Health risk reduction programs in employer-sponsored health plans: Part II-law and ethics.

Science.gov (United States)

Rothstein, Mark A; Harrell, Heather L

2009-08-01

We sought to examine the legal and ethical implications of workplace health risk reduction programs (HRRPs) using health risk assessments, individually focused risk reduction, and financial incentives to promote compliance. We conducted a literature review, analyzed relevant statutes and regulations, and considered the effects of these programs on employee health privacy. A variety of laws regulate HRRPs, and there is little evidence that employer-sponsored HRRPs violate these provisions; infringement on individual health privacy is more difficult to assess. Although current laws permit a wide range of employer health promotion activities, HRRPs also may entail largely unquantifiable costs to employee privacy and related interests.

Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part II—Law and Ethics

Science.gov (United States)

Rothstein, Mark A.; Harrell, Heather L.

2011-01-01

Objective We sought to examine the legal and ethical implications of workplace health risk reduction programs (HRRPs) using health risk assessments, individually focused risk reduction, and financial incentives to promote compliance. Methods We conducted a literature review, analyzed relevant statutes and regulations, and considered the effects of these programs on employee health privacy. Results A variety of laws regulate HRRPs, and there is little evidence that employer-sponsored HRRPs violate these provisions; infringement on individual health privacy is more difficult to assess. Conclusion Although current laws permit a wide range of employer health promotion activities, HRRPs also may entail largely unquantifiable costs to employee privacy and related interests. PMID:19625971

Cost reduction of LWRs - The main features

International Nuclear Information System (INIS)

Board, J.A.; Norman, D.

1991-01-01

For effective generation cost reductions to be achieved while maintaining safety levels, the impact of each of the above element and their interactions must be fully assessed, together with the effects of uncertainty on commercial risk. the amount of interest during construction which must be paid can be minimised by adopting designs, output ratings (unit size), and construction methods which minimise construction time. However this must be done without unduly increasing specific capital cost. Total capital costs can be reduced by sharing design and project launching costs and front-end design and licensing costs, across a series of identical plants. The paper is reviewing costs and performance factors such as those above with the aim of identifying the strategies which might be necessary within and between countries in order to create an environment which would enable cost reductions on LWRs to be made. (author)

Design features and cost reduction potential of JSFR

International Nuclear Information System (INIS)

Katoh, Atsushi; Hayafune, Hiroki; Kotake, Shoji

2014-01-01

Highlights: • Japan Sodium Cooled Fast Reactor (JSFR) is designed to reduce plant commodity. • Cost reduction effectiveness by innovative designs is estimated by bottom up method. • JSFR achieves 76% construction cost reduction compared with Monju by design effort. • Commercial JSFR construction cost could be less than that of conventional LWR. - Abstract: To improve the economic competitiveness of the Japan Sodium-cooled Fast Reactor (JSFR), several innovative designs have been introduced, e.g. reduction of number of main cooling loop, shorter pipe arrangement by adopting thermally durable material, in fact high chromium ferrite steel, a compact reactor vessel (RV), integration of a primary pump and an intermediate heat exchanger (IHX). Since they had not been introduced in the past and existing reactors, a new approach for construction cost estimation has been introduced to handle innovative technologies, for example, concerning different kinds of material, fabrication processes of equipment etc. As results of JSFR construction cost estimations based on the new method and the latest conceptual JSFR design, economic goals of Generation IV nuclear energy systems can be achieved by expecting the following cost reduction effects: commodity reduction by adopting innovative design, an economy of scale by power generation increase, learning effect etc. It is well analyzed quantitatively that feasibility of innovative designs is essential for economic competitiveness of JSFR

Design features and cost reduction potential of JSFR

Energy Technology Data Exchange (ETDEWEB)

Katoh, Atsushi, E-mail: kato.atsushi@jaea.go.jp [Japan Atomic Energy Agency, 4002 Narita, Oarai-machi, Higashi-ibaraki-gun, Ibaraki-ken 311-1393 (Japan); Hayafune, Hiroki [Japan Atomic Energy Agency, 4002 Narita, Oarai-machi, Higashi-ibaraki-gun, Ibaraki-ken 311-1393 (Japan); Kotake, Shoji [The Japan Atomic Power Company, 1-1 Kanda-midoricyo, Chiyoda-ku, Tokyo-to 101-0053 (Japan)

2014-12-15

Highlights: • Japan Sodium Cooled Fast Reactor (JSFR) is designed to reduce plant commodity. • Cost reduction effectiveness by innovative designs is estimated by bottom up method. • JSFR achieves 76% construction cost reduction compared with Monju by design effort. • Commercial JSFR construction cost could be less than that of conventional LWR. - Abstract: To improve the economic competitiveness of the Japan Sodium-cooled Fast Reactor (JSFR), several innovative designs have been introduced, e.g. reduction of number of main cooling loop, shorter pipe arrangement by adopting thermally durable material, in fact high chromium ferrite steel, a compact reactor vessel (RV), integration of a primary pump and an intermediate heat exchanger (IHX). Since they had not been introduced in the past and existing reactors, a new approach for construction cost estimation has been introduced to handle innovative technologies, for example, concerning different kinds of material, fabrication processes of equipment etc. As results of JSFR construction cost estimations based on the new method and the latest conceptual JSFR design, economic goals of Generation IV nuclear energy systems can be achieved by expecting the following cost reduction effects: commodity reduction by adopting innovative design, an economy of scale by power generation increase, learning effect etc. It is well analyzed quantitatively that feasibility of innovative designs is essential for economic competitiveness of JSFR.

Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood

International Nuclear Information System (INIS)

Hirano, Emi; Kawabuchi, Koichi; Fuji, Hiroshi; Onoe, Tsuyoshi; Kumar, Vinay; Shirato, Hiroki

2014-01-01

The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood. We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters. The ICER for EQ-5D, HUI3 and SF-6D were $21 716/QALY, $11 773/QALY, and $20 150/QALY, respectively. One-way sensitivity analyses found that the results were sensitive to discount rate, the risk of hearing loss after proton therapy, and costs of proton irradiation. Cost-effectiveness acceptability curve analysis revealed a 99% probability of proton therapy being cost effective at a societal willingness-to-pay value. Proton beam therapy with cochlear dose reduction improves health outcomes at a cost that is within the acceptable cost-effectiveness range from the payer's standpoint. (author)

Cost effective reductions in the agricultural load of nitrogen to the Baltic Sea

Energy Technology Data Exchange (ETDEWEB)

Elofsson, K.

1997-11-01

To restore the health of the Baltic Sea, the Helsinki Commission, HELCOM, suggests that the nitrogen load should be reduced by 50%. The agricultural sector accounts for about 1/3 of the total load of nitrogen to the Baltic Sea, while point sources account for about 1/4. The remaining load reaches the Baltic as atmospheric deposition. The purpose of this study is to calculate cost effective reductions in the agricultural load of nitrogen to the Baltic Sea coastal waters. The Baltic Sea drainage basin is divided into 17 regions, which differ with respect to costs, leaching and nitrogen retention. For each region, cost functions are estimated for 11 nitrogen abatement measures in the agricultural sector. It is difficult to find reliable data on both costs and biological parameters for all regions included, and several assumptions are made to obtain the cost functions. In this paper the total cost of a 50% reduction of the nitrogen load from arable land is estimated to 11,700 million SEK per year. A decrease in the use of fertilizer nitrogen is the most important measure in a cost effective policy. Other measures included in the cost effective solution are changes in land-use and in manure management practices. If, instead, each country is required to reduce its load by 50%, the total cost will increase by nearly 60%. Three out of nine countries around the Baltic Sea would gain from separate reduction targets, while all others lose by such a policy. The results are sensitive to assumptions about the biological parameters and the shape of the cost functions for reductions in chemical fertilizer. 75 refs, 3 figs, 11 tabs

Systemic cost-effectiveness analysis of food hazard reduction

DEFF Research Database (Denmark)

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

2015-01-01

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

Review comments on Environmental Analysis Cost Reduction Proposals (WIPP-DOE-136), July 1982

International Nuclear Information System (INIS)

Channell, J.K.

1982-11-01

The cost reduction proposals have the laudable goal of significantly reducing the total capital And operating cost connected with WIPP. Furthermore, since the proposed changes would reduce the size and operating rate of the project, they would be expected to have decreased environmental And socioeconomic impacts. However, some of these cost reduction proposals do decrease factors of safety in various components of the project or trade off one type of environmental detriment for another. The report does not contain sufficient detail to justify all of the conclusions reached; more discussion and quantitative information (including costs) is necessary in some cases. Also, there are places where the report is unclear or contradictory. Without a more detailed evaluation, EEG is unable to conclude that each of these cost reduction proposals either has a net environmental/health and safety benefit or a cost savings that justifies a net detriment. A revised Environmental Analysis (EA) should either include additional information or specifically reference backup documents where these conclusions have been justified. In addition, the EA needs to be revised to include the effect of the recently announced (11/18/82) decision by DOE to relocate the underground waste storage areas of the repository to the south

The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies

DEFF Research Database (Denmark)

Jensen, Henning Tarp; Keogh-Brown, Marcus R.; Smith, Richard D.

2013-01-01

. In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel......) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures...... to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote...

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

Science.gov (United States)

Wilcox, Meredith L; Mason, Helen; Fouad, Fouad M; Rastam, Samer; al Ali, Radwan; Page, Timothy F; Capewell, Simon; O'Flaherty, Martin; Maziak, Wasim

2015-01-01

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

Science.gov (United States)

Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

2014-01-01

Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

Modelled Cost-Effectiveness of a Package Size Cap and a Kilojoule Reduction Intervention to Reduce Energy Intake from Sugar-Sweetened Beverages in Australia

Science.gov (United States)

Mantilla Herrera, Ana Maria; Neal, Bruce; Zheng, Miaobing; Lal, Anita; Sacks, Gary

2017-01-01

Interventions targeting portion size and energy density of food and beverage products have been identified as a promising approach for obesity prevention. This study modelled the potential cost-effectiveness of: a package size cap on single-serve sugar sweetened beverages (SSBs) >375 mL (package size cap), and product reformulation to reduce energy content of packaged SSBs (energy reduction). The cost-effectiveness of each intervention was modelled for the 2010 Australia population using a multi-state life table Markov model with a lifetime time horizon. Long-term health outcomes were modelled from calculated changes in body mass index to their impact on Health-Adjusted Life Years (HALYs). Intervention costs were estimated from a limited societal perspective. Cost and health outcomes were discounted at 3%. Total intervention costs estimated in AUD 2010 were AUD 210 million. Both interventions resulted in reduced mean body weight (package size cap: 0.12 kg; energy reduction: 0.23 kg); and HALYs gained (package size cap: 73,883; energy reduction: 144,621). Cost offsets were estimated at AUD 750.8 million (package size cap) and AUD 1.4 billion (energy reduction). Cost-effectiveness analyses showed that both interventions were “dominant”, and likely to result in long term cost savings and health benefits. A package size cap and kJ reduction of SSBs are likely to offer excellent “value for money” as obesity prevention measures in Australia. PMID:28878175

Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

Science.gov (United States)

Silberman, Jordan; Schwartz, Steven; Giuseffi, Danielle L; Wang, Chun; Nevedal, Dana; Bedrosian, Richard

2011-12-01

To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

Costs, emissions reductions, and vehicle repair: evidence from Arizona.

Science.gov (United States)

Ando, A; McConnell, V; Harrington, W

2000-04-01

The Arizona inspection and maintenance (I/M) program provides one of the first opportunities to examine the costs and effectiveness of vehicle emission repair. This paper examines various aspects of emission reductions, fuel economy improvements, and repair costs, drawing data from over 80,000 vehicles that failed the I/M test in Arizona between 1995 and the first half of 1996. We summarize the wealth of data on repair from the Arizona program and highlight its limitations. Because missing or incomplete cost information has been a serious shortcoming for the evaluation of I/M programs, we develop a method for estimating repair costs when they are not reported. We find surprising evidence that almost one quarter of all vehicles that take the I/M test are never observed to pass the test. Using a statistical analysis, we provide some information about the differences between the vehicles that pass and those that do not. Older, more polluting vehicles are much more likely never to pass the I/M test, and their expected repair costs are much higher than those for newer cars. This paper summarizes the evidence on costs and emission reductions in the Arizona program, comparing costs and emissions reductions between cars and trucks. Finally, we examine the potential for more cost-effective repair, first through an analysis of tightening I/M cut points and then by calculating the cost savings of achieving different emission reduction goals when the most cost-effective repairs are made first.

Quantifying costs and benefits of integrated environmental strategies of air quality management and greenhouse gas reduction in the Seoul Metropolitan Area

Energy Technology Data Exchange (ETDEWEB)

Chae, Yeora, E-mail: yrchae@kei.re.kr [Korea Environment Institute, 290 Jinheungno, Eunpyeong-Gu, Seoul 122-706 (Korea, Republic of); Park, Jeongim [Department of Environmental Health Science, Soonchunhyang University, Asan, Chungnam 336-745 (Korea, Republic of)

2011-09-15

This study quantifies the costs and benefits of Integrated Environmental Strategies (IES) of reducing air pollutants and greenhouse gas (GHG) emissions at a minimal cost in the Seoul Metropolitan Area (SMPA) for the year 2014 and compares with current air quality management plans and greenhouse gas (GHG) mitigation plans. The results estimated health benefits from prevention of premature mortality under the IES scenario as 14 trillion Korean won (won) and associated cost as -3.6 trillion won, yielding total benefit, difference of benefits and costs, of 18 trillion won. With the inclusion of benefits from GHG reductions, the total benefits result in 147 trillion won. The difference of human health benefits and costs of air quality management plan and GHG reduction strategies result in 14 trillion won and 8 trillion won, respectively. The research shows that benefits of integrating air quality management and GHG reduction measures are greater than those obtained by air quality management and GHG reduction measures individually. - Highlights: > The costs and benefits of Integrated Environmental Strategies (IES) are quantified.> Benefit under IES is 14 trillion Korean won and cost is -3.6 trillion won.> Benefit of air quality management is 14 trillion won and cost is -0.3 trillion won.> Benefit under GHG reduction is 1.5 trillion won and cost is -6.4 trillion won.> Benefits of IES are greater than those obtained by each measure individually.

Multiple cost criteria for occupational dose reduction

International Nuclear Information System (INIS)

James, J.Z.

1983-01-01

This paper describes a simple, feasible procedure for deciding if a proposed dose reduction measure is justified under ALARA, based on engineering economic principles of project feasibility analysis. Particular attention is given to the fixing of cost criteria: the importance of melding disparate objectives into a single parameter, and the distinction between a cost criterion and a cost consideration. (author)

Further Cost Reduction of Battery Manufacturing

Directory of Open Access Journals (Sweden)

Amir A. Asif

2017-06-01

Full Text Available The demand for batteries for energy storage is growing with the rapid increase in photovoltaics (PV and wind energy installation as well as electric vehicle (EV, hybrid electric vehicle (HEV and plug-in hybrid electric vehicle (PHEV. Electrochemical batteries have emerged as the preferred choice for most of the consumer product applications. Cost reduction of batteries will accelerate the growth in all of these sectors. Lithium-ion (Li-ion and solid-state batteries are showing promise through their downward price and upward performance trends. We may achieve further performance improvement and cost reduction for Li-ion and solid-state batteries through reduction of the variation in physical and electrical properties. These properties can be improved and made uniform by considering the electrical model of batteries and adopting novel manufacturing approaches. Using quantum-photo effect, the incorporation of ultra-violet (UV assisted photo-thermal processing can reduce metal surface roughness. Using in-situ measurements, advanced process control (APC can help ensure uniformity among the constituent electrochemical cells. Industrial internet of things (IIoT can streamline the production flow. In this article, we have examined the issue of electrochemical battery manufacturing of Li-ion and solid-state type from cell-level to battery-level process variability, and proposed potential areas where improvements in the manufacturing process can be made. By incorporating these practices in the manufacturing process we expect reduced cost of energy management system, improved reliability and yield gain with the net saving of manufacturing cost being at least 20%.

Implementation of activity-based costing (ABC) to drive cost reduction efforts in a semiconductor manufacturing operation

Science.gov (United States)

Naguib, Hussein; Bol, Igor I.; Lora, J.; Chowdhry, R.

1994-09-01

This paper presents a case study on the implementation of ABC to calculate the cost per wafer and to drive cost reduction efforts for a new IC product line. The cost reduction activities were conducted through the efforts of 11 cross-functional teams which included members of the finance, purchasing, technology development, process engineering, equipment engineering, production control, and facility groups. The activities of these cross functional teams were coordinated by a cost council. It will be shown that these activities have resulted in a 57% reduction in the wafer manufacturing cost of the new product line. Factors contributed to successful implementation of an ABC management system are discussed.

Cost and schedule reduction for next-generation Candu

International Nuclear Information System (INIS)

Hopwood, J.M.; Yu, S.; Pakan, M.; Soulard, M.

2002-01-01

AECL has developed a suite of technologies for Candu R reactors that enable the next step in the evolution of the Candu family of heavy-water-moderated fuel-channel reactors. These technologies have been combined in the design for the Advanced Candu Reactor TM1 (ACRTM), AECL's next generation Candu power plant. The ACR design builds extensively on the existing Candu experience base, but includes innovations, in design and in delivery technology, that provide very substantial reductions in capital cost and in project schedules. In this paper, main features of next generation design and delivery are summarized, to provide the background basis for the cost and schedule reductions that have been achieved. In particular the paper outlines the impact of the innovative design steps for ACR: - Selection of slightly enriched fuel bundle design; - Use of light water coolant in place of traditional Candu heavy water coolant; - Compact core design with unique reactor physics benefits; - Optimized coolant and turbine system conditions. In addition to the direct cost benefits arising from efficiency improvement, and from the reduction in heavy water, the next generation Candu configuration results in numerous additional indirect cost benefits, including: - Reduction in number and complexity of reactivity mechanisms; - Reduction in number of heavy water auxiliary systems; - Simplification in heat transport and its support systems; - Simplified human-machine interface. The paper also describes the ACR approach to design for constructability. The application of module assembly and open-top construction techniques, based on Candu and other worldwide experience, has been proven to generate savings in both schedule durations and overall project cost, by reducing premium on-site activities, and by improving efficiency of system and subsystem assembly. AECL's up-to-date experience in the use of 3-D CADDS and related engineering tools has also been proven to reduce both engineering and

Cost-effectiveness of reduction of off-site dose

International Nuclear Information System (INIS)

McGrath, J.J.; Macphee, R.; Arbeau, N.; Miskin, J.; Scott, C.K.; Winters, E.

1988-03-01

Since the early 1970's, nuclear power plants have been designed and operated with a target of not releasing more than one percent of the licensed limits (derived emission limits) in liquid and gaseous effluents. The AECB initiated this study of the cost-effectiveness of the reduction of off-site doses as part of a review to determine if further measures to reduce off-site doses might be reasonably achievable. Atlantic Nuclear has estimated the cost of existing technology options that can be applied for a further reduction of radioactive effluents from future CANDU nuclear power plants. Detritiation, filtration, ion exchange and evaporation are included in the assessment. The costs are presented in 1987 Canadian dollars, and include capital and operating costs for a reference 50 year plant life. Darlington NGS and Point Lepreau NGS are the reference nuclear power plant types and locations. The effect resulting from the hypothetical application of each technology has been calculated as the resulting reduction in world collective radiation dose detriment. The CSA N288.1 procedure was used for local pathway analysis and the global dispersion model developed by the NEA (OECD) group of experts was used for dose calculations. The reduction in the 'collective effective dose equivalent commitment' was assumed to exist for 10,000 years, the expected life-span of solid waste repositories. No attempt was made to model world population dynamics. The collective dose reductions were calculated for a nominal world population of 10 billion persons. The estimated cost and effect of applying the technology options are summarized in a tabular form for input to further consideration of 'reasonably achievable off-site dose levels'

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

Directory of Open Access Journals (Sweden)

Helen Mason

Full Text Available BACKGROUND: Coronary Heart Disease (CHD is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy. All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30% resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

Quantifying costs and benefits of integrated environmental strategies of air quality management and greenhouse gas reduction in the Seoul Metropolitan Area

International Nuclear Information System (INIS)

Chae, Yeora; Park, Jeongim

2011-01-01

This study quantifies the costs and benefits of Integrated Environmental Strategies (IES) of reducing air pollutants and greenhouse gas (GHG) emissions at a minimal cost in the Seoul Metropolitan Area (SMPA) for the year 2014 and compares with current air quality management plans and greenhouse gas (GHG) mitigation plans. The results estimated health benefits from prevention of premature mortality under the IES scenario as 14 trillion Korean won (won) and associated cost as -3.6 trillion won, yielding total benefit, difference of benefits and costs, of 18 trillion won. With the inclusion of benefits from GHG reductions, the total benefits result in 147 trillion won. The difference of human health benefits and costs of air quality management plan and GHG reduction strategies result in 14 trillion won and 8 trillion won, respectively. The research shows that benefits of integrating air quality management and GHG reduction measures are greater than those obtained by air quality management and GHG reduction measures individually. - Highlights: → The costs and benefits of Integrated Environmental Strategies (IES) are quantified.→ Benefit under IES is 14 trillion Korean won and cost is -3.6 trillion won.→ Benefit of air quality management is 14 trillion won and cost is -0.3 trillion won.→ Benefit under GHG reduction is 1.5 trillion won and cost is -6.4 trillion won.→ Benefits of IES are greater than those obtained by each measure individually.

Cost-benefit comparison of nuclear and nonnuclear health and safety protective measures and regulations

International Nuclear Information System (INIS)

O'Donnell, E.P.; Mauro, J.J.

1979-01-01

This article compares the costs and benefits of health and safety measures and regulations in the nuclear and nonnuclear fields. A cost-benefit methodology for nuclear safety concerns is presented and applied to existing nuclear plant engineered safety features. Comparisons in terms of investment costs to achieve reductions in mortality rates are then made between nuclear plant safety features and the protective measures and regulations associated with nonnuclear risks, particularly with coal-fired power plants. These comparisons reveal a marked inconsistency in the cost effectiveness of health and safety policy, in which nuclear regulatory policy requires much greater investments to reduce the risk of public mortality than is required in nonnuclear areas where reductions in mortality rates could be achieved at much lower cost. A specific example of regulatory disparity regarding gaseous effluent limits for nuclear and fossil-fuel power plants is presented. It is concluded that a consistent health and safety regulatory policy based on uniform risk and cost-benefit criteria should be adopted and that future proposed Nuclear Regulatory Commission regulatory requirements should be critically evaluated from a cost-benefit viewpoint

Health Insurance Costs and Employee Compensation: Evidence from the National Compensation Survey.

Science.gov (United States)

Anand, Priyanka

2017-12-01

This paper examines the relationship between rising health insurance costs and employee compensation. I estimate the extent to which total compensation decreases with a rise in health insurance costs and decompose these changes in compensation into adjustments in wages, non-health fringe benefits, and employee contributions to health insurance premiums. I examine this relationship using the National Compensation Survey, a panel dataset on compensation and health insurance for a sample of establishments across the USA. I find that total hourly compensation reduces by $0.52 for each dollar increase in health insurance costs. This reduction in total compensation is primarily in the form of higher employee premium contributions, and there is no evidence of a change in wages and non-health fringe benefits. These findings show that workers are absorbing at least part of the increase in health insurance costs through lower compensation and highlight the importance of examining total compensation, and not just wages, when examining the relationship between health insurance costs and employee compensation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV), 2017-2030

Energy Technology Data Exchange (ETDEWEB)

Cook, Jeffrey J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Ardani, Kristen B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Margolis, Robert M. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Fu, Ran [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2018-01-03

The installed cost of solar photovoltaics (PV) has fallen rapidly in recent years and is expected to continue declining in the future. In this report, we focus on the potential for continued PV cost reductions in the residential market. From 2010 to 2017, the levelized cost of energy (LCOE) for residential PV declined from 52 cents per kilowatt-hour (cents/kWh) to 16 cents/kWh (Fu et al. 2017). The U.S. Department of Energy's (DOE's) Solar Energy Technologies Office (SETO) recently set new LCOE targets for 2030, including a target of 5 cents/kWh for residential PV. We present a roadmap for achieving the SETO 2030 residential PV target. Because the 2030 target likely will not be achieved under business-as-usual trends (NREL 2017), we examine two key market segments that demonstrate significant opportunities for cost savings and market growth: installing PV at the time of roof replacement and installing PV as part of the new home construction process. Within both market segments, we identify four key cost-reduction opportunities: market maturation, business model integration, product innovation, and economies of scale. To assess the potential impact of these cost reductions, we compare modeled residential PV system prices in 2030 to the National Renewable Energy Laboratory's (NREL's) quarter one 2017 (Q1 2017) residential PV system price benchmark (Fu et al. 2017). We use a bottom-up accounting framework to model all component and project-development costs incurred when installing a PV system. The result is a granular accounting for 11 direct and indirect costs associated with installing a residential PV system in 2030. All four modeled pathways demonstrate significant installed-system price savings over the Q1 2017 benchmark, with the visionary pathways yielding the greatest price benefits. The largest modeled cost savings are in the supply chain, sales and marketing, overhead, and installation labor cost categories. When we translate these

A capital cost reduction study on the fast breeder reactor plant

International Nuclear Information System (INIS)

Taniyama, H.; Kamei, M.; Moriyama, M.

1991-01-01

A capital cost reduction study has been performed for large fast breeder reactor designs. The primary objective of this study is to show a trend of capital cost reduction between FBR plants at the prototype stage, the demonstration stage, and the future commercialization stage. For the FBR plant at the demonstration stage a construction cost comparison with a light water reactor has also been performed, and the target cost of FBR of below 1.5 times that of the light water reactor cost was achieved. To extend the capital cost reduction study, a feasibility study was made to achieve a capital cost of an FBR less than that of a light water reactor. The recommended design is shown as a future commercialization FBR design concept. (author)

The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity.

Science.gov (United States)

Laxy, Michael; Stark, Renée; Peters, Annette; Hauner, Hans; Holle, Rolf; Teuner, Christina M

2017-08-30

This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31-96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m², this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.

Telecommuting and health care: a potential for cost reductions and productivity gains.

Science.gov (United States)

Jacobs, S M; Pelfrey, S; Van Sell, M

1995-12-01

Health care administrators are striving to maintain positive operating margins while remaining responsive to community needs. As they look for ways to reduce costs and improve productivity, they may consider the benefits associated with telecommuting. Telecommuting refers to the work performed by organizational employees who use computers and telecommunication equipment to work at home or at remote sites one or more days a week. Benefits to the health care industry include release of valuable hospital space, reduced employee turnover, and increased productivity. The time away from the institution may provide administrators with valuable planning time, free from interruptions.

Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

Directory of Open Access Journals (Sweden)

A. D. Chukalla

2017-07-01

Full Text Available Reducing the water footprint (WF of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs that rank management packages according to their cost-effectiveness to reduce the WF need to support the decision making. MCCs enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a given WF permit (expressed in m3  ha−1 per season or to a certain WF benchmark (expressed in m3  t−1 of crop. This paper aims to develop MCCs for WF reduction for a range of selected cases. AquaCrop, a soil-water-balance and crop-growth model, is used to estimate the effect of different management packages on evapotranspiration and crop yield and thus the WF of crop production. A management package is defined as a specific combination of management practices: irrigation technique (furrow, sprinkler, drip or subsurface drip; irrigation strategy (full or deficit irrigation; and mulching practice (no, organic or synthetic mulching. The annual average cost for each management package is estimated as the annualized capital cost plus the annual costs of maintenance and operations (i.e. costs of water, energy and labour. Different cases are considered, including three crops (maize, tomato and potato; four types of environment (humid in UK, sub-humid in Italy, semi-arid in Spain and arid in Israel; three hydrologic years (wet, normal and dry years and three soil types (loam, silty clay loam and sandy loam. For each crop, alternative WF reduction pathways were developed, after which the most cost-effective pathway was selected to develop the MCC for WF reduction. When aiming at WF reduction one can best improve the irrigation strategy first, next the mulching practice and finally the irrigation technique. Moving from a full to deficit irrigation strategy is found to be a no-regret measure: it reduces the WF

Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

Science.gov (United States)

Chukalla, Abebe D.; Krol, Maarten S.; Hoekstra, Arjen Y.

2017-07-01

Reducing the water footprint (WF) of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs) that rank management packages according to their cost-effectiveness to reduce the WF need to support the decision making. MCCs enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a given WF permit (expressed in m3  ha-1 per season) or to a certain WF benchmark (expressed in m3  t-1 of crop). This paper aims to develop MCCs for WF reduction for a range of selected cases. AquaCrop, a soil-water-balance and crop-growth model, is used to estimate the effect of different management packages on evapotranspiration and crop yield and thus the WF of crop production. A management package is defined as a specific combination of management practices: irrigation technique (furrow, sprinkler, drip or subsurface drip); irrigation strategy (full or deficit irrigation); and mulching practice (no, organic or synthetic mulching). The annual average cost for each management package is estimated as the annualized capital cost plus the annual costs of maintenance and operations (i.e. costs of water, energy and labour). Different cases are considered, including three crops (maize, tomato and potato); four types of environment (humid in UK, sub-humid in Italy, semi-arid in Spain and arid in Israel); three hydrologic years (wet, normal and dry years) and three soil types (loam, silty clay loam and sandy loam). For each crop, alternative WF reduction pathways were developed, after which the most cost-effective pathway was selected to develop the MCC for WF reduction. When aiming at WF reduction one can best improve the irrigation strategy first, next the mulching practice and finally the irrigation technique. Moving from a full to deficit irrigation strategy is found to be a no-regret measure: it reduces the WF by reducing water

An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada

Science.gov (United States)

2014-01-01

Background Interest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is to estimate the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. Methods Using an economic model, the costs related to early retirement and reduction in clinical hours of physicians were compared for those who were experiencing burnout against a scenario in which they did not experience burnout. The January 2012 Canadian Medical Association Masterfile was used to determine the number of practicing physicians. Transition probabilities were estimated using 2007–2008 Canadian Physician Health Survey and 2007 National Physician Survey data. Adjustments were also applied to outcome estimates based on ratio of actual to planned retirement and reduction in clinical hours. Results The total cost of burnout for all physicians practicing in Canada is estimated to be $213.1 million ($185.2 million due to early retirement and $27.9 million due to reduced clinical hours). Family physicians accounted for 58.8% of the burnout costs, followed by surgeons for 24.6% and other specialists for 16.6%. Conclusion The cost of burnout associated with early retirement and reduction in clinical hours is substantial and a significant proportion of practicing physicians experience symptoms of burnout. As health systems struggle with human resource shortages and expanding waiting times, this estimate sheds light on the extent to which the burden could be potentially decreased through prevention and promotion activities to address burnout among physicians. PMID:24927847

Practical approach to lung health in Nepal: better prescribing and reduction of cost.

NARCIS (Netherlands)

Shrestha, N.; Samir, K.C.; Baltussen, R.M.P.M.; Kafle, K.K.; Bishai, D.; Niessen, L.

2006-01-01

OBJECTIVES: To assess the impact of Practical Approach to Lung Health (PAL) guidelines on prescription behaviour and the total cost of prescription for patients with asthma, chronic obstructive pulmonary disease and pneumonia. METHODS: Pre- and post-intervention comparison in a cluster randomized

Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

DEFF Research Database (Denmark)

Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

2015-01-01

OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

Who pays for public employee health costs?

Science.gov (United States)

Clemens, Jeffrey; Cutler, David M

2014-12-01

We analyze the incidence of public-employee health benefits. Because these benefits are negotiated through the political process, relevant labor market institutions deviate significantly from the competitive, private-sector benchmark. Empirically, we find that roughly 15 percent of the cost of recent benefit growth was passed onto school district employees through reductions in wages and salaries. Strong teachers' unions were associated with relatively strong linkages between benefit growth and growth in total compensation. Our analysis is consistent with the view that the costs of public workers' benefits are difficult to monitor, contributing to benefit oriented, and often under-funded, compensation schemes. Copyright © 2014 Elsevier B.V. All rights reserved.

Reduction of mesqa improvement costs

Directory of Open Access Journals (Sweden)

Mohamed Ahmed Saad ElFetyany

2017-10-01

Results show that using the revised approach brings down the cost of mesqa improvement from nearly 10,000LE/fed at present to about 6000LE/fed. These reductions based on the analyses of different mesqa modelling through the adoption of certain parameters such as feasibility of the revised design, effective application of continuous flow for water distribution, and downsizing of the capacity of improved mesqas.

Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article

Science.gov (United States)

French, Dustin D.; Dixon, Brian E.; Perkins, Susan M.; Myers, Laura J.; Weiner, Michael; Zillich, Allan J.; Haggstrom, David A.

2016-01-01

Abstract The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers. The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs. A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation. Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office. VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment. There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807–1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees. Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons. PMID:26765453

Hypertension education and adherence in South Africa: a cost-effectiveness analysis of community health workers.

Science.gov (United States)

Gaziano, Thomas A; Bertram, Melanie; Tollman, Stephen M; Hofman, Karen J

2014-03-10

To determine whether training community health workers (CHWs) about hypertension in order to improve adherence to medications is a cost-effective intervention among community members in South Africa. We used an established Markov model with age-varying probabilities of cardiovascular disease (CVD) events to assess the benefits and costs of using CHW home visits to increase hypertension adherence for individuals with hypertension and aged 25-74 in South Africa. Subjects considered for CHW intervention were those with a previous diagnosis of hypertension and on medications but who had not achieved control of their blood pressure. We report our results in incremental cost-effectiveness ratios (ICERs) in US dollars per disability-adjusted life-year (DALY) averted. The annual cost of the CHW intervention is about $8 per patient. This would lead to over a 2% reduction in CVD events over a life-time and decrease DALY burden. Due to reductions in non-fatal CVD events, lifetime costs are only $6.56 per patient. The CHW intervention leads to an incremental cost-effectiveness ratio of $320/DALY averted. At an annual cost of $6.50 or if the blood pressure reduction is 5 mmHg or greater per patient the intervention is cost-saving. Additional training for CHWs on hypertension management could be a cost-effective strategy for CVD in South Africa and a very good purchase according to World Health Organization (WHO) standards. The intervention could also lead to reduced visits at the health centres freeing up more time for new patients or reducing the burden of an overworked staff at many facilities.

The ranking of negative-cost emissions reduction measures

International Nuclear Information System (INIS)

Taylor, Simon

2012-01-01

A flaw has been identified in the calculation of the cost-effectiveness in marginal abatement cost curves (MACCs). The problem affects “negative-cost” emissions reduction measures—those that produce a return on investment. The resulting ranking sometimes favours measures that produce low emissions savings and is therefore unreliable. The issue is important because incorrect ranking means a potential failure to achieve the best-value outcome. A simple mathematical analysis shows that not only is the standard cost-effectiveness calculation inadequate for ranking negative-cost measures, but there is no possible replacement that satisfies reasonable requirements. Furthermore, the concept of negative cost-effectiveness is found to be unsound and its use should be avoided. Among other things, this means that MACCs are unsuitable for ranking negative-cost measures. As a result, MACCs produced by a range of organizations including UK government departments may need to be revised. An alternative partial ranking method has been devised by making use of Pareto optimization. The outcome can be presented as a stacked bar chart that indicates both the preferred ordering and the total emissions saving available for each measure without specifying a cost-effectiveness. - Highlights: ► Marginal abatement cost curves (MACCs) are used to rank emission reduction measures. ► There is a flaw in the standard ranking method for negative-cost measures. ► Negative values of cost-effectiveness (in £/tC or equivalent) are invalid. ► There may be errors in published MACCs. ► A method based on Pareto principles provides an alternative ranking method.

Effect of improved glycemic control on health care costs and utilization.

Science.gov (United States)

Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C

2001-01-10

Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.

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

DEFF Research Database (Denmark)

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

2017-01-01

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

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma.

Science.gov (United States)

Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M

2016-04-01

The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P total health care costs and $2599 (95% CI, $1985-$3212; P total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

Marginal CO2 reduction cost in ENERGY 2000 development. A socio-economic evaluation of the marginal cost for the alternative reduction methods

International Nuclear Information System (INIS)

Maeng, H.

1995-01-01

The official Danish environmental plan involves a reduction of CO 2 within the next 30-50 years. This report describes the analysis of socio-economic cost/consequences of marginal CO 2 reduction by means of various technical solution models. Calculations by means of the special program subroutine SAMFOKO are based on energy balance in annual, monthly, daily and hourly scale. Heat and power savings as well as the development of decentralized power plants are considered in the supply model. Socio-economic consequences in form of charges and cost are discussed. (EG)

The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies.

Science.gov (United States)

Jensen, Henning Tarp; Keogh-Brown, Marcus R; Smith, Richard D; Chalabi, Zaid; Dangour, Alan D; Davies, Mike; Edwards, Phil; Garnett, Tara; Givoni, Moshe; Griffiths, Ulla; Hamilton, Ian; Jarrett, James; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Haines, Andy

We employ a single-country dynamically-recursive Computable General Equilibrium model to make health-focussed macroeconomic assessments of three contingent UK Greenhouse Gas (GHG) mitigation strategies, designed to achieve 2030 emission targets as suggested by the UK Committee on Climate Change. In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures are included; our household energy efficiency strategy is likely to breakeven only over the long term after the investment programme has ceased (beyond our 20 year time horizon). We conclude that UK policy makers will, most likely, have to adopt elements which involve initial net societal costs in order to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote internalization of externalities. Health co-benefits can play a crucial role in bringing down net costs, but our results also suggest the need for adopting holistic assessment methodologies which give proper consideration to welfare-improving health co-benefits with potentially negative economic repercussions (such as increased longevity).

Tobacco retail outlet restrictions: health and cost impacts from multistate life-table modelling in a national population.

Science.gov (United States)

Pearson, Amber L; Cleghorn, Christine L; van der Deen, Frederieke S; Cobiac, Linda J; Kvizhinadze, Giorgi; Nghiem, Nhung; Blakely, Tony; Wilson, Nick

2016-09-22

Since there is some evidence that the density and distribution of tobacco retail outlets may influence smoking behaviours, we aimed to estimate the impacts of 4 tobacco outlet reduction interventions in a country with a smoke-free goal: New Zealand (NZ). A multistate life-table model of 16 tobacco-related diseases, using national data by sex, age and ethnicity, was used to estimate quality-adjusted life years (QALYs) gained and net costs over the remainder of the 2011 NZ population's lifetime. The outlet reduction interventions assumed that increased travel costs can be operationalised as equivalent to price increases in tobacco. All 4 modelled interventions led to reductions of >89% of current tobacco outlets after the 10-year phase-in process. The most effective intervention limited sales to half of liquor stores (and nowhere else) at 129 000 QALYs gained over the lifetime of the population (95% UI: 74 100 to 212 000, undiscounted). The per capita QALY gains were up to 5 times greater for Māori (indigenous population) compared to non-Māori. All interventions were cost-saving to the health system, with the largest saving for the liquor store only intervention: US$1.23 billion (95% UI: $0.70 to $2.00 billion, undiscounted). These tobacco outlet reductions reduced smoking prevalence, achieved health gains and saved health system costs. Effects would be larger if outlet reductions have additional spill-over effects (eg, smoking denormalisation). While these interventions were not as effective as tobacco tax increases (using the same model), these and other strategies could be combined to maximise health gain and to maximise cost-savings to the health system. 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/

Climate change and health costs of air emissions from biofuels and gasoline

Science.gov (United States)

Hill, Jason; Polasky, Stephen; Nelson, Erik; Tilman, David; Huo, Hong; Ludwig, Lindsay; Neumann, James; Zheng, Haochi; Bonta, Diego

2009-01-01

Environmental impacts of energy use can impose large costs on society. We quantify and monetize the life-cycle climate-change and health effects of greenhouse gas (GHG) and fine particulate matter (PM2.5) emissions from gasoline, corn ethanol, and cellulosic ethanol. For each billion ethanol-equivalent gallons of fuel produced and combusted in the US, the combined climate-change and health costs are $469 million for gasoline, $472–952 million for corn ethanol depending on biorefinery heat source (natural gas, corn stover, or coal) and technology, but only $123–208 million for cellulosic ethanol depending on feedstock (prairie biomass, Miscanthus, corn stover, or switchgrass). Moreover, a geographically explicit life-cycle analysis that tracks PM2.5 emissions and exposure relative to U.S. population shows regional shifts in health costs dependent on fuel production systems. Because cellulosic ethanol can offer health benefits from PM2.5 reduction that are of comparable importance to its climate-change benefits from GHG reduction, a shift from gasoline to cellulosic ethanol has greater advantages than previously recognized. These advantages are critically dependent on the source of land used to produce biomass for biofuels, on the magnitude of any indirect land use that may result, and on other as yet unmeasured environmental impacts of biofuels. PMID:19188587

Opportunity costs and local health service spending decisions: a qualitative study from Wales.

Science.gov (United States)

Karlsberg Schaffer, Sarah; Sussex, Jon; Hughes, Dyfrig; Devlin, Nancy

2016-03-25

All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial "shocks" arising from technology appraisals (TAs) issued by NICE and from other cost pressures. Semi-structured interviews were conducted with Finance Directors and Medical Directors from all seven Local Health Boards (LHBs) in NHS Wales. These interviews covered prioritisation processes, as well as methods of financing NICE TAs and other financial shocks at each LHB. We then undertook a systematic identification of themes and topics from the information recorded. The study relates to the period October 2010 to March 2013. The financial impact of NICE TAs is generally anticipated and planned for in advance and the majority of LHBs have contingency funds available to cope with these and other financial shocks within-period. Efficiency savings (defined as reductions in costs with no assumed reductions in quality) were a source of funds for cost pressures of all kinds. Service displacements were not linkable to particular NICE TAs and there appears to be a general lack of explicit prioritisation activities. The Welsh Government has, on occasion, explicitly or implicitly acted as the funder of last resort. Services may be displaced as part of a response to the cumulative impact of all types of cost pressures, including cost-increasing health

Energy savings, emission reductions, and health co-benefits of the green building movement.

Science.gov (United States)

P, MacNaughton; X, Cao; J, Buonocore; J, Cedeno-Laurent; J, Spengler; A, Bernstein; J, Allen

2018-06-01

Buildings consume nearly 40% of primary energy production globally. Certified green buildings substantially reduce energy consumption on a per square foot basis and they also focus on indoor environmental quality. However, the co-benefits to health through reductions in energy and concomitant reductions in air pollution have not been examined.We calculated year by year LEED (Leadership in Energy and Environmental Design) certification rates in six countries (the United States, China, India, Brazil, Germany, and Turkey) and then used data from the Green Building Information Gateway (GBIG) to estimate energy savings in each country each year. Of the green building rating schemes, LEED accounts for 32% of green-certified floor space and publically reports energy efficiency data. We employed Harvard's Co-BE Calculator to determine pollutant emissions reductions by country accounting for transient energy mixes and baseline energy use intensities. Co-BE applies the social cost of carbon and the social cost of atmospheric release to translate these reductions into health benefits. Based on modeled energy use, LEED-certified buildings saved $7.5B in energy costs and averted 33MT of CO 2 , 51 kt of SO 2 , 38 kt of NO x , and 10 kt of PM 2.5 from entering the atmosphere, which amounts to $5.8B (lower limit = $2.3B, upper limit = $9.1B) in climate and health co-benefits from 2000 to 2016 in the six countries investigated. The U.S. health benefits derive from avoiding an estimated 172-405 premature deaths, 171 hospital admissions, 11,000 asthma exacerbations, 54,000 respiratory symptoms, 21,000 lost days of work, and 16,000 lost days of school. Because the climate and health benefits are nearly equivalent to the energy savings for green buildings in the United States, and up to 10 times higher in developing countries, they provide an important and previously unquantified societal value. Future analyses should consider these co-benefits when weighing policy

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

Directory of Open Access Journals (Sweden)

Thomas Poulsen

2017-04-01

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

Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.

Science.gov (United States)

Wellander, Lisa; Wells, Michael B; Feldman, Inna

2016-06-01

-savings due to a reduction in the prevalence of mental health problems and averted additional support required. The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation. Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices. The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs. When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine

Adherence and health care costs

Directory of Open Access Journals (Sweden)

Iuga AO

2014-02-01

Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

Health Services Cost Analyzing in Tabriz Health Centers 2008

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Massumeh gholizadeh

2015-08-01

Full Text Available Background and objectives : Health Services cost analyzing is an important management tool for evidence-based decision making in health system. This study was conducted with the purpose of cost analyzing and identifying the proportion of different factors on total cost of health services that are provided in urban health centers in Tabriz. Material and Methods : This study was a descriptive and analytic study. Activity Based Costing method (ABC was used for cost analyzing. This cross–sectional survey analyzed and identified the proportion of different factors on total cost of health services that are provided in Tabriz urban health centers. The statistical population of this study was comprised of urban community health centers in Tabriz. In this study, a multi-stage sampling method was used to collect data. Excel software was used for data analyzing. The results were described with tables and graphs. Results : The study results showed the portion of different factors in various health services. Human factors by 58%, physical space 8%, medical equipment 1.3% were allocated with high portion of expenditures and costs of health services in Tabriz urban health centers. Conclusion : Based on study results, since the human factors included the highest portion of health services costs and expenditures in Tabriz urban health centers, balancing workload with staff number, institutionalizing performance-based management and using multidisciplinary staffs may lead to reduced costs of services. ​

Cost effective snubber reduction program for nuclear power plants

International Nuclear Information System (INIS)

Adams, T.M.; Antaki, G.A.; Chang, K.C.

1985-01-01

Due to the stringent seismic requirements imposed on nuclear power plants, piping engineers have resorted to the extensive use of snubbers to support nuclear piping systems. The advantage of snubbers is that they provide dynamic restraint while allowing free thermal growth of the pipe. Unfortunately, as more plants go into operation, utilities have to face the costs of strict in-service inspection requirements and risks of unscheduled or extended plant outages associated with snubber failures. The snubber inspection requirements, defined in plant Technical Specifications, require periodic visual inspections of all snubbers and functional tests of a percentage of the plant snubbers, during refueling outages. For a typical 1000 Mw unit this represents from 50 to several hundred snubbers to be functionally tested at each refueling outage. Should failures occur during testing, the sample size must be further increased. Very quickly the costs and risks of extended shutdowns have led the industry to consider, and in many cases implement, snubber reduction programs. At the same time several changes in seismic design criteria have greatly facilitated the reduction of snubbers, making snubber elimination economically and technically attractive. In this paper we examine the costs and benefits of snubber reduction programs and propose a method for evaluating their cost benefits

Health care costs, wages, and aging

OpenAIRE

Louise Sheiner

1999-01-01

While economists generally agree that workers pay for their health insurance costs through reduced wages, there has been little thought devoted to the level at which these costs are passed on: Is each employee's wage reduced by the amount of his or her own health costs, by the average health costs of employees in the firm, or by some amount in between? This paper analyzes one dimension of the question of how firms pass health costs to workers. Using cross-city variation in health costs, I tes...

The economic cost of Alzheimer's disease: Family or public-health burden?

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Diego M. Castro

Full Text Available Abstract Alzheimer's disease (AD patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

Socio-economic and Engineering Assessments of Renewable Energy Cost Reduction Potential

Science.gov (United States)

Seel, Joachim

This dissertation combines three perspectives on the potential of cost reductions of renewable energy--a relevant topic, as high energy costs have traditionally been cited as major reason to vindicate developments of fossil fuel and nuclear power plants, and to justify financial support mechanisms and special incentives for renewable energy generators. First, I highlight the role of market and policy drivers in an international comparison of upfront capital expenses of residential photovoltaic systems in Germany and the United States that result in price differences of a factor of two and suggest cost reduction opportunities. In a second article I examine engineering approaches and siting considerations of large-scale photovoltaic projects in the United States that enable substantial system performance increases and allow thus for lower energy costs on a levelized basis. Finally, I investigate future cost reduction options of wind energy, ranging from capital expenses, operating expenses, and performance over a project's lifetime to financing costs. The assessment shows both substantial further cost decline potential for mature technologies like land-based turbines, nascent technologies like fixed-bottom offshore turbines, and experimental technologies like floating offshore turbines. The following paragraphs summarize each analysis: International upfront capital cost comparison of residential solar systems: Residential photovoltaic (PV) systems were twice as expensive in the United States as in Germany in 2012. This price discrepancy stems primarily from differences in non-hardware or "soft" costs between the two countries, of which only 35% be explained by differences in cumulative market size and associated learning. A survey of German PV installers was deployed to collect granular data on PV soft costs in Germany, and the results are compared to those of a similar survey of U.S. PV installers. Non-module hardware costs and all analyzed soft costs are lower in

How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

International Nuclear Information System (INIS)

Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

2017-01-01

Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.

Least cost planning for CO2-reduction strategies

International Nuclear Information System (INIS)

Seifritz, W.

1990-01-01

A first recommendation for the determination of the minimum costs for a carbon-dioxide reduction strategy is presented. For this, the tabulation of so-called, 'CO 2 -ranking-lists', containing the relationship between the costs of a distinct measure to avoid the emission of certain amount of CO 2 (in dollar/t CO 2 ) versus its potential (in t CO 2 /yr), is indispensable. Some basic aspects of this approach are discussed and a first guess of the costs of some measures to avoid CO 2 -emissions into the atmosphere is presented. (orig.) [de

The predictive validity of the HERO Scorecard in determining future health care cost and risk trends.

Science.gov (United States)

Goetzel, Ron Z; Henke, Rachel Mosher; Benevent, Richele; Tabrizi, Maryam J; Kent, Karen B; Smith, Kristyn J; Roemer, Enid Chung; Grossmeier, Jessica; Mason, Shawn T; Gold, Daniel B; Noeldner, Steven P; Anderson, David R

2014-02-01

To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures. Individual employee health care insurance claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into "high" versus "low" scoring groups and health care cost trends were compared. A secondary analysis examined the tool's ability to predict health risk trends. "High" scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of -1.6% over 3 years) compared with "low" scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring "low." The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.

Cost effectiveness of a screen-and-treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity.

Science.gov (United States)

Kiss, H; Pichler, Eva; Petricevic, L; Husslein, P

2006-08-01

The purpose of this investigation was to determine the cost-saving potential of a simple screen-and-treat program for vaginal infection, which has previously been shown to lead to a reduction of 50% in the rate of preterm births. To determine the potential cost savings, we compared the direct costs of preterm delivery of infants with a birth weight below 1900g with the costs of the screen-and-treat program. We used a cut-off birth weight of 1900g because, in our population, all infants with a birth weight below 1900g were transferred to the neonatal intensive care unit. The direct costs associated with preterm delivery were defined to include the costs of the initial hospitalization of both mother and infant and the costs of outpatient follow-up throughout the first 6 years of life of the former preterm infant. The costs of the screen-and-treat program were defined to include the costs of the screening examination and the resulting costs of antimicrobial treatment and follow-up. All calculations were based on health-economic data obtained in the metropolitan area of Vienna, Austria. The number of preterm infants with a birth weight below 1900g was 12 (0.5%) in the intervention group (N=2058) and 29 (1.3%) in the control group (N=2097). The direct costs per preterm birth were found to amount to EUR (euro) 60262. Overall, the expected total savings in direct costs achieved by the screen-and-treat program and the ensuing 50% reduction in the number preterm births with a birth weight below 1900g amounted to more than euro 11 million. The costs of screening and treatment were found to amount to merely 7% of the direct costs saved as a result of the screen-and-treat program. A simple preterm prevention program, consisting of screening and antimicrobial treatment and follow-up of women with asymptomatic vaginal infection, leads not only to a significant reduction in the rate of preterm births but also to substantial savings in the direct costs associated with prematurity.

Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

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Maurílio de Souza Cazarim

2017-11-01

Full Text Available ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c, were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER. A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.

Development of pollution reduction strategies for Mexico City: Estimating cost and ozone reduction effectiveness

International Nuclear Information System (INIS)

Thayer, G.R.; Hardie, R.W.; Barrera-Roldan, A.

1993-01-01

This reports on the collection and preparation of data (costs and air quality improvement) for the strategic evaluation portion of the Mexico City Air Quality Research Initiative (MARI). Reports written for the Mexico City government by various international organizations were used to identify proposed options along with estimates of cost and emission reductions. Information from appropriate options identified by SCAQMD for Southem California were also used in the analysis. A linear optimization method was used to select a group of options or a strategy to be evaluated by decision analysis. However, the reduction of ozone levels is not a linear function of the reduction of hydrocarbon and NO x emissions. Therefore, a more detailed analysis was required for ozone. An equation for a plane on an isopleth calculated with a trajectory model was obtained using two endpoints that bracket the expected total ozone precursor reductions plus the starting concentrations for hydrocarbons and NO x . The relationship between ozone levels and the hydrocarbon and NO x concentrations was assumed to lie on this plane. This relationship was used in the linear optimization program to select the options comprising a strategy

Biological waste by-production costs in forest management and possibilities for their reduction

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Jiří Kadlec

2004-01-01

Full Text Available Biological wastes in forestry were observed from view of their by-production in silvicultural and logging operations. There were identified points where biological waste was produced in this paper, waste costs ratio for silvicultural and logging operations and were made suggestions for reduction of these costs. Biological waste costs give 34.4% of total costs of silvicultural operations and 30% of total costs of logging operations. Natural regeneration and minor forest produce operations are opportunities for reduction of these costs.

Achieving Cost Reduction Through Data Analytics.

Science.gov (United States)

Rocchio, Betty Jo

2016-10-01

The reimbursement structure of the US health care system is shifting from a volume-based system to a value-based system. Adopting a comprehensive data analytics platform has become important to health care facilities, in part to navigate this shift. Hospitals generate plenty of data, but actionable analytics are necessary to help personnel interpret and apply data to improve practice. Perioperative services is an important revenue-generating department for hospitals, and each perioperative service line requires a tailored approach to be successful in managing outcomes and controlling costs. Perioperative leaders need to prepare to use data analytics to reduce variation in supplies, labor, and overhead. Mercy, based in Chesterfield, Missouri, adopted a perioperative dashboard that helped perioperative leaders collaborate with surgeons and perioperative staff members to organize and analyze health care data, which ultimately resulted in significant cost savings. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.

Science.gov (United States)

Ruiz, Sarah; Snyder, Lynne Page; Rotondo, Christina; Cross-Barnet, Caitlin; Colligan, Erin Murphy; Giuriceo, Katherine

2017-03-01

While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population. Project HOPE—The People-to-People Health Foundation, Inc.

New approaches to cost reduction on the UK continental shelf

Energy Technology Data Exchange (ETDEWEB)

Curtis, M I

1994-12-31

The conference paper deals with cost reduction on the UK continental shelf. New approaches on the reduction of field development costs are compared with the cases if traditional approaches had been followed. Field developments where success in aligning the goals and objectives of the contractors and owners which led to projects being delivered on time but more than 20% below budget, are exemplified. The contractors in the alliance received 55% of the savings in addition to their normal profit. The procedure to follow in such cases, is discussed

New approaches to cost reduction on the UK continental shelf

International Nuclear Information System (INIS)

Curtis, M.I.

1994-01-01

The conference paper deals with cost reduction on the UK continental shelf. New approaches on the reduction of field development costs are compared with the cases if traditional approaches had been followed. Field developments where success in aligning the goals and objectives of the contractors and owners which led to projects being delivered on time but more than 20% below budget, are exemplified. The contractors in the alliance received 55% of the savings in addition to their normal profit. The procedure to follow in such cases, is discussed

[Costs with personnel and productivity analysis of family health program teams in Fortaleza, Ceará].

Science.gov (United States)

Rocha Filho, Fernando dos Santos; da Silva, Marcelo Gurgel Carlos

2009-01-01

The research verified the productivity and the operational personnel costs of eight teams of the Family Health Program (PSF) of two Basic Units of Family Health (UBASF) in Fortaleza, Ceará, through the methodology of costs by absorption, in 2004. The largest expenses were with personnel (75%), mainly with the PSF teams, and medicines (18%). The federal allocations received in September, 2004, by each PSF team, were R$ 9,543.33. The total cost by team was R$ 15,719.00. Some professionals of various PSF teams showed productivity above the set objectives, but the average productivity by doctor and nurse was below fifty per cent of objectives, with high idle time making the work onerous. The unity cost of home visits by doctor and prenatal attendance by nurses were checked, and, would be less expensive if the idle time were reduced. Various alternatives of cost reduction were observed, such as scale savings of some resources and services and re-negotiation of contracts with suppliers and cooperatives. The data obtained will contribute to more accurate planning for the installation and maintenance of PSF teams as well as alternatives of cost reductions, higher productivity, and better quality.

Quantifying the emissions reduction effectiveness and costs of oxygenated gasoline

International Nuclear Information System (INIS)

Lyons, C.E.

1993-01-01

During the fall, winter, and spring of 1991-1992, a measurement program was conducted in Denver, Colorado to quantify the technical and economic effectiveness of oxygenated gasoline in reducing automobile carbon monoxide (CO) emissions. Emissions from 80,000 vehicles under a variety of operating conditions were measured before, during, and after the seasonal introduction of oxygenated gasoline into the region. Gasoline samples were taken from several hundred vehicles to confirm the actual oxygen content of the fuel in use. Vehicle operating conditions, such as cold starts and warm operations, and ambient conditions were characterized. The variations in emissions attributable to fuel type and to operating conditions were then quantified. This paper describes the measurement program and its results. The 1991-1992 Colorado oxygenated gasoline program contributed to a reduction in carbon monoxide (CO) emissions from gasoline-powered vehicles. The measurement program demonstrated that most of the reduction is concentrated in a small percentage of the vehicles that use oxygenated gasoline. The remainder experience little or not reduction in emissions. The oxygenated gasoline program outlays are approximately $25 to $30 million per year in Colorado. These are directly measurable costs, incurred through increased government expenditures, higher costs to private industry, and losses in fuel economy. The measurement program determined the total costs of oxygenated gasoline as an air pollution control strategy for the region. Costs measured included government administration and enforcement, industry production and distribution, and consumer and other user costs. This paper describes the ability of the oxygenated gasoline program to reduce pollution; the overall cost of the program to government, industry, and consumers; and the effectiveness of the program in reducing pollution compared to its costs

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

Science.gov (United States)

Angevine, Peter D; Berven, Sigurd

2014-10-15

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

Controlling Health Care Costs

Science.gov (United States)

Dessoff, Alan

2009-01-01

This article examines issues on health care costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…

Long-term health and medical cost impact of smoking prevention in adolescence.

Science.gov (United States)

Wang, Li Yan; Michael, Shannon L

2015-02-01

To estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. Compared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th-12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24-32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. Effective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs. Published by Elsevier Inc.

Cost analysis of soil-depressurization techniques for indoor radon reduction

International Nuclear Information System (INIS)

Henschel, D.B.

1991-01-01

The article discusses a parametric cost analysis to evaluate active soil depressurization (ASD) systems for indoor radon reduction in houses. The analysis determined the relative importance of 14 ASD design variables and 2 operating variables on the installation and operating costs of residential ASD systems in several types of houses. Knowledge of the most important variables would enable EPA's research and development efforts to be more effectively directed at ways to reduce ASD costs and thus to increase utilization of the technology. Parameters offering the greatest potential for reductions in installation costs included three dealing with houses with poor subslab communication: (1) reducing the number of subslab depressurization pipes; (2) eliminating excavation of large subslab pits beneath the suction pipes to improve suction field extension; and (3) improving the effectiveness of premitigation subslab communication diagnostic testing in achieving simpler, less expensive ASD system designs. In addition, determining acceptable conditions for discharging ASD exhaust at grade level would reduce installation costs. Better design guidance for crawl-space submembrane depressurization (SMD) systems could reduce installation costs, if difficult membrane sealing steps and complete coverage of the crawl-space floor by the membrane can be avoided

Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania.

Directory of Open Access Journals (Sweden)

Emily R Mangone

Full Text Available There is increasing evidence that mobile phone health interventions ("mHealth" can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH, a national text-message (SMS based health communication service in Tanzania.We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320 and at any possible break-even volume.In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs.These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners

Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania.

Science.gov (United States)

Mangone, Emily R; Agarwal, Smisha; L'Engle, Kelly; Lasway, Christine; Zan, Trinity; van Beijma, Hajo; Orkis, Jennifer; Karam, Robert

2016-01-01

There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this

Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand.

Directory of Open Access Journals (Sweden)

Tony Blakely

2015-07-01

Full Text Available Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 ["business as usual," BAU], in a country (New Zealand with large ethnic inequalities in smoking-related and noncommunicable disease (NCD burden.We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million. A total of 260,000 (95% uncertainty interval [UI]: 155,000-419,000 QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000. QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41% less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45-64-y-old women (3.01%. As with all such modeling, there were limitations pertaining to the model structure and input parameters.Ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD burden and health inequalities, they will also

Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand

Science.gov (United States)

Blakely, Tony; Cobiac, Linda J.; Cleghorn, Christine L.; Pearson, Amber L.; van der Deen, Frederieke S.; Kvizhinadze, Giorgi; Nghiem, Nhung; McLeod, Melissa; Wilson, Nick

2015-01-01

Background Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 [“business as usual,” BAU]), in a country (New Zealand) with large ethnic inequalities in smoking-related and noncommunicable disease (NCD) burden. Methods and Findings We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs) gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million). A total of 260,000 (95% uncertainty interval [UI]: 155,000–419,000) QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000). QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population) compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41%) less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45–64-y-old women (3.01%). As with all such modeling, there were limitations pertaining to the model structure and input parameters. Conclusions Ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD

Plant evaluation activities and O and M cost reduction in U.S

International Nuclear Information System (INIS)

Itoh, Takeshi

1998-01-01

Although some nuclear power plants face the possibility of premature retirement, most nuclear power plants have achieved substantial reductions in costs, mainly in O and M costs, and appear to be competitive with new gas and coal fired power plants. Improving competitiveness of existing nuclear power plants in the United States has primarily been driven by the electric utility self assessment activities. However, the background of this activity has been provided by the activities of NRC, INPO, NEI, EUCG and other activities being conducted for improvement of the nuclear power industry as a whole. Utility companies that are in the forefront of this activity have already achieved the reductions in staffing and outage time that are generally known to be effective for reducing O and M costs and are moving forward with rationalization and cost reductions in other areas. However, these electric utility companies are also achieving high safety and reliability. The staff of these electric utility companies have a high degree of autonomy, self motivation and self critical attitude and the staffing of these companies is a numerically small elite. This culture is supported by the self evaluation activity established by each company and is nurtured and supported by the management system. This appears to be one of the major elements in cost reduction. As this is based on U.S. information, differences in the system, society and culture in other nations mean that these findings may not be directly applicable. However, from the point of view of the prospects of nuclear power, these findings have an important meaning. This meaning is that the achievements in the United States of cost reduction activities centering on O and M costs are an important experience for other countries including Japan in reestablishing the economic competitiveness of nuclear power. (author)

Health Clinic Cost Reports

Data.gov (United States)

U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

Modeled effects of an improved building insulation scenario in Europe on air pollution, health and societal costs

DEFF Research Database (Denmark)

Bønløkke, Jakob Hjort; Holst, Gitte Juel; Sigsgaard, Torben

2015-01-01

scenario in Europe would have substantial benefits on health through improvements in air pollution. Health effects and societal cost savings may significantly counterbalance investment costs and should be taken into account when evaluating strategies for mitigation of global warming....... with extensions. Mean annual changes in the main air pollutants were derived for each country. World Health Organization (WHO) and European Union (EU) data on populations and on impacts of pollutants were used to derive health effects and costs. Effects on indoor air quality were not assessed. Results: Projected...... 78678 LY in Europe. A total of 7173 cases of persistent chronic bronchitis could be avoided annually. Several other health outcomes improved similarly. The saved societal costs totaled 6.64 billion € annually. Conclusions: In addition to carbon emission reductions, an improved building insulation...

UMTRA Project-Level Cost Reduction/Productivity Improvement Program manual

International Nuclear Information System (INIS)

1995-06-01

Mission of the Uranium Mill Tailings Remedial Action (UMTRA) Project Cost Reduction/Productivity Improvement Program (CR/PIP) is to contribute to the UMTRA Project's environmental restoration mission by providing the means to achieve and recognize continuous improvements and cost savings. This manual includes program definition, description of UMTRA project organizational responsibilities and interfaces with existing project functions, guidance to contractors, and definition of project-level functions

Climate and Health Impacts of US Emissions Reductions Consistent with 2 C

Science.gov (United States)

Shindell, Drew T.; Lee, Yunha; Faluvegi, Greg

2016-01-01

An emissions trajectory for the US consistent with 2 C warming would require marked societal changes, making it crucial to understand the associated benefits. Previous studies have examined technological potentials and implementation costs and public health benefits have been quantified for less-aggressive potential emissions-reduction policies, but researchers have not yet fully explored the multiple benefits of reductions consistent with 2 C. We examine the impacts of such highly ambitious scenarios for clean energy and vehicles. US transportation emissions reductions avoid approx.0.03 C global warming in 2030 (0.15 C in 2100), whereas energy emissions reductions avoid approx.0.05-0.07 C 2030 warming (approx.0.25 C in 2100). Nationally, however, clean energy policies produce climate disbenefits including warmer summers (although these would be eliminated by the remote effects of similar policies if they were undertaken elsewhere). The policies also greatly reduce damaging ambient particulate matter and ozone. By 2030, clean energy policies could prevent approx.175,000 premature deaths, with approx.22,000 (11,000-96,000; 95% confidence) fewer annually thereafter, whereas clean transportation could prevent approx.120,000 premature deaths and approx.14,000 (9,000-52,000) annually thereafter. Near-term national benefits are valued at approx.US$250 billion (140 billion to 1,050billion) per year, which is likely to exceed implementation costs. Including longer-term, worldwide climate impacts, benefits roughly quintuple, becoming approx.5-10 times larger than estimated implementation costs. Achieving the benefits, however, would require both larger and broader emissions reductions than those in current legislation or regulations.

Solar cost reduction through technical improvements: the concepts of learning and experience

Energy Technology Data Exchange (ETDEWEB)

Krawiec, F.; Flaim, T.

1979-10-01

The concepts of learning and experience are reviewed and their usefulness for predicting the future costs of solar technologies are evaluated. The literature review indicated that the cost estimates for solar energy technologies are typically made assuming a fixed production process, characterized by standard capacity factors, overhead, and labor costs. The learning curve is suggested as a generalization of the costs of potential solar energy systems. The concept of experience is too ambiguous to be useful for cost estimation. There is no logical reason to believe that costs will decline purely as a function of cumulative production, and experience curves do not allow the analyst to identify logical sources of cost reduction directly. The procedures for using learning and aggregated cost curves to estimate the costs of solar technologies are outlined. It is recommended that production histories of analogous products and processes are analyzed and the learning and cost curves for these surrogates are estimated. These curves, if judged applicable, can be used to predict the cost reductions in manufacturing solar energy technologies.

Extreme Cost Reductions with Multi-Megawatt Centralized Inverter Systems

Energy Technology Data Exchange (ETDEWEB)

Schwabe, Ulrich [Alencon LLC; Fishman, Oleg [Alencon LLC

2015-03-20

The objective of this project was to fully develop, demonstrate, and commercialize a new type of utility scale PV system. Based on patented technology, this includes the development of a truly centralized inverter system with capacities up to 100MW, and a high voltage, distributed harvesting approach. This system promises to greatly impact both the energy yield from large scale PV systems by reducing losses and increasing yield from mismatched arrays, as well as reduce overall system costs through very cost effective conversion and BOS cost reductions enabled by higher voltage operation.

Capacity utilization and the cost of primary care visits: Implications for the costs of scaling up health interventions

Directory of Open Access Journals (Sweden)

Johns Benjamin

2008-11-01

Full Text Available Abstract Objective A great deal of international attention has been focussed recently on how much additional funding is required to scale up health interventions to meet global targets such as the Millennium Development Goals (MDGs. Most of the cost estimates that have been made in response have assumed that unit costs of delivering services will not change as coverage increases or as more and more interventions are delivered together. This is most unlikely. The main objective of this paper is to measure the impact of patient load on the cost per visit at primary health care facilities and the extent to which this would influence estimates of the costs and financial requirements to scale up interventions. Methods Multivariate regression analysis was used to explore the determinants of variability in unit costs using data for 44 countries with a total of 984 observations. Findings Controlling for other possible determinants, we find that the cost of an outpatient visit is very sensitive to the number of patients seen by providers each day at primary care facilities. Each 1% increase in patient through-put results, on average, in a 27% reduction in the cost per visit (p Conclusion Variability in capacity utilization, therefore, need to be taken into account in cost estimates, and the paper develops a method by which this can be done.

A Model of Cost Reduction and Standardization: Improved Cost Savings While Maintaining the Quality of Care.

Science.gov (United States)

Guzman, Michael J; Gitelis, Matthew E; Linn, John G; Ujiki, Michael B; Waskerwitz, Matthew; Umanskiy, Konstantin; Muldoon, Joseph P

2015-11-01

Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending. We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction. We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques. This study was conducted in a university-affiliated hospital system. Patients included those undergoing a laparoscopic appendectomy within the hospital system. Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared. During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p day readmissions, postoperative infections, operating time, or reoperations. This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument costs are based on our institution contracts and vary compared with other institutions. In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.

Wealth and Health Behavior: Testing the Concept of a Health Cost.

Science.gov (United States)

van Kippersluis, Hans; Galama, Titus J

2014-11-01

Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed partially explain behavioral differences, and ultimately health outcomes, between wealth groups.

Cost of delivering health care services at primary health facilities in Ghana

Directory of Open Access Journals (Sweden)

Maxwell Ayindenaba Dalaba

2017-11-01

Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

Cost reduction in deep water production systems

International Nuclear Information System (INIS)

Beltrao, R.L.C.

1995-01-01

This paper describes a cost reduction program that Petrobras has conceived for its deep water field. Beginning with the Floating Production Unit, a new concept of FPSO was established where a simple system, designed to long term testing, can be upgraded, on the location, to be the definitive production unit. Regarding to the subsea system, the following projects will be considered. (1) Subsea Manifold: There are two 8-well-diverless manifolds designed for 1,000 meters presently under construction and after a value analysis, a new design was achieved for the next generation. Both projects will be discussed and a cost evaluation will also be provided. (2) Subsea Pipelines: Petrobras has just started a large program aiming to reduce cost on this important item. There are several projects such as hybrid (flexible and rigid) pipes for large diameter in deep water, alternatives laying methods, rigid riser on FPS, new material...etc. The authors intend to provide an overview of each project

Reduction of costs for anemia-management drugs associated with the use of ferric citrate

Directory of Open Access Journals (Sweden)

Thomas A

2014-05-01

Full Text Available Anila Thomas,1 Leif E Peterson2 1Clinical Pharmacy Services, Houston Methodist Hospital, Houston, TX, USA; 2Center for Biostatistics, Houston Methodist Research Institute, Houston, TX, USA Background: Ferric citrate is a novel phosphate binder which has the potential to reduce usage of erythropoietin-stimulating agents (ESAs and intravenous (IV iron used for anemia management during hemodialysis (HD among patients with end-stage renal disease (ESRD. Currently, the potential health care cost savings on a national scale due to the use of ferric citrate in ESRD are undetermined. Methods: Per-patient-per-year costs of ESAs (Epogen® and Aranesp® [Amgen Inc., CA, USA] and IV iron (Venofer® [American Regent, Inc., NY, USA] and Ferrlecit® [Sanofi US, Bridgewater, NJ, USA] were based on RED BOOK™ (Truven Health Analytics New York, NY, USA costs combined with the Centers for Medicare and Medicaid Services (CMS base rate and actual usage in 2011 for the four drugs. The annual number of outpatients undergoing HD in the US was based on frequencies reported by the USRDS (United States Renal Data System. Monte Carlo uncertainty analysis was performed to determine total annual costs and cost reduction based on ferric citrate usage. Results: Total annual cost of ESAs and IV iron for anemia management in ESRD determined by Monte Carlo analysis assuming CMS base rate value was 5.127 (3.664–6.260 billion USD. For actual utilization in 2011, total annual cost of ESAs and IV iron was 3.981 (2.780–4.930 billion USD. If ferric citrate usage reduced ESA utilization by 20% and IV iron by 40%, then total cost would be reduced by 21.2% to 4.038 (2.868–4.914 billion USD for the CMS base rate, and by 21.8% to 3.111 (2.148–3.845 billion USD, based on 2011 actual utilization. Conclusion: It is likely that US health care costs for anemia-management drugs associated with ESRD among HD patients can be reduced by using ferric citrate as a phosphate binder. Keywords

Cost reductions of fuel cells for transport applications: fuel processing options

Energy Technology Data Exchange (ETDEWEB)

Teagan, W P; Bentley, J; Barnett, B [Arthur D. Little, Inc., Cambridge, MA (United States)

1998-03-15

The highly favorable efficiency/environmental characteristics of fuel cell technologies have now been verified by virtue of recent and ongoing field experience. The key issue regarding the timing and extent of fuel cell commercialization is the ability to reduce costs to acceptable levels in both stationary and transport applications. It is increasingly recognized that the fuel processing subsystem can have a major impact on overall system costs, particularly as ongoing R and D efforts result in reduction of the basic cost structure of stacks which currently dominate system costs. The fuel processing subsystem for polymer electrolyte membrane fuel cell (PEMFC) technology, which is the focus of transport applications, includes the reformer, shift reactors, and means for CO reduction. In addition to low cost, transport applications require a fuel processor that is compact and can start rapidly. This paper describes the impact of factors such as fuel choice operating temperature, material selection, catalyst requirements, and controls on the cost of fuel processing systems. There are fuel processor technology paths which manufacturing cost analyses indicate are consistent with fuel processor subsystem costs of under $150/kW in stationary applications and $30/kW in transport applications. As such, the costs of mature fuel processing subsystem technologies should be consistent with their use in commercially viable fuel cell systems in both application categories. (orig.)

Introduction to cost-effectiveness analysis of risk reduction measures in energy systems

International Nuclear Information System (INIS)

1986-07-01

The aim of this report is to introduce readers to methods of cost-effectiveness analysis and their application in risk reduction, especially in connection with the energy-producing industries. The background to the assessment of risk and the problems in estimating it quantitatively are outlined. The methodology of cost-effectiveness analysis is then described, particular attention being given to the way in which results are derived and the overall use that can be made of them. This is followed by a discussion of quantitative applications and an outline of the methods that may be used to derive estimates both of risk and the cost of reducing it. The use of cost-effectiveness analysis is illustrated in an appendix, which gives as a worked example a case study on the reduction of public risk associated with radioactive releases during normal operation of a PWR. After drawing some general conclusions the report recommends that such analyses should normally be used as an aid to risk management whenever several alternative risk reduction measures are under consideration

Cost-Optimal Pathways to 75% Fuel Reduction in Remote Alaskan Villages: Preprint

Energy Technology Data Exchange (ETDEWEB)

Simpkins, Travis; Cutler, Dylan; Hirsch, Brian; Olis, Dan; Anderson, Kate

2015-10-28

There are thousands of isolated, diesel-powered microgrids that deliver energy to remote communities around the world at very high energy costs. The Remote Communities Renewable Energy program aims to help these communities reduce their fuel consumption and lower their energy costs through the use of high penetration renewable energy. As part of this program, the REopt modeling platform for energy system integration and optimization was used to analyze cost-optimal pathways toward achieving a combined 75% reduction in diesel fuel and fuel oil consumption in a select Alaskan village. In addition to the existing diesel generator and fuel oil heating technologies, the model was able to select from among wind, battery storage, and dispatchable electric heaters to meet the electrical and thermal loads. The model results indicate that while 75% fuel reduction appears to be technically feasible it may not be economically viable at this time. When the fuel reduction target was relaxed, the results indicate that by installing high-penetration renewable energy, the community could lower their energy costs by 21% while still reducing their fuel consumption by 54%.

Understanding your health care costs

Science.gov (United States)

... ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this page, ... on out-of-pocket costs. Out-of-Pocket Costs The good news is there is a limit ...

Flying Lessons: Learning from Ryanair's Cost Reduction Culture

Science.gov (United States)

Lawton, Thomas C.

2000-01-01

Through radically improving the value equation for airline customers, Ryanair has served to shake-up established norms and practices in European aviation. Underpinning its price leadership and market success is a vigorous and relentless cost reduction ethos and resultant low break-even load factor. Ryanair has lowered European airline cost structures considerably, shattering existing cost floors. Few competitors are able to follow, either because they do not know how or they are unable due to social settlement obligations or service commitments. At the same time, the company has maintained high average load factors on its flights. Taken in conjunction with its low break-even load factor, this results in consistently high overall profit margins. On this basis, Ryanair is likely to remain a significant competitor and increase its market presence and success across Europe.

Technology learning for fuel cells. An assessment of past and potential cost reductions

International Nuclear Information System (INIS)

Schoots, K.; Van der Zwaan, B.C.C.; Kramer, G.J.

2010-01-01

Fuel cells have gained considerable interest as a means to efficiently convert the energy stored in gases like hydrogen and methane into electricity. Further developing fuel cells in order to reach cost, safety and reliability levels at which their widespread use becomes feasible is an essential prerequisite for the potential establishment of a 'hydrogen economy'. A major factor currently obviating the extensive use of fuel cells is their relatively high costs. At present we estimate these at about 1100 EUR(2005)W for an 80 kW fuel cell system but notice that specific costs vary markedly with fuel cell system power capacity. We analyze past fuel cell cost reductions for both individual manufacturers and the global market. We determine learning curves, with fairly high uncertainty ranges, for three different types of fuel cell technology - AFC, PAFC and PEMFC - each manufactured by a different producer. For PEMFC technology we also calculate a global learning curve, characterised by a learning rate of 21% with an error margin of 4%. Given their respective uncertainties, this global learning rate value is in agreement with those we find for different manufacturers. In contrast to some other new energy technologies, R and D still plays a major role in today's fuel cell improvement process and hence probably explains a substantial part of our observed cost reductions. The remaining share of these cost reductions derives from learning-by-doing proper. Since learning-by-doing usually involves a learning rate of typically 20%, the residual value for pure learning we find for fuel cells is relatively low. In an ideal scenario for fuel cell technology we estimate a bottom-line for specific (80 kW system) manufacturing costs of 95 EUR(2005)W. Although learning curves observed in the past constitute no guarantee for sustained cost reductions in the future, when we assume global total learning at the pace calculated here as the only cost reduction mechanism, this ultimate cost

Buying Health: The Costs of Commercialization and an Alternative Philosophy

Directory of Open Access Journals (Sweden)

Larry Churchill

2013-01-01

Full Text Available This paper argues that commercial forces have steadily encroached into our understanding of medicine and health in modern industrial societies. The impact on the delivery of personal medical services and on common ideas about food and nutrition is profound and largely deleterious to public health. A key component of commercialization is reductionism of medical services, health products and nutritional components into small, marketable units. This reductive force makes both medical services and nutritional components more costly and is corrosive to more holistic concepts of health. We compare commercial and holistic approaches to nutrition in detail and offer an alternative philosophy. Adopting this alternative will require sound public policies that rely less on marketing as a distribution system and that enfranchise individuals to be reflective on their use of medical services, their food and nutrition choices, and their larger health needs.

Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy.

Science.gov (United States)

Yu, Yangyang R; Abbas, Paulette I; Smith, Carolyn M; Carberry, Kathleen E; Ren, Hui; Patel, Binita; Nuchtern, Jed G; Lopez, Monica E

2016-12-01

As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. Process maps were created using medical record time stamps. Labor capacity cost rates were calculated using national median physician salaries, weighted nurse-patient ratios, and hospital cost data. Consumable costs for supplies, pharmacy, laboratory, and food were derived from the hospital general ledger. Time-driven activity-based costing resulted in precise per-minute calculation of personnel costs. Highest costs were in the operating room ($747.07), hospital floor ($388.20), and emergency department ($296.21). Major contributors to length of stay were emergency department evaluation (270min), operating room availability (395min), and post-operative monitoring (1128min). The TDABC model led to $1712.16 in personnel costs and $1041.23 in consumable costs for a total appendicitis cost of $2753.39. Inefficiencies in healthcare delivery can be identified through TDABC. Triage-based standing delegation orders, advanced practice providers, and same day discharge protocols are proposed cost-reducing interventions to optimize value-based care for simple appendicitis. II. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana.

Directory of Open Access Journals (Sweden)

Maxwell Ayindenaba Dalaba

Full Text Available This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS in the identification of maternal complications in Ghana.A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out.Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC in the intervention health centres (before-intervention = 9 /1,000 ANC attendance; after-intervention = 12/1,000 ANC attendance; P-value = 0.010. In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention = 96/1,000 labour clients; P-value = 0.305. Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio decreased from US$17,017.58 (before-intervention to US$15,207.5 (after-intervention. Incremental cost -effectiveness ratio (ICER was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS, cost per pregnancy complication detected was US$285.Computer -assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth

Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

Science.gov (United States)

Yeh, Stuart S.

2009-01-01

The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

Understanding the reductions in US corn ethanol production costs: An experience curve approach

International Nuclear Information System (INIS)

Hettinga, W.G.; Junginger, H.M.; Dekker, S.C.; Hoogwijk, M.; McAloon, A.J.; Hicks, K.B.

2009-01-01

The US is currently the world's largest ethanol producer. An increasing percentage is used as transportation fuel, but debates continue on its costs competitiveness and energy balance. In this study, technological development of ethanol production and resulting cost reductions are investigated by using the experience curve approach, scrutinizing costs of dry grind ethanol production over the timeframe 1980-2005. Cost reductions are differentiated between feedstock (corn) production and industrial (ethanol) processing. Corn production costs in the US have declined by 62% over 30 years, down to 100$ 2005 /tonne in 2005, while corn production volumes almost doubled since 1975. A progress ratio (PR) of 0.55 is calculated indicating a 45% cost decline over each doubling in cumulative production. Higher corn yields and increasing farm sizes are the most important drivers behind this cost decline. Industrial processing costs of ethanol have declined by 45% since 1983, to below 130$ 2005 /m 3 in 2005 (excluding costs for corn and capital), equivalent to a PR of 0.87. Total ethanol production costs (including capital and net corn costs) have declined approximately 60% from 800$ 2005 /m 3 in the early 1980s, to 300$ 2005 /m 3 in 2005. Higher ethanol yields, lower energy use and the replacement of beverage alcohol-based production technologies have mostly contributed to this substantial cost decline. In addition, the average size of dry grind ethanol plants increased by 235% since 1990. For the future it is estimated that solely due to technological learning, production costs of ethanol may decline 28-44%, though this excludes effects of the current rising corn and fossil fuel costs. It is also concluded that experience curves are a valuable tool to describe both past and potential future cost reductions in US corn-based ethanol production

Redesign of an in-market food processor for manufacturing cost reduction using DFMA methodology

Directory of Open Access Journals (Sweden)

Akshay Harlalka

2016-01-01

Full Text Available Reducing the time and cost involved in the product development is very important to stay competitive in the market. Design for Manufacturing and Assembly (DFMA is a cost-reduction framework for designers to evaluate manufacturing aspects of a product design. A case study on an in-market food processor, this paper aims to demonstrate the significance of DFMA implementation on an Indian consumer product. Even though many DFMA case studies have been published till date, very few have dealt with the Indian consumer durables category. In this paper, various cost-reduction opportunities are identified in the design of a food processor manufactured by a reputed company in India. Using the DFMA study, design ideas are developed with an objective of reducing the overall manufacturing cost of the product. As a result of DFMA implementation, significant improvement in terms of the product’s architecture, assembly time and design efficiency is identified. Overall cost reduction of 0.25 USD (United States Dollar was achieved and an improvement in the Design for Assembly (DFA index from 15.99 to 19.93 is reported. This procedure utilized in this paper can be adopted for any consumer durable products of similar type and design improvements and cost reduction can be achieved.

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.

A supply chain cost reduction framework for the South African mobile phone industry

Directory of Open Access Journals (Sweden)

Musenga F. Mpwanya

2017-03-01

Aim: The purpose of this study is to explore supply chain costs in the South African mobile phone industry, and to develop a supply chain cost-reduction framework for the South African mobile phone industry. Setting: This study explores supply chain costs in four mobile phone companies operating in the South African mobile phone industry, of which three mobile network operators and one mobile retailing group. It uses semi-structured interview data collected in 2011. Method: This study adopted a qualitative case study design to understand supply chain costs and develop a supply chain cost-reduction framework for the South African mobile phone industry. Eight semi-structured interviews with managers of mobile phone companies were conducted. The data were analysed with the help of Atlas.ti, using an adapted three-phased analytical framework as suggested by Miles and Huberman (1994 and O’ Dwyer (2004. Results: The study found that consolidation of strategic relationships through collaboration and strategic alliances between MNOs and other supply chain players is one of the ways to drive costs down across the supply chain. Outsourcing of some of the support activities and retailers’ direct purchasing transactions from device manufacturers were also found to be other avenues for reducing supply chain costs in the industry. Conclusion: The study suggests that mobile network operators (MNOs need to consolidate their strategic relationships by increasing the share of the network infrastructure, and emphasising the need to strive for operational efficiencies. This combined effort should result in significant cost reductions across the supply chain. The findings of this study provided some avenues that managers of mobile-phone companies could consider to drive costs down supply chain-wide and service end-users at lower rates. The findings of this study could also help regulating authorities to get insights into supply chain cost reduction and develop appropriate

High and rising health care costs.

Science.gov (United States)

Ginsburg, Paul B

2008-10-01

The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

Containing health costs in the Americas.

Science.gov (United States)

Márquez, P

1990-01-01

In recent years, a series of policy measures affecting both demand and supply components of health care have been adopted in different Latin American and Caribbean countries, as well as in Canada and the United States. In applying these measures various objectives have been pursued, among them: to mobilize additional resources to increase operating budgets; to reduce unnecessary utilization of health services and consumption of pharmaceuticals; to control increasing production costs; and to contain the escalation of health care expenditures. In terms of demand management, some countries have established cost-recovery programmes in an attempt to offset declining revenues. These measures have the potential to generate additional operating income in public facilities, particularly if charges are levied on hospital care. However, only scant information is available on the effects of user charges on demand, utilization, or unit costs. In terms of supply management, corrective measures have concentrated on limiting the quantity and the relative prices of different inputs and outputs. Hiring freezes, salary caps, limitations on new construction and equipment, use of drug lists, bulk procurement of medicines and vaccines, and budget ceilings are among the measures utilized to control production costs in the health sector. To moderate health care expenditures, various approaches have been followed to subject providers to 'financial discipline'. Among them, new reimbursement modalities such as prospective payment systems offer an array of incentives to modify medical practice. Cost-containment efforts have also spawned innovations in the organization and delivery of health services. Group plans have been established on the basis of prepaid premiums to provide directly much or all health care needs of affiliates and their families. The issue of intrasectorial co-ordination, particularly between ministries of health and social security institutions, has much relevance for cost

Technological cost-reduction pathways for attenuator wave energy converters in the marine hydrokinetic environment.

Energy Technology Data Exchange (ETDEWEB)

Bull, Diana L; Ochs, Margaret Ellen

2013-09-01

This report considers and prioritizes the primary potential technical costreduction pathways for offshore wave activated body attenuators designed for ocean resources. This report focuses on technical research and development costreduction pathways related to the device technology rather than environmental monitoring or permitting opportunities. Three sources of information were used to understand current cost drivers and develop a prioritized list of potential costreduction pathways: a literature review of technical work related to attenuators, a reference device compiled from literature sources, and a webinar with each of three industry device developers. Data from these information sources were aggregated and prioritized with respect to the potential impact on the lifetime levelized cost of energy, the potential for progress, the potential for success, and the confidence in success. Results indicate the five most promising costreduction pathways include advanced controls, an optimized structural design, improved power conversion, planned maintenance scheduling, and an optimized device profile.

Cost reduction possibilities for a heavy-ion accelerator for inertial confinement fusion

International Nuclear Information System (INIS)

Thayer, G.R.; Sims, J.R.; Henke, M.D.; Harris, D.B.; Dudziak, D.J.; Phillips, N.R.

1987-10-01

A design was produced for a single module in a cost-optimized accelerator appropriate for a commercial heavy-ion power plant. The goal of the study was to determine if the cost of the accelerator module could be reduced through design options, selection of materials, and manufacturing techniques. Independent cost estimates were obtained for the three main components of the module, and cost reductions of 20% from the cost calculated by the heavy-ion accelerator design/cost-minimization computer code LIACEP were identified. 3 refs., 23 figs

Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract.

Science.gov (United States)

Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

2018-04-13

Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants' profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants' profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance).

Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract

Science.gov (United States)

Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

2018-01-01

Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants’ profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants’ profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance). PMID:29652859

Quantified, localized health benefits of accelerated carbon dioxide emissions reductions

Science.gov (United States)

Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

2018-04-01

Societal risks increase as Earth warms, and increase further for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate, even if they lead to identical warming as trajectories with reduced near-term emissions1. Accelerating carbon dioxide (CO2) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations2. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits3,4. However, 2 °C trajectories not relying on negative emissions or 1.5 °C trajectories require elimination of most fossil-fuel-related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing 21st-century CO2 reductions by 180 GtC, an amount that would shift a `standard' 2 °C scenario to 1.5 °C or could achieve 2 °C without negative emissions. The decreased air pollution leads to 153 ± 43 million fewer premature deaths worldwide, with 40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

Quantified, Localized Health Benefits of Accelerated Carbon Dioxide Emissions Reductions.

Science.gov (United States)

Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

2018-01-01

Societal risks increase as Earth warms, but also for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate even if they lead to identical warming [1]. Accelerating carbon dioxide (CO 2 ) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations [2]. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits [3, 4]. However, 2°C trajectories not relying on negative emissions or 1.5°C trajectories require elimination of most fossil fuel related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing ambition of 21 st century CO 2 reductions by 180 GtC; an amount that would shift a 'standard' 2°C scenario to 1.5°C or could achieve 2°C without negative emissions. The decreased air pollution leads to 153±43 million fewer premature deaths worldwide, with ~40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

Reductions in greenhouse gas emissions and cost by shipping at lower speeds

International Nuclear Information System (INIS)

Lindstad, Haakon; Asbjornslett, Bjorn E.; Stromman, Anders H.

2011-01-01

CO 2 emissions from maritime transport represent a significant part of total global greenhouse gas (GHG) emissions. According to the International Maritime Organization (), maritime transport emitted 1046 million tons (all tons are metric) of CO 2 in 2007, representing 3.3% of the world's total CO 2 emissions. The International Maritime Organization (IMO) is currently debating both technical and market-based measures for reducing greenhouse gas emissions from shipping. This paper presents investigations on the effects of speed reductions on the direct emissions and costs of maritime transport, for which the selection of ship classes was made to facilitate an aggregated representation of the world fleet. The results show that there is a substantial potential for reducing CO 2 emissions in shipping. Emissions can be reduced by 19% with a negative abatement cost (cost minimization) and by 28% at a zero abatement cost. Since these emission reductions are based purely on lower speeds, they can in part be performed now. - Highlights: → We investigates the effects of speed reductions for maritime transport. → The selection of ship classes represent the words fleet. → The transport volumes are kept constant. → The model includes both cost and emissions as a function of speed. → The results show that there is a substantial potential for reducing CO 2 emissions from shipping.

Energy cost reduction in oil pipeline

Energy Technology Data Exchange (ETDEWEB)

Limeira, Fabio Machado; Correa, Joao Luiz Lavoura; Costa, Luciano Macedo Josino da; Silva, Jose Luiz da; Henriques, Fausto Metzger Pessanha [Petrobras Transporte S.A. (TRANSPETRO), Rio de Janeiro, RJ (Brazil)

2012-07-01

One of the key questions of modern society consists on the rational use of the planet's natural resources and energy. Due to the lack of energy, many companies are forced to reduce their workload, especially during peak hours, because residential demand reaches its top and there is not enough energy to fulfill the needs of all users, which affects major industries. Therefore, using energy more wisely has become a strategic issue for any company, due to the limited supply and also for the excessive cost it represents. With the objective of saving energy and reducing costs for oil pipelines, it has been identified that the increase in energy consumption is primordially related to pumping stations and also by the way many facilities are operated, that is, differently from what was originally designed. Realizing this opportunity, in order to optimize the process, this article intends to examine the possibility of gains evaluating alternatives regarding changes in the pump scheme configuration and non-use of pump stations at peak hours. Initially, an oil pipeline with potential to reduce energy costs was chosen being followed by a history analysis, in order to confirm if there was sufficient room to change the operation mode. After confirming the pipeline choice, the system is briefly described and the literature is reviewed, explaining how the energy cost is calculated and also the main characteristics of a pumping system in series and in parallel. In that sequence, technically feasible alternatives are studied in order to operate and also to negotiate the energy demand contract. Finally, costs are calculated to identify the most economical alternative, that is, for a scenario with no increase in the actual transported volume of the pipeline and for another scenario that considers an increase of about 20%. The conclusion of this study indicates that the chosen pipeline can achieve a reduction on energy costs of up to 25% without the need for investments in new

Non-Hardware ("Soft") Cost-Reduction Roadmap for Residential and Small Commercial Solar Photovoltaics, 2013-2020

Energy Technology Data Exchange (ETDEWEB)

Ardani, K.; Seif, D.; Margolis, R.; Morris, J.; Davidson, C.; Truitt, S.; Torbert, R.

2013-08-01

The objective of this analysis is to roadmap the cost reductions and innovations necessary to achieve the U.S. Department of Energy (DOE) SunShot Initiative's total soft-cost targets by 2020. The roadmap focuses on advances in four soft-cost areas: (1) customer acquisition; (2) permitting, inspection, and interconnection (PII); (3) installation labor; and (4) financing. Financing cost reductions are in terms of the weighted average cost of capital (WACC) for financing PV system installations, with real-percent targets of 3.0% (residential) and 3.4% (commercial).

Investigation of different modifications of the modular high temperature reactor for cost reduction

International Nuclear Information System (INIS)

Heek, A. van.

1993-06-01

Regarding the specific costs reactor with low power output have disadvantages compared to large reactors. In this study it was investigated for the HTR Module how to reduce the specific investment costs and consequently the electricity production costs by modification of the reactor and the power plant design. To reduce the investment costs different design changes were investigated, e.g. possible alternatives for the arrangement of the reactors and the steam generators and a different building layout. The cost reduction gained by a more compact type of construction and a reduction of the number of large components remains below 10%. The use of a gas turbine instead of a steam turbine with steam generator would result in a more efficient cost reduction. The increase in the power output has a much bigger potential to reduce the electricity production costs. The best way to realize this is the changing of the core geometry from cylindric to annular. A module concept with a power maximized under certain boundary conditions (limitation of the core temperatures in case of accident, use of proven technology) was worked out in detail. The optimum core geometry and power density, determined by tolerable accident temperatures and core pressure loss, make a thermal power of 350 MW possible. The physical properties and the accident behaviour in case of pressure release and water ingress were investigated. The specific investment costs and the electricity production costs of a 4-Modular Plant for pure electricity production are reduced about 28% resp. 19% compared with the 200 MWth-Module (KWU/Interatom). (orig.) [de

The burden of unintended pregnancies in Brazil: a social and public health system cost analysis

Directory of Open Access Journals (Sweden)

Le HH

2014-07-01

pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality. Keywords: unintended pregnancy, public health, Brazil, abortion

Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis.

LENUS (Irish Health Repository)

Murphy, C L

2015-01-01

The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.

Does mitigation save? Reviewing cost-benefit analyses of disaster risk reduction

OpenAIRE

Shreve, Cheney M.; Kelman, Ilan

2014-01-01

The benefit-cost-ratio (BCR), used in cost-benefit analysis (CBA), is an indicator that attempts to summarize the overall value for money of a project. Disaster costs continue to rise and the demand has increased to demonstrate the economic benefit of disaster risk reduction (DRR) to policy makers. This study compiles and compares original CBA case studies reporting DRR BCRs, without restrictions as to hazard type, location, scale, or other parameters. Many results were identified supporting ...

Reduction of Total Ownership Costs (R-TOC) Best Practices Guide

National Research Council Canada - National Science Library

Reed, Danny

2003-01-01

The purpose of the Reduction of Total Ownership Costs (R-TOC) program is to achieve readiness improvements in weapon systems by improving the reliability of the systems or the efficiency of the processes used to support...

Cost reduction has priority in solar cell research

International Nuclear Information System (INIS)

Van Zolingen, R.J.C.; Sinke, W.C.

1993-01-01

The main topic in the research and development of photovoltaic cells is cost reduction. Although new materials, improved techniques and increasing efficiency are promising aspects of the clean and sustainable option of a photovoltaic conversion of sunlight to produce electricity at a large scale, the high prices form an obstacle. Photovoltaic conversion is at least a factor three too expensive compared to the conventional power generation techniques by means of fossil fuels. Attention is paid to the theoretical maximum efficiency of photovoltaic conversion, the efficiencies realized sofar, the importance of thin film solar cells, the payback period of photovoltaic modules, the environmental impacts of using photovoltaic cells, and finally the costs. 2 figs., 1 ill., 2 tabs., 6 refs

Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje.

Science.gov (United States)

Martinez, Gerardo Sanchez; Spadaro, Joseph V; Chapizanis, Dimitris; Kendrovski, Vladimir; Kochubovski, Mihail; Mudu, Pierpaolo

2018-03-29

Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. we obtained, cleaned, and validated Particulate Matter (PM) concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. In 2012, long-term exposure to PM 2.5 (49.2 μg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM 2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM 2.5 levels to the EU limit (25 μg/m³) could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 μg/m³) could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM 2.5 concentrations could provide substantial health and economic gains to the city.

Dietary fibre intakes and reduction in functional constipation rates among Canadian adults: a cost-of-illness analysis

Directory of Open Access Journals (Sweden)

Mohammad M. H. Abdullah

2015-12-01

Full Text Available Background: Evidence-based research highlights beneficial impacts of dietary fibre on several aspects of the gut pathophysiology that are accompanied by a considerable financial burden in healthcare services. Recommended intakes of dietary fibre may thus associate with financial benefits at a population level. Objective: We sought to systematically assess the potential annual savings in healthcare costs that would follow the reduction in rates of functional constipation and irregularity with increased dietary fibre intakes among Canadian adults. Design: A cost-of-illness analysis was developed on the basis of current and recommended levels of fibre intake in Canada, constipation reduction per 1 g fibre intake, proportion of adults who are likely to consume fibre-rich diets, and population expected to respond to fibre intake. Sensitivity analyses covering a range of assumptions were further implemented within the economic simulation. Results: Our literature searches assumed a 1.8% reduction in constipation rates with each 1 g/day increase in fibre intake. With intakes corresponding to the Institute of Medicine's adequate levels of 38 g/day for men and 25 g/day for women, among 5 and 100% of the adult populations, anywhere between CAD$1.5 and CAD$31.9 million could be saved on constipation-related healthcare costs annually. Each 1 g/day increase in dietary fibre was estimated to result in total annual healthcare cost savings that ranged between CAD$0.1 and CAD$2.5 million. Conclusions: The present research suggests an economic value of increasing dietary fibre intake beyond its well-known health benefits. Healthy-eating behaviours consistent with the recommended intakes of dietary fibre by the general public should hence be advocated as a practical approach for reducing costs associated with the management of constipation in Canada.

Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame.

Science.gov (United States)

van der Deen, Frederieke S; Wilson, Nick; Cleghorn, Christine L; Kvizhinadze, Giorgi; Cobiac, Linda J; Nghiem, Nhung; Blakely, Tony

2018-05-01

There is growing international interest in advancing 'the tobacco endgame'. We use New Zealand (Smokefree goal for 2025) as a case study to model the impacts on smoking prevalence (SP), health gains (quality-adjusted life-years (QALYs)) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation (TFG), (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3. Two models were used: (1) a dynamic population forecasting model for SP and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs. All selected tobacco endgame strategies were associated with reductions in SP by 2025, down from 34.7%/14.1% for Māori (indigenous population)/non-Māori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the TFG; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population's lives ranging from 28 900 QALYs (95% Uncertainty Interval (UI)): 16 500 to 48 200; outlet reduction) to 282 000 QALYs (95%UI: 189 000 to 405 000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the TFG). Implementing endgame strategies is needed to achieve tobacco endgame targets and reduce inequalities in smoking. Given such strategies are new, modelling studies provide provisional information on what approaches may be best. © 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.

Better health at work? An evaluation of the effects and cost-benefits of a structured workplace health improvement programme in reducing sickness absence.

Science.gov (United States)

Braun, T; Bambra, C; Booth, M; Adetayo, K; Milne, E

2015-03-01

This paper presents the results of an evaluation of the Better Health at Work Award-a structured regional workplace health programme which combined changes to the work environment with lifestyle interventions. Baseline and follow-up data on sickness-absence rates and programme costs were collected retrospectively via a web survey of all participating organizations. Changes over time were calculated using 95% confidence intervals of the mean, supplemented by hypothesis testing using a t-test. The indicative cost-benefits of the intervention were also calculated. Participation was associated with a mean reduction in sickness absence of 0.26-1.6 days per employee per year depending on the length and level of participation in the programme. The estimated cost for the programme was £3 per sickness-absence day saved. These results suggest that the Better Health at Work Award could be a cost-effective way of improving health and reducing sickness absence particularly in the public sector. However, controlled evaluations of future interventions are needed. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Investments and costs of oral health care for Family Health Care

Directory of Open Access Journals (Sweden)

Márcia Stefânia Ribeiro Macêdo

2016-01-01

Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding

Investments and costs of oral health care for Family Health Care

Science.gov (United States)

Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

2016-01-01

ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

The effectiveness of health care cost management strategies: a review of the evidence.

Science.gov (United States)

Fronstin, P

1994-10-01

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care

Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs.

Directory of Open Access Journals (Sweden)

Nick Wilson

Full Text Available There is some evidence that home safety assessment and modification (HSAM is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.A previously established Markov macro-simulation model built for the whole New Zealand (NZ population (Pega et al 2016, Injury Prevention was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280. The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million. The incremental cost-effectiveness ratio (ICER was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]. Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population vs non-Māori.This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.

Cost reduction study for the LANL KrF laser-driven LMF design

International Nuclear Information System (INIS)

1989-01-01

This report is in fulfillment of the deliverable requirements for the optical components portions of the LANL-KrF Laser-Driven LMF Design Cost Reduction Study. This report examines the future cost reductions that may accrue through the use of mass production, innovative manufacturing techniques, and new materials. Results are based on data collection and survey of optical component manufacturers, BDM experience, and existing cost models. These data provide a good representation of current methods and technologies from which future estimates can be made. From these data, a series of scaling relationships were developed to project future costs for a selected set of technologies. The scaling relationships are sensitive to cost driving parameters such as size and surface figure requirements as well as quantity requirements, production rate, materials, and manufacturing processes. In addition to the scaling relationships, descriptions of the selected processes were developed along with graphical representations of the processes. This report provides a useful tool in projecting the costs of advanced laser concepts at the component level of detail. A mix of the most diverse yet comparable technologies was chosen for this study. This yielded a useful, yet manageable number of variables to examine. The study has resulted in a first-order cost model which predicts the relative cost behavior of optical components within different variable constraints

Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments.

Science.gov (United States)

Hone, Thomas; Habicht, Jarno; Domente, Silviu; Atun, Rifat

2016-12-01

achieved improvements in health insurance coverage with reductions in OOP for services, which are modest but are eroded by increasing likelihood of OOP for medicines. Insurance coverage was an important determinant for health care costs incurred by patients and patients forgoing health care. Improvements notwithstanding, there is an unfinished agenda of attaining universal health coverage in Moldova to protect individuals from health care costs.

Evaluating a Health Risk Reduction Program.

Science.gov (United States)

Nagelberg, Daniel B.

1981-01-01

A health risk reduction program at Bowling Green State University (Ohio) tested the efficacy of peer education against the efficacy of returning (by mail) health questionnaire results. A peer health education program did not appear to be effective in changing student attitudes or lifestyles; however, the research methodology may not have been…

The hidden cost of wildfires: Economic valuation of health effects of wildfire smoke exposure in Southern California

Science.gov (United States)

Richardson, L.A.; Champ, P.A.; Loomis, J.B.

2012-01-01

There is a growing concern that human health impacts from exposure to wildfire smoke are ignored in estimates of monetized damages from wildfires. Current research highlights the need for better data collection and analysis of these impacts. Using unique primary data, this paper quantifies the economic cost of health effects from the largest wildfire in Los Angeles County's modern history. A cost of illness estimate is $9.50 per exposed person per day. However, theory and empirical research consistently find that this measure largely underestimates the true economic cost of health effects from exposure to a pollutant in that it ignores the cost of defensive actions taken as well as disutility. For the first time, the defensive behavior method is applied to calculate the willingness to pay for a reduction in one wildfire smoke induced symptom day, which is estimated to be $84.42 per exposed person per day. ?? 2011.

Wealth and health behavior: Testing the concept of a health cost

NARCIS (Netherlands)

J.L.W. van Kippersluis (Hans); T.J. Galama (Titus)

2014-01-01

textabstractWealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of

Health economic potential of early nutrition programming: a model calculation of long-term reduction in blood pressure and related morbidity costs by use of long-chain polyunsaturated fatty acid-supplemented formula.

Science.gov (United States)

Straub, Niels; Grunert, Philipp; von Kries, Rüdiger; Koletzko, Berthold

2011-12-01

The reported effect sizes of early nutrition programming on long-term health outcomes are often small, and it has been questioned whether early interventions would be worthwhile in enhancing public health. We explored the possible health economic consequences of early nutrition programming by performing a model calculation, based on the only published study currently available for analysis, to evaluate the effects of supplementing infant formula with long-chain polyunsaturated fatty acids (LC-PUFAs) on lowering blood pressure and lowering the risk of hypertension-related diseases in later life. The costs and health effects of LC-PUFA-enriched and standard infant formulas were compared by using a Markov model, including all relevant direct and indirect costs based on German statistics. We assessed the effect size of blood pressure reduction from LC-PUFA-supplemented formula, the long-term persistence of the effect, and the effect of lowered blood pressure on hypertension-related morbidity. The cost-effectiveness analysis showed an increased life expectancy of 1.2 quality-adjusted life-years and an incremental cost-effectiveness ratio of -630 Euros (discounted to present value) for the LC-PUFA formula in comparison with standard formula. LC-PUFA nutrition was the superior strategy even when the blood pressure-lowering effect was reduced to the lower 95% CI. Breastfeeding is the recommended feeding practice, but infants who are not breastfed should receive an appropriate infant formula. Following this model calculation, LC-PUFA supplementation of infant formula represents an economically worthwhile prevention strategy, based on the costs derived from hypertension-linked diseases in later life. However, because our analysis was based on a single randomized controlled trial, further studies are required to verify the validity of this thesis.

Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje

Directory of Open Access Journals (Sweden)

Gerardo Sanchez Martinez

2018-03-01

Full Text Available Background: Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. Methods: we obtained, cleaned, and validated Particulate Matter (PM concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. Results: In 2012, long-term exposure to PM2.5 (49.2 μg/m3 caused an estimated 1199 premature deaths (CI95% 821–1519. The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104–977 from cardiovascular diseases, and 937 admissions (CI95% 937–1869 for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 μg/m3 could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 μg/m3 could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. Conclusions: Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city.

The Cost of Health Services Delivery in Health Houses of Alborz: A Case Study

Directory of Open Access Journals (Sweden)

Javad Ghoddousinejad

2015-07-01

Full Text Available Background and Objectives : Health houses play an active role to improve health status of rural population.Furthermore, it is important to know the costs of provided services. This research was designed to determine the costs of healthcare delivery in health houses of ALBORZ district. Material and Methods : In this cross-sectional descriptive study, Activity Based Costing (ABC was used to analyze the costs of services. Results : The average Direct Costs (DC of healthcare delivery in health houses was estimated 37033365 Rials. Direct and Indirect Costs (IC of service delivery in health houses were 65.91% and 34.09% of Total Costs (TC respectively. Conclusion : Since human resources play the most important role in determining the costs of health services delivery in healthcare, reforming payment mechanisms would be a suitable solution to reduce extra costs. Moreover, in order to decrease extra costs, it is essential to modify activities and eliminate parallel tasks.

Long-term, low-level radwaste volume-reduction strategies. Volume 4. Waste disposal costs. Final report

International Nuclear Information System (INIS)

Sutherland, A.A.; Adam, J.A.; Rogers, V.C.; Merrell, G.B.

1984-11-01

Volume 4 establishes pricing levels at new shallow land burial grounds. The following conclusions can be drawn from the analyses described in the preceding chapters: Application of volume reduction techniques by utilities can have a significant impact on the volumes of wastes going to low-level radioactive waste disposal sites. Using the relative waste stream volumes in NRC81 and the maximum volume reduction ratios provided by Burns and Roe, Inc., it was calculated that if all utilities use maximum volume reduction the rate of waste receipt at disposal sites will be reduced by 40 percent. When a disposal site receives a lower volume of waste its total cost of operation does not decrease by the same proportion. Therefore the average cost for a unit volume of waste received goes up. Whether the disposal site operator knows in advance that he will receive a smaller amount of waste has little influence on the average unit cost ($/ft) of the waste disposed. For the pricing algorithm postulated, the average disposal cost to utilities that volume reduce is relatively independent of whether all utilities practice volume reduction or only a few volume reduce. The general effect of volume reduction by utilities is to reduce their average disposal site costs by a factor of between 1.5 to 2.5. This factor is generally independent of the size of the disposal site. The largest absolute savings in disposal site costs when utilities volume reduce occurs when small disposal sites are involved. This results from the fact that unit costs are higher at small sites. Including in the pricing algorithm a factor that penalizes waste generators who contribute larger amounts of the mobile nuclides 3 H, 14 C, 99 Tc, and 129 I, which may be the subject of site inventory limits, lowers unit disposal costs for utility wastes that contain only small amounts of the nuclides and raises unit costs for other utility wastes

The impact of unit cost reductions on gross profit: Increasing or decreasing returns?

Directory of Open Access Journals (Sweden)

Ely Dahan

2011-09-01

Full Text Available We suggest that marketers actively participate in reducing unit costs during new product development, consistent with the theme of integrated marketing and manufacturing. Most marketing managers misjudge the impact on gross profit of reducing variable unit manufacturing costs, mistakenly believing that such cost reductions yield decreasing or linear returns while they actually generate increasing returns.

Levelized cost-risk reduction prioritization of waste disposal options

International Nuclear Information System (INIS)

Wilkinson, V.K.; Young, J.M.

1992-01-01

The prioritization of solid waste disposal options in terms of reduced risk to workers, the public, and the environment has recently generated considerable governmental and public interest. In this paper we address the development of a methodology to establish priorities for waste disposal options, such as incineration, landfills, long-term storage, waste minimization, etc. The study is one result of an overall project to develop methodologies for Probabilistic Risk Assessments (PRAs) of non-reactor nuclear facilities for the US Department of Energy. Option preferences are based on a levelized cost-risk reduction analysis. Option rankings are developed as functions of disposal option cost and timing, relative long- and short-term risks, and possible accident scenarios. We examine the annual costs and risks for each option over a large number of years. Risk, in this paper, is defined in terms of annual fatalities (both prompt and long-term) and environmental restoration costs that might result from either an accidental release or long-term exposure to both plant workers and the public near the site or facility. We use event timing to weigh both costs and risks; near-term costs and risks are discounted less than future expenditures and fatalities. This technique levels the timing of cash flows and benefits by converting future costs and benefits to present value costs and benefits. We give an example Levelized Cost-Benefit Analysis of incinerator location options to demonstrate the methodology and required data

Reduction of cost of poor quality in nuclear fuel manufacturing

International Nuclear Information System (INIS)

Holmqvist, B.

2000-01-01

Within ABB reduction of Cost of Poor Quality (COPQ) has become an important process to focus quality improvement initiatives on bottom-line results. The process leads to improved bottom-line results, through cost savings, but it also leads to quality improvements in our processes, products and services. The traditional way of measuring and controlling COPQ in the production workshops is not enough. It is of vital importance to include other non-value creating costs as well, both internally, e.g. in the engineering work, and externally, in delivered products and purchased goods. ABB Atom has since a number of years used the COPQ process in the various steps of nuclear fuel manufacturing. The definition has been expanded to cover, for instance: Scrap, rework and deviations; Margin slippage; Warranty costs; Lack of supplier performance; Excess and obsolete inventory. Each of the COPQ elements has a responsible 'owner' within the management of the Nuclear Fuel Division. The owners form a COPQ task force, which is responsible for analyzing results, setting goals and initiating improvement actions. The COPQ result is updated each month and is presented to all employees in several ways, such as Intranet. For the various COPQ elements improvement initiatives have been implemented. The presentation will describe some of them, such as reduction of: Scrap, rework and deviations through a process with zero defect meetings, high level of process automation, statistical methods; Margin slippage through business process re-engineering; Warranty costs through an improved design review process and expanded testing of new products; Costs for lack in supplier performance through a new concept for supplier QA/QC. It is our strong belief that both ABB Atom and our Customers will benefit from the COPQ process since it leads to a higher quality for nuclear fuel and control rods and facilitates lower product prices. (author)

Seeking the competitive advantage: it's more than cost reduction.

Science.gov (United States)

South, S F

1999-01-01

Most organizations focus considerable time and energy on reducing operating costs as a way to attain marketplace advantage. This strategy was not inappropriate in the past. To be competitive in the future, however, focus must be placed on other issues, not just cost reduction. The near future will be dominated by service industries, knowledge management, and virtual partnerships, with production optimization and flexibility, innovation, and strong partnerships defining those organizations that attain competitive advantage. Competitive advantage will reside in clarifying the vision and strategic plan, reviewing and redesigning work processes to optimize resources and value-added work, and creating change-ready environments and empowered workforces.

Understanding the reductions in US corn ethanol production costs: an experience curve approach

NARCIS (Netherlands)

Hettinga, W.; Junginger, H.M.; Dekker, S.C.; Hoogwijk, M.; McAloon, A.; Hicks, K.

2009-01-01

The US is currently the world's largest ethanol producer. An increasing percentage is used as transportation fuel, but debates continue on its costs competitiveness and energy balance. In this study, technological development of ethanol production and resulting cost reductions are investigated by

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."

COST OF PRIMARY HEALTH CARE IN PAKISTAN.

Science.gov (United States)

Malik, Muhammad Ashar; Gul, Wahid; Iqbal, Saleem Perwaiz; Abrejo, Farina

2015-01-01

Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan. Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005-06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits to BHUs. Perspective on cost estimates was district-based health planning and management of BHUs. Average recurring cost was PKR.245 (USD 4.1) per OPV to BHU. Staff salaries constituted 90% of recurrent cost. On the average there were 16 OPV per day to the BHUs. CONCLUDION: Recurrent cost per OPV has doubled from the previous estimates of cost of OPV in Baluchistan. The estimated recurrent cost was six times higher than average consultation charges with the private general practitioner (GP) in the country (i.e., PKR 50/ GP consultation). Performance of majority of the BHUs was much lower than the performance target (50 patients per day) set in the sixth five-year plan of the government of Pakistan. The Government of Pakistan may use these analyses to revisit the performance target, staffinL and location of BHUs.

Risk management study for the Hanford Site facilities: Risk reduction cost comparison for the retired Hanford Site facilities

International Nuclear Information System (INIS)

Coles, G.A.; Egge, R.G.; Senger, E.; Shultz, M.W.; Taylor, W.E.

1994-02-01

This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km 2 Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This cost-comparison evaluation (1) determines relative costs for reducing risk to acceptable levels; (2) compares the cost of reducing risk using different risk-reduction options; and (3) compares the cost of reducing risks at different facilities. The result is an identification of the cost effective risk-reduction measures. Supporting information required to develop costs of the various risk-reduction options also is included

Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China.

Science.gov (United States)

Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

2016-12-01

Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m 2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m 3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m 3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

Estimating the mental health costs of racial discrimination

Directory of Open Access Journals (Sweden)

Amanuel Elias

2016-11-01

Full Text Available Abstract Background Racial discrimination is a pervasive social problem in several advanced countries such as the U.S., U.K., and Australia. Public health research also indicates a range of associations between exposure to racial discrimination and negative health, particularly, mental health including depression, anxiety, and post-traumatic stress disorder (PTSD. However, the direct negative health impact of racial discrimination has not been costed so far although economists have previously estimated indirect non-health related productivity costs. In this study, we estimate the burden of disease due to exposure to racial discrimination and measure the cost of this exposure. Methods Using prevalence surveys and data on the association of racial discrimination with health outcomes from a global meta-analysis, we apply a cost of illness method to measure the impact of racial discrimination. This estimate indicates the direct health cost attributable to racial discrimination and we convert the estimates to monetary values based on conventional parameters. Results Racial discrimination costs the Australian economy 235,452 in disability adjusted life years lost, equivalent to $37.9 billion per annum, roughly 3.02% of annual gross domestic product (GDP over 2001–11, indicating a sizeable loss for the economy. Conclusion Substantial cost is incurred due to increased prevalence of racial discrimination as a result of its association with negative health outcomes (e.g. depression, anxiety and PTSD. This implies that potentially significant cost savings can be made through measures that target racial discrimination. Our research contributes to the debate on the social impact of racial discrimination, with implications for policies and efforts addressing it.

Cost reduction potentials of offshore wind power in Germany

International Nuclear Information System (INIS)

Hobohm, Jens; Krampe, Leonard; Peter, Frank

2014-01-01

Offshore wind power is a major hope for the German energy turnaround. However, it will only be possible to tap its cost reduction potentials if industry, the political leadership and the administrative authorities join forces to create the necessary preconditions. An important requirement for this capital-intensive technology are stable legal and political framework conditions. A recent study on the future shows what needs to be done.

Health Advocacy--Counting the Costs

Science.gov (United States)

Dyall, Lorna; Marama, Maria

2010-01-01

Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of…

Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje

DEFF Research Database (Denmark)

Sanchez Martinez, Gerardo; Spadaro, Joseph V.; Chapizanis, Dimitris

2018-01-01

the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. In 2012, long-term exposure to PM2.5 (49.2 μg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution...... was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 μg/m³) could have....... Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city....

48 CFR 52.215-11 - Price Reduction for Defective Certified Cost or Pricing Data-Modifications.

Science.gov (United States)

2010-10-01

... accordingly and the contract shall be modified to reflect the reduction. This right to a price reduction is... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Price Reduction for... CONTRACT CLAUSES Text of Provisions and Clauses 52.215-11 Price Reduction for Defective Certified Cost or...

Distance education for tobacco reduction with Inuit frontline health workers.

Science.gov (United States)

Collins, Rob; Hammond, Merryl; Carry, Catherine L; Kinnon, Dianne; Killulark, Joan; Nevala, Janet

2013-01-01

Tobacco reduction is a major priority in Canadian Inuit communities. However, many Inuit frontline health workers lacked the knowledge, confidence and support to address the tobacco epidemic. Given vast distances, high costs of face-to-face training and previous successful pilots using distance education, this method was chosen for a national tobacco reduction course. To provide distance education about tobacco reduction to at least 25 frontline health workers from all Inuit regions of Canada. Promising practices globally were assessed in a literature survey. The National Inuit Tobacco Task Group guided the project. Participants were selected from across Inuit Nunangat. They chose a focus from a "menu" of 6 course options, completed a pre-test to assess individual learning needs and chose which community project(s) to complete. Course materials were mailed, and trainers provided intensive, individualized support through telephone, fax and e-mail. The course ended with an open-book post-test. Follow-up support continued for several months post-training. Of the 30 participants, 27 (90%) completed the course. The mean pre-test score was 72% (range: 38-98%). As the post-test was done using open books, everyone scored 100%, with a mean improvement of 28% (range: 2-62%). Although it was often challenging to contact participants through phone, a distance education approach was very practical in a northern context. Learning is more concrete when it happens in a real-life context. As long as adequate support is provided, we recommend individualized distance education to others working in circumpolar regions.

Annual Energy Usage Reduction and Cost Savings of a School: End-Use Energy Analysis

Science.gov (United States)

Alghoul, M. A.; Bakhtyar, B.; Asim, Nilofar; Sopian, K.

2014-01-01

Buildings are among the largest consumers of energy. Part of the energy is wasted due to the habits of users and equipment conditions. A solution to this problem is efficient energy usage. To this end, an energy audit can be conducted to assess the energy efficiency. This study aims to analyze the energy usage of a primary school and identify the potential energy reductions and cost savings. A preliminary audit was conducted, and several energy conservation measures were proposed. The energy conservation measures, with reference to the MS1525:2007 standard, were modelled to identify the potential energy reduction and cost savings. It was found that the school's usage of electricity exceeded its need, incurring an excess expenditure of RM 2947.42. From the lighting system alone, it was found that there is a potential energy reduction of 5489.06 kWh, which gives a cost saving of RM 2282.52 via the improvement of lighting system design and its operating hours. Overall, it was found that there is a potential energy reduction and cost saving of 20.7% when the energy conservation measures are earnestly implemented. The previous energy intensity of the school was found to be 50.6 kWh/m2/year, but can theoretically be reduced to 40.19 kWh/mm2/year. PMID:25485294

Health care costs: saving in the private sector.

Science.gov (United States)

Robeson, F E

1979-01-01

Robeson offers a number of options to employers to help reduce the impact of increasing health care costs. He points out that large organizations which employ hundreds of people have considerable market power which can be exerted to contain costs. It is suggested that the risk management departments assume the responsibility for managing the effort to reduce the costs of medical care and of the health insurance programs of these organizations since that staff is experienced at evaluating premiums and negotiating with third-party payors. The article examines a number of short-run strategies for firms to pursue to contain health care costs: (1) use alternative delivery systems such as health maintenance organizations (HMOs) which have cost-cutting potential but require marketing efforts to persuade employees of their desirability; (2) contracts with third-party payors which require a second opinion (peer review), a practice which saved one labor union over $2 million from 1972 to 1976; (3) implementation of insurance coverage for less expensive outpatient care; and (4) the use of claims review. These strategies are compared in terms of four criteria: supply of demand for health services; management effort; cost; and time necessary for realized savings. Robeson concludes that development of a management plan for containing health care costs requires an extensive analysis of alternatives, organizational objectives, existing policies, and resources, and offers a table summarizing the cost-containment strategies that a firm should consider.

Public risk-reduction measures: cost-effectiveness from a global point-of-view

International Nuclear Information System (INIS)

Oliveira, L.F.S. de; Motta Barros, E.B. da; Fleming, P.V.; Rosa, L.P.

1985-05-01

A review of systemic or global approach to cost-effectiveness analysis of risk-reduction measures is presented, and its advantages and limitations are discussed. The method is applied for problem of the cost-effectiveness of increasing the Angra 3 reactor containment wall thickness from 60cm to 180cm thick, in case of a direct commercial aircraft crash on it. (Author) [pt

Costs and Performance of English Mental Health Providers.

Science.gov (United States)

Moran, Valerie; Jacobs, Rowena

2017-06-01

Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. The results suggest that some providers may have to increase

COST OF SELECTIVE CATALYTIC REDUCTION (SCR) APPLICATION FOR NOX CONTROL ON COAL-FIRED BOILERS

Science.gov (United States)

The report provides a methodology for estimating budgetary costs associated with retrofit applications of selective catalytic reduction (SCR) technology on coal-fired boilers. SCR is a postcombustion nitrogen oxides (NOx) control technology capable of providing NOx reductions >90...

Reduction in Fabrication Costs of Gas Diffusion Layers

Energy Technology Data Exchange (ETDEWEB)

Jason Morgan; Donald Connors; Michael Hickner

2012-07-10

Ballard Material Products (BMP) performed a pre-design technical and cost analysis of state of the art production technologies feasible for high volume GDL manufacturing. Based upon criteria that also included environmental health and safety, customer quality requirements, and future needs, BMP selected technologies that can be integrated into its current manufacturing process. These selections included Many-At-A-Time (MAAT) coating and continuous mixing technologies, as well as various on-line process control tools. These processes have allowed BMP to produce high performance GDLs at lower cost for near-term markets, as well as to define the inputs needed to develop a conceptual Greenfield facility to meet the cost targets for automotive volumes of 500,000 vehicles per year.

Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis.

Science.gov (United States)

Bray, Nathan; Burns, Paul; Jones, Alice; Winrow, Eira; Edwards, Rhiannon Tudor

2017-12-01

We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing. An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards. Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (-£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

Health insurance, cost expectations, and adverse job turnover.

Science.gov (United States)

Ellis, Randall P; Albert Ma, Ching-To

2011-01-01

Because less healthy employees value health insurance more than the healthy ones, when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover, and it implies that a firm's expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes, or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs, some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999 MEDSTAT MarketScan and 1997 Employer Health Insurance Survey data, we find that expected employee health expenditures at firms that offer insurance have lower within-firm and higher between-firm variance than at firms that do not. Turnover rates are systematically higher in industries in which firms are less likely to offer insurance. Simulations of the offer decision capturing between-firm health-cost heterogeneity and expected turnover rates match the observed pattern across firm sizes well. 2010 John Wiley & Sons, Ltd.

Learning Together; part 2: training costs and health gain - a cost analysis.

Science.gov (United States)

Cullen, Katherine; Riches, Wendy; Macaulay, Chloe; Spicer, John

2017-01-01

Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. Activity data was collected from Training Practices hosting Learning Together. A computer based model was developed to analyse the costs of the Learning Together intervention compared to usual training in a partial economic evaluation. The results of the model were used to value the health gain required to make the intervention cost effective. Data were returned for 363 patients booked into 61 clinics across 16 Training Practices. Learning Together clinics resulted in an increase in costs of £37 per clinic. Threshold analysis illustrated one child with a common illness like constipation needs to be well for two weeks, in one Practice hosting four training clinics for the clinics to be considered cost effective. Learning Together is of minimal training cost. Our threshold analysis produced a rubric that can be used locally to test cost effectiveness at a Practice or Programme level.

Reduction in sick leave and costs to society of patients with Meniere's disease after treatment of temporomandibular and cervical spine disorders: a controlled six-year cost-benefit study.

Science.gov (United States)

Bjorne, Assar; Agerberg, Göran

2003-04-01

This study compares the frequency of sick leave between the three-year period after and the three-year period before coordinated treatment of temporomandibular and cervical spine disorders in 24 patients (ten males and 14 females) diagnosed with Meniere's disease. The frequency of sick leave for the patients was also compared with the frequency of sick leave in a control group from the population. A cost-benefit analysis was made regarding the costs to society of sick leave related to the treatment costs of the patients. In a previous study the same patients were treated for their severe signs and symptoms of temporomandibular and cervical spine disorders, and they reported a substantial reduction in their vertigo, non-whirling dizziness, tinnitus, feeling of fullness in the ear, pain in the face and jaws, pain in the neck and shoulders, and headache. The number of days of sick leave and the year the patient began to receive disability pension due to the symptoms of Meniere's disease were obtained from the National Health Insurance Service in Sweden. Two of the patients received disability pension benefits due to Meniere's disease 17 years prior to their normal retirement pension. A third patient received disability pension for another reason and two were receiving a retirement pension. Data on the remaining 19 patients showed a considerable reduction in number of days of sick leave during the three-year period after coordinated treatment (270 days) compared with the three-year period before the treatment (1,536 days). The control subjects used a total of 14 days sick leave for the same symptoms during the same six-year period. Vertigo (nine days) was the dominant cause followed by pain in the neck and shoulders, and headache. The reduction in sick leave for the 19 nonretired patients and the treatment costs for the 24 patients can be used for a simple cost-benefit calculation for the subgroup of nonretired patients. During the first three years after treatment the

Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study

OpenAIRE

Prof Anil Markandya, PhD; Jon Sampedro, MSc; Steven J Smith, PhD; Rita Van Dingenen, PhD; Cristina Pizarro-Irizar, PhD; Prof Iñaki Arto, PhD; Prof Mikel González-Eguino, PhD

2018-01-01

Background: Although the co-benefits from addressing problems related to both climate change and air pollution have been recognised, there is not much evidence comparing the mitigation costs and economic benefits of air pollution reduction for alternative approaches to meeting greenhouse gas targets. We analysed the extent to which health co-benefits would compensate the mitigation cost of achieving the targets of the Paris climate agreement (2°C and 1·5°C) under different scenarios in which ...

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

Science.gov (United States)

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

2012-02-23

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

Reduction of capital costs of nuclear power plants. NEA-report

International Nuclear Information System (INIS)

2000-01-01

Since the the mid-1980s, the declining real prices of fossil fuels and the significant improvements in thermal efficiencies of combined cycle power plants have eroded the economic competitiveness of nuclear power plants in most OECD countries. In order for nuclear power to remain a viable option for the next millennium, the cost of electricity from nuclear power plant must be greatly reduced to be competitive with alternative sources. Of the three major components of nuclear generation cost - capital, O and M and fuel - the capital cost component makes up approximately 60 per cent of the total. Therefore, identification of the means to reduce the capital costs of nuclear power plants is a high priority activity toward keeping nuclear power competitive. Among a number of capital cost reduction measures, the principal ones were agreed by the expert group as follows: Increased plant size, improved construction methods, reduced construction schedule, design improvement, improved procurement, organisation and contractual aspects, standardisation and construction in series, multiple unit construction, regulatory and policy reform. (orig.)

Beyond the learning curve: factors influencing cost reductions in photovoltaics

International Nuclear Information System (INIS)

Nemet, Gregory F.

2006-01-01

The extent and timing of cost-reducing improvements in low-carbon energy systems are important sources of uncertainty in future levels of greenhouse-gas emissions. Models that assess the costs of climate change mitigation policy, and energy policy in general, rely heavily on learning curves to include technology dynamics. Historically, no energy technology has changed more dramatically than photovoltaics (PV), the cost of which has declined by a factor of nearly 100 since the 1950s. Which changes were most important in accounting for the cost reductions that have occurred over the past three decades? Are these results consistent with the notion that learning from experience drove technical change? In this paper, empirical data are assembled to populate a simple model identifying the most important factors affecting the cost of PV. The results indicate that learning from experience, the theoretical mechanism used to explain learning curves, only weakly explains change in the most important factors-plant size, module efficiency, and the cost of silicon. Ways in which the consideration of a broader set of influences, such as technical barriers, industry structure, and characteristics of demand, might be used to inform energy technology policy are discussed

Explaining the reductions in US corn ethanol processing costs: Testing competing hypotheses

International Nuclear Information System (INIS)

Chen Xiaoguang; Khanna, Madhu

2012-01-01

The processing costs of US corn ethanol have declined by 45% since 1983 as production volumes have increased seventeen-fold. We investigate the role of various factors that could explain this, including economies of scale, cumulative experience, induced innovation in response to rising input prices, an autonomous technological change, and trade induced competition from imported ethanol. Using data on dry-mill ethanol processing costs over the 1983–2005 period, we find evidence to show that US corn ethanol production exhibited decreasing returns to scale, that learning by doing played an important role in reducing these processing costs with a learning rate of 0.25, and that sugarcane ethanol imports contributed to making the corn ethanol industry more competitive. Other factors such as the rising prices of energy and labor did induce lower processing costs, but the effect is not statistically significant. The inclusion of these competing explanations for the reduction in processing costs of US corn ethanol lead to a significantly higher learning rate than otherwise, and this learning rate is found to be robust across specifications. - Highlights: ► We investigate the role of various factors that could explain the reduction in US corn ethanol processing costs over the period 1983–2005. ► We find that US corn ethanol production exhibited decreasing returns to scale. ► Learning by doing played an important role in reducing these costs with a learning rate of 0.25. ► Sugarcane ethanol imports contributed to making the corn ethanol industry more competitive. ► Rising prices of energy and labor did induce lower processing costs, but the effect is not statistically significant.

Practice Innovation, Health Care Utilization and Costs in a Network of Federally Qualified Health Centers and Hospitals for Medicaid Enrollees.

Science.gov (United States)

Johnson, Tricia J; Jones, Art; Lulias, Cheryl; Perry, Anthony

2018-06-01

State Medicaid programs need cost-effective strategies to provide high-quality care that is accessible to individuals with low incomes and limited resources. Integrated delivery systems have been formed to provide care across the continuum, but creating a shared vision for improving community health can be challenging. Medical Home Network was created as a network of primary care providers and hospital systems providing care to Medicaid enrollees, guided by the principles of egalitarian governance, practice-level care coordination, real-time electronic alerts, and pay-for-performance incentives. This analysis of health care utilization and costs included 1,189,195 Medicaid enrollees. After implementation of Medical Home Network, a risk-adjusted increase of $9.07 or 4.3% per member per month was found over the 2 years of implementation compared with an increase of $17.25 or 9.3% per member per month, before accounting for the cost of care management fees and other financial incentives, for Medicaid enrollees within the same geographic area with a primary care provider outside of Medical Home Network. After accounting for care coordination fees paid to providers, the net risk-adjusted cost reduction was $11.0 million.

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.

Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States.

Science.gov (United States)

Peterson, Cora; Grosse, Scott D; Li, Rui; Sharma, Andrea J; Razzaghi, Hilda; Herman, William H; Gilboa, Suzanne M

2015-01-01

Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC)-preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States. Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs. We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost. Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care. Published by Elsevier Inc.

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.

Explaining the experience curve: Cost reductions of Brazilian ethanol from sugarcane

International Nuclear Information System (INIS)

van den Wall Bake, J.D.; Junginger, M.; Faaij, A.; Poot, T.; Walter, A.

2009-01-01

Production costs of bio-ethanol from sugarcane in Brazil have declined continuously over the last three decades. The aims of this study are to determine underlying reasons behind these cost reductions, and to assess whether the experience curve concept can be used to describe the development of feedstock costs and industrial production costs. The analysis was performed using average national costs data, a number of prices (as a proxy for production costs) and data on annual Brazilian production volumes. Results show that the progress ratio (PR) for feedstock costs is 0.68 and 0.81 for industrial costs (excluding feedstock costs). The experience curve of total production costs results in a PR of 0.80. Cost breakdowns of sugarcane production show that all sub-processes contributed to the total, but that increasing yields have been the main driving force. Industrial costs mainly decreased because of increasing scales of the ethanol plants. Total production costs at present are approximately 340 US$/m ethanol 3 (16 US$/GJ). Based on the experience curves for feedstock and industrial costs, total ethanol production costs in 2020 are estimated between US$ 200 and 260/m 3 (9.4-12.2 US$/GJ). We conclude that using disaggregated experience curves for feedstock and industrial processing costs provide more insights into the factors that lowered costs in the past, and allow more accurate estimations for future cost developments. (author)

Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis.

Science.gov (United States)

Pearson-Stuttard, Jonathan; Kypridemos, Chris; Collins, Brendan; Mozaffarian, Dariush; Huang, Yue; Bandosz, Piotr; Capewell, Simon; Whitsel, Laurie; Wilde, Parke; O'Flaherty, Martin; Micha, Renata

2018-04-01

Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy. We used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect

Cost-effectiveness analysis of risk reduction at nuclear power plants

International Nuclear Information System (INIS)

Lochard, J.; Maccia, C.; Pages, P.

1985-01-01

Cost-effectiveness analysis of risk reduction is now widely accepted as a rational analytical framework to consistently address the resource allocation problem underlying any risk management process. This paper presents how this technique can be usefully applied to complex systems such as the management of radioactive releases from nuclear power plants into the environment. (orig.) [de

The high price of depression: Family members' health conditions and health care costs.

Science.gov (United States)

Ray, G Thomas; Weisner, Constance M; Taillac, Cosette J; Campbell, Cynthia I

2017-05-01

To compare the health conditions and health care costs of family members of patients diagnosed with a Major Depressive Disorder (MDD) to family members of patients without an MDD diagnosis. Using electronic health record data, we identified family members (n=201,914) of adult index patients (n=92,399) diagnosed with MDD between 2009 and 2014 and family members (n=187,011) of matched patients without MDD. Diagnoses, health care utilization and costs were extracted for each family member. Logistic regression and multivariate models were used to compare diagnosed health conditions, health services cost, and utilization of MDD and non-MDD family members. Analyses covered the 5years before and after the index patient's MDD diagnosis. MDD family members were more likely than non-MDD family members to be diagnosed with mood disorders, anxiety, substance use disorder, and numerous other conditions. MDD family members had higher health care costs than non-MDD family members in every period analyzed, with the highest difference being in the year before the index patient's MDD diagnosis. Family members of patients with MDD are more likely to have a number of health conditions compared to non-MDD family members, and to have higher health care cost and utilization. Copyright © 2017. Published by Elsevier Inc.

[Costs of maternal-infant care in an institutionalized health care system].

Science.gov (United States)

Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

1998-01-01

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

Possibility of material cost reduction toward development of low-cost second-generation superconducting wires

Science.gov (United States)

Ichinose, Ataru; Horii, Shigeru; Doi, Toshiya

2017-10-01

Two approaches to reducing the material cost of second-generation superconducting wires are proposed in this paper: (1) instead of the electrical stabilizing layers of silver and copper presently used on the superconducting layer, a Nb-doped SrTiO3 conductive buffer layer and cube-textured Cu are proposed as an advanced architecture, and (2) the use of an electromagnetic (EM) steel tape as a metal substrate of coated conductors in a conventional architecture. In structures fabricated without using electrical stabilizing layers on the superconducting layer, the critical current density achieved at 77 K in a self-field was approximately 2.6 MA/cm2. On the other hand, in the case of using EM steel tapes, although the critical current density was far from practical at the current stage, the biaxial alignment of YBa2Cu3O y (YBCO) and buffer layers was realized without oxidation on the metal surface. In this study, the possibility of material cost reduction has been strongly indicated toward the development of low-cost second-generation superconducting wires in the near future.

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

The Correlation of a Corporate Culture of Health Assessment Score and Health Care Cost Trend.

Science.gov (United States)

Fabius, Raymond; Frazee, Sharon Glave; Thayer, Dixon; Kirshenbaum, David; Reynolds, Jim

2018-02-19

Employers that strive to create a corporate environment that fosters a culture of health often face challenges when trying to determine the impact of improvements on health care cost trends. This study aims to test the stability of the correlation between health care cost trend and corporate health assessment scores (CHAS) using a culture of health measurement tool. Correlation analysis of annual health care cost trend and CHAS on a small group of employers using a proprietary CHAS tool. Higher CHAS scores are generally correlated with lower health care cost trend. For employers with several years of CHAS measurements, this correlation remains, although imperfectly. As culture of health scores improve, health care costs trends moderate. These findings provide further evidence of the inverse relationship between organizational CHAS performance and health care cost trend.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0.

A tutorial on activity-based costing of electronic health records.

Science.gov (United States)

Federowicz, Marie H; Grossman, Mila N; Hayes, Bryant J; Riggs, Joseph

2010-01-01

As the American Recovery and Restoration Act of 2009 allocates $19 billion to health information technology, it will be useful for health care managers to project the true cost of implementing an electronic health record (EHR). This study presents a step-by-step guide for using activity-based costing (ABC) to estimate the cost of an EHR. ABC is a cost accounting method with a "top-down" approach for estimating the cost of a project or service within an organization. The total cost to implement an EHR includes obvious costs, such as licensing fees, and hidden costs, such as impact on productivity. Unlike other methods, ABC includes all of the organization's expenditures and is less likely to miss hidden costs. Although ABC is used considerably in manufacturing and other industries, it is a relatively new phenomenon in health care. ABC is a comprehensive approach that the health care field can use to analyze the cost-effectiveness of implementing EHRs. In this article, ABC is applied to a health clinic that recently implemented an EHR, and the clinic is found to be more productive after EHR implementation. This methodology can help health care administrators assess the impact of a stimulus investment on organizational performance.

Cost reduction potentials in the German market for balancing power

International Nuclear Information System (INIS)

Flinkerbusch, Kai; Heuterkes, Michael

2010-01-01

This article examines potential cost reductions in the market for balancing power by pooling all four German control areas. In a united control area both the procurement and the production of balancing power may be more efficient than in four separated control areas. Our data contain bids on energy procurement as well as balancing power flows in the period from December 2007 to November 2008. A reference scenario simulates the market results for secondary and tertiary balancing power. Subsequently, we simulate a united control area. We show that in the period under review the total costs of balancing power are reduced by 17%. (author)

Accounting for Health and Safety costs

DEFF Research Database (Denmark)

Rikhardsson, Pall M.

A part of the emerging sustainability management accounting is corporate health and safety performance. One performance dimension is the costs of occupational accidents in companies. The underlying logic for calculating these costs is that if occupational accidents are prevented then these costs...... could be avoided. This chapter presents and discusses selected methods for calculating the costs of occupational accidents. The focus is on presenting the characteristics of each method and disclosing the benefits and drawbacks of each method...

A Review of Last Mile Logistics Innovations in an Externalities Cost Reduction Vision

Directory of Open Access Journals (Sweden)

Luigi Ranieri

2018-03-01

Full Text Available In this paper, a review of the recent scientific literature contributions on innovative strategies for last mile logistics, focusing on externalities cost reduction, is presented. Transport is causing problems in urban areas, in particular in freight transport: modern cities need solutions to reduce externalities costs such as congestion, pollution and others, which have increased in the last few years, especially due to the growth of goods delivery. Online sales and globalization lead to new trends in freight transport, and moreover, a larger quantity of goods is expected to be delivered in the next future. In this context, most of the delivered goods end up in the city centers. Last mile logistics is the least efficient stage of the supply chain and comprises up to 28% of the total delivery cost. Therefore, the improvement of last mile logistics and a significant externalities reduction are very important challenges for researchers. New technologies and transport means, innovative techniques and organizational strategies allow handling in a more effective way the last mile delivery in urban areas. Based on the Systematic Literature Review (SLR method, recent papers that significantly contributed, with original proposals, to the reduction of externalities in urban logistics are identified and analyzed in this work. Furthermore, a classification of the papers dealing with the externality reduction problem is presented. It is consistent with a general formulation proposed to evaluate external costs in urban area. The innovative contributions are classified into five main categories: innovative vehicles, proximity stations or points, collaborative and cooperative urban logistics, optimization of transport management and routing, innovations in public policies and infrastructures. The new paradigm of smart logistics is based on the combination of these concepts and on the proposed innovations.

Community Mental Health Clinic Cost Reports

Data.gov (United States)

U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Community Mental Health Center (CMHC). This data was reported on form CMS-2088-92. The data in this...

A probabilistic production costing analysis of SO2 emissions reduction strategies for Ohio: emissions, costs and employment tradeoffs

International Nuclear Information System (INIS)

Heslin, J.S.; Hobbs, B.F.

1991-01-01

A new approach for state- and utility-level analysis of the cost and regional economic impacts of strategies for reducing utility SO 2 emissions is summarized and applied to Ohio. The methodology is based upon probabilistic production costing and economic input-output analysis. It is an improvement over previous approaches because it: (1) accurately models random outages of generating units, 'must-run' constraints on unit output, and the distribution of power demands; and (2) runs quickly on a microcomputer and yet considers the entire range of potential control strategies from a systems perspective. The input-output analysis considers not only the economic effects of utility fuel use and capital investment, but also those of increased electric rates. Two distinct strategies are found to be most attractive for Ohio. The first, more flexible one, consists of emissions dispatching (ED) alone to meet short run emissions reduction targets. A 75 percent reduction can then be achieved by the turn of the century by combining ED and fuel switching (FS) with flue gas desulfurization, limestone injection multistage burners, and physical coal cleaning at selected plants. The second is a scrubber-based strategy which includes ED. By the year 2000, energy conservation becomes a cost effective component of these strategies. In order to minimize compliance costs, acid rain legislation which facilitates emission trading and places regional tonnage limits on emissions is desirable

Cost reduction and safety design features of new nuclear power plants in India. Annex 13

International Nuclear Information System (INIS)

Sharma, V.K.

2002-01-01

Indian Nuclear Power Programme is designed to exploit limited reserves of uranium and extensive resource of thorium. Pressurised heavy water reactors are found most suitable and form the main stay of the first stage of the programme. Thorium utilisation is achieved in the second and third stages. Today India has total installed capacity of 2720 MWe of PHWRs which are operating with high plant load factors of over 80%. Rich experience of construction and operation of over 150 reactor years is being utilised in effecting cost reduction and safety improvements. Standardisation and reduction in gestation period by preproject activities, advance procurement and work packages of engineer, procure, construct and commission are some of the techniques being adopted for cost reduction in the new projects. But the cost of safety is rising. Design basis event of double ended guillotine rupture of primary pressure boundary needs a relook based on current knowledge of material behaviour. This event appears improbable. Similarly some of the safety related systems like closed loop cooling water operating at low temperature and pressure, and low usage factors may be designed as per standard codes without invoking special nuclear requirements. The paper will address these issues and highlight the possible areas for cost reduction both in operating and safety systems. Modern construction and project management techniques are being employed. Gestation period of 5 years and cost of less than US $1400 per KWe are the present targets. In Indian environment nuclear power is found to be competitive with thermal power plants at distances of about 800 Kms from the coal mines. (author)

Cost-effectiveness analysis of risk reduction at nuclear power plants: What have we learned from experience

International Nuclear Information System (INIS)

Lochard, J.; Pages, P.

1984-01-01

Within the field of risk management techniques, cost-effectiveness analysis of risk reduction is now recognized as an adequate method for evaluating and defining the optimal allocation of protection and safety resources within large industrial systems. The paper considers some of the issues that arise in connection with cost-effectiveness analysis of risk reduction at nuclear power stations. Particular attention is called to both the interdependence between criteria that characterize risk reduction problems and the resulting aggregation and weighting procedures needed when the multidimensionality of criteria is explicitly taken into account. The discussion of these problems is illustrated with results of case studies on both public and occupational risk reduction at French PWRs during normal operation. (author)

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

Energy Technology Data Exchange (ETDEWEB)

Scott, Michael T. [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (United States); Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States)

2016-10-01

Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P<.0001). With a >16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.

Science.gov (United States)

Scott, Michael T; Todd, Kimberly E; Oakley, Heather; Bradley, Julie A; Rotondo, Ronny L; Morris, Christopher G; Klein, Stuart; Mendenhall, Nancy P; Indelicato, Daniel J

2016-10-01

To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of "$[(anesthesia cost to payer during radiation therapy course/6) - (CCLS expense to payer/N)]" per child (N) treated with radiation therapy, where N equals the number of children aged 3 to 12�

Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

International Nuclear Information System (INIS)

Scott, Michael T.; Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P.; Indelicato, Daniel J.

2016-01-01

Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P 16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation therapy, where N

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

Directory of Open Access Journals (Sweden)

Phillips Ceri J

2012-02-01

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

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

Science.gov (United States)

Ekwaru, John Paul; Ohinmaa, Arto; Tran, Bach Xuan; Setayeshgar, Solmaz; Johnson, Jeffrey A; Veugelers, Paul J

2017-01-01

The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach. We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICERSchool-based health promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.

Cost-effectiveness in fall prevention for older women.

Science.gov (United States)

Hektoen, Liv F; Aas, Eline; Lurås, Hilde

2009-08-01

The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the > or = 80-year age group in Norway. The impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimated reduction in the number of falls obtained with the chosen programme, we calculated the incremental costs and the incremental effect of the exercise programme as compared with no prevention. The calculation of the average healthcare cost of falling was based on assumptions regarding the distribution of fall injuries reported in the literature, four constructed representative case histories, assumptions regarding healthcare provision associated with the treatment of the specified cases, and estimated unit costs from Norwegian cost data. We calculated the average healthcare costs per fall for the first year. We found that the reduction in healthcare costs per individual for treating fall-related injuries was 1.85 times higher than the cost of implementing a fall prevention programme. The reduction in healthcare costs more than offset the cost of the prevention programme for women aged > or = 80 years living at home, which indicates that health authorities should increase their focus on prevention. The main intention of this article is to stipulate costs connected to falls among the elderly in a transparent way and visualize the whole cost picture. Cost-effectiveness analysis is a health policy tool that makes politicians and other makers of health policy conscious of this complexity.

Estimating the Cost of Providing Foundational Public Health Services.

Science.gov (United States)

Mamaril, Cezar Brian C; Mays, Glen P; Branham, Douglas Keith; Bekemeier, Betty; Marlowe, Justin; Timsina, Lava

2017-12-28

To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. The average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation. © Health Research and Educational Trust.

Reducing health care costs - potential and limitations of local ...

African Journals Online (AJOL)

Reducing health care costs - potential and limitations of local authority health services. ... both the quality and the cost-effectiveness of health care would be improved. ... LAs offer an appropriate structure for effective community control over the ...

[Evaluating cost/equity in the Colombian health system, 1998-2005].

Science.gov (United States)

Eslava-Schmalbach, Javier; Barón, Gilberto; Gaitán-Duarte, Hernando; Alfonso, Helman; Agudelo, Carlos; Sánchez, Carolina

2008-01-01

An economic analysis of cost-equity (from society's viewpoint) for evaluating the impact of Law 100/93 in Colombia between 1998 and 2005. An economic analysis compared costs and equity in health in Colombia between 1998 and 2005. Data was taken from the Colombian Statistics' Administration Department ( Departamento Administrativo Nacional de Estadistica - DANE) and from national demographic and health surveys carried out in 2000 and 2005. Information regarding costs was taken from the National Health Accounts' System. Inequity in Health was considered in line with the Inequity in Health Index (IHI). Incremental and average cost-equity analysis covered three sub-periods; 1998-1999 (during which time per capita gross internal product became reduced in Colombia ), 2000-2001 (during which time total health expense became reduced) and 2001 -2005. An unstable tendency for inequity in health becoming reduced during the period was revealed. There was an inverse relationship between IHI and public health spending and a direct relationship between out-of-pocket spending on health and equity in health (Spearman, p<0.05). The second period had the best incremental cost-equity ratio. Fluctuations in IHI and marginal cost-equity during the periods being analysed suggested that health spending depended on equity in health in Colombia during the period being studied.

Cost reduction for large turbine generator Pedestal in high seismic zone

International Nuclear Information System (INIS)

Sawhney, P.S.; Irani, P.; Pusheck, B.N.

1985-01-01

Turbine Generator Pedestals have generally been designed using reinforced concrete. For present day large turbine generators (1100 MWe class and above) with tall (about 80 feet) pedestals, the amount of reinforcing steel becomes quite large, especially for plants in high seismic zones. With the prime objective of cost reduction, an approach using steel/concrete composite design has been studied for a large BWR Turbine Generator pedestal with 0.3g peak ground acceleration. Large prefabricated steel modules were adopted for composite design and simplified construction. Design was based on the ACI and AISC codes. Costs and schedules were developed and compared with those for a conventionally designed reinforced concrete pedestal. Composite design was found to give considerable cost and schedule advantage over the conventional reinforced concrete design

Risk management study for the Hanford Site facilities: Risk reduction cost comparison for the retired Hanford Site facilities. Volume 4

Energy Technology Data Exchange (ETDEWEB)

Coles, G.A.; Egge, R.G.; Senger, E.; Shultz, M.W.; Taylor, W.E.

1994-02-01

This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km{sup 2} Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This cost-comparison evaluation (1) determines relative costs for reducing risk to acceptable levels; (2) compares the cost of reducing risk using different risk-reduction options; and (3) compares the cost of reducing risks at different facilities. The result is an identification of the cost effective risk-reduction measures. Supporting information required to develop costs of the various risk-reduction options also is included.

Costs of health care across primary care models in Ontario.

Science.gov (United States)

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

Directory of Open Access Journals (Sweden)

Patricia Steinert

2016-08-01

Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

Health sector costs of self-reported food allergy in Europe: a patient-based cost of illness study

NARCIS (Netherlands)

Mugford, M.; Fox, M.; Voordouw, J.; Cornelisse-Vermaat, J.R.; Antonides, G.; Hoz Caballer, de la B.

2013-01-01

Introduction: Food allergy is a recognized health problem, but little has been reported on its cost for health services. The EuroPrevall project was a European study investigating the patterns, prevalence and socio-economic cost of food allergy. Aims: To investigate the health service cost for

Health sector costs of self-reported food allergy in Europe : A patient-based cost of illness study

NARCIS (Netherlands)

Fox, Margaret; Mugford, Miranda; Voordouw, Jantine; Cornelisse-Vermaat, Judith; Antonides, Gerrit; de la Hoz Caballer, Belen; Cerecedo, Inma; Zamora, Javier; Rokicka, Ewa; Jewczak, Maciej; Clark, Allan B; Kowalski, Marek L; Papadopoulos, Nikos; Knulst, Anna C; Seneviratne, Suranjith; Belohlavkova, Simona; Asero, Roberto; de Blay, Frederic; Purohit, Ashok; Clausen, Michael; Flokstra de Blok, Bertine; Dubois, Anthony E; Fernandez-Rivas, Montserrat; Burney, Peter; Frewer, Lynn J; Mills, Clare E N

2013-01-01

Introduction: Food allergy is a recognized health problem, but little has been reported on its cost for health services. The EuroPrevall project was a European study investigating the patterns, prevalence and socio-economic cost of food allergy. Aims: To investigate the health service cost for

48 CFR 52.215-10 - Price Reduction for Defective Certified Cost or Pricing Data.

Science.gov (United States)

2010-10-01

... Defective Certified Cost or Pricing Data. 52.215-10 Section 52.215-10 Federal Acquisition Regulations System... Text of Provisions and Clauses 52.215-10 Price Reduction for Defective Certified Cost or Pricing Data... or Pricing Data (OCT 2010) (a) If any price, including profit or fee, negotiated in connection with...

Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

Science.gov (United States)

de la Torre-Díez, Isabel; López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

2015-02-01

A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

Resolving the "Cost-Effective but Unaffordable" Paradox: Estimating the Health Opportunity Costs of Nonmarginal Budget Impacts.

Science.gov (United States)

Lomas, James; Claxton, Karl; Martin, Stephen; Soares, Marta

2018-03-01

Considering whether or not a proposed investment (an intervention, technology, or program of care) is affordable is really asking whether the benefits it offers are greater than its opportunity cost. To say that an investment is cost-effective but not affordable must mean that the (implicit or explicit) "threshold" used to judge cost-effectiveness does not reflect the scale and value of the opportunity costs. Existing empirical estimates of health opportunity costs are based on cross-sectional variation in expenditure and mortality outcomes by program budget categories (PBCs) and do not reflect the likely effect of nonmarginal budget impacts on health opportunity costs. The UK Department of Health regularly updates the needs-based target allocation of resources to local areas of the National Health Service (NHS), creating two subgroups of local areas (those under target allocation and those over). These data provide the opportunity to explore how the effects of changes in health care expenditure differ with available resources. We use 2008-2009 data to evaluate two econometric approaches to estimation and explore a range of criteria for accepting subgroup specific effects for differences in expenditure and outcome elasticities across the 23 PBCs. Our results indicate that health opportunity costs arising from an investment imposing net increases in expenditure are underestimated unless account is taken of likely nonmarginal effects. They also indicate the benefits (reduced health opportunity costs or increased value-based price of a technology) of being able to "smooth" these nonmarginal budget impacts by health care systems borrowing against future budgets or from manufacturers offering "mortgage" type arrangements. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

1988-12-01

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

The effect of risk perception on public preferences and willingness to pay for reductions in the health risks posed by toxic cyanobacterial blooms.

Science.gov (United States)

Hunter, Peter D; Hanley, Nick; Czajkowski, Mikołaj; Mearns, Kathryn; Tyler, Andrew N; Carvalho, Laurence; Codd, Geoffrey A

2012-06-01

Mass populations of toxin-producing cyanobacteria are an increasingly common occurrence in inland and coastal waters used for recreational purposes. These mass populations pose serious risks to human and animal health and impose potentially significant economic costs on society. In this study, we used contingent valuation (CV) methods to elicit public willingness to pay (WTP) for reductions in the morbidity risks posed by blooms of toxin-producing cyanobacteria in Loch Leven, Scotland. We found that 55% of respondents (68% excluding protest voters) were willing to pay for a reduction in the number of days per year (from 90, to either 45 or 0 days) that cyanobacteria pose a risk to human health at Loch Leven. The mean WTP for a risk reduction was UK£9.99-12.23/household/year estimated using a logistic spike model. In addition, using the spike model and a simultaneous equations model to control for endogeneity bias, we found the respondents' WTP was strongly dependent on socio-demographic characteristics, economic status and usage of the waterbody, but also individual-specific attitudes and perceptions towards health risks. This study demonstrates that anticipated health risk reductions are an important nonmarket benefit of improving water quality in recreational waters and should be accounted for in future cost-benefit analyses such as those being undertaken under the auspices of the European Union's Water Framework Directive, but also that such values depend on subjective perceptions of water-related health risks and general attitudes towards the environment. Copyright © 2012 Elsevier B.V. All rights reserved.

Health Outcomes and Costs of Social Work Services: A Systematic Review.

Science.gov (United States)

Steketee, Gail; Ross, Abigail M; Wachman, Madeline K

2017-12-01

Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession's person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using "social work" AND "cost" and "health" for trials published from 1990 to 2017. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team

Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

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Jack, Helen; Wagner, Ryan G.; Petersen, Inge; Thom, Rita; Newton, Charles R.; Stein, Alan; Kahn, Kathleen; Tollman, Stephen; Hofman, Karen J.

2014-01-01

Background Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions. Design Narrative overview methodology. Results and conclusions Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context. PMID:24848654

Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

Directory of Open Access Journals (Sweden)

Helen Jack

2013-05-01

Full Text Available Background: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS disorders and the cost-effectiveness of treatment interventions. Design: Narrative overview methodology. Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1 accurate and thorough assessment of the health burdens of MNS disorders, 2 design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3 information on the use and costs of traditional medicines, and 4 cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

Science.gov (United States)

Crawshaw, Benjamin P; Chien, Hung-Lun; Augestad, Knut M; Delaney, Conor P

2015-05-01

an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy. Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.

A COST-REDUCTION OF SELF-COMPACTING CONCRETE INCORPORATING RAW RICE HUSK ASH

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H. AWANG

2016-01-01

Full Text Available The higher material cost of self-compacting concrete (SCC as compared to normal vibrated concrete is mainly due to its higher cement content. In order to produce economical SCC, a significant amount of cement should be replaced with cheaper material options, which are commonly found in byproduct materials such as limestone powder (LP, fly ash (FA and raw rice husk ash (RRHA. However, the use of these byproduct materials to replace the high volumes of cement in an SCC mixture will produce deleterious effects such as strength reduction. Thus, the objective of this paper is to investigate the optimum SCC mixture proportioning capable of minimizing SCC’s material cost. A total of fifteen mixes were prepared. This study showed that raw rice husk ash exhibited positive correlations with fly ash and fine limestone powder and were able to produce high compressive and comparable to normal concrete. The SCC-mix made with quaternary cement-blend comprising OPC/LP/FA/RRHA at 55/15/15/15 weight percentage ratio is found to be capable of maximizing SCC’s material-cost reduction to almost 19% as compared with the control mix

Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm.

Science.gov (United States)

Schwartz, Marshall Z

2012-01-01

The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and

The health system cost of post-abortion care in Rwanda

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Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola

2015-01-01

Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs. PMID:24548846

Impact of a Novel Cost-Saving Pharmacy Program on Pregabalin Use and Health Care Costs.

Science.gov (United States)

Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia

2016-02-01

Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di

Cost-Effectiveness Analysis of Surface Flow Constructed Wetlands (SFCW) for Nutrient Reduction in Drainage Discharge from Agricultural Fields in Denmark.

Science.gov (United States)

Gachango, F G; Pedersen, S M; Kjaergaard, C

2015-12-01

Constructed wetlands have been proposed as cost-effective and more targeted technologies in the reduction of nitrogen and phosphorous water pollution in drainage losses from agricultural fields in Denmark. Using two pig farms and one dairy farm situated in a pumped lowland catchment as case studies, this paper explores the feasibility of implementing surface flow constructed wetlands (SFCW) based on their cost effectiveness. Sensitivity analysis is conducted by varying the cost elements of the wetlands in order to establish the most cost-effective scenario and a comparison with the existing nutrients reduction measures carried out. The analyses show that the cost effectiveness of the SFCW is higher in the drainage catchments with higher nutrient loads. The range of the cost effectiveness ratio on nitrogen reduction differs distinctively with that of catch crop measure. The study concludes that SFCW could be a better optimal nutrients reduction measure in drainage catchments characterized with higher nutrient loads.

The cost-effectiveness of methanol for reducing motor vehicle emissions and urban ozone

International Nuclear Information System (INIS)

Krupnick, A.J.; Walls, M.A.

1992-01-01

This article analyzes the costs and emissions characteristics of methanol vehicles. The cost-effectiveness of methanol - the cost per ton of reactive hydrocarbon emissions reduced - is calculated and compared to the cost-effectiveness of other hydrocarbon reduction strategies. Methanol is found to cost from $33,000 to nearly $60,000 per ton, while several other options are available for under $10,000 per ton. The cost per part-per-million reduction in peak ambient ozone levels is also computed for two cities, Houston and Philadelphia. Despite the greater improvement in ozone in Philadelphia than Houston, methanol is found to be more cost-effective in Houston. This result occurs because Houston's distribution and marketing costs are lower than Philadelphia's. The costs in both cities, however, are far higher than estimates of the benefits from acute health improvements. Finally, the reduction in ozone exposure in Los Angeles is estimated and the costs of the reduction compared with an estimate of acute health benefits. Again, the benefits fall far short of the costs. 51 refs., 5 tabs

Supplier’s Joint Investments in Cost Reduction and Quality Improvement in a Decentralized Supply Chain

Directory of Open Access Journals (Sweden)

Hengyun Zhang

2017-01-01

Full Text Available We consider a decentralized supply chain with a downstream manufacturer and an upstream supplier. The upstream supplier sells a product to the manufacturer, who faces a quality and price sensitive demand. The supplier has a chance to invest in both cost reduction and quality improvement of its product. We derive the optimal investment and pricing decisions for the supply chain members. We do so in both the centralized and the decentralized supply chains. We show that the optimal investment and pricing decisions in the decentralized supply chain may deviate from that in the centralized supply chain. We develop a mechanism to coordinate the decentralized supply chain. The developed mechanism contains four policies: wholesale price, sharing of revenue, sharing of cost reduction investment cost, and sharing of quality improvement investment cost. We also show that the developed coordination mechanism can lead to Pareto improvement.

Modeling the cost-effectiveness of health care systems for alcohol use disorders: how implementation of eHealth interventions improves cost-effectiveness

NARCIS (Netherlands)

Smit, Filip; Lokkerbol, Joran; Riper, Heleen; Majo, Maria Cristina; Boon, Brigitte; Blankers, Matthijs

2011-01-01

Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed. The aim of ALCMOD is to estimate the cost-effectiveness of competing health

Basing care reforms on evidence: the Kenya health sector costing model.

Science.gov (United States)

Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

2011-05-27

The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead

Basing care reforms on evidence: The Kenya health sector costing model

Science.gov (United States)

2011-01-01

Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health

COSTS OF THE HEALTH CARE IN RUSSIA ASSOCIATED WITH SMOKING

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A. V. Kontsevaya

2011-01-01

Full Text Available Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.

Science.gov (United States)

Revill, Paul; Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J

2018-01-01

The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. The findings have

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

Science.gov (United States)

Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J.

2018-01-01

Background The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. Key issues for economic evaluation The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest

Perceptions of managers regarding supply chain cost reduction in the South African mobile phone industry

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Musenga F. Mpwanya

2015-06-01

Full Text Available Background: Many industries, including the mobile phone industry, experience a surge in supply chain (SC costs in the provision of products and services to their customers. Despite this, only a few studies have been conducted on SC cost reduction in South Africa and globally. Objective: This study seeks to understand the perceptions of managers regarding cost reduction in the South African mobile phone SC. Method: A qualitative case study was conducted, involving eight willing managers and using semi-structured interviews, observation and documents. Interviews transcripts were analysed thematically with the help of Atlas.ti and a threefold process was followed, comprising data reduction, data display and data interpretation and conclusion drawing. Results: The findings suggest that mobile phone companies should consolidate their strategic relationships and be efficient, in order to effectively reduce costs in the South African mobile phone SC. To achieve this, whilst South African mobile network operators have to share more and more infrastructure and outsource their operations, other mobile phone companies should re-engineer their operational processes and their reduce costs across the SC. Conclusion: The knowledge generated from this study should assist South African mobile phone companies to reduce their SC costs and address high-priced mobile services. On the other hand, this study should assist regulating authorities (the Department of Communications and the Independent Communication Authority of South Africa to gain insights into the challenges faced by the mobile phone industry in South Africa and, therefore, to make appropriate and adequate mobile telecommunication policies.

Preventing Obesity in the USA: Impact on Health Service Utilization and Costs.

Science.gov (United States)

Cecchini, Michele; Sassi, Franco

2015-07-01

With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate. This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA. The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010). In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits. Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

A sensitivity analysis of timing and costs of greenhouse gas emission reductions

NARCIS (Netherlands)

Gerlagh, R.; van der Zwaan, B.C.C.

2004-01-01

This paper analyses the optimal timing and macro-economic costs of carbon emission reductions that mitigate the global average atmospheric temperature increase. We use a macro-economic model in which there are two competing energy sources, fossil-fuelled and non-fossil-fuelled. Technological change

Results and assessment of participation of VUPEK in coordinated research project of the IAEA ''Comparison of cost-effectiveness of risk reduction among different energy systems''

International Nuclear Information System (INIS)

Kadlec, J.; Horacek, P.

1989-01-01

The results and conclusions are summarized of the research programme ''Comparison of cost-effectiveness of risk reduction among different energy systems'' co-ordinated in 1983 to 1988 by the International Atomic Energy Agency. Institutes in 18 member states were involved which performed 33 case studies in the field of risk reduction in various power systems or their parts. A comparison with cost-effectiveness of risk reduction in other fields was made as well. The health risks (occupational, those of population) and the environmental risks were evaluated. The case studies cover various stages of the decision-making process and various decision makers. The solution resulted in 5 methodological studies and 16 models. 11 case studies and 1 methodological study were conducted by the Research Institute of the Fuel and Energy Complex. The experiences obtained, the questions so far unanswered and recommendations for those who will perform similar studies are given. (author). 1 fig., 2 tabs., 3 refs

Lower Costs, Better Care- Reforming Our Health Care Delivery

Data.gov (United States)

U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

Final cost reduction study for the Geysers Recharge Alternative. Volume 1

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-11-01

The purpose of this study is to determine whether or not cost reduction opportunities exist for the Geysers Recharge Alternative as defined in the Santa Rosa Subregional Long-Term Wastewater Project EIR/EIS. The City of Santa Rosa has been directed to have a plan for reclaimed water disposal in place by 1999 which will meet future capacity needs under all weather conditions. A Draft EIR/EIS released in July 1996 and a Final EIR certified in June 1997 examine four primary alternatives plus the No Action Alternative. Two of the primary alternatives involve agricultural irrigation with reclaimed water, either in western or southern Sonoma County. Another involves increased discharge of reclaimed water into the Russian River. The fourth involves using reclaimed water to replenish the geothermal reservoir at the Geysers. The addition of this water source would enable the Geysers operators to produce more steam from the geothermal area and thereby prolong the life and economic production level of the steamfield and the geothermal power plants supplied by the steamfield. This study provides additional refined cost estimates for new scenarios which utilize an alternative pipeline alignment and a range of reclaimed water flows, which deliver less water to the Geysers than proposed in the EIR/EIS (by distributing flow to other project components). Also, electrical power rates were revised to reflect the recent changes in costs associated with deregulation of the power industry. In addition, this report provides information on sources of potential public and private funding available and future environmental documentation required if the cost reduction scenarios were to be selected by the City as part of their preferred alternative.

Simulating greenhouse gas (GHG) allowance cost and GHG emission reduction in Western Europe

International Nuclear Information System (INIS)

Delarue, Erik; Lamberts, Hans; D'haeseleer, William

2007-01-01

Due to the growing concern for global warming, the EU25 have implemented the European Union Greenhouse Gas Emission Trading Scheme (EU ETS). In the first trading period (2005-2007), part of the targeted GHG emission reductions presumably will have to result from a switch from coal fired electricity generation to gas fired electricity generation. It is possible to calculate the allowance cost necessary to switch a certain coal fired plant with a certain gas fired plant in the merit order. The allowance cost obtained is a so called switching point. When comparing historic European Union Allowance (EUA) prices (2005) with the corresponding historic switching points, the EUA prices were found high enough to cause a certain switch in the summer season. This finding leads to the use of switching points in establishing allowance cost profiles for several scenarios. A variable gas price profile is used in the simulation tool E-Simulate to simulate electricity generation and related GHG emissions in an eight zonal model representing Western Europe. Several GHG allowance cost profile scenarios are examined. For each scenario, electricity generation in the considered countries is clarified. The focus however lies on the GHG emission reduction potentials. These potentials are addressed for each scenario

Costs of certified emission reductions under the Clean Development Mechanism of the Kyoto Protocol

International Nuclear Information System (INIS)

Rahman, Shaikh M.; Kirkman, Grant A.

2015-01-01

This paper examines the cost structure of certified emission reductions (CERs) through various types of projects under the Clean Development Mechanism (CDM) of the Kyoto Protocol. Using the CDM project data, the costs of CERs and their variation across technology and over time and space are estimated by applying alternative functional forms and specifications. Results show that the average cost of CERs decreases with the project scale and duration, scale and duration effects significantly vary across project types, and there is an upward trend in costs. The results also show that the distribution of the projects in the CDM portfolio or a given location does not strictly follow the relative cost structure, nor does the distribution of the CDM projects in different host countries follow the principle of comparative advantage. More than 84% of the CDM portfolio consists of various energy projects with substantially higher costs of CERs than afforestation and reforestation, industrial and landfill gas reduction, and methane avoidance projects, which are only 12% of all projects. While per unit cost of abatement plays an important role in the bottom-up and top-down models to evaluate emission reduction potential and analyze policy alternatives, the findings contradict the presumption of such models that project investors seek out low-cost opportunities. At the aggregate level, the cost of CER by the projects in Asia and Europe is similar but higher than those hosted in Africa, Americas, and Oceania. Yet more than 83% of the projects in the CDM portfolio are located in Asia; more than 69% of the projects are in China and India alone. China appears to have a comparative advantage (i.e., lowest opportunity cost) in energy efficiency projects, while India has a comparative advantage in hydro power projects and Brazil has a comparative advantage in wind power projects. In contrast, energy efficiency category accounts for only 8% of the CDM projects in China, hydro power

Views of US physicians about controlling health care costs.

Science.gov (United States)

Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

2013-07-24

Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1

COMPARISON OF WEST GERMAN AND U.S. FLUE GAS DESULFURIZATION AND SELECTIVE CATALYTIC REDUCTION COSTS

Science.gov (United States)

The report documents a comparison of the actual cost retrofitting flue gas desulfurization (FGD) and selective catalytic reduction (SCR) on Federal Republic of German (FRG) boilers to cost estimating procedures used in the U.S. to estimate the retrofit of these controls on U.S. b...

Cost-Effectiveness of Emission Reduction for the Indonesian Coal-Fired Power Plants

NARCIS (Netherlands)

Handayani, Kamia; Krozer, Yoram

2014-01-01

This paper presents the result of research on the cost-effectiveness of emission reduction in the selected coal-fired power plants (CFPPs) in Indonesia. The background of this research is the trend of more stringent environmental regulation regarding air emission from coal-fired power plants (CFPPs)

Elimination of maintenance outage and cost reduction by development of outage-free maintenance techniques

International Nuclear Information System (INIS)

Jakabe, Hideo; Maruyama, Yoshinaga

1996-01-01

The development program of KEPCO on outage-free maintenance techniques for distribution line work since 1984 is overviewed. It has succeeded in eliminating maintenance outages since 1989. The original aim was to improve customer satisfaction. However, in all, four benefits were realised through the development. These are cost reduction, securing of worker safety, improvement of customer service, and advancement of distribution techniques and morale in KEPCO. The introduction of robotic techniques for maintenance work and manipulator techniques for repair work is planned for further modernization. These new techniques are helping in both work safety and work efficiency improvement. Cost reduction and advancement of distribution line work techniques is also considered. (R.P.)

Preventive health screenings and health consultations in primary care increase life expectancy without increasing costs

DEFF Research Database (Denmark)

Rasmussen, Susanne R; Thomsen, Janus Laust; Kilsmark, Janni

2007-01-01

AIMS: The intention was to investigate whether preventive health checks and health discussions are cost effective. METHODS: In a randomized trial the authors compared two intervention groups (A and B) and one control group. In 1991 2,000 30- to 49-year-old persons were invited and those who...... were given fixed appointments for health consultations. The follow-up period was six years. Analysis was carried out on the "intention to treat" principle. Outcome parameters were life years gained, and direct and total health costs (including productivity costs), discounted by 3% annually. Costs were...... in average direct (3,255 euro (3,703 euro) versus 4,186 euro) and total costs (10,409 euro (9,399 euro) versus 10,667 euro). The effect in group B is, however, better than in group A with no significant differences in costs. The results are insensitive to a range of assumptions regarding costs, effects...

Update of the Dutch manual for costing studies in health care.

Directory of Open Access Journals (Sweden)

Tim A Kanters

Full Text Available Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version.An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute.The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1 costs within the health care sector; 2 patient and family costs; and 3 costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added.The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines.

The multiplier effect of the health education-risk reduction program in 28 states and 1 territory.

Science.gov (United States)

Kreuter, M W; Christensen, G M; Divincenzo, A

1982-01-01

The multiplier effect of the Health Education-Risk Reduction (HE-RR) Grants Program funded by the Public Health Service is examined to identify outcomes for the period 1978-81. Responses to a questionnaire from the directors of health education of 28 States and 1 Territory supplied the information concerning new health promotion activities generated by the program. The directors were asked to identify and give cost estimates of new activities that resulted from State-level and local intervention projects. A method for calculating the extent to which the HE-RR program influenced new health promotion activities that were funded by alternate sources was devised. The calculation, termed the new activity rate, was applied to the survey data. Rates calculated for the HE-RR program revealed that it generated nearly $4 million in new health promotion activities, most of them funded by the private and voluntary segments of society.

Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

Science.gov (United States)

Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

Cost-Effectiveness of Emissions Reduction through Vehicle Repair Compared to CNG Conversion.

Science.gov (United States)

Guenther, Paul L; Lesko, Jon M; Stedman, Donald H

1996-10-01

In return for a temporary waiver from converting five vehicles to operate on compressed natural gas (CNG) for the Denver Clean Fuels program, the University of Denver identified, tested, repaired, and retested nine employee commuter vehicles. The results of the study validated the concept that employer-based identification and repair programs can be carried out in a cost-effective way. On average, each repaired vehicle removed fifty times more carbon monoxide (CO) emissions from Denver air than each CNG conversion. The average cost of each repair was eight times less than the average cost of each conversion. The average fuel economy benefit from the repairs was enough to pay for the average cost of repairs in less than three years of normal driving. When the expected lifetimes of repairs and conversions are included, the targeted repair program appears to be over sixty times more cost-effective as a CO emissions reduction strategy than CNG conversion.

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

Directory of Open Access Journals (Sweden)

Daniel G Datiko

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

Health Outcomes and Costs of Social Work Services: A Systematic Review

Science.gov (United States)

Ross, Abigail M.; Wachman, Madeline K.

2017-01-01

Background. Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession’s person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. Objectives. To systematically review international studies of the effect of social work–involved health services on health and economic outcomes. Search Methods. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017. Selection Criteria. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Data Collection and Analysis. Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Main Results. Average study quality was fair. Studies of 7 social work–led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Conclusions. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to

Activity-based costing of health-care delivery, Haiti.

Science.gov (United States)

McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

2018-01-01

To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

The total lifetime health cost savings of smoking cessation to society

DEFF Research Database (Denmark)

Rasmussen, Gitte Susanne; Prescott, Eva; Sørensen, Thorkild I A

2005-01-01

Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined.......Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined....

Analyses on Cost Reduction and CO2 Mitigation by Penetration of Fuel Cells to Residential Houses

Science.gov (United States)

Aki, Hirohisa; Yamamoto, Shigeo; Kondoh, Junji; Murata, Akinobu; Ishii, Itaru; Maeda, Tetsuhiko

This paper presents analyses on the penetration of polymer electrolyte fuel cells (PEFC) into a group of 10 residential houses and its effects of CO2 emission mitigation and consumers’ cost reduction in next 30 years. The price is considered to be reduced as the penetration progress which is expected to begin in near future. An experimental curve is assumed to express the decrease of the price. Installation of energy interchange systems which involve electricity, gas and hydrogen between a house which has a FC and contiguous houses is assumed to utilize both electricity and heat more efficiently, and to avoid start-stop operation of fuel processor (reformer) as much as possible. A multi-objective model which considers CO2 mitigation and consumers’ cost reduction is constructed and provided a Pareto optimum solution. A solution which simultaneously realizes both CO2 mitigation and consumers’ cost reduction appeared in the Pareto optimum solution. Strategies to reduce CO2 emission and consumers’ cost are suggested from the results of the analyses. The analyses also revealed that the energy interchange systems are effective especially in the early stage of the penetration.

The importance of capital cost reduction in improving nuclear economics

International Nuclear Information System (INIS)

Langmo, A.; Braun, C.

1996-01-01

In the developed countries having existing nuclear programs, the situation necessitates lower total power generation cost. The restructuring of utility industry due to the deregulation causes to reorganize the ownership of some nuclear plants, and the overall economics of nuclear plants in relation to their local competition is reexamined. The reluctance to make any new long term capital cost commitment arises, and it makes new plant construction less likely in near future, and plant upgrading and improvement to be put to intense scrutiny. The capital cost recovery in existing nuclear plants in USA is discussed. It is important to recognize that there is very little that can be done to affect already expended capital, and only that can be done is to improve plant capacity factors, besides write-off. The roles of architects and engineers in improved plant economics are now evaluated by the various organizations which are interested in the participation in new nuclear industry reorganization and restructuring. The reduction of operation and maintenance costs and capital investment, and the improvement of capacity factor are reported. In new ALWR construction program, architects and engineers can significantly support the control of plant capital costs by the selection of the plant design and the sites, and the strategies of procurement and contract, construction schedule and others. (K.I.)

How to solve the cost crisis in health care.

Science.gov (United States)

Kaplan, Robert S; Porter, Michael E

2011-09-01

U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions--not organizational units or narrow diagnostic treatment groups--as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-cased costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Schön Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.

42 CFR 100.2 - Average cost of a health insurance policy.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Average cost of a health insurance policy. 100.2... VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of determining..., less certain deductions. One of the deductions is the average cost of a health insurance policy, as...

Cost-effectiveness analysis of surface flow constructed wetlands (SFCW) for nutrient reduction in drainage discharge from agricultural fields in Denmark

DEFF Research Database (Denmark)

Gachango, Florence Gathoni; Pedersen, Søren Marcus; Kjærgaard, Charlotte

2015-01-01

Constructed wetlands have been proposed as cost-effective and more targeted technologies in the reduction of nitrogen and phosphorous water pollution in drainage losses from agricultural fields in Denmark. Using two pig farms and one dairy farm situated in a pumped lowland catchment as case studies......, this paper explores the feasibility of implementing surface flow constructed wetlands (SFCW) based on their cost effectiveness. Sensitivity analysis is conducted by varying the cost elements of the wetlands in order to establish the most cost-effective scenario and a comparison with the existing nutrients...... reduction measures carried out. The analyses show that the cost effectiveness of the SFCW is higher in the drainage catchments with higher nutrient loads. The range of the cost effectiveness ratio on nitrogen reduction differs distinctively with that of catch crop measure. The study concludes that SFCW...

Home Health Care: Services and Cost

Science.gov (United States)

Widmer, Geraldine; And Others

1978-01-01

Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions.

Science.gov (United States)

Owens, Douglas K; Qaseem, Amir; Chou, Roger; Shekelle, Paul

2011-02-01

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit. Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs. This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.

To Your Health: NLM update transcript - U.S. health costs and care

Science.gov (United States)

... https://medlineplus.gov/podcast/transcript052118.html To Your Health: NLM update Transcript U.S. health costs and care : 05/21/2018 To use ... is what's new this week in To Your Health, a consumer health-oriented podcast from NLM, that ...

Cost-Effectiveness Analysis of Systemic Therapies in Advanced Pancreatic Cancer in the Canadian Health Care System.

Science.gov (United States)

Coyle, Doug; Ko, Yoo-Joung; Coyle, Kathryn; Saluja, Ronak; Shah, Keya; Lien, Kelly; Lam, Henry; Chan, Kelvin K W

2017-04-01

To assess the cost-effectiveness of gemcitabine (G), G + 5-fluorouracil, G + capecitabine, G + cisplatin, G + oxaliplatin, G + erlotinib, G + nab-paclitaxel (GnP), and FOLFIRINOX in the treatment of advanced pancreatic cancer from a Canadian public health payer's perspective, using data from a recently published Bayesian network meta-analysis. Analysis was conducted through a three-state Markov model and used data on the progression of disease with treatment from the gemcitabine arms of randomized controlled trials combined with estimates from the network meta-analysis for the newer regimens. Estimates of health care costs were obtained from local providers, and utilities were derived from the literature. The model estimates the effect of treatment regimens on costs and quality-adjusted life-years (QALYs) discounted at 5% per annum. At a willingness-to-pay (WTP) threshold of greater than $30,666 per QALY, FOLFIRINOX would be the most optimal regimen. For a WTP threshold of $50,000 per QALY, the probability that FOLFIRINOX would be optimal was 57.8%. There was no price reduction for nab-paclitaxel when GnP was optimal. From a Canadian public health payer's perspective at the present time and drug prices, FOLFIRINOX is the optimal regimen on the basis of the cost-effectiveness criterion. GnP is not cost-effective regardless of the WTP threshold. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs.

Science.gov (United States)

Wurzelbacher, Steven J; Bertke, Stephen J; Lampl, Michael P; Bushnell, P Timothy; Meyers, Alysha R; Robins, David C; Al-Tarawneh, Ibraheem S

2014-12-01

This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. © 2014 Wiley Periodicals, Inc.

Investments and costs of oral health care for Family Health Care.

Science.gov (United States)

Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

2016-07-21

To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health's share in funding was also calculated, and the factors that influence cost behavior were described. The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health's financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the team's operational cost. Estimar os investimentos

Soft-copy sonography: cost reduction sensitivity analysis in a pediatric hospital.

Science.gov (United States)

Don, S; Albertina, M J; Ammann, D

1998-03-01

Our objective was to determine whether interpreting sonograms of pediatric patients using soft-copy (computer workstation) instead of laser-printed film could reduce costs for a pediatric radiology department. We used theoretic models of growth to analyze costs. The costs of a sonographic picture archiving and communication system (three interface devices, two workstations, a network server, maintenance expenses, and storage media costs) were compared with the potential savings of eliminating film and increasing technologist efficiency or reducing the number of technologists. The model was based on historic trends and future capitation estimates that will reduce fee-for-service reimbursement. The effects of varying the study volume and reducing technologists' work hours were analyzed. By converting to soft-copy interpretation, we saved 6 min 32 sec per examination by eliminating film processing waiting time, thus reducing examination time from 30 min to 24 min. During an average day of 27 examinations, 176 min were saved. However, 33 min a day were spent retrieving prior studies from long-term storage; thus, 143 extra minutes a day were available for scanning. This improved efficiency could result in five more sonograms a day obtained by converting to soft-copy interpretation, using existing staff and equipment. Alternatively, five examinations a day would equate to one half of a full-time equivalent technologists position. Our analysis of costs considered that the hospital's anticipated growth of sonography and the depreciation of equipment during 5 years resulted in a savings of more than $606,000. Increasing the examinations by just 200 sonograms in the first year and no further growth resulted in a savings of more than $96,000. If the number of sonograms stayed constant, elimination of film printing alone resulted in a loss of approximately $157,000; reduction of one half of a full-time equivalent technologist's position would recuperate approximately $134

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

Directory of Open Access Journals (Sweden)

John Paul Ekwaru

Full Text Available The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach.We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY, from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate.The incremental cost-effectiveness ratio(ICER of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICERhealth promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.

Escalating Health Care Cost due to Unnecessary Diagnostic Testing

Directory of Open Access Journals (Sweden)

MUHAMMAD AZAM ISHAQUE CHAUDHARY

2017-07-01

Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India.

Science.gov (United States)

Prinja, Shankar; Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

2016-01-01

With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively. The study estimates can be used

Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study.

Science.gov (United States)

Markandya, Anil; Sampedro, Jon; Smith, Steven J; Van Dingenen, Rita; Pizarro-Irizar, Cristina; Arto, Iñaki; González-Eguino, Mikel

2018-03-01

Although the co-benefits from addressing problems related to both climate change and air pollution have been recognised, there is not much evidence comparing the mitigation costs and economic benefits of air pollution reduction for alternative approaches to meeting greenhouse gas targets. We analysed the extent to which health co-benefits would compensate the mitigation cost of achieving the targets of the Paris climate agreement (2°C and 1·5°C) under different scenarios in which the emissions abatement effort is shared between countries in accordance with three established equity criteria. Our study had three stages. First, we used an integrated assessment model, the Global Change Assessment Model (GCAM), to investigate the emission (greenhouse gases and air pollutants) pathways and abatement costs of a set of scenarios with varying temperature objectives (nationally determined contributions, 2°C, or 1·5°C) and approaches to the distribution of climate change methods (capability, constant emission ratios, and equal per capita). The resulting emissions pathways were transferred to an air quality model (TM5-FASST) to estimate the concentrations of particulate matter and ozone in the atmosphere and the resulting associated premature deaths and morbidity. We then applied a monetary value to these health impacts by use of a term called the value of statistical life and compared these values with those of the mitigation costs calculated from GCAM, both globally and regionally. Our analysis looked forward to 2050 in accordance with the socioeconomic narrative Shared Socioeconomic Pathways 2. The health co-benefits substantially outweighed the policy cost of achieving the target for all of the scenarios that we analysed. In some of the mitigation strategies, the median co-benefits were double the median costs at a global level. The ratio of health co-benefit to mitigation cost ranged from 1·4 to 2·45, depending on the scenario. At the regional level, the costs of

Potential Cost Savings From Reduction of Regional Variation in Medicare Spending

Directory of Open Access Journals (Sweden)

Yunjie Song

2016-04-01

Full Text Available Potential cost savings estimated from reduction of regional variation in Medicare spending are considerable but questioned. This article evaluates the validity of the principal methods that have been used in the estimations of the potential savings. Three estimation approaches were identified. The first approach uses adjusted expenditures to calculate avoidable costs, but adjusted expenditures can be independent of avoidable costs, and measurement errors are not controlled. The second approach uses an outcome variable to replace its causal factors, and is not acceptable because the association between the outcomes and the causes is untestable. The final approach uses surveys to directly measure physician beliefs and patient preferences, but the sole study using this approach is weakened by sample selection biases and incomplete controls. A development of reliable measures and a switch of observation from clinic settings to geographic contexts could make the estimations more convincing.

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

Science.gov (United States)

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

2010-11-01

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

Pipeline cost reduction through effective project management and applied technology

Energy Technology Data Exchange (ETDEWEB)

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

2005-07-01

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

Heliostat cost reduction study.

Energy Technology Data Exchange (ETDEWEB)

Jones, Scott A.; Lumia, Ronald. (University of New Mexico, Albuquerque, NM); Davenport, Roger (Science Applications International Corporation, San Diego, CA); Thomas, Robert C. (Advanced Thermal Systems, Centennial, CO); Gorman, David (Advanced Thermal Systems, Larkspur, CO); Kolb, Gregory J.; Donnelly, Matthew W.

2007-06-01

Power towers are capable of producing solar-generated electricity and hydrogen on a large scale. Heliostats are the most important cost element of a solar power tower plant. Since they constitute {approx} 50% of the capital cost of the plant it is important to reduce heliostat cost as much as possible to improve the economic performance of power towers. In this study we evaluate current heliostat technology and estimate a price of $126/m{sup 2} given year-2006 materials and labor costs for a deployment of {approx}600 MW of power towers per year. This 2006 price yields electricity at $0.067/kWh and hydrogen at $3.20/kg. We propose research and development that should ultimately lead to a price as low as $90/m{sup 2}, which equates to $0.056/kWh and $2.75/kg H{sup 2}. Approximately 30 heliostat and manufacturing experts from the United States, Europe, and Australia contributed to the content of this report during two separate workshops conducted at the National Solar Thermal Test Facility.

Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

Science.gov (United States)

Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

2018-06-01

Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

Managing health care costs: strategies available to small businesses.

Science.gov (United States)

Higgins, C W; Finley, L; Kinard, J

1990-07-01

Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.

Health services utilization and costs of the insured and uninsured ...

African Journals Online (AJOL)

Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods ...

FPs lower hospital readmission rates and costs.

Science.gov (United States)

Chetty, Veerappa K; Culpepper, Larry; Phillips, Robert L; Rankin, Jennifer; Xierali, Imam; Finnegan, Sean; Jack, Brian

2011-05-01

Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the numbers of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings.

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

Cost reductions for offshore wind power. Exploring the balance between scaling, learning and R and D

International Nuclear Information System (INIS)

Van der Zwaan, B.; Rivera-Tinoco, R.; Lensink, S.; Van den Oosterkamp, P.

2012-01-01

Offshore wind electricity generation is prospected to increase substantially in the near future at a number of locations, like in the Baltic, Irish and North Sea, and emerge at several others. The global growth of offshore wind technology is likely to be accompanied by reductions in wind park construction costs, both as a result of scaling and learning effects. Since 2005, however, significant cost increases have been observed. A recent surge in commodity prices proves to constitute one of the main drivers of these cost increases. This observation begs the question whether wind turbine manufacturers should return to the laboratory for undertaking R and D that explores the use of alternative materials and bring offshore wind energy closer to competitiveness. It is demonstrated that if one abstracts from material price fluctuations, in particular for metals such as copper and steel, turbine production plus installation cost data publicly available for a series of offshore wind park projects (realized in several European countries since the 1990's) show a cost reduction trend. Hence various other sources of cost increases, such as due to the progressively larger distances from the shore (and correspondingly greater depths at sea) at which wind parks have been (and will be) built, are outshadowed by cost reduction effects. When one expresses the overall cost development for offshore wind energy capacity as an experience curve, a learning rate is found of 3%, which reflects a mixture of economies-of-scale and learning-by-doing mechanisms. Also the impact is quantified on offshore wind power construction costs from the recent tightness in the market for turbine manufacturing and installation services: without the demand-supply response inertia at the origin of this tightness it is estimated that the learning rate would be 5%. Since these learning rates are relatively low - in comparison to those observed for other technologies, and in view of the high current capacity

A Spatial-Economic Cost-Reduction Pathway Analysis for U.S. Offshore Wind Energy Development from 2015-2030

Energy Technology Data Exchange (ETDEWEB)

Beiter, Philipp; Stehly, Tyler

2016-10-05

The potential for cost reduction and economic viability for offshore wind varies considerably within the United States. This analysis models the cost impact of a range of offshore wind locational cost variables across more than 7,000 potential coastal sites in the United States' offshore wind resource area. It also assesses the impact of over 50 technology innovations on potential future costs between 2015 and 2027 (Commercial Operation Date) for both fixed-bottom and floating wind systems. Comparing these costs to an initial assessment of local avoided generating costs, this analysis provides a framework for estimating the economic potential for offshore wind. Analyzing economic potential within this framework can help establish a refined understanding across industries of the technology and site-specific risks and opportunities associated with future offshore wind development. The findings from the original report indicate that under the modeled scenario, offshore wind can be expected to achieve significant cost reductions and may approach economic viability in some parts of the United States within the next 15 years.

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

Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis

DEFF Research Database (Denmark)

Baandrup, Lone; Sørensen, Jan; Lublin, Henrik Kai Francis

2012-01-01

at the two cross-sectional dates was recorded and used as proxy of polypharmacy exposure during the preceding year. A multivariate generalised linear model was fitted with total costs of primary and secondary health service use as dependent variable, and antipsychotic polypharmacy, diagnosis, age, gender......, disease duration, psychiatric inpatient admissions, and treatment site as covariates. RESULTS: The sample consisted of 736 outpatients with a diagnosis in the schizophrenia spectrum. Antipsychotic polypharmacy was associated with significantly higher total health service costs compared with monotherapy...

Direct health care costs associated with asthma in British Columbia

Science.gov (United States)

Sadatsafavi, Mohsen; Lynd, Larry; Marra, Carlo; Carleton, Bruce; Tan, Wan C; Sullivan, Sean; FitzGerald, J Mark

2010-01-01

BACKGROUND: A better understanding of health care costs associated with asthma would enable the estimation of the economic burden of this increasingly common disease. OBJECTIVE: To determine the direct medical costs of asthma-related health care in British Columbia (BC). METHODS: Administrative health care data from the BC Linked Health Database and PharmaNet database from 1996 to 2000 were analyzed for BC residents five to 55 years of age, including the billing information for physician visits, drug dispensations and hospital discharge records. A unit cost was assigned to physician/emergency department visits, and government reimbursement fees for prescribed medications were applied. The case mix method was used to calculate hospitalization costs. All costs were reported in inflation-adjusted 2006 Canadian dollars. RESULTS: Asthma resulted in $41,858,610 in annual health care-related costs during the study period ($331 per patient-year). The major cost component was medications, which accounted for 63.9% of total costs, followed by physician visits (18.3%) and hospitalization (17.8%). When broader definitions of asthma-related hospitalizations and physician visits were used, total costs increased to $56,114,574 annually ($444 per patient-year). There was a statistically significant decrease in the annual per patient cost of hospitalizations (P<0.01) over the study period. Asthma was poorly controlled in 63.5% of patients, with this group being responsible for 94% of asthma-related resource use. CONCLUSION: The economic burden of asthma is significant in BC, with the majority of the cost attributed to poor asthma control. Policy makers should investigate the reason for lack of proper asthma control and adjust their policies accordingly to improve asthma management. PMID:20422063

Cost analysis of public health influenza vaccine clinics in Ontario.

Science.gov (United States)

Mercer, Nicola J

2009-01-01

Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose. Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices. The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs. The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

How Expensive Is Expensive Enough? Opportunities for Cost Reductions in Offshore Wind Energy Logistics

Directory of Open Access Journals (Sweden)

Thomas Poulsen

2016-06-01

Full Text Available This paper reveals that logistics may conservatively amount to 18% of the levelized cost of energy for offshore wind farms. This is the key finding from an extensive case study carried out within the organization of the world’s leading offshore wind farm developer and operator. The case study aimed to, and produced, a number of possible opportunities for offshore wind cost reductions through logistics innovation; however, within the case study company, no company-wide logistics organization existed to focus horizontally on reducing logistics costs in general. Logistics was not well defined within the case study company, and a logistics strategy did not exist. With full life-cycle costs of offshore wind farms still high enough to present a political challenge within the European Union in terms of legislation to ensure offshore wind diffusion beyond 2020, our research presents logistics as a next frontier for offshore wind constituencies. This important area of the supply chain is ripe to academically and professionally cultivate and harvest in terms of offshore wind energy cost reductions. Our paper suggests that a focused organizational approach for logistics both horizontally and vertically within the company organizations could be the way forward, coupled with a long-term legislative environment to enable the necessary investments in logistics assets and transport equipment.

[Cost-effectiveness in Dutch mental health care: future because of ROM?

NARCIS (Netherlands)

Agthoven, M. van; Kolk, A. van der; Knegtering, H.; Delespaul, P.A.; Arends, J.; Jeurissen, P.P.T.; Krabbe, P.F.M.; Huijsman, R.; Luijk, R.; Beurs, E. de; Hakkaart-van Roijen, L.; Bruggeman, R.

2015-01-01

BACKGROUND: The document reporting Dutch mental health care negotiations for 2014 - 2017 calls for a cost decrease based on cost-effectiveness. Thanks to rom, the Dutch mental health care seems well prepared for cost-effectiveness research.
AIM: Evaluate how valid cost-effectiveness research

Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking.

Science.gov (United States)

Ride, Jemimah; Lorgelly, Paula; Tran, Thach; Wynter, Karen; Rowe, Heather; Fisher, Jane

2016-11-18

Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems. The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial. 48 Maternal and Child Health Centres in Victoria, Australia. Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm. WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue. The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics. The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold. The results suggest that, although WWWT shows promise as a preventive intervention for postnatal

Health Care Analysis for the MCRMC Insurance Cost Model

Science.gov (United States)

2015-06-01

incentive to reduce utilization  Subsidy to leave TRICARE and use other private health insurance  Increases in TRICARE premiums and co-pays  This...analysis develops the estimated cost of providing health care through a premium -based insurance model consistent with an employer-sponsored benefit...State  Income  Plan premium data  Contract cost data 22 May 2015 9 Agenda  Overview  Background  Data  Insurance Cost Estimate Methodology

Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

Science.gov (United States)

Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

2015-04-01

Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

Cost-Effectiveness of a School-Based Emotional Health Screening Program

Science.gov (United States)

Kuo, Elena; Stoep, Ann Vander; McCauley, Elizabeth; Kernic, Mary A.

2009-01-01

Background: School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening…

Cost-effective policy instruments for greenhouse gas emission reduction and fossil fuel substitution through bioenergy production in Austria

International Nuclear Information System (INIS)

Schmidt, Johannes; Leduc, Sylvain; Dotzauer, Erik; Schmid, Erwin

2011-01-01

Climate change mitigation and security of energy supply are important targets of Austrian energy policy. Bioenergy production based on resources from agriculture and forestry is an important option for attaining these targets. To increase the share of bioenergy in the energy supply, supporting policy instruments are necessary. The cost-effectiveness of these instruments in attaining policy targets depends on the availability of bioenergy technologies. Advanced technologies such as second-generation biofuels, biomass gasification for power production, and bioenergy with carbon capture and storage (BECCS) will likely change the performance of policy instruments. This article assesses the cost-effectiveness of energy policy instruments, considering new bioenergy technologies for the year 2030, with respect to greenhouse gas emission (GHG) reduction and fossil fuel substitution. Instruments that directly subsidize bioenergy are compared with instruments that aim at reducing GHG emissions. A spatially explicit modeling approach is used to account for biomass supply and energy distribution costs in Austria. Results indicate that a carbon tax performs cost-effectively with respect to both policy targets if BECCS is not available. However, the availability of BECCS creates a trade-off between GHG emission reduction and fossil fuel substitution. Biofuel blending obligations are costly in terms of attaining the policy targets. - Highlights: → Costs of energy policies and effects on reduction of CO 2 emissions and fossil fuel consumption. → Particular focus on new bioenergy production technologies such as second generation biofuels. → Spatially explicit techno-economic optimization model. → CO 2 tax: high costs for reducing fossil fuel consumption if carbon capture and storage is available. → Biofuel policy: no significant reductions in CO 2 emissions or fossil fuel consumption.

Health care development: integrating transaction cost theory with social support theory.

Science.gov (United States)

Hajli, M Nick; Shanmugam, Mohana; Hajli, Ali; Khani, Amir Hossein; Wang, Yichuan

2014-07-28

The emergence of Web 2.0 technologies has already been influential in many industries, and Web 2.0 applications are now beginning to have an impact on health care. These new technologies offer a promising approach for shaping the future of modern health care, with the potential for opening up new opportunities for the health care industry as it struggles to deal with challenges including the need to cut costs, the increasing demand for health services and the increasing cost of medical technology. Social media such as social networking sites are attracting more individuals to online health communities, contributing to an increase in the productivity of modern health care and reducing transaction costs. This study therefore examines the potential effect of social technologies, particularly social media, on health care development by adopting a social support/transaction cost perspective. Viewed through the lens of Information Systems, social support and transaction cost theories indicate that social media, particularly online health communities, positively support health care development. The results show that individuals join online health communities to share and receive social support, and these social interactions provide both informational and emotional support.

Spacecraft COst REduction Team (SCORE): TQM/CI on a massive scale

Science.gov (United States)

Bullard, Jerry D.

1992-01-01

The business of building satellites and space systems has matured. Few missions require, or can afford, excellent performance at any price. The new paradigm is doing more with less, providing quality systems at lower cost--in other words, doing our job 'Faster-Better-Cheaper.' The TRW Spacecraft COst REduction (SCORE) initiative was launched in 1990 by Daniel S. Goldin, then general manager of TRW's Space & Technology Group. The SCORE mission is to apply continuous improvement (CI) techniques to effect major reductions in the cost (our primary goal) and span time (as a corollary) required for the production of spacecraft. SCORE is a multi-year initiative that is having a profound effect on both the procedural and the cultural aspects of how we do business. The objectives of this initiative are being realized. The focus of this paper is not on the results of SCORE per se, but rather on the things we have leaned about how to do continuous improvement on a massive scale, with multilevel (hierarchical) CI teams. The following sections summarize the chronology of the SCORE initiative, from team formation to development of the year-end report for 1991. Lessons learned, the core of this presentation, are discussed--with particular focus on the unique aspects of SCORE. The SCORE initiative is continuing and, as a part of our evolving culture, will never end. It has resulted in profound insights into the way we do work and (the topic at hand) how to do CI for large and complex multidisciplinary development activities.

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.

Multimorbidity in chronic disease: impact on health care resources and costs

Directory of Open Access Journals (Sweden)

McPhail SM

2016-07-01

Full Text Available Steven M McPhail1,2 1Centre for Functioning and Health Research, Metro South Health, 2Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied. There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to

PowerFilm PowerShade Fixed Site Solar System Cost Reduction Plan

Science.gov (United States)

2014-07-31

system was designed which adds capability of grid tie connection to the standalone function. This battery operating system has built-in intelligence...goal concerning alternative conductive grid inks was to reduce the cost of the silver ink layer without a reduction in PV power with experimentation... system . To overcome this loss, a new BOS unit with higher power transfer efficiency has been developed. This system also has grid tie

The cost of health professionals' brain drain in Kenya

Directory of Open Access Journals (Sweden)

Gbary Akpa

2006-07-01

Full Text Available Abstract Background Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK and the United States of America (USA; (ii to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA; and (iii to describe other losses from brain drain. Methods The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years and the age of retirement (62 years in recipient countries. Results The total cost of educating a single medical doctor from primary school to university is US$ 65,997; and for every doctor who emigrates, a country loses about US$ 517,931 worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is US$ 43,180; and for every nurse that emigrates, a country loses about US$ 338,868 worth of returns from investment. Conclusion Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious

Cost Analysis of a Digital Health Care Model in Sweden.

Science.gov (United States)

Ekman, Björn

2017-09-22

Digital technologies in health care are expected to increase in scope and to affect ever more parts of the health care system. It is important to enhance the knowledge of whether new digital methods and innovations provide value for money compared with traditional models of care. The objective of the study was to evaluate whether a digital health care model for primary care is a less costly alternative compared with traditional in-office primary care in Sweden. Cost data for the two care models were collected and analyzed to obtain a measure in local currency per care contact. The comparison showed that the total economic cost of a digital consultation is 1960 Swedish krona (SEK) (SEK100 = US$11.29; February 2017) compared with SEK3348 for a traditional consultation at a health care clinic. Cost differences arose on both the provider side and on the user side. The digital health care model may be a less costly alternative to the traditional health care model. Depending on the rate of digital substitution, gross economic cost savings of between SEK1 billion and SEK10 billion per year could be realized if more digital consultations were made. Further studies are needed to validate the findings, assess the types of care most suitable for digital care, and also to obtain various quality-adjusted outcome measures.

Factory '82 - 30% reduction of operation cost at short term. Fabrik '82. Kurzzeitig 30% der Betriebskosten beeinflussen

Energy Technology Data Exchange (ETDEWEB)

1982-01-01

The present-day situation of many companies is characterized by a decreasing production volume. Consequences and effects of this phenomenon on production and ancillary branches are presented and analysed under aspects of cost, measures are described for influencing operation cost in an effective and continuing way at short term: cost of energy and disposal, heat insulation and heat recovery, cost reduction by computer application, cost reduction with material flow, operational cost analyses with detection of weak spots. Replanning factories and subsections which frequently have shown to be necessary - new planning projects have become more or less rare these days - is accounted for by the range of problem-related topics. Next to issues of CAD in factory planning, another approach is demonstrated which is still underutilized when designing and using factory buildings in keeping with cost: value-analysis factory planning.

Public health impact and cost-effectiveness of intranasal live attenuated influenza vaccination of children in Germany.

Science.gov (United States)

Damm, Oliver; Eichner, Martin; Rose, Markus Andreas; Knuf, Markus; Wutzler, Peter; Liese, Johannes Günter; Krüger, Hagen; Greiner, Wolfgang

2015-06-01

In 2011, intranasally administered live attenuated influenza vaccine (LAIV) was approved in the EU for prophylaxis of seasonal influenza in 2-17-year-old children. Our objective was to estimate the potential epidemiological impact and cost-effectiveness of an LAIV-based extension of the influenza vaccination programme to healthy children in Germany. An age-structured dynamic model of influenza transmission was developed and combined with a decision-tree to evaluate different vaccination strategies in the German health care system. Model inputs were based on published literature or were derived by expert consulting using the Delphi technique. Unit costs were drawn from German sources. Under base-case assumptions, annual routine vaccination of children aged 2-17 years with LAIV assuming an uptake of 50% would prevent, across all ages, 16 million cases of symptomatic influenza, over 600,000 cases of acute otitis media, nearly 130,000 cases of community-acquired pneumonia, nearly 1.7 million prescriptions of antibiotics and over 165,000 hospitalisations over 10 years. The discounted incremental cost-effectiveness ratio was 1,228 per quality-adjusted life year gained from a broad third-party payer perspective (including reimbursed direct costs and specific transfer payments), when compared with the current strategy of vaccinating primarily risk groups with the conventional trivalent inactivated vaccine. Inclusion of patient co-payments and indirect costs in terms of productivity losses resulted in discounted 10-year cost savings of 3.4 billion. In conclusion, adopting universal influenza immunisation of healthy children and adolescents would lead to a substantial reduction in influenza-associated disease at a reasonable cost to the German statutory health insurance system. On the basis of the epidemiological and health economic simulation results, a recommendation of introducing annual routine influenza vaccination of children 2-17 years of age might be taken into

The economic costs of radiation-induced health effects: Estimation and simulation

International Nuclear Information System (INIS)

Nieves, L.A.; Tawil, J.J.

1988-08-01

This effort improves the quantitative information available for use in evaluating actions that alter health risks due to population exposure to ionizing radiation. To project the potential future costs of changes in health effects risks, Pacific Northwest Laboratory (PNL) constructed a probabilistic computer model, Health Effects Costs Model (HECOM), which utilizes the health effect incidence estimates from accident consequences models to calculate the discounted sum of the economic costs associated with population exposure to ionizing radiation. Application of HECOM to value-impact and environmental impact analyses should greatly increase the quality of the information available for regulatory decision making. Three major types of health effects present risks for any population sustaining a significant radiation exposure: acute radiation injuries (and fatalities), latent cancers, and impairments due to genetic effects. The literature pertaining to both incidence and treatment of these health effects was reviewed by PNL and provided the basis for developing economic cost estimates. The economic costs of health effects estimated by HECOM represent both the value of resources consumed in diagnosing, treating, and caring for the patient and the value of goods not produced because of illness or premature death due to the health effect. Additional costs to society, such as pain and suffering, are not included in the PNL economic cost measures since they do not divert resources from other uses, are difficult to quantify, and do not have a value observable in the marketplace. 83 refs., 3 figs., 19 tabs

The economic costs of radiation-induced health effects: Estimation and simulation

Energy Technology Data Exchange (ETDEWEB)

Nieves, L.A.; Tawil, J.J.

1988-08-01

This effort improves the quantitative information available for use in evaluating actions that alter health risks due to population exposure to ionizing radiation. To project the potential future costs of changes in health effects risks, Pacific Northwest Laboratory (PNL) constructed a probabilistic computer model, Health Effects Costs Model (HECOM), which utilizes the health effect incidence estimates from accident consequences models to calculate the discounted sum of the economic costs associated with population exposure to ionizing radiation. Application of HECOM to value-impact and environmental impact analyses should greatly increase the quality of the information available for regulatory decision making. Three major types of health effects present risks for any population sustaining a significant radiation exposure: acute radiation injuries (and fatalities), latent cancers, and impairments due to genetic effects. The literature pertaining to both incidence and treatment of these health effects was reviewed by PNL and provided the basis for developing economic cost estimates. The economic costs of health effects estimated by HECOM represent both the value of resources consumed in diagnosing, treating, and caring for the patient and the value of goods not produced because of illness or premature death due to the health effect. Additional costs to society, such as pain and suffering, are not included in the PNL economic cost measures since they do not divert resources from other uses, are difficult to quantify, and do not have a value observable in the marketplace. 83 refs., 3 figs., 19 tabs.

Health care resource use and costs among patients with cushing disease.

Science.gov (United States)

Swearingen, Brooke; Wu, Ning; Chen, Shih-Yin; Pulgar, Sonia; Biller, Beverly M K

2011-01-01

To assess health care costs associated with Cushing disease and to determine changes in overall and comorbidity-related costs after surgical treatment. In this retrospective cohort study, patients with Cushing disease were identified from insurance claims databases by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for Cushing syndrome (255.0) and either benign pituitary adenomas (227.3) or hypophysectomy (07.6×) between 2004 and 2008. Each patient with Cushing disease was age- and sex-matched with 4 patients with nonfunctioning pituitary adenomas and 10 population control subjects. Comorbid conditions and annual direct health care costs were assessed within each calendar year. Postoperative changes in health care costs and comorbidity-related costs were compared between patients presumed to be in remission and those with presumed persistent disease. Of 877 identified patients with Cushing disease, 79% were female and the average age was 43.4 years. Hypertension, diabetes mellitus, and hyperlipidemia were more common among patients with Cushing disease than in patients with nonfunctioning pituitary adenomas or in control patients (PCushing disease had significantly higher total health care costs (2008: $26 440 [Cushing disease] vs $13 708 [nonfunctioning pituitary adenomas] vs $5954 [population control], Pdisease-related costs with remission. A significant increase in postoperative health care costs was observed in those patients not in remission. Patients with Cushing disease had more comorbidities than patients with nonfunctioning pituitary adenomas or control patients and incurred significantly higher annual health care costs; these costs decreased after successful surgery and increased after unsuccessful surgery.

The EOS 2D/3D X-ray imaging system: A cost-effectiveness analysis quantifying the health benefits from reduced radiation exposure

International Nuclear Information System (INIS)

Faria, Rita; McKenna, Claire; Wade, Ros; Yang, Huiqin; Woolacott, Nerys; Sculpher, Mark

2013-01-01

Objectives: To evaluate the cost-effectiveness of the EOS ® 2D/3D X-ray imaging system compared with standard X-ray for the diagnosis and monitoring of orthopaedic conditions. Materials and methods: A decision analytic model was developed to quantify the long-term costs and health outcomes, expressed as quality-adjusted life years (QALYs) from the UK health service perspective. Input parameters were obtained from medical literature, previously developed cancer models and expert advice. Threshold analysis was used to quantify the additional health benefits required, over and above those associated with radiation-induced cancers, for EOS ® to be considered cost-effective. Results: Standard X-ray is associated with a maximum health loss of 0.001 QALYs, approximately 0.4 of a day in full health, while the loss with EOS ® is a maximum of 0.00015 QALYs, or 0.05 of a day in full health. On a per patient basis, EOS ® is more expensive than standard X-ray by between £10.66 and £224.74 depending on the assumptions employed. The results suggest that EOS ® is not cost-effective for any indication. Health benefits over and above those obtained from lower radiation would need to double for EOS to be considered cost-effective. Conclusion: No evidence currently exists on whether there are health benefits associated with imaging improvements from the use of EOS ® . The health benefits from radiation dose reductions are very small. Unless EOS ® can generate additional health benefits as a consequence of the nature and quality of the image, comparative patient throughput with X-ray will be the major determinant of cost-effectiveness

The cost of universal health care in India: a model based estimate.

Science.gov (United States)

Prinja, Shankar; Bahuguna, Pankaj; Pinto, Andrew D; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

2012-01-01

As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8%) of the GDP for universalizing health care services. The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

Analysis of Fuel Cell Markets in Japan and the US: Experience Curve Development and Cost Reduction Disaggregation

Energy Technology Data Exchange (ETDEWEB)

Wei, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Smith, Sarah J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sohn, Michael D. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2016-07-15

Fuel cells are both a longstanding and emerging technology for stationary and transportation applications, and their future use will likely be critical for the deep decarbonization of global energy systems. As we look into future applications, a key challenge for policy-makers and technology market forecasters who seek to track and/or accelerate their market adoption is the ability to forecast market costs of the fuel cells as technology innovations are incorporated into market products. Specifically, there is a need to estimate technology learning rates, which are rates of cost reduction versus production volume. Unfortunately, no literature exists for forecasting future learning rates for fuel cells. In this paper, we look retrospectively to estimate learning rates for two fuel cell deployment programs: (1) the micro-combined heat and power (CHP) program in Japan, and (2) the Self-Generation Incentive Program (SGIP) in California. These two examples have a relatively broad set of historical market data and thus provide an informative and international comparison of distinct fuel cell technologies and government deployment programs. We develop a generalized procedure for disaggregating experience-curve cost-reductions in order to disaggregate the Japanese fuel cell micro-CHP market into its constituent components, and we derive and present a range of learning rates that may explain observed market trends. Finally, we explore the differences in the technology development ecosystem and market conditions that may have contributed to the observed differences in cost reduction and draw policy observations for the market adoption of future fuel cell technologies. The scientific and policy contributions of this paper are the first comparative experience curve analysis of past fuel cell technologies in two distinct markets, and the first quantitative comparison of a detailed cost model of fuel cell systems with actual market data. The resulting approach is applicable to

Conference 'onshore and offshore wind energy cost reduction: challenges and opportunities for the industry in France and in Germany'

International Nuclear Information System (INIS)

Abadie, Pierre-Marie; Hinsch, Thomas; Wallasch, Anna-Kathrin; Giese, Norbert; Guyet, Quentin; Lenhardt, Edouard; Beinke, Thies; Bodenstab, Marc; Wolff, Nicolas; Burkhardt, Claus; Lessmeister, Andreas L.

2012-01-01

The French-German office for Renewable energies (OFAEnR) organised a conference on cost reduction in onshore and offshore wind energy. In the framework of this French-German exchange of experience, about 140 participants exchanged views on the cost allocation in onshore wind energy projects, on their financing, and on the transport and logistics profitability challenges. Concrete examples of operating and maintenance cost reductions in offshore wind energy projects were presented as well. This document brings together the available presentations (slides) made during this event: 1 - Overview of France's onshore and offshore wind support policies (Pierre-Marie Abadie); 2 - Keynote: Framework conditions for cost reductions in the German wind energy sector (Thomas Hinsch); 3 - Cost of onshore wind energy projects in Germany - Status and experience feedback (Anna-Kathrin Wallasch); 4 - Crown estate's Offshore Wind Cost Reduction Pathways Study: how to transpose the conclusions to the German case (Norbert Giese); 5 - Combined Forces for Reliable Supply Chain - French-German Convergence of expertise: strategic partnerships for offshore projects implementation (Quentin Guyet, Edouard Lenhardt); 6 - Reducing costs of onshore and offshore wind energy. Mon2Sea research project - Real-time monitoring of transport and cargo handling of components for the offshore installation of wind turbines (Thies Beinke, Marc Bodenstab); 7 - expertise, Innovation and reduction of cost of energy: Vestas experience (Nicolas Wolff); 8 - Far-Offshore-Wind projects. Results of the First German Offshore Windpark alpha ventus (Claus Burkhardt); 9 - Maintenance for Offshore-Wind parks: examples and good practices for the future (Andreas L. Lessmeister)

Schedule and cost reduction of nuclear generating facilities in Ontario study overview

International Nuclear Information System (INIS)

Huterer, J.

1991-01-01

During the five year period 1985 to 1990, Ontario Hydro conducted a major study with the objective to reduce the cost and construction duration for future nuclear generating facilities in Ontario. This paper reports on the study called Major Projects: Schedule and Cost Reduction Study (SCRS). Ontario Hydro is a public utility with the responsibility for meeting electricity need for the province of Ontario with a population of 9.6 million. In order to adequately address future electricity needs, Ontario Hydro has developed and submitted a demand/supply plan which covers the next 25 years. The SCRS for major projects contributed to this demand/supply plan

Improving health care costing with resource consumption accounting.

Science.gov (United States)

Ozyapici, Hasan; Tanis, Veyis Naci

2016-07-11

Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

48 CFR 1615.407-1 - Rate reduction for defective pricing or defective cost or pricing data.

Science.gov (United States)

2010-10-01

... defective pricing or defective cost or pricing data. 1615.407-1 Section 1615.407-1 Federal Acquisition... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1615.407-1 Rate reduction for defective pricing or defective cost or pricing data. The clause set forth in section 1652.215-70...

48 CFR 1652.215-70 - Rate Reduction for Defective Pricing or Defective Cost or Pricing Data.

Science.gov (United States)

2010-10-01

... Defective Pricing or Defective Cost or Pricing Data. 1652.215-70 Section 1652.215-70 Federal Acquisition... CLAUSES AND FORMS CONTRACT CLAUSES Texts of FEHBP Clauses 1652.215-70 Rate Reduction for Defective Pricing or Defective Cost or Pricing Data. As prescribed in 1615.407-1, the following clause shall be...

New Zealand cuts health spending to control costs

OpenAIRE

2010-01-01

New Zealand’s health-care system is undergoing a series of cutbacks to reduce costs, but critics are concerned that the health of people on low incomes and in some population groups may suffer. Rebecca Lancashire reports in our series on health financing.

[Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

Science.gov (United States)

Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

2004-01-01

In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.

ISS Operations Cost Reductions Through Automation of Real-Time Planning Tasks

Science.gov (United States)

Hall, Timothy A.; Clancey, William J.; McDonald, Aaron; Toschlog, Jason; Tucker, Tyson; Khan, Ahmed; Madrid, Steven (Eric)

2011-01-01

In 2007 the Johnson Space Center s Mission Operations Directorate (MOD) management team challenged their organizations to find ways to reduce the cost of operations for supporting the International Space Station (ISS) in the Mission Control Center (MCC). Each MOD organization was asked to define and execute projects that would help them attain cost reductions by 2012. The MOD Operations Division Flight Planning Branch responded to this challenge by launching several software automation projects that would allow them to greatly improve console operations and reduce ISS console staffing and intern reduce operating costs. These tasks ranged from improving the management and integration mission plan changes, to automating the uploading and downloading of information to and from the ISS and the associated ground complex tasks that required multiple decision points. The software solutions leveraged several different technologies including customized web applications and implementation of industry standard web services architecture; as well as engaging a previously TRL 4-5 technology developed by Ames Research Center (ARC) that utilized an intelligent agent-based system to manage and automate file traffic flow, archive data, and generate console logs. These projects to date have allowed the MOD Operations organization to remove one full time (7 x 24 x 365) ISS console position in 2010; with the goal of eliminating a second full time ISS console support position by 2012. The team will also reduce one long range planning console position by 2014. When complete, these Flight Planning Branch projects will account for the elimination of 3 console positions and a reduction in staffing of 11 engineering personnel (EP) for ISS.

The cost of universal health care in India: a model based estimate.

Directory of Open Access Journals (Sweden)

Shankar Prinja

Full Text Available INTRODUCTION: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. METHODS: We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. RESULTS: We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73 per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8% of the GDP for universalizing health care services. CONCLUSION: The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

Prospective Health: Duke's Approach to Improving Employee Health and Managing Health Care Costs

Science.gov (United States)

Davidson, H. Clint, Jr.

2004-01-01

If developing a healthy workforce is critical to reining in the skyrocketing cost of health care, then why have so many attempts at preventive health or disease management fallen short? How can employers connect with employees to engage them in changing unhealthy habits or lifestyles? Duke University has launched an innovative new approach called…

A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

Science.gov (United States)

Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

2012-01-01

BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

Health benefits of a reduction of PM10 and NO2 exposure after implementing a clean air plan in the Agglomeration Lausanne-Morges.

Science.gov (United States)

Castro, Alberto; Künzli, Nino; Götschi, Thomas

2017-07-01

Exposure to urban air pollution has been associated with adverse effects on cardio-vascular and respiratory health, both short and long term. Consequently, governments have applied policies to reduce air pollution. Quantitative health impact assessments of hypothetic changes in air pollution have been conducted at national and global level, but assessments of observed air pollution changes associated with specific clean air policies at a local or regional scale remain scarce. This study estimates health impacts attributable to a decrease in PM 10 and NO 2 exposure in the Agglomeration of Lausanne-Morges (ALM), Switzerland, between 2005 and 2015, corresponding to the implementation period of a supra-municipal plan of measures to reduce air pollution in different sectors such as transport, energy, and industry (called Plan OPair 05). The health impact assessment compares health effects attributed to air pollution exposure levels in 2015 (reference case) with those in 2005 (counterfactual scenario), using 2015 as baseline for all other input data. In the ALM, the modeled PM 10 exposure reduction of 3.3μg/m 3 from 2005 to 2015 prevents 26 premature deaths (equivalent to around 290 years of life lost), 215 hospitalization days due to cardio-vascular and respiratory diseases as well as approximately 47,000 restricted activity days annually. Monetized health impacts of the reduction of PM 10 exposure are valued at approximately CHF 36 million annually. Immaterial costs, mainly related to the economic valuation of years of life lost, dominate the monetized health impacts (90% of total value), while savings at the workplace (net loss in production and reoccupation costs) amount to about CHF 1.9 million, and savings in health care costs to about CHF 0.5 million. The assessment is sensitive to the value assigned to immaterial costs and to uncertainties in the relative risk estimates, whereas variations in the baseline year (i.e. using 2005 data instead of 2015 data) affect

Population Aging in Iran and Rising Health Care Costs

Directory of Open Access Journals (Sweden)

Mohammad Mirzaie

2017-09-01

Conclusion Based on the results of this research, it can be said that people throughout their life cycle always allocate a percentage of their total spending to health care costs, but the percentage of this allocation is different at different ages. In a way the demand for healthcare costs increases with aging, it rises significantly in the old age. At the macro level, due to an increase in the percentage of elderly in the population over the next decade, there will also be an increase in the share of health care costs.

Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR.

Science.gov (United States)

Huynh, Lynn; Totev, Todor; Vekeman, Francis; Neary, Maureen P; Duh, Mei S; Benson, Al B

2017-09-01

To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor's perspective. Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p = .03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p = .01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p = .02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients

National and sub-national analysis of the health benefits and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan.

Science.gov (United States)

Carvalho, Natalie; Salehi, Ahmad Shah; Goldie, Sue J

2013-01-01

Afghanistan has one of the highest rates of maternal mortality in the world. We assess the health outcomes and cost-effectiveness of strategies to improve the safety of pregnancy and childbirth in Afghanistan. Using national and sub-national data, we adapted a previously validated model that simulates the natural history of pregnancy and pregnancy-related complications. We incorporated data on antenatal care, family planning, skilled birth attendance and information about access to transport, referral facilities and quality of care. We evaluated single interventions (e.g. family planning) and strategies that combined several interventions packaged as integrated services (transport, intrapartum care). Outcomes included pregnancy-related complications, maternal deaths, maternal mortality ratios, costs and cost-effectiveness ratios. Model-projected reduction in maternal deaths between 1999-2002 and 2007-08 approximated 20%. Increasing family planning was the most effective individual intervention to further reduce maternal mortality; up to 1 in 3 pregnancy-related deaths could be prevented if contraception use approached 60%. Nevertheless, reductions in maternal mortality reached a threshold (∼30% to 40%) without strategies that assured women access to emergency obstetrical care. A stepwise approach that coupled improved family planning with incremental improvements in skilled attendance, transport, referral and appropriate intrapartum care and high-quality facilities prevented 3 of 4 maternal deaths. Such an approach would cost less than US$200 per year of life saved at the national level, well below Afghanistan's per capita gross domestic product (GDP), a common benchmark for cost-effectiveness. Similar results were noted sub-nationally. Our findings reinforce the importance of early intensive efforts to increase family planning for spacing and limiting births and to provide control of fertility choices. While significant improvements in health delivery

The EOS 2D/3D X-ray imaging system: A cost-effectiveness analysis quantifying the health benefits from reduced radiation exposure

Energy Technology Data Exchange (ETDEWEB)

Faria, Rita, E-mail: rita.nevesdefaria@york.ac.uk [Centre for Health Economics, University of York, York (United Kingdom); McKenna, Claire [Centre for Health Economics, University of York, York (United Kingdom); Wade, Ros; Yang, Huiqin; Woolacott, Nerys [Centre for Reviews and Dissemination, University of York, York (United Kingdom); Sculpher, Mark [Centre for Health Economics, University of York, York (United Kingdom)

2013-08-15

Objectives: To evaluate the cost-effectiveness of the EOS{sup ®} 2D/3D X-ray imaging system compared with standard X-ray for the diagnosis and monitoring of orthopaedic conditions. Materials and methods: A decision analytic model was developed to quantify the long-term costs and health outcomes, expressed as quality-adjusted life years (QALYs) from the UK health service perspective. Input parameters were obtained from medical literature, previously developed cancer models and expert advice. Threshold analysis was used to quantify the additional health benefits required, over and above those associated with radiation-induced cancers, for EOS{sup ®} to be considered cost-effective. Results: Standard X-ray is associated with a maximum health loss of 0.001 QALYs, approximately 0.4 of a day in full health, while the loss with EOS{sup ®} is a maximum of 0.00015 QALYs, or 0.05 of a day in full health. On a per patient basis, EOS{sup ®} is more expensive than standard X-ray by between £10.66 and £224.74 depending on the assumptions employed. The results suggest that EOS{sup ®} is not cost-effective for any indication. Health benefits over and above those obtained from lower radiation would need to double for EOS to be considered cost-effective. Conclusion: No evidence currently exists on whether there are health benefits associated with imaging improvements from the use of EOS{sup ®}. The health benefits from radiation dose reductions are very small. Unless EOS{sup ®} can generate additional health benefits as a consequence of the nature and quality of the image, comparative patient throughput with X-ray will be the major determinant of cost-effectiveness.