Forestry-related pathways for the movement of exotic plant pests into and within the greater Caribbean region

Science.gov (United States)

Leslie Newton; Heike Meissner; Andrea. Lemay

2011-01-01

Forests of the Greater Caribbean Region (GCR) are important ecologically and economically. These unique ecosystems are under increasing pressure from exotic pests, which may cause extensive environmental damage and cost billions of dollars in control programs, lost production, and forest restoration.

Intangible costs of alcohol dependence from the perspective of patients and their relatives: A contingent valuation study.

Science.gov (United States)

Mosquera Nogueira, Jacinto; Rodríguez-Míguez, Eva

2018-04-15

Alcohol dependence causes multiple problems not only for the person suffering dependence but also for others. In this study, the contingent valuation method is proposed to measure the intangible effects of alcohol dependence from the perspective of the persons directly involved: the patients and their relatives. Interviews were conducted with 145 patients and 61 relatives. Intangible effects of alcohol dependence were determined based on willingness to pay for a hypothetical treatment for dependence, with different success scenarios (100% and 50%). The mean monthly willingness to pay among the alcohol-dependent population was €129 and €168, respectively, for the treatments with 100% and 50% success. The willingness to pay of relatives was greater in both scenarios (€307 and €420, respectively), which could be explained by their greater perception of the family, labour, and health problems resulting from alcohol dependence. Regression analysis showed that patients' willingness to pay is positively related to treatment efficacy, personal income and moderate health deterioration, and negatively related to feeling discouraged and depressed. The results from this study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence. The intangible costs estimated can be added to the direct and indirect costs commonly used.

Unpaid ecological costs related to emissions in the air

International Nuclear Information System (INIS)

Moreau, Sylvain; Bottin, Anne; Nauroy, Frederic; Boitard, Corinne; Bird, Geoffrey; David, Michel; Greffet, Pierre; Mordant, Guillaume; Moreau, Sylvain; Nirascou, Francoise; Le Moullec, Aurelie; Berthier, Jean-Pierre; Hassan, Marie-Elizabeth; Curri-Lemaitre, Elen; Lagarenne, Christine; Devaux, Jeremy; Nicklaus, Doris; Puydarrieux, Philippe; Vanoli, Andre; Schucht, Simone

2014-05-01

This study proposes an analysis of unpaid ecological terms based on the use of new economic indicators related to sustainable development (going beyond the GDP, adjusted accounting aggregates, accounting unpaid ecological costs), an analysis of unpaid ecological costs related to climate change (context, used results and data, definitions of trajectories associated with greenhouse gas emissions, cost to be applied to emissions to get rid of, assessment of unpaid ecological costs), and an analysis of unpaid ecological costs related to air pollution (objectives, standard to be adopted, towards more ambitious emission reduction and re-assessed costs, unpaid ecological costs in 2010)

Relative costs to nuclear plants: international experience

International Nuclear Information System (INIS)

Souza, Jair Albo Marques de

1992-03-01

This work approaches the relative costs to nuclear plants in the Brazil. It also presents the calculation methods and its hypothesis to determinate the costs, and the nacional experience in costs of investment, operating and maintenance of the nuclear plants

Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

Science.gov (United States)

Hoque, Mohammad Enamul; Dasgupta, Sushil Kanta; Naznin, Eva; Al Mamun, Abdullah

2015-10-01

This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication. © 2015 John Wiley & Sons Ltd.

[Cost effectiveness of workplace smoking policies].

Science.gov (United States)

Raaijmakers, Tamara; van den Borne, Inge

2003-01-01

This study reviews the motivations of companies to set out a policy for controlling smoking, the economic benefits for the company resulting from such a policy and the costs, broken down by European Union countries. The literature on the costs of implementing a policy related to smoking at the workplace is reviewed. The main objective of policies related to smoking at the workplace is that of safeguarding employees from environmental tobacco smoke. Other reasons are cutting costs, improving the company image, and reducing absenteeism, occupational accidents, internal quarrels and extra costs due to cigarette smoking, protection against environmental tobacco smoke does not entail any higher costs for companies, and economic advantages are visible. The benefits are by far greater than the costs involved, particularly on a long-range basis, and seem to be greater when smoking at the workplace is completely prohibited and no smoking areas are set.

Alcohol- and drug-related absenteeism: a costly problem.

Science.gov (United States)

Roche, Ann; Pidd, Ken; Kostadinov, Victoria

2016-06-01

Absenteeism related to alcohol and other drug (AOD) use can place a substantial burden on businesses and society. This study estimated the cost of AOD-related absenteeism in Australia using a nationally representative dataset. A secondary analysis of the 2013 National Drug Strategy Household Survey (n=12,196) was undertaken. Two measures of AOD-related absenteeism were used: participants' self-reported absence due to AOD use (M1); and the mean difference in absence due to any illness/injury for AOD users compared to abstainers (M2). Both figures were multiplied by $267.70 (average day's wage in 2013 plus 20% on-costs) to estimate associated costs. M1 resulted in an estimation of 2.5 million days lost annually due to AOD use, at a cost of more than $680 million. M2 resulted in an estimation of almost 11.5 million days lost, at a cost of $3 billion. AOD-related absenteeism represents a significant and preventable impost upon Australian businesses. Workplaces should implement evidence-based interventions to promote healthy employee behaviour and reduce AOD-related absenteeism. © 2015 Public Health Association of Australia.

The cost of HIV/AIDS-related morbidity and mortality to households: Preliminary estimates for Soweto

Directory of Open Access Journals (Sweden)

V Naidu

2014-06-01

Full Text Available This article has two main aims: to provide data on the cost of HIV/AIDS to urban South African households and to contribute to the development of a methodology that could be used in later studies. Data on the costs of HIV/AIDS-related morbidity and mortality were collected from a purposively selected sample of households in Soweto on four occasions between September 2002 and August 2003. The sample comprised 61 affected households, which had at least one member with a CD4 count of 200 or less at the start of the study, and 52 non-affected households. Three types of costs were examined – financial, economic and the present value of lost future earnings. The data suggest that the financial costs of morbidity and mortality were three and two times greater, respectively, for affected households than for those non-affected households that reported disease and/or death. Mortality costs far exceeded morbidity costs. The present value of lost future earnings, where the deceased had previously been an income earner, proved to be the major cost incurred by an affected household.

Relational Climate and Health Care Costs: Evidence From Diabetes Care.

Science.gov (United States)

Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K

2018-01-01

Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.

Comparisons of hypertension-related costs from multinational clinical studies.

Science.gov (United States)

Mullins, C Daniel; Sikirica, Mirko; Seneviratne, Viran; Ahn, Jeonghoon; Akhras, Kasem S

2004-01-01

This study identifies and compares the individual cost components of hospital and ambulatory services that manage the care of hypertensive patients in eight countries: the US, the UK, France, Spain, Germany, Italy, Canada and Australia. Hypertension-related costs are classified according to four major cardiovascular events: (i) acute myocardial infarction; (ii) congestive heart failure; (iii) stroke; and (iv) renal failure, which was subdivided into renal failure treated by dialysis and renal failure treated by kidney transplantation. To make cross-country costs comparisons, we used the DRG codes used in the US and DRG-like codes from each country. US cost information was obtained from hypertension data available from the literature and health economics researchers. For costs in other countries, we consulted with national health economics experts in each country, used analyses by the Research Triangle Institute, and performed Medline and international literature searches. When available, we obtained information from the countries' public and private nationally representative data sources. For cross-country currency adjustments, all currencies were converted using the Purchasing Power Parities from the Organisation for Economic Cooperation and Development, and then converted into inflation-adjusted year 2000 US dollars. There exists considerable variation in hypertension-related costs from multinational clinical studies. This study documents that costs are generally higher in the US than in other countries; however, this is not always true. In particular, costs of treating heart failure in France and the costs of renal failure without transplantation in Germany and the UK are relatively high. While analysing multinational hypertensive cost data, this study also addresses the impact of cross-country cost variations on cost analyses. During the last decade, drug-development researchers have drawn extensively upon multinational trials to resolve enrollment problems and

Does increasing community and liquor licensees' awareness, police activity, and feedback reduce alcohol-related violent crime? A benefit-cost analysis.

Science.gov (United States)

Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M; Petrie, Dennis J

2013-10-28

Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees' awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.

Does Increasing Community and Liquor Licensees’ Awareness, Police Activity, and Feedback Reduce Alcohol-Related Violent Crime? A Benefit-Cost Analysis

Science.gov (United States)

Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M.; Petrie, Dennis J.

2013-01-01

Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions. PMID:24169411

Does Increasing Community and Liquor Licensees’ Awareness, Police Activity, and Feedback Reduce Alcohol-Related Violent Crime? A Benefit-Cost Analysis

Directory of Open Access Journals (Sweden)

Dennis J. Petrie

2013-10-01

Full Text Available Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.

Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

Science.gov (United States)

Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

2016-09-01

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

Socio-economic considerations of cleaning Greater Vancouver's air

International Nuclear Information System (INIS)

2005-08-01

Socio-economic considerations of better air quality on the Greater Vancouver population and economy were discussed. The purpose of the study was to provide socio-economic information to staff and stakeholders of the Greater Vancouver Regional District (GVRD) who are participating in an Air Quality Management Plan (AQMP) development process and the Sustainable Region Initiative (SRI) process. The study incorporated the following methodologies: identification and review of Canadian, American, and European quantitative socio-economic, cost-benefit, cost effectiveness, competitiveness and health analyses of changes in air quality and measures to improve air quality; interviews with industry representatives in Greater Vancouver on competitiveness impacts of air quality changes and ways to improve air quality; and a qualitative analysis and discussion of secondary quantitative information that identifies and evaluates socio-economic impacts arising from changes in Greater Vancouver air quality. The study concluded that for the Greater Vancouver area, the qualitative analysis of an improvement in Greater Vancouver air quality shows positive socio-economic outcomes, as high positive economic efficiency impacts are expected along with good social quality of life impacts. 149 refs., 30 tabs., 6 appendices

Cost of care for subjective tinnitus in relation to patient satisfaction.

Science.gov (United States)

Goldstein, Eric; Ho, Chuan-Xing; Hanna, Rania; Elinger, Clara; Yaremchuk, Kathleen L; Seidman, Michael D; Jesse, Michelle T

2015-03-01

A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures. A retrospective chart review and a patient satisfaction questionnaire. All data were collected from a large Midwestern hospital. Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales. Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453). Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Analysis of medication-related malpractice claims: causes, preventability, and costs.

Science.gov (United States)

Rothschild, Jeffrey M; Federico, Frank A; Gandhi, Tejal K; Kaushal, Rainu; Williams, Deborah H; Bates, David W

2002-11-25

Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention. We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs. Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64,700-74,200), but costs were considerably greater for preventable inpatient ADEs (mean, $376,500). Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.

Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

Science.gov (United States)

Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

2016-01-01

Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation-related

Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

Science.gov (United States)

Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

2010-04-01

Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

Cost of work-related injuries in insured workplaces in Lebanon.

OpenAIRE

Fayad, Rim; Nuwayhid, Iman; Tamim, Hala; Kassak, Kassem; Khogali, Mustafa

2003-01-01

OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics. METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims. FINDINGS: ...

The ability of land owners and their cooperatives to leverage payments greater than opportunity costs from conservation contracts.

Science.gov (United States)

Lennox, Gareth D; Armsworth, Paul R

2013-06-01

In negotiations over land-right acquisitions, landowners have an informational advantage over conservation groups because they know more about the opportunity costs of conservation measures on their sites. This advantage creates the possibility that landowners will demand payments greater than the required minimum, where this minimum required payment is known as the landowner’s willingness to accept (WTA). However, in recent studies of conservation costs, researchers have assumed landowners will accept conservation with minimum payments. We investigated the ability of landowners to demand payments above their WTA when a conservation group has identified multiple sites for protection. First, we estimated the maximum payment landowners could potentially demand, which is set when groups of landowners act as a cooperative. Next, through the simulation of conservation auctions, we explored the amount of money above landowners’ WTA (i.e., surplus) that conservation groups could cede to secure conservation agreements, again investigating the influence of landowner cooperatives. The simulations showed the informational advantage landowners held could make conservation investments up to 42% more expensive than suggested by the site WTAs. Moreover, all auctions resulted in landowners obtaining payments greater than their WTA; thus, it may be unrealistic to assume landowners will accept conservation contracts with minimum payments. Of particular significance for species conservation, conservation objectives focused on overall species richness,which therefore recognize site complementarity, create an incentive for land owners to form cooperatives to capture surplus. To the contrary, objectives in which sites are substitutes, such as the maximization of species occurrences, create a disincentive for cooperative formation.

48 CFR 231.205-1 - Public relations and advertising costs.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Public relations and... PROCEDURES Contracts With Commercial Organizations 231.205-1 Public relations and advertising costs. (e) See... public relations and advertising costs also include monies paid to the Government associated with the...

12 CFR 714.5 - What is required if you rely on an estimated residual value greater than 25% of the original cost...

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false What is required if you rely on an estimated residual value greater than 25% of the original cost of the leased property? 714.5 Section 714.5 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS LEASING § 714.5 What is...

10 CFR 72.108 - Spent fuel, high-level radioactive waste, or reactor-related greater than Class C waste...

Science.gov (United States)

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Spent fuel, high-level radioactive waste, or reactor... RADIOACTIVE WASTE, AND REACTOR-RELATED GREATER THAN CLASS C WASTE Siting Evaluation Factors § 72.108 Spent fuel, high-level radioactive waste, or reactor-related greater than Class C waste transportation. The...

Cost-effectiveness modeling for neuropathic pain treatments: investigating the relative importance of parameters using an open-source model.

Science.gov (United States)

Hirst, Matthew; Bending, Matthew W; Baio, Gianluca; Yesufu-Udechuku, Amina; Dunlop, William C N

2018-06-08

The study objective was to develop an open-source replicate of a cost-effectiveness model developed by National Institute for Health and Care (NICE) in order to explore uncertainties in health economic modeling of novel pharmacological neuropathic pain treatments. The NICE model, consisting of a decision tree with branches for discrete levels of pain relief and adverse event (AE) severities, was replicated using R and used to compare a hypothetical neuropathic pain drug to pregabalin. Model parameters were sourced from NICE's clinical guidelines and associated with probability distributions to account for underlying uncertainty. A simulation-based scenario analysis was conducted to assess how uncertainty in efficacy and AEs affected the net monetary benefit (NMB) for the hypothetical treatment at a cost-effectiveness threshold of £20,000 per QALY. Relative to pregabalin, an increase in efficacy was associated with greater NMB than an improvement in tolerability. A greater NMB was observed when efficacy was marginally higher than that of pregabalin while maintaining the same level of AEs than when efficacy was equivalent to pregabalin but with a more substantial reduction in AEs. In the latter scenario, the NMB was only positive at a low cost-effectiveness threshold. The replicate model shares the limitations described in the NICE guidelines. There is a lack of support in scientific literature for the assumption that increased efficacy is associated with a greater reduction in tolerability. The replicate model also included a single comparator, unlike the NICE model. Pain relief is a stronger driver of NMB than tolerability at a cost-effectiveness threshold of £20,000 per QALY. Health technology assessment decisions which are influenced by NICE's model may reward efficacy gains even if they are associated with more severe AEs. This contrasts with recommendations from clinical guidelines for neuropathic pain which place more equal weighting on improvements in

48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true FEHBP public relations and... COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-70 FEHBP public relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP...

Costs and compensation of work‐related injuries in British Columbia sawmills

Science.gov (United States)

Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

2007-01-01

Objective To estimate the costs of work‐related injury in a cohort of sawmill workers in British Columbia from the perspective of the workers' compensation system. Methods Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5786 actively employed sawmill workers. A total of 173 work‐related injury cases were identified from these records using the International classification of diseases—ninth revision (ICD‐9) external cause of injury codes and the responsibility of payment schedule. Workers' compensation records were extracted and matched with hospital records by dates and ICD‐9 diagnosis codes. All costs were converted into 1995 constant Canadian dollars using the Provincial General Consumer Price Index for the non‐healthcare costs and Medical Consumer Price Index for the healthcare costs. A 5% discounting rate was applied to adjust for the time value of money. For the uncompensated cases, costs were imputed from the compensated cases using the median cost for a similar nature of injury. Results 370 hospitalisation events due to injury were captured, and by either of the two indicators (E Codes or payment schedules), 173 (47%) hospitalisation events due to injury, were identified as work related. The median healthcare cost was $4377 and the median non‐healthcare cost was $16 559 for a work‐related injury. The median non‐healthcare and healthcare costs by injury were falls, $19 978 and $5185; struck by falling object, $32 398 and $8625; struck against, $12 667 and $5741; machinery related, $26 480 and $6643; caught in or between, $24 130 and $4389; and overexertion, $7801 and $2710. The total cost was $10 374 115 for non‐healthcare and $1 764 137 for healthcare. The compensation agency did not compensate $874 871 (8.4%) of the non‐healthcare costs and $200 588 (11.4%) of the healthcare costs. Conclusion Eliminating avoidable work‐related injury events can save valuable resources. PMID:17053018

Costs and compensation of work-related injuries in British Columbia sawmills.

Science.gov (United States)

Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

2007-03-01

To estimate the costs of work-related injury in a cohort of sawmill workers in British Columbia from the perspective of the workers' compensation system. Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5786 actively employed sawmill workers. A total of 173 work-related injury cases were identified from these records using the International classification of diseases-ninth revision (ICD-9) external cause of injury codes and the responsibility of payment schedule. Workers' compensation records were extracted and matched with hospital records by dates and ICD-9 diagnosis codes. All costs were converted into 1995 constant Canadian dollars using the Provincial General Consumer Price Index for the non-healthcare costs and Medical Consumer Price Index for the healthcare costs. A 5% discounting rate was applied to adjust for the time value of money. For the uncompensated cases, costs were imputed from the compensated cases using the median cost for a similar nature of injury. 370 hospitalisation events due to injury were captured, and by either of the two indicators (E Codes or payment schedules), 173 (47%) hospitalisation events due to injury, were identified as work related. The median healthcare cost was 4377 dollars and the median non-healthcare cost was 16,559 dollars for a work-related injury. The median non-healthcare and healthcare costs by injury were falls, 19,978 dollars and 5185 dollars; struck by falling object, 32,398 dollars and 8625 dollars; struck against, 12,667 dollars and 5741 dollars; machinery related, 26,480 dollars and 6643 dollars; caught in or between, 24,130 dollars and 4389 dollars; and overexertion, 7801 dollars and 2710 dollars. The total cost was 10,374,115 dollars for non-healthcare and 1,764,137 dollars for healthcare. The compensation agency did not compensate 874,871 dollars (8.4%) of the non-healthcare costs and 200,588 dollars (11.4%) of the healthcare costs. Eliminating avoidable work-related injury events

Economic Cost Analysis Related to Complications in General and Digestive Surgery.

Science.gov (United States)

Gomez-Rosado, Juan-Carlos; Salas-Turrens, Jose; Olry-de-Labry-Lima, Antonio

2018-04-21

The aim was to assess the impact on economic costs and length of stay (LOS) of postoperative complications. 5,822 records from BMDS (2014-2015) are included. A descriptive, univariate and multivariate study evaluated the correlation between complications, Clavien-Dindo grade and vacation periods with LOS and economic costs, based on a full-cost model, aggregated by DRG. Mean cost per stay was €676.71, and €4,309.02 per episode. Complications appeared in 639 patients (11%). Admission to ICU was required in 203 patients, re-operation in 134 and re-admission in 243, while 66 patients died (1.1%). Complications caused significantly longer LOS (20.08 vs 5.48 days) and higher economic cost (€11,670.31 vs €3,354.12); infectious complications were the most frequent and respiratory the most expensive (€20,428.53), together with ICU admission (€20,242.66). Clavien-Dindo grade correlated with greater LOS and costs (except gradev). During vacation periods, complications and LOS are increased, but costs of these complications and LOS did not differ significantly from complications detected in non-vacation periods. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

The Relationship Between Job Satisfaction and Productivity-Related Costs: A Longitudinal Analysis.

Science.gov (United States)

Arnold, Amélie E; Coffeng, Jennifer K; Boot, Cécile R L; van der Beek, Allard J; van Tulder, Maurits W; Nieboer, Dagmar; van Dongen, Johanna M

2016-09-01

The aim of this study was to examine the longitudinal relationship between job satisfaction and total productivity-related costs, and between job satisfaction and absenteeism and presenteeism costs separately. A secondary aim was to explore whether these relationships differed across job types. Linear generalized estimating equation analyses were used to explore the longitudinal relationships. To explore whether the relationships differed across job types, stratified analyses were performed. A significant relationship was found between job satisfaction and total productivity-related costs [β = &OV0556;-273; 95% confidence interval (95% CI): -407 to -200] and between job satisfaction and presenteeism costs (β = &OV0556;-276; 95% CI: -367 to -235), but not between job satisfaction and absenteeism costs. These relationships differed across job types. Higher levels of job satisfaction were longitudinally related to lower total productivity-related costs and presenteeism costs, but not to lower absenteeism costs. These relationships seem to differ across job types.

The hospital costs of treating work-related sawmill injuries in British Columbia.

Science.gov (United States)

Alamgir, Hasanat; Tompa, Emile; Koehoorn, Mieke; Ostry, Aleck; Demers, Paul A

2007-05-01

This study estimates the hospital costs of treating work-related injury among a cohort of sawmill workers in British Columbia. Hospital discharge records were extracted from 1989 to 1998 for a cohort of 5,876 actively employed sawmill workers. Injury cases were identified as work-related from these records using ICD-9 external cause of injury codes that indicate place of occurrence and the responsibility of payment schedule that identifies workers' compensation as being responsible for payment. The hospitals in British Columbia have a standard ward rate chart prepared annually by the provincial Ministry of Health to bill and collect payment from agency like workers' compensation agency. Costs were calculated from the hospital perspective using this billing chart. All costs were expressed in 1995 Canadian dollars. The workers' compensation claim records for this study population were extracted and matched with the hospitalised work-related injury records. Costs were also calculated for work-related hospitalisations that the hospital did not appear to be reimbursed for by the workers' compensation system. There were 173 injuries requiring hospitalisation during the 10-year followup period. The median stay in hospitals was 3 days and the median hospital costs were $847. The most costly cause of injury categories were fire, flame, natural and environmental and struck against with median costs of $10,575 and $1,206, respectively, while the least costly category was cutting and piercing with median costs of $296. The most costly nature of injury categories were burns and fracture of lower limb with median costs of $10,575 and $1,800, respectively, while the least costly category was dislocation, sprains and strains with median costs of $437. The total hospital costs for all the work-related injuries were $434,990. Out of a total hospital cost of $434,990 for the 173 work-related injuries, the provincial compensation agency apparently did not compensate $50,663 (12

48 CFR 2131.205-1 - Public relations and advertising costs.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Public relations and... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 2131.205-1 Public relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the following...

10 CFR 72.128 - Criteria for spent fuel, high-level radioactive waste, reactor-related greater than Class C waste...

Science.gov (United States)

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Criteria for spent fuel, high-level radioactive waste, reactor-related greater than Class C waste, and other radioactive waste storage and handling. 72.128... STORAGE OF SPENT NUCLEAR FUEL, HIGH-LEVEL RADIOACTIVE WASTE, AND REACTOR-RELATED GREATER THAN CLASS C...

Transaction-cost Expenditures and the Relative Performance of Mutual Funds

OpenAIRE

John M.R. Chalmers; Roger M. Edelen; Gregory B. Kadlec

1999-01-01

We directly estimate annual trading costs for a sample of equity mutual funds and find that these costs are large and exhibit substantial cross sectional variation. Trading costs average 0.78% of fund assets per year and have an inter-quartile range of 0.59%. Trading costs, like expense ratios, are negatively related to fund returns and we find no evidence that on average trading costs are recovered in higher gross fund returns. We find that our direct estimates of trading costs have more exp...

German EstSmoke: estimating adult smoking-related costs and consequences of smoking cessation for Germany.

Science.gov (United States)

Sonntag, Diana; Gilbody, Simon; Winkler, Volker; Ali, Shehzad

2018-01-01

We compared predicted life-time health-care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines. German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related diseases were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health-care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. Germany. German population of prevalent current, never and ex-smokers in 2009. Life-time cost and outcomes in current, never and ex-smokers. If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life-time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life-time costs between current smokers and ex-smokers by at least €1.7 billion. Modelling suggests that the life-time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health-care expenditures for current smokers by at least 4%. © 2017 Society for the Study of Addiction.

On the relation between cost and service models for general inventory systems

NARCIS (Netherlands)

Houtum, van G.J.J.A.N.; Zijm, W.H.M.

2000-01-01

In this paper, we present a systematic overview of possible relations between cost and service models for fairly general single- and multi-stage inventory systems. In particular, we relate various types of penalty costs in pure cost models to equivalent types of service measures in service models.

Induction-related cost of patients with acute myeloid leukaemia in France.

Science.gov (United States)

Nerich, Virginie; Lioure, Bruno; Rave, Maryline; Recher, Christian; Pigneux, Arnaud; Witz, Brigitte; Escoffre-Barbe, Martine; Moles, Marie-Pierre; Jourdan, Eric; Cahn, Jean Yves; Woronoff-Lemsi, Marie-Christine

2011-04-01

The economic profile of acute myeloid leukaemia (AML) is badly known. The few studies published on this disease are now relatively old and include small numbers of patients. The purpose of this retrospective study was to evaluate the induction-related cost of 500 patients included in the AML 2001 trial, and to determine the explanatory factors of cost. "Induction" patient's hospital stay from admission for "induction" to discharge after induction. The study was performed from the French Public Health insurance perspective, restrictive to hospital institution costs. The average management of a hospital stay for "induction" was evaluated according to the analytical accounting of Besançon University Teaching Hospital and the French public Diagnosis-Related Group database. Multiple linear regression was used to search for explanatory factors. Only direct medical costs were included: treatment and hospitalisation. Mean induction-related direct medical cost was estimated at €41,852 ± 6,037, with a mean length of hospital stay estimated at 36.2 ± 10.7 days. After adjustment for age, sex and performance status, only two explanatory factors were found: an additional induction course and salvage course increased induction-related cost by 38% (± 4) and 15% (± 1) respectively, in comparison to one induction. These explanatory factors were associated with a significant increase in the mean length of hospital stay: 45.8 ± 11.6 days for 2 inductions and 38.5 ± 15.5 if the patient had a salvage course, in comparison to 32.9 ± 7.7 for one induction (P cost for patients with AML.

Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis

DEFF Research Database (Denmark)

Wallman, Johan K; Eriksson, Jonas K; Nilsson, Jan-Åke

2016-01-01

between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs. RESULTS: Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work......OBJECTIVE: To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA). METHODS: Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005-2010. Health Assessment...... Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare...

Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D.

Science.gov (United States)

Blumberg, Dana M; Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; De Moraes, C Gustavo

2015-09-01

Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. Effect of the implementation of the Medicare Part D drug benefit. The change in cost-related nonadherence and the change in cost-reduction strategies. Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P cost-related nonadherence measures were female sex, younger age, lower income (implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical

Comparing the relative cost-effectiveness of diagnostic studies: a new model

International Nuclear Information System (INIS)

Patton, D.D.; Woolfenden, J.M.; Wellish, K.L.

1986-01-01

We have developed a model to compare the relative cost-effectiveness of two or more diagnostic tests. The model defines a cost-effectiveness ratio (CER) for a diagnostic test as the ratio of effective cost to base cost, only dollar costs considered. Effective cost includes base cost, cost of dealing with expected side effects, and wastage due to imperfect test performance. Test performance is measured by diagnostic utility (DU), a measure of test outcomes incorporating the decision-analytic variables sensitivity, specificity, equivocal fraction, disease probability, and outcome utility. Each of these factors affecting DU, and hence CER, is a local, not universal, value; these local values strongly affect CER, which in effect becomes a property of the local medical setting. When DU = +1 and there are no adverse effects, CER = 1 and the patient benefits from the test dollar for dollar. When there are adverse effects effective cost exceeds base cost, and for an imperfect test DU 1. As DU approaches 0 (worthless test), CER approaches infinity (no effectiveness at any cost). If DU is negative, indicating that doing the test at all would be detrimental, CER also becomes negative. We conclude that the CER model is a useful preliminary method for ranking the relative cost-effectiveness of diagnostic tests, and that the comparisons would best be done using local values; different groups might well arrive at different rankings. (Author)

Relative costs of anesthesiologist prepared, hospital pharmacy prepared and outsourced anesthesia drugs.

Science.gov (United States)

Jelacic, Srdjan; Craddick, Karen; Nair, Bala G; Bounthavong, Mark; Yeung, Kai; Kusulos, Dolly; Knutson, Jennifer A; Somani, Shabir; Bowdle, Andrew

2017-02-01

Anesthesia drugs can be prepared by anesthesia providers, hospital pharmacies or outsourcing facilities. The decision whether to outsource all or some anesthesia drugs is challenging since the costs associated with different anesthesia drug preparation methods remain poorly described. The costs associated with preparation of 8 commonly used anesthesia drugs were analyzed using a budget impact analysis for 4 different syringe preparation strategies: (1) all drugs prepared by anesthesiologist, (2) drugs prepared by anesthesiologist and hospital pharmacy, (3) drugs prepared by anesthesiologist and outsourcing facility, and (4) all drugs prepared by outsourcing facility. A strategy combining anesthesiologist and hospital pharmacy prepared drugs was associated with the lowest estimated annual cost in the base-case budget impact analysis with an annual cost of $225 592, which was lower than other strategies by a margin of greater than $86 000. A combination of anesthesiologist and hospital pharmacy prepared drugs resulted in the lowest annual cost in the budget impact analysis. However, the cost of drugs prepared by an outsourcing facility maybe lower if the capital investment needed for the establishment and maintenance of the US Pharmacopeial Convention Chapter compliant facility is included in the budget impact analysis. Copyright © 2016 Elsevier Inc. All rights reserved.

Relational Benefits & Costs in Social Media Brand Pages

OpenAIRE

Tsimonis, Georgios; Dimitriadis, Sergios

2014-01-01

Attracted by the rapid penetration of social media into society, firms are increasingly using them to offer interactive services to their customers, and to create or enhance their relationships with them. As the number of consumers who join brand pages on social media platforms raises, it brings to the front a new question: What relational benefits and costs arise from customer interactions with brands in social media? Thus, this study is an attempt to identify what benefits and costs users p...

Crime in relation to urban design. Case study: The Greater Cairo Region

Directory of Open Access Journals (Sweden)

Heba Adel

2016-09-01

Full Text Available Crime is a part of any social system and known to human communities since its origins. It differs from community to another, even within one community it doesn’t occur equally in all places and nor by the same way. It is also concentrated in some places more than others, sometimes increases, sometimes decreases, etc. Previous researches have proved that crime rate has significant correlation with different social factors: education levels, poverty rates and lack of social organization, while others have drawn the attention to its relation with the built environment. They proposed that crime occurs in places where both opportunities and criminals are available. The role of this paper is to identify urban circumstances related to crime occurrence within the Greater Cairo Region, and to propose different ways to reduce these crimes. Consecutively, agglomeration’s main districts were scrutinized according to social analysis, street-network pattern and land-use.

Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria

Directory of Open Access Journals (Sweden)

Maria Dimitrova

2017-08-01

Full Text Available ObjectiveHCV infection is a leading cause of chronic liver disease with long-term complications—extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital “Queen Joanna-ISUL” for 3-year period (2012–2014.MethodsIt is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital “Queen Joanna-ISUL” for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF, hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal–Wallis, and Friedman tests were used for statistical processing.Results76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839 with an average cost per patient 4,577 BGN (€2,340. Statistically significant correlation was observed between the total cost per patient from the different payers’ perspective and the Child-Pugh cirrhosis score.ConclusionHCV-related

The health-related social costs of alcohol in Belgium.

Science.gov (United States)

Verhaeghe, Nick; Lievens, Delfine; Annemans, Lieven; Vander Laenen, Freya; Putman, Koen

2017-12-16

Alcohol is associated with adverse health effects causing a considerable economic impact to society. A reliable estimate of this economic impact for Belgium is lacking. This is the aim of the study. A prevalence-based approach estimating the direct, indirect and intangible costs for the year 2012 was used. Attributional fractions for a series of health effects were derived from literature. The human capital approach was used to estimate indirect costs, while the concept of disability-adjusted life years was used to estimate intangible costs. Sensitivity and scenario analyses were conducted to assess the uncertainty around cost estimates and to evaluate the impact of alternative modelling assumptions. In 2012, total alcohol-attributable direct costs were estimated at €906.1 million, of which the majority were due to hospitalization (€743.7 million, 82%). The indirect costs amounted to €642.6 million, of which 62% was caused by premature mortality. Alcohol was responsible for 157,500 disability-adjusted life years representing €6.3 billion intangible costs. Despite a number of limitations intrinsic to this kind of research, the study can be considered as the most comprehensive analysis thus far of the health-related social costs of alcohol in Belgium.

Targeting the probability versus cost of feared outcomes in public speaking anxiety.

Science.gov (United States)

Nelson, Elizabeth A; Deacon, Brett J; Lickel, James J; Sy, Jennifer T

2010-04-01

Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed. Published by Elsevier Ltd.

48 CFR 31.205-1 - Public relations and advertising costs.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Public relations and... Organizations 31.205-1 Public relations and advertising costs. (a) Public relations means all functions and...; or (2) Maintaining or promoting reciprocal understanding and favorable relations with the public at...

Costs and revenues of investment in enterprise-related schooling.

NARCIS (Netherlands)

Hartog, J.; Groot, W.J.N.; Oosterbeek, H.

1994-01-01

In this paper, a general specification of the wage equation is used to derive a marginal revenue equation for enterprise-related schooling. The optimal amount of investment in enterprise-related schooling is found by equating the marginal revenues and marginal costs. For the empirical analysis, the

Modelling User-Costs in Life Cycle Cost-Benefit (LCCB) analysis

DEFF Research Database (Denmark)

Thoft-Christensen, Palle

2008-01-01

The importance of including user's costs in Life-Cycle Cost-Benefit analysis of structures is discussed in this paper. This is especially for bridges of great importance. Repair or/and failure of a bridge will usually result in user costs greater than the repair or replacement costs of the bridge...

Planning for greater-confinement disposal

International Nuclear Information System (INIS)

Gilbert, T.L.; Luner, C.; Meshkov, N.K.; Trevorrow, L.E.; Yu, C.

1984-01-01

This contribution is a progress report for preparation of a document that will summarize procedures and technical information needed to plan for and implement greater-confinement disposal (GCD) of low-level radioactive waste. Selection of a site and a facility design (Phase I), and construction, operation, and extended care (Phase II) will be covered in the document. This progress report is limited to Phase I. Phase I includes determination of the need for GCD, design alternatives, and selection of a site and facility design. Alternative designs considered are augered shafts, deep trenches, engineered structures, high-integrity containers, hydrofracture, and improved waste form. Design considerations and specifications, performance elements, cost elements, and comparative advantages and disadvantages of the different designs are covered. Procedures are discussed for establishing overall performance objectives and waste-acceptance criteria, and for comparative assessment of the performance and cost of the different alternatives. 16 references

Planning for greater-confinement disposal

International Nuclear Information System (INIS)

Gilbert, T.L.; Luner, C.; Meshkov, N.K.; Trevorrow, L.E.; Yu, C.

1984-01-01

This contribution is a progress report for preparation of a document that will summarize procedures and technical information needed to plan for and implement greater-confinement disposal (GCD) of low-level radioactive waste. Selection of a site and a facility design (Phase I), and construction, operation, and extended care (Phase II) will be covered in the document. This progress report is limited to Phase I. Phase I includes determination of the need for GCD, design alternatives, and selection of a site and facility design. Alternative designs considered are augered shafts, deep trenches, engineered structures, high-integrity containers, hydrofracture, and improved waste form. Design considerations and specifications, performance elements, cost elements, and comparative advantages and disadvantages of the different designs are covered. Procedures are discussed for establishing overall performance objecties and waste-acceptance criteria, and for comparative assessment of the performance and cost of the different alternatives. 16 refs

Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

Science.gov (United States)

Siskind, Dan; Harris, Meredith; Diminic, Sandra; Carstensen, Georgia; Robinson, Gail; Whiteford, Harvey

2014-11-01

A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status

Benefit-cost-risk analysis of alternatives for greater-confinement disposal of radioactive waste

International Nuclear Information System (INIS)

Gilbert, T.L.; Luner, C.; Peterson, J.M.

1983-01-01

Seven alternatives are included in the analysis: near-surface disposal; improved waste form; below-ground engineered structure; augered shaft; shale fracturing; shallow geologic repository; and high-level waste repository. These alternatives are representative generic facilities that span the range from low-level waste disposal practice to high-level waste disposal practice, tentatively ordered according to an expected increasing cost and/or effectiveness of confinement. They have been chosen to enable an assessment of the degree of confinement that represents an appropriate balance between public health and safety requirements and costs rather than identification of a specific preferred facility design. The objective of the analysis is to provide a comparative ranking of the alternatives on the basis of benefit-cost-risk considerations

Cost of tobacco-related diseases, including passive smoking, in Hong Kong.

Science.gov (United States)

McGhee, S M; Ho, L M; Lapsley, H M; Chau, J; Cheung, W L; Ho, S Y; Pow, M; Lam, T H; Hedley, A J

2006-04-01

Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking. To estimate the health-related costs of tobacco from both active and passive smoking. Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of USD 1.3 million for a life lost. In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was USD 532 million for active smoking and USD 156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to USD 9.4 billion. The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere.

Length of stay and associated costs of obesity related hospital admissions in Ireland.

LENUS (Irish Health Repository)

Vellinga, Akke

2008-01-01

BACKGROUND: Obesity is the cause of other chronic diseases, psychological problems, obesity shortens the lifespan and puts strain on health systems. The risk associated with childhood obesity in particular, which will accelerate the development of adult morbidity and mortality, has been identified as an emerging public health problem. METHODS: To estimate the length of stay and associated hospital costs for obesity related illnesses a cost of illness study was set up. All discharges from all acute hospitals in the Republic of Ireland from 1997 to 2004 with a principal or secondary diagnostic code for obesity for all children from 6 to 18 years of age and for adults were collected.A discharge frequency was calculated by dividing obesity related discharges by the total number of diagnoses (principal and secondary) for each year. The hospital costs related to obesity was calculated based on the total number of days care. RESULTS: The discharge frequency of obesity related conditions increased from 1.14 in 1997 to 1.49 in 2004 for adults and from 0.81 to 1.37 for children. The relative length of stay (number of days in care for obesity related conditions per 1000 days of hospital care given) increased from 1.47 in 1997 to 4.16 in 2004 for children and from 3.68 in 1997 to 6.74 in 2004 for adults.Based on the 2001 figures for cost per inpatient bed day, the annual hospital cost was calculated to be 4.4 Euromillion in 1997, increasing to 13.3 Euromillion in 2004. At a 20% variable hospital cost the cost ranges from 0.9 Euromillion in 1997 to 2.7 Euromillion in 2004; a 200% increase. CONCLUSION: The annual increase in the proportion of hospital discharges related to obesity is alarming. This increase is related to a significant increase in economic costs. This paper emphasises the need for action at an early stage of life. Health promotion and primary prevention of obesity should be high on the political agenda.

Does the cost of robotic cholecystectomy translate to a financial burden?

Science.gov (United States)

Rosemurgy, Alexander; Ryan, Carrie; Klein, Richard; Sukharamwala, Prashant; Wood, Thomas; Ross, Sharona

2015-08-01

Robotic application to cholecystectomy has dramatically increased, though its impact on cost of care and reimbursement has not been elucidated. We undertook this study to evaluate and compare cost of care and reimbursement with robotic versus laparoscopic cholecystectomy. The charges and reimbursement of all robotic and laparoscopic cholecystectomies at one hospital undertaken from June 2012 to June 2013 were determined. Operative duration is defined as time into and time out of the operating room. Data are presented as median data. Comparisons were undertaken using the Mann-Whitney U-test with significance accepted at p ≤ 0.05. Robotic cholecystectomy took longer (47 min longer) and had greater charges ($8,182.57 greater) than laparoscopic cholecystectomy (p depreciation, interest, and taxes (EBDIT), and Net Income were not impacted by approach. Relative to laparoscopic cholecystectomy, robotic cholecystectomy takes longer and has greater charges. Revenue, EBDIT, and Net Income are similar after either approach; this indicates that costs with either approach are similar. Notably, this is possible because much of hospital-based costs are determined by cost allocation and not cost accounting. Thus, the cost of longer operations and costs inherent to the robotic approach for cholecystectomy do not translate to a perceived financial burden.

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

DEFF Research Database (Denmark)

Parlesak, A.; Tetens, Inge; Dejgård Jensen, Jørgen

2016-01-01

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent...... both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear...... in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater...

Sequential optimization of matrix chain multiplication relative to different cost functions

KAUST Repository

Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail

2011-01-01

In this paper, we present a methodology to optimize matrix chain multiplication sequentially relative to different cost functions such as total number of scalar multiplications, communication overhead in a multiprocessor environment, etc. For n matrices our optimization procedure requires O(n 3) arithmetic operations per one cost function. This work is done in the framework of a dynamic programming extension that allows sequential optimization relative to different criteria. © 2011 Springer-Verlag Berlin Heidelberg.

Greater oil investment opportunities

International Nuclear Information System (INIS)

Arenas, Ismael Enrique

1997-01-01

Geologically speaking, Colombia is a very attractive country for the world oil community. According to this philosophy new and important steps are being taken to reinforce the oil sector: Expansion of the exploratory frontier by including a larger number of sedimentary areas, and the adoption of innovative contracting instruments. Colombia has to offer, Greater economic incentives for the exploration of new areas to expand the exploratory frontier, stimulation of exploration in areas with prospectivity for small fields. Companies may offer Ecopetrol a participation in production over and above royalties, without it's participating in the investments and costs of these fields, more favorable conditions for natural gas seeking projects, in comparison with those governing the terms for oil

Inequalities in the distribution of the costs of alcohol misuse in Scotland: a cost of illness study.

Science.gov (United States)

Johnston, Marjorie C; Ludbrook, Anne; Jaffray, Mariesha A

2012-01-01

To examine the distribution of the costs of alcohol misuse across Scotland in 2009/2010, in relation to deprivation. A cost of illness approach was used. Alcohol-related harmful effects were assessed for inclusion using a literature review. This was based upon the following categories: direct healthcare costs, intangible health costs, social care costs, crime costs and labour and productivity costs. An analysis of secondary data supplemented by a literature review was carried out to quantify each harmful effect, determine its value and provide an estimate of the distribution by deprivation. The deprivation distributions used were area measures (primarily the Scottish Index of Multiple Deprivation). The overall cost was £7457 million. Two alcohol harmful effects were not included in the overall cost by deprivation due to a lack of data. These were 'children's social work and hearing system' and the criminal justice system costs from 'alcohol-specific offences'. The included alcohol harmful effects demonstrated that 40.41% of the total cost arose from the 20% most deprived areas. The intangible cost category was the largest category (78.65%). The study found that the burden of alcohol harmful effects is greater in deprived groups and these burdens do not simply arise from deprived groups but are also experienced more by these groups. The study was limited by a lack of data availability in certain areas, leading to less-precise cost estimates.

The indirect costs of cancer-related absenteeism in the workplace in Poland.

Science.gov (United States)

Macioch, Tomasz; Hermanowski, Tomasz

2011-12-01

The aim of this study was to evaluate cancer-related absenteeism costs in Poland. Data on sickness absences and disability were retrieved from the Department of Statistics of the Social Insurance Institution. The cost of lost productivity owing to premature death was estimated from data retrieved from the Polish National Cancer Registry. Absenteeism costs were estimated on the basis of the measure of gross value added per employee. The costs of lost productivity owing to sick leave, disability, and premature death were estimated to be 1.572 billion EUR, 0.504 billion EUR, and 0.535 billion EUR, respectively, in 2009. The indirect costs of lost productivity owing to cancer-related sick leave, disability, and premature death have a substantial effect on the Polish economy. In 2009, they accounted for more than 0.8% of GDP.

Audit report on GDF Suez's supply costs and non-supply related costs in natural gas regulated sale tariffs - May 2014

International Nuclear Information System (INIS)

2014-05-01

After having recalled the legal context of objectives of this audit performed by the French Commission for Energy Regulation (CRE), this report proposes an analysis of GDF Suez's dissociated accounting which showed that costs are covered by natural gas regulated sale tariffs. In the second part, it comments the current market indexing used in tariff formula, comments current and present negotiations and their consequences for the market indexing share in long term contracts, discusses the issue of tariff volatility related to an increased market indexing share, discusses the possible re-examination of indices at the occasion of formula reviewing, and outlines that the diversified supplier portfolio allows optimisation operations. The third part addresses non-supply related costs: evolution of different infrastructure costs (related to distribution, transport, and storage) to be taken into account in regulated sale tariffs, evolution of commercial costs. Some recommendations are then made regarding the perspective of a tariff formula revision, and the perspectives of evolution of non-supply related costs

Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland.

Directory of Open Access Journals (Sweden)

Themba G Ginindza

Full Text Available Human papillomavirus (HPV has proven to be the cause of several severe clinical conditions on the cervix, vulva, vagina, anus, oropharynx and penis. Several studies have assessed the costs of cervical lesions, cervical cancer (CC, and genital warts. However, few have been done in Africa and none in Swaziland. Cost analysis is critical in providing useful information for economic evaluations to guide policymakers concerned with the allocation of resources in order to reduce the disease burden.A prevalence-based cost of illness (COI methodology was used to investigate the economic burden of HPV-related diseases. We used a top-down approach for the cost associated with hospital care and a bottom-up approach to estimate the cost associated with outpatient and primary care. The current study was conducted from a provider perspective since the state bears the majority of the costs of screening and treatment in Swaziland. All identifiable direct medical costs were considered for cervical lesions, cervical cancer and genital warts, which were primary diagnoses during 2015. A mix of bottom up micro-costing ingredients approach and top-down approaches was used to collect data on costs. All costs were computed at the price level of 2015 and converted to dollars ($.The total annual estimated direct medical cost associated with screening, managing and treating cervical lesions, CC and genital warts in Swaziland was $16 million. The largest cost in the analysis was estimated for treatment of high-grade cervical lesions and cervical cancer representing 80% of the total cost ($12.6 million. Costs for screening only represented 5% of the total cost ($0.9 million. Treatment of genital warts represented 6% of the total cost ($1million.According to the cost estimations in this study, the economic burden of HPV-related cervical diseases and genital warts represents a major public health issue in Swaziland. Prevention of HPV infection with a national HPV immunization

Economic Consequences and Potentially Preventable Costs Related to Osteoporosis in the Netherlands.

Science.gov (United States)

Dunnewind, Tom; Dvortsin, Evgeni P; Smeets, Hugo M; Konijn, Rob M; Bos, Jens H J; de Boer, Pieter T; van den Bergh, Joop P; Postma, Maarten J

2017-06-01

Osteoporosis often does not involve symptoms, and so the actual number of patients with osteoporosis is higher than the number of diagnosed individuals. This underdiagnosis results in a treatment gap. To estimate the total health care resource use and costs related to osteoporosis in the Netherlands, explicitly including fractures, and to estimate the proportion of fracture costs that are linked to the treatment gap and might therefore be potentially preventable; to also formulate, on the basis of these findings, strategies to optimize osteoporosis care and treatment and reduce its related costs. In this retrospective study, data of the Achmea Health Database representing 4.2 million Dutch inhabitants were used to investigate the economic consequence of osteoporosis in the Netherlands in 2010. Specific cohorts were created to identify osteoporosis-related fractures and their costs. Besides, costs of pharmaceutical treatment regarding osteoporosis were included. Using data from the literature, the treatment gap was estimated. Sensitivity analysis was performed on the base-case results. A total of 108,013 individuals with a history of fractures were included in this study. In this population, 59,193 patients were using anti-osteoporotic medication and 86,776 patients were using preventive supplements. A total number of 3,039 osteoporosis-related fractures occurred. The estimated total costs were €465 million. On the basis of data presented in the literature, the treatment gap in our study population was estimated to vary from 60% to 72%. The estimated total costs corrected for treatment gap were €1.15 to €1.64 billion. These results indicate room for improvement in the health care policy against osteoporosis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.

Science.gov (United States)

Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

2014-01-01

Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p<0.001). This

Tapping Transaction Costs to Forecast Acquisition Cost Breaches

Science.gov (United States)

2016-01-01

experience a cost breach. In our medical example, we could use survival analysis to identify risk fac- tors, such as obesity , that might indicate a greater... exogenous variables on the probability of a dichotomous outcome, such as whether or not a cost breach occurs in any given program year. Logit is

Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

Science.gov (United States)

Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

2014-11-13

The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

Direct diabetes-related costs in young patients with early-onset, long-lasting type 1 diabetes.

Directory of Open Access Journals (Sweden)

Christina Bächle

Full Text Available OBJECTIVE: To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. RESEARCH DESIGN AND METHODS: Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2 years, mean diabetes duration 10.9 (SD 1.9 years, as of 31.12.2007. Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV. Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance. Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. RESULTS: Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881. Costs for glucose self-monitoring were the main cost category (28.5%, followed by costs for continuous subcutaneous insulin infusion (25.0%, diabetes-related hospitalizations (22.1% and insulin (18.4%. Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. CONCLUSIONS: Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

[Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].

Science.gov (United States)

Liang, Sen; Zhang, Shun-xiang; Ma, Qi-shan; Xiao, He-wei; Lü, Qiu-ying; Xie, Xu; Mei, Shu-jiang; Hu, Dong-sheng; Zhou, Bo-ping; Li, Bing; Chen, Jing-fang; Cui, Fu-qiang; Wang, Fu-zhen; Liang, Xiao-feng

2010-12-01

To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the

Artificial selection on relative brain size in the guppy reveals costs and benefits of evolving a larger brain.

Science.gov (United States)

Kotrschal, Alexander; Rogell, Björn; Bundsen, Andreas; Svensson, Beatrice; Zajitschek, Susanne; Brännström, Ioana; Immler, Simone; Maklakov, Alexei A; Kolm, Niclas

2013-01-21

The large variation in brain size that exists in the animal kingdom has been suggested to have evolved through the balance between selective advantages of greater cognitive ability and the prohibitively high energy demands of a larger brain (the "expensive-tissue hypothesis"). Despite over a century of research on the evolution of brain size, empirical support for the trade-off between cognitive ability and energetic costs is based exclusively on correlative evidence, and the theory remains controversial. Here we provide experimental evidence for costs and benefits of increased brain size. We used artificial selection for large and small brain size relative to body size in a live-bearing fish, the guppy (Poecilia reticulata), and found that relative brain size evolved rapidly in response to divergent selection in both sexes. Large-brained females outperformed small-brained females in a numerical learning assay designed to test cognitive ability. Moreover, large-brained lines, especially males, developed smaller guts, as predicted by the expensive-tissue hypothesis, and produced fewer offspring. We propose that the evolution of brain size is mediated by a functional trade-off between increased cognitive ability and reproductive performance and discuss the implications of these findings for vertebrate brain evolution. Copyright © 2013 Elsevier Ltd. All rights reserved.

Estimate of the cost of multiple sclerosis in Spain by literature review.

Science.gov (United States)

Fernández, Oscar; Calleja-Hernández, Miguel Angel; Meca-Lallana, José; Oreja-Guevara, Celia; Polanco, Ana; Pérez-Alcántara, Ferran

2017-08-01

Multiple Sclerosis (MS) is a progressive disease leading to increasing disability and costs. A literature review was carried out to identify MS costs and to estimate its economic burden in Spain. Areas Covered: The public electronic databases PubMed, ScienceDirect and IBECS were consulted and a manual review of communications presented at related congresses was carried out. A total of 225 references were obtained, of which 43 were finally included in the study. Expert Commentary: Three major cost groups were identified: direct healthcare costs, direct non-healthcare costs and indirect costs. There is a direct relationship between disease progression and increased costs, mainly direct non-healthcare costs (greater need for informal care) and indirect costs (greater loss of productivity). The total cost associated with MS in Spain is €1,395 million per year, and that the mean annual cost per patient is €30,050. Beyond costs, a large impact on the quality of life of patients, with an annual loss of up to 13,000 quality-adjusted life years was also estimated. MS has a large economic impact on Spanish society and a significant impact on the quality of life of patients.

Procedures’ costs related to outpatient chemotherapy treatment of women suffering from breast cancer

Directory of Open Access Journals (Sweden)

Caroline Rife Nobrega

2014-08-01

Full Text Available To identify the direct cost of procedures related to an outpatient chemotherapy treatment for women with breast cancer. Method: This is a quantitative research, using the case study methodology, performed in an outpatient chemotherapy of a private hospital. The total cost was calculated by multiplying the time spent by professionals involved in therapeutic procedures, the unit cost of direct labor, adding to the cost of materials, drugs and solutions. For performing the calculations, we used the Brazilian currency (R$. Results: The average total cost per chemotherapy session corresponded to R$ 1,783.01 (100%, being R$ 1,671.66 (93,75% spent with drugs, R$ 74,98 (4.21% with materials, R$ 28.49 (1.60% with labor and R$ 7.88 (0.44% with solutions. Conclusion: The results may support discussions and decision making for the management of costs related to chemotherapy aimed at reducing expenses and eliminating waste without harm to the care provided.

Cost of osteoporosis-related fracture in Italy. Results of the BLOCK study

Directory of Open Access Journals (Sweden)

Luca Degli Esposti

2011-09-01

Full Text Available The objectives of the present study were to calculate the cost of illness of osteoporosis and to assess drug utilization patterns in postmenopausal women after a fracture-related hospitalization. The study subjects were enrolled from a large population-based administrative database. Female patients (age ≥ 65 years who were hospitalized for a typical osteoporotic fracture between 1/1/2000 and 31/12/2005 were included. Patients were classified as exposed/unexposed to treatment according to the presence/absence of at least one prescription for an osteoporosis-related medication in the 6 months following the discharge date. Treatment adherence was calculated for patients who were exposed to bisphosphonate therapy and was defined as at least 80% of treatment coverage during the follow-up period of 18 months after the discharge date. Hospitalizations, medications, diagnostic tests, laboratory tests and specialist visits during the 18-month follow-up period were collected and classified as osteoporosis-related or non-related to osteoporosis. A total of 12,376 patients were included in the study (mean age ± SD, 79.1 ± 7.5 years, out of which 97.9% (n = 12,110 were hospitalized due to an osteoporosis-related fracture and only 2.1% (n = 266 had general osteoporosis diagnosis. Among the 12,110 women with a fracture, 15.2% (n = 1,845 had a subsequent fracture-related hospitalization (63.8% of the patients had hip fracture. Only 32.3% (n = 4,001 of all included patients was exposed to osteoporosis-related medications and out of those patients exposed to bisphosphonates (n = 860 only 34.2% (n = 294 was adherent to therapy. The average cost per patient was € 4,481, of which € 1,089 was for osteoporosis-related and € 3,392 for non-osteoporosis-related items. The average cost of a matching cohort of patients without hospitalizations for fracture was € 2,339. Among osteoporosis-related costs, 87.0% was due to hospitalizations for subsequent fractures

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Mahayni, Malek A.

2011-07-01

Finding optimal paths in directed graphs is a wide area of research that has received much of attention in theoretical computer science due to its importance in many applications (e.g., computer networks and road maps). Many algorithms have been developed to solve the optimal paths problem with different kinds of graphs. An algorithm that solves the problem of paths’ optimization in directed graphs relative to different cost functions is described in [1]. It follows an approach extended from the dynamic programming approach as it solves the problem sequentially and works on directed graphs with positive weights and no loop edges. The aim of this thesis is to implement and evaluate that algorithm to find the optimal paths in directed graphs relative to two different cost functions ( , ). A possible interpretation of a directed graph is a network of roads so the weights for the function represent the length of roads, whereas the weights for the function represent a constraint of the width or weight of a vehicle. The optimization aim for those two functions is to minimize the cost relative to the function and maximize the constraint value associated with the function. This thesis also includes finding and proving the relation between the two different cost functions ( , ). When given a value of one function, we can find the best possible value for the other function. This relation is proven theoretically and also implemented and experimented using Matlab®[2].

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. Copyright © 2015 Elsevier Ltd. All rights reserved.

The High Direct Medical Costs of Prader-Willi Syndrome.

Science.gov (United States)

Shoffstall, Andrew J; Gaebler, Julia A; Kreher, Nerissa C; Niecko, Timothy; Douglas, Diah; Strong, Theresa V; Miller, Jennifer L; Stafford, Diane E; Butler, Merlin G

2016-08-01

To assess medical resource utilization associated with Prader-Willi syndrome (PWS) in the US, hypothesized to be greater relative to a matched control group without PWS. We used a retrospective case-matched control design and longitudinal US administrative claims data (MarketScan) during a 5-year enrollment period (2009-2014). Patients with PWS were identified by Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 759.81. Controls were matched on age, sex, and payer type. Outcomes included total, outpatient, inpatient and prescription costs. After matching and application of inclusion/exclusion criteria, we identified 2030 patients with PWS (1161 commercial, 38 Medicare supplemental, and 831 Medicaid). Commercially insured patients with PWS (median age 10 years) had 8.8-times greater total annual direct medical costs than their counterparts without PWS (median age 10 years: median costs $14 907 vs $819; P < .0001; mean costs: $28 712 vs $3246). Outpatient care comprised the largest portion of medical resource utilization for enrollees with and without PWS (median $5605 vs $675; P < .0001; mean $11 032 vs $1804), followed by mean annual inpatient and medication costs, which were $10 879 vs $1015 (P < .001) and $6801 vs $428 (P < .001), respectively. Total annual direct medical costs were ∼42% greater for Medicaid-insured patients with PWS than their commercially insured counterparts, an increase partly explained by claims for Medicaid Waiver day and residential habilitation. Direct medical resource utilization was considerably greater among patients with PWS than members without the condition. This study provides a first step toward quantifying the financial burden of PWS posed to individuals, families, and society. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and Realities.

Science.gov (United States)

Rubin, Geoffrey D

2017-02-01

Costs direct decisions that influence the effectiveness of radiology in the care of patients on a daily basis. Yet many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported. In the United States, recent payment trends directing value-based payments for bundles of care advance the imperative for radiology providers to articulate their value. This begins with the development of an understanding of the providers' own costs, as well as the complex interrelationships and imaging-associated costs of other participants across the imaging value chain. Controlling the costs of imaging necessitates understanding them at a procedural level and quantifying the costs of delivering specific imaging services. Effective product-level costing is dependent on a bottom-up approach, which is supported through recent innovations in time-dependent activity-based costing. Once the costs are understood, they can be managed. Within the high fixed cost and high overhead cost environment of health care provider organizations, stakeholders must understand the implications of misaligned top-down cost management approaches that can both paradoxically shift effort from low-cost workers to much costlier professionals and allocate overhead costs counterproductively. Radiology's engagement across a broad spectrum of care provides an excellent opportunity for radiology providers to take a leading role within the health care organizations to enhance value and margin through principled and effective cost management. Following a discussion of the rationale for measuring costs, this review contextualizes costs from the perspectives of a variety of stakeholders (relativity), discusses core concepts in how costs are classified (rudiments), presents common and improved methods for measuring

Reducing healthcare costs facilitated by surgical auditing: a systematic review.

Science.gov (United States)

Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria

2015-07-01

Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

Review of the cost components of introducing industrially fortified rice.

Science.gov (United States)

Roks, Eveline

2014-09-01

Micronutrient deficiencies affect over two billion people worldwide, particularly in developing countries. Fortification of staple foods with multiple micronutrients is a cost-effective strategy to increase vitamin and mineral intake. The objective of this paper is to review the cost elements of industrially fortified rice by identifying the costs related to the implementation of rice fortification programs, using the experience of the United Nations World Food Programme in its pilot countries. The actual total costs of rice fortification are not easily captured. Core cost elements include the production of fortified rice kernels, transportation to the point of blending, blending of fortified with unfortified rice, costs related to sales or distribution, quality control and assurance, and additional planning. In the introduction phase, organizations or coalitions seeking to advance rice fortification will face additional costs related to the initiation of rice fortification. In the scale-up phase, greater efficiency in the supply chain and economies of scale can be expected. Different cost elements are normally borne by different stakeholders. This makes the implementation of rice fortification programs a feasible option to reach vulnerable populations with inadequate access to affordable nutrition solutions. © 2014 New York Academy of Sciences.

Health-related economic costs of the Three-Mile Island accident.

Science.gov (United States)

Hu, T W; Slaysman, K S

1984-01-01

On March 1979, a nuclear power station at Three-Mile Island (TMI) near Harrisburg, Pennsylvania, had a major breakdown. During the two-week period of the accident, about 150,000 residents were evacuated for reasons associated with safety and health. Many residents during and after the accident, regardless of whether they left or stayed, made mental and physical adjustments due to this accident. This paper is to estimate the economic costs incurred by individuals or communities as a result of a change in physical or mental health status and/or a change in health care services due to the TMI accident. The findings indicate that stress symptoms caused by the accident did affect the health-related behaviors of area residents. Of the costs examined, the economic costs of work days lost and physician visits are the largest cost items. There were some increases in consumption of alcohol, cigarettes, and tranquilizers immediately following the accident.

Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease.

Science.gov (United States)

Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

2010-11-01

Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year. Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on

Unit Cost Compendium Calculations

Data.gov (United States)

U.S. Environmental Protection Agency — The Unit Cost Compendium (UCC) Calculations raw data set was designed to provide for greater accuracy and consistency in the use of unit costs across the USEPA...

The "costs" of urinary incontinence for women.

Science.gov (United States)

Subak, Leslee L; Brown, Jeanette S; Kraus, Stephen R; Brubaker, Linda; Lin, Feng; Richter, Holly E; Bradley, Catherine S; Grady, Deborah

2006-04-01

To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. Mean age was 56 +/- 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from 0.37 dollars (0, 4 dollars) for slight to 10.98 dollars (4, 21 dollars) for very severe incontinence. Costs increased with incontinence severity (P women (P women with urge compared with those having stress incontinence (P lower Health Utilities Index score (mean 0.90 +/- 0.11 for weekly and 0.81 +/- 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of 70 dollars +/- 64 dollars per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit. Women with severe urinary incontinence pay 900 dollars annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life. III.

Moderation of the Relation of County-Level Cost of Living to Nutrition by the Supplemental Nutrition Assistance Program.

Science.gov (United States)

Basu, Sanjay; Wimer, Christopher; Seligman, Hilary

2016-11-01

To examine the association of county-level cost of living with nutrition among low-income Americans. We used the National Household Food Acquisition and Purchase Survey (2012-2013; n = 14 313; including 5414 persons in households participating in the Supplemental Nutrition Assistance Program [SNAP]) to examine associations between county-level cost-of-living metrics and both food acquisitions and the Healthy Eating Index, with control for individual-, household-, and county-level covariates and accounting for unmeasured confounders influencing both area of living and food acquisition. Living in a higher-cost county-particularly one with high rent costs-was associated with significantly lower volume of acquired vegetables, fruits, and whole grains; greater volume of acquired refined grains, fats and oils, and added sugars; and an 11% lower Healthy Eating Index score. Participation in SNAP was associated with nutritional improvements among persons living in higher-cost counties. Living in a higher-cost county (particularly with high rent costs) is associated with poorer nutrition among low-income Americans, and SNAP may mitigate the negative nutritional impact of high cost of living.

Parameters of Dismantling Techniques Related to Costs for Decommissioning of Nuclear Facilities

International Nuclear Information System (INIS)

Jeong, Kwanseong; Moon, Jeikwon; Choi, Byungseon

2012-01-01

Reliable cost estimating is one of the most important elements of decommissioning operation. Reliable cost estimating is one of the most important elements of decommissioning planning. Alternative technologies may be evaluated and compared on their efficiency and effectiveness, and measured against a baseline cost as to the feasibility and benefit derived from the technology. This principle ensures that the cost consideration is economically sound and practical for funding. This paper provides a list with basic review of cutting and dismantling techniques, including some typical characteristics if available, as well as aspects of implementation, parameters of cutting and dismantling techniques in decommissioning costing. This paper gives an overview of the principles of the unit factor approach and its implementation in costing in relation to dismantling activities. In general, proper evaluation of decommissioning costs is important for following issues and relevant measures for achieving the listed aspects are: · Selection of a decommissioning strategy and activities: several decommissioning options should be evaluated: · Support to a cost-benefit analysis to ensure that the principle of optimization and reasonably practicable measures are applied: the extent of evaluated decommissioning options should cover all possible scenarios for dismantling activities; · Estimate of required financial resources for the selected strategy: the selected option should involve the dismantling activities in a structure and extent relevant to real procedure of dismantling activities; · Preparation of the project schedule, workforce requirements and phased funding needs: dismantling activities should be structured according to the tasks of the decommissioning schedule; · Definition of measures for proper management and maintenance of resources for safe and timely decommissioning: the time distribution and safety related parameters of dismantling activities should be known

Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators.

Science.gov (United States)

Jansen, Jeroen P; Incerti, Devin; Mutebi, Alex; Peneva, Desi; MacEwan, Joanna P; Stolshek, Bradley; Kaur, Primal; Gharaibeh, Mahdi; Strand, Vibeke

2017-07-01

To determine the cost-effectiveness of treatment sequences of biologic disease-modifying anti-rheumatic drugs or Janus kinase/STAT pathway inhibitors (collectively referred to as bDMARDs) vs conventional DMARDs (cDMARDs) from the US societal perspective for treatment of patients with moderately to severely active rheumatoid arthritis (RA) with inadequate responses to cDMARDs. An individual patient simulation model was developed that assesses the impact of treatments on disease based on clinical trial data and real-world evidence. Treatment strategies included sequences starting with etanercept, adalimumab, certolizumab, or abatacept. Each of these treatment strategies was compared with cDMARDs. Incremental cost, incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each treatment sequence relative to cDMARDs. The cost-effectiveness of each strategy was determined using a US willingness-to-pay (WTP) threshold of $150,000/QALY. For the base-case scenario, bDMARD treatment sequences were associated with greater treatment benefit (i.e. more QALYs), lower lost productivity costs, and greater treatment-related costs than cDMARDs. The expected ICERs for bDMARD sequences ranged from ∼$126,000 to $140,000 per QALY gained, which is below the US-specific WTP. Alternative scenarios examining the effects of homogeneous patients, dose increases, increased costs of hospitalization for severely physically impaired patients, and a lower baseline Health Assessment Questionnaire (HAQ) Disability Index score resulted in similar ICERs. bDMARD treatment sequences are cost-effective from a US societal perspective.

During early and mid-adolescence, greater mental toughness is related to increased sleep quality and quality of life.

Science.gov (United States)

Brand, Serge; Kalak, Nadeem; Gerber, Markus; Clough, Peter J; Lemola, Sakari; Pühse, Uwe; Holsboer-Trachsler, Edith

2016-06-01

The aim of this study was to explore the association between mental toughness, subjective sleep, physical activity, and quality of life during early and mid-adolescence. A total of 1475 participants (mean age = 13.4 years; range: 11-16 years) took part in the study. They completed questionnaires related to mental toughness, physical activity, subjective sleep, and quality of life. Greater mental toughness was related to more favorable quality of life and increased subjective sleep. Mental toughness was not related to physical activity. Increased mental toughness, favorable quality of life, and sleep are related during early and mid-adolescence. Against our expectations, mental toughness was not related to physical activity. © The Author(s) 2014.

The Potential Cost-Effectiveness of Amblyopia Screening Programs

Science.gov (United States)

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

2013-01-01

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

High cost of stage IV pressure ulcers.

Science.gov (United States)

Brem, Harold; Maggi, Jason; Nierman, David; Rolnitzky, Linda; Bell, David; Rennert, Robert; Golinko, Michael; Yan, Alan; Lyder, Courtney; Vladeck, Bruce

2010-10-01

The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers. A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated. Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 community-acquired) were identified and their charts were reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during 1 admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars. Copyright © 2010 Elsevier Inc. All rights reserved.

Relative Greenhouse Gas Abatement Cost Competitiveness of Biofuels in Germany

Directory of Open Access Journals (Sweden)

Markus Millinger

2018-03-01

Full Text Available Transport biofuels derived from biogenic material are used for substituting fossil fuels, thereby abating greenhouse gas (GHG emissions. Numerous competing conversion options exist to produce biofuels, with differing GHG emissions and costs. In this paper, the analysis and modeling of the long-term development of GHG abatement and relative GHG abatement cost competitiveness between crop-based biofuels in Germany are carried out. Presently dominant conventional biofuels and advanced liquid biofuels were found not to be competitive compared to the substantially higher yielding options available: sugar beet-based ethanol for the short- to medium-term least-cost option and substitute natural gas (SNG for the medium to long term. The competitiveness of SNG was found to depend highly on the emissions development of the power mix. Silage maize-based biomethane was found competitive on a land area basis, but not on an energetic basis. Due to land limitations, as well as cost and GHG uncertainty, a stronger focus on the land use of crop-based biofuels should be laid out in policy.

The Relative Concentrations of Nutrients and Toxins Dictate Feeding by a Vertebrate Browser, the Greater Glider Petauroides volans.

Directory of Open Access Journals (Sweden)

Lora M Jensen

Full Text Available Although ecologists believe that vertebrate herbivores must select a diet that allows them to meet their nutritional requirements, while avoiding intoxication by plant secondary metabolites, this is remarkably difficult to show. A long series of field and laboratory experiments means that we have a good understanding of the factors that affect feeding by leaf-eating marsupials. This knowledge and the natural intraspecific variation in Eucalyptus chemistry allowed us to test the hypothesis that the feeding decisions of greater gliders (Petauroides volans depend on the concentrations of available nitrogen (incorporating total nitrogen, dry matter digestibility and tannins and of formylated phloroglucinol compounds (FPCs, potent antifeedants unique to Eucalyptus. We offered captive greater gliders foliage from two species of Eucalyptus, E. viminalis and E. melliodora, which vary naturally in their concentrations of available nitrogen and FPCs. We then measured the amount of foliage eaten by each glider and compared this with our laboratory analyses of foliar total nitrogen, available nitrogen and FPCs for each tree offered. The concentration of FPCs was the main factor that determined how much gliders ate of E. viminalis and E. melliodora, but in gliders fed E. viminalis the concentration of available nitrogen was also a significant influence. In other words, greater gliders ate E. viminalis leaves with a particular combination of FPCs and available nitrogen that maximised the nutritional gain but minimised their ingestion of toxins. In contrast, the concentration of total nitrogen was not correlated with feeding. This study is among the first to empirically show that browsing herbivores select a diet that balances the potential gain (available nutrients and the potential costs (plant secondary chemicals of eating leaves. The major implication of the study is that it is essential to identify the limiting nutrients and relevant toxins in a system in

78 FR 17300 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

Science.gov (United States)

2013-03-21

... and II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and... Relating to Grants and Cooperative Agreements; Cost Principles and Administrative Requirements (Including...

The Social Costs of Health-related Early Retirement in Germany

DEFF Research Database (Denmark)

Hostenkamp, Gisela; Stolpe, Michael

2012-01-01

Using data from the German Socio-economic Panel, we study how stratification in health and income contributes to the social cost of health-related early retirement, the balance of lost labour income and health benefits. On average, early retirees improve their health by almost two thirds...... of the loss suffered during the last four working years. We calibrate counterfactual scenarios and find keeping all workers in very good health, the highest of five categories of self-assessed health, would delay the average retirement age by more than three years and reduce the social costs by more than 20...

An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures.

Science.gov (United States)

Nshimyumukiza, Léon; Durand, Audrey; Gagnon, Mathieu; Douville, Xavier; Morin, Suzanne; Lindsay, Carmen; Duplantie, Julie; Gagné, Christian; Jean, Sonia; Giguère, Yves; Dodin, Sylvie; Rousseau, François; Reinharz, Daniel

2013-02-01

A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could

Beyond co-pays and out-of-pocket costs: perceptions of health-related financial burden in managing asthma among African American women.

Science.gov (United States)

Patel, Minal R; Nelson, Belinda W; Id-Deen, Effat; Caldwell, Cleopatra H

2014-12-01

The purpose of this study was to define perceptions of health-related financial burden based on the views of individuals who report these perceptions through qualitative approaches. Four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview was employed by facilitators. Coded transcripts were analyzed for themes regarding dimensions of the meaning of financial burden. Major domains of financial burden identified included (1) high out-of-pocket expenses; (2) lost wages from exacerbations, inability to maintain a stable job and stress from making decisions about taking a sick day or coming to work; (3) transport costs; (4) both costs and stress of managing insurance eligibility and correcting erroneous bills. Greater awareness of factors that add to perceptions of financial burden might better equip researchers to develop interventions to help care teams manage such concerns with their patients.

Cost-effectiveness of per oral endoscopic myotomy relative to laparoscopic Heller myotomy for the treatment of achalasia.

Science.gov (United States)

Greenleaf, Erin K; Winder, Joshua S; Hollenbeak, Christopher S; Haluck, Randy S; Mathew, Abraham; Pauli, Eric M

2018-01-01

Per oral endoscopic myotomy (POEM) has recently emerged as a viable option relative to the classic approach of laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. In this cost-utility analysis of POEM and LHM, we hypothesized that POEM would be cost-effective relative to LHM. A stochastic cost-utility analysis of treatment for achalasia was performed to determine the cost-effectiveness of POEM relative to LHM. Costs were estimated from the provider perspective and obtained from our institution's cost-accounting database. The measure of effectiveness was quality-adjusted life years (QALYs) which were estimated from direct elicitation of utility using a visual analog scale. The primary outcome was the incremental cost-effectiveness ratio (ICER). Uncertainty was assessed by bootstrapping the sample and computing the cost-effectiveness acceptability curve (CEAC). Patients treated within an 11-year period (2004-2016) were recruited for participation (20 POEM, 21 LHM). During the index admission, the mean costs for POEM ($8630 ± $2653) and the mean costs for LHM ($7604 ± $2091) were not significantly different (P = 0.179). Additionally, mean QALYs for POEM (0.413 ± 0.248) were higher than that associated with LHM (0.357 ± 0.338), but this difference was also not statistically significant (P = 0.55). The ICER suggested that it would cost an additional $18,536 for each QALY gained using POEM. There was substantial uncertainty in the ICER; there was a 48.25% probability that POEM was cost-effective at the mean ICER. At a willingness-to-pay threshold of $100,000, there was a 68.31% probability that POEM was cost-effective relative to LHM. In the treatment of achalasia, POEM appears to be cost-effective relative to LHM depending on one's willingness-to-pay for an additional QALY.

Environmental damage costs from airborne pollution of industrial activities in the greater Athens, Greece area and the resulting benefits from the introduction of BAT

International Nuclear Information System (INIS)

Mirasgedis, S.; Hontou, V.; Georgopoulou, E.; Sarafidis, Y.; Gakis, N.; Lalas, D.P.; Loukatos, A.; Gargoulas, N.; Mentzis, A.; Economidis, D.; Triantafilopoulos, T.; Korizi, K.; Mavrotas, G.

2008-01-01

Attributing costs to the environmental impacts associated with industrial activities can greatly assist in protecting human health and the natural environment as monetary values are capable of directly influencing technological and policy decisions without changing the rules of the market. This paper attempts to estimate the external cost attributable to the atmospheric pollution from 'medium and high environmental burden' industrial activities located in the greater Athens area and the benefits from Best Available Techniques (BAT) introduction. To this end a number of typical installations were defined to be used in conjunction with the Impact Pathway Approach developed in the context of the ExternE project to model all industrial sectors/sub-sectors located in the area of interest. Total environmental externalities due to air pollutants emitted by these industrial activities were found to reach 211 M Euro per year, associated mainly with human mortality and morbidity due to PM 10 emissions, as well as with climate change impacts due to CO 2 emissions for which non-metallic minerals and oil processing industries are the main sources. The results obtained can be used as the basis for an integrated evaluation of potential BAT, taking into account not only private costs and benefits but also the environmental externalities, thus leading to policy decisions that maximize social welfare in each industrial sector/sub-sector

Simultaneous bilateral isolated greater trochanter fracture

Directory of Open Access Journals (Sweden)

Maruti Kambali

2013-01-01

Full Text Available A 48-year-old woman sustained simultaneous isolated bilateral greater trochanteric fracture, following a road traffic accident. The patient presented to us 1 month after the injury. She presented with complaints of pain in the left hip and inability to walk. Roentgenograms revealed displaced comminuted bilateral greater trochanter fractures. The fracture of the left greater trochanter was reduced and fixed internally using the tension band wiring technique. The greater trochanter fracture on the right side was asymptomatic and was managed conservatively. The patient regained full range of motion and use of her hips after a postoperative follow-up of 6 months. Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports of this particular type of injury are not plentiful and the average textbook coverage afforded to this entity is limited. In our study we discuss the mechanism of injury and the various treatment options available.

[Costs of temporary disability in Spain related to diabetes mellitus and its complications].

Science.gov (United States)

Vicente-Herrero, M Teófila; Terradillos García, M Jesús; Capdevila García, Luisa M; Ramírez Iñiguez de la Torre, M Victoria; López-González, Angel Arturo

2013-10-01

To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. In 2011, diabetes and its complications were related to 2.567 TD processes, which resulted in the loss of 154.214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297.095.3 €, with an estimated cost per patient and year of 141 €. These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Christopher S. Hollenbeak

2016-01-01

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

The relative cost of bent-hip bent-knee walking is reduced in water.

Science.gov (United States)

Kuliukas, Algis V; Milne, Nick; Fournier, Paul

2009-01-01

The debate about how early hominids walked may be characterised as two competing hypotheses: They moved with a fully upright (FU) gait, like modern humans, or with a bent-hip, bent-knee (BK) gait, like apes. Both have assumed that this bipedalism was almost exclusively on land, in trees or a combination of the two. Recent findings favoured the FU hypothesis by showing that the BK gait is 50-60% more energetically costly than a FU human gait on land. We confirm these findings but show that in water this cost differential is markedly reduced, especially in deeper water, at slower speeds and with greater knee flexion. These data suggest that the controversy about australopithecine locomotion may be eased if it is assumed that wading was a component of their locomotor repertoire and supports the idea that shallow water might have been an environment favourable to the evolution of early forms of "non-optimal" hominid bipedalism.

Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System.

Science.gov (United States)

Tseng, Phillip; Kaplan, Robert S; Richman, Barak D; Shah, Mahek A; Schulman, Kevin A

2018-02-20

Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of

Social costs of energy

International Nuclear Information System (INIS)

Jones, P.M.S.

1990-01-01

There have been many studies over the past 20 years which have looked at the environmental and other impacts of energy production, conversion and use. A number of these have attempted to put a monetary value to the external costs which are not reflected in the prices charged for energy. The topic has received increased attention recently as a direct result of the recognition of the potentially large social costs that might arise from the depletion of the ozone layer, the consequences of global warming and the continued releases of acid gases from fossil fuel combustion. The determination of external costs was attempted in the report for the European Economic Community, EUR11519, ''Social Costs of Energy Consumption'', by O Hohmeyer. Due to its official sponsorship, this report has been afforded greater respect than it deserves and is being used in some quarters to claim that the external costs of nuclear power are high relative to those of fossil fuels. The remainder of this note looks at some of the serious deficiencies of the document and why its conclusions offer no meaningful guidance to policy makers. So far as the present author is aware no serious criticism of the Hohmeyer study has previously appeared. (author)

21 Cost-Saving Measures For The Judiciary

Directory of Open Access Journals (Sweden)

Jessica Vapnek

2013-02-01

Full Text Available Courts around the world are increasingly facing budget cuts and funding shortfalls. Budget problems are particularly acute in developing countries, where courts need to increase efficiency and access to justice while also managing resource limitations. International development agencies and donors expect measurable progress to justify continued funding of judicial reform projects. Yet, as rule of law efforts in developing countries improve public perception of courts and streamline court administration, more cases may be filed. Greater use of the courts puts greater strain on court resources, triggering the need to implement cost-saving measures while maintaining effective court administration.This paper outlines 21 measures that courts can implement to reduce costs. Specific examples from developing countries are presented wherever possible, with additional examples drawn from the United States and Europe. Although this paper is intended mainly for audiences in developing countries, the issues facing those courts are similar to issues addressed through court reforms in the United States over the past 50 years. For this reason, examples of cost-saving measures from developed countries such as the United States may be directly applicable or could be used as starting points to spur further cost savings innovation in the developing world.Section I of this paper explains the context for the implementation of judicial cost-saving measures, and raises some issues for reflection. Section II sets out specific judicial cost-saving measures, dividing them into three categories: measures that address court operations; measures directed at staffing and salaries; and measures that relate to court and case management. Section III discusses ways that countries and judiciaries can generate ideas for new and innovative cost-saving mechanisms.

Planning for greater confinement disposal

International Nuclear Information System (INIS)

Gilbert, T.L.; Luner, C.; Meshkov, N.K.; Trevorrow, L.E.; Yu, C.

1985-01-01

A report that provides guidance for planning for greater-confinement disposal (GCD) of low-level radioactive waste is being prepared. The report addresses procedures for selecting a GCD technology and provides information for implementing these procedures. The focus is on GCD; planning aspects common to GCD and shallow-land burial are covered by reference. Planning procedure topics covered include regulatory requirements, waste characterization, benefit-cost-risk assessment and pathway analysis methodologies, determination of need, waste-acceptance criteria, performance objectives, and comparative assessment of attributes that support these objectives. The major technologies covered include augered shafts, deep trenches, engineered structures, hydrofracture, improved waste forms, and high-integrity containers. Descriptive information is provided, and attributes that are relevant for risk assessment and operational requirements are given. 10 refs., 3 figs., 2 tabs

Bioenergetic components of reproductive effort in viviparous snakes: costs of vitellogenesis exceed costs of pregnancy.

Science.gov (United States)

Van Dyke, James U; Beaupre, Steven J

2011-12-01

Reproductive effort has been defined as the proportion of an organism's energy budget that is allocated to reproduction over a biologically meaningful time period. Historically, studies of reproductive bioenergetics considered energy content of gametes, but not costs of gamete production. Although metabolic costs of vitellogenesis (MCV) fundamentally reflect the primary bioenergetic cost of reproductive allocation in female reptiles, the few investigations that have considered costs of reproductive allocation have focused on metabolic costs of pregnancy (MCP) in viviparous species. We define MCP as energetic costs incurred by pregnant females, including all costs of maintaining gestation conditions necessary for embryogenesis. MCP by our definition do not include fetal costs of embryogenesis. We measured metabolic rates in five species of viviparous snakes (Agkistrodon contortrix, Boa constrictor, Eryx colubrinus, Nerodia sipedon, and Thamnophis sirtalis) during vitellogenesis and pregnancy in order to estimate MCV and MCP. Across all species, MCV were responsible for 30% increases in maternal metabolism. Phylogenetically-independent contrasts showed that MCV were significantly greater in B. constrictor than in other species, likely because B. constrictor yolk energy content was greater than that of other species. Estimates of MCP were not significantly different from zero in any species. In viviparous snakes, MCV appear to represent significant bioenergetic expenditures, while MCP do not. We suggest that MCV, together with yolk energy content, represent the most significant component of reptilian reproductive effort, and therefore deserve greater attention than MCP in studies of reptilian reproductive bioenergetics. Copyright © 2011 Elsevier Inc. All rights reserved.

Factors associated with geographic variation in cost per episode of care for three medical conditions

Science.gov (United States)

2014-01-01

Objective To identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options. Methods We use 2004–2006 Medicare claims data for elderly beneficiaries from sixty nationally representative communities to estimate multivariate models for the probability of surgery and cost per episode of care as a function local market factors, including Medicare physician reimbursement for surgical versus non-surgical treatment and the availability of primary care and specialty physicians. We used Symmetry’s Episode Treatment Groups (ETG) software to group claims into episodes for the three conditions (n = 540,874 episodes). Results Higher Medicare reimbursement for surgical episodes and greater availability of the relevant specialists are significantly associated with more surgery and higher cost per episode for all three conditions, while greater availability of primary care physicians is significantly associated with less frequent surgery and lower cost per episode. Conclusion Relative Medicare reimbursement rates for surgical vs. non-surgical treatments and the availability of both primary care physicians and relevant specialists are associated with the likelihood of surgery and cost per episode. PMID:24949281

Indirect, out-of-pocket and medical costs from influenza-related illness in young children.

Science.gov (United States)

Ortega-Sanchez, Ismael R; Molinari, Noelle-Angelique M; Fairbrother, Gerry; Szilagyi, Peter G; Edwards, Kathryn M; Griffin, Marie R; Cassedy, Amy; Poehling, Katherine A; Bridges, Carolyn; Staat, Mary Allen

2012-06-13

Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. Using a population-based surveillance network, we evaluated a representative group of children aged accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination. Published by Elsevier Ltd.

Relating cost-benefit analysis results with transport project decisions in the Netherlands

NARCIS (Netherlands)

Annema, Jan Anne; Frenken, Koen|info:eu-repo/dai/nl/207145253; Koopmans, Carl; Kroesen, Maarten

2017-01-01

This paper relates the cost-benefit analysis (CBA) results of transportation policy proposals in the Netherlands with the decision to implement or abandon the proposal. The aim of this study is to explore the relation between the CBA results and decision-making. Multinomial logit regression models

Relating cost-benefit analysis results with transport project decisions in the Netherlands

NARCIS (Netherlands)

Annema, J.A.; Frenken, Koen; Koopmans, Carl; Kroesen, M.

2017-01-01

This paper relates the cost-benefit analysis (CBA) results of transportation policy proposals in the Netherlands with the decision to implement or abandon the proposal. The aim of this study is to explore the relation between the CBA results and decision-making. Multinomial logit regression

Reactive control processes contributing to residual switch cost and mixing cost in young and old adults

Directory of Open Access Journals (Sweden)

Lisa Rebecca Whitson

2014-04-01

Full Text Available In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost and when repeating a task alone rather than intermixed with another task (mixing cost. These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs. Moreover, residual RT mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these ‘mixed’ repeat trials (Karayanidis et al., 2011. In this study, we examine stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. We argue that, together with evidence of greater proactive control and more cautious responding for these trials, these findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

Cost Benefit of Comprehensive Primary and Preventive School-Based Health Care.

Science.gov (United States)

Padula, William V; Connor, Katherine A; Mueller, Josiah M; Hong, Jonathan C; Velazquez, Gabriela Calderon; Johnson, Sara B

2018-01-01

The Rales Health Center is a comprehensive school-based health center at an urban elementary/middle school. Rales Health Center provides a full range of pediatric services using an enriched staffing model consisting of pediatrician, nurse practitioner, registered nurses, and medical office assistant. This staffing model provides greater care but costs more than traditional school-based health centers staffed by part-time nurses. The objective was to analyze the cost benefit of Rales Health Center enhanced staffing model compared with a traditional school-based health center (standard care), focusing on asthma care, which is among the most prevalent chronic conditions of childhood. In 2016, cost-benefit analysis using a decision tree determined the net social benefit of Rales Health Center compared with standard care from the U.S. societal perspective based on the 2015-2016 academic year. It was assumed that Rales Health Center could handle greater patient throughput related to asthma, decreased prescription costs, reduced parental resources in terms of missed work time, and improved student attendance. Univariate and multivariate probabilistic sensitivity analyses were conducted. The expected cost to operate Rales Health Center was $409,120, compared with standard care cost of $172,643. Total monetized incremental benefits of Rales Health Center were estimated to be $993,414. The expected net social benefit for Rales Health Center was $756,937, which demonstrated substantial societal benefit at a return of $4.20 for every dollar invested. This net social benefit estimate was robust to sensitivity analyses. Despite the greater cost associated with the Rales Health Center's enhanced staffing model, the results of this analysis highlight the cost benefit of providing comprehensive, high-quality pediatric care in schools, particularly schools with a large proportion of underserved students. Copyright © 2018 American Journal of Preventive Medicine. Published by

Understanding Time-driven Activity-based Costing.

Science.gov (United States)

Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

2016-03-01

Transitioning to a value-based health care system will require providers to increasingly scrutinize their outcomes and costs. Although there has been a great deal of effort to understand outcomes, cost accounting in health care has been a greater challenge. Currently the cost accounting methods used by hospitals and providers are based off a fee-for-service system. As resources become increasingly scarce and the health care system attempts to understand which services provide the greatest value, it will be critically important to understand the true costs of delivering a service. An understanding of the true costs of a particular service will help providers make smarter decisions on how to allocate and utilize resources as well as determine which activities are nonvalue added. Achieving value will require providers to have a greater focus on accurate outcome data as well as better methods of cost accounting.

Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

Science.gov (United States)

Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

2015-10-01

Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose

Laboratory cost and utilization containment.

Science.gov (United States)

Steiner, J W; Root, J M; White, D C

1991-01-01

The authors analyzed laboratory costs and utilization in 3,771 cases of Medicare inpatients admitted to a New England academic medical center ("the Hospital") from October 1, 1989 to September 30, 1990. The data were derived from the Hospital's Decision Resource System comprehensive data base. The authors established a historical reference point for laboratory costs as a percentage of total inpatient costs using 1981-82 Medicare claims data and cost report information. Inpatient laboratory costs were estimated at 9.5% of total inpatient costs for pre-Diagnostic Related Groups (DRGs) Medicare discharges. Using this reference point and adjusting for the Hospital's 1990 case mix, the "expected" laboratory cost was 9.3% of total cost. In fact, the cost averaged 11.5% (i.e., 24% above the expected cost level), and costs represented an even greater percentage of DRG reimbursement at 12.9%. If we regard the reimbursement as a total cost target (to eliminate losses from Medicare), then that 12.9% is 39% above the "expected" laboratory proportion of 9.3%. The Hospital lost an average of $1,091 on each DRG inpatient. The laboratory contributed 29% to this loss per case. Compared to other large hospitals, the Hospital was slightly (3%) above the mean direct cost per on-site test and significantly (58%) above the mean number of inpatient tests per inpatient day compared to large teaching hospitals. The findings suggest that careful laboratory cost analyses will become increasingly important as the proportion of patients reimbursed in a fixed manner grows. The future may hold a prospective zero-based laboratory budgeting process based on predictable patterns of DRG admissions or other fixed-reimbursement admission and laboratory utilization patterns.

Contemporary Costs Associated With Transcatheter Aortic Valve Replacement: A Propensity-Matched Cost Analysis.

Science.gov (United States)

Ailawadi, Gorav; LaPar, Damien J; Speir, Alan M; Ghanta, Ravi K; Yarboro, Leora T; Crosby, Ivan K; Lim, D Scott; Quader, Mohammed A; Rich, Jeffrey B

2016-01-01

The Placement of Aortic Transcatheter Valve (PARTNER) trial suggested an economic advantage for transcatheter aortic valve replacement (TAVR) for high-risk patients. The purpose of this study was to evaluate the cost effectiveness of TAVR in the "real world" by comparing TAVR with surgical aortic valve replacement (SAVR) in intermediate-risk and high-risk patients. A multiinstitutional database of The Society of Thoracic Surgeons (STS) (2011 to 2013) linked with estimated cost data was evaluated for isolated TAVR and SAVR operations (n = 5,578). TAVR-treated patients (n = 340) were 1:1 propensity matched with SAVR-treated patients (n = 340). Patients undergoing SAVR were further stratified into intermediate-risk (SAVR-IR: predicted risk of mortality [PROM] 4% to 8%) and high-risk (SAVR-HR: PROM >8%) cohorts. Median STS PROM for TAVR was 6.32% compared with 6.30% for SAVR (SAVR-IR 4.6% and SAVR-HR 12.4%). A transfemoral TAVR approach was most common (61%). Mortality was higher for TAVR (10%) compared with SAVR (6%, p costs compared with SAVR ($69,921 vs $33,598, p cost of TAVR was largely driven by the cost of the valve (all p cost savings versus TAVR. TAVR was associated with greater total costs and mortality compared with SAVR in intermediate-risk and high-risk patients while conferring lower major morbidity and improved resource use. Increased cost of TAVR appears largely related to the cost of the valve. Until the price of TAVR valves decreases, these data suggest that TAVR may not provide the most cost-effective strategy, particularly for intermediate-risk patients. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study.

Science.gov (United States)

Brown, V; Moodie, M; Cobiac, L; Mantilla Herrera, A M; Carter, R

2017-05-04

Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis. Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under "best case" assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2�

[Cost assessment for endoscopic procedures in the German diagnosis-related-group (DRG) system - 5 year cost data analysis of the German Society of Gastroenterology project].

Science.gov (United States)

Rathmayer, Markus; Heinlein, Wolfgang; Reiß, Claudia; Albert, Jörg G; Akoglu, Bora; Braun, Martin; Brechmann, Thorsten; Gölder, Stefan K; Lankisch, Tim; Messmann, Helmut; Schneider, Arne; Wagner, Martin; Dollhopf, Markus; Gundling, Felix; Röhling, Michael; Haag, Cornelie; Dohle, Ines; Werner, Sven; Lammert, Frank; Fleßa, Steffen; Wilke, Michael H; Schepp, Wolfgang; Lerch, Markus M

2017-10-01

Background  In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. Methods  To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Results  Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. Discussion  For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses. © Georg Thieme Verlag KG Stuttgart · New York.

Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results from a Pilot Study

Science.gov (United States)

Patel, Minal R.; Resnicow, Kenneth; Lang, Ian; Kraus, Kathleen; Heisler, Michele

2018-01-01

Background: Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. Aims: We developed a financial burden resource tool and examined its acceptability and the preliminary effects on…

Uncertainty in relative cost investigation

International Nuclear Information System (INIS)

Bunn, D.; Viahos, K.

1989-01-01

One of the consequences of the privatization of the Central Electricity Generating Board has been a weakening of the economic case for nuclear generation over coal. Nuclear has higher capital, but lower operating costs than coal and is therefore favoured in capital budgeting by discounting at lower rates of return. In the Sizewell case (in 1987), discounting at the public sector rate of 5 per cent favoured nuclear. However, the private sector will require higher rates of return, thus rendering nuclear less attractive. Hence the imposition by the government of a diversity constraint on the privatized industry to ensure that contracts are made for a minimum fraction of non-fossil (essentially nuclear) energy. An electricity capacity planning model was developed to estimate the costs of imposing various non-fossil energy constraints on the planning decision of a privatized electricity supply industry, as a function of various discount rates. Using a large-scale linear programming technique, the model optimizes over a 50 year horizon the schedule of installation, and mix of generating capacity, both with and without a minimum non-fossil constraint. The conclusion is that the opportunity cost of diversity may be a complex joint substation of more than one type of plant (eg coal and gas) depending on the discount rate. (author)

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets.

Science.gov (United States)

Parlesak, Alexandr; Tetens, Inge; Dejgård Jensen, Jørgen; Smed, Sinne; Gabrijelčič Blenkuš, Mojca; Rayner, Mike; Darmon, Nicole; Robertson, Aileen

2016-01-01

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.

Use of spikants in HTGR fuel and their effect on costs

International Nuclear Information System (INIS)

Brooks, L.H.

1979-05-01

The costs of fresh fuel fabrication have been estimated for flowsheets that have spikant added (Co-60) at various points. The costs are compared with refabricated and fresh fuel fabrication costs. It is shown that the costs increase as the spikant is added nearer to the plant feed point. The least cost is achieved by adding a detachable spikant to the finished fuel element. The highest cost is incurred when the spikant is fed in with the plant feed. This cost is greater than that for refabricated fuel because extra process cells are necessary to prepare the spikant and, in addition, the gamma flux from the Co-60 is much greater than from U-232 and greater precautions have to be taken

Alcohol-related hand injuries: an unnecessary social and economic cost.

OpenAIRE

Marston, R. A.

1992-01-01

Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were therefore preventable. The economic cost to the unit is discussed.

The cost of electrocoagulation

Energy Technology Data Exchange (ETDEWEB)

Donini, J.C.; Kan, J.; Szynkarczuk, J.; Hassan, T.A.; Kar, K.L.

1993-01-01

Electrocoagulation could be an attractive and suitable method for separating solids from waste water. The electrocoagulation of kaolinite and bentonite suspensions was studied in a pilot electrocoagulation unit to assess the cost and efficiency of the process. Factors affecting cost such as the formation of passivation layers on electrode plates and the recirculation and concentration of sodium chloride were examined. Colorimetry was used to analyze aluminum content in the suspension. The results were used to calculate the cost due to consumption of electrode material (aluminium) during the process. Total cost was assumed to comprise the energy cost and the cost of electrode material. Comparison was based on the settling properties of the treated product: turbidity, settling rate, and cake height. In most cases, aluminium efficiency averaged around 200% and material cost accounted for 80% of total cost. Although higher concentrations of sodium chloride could only slightly increase aluminium efficiency and electrode efficiency, the higher concentrations resulted in much greater total cost, due to the greater current generated by the increased suspension conductivity, which in turn dissolved a larger amount of aluminium. The recirculation loop increased the flow rate by 3-10 times, enhancing the mass transport between the electrodes and resulting in lower cost and better settling properties. Over the course of two months the electrodes coatings became thicker while efficiency decreased. The electrode efficiency was found to be as high as 94% for virgin electrodes and as low as 10% after two months. 8 refs., 25 figs., 9 tabs.

Risk assessment and management of brucellosis in the southern greater Yellowstone area (II): Cost-benefit analysis of reducing elk brucellosis prevalence.

Science.gov (United States)

Boroff, Kari; Kauffman, Mandy; Peck, Dannele; Maichak, Eric; Scurlock, Brandon; Schumaker, Brant

2016-11-01

Recent cases of bovine brucellosis (Brucella abortus) in cattle (Bos taurus) and domestic bison (Bison bison) of the southern Greater Yellowstone Area (SGYA) have been traced back to free-ranging elk (Cervus elaphus). Several management activities have been implemented to reduce brucellosis seroprevalence in elk, including test-and-slaughter, low-density feeding at elk winter feedgrounds, and elk vaccination. It is unclear which of these activities are most cost-effective at reducing the risk of elk transmitting brucellosis to cattle. In a companion paper, a stochastic risk model was used to translate a reduction in elk seroprevalence to a reduction in the risk of transmission to cattle. Here, we use those results to estimate the expected economic benefits and costs of reducing seroprevalence in elk using three different management activities: vaccination of elk with Brucella strain 19 (S19), low-density feeding of elk, and elk test-and-slaughter. Results indicate that the three elk management activities yield negative expected net benefits, ranging from -$2983 per year for low-density feeding to -$595,471 per year for test-and-slaughter. Society's risk preferences will determine whether strategies that generate small negative net benefit, such as low-density feeding, are worth implementing. However, activities with large negative net benefits, such as test-and-slaughter and S19 vaccination, are unlikely to be economically worthwhile. Given uncertainty about various model parameters, we identify some circumstances in which individual management activities might generate positive expected net benefit. Copyright © 2016 Elsevier B.V. All rights reserved.

Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting.

Science.gov (United States)

Natarajan, Pradeep; Young, Robin; Stitziel, Nathan O; Padmanabhan, Sandosh; Baber, Usman; Mehran, Roxana; Sartori, Samantha; Fuster, Valentin; Reilly, Dermot F; Butterworth, Adam; Rader, Daniel J; Ford, Ian; Sattar, Naveed; Kathiresan, Sekar

2017-05-30

Relative risk reduction with statin therapy has been consistent across nearly all subgroups studied to date. However, in analyses of 2 randomized controlled primary prevention trials (ASCOT [Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm] and JUPITER [Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin]), statin therapy led to a greater relative risk reduction among a subgroup at high genetic risk. Here, we aimed to confirm this observation in a third primary prevention randomized controlled trial. In addition, we assessed whether those at high genetic risk had a greater burden of subclinical coronary atherosclerosis. We studied participants from a randomized controlled trial of primary prevention with statin therapy (WOSCOPS [West of Scotland Coronary Prevention Study]; n=4910) and 2 observational cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults] and BioImage; n=1154 and 4392, respectively). For each participant, we calculated a polygenic risk score derived from up to 57 common DNA sequence variants previously associated with coronary heart disease. We compared the relative efficacy of statin therapy in those at high genetic risk (top quintile of polygenic risk score) versus all others (WOSCOPS), as well as the association between the polygenic risk score and coronary artery calcification (CARDIA) and carotid artery plaque burden (BioImage). Among WOSCOPS trial participants at high genetic risk, statin therapy was associated with a relative risk reduction of 44% (95% confidence interval [CI], 22-60; P statin therapy was 3.6% (95% CI, 2.0-5.1) among those in the high genetic risk group and 1.3% (95% CI, 0.6-1.9) in all others. Each 1-SD increase in the polygenic risk score was associated with 1.32-fold (95% CI, 1.04-1.68) greater likelihood of having coronary artery calcification and 9.7% higher (95% CI, 2.2-17.8) burden of carotid plaque. Those at high genetic risk have a greater

Greater temperature sensitivity of plant phenology at colder sites

DEFF Research Database (Denmark)

Prevey, Janet; Vellend, Mark; Ruger, Nadja

2017-01-01

Warmer temperatures are accelerating the phenology of organisms around the world. Temperature sensitivity of phenology might be greater in colder, higher latitude sites than in warmer regions, in part because small changes in temperature constitute greater relative changes in thermal balance...

Antiepileptic Drug Titration and Related Health Care Resource Use and Costs.

Science.gov (United States)

Fishman, Jesse; Kalilani, Linda; Song, Yan; Swallow, Elyse; Wild, Imane

2018-02-27

Unexpected breakthrough seizures resulting from suboptimal antiepileptic drug (AED) dosing during the titration period, as well as adverse events resulting from rapid AED titration, may influence the titration schedule and significantly increase health care resource use (HRU) and health care costs. To assess the relationship between AEDs, HRU, and costs during AED titration and maintenance. Practicing neurologists were recruited from a nationwide panel to provide up to 3 patient records each for this retrospective medical chart review. Patients with epilepsy who were aged ≥ 18 years and had initiated an AED between January 1, 2014, and January 1, 2016, were followed for 6 months from AED initiation. Titration duration was the time from AED initiation to the beginning of treatment maintenance as determined by the physician. Outcomes were epilepsy-specific HRU (hospitalizations, emergency department visits, outpatient visits, physician referral, laboratory testing/diagnostic imaging, and phone calls) and related costs that occurred during the titration or maintenance treatment periods. Of 811 patients, 156, 128, 125, 120, 114, 107, and 61 initiated the following AEDs: levetiracetam, lamotrigine, lacosamide, valproate, topiramate, carbamazepine, and phenytoin, respectively. Most patients (619/803 [77.1%] with complete AED data) received monotherapy. Baseline characteristics were similar across AEDs (mean [SD] age, 36.6 [14.4] years; 59.0% male). Kaplan-Meier estimates of titration duration ranged from 3.3 weeks (phenytoin) to 8.1 weeks (lamotrigine). From titration to maintenance, the overall incidence of HRU per person-month decreased 54.5%-89.3% for each HRU measure except outpatient visits (24.6% decrease). Total epilepsy-related costs decreased from $80.48 to $42.77 per person-month, or 46.9% from titration to maintenance. AED titration periods had higher HRU rates and costs than AED maintenance, suggesting that use of AEDs with shorter titration requirements

[Cost-Effectiveness and Cost-Utility Analyses of Antireflux Medicine].

Science.gov (United States)

Gockel, Ines; Lange, Undine Gabriele; Schürmann, Olaf; Jansen-Winkeln, Boris; Sibbel, Rainer; Lyros, Orestis; von Dercks, Nikolaus

2018-04-12

Laparoscopic antireflux surgery and medical therapy with proton pump inhibitors are gold standards of gastroesophageal reflux treatment. On account of limited resources and increasing healthcare needs and costs, in this analysis, not only optimal medical results, but also superiority in health economics of these 2 methods are evaluated. We performed an electronic literature survey in MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) as well as in the NHS Economic Evaluation Database, including studies published until 1/2017. Only studies considering the effect size of QALY (Quality-Adjusted Life Years) (with respect to different quality of life-scores) as primary outcome comparing laparoscopic fundoplication and medical therapy were included. Criteria of comparison were ICER (Incremental Cost-Effectiveness Ratio) and ICUR (Incremental Cost-Utility Ratio). Superiority of the respective treatment option for each publication was worked out. In total, 18 comparative studies were identified in the current literature with respect to above-mentioned search terms, qualifying for the defined inclusion criteria. Six studies were finally selected for analyses. Out of 6 publications, 3 showed superiority of laparoscopic fundoplication over long-term medical management based on current cost-effectiveness data. Limitations were related to different time intervals, levels of evidence of studies and underlying resources/costs of analyses, healthcare systems and applied quality of life instruments. Future prospective, randomized trials should examine this comparison in greater detail. Additionally, there is a large potential for further research in the health economics assessment of early diagnosis and prevention measures of reflux disease and Barrett's esophagus/carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.

Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q.

Science.gov (United States)

Matros, Evan; Albornoz, Claudia R; Razdan, Shantanu N; Mehrara, Babak J; Macadam, Sheina A; Ro, Teresa; McCarthy, Colleen M; Disa, Joseph J; Cordeiro, Peter G; Pusic, Andrea L

2015-04-01

Reimbursement has been recognized as a physician barrier to autologous reconstruction. Autologous reconstructions are more expensive than prosthetic reconstructions, but provide greater health-related quality of life. The authors' hypothesis is that autologous tissue reconstructions are cost-effective compared with prosthetic techniques when considering health-related quality of life and patient satisfaction. A cost-effectiveness analysis from the payer perspective, including patient input, was performed for unilateral and bilateral reconstructions with deep inferior epigastric perforator (DIEP) flaps and implants. The effectiveness measure was derived using the BREAST-Q and interpreted as the cost for obtaining 1 year of perfect breast health-related quality-adjusted life-year. Costs were obtained from the 2010 Nationwide Inpatient Sample. The incremental cost-effectiveness ratio was generated. A sensitivity analysis for age and stage at diagnosis was performed. BREAST-Q scores from 309 patients with implants and 217 DIEP flap reconstructions were included. The additional cost for obtaining 1 year of perfect breast-related health for a unilateral DIEP flap compared with implant reconstruction was $11,941. For bilateral DIEP flaps compared with implant reconstructions, the cost for an additional breast health-related quality-adjusted life-year was $28,017. The sensitivity analysis demonstrated that the cost for an additional breast health-related quality-adjusted life-year for DIEP flaps compared with implants was less for younger patients and earlier stage breast cancer. DIEP flaps are cost-effective compared with implants, especially for unilateral reconstructions. Cost-effectiveness of autologous techniques is maximized in women with longer life expectancy. Patient-reported outcomes findings can be incorporated into cost-effectiveness analyses to demonstrate the relative value of reconstructive procedures.

A cost summary applicable to seismic construction and maintenance of nuclear safety related piping

International Nuclear Information System (INIS)

Stevenson, J.D.

1995-01-01

This paper presents a summary of costs applicable to nuclear power plant piping for an earthquake defined as 0.2 SSE-PGA as a function of three eras of initial construction: 1967--1974, 1974--1981 and 1981--1990. Costs have been presented for both new construction and maintenance in operating plants using both the original PSAR-FSAR design criteria and current SRP requirements. It is recommended that the cost information contained in this report be considered in evaluating the cost benefit relationships associated with current and proposed future changes in seismic design procedures applicable to safety-related piping systems

Functional brain and age-related changes associated with congruency in task switching

Science.gov (United States)

Eich, Teal S.; Parker, David; Liu, Dan; Oh, Hwamee; Razlighi, Qolamreza; Gazes, Yunglin; Habeck, Christian; Stern, Yaakov

2016-01-01

Alternating between completing two simple tasks, as opposed to completing only one task, has been shown to produce costs to performance and changes to neural patterns of activity, effects which are augmented in old age. Cognitive conflict may arise from factors other than switching tasks, however. Sensorimotor congruency (whether stimulus-response mappings are the same or different for the two tasks) has been shown to behaviorally moderate switch costs in older, but not younger adults. In the current study, we used fMRI to investigate the neurobiological mechanisms of response-conflict congruency effects within a task switching paradigm in older (N=75) and younger (N=62) adults. Behaviorally, incongruency moderated age-related differences in switch costs. Neurally, switch costs were associated with greater activation in the dorsal attention network for older relative to younger adults. We also found that older adults recruited an additional set of brain areas in the ventral attention network to a greater extent than did younger adults to resolve congruency-related response-conflict. These results suggest both a network and an age-based dissociation between congruency and switch costs in task switching. PMID:27520472

International cost relations in electric power generation

International Nuclear Information System (INIS)

Schmitt, D.; Duengen, H.; Wilhelm, M.

1986-01-01

In spite of the fact that analyses of the cost of electric power generation as the result of international comparative evaluations are indisputably relevant, problems pending in connection with the costs of representative power plant technologies are of the methodological bind. German authors have hitherto also been failing to clear up and consider all aspects connected with the problems of data acquisition and the adequate interpretation of results. The analysis presented by the paper abstracted therefore aims at the following: 1) Systematization of the different categories of cost relevant in connection with international comparative evaluation. Classification into different categories of decision making and development of standards meeting the requirements of international comparative evaluation. 2) Calculation of relevant average financial costs of Western German, America and French fossil-fuel and nuclear power plants by means of adequate calculation models, that is the assessment of costs with regard to countries and power plant technologies which are relevant to the Federal Republic of Germany. 3) Analysis of the resulting differences and determinantal interpretation. (orig./UA) [de

77 FR 11778 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

Science.gov (United States)

2012-02-28

... and II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and... available on OMB's Web site at http://www.whitehouse.gov/omb/circulars_default/ . The Cost Principles for... E (Principles for Determining Costs Applicable to Research and Development Under Grants and...

78 FR 7282 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

Science.gov (United States)

2013-02-01

... II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and... further review, the Cost Principles for Hospitals at 45 CFR Part 74, Appendix E. The proposal consolidates... instructed the OMB Director to ``review and where appropriate revise guidance concerning cost principles...

Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial.

Science.gov (United States)

Coulton, Simon; Clift, Stephen; Skingley, Ann; Rodriguez, John

2015-09-01

As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people. To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England. A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more. A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06-4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53-7.01), anxiety (mean difference = -1.78; -2.5 to -1.06) and depression (mean difference = -1.52; -2.13 to -0.92). Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people. © The Royal College of Psychiatrists 2015.

Management and cost accounting

CERN Document Server

Drury, Colin

1992-01-01

This third edition of a textbook on management and cost accounting features coverage of activity-based costing (ABC), advance manufacturing technologies (AMTs), JIT, MRP, target costing, life-cycle costing, strategic management accounting, total quality management and customer profitability analysis. Also included are revised and new end-of-chapter problems taken from past examination papers of CIMA, ACCA and ICAEW. There is increased reference to management accounting in practice, including many of the results of the author's CIMA sponsored survey, and greater emphasis on operational control and performance measurement.

Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study

Directory of Open Access Journals (Sweden)

V. Brown

2017-05-01

Full Text Available Abstract Background Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention. Methods A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs were reported and results were tested through sensitivity analysis. Results Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings, measured against a comparator of no additional increase in fuel excise. Under “best case” assumptions, the intervention

Human health risks analysis: assessment of health costs of energy related pollutants

International Nuclear Information System (INIS)

Ginevan, M.E.; Grahn, D.; Lundy, R.T.; Brown, C.D.; Curtiss, J.B.

1979-01-01

This section contains a summary of research on the assessment of health costs of energy related pollutants. It includes the development of new statistical methodology, mathematical models, and data bases relevant to the assessment

77 FR 17360 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...

Science.gov (United States)

2012-03-26

... II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...; cost principles and administrative requirements (including Single Audit Act). The original comment...-idx?c=ecfr&tpl=/ecfrbrowse/Title02/2cfrv1_02.tpl . The Cost Principles for Hospitals are in the...

Local Property Tax Limitations vs. School District Employee Pension Costs in Pennsylvania

Science.gov (United States)

Hartman, William T.; Shrom, Timothy J.

2014-01-01

In Pennsylvania as in many other states, employee pension costs are a significant source of financial pressure for school districts (Zeehandelaar and Northern 2013, Pennsylvania Public Employees' Retirement Commission 2013). In order to gain greater insight into the nature of Pennsylvania school districts' financial burden related to pension…

The cost of lost productivity due to premature cancer-related mortality: an economic measure of the cancer burden.

Science.gov (United States)

Hanly, Paul A; Sharp, Linda

2014-03-26

Most measures of the cancer burden take a public health perspective. Cancer also has a significant economic impact on society. To assess this economic burden, we estimated years of potential productive life lost (YPPLL) and costs of lost productivity due to premature cancer-related mortality in Ireland. All cancers combined and the 10 sites accounting for most deaths in men and in women were considered. To compute YPPLL, deaths in 5-year age-bands between 15 and 64 years were multiplied by average working-life expectancy. Valuation of costs, using the human capital approach, involved multiplying YPPLL by age-and-gender specific gross wages, and adjusting for unemployment and workforce participation. Sensitivity analyses were conducted around retirement age and wage growth, labour force participation, employment and discount rates, and to explore the impact of including household production and caring costs. Costs were expressed in €2009. Total YPPLL was lower in men than women (men = 10,873; women = 12,119). Premature cancer-related mortality costs were higher in men (men: total cost = €332 million, cost/death = €290,172, cost/YPPLL = €30,558; women: total cost = €177 million, cost/death = €159,959, cost/YPPLL = €14,628). Lung cancer had the highest premature mortality cost (€84.0 million; 16.5% of total costs), followed by cancers of the colorectum (€49.6 million; 9.7%), breast (€49.4 million; 9.7%) and brain & CNS (€42.4 million: 8.3%). The total economic cost of premature cancer-related mortality in Ireland amounted to €509.5 million or 0.3% of gross domestic product. An increase of one year in the retirement age increased the total all-cancer premature mortality cost by 9.9% for men and 5.9% for women. The inclusion of household production and caring costs increased the total cost to €945.7 million. Lost productivity costs due to cancer-related premature mortality are significant. The higher premature mortality cost in males than

Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

LENUS (Irish Health Repository)

Sheridan, A

2012-03-08

BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

Extent, nature and hospital costs of fireworks-related injuries during the Wednesday Eve festival in Iran.

Science.gov (United States)

Alinia, Siros; Rezaei, Satar; Daroudi, Rajabali; Hadadi, Mashyaneh; Akbari Sari, Ali

2013-01-01

Fireworks are commonly used in local and national celebrations. The aim of this study is to explore the extent, nature and hospital costs of injuries related to the Persian Wednesday Eve festival in Iran. Data for injuries caused by fireworks during the 2009 Persian Wednesday Eve festival were collected from the national Ministry of Health database. Injuries were divided into nine groups and the average and total hospital costs were estimated for each group. The cost of care for patients with burns was estimated by reviewing a sample of 100 patients randomly selected from a large burn center in Tehran. Other costs were estimated by conducting semi structured interviews with expert managers at two large government hospitals. 1817 people were injured by fireworks during the 2009 Wednesday Eve festival. The most frequently injured sites were the hand (43.3%), eye (24.5%) and face (13.2%), and the most common types of injury were burns (39.9%), contusions/abrasions (24.6%) and lacerations (12.7%). The mean length of hospital stay was 8.15 days for patients with burns, 10.7 days for those with amputations, and 3 days for those with other types of injury. The total hospital cost of injuries was US$ 284 000 and the average cost per injury was US$ 156. The total hospital cost of patients with amputations was US$ 48 598. Most of the costs were related to burns (56.6%) followed by amputations (12.2%). Injuries related to the Persian Wednesday Eve festival are common and lead to extensive morbidity and medical costs. © 2013 KUMS, All rights reserved.

State-Level Estimates of Cancer-Related Absenteeism Costs

Science.gov (United States)

Tangka, Florence K.; Trogdon, Justin G.; Nwaise, Isaac; Ekwueme, Donatus U.; Guy, Gery P.; Orenstein, Diane

2016-01-01

Background Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. Methods In analyses of data from the 2004–2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. Results We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. Conclusions The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. PMID:23969498

Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

Science.gov (United States)

Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

2018-03-20

No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

Impact of quadrivalent influenza vaccine on public health and influenza-related costs in Australia

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Aurélien Jamotte

2016-07-01

Full Text Available Abstract Background Annual trivalent influenza vaccines (TIV containing three influenza strains (A/H1N1, A/H3N2, and one B have been recommended for the prevention of influenza. However, worldwide co-circulation of two distinct B lineages (Victoria and Yamagata and difficulties in predicting which lineage will predominate each season have led to the development of quadrivalent influenza vaccines (QIV, which include both B lineages. Our analysis evaluates the public health benefit and associated influenza-related costs avoided which would have been obtained by using QIV rather than TIV in Australia over the period 2002–2012. Methods A static model stratified by age group was used, focusing on people at increased risk of influenza as defined by the Australian vaccination recommendations. B-lineage cross-protection was accounted for. We calculated the potential impact of QIV compared with TIV over the seasons 2002–2012 (2009 pandemic year excluded using Australian data on influenza circulation, vaccine coverage, hospitalisation and mortality rates as well as unit costs, and international data on vaccine effectiveness, influenza attack rate, GP consultation rate and working days lost. Third-party payer and societal influenza-related costs were estimated in 2014 Australian dollars. Sensitivity analyses were conducted. Results Using QIV instead of TIV over the period 2002–2012 would have prevented an estimated 68,271 additional influenza cases, 47,537 GP consultations, 3,522 hospitalisations and 683 deaths in the population at risk of influenza. These results translate into influenza-related societal costs avoided of $46.5 million. The estimated impact of QIV was higher for young children and the elderly. The overall impact of QIV depended mainly on vaccine effectiveness and the influenza attack rate attributable to the mismatched B lineage. Conclusion The broader protection offered by QIV would have reduced the number of influenza infections

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Abubeker, Jewahir Ali; Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail

2011-01-01

This paper is devoted to the consideration of an algorithm for sequential optimization of paths in directed graphs relative to di_erent cost functions. The considered algorithm is based on an extension of dynamic programming which allows

Reactive control processes contributing to residual switch cost and mixing cost across the adult lifespan.

Science.gov (United States)

Whitson, Lisa R; Karayanidis, Frini; Fulham, Ross; Provost, Alexander; Michie, Patricia T; Heathcote, Andrew; Hsieh, Shulan

2014-01-01

In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost) and when repeating a task alone rather than intermixed with another task (mixing cost). These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs). Moreover, residual reaction time mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these "mixed" repeat trials (Karayanidis et al., 2011). In this paper, we analyze stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. These findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

Direct medical cost of stroke in Singapore.

Science.gov (United States)

Ng, Charmaine Shuyu; Toh, Matthias Paul Han Sim; Ng, Jiaying; Ko, Yu

2015-10-01

Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority. © 2015 World Stroke Organization.

Direct medical cost of influenza-related hospitalizations among severe acute respiratory infections cases in three provinces in China.

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Lei Zhou

Full Text Available BACKGROUND: Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. METHODS: Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital's Hospital Information System (HIS and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range and median (interquartile range [IQR] costs were calculated and compared among children (≤15 years, adults (16-64 years and elderly (≥65 years groups. Factors influencing cost were analyzed. RESULTS: A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range direct medical cost was $1,797 ($80-$27,545 for all hospitalizations, and the median (IQR direct medical cost was $231 ($164, $854 ($890, and $2,263 ($7,803 for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. CONCLUSION: Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies.

The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

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Bahia Luciana

2012-06-01

Full Text Available Abstract Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS. Methods Population attributable risk (PAR was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR ≥ 1.20 or RR ≥1.10 and  Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Mahayni, Malek A.

2011-01-01

developed to solve the optimal paths problem with different kinds of graphs. An algorithm that solves the problem of paths’ optimization in directed graphs relative to different cost functions is described in [1]. It follows an approach extended from

Data Flow in Relation to Life-Cycle Costing of Construction Projects in the Czech Republic

Science.gov (United States)

Biolek, Vojtěch; Hanák, Tomáš; Marović, Ivan

2017-10-01

Life-cycle costing is an important part of every construction project, as it makes it possible to take into consideration future costs relating to the operation and demolition phase of a built structure. In this way, investors can optimize the project design to minimize the total project costs. Even though there have already been some attempts to implement BIM software in the Czech Republic, the current state of affairs does not support automated data flow between the bill of costs and applications that support building facility management. The main aim of this study is to critically evaluate the current situation and outline a future framework that should allow for the use of the data contained in the bill of costs to manage building operating costs.

Allocation to reproduction and relative reproductive costs in two species of dioecious Anacardiaceae with contrasting phenology.

Science.gov (United States)

Matsuyama, Shuhei; Sakimoto, Michinori

2008-06-01

The cost of reproduction in dioecious plants is often female-biased. However, several studies have reported no difference in costs of reproduction between the sexes. In this study, the relative reproductive allocation and costs at the shoot and whole-plant levels were examined in woody dioecious Rhus javanica and R. trichocarpa, in order to examine differences between types of phenophase (i.e. physiological stage of development). Male and female Rhus javanica and R. trichocarpa were sampled and the reproductive and vegetative allocation of the shoot were estimated by harvesting reproductive current-year shoots during flowering and fruiting. Measurements were made of the number of reproductive and total current-year shoots per whole plant, and of the basal area increment (BAI). The numbers of reproductive and total current-year shoots per 1-year-old shoot were counted in order to examine the costs in the following year at the shoot level. A female-biased annual reproductive allocation was found; however, the ratio of reproductive current-year shoots per tree and the BAI did not differ between sexes in Rhus javanica and R. trichocarpa. The percentage of 1-year-old shoots with at least one reproductive current-year shoot was significantly male-biased in R. trichocarpa, but not in R. javanica, indicating that there was a relative cost at the shoot level only in R. trichocarpa. The female-biased leaf mass per shoot, an indicator of compensation for costs, was only found in R. javanica. Relative reproductive costs at the shoot level were detected in Rhus trichocarpa, which has simultaneous leafing and flowering, but not in R. javanica, which has leafing followed by flowering. However, the costs for the whole-plant level were diminished in both species. The results suggest that the phenophase type may produce the different costs for R. javanica and R. trichocarpa through the development of a compensation mechanism.

Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

Directory of Open Access Journals (Sweden)

Reynolds Matthew W

2011-05-01

Full Text Available Abstract Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions was examined, and hospital costs and length of stay (LOS were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates was 6.0 days and ranged from 1

Technical concept for a greater-confinement-disposal test facility

International Nuclear Information System (INIS)

Hunter, P.H.

1982-01-01

Greater confinement disposal (GCO) has been defined by the National Low-Level Waste Program as the disposal of low-level waste in such a manner as to provide greater containment of radiation, reduce potential for migration or dispersion or radionuclides, and provide greater protection from inadvertent human and biological intrusions in order to protect the public health and safety. This paper discusses: the need for GCD; definition of GCD; advantages and disadvantages of GCD; relative dose impacts of GCD versus shallow land disposal; types of waste compatible with GCD; objectives of GCD borehole demonstration test; engineering and technical issues; and factors affecting performance of the greater confinement disposal facility

Cost-effectiveness of single versus double embryo transfer in IVF in relation to female age

NARCIS (Netherlands)

van Loendersloot, Laura L.; Moolenaar, Lobke M.; van Wely, Madelon; Repping, Sjoerd; Bossuyt, Patrick M.; Hompes, Peter G. A.; van der Veen, Fulco; Mol, Ben Willem J.

2017-01-01

Objective: To evaluate the cost-effectiveness of single embryo transfer followed by an additional frozen thawed single embryo transfer, if more embryos are available, as compared to double embryo transfer in relation to female age. Study design: We used a decision tree model to evaluate the costs

Specific count model for investing the related factors of cost of GERD and functional dyspepsia

Science.gov (United States)

Abadi, Alireza; Chaibakhsh, Samira; Safaee, Azadeh; Moghimi-Dehkordi, Bijan

2013-01-01

Aim The purpose of this study is to analyze the cost of GERD and functional dyspepsia for investing its related factors. Background Gastro-oesophageal reflux disease GERD and dyspepsia are the most common symptoms of gastrointestinal disorders. Recent studies showed high prevalence and variety of clinical presentation of these two symptoms imposed enormous economic burden to the society. Cost data that related to economics burden have specific characteristics. So this kind of data needs to specific models. Poisson regression (PR) and negative binomial regression (NB) are the models that were used for analyzing cost data in this paper. Patients and methods This study designed as a cross-sectional household survey from May 2006 to December 2007 on a random sample of individual in the Tehran province, Iran to find the prevalence of gastrointestinal symptoms and disorders and its related factors. The Cost in each item was counted. PR and NB were carried out to the data respectively. Likelihood ratio test was performed for comparison between models. Also Log likelihood, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare performance of the models. Results According to Likelihood ratio test and all three criterions that we used to compare performance of the models, NB was the best model for analyzing this cost data. Sex, age and insurance statues were being significant. Conclusion PR and NB models were carried out for this data and according the results improved fit of the NB model over PR, it clearly indicates that over-dispersion is involved due to unobserved heterogeneity and/or clustering. NB model in cost data more appropriate fit than PR. PMID:24834282

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

Directory of Open Access Journals (Sweden)

Johanna J. Vollenweider

2011-01-01

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

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

Science.gov (United States)

Vollenweider, Johanna J; Gregg, Jake L; Heintz, Ron A; Hershberger, Paul K

2011-01-01

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

Measuring the societal burden of cancer: the cost of lost productivity due to premature cancer-related mortality in Europe.

Science.gov (United States)

Hanly, Paul; Soerjomataram, Isabelle; Sharp, Linda

2015-02-15

Every cancer-related death in someone of working age represents an economic loss to society. To inform priorities for cancer control, we estimated costs of lost productivity due to premature cancer-related mortality across Europe, for all cancers and by site, gender, region and country. Cancer deaths in 2008 were obtained from GLOBOCAN for 30 European countries across four regions. Costs were valued using the human capital approach. Years of productive life lost (YPLL) were computed by multiplying deaths between 15 and 64 years by working-life expectancy, then by country-, age- and gender-specific annual wages, corrected for workforce participation and unemployment. Lost productivity costs due to premature cancer-related mortality in Europe in 2008 were €75 billion. Male costs (€49 billion) were almost twice female costs (€26 billion). The most costly sites were lung (€17 billion; 23% of total costs), breast (€7 billion; 9%) and colorectum (€6 billion; 8%). Stomach cancer (in Southern and Central-Eastern Europe) and pancreatic cancer (in Northern and Western Europe) were also among the most costly sites. The average lost productivity cost per cancer death was €219,241. Melanoma had the highest cost per death (€312,798), followed by Hodgkin disease (€306,628) and brain and CNS cancer (€288,850). Premature mortality costs were 0.58% of 2008 European gross domestic product, highest in Central-Eastern Europe (0.81%) and lowest in Northern Europe (0.51%). Premature cancer-related mortality costs in Europe are significant. These results provide a novel perspective on the societal cancer burden and may be used to inform priority setting for cancer control. © 2014 UICC.

Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

Science.gov (United States)

Tucker, Larry A.; Clegg, Alan G.

2002-01-01

Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

PERCEPTIONS OF PROFESSIONAL ACCOUNTANTS ON THE COSTS AND BENEFITS OF IMPLEMENTING IAS/IFRS IN ROMANIA

Directory of Open Access Journals (Sweden)

ANDREEA PAULA DUMITRU

2014-11-01

Full Text Available This study aims to investigate the perceptions of professional accountants on the costs, benefits and implications of applying IFRS in Romania. The main results show that the benefits of implementing IFRS is ensuring greater transparency and comparability of financial information. In terms of costs, most respondents felt that the main costs is related to staff training, this being one of the factors that have caused difficulties in implementing IFRS. Regarding the quality of financial information after the adoption of standards, we conclude that it will improve considerably.

COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

Directory of Open Access Journals (Sweden)

Moisello Anna Maria

2012-07-01

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

Neighborhood walkability and hospital treatment costs: A first assessment.

Science.gov (United States)

Yu, Yan; Davey, Rachel; Cochrane, Tom; Learnihan, Vincent; Hanigan, Ivan C; Bagheri, Nasser

2017-06-01

Health system expenditure is a global concern, with hospital cost a major component. Built environment has been found to affect physical activity and health outcomes. The purpose of the study was a first assessment of the relationship between neighborhood walkability and hospital treatment costs. For 88 neighborhoods in the Australian Capital Territory (ACT), 2011-2013, a total of 30,690 public hospital admissions for the treatment of four diagnostic groups (cancers, endocrine, nutritional and metabolic diseases, circulatory diseases and respiratory diseases) were extracted from the ACT admitted patient care database and analyzed in relation to the Walk Score® index as a measure of walkability. Hospital cost was calculated according to the cost weight of the diagnosis related group assigned to each admission. Linear regressions were used to analyze the associations of walkability with hospital cost per person, admissions per person and cost per admission at the neighborhood level. An inverse association with neighborhood walkability was found for cost per person and admissions per person, but not cost per admission. After adjusting for age, sex and socioeconomic status, a 20-unit increase in walkability was associated with 12.1% (95% CI: 7.1-17.0%) lower cost and 12.5% (8.1-17.0%) fewer admissions. These associations did not vary by neighborhood socioeconomic status. This exploratory analysis suggests the potential for improved population health and reduced hospital cost with greater neighborhood walkability. Further research should replicate the analysis with data from other urban settings, and focus on the behavioral mechanisms underlying the inverse walkability-hospital cost association. Copyright © 2017 Elsevier Inc. All rights reserved.

Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research.

Science.gov (United States)

van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

2018-01-01

The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2) developing a costing tool to support reviewers of grant proposals in assessing whether the proposed budget is realistic. For granted study proposals from the Netherlands Organization for Health Research and Development (ZonMw), type of study, potential cost drivers, proposed budget, and general characteristics were extracted. Regression analysis was conducted in an attempt to generate a 'predicted budget' for certain combinations of cost drivers, for implementation in the costing tool. Of 133 drug-related research grant proposals, 74 were included for complete data extraction. Because an association between cost drivers and budgets was not confirmed, we could not generate a predicted budget based on regression analysis, but only historic reference budgets given certain study characteristics. The costing tool was designed accordingly, i.e. with given selection criteria the tool returns the range of budgets in comparable studies. This range can be used in VOI analysis to estimate whether the expected net benefit of sampling will be positive to decide upon the net value of future research. The absence of association between study characteristics and budgets may indicate inconsistencies in the budgeting or granting process. Nonetheless, the tool generates useful information on historical budgets, and the option to formally relate VOI to budgets. To our knowledge, this is the first attempt at creating such a tool, which can be complemented with new studies being granted, enlarging the underlying database and keeping estimates up to date.

Cost-of-illness and disease burden of food-related pathogens in the Netherlands, 2011

NARCIS (Netherlands)

Mangen, Marie Josée J; Bouwknegt, Martijn; Friesema, Ingrid H M; Haagsma, Juanita A.; Kortbeek, Laetitia M.; Tariq, Luqman; Wilson, Margaret; van Pelt, Wilfrid; Havelaar, Arie H.|info:eu-repo/dai/nl/072306122

2015-01-01

To inform risk management decisions on control and prevention of food-related disease, both the disease burden expressed in Disability Adjusted Life Years (DALY) and the cost-of-illness of food-related pathogens are estimated and presented. Disease burden of fourteen pathogens that can be

Costs of treating patients with schizophrenia who have illness-related crisis events

Directory of Open Access Journals (Sweden)

Peng Xiaomei

2008-08-01

Full Text Available Abstract Background Relatively little is known about the relationship between psychosocial crises and treatment costs for persons with schizophrenia. This naturalistic prospective study assessed the association of recent crises with mental health treatment costs among persons receiving treatment for schizophrenia. Methods Data were drawn from a large multi-site, non-interventional study of schizophrenia patients in the United States, conducted between 1997 and 2003. Participants were treated at mental health treatment systems, including the Department of Veterans Affairs (VA hospitals, community mental health centers, community and state hospitals, and university health care service systems. Total costs over a 1-year period for mental health services and component costs (psychiatric hospitalizations, antipsychotic medications, other psychotropic medications, day treatment, emergency psychiatric services, psychosocial/rehabilitation group therapy, individual therapy, medication management, and case management were calculated for 1557 patients with complete medical information. Direct mental health treatment costs for patients who had experienced 1 or more of 5 recent crisis events were compared to propensity-matched samples of persons who had not experienced a crisis event. The 5 non-mutually exclusive crisis event subgroups were: suicide attempt in the past 4 weeks (n = 18, psychiatric hospitalization in the past 6 months (n = 240, arrest in the past 6 months (n = 56, violent behaviors in the past 4 weeks (n = 62, and diagnosis of a co-occurring substance use disorder (n = 413. Results Across all 5 categories of crisis events, patients who had a recent crisis had higher average annual mental health treatment costs than patients in propensity-score matched comparison samples. Average annual mental health treatment costs were significantly higher for persons who attempted suicide ($46,024, followed by persons with psychiatric hospitalization in

Low Cost, High-Throughput 3-D Pulmonary Imager Using Hyperpolarized Contrast Agents and Low-Field MRI

Science.gov (United States)

2017-10-01

greater gas polarizations and production amounts/ throughputs- benefiting in particular from the advent of com- pact, high-power, relatively low- cost ...Award Number: W81XWH-15-1-0271 TITLE: Low- Cost , High-Throughput 3-D Pulmonary Imager Using Hyperpolarized Contrast Agents and Low-Field MRI...DISTRIBUTION STATEMENT: Approved for Public Release; Distribution Unlimited The views, opinions and/or findings contained in this report are those of the

Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars

DEFF Research Database (Denmark)

Petersen, Lars Bo; Olsen, Kim Rose; Christensen, Jennifer Heather

2014-01-01

resource utilization. Differences in resources used for surgical and post-surgical management were calculated for each patient. Results: Converted to monetary units, the total costs for panoramic imaging equalized (sic)49.29 and for CBCT examination (sic)184.44. Modifying effects on this outcome......Objectives: The aim of this prospective clinical study was to derive the absolute and relative costs of cone beam CT (CBCT) and panoramic imaging before removal of an impacted mandibular third molar. Furthermore, the study aimed to analyse the influence of different cost-setting scenarios...... on the outcome of the absolute and relative costs and the incremental costs related to surgery. Methods: A randomized clinical trial compared complications following surgical removal of a mandibular third molar, where the pre-operative diagnostic method had been panoramic imaging or CBCT. The resources implied...

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

Science.gov (United States)

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

2010-02-01

: A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for

The mortality effect of ship-related fine particulate matter in the Sydney greater metropolitan region of NSW, Australia.

Science.gov (United States)

Broome, Richard A; Cope, Martin E; Goldsworthy, Brett; Goldsworthy, Laurie; Emmerson, Kathryn; Jegasothy, Edward; Morgan, Geoffrey G

2016-02-01

This study investigates the mortality effect of primary and secondary PM2.5 related to ship exhaust in the Sydney greater metropolitan region of Australia. A detailed inventory of ship exhaust emissions was used to model a) the 2010/11 concentration of ship-related PM2.5 across the region, and b) the reduction in PM2.5 concentration that would occur if ships used distillate fuel with a 0.1% sulfur content at berth or within 300 km of Sydney. The annual loss of life attributable to 2010/11 levels of ship-related PM2.5 and the improvement in survival associated with use of low-sulfur fuel were estimated from the modelled concentrations. In 2010/11, approximately 1.9% of the region-wide annual average population weighted-mean concentration of all natural and human-made PM2.5 was attributable to ship exhaust, and up to 9.4% at suburbs close to ports. An estimated 220 years of life were lost by people who died in 2010/11 as a result of ship exhaust-related exposure (95% CIβ: 140-290, where CIβ is the uncertainty in the concentration-response coefficient only). Use of 0.1% sulfur fuel at berth would reduce the population weighted-mean concentration of PM2.5 related to ship exhaust by 25% and result in a gain of 390 life-years over a twenty year period (95% CIβ: 260-520). Use of 0.1% sulfur fuel within 300 km of Sydney would reduce the concentration by 56% and result in a gain of 920 life-years over twenty years (95% CIβ: 600-1200). Ship exhaust is an important source of human exposure to PM2.5 in the Sydney greater metropolitan region. This assessment supports intervention to reduce ship emissions in the GMR. Local strategies to limit the sulfur content of fuel would reduce exposure and will become increasingly beneficial as the shipping industry expands. A requirement for use of 0.1% sulfur fuel by ships within 300 km of Sydney would provide more than twice the mortality benefit of a requirement for ships to use 0.1% sulfur fuel at berth. Copyright © 2015 Elsevier

Evaluating lek occupancy of greater sage-grouse in relation to landscape cultivation in the Dakotas

Science.gov (United States)

Smith, Joe T.; Flake, Lester D.; Higgins, Kenneth F.; Kobriger, Gerald D.; Homer, Collin G.

2005-01-01

Greater Sage-Grouse (Centrocercus urophasianus) have been declining in many states and provinces of North America, and North and South Dakota hold no exception to these declines. We studied effects of cultivated land on Greater Sage-Grouse lek abandonment in North and South Dakota. Landscape-level data were assessed using satellite imagery within a geographic information system. Comparisons were made of 1972-1976 and 1999-2000 percent cultivated and noncultivated land. These comparisons were made between land uses surrounding active leks versus inactive leks, active leks versus random locations, and abandoned regions versus active regions. The 1999-2000 imagery illustrated that percent cultivated land was greater near abandoned leks (4-km buffers) than near active leks in North Dakota or random sites, but this did not hold true in South Dakota. Comparison of an extensive region of abandoned leks with a region of active leks in North Dakota illustrated a similar increase as well as dispersion of cultivation within the abandoned region. However, 1972-1976 imagery revealed that this relationship between percentage of cultivated land and lek activity in North Dakota has been static over the last 30 years. Thus, if the decline of Greater Sage-Grouse is the result of cultivated land infringements, it occurred prior to 1972 in North Dakota.

Innovation in technology for the least product price and cost - a new minimum cost relation for reductions during technological learning

International Nuclear Information System (INIS)

Duffey, R.B.

2004-01-01

By analogy with the concepts of human learning, we show and introduce a new method to obtain least product cost and price that includes the effect of innovation and technological learning in manufacturing and production. This key result is a new paradigm instead of the usual economic 'power law' formulation. The new analysis is based on extensive analysis of many technological systems, and is directly related to the presence of learning as experience is accumulated. The results agree with the observed data. By using a consistent basis, the method replaces previous empirical 'power law' descriptions of the technological learning curve with a new 'marginal minimum cost equation' (MCE). (author)

Greater confinement disposal of radioactive wastes

International Nuclear Information System (INIS)

Trevorrow, L.E.; Gilbert, T.L.; Luner, C.; Merry-Libby, P.A.; Meshkov, N.K.; Yu, C.

1985-01-01

Low-level radioactive waste (LLW) includes a broad spectrum of different radionuclide concentrations, half-lives, and hazards. Standard shallow-land burial practice can provide adequate protection of public health and safety for most LLW. A small volume fraction (approx. 1%) containing most of the activity inventory (approx. 90%) requires specific measures known as greater-confinement disposal (GCD). Different site characteristics and different waste characteristics - such as high radionuclide concentrations, long radionuclide half-lives, high radionuclide mobility, and physical or chemical characteristics that present exceptional hazards - lead to different GCD facility design requirements. Facility design alternatives considered for GCD include the augered shaft, deep trench, engineered structure, hydrofracture, improved waste form, and high-integrity container. Selection of an appropriate design must also consider the interplay between basic risk limits for protection of public health and safety, performance characteristics and objectives, costs, waste-acceptance criteria, waste characteristics, and site characteristics

Costs and cost-effectiveness of periviable care.

Science.gov (United States)

Caughey, Aaron B; Burchfield, David J

2014-02-01

With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.

Drilling cost analysis

International Nuclear Information System (INIS)

Anand, A.B.

1992-01-01

Drilling assumes greater importance in present day uranium exploration which emphasizes to explore more areas on the basis of conceptual model than merely on surface anomalies. But drilling is as costly as it is important and consumes a major share (50% to 60%) of the exploration budget. As such the cost of drilling has great bearing on the exploration strategy as well as on the overall cost of the project. Therefore, understanding the cost analysis is very much important when planning or intensifying an exploration programme. This not only helps in controlling the current operations but also in planning the budgetary provisions for future operations. Also, if the work is entrusted to a private party, knowledge of in-house cost analysis helps in fixing the rates of drilling in different formations and areas to be drilled. Under this topic, various factors that contribute to the cost of drilling per meter as well as ways to minimize the drilling cost for better economic evaluation of mineral deposits are discussed. (author)

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

Science.gov (United States)

Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

The Cost of Smoking in California.

Science.gov (United States)

Max, Wendy; Sung, Hai-Yen; Shi, Yanling; Stark, Brad

2016-05-01

The economic impact of smoking, including healthcare costs and the value of lost productivity due to illness and mortality, was estimated for California for 2009. Smoking-attributable healthcare costs were estimated using a series of econometric models that estimate expenditures for hospital care, ambulatory care, prescriptions, home health care, and nursing home care. Lost productivity due to illness was estimated using an econometric model predicting how smoking status affects the number of days lost from work or other activities. The value of lives lost from premature mortality due to smoking was estimated using an epidemiological approach. Almost 4 million Californians still smoke, including 146 000 adolescents. The cost of smoking in 2009 totaled $18.1 billion, including $9.8 billion in healthcare costs, $1.4 billion in lost productivity from illness, and $6.8 billion in lost productivity from premature mortality. This amounts to $487 per California resident and $4603 per smoker. Costs were greater for men than for women. Hospital costs comprised 44% of healthcare costs. Despite extensive efforts at tobacco control in California, healthcare and lost productivity costs attributable to smoking remain high. Compared to costs for 1999, the total cost was 15% greater in 2009. However, after adjusting for inflation, real costs have fallen by 13% over the past decade, indicating that efforts have been successful in reducing the economic burden of smoking in the state. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Validation of generic cost estimates for construction-related activities at nuclear power plants: Final report

International Nuclear Information System (INIS)

Simion, G.; Sciacca, F.; Claiborne, E.; Watlington, B.; Riordan, B.; McLaughlin, M.

1988-05-01

This report represents a validation study of the cost methodologies and quantitative factors derived in Labor Productivity Adjustment Factors and Generic Methodology for Estimating the Labor Cost Associated with the Removal of Hardware, Materials, and Structures From Nuclear Power Plants. This cost methodology was developed to support NRC analysts in determining generic estimates of removal, installation, and total labor costs for construction-related activities at nuclear generating stations. In addition to the validation discussion, this report reviews the generic cost analysis methodology employed. It also discusses each of the individual cost factors used in estimating the costs of physical modifications at nuclear power plants. The generic estimating approach presented uses the /open quotes/greenfield/close quotes/ or new plant construction installation costs compiled in the Energy Economic Data Base (EEDB) as a baseline. These baseline costs are then adjusted to account for labor productivity, radiation fields, learning curve effects, and impacts on ancillary systems or components. For comparisons of estimated vs actual labor costs, approximately four dozen actual cost data points (as reported by 14 nuclear utilities) were obtained. Detailed background information was collected on each individual data point to give the best understanding possible so that the labor productivity factors, removal factors, etc., could judiciously be chosen. This study concludes that cost estimates that are typically within 40% of the actual values can be generated by prudently using the methodologies and cost factors investigated herein

Cost-effectiveness and the socialization of health care.

Science.gov (United States)

Musgrove, P

1995-01-01

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

Nuclear generating station and heavy water plant cost estimates for strategy studies

International Nuclear Information System (INIS)

Archinoff, G.H.

1979-07-01

Nuclear generating station capital, operating and maintenance costs are basic input data for strategy analyses of alternate nuclear fuel cycles. This report presents estimates of these costs for natural uranium CANDU stations, CANDU stations operating on advanced fuel cycles, and liquid metal fast breeder reactors. Cost estimates for heavy water plants are also presented. The results show that station capital costs for advanced fuel cycles are not expected to be significantly greater than those for natural uranium stations. LMFBR capital costs are expected to be 25-30 percent greater than for CANDU's. (auth)

Greater-confinement disposal of low-level radioactive wastes

International Nuclear Information System (INIS)

Trevorrow, L.E.; Gilbert, T.L.; Luner, C.; Merry-Libby, P.A.; Meshkov, N.K.; Yu, C.

1985-01-01

Low-level radioactive wastes include a broad spectrum of wastes that have different radionuclide concentrations, half-lives, and physical and chemical properties. Standard shallow-land burial practice can provide adequate protection of public health and safety for most low-level wastes, but a small volume fraction (about 1%) containing most of the activity inventory (approx.90%) requires specific measures known as ''greater-confinement disposal'' (GCD). Different site characteristics and different waste characteristics - such as high radionuclide concentrations, long radionuclide half-lives, high radionuclide mobility, and physical or chemical characteristics that present exceptional hazards - lead to different GCD facility design requirements. Facility design alternatives considered for GCD include the augered shaft, deep trench, engineered structure, hydrofracture, improved waste form, and high-integrity container. Selection of an appropriate design must also consider the interplay between basic risk limits for protection of public health and safety, performance characteristics and objectives, costs, waste-acceptance criteria, waste characteristics, and site characteristics. This paper presents an overview of the factors that must be considered in planning the application of methods proposed for providing greater confinement of low-level wastes. 27 refs

Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

International Nuclear Information System (INIS)

Kim, Gang Deuk; Oh, Jung Taek

2008-01-01

This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related

Effect of phenotype on health care costs in Crohn's disease: A European study using the Montreal classification.

Science.gov (United States)

Odes, Selwyn; Vardi, Hillel; Friger, Michael; Wolters, Frank; Hoie, Ole; Moum, Bjørn; Bernklev, Tomm; Yona, Hagit; Russel, Maurice; Munkholm, Pia; Langholz, Ebbe; Riis, Lene; Politi, Patrizia; Bondini, Paolo; Tsianos, Epameinondas; Katsanos, Kostas; Clofent, Juan; Vermeire, Severine; Freitas, João; Mouzas, Iannis; Limonard, Charles; O'Morain, Colm; Monteiro, Estela; Fornaciari, Giovanni; Vatn, Morten; Stockbrugger, Reinhold

2007-12-01

Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost. Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes. In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P<0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P<0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P<0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses. Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

Greater happiness for a greater number: Is that possible in Austria?

NARCIS (Netherlands)

R. Veenhoven (Ruut)

2011-01-01

textabstractWhat is the final goal of public policy? Jeremy Bentham (1789) would say: greater happiness for a greater number. He thought of happiness as subjective enjoyment of life; in his words as “the sum of pleasures and pains”. In his time the happiness of the great number could not be measured

Greater happiness for a greater number: Is that possible in Germany?

NARCIS (Netherlands)

R. Veenhoven (Ruut)

2009-01-01

textabstractWhat is the final goal of public policy? Jeremy Bentham (1789) would say: greater happiness for a greater number. He thought of happiness as subjective enjoyment of life; in his words as “the sum of pleasures and pains”. In his time the Happiness of the great number could not be measured

[Pay for performance explained by transaction costs theory].

Science.gov (United States)

Gorbaneff, Yuri; Cortes, Ariel; Torres, Sergio; Yepes, Francisco

2011-01-01

To evaluate the ability of transaction costs theory to explain incentives in the health care chain. We performed a case study of CPS, a health insurance company in Bogota (Colombia), which preferred not to publish its name. CPS moves in the environment of high transaction costs and uses the hybrid form of governance at the outpatient level. Incentive intensity, administrative control and the contract all agree with the theory. At the hospital level, the market is used, despite greater uncertainty. Because of the discrete form (1.0) of the incentives and the absence of administrative control, it is difficult for CPS to relate payment to hospital performance. Transaction costs theory explains the configuration of incentives. Another contribution made by this theory to the literature is the criterion to differentiate between the market and the hybrid. We propose that the market uses discrete-type (1.0) incentives, while the hybrid uses continuous, commission-like incentives. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Estimating the costs of work-related accidents and ill-health: An analysis of European data sources

NARCIS (Netherlands)

Heuvel, S. van den; Zwaan, L. van der; Dam, L. van; Oude Hengel, K.M.; Eekhout, I.; Emmerik, M.L. van; Oldenburg, C.; Brück, C.; Janowski, P.; Wilhelm, C.

2017-01-01

This report presents the results of a survey of national and international data sources on the costs of work-related injuries, illnesses and deaths. The aim was to evaluate the quality and comparability of different sources as a first step towards estimating the costs of accidents and ill-health at

Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia.

Science.gov (United States)

Bellon, Michelle L; Barton, Christopher; McCaffrey, Nikki; Parker, Denise; Hutchinson, Claire

2017-08-01

Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable

Burn related mortality in Greater Manchester: 11-year review of Regional Coronial Department Data.

Science.gov (United States)

Hussain, Amer; Dunn, Ken

2015-03-01

The Coroners Department (CD) records hold important demographic, injury and death details for victims of burn injuries derived from various sources yet this rich source of data has been infrequently utilised previously in describing the epidemiology of burn related mortality. The aim of this study was to use CD data to comprehensively investigate burn related mortality in the Greater Manchester region of United Kingdom. A retrospective study design was used to collect data for deceased demographics, injury details, site of death and cause of death from four CD offices in GM over an 11-year period (2000-2010 inclusive). Office of National Statistics (ONS) population metrics were used to calculate age- and gender-specific population denominators and mortality rates. Index of Multiple Deprivation (IMD) was used to correlate mortality with deprivation. Linear regression and Pearson's/Spearman's rank correlation were used to calculate trends and correlations. Poisson regression was used to calculate relative risk (IRR) between age- and gender groups. There were 314 recorded deaths in the region over the study period and thermal injury was 3-times less likely to result in death in 2010 compared to 2000. The largest proportion of these deaths (24.8%) was comprised of individuals ≥75 years in age. The relative risk of mortality in males was nearly 1.5-times higher and a significant majority of victims (77%) sustained their burn injury at their own home/residence. Inhalation injury without cutaneous burns was the most frequent type of injury (33%) and accidental house fires caused nearly half (49%) the injuries resulting in death. Sixty-five percent of deaths during this period were recorded to have occurred outside of regional burn service (RBS) hospitals and the commonest cause of immediate death on the death certificates was "inhalation of products of combustion" (32.1%). Within the >75 years age group the risk of death significantly increased with every quintile

The relation of potassium and sodium intakes to diet cost among U.S. adults.

Science.gov (United States)

Drewnowski, A; Rehm, C D; Maillot, M; Monsivais, P

2015-01-01

The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.

Lowland tapir (Tapirus terrestris) distribution, activity patterns and relative abundance in the Greater Madidi-Tambopata Landscape.

Science.gov (United States)

Wallace, Robert; Ayala, Guido; Viscarra, Maria

2012-12-01

Lowland tapir distribution is described in northwestern Bolivia and southeastern Peru within the Greater Madidi-Tambopata Landscape, a priority Tapir Conservation Unit, using 1255 distribution points derived from camera trapping efforts, field research and interviews with park guards from 5 national protected areas and hunters from 19 local communities. A total of 392 independent camera trapping events from 14 camera trap surveys at 11 sites demonstrated the nocturnal and crepuscular activity patterns (86%) of the lowland tapir and provide 3 indices of relative abundance for spatial and temporal comparison. Capture rates for lowland tapirs were not significantly different between camera trapping stations placed on river beaches versus those placed in the forest. Lowland tapir capture rates were significantly higher in the national protected areas of the region versus indigenous territories and unprotected portions of the landscape. Capture rates through time suggested that lowland tapir populations are recovering within the Tuichi Valley, an area currently dedicated towards ecotourism activities, following the creation (1995) and subsequent implementation (1997) of the Madidi National Park in Bolivia. Based on our distributional data and published conservative estimates of population density, we calculated that this transboundary landscape holds an overall lowland tapir population of between 14 540 and 36 351 individuals, of which at least 24.3% are under protection from national and municipal parks. As such, the Greater Madidi-Tambopata Landscape should be considered a lowland tapir population stronghold and priority conservation efforts are discussed in order to maintain this population. © 2012 Wiley Publishing Asia Pty Ltd, ISZS and IOZ/CAS.

Breast and prostate cancer productivity costs: a comparison of the human capital approach and the friction cost approach.

Science.gov (United States)

Hanly, Paul; Timmons, Aileen; Walsh, Paul M; Sharp, Linda

2012-05-01

Productivity costs constitute a substantial proportion of the total societal costs associated with cancer. We compared the results of applying two different analytical methods--the traditional human capital approach (HCA) and the emerging friction cost approach (FCA)--to estimate breast and prostate cancer productivity costs in Ireland in 2008. Data from a survey of breast and prostate cancer patients were combined with population-level survival estimates and a national wage data set to calculate costs of temporary disability (cancer-related work absence), permanent disability (workforce departure, reduced working hours), and premature mortality. For breast cancer, productivity costs per person using the HCA were € 193,425 and those per person using the FCA were € 8,103; for prostate cancer, the comparable estimates were € 109,154 and € 8,205, respectively. The HCA generated higher costs for younger patients (breast cancer) because of greater lifetime earning potential. In contrast, the FCA resulted in higher productivity costs for older male patients (prostate cancer) commensurate with higher earning capacity over a shorter time period. Reduced working hours postcancer was a key driver of total HCA productivity costs. HCA costs were sensitive to assumptions about discount and growth rates. FCA costs were sensitive to assumptions about the friction period. The magnitude of the estimates obtained in this study illustrates the importance of including productivity costs when considering the economic impact of illness. Vastly different results emerge from the application of the HCA and the FCA, and this finding emphasizes the importance of choosing the study perspective carefully and being explicit about assumptions that underpin the methods. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of volumetric alcohol taxation in Australia.

Science.gov (United States)

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

2010-04-19

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

Evolution of investment costs related to wood energy collective installations (2000-2006). Final report - Synthesis

International Nuclear Information System (INIS)

2009-04-01

Based on a survey on 90 French projects, and on a comparison with 76 German projects and 36 Austrian projects, this document proposes a synthesis of a study which aimed at identifying and analysing the evolution of investment costs for wood collective heating systems between 2000 and 2006. Data are analysed and commented while stressing their limitations which are related to their quality, to project heterogeneity, to economic value scattering. The evolution of investment costs of French projects is analysed in terms of global cost, and of items (heat production, public works, studies and construction, item ratios)

Importance of taste, nutrition, cost and convenience in relation to diet quality: Evidence of nutrition resilience among US adults using National Health and Nutrition Examination Survey (NHANES) 2007-2010.

Science.gov (United States)

Aggarwal, Anju; Rehm, Colin D; Monsivais, Pablo; Drewnowski, Adam

2016-09-01

Concerns with taste, nutrition, cost, and convenience are said to be key influences on food choices. This study examined the importance of food-related attitudes in relation to diet quality using US national level data. Interactions by socioeconomic status (SES), gender and race/ethnicity were tested. Analyses of 8957 adults from National Health and Nutrition Examination Survey (NHANES 2007-2010) were conducted in 2014-15. Perceived importance of taste, nutrition, cost, and convenience in dietary choices were assessed using 4-point Likert scales. Education and family income-to-poverty ratio (FIPR) were SES indicators. Healthy Eating Index (HEI-2010), a measure of adherence to 2010 dietary guidelines, was the diet quality measure. Survey-weighted regressions examined associations between attitudes and HEI, and tested for interactions. Taste was rated as "very important" by 77.0% of the US adults, followed by nutrition (59.9%), cost (39.9%), and convenience (29.8%). However, it was the perceived importance of nutrition that most strongly predicted HEI (β: +8.0 HEI scores among "very important" vs. "not at all important"). By contrast, greater importance for taste and convenience had a weak inverse relation with HEI (β: -5.1 and -1.5 respectively), adjusting for SES. Significant interactions were observed by race/ethnicity, but not SES and gender. Those who prioritized nutrition during food shopping had higher-quality diets regardless of gender, education and income in the US. Certain racial/ethnic groups managed to eat healthy despite attaching importance to cost and convenience. This is the first evidence of nutrition resilience among US adults using national data, which has huge implications for nutrition interventions. Published by Elsevier Inc.

Recovery Risk and Labor Costs in Public-Private Partnerships : Contractual Choice in the US Water industry

OpenAIRE

Albalate, Daniel, 1980-; Bel i Queralt, Germà, 1963-; Geddes, R. Richard

2012-01-01

We use an ordered logistic model to empirically examine the factors that explain varying degrees of private involvement in the U.S. water sector through public-private partnerships. Our estimates suggest that a variety of factors help explain greater private participation in this sector. We find that the risk to private participants regarding cost recovery is an important driver of private participation. The relative cost of labor is also a key factor in determining the degree of private invo...

The relative importance of factors that determine log-hauling costs

Science.gov (United States)

A. Jeff Martin; A. Jeff Martin

1971-01-01

Hauling costs are a major expense to lumbermen, but little is known about which factors affect hauling costs the most. A recent Forest Service study of hauling costs on 34 logging operations sheds light on whmich factors of cost are important and which might require less attention. These results should help lumbermen adopt a cost accounting procedure and help them with...

Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

Science.gov (United States)

Carel, R S

1982-04-01

The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

Scaling cost-sharing to wages: how employers can reduce health spending and provide greater economic security.

Science.gov (United States)

Robertson, Christopher T

2014-01-01

In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums. Yet, there are legal obstacles to scaled cost-sharing. The group-based nature of employer health insurance, reinforced by federal law, makes it difficult for scaling to be achieved through individual choices. The Affordable Care Act's (ACA) "essential coverage" mandate also caps cost-sharing even for wealthy workers that need no such cap. Additionally, there is a tax distortion in favor of highly paid workers purchasing healthcare through insurance rather than out-of-pocket. These problems are all surmountable. In particular, the ACA has expanded the applicability of an unenforced employee-benefits rule that prohibits "discrimination" in favor of highly compensated workers. A novel analysis shows that this statute gives the Internal Revenue Service the authority to require scaling and to thereby eliminate the current inequities and inefficiencies caused by the tax distortion. The promise is smarter insurance for over 150 million Americans.

Smoking is Associated with Higher Disease-related Costs and Lower Health-related Quality of Life in Inflammatory Bowel Disease

NARCIS (Netherlands)

Severs, M.; Mangen, M.J.; Valk, M.E. van der; Fidder, H.H.; Dijkstra, G.; Have, M. van der; Bodegraven, A.A. van; Jong, D.J. de; Woude, C.J. van der; Romberg-Camps, M.J.; Clemens, C.H.; Jansen, J.M.; Meeberg, P.C. van de; Mahmmod, N.; Ponsioen, C.Y.; Vermeijden, J.R.; Jong, A E F de; Pierik, M.; Siersema, P.D.; Oldenburg, B.

2017-01-01

Background and Aims: Smoking affects the course of inflammatory bowel disease [IBD]. We aimed to study the impact of smoking on IBD-specific costs and health-related quality-of-life [HrQoL] among adults with Crohn's disease [CD] and ulcerative colitis [UC]. Methods: A large cohort of IBD patients

Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

Energy Technology Data Exchange (ETDEWEB)

Kim, Gang Deuk; Oh, Jung Taek [Wonkwang University Hospital, Iksan (Korea, Republic of)

2008-12-15

This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related

Assessing medication adherence and healthcare utilization and cost patterns among hospital-discharged patients with schizoaffective disorder.

Science.gov (United States)

Karve, Sudeep; Markowitz, Michael; Fu, Dong-Jing; Lindenmayer, Jean-Pierre; Wang, Chi-Chuan; Candrilli, Sean D; Alphs, Larry

2014-06-01

Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant. Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge. From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity. We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46% during the 60-day period prior to index inpatient admission, which improved to 80% during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365). We observed considerably lower (46%) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8% (54%) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication

The influence of (toll-related) travel costs in residential location decisions of households : A stated choice approach

NARCIS (Netherlands)

Tillema, T.; van Wee, B.; Ettema, D.

2010-01-01

In this paper, we investigate the impact of travel costs, in particular toll costs, on the residential location choice of households, using a stated choice survey. Within the stated choice experiment, car drivers that frequently face traffic congestion, traded-off several trip-related (including

Cost of privatisation versus government alcohol retailing systems: Canadian example.

Science.gov (United States)

Popova, Svetlana; Patra, Jayadeep; Sarnocinska-Hart, Anna; Gnam, William H; Giesbrecht, Norman; Rehm, Jürgen

2012-01-01

Alcohol retail monopolies have been established in many countries to restrict alcohol availability and thus, minimise alcohol-related harm.The aim of this study was to estimate the impact of the privatisation of alcohol sales on the burden and direct health-care, law enforcement costs and indirect costs (lost productivity due to disability or premature mortality) in Canada. Simulation modelling. International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse were used. All burden and costs were compared with the baseline taken from the aggregate Cost Study on Substance Abuse in Canada 2002. If all Canadian provinces and territories were to privatise alcohol sales we assume that consumption would increase from 10% to 20% based on available Canadian literature. Under the 10% scenario the costs would increase from 6% ($828 million) and under the 20% scenario costs would increase 12% ($1.6 billion).This increase is substantially greater than the tax and mark-up revenue gained from increased sales,and represents a net loss. Alcohol-attributable burden and associated costs will increase markedly if all Canadian provinces and territories gave up the government alcohol retailing systems.For public health and economic reasons, governments should continue to have a strong role in alcohol retailing.

Workplace smoking related absenteeism and productivity costs in Taiwan.

Science.gov (United States)

Tsai, S P; Wen, C P; Hu, S C; Cheng, T Y; Huang, S J

2005-06-01

To estimate productivity losses and financial costs to employers caused by cigarette smoking in the Taiwan workplace. The human capital approach was used to calculate lost productivity. Assuming the value of lost productivity was equal to the wage/salary rate and basing the calculations on smoking rate in the workforce, average days of absenteeism, average wage/salary rate, and increased risk and absenteeism among smokers obtained from earlier research, costs due to smoker absenteeism were estimated. Financial losses caused by passive smoking, smoking breaks, and occupational injuries were calculated. Using a conservative estimate of excess absenteeism from work, male smokers took off an average of 4.36 sick days and male non-smokers took off an average of 3.30 sick days. Female smokers took off an average of 4.96 sick days and non-smoking females took off an average of 3.75 sick days. Excess absenteeism caused by employee smoking was estimated to cost USD 178 million per annum for males and USD 6 million for females at a total cost of USD 184 million per annum. The time men and women spent taking smoking breaks amounted to nine days per year and six days per year, respectively, resulting in reduced output productivity losses of USD 733 million. Increased sick leave costs due to passive smoking were approximately USD 81 million. Potential costs incurred from occupational injuries among smoking employees were estimated to be USD 34 million. Financial costs caused by increased absenteeism and reduced productivity from employees who smoke are significant in Taiwan. Based on conservative estimates, total costs attributed to smoking in the workforce were approximately USD 1032 million.

Patient level costing in Ireland: process, challenges and opportunities.

Science.gov (United States)

Murphy, A; McElroy, B

2015-03-01

In 2013, the Department of Health released their policy paper on hospital financing entitled Money Follows the Patient. A fundamental building block for the proposed financing model is patient level costing. This paper outlines the patient level costing process, identifies the opportunities and considers the challenges associated with the process in the Irish hospital setting. Methods involved a review of the existing literature which was complemented with an interview with health service staff. There are considerable challenges associated with implementing patient level costing including deficits in information and communication technologies and financial expertise as well as timeliness of coding. In addition, greater clinical input into the costing process is needed compared to traditional costing processes. However, there are long-term benefits associated with patient level costing; these include empowerment of clinical staff, improved transparency and price setting and greater fairness, especially in the treatment of outliers. These can help to achieve the Government's Health Strategy. The benefits of patient level costing need to be promoted and a commitment to investment in overcoming the challenges is required.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals.

Science.gov (United States)

Lima, Antônio Fernandes Costa

2017-04-01

to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked) time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL). Hospital C presented the highest mean direct cost (BRL 184.52), 5.23 times greater than the value for Hospital A (BRL 35.29) and 3.91 times greater than Hospital B (BRL 47.22). the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

The lifetime costs of overweight and obesity in childhood and adolescence: a systematic review.

Science.gov (United States)

Hamilton, D; Dee, A; Perry, I J

2018-04-01

Research into lifetime costs of obesity in childhood is growing. This review synthesizes that knowledge. A computerized search of the international literature since 2000 was conducted. Mean total lifetime healthcare and productivity costs were estimated and inflated to 2014 Irish euros. This resulted in 13 published articles. The methodology used in these studies varied widely, and only one study estimated both healthcare and productivity costs. Cognizant of this heterogeneity, the mean total lifetime cost of a child or adolescent with obesity was €149,206 (range, €129,410 to €178,933) for a boy and €148,196 (range, €136,576 to €173,842) for a girl. This was divided into an average of €16,229 (range, €6,580 to €35,810) in healthcare costs and €132,977 (range, €122,830 to €143,123) in productivity losses for boys and €19,636 (range, €8,016 to €45,283) and €128,560, respectively, for girls. Income penalty accounted for the greater part of productivity costs, amounting to €97,118 (range, €86,971 to €107,264) per male adolescent with obesity and €126,108 per female adolescent. Healthcare costs and income penalty appear greater in girls while costs because of workdays lost seem greater in boys. There is proportionality between body mass index and costs. Productivity costs are greater than healthcare costs. © 2017 World Obesity Federation.

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

Directory of Open Access Journals (Sweden)

Abbass, Ibrahim

2015-05-01

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

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

Science.gov (United States)

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

2010-01-21

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

Cost-effectiveness of external cephalic version for term breech presentation

Directory of Open Access Journals (Sweden)

Carvalho Brendan

2010-01-01

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

Dietary standards for school catering in France: serving moderate quantities to improve dietary quality without increasing the food-related cost of meals.

Science.gov (United States)

Vieux, Florent; Dubois, Christophe; Allegre, Laëtitia; Mandon, Lionel; Ciantar, Laurent; Darmon, Nicole

2013-01-01

To assess the impact on food-related cost of meals to fulfill the new compulsory dietary standards for primary schools in France. A descriptive study assessed the relationship between the level of compliance with the standards of observed school meals and their food-related cost. An analytical study assessed the cost of series of meals published in professional journals, and complying or not with new dietary standards. The costs were based on prices actually paid for food used to prepare school meals. Food-related cost of meals. Parametric and nonparametric tests from a total of 42 and 120 series of 20 meals in the analytical and descriptive studies, respectively. The descriptive study indicated that meeting the standards was not related to cost. The analytical study showed that fulfilling the frequency guidelines increased the cost, whereas fulfilling the portion sizes criteria decreased it. Series of meals fully respecting the standards (ie, frequency and portion sizes) cost significantly less (-0.10 €/meal) than series not fulfilling them, because the standards recommend smaller portion sizes. Introducing portion sizes rules in dietary standards for school catering may help increase dietary quality without increasing the food cost of meals. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Abubeker, Jewahir Ali

2011-05-14

This paper is devoted to the consideration of an algorithm for sequential optimization of paths in directed graphs relative to di_erent cost functions. The considered algorithm is based on an extension of dynamic programming which allows to represent the initial set of paths and the set of optimal paths after each application of optimization procedure in the form of a directed acyclic graph.

A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia

Directory of Open Access Journals (Sweden)

Hawela Moonga

2007-02-01

Full Text Available Abstract Background Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. Data gathered by the National Malaria Control Centre has shown that recently observed widespread treatment failure of SP and chloroquine precipitated a surge in malaria-related morbidity and mortality. As a result, the Government has recently replaced chloroquine and SP with combination therapy as first-line treatment for malaria. Despite the acclaimed therapeutic advantages of ACTs over monotherapies with SP and CQ, the cost of ACTs is much greater, raising concerns about affordability in many poor countries such as Zambia. This study evaluates the cost-effectiveness analysis of artemether-lumefantrine, a version of ACTs adopted in Zambia in mid 2004. Methods Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis. Findings The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line

Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales.

Science.gov (United States)

Mitchell, Rebecca J; Lower, Tony

2018-04-19

To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost. © 2018 National Rural Health Alliance Ltd.

Cost-of-Illness Trends Associated with Thyroid Disease in Korea

Directory of Open Access Journals (Sweden)

Kyung-Rae Hyun

2014-09-01

Full Text Available BackgroundThe purpose of this study is to analyze the scale of and trends associated with the cost-of-illness of thyroid disease in Korea at 2-year intervals during the last 10 years for which data are available.MethodsCost-of-illness was estimated in terms of direct and indirect costs. Direct costs include direct medical costs due to hospitalization, outpatient and pharmacy sectors, transportation, and care-giver costs. Indirect costs include future income loss due to premature death and loss of productivity as a result of absence from work.ResultsThe cost-of-illness of thyroid disease in Korea was estimated at 224.2 billion won in 2002, 303.4 billion won in 2004, 400.3 billion won in 2006, 570.4 billion won in 2008, and 762.2 billion won in 2010. For example, the cost-of-illness of thyroid disease in 2010 was 3.4 times greater compared to 2002. The direct cost of the total cost-of-illness was 69.7%, which accounted for the highest proportion of costs. Cost-of-illness for individuals between the ages of 30 and 50 accounted for the greatest share of costs.ConclusionThe cost-of-illness of thyroid disease was relatively large in economically active age groups, and demonstrated a very rapid growth rate compared to other major diseases in Korea. Therefore, we suggest nationwide recognition of the importance of prevention and management of thyroid disease and prioritization of the management of thyroid disease among current and future health promotion policies in Korea.

Price-Transparency and Cost Accounting

Science.gov (United States)

Eakin, Cynthia; Fischer, Katrina

2015-01-01

Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

Price-Transparency and Cost Accounting

Directory of Open Access Journals (Sweden)

Peter Hilsenrath PhD

2015-04-01

Full Text Available Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers.

Natural gas and CO2 price variation: impact on the relative cost-efficiency of LNG and pipelines.

Science.gov (United States)

Ulvestad, Marte; Overland, Indra

2012-06-01

THIS ARTICLE DEVELOPS A FORMAL MODEL FOR COMPARING THE COST STRUCTURE OF THE TWO MAIN TRANSPORT OPTIONS FOR NATURAL GAS: liquefied natural gas (LNG) and pipelines. In particular, it evaluates how variations in the prices of natural gas and greenhouse gas emissions affect the relative cost-efficiency of these two options. Natural gas is often promoted as the most environmentally friendly of all fossil fuels, and LNG as a modern and efficient way of transporting it. Some research has been carried out into the local environmental impact of LNG facilities, but almost none into aspects related to climate change. This paper concludes that at current price levels for natural gas and CO 2 emissions the distance from field to consumer and the volume of natural gas transported are the main determinants of transport costs. The pricing of natural gas and greenhouse emissions influence the relative cost-efficiency of LNG and pipeline transport, but only to a limited degree at current price levels. Because more energy is required for the LNG process (especially for fuelling the liquefaction process) than for pipelines at distances below 9100 km, LNG is more exposed to variability in the price of natural gas and greenhouse gas emissions up to this distance. If the prices of natural gas and/or greenhouse gas emission rise dramatically in the future, this will affect the choice between pipelines and LNG. Such a price increase will be favourable for pipelines relative to LNG.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals

Directory of Open Access Journals (Sweden)

Antônio Fernandes Costa Lima

Full Text Available ABSTRACT Objective: to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. Method: this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL. Results: Hospital C presented the highest mean direct cost (BRL 184.52, 5.23 times greater than the value for Hospital A (BRL 35.29 and 3.91 times greater than Hospital B (BRL 47.22. Conclusion: the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

Renaissance: A revolutionary approach for providing low-cost ground data systems

Science.gov (United States)

Butler, Madeline J.; Perkins, Dorothy C.; Zeigenfuss, Lawrence B.

1996-01-01

The NASA is changing its attention from large missions to a greater number of smaller missions with reduced development schedules and budgets. In relation to this, the Renaissance Mission Operations and Data Systems Directorate systems engineering process is presented. The aim of the Renaissance approach is to improve system performance, reduce cost and schedules and meet specific customer needs. The approach includes: the early involvement of the users to define the mission requirements and system architectures; the streamlining of management processes; the development of a flexible cost estimation capability, and the ability to insert technology. Renaissance-based systems demonstrate significant reuse of commercial off-the-shelf building blocks in an integrated system architecture.

Sport-related concussions in New Zealand: a review of 10 years of Accident Compensation Corporation moderate to severe claims and costs.

Science.gov (United States)

King, Doug; Gissane, Conor; Brughelli, Matt; Hume, Patria A; Harawira, Joseph

2014-05-01

This paper provides an overview of the epidemiology of sport-related concussion and associated costs in New Zealand requiring medical treatment from 2001 to 2011 in seven sports codes. A retrospective review of injury entitlement claims by seven sports from 2001 to 2011. Data were analyzed by sporting code, age, ethnicity, gender and year of competition for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs. A total of 20,902 claims costing $NZD 16,546,026 were recorded over the study period of which 1330 (6.4%) were MSC claims. The mean yearly number and costs of MSC claims were 133 ± 36 and $1,303,942 ± 378,949. Rugby union had the highest number of MSC claims per year (38; 95% CI 36-41 per 1000 MSC claims). New Zealand Māori recorded the highest total ($6,000,759) and mean cost ($21,120) per MSC claim. Although MSC injury claims were only 6.4% of total claims, they accounted for 79.1% of total costs indicating that although the majority of sport-related concussions may be minor in severity, the related economic costs associated with more serious sport-related concussion can be high. The finding that rugby union recorded the most MSC claims in the current study was not unexpected. Of concern is that rugby league recorded a low number of MSC claims but the highest mean cost per claim. Due to the high mean cost per concussion, and the high total and mean cost for New Zealand Māori, further investigation is warranted. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Cost analysis and cost justification of automated data processing in the clinical laboratory.

Science.gov (United States)

Westlake, G E

1983-03-01

Prospective cost analysis of alternative data processing systems can be facilitated by proper selection of the costs to be analyzed and realistic appraisal of the effect on staffing. When comparing projects with dissimilar cash flows, techniques such as analysis of net present value can be helpful in identifying financial benefits. Confidence and accuracy in prospective analyses will increase as more retrospective studies are published. Several accounts now in the literature describe long-term experience with turnkey laboratory information systems. Acknowledging the difficulty in longitudinal studies, they all report favorable effects on labor costs and recovery of lost charges. Enthusiasm is also expressed for the many intangible benefits of the systems. Several trends suggest that cost justification and cost effectiveness will be more easily demonstrated in the future. These are the rapidly decreasing cost of hardware (with corresponding reduction in service costs) and the entry into the market of additional systems designed for medium to small hospitals. The effect of broadening the sales base may be lower software prices. Finally, operational and executive data management and reporting are destined to become the premier extensions of the LIS for cost justification. Aptly applied, these facilities can promote understanding of costs, control of costs, and greater efficiency in providing laboratory services.

Cost of presumptive source term Remedial Actions Laboratory for energy-related health research, University of California, Davis

International Nuclear Information System (INIS)

Last, G.V.; Bagaasen, L.M.; Josephson, G.B.; Lanigan, D.C.; Liikala, T.L.; Newcomer, D.R.; Pearson, A.W.; Teel, S.S.

1995-12-01

A Remedial Investigation/Feasibility Study (RI/FS) is in progress at the Laboratory for Energy Related Health Research (LEHR) at the University of California, Davis. The purpose of the RI/FS is to gather sufficient information to support an informed risk management decision regarding the most appropriate remedial actions for impacted areas of the facility. In an effort to expedite remediation of the LEHR facility, the remedial project managers requested a more detailed evaluation of a selected set of remedial actions. In particular, they requested information on both characterization and remedial action costs. The US Department of Energy -- Oakland Office requested the assistance of the Pacific Northwest National Laboratory to prepare order-of-magnitude cost estimates for presumptive remedial actions being considered for the five source term operable units. The cost estimates presented in this report include characterization costs, capital costs, and annual operation and maintenance (O ampersand M) costs. These cost estimates are intended to aid planning and direction of future environmental remediation efforts

Assessing and forecasting groundwater development costs in Sub ...

African Journals Online (AJOL)

Greater use of groundwater in Sub-Saharan Africa is a pre-requisite for improved human welfare; however, the costs associated with groundwater development are prohibitively high and poorly defined. This study identifies and disaggregates the costs of groundwater development in 11 Sub-Saharan African countries, while ...

Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study.

Science.gov (United States)

Patel, Minal R; Resnicow, Kenneth; Lang, Ian; Kraus, Kathleen; Heisler, Michele

2018-02-01

Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting. We report a pre-post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool. Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% "learned a lot," 98% "topics relevant" 95% "applicable to their lives," 98% "liked the information"). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p financial management (33.83 to 39.62, p financial burden. A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.

The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England.

Science.gov (United States)

Mahon, James; Lifschitz, Carlos; Ludwig, Thomas; Thapar, Nikhil; Glanville, Julie; Miqdady, Mohamad; Saps, Miguel; Quak, Seng Hock; Lenoir Wijnkoop, Irene; Edwards, Mary; Wood, Hannah; Szajewska, Hania

2017-11-14

To estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents. To estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a 'de novo' analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated. Our calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies. The total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Output Cost of Gender Discrimination: A Model-Based Macroeconomic Estimate

OpenAIRE

Cavalcanti, Tiago V. de V.; Tavares, José

2008-01-01

Gender-based discrimination is a pervasive and costly phenomenon. To a greater or lesser extent, all economies present a gender wage gap, associated with lower female labour force participation rates and higher fertility. This paper presents a growth model where saving, fertility and labour market participation are endogenously determined, and there is wage discrimination. The model is calibrated to mimic the performance of the U.S. economy, including the gender wage gap and relative female l...

The Life Cycle Cost (LCC) of Life Support Recycling and Resupply

Science.gov (United States)

Jones, Harry W.

2015-01-01

Brief human space missions supply all the crew's water and oxygen from Earth. The multiyear International Space Station (ISS) program instead uses physicochemical life support systems to recycle water and oxygen. This paper compares the Life Cycle Cost (LCC) of recycling to the LCC of resupply for potential future long duration human space missions. Recycling systems have high initial development costs but relatively low durationdependent support costs. This means that recycling is more cost effective for longer missions. Resupplying all the water and oxygen requires little initial development cost but has a much higher launch mass and launch cost. The cost of resupply increases as the mission duration increases. Resupply is therefore more cost effective than recycling for shorter missions. A recycling system pays for itself when the resupply LCC grows greater over time than the recycling LCC. The time when this occurs is called the recycling breakeven date. Recycling will cost very much less than resupply for long duration missions within the Earth-Moon system, such as a future space station or Moon base. But recycling would cost about the same as resupply for long duration deep space missions, such as a Mars trip. Because it is not possible to provide emergency supplies or quick return options on the way to Mars, more expensive redundant recycling systems will be needed.

Environmentally Related Diseases and the Possibility of Valuation of Their Social Costs

Directory of Open Access Journals (Sweden)

Ilona Hajok

2014-01-01

Full Text Available The risks of the morbidity of the asbestos-related lung cancer was estimated in the general population of Poles as the result of increased exposure to asbestos fibers during the removal of asbestos-cement products and the possibility of the valuation of the social costs related to this risk. The prediction of the new incidences was made using linear regression model. The forecast shows that to the end of 2030 about 3,500 new cases of lung cancer can be expected as a result of occupational exposure to asbestos in the past which makes together with paraoccupational exposure about 14.000 new cases. The forecast shows the increasing number of asbestos-related lung cancer in Poland and indicates the priority areas where preventive action should be implemented.

Matching Cost Filtering for Dense Stereo Correspondence

Directory of Open Access Journals (Sweden)

Yimin Lin

2013-01-01

Full Text Available Dense stereo correspondence enabling reconstruction of depth information in a scene is of great importance in the field of computer vision. Recently, some local solutions based on matching cost filtering with an edge-preserving filter have been proved to be capable of achieving more accuracy than global approaches. Unfortunately, the computational complexity of these algorithms is quadratically related to the window size used to aggregate the matching costs. The recent trend has been to pursue higher accuracy with greater efficiency in execution. Therefore, this paper proposes a new cost-aggregation module to compute the matching responses for all the image pixels at a set of sampling points generated by a hierarchical clustering algorithm. The complexity of this implementation is linear both in the number of image pixels and the number of clusters. Experimental results demonstrate that the proposed algorithm outperforms state-of-the-art local methods in terms of both accuracy and speed. Moreover, performance tests indicate that parameters such as the height of the hierarchical binary tree and the spatial and range standard deviations have a significant influence on time consumption and the accuracy of disparity maps.

Low-cost wireless voltage & current grid monitoring

Energy Technology Data Exchange (ETDEWEB)

Hines, Jacqueline [SenSanna Inc., Arnold, MD (United States)

2016-12-31

This report describes the development and demonstration of a novel low-cost wireless power distribution line monitoring system. This system measures voltage, current, and relative phase on power lines of up to 35 kV-class. The line units operate without any batteries, and without harvesting energy from the power line. Thus, data on grid condition is provided even in outage conditions, when line current is zero. This enhances worker safety by detecting the presence of voltage and current that may appear from stray sources on nominally isolated lines. Availability of low-cost power line monitoring systems will enable widespread monitoring of the distribution grid. Real-time data on local grid operating conditions will enable grid operators to optimize grid operation, implement grid automation, and understand the impact of solar and other distributed sources on grid stability. The latter will enable utilities to implement eneygy storage and control systems to enable greater penetration of solar into the grid.

The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis.

Science.gov (United States)

Gaunt, Francesca; Devine, Maria; Pennington, Mark; Vernazza, Chris; Gwynnett, Erika; Steen, Nick; Heasman, Peter

2008-09-01

To systematically evaluate the evidence for effectiveness of supportive periodontal care (SPC) provided in specialist care and general practice for patients with chronic periodontitis; to construct a model for the cost effectiveness of SPC. Electronic database searches of MEDLINE, EMBASE and SCOPUS were performed with hand searching of relevant journals and Workshops of Periodontology. SPC for patients with chronic periodontitis, at least 12 months follow-up and clinical attachment level as a primary outcome. Three articles addressed the question (Nyman et al. 1975, Axelsson & Lindhe 1981, Cortellini et al. 1994): Deltas CAL for patients undergoing "specialist" SPC were 0.1 mm (2 years), 0.2 mm (6 years) and -0.01 mm (3 years) respectively. In generalist care the Deltas CAL during SPC were -2.2, -1.8 and -2.8 mm. Differences between specialist and generalist SPC were an extra 20.59 tooth years and 3.95 mm attachment loss for generalist SPC. Incremental cost-effectiveness ratios were an extra 288 euros for one tooth year or an extra 1503 euros/1 mm reduction in loss of attachment for SPC delivered in specialist care. SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.

A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

Science.gov (United States)

Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

2016-07-27

Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

The economic costs of energy

International Nuclear Information System (INIS)

Brookes, L.G.

1980-01-01

At a recent symposium, the economic costs of nuclear power were examined in four lectures which considered; (1) The performance of different types, size and ages of nuclear power plants. (2) The comparison between coal and nuclear power costs based on the principle of net effective cash. (3) The capital requirements of a nuclear programme. (4) The comparative costs, now and in the future, of coal-fired and nuclear plants. It is concluded that uncertainties seem to get greater rather than smaller with time probably due to the high and fluctuating world inflation rates and the great uncertainty about world economic performance introduced by the politicising of world oil supplies. (UK)

Differential fitness costs of reproduction between the sexes

OpenAIRE

Penn, Dustin J.; Smith, Ken R.

2006-01-01

Natural selection does not necessarily favor maximal reproduction because reproduction imposes fitness costs, reducing parental survival, and offspring quality. Here, we show that parents in a preindustrial population in North America incurred fitness costs from reproduction, and women incurred greater costs than men. We examined the survivorship and reproductive success (Darwinian fitness) of 21,684 couples married between 1860 and 1895 identified in the Utah Population Database. We found th...

Older adults learn less, but still reduce metabolic cost, during motor adaptation

Science.gov (United States)

Huang, Helen J.

2013-01-01

The ability to learn new movements and dynamics is important for maintaining independence with advancing age. Age-related sensorimotor changes and increased muscle coactivation likely alter the trial-and-error-based process of adapting to new movement demands (motor adaptation). Here, we asked, to what extent is motor adaptation to novel dynamics maintained in older adults (≥65 yr)? We hypothesized that older adults would adapt to the novel dynamics less well than young adults. Because older adults often use muscle coactivation, we expected older adults to use greater muscle coactivation during motor adaptation than young adults. Nevertheless, we predicted that older adults would reduce muscle activity and metabolic cost with motor adaptation, similar to young adults. Seated older (n = 11, 73.8 ± 5.6 yr) and young (n = 15, 23.8 ± 4.7 yr) adults made targeted reaching movements while grasping a robotic arm. We measured their metabolic rate continuously via expired gas analysis. A force field was used to add novel dynamics. Older adults had greater movement deviations and compensated for just 65% of the novel dynamics compared with 84% in young adults. As expected, older adults used greater muscle coactivation than young adults. Last, older adults reduced muscle activity with motor adaptation and had consistent reductions in metabolic cost later during motor adaptation, similar to young adults. These results suggest that despite increased muscle coactivation, older adults can adapt to the novel dynamics, albeit less accurately. These results also suggest that reductions in metabolic cost may be a fundamental feature of motor adaptation. PMID:24133222

Social/economic costs and health-related quality of life in patients with spinal muscular atrophy (SMA) in Spain.

Science.gov (United States)

López-Bastida, Julio; Peña-Longobardo, Luz María; Aranda-Reneo, Isaac; Tizzano, Eduardo; Sefton, Mark; Oliva-Moreno, Juan

2017-08-18

The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) of patients with Spinal Muscular Atrophy (SMA) and their caregivers in Spain. This was a cross-sectional and retrospective study of patients diagnosed with SMA in Spain. We adopted a bottom up, prevalence approach design to study patients with SMA. The patient's caregivers completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and non-healthcare services. Costs were estimated from a societal perspective (including healthcare costs and non-healthcare costs), and health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire. The main caregivers also answered a questionnaire on their characteristics and on their HRQOL. A total of 81 caregivers of patients with different subtypes of SMA completed the questionnaire. Based on the reference unitary prices for 2014, the average annual costs per patient were € 33,721. Direct healthcare costs were € 10,882 (representing around 32.3% of the total cost) and the direct non-healthcare costs were € 22,839 (67.7% of the total cost). The mean EQ-5D social tariff score for patients was 0.16, and the mean score of the EQ-5D visual analogue scale was 54. The mean EQ-5D social tariff score for caregivers was 0.49 and their mean score on the EQ-5D visual analogue scale was 69. The results highlight the burden that SMA has in terms of costs and decreased HRQOL, not only for patients but also for their caregivers. In particular, the substantial social/economic burden is mostly attributable to the high direct non-healthcare costs.

The operating cost of electrocoagulation

Energy Technology Data Exchange (ETDEWEB)

Donini, J.C.; Kan, J.; Szynkarczuk, J.; Hassan, T.A.; Kar, K.L. (Canadian Centre for Mineral and Energy Technology, Devon, AB (Canada))

1994-12-01

The electrocoagulation of kaolinite and bentonite suspensions was studied in a pilot-scale electrocoagulation system to assess the operating cost and efficiency of the process. Factors affecting the operating cost such as formation of passivation layers on electrode plates, flow velocity, and concentration of NaCl in the suspension were examined. The operating costs investigated were the power cost of the electrocoagulation cell and the material cost due to the consumption of the aluminum electrode. Comparison was based on the settling properties of the treated product: turbidity, settling rate, and cake height. Higher NaCl concentration resulted in greater amounts of Al dissolved chemically and electrochemically into the suspension and thus a better clarity of the supernatant of the treated product. Increased flow velocity could reduce significantly the operating cost while improving both clarity of the supernatant and compactness of the sludge volume. The passivation layers developed quickly with time during the electrocoagulation process and more energy became wasted on the layers. 10 refs., 12 figs.

A predation cost to bold fish in the wild

DEFF Research Database (Denmark)

Hulthén, Kaj; Chapman, Ben; Nilsson, Anders P.

2017-01-01

in the animal kingdom. Theory predicts that individual behavioural types differ in a cost-benefit trade-off where bolder individuals benefit from greater access to resources while paying higher predation-risk costs. However, explicitly linking predation events to individual behaviour under natural conditions...

Dark respiration of leaves and traps of terrestrial carnivorous plants: are there greater energetic costs in traps?

Czech Academy of Sciences Publication Activity Database

Adamec, Lubomír

2010-01-01

Roč. 5, č. 1 (2010), s. 121-124 ISSN 1895-104X Institutional research plan: CEZ:AV0Z60050516 Keywords : Aerobic respiration * metabolic costs * trap specialization Subject RIV: EF - Botanics Impact factor: 0.685, year: 2010

Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

Science.gov (United States)

Winkelman, Tyler N. A.; Heisler, Michele; Dalton, Vanessa K.

2018-01-01

Our objective was to measure obstetric outcomes and delivery-related health care utilization and costs among pregnant women with multiple chronic conditions. We used 2013–2014 data from the National Inpatient Sample to measure obstetric outcomes and delivery-related health care utilization and costs among women with no chronic conditions, 1 chronic condition, and multiple chronic conditions. Women with multiple chronic conditions were at significantly higher risk than women with 1 chronic condition or no chronic conditions across all outcomes measured. High-value strategies are needed to improve birth outcomes among vulnerable mothers and their infants. PMID:29420168

Greater efficiency in attentional processing related to mindfulness meditation.

NARCIS (Netherlands)

Hurk, P.A.M. van den; Giommi, F.; Gielen, S.C.A.M.; Speckens, A.E.M.; Barendregt, H.P.

2010-01-01

In this study, attentional processing in relation to mindfulness meditation was investigated. Since recent studies have suggested that mindfulness meditation may induce improvements in attentional processing, we have tested 20 expert mindfulness meditators in the attention network test. Their

Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers' quitline.

Science.gov (United States)

Farrelly, Matthew C; Hussin, Altijani; Bauer, Ursula E

2007-12-01

This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline. Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed. There was a positive and statistically significant relation between call volume and expenditures for television (padvertisements and a marginally significant effect for expenditures on newspaper advertisements (peffect was for television advertising. However, because of differences in advertising costs, for every $1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively. Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures.

Distribution costs -- the cost of local delivery

International Nuclear Information System (INIS)

Winger, N.; Zarnett, P.; Carr, J.

2000-01-01

Most of the power transmission system in the province of Ontario is owned and operated as a regulated monopoly by Ontario Hydro Services Company (OHSC). Local distribution systems deliver to end-users from bulk supply points within a service territory. OHSC distributes to approximately one million, mostly rural customers, while the approximately 250 municipal utilities together serve about two million, mostly urban customers. Under the Energy Competition Act of 1998 local distribution companies will face some new challenges, including unbundled billing systems, a broader range of distribution costs, increased costs, made up of corporate taxes or payments in lieu of taxes and added costs for regulatory affairs. The consultants provide a detailed discussion of the components of distribution costs, the three components of the typical budget process (capital expenditures, (CAPEX), operating and maintenance (O and M) and administration and corporate (GA and C), a summary of some typical distribution costs in Ontario, and the estimated impacts of the Energy Competition Act (ECA) compliance on charges and rates. Various mitigation strategies are also reviewed. Among these are joint ventures by local distribution companies to reduce ECA compliance costs, re-examination of controllable costs, temporary reduction of the allowable return on equity (ROE) by 50 per cent, and/or reducing the competitive transition charge (CTC). It is estimated that either one of these two reductions could eliminate the full amount of the five to seven per cent uplift in delivered energy service costs. The conclusion of the consultants is that local distribution delivery charges will make up a greater proportion of end-user cost in the future than it has in the past. An increase to customers of about five per cent is expected when the competitive electricity market opens and unbundled billing begins. The cost increase could be mitigated by a combination of actions that would be needed for about

Cost of space-based laser ballistic missile defense.

Science.gov (United States)

Field, G; Spergel, D

1986-03-21

Orbiting platforms carrying infrared lasers have been proposed as weapons forming the first tier of a ballistic missile defense system under the President's Strategic Defense Initiative. As each laser platform can destroy a limited number of missiles, one of several methods of countering such a system is to increase the number of offensive missiles. Hence it is important to know whether the cost-exchange ratio, defined as the ratio of the cost to the defense of destroying a missile to the cost to the offense of deploying an additional missile, is greater or less than 1. Although the technology to be used in a ballistic missile defense system is still extremely uncertain, it is useful to examine methods for calculating the cost-exchange ratio. As an example, the cost of an orbiting infrared laser ballistic missile defense system employed against intercontinental ballistic missiles launched simultaneously from a small area is compared to the cost of additional offensive missiles. If one adopts lower limits to the costs for the defense and upper limits to the costs for the offense, the cost-exchange ratio comes out substantially greater than 1. If these estimates are confirmed, such a ballistic missile defense system would be unable to maintain its effectiveness at less cost than it would take to proliferate the ballistic missiles necessary to overcome it and would therefore not satisfy the President's requirements for an effective strategic defense. Although the method is illustrated by applying it to a space-based infrared laser system, it should be straightforward to apply it to other proposed systems.

Cost minimization analysis of different growth hormone pen devices based on time-and-motion simulations

Directory of Open Access Journals (Sweden)

Kim Jaewhan

2010-04-01

Full Text Available Abstract Background Numerous pen devices are available to administer recombinant Human Growth Hormone (rhGH, and both patients and health plans have varying issues to consider when selecting a particular product and device for daily use. Therefore, the present study utilized multi-dimensional product analysis to assess potential time involvement, required weekly administration steps, and utilization costs relative to daily rhGH administration. Methods Study objectives were to conduct 1 Time-and-Motion (TM simulations in a randomized block design that allowed time and steps comparisons related to rhGH preparation, administration and storage, and 2 a Cost Minimization Analysis (CMA relative to opportunity and supply costs. Nurses naïve to rhGH administration and devices were recruited to evaluate four rhGH pen devices (2 in liquid form, 2 requiring reconstitution via TM simulations. Five videotaped and timed trials for each product were evaluated based on: 1 Learning (initial use instructions, 2 Preparation (arrange device for use, 3 Administration (actual simulation manikin injection, and 4 Storage (maintain product viability between doses, in addition to assessment of steps required for weekly use. The CMA applied micro-costing techniques related to opportunity costs for caregivers (categorized as wages, non-drug medical supplies, and drug product costs. Results Norditropin® NordiFlex and Norditropin® NordiPen (NNF and NNP, Novo Nordisk, Inc., Bagsværd, Denmark took less weekly Total Time (p ® Pen (GTP, Pfizer, Inc, New York, New York or HumatroPen® (HTP, Eli Lilly and Company, Indianapolis, Indiana. Time savings were directly related to differences in new package Preparation times (NNF (1.35 minutes, NNP (2.48 minutes GTP (4.11 minutes, HTP (8.64 minutes, p Conclusions Time-and-motion simulation data used to support a micro-cost analysis demonstrated that the pen device with the greater time demand has highest net costs.

Moderate Baseline Vagal Tone Predicts Greater Prosociality in Children

Science.gov (United States)

Miller, Jonas G.; Kahle, Sarah; Hastings, Paul D.

2016-01-01

Vagal tone is widely believed to be an important physiological aspect of emotion regulation and associated positive behaviors. However, there is inconsistent evidence for relations between children’s baseline vagal tone and their helpful or prosocial responses to others (Hastings & Miller, 2014). Recent work in adults suggests a quadratic association (inverted U-shape curve) between baseline vagal tone and prosociality (Kogan et al., 2014). The present research examined whether this nonlinear association was evident in children. We found consistent evidence for a quadratic relation between vagal tone and prosociality across 3 samples of children using 6 different measures. Compared to low and high vagal tone, moderate vagal tone in early childhood concurrently predicted greater self-reported prosociality (Study 1), observed empathic concern in response to the distress of others and greater generosity toward less fortunate peers (Study 2), and longitudinally predicted greater self-, mother-, and teacher-reported prosociality 5.5 years later in middle childhood (Study 3). Taken together, our findings suggest that moderate vagal tone at rest represents a physiological preparedness or tendency to engage in different forms of prosociality across different contexts. Early moderate vagal tone may reflect an optimal balance of regulation and arousal that helps prepare children to sympathize, comfort, and share with others. PMID:27819463

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

International Nuclear Information System (INIS)

Collstrand, F.

1994-02-01

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

Report on ENGIE's regulated tariffs for gas sale - Audit supply costs and non-supply related costs. Deliberation of the Commission for energy regulation on the 25 May 2016 bearing approval of the audit report on supply costs and non-supply related costs as basis for the calculation of the evolution of ENGIE's regulated tariffs for natural gas sale

International Nuclear Information System (INIS)

Ladoucette, Philippe De; Edwige, Catherine; Gassin, Helene; Padova, Yann; Sotura, Jean-Pierre

2016-05-01

After a recall of the context and objectives of the analysis performed by the French Commission for Energy Regulation (CRE), and a synthetic presentation of the main conclusions, this report first proposes an assessment for 2015 by discussing the share of consumptions provided under the regulated tariff with respect to those provided on the retail market, the evolution of these tariffs, by noticing that ENGIE costs have been covered by income associated with sales at regulated tariffs. The second part addresses perspectives of evolution for supply costs by outlining the existence of market indexing, the lack of factors which would justify an evolution of gas price indexing level, and a possible reviewing of indices at the moment of revision of the indexing formula. The third part addresses the perspectives of evolution of non-supply related costs. It notices the impact of recent evolution of infrastructure costs, some lack of information regarding provisional trade costs, and a significant decrease of these costs for 2016

Greater happiness for a greater number: Is that possible? If so how? (Arabic)

NARCIS (Netherlands)

R. Veenhoven (Ruut); E. Samuel (Emad)

2012-01-01

textabstractWhat is the final goal of public policy? Jeremy Bentham (1789) would say: greater happiness for a greater number. He thought of happiness as subjective enjoyment of life; in his words as “the sum of pleasures and pains”. In his time, the happiness of the great number could not be

Nuclear-fuel-cycle costs. Consolidated Fuel-Reprocessing Program

International Nuclear Information System (INIS)

Burch, W.D.; Haire, M.J.; Rainey, R.H.

1981-01-01

The costs for the back-end of the nuclear fuel cycle, which were developed as part of the Nonproliferation Alternative Systems Assessment Program (NASAP), are presented. Total fuel-cycle costs are given for the pressurized-water reactor once-through and fuel-recycle systems, and for the liquid-metal fast-breeder-reactor system. These calculations show that fuel-cycle costs are a small part of the total power costs. For breeder reactors, fuel-cycle costs are about half that of the present once-through system. The total power cost of the breeder-reactor system is greater than that of light-water reactor at today's prices for uranium and enrichment

Programas de mantenimiento de metadona con servicios auxiliares: un estudio de coste-efectividad Methadone maintenance programs with supplementary services: a cost-effectiveness study

Directory of Open Access Journals (Sweden)

E. Puigdollers

2003-04-01

activity registries. Sociodemographic, health-related and toxicological data were collected through a semi-structured interview. A cost-effectiveness analysis was performed through two multiple linear regressions with the same adjusting variables. Results: The greater the number of supplementary services involved, the higher the costs. The adjusted models revealed a significant increase in health-related quality of life (an increase of 8% in the Nottingham Health Profile and in costs (17% between low- and medium-intensity programs. Conclusion: The medium-intensity program showed the best cost-effectiveness ratio. However, the study's limitations preclude categoric generalization of the data.

Cost prediction following traumatic brain injury: model development and validation.

Science.gov (United States)

Spitz, Gershon; McKenzie, Dean; Attwood, David; Ponsford, Jennie L

2016-02-01

The ability to predict costs following a traumatic brain injury (TBI) would assist in planning treatment and support services by healthcare providers, insurers and other agencies. The objective of the current study was to develop predictive models of hospital, medical, paramedical, and long-term care (LTC) costs for the first 10 years following a TBI. The sample comprised 798 participants with TBI, the majority of whom were male and aged between 15 and 34 at time of injury. Costing information was obtained for hospital, medical, paramedical, and LTC costs up to 10 years postinjury. Demographic and injury-severity variables were collected at the time of admission to the rehabilitation hospital. Duration of PTA was the most important single predictor for each cost type. The final models predicted 44% of hospital costs, 26% of medical costs, 23% of paramedical costs, and 34% of LTC costs. Greater costs were incurred, depending on cost type, for individuals with longer PTA duration, obtaining a limb or chest injury, a lower GCS score, older age at injury, not being married or defacto prior to injury, living in metropolitan areas, and those reporting premorbid excessive or problem alcohol use. This study has provided a comprehensive analysis of factors predicting various types of costs following TBI, with the combination of injury-related and demographic variables predicting 23-44% of costs. PTA duration was the strongest predictor across all cost categories. These factors may be used for the planning and case management of individuals following TBI. 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/

Trouble Sleeping Associated With Lower Work Performance and Greater Health Care Costs: Longitudinal Data From Kansas State Employee Wellness Program.

Science.gov (United States)

Hui, Siu-kuen Azor; Grandner, Michael A

2015-10-01

To examine the relationships between employees' trouble sleeping and absenteeism, work performance, and health care expenditures over a 2-year period. Utilizing the Kansas State employee wellness program (EWP) data set from 2008 to 2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and health care costs as the outcomes. EWP participants (N = 11,698 in 2008; 5636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all P work performance ratings (all P health care costs (P work attendance, work performance, and health care costs.

Sequential Optimization of Global Sequence Alignments Relative to Different Cost Functions

KAUST Repository

Odat, Enas M.

2011-05-01

The purpose of this dissertation is to present a methodology to model global sequence alignment problem as directed acyclic graph which helps to extract all possible optimal alignments. Moreover, a mechanism to sequentially optimize sequence alignment problem relative to different cost functions is suggested. Sequence alignment is mostly important in computational biology. It is used to find evolutionary relationships between biological sequences. There are many algo- rithms that have been developed to solve this problem. The most famous algorithms are Needleman-Wunsch and Smith-Waterman that are based on dynamic program- ming. In dynamic programming, problem is divided into a set of overlapping sub- problems and then the solution of each subproblem is found. Finally, the solutions to these subproblems are combined into a final solution. In this thesis it has been proved that for two sequences of length m and n over a fixed alphabet, the suggested optimization procedure requires O(mn) arithmetic operations per cost function on a single processor machine. The algorithm has been simulated using C#.Net programming language and a number of experiments have been done to verify the proved statements. The results of these experiments show that the number of optimal alignments is reduced after each step of optimization. Furthermore, it has been verified that as the sequence length increased linearly then the number of optimal alignments increased exponentially which also depends on the cost function that is used. Finally, the number of executed operations increases polynomially as the sequence length increase linearly.

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

Science.gov (United States)

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

2012-11-01

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

Cost of preventing workplace heat-related illness through worker breaks and the benefit of climate-change mitigation

Science.gov (United States)

Takakura, Jun'ya; Fujimori, Shinichiro; Takahashi, Kiyoshi; Hijioka, Yasuaki; Hasegawa, Tomoko; Honda, Yasushi; Masui, Toshihiko

2017-06-01

The exposure of workers to hot environments is expected to increase as a result of climate change. In order to prevent heat-related illness, it is recommended that workers take breaks during working hours. However, this would lead to reductions in worktime and labor productivity. In this study, we estimate the economic cost of heat-related illness prevention through worker breaks associated with climate change under a wide range of climatic and socioeconomic conditions. We calculate the worktime reduction based on the recommendation of work/rest ratio and the estimated future wet bulb glove temperature, which is an index of heat stresses. Corresponding GDP losses (cost of heat-related illness prevention through worker breaks) are estimated using a computable general equilibrium model throughout this century. Under the highest emission scenario, GDP losses in 2100 will range from 2.6 to 4.0% compared to the current climate conditions. On the other hand, GDP losses will be less than 0.5% if the 2.0 °C goal is achieved. The benefit of climate-change mitigation for avoiding worktime loss is comparable to the cost of mitigation (cost of the greenhouse gas emission reduction) under the 2.0 °C goal. The relationship between the cost of heat-related illness prevention through worker breaks and global average temperature rise is approximately linear, and the difference in economic loss between the 1.5 °C goal and the 2.0 °C goal is expected to be approximately 0.3% of global GDP in 2100. Although climate mitigation and socioeconomic development can limit the vulnerable regions and sectors, particularly in developing countries, outdoor work is still expected to be affected. The effectiveness of some adaptation measures such as additional installation of air conditioning devices or shifting the time of day for working are also suggested. In order to reduce the economic impacts, adaptation measures should also be implemented as well as pursing ambitious climate change

BENEFIT-COST ANALYSIS IN U.S. ENVIRONMENTAL REGULATORY DECISIONS

OpenAIRE

Easter, K. William; Archibald, Sandra O.

1998-01-01

As the number and cost of environmental regulations have increased over the last thirty years, the regulated community, taxpayers, and policy makers have begun to demand that the benefits of regulations justify their costs. The use of benefit-cost analysis as an integral part of developing new regulations is increasing and the demands and expectations being placed on the method have expanded. Although benefit-cost analysis is expected to play an even greater role in environmental decision mak...

Integrated Cost Allocation of Transmission Usage under Electricity Markets

Directory of Open Access Journals (Sweden)

Hermagasantos Zein

2012-08-01

Full Text Available Cost allocation of transmission usage on the power networks is an important issue especially in the modern electricity market mechanism. In this context, all costs that have been embedded in the transmission, embedded cost, should be covered by the transmission users. This paper follows general methods, where generators are fullyresponsible to cover the embedded cost. It proposes a method to determine the cost allocation of transmission usage based on decomposition through the superposition techinique to determine power flow contributions from an integrated base case of the results of the power flow calculations of all transactions, bilateral and nonbilateral contracts. Mathematically, the applied formulations are illustrated clearly in this paper. The proposed method has been tested with 5-bus system and the results are much different compared to a few of the published methods. This is shown by the test results on the 5 bus system. The published methods produce total power flow contributions in each line is greater than the actual. And they earn total revenues approximately 11.6% greater than the embedded cost. While on the proposed method, the power flow contribu tions are equal to the actual and the revenues are equal to the embedded cost. It shows also that the proposed method gives results as expected.

Respiratory viral infections in infancy and school age respiratory outcomes and healthcare costs.

Science.gov (United States)

MacBean, Victoria; Drysdale, Simon B; Yarzi, Muska N; Peacock, Janet L; Rafferty, Gerrard F; Greenough, Anne

2018-03-01

To determine the impact of viral lower respiratory tract infections (LRTIs) in infancy including rhinovirus (RV) and infancy respiratory syncytial virus (RSV), on school age pulmonary function and healthcare utilization in prematurely born children. School age respiratory outcomes would be worse and healthcare utilization greater in children who had viral LRTIs in infancy. Prospective study. A cohort of prematurely born children who had symptomatic LRTIs during infancy documented, was recalled. Pulmonary function was assessed at 5 to 7 years of age and health related costs of care from aged one to follow-up determined. Fifty-one children, median gestational age 33 +6 weeks, were assessed at a median (IQR) age 7.03 (6.37-7.26) years. Twenty-one children had no LRTI, 14 RV LRTI, 10 RSV LRTI, and 6 another viral LRTI (other LRTI). Compared to the no LRTI group, the RV group had a lower FEV 1 (P = 0.033) and the other LRTI group a lower FVC (P = 0.006). Non-respiratory medication costs were higher in the RV (P = 0.018) and RSV (P = 0.013) groups. Overall respiratory healthcare costs in the RV (£153/year) and RSV (£27/year) groups did not differ significantly from the no LRTI group (£56/year); the other LRTI group (£431/year) had higher respiratory healthcare costs (P = 0.042). In moderately prematurely born children, RV and RSV LRTIs in infancy were not associated with higher respiratory healthcare costs after infancy. Children who experienced LRTIs caused by other respiratory viruses (including RV) had higher respiratory healthcare costs and greater pulmonary function impairment. © 2018 Wiley Periodicals, Inc.

Global timber investments, wood costs, regulation, and risk

Science.gov (United States)

F. Cubbage; S. Koesbandana; P Mac Donagh; R. Rubilar; G Balmelli; V. Morales Olmos; R. De La Torre; M. Murara; V.A. Hoeflich; H. Kotze; R Gonzalez; O. Carrero; G. Frey; T. Adams; J. Turner; R. Lord; J. Huang; C. MacIntyre; Kathleen McGinley; R. Abt; R. Phillips

2010-01-01

We estimated financial returns and wood production costs in 2008 for the primary timber plantation species. Excluding land costs, returns for exotic plantations in almost all of South America e Brazil, Argentina, Uruguay, Chile, Colombia, Venezuela, and Paraguay e were substantial. Eucalyptus species returns were generally greater than those for Pinus species in each...

Evaluation of Costs in Asparagus Production in Relation to Different Technological Processes in Conditions of Slovak Republic

Directory of Open Access Journals (Sweden)

Patrik Burg

2014-01-01

Full Text Available This study deals with analysis structure of cost on the production of asparagus in relation to three different technological processes in conditions of Slovak Republic. Obtained results can be used as a template to prepare budgets and make production decisions to estimate potential returns and to analyze investment and financial analysis decisions in the asparagus cultivation. Production practices used in the budget are based on typical practices for asparagus in this country. From the analysis of the cost structure of assessed variants different technological procedures follows that the largest share of the costs fall to purchased material and labor.

Savings in acute care costs if all older adults treated for fall-related injuries completed matter of balance.

Science.gov (United States)

Howland, Jonathan; Shankar, Kalpana Narayan; Peterson, Elizabeth W; Taylor, Alyssa A

Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults, and recruitment usually occurs through direct marketing to the target population, rather than through referrals from healthcare providers. Matter of Balance , a program developed to reduce fear of falling and associated activity restriction in community-dwelling older adults, is currently being delivered in 38 of the 50 United States. In this study, we estimate the one-year medical care cost savings if older adults treated at Massachusetts hospitals for fall-related injuries were referred by healthcare providers to participate in Matter of Balance . Data from several sources were used for this study. We estimated annual cost savings in older adult falls recidivism for a hypothetical 100 patients presenting at an emergency department for a fall-related injury, assuming that all were referred to, and 50 % completed, Matter of Balance . This cost-saving estimate was subsequently expanded based on the actual number (43,931) of older adult patients presenting at, and discharged from Massachusetts emergency departments for all fall-related injuries in 2012. Cost savings were calculated for two additional participation rates: 25 % and 75 %. The return on investment (ROI), was calculated based on the percentage of return per each dollar invested. The calculated ROI for Matter of Balance was 144 %. Statewide savings ranged from $2.79 million assuming a 25 % participation rate to $8.37 million, assuming a 75 % participation rate. Referral to evidence-based falls prevention programs of older adult patients presenting at EDs with a fall-related injury could reduce subsequent falls and associated treatment costs.

How much does a diabetes out-patient appointment actually cost? An argument for PLICS.

Science.gov (United States)

Grant, Paul

2015-01-01

The national tariff system for clinical processes and procedures aims to put a discrete unit cost on clinical activity. Calculating such costs can be subject to a great deal of local variation and interpretation. Given the rising costs of diabetes the purpose of this paper is to ask the question what does a diabetes outpatient appointment in the UK NHS actually cost? This is important in a time of financial austerity and healthcare rationing because it can be difficult to decipher the attribution of costs within the acute hospital setting. Exploring this question, the author considers the present cost model and analyse in terms of the language of unit model cost; the basic tariff system and how it works in diabetes and looking at internal cost information the author attempts to unbundle the cost to provide a more accurate value for the cost object. One major finding is that costs and overheads are divided arbitrarily as opposed to being distributed on the basis of measured relative consumption. Alternative costing methods are appraised to demonstrate that a patient level episodic costing approach such as patient level information and costing system (PLICS) which incorporates aspects of activity-based costing (ABC) would be far more appropriate. Using time driven ABC (TDABC), a new patient appointment costs £162 for 30 minutes and a follow-up appointment costs £81 for 15 minutes. PLICS has the added benefit of greater financial and clinical transparency and this goes some way towards the holy grail of greater engagement with the doctors delivering clinical care. It would appear that there are different purposes of different costing systems. One can argue that a costing system is there to both contain costs and divide overheads and demonstrate activity. Depending on how data are interpreted costing information can be an agent of enlightenment and behavioural modification for healthcare professionals to show them their direct and indirect costs, their capacity and

Atmospheric Methane Enhancements Related with Natural Gas Usage in the Greater Houston Area

Science.gov (United States)

Sanchez, N. P.; Zheng, C.; Ye, W.; Czader, B.; Cohan, D. S.; Tittel, F. K.; Griffin, R. J.

2017-12-01

Natural gas (NG) usage as a replacement of oil and coal has increased significantly in the U.S in recent years. Despite the benefits associated with this fuel, leakage from NG distribution systems and in-use uncombusted NG (e.g., compressed natural gas vehicles) can be relevant sources of methane (CH4) emissions in urban centers. Methane, the main constituent of NG, is a potent greenhouse gas impacting the chemistry of the atmosphere, whose emission might outweigh the potential environmental advantages of NG use. Although the Greater Houston area (GHA) is the fifth-largest metropolitan area in the U.S, no studies on the potential impact of NG usage on atmospheric CH4 levels have been published in the scientific literature to date. In this work, a mobile-based study of CH4 and ethane (C2H6) concentration levels in eight residential zones with different expected probability of NG leakage in the GHA was conducted in the summer of 2016. A novel laser-based sensor system for simultaneous detection of CH4 and C2H6 was developed and deployed in a mid-sized vehicle, and monitoring of these gas species was conducted for over 14 days covering 250 road miles. Both linear discriminant and cluster analyses were performed to assess the spatial variability of atmospheric CH4 concentrations in the GHA. These analyses showed clear differences in the CH4 mixing ratios in an inter- and intra-neighborhood level and indicated the presence of high CH4 concentration clusters mainly located in the central and west central parts of the GHA. Source discrimination analyses based on orthogonal regression analysis and a Keeling-like plot method were conducted to establish the predominant origin of CH4 in the identified high concentration clusters and in over 30 CH4 concentration peaks observed during the field campaign. Results of these analyses indicate that thermogenic sources of CH4 (e.g., NG) were predominant in short-duration concentration spikes (lasting less than 10 minutes), while CH4

No costly prosociality among related long-tailed macaques (Macaca fascicularis).

Science.gov (United States)

Sterck, Elisabeth H M; Olesen, Caroline U; Massen, Jorg J M

2015-08-01

Altruism, benefiting another at a cost to the donor, may be achieved through prosocial behavior. Studies of nonhuman animals typically investigate prosocial behavior with paradigms in which the donor can choose to give a recipient a food item, and the choice does not affect the donor's reward (which is either present or absent). In such tasks, long-tailed macaques (Macaca fascicularis) show prosocial behavior, especially toward kin. Here, we tested captive long-tailed macaques with related recipients in an alternative task, in which the donor had to give up a preferred reward to benefit the recipient; that is, they had to choose a lower valued reward for themselves to provide food to their kin. Overall, the macaques did not provide their kin with food. The task forced the donor to balance its prosocial behavior with its selfish choice for a higher value reward, a balance that turned out to favor selfish motives. Consequently, our study shows that a prosocial tendency is not sufficient to elicit costly prosocial behavior in long-tailed macaques. Subsequently, we feel that tasks in which the donor must choose a lower value reward to benefit another individual may allow the titration of the strength of prosocial behavior, and thus provides interesting possibilities for future comparative studies. (c) 2015 APA, all rights reserved).

Mitigation potential and cost in tropical forestry - relative role for agroforestry

Energy Technology Data Exchange (ETDEWEB)

Makundi, Willy R.; Sathaye, Jayant A.

2004-01-01

This paper summarizes studies of carbon mitigation potential (MP) and costs of forestry options in seven developing countries with a focus on the role of agroforestry. A common methodological approach known as comprehensive mitigation assessment process (COMAP) was used in each study to estimate the potential and costs between 2000 and 2030. The approach requires the projection of baseline and mitigation land-use scenarios derived from the demand for forest products and forestland for other uses such as agriculture and pasture. By using data on estimated carbon sequestration, emission avoidance, costs and benefits, the model enables one to estimate cost effectiveness indicators based on monetary benefit per t C, as well as estimates of total mitigation costs and potential when the activities are implemented at equilibrium level. The results show that about half the MP of 6.9 Gt C (an average of 223 Mt C per year) between 2000 and 2030 in the seven countries could be achieved at a negative cost, and the other half at costs not exceeding $100 per t C. Negative cost indicates that non-carbon revenue is sufficient to offset direct costs of about half of the options. The agroforestry options analyzed bear a significant proportion of the potential at medium to low cost per t C when compared to other options. The role of agroforestry in these countries varied between 6% and 21% of the MP, though the options are much more cost effective than most due to the low wage or opportunity cost of rural labor. Agroforestry options are attractive due to the large number of people and potential area currently engaged in agriculture, but they pose unique challenges for carbon and cost accounting due to the dispersed nature of agricultural activities in the tropics, as well as specific difficulties arising from requirements for monitoring, verification, leakage assessment and the establishment of credible baselines.

Obesity-specific neural cost of maintaining gait performance under complex conditions in community-dwelling older adults.

Science.gov (United States)

Osofundiya, Olufunmilola; Benden, Mark E; Dowdy, Diane; Mehta, Ranjana K

2016-06-01

Recent evidence of obesity-related changes in the prefrontal cortex during cognitive and seated motor activities has surfaced; however, the impact of obesity on neural activity during ambulation remains unclear. The purpose of this study was to determine obesity-specific neural cost of simple and complex ambulation in older adults. Twenty non-obese and obese individuals, 65years and older, performed three tasks varying in the types of complexity of ambulation (simple walking, walking+cognitive dual-task, and precision walking). Maximum oxygenated hemoglobin, a measure of neural activity, was measured bilaterally using a portable functional near infrared spectroscopy system, and gait speed and performance on the complex tasks were also obtained. Complex ambulatory tasks were associated with ~2-3.5 times greater cerebral oxygenation levels and ~30-40% slower gait speeds when compared to the simple walking task. Additionally, obesity was associated with three times greater oxygenation levels, particularly during the precision gait task, despite obese adults demonstrating similar gait speeds and performances on the complex gait tasks as non-obese adults. Compared to existing studies that focus solely on biomechanical outcomes, the present study is one of the first to examine obesity-related differences in neural activity during ambulation in older adults. In order to maintain gait performance, obesity was associated with higher neural costs, and this was augmented during ambulatory tasks requiring greater precision control. These preliminary findings have clinical implications in identifying individuals who are at greater risk of mobility limitations, particularly when performing complex ambulatory tasks. Copyright © 2016 Elsevier Ltd. All rights reserved.

Land cover mapping of Greater Mesoamerica using MODIS data

Science.gov (United States)

Giri, Chandra; Jenkins, Clinton N.

2005-01-01

A new land cover database of Greater Mesoamerica has been prepared using moderate resolution imaging spectroradiometer (MODIS, 500 m resolution) satellite data. Daily surface reflectance MODIS data and a suite of ancillary data were used in preparing the database by employing a decision tree classification approach. The new land cover data are an improvement over traditional advanced very high resolution radiometer (AVHRR) based land cover data in terms of both spatial and thematic details. The dominant land cover type in Greater Mesoamerica is forest (39%), followed by shrubland (30%) and cropland (22%). Country analysis shows forest as the dominant land cover type in Belize (62%), Cost Rica (52%), Guatemala (53%), Honduras (56%), Nicaragua (53%), and Panama (48%), cropland as the dominant land cover type in El Salvador (60.5%), and shrubland as the dominant land cover type in Mexico (37%). A three-step approach was used to assess the quality of the classified land cover data: (i) qualitative assessment provided good insight in identifying and correcting gross errors; (ii) correlation analysis of MODIS- and Landsat-derived land cover data revealed strong positive association for forest (r2 = 0.88), shrubland (r2 = 0.75), and cropland (r2 = 0.97) but weak positive association for grassland (r2 = 0.26); and (iii) an error matrix generated using unseen training data provided an overall accuracy of 77.3% with a Kappa coefficient of 0.73608. Overall, MODIS 500 m data and the methodology used were found to be quite useful for broad-scale land cover mapping of Greater Mesoamerica.

Report on estimated nuclear energy related cost for fiscal 1991

International Nuclear Information System (INIS)

1991-01-01

The report first describes major actions planned to be taken in Japan in fiscal 1991 in the field of nuclear energy utilization. Major activities to be made for comprehensive strengthening of safety assurance measures are described, focusing on improvement of nuclear energy related safety regulations, promotion of research for safety assurance, improvement and strengthening of disaster prevention measures, environmental radioactivity surveys, control of exposure of workers engaged in radioactivity related jobs, etc. The report then describes actions required for the establishment of a nuclear fuel cycle, focusing on the procurement of uranium resources, establishment of a uranium enrichment process, reprocessing of spent fuel, application of recovered uranium, etc. Other activities are required for the development of new type reactors, effective application of plutonium, development of basic techniques, international contributions, cooperation with the public. Then, the report summarizes estimated costs required for the activities to be performed by the Japan Atomic Energy Research Institute, Power Reactor and Nuclear Fuel Development Corporation, National Institute of Radiological Sciences, Institute of Physical and Chemical Research. (N.K.)

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

Science.gov (United States)

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

2014-07-01

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

Synthesis and characterization of low cost magnetorheological (MR) fluids

Science.gov (United States)

Sukhwani, V. K.; Hirani, H.

2007-04-01

Magnetorheological fluids have great potential for engineering applications due to their variable rheological behavior. These fluids find applications in dampers, brakes, shock absorbers, and engine mounts. However their relatively high cost (approximately US600 per liter) limits their wide usage. Most commonly used magnetic material "Carbonyl iron" cost more than 90% of the MR fluid cost. Therefore for commercial viability of these fluids there is need of alternative economical magnetic material. In the present work synthesis of MR fluid has been attempted with objective to produce low cost MR fluid with high sedimentation stability and greater yield stress. In order to reduce the cost, economical electrolytic Iron powder (US 10 per Kg) has been used. Iron powder of relatively larger size (300 Mesh) has been ball milled to reduce their size to few microns (1 to 10 microns). Three different compositions have been prepared and compared for MR effect produced and stability. All have same base fluid (Synthetic oil) and same magnetic phase i.e. Iron particles but they have different additives. First preparation involves organic additives Polydimethylsiloxane (PDMS) and Stearic acid. Other two preparations involve use of two environmental friendly low-priced green additives guar gum (US 2 per Kg) and xanthan gum (US 12 per Kg) respectively. Magnetic properties of Iron particles have been measured by Vibrating Sample Magnetometer (VSM). Morphology of Iron particles and additives guar gum and xanthan gum has been examined by Scanning Electron Microscopy (SEM) and Particles Size Distribution (PSD) has been determined using Particle size analyzer. Microscopic images of particles, MH plots and stability of synthesized MR fluids have been reported. The prepared low cost MR fluids showed promising performance and can be effectively used for engineering applications demanding controllability in operations.

Social capital and transaction cost on co-creating IT value towards inter-organizational EMR exchange.

Science.gov (United States)

Chang, Hsin Hsin; Hung, Chung-Jye; Huang, Ching Ying; Wong, Kit Hong; Tsai, Yi Ju

2017-01-01

This study adopts social capital theory and transaction cost theory to explore the feasibility of an inter-organizational cross-hospital electronic medical records (EMR) exchange system, and the factors that affect its adoption. The concept of value co-creation is also used to assess such a system, and its influence on the performance of participating medical institutes. This research collected 330 valid paper-based questionnaires from the medical staff of various institutes. The results showed that social interaction ties and shared vision positively affected medical institutes' willingness to adopt the EMR exchange system, while asset specificity and uncertainty increased the related transaction costs. With a greater willingness to invest in relation-specific assets and to meet the related transaction costs, this behavior lead to an increase in medical IT value, as well as better results for the related medical institutes, medical staff, and patients. Therefore, this study suggests that such institutes encourage their medical staff to participate in seminars or reunions in order to develop their professional and social networks, and set up clear schedules and desire for expected effects when introducing the cross-hospital EMR exchange system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data.

Science.gov (United States)

Lee, Aaron Y; Butt, Thomas; Chew, Emily; Agron, Elvira; Clemons, Traci E; Egan, Catherine A; Lee, Cecilia S; Tufail, Adnan

2018-04-01

To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4. A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes. Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model. For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient. The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost-effectiveness analysis of antiviral therapy in patients with advanced hepatitis B virus-related hepatocellular carcinoma treated with sorafenib.

Science.gov (United States)

Zhang, Pengfei; Yang, Yu; Wen, Feng; Wheeler, John; Fu, Ping; Li, Qiu

2016-12-01

Antiviral therapy has been demonstrated to significantly improve the survival in patients with advanced hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). The aim of the study was to investigate the cost-effectiveness of antiviral therapy in patients with advanced HBV-related HCC treated with sorafenib. To conduct the analysis, a Markov model comprising three health states (progression-free survival, progressive disease, and death) was created. The efficacy data were derived from medical records. Cost data were collected based on the Chinese national drug prices. Utility data came from the previously published studies. One-way sensitivity analyses as well as probabilistic sensitivity analyses were performed to explore model uncertainties. In the base-case analysis, addition of antiviral therapy to sorafenib generated an effectiveness of 0.68 quality-adjusted life years (QALYs) at a cost of $25 026.04, while sorafenib monotherapy gained an effectiveness of 0.42 QALYs at a cost of $20 249.64. The incremental cost-effectiveness ratio (ICER) was $18 370.77/QALY for antiviral therapy group versus non-antiviral therapy group. On the other hand, the ICER between the two groups in patients with high or low HBV-DNA load, with or without cirrhosis, normal or elevated alanine aminotransferase/aspartate aminotransferase were $16 613.97/QALY, $19 774.16/QALY, $14 587.66/QALY, $19 873.84/QALY, $17 947.07/QALY, and $18 785.58/QALY, respectively. Based on the cost-effectiveness threshold ($20 301.00/QALY in China), addition of antiviral therapy to sorafenib is considered to be a cost-effective option compared with sorafenib monotherapy in patients with advanced HBV-related HCC in China from the patient's perspective. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

The reliability of running economy expressed as oxygen cost and energy cost in trained distance runners.

Science.gov (United States)

Shaw, Andrew J; Ingham, Stephen A; Fudge, Barry W; Folland, Jonathan P

2013-12-01

This study assessed the between-test reliability of oxygen cost (OC) and energy cost (EC) in distance runners, and contrasted it with the smallest worthwhile change (SWC) of these measures. OC and EC displayed similar levels of within-subject variation (typical error < 3.85%). However, the typical error (2.75% vs 2.74%) was greater than the SWC (1.38% vs 1.71%) for both OC and EC, respectively, indicating insufficient sensitivity to confidently detect small, but meaningful, changes in OC and EC.

Combined Waste Form Cost Trade Study

International Nuclear Information System (INIS)

Gombert, Dirk; Piet, Steve; Trickel, Timothy; Carter, Joe; Vienna, John; Ebert, Bill; Matthern, Gretchen

2008-01-01

A new generation of aqueous nuclear fuel reprocessing, now in development under the auspices of the DOE Office of Nuclear Energy (NE), separates fuel into several fractions, thereby partitioning the wastes into groups of common chemistry. This technology advance enables development of waste management strategies that were not conceivable with simple PUREX reprocessing. Conventional wisdom suggests minimizing high level waste (HLW) volume is desirable, but logical extrapolation of this concept suggests that at some point the cost of reducing volume further will reach a point of diminishing return and may cease to be cost-effective. This report summarizes an evaluation considering three groupings of wastes in terms of cost-benefit for the reprocessing system. Internationally, the typical waste form for HLW from the PUREX process is borosilicate glass containing waste elements as oxides. Unfortunately several fission products (primarily Mo and the noble metals Ru, Rh, Pd) have limited solubility in glass, yielding relatively low waste loading, producing more glass, and greater disposal costs. Advanced separations allow matching the waste form to waste stream chemistry, allowing the disposal system to achieve more optimum waste loading with improved performance. Metals can be segregated from oxides and each can be stabilized in forms to minimize the HLW volume for repository disposal. Thus, a more efficient waste management system making the most effective use of advanced waste forms and disposal design for each waste is enabled by advanced separations and how the waste streams are combined. This trade-study was designed to juxtapose a combined waste form baseline waste treatment scheme with two options and to evaluate the cost-benefit using available data from the conceptual design studies supported by DOE-NE

Viability costs of reproduction and behavioral compensation in western mosquitofish (Gambusia affinis).

Science.gov (United States)

Laidlaw, Clinton T; Condon, Jacob M; Belk, Mark C

2014-01-01

The cost of reproduction hypothesis suggests that current reproduction has inherent tradeoffs with future reproduction. These tradeoffs can be both in the form of energy allocated to current offspring as opposed to somatic maintenance and future reproduction (allocation costs), or as an increase in mortality as a result of morphological or physiological changes related to reproduction (viability costs). Individuals may be able to decrease viability costs by altering behavior. Female western mosquitofish, Gambusia affinis experience a reduction in swimming ability as a consequence of pregnancy. We test for a viability cost of reproduction, and for behavioral compensation in pregnant female G. affinis by measuring survival of females in early and later stages of pregnancy when exposed to predation. Late-stage pregnant females experience a 70% greater probability of mortality compared to early-stage pregnant females. The presence of a refuge roughly doubled the odds of survival of both early and late-stage pregnant females. However, there was no interaction between refuge availability and stage of pregnancy. These data do not provide evidence for behavioral compensation by female G. affinis for elevated viability costs incurred during later stages of pregnancy. Behavioral compensation may be constrained by other aspects of the cost of reproduction.

Viability costs of reproduction and behavioral compensation in western mosquitofish (Gambusia affinis.

Directory of Open Access Journals (Sweden)

Clinton T Laidlaw

Full Text Available The cost of reproduction hypothesis suggests that current reproduction has inherent tradeoffs with future reproduction. These tradeoffs can be both in the form of energy allocated to current offspring as opposed to somatic maintenance and future reproduction (allocation costs, or as an increase in mortality as a result of morphological or physiological changes related to reproduction (viability costs. Individuals may be able to decrease viability costs by altering behavior. Female western mosquitofish, Gambusia affinis experience a reduction in swimming ability as a consequence of pregnancy. We test for a viability cost of reproduction, and for behavioral compensation in pregnant female G. affinis by measuring survival of females in early and later stages of pregnancy when exposed to predation. Late-stage pregnant females experience a 70% greater probability of mortality compared to early-stage pregnant females. The presence of a refuge roughly doubled the odds of survival of both early and late-stage pregnant females. However, there was no interaction between refuge availability and stage of pregnancy. These data do not provide evidence for behavioral compensation by female G. affinis for elevated viability costs incurred during later stages of pregnancy. Behavioral compensation may be constrained by other aspects of the cost of reproduction.

Perceived Cost and Intrinsic Motor Variability Modulate the Speed-Accuracy Trade-Off.

Directory of Open Access Journals (Sweden)

Matteo Bertucco

Full Text Available Fitts' Law describes the speed-accuracy trade-off of human movements, and it is an elegant strategy that compensates for random and uncontrollable noise in the motor system. The control strategy during targeted movements may also take into account the rewards or costs of any outcomes that may occur. The aim of this study was to test the hypothesis that movement time in Fitts' Law emerges not only from the accuracy constraints of the task, but also depends on the perceived cost of error for missing the targets. Subjects were asked to touch targets on an iPad® screen with different costs for missed targets. We manipulated the probability of error by comparing children with dystonia (who are characterized by increased intrinsic motor variability to typically developing children. The results show a strong effect of the cost of error on the Fitts' Law relationship characterized by an increase in movement time as cost increased. In addition, we observed a greater sensitivity to increased cost for children with dystonia, and this behavior appears to minimize the average cost. The findings support a proposed mathematical model that explains how movement time in a Fitts-like task is related to perceived risk.

Cost justification of chiller replacement

International Nuclear Information System (INIS)

Baker, T.J.; Baumer, R.A.

1993-01-01

We often hear of products with paybacks that are too good to be true. Just a few weeks ago,a client received a recommendation from a national service company's local office. In the letter the company recommended that open-quotes due to the age and condition of the boiler ... that the school consider replacing the boiler... The cost for the new boiler can usually be recovered by lower fuel bills in 2 to 3 yearsclose quotes. This was for an installation in Southeast Texas where the boiler is only used 4 to 5 months per year. Analysis show the above claims to be nonsense. A new boiler would cost about $47,000 installed. Current total gas bills for the facility are $15,630 per year. They would have to shutoff the gas to the facility to have a three year payback. In fact, only two-thirds of the gas is used to heat the facility so we have only $10, 000 to write off against the new boiler. How much will the greater efficiency save? A 30% savings due to greater efficiency produces $3,000 per year in gas savings to offset the $47,000 cost, a 16 year payback. And much of the efficiency savings can be realized by adjusting the existing boiler. In another care a client wanted to investigate replacement of a twenty year old chiller plant with more efficient equipment. We investigated the project and determined that the payback would be greater than ten years. They did not operate the equipment during the summer and at less than 50% of capacity the balance of the year

Cost of treating sagittal synostosis in the first year of life.

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Abbott, Megan M; Rogers, Gary F; Proctor, Mark R; Busa, Kathleen; Meara, John G

2012-01-01

Endoscopically assisted suturectomy (EAS) has been reported to reduce the morbidity and cost of treating sagittal synostosis when compared with traditional open cranial vault remodeling (CVR) procedures. Whereas the former claim is well substantiated and intuitive, the latter has not been validated by rigorous cost analysis. Patient medical records and financial database reports were culled retrospectively to determine the total cost associated with both EAS and CVR during 1 year of care. Recorded cost data included physician and hospital services, orthotic equipment and fittings, and indirect patient cost. Ten patients treated with CVR were compared with 10 patients who underwent EAS. The CVR patients incurred greater costs in nearly all categories studied, including overall 1-year costs, physician services, hospital services, supplies/equipment, medications/intravenous fluids, and laboratory and blood bank services. Postoperative costs were greater in the EAS group, primarily because of the cost associated with orthotic services and indirect patient costs for travel and lost work. However, overall indirect patient costs for the whole year did not differ between the groups. One-year median costs were $55,121 for CVR and $23,377 for EAS. Early clinical results were similar for the 2 groups. Cranial vault remodeling was more costly in the first year of treatment than EAS, although indirect patient costs were similar. The favorable cost of EAS compared with CVR provides further justification to consider this procedure as first-line treatment of sagittal synostosis in young infants.

The potential for reducing atmospheric carbon by large-scale afforestation in China and related cost/benefit analysis

International Nuclear Information System (INIS)

Deying Xu

1995-01-01

In this paper, the amount of carbon sequestered through large-scale afforestation and related costs and benefits are calculated, assuming that the forests are managed in perpetual rotations. Based on land availability for afforestation, 20 cases are identified in five suitable regions in China. The least expensive way of developing forests for the purpose of sequestering carbon emissions is the case of Pinus massoniana from the initial investment point of view, and then Spruce. The cases of open forest management are relatively less expensive options because of their low initial investment and long rotations, although their annual wood increments are low. Some less productive tree species have higher net costs for carbon sequestering. For most of the agroforestry systems the net costs are low, especially in the south, the southwest, and the north of China, though their initial investments are high. If the total land available is afforested, the net carbon sequestering will be about 9.7 billion tons under perpetual rotations, amounting to 16.3 times the total industrial carbon release in 1988 in China, and the total initial cost for such a programme is estimated at 19.3 billion US$. Some hindrances in developing forests in China are discussed. (Author)

Cost savings from nuclear regulatory reform: An econometric model

International Nuclear Information System (INIS)

Canterbery, E.R.; Johnson, B.; Reading, D.

1996-01-01

The nuclear-generated power touted in the 1950s as someday being open-quotes too cheap to meterclose quotes got dismissed in the 1980s as incapable of being both safe and cost effective. Today, less than 20 percent of American's electricity is nuclear-generated, no new plants are planned or on order, and some of the earliest units are scheduled for decommissioning within the next decade. Even so, interest in nuclear power has been revived by increasing energy demands, concerns about global warming, and the uncertainty surrounding oil resources in the Persian Gulf. As a long-term alternative to fossil fuels, atomic energy offers the important advantages of clean air and domestic availability of fuel. But these advantages will count for little unless and until the costs of nuclear power can be seen as reasonable. The authors premise is that the relevant costs are those of providing safe and environmentally clean electric energy. To the extent that increased costs have resulted from increasingly stringent regulations, they reflect the internalization of external costs. Indeed, the external costs of nuclear power (particularly safety and environmental protection) have been internalized to a greater degree than with most alternative fuel sources used by electric utilities. Nuclear construction costs are properly compared with those of alternative sources only after the latter are adjusted for environmental damage and endangerment, including, as examples, the costs of oil spills, of building double-hulled tankers, and of building off-shore offloading facilities. A shift to nuclear sources could reduce these costs whereas it would increase disposal costs for radioactive materials. The authors contend that a better understanding of nuclear plant construction costs is pivotal to a balanced evaluation of the merits of uranium relative to other fuel choices. 12 refs., 2 figs., 5 tabs

Construction cost impacts related to manpower, material, and equipment factors in contractor firms perspective

Science.gov (United States)

Husin, Saiful; Abdullah, Riza, Medyan; Afifuddin, Mochammad

2017-11-01

Risk can be defined as consequences which possible happened inscrutably. Although an activity has planned as good as possible, but it keep contains uncertainty. Implementation of construction project was encountering various risk impacts from a number of risk factors. This study was intended to analyze the impacts of construction cost to for contractor firms as construction project executor related to the factors of manpower, material and equipment. The study was using data obtained from questionnaires distributed to 15 large qualification contractor firms. The period of study classified into conflict period (2000-2004), post tsunami disaster rehabilitation and reconstruction period (2005-2009), and post rehabilitation and reconstruction period (2010-present). The statistical analysis of severity index and variance used to analyze the data. The three risk factors reviewed generally affected the cost in a medium impact. The high impact occurred in minor variables, which are `increase in material prices', `theft of materials', and `the fuel scarcity'. In overall, the three risk factors and the observed period contributed significant impact on construction costs.

The Feto-Maternal Health Cost of Intimate Partner Violence Among Delivery-Related Discharges in the United States, 2002-2009.

Science.gov (United States)

Mogos, Mulubrhan F; Araya, Winta N; Masho, Saba W; Salemi, Jason L; Shieh, Carol; Salihu, Hamisu M

2016-02-01

Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost. © The Author(s) 2014.

Economic costs of drug abuse: financial, cost of illness, and services.

Science.gov (United States)

Cartwright, William S

2008-03-01

This article examines costs as they relate to the financial costs of providing drug abuse treatment in private and public health plans, costs to society relating to drug abuse, and many smaller costing studies of various stakeholders in the health care system. A bibliography is developed from searches across PubMed, Web of Science, and other bibliographic sources. The review indicates that a wide collection of cost findings is available to policy makers. For example, the financial aspects of health plans have been dominated by considerations of actuarial costs of parity for drug abuse treatment. Cost-of-illness methods have been developed and extended to drug abuse costing to measure the national level of burden and are important to the economic evaluation of interventions at the program level. Costing is done in many small and focused studies, reflecting the interests of different stakeholders in the health care system. For costs in programs and health plans, as well as cost offsets of the impact of substance abuse treatment on medical expenditures, findings are surprisingly important to policy makers. Maintaining ongoing research that is highly policy relevant from the point of view of health services, more is needed on costing concepts and measurement applications.

Herbivory eliminates fitness costs of mutualism exploiters.

Science.gov (United States)

Simonsen, Anna K; Stinchcombe, John R

2014-04-01

A common empirical observation in mutualistic interactions is the persistence of variation in partner quality and, in particular, the persistence of exploitative phenotypes. For mutualisms between hosts and symbionts, most mutualism theory assumes that exploiters always impose fitness costs on their host. We exposed legume hosts to mutualistic (nitrogen-fixing) and exploitative (non-nitrogen-fixing) symbiotic rhizobia in field conditions, and manipulated the presence or absence of insect herbivory to determine if the costly fitness effects of exploitative rhizobia are context-dependent. Exploitative rhizobia predictably reduced host fitness when herbivores were excluded. However, insects caused greater damage on hosts associating with mutualistic rhizobia, as a consequence of feeding preferences related to leaf nitrogen content, resulting in the elimination of fitness costs imposed on hosts by exploitative rhizobia. Our experiment shows that herbivory is potentially an important factor in influencing the evolutionary dynamic between legumes and rhizobia. Partner choice and host sanctioning are theoretically predicted to stabilize mutualisms by reducing the frequency of exploitative symbionts. We argue that herbivore pressure may actually weaken selection on choice and sanction mechanisms, thus providing one explanation of why host-based discrimination mechanisms may not be completely effective in eliminating nonbeneficial partners. © 2014 The Authors. New Phytologist © 2014 New Phytologist Trust.

[Cost per capita in outpatients by gender].

Science.gov (United States)

Villarreal-Ríos, Enrique; Campos Esparza, Maribel; Galicia Rodríguez, Liliana; Martínez González, Lidia; Vargas Daza, Emma Rosa; Torres Labra, Guadalupe; Patiño Vega, Adolfo; Rivera Martínez, María Teresa; Aparicio Rojas, Raúl; Juárez Durán, Martín

2011-03-01

The objective of this study is to identify the annual cost per capita by gender in first level of attention. It is a cost study in Family Physician Units in Mexico. The information corresponded to the year of 2004 and the study divided in the use profile and cost attention. USE PROFILE OF SERVICES: it was studied 1,585 clinical registries of patients, use profile defined by average and attention reasons by department, gender and age group. COST ATTENTION: considered in American dollars it included fixed unit cost (departmentalization adjusted by productivity), variable unit cost (micro cost technical), department unite cost by type attention, and department unit cost by age and gender. The life expectancy was of 73 years for men and 78 for women. Three scenes were identified. The annual cost per capita is superior among woman [US$73.24 (IC 95% $11.38 - $197.49)] than in man [$ 53.11 (IC 95% 2.51 - 207.71)]. The conclusion found that in the first level of attention the cost per capita is greater in woman than in man.

Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

Science.gov (United States)

van der Kamp, Jonathan; Bachmann, Till M

2015-03-03

"Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making.

Metabolic cost and mechanics of walking in women with fibromyalgia syndrome.

Science.gov (United States)

MacPhee, Renée S; McFall, Kristen; Perry, Stephen D; Tiidus, Peter M

2013-10-18

Fibromyalgia syndrome (FS) is characterized by the presence of widespread pain, fatigue, muscle weakness and reduced work capacity. Previous research has demonstrated that women with fibromyalgia have altered walking (gait) patterns, which may be a consequence of muscular pain. This altered gait is characterized by greater reliance on hip flexors rather than ankle plantar flexors and resembles gait patterns seen in normal individuals walking at higher speeds, suggesting that gait of individuals with fibromyalgia may be less efficient.This study compared rates of energy expenditure of 6 females with FS relative to 6 normal, age and weight matched controls, at various walking speeds on a motorized treadmill. Metabolic measurements including V02 (ml/kg/min), respirations, heart rate and calculated energy expenditures as well as the Borg Scale of Perceived Exertion scale ratings were determined at baseline and for 10 min while walking at each of 2, 4 and 5 km/hour on 1% grade. Kinematic recordings of limb and body movements while treadmill walking and separate measurements of ground reaction forces while walking over ground were also determined. In addition, all subjects completed the RAND 36-Item Health Survey (1.0). Gait analysis results were similar to previous reports of altered gait patterns in FS females. Despite noticeable differences in gait patterns, no significant differences (p > 0.05) existed between the FS and control subjects on any metabolic measures at any walking speed. Total number of steps taken was also similar between groups. Ratings on the Borg Scale of Perceived Exertion, the RAND and self-reported levels of pain indicated significantly greater (p gait patterns and greater perceptions of effort and pain did not significantly increase the metabolic costs of walking in women with FS and hence, increased sensations of fatigue in FS women may not be related to alteration in metabolic cost of ambulation.

Greater general startle reflex is associated with greater anxiety levels: a correlational study on 111 young women

Directory of Open Access Journals (Sweden)

Eleonora ePoli

2015-02-01

Full Text Available Startle eyeblink reflex is a valid non-invasive tool for studying attention, emotion and psychiatric disorders. In the absence of any experimental manipulation, the general (or baseline startle reflex shows a high inter-individual variability, which is often considered task-irrelevant and therefore normalized across participants. Unlike the above view, we hypothesized that greater general startle magnitude is related to participants’ higher anxiety level. 111 healthy young women, after completing the State-Trait Anxiety Inventory, were randomly administered 10 acoustic white noise probes (50 ms, 100 dBA acoustic level while integrated EMG from left and right orbicularis oculi was recorded. Results showed that participants with greater state anxiety levels exhibited larger startle reflex magnitude from the left eye (r109=0.23, p<0.05. Furthermore, individuals who perceived the acoustic probe as more aversive reported the largest anxiety scores (r109=0.28, p<0.05 and had the largest eyeblinks, especially in the left eye (r109 = 0.34, p<0.001. Results suggest that general startle may represent a valid tool for studying the neural excitability underlying anxiety and emotional dysfunction in neurological and mental disorders.

Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe.

Science.gov (United States)

Chevreul, Karine; Michel, Morgane; Brigham, Karen Berg; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Schieppati, Arrigo; Iskrov, Georgi; Péntek, Márta; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Persson, Ulf; Fattore, Giovani

2016-04-01

Our goal was to provide data on the economic burden and health-related quality of life (HRQOL) of patients with cystic fibrosis (CF) and their caregivers in Europe. A cross-sectional study was carried out on adults and children with CF in eight European countries. Patients completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and presence of a caregiver. Costs were calculated with a bottom-up approach using unit costs from each participating country, and HRQOL was assessed using EQ-5D. The principal caregiver also answered a questionnaire on their characteristics, HRQOL and burden. A total of 905 patients with CF was included (399 adults and 506 children). The total average annual cost per patient varied from €21,144 in Bulgaria to €53,256 in Germany. Adults had higher direct healthcare costs than children, but children had much higher informal care costs (P costs increased with patients' level of dependence. In adults, mean utility fell between 0.640 and 0.870, and the visual analogue scale ranged from 46.0 to 69.7. There was no difference in caregiver HRQOL regardless of whether they cared for an adult or a child. However, caregivers who looked after a child had a significantly higher burden (P = 0.0013). Our study highlights the burden of CF in terms of costs and decreased HRQOL for both patients and their caregivers throughout Europe.

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

Directory of Open Access Journals (Sweden)

Smita Nayak

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

The costs of treating acute heart failure: an economic analysis of the SURVIVE trial.

Science.gov (United States)

de Lissovoy, Gregory; Fraeman, Kathy; Salon, Jeff; Chay Woodward, Tatia; Sterz, Raimund

2008-01-01

To estimate the incremental cost per life year gained with levosimendan relative to dobutamine in treatment of acute heart failure based on the Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support (SURVIVE) trial. SURVIVE enrolled 1,327 patients (levosimendan 664, dobutamine 663) from nine nations with 180-day survival from date of randomisation as the primary endpoint. Hospital resource utilisation was determined via clinical case reports. Unit costs were derived from hospital payment schedules for France, Germany and the UK, and represent a third-party payer perspective. Cost-effectiveness analysis was performed for a subset of the SURVIVE patient population selected in accordance with current levosimendan labeling. Mortality in the levosimendan group was 26 versus 28% for dobutamine (hazard ratio 0.91, 95% confidence interval 0.74-1.13, p=0.40). Initial hospitalisation length of stay was identical (levosimendan 14.4, dobutamine 14.5, p=0.98). Slightly lower rates of readmission were observed for levosimendan relative to dobutamine at 31 (p=0.13) and 180 days (p=0.23). Mean costs excluding study drug were equivalent for the index admission (levosimendan euro5,060, dobutamine euro4,952; p=0.91) and complete episode (levosimendan euro5,396, dobutamine euro5,275; p=0.93). At an acquisition cost of euro600 per vial, there is at least 50% likelihood that levosimendan is cost effective relative to dobutamine if willingness to pay is equal to or greater than euro15,000 per life year gained.

Trouble Sleeping Associated with Lower Work Performance and Greater Healthcare Costs: Longitudinal Data from Kansas State Employee Wellness Program

Science.gov (United States)

Hui, Siu-kuen Azor; Grandner, Michael A.

2015-01-01

Objective To examine the relationships between employees’ trouble sleeping and absenteeism, work performance, and healthcare expenditures over a two year period. Methods Utilizing the Kansas State employee wellness program (EWP) dataset from 2008–2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and healthcare costs as the outcomes. Results EWP participants (N=11,698 in 2008; 5,636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all p performance ratings (all p performance, and healthcare costs. PMID:26461857

Improving greater trochanteric reattachment with a novel cable plate system.

Science.gov (United States)

Baril, Yannick; Bourgeois, Yan; Brailovski, Vladimir; Duke, Kajsa; Laflamme, G Yves; Petit, Yvan

2013-03-01

Cable-grip systems are commonly used for greater trochanteric reattachment because they have provided the best fixation performance to date, even though they have a rather high complication rate. A novel reattachment system is proposed with the aim of improving fixation stability. It consists of a Y-shaped fixation plate combined with locking screws and superelastic cables to reduce cable loosening and limit greater trochanter movement. The novel system is compared with a commercially available reattachment system in terms of greater trochanter movement and cable tensions under different greater trochanteric abductor application angles. A factorial design of experiments was used including four independent variables: plate system, cable type, abductor application angle, and femur model. The test procedure included 50 cycles of simultaneous application of an abductor force on the greater trochanter and a hip force on the femoral head. The novel plate reduces the movements of a greater trochanter fragment within a single loading cycle up to 26%. Permanent degradation of the fixation (accumulated movement based on 50-cycle testing) is reduced up to 46%. The use of superelastic cables reduces tension loosening up to 24%. However this last improvement did not result in a significant reduction of the grater trochanter movement. The novel plate and cables present advantages over the commercially available greater trochanter reattachment system. The plate reduces movements generated by the hip abductor. The superelastic cables reduce cable loosening during cycling. Both of these positive effects could decrease the risks related to grater trochanter non-union. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Science.gov (United States)

Chin, Garwin; Wright, David J.; Snir, Nimrod; Schwarzkopf, Ran

2018-01-01

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. PMID:26387923

Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

Science.gov (United States)

Worrall, A; Rea, J N; Ben-Shlomo, Y

1997-01-04

To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Inner city group practice with a socioeconomically diverse population. 382 male and female subjects of all ages, with a total of 1296 person years of observation. Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method

Directory of Open Access Journals (Sweden)

Sase Yuji

2011-09-01

Full Text Available Abstract Background Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. Methods We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views, knee (three views, wrist (two views, and other. Indirect costs were allocated to cost objects using the ABC method. Results The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. Conclusions The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method.

Science.gov (United States)

Muto, Hiroshi; Tani, Yuji; Suzuki, Shigemasa; Yokooka, Yuki; Abe, Tamotsu; Sase, Yuji; Terashita, Takayoshi; Ogasawara, Katsuhiko

2011-09-30

Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Transaction cost of micro and small enterprises financing

Directory of Open Access Journals (Sweden)

Ghana Atma Sulistya

2016-10-01

Full Text Available High transaction costs become one of the obstacles for the micro and small enterprises (MSEs to access financial loans to the bank. In order to minimize the transaction costs, group lending scheme become  alternative, so that both sides are pay lower transaction costs, and MSEs are able to improve their welfare. This study aims to analyze the credit process and transaction costs incurred on the model of individuals and groups lending and to compare the magnitude of transaction costs on both models. Mixed Method Analysis is used to analyze the component of transaction costs and the magnitude of the transaction cost on both models.These results indicate there are differences in transaction costs incurred on both schemes. In the amount of the transaction costs, the overall group scheme still allows for greater compared to individual schemes and dominated by the cost of the disbursement. Even so, the transaction cost per member group is much smaller than the individual schemes.

An application of the Rayleigh distribution to contract cost data

OpenAIRE

Abernethy, Thomas S.

1984-01-01

Approved for public release; distribution unlimited Accurate cost models are essential to the proper monitoring of contract cost data. The greater the accuracy of the model, the earlier contract cost overruns can be recognized and their cause(s) ascertained. The availability of a variety of cost models allows flexibility in choosing the correct model for the particular circumstances and increases the chances of being able to select a model that can provide reliable forecasts about future c...

Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.

Science.gov (United States)

Burger, Emily A; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S; Kim, Jane J

2014-01-01

Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding

Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.

Directory of Open Access Journals (Sweden)

Emily A Burger

Full Text Available BACKGROUND: Increasingly, countries have introduced female vaccination against human papillomavirus (HPV, causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. METHODS: A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. RESULTS: Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY gained when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY, it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. CONCLUSIONS: At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is

Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys

Science.gov (United States)

Burger, Emily A.; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S.; Kim, Jane J.

2014-01-01

Background Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. Methods A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Results Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered ‘good value for money.’ For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. Conclusions At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more

Indoor Temperatures in Low Cost Housing in Johannesburg, South Africa

Directory of Open Access Journals (Sweden)

Nisha Naicker

2017-11-01

Full Text Available Ambient and indoor temperature affects thermal comfort and human health. In a changing climate with a predicted change in temperature extremes, understanding indoor temperatures, both hot and cold, of different housing types is important. This study aimed to assess the hourly, daily and monthly variation in indoor temperatures in different housing types, namely formal houses, informal houses, flats, government-built low-cost houses and old, apartheid era low-cost housing, in five impoverished urban communities in Johannesburg, South Africa. During the cross-sectional survey of the Health, Environment and Development study data loggers were installed in 100 homes (20 per suburb from February to May 2014. Indoor temperature and relative humidity were recorded on an hourly basis. Ambient outdoor temperatures were obtained from the nearest weather station. Indoor and outdoor temperature and relative humidity levels were compared; and an inter-comparison between the different housing types were also made. Apparent temperature was calculated to assess indoor thermal comfort. Data from 59 retrieved loggers showed a significant difference in monthly mean indoor temperature between the five different housing types (p < 0.0001. Low cost government-built houses and informal settlement houses had the greatest variation in temperature and experienced temperatures between 4 and 5 °C warmer than outdoor temperatures. Housing types occupied by poor communities experienced indoor temperature fluctuations often greater than that observed for ambient temperatures. Families living in government-built low-cost and informally-constructed homes are the most at risk for indoor temperature extremes. These types of housing should be prioritised for interventions aimed at assisting families to cope with extreme temperatures, gaining optimal thermal comfort and preventing temperature-related health effects.

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

DEFF Research Database (Denmark)

Parlesak, A.; Tetens, Inge; Dejgård Jensen, Jørgen

2016-01-01

programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods...... in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater...... variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. Use of linear programming...

Integrated waste management system costs in a MPC system

International Nuclear Information System (INIS)

Supko, E.M.

1995-01-01

The impact on system costs of including a centralized interim storage facility as part of an integrated waste management system based on multi-purpose canister (MPC) technology was assessed in analyses by Energy Resources International, Inc. A system cost savings of $1 to $2 billion occurs if the Department of Energy begins spent fuel acceptance in 1998 at a centralized interim storage facility. That is, the savings associated with decreased utility spent fuel management costs will be greater than the cost of constructing and operating a centralized interim storage facility

Cost effectiveness of pegaptanib for the treatment of age-related macular degeneration in the UK.

Science.gov (United States)

Wolowacz, Sorrel E; Roskell, Neil; Kelly, Steven; Maciver, Fiona M; Brand, Chris S

2007-01-01

Age-related macular degeneration (AMD) is the primary cause of vision loss in the elderly and results in significant economic and humanistic burden. The selective vascular endothelial growth factor inhibitor, pegaptanib (Macugen) is indicated for patients with neovascular AMD. Guidance is needed regarding the cost effectiveness of treatment, any variation between sub-populations of differing clinical characteristics and the optimum duration of treatment. To estimate the cost effectiveness of pegaptanib versus best supportive care (BSC) for AMD from the perspective of the UK government, and to evaluate the impact of patient characteristics and differing treatment discontinuation scenarios. A cohort of 1000 patients aged >45 years with a best-corrected visual acuity (VA) in their better-seeing eye of age, gender, lesion type or lesion size as covariates. Mortality rates were adjusted for the age, gender and VA of the population. Cost effectiveness was expressed as the incremental cost (IC) per vision-year saved and IC/QALY. Uncertainty was explored by probabilistic and univariate sensitivity analysis. Costs (year 2005 values) and outcomes were discounted at 3.5% per anum. In the base-case analysis, treatment was targeted to patients with a VA of 6/12 to 6/95 and discontinued after 2 years, or earlier if VA fell below 6/95 or by > or =6 lines. The IC/QALY was estimated as 8023 pounds(upper 95% CI 20,641 pounds). Cost effectiveness varied by age (age age > or =75 years = 11,657 pounds/QALY) and by pre-treatment VA (6/12-6/95 = 8023 pounds/QALY; 6/12-6/60 = 6664 pounds/QALY; 6/12-6/24 = 1920 pounds/QALY). Gender and lesion type or size had little effect. Cost effectiveness was not sensitive to precise rules for treatment discontinuation, but was maximised if treatment was discontinued in patients no longer likely to benefit. The results suggest that pegaptanib treatment is likely to be cost effective across all groups studied, and marginally more cost effective in

Cost Behavior

DEFF Research Database (Denmark)

Hoffmann, Kira

The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

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.

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

Science.gov (United States)

Fleck, Leonard M

2018-04-01

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

An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion

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Hanvoravongchai Piya

2012-12-01

Full Text Available Abstract Background There is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS of Asia, high socio-economic diversity and fertile conditions for the emergence and spread of infectious diseases underscore the importance of transnational cooperation. Investigation of healthcare resource distribution and inequalities can help determine the need for, and inform decisions regarding, resource sharing and mobilisation. Methods We collected data on healthcare resources deemed important for responding to pandemic influenza through surveys of hospitals and district health offices across four countries of the GMS (Cambodia, Lao PDR, Thailand, Vietnam. Focusing on four key resource types (oseltamivir, hospital beds, ventilators, and health workers, we mapped and analysed resource distributions at province level to identify relative shortages, mismatches, and clustering of resources. We analysed inequalities in resource distribution using the Gini coefficient and Theil index. Results Three quarters of the Cambodian population and two thirds of the Laotian population live in relatively underserved provinces (those with resource densities in the lowest quintile across the region in relation to health workers, ventilators, and hospital beds. More than a quarter of the Thai population is relatively underserved for health workers and oseltamivir. Approximately one fifth of the Vietnamese population is underserved for beds and ventilators. All Cambodian provinces are underserved for at least one resource. In Lao PDR, 11 percent of the population is underserved by all four resource items. Of the four resources, ventilators and oseltamivir were most unequally distributed. Cambodia generally showed higher levels of inequalities in resource distribution compared to other countries. Decomposition of the Theil index suggests that inequalities result principally from

Adjustment of Business Expatriates in Greater China: A Strategic Perspective

DEFF Research Database (Denmark)

Selmer, Jan

2006-01-01

Research has found that due to similarities, firms which have gained business experience elsewhere in Greater China may exhibit relatively better performance in mainland China. Hence, the experience of business expatriates could be of strategic importance for the expansion path of their firms...

How Europe's Low-Cost Carriers Sidestepped Traditional Carriers' Competitive Advantages

DEFF Research Database (Denmark)

Hvass, Kristian Anders

-cost airlines were more successful and had a greater initial impact in their early years than their U.S. compatriots. This paper will attempt to highlight some of the differences between the two markets and explain why European low-cost airlines had more advantages following their market deregulation...

Cost-benefit evaluation of containment related engineered safety features of Indian pressurized heavy water reactors

International Nuclear Information System (INIS)

Bajaj, S.S.; Bhawal, R.N.; Rustagi, R.S.

1984-01-01

The typical containment system for a commercial nuclear reactor uses several engineered safety features to achieve its objective of limiting the release of radioactive fission products to the environment in the event of postulated accident conditions. The design of containment systems and associated features for Indian Pressurized Heavy Water Reactors (PHWRs) has undergone progressive improvement in successive projects. In particular, the current design adopted for the Narora Atomic Power Project (NAPP) has seen several notable improvements. The paper reports on a cost-benefit study in respect of three containment related engineered safety features and subsystems of NAPP, viz. (i) secondary containment envelope, (ii) primary containment filtration and pump-back system, and (iii) secondary containment filtration, recirculation and purge system. The effect of each of these systems in reducing the environmental releases of radioactivity following a design basis accident is presented. The corresponding reduction in population exposure and the associated monetary value of this reduction in exposure are also given. The costs of the features and subsystem under consideration are then compared with the monetary value of the exposures saved, as well as other non-quantified benefits, to arrive at conclusions regarding the usefulness of each subsystem. This study clearly establishes for the secondary containment envelope the benefit in terms of reduction in public exposure giving a quantitative justification for the costs involved. In the case of the other two subsystems, which involve relatively low costs, while all benefits have not been quantified, their desirability is justified on qualitative considerations. It is concluded that the engineered safety features adopted in the current containment system design of Indian PHWRs contribute to reducing radiation exposures during accident conditions in accordance with the ALARA ('as low as reasonably achievable') principle

The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation

Science.gov (United States)

Doran, Tim; Cookson, Richard

2016-01-01

Background There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course. Methods Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs. Results A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31 298/100 000 population in the most affluent fifth of areas to 43 385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was £4.8 billion. A social gradient was also observed in the modelled lifetime costs where the lower life expectancy was not sufficient to outweigh the higher average costs in the more deprived populations. Lifetime costs for women were 14% greater than for men, due to higher costs in the reproductive years and greater life expectancy. Conclusions Socioeconomic inequalities result in increased morbidity and decreased life expectancy. Interventions to reduce inequality and improve health in more deprived neighbourhoods have the potential to save money for health systems not only within years but across peoples’ entire lifetimes, despite increased costs due to longer life expectancies. PMID:27189975

Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries.

Science.gov (United States)

Boehler, Christian E H; Lord, Joanne

2016-01-01

Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%-19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical

Do Statins Reduce the Health and Health Care Costs of Obesity?

Science.gov (United States)

Gaudette, Étienne; Goldman, Dana P; Messali, Andrew; Sood, Neeraj

2015-07-01

Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae. Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins. Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %. Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

Natural Gas and CO2 Price Variation: Impact on the Relative Cost-Efficiency of LNG and Pipelines

OpenAIRE

Øverland, Indra; Ulvestad, Marte

2012-01-01

This article develops a formal model for comparing the cost structure of the two main transport options for natural gas: liquefied natural gas (LNG) and pipelines. In particular, it evaluates how variations in the prices of natural gas and greenhouse gas emissions affect the relative cost-efficiency of these two options. Natural gas is often promoted as the most environmentally friendly of all fossil fuels, and LNG as a modern and efficient way of transporting it. Some research has been carri...

Contracting for health services in New Zealand: a transaction cost analysis.

Science.gov (United States)

Ashton, T

1998-02-01

The splitting of the functions of purchaser and provider in the New Zealand health system in 1993 necessitated the use of explicit contracts between the two parties. This paper examines contracting experiences during the first two years of operation. The study focuses on four services: rest homes, primary care clinics, surgical services, and acute mental health services. The insights of transaction cost economics form the theoretical framework. The objective of this study was to examine whether the transaction costs associated with contracting vary across the four different services, and whether different types of contracts and contractual relationships are emerging as transactors attempt to reduce these costs. Information was collected in a series of 53 interviews with purchasers and providers, together with any relevant documentation. The results suggest that the costs of contracting are indeed greater for some services than for others. Other variables such as the style of negotiations, the type and specificity of contracts and the degree of monitoring also differ across the four services. At this early stage of the reform process, there was little evidence that purchasers and providers were attempting to reduce transaction costs by negotiating more flexible, longer-term, relational contracts. The main benefit from contracting to date has been improved accountability of service providers.

The Relation of Design Parameters, Plant Capacity and Processing Costs in Cobalt-60 Sterilization Plants

International Nuclear Information System (INIS)

Brown, M.G.

1967-01-01

The paper describes the main features of three basic types of cobalt-60 sterilization plants which have been designed to provide a complete range of capacities for radiosterilization of medical products. The smallest plant has a capacity of up to 50 000 cubic feet of medical products a year, the intermediate size plant has a capacity of up to 500 000 cubic feet a year, and the largest plant has a capacity in excess of 1000 000 cubic feet a year. The relations between capital costs, rate of production, efficiency and unit processing costs for each type of plant are discussed. The method of selecting the best type of plant for a particular need will also be outlined. (author)

78 FR 50088 - Notice of Availability of the Northwest Colorado Greater Sage-Grouse Draft Resource Management...

Science.gov (United States)

2013-08-16

... Availability of the Northwest Colorado Greater Sage- Grouse Draft Resource Management Plan Amendment and Draft... Land Management (BLM) has prepared a Northwest Colorado Greater Sage-Grouse Draft Resource Management.../or mailings. ADDRESSES: You may submit comments related to the Northwest Colorado Greater Sage-Grouse...

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

Science.gov (United States)

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

2014-10-01

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

Optimization of solar cell contacts by system cost-per-watt minimization

Science.gov (United States)

Redfield, D.

1977-01-01

New, and considerably altered, optimum dimensions for solar-cell metallization patterns are found using the recently developed procedure whose optimization criterion is the minimum cost-per-watt effect on the entire photovoltaic system. It is also found that the optimum shadow fraction by the fine grid is independent of metal cost and resistivity as well as cell size. The optimum thickness of the fine grid metal depends on all these factors, and in familiar cases it should be appreciably greater than that found by less complete analyses. The optimum bus bar thickness is much greater than those generally used. The cost-per-watt penalty due to the need for increased amounts of metal per unit area on larger cells is determined quantitatively and thereby provides a criterion for the minimum benefits that must be obtained in other process steps to make larger cells cost effective.

Rehabilitation costs

Energy Technology Data Exchange (ETDEWEB)

Kubo, Arthur S [BDM Corp., VA (United States); [Bikini Atoll Rehabilitation Committee, Berkeley, CA (United States)

1986-07-01

The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates.

Rehabilitation costs

International Nuclear Information System (INIS)

Kubo, Arthur S.

1986-01-01

The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates

Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System.

Science.gov (United States)

Edney, Laura Catherine; Haji Ali Afzali, Hossein; Cheng, Terence Chai; Karnon, Jonathan

2018-02-01

Spending on new healthcare technologies increases net population health when the benefits of a new technology are greater than their opportunity costs-the benefits of the best alternative use of the additional resources required to fund a new technology. The objective of this study was to estimate the expected incremental cost per quality-adjusted life-year (QALY) gained of increased government health expenditure as an empirical estimate of the average opportunity costs of decisions to fund new health technologies. The estimated incremental cost-effectiveness ratio (ICER) is proposed as a reference ICER to inform value-based decision making in Australia. Empirical top-down approaches were used to estimate the QALY effects of government health expenditure with respect to reduced mortality and morbidity. Instrumental variable two-stage least-squares regression was used to estimate the elasticity of mortality-related QALY losses to a marginal change in government health expenditure. Regression analysis of longitudinal survey data representative of the general population was used to isolate the effects of increased government health expenditure on morbidity-related, QALY gains. Clinical judgement informed the duration of health-related quality-of-life improvement from the annual increase in government health expenditure. The base-case reference ICER was estimated at AUD28,033 per QALY gained. Parametric uncertainty associated with the estimation of mortality- and morbidity-related QALYs generated a 95% confidence interval AUD20,758-37,667. Recent public summary documents suggest new technologies with ICERs above AUD40,000 per QALY gained are recommended for public funding. The empirical reference ICER reported in this article suggests more QALYs could be gained if resources were allocated to other forms of health spending.

How should fixed costs in the network be covered?

International Nuclear Information System (INIS)

1999-01-01

The report examines how tariffs that are only meant to cover costs in the transmission network should be formulated. Should the tariffs be based on power figures, such as for instance installed production capacity, or on an energy figure such as total annual energy production? Tariffs based on the producers' installed production capacity will in the long run cause the prises to rise under peak loads while tariffs based on generated energy elevate the consumer price by a small amount for all load segments. Thus, tariffs based on installed power capacity cause greater price distortion and greater socio-economic losses than energy tariffs. There are good arguments that fixed costs should mainly be paid by consumers with inelastic demand

[Practical and theoretical aspects of cost-benefit relations in viscerosynthesis].

Science.gov (United States)

Fuchs, K H; Heimbucher, J; Geiger, D; Thiede, A

1997-01-01

The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. Anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as stapling instruments, can be used in a cost saving aspect, if they help to increase anastomotic safety, time saving and expansion of surgical indication. Manual sutures thus represent the cheapest anastomotic technique as continuous sutures would cost between DM 10.- to 20.- and single stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastomotic techniques should only complete the skill for selected indications. The overall staff expenditure for extended operations amounts around DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additional operation. However, a circular stapler anastomosis that costs between DM 650.- to 850.- is twice as expensive as manual sutures notwithstanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mandatory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.

A cost-effectiveness analysis to illustrate the impact of cost definitions on results, interpretations and comparability of pharmacoeconomic studies in the US.

Science.gov (United States)

Tunis, Sandra L

2009-01-01

There is a lack of a uniform proxy for defining direct medical costs in the US. This potentially important source of variation in modelling and other types of economic studies is often overlooked. The extent to which increased expenditures for an intervention can be offset by reductions in subsequent service costs can be directly related to the choice of cost definitions. To demonstrate how different cost definitions for direct medical costs can impact results and interpretations of a cost-effectiveness analysis. The IMS-CORE Diabetes Model was used to project the lifetime (35-year) cost effectiveness in the US of one pharmacological intervention 'medication A' compared with a second 'medication B' (both unspecified) for type 2 diabetes mellitus. The complications modelled included cardiovascular disease, renal disease, eye disease and neuropathy. The model had a Markov structure with Monte Carlo simulations. Utility values were derived from the published literature. Complication costs were obtained from a retrospective database study that extracted anonymous patient-level data from (primarily private payer) adjudicated medical and pharmaceutical claims. Costs for pharmacy services, outpatient services and inpatient hospitalizations were included. Cost definitions for complications included charged, allowed and paid amounts, and for medications included both wholesale acquisition cost (WAC) and average wholesale price (AWP). Costs were reported in year 2007 values. The cost-effectiveness results differed according to the particular combination of cost definitions employed. The use of charges greatly increased costs for complications. When the analysis incorporated WAC medication prices with charged amounts for complication costs, the incremental cost-effectiveness ratio (ICER) for medication A versus medication B was $US6337 per QALY. When AWP prices were used with charged amounts, medication A became a dominant treatment strategy, i.e. lower costs with greater

Teacher Costs

OpenAIRE

DINIS MOTA DA COSTA PATRICIA; DE SOUSA LOBO BORGES DE ARAUJO LUISA

2015-01-01

The purpose of this technical brief is to assess current methodologies for the collection and calculation of teacher costs in European Union (EU) Member States in view of improving data series and indicators related to teacher salaries and teacher costs. To this end, CRELL compares the Eurydice collection on teacher salaries with the similar Organisation for Economic Co-operation and Development (OECD) data collection and calculates teacher costs based on the methodology established by Statis...

Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review.

Science.gov (United States)

Mouhayar, Youssef; Yin, Ophelia; Mumford, Sunni L; Segars, James H

2017-06-01

The cost of fertility treatment is expensive and interventions that reduce cost can lead to greater efficiency and fewer embryos transferred. Endometrial polyps contribute to infertility and are frequently removed prior to infertility treatment. It is unclear whether polypectomy reduces fertility treatment cost and if so, the magnitude of cost reduction afforded by the procedure. The aim of this study was to determine whether performing office or operative hysteroscopic polypectomy prior to infertility treatment would be cost-effective. PubMed, Embase, and Cochrane libraries were used to identify publications reporting pregnancy rates after hysteroscopic polypectomy. Studies were required to have a polypectomy treatment group and control group of patients with polyps that were not resected. The charges of infertility treatments and polypectomy were obtained through infertility organizations and a private healthcare cost reporting website. These charges were applied to a decision tree model over the range of pregnancy rates observed in the representative studies to calculate an average cost per clinical or ongoing pregnancy. A sensitivity analysis was conducted to assess cost savings of polypectomy over a range of pregnancy rates and polypectomy costs. Pre-treatment office or operative hysteroscopic polypectomy ultimately saved €6658 ($7480) and €728 ($818), respectively, of the average cost per clinical pregnancy in women treated with four cycles of intrauterine insemination. Polypectomy prior to intrauterine insemination was cost-effective for clinical pregnancy rates greater than 30.2% for office polypectomy and 52.6% for operative polypectomy and for polypectomy price <€4414 ($4959). Office polypectomy or operative polypectomy saved €15,854 ($17,813) and €6644 ($7465), respectively, from the average cost per ongoing pregnancy for in vitro fertilization/intracytoplasmic sperm injection treated women and was cost-effective for ongoing pregnancy rates

Active convergence between the Lesser and Greater Caucasus in Georgia: Constraints on the tectonic evolution of the Lesser-Greater Caucasus continental collision

Science.gov (United States)

Sokhadze, G.; Floyd, M.; Godoladze, T.; King, R.; Cowgill, E. S.; Javakhishvili, Z.; Hahubia, G.; Reilinger, R.

2018-01-01

We present and interpret newly determined site motions derived from GPS observations made from 2008 through 2016 in the Republic of Georgia, which constrain the rate and locus of active shortening in the Lesser-Greater Caucasus continental collision zone. Observation sites are located along two ∼160 km-long profiles crossing the Lesser-Greater Caucasus boundary zone: one crossing the Rioni Basin in western Georgia and the other crossing further east near the longitude of Tbilisi. Convergence across the Rioni Basin Profile occurs along the southern margin of the Greater Caucasus, near the surface trace of the north-dipping Main Caucasus Thrust Fault (MCTF) system, and is consistent with strain accumulation on the fault that generated the 1991 MW6.9 Racha earthquake. In contrast, convergence along the Tbilisi Profile occurs near Tbilisi and the northern boundary of the Lesser Caucasus (near the south-dipping Lesser Caucasus Thrust Fault), approximately 50-70 km south of the MCTF, which is inactive within the resolution of geodetic observations (< ± 0.5 mm/yr) at the location of the Tbilisi Profile. We suggest that the southward offset of convergence along strike of the range is related to the incipient collision of the Lesser-Greater Caucasus, and closing of the intervening Kura Basin, which is most advanced along this segment of the collision zone. The identification of active shortening near Tbilisi requires a reevaluation of seismic hazards in this area.

Construction Costs Assessment of Structural Systems for Low-Rise and Social Welfare Housing

Directory of Open Access Journals (Sweden)

Carrillo Julián

2015-09-01

Full Text Available A comparative analysis of the costs related to the construction of low-rise, low-cost and social welfare housing was carried out. The study included three of the most commonly used structural systems for low-rise housing in Latin America, such as the traditional system of confined masonry walls, concrete walls conventionally reinforced with welded-wire meshes and concrete walls reinforced with steel fiber. The cost comparison was carried out by budgets analysis, which were performed based on construction quantities, unit prices and particular items for each structural system. It was found in the study that, from an economic point of view, the systems of concrete walls reinforced with welded-wire meshes or steel fibers are more advantageous than confined masonry systems. In addition, the integral comparison of the three structural systems demonstrates that the industrialized system of steel fiber reinforced concrete walls allows obtaining greater advantages of cleaning and sustainability, faster construction, lower cost and a more attractive scenario for builders investing in such projects.

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals.

Science.gov (United States)

Glandon, G L; Counte, M A

1995-11-01

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

[Prevention of catheter-related infection: usefulness and cost-effectiveness of antiseptic catheters in children].

Science.gov (United States)

Lenz, Ana M; Vassallo, Juan C; Moreno, Guillermo E; Althabe, María; Gómez, Silvia; Magliola, Ricardo; Casimir, Lidia; Bologna, Rosa; Barretta, Jorge; Ruffa, Pablo

2010-06-01

To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter- related blood stream infections (CR-BSI). Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods. A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic- impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 dayscatheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1- 48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.

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.

Report on gas sales regulated tariffs of GDF Suez. Audit of supply costs and of non-supply related costs - May 2015. Deliberation of the Commission for Energy Regulation of the 13 May 2015 bearing approval of the report of analysis of supply and non-supply related costs used as a basis for the calculation of the evolution of natural gas sales regulated tariffs of GDF Suez

International Nuclear Information System (INIS)

Gassin, Helene; Padova, Yann; Sotura, Jean-Pierre; Monteil, Anne; Casadei, Cecile

2015-05-01

After a presentation of the context and objectives of works performed by the CRE (the French commission for energy regulation), and a synthetic presentation of the main conclusions, this report first proposes an assessment for 2014 by presenting and discussing the fact that regulated tariffs have followed a downward trend since the beginning of 2014, that sales at regulated tariffs have strongly decreased, and that GDF Suez costs have been covered by revenues from sales at regulated tariffs. The second part proposes an analysis of the evolution perspectives for supply costs by commenting the calculation formula, the difference between gas market price and LT contract prices, the always stronger indexing of contracts on gas market prices. The last part addresses the perspectives of evolution of non-supply related costs by commenting the taking of infrastructure cost evolution into account, the steadiness of provisional commercial costs, and the consequence of the customer portfolio evolution on the distribution of commercial force costs. Some recommendations are made on the evolution perspectives for supply and non-supply related costs, and on the modalities of assignment of commercial costs among the different types of customers (regulated tariffs or market price)

Market power and state costs of HIV/AIDS drugs.

Science.gov (United States)

Leibowitz, Arleen A; Sood, Neeraj

2007-03-01

We examine whether U.S. states can use their market power to reduce the costs of supplying prescription drugs to uninsured and underinsured persons with HIV through a public program, the AIDS Drug Assistance Program (ADAP). Among states that purchase drugs from manufacturers and distribute them directly to clients, those that purchase a greater volume pay lower average costs per prescription. Among states depending on retail pharmacies to distribute drugs and then claiming rebates from manufacturers, those that contract with smaller numbers of pharmacy networks have lower average costs. Average costs per prescription do not differ between the two purchase methods.

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

Science.gov (United States)

O’Byrne, Michael L.; Gillespie, Matthew J.; Shinohara, Russell T.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

2015-01-01

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure. PMID:25965721

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

Science.gov (United States)

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

2017-08-01

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

Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases.

Science.gov (United States)

Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

2016-01-01

In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.

Greater-confinement disposal

International Nuclear Information System (INIS)

Trevorrow, L.E.; Schubert, J.P.

1989-01-01

Greater-confinement disposal (GCD) is a general term for low-level waste (LLW) disposal technologies that employ natural and/or engineered barriers and provide a degree of confinement greater than that of shallow-land burial (SLB) but possibly less than that of a geologic repository. Thus GCD is associated with lower risk/hazard ratios than SLB. Although any number of disposal technologies might satisfy the definition of GCD, eight have been selected for consideration in this discussion. These technologies include: (1) earth-covered tumuli, (2) concrete structures, both above and below grade, (3) deep trenches, (4) augered shafts, (5) rock cavities, (6) abandoned mines, (7) high-integrity containers, and (8) hydrofracture. Each of these technologies employ several operations that are mature,however, some are at more advanced stages of development and demonstration than others. Each is defined and further described by information on design, advantages and disadvantages, special equipment requirements, and characteristic operations such as construction, waste emplacement, and closure

Designer's unified cost model

Science.gov (United States)

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

1992-01-01

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

Addressing Disease-Related Malnutrition in Healthcare

Science.gov (United States)

Correia, Maria Isabel; Hegazi, Refaat A.; Diaz-Pizarro Graf, José Ignacio; Gomez-Morales, Gabriel; Fuentes Gutiérrez, Catalina; Goldin, Maria Fernanda; Navas, Angela; Pinzón Espitia, Olga Lucia; Tavares, Gilmária Millere

2015-01-01

Alarmingly high rates of disease-related malnutrition have persisted in hospitals of both emerging and industrialized nations over the past 2 decades, despite marked advances in medical care over this same interval. In Latin American hospitals, the numbers are particularly striking; disease-related malnutrition has been reported in nearly 50% of adult patients in Argentina, Brazil, Chile, Costa Rica, Cuba, Dominican Republic, Ecuador, Mexico, Panama, Paraguay, Peru, Puerto Rico, Venezuela, and Uruguay. The tolls of disease-related malnutrition are high in both human and financial terms—increased infectious complications, higher incidence of pressure ulcers, longer hospital stays, more frequent readmissions, greater costs of care, and increased risk of death. In an effort to draw attention to malnutrition in Latin American healthcare, a feedM.E. Latin American Study Group was formed to extend the reach and support the educational efforts of the feedM.E. Global Study Group. In this article, the feedM.E. Latin American Study Group shows that malnutrition incurs excessive costs to the healthcare systems, and the study group also presents evidence of how appropriate nutrition care can improve patients’ clinical outcomes and lower healthcare costs. To achieve the benefits of nutrition for health throughout Latin America, the article presents feedM.E.’s simple and effective Nutrition Care Pathway in English and Spanish as a way to facilitate its use. PMID:25883116

Future Costs, Fixed Healthcare Budgets, and the Decision Rules of Cost-Effectiveness Analysis.

Science.gov (United States)

van Baal, Pieter; Meltzer, David; Brouwer, Werner

2016-02-01

Life-saving medical technologies result in additional demand for health care due to increased life expectancy. However, most economic evaluations do not include all medical costs that may result from this additional demand in health care and include only future costs of related illnesses. Although there has been much debate regarding the question to which extent future costs should be included from a societal perspective, the appropriate role of future medical costs in the widely adopted but more narrow healthcare perspective has been neglected. Using a theoretical model, we demonstrate that optimal decision rules for cost-effectiveness analyses assuming fixed healthcare budgets dictate that future costs of both related and unrelated medical care should be included. Practical relevance of including the costs of future unrelated medical care is illustrated using the example of transcatheter aortic valve implantation. Our findings suggest that guidelines should prescribe inclusion of these costs. Copyright © 2014 John Wiley & Sons, Ltd.

Econometric modeling of health care costs and expenditures: a survey of analytical issues and related policy considerations.

Science.gov (United States)

Mullahy, John

2009-07-01

Econometric modeling of healthcare costs and expenditures has become an important component of decision-making across a wide array of real-world settings. The objective of this article is to provide a brief summary of important conceptual and analytical issues involved in econometric healthcare cost modeling. To this end, the article explores: outcome measures typically analyzed in such work; the decision maker's perspective in econometric cost modeling exercises; specific analytical issues in econometric model specification; statistical goodness-of-fit testing; empirical implications of "upper tail" (or "high cost") phenomena; and issues relating to the reporting of findings. Some of the concepts explored here are illustrated in light of samples drawn from the 2005 Medical Expenditure Panel Survey and the 2005 Nationwide Inpatient Sample. Analysts of healthcare cost data have at their disposal an increasingly sophisticated tool kit for analyzing such data that can in principle and in fact yield increasingly interesting insights into data structures. Yet for such analyses to usefully inform policy decisions, the manner in which such studies are designed, undertaken, and reported must accommodate considerations relevant to the decision-making community. The article concludes with some preliminary thoughts on how such bridges might be constructed.

20 CFR 627.435 - Cost principles and allowable costs.

Science.gov (United States)

2010-04-01

... system, including the costs of hearings and appeals, and related expenses such as lawyers' fees. Legal...) Legal expenses for the prosecution of claims against the Federal Government, including appeals to an... incurred by the SJTCC, HRIC, PIC's, and other advisory councils or committees; (3) Advertising costs; (4...

VISIBLE COSTS AND HIDDEN COSTS IN THE BAKING INDUSTRY

Directory of Open Access Journals (Sweden)

Criveanu Maria

2013-04-01

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

Hospitals with greater diversities of physiologically complex procedures do not achieve greater surgical growth in a market with stable numbers of such procedures.

Science.gov (United States)

Dexter, Franklin; Epstein, Richard H; Lubarsky, David A

2018-05-01

Although having a large diversity of types of procedures has a substantial operational impact on the surgical suites of hospitals, the strategic importance is unknown. In the current study, we used longitudinal data for all hospitals and patient ages in the State of Florida to evaluate whether hospitals with greater diversity of types of physiologically complex major therapeutic procedures (PCMTP) also had greater rates of surgical growth. Observational cohort study. 1479 combinations of hospitals in the State of Florida and fiscal years, 2008-2015. The types of International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) procedures studied were PCMT, defined as: a) major therapeutic procedure; b) >7 American Society of Anesthesiologists base units; and c) performed during a hospitalization with a Diagnosis Related Group with a mean length of stay ≥4.0days. The number of procedures of each type of PCMTP commonly performed at each hospital was calculated by taking 1/Herfindahl index (i.e., sum of the squares of the proportions of all procedures of each type of PCMTP). Over the 8 successive years studied, there was no change in the number of PCMTP being performed (Kendall's τ b =-0.014±0.017 [standard error], P=0.44; N=1479 hospital×years). Busier and larger hospitals commonly performed more types of PCMTP, respectively categorized based on performed PCMTP (τ=0.606±0.017, P<0.0001) or hospital beds (τ=0.524±0.017, P<0.0001). There was no association between greater diversity of types of PCMTP commonly performed and greater annual growth in numbers of PCMTP (τ=0.002±0.019, P=0.91; N=1295 hospital×years). Conclusions were the same with multiple sensitivity analyses. Post hoc, it was recognized that hospitals performing a greater diversity of PCMTP were more similar to the aggregate of other hospitals within the same health district (τ=0.550±0.017, P<0.0001). During a period with no overall growth in PCMTP, hospitals with

Associations Between Religion-Related Factors and Cervical Cancer Screening Among Muslims in Greater Chicago

Science.gov (United States)

Padela, Aasim I.; Peek, Monica; Johnson-Agbakwu, Crista E.; Hosseinian, Zahra; Curlin, Farr

2015-01-01

Objective This study aimed to assess rates of Papanicolaou (Pap) testing and associations between religion-related factors and these rates among a racially and ethnically diverse sample of American Muslim women. Materials and Methods A community-based participatory research design was used in partnering with the Council of Islamic Organizations of Greater Chicago to recruit Muslim women attending mosque and community events. These participants self-administered surveys incorporating measures of fatalism, religiosity, perceived discrimination, Islamic modesty, and a marker of Pap test use. Results A total of 254 survey respondents were collected with nearly equal numbers of Arabs, South Asians, and African American respondents. Of these respondents, 84% had obtained a Pap test in their lifetime, with individuals who interpret disease as a manifestation of God’s punishment having a lower odds of having had Pap testing after controlling for sociodemographic factors (odds ratio [OR] = 0.87, 95% CI = 0.77–1.0). In multivariate models, living in the United States for more than 20 years (OR = 4.7, 95% CI = 1.4–16) and having a primary care physician (OR = 7.7, 95% CI = 2.5–23.4) were positive predictors of having had a Pap test. Ethnicity, fatalistic beliefs, perceived discrimination, and modesty levels were not significantly associated with Pap testing rates. Conclusions To our knowledge, this is the first study to assess Pap testing behaviors among a diverse sample of American Muslim women and to observe that negative religious coping (e.g., viewing health problems as a punishment from God) is associated with a lower odds of obtaining a Pap test. The relationship between religious coping and cancer screening behaviors deserves further study so that religious values can be appropriately addressed through cancer screening programs. PMID:24914883

An Analysis of the Authorities' Expected Costs Related to the Decommissioning Programme

International Nuclear Information System (INIS)

Lindskog, Staffan; Borg, Lorens; Lichtenberg, Steen

2002-05-01

The analysis serves two general aims. These are: (1) To establish a neutral value of the authorities' total expected future costs arising from the decommissioning programme and identify the related uncertainties and their primary sources. The result is measured as a Net Present Value figure (NPV). (2) To test the suggested procedure under development. The analysis procedure follows the basics of the suggested estimate procedure 1. This analysis deals with a programme of an unusually long duration. The timing itself is highly uncertain. In addition, R and D is still to be finished. (I) Costs from January 1 2003 arising from all necessary activities of SKI and SSI and which directly or indirectly relate to the decommissioning programme: They include activities at the power plants after the operating period and until the end of the decommissioning period, and similar activities at CLAB and other communal or shared facilities, as well as related administration, R and D, etc. (II) Any future 'wage inflation'. (III) Events not known today, as well as effects on the programme of minor and medium-scale unplanned events. (IV) Effects of major force majeure events are excluded, for example, a serious nuclear accident in Sweden or elsewhere. (V) Activities and obligations related to nuclear power plants in operation as well as other applications of nuclear materials (e.g. at hospitals) are excluded from the study. (VI) The price level is SEK as at 2002-01-01. (VII) The discount factor as recommended by KAFS and used in the present decommissioning funding is also used here. Hence, it operates at an annual rate of 4% until 2020, and 2.5% thereafter. (VIII) This analysis is limited to the AUB scenario. The parallel GB estimate can be derived from the results of this estimate, subject to minor adjustments. Our basic findings: The total Net Present Value is calculated at Mean Value(M): 2,912 MSEK Standard Deviation (S): 980 MSEK 1. An estimate procedure for the decommissioning

The effect of alcohol treatment on social costs of alcohol dependence: results from the COMBINE study.

Science.gov (United States)

Zarkin, Gary A; Bray, Jeremy W; Aldridge, Arnie; Mills, Michael; Cisler, Ron A; Couper, David; McKay, James R; O'Malley, Stephanie

2010-05-01

The COMBINE (combined pharmacotherapies and behavioral intervention) clinical trial recently evaluated the efficacy of pharmacotherapies, behavioral therapies, and their combinations for the treatment of alcohol dependence. Previously, the cost and cost-effectiveness of COMBINE have been studied. Policy makers, patients, and nonalcohol-dependent individuals may be concerned not only with alcohol treatment costs but also with the effect of alcohol interventions on broader social costs and outcomes. To estimate the sum of treatment costs plus the costs of health care utilization, arrests, and motor vehicle accidents for the 9 treatments in COMBINE 3 years postrandomization. A cost study based on a randomized controlled clinical trial. : The study involved 786 participants 3 years postrandomization. Multivariate results show no significant differences in mean costs between any of the treatment arms as compared with medical management (MM) + placebo for the 3-year postrandomization sample. The median costs of MM + acamprosate, MM + naltrexone, MM + acamprosate + naltrexone, and MM + acamprosate + combined behavioral intervention were significantly lower than the median cost for MM + placebo. The results show that social cost savings are generated relative to MM + placebo by 3 years postrandomization, and the magnitude of these cost savings is greater than the costs of the COMBINE treatment received 3 years prior. Our study suggests that several alcohol treatments may indeed lead to reduced median social costs associated with health care, arrests, and motor vehicle accidents.

Managing orthopedics and neurosciences costs through standard treatment protocols.

Science.gov (United States)

McGinnity, E S; Pluth, T E

1994-06-01

High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines