性。%The transmission costs are firstly calculated by cost plus profit method,then the costs are divided into utilization costs and security costs in view of the advantage flow method.The transmission costs are allocated on the basis of power flow tracing and generalized generation distribution factors.Finally,this paper uses a 5-bus system to verify the effectiveness of this proposed method.

  2. Multisymplectic effective General Boundary Field Theory

    CERN Document Server

    Arjang, Mona

    2013-01-01

    The transfer matrix in lattice field theory connects the covariant and the initial data frameworks; in spin foam models, it can be written as a composition of elementary cellular amplitudes/propagators. We present a framework for discrete spacetime classical field theory in which solutions to the field equations over elementary spacetime cells may be amalgamated if they satisfy simple gluing conditions matching the composition rules of cellular amplitudes in spin foam models. Furthermore, the formalism is endowed with a multisymplectic structure responsible for local conservation laws. Some models within our framework are effective theories modeling a system at a given scale. Our framework allows us to study coarse graining and the continuum limit.

  3. Cost-effectiveness of HIV counseling and testing in US prisons.

    Science.gov (United States)

    Varghese, B; Peterman, T A

    2001-06-01

    The prevalence of human immunodeficiency virus (HIV) in correctional facilities is much higher than in the general population. However, HIV prevention resources are limited, making it important to evaluate different prevention programs in prison settings. Our study presents the cost-effectiveness of offering HIV counseling and testing (CT) to soon-to-be-released inmates in US prisons. A decision model was used to estimate the costs and benefits (averted HIV cases) of HIV testing and counseling compared to no CT from a societal perspective. Model parameters were HIV prevalence among otherwise untested inmates (1%); acceptance of CT (50%); risk for HIV transmission from infected individuals (7%); risk of HIV acquisition for uninfected individuals (0.3%); and reduction of risk after counseling for those infected (25%) and uninfected (20%). Marginal costs of testing and counseling per person were used (no fixed costs). If infected, the cost was $78.17; if uninfected, it was $24.63. A lifetime treatment cost of $186,900 was used to estimate the benefits of prevented HIV infections. Sensitivity and threshold analysis were done to test the robustness of these parameters. Our baseline model shows that, compared to no CT, offering CT to 10,000 inmates detects 50 new or previously undiagnosed infections and averts 4 future cases of HIV at a cost of $125,000 to prison systems. However, this will save society over $550,000. Increase in HIV prevalence, risk of transmission, or effectiveness of counseling increased societal savings. As prevalence increases, focusing on HIV-infected inmates prevents additional future infections; however, when HIV prevalence is less than 5%, testing and counseling of both infected and uninfected inmates are important for HIV prevention.

  4. Cost-effectiveness analysis of paclitaxel-coated balloons for endovascular therapy of femoropopliteal arterial obstructions.

    Science.gov (United States)

    Diehm, Nicolas; Schneider, Henrique

    2013-12-01

    To explore the cost-effectiveness of using drug-eluting balloon (DEB) angioplasty for the treatment of femoropopliteal arterial lesions, which has been shown to significantly lower the rates of target lesion revascularization (TLR) compared with standard balloon angioplasty (BA). A simplified decision-analytic model based on TLR rates reported in the literature was applied to baseline and follow-up costs associated with in-hospital patient treatment during 1 year of follow-up. Costs were expressed in Swiss Francs (sFr) and calculated per 100 patients treated. Budgets were analyzed in the context of current SwissDRG reimbursement figures and calculated from two different perspectives: a general budget on total treatment costs (third-party healthcare payer) as well as a budget focusing on the physician/facility provider perspective. After 1 year, use of DEB was associated with substantially lower total inpatient treatment costs when compared with BA (sFr 861,916 vs. sFr 951,877) despite the need for a greater investment at baseline related to higher prices for DEBs. In the absence of dedicated reimbursement incentives, however, use of DEB was shown to be the financially less favorable treatment approach from the physician/facility provider perspective (12-month total earnings: sFr 179,238 vs. sFr 333,678). Use of DEBs may be cost-effective through prevention of TLR at 1 year of follow-up. The introduction of dedicated financial incentives aimed at improving DEB reimbursements may help lower total healthcare costs.

  5. Cost-effectiveness of nutritional counseling for obese patients and patients at risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Olsen, Jens; Willaing, Ingrid; Ladelund, Steen

    2005-01-01

    counseling by a general practitioner (GP) or a dietician. METHODS: A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated...... on the basis of registered use of time (dieticians) or agreed salaries (GPs). RESULTS: The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP--0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also...... patient groups and interventions report effects within the same magnitude. The GP group was the most cost-effective, but it must be concluded that both counseling strategies were relatively cost-effective. Even though the cost of gaining an extra life year was estimated to be 59,987 DKK in the dietician...

  6. Examining the cost-effectiveness of early dental visits.

    Science.gov (United States)

    Lee, Jessica Y; Bouwens, Thomas J; Savage, Matthew F; Vann, William F

    2006-01-01

    The subject of early dental visits as an integral dimension of anticipatory guidance and the related supporting scientific evidence for this concept is a critical and timely issue for the dental profession. The purpose of this paper was to review the scientific evidence and rationale for early dental visits. In theory, early dental visits can prevent disease and reduce costs. During the age 1 dental visit, there is strong emphasis on prevention and parents are given: (1) counseling on infant oral hygiene; (2) home and office-based fluoride therapies; (3) dietary counseling; and (4) information relative to oral habits and dental injury prevention. There is evidence that the early preventive visits can reduce the need for restorative and emergency care, therefore reducing dentally related costs among high-risk children. Preschool Medicaid children who had an early preventive dental visit by age 1 were more likely to use subsequent preventive services and experienced less dentally related costs. These finding have significant policy implications, and more research is needed to examine this effect in a low-risk population.

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

    Directory of Open Access Journals (Sweden)

    David Bin Chia Wu

    2013-03-01

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

  8. Telemedicine-based diabetic retinopathy screening programs: an evaluation of utility and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Cuadros JA

    2015-06-01

    Full Text Available Jorge A Cuadros Optometry/Vision Science, University of California, Berkeley, CA, USA Abstract: Diabetes is the main cause of blindness among working age adults, although treatment is highly effective in preventing vision loss. Eye examinations are recommended on a yearly basis for most patients for timely detection of retinal disease. Telemedicine-based diabetic retinopathy screening (TMDRS programs have been developed to identify patients with sight-threatening diabetic eye disease because patients are often noncompliant with recommended live eye examinations. This article reviews the cost-effectiveness of the various forms of TMDRS. A review of relevant articles, mostly published since 2008, shows that societal benefits generally outweigh the costs of TMDRS. However, advances in technology to improve efficacy, lower costs, and broaden screening to other sight-threatening conditions, such as glaucoma and refractive error, are necessary to improve the sustainability of TMDRS within health care organizations. Patient satisfaction with these telemedicine programs is generally high. New models of shared care with primary care providers and staff are emerging to improve patient engagement and follow-up care when individuals are found to have sight-threatening eye disease. TMDRS programs are growing and provide valuable clinical benefit. The cost-utility is currently well proven in locations with limited access to regular eye care services, such as rural areas, poor communities, and prison systems; however, improvements over time are necessary for these programs to be cost-effective in mainstream medical settings in the future. Keywords: telemedicine, diabetes, retinopathy, retinal imaging

  9. Factors Effect Direct Cost of Hospital Foodservices and Approximate Cost Analyze

    Directory of Open Access Journals (Sweden)

    Fatma Çelik

    2006-01-01

    Full Text Available The aim of this study was to investigate the cost of foodservice for the university hospital by taking into account of the criteria’s of well diet balanced using information technology. The data explain cost of food were obtained from input, output of hospital food barn that processed by hospital information system for 1995, 2000-2004 years. All details for calculating the net expenditure of food and direct cost of nutrition services were obtained from hospital information system that records all data on line. The energy and nutrient values of daily food served were calculated using the output of hospital food barn by the computer software that was developed. It was found that, our hospital catering system supplied a daily food ration of 2728 kcal and 98,1 gr protein/person in 2004.It has found that the cost of food was increased 10 times from 1995 to 2004. The expenditure of food groups that used in the hospital was 58.96% percent in the total cost of all nutrition services. The big part (28.92% of food expenditure was red meat and pulses. It has been thought that the daily approximate food cost for per person was 3,15 YTL. The total approximate cost could be estimated by adding the cost of staffs and the various managing expenditures to the approximate food cost. These data would be used to make the hospital foodservices private.In conclusion, to be successful in managing hospital food services depends on regular inspection and to take all costs under control daily. To present the results of cost analysis for hospitals will increase the quality of foodservices and will be possible to compare with the others.

  10. [Cost-effectiveness study of internist joint practices].

    Science.gov (United States)

    Dupierry, Raphael Patrick; Kaschny, Martin

    2008-07-15

    Practicing doctors are managers of their own practice. A doctor, who manages his practice besides his technical qualification, considering business aspects, enables a solid economic base. The objective of this article is to point out key starting points for an effective management of internist doctors' practices. Within the article it has particularly been analyzed, to what extent cooperations make an impact on the return and cost structure. For this purpose, a total of 495 business assessments from the DATEV eG of internist doctors' practices have been analyzed. The percental returns of smaller internistic joint practices (averaged turnover: 573,071 Euros) is about 6% higher than the percental returns of internistic doctors' practices (averaged turnover: 384,049 Euros). This result shows that small internistic joint practices work more efficiently. In contrast to this result bigger joint practices (averaged turnover: 1,618,608 Euros) gain an about 6% lower percental return than internistic doctors' practices. The reasons for this result are, compared to the internistic doctors' practices, the higher consumption of materials (+7%), the higher personnel costs (+3.5%), and the higher occupancy costs (+0.2%). On the basis of these results it can be concluded, that medium-sized internistic joint practices work more efficiently than internistic doctors' practices as well as large internistic joint practices. On the basis of the results it can be concluded, that internist cooperations can make good economic sense. However, the extent of cost efficiency and profit increase is particularly dependent on the size of the practice, the offered service portfolio, and the human resource management.

  11. Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs

    NARCIS (Netherlands)

    F. Karapinar-Çarkit (Fatma); S.D. Borgsteede (Sander); J. Zoer (Jan); T.C.G. Egberts (Toine); P.M.L.A. van den Bemt (Patricia); M.W. van Tulder (Maurits)

    2012-01-01

    textabstractBACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs. OBJECTIVE: To evaluate the

  12. Beamforming effects on generalized Nakagami imaging

    Science.gov (United States)

    Yu, Xue; Guo, Yuexin; Huang, Sheng-Min; Li, Meng-Lin; Lee, Wei-Ning

    2015-10-01

    Ultrasound tissue characterization is crucial for the detection of tissue abnormalities. Since the statistics of the backscattered ultrasound signals strongly depend on density and spatial arrangement of local scatterers, appropriate modeling of the backscattered signals may be capable of providing unique physiological information on local tissue properties. Among various techniques, the Nakagami imaging, realized in a window-based estimation scheme, has a good performance in assessing different scatterer statistics in tissues. However, inconsistent m values have been reported in literature and obtained only from a local tissue region, abating the reliability of Nakagami imaging in tissue characterization. The discrepancies in m values in relevant literature may stem from the nonuniformity of the ultrasound image resolution, which is often neglected. We therefore hypothesized that window-based Nakagami m estimation was highly associated with the regional spatial resolution of ultrasound imaging. To test this hypothesis, our study investigated the effect of beamforming methods, including synthetic aperture (SA), coherent plane wave compounding (CPWC), multi-focusing (MF), and single-focusing (SF), on window-based m parameter estimation from the perspective of the resolution cell. The statistics of m parameter distribution as a function of imaging depth were characterized by their mean, variance, and skewness. The phantom with a low scatterer density (16 scatterers mm-3) had significantly lower m values compared to the ones with high scatterer densities (32 and 64 scatterers mm-3). Results from the homogeneous phantom with 64 scatterers mm-3 showed that SA, MF, and CPWC had relatively uniform lateral resolutions compared to SF and thus relatively constant m estimates at different imaging depths. Our findings suggest that an ultrasound imaging regime exhibiting invariant spatial resolution throughout the entire imaging field of view would be the most appropriate for

  13. Development and Manufacture of Cost Effective Composite Drill Pipe

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-09-29

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

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

    Science.gov (United States)

    Newton, Heather

    2017-06-22

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

  15. Privacy Enforcement in a Cost-Effective Smart Grid

    DEFF Research Database (Denmark)

    Mikkelsen, Søren Aagaard

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

  16. Cost-Effective Helicopter Options for Partner Nations

    Science.gov (United States)

    2015-01-01

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

  17. DEVELOPMENT AND MANUFACTURE OF COST EFFECTIVE COMPOSITE DRILL PIPE

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-03-18

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

  18. The redundant target effect is affected by modality switch costs

    DEFF Research Database (Denmark)

    Gondan, Matthias; Lange, K.; Rösler, F.;

    2004-01-01

    , possibly due to multisensory interactions. In random stimulus sequences, reaction times are slower when the stimulus is preceded by a stimulus of a different modality (modality switch effect [MSE]). Simple reaction time redundant target experiments with auditory-visual, visual-tactile, and auditory......-tactile stimulus combinations were run to determine whether the RTE may be partly explained by MSEs because bimodal stimuli do not require a modality switch. In all three modality pairings, significant MSEs and RTEs were observed. However, the RTE was still significant after reaction times were corrected...... for the MSE, supporting the hypothesis that coactivation occurs independently of modality switch costs....

  19. Life cycle costing for current Rohr and AM general buses and General Motors RTS-II bus. Final report, Mar 1976--Jul 1976

    Energy Technology Data Exchange (ETDEWEB)

    Kain, H.R.; Marks, G.J.; Staszak, L.A.

    1976-07-09

    UMTA is considering the use of the life cycle costing concept in the procurement procedures for intracity buses. These relevant factors have been identified as the bus price, maintenance costs (including preventive maintenance), fuel costs, and tire costs. Evaluation of practices of bus operators and manufacturers indicates that they are in a position to agree mutually upon an evaluation process dependent upon: (1) maintenance cost data, (2) design-related maintenance elements, (3) fuel and tire costs, (4) useful life of a bus for evaluation purposes, and (5) initial bus purchase price. Inasmuch as the follow-on costs considered in the evaluation of bus bids exceed the cost of the bus itself, the life cycle costing approach highlights the follow-on costs. Of paramount importance is the flexibility to introduce design improvements that can result in savings during the life of the bus.

  20. Motion – The Available Treatments for Hepatits C Are Cost Effective: Arguments for the Motion

    Directory of Open Access Journals (Sweden)

    Norah Terrault

    2002-01-01

    Full Text Available The treatment of hepatitis C has evolved over the past decade, and a combination of interferon (IFN, pegylated or standard type, and ribavirin is now acknowledged as the therapy of choice. Questions remain, however, about the duration of treatment and which patients are the most likely to benefit from therapy. Cost effectiveness analyses (CEAs have been employed to answer these questions. Before the results can be interpreted appropriately, however, clinicians must make themselves aware of the underlying assumptions and the nature of the ‘reference’ case. Moreover, certain parameters, including quality-of-life evaluations, may not be easily translated from one jurisdiction to another. The costs and benefits of treatment are often very sensitive to such factors as patient age, viral load, histological severity and the viral genotype. Randomized controlled clinical trials, and the CEAs on which they are based, have shown that combination therapy is more cost effective than IFN monotherapy, and that both are cost effective compared with no treatment. Ongoing research on the use of pegylated IFN, weight-adjusted dosing of ribavirin, and the treatment of relapsers and nonresponders will provide valuable data that could be incorporated into future CEAs. Health care resources are vast, but not limitless. Therefore, health care providers need to become aware of how best to allocate resources to the general population. CEAs can facilitate this process by determining which treatment strategies are likely to yield the greatest clinical benefits without excessive expenditures.

  1. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  2. Cost effectiveness of rural development programme instruments in denmark

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  3. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

    Directory of Open Access Journals (Sweden)

    Dongfeng Gu

    2015-08-01

    Full Text Available Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg. Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015 were considered cost-effective. Treating hypertensive adults with prior

  4. Better informing decision making with multiple outcomes cost-effectiveness analysis under uncertainty in cost-disutility space.

    Directory of Open Access Journals (Sweden)

    Nikki McCaffrey

    Full Text Available Comparing multiple, diverse outcomes with cost-effectiveness analysis (CEA is important, yet challenging in areas like palliative care where domains are unamenable to integration with survival. Generic multi-attribute utility values exclude important domains and non-health outcomes, while partial analyses-where outcomes are considered separately, with their joint relationship under uncertainty ignored-lead to incorrect inference regarding preferred strategies.The objective of this paper is to consider whether such decision making can be better informed with alternative presentation and summary measures, extending methods previously shown to have advantages in multiple strategy comparison.Multiple outcomes CEA of a home-based palliative care model (PEACH relative to usual care is undertaken in cost disutility (CDU space and compared with analysis on the cost-effectiveness plane. Summary measures developed for comparing strategies across potential threshold values for multiple outcomes include: expected net loss (ENL planes quantifying differences in expected net benefit; the ENL contour identifying preferred strategies minimising ENL and their expected value of perfect information; and cost-effectiveness acceptability planes showing probability of strategies minimising ENL.Conventional analysis suggests PEACH is cost-effective when the threshold value per additional day at home (1 exceeds $1,068 or dominated by usual care when only the proportion of home deaths is considered. In contrast, neither alternative dominate in CDU space where cost and outcomes are jointly considered, with the optimal strategy depending on threshold values. For example, PEACH minimises ENL when 1=$2,000 and 2=$2,000 (threshold value for dying at home, with a 51.6% chance of PEACH being cost-effective.Comparison in CDU space and associated summary measures have distinct advantages to multiple domain comparisons, aiding transparent and robust joint comparison of costs and

  5. Quality and cost improvement of healthcare via complementary measurement and diagnosis of patient general health outcome using electronic health record data: research rationale and design.

    Science.gov (United States)

    Stusser, Rodolfo J; Dickey, Richard A

    2013-12-01

    In this evolving 'third era of health', one of the US Health Care Reform Act's goals is to effectively facilitate the primary care physician's ability to better diagnose and manage the health outcome of the outpatient. That goal must include research on the complementary quantitative-qualitative assessment and rating of the patient's health status. This paper proposes an overview of the rationale and design of a research program for a balanced measurement and diagnostic clinical decision support system (CDSS) of the changing general health status of the patient -including disease- using electronic health record (EHR) data. The rationale, objectives, health metric-diagnostic tools architecture, simulation-optimization, and clinical trials are outlined. Resources, time frames, costs, feasibility, healthcare benefits and data-integration of the project are delineated. The basis and components of the research program to achieve an automated-CDSS to complement physician's clinical judgment, calculating a mathematical 'health equation' from each patient's EHR database, assisting physician-patient collaboration to diagnose, and improve general health outcomes is described. Use of multiple dimensional index, ways of classification, and causal factors' assessments, to arrive at the EHR-based CDSS algorithm-software providing a general health level and state rating of the patient are proposed. Its application could provide a compass for the general practitioner's best choice and use of the myriad of healthcare educational and technological options available with lower costs for everyday clinical practice and research. It could advance the approaches and focus of the 'eras of diseases', to the promising 'era of health', in an integrated, general approach to 'health.'

  6. What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?

    Science.gov (United States)

    Galasko, Gavin I W; Barnes, Sophie C; Collinson, Paul; Lahiri, Avijit; Senior, Roxy

    2006-01-01

    To assess the screening characteristics and cost-effectiveness of screening for left ventricular systolic dysfunction (LVSD) in community subjects. A total of 1392 members of the general public and 928 higher risk subjects were randomly selected from seven community practices. Attending subjects underwent an ECG, N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels, and traditional echocardiography (TE). A total of 533 consecutive subjects underwent hand-held echocardiography (HE). The screening characteristics and cost-effectiveness (cost per case of LVSD diagnosed) of eight strategies to predict LVSD (LVSD cost-effective, screening low-risk subjects least cost-effective. TE screening was the least cost-effective strategy. NTproBNP screening gave similar cost savings to ECG screening; HE screening greater cost-savings, and HE screening following NTproBNP or ECG pre-screening the greatest cost-savings, costing approximately 650 Euros per case of LVSD diagnosed in high-risk subjects (63% cost-savings vs.TE). Thus several different modalities allow cost-effective community-based screening for LVSD, especially in high-risk subjects. Such programmes would be cost-effective and miss few cases of LVSD in the community.

  7. Effectiveness and cost-effectiveness of the pharmacological treatment of Alzheimer's disease and vascular dementia.

    Science.gov (United States)

    Versijpt, Jan

    2014-01-01

    Until an effective and especially disease-modifying treatment for Alzheimer's disease (AD) and vascular dementia (VaD) is available, the currently available pharmacological therapeutic arsenal aims at merely improving symptomatology. Health economic data make an important contribution to the planning of healthcare services and the estimation of the cost of drug reimbursement. As such, both for cholinesterase inhibitors and, to a lesser extent, for memantine it can be claimed that the direct cost of the drug itself is eclipsed by the cost savings associated with delaying institutionalization or delaying the time of progression into a more severe disease state. The present manuscript reviews several factors contributing to the costs of dementia, gives an overview of available studies claiming both the effectiveness and cost-effectiveness of current dementia treatments, and highlights strengths and weaknesses of the aforementioned studies.

  8. Cost effective Internet access and video conferencing for a community cancer network.

    Science.gov (United States)

    London, J W; Morton, D E; Marinucci, D; Catalano, R; Comis, R L

    1995-01-01

    Utilizing the ubiquitous personal computer as a platform, and Integrated Services Digital Network (ISDN) communications, cost effective medical information access and consultation can be provided for physicians at geographically remote sites. Two modes of access are provided: information retrieval via the Internet, and medical consultation video conferencing. Internet access provides general medical information such as current treatment options, literature citations, and active clinical trials. During video consultations, radiographic and pathology images, and medical text reports (e.g., history and physical, pathology, radiology, clinical laboratory reports), may be viewed and simultaneously annotated by either video conference participant. Both information access modes have been employed by physicians at community hospitals which are members of the Jefferson Cancer Network, and oncologists at Thomas Jefferson University Hospital. This project has demonstrated the potential cost effectiveness and benefits of this technology.

  9. The Effectiveness, Costs and Coastal Protection Benefits of Natural and Nature-Based Defences.

    Science.gov (United States)

    Narayan, Siddharth; Beck, Michael W; Reguero, Borja G; Losada, Iñigo J; van Wesenbeeck, Bregje; Pontee, Nigel; Sanchirico, James N; Ingram, Jane Carter; Lange, Glenn-Marie; Burks-Copes, Kelly A

    2016-01-01

    There is great interest in the restoration and conservation of coastal habitats for protection from flooding and erosion. This is evidenced by the growing number of analyses and reviews of the effectiveness of habitats as natural defences and increasing funding world-wide for nature-based defences-i.e. restoration projects aimed at coastal protection; yet, there is no synthetic information on what kinds of projects are effective and cost effective for this purpose. This paper addresses two issues critical for designing restoration projects for coastal protection: (i) a synthesis of the costs and benefits of projects designed for coastal protection (nature-based defences) and (ii) analyses of the effectiveness of coastal habitats (natural defences) in reducing wave heights and the biophysical parameters that influence this effectiveness. We (i) analyse data from sixty-nine field measurements in coastal habitats globally and examine measures of effectiveness of mangroves, salt-marshes, coral reefs and seagrass/kelp beds for wave height reduction; (ii) synthesise the costs and coastal protection benefits of fifty-two nature-based defence projects and; (iii) estimate the benefits of each restoration project by combining information on restoration costs with data from nearby field measurements. The analyses of field measurements show that coastal habitats have significant potential for reducing wave heights that varies by habitat and site. In general, coral reefs and salt-marshes have the highest overall potential. Habitat effectiveness is influenced by: a) the ratios of wave height-to-water depth and habitat width-to-wavelength in coral reefs; and b) the ratio of vegetation height-to-water depth in salt-marshes. The comparison of costs of nature-based defence projects and engineering structures show that salt-marshes and mangroves can be two to five times cheaper than a submerged breakwater for wave heights up to half a metre and, within their limits, become more cost

  10. The Effectiveness, Costs and Coastal Protection Benefits of Natural and Nature-Based Defences.

    Directory of Open Access Journals (Sweden)

    Siddharth Narayan

    Full Text Available There is great interest in the restoration and conservation of coastal habitats for protection from flooding and erosion. This is evidenced by the growing number of analyses and reviews of the effectiveness of habitats as natural defences and increasing funding world-wide for nature-based defences-i.e. restoration projects aimed at coastal protection; yet, there is no synthetic information on what kinds of projects are effective and cost effective for this purpose. This paper addresses two issues critical for designing restoration projects for coastal protection: (i a synthesis of the costs and benefits of projects designed for coastal protection (nature-based defences and (ii analyses of the effectiveness of coastal habitats (natural defences in reducing wave heights and the biophysical parameters that influence this effectiveness. We (i analyse data from sixty-nine field measurements in coastal habitats globally and examine measures of effectiveness of mangroves, salt-marshes, coral reefs and seagrass/kelp beds for wave height reduction; (ii synthesise the costs and coastal protection benefits of fifty-two nature-based defence projects and; (iii estimate the benefits of each restoration project by combining information on restoration costs with data from nearby field measurements. The analyses of field measurements show that coastal habitats have significant potential for reducing wave heights that varies by habitat and site. In general, coral reefs and salt-marshes have the highest overall potential. Habitat effectiveness is influenced by: a the ratios of wave height-to-water depth and habitat width-to-wavelength in coral reefs; and b the ratio of vegetation height-to-water depth in salt-marshes. The comparison of costs of nature-based defence projects and engineering structures show that salt-marshes and mangroves can be two to five times cheaper than a submerged breakwater for wave heights up to half a metre and, within their limits, become

  11. The cost-effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost-utility analysis.

    Science.gov (United States)

    Sutton, A J; Edmunds, W J; Sweeting, M J; Gill, O N

    2008-11-01

    Prisoners have a high prevalence of hepatitis C virus (HCV) infection compared with the general population in England and Wales and in many locations throughout the world. This is because of large numbers of injecting drug users that engage in behaviours likely to transmit HCV being present within prison populations. It is, therefore, suggested that prison may be an appropriate location for HCV screening and treatment to be administered. Using cost-utility analysis, this study considers the costs and benefits of administering a single round of screening on reception into prison to all individuals followed by possible later screening in the community and comparing this to individuals who may only be tested and treated in the community at a later date. The cost/QALY of one round of prison testing and treatment was found to be 54,852 pounds sterling, although probabilistic sensitivity analysis showed extensive uncertainty about this estimate. One-way sensitivity analysis revealed the importance of the parameters describing the progression of chronic HCV and the discount rates. While the results presented here at baseline would suggest that screening and treatment for HCV in prisons is not cost-effective, these results are subject to much uncertainty. The importance of the rates describing the progression of chronic HCV on the cost-effectiveness of this intervention has been demonstrated and this suggests that future work should be undertaken to gain further insight into the rates that individuals progress to the later stages of chronic HCV infection.

  12. Valuation of road safety effects in cost-benefit analysis.

    Science.gov (United States)

    Wijnen, Wim; Wesemann, Paul; de Blaeij, Arianne

    2009-11-01

    Cost-benefit analysis is a common method for evaluating the social economic impact of transport projects, and in many of these projects the saving of human lives is an issue. This implies, within the framework of cost-benefit analysis, that a monetary value should be attached to saving human lives. This paper discusses the 'Value of a Statistical Life' (VoSL), a concept that is often used for monetising safety effects, in the context of road safety. Firstly, the concept of 'willingness to pay' for road safety and its relation to the VoSL are explained. The VoSL approach will be compared to other approaches to monetise safety effects, in particular the human capital approach and 'quality adjusted life years'. Secondly, methods to estimate the VoSL and their applicability to road safety will be discussed. Thirdly, the paper reviews the VoSL estimates that have been found in scientific research and compares them with the values that are used in policy evaluations. Finally, a VoSL study in the Netherlands will be presented as a case study, and its applicability in policy evaluation will be illustrated.

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

    Science.gov (United States)

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

    2014-01-01

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

  14. The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Lesong Conteh

    still remain highly cost effective in all sites where IPTi had a statistically significant effect on clinical malaria. CONCLUSIONS: IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective.

  15. The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa.

    Science.gov (United States)

    Conteh, Lesong; Sicuri, Elisa; Manzi, Fatuma; Hutton, Guy; Obonyo, Benson; Tediosi, Fabrizio; Biao, Prosper; Masika, Paul; Matovu, Fred; Otieno, Peter; Gosling, Roly D; Hamel, Mary; Odhiambo, Frank O; Grobusch, Martin P; Kremsner, Peter G; Chandramohan, Daniel; Aponte, John J; Egan, Andrea; Schellenberg, David; Macete, Eusebio; Slutsker, Laurence; Newman, Robert D; Alonso, Pedro; Menéndez, Clara; Tanner, Marcel

    2010-06-15

    all sites where IPTi had a statistically significant effect on clinical malaria. IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective.

  16. Cost Effectiveness Analysis of Antibiotic Used among Sepsis Patients in Hospital in Bandung

    Directory of Open Access Journals (Sweden)

    Cherry Rahayu

    2013-06-01

    Full Text Available The aim of this study was to determine the antibiotic combination group that were the most effective in cost (cost effectiveness used as sepsis with respiratory infections treatment at one of hospital in Bandung. Observational study was conducted by retrospective data. Data were collected from medical record from inpatients sepsis with respiratory infection and received empirical therapy cefotaxime-metronidazole or cefotaxime-erythromycin. Direct medical cost is collected from empirical antibiotic costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The results of Incremental Cost Effectiveness Ratio (ICER showed that ratio of direct medical cost and survived patients is 3.301.090,00 IDR for cefotaxime-metronidazole that compared to other empirical antibiotic, and 2.227.366,89 IDR for cefotaxime-erythromycin. It can be conclude that the combination of cefotaxime-erythromycin is more cost effective than cefotaxime-metronidazole.

  17. Analysis of the Effect of Employee Costs on Company Performance

    Directory of Open Access Journals (Sweden)

    Željko Požega

    2010-07-01

    Full Text Available The goal of every economic entity is to accomplish an optimal system of compensation management and to reach maximum returns through optimal employee investment, raising their motivation and knowledge as well as developing their abilities and skills. In order to reach this goal of maximizing company performance it is necessary to systematically approach the management of human resources within a certain economic entity and to create the fairest material and non-material reward and punishment system by using compensation management methods. This in turn will bring about a positive working atmosphere in the company, where employees will rapidly and easily adjust to changes, interact and co-operate with one another at a high level. This research, which studies the effect of employee costs on company performance, is divided into three chapters. The first chapter provides a brief theoretical overview of the importance of compensation management in human resources administration and reaching business efficiency, i.e. the different possibilities of creating a reward and punishment system in a company which aims to organise an optimal working atmosphere. The second chapter demonstrates the applied methodology and illustrates the information from different companies, which has been used in this research and analysis. The information comprises statistical data of employee costs, income, profits and losses from a sample of companies from the Republic of Croatia in 2008. The third part deals with the analysis and interpretation of the research results which show the effect of employee costs on the income and company performance, also expressed per employee. The goal of this research is to test the hypothesis that companies with higher employee cost, i.e. with higher investment in human resources, on average obtain a higher income and a higher profit per employee and are more efficient and more successful on the market. From the given hypothesis, one can

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-29

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

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

    Directory of Open Access Journals (Sweden)

    Shiv Prakash Bihari

    2016-03-01

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

  20. A dynamic perspective on pharmaceutical competition, drug development and cost effectiveness.

    Science.gov (United States)

    Refoios Camejo, Rodrigo; McGrath, Clare; Herings, Ron

    2011-04-01

    Limited healthcare budgets result in payers adopting policies at national, regional or local level to achieve allocative efficiency in drug spending. Some of these aim at creating a link between pharmaceutical prices and the value they provide by setting a cost effectiveness (CE) threshold as the maximum acceptable ratio between incremental costs and effects of new drugs. The clinical effectiveness of the comparator used in those CE analyses tends to be greater over time, whilst, due to market competition and loss of exclusivity, their price is expected to be lower. At the same time, research and development (R&D) costs increase with inflation and with efforts to address regulation towards increased safety concerns. As effective patent times decrease, a minimum price constraint raises for the new entrant. These features occur at different rates across disease areas and are expected to result in differently shaped innovation curves. In this scenario, we demonstrate that a general arbitrary threshold may prevent further efficient R&D. Investment may be withdrawn before the optimum innovation point is reached and affordable clinical effectiveness may be lost. We conclude that disease-specific characteristics are an additional consideration in CE decision rules to accommodate the particularities of innovation across disease areas.

  1. National Research Council Dialogue to Assess Progress on NASA's Systems Engineering Cost/Risk Analysis Capability Roadmap Development: General Background and Introduction

    Science.gov (United States)

    Regenie, Victoria

    2005-01-01

    Contents include the following: General Background and Introduction of Capability. Roadmaps for Systems Engineering Cost/Risk Analysis. Agency Objectives. Strategic Planning Transformation. Review Capability Roadmaps and Schedule. Review Purpose of NRC Review. Capability Roadmap Development (Progress to Date).

  2. The value of heterogeneity for cost-effectiveness subgroup analysis: conceptual framework and application.

    Science.gov (United States)

    Espinoza, Manuel A; Manca, Andrea; Claxton, Karl; Sculpher, Mark J

    2014-11-01

    This article develops a general framework to guide the use of subgroup cost-effectiveness analysis for decision making in a collectively funded health system. In doing so, it addresses 2 key policy questions, namely, the identification and selection of subgroups, while distinguishing 2 sources of potential value associated with heterogeneity. These are 1) the value of revealing the factors associated with heterogeneity in costs and outcomes using existing evidence (static value) and 2) the value of acquiring further subgroup-related evidence to resolve the uncertainty given the current understanding of heterogeneity (dynamic value). Consideration of these 2 sources of value can guide subgroup-specific treatment decisions and inform whether further research should be conducted to resolve uncertainty to explain variability in costs and outcomes. We apply the proposed methods to a cost-effectiveness analysis for the management of patients with acute coronary syndrome. This study presents the expected net benefits under current and perfect information when subgroups are defined based on the use and combination of 6 binary covariates. The results of the case study confirm the theoretical expectations. As more subgroups are considered, the marginal net benefit gains obtained under the current information show diminishing marginal returns, and the expected value of perfect information shows a decreasing trend. We present a suggested algorithm that synthesizes the results to guide policy.

  3. Assessing the Battery Cost at Which Plug-In Hybrid Medium-Duty Parcel Delivery Vehicles Become Cost-Effective

    Energy Technology Data Exchange (ETDEWEB)

    Ramroth, L. A.; Gonder, J. D.; Brooker, A. D.

    2013-04-01

    The National Renewable Energy Laboratory (NREL) validated diesel-conventional and diesel-hybrid medium-duty parcel delivery vehicle models to evaluate petroleum reductions and cost implications of hybrid and plug-in hybrid diesel variants. The hybrid and plug-in hybrid variants are run on a field data-derived design matrix to analyze the effect of drive cycle, distance, engine downsizing, battery replacements, and battery energy on fuel consumption and lifetime cost. For an array of diesel fuel costs, the battery cost per kilowatt-hour at which the hybridized configuration becomes cost-effective is calculated. This builds on a previous analysis that found the fuel savings from medium duty plug-in hybrids more than offset the vehicles' incremental price under future battery and fuel cost projections, but that they seldom did so under present day cost assumptions in the absence of purchase incentives. The results also highlight the importance of understanding the application's drive cycle specific daily distance and kinetic intensity.

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    NARCIS (Netherlands)

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

    2005-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-02-15

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