WorldWideScience

Sample records for include cost analyses

  1. Walking- and cycling track networks in Norwegian cities : cost-benefit analyses including health effects and external costs of road traffic : summary

    Science.gov (United States)

    2002-04-01

    Cost- benefit analyses of walking- and cycling track net-works in three Norwegian cities are presented in this study. A project group working with a National Cycling Strategy in Norway initialised the study. Motivation for starting the study is the P...

  2. Methodology of cost benefit analyses

    International Nuclear Information System (INIS)

    Patrik, M.; Babic, P.

    2000-10-01

    The report addresses financial aspects of proposed investments and other steps which are intended to contribute to nuclear safety. The aim is to provide introductory insight into the procedures and potential of cost-benefit analyses as a routine guide when making decisions on costly provisions as one of the tools to assess whether a particular provision is reasonable. The topic is applied to the nuclear power sector. (P.A.)

  3. Cost-Benefit Analyses of Transportation Investments

    DEFF Research Database (Denmark)

    Næss, Petter

    2006-01-01

    -to-pay investigations. Accepting the ontological and epistemological assumptions of cost-benefit analysis involves an implicit acceptance of the ethical and political values favoured by these assumptions. Cost-benefit analyses of transportation investment projects tend to neglect long-term environmental consequences...... and needs among population groups with a low ability to pay. Instead of cost-benefit analyses, impact analyses evaluating the likely effects of project alternatives against a wide range of societal goals is recommended, with quantification and economic valorisation only for impact categories where this can......This paper discusses the practice of cost-benefit analyses of transportation infrastructure investment projects from the meta-theoretical perspective of critical realism. Such analyses are based on a number of untenable ontological assumptions about social value, human nature and the natural...

  4. Analyse of Maintenance Cost in ST

    CERN Document Server

    Jenssen, B W

    2001-01-01

    An analyse has been carried out in ST concerning the total costs for the division. Even though the target was the maintenance costs in ST, the global budget over has been analysed. This has been done since there is close relation between investments & consolidation and the required level for maintenance. The purpose of the analyse was to focus on maintenance cost in ST as a ratio of total maintenance costs over the replacement value of the equipment, and to make some comparisons with other industries and laboratories. Families of equipment have been defined and their corresponding ratios calculated. This first approach gives us some "quantitative" measurements. This analyse should be combined with performance indicators (more "qualitative" measurements) that are telling us how well we are performing. This will help us in defending our budget, make better priorities, and we will satisfy the requirements from our external auditors.

  5. The Economic Cost of Homosexuality: Multilevel Analyses

    Science.gov (United States)

    Baumle, Amanda K.; Poston, Dudley, Jr.

    2011-01-01

    This article builds on earlier studies that have examined "the economic cost of homosexuality," by using data from the 2000 U.S. Census and by employing multilevel analyses. Our findings indicate that partnered gay men experience a 12.5 percent earnings penalty compared to married heterosexual men, and a statistically insignificant earnings…

  6. Protocol-driven costs in trial-based pharmacoeconomic analyses.

    Science.gov (United States)

    Gandjour, Afschin

    2011-12-01

    Many authors and guidelines have proposed to exclude protocol-driven costs from cost-effectiveness analyses alongside clinical trials because they do not occur in clinical practice. This article, however, argues that only costs to improve patient adherence can be excluded, as the underlying protocol-driven activities have a clearly distinguishable cost and utility impact (most of the time). All other protocol-driven costs need to be included because the cost and utility impact of the underlying protocol-driven activities cannot be easily separated.

  7. Cost/benefit analyses of environmental impact

    International Nuclear Information System (INIS)

    Goldman, M.I.

    1974-01-01

    Various aspects of cost-benefit analyses are considered. Some topics discussed are: regulations of the National Environmental Policy Act (NEPA); statement of AEC policy and procedures for implementation of NEPA; Calvert Cliffs decision; AEC Regulatory Guide; application of risk-benefit analysis to nuclear power; application of the as low as practicable (ALAP) rule to radiation discharges; thermal discharge restrictions proposed by EPA under the 1972 Amendment to the Water Pollution Control Act; estimates of somatic and genetic insult per unit population exposure; occupational exposure; EPA Point Source Guidelines for Discharges from Steam Electric Power Plants; and costs of closed-cycle cooling using cooling towers. (U.S.)

  8. Ethics of cost analyses in medical education.

    Science.gov (United States)

    Walsh, Kieran

    2013-11-01

    Cost analyses in medical education are rarely straightforward, and rarely lead to clear-cut conclusions. Occasionally they do lead to clear conclusions but even when that happens, some stakeholders will ask difficult but valid questions about what to do following cost analyses-specifically about distributive justice in the allocation of resources. At present there are few or no debates about these issues and rationing decisions that are taken in medical education are largely made subconsciously. Distributive justice 'concerns the nature of a socially just allocation of goods in a society'. Inevitably there is a large degree of subjectivity in the judgment as to whether an allocation is seen as socially just or ethical. There are different principles by which we can view distributive justice and which therefore affect the prism of subjectivity through which we see certain problems. For example, we might say that distributive justice at a certain institution or in a certain medical education system operates according to the principle that resources must be divided equally amongst learners. Another system may say that resources should be distributed according to the needs of learners or even of patients. No ethical system or model is inherently right or wrong, they depend on the context in which the educator is working.

  9. The Quality of Cost-Utility Analyses in Orthopedic Trauma.

    Science.gov (United States)

    Nwachukwu, Benedict U; Schairer, William W; O'Dea, Evan; McCormick, Frank; Lane, Joseph M

    2015-08-01

    As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma. Copyright 2015, SLACK Incorporated.

  10. Analysing biomass torrefaction supply chain costs.

    Science.gov (United States)

    Svanberg, Martin; Olofsson, Ingemar; Flodén, Jonas; Nordin, Anders

    2013-08-01

    The objective of the present work was to develop a techno-economic system model to evaluate how logistics and production parameters affect the torrefaction supply chain costs under Swedish conditions. The model consists of four sub-models: (1) supply system, (2) a complete energy and mass balance of drying, torrefaction and densification, (3) investment and operating costs of a green field, stand-alone torrefaction pellet plant, and (4) distribution system to the gate of an end user. The results show that the torrefaction supply chain reaps significant economies of scale up to a plant size of about 150-200 kiloton dry substance per year (ktonDS/year), for which the total supply chain costs accounts to 31.8 euro per megawatt hour based on lower heating value (€/MWhLHV). Important parameters affecting total cost are amount of available biomass, biomass premium, logistics equipment, biomass moisture content, drying technology, torrefaction mass yield and torrefaction plant capital expenditures (CAPEX). Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Spent fuel shipping costs for transportation logistics analyses

    International Nuclear Information System (INIS)

    Cole, B.M.; Cross, R.E.; Cashwell, J.W.

    1983-05-01

    Logistics analyses supplied to the nuclear waste management programs of the U.S. Department of Energy through the Transportation Technology Center (TTC) at Sandia National Laboratories are used to predict nuclear waste material logistics, transportation packaging demands, shipping and receiving rates and transportation-related costs for alternative strategies. This study is an in-depth analysis of the problems and contingencies associated with the costs of shipping irradiated reactor fuel. These costs are extremely variable however, and have changed frequently (sometimes monthly) during the past few years due to changes in capital, fuel, and labor costs. All costs and charges reported in this study are based on January 1982 data using existing transport cask systems and should be used as relative indices only. Actual shipping costs would be negotiable for each origin-destination combination

  12. Cost-efficiency analyses of offshore 3D seismic survey

    OpenAIRE

    Liu, Youjun

    2015-01-01

    Master's thesis in Industrial economics The main objective of this project is to analyses the factors that affect the cost and efficiency during the offshore 3D seismic survey. Four parts will be discussed to support the main objective--the equipment, environment, decision making on the investment and human factors. These parts will analyze how those elements affect the cost and efficiency in 3D seismic surveys and how to optimize these effects during production. The study focus on e...

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

    Science.gov (United States)

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

    2018-04-12

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

  14. A review of the role of cost-benefit analyses in 2-1-1 diffusion.

    Science.gov (United States)

    Shank, Nancy

    2012-12-01

    The 2-1-1 helpline is a social services innovation that has spread rapidly throughout the U.S. Policy diffusion theory suggests that policymakers seek to reduce uncertainty by anticipating the effects of a proposed innovation through tools such as cost-benefit analyses. Few policy diffusion studies have examined use of information, such as cost-benefit analyses, in the diffusion process. The purpose of this study is to examine how cost-benefit analyses were used during the rapid diffusion of 2-1-1 across states. The paper also describes components of 2-1-1 cost-benefit analyses. In 2011, cost-benefit analyses of 2-1-1 and substantive citations of them were identified through scholarly key word searches using Academic Search Premier and Web of Science, general Internet searches using Google search terms, and communications with academicians and 2-1-1 practitioners through personal contact and e-mail discussion groups. To be included in this study, documents had to be related to 2-1-1 helplines, present information about their costs and benefits, and be formal documents. The documents were catalogued and analyzed for cost-benefit analyses or references to analyses, and stated purpose. Of the 19 documents that met eligibility inclusion criteria, nine were original cost-benefit analyses and ten referenced analyses conducted for other jurisdictions. The diffusion of 2-1-1 helplines in the U.S. has been influenced by interjurisdictional exchange of cost-benefit analyses, in both the creation of original analyses and/or the referencing of previous work. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Which Costs Matter? Costs Included in Economic Evaluation and their Impact on Decision Uncertainty for Stable Coronary Artery Disease.

    Science.gov (United States)

    Lomas, James; Asaria, Miqdad; Bojke, Laura; Gale, Chris P; Richardson, Gerry; Walker, Simon

    2018-02-14

    Variation exists in the resource categories included in economic evaluations, and National Institute for Health and Care Excellence (NICE) guidance suggests the inclusion only of costs related to the index condition or intervention. However, there is a growing consensus that all healthcare costs should be included in economic evaluations for Health Technology Assessments (HTAs), particularly those related to extended years of life. We aimed to quantify the impact of a range of cost categories on the adoption decision about a hypothetical intervention, and uncertainty around that decision, for stable coronary artery disease (SCAD) based on a dataset comprising 94,966 patients. Three costing scenarios were considered: coronary heart disease (CHD) costs only, cardiovascular disease (CVD) costs and all costs. The first two illustrate different interpretations of what might be regarded as related costs. Employing a 20-year time horizon, the highest mean expected incremental cost was when all costs were included (£2468) and the lowest when CVD costs only were included (£2377). The probability of the treatment being cost effective, estimating health opportunity costs using a ratio of £30,000 per quality-adjusted life-year (QALY), was different for each of the CHD (70%) costs, CVD costs (73%) and all costs (56%) scenarios. The results concern a hypothetical intervention and are illustrative only, as such they cannot necessarily be generalised to all interventions and diseases. Cost categories included in an economic evaluation of SCAD impact on estimates of both cost effectiveness and decision uncertainty. With an aging and co-morbid population, the inclusion of all healthcare costs may have important ramifications for the selection of healthcare provision on economic grounds.

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

    Science.gov (United States)

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

    2012-09-15

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

  17. Cost-benefit analyses of supplementary measles immunisation in the highly immunized population of New Zealand.

    Science.gov (United States)

    Hayman, D T S; Marshall, J C; French, N P; Carpenter, T E; Roberts, M G; Kiedrzynski, T

    2017-09-05

    As endemic measles is eliminated from countries through increased immunisation, the economic benefits of enhanced immunisation programs may come into question. New Zealand has suffered from outbreaks after measles introductions from abroad and we use it as a model system to understand the benefits of catch up immunisation in highly immunised populations. We provide cost-benefit analyses for measles supplementary immunisation in New Zealand. We model outbreaks based on estimates of the basic reproduction number in the vaccinated population (R v , the number of secondary infections in a partially immunised population), based on the number of immunologically-naïve people at district and national levels, considering both pre- and post-catch up vaccination scenarios. Our analyses suggest that measles R v often includes or exceeds one (0.18-3.92) despite high levels of population immunity. We calculate the cost of the first 187 confirmed and probable measles cases in 2014 to be over NZ$1 million (∼US$864,200) due to earnings lost, case management and hospitalization costs. The benefit-cost ratio analyses suggest additional vaccination beyond routine childhood immunisation is economically efficient. Supplemental vaccination-related costs are required to exceed approximately US$66 to US$1877 per person, depending on different scenarios, before supplemental vaccination is economically inefficient. Thus, our analysis suggests additional immunisation beyond childhood programs to target naïve individuals is economically beneficial even when childhood immunisation rates are high. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Collecting and analysing cost data for complex public health trials: reflections on practice

    Directory of Open Access Journals (Sweden)

    Neha Batura

    2014-02-01

    Full Text Available Background: Current guidelines for the conduct of cost-effectiveness analysis (CEA are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective: This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design: We describe the generally accepted methods (norms for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results: When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity

  19. Making Sense of Cost-Effectiveness and Benefit-Cost Analyses.

    Science.gov (United States)

    Temkin, Sanford

    Although two economic methods, cost effectiveness and benefit-cost analysis, are frequently mentioned as useful tools for educational decision making, only one, cost effectiveness, has potential for making a contribution to this field. A benefit-cost analysis tries for each alternative to measure benefits and costs, which are then discounted to…

  20. The Impact of Including Below Detection Limit Samples in Post Decommissioning Soil Sample Analyses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hwan; Yim, Man-Sung [KAIST, Daejeon (Korea, Republic of)

    2016-10-15

    To meet the required standards the site owner has to show that the soil at the facility has been sufficiently cleaned up. To do this one must know the contamination of the soil at the site prior to clean up. This involves sampling that soil to identify the degree of contamination. However there is a technical difficulty in determining how much decontamination should be done. The problem arises when measured samples are below the detection limit. Regulatory guidelines for site reuse after decommissioning are commonly challenged because the majority of the activity in the soil at or below the limit of detection. Using additional statistical analyses of contaminated soil after decommissioning is expected to have the following advantages: a better and more reliable probabilistic exposure assessment, better economics (lower project costs) and improved communication with the public. This research will develop an approach that defines an acceptable method for demonstrating compliance of decommissioned NPP sites and validates that compliance. Soil samples from NPP often contain censored data. Conventional methods for dealing with censored data sets are statistically biased and limited in their usefulness. In this research, additional methods are performed using real data from a monazite manufacturing factory.

  1. 41 CFR 301-74.4 - What should cost comparisons include?

    Science.gov (United States)

    2010-07-01

    ... comparisons include? 301-74.4 Section 301-74.4 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 74-CONFERENCE PLANNING Agency Responsibilities § 301-74.4 What should cost comparisons include? Cost comparisons should include...

  2. Classical evolution and quantum generation in generalized gravity theories including string corrections and tachyons: Unified analyses

    International Nuclear Information System (INIS)

    Hwang, Jai-chan; Noh, Hyerim

    2005-01-01

    We present cosmological perturbation theory based on generalized gravity theories including string theory correction terms and a tachyonic complication. The classical evolution as well as the quantum generation processes in these varieties of gravity theories are presented in unified forms. These apply both to the scalar- and tensor-type perturbations. Analyses are made based on the curvature variable in two different gauge conditions often used in the literature in Einstein's gravity; these are the curvature variables in the comoving (or uniform-field) gauge and the zero-shear gauge. Applications to generalized slow-roll inflation and its consequent power spectra are derived in unified forms which include a wide range of inflationary scenarios based on Einstein's gravity and others

  3. A systematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis.

    Science.gov (United States)

    Hiligsmann, Mickaël; Evers, Silvia M; Ben Sedrine, Wafa; Kanis, John A; Ramaekers, Bram; Reginster, Jean-Yves; Silverman, Stuart; Wyers, Caroline E; Boonen, Annelies

    2015-03-01

    Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal osteoporosis remains and even increases. This study aims to identify all recent economic evaluations on drugs for postmenopausal osteoporosis, to critically appraise the reporting quality, and to summarize the results. A literature search using Medline, the National Health Service Economic Evaluation database and the Cost-Effectiveness Analysis Registry was undertaken to identify original articles published between January 1, 2008 and December 31, 2013. Studies that assessed cost effectiveness of drugs in postmenopausal osteoporosis were included. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of these articles. Of 1,794 articles identified, 39 studies fulfilled the inclusion criteria. They were conducted in 14 different countries and nine active interventions were assessed. When compared with no treatment, active osteoporotic drugs were generally cost effective in postmenopausal women aged over 60-65 years with low bone mass, especially those with prior vertebral fractures. Key drivers of cost effectiveness included individual fracture risk, medication adherence, selected comparators and country-specific analyses. Quality of reporting varied between studies with an average score of 17.9 out of 24 (range 7-21.5). This review found a substantial number of published cost-effectiveness analyses of drugs in osteoporosis in the last 6 years. Results and critical appraisal of these articles can help decision makers when prioritizing health interventions and can inform the development of future economic evaluations.

  4. Analysing Incentive and Cost Sharing Issues in Livestock Disease Management

    DEFF Research Database (Denmark)

    Biira, Juliet

    This PhD thesis tackles two main issues in livestock health management: a) the incentives for animal disease prevention on Danish livestock farms and b) allocation of costs of animal disease outbreaks and animal disease preparedness, among stakeholders involved in the livestock sector. The main...... contributions of this thesis are firstly the investigation of incentives for Danish livestock farmers to prevent animal diseases at the farm level and recommendations on how they could be improved. Secondly, the exploration of a mutual fund as a possibility for risk pooling among farmers and how it can...... for not participating for those not willing to participate. The research is based on data from a survey of 325 Danish pig farmers sent out in May 2014. The results reveal that factors significantly affecting the deciding to participate are famers’ knowledge on animal diseases, risk attitude and SPF classification...

  5. Systematic review of cost-effectiveness analyses of treatments for psoriasis.

    Science.gov (United States)

    Zhang, Wei; Islam, Nazrul; Ma, Canice; Anis, Aslam H

    2015-04-01

    Psoriasis is a chronic inflammatory disease of the skin that has a major effect on an individual's physical and mental function. The disease is associated with increased healthcare resource use and costs, therefore cost-effectiveness analysis (CEA) can be used to assist decision makers with determining which treatments are optimal within a constrained healthcare system budget. Our aim was to systematically review the current literature on the CEA of existing treatment options for psoriasis, assess the quality of these studies, and summarize the evidence on the drivers of cost effectiveness. A literature search using Medical Subject Headings and keywords was performed in the MEDLINE, EMBASE and Health Technology Assessment databases, as well as the National Health Service Economic Evaluation Database; the CEA Registry was searched using keywords only. All references within the relevant review articles were examined manually. Two researchers independently determined the final articles and a third researcher resolved any discrepancies. We evaluated study quality in terms of the study perspective, effectiveness measures, cost measures, economic model, and time horizon. Any sensitivity analyses conducted in the studies were examined to identify the drivers of cost effectiveness, which included any variables leading to changes in the study conclusions. Fifty-three articles were included in our final review: 70% did not explicitly include costs related to adverse events; approximately one-quarter used quality-adjusted life-years; and 34% applied a time horizon under 1 year. In 18 of the 38 studies that conducted a sensitivity analysis, the cost-effectiveness results were impacted by uncertainty. The main key drivers of cost effectiveness were the costs related to the treatment, values and choice of efficacy, utility values, hospitalization for non-responders, time horizon, model structure, and utility mapping method. High-quality cost-effectiveness studies are required to

  6. Comparative chloroplast genomics: Analyses including new sequencesfrom the angiosperms Nuphar advena and Ranunculus macranthus

    Energy Technology Data Exchange (ETDEWEB)

    Raubeso, Linda A.; Peery, Rhiannon; Chumley, Timothy W.; Dziubek,Chris; Fourcade, H. Matthew; Boore, Jeffrey L.; Jansen, Robert K.

    2007-03-01

    The number of completely sequenced plastid genomes available is growing rapidly. This new array of sequences presents new opportunities to perform comparative analyses. In comparative studies, it is most useful to compare across wide phylogenetic spans and, within angiosperms, to include representatives from basally diverging lineages such as the new genomes reported here: Nuphar advena (from a basal-most lineage) and Ranunculus macranthus (from the basal group of eudicots). We report these two new plastid genome sequences and make comparisons (within angiosperms, seed plants, or all photosynthetic lineages) to evaluate features such as the status of ycf15 and ycf68 as protein coding genes, the distribution of simple sequence repeats (SSRs) and longer dispersed repeats (SDR), and patterns of nucleotide composition.

  7. Lamb Production Costs: Analyses of Composition and Elasticities Analysis of Lamb Production Costs

    Directory of Open Access Journals (Sweden)

    C. Raineri

    2015-08-01

    Full Text Available Since lamb is a commodity, producers cannot control the price of the product they sell. Therefore, managing production costs is a necessity. We explored the study of elasticities as a tool for basing decision-making in sheep production, and aimed at investigating the composition and elasticities of lamb production costs, and their influence on the performance of the activity. A representative sheep production farm, designed in a panel meeting, was the base for calculation of lamb production cost. We then performed studies of: i costs composition, and ii cost elasticities for prices of inputs and for zootechnical indicators. Variable costs represented 64.15% of total cost, while 21.66% were represented by operational fixed costs, and 14.19% by the income of the factors. As for elasticities to input prices, the opportunity cost of land was the item to which production cost was more sensitive: a 1% increase in its price would cause a 0.2666% increase in lamb cost. Meanwhile, the impact of increasing any technical indicator was significantly higher than the impact of rising input prices. A 1% increase in weight at slaughter, for example, would reduce total cost in 0.91%. The greatest obstacle to economic viability of sheep production under the observed conditions is low technical efficiency. Increased production costs are more related to deficient zootechnical indexes than to high expenses.

  8. DNA sequence analyses of blended herbal products including synthetic cannabinoids as designer drugs.

    Science.gov (United States)

    Ogata, Jun; Uchiyama, Nahoko; Kikura-Hanajiri, Ruri; Goda, Yukihiro

    2013-04-10

    In recent years, various herbal products adulterated with synthetic cannabinoids have been distributed worldwide via the Internet. These herbal products are mostly sold as incense, and advertised as not for human consumption. Although their labels indicate that they contain mixtures of several potentially psychoactive plants, and numerous studies have reported that they contain a variety of synthetic cannabinoids, their exact botanical contents are not always clear. In this study, we investigated the origins of botanical materials in 62 Spice-like herbal products distributed on the illegal drug market in Japan, by DNA sequence analyses and BLAST searches. The nucleotide sequences of four regions were analyzed to identify the origins of each plant species in the herbal mixtures. The sequences of "Damiana" (Turnera diffusa) and Lamiaceae herbs (Mellissa, Mentha and Thymus) were frequently detected in a number of products. However, the sequences of other plant species indicated on the packaging labels were not detected. In a few products, DNA fragments of potent psychotropic plants were found, including marijuana (Cannabis sativa), "Diviner's Sage" (Salvia divinorum) and "Kratom" (Mitragyna speciosa). Their active constituents were also confirmed using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS), although these plant names were never indicated on the labels. Most plant species identified in the products were different from the plants indicated on the labels. The plant materials would be used mainly as diluents for the psychoactive synthetic compounds, because no reliable psychoactive effects have been reported for most of the identified plants, with the exception of the psychotropic plants named above. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Comparative chloroplast genomics: analyses including new sequences from the angiosperms Nuphar advena and Ranunculus macranthus

    Directory of Open Access Journals (Sweden)

    Boore Jeffrey L

    2007-06-01

    Full Text Available Abstract Background The number of completely sequenced plastid genomes available is growing rapidly. This array of sequences presents new opportunities to perform comparative analyses. In comparative studies, it is often useful to compare across wide phylogenetic spans and, within angiosperms, to include representatives from basally diverging lineages such as the genomes reported here: Nuphar advena (from a basal-most lineage and Ranunculus macranthus (a basal eudicot. We report these two new plastid genome sequences and make comparisons (within angiosperms, seed plants, or all photosynthetic lineages to evaluate features such as the status of ycf15 and ycf68 as protein coding genes, the distribution of simple sequence repeats (SSRs and longer dispersed repeats (SDR, and patterns of nucleotide composition. Results The Nuphar [GenBank:NC_008788] and Ranunculus [GenBank:NC_008796] plastid genomes share characteristics of gene content and organization with many other chloroplast genomes. Like other plastid genomes, these genomes are A+T-rich, except for rRNA and tRNA genes. Detailed comparisons of Nuphar with Nymphaea, another Nymphaeaceae, show that more than two-thirds of these genomes exhibit at least 95% sequence identity and that most SSRs are shared. In broader comparisons, SSRs vary among genomes in terms of abundance and length and most contain repeat motifs based on A and T nucleotides. Conclusion SSR and SDR abundance varies by genome and, for SSRs, is proportional to genome size. Long SDRs are rare in the genomes assessed. SSRs occur less frequently than predicted and, although the majority of the repeat motifs do include A and T nucleotides, the A+T bias in SSRs is less than that predicted from the underlying genomic nucleotide composition. In codon usage third positions show an A+T bias, however variation in codon usage does not correlate with differences in A+T-richness. Thus, although plastome nucleotide composition shows "A

  10. Comparative chloroplast genomics: analyses including new sequences from the angiosperms Nuphar advena and Ranunculus macranthus.

    Science.gov (United States)

    Raubeson, Linda A; Peery, Rhiannon; Chumley, Timothy W; Dziubek, Chris; Fourcade, H Matthew; Boore, Jeffrey L; Jansen, Robert K

    2007-06-15

    The number of completely sequenced plastid genomes available is growing rapidly. This array of sequences presents new opportunities to perform comparative analyses. In comparative studies, it is often useful to compare across wide phylogenetic spans and, within angiosperms, to include representatives from basally diverging lineages such as the genomes reported here: Nuphar advena (from a basal-most lineage) and Ranunculus macranthus (a basal eudicot). We report these two new plastid genome sequences and make comparisons (within angiosperms, seed plants, or all photosynthetic lineages) to evaluate features such as the status of ycf15 and ycf68 as protein coding genes, the distribution of simple sequence repeats (SSRs) and longer dispersed repeats (SDR), and patterns of nucleotide composition. The Nuphar [GenBank:NC_008788] and Ranunculus [GenBank:NC_008796] plastid genomes share characteristics of gene content and organization with many other chloroplast genomes. Like other plastid genomes, these genomes are A+T-rich, except for rRNA and tRNA genes. Detailed comparisons of Nuphar with Nymphaea, another Nymphaeaceae, show that more than two-thirds of these genomes exhibit at least 95% sequence identity and that most SSRs are shared. In broader comparisons, SSRs vary among genomes in terms of abundance and length and most contain repeat motifs based on A and T nucleotides. SSR and SDR abundance varies by genome and, for SSRs, is proportional to genome size. Long SDRs are rare in the genomes assessed. SSRs occur less frequently than predicted and, although the majority of the repeat motifs do include A and T nucleotides, the A+T bias in SSRs is less than that predicted from the underlying genomic nucleotide composition. In codon usage third positions show an A+T bias, however variation in codon usage does not correlate with differences in A+T-richness. Thus, although plastome nucleotide composition shows "A+T richness", an A+T bias is not apparent upon more in

  11. System Evaluations and Life-Cycle Cost Analyses for High-Temperature Electrolysis Hydrogen Production Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Edwin A. Harvego; James E. O' Brien; Michael G. McKellar

    2012-05-01

    This report presents results of system evaluations and lifecycle cost analyses performed for several different commercial-scale high-temperature electrolysis (HTE) hydrogen production concepts. The concepts presented in this report rely on grid electricity and non-nuclear high-temperature process heat sources for the required energy inputs. The HYSYS process analysis software was used to evaluate both central plant designs for large-scale hydrogen production (50,000 kg/day or larger) and forecourt plant designs for distributed production and delivery at about 1,500 kg/day. The HYSYS software inherently ensures mass and energy balances across all components and it includes thermodynamic data for all chemical species. The optimized designs described in this report are based on analyses of process flow diagrams that included realistic representations of fluid conditions and component efficiencies and operating parameters for each of the HTE hydrogen production configurations analyzed. As with previous HTE system analyses performed at the INL, a custom electrolyzer model was incorporated into the overall process flow sheet. This electrolyzer model allows for the determination of the average Nernst potential, cell operating voltage, gas outlet temperatures, and electrolyzer efficiency for any specified inlet steam, hydrogen, and sweep-gas flow rates, current density, cell active area, and external heat loss or gain. The lifecycle cost analyses were performed using the H2A analysis methodology developed by the Department of Energy (DOE) Hydrogen Program. This methodology utilizes spreadsheet analysis tools that require detailed plant performance information (obtained from HYSYS), along with financial and cost information to calculate lifecycle costs. There are standard default sets of assumptions that the methodology uses to ensure consistency when comparing the cost of different production or plant design options. However, these assumptions may also be varied within the

  12. What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses.

    Science.gov (United States)

    Doble, Brett; Wordsworth, Sarah; Rogers, Chris A; Welbourn, Richard; Byrne, James; Blazeby, Jane M

    2017-08-01

    This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven 'important' cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended 'important' cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.

  13. Predictive Engineering Tools for Injection-Molded Long-Carbon-Thermoplastic Composites: Weight and Cost Analyses

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Ba Nghiep [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Fifield, Leonard S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gandhi, Umesh N. [Toyota Research Inst. North America, Ann Arbor, MI (United States); Mori, Steven [MAGNA Exteriors and Interiors Corporation, Aurora, ON (Canada); Wollan, Eric J. [PlastiComp, Inc., Winona, MN (United States)

    2016-08-01

    This project proposed to integrate, optimize and validate the fiber orientation and length distribution models previously developed and implemented in the Autodesk Simulation Moldflow Insight (ASMI) package for injection-molded long-carbon-fiber thermoplastic composites into a cohesive prediction capability. The current effort focused on rendering the developed models more robust and efficient for automotive industry part design to enable weight savings and cost reduction. The project goal has been achieved by optimizing the developed models, improving and integrating their implementations in ASMI, and validating them for a complex 3D LCF thermoplastic automotive part (Figure 1). Both PP and PA66 were used as resin matrices. After validating ASMI predictions for fiber orientation and fiber length for this complex part against the corresponding measured data, in collaborations with Toyota and Magna PNNL developed a method using the predictive engineering tool to assess LCF/PA66 complex part design in terms of stiffness performance. Structural three-point bending analyses of the complex part and similar parts in steel were then performed for this purpose, and the team has then demonstrated the use of stiffness-based complex part design assessment to evaluate weight savings relative to the body system target (≥ 35%) set in Table 2 of DE-FOA-0000648 (AOI #1). In addition, starting from the part-to-part analysis, the PE tools enabled an estimated weight reduction for the vehicle body system using 50 wt% LCF/PA66 parts relative to the current steel system. Also, from this analysis an estimate of the manufacturing cost including the material cost for making the equivalent part in steel has been determined and compared to the costs for making the LCF/PA66 part to determine the cost per “saved” pound.

  14. Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review.

    Science.gov (United States)

    Nwachukwu, Benedict U; Schairer, William W; Bernstein, Jaime L; Dodwell, Emily R; Marx, Robert G; Allen, Answorth A

    2015-06-01

    As increasing attention is paid to the cost of health care delivered in the United States (US), cost-effectiveness analyses (CEAs) are gaining in popularity. Reviews of the CEA literature have been performed in other areas of medicine, including some subspecialties within orthopaedics. Demonstrating the value of medical procedures is of utmost importance, yet very little is known about the overall quality and findings of CEAs in sports medicine. To identify and summarize CEA studies in orthopaedic sports medicine and to grade the quality of the available literature. Systematic review. A systematic review of the literature was performed to compile findings and grade the methodological quality of US-based CEA studies in sports medicine. The Quality of Health Economic Studies (QHES) instrument and the checklist by the US Panel on Cost-effectiveness in Health and Medicine were used to assess study quality. One-sided Fisher exact testing was performed to analyze the predictors of high-quality CEAs. Twelve studies met inclusion criteria. Five studies examined anterior cruciate ligament reconstruction, 3 studies examined rotator cuff repair, 2 examined autologous chondrocyte implantation, 1 study examined hip arthroscopic surgery, and 1 study examined the operative management of shoulder dislocations. Based on study findings, operative intervention in sports medicine is highly cost-effective. The quality of published evidence is good, with a mean quality score of 81.8 (range, 70-94). There is a trend toward higher quality in more recent publications. No significant predictor of high-quality evidence was found. The CEA literature in sports medicine is good; however, there is a paucity of studies, and the available evidence is focused on a few procedures. More work needs to be conducted to quantify the cost-effectiveness of different techniques and procedures within sports medicine. The QHES tool may be useful for the evaluation of future CEAs. © 2014 The Author(s).

  15. A practical approach for calculating reliable cost estimates from observational data: application to cost analyses in maternal and child health.

    Science.gov (United States)

    Salemi, Jason L; Comins, Meg M; Chandler, Kristen; Mogos, Mulubrhan F; Salihu, Hamisu M

    2013-08-01

    Comparative effectiveness research (CER) and cost-effectiveness analysis are valuable tools for informing health policy and clinical care decisions. Despite the increased availability of rich observational databases with economic measures, few researchers have the skills needed to conduct valid and reliable cost analyses for CER. The objectives of this paper are to (i) describe a practical approach for calculating cost estimates from hospital charges in discharge data using publicly available hospital cost reports, and (ii) assess the impact of using different methods for cost estimation in maternal and child health (MCH) studies by conducting economic analyses on gestational diabetes (GDM) and pre-pregnancy overweight/obesity. In Florida, we have constructed a clinically enhanced, longitudinal, encounter-level MCH database covering over 2.3 million infants (and their mothers) born alive from 1998 to 2009. Using this as a template, we describe a detailed methodology to use publicly available data to calculate hospital-wide and department-specific cost-to-charge ratios (CCRs), link them to the master database, and convert reported hospital charges to refined cost estimates. We then conduct an economic analysis as a case study on women by GDM and pre-pregnancy body mass index (BMI) status to compare the impact of using different methods on cost estimation. Over 60 % of inpatient charges for birth hospitalizations came from the nursery/labor/delivery units, which have very different cost-to-charge markups (CCR = 0.70) than the commonly substituted hospital average (CCR = 0.29). Using estimated mean, per-person maternal hospitalization costs for women with GDM as an example, unadjusted charges ($US14,696) grossly overestimated actual cost, compared with hospital-wide ($US3,498) and department-level ($US4,986) CCR adjustments. However, the refined cost estimation method, although more accurate, did not alter our conclusions that infant/maternal hospitalization costs

  16. Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

    Science.gov (United States)

    van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

    2017-09-01

    Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. 78 FR 26847 - Including Specific Pavement Types in Federal-aid Highway Traffic Noise Analyses

    Science.gov (United States)

    2013-05-08

    ... receipt of comments must include a self-addressed, stamped postcard or you may print the acknowledgment... in the highway industry, the FHWA is interested in how some of these new technologies and techniques...

  18. Reference model for measuring and analysing costs – particularly in business informatics

    OpenAIRE

    Milos Maryska

    2010-01-01

    This paper is devoted to problems of management of cost efficiency of business informatics with Business Intelligence (BI) assistance. It defines basic critical points that must be taken into account during creating models for management of cost efficiency of business informatics. It proposes new model for management of cost efficiency, this model include also definitions of dimensions and indicators for measuring of this cost efficiency. The model takes into account requirements that pose cl...

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

    Directory of Open Access Journals (Sweden)

    Georges SARAFOPOULOS

    2017-07-01

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

  20. Seismic hazard analyses for Taipei city including deaggregation, design spectra, and time history with excel applications

    Science.gov (United States)

    Wang, Jui-Pin; Huang, Duruo; Cheng, Chin-Tung; Shao, Kuo-Shin; Wu, Yuan-Chieh; Chang, Chih-Wei

    2013-03-01

    Given the difficulty of earthquake forecast, Probabilistic Seismic Hazard Analysis (PSHA) has been a method to best estimate site-specific ground motion or response spectra in earthquake engineering and engineering seismology. In this paper, the first in-depth PSHA study for Taipei, the economic center of Taiwan with a six-million population, was carried out. Unlike the very recent PSHA study for Taiwan, this study includes the follow-up hazard deaggregation, response spectra, and the earthquake motion recommendations. Hazard deaggregation results show that moderate-size and near-source earthquakes are the most probable scenario for this city. Moreover, similar to the findings in a few recent studies, the earthquake risk for Taipei should be relatively high and considering this city's importance, the high risk should not be overlooked and a potential revision of the local technical reference would be needed. In addition to the case study, some innovative Excel applications to PSHA are introduced in this paper. Such spreadsheet applications are applicable to geosciences research as those developed for data reduction or quantitative analysis with Excel's user-friendly nature and wide accessibility.

  1. Experiences of including costs of added life years in health economic evaluations in Sweden

    Directory of Open Access Journals (Sweden)

    Laura Pirhonen

    2014-06-01

    Full Text Available It is of importance to include the appropriate costs and outcomes when evaluating a health intervention. Sweden is the only country where the national guidelines of decisions on reimbursement explicitly state that costs of added life years should be accounted for when presenting health economic evaluations. The aim of this article is to, from a theoretical and empirical point of view, critically analyze the Swedish recommendations used by the Dental and Pharmaceutical Benefits Agency (TLV, when it comes to the use of costs of added life years in economic evaluations of health care. The aim is furthermore to analyze the numbers used in Sweden and discuss their impact on the incremental cost‑effectiveness ratios of assessed technologies. If following a societal perspective, based on welfare economics, there is strong support for the inclusion of costs of added life years in health economic evaluations. These costs have a large impact on the results. However this fact may be in conflict with ethical concerns of allocation of health care resources, such as favoring the younger part of the population over the older. It is important that the estimates of production and consumption reflect the true societal values, which is not the case with the values used in Sweden.http://dx.doi.org/10.7175/fe.v15i2.925

  2. Review of the risks and benefits of yellow fever vaccination including some new analyses.

    Science.gov (United States)

    Monath, Thomas P

    2012-04-01

    The live, attenuated yellow fever (YF) 17D vaccine provides highly effective and durable immunity and is widely used for travelers to and residents of endemic areas of South America and Africa. Neurotropic and viscerotropic serious adverse events associated with these vaccines occur rarely, but YF 17D vaccine-associated viscerotropic disease (YEL-AVD) is notable for its lethality. There appear to be two distinct patterns of risk for YEL-AVD: the first in younger persons, particularly women, with defects in innate immunity, in whom the case-fatality rate is higher; and the second in elderly persons, particularly men with age-related immune senescence and a lower case-fatality rate. From 1990 to the present, the number of cases (n = 31) and deaths (n = 12) from YEL-AVD in travelers has exceeded the reports of YF (n = 6) acquired by natural infection, raising the question whether the risk of vaccination exceeds the benefit in travelers. To provide some guidance on this point, the rate of vaccine-related injury is compared with the rate of naturally acquired disease in a new analysis that estimates the immunologically susceptible denominator population in YF endemic and epidemic areas. For many years, the risk of vaccine-related illness and death was similar to the risk of illness and death from natural infection with YF in South America. Africa posed a substantially higher estimated risk of wild-type YF than vaccine-related injury. Multiple factors should be considered in making decisions about YF vaccination, including specific destination, season of the year, local evidence for YF transmission, likelihood of exposure to vector mosquitoes and individual risk factors for YEL-AVD, with the goal of increasing vaccine coverage for travel to high-risk areas and reducing unnecessary vaccination. Prospects for future, safer vaccines are also described.

  3. Performance analysis of the MHD-steam combined cycle, including the influence of cost

    Energy Technology Data Exchange (ETDEWEB)

    Berry, G. F.; Dennis, C. B.

    1980-08-01

    The MHD Systems group of the ANL Engineering Division is conducting overall system studies, utilizing the computer simulation code that has been developed at ANL. This analytical investigation is exploring a range of possible performance variables, in order to determine the sensitivity of a specific plant design to variation in key system parameters and, ultimately, to establish probable system performance limits. The comprehensive computer code that has been developed for this task will analyze and simulate an MHD power plant for any number of different configurations, and will hold constraints automatically while conducting either sensitivity studies or optimization. A summary of a sensitivity analysis conducted for a combined cycle, MHD-steam power plant is presented. The influence of several of the more important systems parameters were investigated in a systematic fashion, and the results are presented in graphical form. The report is divided into four sections. Following the introduction, the second section describes in detail the results of a validation study conducted to insure that the code is functioning correctly. The third section includes a description of the ANL cost algorithm and a detailed comparison between the ANL cost results and published OCMHD cost information. it is further demonstrated in this section that good agreement is obtained for the calculated cost of electricity. The fourth section is a sensitivity study and optimization for a specific OCMHD configuration over several key plant parameters.

  4. Comparative effectiveness and cost-effectiveness analyses frequently agree on value.

    Science.gov (United States)

    Glick, Henry A; McElligott, Sean; Pauly, Mark V; Willke, Richard J; Bergquist, Henry; Doshi, Jalpa; Fleisher, Lee A; Kinosian, Bruce; Perfetto, Eleanor; Polsky, Daniel E; Schwartz, J Sanford

    2015-05-01

    The Patient-Centered Outcomes Research Institute, known as PCORI, was established by Congress as part of the Affordable Care Act (ACA) to promote evidence-based treatment. Provisions of the ACA prohibit the use of a cost-effectiveness analysis threshold and quality-adjusted life-years (QALYs) in PCORI comparative effectiveness studies, which has been understood as a prohibition on support for PCORI's conducting conventional cost-effectiveness analyses. This constraint complicates evidence-based choices where incremental improvements in outcomes are achieved at increased costs of care. How frequently this limitation inhibits efficient cost containment, also a goal of the ACA, depends on how often more effective treatment is not cost-effective relative to less effective treatment. We examined the largest database of studies of comparisons of effectiveness and cost-effectiveness to see how often there is disagreement between the more effective treatment and the cost-effective treatment, for various thresholds that may define good value. We found that under the benchmark assumption, disagreement between the two types of analyses occurs in 19 percent of cases. Disagreement is more likely to occur if a treatment intervention is musculoskeletal and less likely to occur if it is surgical or involves secondary prevention, or if the study was funded by a pharmaceutical company. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries

    Directory of Open Access Journals (Sweden)

    Marco Barbieri

    2016-12-01

    Full Text Available Objective: The objective of this study is to review published cost-utility analyses of vaccination strategies in eight European countries and to assess whether there are differences in cost-effectiveness terms among countries and vaccinations. Methods: A systematic search of the literature was conducted using the National Health Service Economic Evaluation Database and the PubMed database. Cost-utility analyses of any type of vaccination that used quality-adjusted life years (QALYs as measure of benefit and conducted in Belgium, France, Germany, Italy, Spain, Sweden, the Netherlands or the UK were included. Results: A total of 94 studies were identified. As a result of our search methodology, the vast majority of studies were conducted in the Netherlands or UK (33 and 30 studies, respectively. The most frequent vaccination types were against Human papillomavirus (HPV with 23 studies, followed by vaccination against pneumococcal infections (19 studies. The analysed vaccinations were generally cost-effective but with high variability. Considering an incremental cost effectiveness ratio (ICER of 40,000€/QALY, we noticed that the following vaccinations studies are below this threshold, i.e. all varicella and influenza (with one outlier studies, 90% of the studies for HPV and 75% of the studies for pneumococcal vaccinations. Rotavirus vaccination was considered as not cost-effective, with only 30% of studies below the threshold of 40,000€/QALY. There was no clear trend for vaccinations being more cost-effective in some countries. Conclusions: The published literature has shown that vaccination strategies are generally cost-effective in European countries. High heterogeneity in the results among studies and countries was found.

  6. Cost and benefit including value of life, health and environmental damage measured in time units

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager; Friis-Hansen, Peter

    2009-01-01

    Key elements of the authors' work on money equivalent time allocation to costs and benefits in risk analysis are put together as an entity. This includes the data supported dimensionless analysis of an equilibrium relation between total population work time and gross domestic product leading...... of this societal value over the actual costs, used by the owner for economically optimizing an activity, motivates a simple risk accept criterion suited to be imposed on the owner by the public. An illustration is given concerning allocation of economical means for mitigation of loss of life and health on a ferry...... in fire. Finally a definition is suggested for a nature preservation willingness index, which by an invariance postulate leads to a rational format for allocating means to avoid pollution accidents....

  7. Asthma Cost-Effectiveness Analyses : Are We Using the Recommended Outcomes in Estimating Value?

    NARCIS (Netherlands)

    Kim, Chong H; Dilokthornsakul, Piyameth; Campbell, Jonathan D; van Boven, Job F M

    2018-01-01

    BACKGROUND: Asthma medication cost-effectiveness analyses (CEAs) lack the qualitative assessment regarding whether they capture the National Institutes for Health (NIH) 2012 recommended outcomes necessary to allow robust cross-study comparisons. OBJECTIVE: We aimed to assess the current asthma

  8. From intermediate to final behavioral endpoints; Modeling cognitions in (cost-)effectiveness analyses in health promotion

    NARCIS (Netherlands)

    Prenger, Hendrikje Cornelia

    2012-01-01

    Cost-effectiveness analyses (CEAs) are considered an increasingly important tool in health promotion and psychology. In health promotion adequate effectiveness data of innovative interventions are often lacking. In case of many promising interventions the available data are inadequate for CEAs due

  9. Robustness assessments are needed to reduce bias in meta-analyses that include zero-event randomized trials

    DEFF Research Database (Denmark)

    Keus, F; Wetterslev, J; Gluud, C

    2009-01-01

    of statistical method on inference. RESULTS: In seven meta-analyses of seven outcomes from 15 trials, there were zero-event trials in 0 to 71.4% of the trials. We found inconsistency in significance in one of seven outcomes (14%; 95% confidence limit 0.4%-57.9%). There was also considerable variability...... in the confidence limits, the intervention-effect estimates, and heterogeneity for all outcomes. CONCLUSIONS: The statistical method may influence the inference drawn from a meta-analysis that includes zero-event trials. Robustness assessments are needed to reduce bias in meta-analyses that include zero......OBJECTIVES: Meta-analysis of randomized trials with binary data can use a variety of statistical methods. Zero-event trials may create analytic problems. We explored how different methods may impact inferences from meta-analyses containing zero-event trials. METHODS: Five levels of statistical...

  10. Good research practices for measuring drug costs in cost-effectiveness analyses: a societal perspective: the ISPOR Drug Cost Task Force report--Part II.

    Science.gov (United States)

    Garrison, Louis P; Mansley, Edward C; Abbott, Thomas A; Bresnahan, Brian W; Hay, Joel W; Smeeding, James

    2010-01-01

    Major guidelines regarding the application of cost-effectiveness analysis (CEA) have recommended the common and widespread use of the "societal perspective" for purposes of consistency and comparability. The objective of this Task Force subgroup report (one of six reports from the International Society for Pharmacoeconomics and Outcomes Research [ISPOR] Task Force on Good Research Practices-Use of Drug Costs for Cost Effectiveness Analysis [Drug Cost Task Force (DCTF)]) was to review the definition of this perspective, assess its specific application in measuring drug costs, identify any limitations in theory or practice, and make recommendations regarding potential improvements. Key articles, books, and reports in the methodological literature were reviewed, summarized, and integrated into a draft review and report. This draft report was posted for review and comment by ISPOR membership. Numerous comments and suggestions were received, and the report was revised in response to them. The societal perspective can be defined by three conditions: 1) the inclusion of time costs, 2) the use of opportunity costs, and 3) the use of community preferences. In practice, very few, if any, published CEAs have met all of these conditions, though many claim to have taken a societal perspective. Branded drug costs have typically used actual acquisition cost rather than the much lower social opportunity costs that would reflect only short-run manufacturing and distribution costs. This practice is understandable, pragmatic, and useful to current decision-makers. Nevertheless, this use of CEA focuses on static rather than dynamic efficacy and overlooks the related incentives for innovation. Our key recommendation is that current CEA practice acknowledge and embrace this limitation by adopting a new standard for the reference case as one of a "limited societal" or "health systems" perspective, using acquisition drug prices while including indirect costs and community preferences. The

  11. Good research practices for measuring drug costs in cost-effectiveness analyses: an international perspective: the ISPOR Drug Cost Task Force report--Part VI.

    Science.gov (United States)

    Shi, Lizheng; Hodges, Meredith; Drummond, Michael; Ahn, Jeonghoon; Li, Shu Chuen; Hu, Shanlian; Augustovski, Federico; Hay, Joel W; Smeeding, Jim

    2010-01-01

    The pharmacoeconomic guidelines available in the literature or promulgated in many countries are either vague or silent about how drug costs should be established or measured so an international comparison of cost-effectiveness analysis (CEA) results can be made. The objective of this report is to provide guidance and recommendations on how drug costs should be measured for CEAs done from an internationally comparative perspective. Members of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force on Good Research Practices-Use of Drug Costs for Cost Effectiveness Analysis (Drug Cost Task Force [DCTF]) subgroup from several countries were experienced developers or users of CEA models, and worked in academia, industry, and as advisors to governments. They solicited comments on drafts from a core group of 174 external reviewers and more broadly, from the members of the ISPOR at the ISPOR 12th Annual International meeting and via the ISPOR Web site. Drug units should be standardized in terms of volume of active ingredient, regardless of packaging and dosing strength variations across countries. Drug costs should be measured in local currency per unit of active ingredient and should be converted to other currencies using sensitivity analyses of purchasing power parities (PPP) and exchange rates, whichever is more appropriate. When using drug prices from different years, the consumer price index for the local currency should be applied before the PPP and/or exchange rate conversion. CEA researchers conducting international pharmacoeconomic analysis should tailor the appropriate measure of drug costs to the international perspective, to maintain clarity and transparency on drug cost measurement in the context of international drug comparison and report the sensitivity of CEA results to reasonable cost conversions.

  12. Samfundsøkonomisk cost-benefit-analyse af kriminalpræventive indsatser

    DEFF Research Database (Denmark)

    Højbjerg Jacobsen, Rasmus

    CEBR har for Det Kriminalpræventive Råd og TrygFonden gennemført dette projekt i perioden september 2012 til juni 2013. Formålet med projektet har været at opstille og gennemføre en samfundsøkonomisk cost-benefit-analyse af kriminalpræventive projekter i Danmark. Som en del af projektet har CEBR ...

  13. Reference model for measuring and analysing costs – particularly in business informatics

    Directory of Open Access Journals (Sweden)

    Milos Maryska

    2010-04-01

    Full Text Available This paper is devoted to problems of management of cost efficiency of business informatics with Business Intelligence (BI assistance. It defines basic critical points that must be taken into account during creating models for management of cost efficiency of business informatics. It proposes new model for management of cost efficiency, this model include also definitions of dimensions and indicators for measuring of this cost efficiency. The model takes into account requirements that pose claim on management of cost efficiency necessitated by accounting and requirements from consultancy with managers of companies. It also takes into account requirement of methodologies for management business informatics and methods and processes for evaluating and measuring business informatics. This methodologies, methods and processes are transformed into procedures that are appropriate for measuring and evaluating business informatics. This model is intended for monitoring of actual situation, evolution cost efficiency of business informatics and it can be used for making decisions about convenience of outsourcing of business informatics. There are presented some examples from presentation level of mentioned model for measuring of cost efficiency of business informatics. This presentation level is in the form of tables and also in the form of dashboards.

  14. Combined analyses of costs, market value and eco-costs in circular business models : eco-efficient value creation in remanufacturing

    NARCIS (Netherlands)

    Vogtländer, J.G.; Scheepens, A.E.; Bocken, N.M.P.; Peck, D.P.

    2017-01-01

    Eco-efficient Value Creation is a method to analyse innovative product and service design together with circular business strategies. The method is based on combined analyses of the costs, market value (perceived customer value) and eco-costs. This provides a prevention-based single indicator for

  15. Coauthorship and institutional collaborations on cost-effectiveness analyses: a systematic network analysis.

    Directory of Open Access Journals (Sweden)

    Ferrán Catalá-López

    Full Text Available BACKGROUND: Cost-Effectiveness Analysis (CEA has been promoted as an important research methodology for determining the efficiency of healthcare technology and guiding medical decision-making. Our aim was to characterize the collaborative patterns of CEA conducted over the past two decades in Spain. METHODS AND FINDINGS: A systematic analysis was carried out with the information obtained through an updated comprehensive literature review and from reports of health technology assessment agencies. We identified CEAs with outcomes expressed as a time-based summary measure of population health (e.g. quality-adjusted life-years or disability-adjusted life-years, conducted in Spain and published between 1989 and 2011. Networks of coauthorship and institutional collaboration were produced using PAJEK software. One-hundred and thirty-one papers were analyzed, in which 526 authors and 230 institutions participated. The overall signatures per paper index was 5.4. Six major groups (one with 14 members, three with 7 members and two with 6 members were identified. The most prolific authors were generally affiliated with the private-for-profit sector (e.g. consulting firms and the pharmaceutical industry. The private-for-profit sector maintains profuse collaborative networks including public hospitals and academia. Collaboration within the public sector (e.g. healthcare administration and primary care was weak and fragmented. CONCLUSIONS: This empirical analysis reflects critical practices among collaborative networks that contributed substantially to the production of CEA, raises challenges for redesigning future policies and provides a framework for similar analyses in other regions.

  16. System-Cost-Optimized Smart EVSE for Residential Application: Final Technical Report including Manufacturing Plan

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Charles [Delta Products, Triangle Park, NC (United States)

    2015-05-15

    In the 2nd quarter of 2012, a program was formally initiated at Delta Products to develop smart-grid-enabled Electric Vehicle Supply Equipment (EVSE) product for residential use. The project was funded in part by the U.S. Department of Energy (DOE), under award DE-OE0000590. Delta products was the prime contractor to DOE during the three year duration of the project. In addition to Delta Products, several additional supplier-partners were engaged in this research and development (R&D) program, including Detroit Edison DTE, Mercedes Benz Research and Development North America, and kVA. This report summarizes the program and describes the key research outcomes of the program. A technical history of the project activities is provided, which describes the key steps taken in the research and the findings made at successive stages in the multi-stage work. The evolution of an EVSE prototype system is described in detail, culminating in prototypes shipped to Department of Energy Laboratories for final qualification. After the program history is reviewed, the key attributes of the resulting EVSE are described in terms of functionality, performance, and cost. The results clearly demonstrate the ability of this EVSE to meet or exceed DOE's targets for this program, including: construction of a working product-intent prototype of a smart-grid-enabled EVSE, with suitable connectivity to grid management and home-energy management systems, revenue-grade metering, and related technical functions; and cost reduction of 50% or more compared to typical market priced EVSEs at the time of DOE's funding opportunity announcement (FOA), which was released in mid 2011. In addition to meeting all the program goals, the program was completed within the original budget and timeline established at the time of the award. The summary program budget and timeline, comparing plan versus actual values, is provided for reference, along with several supporting explanatory notes. Technical

  17. The cost-effectiveness of gestational diabetes screening including prevention of type 2 diabetes

    DEFF Research Database (Denmark)

    Marseille, Elliot; Lohse, Nicolai; Jiwani, Aliya

    2013-01-01

    Gestational diabetes mellitus (GDM) is associated with elevated risks of perinatal complications and type 2 diabetes mellitus, and screening and intervention can reduce these risks. We quantified the cost, health impact and cost-effectiveness of GDM screening and intervention in India and Israel,...

  18. Retrospective cost-effectiveness analyses for polio vaccination in the United States.

    Science.gov (United States)

    Thompson, Kimberly M; Tebbens, Radboud J Duintjer

    2006-12-01

    The history of polio vaccination in the United States spans 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of resources. We estimated cost-effectiveness ratios and assessed the net benefits of polio vaccination applicable at various points in time from the societal perspective and we discounted these back to appropriate points in time. We reconstructed vaccine price data from available sources and used these to retrospectively estimate the total costs of the U.S. historical polio vaccination strategies (all costs reported in year 2002 dollars). We estimate that the United States invested approximately US dollars 35 billion (1955 net present value, discount rate of 3%) in polio vaccines between 1955 and 2005 and will invest approximately US dollars 1.4 billion (1955 net present value, or US dollars 6.3 billion in 2006 net present value) between 2006 and 2015 assuming a policy of continued use of inactivated poliovirus vaccine (IPV) for routine vaccination. The historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths (1955 net present values of approximately 480,000 cases and 73,000 deaths). Due to treatment cost savings, the investment implies net benefits of approximately US dollars 180 billion (1955 net present value), even without incorporating the intangible costs of suffering and death and of averted fear. Retrospectively, the U.S. investment in polio vaccination represents a highly valuable, cost-saving public health program. Observed changes in the cost-effectiveness ratio estimates over time suggest the need for living economic models for interventions that appropriately change with time. This article also demonstrates that estimates of cost-effectiveness ratios at any single time point may fail to adequately consider the context of the investment made to date and the importance of

  19. [Efficiency of human papillomavirus vaccination--estimates based on Dutch cost effectiveness analyses].

    Science.gov (United States)

    Westra, Tjalke A; Daemen, Toos; Postma, Maarten J; Wilschut, Jan C

    2009-01-01

    Up to now the turnout for the human papillomavirus (HPV) vaccination programme implemented this year in the Netherlands has been lower than expected. This may be the result of negative publicity and doubts about the efficacy of the vaccination programme. To provide some clarity about the efficacy, this article gives an overview of the cost effectiveness analyses carried out on the introduction of HPV vaccination in the Netherlands. These studies have shown that vaccination of a cohort of 12-year-old girls using the HPV vaccine may ultimately prevent per year 217-421 cases of cervical cancer and 93-173 deaths caused by this disease in the Netherlands. It has also been shown that HPV vaccination is a cost effective strategy and that about 1000 girls must be vaccinated to prevent 1 death. The actual health benefits gained by HPV vaccination are strongly dependent on vaccination coverage. It is therefore important that this remains high (85-100%).

  20. Using an operating cost model to analyse the selection of aircraft type on short-haul routes

    CSIR Research Space (South Africa)

    Ssamula, B

    2006-08-01

    Full Text Available operating cost model to analyse suitable aircraft choices, for short haul routes, in terms of cost-related parameters, for aircraft commonly used within Africa. In this paper all the parameters that are crucial in analysing a transport service are addressed...

  1. Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries

    OpenAIRE

    Barbieri, Marco; Capri, Stefano

    2016-01-01

    Objective: The objective of this study is to review published cost-utility analyses of vaccination strategies in eight European countries and to assess whether there are differences in cost-effectiveness terms among countries and vaccinations. Methods: A systematic search of the literature was conducted using the National Health Service Economic Evaluation Database and the PubMed database. Cost-utility analyses of any type of vaccination that used quality-adjusted life years (QALYs) as me...

  2. The role of cognition in cost-effectiveness analyses of behavioral interventions

    Directory of Open Access Journals (Sweden)

    Prenger Rilana

    2012-03-01

    Full Text Available Abstract Background Behavioral interventions typically focus on objective behavioral endpoints like weight loss and smoking cessation. In reality, though, achieving full behavior change is a complex process in which several steps towards success are taken. Any progress in this process may also be considered as a beneficial outcome of the intervention, assuming that this increases the likelihood to achieve successful behavior change eventually. Until recently, there has been little consideration about whether partial behavior change at follow-up should be incorporated in cost-effectiveness analyses (CEAs. The aim of this explorative review is to identify CEAs of behavioral interventions in which cognitive outcome measures of behavior change are analyzed. Methods Data sources were searched for publications before May 2011. Results Twelve studies were found eligible for inclusion. Two different approaches were found: three studies calculated separate incremental cost-effectiveness ratios for cognitive outcome measures, and one study modeled partial behavior change into the final outcome. Both approaches rely on the assumption, be it implicitly or explicitly, that changes in cognitive outcome measures are predictive of future behavior change and may affect CEA outcomes. Conclusion Potential value of cognitive states in CEA, as a way to account for partial behavior change, is to some extent recognized but not (yet integrated in the field. In conclusion, CEAs should consider, and where appropriate incorporate measures of partial behavior change when reporting effectiveness and hence cost-effectiveness.

  3. MEDLINE, EMBASE, and Cochrane index most primary studies but not abstracts included in orthopedic meta-analyses.

    Science.gov (United States)

    Slobogean, Gerard P; Verma, Ashim; Giustini, Dean; Slobogean, Bronwyn L; Mulpuri, Kishore

    2009-12-01

    To test the hypothesis that all primary studies used in orthopedic meta-analyses are indexed in MEDLINE or EMBASE. Using MEDLINE from 1995 to 2005, we retrieved all published meta-analyses of orthopedic surgical interventions. The primary studies in each meta-analysis were defined as the "gold standard" set. MEDLINE and EMBASE were searched for each primary study, and a recall rate was calculated. Secondary searches were performed using Web of Science (WoS), the Cochrane databases, and CINAHL. High recall rates were achieved searching MEDLINE (90%) and EMBASE (81%) for the gold standard set, and the combined search retrieved 91%. Titles not indexed by MEDLINE or EMBASE included 45 abstracts, eight journal articles, and three unpublished studies. Searching the Cochrane databases yielded 36 titles not in MEDLINE or EMBASE. Using all three databases produced 97% recall of the primary studies; WoS and CINAHL did not increase the recall rate. These results suggest that a very high percentage of primary research in orthopedics can be found using the major databases. Additional database searches are unlikely to increase the yield of published manuscripts; however, conference proceedings and journal supplements should still be searched to ensure that relevant remaining reports are identified.

  4. Incorporating uncertainty of management costs in sensitivity analyses of matrix population models.

    Science.gov (United States)

    Salomon, Yacov; McCarthy, Michael A; Taylor, Peter; Wintle, Brendan A

    2013-02-01

    The importance of accounting for economic costs when making environmental-management decisions subject to resource constraints has been increasingly recognized in recent years. In contrast, uncertainty associated with such costs has often been ignored. We developed a method, on the basis of economic theory, that accounts for the uncertainty in population-management decisions. We considered the case where, rather than taking fixed values, model parameters are random variables that represent the situation when parameters are not precisely known. Hence, the outcome is not precisely known either. Instead of maximizing the expected outcome, we maximized the probability of obtaining an outcome above a threshold of acceptability. We derived explicit analytical expressions for the optimal allocation and its associated probability, as a function of the threshold of acceptability, where the model parameters were distributed according to normal and uniform distributions. To illustrate our approach we revisited a previous study that incorporated cost-efficiency analyses in management decisions that were based on perturbation analyses of matrix population models. Incorporating derivations from this study into our framework, we extended the model to address potential uncertainties. We then applied these results to 2 case studies: management of a Koala (Phascolarctos cinereus) population and conservation of an olive ridley sea turtle (Lepidochelys olivacea) population. For low aspirations, that is, when the threshold of acceptability is relatively low, the optimal strategy was obtained by diversifying the allocation of funds. Conversely, for high aspirations, the budget was directed toward management actions with the highest potential effect on the population. The exact optimal allocation was sensitive to the choice of uncertainty model. Our results highlight the importance of accounting for uncertainty when making decisions and suggest that more effort should be placed on

  5. Cost-effectiveness analysis of chemical testing for decision-support: How to include animal welfare?

    NARCIS (Netherlands)

    Gabbert, S.G.M.; Ierland, van E.C.

    2010-01-01

    Toxicity testing for regulatory purposes raises the question of test selection for a particular endpoint. Given the public's concern for animal welfare, test selection is a multi-objective decision problem that requires balancing information outcome, animal welfare loss, and monetary testing costs.

  6. The Potential to Forgo Social Welfare Gains through Over reliance on Cost Effectiveness/Cost Utility Analyses in the Evidence Base for Public Health

    International Nuclear Information System (INIS)

    Cohen, D.R.; Patel, N.

    2010-01-01

    Economic evaluations of clinical treatments most commonly take the form of cost effectiveness or cost utility analyses. This is appropriate since the main sometimes the only benefit of such interventions is increased health. The majority of economic evaluations in public health, however, have also been assessed using these techniques when arguably cost benefit analyses would in many cases have been more appropriate, given its ability to take account of non health benefits as well. An examination of the non health benefits from a sample of studies featured in a recent review of economic evaluations in public health illustrates how over focusing on cost effectiveness/cost utility analyses may lead to forgoing potential social welfare gains from programmes in public health. Prior to evaluation, programmes should be considered in terms of the potential importance of non health benefits and where these are considerable would be better evaluated by more inclusive economic evaluation techniques.

  7. Patient and program costs, and outcomes, of including gender-sensitive services in intensive inpatient programs for substance use.

    Science.gov (United States)

    Hornack, Sarah E; Yates, Brian T

    2017-12-01

    Gender-sensitive services (GSS) attempt to make substance use treatment better for women, but at what cost and with what results? We sought answers to these questions in a federally-funded study by measuring separately the patient and provider costs of adding GSS, outcomes, and cost-outcome relationships for 12 mixed-gender intensive inpatient programs (IIP) that varied in amounts and types of GSS. GSS costs to female inpatients included time devoted to GSS and expenses for care of dependents while in the IIP. GSS costs to providers included time spent with patients, indirect services, treatment facilities, equipment, and materials. Offering more GSS was expected to consume more patient and provider resources. Offering more GSS also was expected to enhance outcomes and cost-outcome relationships. We found that average GSS costs to patients at the IIPs were $585 ($515-$656) per patient. Average GSS costs to providers at the IIPs were $344 ($42-$544) per patient. GSS costs to patients significantly exceeded GSS costs to providers. Contrary to previous research, offering more GSS services to patients did not result in significantly higher costs to patients or providers. IIPs offering more GSS may have delivered fewer traditional services, but this did not significantly affect outcomes, i.e., days until returning to another substance use treatment. In fact, median cost-outcome for these IIPs was a promising 35 treatment-free days, i.e., over a month, per $100 of GSS resources used by patients and providers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Performance analysis of the MHD-steam combined cycle, including the influence of cost

    Science.gov (United States)

    Berry, G. F.; Dennis, C. B.

    1980-08-01

    A range of possible performance variables is explored in order to determine the sensitivity of a specific plant design to variation in key system parameters and, ultimately, to establish probable system performance limits. The comprehensive computer code that was developed analyzes and simulates an MHD plant for any number of different configurations, and holds constraints automatically while conducting either sensitivity studies or optimization. A summary of a sensitivity analysis conducted for a combined cycle, MHD steam power plant is presented. The influence of several of the more important system parameters were investigated and the results are presented in graphical form. The ANL cost algorithm is described and it is demonstrated that good agreement is obtained for the calculated cost of electricity.

  9. Putting the ‘Q’ in QALY in cost-utility analyses

    DEFF Research Database (Denmark)

    Oddershede, Lars

    Resources are scare and healthcare systems must, therefore, prioritize which new technologies should be funded, and which should be rejected. To aid decision makers in their choice, economic evaluations can be conducted to assess the cost-effectiveness of the new technologies. The present thesis...... argues that two problems could be solved by updating the Danish guideline for economic evaluations to include a stated preference for measuring effectiveness in terms of quality adjusted life-years (QALYs). Firstly, it would be possible to compare the cost-effectiveness of new technologies across...... data are available. Using the methodological papers and economic evaluations conducted during the PhD project; the thesis exemplifies why it is important to use standardized methods when calculating QALYs in economic evaluations. The thesis recommends that a shared measure of health, QALYs, is used...

  10. Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods.

    Science.gov (United States)

    Kauvar, Arielle N B; Cronin, Terrence; Roenigk, Randall; Hruza, George; Bennett, Richard

    2015-05-01

    Basal cell carcinoma (BCC) is the most common cancer in the US population affecting approximately 2.8 million people per year. Basal cell carcinomas are usually slow-growing and rarely metastasize, but they do cause localized tissue destruction, compromised function, and cosmetic disfigurement. To provide clinicians with guidelines for the management of BCC based on evidence from a comprehensive literature review, and consensus among the authors. An extensive review of the medical literature was conducted to evaluate the optimal treatment methods for cutaneous BCC, taking into consideration cure rates, recurrence rates, aesthetic and functional outcomes, and cost-effectiveness of the procedures. Surgical approaches provide the best outcomes for BCCs. Mohs micrographic surgery provides the highest cure rates while maximizing tissue preservation, maintenance of function, and cosmesis. Mohs micrographic surgery is an efficient and cost-effective procedure and remains the treatment of choice for high-risk BCCs and for those in cosmetically sensitive locations. Nonsurgical modalities may be used for low-risk BCCs when surgery is contraindicated or impractical, but the cure rates are lower.

  11. SUBSTANTIATION OF THE COST OF HOUSING CONSTRUCTION INCLUDING THE FACTOR OF INVESTMENT ATTRACTIVENESS OF TERRITORIES

    Directory of Open Access Journals (Sweden)

    ZAIATS Yi. I.

    2015-11-01

    Full Text Available Problem statement. For planning and organization of urban construction is necessary to analyze the use of areas. Territorial resources of the city, being used for construction and other urban purposes, consists of plots of land: disposable, reserved and undeveloped in previous years of construction in progress; residential districts and blocks of obsolete housing fund; industrial and municipal and warehouse enterprises being used irrationally or stopped to work; the defence department, where the amortized warehouses and other main funds are that are not used by purpose; agricultural enterprises where the obsolete industrial funds, haying, nurseries, greenhouses. The number of free areas suitable for future urban development is extremely limited. However a considerable part of the territories of almost all functional zones is used inefficiently. Purpose. Formalization of a factor of investment attractiveness of territories for the further identification and research of the connection between it and the cost of housing construction is necessary. Conclusion. The identification of regularities of influence of the factor of investment attractiveness of territories on the cost of construction of high-rise buildings allow to obtain a quantitative estimate of this effect and can be used in the development of the methodology of substantiation of the expediency and effectiveness of the implementation of highrise construction projects, based on organizational and technological aspects.

  12. Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy.

    Science.gov (United States)

    Sultana, A; Tudur Smith, C; Cunningham, D; Starling, N; Tait, D; Neoptolemos, J P; Ghaneh, P

    2007-04-23

    There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005). No published meta-analysis (Fung et al, 2003; Banu et al, 2005; Liang, 2005; Bria et al, 2006; Milella et al, 2006) has included randomised controlled trials employing radiation therapy. The aim of this systematic review was to compare the following: (i) chemoradiation followed by chemotherapy (combined modality therapy) vs best supportive care (ii) radiotherapy vs chemoradiation (iii) radiotherapy vs combined modality therapy (iv) chemotherapy vs combined modality therapy (v) 5FU-based combined modality treatment vs another-agent-based combined modality therapy. Relevant randomised controlled trials were identified by searching databases, trial registers and conference proceedings. The primary end point was overall survival and secondary end points were progression-free survival/time-to-progression, response rate and adverse events. Survival data were summarised using hazard ratio (HR) and response-rate/adverse-event data with relative risk. Eleven trials involving 794 patients met the inclusion criteria. Length of survival with chemoradiation was increased compared with radiotherapy alone (two trials, 168 patients, HR 0.69; 95% confidence interval (CI) 0.51-0.94), but chemoradiation followed by chemotherapy did not lead to a survival advantage over chemotherapy alone (two trials, 134 patients, HR 0.79; CI 0.32-1.95). Meta-analyses could not be performed for the other comparisons. A survival benefit was demonstrated for chemoradiation over radiotherapy alone. Chemoradiation followed by chemotherapy did not demonstrate any survival advantage over chemotherapy alone, but important clinical differences cannot be ruled out due to the wide CI.

  13. An educational review of the statistical issues in analysing utility data for cost-utility analysis.

    Science.gov (United States)

    Hunter, Rachael Maree; Baio, Gianluca; Butt, Thomas; Morris, Stephen; Round, Jeff; Freemantle, Nick

    2015-04-01

    The aim of cost-utility analysis is to support decision making in healthcare by providing a standardised mechanism for comparing resource use and health outcomes across programmes of work. The focus of this paper is the denominator of the cost-utility analysis, specifically the methodology and statistical challenges associated with calculating QALYs from patient-level data collected as part of a trial. We provide a brief description of the most common questionnaire used to calculate patient level utility scores, the EQ-5D, followed by a discussion of other ways to calculate patient level utility scores alongside a trial including other generic measures of health-related quality of life and condition- and population-specific questionnaires. Detail is provided on how to calculate the mean QALYs per patient, including discounting, adjusting for baseline differences in utility scores and a discussion of the implications of different methods for handling missing data. The methods are demonstrated using data from a trial. As the methods chosen can systematically change the results of the analysis, it is important that standardised methods such as patient-level analysis are adhered to as best as possible. Regardless, researchers need to ensure that they are sufficiently transparent about the methods they use so as to provide the best possible information to aid in healthcare decision making.

  14. The total assessment profile, volume 2. [including societal impact, cost effectiveness, and economic analysis

    Science.gov (United States)

    Leininger, G.; Jutila, S.; King, J.; Muraco, W.; Hansell, J.; Lindeen, J.; Franckowiak, E.; Flaschner, A.

    1975-01-01

    Appendices are presented which include discussions of interest formulas, factors in regionalization, parametric modeling of discounted benefit-sacrifice streams, engineering economic calculations, and product innovation. For Volume 1, see .

  15. Concept of ground facilities and the analyses of the factors for cost estimation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. Y.; Choi, H. J.; Choi, J. W.; Kim, S. K.; Cho, D. K

    2007-09-15

    The geologic disposal of spent fuels generated from the nuclear power plants is the only way to protect the human beings and the surrounding environments present and future. The direct disposal of the spent fuels from the nuclear power plants is considered, and a Korean Reference HLW disposal System(KRS) suitable for our representative geological conditions have been developed. In this study, the concept of the spent fuel encapsulation process as a key of the above ground facilities for deep geological disposal was established. To do this, the design requirements, such as the functions and the spent fuel accumulations, were reviewed. Also, the design principles and the bases were established. Based on the requirements and the bases, the encapsulation process of the spent fuel from receiving spent fuel of nuclear power plants to transferring canister into the underground repository was established. Simulation for the above-ground facility in graphic circumstances through KRS design concept and disposal scenarios for spent nuclear fuel showed that an appropriate process was performed based on facility design concept and required for more improvement on construction facility by actual demonstration test. And, based on the concept of the above ground facilities for the Korean Reference HLW disposal System, the analyses of the factors for the cost estimation was carried out.

  16. Robustness Assessments Are Needed to Reduce Bias in Meta-Analyses That Include Zero-Event Randomized Trials

    NARCIS (Netherlands)

    Keus, F.; Wetterslev, J.; Gluud, C.; Gooszen, H. G.; van Laarhoven, C. J. H. M.

    OBJECTIVES: Meta-analysis of randomized trials with binary data can use a variety of statistical methods. Zero-event trials may create analytic problems. We explored how different methods may impact inferences from meta-analyses containing zero-event trials. METHODS: Five levels of statistical

  17. Robustness assessments are needed to reduce bias in meta-analyses that include zero-event randomized trials.

    NARCIS (Netherlands)

    Keus, F.; Wetterslev, J.; Gluud, C.; Gooszen, H.G.; Laarhoven, C.J.H.M. van

    2009-01-01

    OBJECTIVES: Meta-analysis of randomized trials with binary data can use a variety of statistical methods. Zero-event trials may create analytic problems. We explored how different methods may impact inferences from meta-analyses containing zero-event trials. METHODS: Five levels of statistical

  18. Cost-effectiveness analyses of elective orthopaedic surgical procedures in patients with inflammatory arthropathies

    DEFF Research Database (Denmark)

    Osnes-Ringen, H.; Kvamme, M. K.; Sønbø Kristiansen, Ivar

    2011-01-01

    . The health benefit from surgery was subsequently translated into QALYs. The direct treatment costs in the first year were, for each patient, derived from the hospital's cost per patient accounting system (KOSPA). The costs per QALY were estimated and future costs and benefits were discounted at 4%. Results......: Improvement in utility at 1-year follow-up was 0.10 with EQ-5D and 0.03 with SF-6D (p procedures. The 5-year cost per QALY was EUR 17...... 800 for non-replacement surgical procedures measured by EQ-5D (SF-6D: EUR 67 500). Conclusions: Elective orthopaedic surgery in patients with inflammatory arthropathies was cost-effective when measured with EQ-5D, and some procedures were also cost-effective when SF-6D was used in the economic...

  19. Including health economic analysis in pilot studies: lessons learned from a cost-utility analysis within the PROSPECTIV pilot study

    Directory of Open Access Journals (Sweden)

    Richéal M. Burns

    2017-07-01

    Full Text Available PurposeTo assess feasibility and health economic benefits and costs as part of a pilot study for a nurse-led, psychoeducational intervention (NPLI for prostate cancer in order to understand the potential for cost effectiveness as well as contribute to the design of a larger scale trial.MethodsMen with stable prostate cancer post-treatment were recruited from two cancer centres in the UK. Eighty-three men were randomised to the NLPI plus usual care or usual care alone (UCA (42 NLPI and 41 UCA; the NLPI plus usual care was delivered in the primary-care setting (the intervention and included an initial face-to-face consultation with a trained nurse, with follow-up tailored to individual needs. The study afforded the opportunity to undertake a short-term within pilot analysis. The primary outcome measure for the economic evaluation was quality of life, as measured by the EuroQol five dimensions questionnaire (EQ-5D (EQ-5D-5L instrument. Costs (£2014 assessed included health-service resource use, out-of-pocket expenses and losses from inability to undertake usual activities.ResultsTotal and incremental costs varied across the different scenarios assessed, with mean cost differences ranging from £173 to £346; incremental effect, as measured by the change in utility scores over the duration of follow-up, exhibited wide confidence intervals highlighting inconclusive effectiveness (95% CI: -0.0226; 0.0438. The cost per patient of delivery of the intervention would be reduced if rolled out to a larger patient cohort.ConclusionsThe NLPI is potentially cost saving depending on the scale of delivery; however, the results presented are not considered generalisable.

  20. Visual CRO display of pulse height distribution including discriminator setting for a single channel X-ray analyser

    International Nuclear Information System (INIS)

    Shaw, S.E.

    1979-01-01

    An outline for a simple pulse spectroscope which attaches to a standard laboratory CRO is presented. The peak amplitude voltage of each pulse from the linear amplifier of a single channel X-ray analyser is stored for the duration of one oscilloscope trace. For each amplifier pulse, input from the discriminator is tested and if these is coincidence of pulses the oscilloscope beam is blanked for approximately the first 2 cm of its traverse across the screen. Repetition of pulses forms a pulse height distribution with a rectangular dark area marking the position of the discriminator window. (author)

  1. Accounting for Heterogeneity in Relative Treatment Effects for Use in Cost-Effectiveness Models and Value-of-Information Analyses.

    Science.gov (United States)

    Welton, Nicky J; Soares, Marta O; Palmer, Stephen; Ades, Anthony E; Harrison, David; Shankar-Hari, Manu; Rowan, Kathy M

    2015-07-01

    Cost-effectiveness analysis (CEA) models are routinely used to inform health care policy. Key model inputs include relative effectiveness of competing treatments, typically informed by meta-analysis. Heterogeneity is ubiquitous in meta-analysis, and random effects models are usually used when there is variability in effects across studies. In the absence of observed treatment effect modifiers, various summaries from the random effects distribution (random effects mean, predictive distribution, random effects distribution, or study-specific estimate [shrunken or independent of other studies]) can be used depending on the relationship between the setting for the decision (population characteristics, treatment definitions, and other contextual factors) and the included studies. If covariates have been measured that could potentially explain the heterogeneity, then these can be included in a meta-regression model. We describe how covariates can be included in a network meta-analysis model and how the output from such an analysis can be used in a CEA model. We outline a model selection procedure to help choose between competing models and stress the importance of clinical input. We illustrate the approach with a health technology assessment of intravenous immunoglobulin for the management of adult patients with severe sepsis in an intensive care setting, which exemplifies how risk of bias information can be incorporated into CEA models. We show that the results of the CEA and value-of-information analyses are sensitive to the model and highlight the importance of sensitivity analyses when conducting CEA in the presence of heterogeneity. The methods presented extend naturally to heterogeneity in other model inputs, such as baseline risk. © The Author(s) 2015.

  2. Geographical analyses of wood chips potentials, cost and supply for sustainable energy production in Denmark

    DEFF Research Database (Denmark)

    Möller, Bernd

    2004-01-01

    The paper presents a study which uses a practical application of rasterbased geographical information system to perform cost-supply analysis of wood chips resources for energy production.......The paper presents a study which uses a practical application of rasterbased geographical information system to perform cost-supply analysis of wood chips resources for energy production....

  3. Differential Game Analyses of Logistics Service Supply Chain Coordination by Cost Sharing Contract

    Directory of Open Access Journals (Sweden)

    Haifeng Zhao

    2014-01-01

    Full Text Available Cooperation of all the members in a supply chain plays an important role in logistics service. The service integrator can encourage cooperation from service suppliers by sharing their cost during the service, which we assume can increase the sales by accumulating the reputation of the supply chain. A differential game model is established with the logistics service supply chain that consists of one service integrator and one supplier. And we derive the optimal solutions of the Nash equilibrium without cost sharing contract and the Stackelberg equilibrium with the integrator as the leader who partially shares the cost of the efforts of the supplier. The results make the benefits of the cost sharing contract in increasing the profits of both players as well as the whole supply chain explicit, which means that the cost sharing contract is an effective coordination mechanism in the long-term relationship of the members in a logistics service supply chain.

  4. Studies and analyses of the management of scientific research and development, including implementation and application at NASA centers

    Science.gov (United States)

    Rubenstein, A. H.

    1975-01-01

    Summary results obtained through the Program of Research on the Management of Research and Development (POMRAD) were presented. The nature of the overall program and the specific projects undertaken were described. Statistical data is also given concerning the papers, publications, people, and major program areas associated with the program. The actual list of papers, names of doctoral and masters theses, and other details of the program are included as appendices.

  5. Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

    OpenAIRE

    Sultana, A; Tudur Smith, C; Cunningham, D; Starling, N; Tait, D; Neoptolemos, J P; Ghaneh, P

    2007-01-01

    There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005). No published meta-analysis (Fung et al, 2003; Banu et al, 2005; Liang, 2005; Bria et al, 2006; Milella et al, 2006) has included randomised controlled trials employing radiation therapy. The aim of this systematic review was to compare the following: (i) chemoradiation followed by chemotherapy (combined modality th...

  6. Tracking the direct impact of rainfall on groundwater at Mt. Fuji by multiple analyses including microbial DNA

    Science.gov (United States)

    Sugiyama, Ayumi; Masuda, Suguru; Nagaosa, Kazuyo; Tsujimura, Maki; Kato, Kenji

    2018-02-01

    A total of 2 to 3 million tons of spring water flushes out from the foot of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport, residence time of stored groundwater at Mt. Fuji was estimated at ˜ 15-30 years by the 36Cl / Cl ratio (Tosaki et al., 2011). This range, however, represents the average residence time of groundwater that was mixed before it flushed out. To elucidate the route of groundwater in a given system, we determined signatures of direct impacts of rainfall on groundwater, using microbial, stable isotopic (δ18O), and chemical analyses (concentration of silica). Chemical analysis of the groundwater gave an average value of the water, which was already mixed with waters from various sources and routes in the subsurface environment. The microbial analysis suggested locations of water origin and paths. In situ observation during four rainfall events revealed that the stable oxygen isotopic signature obtained from spring water (at 726 m a.s.l., site SP-0 m) and shallow groundwater (at 150 m a.s.l., site GW-42 m), where the average recharge height from rainfall was 1700-1800 m, became greater than values observed prior to a torrential rain producing more than 300 mm of precipitation. The concentration of silica decreased after this event. In addition, the abundance of Bacteria in spring water increased, suggesting the influence of heavy rain. Such changes did not appear when rainfall was less than 100 mm per event. The above findings indicate a rapid flow of rain through the shallow part of the aquifer, which appeared within a few weeks of torrential rain extracting abundant microbes from soil in the studied geologic setting. Interestingly, we found that after the torrential rain, the abundance of Archaea increased in the deep groundwater at site GW-550 m, ˜ 12 km downstream of SP-0 m. However, chemical parameters did not show any change after the event. This suggests that strengthened piston flow caused by

  7. The performance and publication of cost-utility analyses in plastic surgery: Making our specialty relevant

    Science.gov (United States)

    Thoma, Achilleas; Ignacy, Teegan A; Ziolkowski, Natalia; Voineskos, Sophocles

    2012-01-01

    Increased spending and reduced funding for health care is forcing decision makers to prioritize procedures and redistribute funds. Decision making is based on reliable data regarding the costs and benefits of medical and surgical procedures; such a study design is known as an economic evaluation. The onus is on the plastic surgery community to produce high-quality economic evaluations that support the cost effectiveness of the procedures that are performed. The present review focuses on the cost-utility analysis and its role in deciding whether a novel technique/procedure/technology should be accepted over one that is prevalent. Additionally, the five steps in undertaking a cost-utility (effectiveness) analysis are outlined. PMID:23997587

  8. Spatial analyses of cost efficient measures to reduce N-leaching

    DEFF Research Database (Denmark)

    Jacobsen, Brian H.; Abildtrup, Jens; Ørum, Jens Erik

    (WFD). The analysis shows that the geographical position of the measures are very important in order to achieve the expected nutrient reduction. The current income varies a lot in the River basin and this might influence the choice of cost effective measures to reduce nutrient load. Furthermore a close...... leaching. The farmers have paid 60% of the costs. The paper then describes an example of a regional analysis covering the River Basin of Ringkøbing Fjord in Denmark, which indicates the type of calculations needed to find the measures and costs in order to comply with parts of the Water Framework Directive......The Nitrate Directive has only been implemented satisfactorily in a few EU countries. The Commission have accepted the Danish implementation of the directive based on the Plan for the Aquatic Environment II. The costs of this plan has been calculated to 70 million € or 2,0 € per kg N in reduced...

  9. The concept of computer software designed to identify and analyse logistics costs in agricultural enterprises

    Directory of Open Access Journals (Sweden)

    Karol Wajszczyk

    2009-01-01

    Full Text Available The study comprised research, development and computer programming works concerning the development of a concept for the IT tool to be used in the identification and analysis of logistics costs in agricultural enterprises in terms of the process-based approach. As a result of research and programming work an overall functional and IT concept of software was developed for the identification and analysis of logistics costs for agricultural enterprises.

  10. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  11. Tracking the direct impact of rainfall on groundwater at Mt. Fuji by multiple analyses including microbial DNA

    Directory of Open Access Journals (Sweden)

    A. Sugiyama

    2018-02-01

    Full Text Available A total of 2 to 3 million tons of spring water flushes out from the foot of Mt. Fuji, the largest volcanic mountain in Japan. Based on the concept of piston flow transport, residence time of stored groundwater at Mt. Fuji was estimated at  ∼  15–30 years by the 36Cl ∕ Cl ratio (Tosaki et al., 2011. This range, however, represents the average residence time of groundwater that was mixed before it flushed out. To elucidate the route of groundwater in a given system, we determined signatures of direct impacts of rainfall on groundwater, using microbial, stable isotopic (δ18O, and chemical analyses (concentration of silica. Chemical analysis of the groundwater gave an average value of the water, which was already mixed with waters from various sources and routes in the subsurface environment. The microbial analysis suggested locations of water origin and paths. In situ observation during four rainfall events revealed that the stable oxygen isotopic signature obtained from spring water (at 726 m a.s.l., site SP-0 m and shallow groundwater (at 150 m a.s.l., site GW-42 m, where the average recharge height from rainfall was 1700–1800 m, became greater than values observed prior to a torrential rain producing more than 300 mm of precipitation. The concentration of silica decreased after this event. In addition, the abundance of Bacteria in spring water increased, suggesting the influence of heavy rain. Such changes did not appear when rainfall was less than 100 mm per event. The above findings indicate a rapid flow of rain through the shallow part of the aquifer, which appeared within a few weeks of torrential rain extracting abundant microbes from soil in the studied geologic setting. Interestingly, we found that after the torrential rain, the abundance of Archaea increased in the deep groundwater at site GW-550 m,  ∼  12 km downstream of SP-0 m. However, chemical parameters did not show any change

  12. Detection of Organic Constituents Including Chloromethylpropene in the Analyses of the ROCKNEST Drift by Sample Analysis at Mars (SAM)

    Science.gov (United States)

    Eigenbrode, J. L.; Glavin, D.; Coll, P.; Summons, R. E.; Mahaffy, P.; Archer, D.; Brunner, A.; Conrad, P.; Freissinet, C.; Martin, M.; hide

    2013-01-01

    key challenge in assessing the habitability of martian environments is the detection of organic matter - a requirement of all life as we know it. The Curiosity rover, which landed on August 6, 2012 in Gale Crater of Mars, includes the Sample Analysis at Mars (SAM) instrument suite capable of in situ analysis of gaseous organic components thermally evolved from sediment samples collected, sieved, and delivered by the MSL rover. On Sol 94, SAM received its first solid sample: scooped sediment from Rocknest that was sieved to analysis was performed. This blank served 1) to clean the analytical instrument of SAMinternal materials that accumulated in the gas processing system since integration into the rover, and 2) to characterize the background signatures of SAM. Both the blank and the Rocknest samples showed the presence of hydrocarbon components.

  13. Analysing the Relationship between New Housing Supply and Residential Construction Costs with Regional Heterogeneities

    Directory of Open Access Journals (Sweden)

    Junxiao Liu

    2011-09-01

    Full Text Available New housing supply in Australia has been experiencing a low increasing rate in conjunction with a dramatic increase in residential construction costs since the 1990s. This study aims to estimate the relationship between new housing supply and residential construction costs with the regional heterogeneities. Based on a panel error correction model, it can be identified that there is a causal link and a significant correlation between new housing supply and construction costs in the Australian sub-national housing construction markets. The model developed in this research assists policy makers to better understand the nature of the supply side of the housing sector and then enact appropriate policies to improve the new housing supply in Australia.

  14. Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

    Directory of Open Access Journals (Sweden)

    K M Holtzer-Goor

    Full Text Available Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS located with the general practitioner (GP. This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer, home care, informal care, and implementation costs.With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%, or receive care for containment only. In both of these groups no health gains were achieved.Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

  15. [Cost analyses of medical care for schizophrenia and depression in México, 2005-2013].

    Science.gov (United States)

    Arredondo, Armando; Díaz-Castro, Lina; Cabello-Rangel, Hector; Arredondo, Pablo; Recaman, Ana Lucía

    2018-02-05

    The study aimed to analyze the costs of medical care for mental disorders in the Mexican health system. This was a retrospective cross-sectional evaluation study. As markers for the problem, the study selected two of the principal psychological processes in mental disorders in recent years: depression and schizophrenia. Annual accumulated incidence was identified based on epidemiological reporting by type of institution in 2005-2013. The mean annual case management cost was determined with the instrumentation and consensus technique, identifying the production functions, types of inputs, costs, and amounts of inputs ordered, concentrated in the mean case matrix. Finally, an econometric adjustment factor was applied to control the inflationary effect for each year in the study period. Mean annual case management cost was USD 2,216.00 for schizophrenia and USD 2,456.00 for depression. All the institutions in the Mexican health system showed upward and constant epidemiological and economic trends. The total cost for the two disorders in the last year of the period (2013) was USD 39,081,234.00 (USD 18,119,877.00 for schizophrenia and USD 20,961,357.00 for depression). The largest impact for the two disorders combined was in institutions serving the population without health insurance (USD 24,852,321.00) versus the population with private insurance (USD 12,891,977.00). The cost of meeting the demand for services for the two disorders differs considerably between institutions that treat the population with private health service versus the population without, and is higher in the latter. The study's epidemiological and economic indicators provide evidence for decision-making in the use and allocation of healthcare resources for these two disorders in the coming years.

  16. Using niche-modelling and species-specific cost analyses to determine a multispecies corridor in a fragmented landscape

    Science.gov (United States)

    Zurano, Juan Pablo; Selleski, Nicole; Schneider, Rosio G.

    2017-01-01

    Misiones, Argentina, contains the largest remaining tract of Upper Paraná Atlantic Forest ecoregion; however, ~50% of native forest is unprotected and located in a mosaic of plantations, agriculture, and pastures. Existing protected areas are becoming increasingly isolated due to ongoing habitat modification. These factors, combined with lower than expected regional carnivore densities, emphasize the need to understand the effect of fragmentation on animal movement and connectivity between protected areas. Using detection dogs and genetic analyses of scat, we collected data on jaguars (Panthera onca), pumas (Puma concolor), ocelots (Leopardus pardalis), oncillas (Leopardus tigrinus), and bush dogs (Speothos venaticus) across habitats that varied in vegetation, disturbance, human proximity, and protective status. With MaxEnt we evaluated habitat use, habitat suitability, and potential species richness for the five carnivores across northern-central Misiones, Argentina. Through a multifaceted cost analysis that included unique requirements of each carnivore and varying degrees of overlap among them, we determined the optimal location for primary/secondary corridors that would link the northern-central zones of the Green Corridor in Misiones and identified areas within these corridors needing priority management. A secondary analysis, comparing these multispecies corridors with the jaguar’s unique requirements, demonstrated that this multispecies approach balanced the preferences of all five species and effectively captured areas required by this highly restricted and endangered carnivore. We emphasize the potential importance of expanding beyond a single umbrella or focal species when developing biological corridors that aim to capture the varied ecological requirements of coexisting species and ecological processes across the landscape. Detection dogs and genetic analyses of scat allow data on multiple species to be collected efficiently across multiple habitat

  17. Cost/benefit and risk/benefit analyses in LMFBR program planning

    International Nuclear Information System (INIS)

    Brewer, S.T.; Benson, R.A.; Palmer, R.S.

    1978-01-01

    The subject is discussed under the following headings: incentives analyses, uranium availability, electrical demand, the present value of future savings, alternatives to the breeder, environmental considerations, development program risks, results and conclusions. (U.K.)

  18. The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe.

    Science.gov (United States)

    Jit, Mark; Bilcke, Joke; Mangen, Marie-Josée J; Salo, Heini; Melliez, Hugues; Edmunds, W John; Yazdan, Yazdanpanah; Beutels, Philippe

    2009-10-19

    Cost-effectiveness analyses are usually not directly comparable between countries because of differences in analytical and modelling assumptions. We investigated the cost-effectiveness of rotavirus vaccination in five European Union countries (Belgium, England and Wales, Finland, France and the Netherlands) using a single model, burden of disease estimates supplied by national public health agencies and a subset of common assumptions. Under base case assumptions (vaccination with Rotarix, 3% discount rate, health care provider perspective, no herd immunity and quality of life of one caregiver affected by a rotavirus episode) and a cost-effectiveness threshold of euro30,000, vaccination is likely to be cost effective in Finland only. However, single changes to assumptions may make it cost effective in Belgium and the Netherlands. The estimated threshold price per dose for Rotarix (excluding administration costs) to be cost effective was euro41 in Belgium, euro28 in England and Wales, euro51 in Finland, euro36 in France and euro46 in the Netherlands.

  19. Analysing the agricultural cost and non-market benefits of implementing the water framework directive

    NARCIS (Netherlands)

    Bateman, I.J.; Brouwer, R.; Davies, H.; Day, B.H.; Deflandre, A.; Di Falco, S.; Georgiou, S.; Hadley, D.; Hutchins, M.; Jones, A.P.; Kay, D.; Leeks, G.; Lewis, M.; Lovett, A.A.; Neal, C.; Posen, P.; Rigby, D.; Turner, R.K.

    2006-01-01

    Implementation of the Water Framework Directive (WFD) represents a fundamental change in the management of water in Europe with a requirement that member states ensure 'good ecological status' for all water bodies by 2015. Agriculture is expected to bear a major share of WFD implementation costs as

  20. Transferability of results of cost utility analyses for biologicals in inflammatory conditions for Central and Eastern European countries.

    Science.gov (United States)

    Gulácsi, László; Rencz, Fanni; Péntek, Márta; Brodszky, Valentin; Lopert, Ruth; Hevér, Noémi V; Baji, Petra

    2014-05-01

    Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.

  1. Energy density of foods and diets in Mexico and their monetary cost by socioeconomic strata: analyses of ENSANUT data 2012.

    Science.gov (United States)

    Mendoza, Alfonso; Pérez, Ana E; Aggarwal, Anju; Drewnowski, Adam

    2017-07-01

    In January 2014, Mexico implemented an 8% tax on non-essential foods with energy density ≥275 kcal/100 g, with a view to prevent obesity. This study explored energy density of foods and diets in Mexico and their monetary cost across population subgroups. Dietary intakes for 3057 adults (ages ≥19 years) were obtained from the nationally representative Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Energy density (kcal/g) was calculated for foods, food groups and total diets. The mean national retail prices for 153 foods were obtained from the National Institute for Geography and Statistics (INEGI). The monetary cost of total diets (MXN/day) was estimated by attaching food prices to dietary intakes from the ENSANUT food frequency questionnaire. A series of descriptive analyses and regression models examined associations among dietary energy density and diet cost by age, gender, rural or urban residence and socioeconomic status (SES). Energy-dense grains, fats and sweets cost less per calorie than did milk and dairy, meat, vegetables and fruit. Lower cost diets derived more calories from tortillas, tamales, beans and sugar, whereas higher cost diets contained more non-essential energy-dense processed foods and more sugar sweetened beverages, and fruits and vegetables. At each quintile of energy intake, higher dietary energy density was associated with lower energy-adjusted diet costs. Traditional energy-dense tortillas and tamales, also characterised by lower cost, were consumed more by the rural poor. Urban dwellers had more 'western-style' diets. Food patterns in Mexico appear to be driven by monetary cost and SES. 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/.

  2. Applying cost analyses to drive policy that protects children. Mercury as a case study

    Energy Technology Data Exchange (ETDEWEB)

    Leonardo Trasande; Clyde Schechter; Karla A. Haynes; Philip J. Landrigan [Mount Sinai School of Medicine, New York, NY (United States). Department of Community and Preventive Medicine

    2006-09-15

    Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging from 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually. $1.3 billion of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 excess cases of mental retardation annually. This number accounts for 3.2% of MR cases in the United States. If the lifetime excess cost of a case of MR is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually. Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years.

  3. The influence of time horizon on results of cost-effectiveness analyses.

    Science.gov (United States)

    Kim, David D; Wilkinson, Colby L; Pope, Elle F; Chambers, James D; Cohen, Joshua T; Neumann, Peter J

    2017-12-01

    Debates persist on the appropriate time horizon from a payer's perspective and how the time horizon in cost-effectiveness analysis (CEA) influences the value assessment. We systematically reviewed the Tufts Medical Center CEA Registry and identified US-based studies that used a payer perspective from 2005-2014. We classified the identified CEAs as short-term (time horizon ≤ 5 years) and long-term (> 5 years), and examined associations between study characteristics and the specified time horizon. We also developed case studies with selected interventions to further explore the relationship between time horizon and projected costs, benefits, and incremental cost-effectiveness ratios (ICER). Among 782 identified studies that met our inclusion criteria, 552 studies (71%) utilized a long-term time horizon while 198 studies (25%) used a short-term horizon. Among studies that employed multiple time horizons, the extension of the time horizon yielded more favorable ICERs in 19 cases and less favorable ICERs in 4 cases. Case studies showed the use of a longer time horizon also yielded more favorable ICERs. The assumed time horizon in CEAs can substantially influence the value assessment of medical interventions. To capture all consequences, we encourage the use of time horizons that extend sufficiently into the future.

  4. Lifetime cost-utility analyses of deferasirox in beta-thalassaemia patients with chronic iron overload: a UK perspective.

    Science.gov (United States)

    Karnon, Jonathan; Tolley, Keith; Vieira, Joao; Chandiwana, David

    2012-12-01

    using balloon infusers. Sensitivity analyses showed that even when the proportion of patients using balloon infusers is decreased from 79 to 25 %, the incremental cost per QALY gained remains well under £20,000. Higher drug acquisition costs for deferasirox are offset by the avoidance of infusion-related equipment costs. Combined with health benefits derived from an oral mode of administration and improved compliance, deferasirox has a high probability of being a cost-effective intervention compared with deferoxamine.

  5. Multi-person and multi-attribute design evaluations using evidential reasoning based on subjective safety and cost analyses

    International Nuclear Information System (INIS)

    Wang, J.; Yang, J.B.; Sen, P.

    1996-01-01

    This paper presents an approach for ranking proposed design options based on subjective safety and cost analyses. Hierarchical system safety analysis is carried out using fuzzy sets and evidential reasoning. This involves safety modelling by fuzzy sets at the bottom level of a hierarchy and safety synthesis by evidential reasoning at higher levels. Fuzzy sets are also used to model the cost incurred for each design option. An evidential reasoning approach is then employed to synthesise the estimates of safety and cost, which are made by multiple designers. The developed approach is capable of dealing with problems of multiple designers, multiple attributes and multiple design options to select the best design. Finally, a practical engineering example is presented to demonstrate the proposed multi-person and multi-attribute design selection approach

  6. Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil.

    Science.gov (United States)

    Campolina, Alessandro G; Rozman, Luciana M; Decimoni, Tassia C; Leandro, Roseli; Novaes, Hillegonda M D; De Soárez, Patrícia Coelho

    2017-04-01

    Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis. Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs. Many published Brazilian cost-utility studies

  7. Environmental protection by cost minimization: Least Cost Planning for traffic. Includes a guide for the application in local communities; Umweltentlastung durch Kostenminimierung: Least Cost Planning im Verkehr. Mit Leitfaden fuer die Anwendung in Kommunen

    Energy Technology Data Exchange (ETDEWEB)

    Bracher, T.; Diegmann, V.; Eckart, C.F.; Liwicki, M.; Lobenberg, G.; Wetzel, C. [Gesellschaft fuer Informatik, Verkehrs- und Umweltplanung mbH (IVU), Berlin (Germany); Bergmann, M.; Uricher, A.; Lueers, A. [Oeko-Institut, Inst. fuer Angewandte Oekologie e.V., Freiburg im Breisgau (Germany); Becker, U.; Karl, G.; Karl, B.; Voellings, A. [Technische Univ. Dresden (Germany). Lehrstuhl fuer Verkehrsoekologie

    1999-08-01

    An intermodal approach for the evaluation of transportation services on the municipal level was developed. Both non-motorised and motorised transportation were included. The approach aims at helping communities to provide an economically and ecologically viable transport policy. Least Cost Transportation Planning (LCTP) was developed to transfer the successful concept of Least Cost Planning from the energy sector to transportation. The conclusion from an analysis of LCTP literature and present evaluation methods was that an improved approach should be intermodal and integrate users, public bodies and transport companies as well as all planning sectors. An approach was developed firstly to identify and clarify transportation expenditures and incomes of a city within a year, and secondly for the evaluation of planning alternatives. This was illustrated for the access system of an industrial area with adjacent railway services in the town of Freiburg. Three alternatives were compared: the extension of a tramway line, the upgrading of the present bus system, and the development of a service and bicycle provision concept for rail stations and companies. Besides income and expenditure for each alternative, the effects on transport demand, the impact on air pollution and noise and on space consumption were presented. As a result, the bicycle concept is in most items better than its alternatives. The final report has three volumes and there is an extra guideline for implementing the method within municipalities. It includes a set of excel sheet tables for an easy application (all in German). (orig.) [German] Fuer die Verkehrsplanung wurde ein verkehrstraegeruebergreifendes Bewertungsverfahren fuer Kommunen entwickelt, das motorisierte und nicht motorisierte Verkehrstraeger einbezieht. Das Verfahren soll Gemeinden unterstuetzen, eine oekonomische und oekologisch vertraegliche Verkehrspolitik zu verfolgen. Least Cost Transportation Planning (LCTP) zielt darauf ab, das fuer

  8. Using meta-regression analyses in addition to conventional systematic review methods to examine the variation in cost-effectiveness results : A case study

    NARCIS (Netherlands)

    L.T. Burgers (Laura); F.T. van de Wetering (Fleur); J.L. Severens (Hans); W.K. Redekop (Ken)

    2016-01-01

    textabstractBackground: Systematic reviews of cost-effectiveness analyses summarize results and describe study characteristics. Variability in the study results is often explained qualitatively or based on sensitivity analyses of individual studies. However, variability due to input parameters and

  9. Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses.

    Science.gov (United States)

    Elbert, Niels J; van Os-Medendorp, Harmieke; van Renselaar, Wilco; Ekeland, Anne G; Hakkaart-van Roijen, Leona; Raat, Hein; Nijsten, Tamar E C; Pasmans, Suzanne G M A

    2014-04-16

    eHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking. We conducted a systematic review of systematic reviews and meta-analyses on the effectiveness/cost-effectiveness of eHealth interventions in patients with somatic diseases to analyze whether, and to what possible extent, the outcome of recent research supports or differs from previous conclusions. Literature searches were performed in PubMed, EMBASE, The Cochrane Library, and Scopus for systematic reviews and meta-analyses on eHealth interventions published between August 2009 and December 2012. Articles were screened for relevance based on preset inclusion and exclusion criteria. Citations of residual articles were screened for additional literature. Included papers were critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement before data were extracted. Based on conclusions drawn by the authors of the included articles, reviews and meta-analyses were divided into 1 of 3 groups: suitable, promising, or limited evidence on effectiveness/cost-effectiveness. Cases of uncertainty were resolved by consensus discussion. Effect sizes were extracted from papers that included a meta-analysis. To compare our results with previous findings, a trend analysis was performed. Our literature searches yielded 31 eligible reviews, of which 20 (65%) reported on costs. Seven papers (23%) concluded that eHealth is effective/cost-effective, 13 (42%) underlined that evidence is promising, and others found limited or inconsistent proof. Methodological quality of the included reviews and meta-analyses was generally considered high. Trend analysis showed a considerable accumulation of literature on eHealth. However, a similar percentage of papers concluded that eHealth is effective/cost-effective or

  10. Consequence modeling for nuclear weapons probabilistic cost/benefit analyses of safety retrofits

    Energy Technology Data Exchange (ETDEWEB)

    Harvey, T.F.; Peters, L.; Serduke, F.J.D.; Hall, C.; Stephens, D.R.

    1998-01-01

    The consequence models used in former studies of costs and benefits of enhanced safety retrofits are considered for (1) fuel fires; (2) non-nuclear detonations; and, (3) unintended nuclear detonations. Estimates of consequences were made using a representative accident location, i.e., an assumed mixed suburban-rural site. We have explicitly quantified land- use impacts and human-health effects (e.g. , prompt fatalities, prompt injuries, latent cancer fatalities, low- levels of radiation exposure, and clean-up areas). Uncertainty in the wind direction is quantified and used in a Monte Carlo calculation to estimate a range of results for a fuel fire with uncertain respirable amounts of released Pu. We define a nuclear source term and discuss damage levels of concern. Ranges of damages are estimated by quantifying health impacts and property damages. We discuss our dispersal and prompt effects models in some detail. The models used to loft the Pu and fission products and their particle sizes are emphasized.

  11. Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis

    Science.gov (United States)

    Maldonado, Yvonne; Ioannidis, John P. A.; Contopoulos-Ioannidis, Despina

    2017-01-01

    Background Inclusion of vaccine herd-protection effects in cost-effectiveness analyses (CEAs) can impact the CEAs-conclusions. However, empirical epidemiologic data on the size of herd-protection effects from original studies are limited. Methods We performed a quantitative comparative analysis of the impact of herd-protection effects in CEAs for four childhood vaccinations (pneumococcal, meningococcal, rotavirus and influenza). We considered CEAs reporting incremental-cost-effectiveness-ratios (ICERs) (per quality-adjusted-life-years [QALY] gained; per life-years [LY] gained or per disability-adjusted-life-years [DALY] avoided), both with and without herd protection, while keeping all other model parameters stable. We calculated the size of the ICER-differences without vs with-herd-protection and estimated how often inclusion of herd-protection led to crossing of the cost-effectiveness threshold (of an assumed societal-willingness-to-pay) of $50,000 for more-developed countries or X3GDP/capita (WHO-threshold) for less-developed countries. Results We identified 35 CEA studies (20 pneumococcal, 4 meningococcal, 8 rotavirus and 3 influenza vaccines) with 99 ICER-analyses (55 per-QALY, 27 per-LY and 17 per-DALY). The median ICER-absolute differences per QALY, LY and DALY (without minus with herd-protection) were $15,620 (IQR: $877 to $48,376); $54,871 (IQR: $787 to $115,026) and $49 (IQR: $15 to $1,636) respectively. When the target-vaccination strategy was not cost-saving without herd-protection, inclusion of herd-protection always resulted in more favorable results. In CEAs that had ICERs above the cost-effectiveness threshold without herd-protection, inclusion of herd-protection led to crossing of that threshold in 45% of the cases. This impacted only CEAs for more developed countries, as all but one CEAs for less developed countries had ICERs below the WHO-cost-effectiveness threshold even without herd-protection. In several analyses, recommendation for the

  12. Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis.

    Science.gov (United States)

    Holubar, Marisa; Stavroulakis, Maria Christina; Maldonado, Yvonne; Ioannidis, John P A; Contopoulos-Ioannidis, Despina

    2017-01-01

    Inclusion of vaccine herd-protection effects in cost-effectiveness analyses (CEAs) can impact the CEAs-conclusions. However, empirical epidemiologic data on the size of herd-protection effects from original studies are limited. We performed a quantitative comparative analysis of the impact of herd-protection effects in CEAs for four childhood vaccinations (pneumococcal, meningococcal, rotavirus and influenza). We considered CEAs reporting incremental-cost-effectiveness-ratios (ICERs) (per quality-adjusted-life-years [QALY] gained; per life-years [LY] gained or per disability-adjusted-life-years [DALY] avoided), both with and without herd protection, while keeping all other model parameters stable. We calculated the size of the ICER-differences without vs with-herd-protection and estimated how often inclusion of herd-protection led to crossing of the cost-effectiveness threshold (of an assumed societal-willingness-to-pay) of $50,000 for more-developed countries or X3GDP/capita (WHO-threshold) for less-developed countries. We identified 35 CEA studies (20 pneumococcal, 4 meningococcal, 8 rotavirus and 3 influenza vaccines) with 99 ICER-analyses (55 per-QALY, 27 per-LY and 17 per-DALY). The median ICER-absolute differences per QALY, LY and DALY (without minus with herd-protection) were $15,620 (IQR: $877 to $48,376); $54,871 (IQR: $787 to $115,026) and $49 (IQR: $15 to $1,636) respectively. When the target-vaccination strategy was not cost-saving without herd-protection, inclusion of herd-protection always resulted in more favorable results. In CEAs that had ICERs above the cost-effectiveness threshold without herd-protection, inclusion of herd-protection led to crossing of that threshold in 45% of the cases. This impacted only CEAs for more developed countries, as all but one CEAs for less developed countries had ICERs below the WHO-cost-effectiveness threshold even without herd-protection. In several analyses, recommendation for the adoption of the target

  13. Cost estimating relationships for coal conversion process units. Volume 1. Technical report. [Includes in some cases dependence on capacity and data references from which estimates were derived

    Energy Technology Data Exchange (ETDEWEB)

    Dodson, E.N.; Carden, H.W.; Curtis, R.L.; Heidler, L.M.; Roppel, J.D.

    1981-04-01

    Cost estimating relationships for commercial-scale coal conversion process units are developed in this study. The specific units include: coal preparation, oxygen plant, gasification, shift conversion, acid gas/CO/sub 2/ removal, sulfur recovery, and the dissolver. Also set forth is a detailed Cost Chart of Accounts, together with a discussion of cost analysis procedures and problems.

  14. Population-based cost-offset analyses for disorder-specific treatment of anorexia nervosa and bulimia nervosa in Germany.

    Science.gov (United States)

    Bode, Katharina; Götz von Olenhusen, Nina Maria; Wunsch, Eva-Maria; Kliem, Sören; Kröger, Christoph

    2017-03-01

    Previous research has shown that anorexia nervosa (AN) and bulimia nervosa (BN) are expensive illnesses to treat. To reduce their economic burden, adequate interventions need to be established. Our objective was to conduct cost-offset analyses for evidence-based treatment of eating disorders using outcome data from a psychotherapy trial involving cognitive behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for AN and a trial involving CBT for BN. Assuming a currently running, ideal healthcare system using a 12-month, prevalence-based approach and varying the willingness to participate in treatment, we investigated whether the potential financial benefits of AN- and BN-related treatment outweigh the therapy costs at the population level. We elaborated on a formula that allows calculating cost-benefit relationships whereby the calculation of the parameters is based on estimates from data of health institutions within the German healthcare system. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. The annual costs of an untreated eating disorder were 2.38 billion EUR for AN and 617.69 million EUR for BN. Independent of the willingness to participate in treatment, the cost-benefit relationships for the treatment remained constant at 2.51 (CBT) and 2.33 (FPT) for AN and 4.05 (CBT) for BN. This consistency implies that for each EUR invested in the treatment, between 2.33 and 4.05 EUR could be saved each year. Our findings suggest that the implementation of evidence-based psychotherapy treatments for AN and BN may achieve substantial cost savings at the population level. © 2017 Wiley Periodicals, Inc.

  15. Design and testing of indigenous cost effective three dimensional radiation field analyser (3D RFA).

    Science.gov (United States)

    Ganesh, K M; Pichandi, A; Nehru, R M; Ravikumar, M

    2014-06-01

    The aim of the study is to design and validate an indigenous three dimensional Radiation Field Analyser (3D RFA). The feed system made for X, Y and Z axis movements is of lead screw with deep ball bearing mechanism made up of stain less steel driven by stepper motors with accuracy less than 0.5 mm. The telescopic column lifting unit was designed using linear actuation technology for lifting the water phantom. The acrylic phantom with dimensions of 800 x 750 x 570 mm was made with thickness of 15 mm. The software was developed in visual basic programming language, classified into two types, viz. beam analyzer software and beam acquisition software. The premeasurement checks were performed as per TG 106 recommendations. The physical parameters of photon PDDs such as Dmax, D10, D20 and Quality Index (QI), and the electron PDDs such as R50, Rp, E0, Epo and X-ray contamination values can be obtained instantaneously by using the developed RFA system. Also the results for profile data such as field size, central axis deviation, penumbra, flatness and symmetry calculated according to various protocols can be obtained for both photon and electron beams. The result of PDDs for photon beams were compared with BJR25 supplement values and the profile data were compared with TG 40 recommendation. The results were in agreement with standard protocols.

  16. Dignity and cost-effectiveness: analysing the responsibility for decisions in medical ethics.

    Science.gov (United States)

    Robertson, G S

    1984-01-01

    In the operation of a health care system, defining the limits of medical care is the joint responsibility of many parties including clinicians, patients, philosophers and politicians. It is suggested that changes in the potential for prolonging life make it necessary to give doctors guidance which may have to incorporate certain features of utilitarianism, individualism and patient-autonomy. PMID:6502644

  17. Review of economics and cost-effectiveness analyses of anticoagulant therapy for stroke prevention in atrial fibrillation in the US.

    Science.gov (United States)

    von Schéele, Birgitta; Fernandez, Maria; Hogue, Susan Lynn; Kwong, Winghan Jacqueline

    2013-05-01

    To summarize the available evidence on the issues in health economics related to oral anticoagulation for stroke prevention in atrial fibrillation (AF) in the US. A literature review was performed using PubMed, EMBASE, Cochrane Library, and International Pharmaceutical Abstracts, as well as the websites of professional organizations. The search was conducted according to a prespecified protocol, limiting articles to those published in English from 2001 to October 2012 and focused on the economics associated with AF and AF-related stroke in the US. Data from 27 studies were extracted and included in the review. Strokes in patients with AF are more debilitating and have higher recurrence rates and mortality compared with strokes unrelated to AF. However, data describing the long-term cost of AF-related stroke and stroke subtypes remain limited. The costs of major gastrointestinal (GI) bleeding and intracranial bleeding related to warfarin are significant, whereas the costs of the more frequent minor GI bleeding are relatively low. Overall, the cost-effectiveness of warfarin versus aspirin or no treatment in patients with at least 1 risk factor for stroke is well established. Economic evaluations based on results from randomized controlled clinical trials generally found that new anticoagulants were a cost-effective alternative to warfarin for stroke prevention in AF. However, these cost-effectiveness results are highly sensitive to how well optimal international normalized ratio control is maintained (within target of 2.0-3.0) for warfarin and the time horizon used for analysis. Time in therapeutic range for warfarin in routine clinical practice was lower than in clinical trials, as shown by previous studies. This review identified several areas of uncertainty regarding the economic benefit of anticoagulants. The generalizability of cost-effectiveness results of anticoagulant therapy in AF based on clinical trial data must be confirmed by comparative effectiveness

  18. Buy now, saved later? The critical impact of time-to-pandemic uncertainty on pandemic cost-effectiveness analyses.

    Science.gov (United States)

    Drake, Tom; Chalabi, Zaid; Coker, Richard

    2015-02-01

    Investment in pandemic preparedness is a long-term gamble, with the return on investment coming at an unknown point in the future. Many countries have chosen to stockpile key resources, and the number of pandemic economic evaluations has risen sharply since 2009. We assess the importance of uncertainty in time-to-pandemic (and associated discounting) in pandemic economic evaluation, a factor frequently neglected in the literature to-date. We use a probability tree model and Monte Carlo parameter sampling to consider the cost effectiveness of antiviral stockpiling in Cambodia under parameter uncertainty. Mean elasticity and mutual information (MI) are used to assess the importance of time-to-pandemic compared with other parameters. We also consider the sensitivity to choice of sampling distribution used to model time-to-pandemic uncertainty. Time-to-pandemic and discount rate are the primary drivers of sensitivity and uncertainty in pandemic cost effectiveness models. Base case cost effectiveness of antiviral stockpiling ranged between is US$112 and US$3599 per DALY averted using historical pandemic intervals for time-to-pandemic. The mean elasticities for time-to-pandemic and discount rate were greater than all other parameters. Similarly, the MI scores for time to pandemic and discount rate were greater than other parameters. Time-to-pandemic and discount rate were key drivers of uncertainty in cost-effectiveness results regardless of time-to-pandemic sampling distribution choice. Time-to-pandemic assumptions can "substantially" affect cost-effectiveness results and, in our model, is a greater contributor to uncertainty in cost-effectiveness results than any other parameter. We strongly recommend that cost-effectiveness models include probabilistic analysis of time-to-pandemic uncertainty. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  19. The cause of cost in the management of odontogenic infections 2: multivariate outcome analyses.

    Science.gov (United States)

    Christensen, Brian; Han, Michael; Dillon, Jasjit K

    2013-12-01

    The purpose of this retrospective cohort study was to evaluate the demographic, social, treatment, and hospital course variables associated with length of stay (LOS), intensive care unit (ICU) use, and additional operating room (OR) use in patients admitted for odontogenic infections. A retrospective chart review was conducted in patients admitted for odontogenic infections at Harborview Medical Center from July 1, 2001 through June 30, 2011. In total, 318 patient charts were reviewed and included. In the multivariate linear regression analysis on LOS, the variables drug abuse, location of treatment, number of spaces involved, side or location of infection, ICU use, length of ICU stay, additional OR use, peak temperature, admission white blood cell count, peak white blood cell count, and peak blood sugar accounted for 68.2% of the variation. In the multivariate logistic regression analysis on ICU use, the variables OR time, number of spaces involved, and peak blood sugar accounted for 32.5% of the variation. LOS was the only variable significantly associated with additional OR use in the multivariate analysis. An understanding of the key variables involved in LOS in patients with odontogenic infections has been greatly improved by recent studies and reinforced by the present study. The authors present a starting point for a greater understanding of the variables involved in ICU use, but much more work is needed to address variables identifying patients requiring reoperation. Future studies should aim to create multivariate models explaining all variations in these outcome variables. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies.

    Science.gov (United States)

    Krol, Marieke; Papenburg, Jocé; van Exel, Job

    2015-02-01

    Informal care makes an important contribution to societal welfare. However, it may involve substantial time costs and can have a considerable negative effect on the health and well-being of informal caregivers. These costs and effects of informal caregiving are often excluded in economic evaluations of healthcare interventions. The impact of this exclusion on the outcomes of these evaluations is largely unknown. This study aimed to explore the inclusion of informal care in economic evaluations and the potential impact of the costs and effects of informal caregiving on cost-effectiveness outcomes. A systematic review was conducted to identify economic evaluations of interventions in four distinct disease areas where informal care is potentially important: Alzheimer's disease, metastatic colorectal cancer, Parkinson's disease and rheumatoid arthritis. It was recorded how often economic evaluations included informal caregiving. Next, for the studies including informal care, the impact on cost-effectiveness outcomes was determined by removing informal care costs and effects of the cost-effectiveness calculations and recalculating the outcomes. The new cost-effectiveness outcomes were then compared with the original reported outcomes. The study identified 100 economic evaluations investigating interventions targeted at Alzheimer's disease (n = 25), metastatic colorectal cancer (n = 24), Parkinson's disease (n = 8) and rheumatoid arthritis (n = 43). Twenty-three of these evaluations (23 %) included costs and/or effects of informal caregiving: 64 % of the Alzheimer's disease studies, 0 % of the metastatic colorectal cancer studies, 13 % of Parkinson's disease studies and 14 % of rheumatoid arthritis studies. When informal care was included, this mostly concerned time costs. Studies rarely included both costs and effects. The effect of including or excluding informal care costs or effects on cost-effectiveness outcomes in most studies was modest, but in some studies the

  1. Assessing the 'Waste Hierarchy' a social cost-benefit analyse of MSW management in the European Union

    International Nuclear Information System (INIS)

    Brisson, I. E.

    1997-01-01

    This paper discusses, in the context of an impending 'waste crisis', the concept of optimal waste generation and an optimal mix of municipal solid waste (MSW) management methods. It argues that excessive quantities of MSW are likely to be generated, and consequently excessive demand for waste services will exist, as long as the marginal cost of waste services facing the household is zero. In order to avoid this excess demand, households should be charged for waste services according to their use of it, and not as presently at a flat rate. In the price to be paid by householders should be included financial as well as external costs. With respect to the optimal mix of MSW management methods, the paper asserts that this would be attained when the marginal net social costs of each management methods were equal. After setting out the theoretical background, the paper then proceeds to undertake a social cost-benefit analysis of waste management methods currently employed by the 12 'old' European Union Member States, including external and financial costs of landfill, incineration, recycling and composting. The estimates obtained from this analysis are used to assess the validity of the 'waste hierarchy', which has won widespread acceptance, and is used as a guideline in a number of countries' waste policies. In the light of the widespread focus on increasing recycling efforts, a sensitivity analysis is carried out to ascertain whether particular materials are especially suited for recycling, and whether there are other materials for which recycling should not be encouraged. (au) 16 refs

  2. Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile neutropenia risk in patients receiving chemotherapy for non-Hodgkin's lymphoma: cost-effectiveness analyses.

    Science.gov (United States)

    Hill, Gregory; Barron, Richard; Fust, Kelly; Skornicki, Michelle E; Taylor, Douglas C A; Weinstein, Milton C; Lyman, Gary H

    2014-01-01

    Evaluate the cost-effectiveness of primary vs secondary prophylaxis (PP vs SP) with pegfilgrastim to reduce the risk of febrile neutropenia (FN) in Non-Hodgkin's Lymphoma (NHL) patients receiving myelosuppressive chemotherapy from a US payer perspective. A Markov model was used to compare PP vs SP with pegfilgrastim in a cohort of patients receiving six cycles of cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or CHOP plus rituximab (CHOP-R) chemotherapy. Model inputs, including efficacy of pegfilgrastim in reducing risk of FN and costs, were estimated from publicly available sources and peer-reviewed publications. Incremental cost-effectiveness was evaluated in terms of net cost per life-year saved (LYS), per quality-adjusted life-year (QALY) gained, and per FN event avoided over a lifetime horizon. Deterministic and probabilistic analyses were performed to assess sensitivity and robustness of results. Lifetime costs for PP were $5000 greater than for SP; however, PP was associated with fewer FN events and more LYs and QALYs gained vs SP. Incremental cost-effectiveness ratios (ICERs) for PP vs SP for CHOP were $13,400 per FN event avoided, $29,500 per QALY gained, and $25,800 per LYS. CHOP-R results were similar ($15,000 per FN event avoided, $33,000 per QALY gained, and $28,900 per LYS). Results were most sensitive to baseline FN risk, cost per FN episode, and odds ratio for reduced relative dose intensity due to prior FN event. PP was cost-effective vs SP in 85% of simulations at a $50,000 per QALY threshold. In the absence of NHL-specific data, estimates for pegfilgrastim efficacy and relative risk reduction of FN were based on available data for neoadjuvant TAC in patients with breast cancer. Baseline risks of FN for CHOP and CHOP-R were assumed to be equivalent. PP with pegfilgrastim is cost-effective compared to SP with pegfilgrastim in NHL patients receiving CHOP or CHOP-R.

  3. Cost-effectiveness of hematopoietic stem cell mobilization strategies including plerixafor in multiple myeloma and lymphoma patients.

    Science.gov (United States)

    Tichopád, Aleš; Vítová, Veronika; Kořístek, Zdeněk; Lysák, Daniel

    2013-12-01

    Peripheral blood stem cells (PBSCs) are preferred source of hematopoietic stem cells for autologous transplantation. Mobilization of PBSCs using chemotherapy and/or granulocyte colony-stimulating factor (G-CSF) however fails in around 20%. Combining G-CSF with plerixafor increases the mobilizations success. We compared cost-effectiveness of following schemes: the use of plerixafor "on demand" (POD) during the first mobilization in all patients with inadequate response, the remobilization with plerixafor following failure of the first standard mobilization (SSP), and the standard (re)mobilization scheme without plerixafor (SSNP). Decision tree models populated with data from a first-of-a-kind patient registry in six Czech centers (n = 93) were built to compare clinical benefits and direct costs from the payer's perspective. The success rates and costs for POD, SSP and SSNP mobilizations were; 94.9%, $7,197; 94.7%, $8,049; 84.7%, $5,991, respectively. The direct cost per successfully treated patient was $7,586, $8,501, and $7,077, respectively. The cost of re-mobilization of a poor mobilizer was $5,808 with G-CSF only and $16,755 if plerixafor was added. The total cost of plerixafor "on-demand" in the sub-cohort of poor mobilizers was $17,120. Generally, plerixafor improves the mobilization success by 10% and allows an additional patient to be successfully mobilized for incremental $11,803. Plerixafor is better and cheaper if used "on demand" than within a subsequent remobilization. Copyright © 2013 Wiley Periodicals, Inc.

  4. Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

    Science.gov (United States)

    Rognoni, Carla; Tarricone, Rosanna

    2017-01-17

    This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Italian Healthcare Service perspective. Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent

  5. Analysis of Implementing Lifetime Energy Cost, Including Fully Burdened Cost of Fuel and Energy Footprints of Contractors, as Mandatory Decision Factors in Navy Acquisition

    Science.gov (United States)

    2010-06-01

    Cost Of Energy, Energy Efficiency, Energy Footprint, Mandatory Evaluation Factors, Navy Acquisition, Energy Management Systems, Corporate Social Responsibility 16...Chairman of the Joint Chiefs of Staff CPG Comprehensive Procurement Guidelines CSR Corporate Social Responsibility DAG Defense Acquisition... corporate social responsibility (CSR), in the pursuit of maximizing profit, corporations are incentivized, at least theoretically, to produce their goods

  6. Risk- and cost-benefit analyses of breast screening programs derived from absorbed dose measurements in the Netherlands

    International Nuclear Information System (INIS)

    Zuur, C.; Broerse, J.J.

    1985-01-01

    Risk- and cost benefit analyses for breast screening programs are being performed, employing the risk-factors for induction of breast cancer from six extensive follow-up studies. For women of the age group above 35 years and for a risk period of 30 years after a 10-year latency period, a factor of extra cases of 20 x 10 -6 mGy -1 can be estimated. Measurements are being performed in Dutch hospitals to determine the mean absorbed tissue dose. These doses vary from 0.6 to 4.4 mGy per radiography. For a dose of 1 mGy per radiograph and yearly screening of women between 35 and 75 years, the risk of radiogenic breast cancer is about 1% of the natural incidence (85,000 per 10 6 women) in this group. A recommended frequency of screening has to be based on medical, social and financial considerations. The gain in woman years and in completely cured women is being estimated for screening with intervals of 12 instead of 24 months. The medical and social benefit is 1,520 years life-time and 69 more cases completely cured per 1,000 breast cancer patients. The financial profit of a completely cured instead of an ultimately fatal cancer can be roughly estimated at 55,000 guilders. In addition the costs per gained woman-year are about 5,000 guilders. In consequence, the extra costs of annual additional rounds of mammographic screening are balanced by the benefit. (Auth.)

  7. Comprehensive genomic analyses of the OM43 clade including a novel species from Red Sea indicate ecotype differentiation among marine methylotrophs

    KAUST Repository

    Jimenez Infante, Francy M.

    2015-12-11

    The OM43 clade within the family Methylophilaceae of Betaproteobacteria represents a group of methylotrophs playing important roles in the metabolism of C1 compounds in marine environments and other aquatic environments around the globe. Using dilution-to-extinction cultivation techniques, we successfully isolated a novel species of this clade (designated here as MBRS-H7) from the ultra-oligotrophic open ocean waters of the central Red Sea. Phylogenomic analyses indicate that MBRS-H7 is a novel species, which forms a distinct cluster together with isolate KB13 from Hawaii (H-RS cluster) that is separate from that represented by strain HTCC2181 (from the Oregon coast). Phylogenetic analyses using the robust 16S–23S internal transcribed spacer revealed a potential ecotype separation of the marine OM43 clade members, which was further confirmed by metagenomic fragment recruitment analyses that showed trends of higher abundance in low chlorophyll and/or high temperature provinces for the H-RS cluster, but a preference for colder, highly productive waters for the HTCC2181 cluster. This potential environmentally driven niche differentiation is also reflected in the metabolic gene inventories, which in the case of H-RS include those conferring resistance to high levels of UV irradiation, temperature, and salinity. Interestingly, we also found different energy conservation modules between these OM43 subclades, namely the existence of the NADH:quinone oxidoreductase NUO system in the H-RS and the non-homologous NQR system in HTCC2181, which might have implications on their overall energetic yields.

  8. Comprehensive Genomic Analyses of the OM43 Clade, Including a Novel Species from the Red Sea, Indicate Ecotype Differentiation among Marine Methylotrophs.

    Science.gov (United States)

    Jimenez-Infante, Francy; Ngugi, David Kamanda; Vinu, Manikandan; Alam, Intikhab; Kamau, Allan Anthony; Blom, Jochen; Bajic, Vladimir B; Stingl, Ulrich

    2016-02-15

    The OM43 clade within the family Methylophilaceae of Betaproteobacteria represents a group of methylotrophs that play important roles in the metabolism of C1 compounds in marine environments and other aquatic environments around the globe. Using dilution-to-extinction cultivation techniques, we successfully isolated a novel species of this clade (here designated MBRS-H7) from the ultraoligotrophic open ocean waters of the central Red Sea. Phylogenomic analyses indicate that MBRS-H7 is a novel species that forms a distinct cluster together with isolate KB13 from Hawaii (Hawaii-Red Sea [H-RS] cluster) that is separate from the cluster represented by strain HTCC2181 (from the Oregon coast). Phylogenetic analyses using the robust 16S-23S internal transcribed spacer revealed a potential ecotype separation of the marine OM43 clade members, which was further confirmed by metagenomic fragment recruitment analyses that showed trends of higher abundance in low-chlorophyll and/or high-temperature provinces for the H-RS cluster but a preference for colder, highly productive waters for the HTCC2181 cluster. This potential environmentally driven niche differentiation is also reflected in the metabolic gene inventories, which in the case of the H-RS cluster include those conferring resistance to high levels of UV irradiation, temperature, and salinity. Interestingly, we also found different energy conservation modules between these OM43 subclades, namely, the existence of the NADH:quinone oxidoreductase complex I (NUO) system in the H-RS cluster and the nonhomologous NADH:quinone oxidoreductase (NQR) system in the HTCC2181 cluster, which might have implications for their overall energetic yields. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  9. Measures of quality, costs and equity in primary health care instruments developed to analyse and compare primary care in 35 countries

    NARCIS (Netherlands)

    Schäfer, Willemijn L. A.; Boerma, Wienke G. W.; Kringos, Dionne S.; de Ryck, Evelyne; Greß, Stefan; Heinemann, Stephanie; Murante, Anna Maria; Rotar-Pavlic, Danica; Schellevis, François G.; Seghieri, Chiara; van den Berg, Michael J.; Westert, Gert P.; Willems, Sara; Groenewegen, Peter P.

    2013-01-01

    The Quality and Costs of Primary Care in Europe (QUALICOPC) study aims to analyse and compare how primary health care systems in 35 countries perform in terms of quality, costs and equity. This article answers the question 'How can the organisation and delivery of primary health care and its

  10. Development of a method for calculating the cost of the program for decommissioning of nuclear power plants. Prognosis of future costs for the authorities including the corresponding net present value. Analysis performed May 6-7 and June 8 2004

    International Nuclear Information System (INIS)

    Borg, Lorens; Lichtenberg, Steen; Lindskog, Staffan

    2004-09-01

    The aim of this report is to present a calculation of the authorities' total future costs in terms of their activities to monitor a safe and prudent decommission of the power plants, including the long term storage of the used fuel. An assessment of the inherent uncertainty in this estimate is also made. The study forms an integrated part of the total monitoring into the financial assessment of the whole programme of decommissioning and demolition of the Swedish nuclear power plants that continuously is made by SKI. Hence, the estimate is presented with the additional function of supporting SKI's annual calculations of fees and contingencies in accordance with the Swedish Finance Act. Main result The expected Net Present Value of the authorities' costs as at January 2004 price level have consequently been estimated as follows: Mean Value (M): 2303 MSEK Standard deviation (S): 538 MSEK 8 This result tallies with the corresponding prognoses for the last two years. An additional clarification of a number of key figures resulted in some reduction of the total Net Present Value. By way of supplement to this main result, the undiscounted costs have been estimated (calculation 2). Besides, a tentative estimate has also been made by incorporating the official view on the future development on real rate of return in a long time perspective (calculation 3). The uncertainty of the result is significant in terms of the final budget figures and of the scale of the supplementary amounts in those situations where the budgets must be prudent and conservative. There may be a potential for further reduction of the current uncertainty in that the greatest causes of uncertainty now have been identified and ranked in order of priority. The greatest causes of uncertainty are set out in the table below. No. Cause of uncertainty Uncertainty group 1 Priority 2 1 Correction allowing for the uncertainty of the real interest rate N 55 % 2 Productivity E2 8 % 3 Uncertainty in the current base

  11. Refining cost-effectiveness analyses using the net benefit approach and econometric methods: an example from a trial of anti-depressant treatment.

    Science.gov (United States)

    Sabes-Figuera, Ramon; McCrone, Paul; Kendricks, Antony

    2013-04-01

    Economic evaluation analyses can be enhanced by employing regression methods, allowing for the identification of important sub-groups and to adjust for imperfect randomisation in clinical trials or to analyse non-randomised data. To explore the benefits of combining regression techniques and the standard Bayesian approach to refine cost-effectiveness analyses using data from randomised clinical trials. Data from a randomised trial of anti-depressant treatment were analysed and a regression model was used to explore the factors that have an impact on the net benefit (NB) statistic with the aim of using these findings to adjust the cost-effectiveness acceptability curves. Exploratory sub-samples' analyses were carried out to explore possible differences in cost-effectiveness. Results The analysis found that having suffered a previous similar depression is strongly correlated with a lower NB, independent of the outcome measure or follow-up point. In patients with previous similar depression, adding an selective serotonin reuptake inhibitors (SSRI) to supportive care for mild-to-moderate depression is probably cost-effective at the level used by the English National Institute for Health and Clinical Excellence to make recommendations. This analysis highlights the need for incorporation of econometric methods into cost-effectiveness analyses using the NB approach.

  12. Cleanup procedures at the Nevada Test Site and at other radioactively contaminated sites including representative costs of cleanup and treatment of contaminated areas

    International Nuclear Information System (INIS)

    Talmage, S.S.; Chilton, B.D.

    1987-09-01

    This review summarizes available information on cleanup procedures at the Nevada Test Site and at other radioactively contaminated sites. Radionuclide distribution and inventory, size of the contaminated areas, equipment, and cleanup procedures and results are included. Information about the cost of cleanup and treatment for contaminated land is presented. Selected measures that could be useful in estimating the costs of cleaning up radioactively contaminated areas are described. 76 refs., 16 tabs

  13. A perspective on electric vehicles: cost-benefit analysis and potential demand; Les vehicules electriques en perspective. Analyse couts-avantages et demande potentielle

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    This report proposes some quantitative elements to assess the large scale diffusion of electric vehicles and analyse the potential demand for such vehicles. The first part proposes a cost-benefit analysis of the development of electric vehicles based on estimated costs and expected benefits by 2020. It addresses the following issues: framework and hypothesis, total cost of ownership, costs related to the deployment of a network of recharging infrastructures, assessment of external costs, and comparative cost-benefit analysis of electric vehicles. In the second part, the authors aim at identifying a potential demand for electric vehicles from the 2008 French national transport displacement survey (ENTD 2008) which provides recent data on the mobility of the French population

  14. Effects of Including Misidentified Sharks in Life History Analyses: A Case Study on the Grey Reef Shark Carcharhinus amblyrhynchos from Papua New Guinea.

    Science.gov (United States)

    Smart, Jonathan J; Chin, Andrew; Baje, Leontine; Green, Madeline E; Appleyard, Sharon A; Tobin, Andrew J; Simpfendorfer, Colin A; White, William T

    2016-01-01

    Fisheries observer programs are used around the world to collect crucial information and samples that inform fisheries management. However, observer error may misidentify similar-looking shark species. This raises questions about the level of error that species misidentifications could introduce to estimates of species' life history parameters. This study addressed these questions using the Grey Reef Shark Carcharhinus amblyrhynchos as a case study. Observer misidentification rates were quantified by validating species identifications using diagnostic photographs taken on board supplemented with DNA barcoding. Length-at-age and maturity ogive analyses were then estimated and compared with and without the misidentified individuals. Vertebrae were retained from a total of 155 sharks identified by observers as C. amblyrhynchos. However, 22 (14%) of these were sharks were misidentified by the observers and were subsequently re-identified based on photographs and/or DNA barcoding. Of the 22 individuals misidentified as C. amblyrhynchos, 16 (73%) were detected using photographs and a further 6 via genetic validation. If misidentified individuals had been included, substantial error would have been introduced to both the length-at-age and the maturity estimates. Thus validating the species identification, increased the accuracy of estimated life history parameters for C. amblyrhynchos. From the corrected sample a multi-model inference approach was used to estimate growth for C. amblyrhynchos using three candidate models. The model averaged length-at-age parameters for C. amblyrhynchos with the sexes combined were L∞ = 159 cm TL and L0 = 72 cm TL. Females mature at a greater length (l50 = 136 cm TL) and older age (A50 = 9.1 years) than males (l50 = 123 cm TL; A50 = 5.9 years). The inclusion of techniques to reduce misidentification in observer programs will improve the results of life history studies and ultimately improve management through the use of more accurate data

  15. Cytogenetic analyses of eight species in the genus Leptodactylus Fitzinger, 1843 (Amphibia, Anura, Leptodactylidae), including a new diploid number and a karyotype with multiple translocations

    Science.gov (United States)

    2012-01-01

    Background The karyotypes of Leptodactylus species usually consist of 22 bi-armed chromosomes, but morphological variations in some chromosomes and even differences in the 2n have been reported. To better understand the mechanisms responsible for these differences, eight species were analysed using classical and molecular cytogenetic techniques, including replication banding with BrdU incorporation. Results Distinct chromosome numbers were found: 2n = 22 in Leptodactylus chaquensis, L. labyrinthicus, L. pentadactylus, L. petersii, L. podicipinus, and L. rhodomystax; 2n = 20 in Leptodactylus sp. (aff. podicipinus); and 2n = 24 in L. marmoratus. Among the species with 2n = 22, only three had the same basic karyotype. Leptodactylus pentadactylus presented multiple translocations, L. petersii displayed chromosome morphological discrepancy, and L. podicipinus had four pairs of telocentric chromosomes. Replication banding was crucial for characterising this variability and for explaining the reduced 2n in Leptodactylus sp. (aff. podicipinus). Leptodactylus marmoratus had few chromosomes with a similar banding patterns to the 2n = 22 karyotypes. The majority of the species presented a single NOR-bearing pair, which was confirmed using Ag-impregnation and FISH with an rDNA probe. In general, the NOR-bearing chromosomes corresponded to chromosome 8, but NORs were found on chromosome 3 or 4 in some species. Leptodactylus marmoratus had NORs on chromosome pairs 6 and 8. The data from C-banding, fluorochrome staining, and FISH using the telomeric probe helped in characterising the repetitive sequences. Even though hybridisation did occur on the chromosome ends, telomere-like repetitive sequences outside of the telomere region were identified. Metaphase I cells from L. pentadactylus confirmed its complex karyotype constitution because 12 chromosomes appeared as ring-shaped chain in addition to five bivalents. Conclusions Species of Leptodactylus exhibited both major and minor

  16. Should asymptomatic men be included in chlamydia screening programs? Cost-effectiveness of chlamydia screening among male and female entrants to a national job training program.

    Science.gov (United States)

    Blake, Diane R; Quinn, Thomas C; Gaydos, Charlotte A

    2008-01-01

    To compare the cost-effectiveness of various chlamydia screening strategies within a population of male and female youth entering a national job training program. Cost-effectiveness analysis of various chlamydia screening strategies among a cohort of 4000 female and male New England job training students. Strategies for women include (a) no screening, (b) universal endocervical DNA probe screening, (c) universal urine based NAAT screening, and (d) universal endocervical NAAT screening. Strategies for men include (a) no screening, (b) selective urine NAAT screening of leukocyte esterase (LE)-positive urines, and (c) universal urine-based NAAT screening. Universal endocervical NAAT screening of women and universal urine NAAT screening of men were the most effective and cost-effective strategies individually and in combination. Endocervical NAAT screening of women prevented 23 more cases of PID and saved $27,000 more than endocervical DNA probe screening. Likewise, universal urine NAAT screening of men prevented 21 more cases of PID in their female partners and saved $16,000 more than selective urine NAAT screening of LE positive men. Use of a sensitive NAAT to screen both men and women for chlamydia upon entry to a National Job Training Program is cost-effective, cost-saving, and provides a public health opportunity to substantially reduce chlamydia infections among youth at risk for sexually transmitted diseases.

  17. Audit of Trichomonas vaginalis test requesting by community referrers after a change from culture to molecular testing, including a cost analysis.

    Science.gov (United States)

    Bissessor, Liselle; Wilson, Janet; McAuliffe, Gary; Upton, Arlo

    2017-06-16

    Trichomonas vaginalis (TV) prevalence varies among different communities and peoples. The availability of robust molecular platforms for the detection of TV has advanced diagnosis; however, molecular tests are more costly than phenotypic methodologies, and testing all urogenital samples is costly. We recently replaced culture methods with the Aptima Trichomonas vaginalis nucleic acid amplification test on specific request and as reflex testing by the laboratory, and have audited this change. Data were collected from August 2015 (microbroth culture and microscopy) and August 2016 (Aptima TV assay) including referrer, testing volumes, results and test cost estimates. In August 2015, 10,299 vaginal swabs, and in August 2016, 2,189 specimens (urogenital swabs and urines), were tested. The positivity rate went from 0.9% to 5.3%, and overall more TV infections were detected in 2016. The number needed to test and cost for one positive TV result respectively was 111 and $902.55 in 2015, and 19 and $368.92 in 2016. Request volumes and positivity rates differed among referrers. The methodology change was associated with higher overall detection of TV, and reductions in the numbers needed to test/cost for one TV diagnosis. Our audit suggests that there is room for improvement with TV test requesting in our community.

  18. Cost-effectiveness and cost-benefit analyses of a multidisciplinary intervention compared with a brief intervention to facilitate return to work in sick-listed patients with low back pain.

    Science.gov (United States)

    Jensen, Chris; Nielsen, Claus Vinther; Jensen, Ole Kudsk; Petersen, Karin Dam

    2013-06-01

    Randomized clinical trial of 2 interventions in 351 employees sick listed due to low back pain (LBP) and a subsequent validation study (n = 120) to validate results from subgroup analyses in the original study. To compose health economic analyses (cost-effectiveness- and cost-benefit analyses) of multidisciplinary versus brief intervention by calculating health care sector costs and sick leave benefits. Both brief and multidisciplinary interventions have been reported to be superior relative to usual care when comparing intervention costs with saved costs for sick leave benefits. We reported similar return to work rates in a brief and a multidisciplinary intervention group, but different return to work rates in subgroups. The brief intervention comprised clinical examination and reassuring advice. The multidisciplinary intervention was conducted by a case manager and a team of specialists. The costs of medicine, health care services, and sick leave benefits were calculated on the basis of registers. The mean intervention cost per patient was € 1377 higher in the multidisciplinary intervention (n = 176) than in the brief intervention group (n = 175), and sick leave was not averted. However, sick leave was averted in a subgroup receiving the multidisciplinary intervention and the mean incremental intervention cost for 1 saved sick leave week in this subgroup (n = 60) of patients, who thought they were at risk of losing their job or had little influence on their work situation was € 217. The latter finding was verified in the validation study (n = 28). The brief intervention resulted in fewer sick leave weeks and was less expensive than the multidisciplinary intervention. The multidisciplinary intervention only outperformed the brief intervention in terms of costs in a subgroup of sick-listed employees who thought they were at risk of losing their job or had little influence on their work situation. 2.

  19. Innovative cost engineering approaches, analyses and methods applied to spaceliner - an advanced, hypersonic, suborbital spaceplane case-study

    OpenAIRE

    Trivailo, Olga

    2017-01-01

    When commencing a new program within the space sector, the question of expected program costs has emerged as a most critical criterion to be considered, especially within the context of large and highly complex international programs where multiple domains and disciplines are directly interfaced. Given added technical, economic, and political complexities, the real challenge is to representatively estimate costs during the early program phases where physical, technical, performance and progra...

  20. An update to "The cost-effectiveness of rotavirus vaccination: comparative analyses for five European countries and transferability in Europe".

    Science.gov (United States)

    Jit, Mark; Mangen, Marie-Josée J; Melliez, Hugues; Yazdanpanah, Yazdan; Bilcke, Joke; Salo, Heini; Edmunds, W John; Beutels, Philippe

    2010-11-03

    A cost-effectiveness analysis of rotavirus vaccination in Belgium, England and Wales, Finland, France and the Netherlands published in 2009 was updated based on recent studies on rotavirus burden of disease and vaccine efficacy. All the qualitative conclusions in the previous study were found to remain valid. Vaccination remains cost-effective in Finland only when using plausible tender prices. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Systematic review of cost-effectiveness analyses of novel oral anticoagulants for stroke prevention in atrial fibrillation.

    Science.gov (United States)

    Ferreira, João; Mirco, Ana

    2015-03-01

    Novel oral anticoagulants are emerging options for the prevention and treatment of thromboembolic diseases. They are increasingly used in clinical practice due to their simplicity of use and clinical benefits, but an important step is to evaluate their cost-effectiveness. The aim of the AFFORD study (A Review of Cost EFFectiveness of Novel ORal Anticoagulant Drugs) was to perform a systematic review of cost-effectiveness studies of novel oral anticoagulants for stroke prevention in non-valvular atrial fibrillation (AF). A systematic review of the literature was conducted by searching the PubMed, Embase, Scopus, Cochrane and Web of Knowledge databases to identify all cost-effectiveness studies of novel oral anticoagulants for stroke prevention in AF. The search identified 27 studies, 18 with dabigatran, three with apixaban, two with rivaroxaban and four with at least two of these drugs. The incremental cost-effectiveness ratios were 30 405 ± 16 101 euros per quality-adjusted life-year (QALY) for dabigatran 110 mg, 17 566 ± 16 902 euros/QALY for dabigatran 150 mg, 8102 ± 3252 euros/QALY for age-adjusted dabigatran, 11 897 ± 3341 euros/QALY for apixaban and 17 960 ± 12 005 euros/QALY for rivaroxaban. The present systematic review demonstrates that novel oral anticoagulants are cost-effective for stroke prevention in AF. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  2. Cost Analyses of Measures to Improve Residential Energy Ratings to 6 Stars - Playford North Development, South Australia

    Directory of Open Access Journals (Sweden)

    Timothy O'Leary

    2010-07-01

    Full Text Available  This paper reports the results of a study on the cost implications of achieving greater energy efficiency as measured by House Energy Rating(HER ‘stars’ for new housing on a greenfield development in the northern suburbs of Adelaide. Twelve house designs typical of the housing options available from a number of builders engaged with this development were modeled using the 2nd generation Building Code of Australia (BCA accredited energy rating assessment tool AccuRate. Where the model predicted a rating below the minimum rating (6 star proposed under the recently agreed Commonwealth of Australia, National Energy Efficiency strategy, the designs were modified in order to improve the rating to 6 stars using a combination of specification changes and energy efficient technology options. These changes or options were then priced at prevailing building suppliers and subcontractors retail cost levels in order that an average ‘extra cost to 6 star’ and range of indicative costs to achieve 6 star housing compliance could be articulated. The results revealed that standard and currently available technologies, such a reflective foil barriers, increased insulation and low emissivity ‘e’ type glazing provide a means to achieving 6 star ratings at a modest additional cost, i.e. 1-2% of total construction and development costs.

  3. Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost-effectiveness and value of information analyses.

    Science.gov (United States)

    Stevenson, M D; Scope, A; Sutcliffe, P A; Booth, A; Slade, P; Parry, G; Saxon, D; Kalthenthaler, E

    2010-09-01

    . These were tested using univariate sensitivity analyses. Supplementary analyses that fitted distributions to the cost of treatment and the duration of comparative advantage reported a cost per QALY of 36,062 pounds (95% CI 20,464 to 59,262 pounds). The cost per QALY ratio for group CBT in PND was uncertain because of gaps in the evidence base. There was little quantitative or qualitative RCT evidence to assess the effectiveness of group CBT for PND. The evidence that was available was of low quality in the main because of poor reporting of the results. Furthermore, little information was reported on concurrent treatment used in the studies, which was controlled for in only two of the studies. Evidence from the clinical effectiveness review provided inconsistent and low quality information on which to base any interpretations for service provision. Although three of the included studies provided some indication that group psycho-education incorporating CBT is effective compared with RPC, there is enough doubt in the quality of the study, the level of CBT implemented in the group programmes, and the applicability to a PND population to limit any interpretations significantly. It is also considered that the place of group CBT in a stepped care programme needs to be identified, as well as there being a need for a clearer referral process for group CBT.

  4. Pulmonary artery pressure-guided heart failure management: US cost-effectiveness analyses using the results of the CHAMPION clinical trial.

    Science.gov (United States)

    Martinson, Melissa; Bharmi, Rupinder; Dalal, Nirav; Abraham, William T; Adamson, Philip B

    2017-05-01

    Haemodynamic-guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study. An estimate of the cost-effectiveness of haemodynamic-guided HF management was made based on observations published in the randomized, prospective single-blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months). Markov modelling with Monte Carlo simulation was used to approximate comprehensive costs and quality-adjusted life years (QALYs) from a payer perspective. Unit costs were estimated using the Truven Health MarketScan database from April 2008 to March 2013. Over a 5-year horizon, patients in the Treatment group had average QALYs of 2.56 with a total cost of US$56 974; patients in the Control group had QALYs of 2.16 with a total cost of US$52 149. The incremental cost-effectiveness ratio (ICER) was US$12 262 per QALY. Using comprehensive cost modelling, including all anticipated costs of HF and non-HF hospitalizations, physician visits, prescription drugs, long-term care, and outpatient hospital visits over 5 years, the Treatment group had a total cost of US$212 004 and the Control group had a total cost of US$200 360. The ICER was US$29 593 per QALY. Standard economic modelling suggests that pulmonary artery pressure-guided management of HF using the CardioMEMS™ HF System is cost-effective from the US-payer perspective. This analysis provides the background for further modelling in specific country healthcare systems and cost structures. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

  5. Cost-effectiveness of insulin aspart versus human soluble insulin in type 2 diabetes in four European countries: subgroup analyses from the PREDICTIVE study.

    Science.gov (United States)

    Palmer, James L; Goodall, Gordon; Nielsen, Steffen; Kotchie, Robert W; Valentine, William J; Palmer, Andrew J; Roze, Stéphane

    2008-05-01

    To evaluate the long-term health economic outcomes associated with insulin aspart (IAsp) compared to human soluble insulin (HI) in type 2 diabetes patients on basal-bolus therapy in Sweden, Spain, Italy and Poland. A published computer simulation model of diabetes was used to predict life expectancy, quality-adjusted life expectancy and incidence of diabetes-related complications. Baseline cohort characteristics (age 61.6 years, duration of diabetes 13.2 years, 45.1% male, HbA(1c) 8.2%, BMI 29.8 kg/m(2)) and treatment effects were derived from the PREDICTIVE observational study. Country-specific complication costs were derived from published sources. The analyses were run over 35-year time horizons from third-party payer perspectives in Spain, Italy and Poland and from a societal perspective in Sweden. Future costs and clinical benefits were discounted at country-specific discount rates. Sensitivity analyses were performed. IAsp was associated with improvements in discounted life expectancy and quality-adjusted life expectancy, and a reduced incidence of most diabetes-related complications versus HI in all four settings. IAsp was associated with societal cost-savings in Sweden (SEK 2470), direct medical cost-savings in Sweden and Spain (SEK 8248 and euro 1382, respectively), but increased direct costs in Italy (euro 2235) and Poland (euro 743). IAsp was associated with improved quality-adjusted life expectancy in Sweden (0.077 QALYs), Spain (0.080 QALYs), Italy (0.120 QALYs) and Poland (0.003 QALYs). IAsp was dominant versus HI in both Sweden and Spain, would be considered cost-effective in Italy with an incremental cost-effectiveness ratio of euro 18,597 per QALY gained, but would not be considered cost-effective in Poland.

  6. The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review.

    Science.gov (United States)

    Wichmann, Anne B; Adang, Eddy Mm; Stalmeier, Peep Fm; Kristanti, Sinta; Van den Block, Lieve; Vernooij-Dassen, Myrra Jfj; Engels, Yvonne

    2017-04-01

    In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care. To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year's value for palliative care. The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped. A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years. Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied. The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to-in addition to the EQ-5D- make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.

  7. Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV infection: a general trend

    Directory of Open Access Journals (Sweden)

    Frédéric Gervais

    2017-03-01

    Full Text Available Abstract Background Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1 collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2 explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination. Methods A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies. Results A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness. Conclusions This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

  8. Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer.

    Directory of Open Access Journals (Sweden)

    Ester Vilaprinyo

    Full Text Available The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1 To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2 To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial, the starting ages (40, 45 and 50 years and the ending ages (69 and 74 years in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.

  9. Discharge and water-quality data for selected streams at low flow including some bottom-material analyses, and limnological study of six lakes, Westchester County, New York

    Science.gov (United States)

    Archer, Roger J.; Turk, John T.

    1977-01-01

    Water-quality data collected at sites on 33 Westchester County, N.Y., streams August 4 to 6, 1976 during low flow (80-percent or more duration) indicate that although the chemical characteristics of most streams met State standards for water-supply source waters, none met the coliform standard, and several failed to meet standards for organic nitrogen, pH, and dissolved oxygen. Chemical analyses of bottom materials indicated detectable concentrations of the insecticides chlordane, dieldrin, and DDT at most of the 17 stream sites sampled. Polychlorinated biphenyls(PCB's) were found in more than half the samples, and the lead concentration on one stream was significantly higher than at the other sites. The six lakes studied are similar in bedrock geology, climate, and algal types and numbers. Minor differences in the chemistry of the lakes is attributable to the presence or absence of marble (calcium carbonate) in the gneissic basins, septic loadings of soluble constituents, or runoff containing salt from winter road deicing. The lakes probably receive most of their water by direct runoff and groundwater seepage rather than from major streams. All six lakes can be classed as eutrophic on the basis of algal type and density, dissolved-oxygen distribution, and nitrogen and phosphorus concentrations. (Woodard-USGS)

  10. Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness

    DEFF Research Database (Denmark)

    Eskesen, T G; Wetterslev, M; Perner, A

    2016-01-01

    PURPOSE: Central venous pressure (CVP) has been shown to have poor predictive value for fluid responsiveness in critically ill patients. We aimed to re-evaluate this in a larger sample subgrouped by baseline CVP values. METHODS: In April 2015, we systematically searched and included all clinical...... studies evaluating the value of CVP in predicting fluid responsiveness. We contacted investigators for patient data sets. We subgrouped data as lower (12 mmHg) baseline CVP. RESULTS: We included 51 studies; in the majority, mean/median CVP values were...... the lower 95% CI crossed 0.50. We identified some positive and negative predictive value for fluid responsiveness for specific low and high values of CVP, respectively, but none of the predictive values were above 66% for any CVPs from 0 to 20 mmHg. There were less data on higher CVPs, in particular >15 mm...

  11. Prostate tumor alignment and continuous, real-time adaptive radiation therapy using electromagnetic fiducials: clinical and cost-utility analyses.

    Science.gov (United States)

    Quigley, Martin M; Mate, Timothy P; Sylvester, John E

    2009-01-01

    To evaluate the accuracy, utility, and cost effectiveness of a new electromagnetic patient positioning and continuous, real-time monitoring system, which uses permanently implanted resonant transponders in the target (Calypso 4D Localization System and Beacon transponders, Seattle, WA) to continuously monitor tumor location and movement during external beam radiation therapy of the prostate. This clinical trial studied 43 patients at 5 sites. All patients were implanted with 3 transponders each. In 41 patients, the system was used for initial alignment at each therapy session. Thirty-five patients had continuous monitoring during their radiation treatment. Over 1,000 alignment comparisons were made to a commercially available kV X-ray positioning system (BrainLAB ExacTrac, Munich, Germany). Using decision analysis and Markov processes, the outcomes of patients were simulated over a 5-year period and measured in terms of costs from a payer's perspective and quality-adjusted life years (QALYs). All patients had satisfactory transponder implantations for monitoring purposes. In over 75% of the treatment sessions, the correction to conventional positioning (laser and tattoos) directed by an electromagnetic patient positioning and monitoring system was greater than 5 mm. Ninety-seven percent (34/35) of the patients who underwent continuous monitoring had target motion that exceeded preset limits at some point during the course of their radiation therapy. Exceeding preset thresholds resulted in user intervention at least once during the therapy in 80% of the patients (28/35). Compared with localization using ultrasound, electronic portal imaging devices (EPID), or computed tomography (CT), localization with the electromagnetic patient positioning and monitoring system yielded superior gains in QALYs at comparable costs. Most patients positioned with conventional tattoos and lasers for prostate radiation therapy were found by use of the electromagnetic patient positioning

  12. Disease activity-guided dose optimisation of adalimumab and etanercept is a cost-effective strategy compared with non-tapering tight control rheumatoid arthritis care: analyses of the DRESS study.

    Science.gov (United States)

    Kievit, Wietske; van Herwaarden, Noortje; van den Hoogen, Frank Hj; van Vollenhoven, Ronald F; Bijlsma, Johannes Wj; van den Bemt, Bart Jf; van der Maas, Aatke; den Broeder, Alfons A

    2016-11-01

    A disease activity-guided dose optimisation strategy of adalimumab or etanercept (TNFi (tumour necrosis factor inhibitors)) has shown to be non-inferior in maintaining disease control in patients with rheumatoid arthritis (RA) compared with usual care. However, the cost-effectiveness of this strategy is still unknown. This is a preplanned cost-effectiveness analysis of the Dose REduction Strategy of Subcutaneous TNF inhibitors (DRESS) study, a randomised controlled, open-label, non-inferiority trial performed in two Dutch rheumatology outpatient clinics. Patients with low disease activity using TNF inhibitors were included. Total healthcare costs were measured and quality adjusted life years (QALY) were based on EQ5D utility scores. Decremental cost-effectiveness analyses were performed using bootstrap analyses; incremental net monetary benefit (iNMB) was used to express cost-effectiveness. 180 patients were included, and 121 were allocated to the dose optimisation strategy and 59 to control. The dose optimisation strategy resulted in a mean cost saving of -€12 280 (95 percentile -€10 502; -€14 104) per patient per 18 months. There is an 84% chance that the dose optimisation strategy results in a QALY loss with a mean QALY loss of -0.02 (-0.07 to 0.02). The decremental cost-effectiveness ratio (DCER) was €390 493 (€5 085 184; dominant) of savings per QALY lost. The mean iNMB was €10 467 (€6553-€14 037). Sensitivity analyses using 30% and 50% lower prices for TNFi remained cost-effective. Disease activity-guided dose optimisation of TNFi results in considerable cost savings while no relevant loss of quality of life was observed. When the minimal QALY loss is compensated with the upper limit of what society is willing to pay or accept in the Netherlands, the net savings are still high. NTR3216; Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  13. Five-year examination of utilization and drug cost outcomes associated with benefit design changes including reference pricing for proton pump inhibitors in a state employee health plan.

    Science.gov (United States)

    Johnson, Jill T; Neill, Kathryn K; Davis, Dwight A

    2011-04-01

    The Arkansas State Employee Benefits Division (EBD) is a self-insured program comprising public school and other state employees, their spouses, and dependents. Previous research published in JMCP (2006) showed drug cost savings of $2.20 per member per month (PMPM; 37.6%) or annualized savings of $3.4 million associated with a benefit design change and coverage of the proton pump inhibitor (PPI) omeprazole over-the-counter (OTC) beginning in March 2004. On May 1, 2005, brand esomeprazole was excluded from coverage, with current users grandfathered for 4 months until September 2005. Reference pricing for PPIs, including esomeprazole but excluding generic omeprazole, was implemented on September 1, 2005, and the beneficiary cost share for all PPIs except generic omeprazole was determined from comparison of the PPI actual price to the $0.90 omeprazole OTC reference price per unit. To examine PPI utilization and drug costs before and after (a) excluding esomeprazole from coverage (with grandfathering current users) and (b) implementing a therapeutic maximum allowable cost (TMAC), or reference-pricing benefit design, for the PPI class in a large state employee health plan with fairly stable enrollment of approximately 127,500 members in 2005 through 2008 and approximately 128,000 members in 2009 Q1. The pharmacy claims database for the EBD was used to examine utilization and cost data for PPIs in a longitudinal analysis for the 61-month period from March 1, 2004, through March 31, 2009. Pharmacy claims data were compared for the period 14 months prior to esomeprazole exclusion (preperiod), 4 months during the esomeprazole exclusion (postperiod 1), and the ensuing 43 months of PPI reference pricing (postperiod 2). PPI cost and utilization data for the intervention group of approximately 127,500 beneficiaries were compared with a group of 122 self-insured employers with a total of nearly 1 million beneficiaries whose pharmacy benefits did not include reference pricing for

  14. Clinical benefit, complication patterns and cost effectiveness of laser in situ keratomileusis (LASIK) in moderate myopia: results of independent meta analyses on clinical outcome and postoperative complication profiles.

    Science.gov (United States)

    Lamparter, J; Dick, H B; Krummenauer, Frank

    2005-09-12

    Laser in situ keratomileusis (LASIK) means a patient investment of 2426 Euro per eye, which usually cannot be funded by European health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of LASIK could become an important indication of allocation decisions. Therefore an evidence based estimation of its incremental cost effectiveness was intended. Three independent meta analyses were implemented to estimate the refractive gain (dpt) due to conventional LASIK procedures as well as the predictability of the latter (%) (fraction of eyes achieving a postoperative refraction with maximum deviation of +/- 0.5 dpt from the target refraction). Study reports of 1995 - 2004 (English or German language) were screened for appropriate key words. Meta effects in refractive gain and predictability were estimated by means and standard deviations of reported effect measures. Cost data were estimated by German DRG rates and individual clinical pathway calculations; cost effectiveness was then computed in terms of the incremental cost effectiveness ratio (ICER) for both clinical benefit endpoints. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effects' 95% confidence intervals. Total direct costs from the patients' perspective were estimated at 2426 Euro per eye, associated with a refractive meta benefit of 5.93 dpt (95% meta confidence interval 5.32 - 6.54 dpt) and a meta predictability of 67% (43% - 91%). In terms of incremental costs, the unilateral LASIK implied a patient investion of 409 Euro (sensitivity range 351 - 473 Euro) per gained refractive unit or 36 Euro (27 - 56 Euro) per gained percentage point in predictability. When LASIK associated complication patterns were considered, the total direct costs amounted up to 3075 Euro, resulting in incremental costs of 519 Euro / dpt (sensitivity range 445 - 600 Euro / dpt) or 46 Euro / % (34 - 72 Euro / %). Most frequently

  15. [Clinical and cost effectiveness of rehabilitation programs including physical exercises for patients with ischemic heart disease under conditions of resort and outpatient clinics].

    Science.gov (United States)

    Shikhova, E V; Guliaeva, S F; Tsarev, Iu K; Chervotkina, L A

    2010-01-01

    The objective of the present study was to evaluate clinical and cost effectiveness of rehabilitation programs including long-term physical training of moderate intensity intended for the management of patients with coronary heart disease (CHD) who had undergone acute coronary events; the programs were adapted to the treatment under conditions of spa resorts, dispensaries, and outpatient clinics. It was shown that rehabilitation of patients presenting with CDH with the use of moderately intensive physical exercises during a long period enhances the effectiveness of application of the available funds due to improved clinical course of coronary heart disease, tolerance of physical load, and quality of life.

  16. Are decisions using cost-utility analyses robust to choice of SF-36/SF-12 preference-based algorithm?

    Directory of Open Access Journals (Sweden)

    Walton Surrey M

    2005-03-01

    Full Text Available Abstract Background Cost utility analysis (CUA using SF-36/SF-12 data has been facilitated by the development of several preference-based algorithms. The purpose of this study was to illustrate how decision-making could be affected by the choice of preference-based algorithms for the SF-36 and SF-12, and provide some guidance on selecting an appropriate algorithm. Methods Two sets of data were used: (1 a clinical trial of adult asthma patients; and (2 a longitudinal study of post-stroke patients. Incremental costs were assumed to be $2000 per year over standard treatment, and QALY gains realized over a 1-year period. Ten published algorithms were identified, denoted by first author: Brazier (SF-36, Brazier (SF-12, Shmueli, Fryback, Lundberg, Nichol, Franks (3 algorithms, and Lawrence. Incremental cost-utility ratios (ICURs for each algorithm, stated in dollars per quality-adjusted life year ($/QALY, were ranked and compared between datasets. Results In the asthma patients, estimated ICURs ranged from Lawrence's SF-12 algorithm at $30,769/QALY (95% CI: 26,316 to 36,697 to Brazier's SF-36 algorithm at $63,492/QALY (95% CI: 48,780 to 83,333. ICURs for the stroke cohort varied slightly more dramatically. The MEPS-based algorithm by Franks et al. provided the lowest ICUR at $27,972/QALY (95% CI: 20,942 to 41,667. The Fryback and Shmueli algorithms provided ICURs that were greater than $50,000/QALY and did not have confidence intervals that overlapped with most of the other algorithms. The ICUR-based ranking of algorithms was strongly correlated between the asthma and stroke datasets (r = 0.60. Conclusion SF-36/SF-12 preference-based algorithms produced a wide range of ICURs that could potentially lead to different reimbursement decisions. Brazier's SF-36 and SF-12 algorithms have a strong methodological and theoretical basis and tended to generate relatively higher ICUR estimates, considerations that support a preference for these algorithms over the

  17. Building Maintenance and Repair Data for Life-Cycle Cost Analyses: Heating, Ventilating, and Air Conditioning (HVAC) Systems

    Science.gov (United States)

    1991-05-01

    labeled "Present Worth of All 25-Year Maint,.nance and Repair Costs," ,ere developed by multipl)ing the resources in Table 2 by the 7 or 10 percent...00 m 30 c 000 CD OMOO CC m *~ O mO co 0 c~ m n 0mc c. co 0 m00mm o mo cU m m Dm M .N.Q mcn, In N m g -t C𔄃’ m’ g. 0 .0 .O 0 c gmO mOo gg 2 0 ! NOO O...9JJ CLUCLCU UUIJLL w-- U ~ U .. u., U CUJ.l UUUILII uC. x.0* gMO MW a-- . C CA4"= ""r O- lw *-*-*-fl . . EMCCJU M"- 0 n .... .... .... .... .2 .. fl== W

  18. Cost tradeoffs in consequence management at nuclear power plants: A risk based approach to setting optimal long-term interdiction limits for regulatory analyses

    International Nuclear Information System (INIS)

    Mubayi, V.

    1995-05-01

    The consequences of severe accidents at nuclear power plants can be limited by various protective actions, including emergency responses and long-term measures, to reduce exposures of affected populations. Each of these protective actions involve costs to society. The costs of the long-term protective actions depend on the criterion adopted for the allowable level of long-term exposure. This criterion, called the ''long term interdiction limit,'' is expressed in terms of the projected dose to an individual over a certain time period from the long-term exposure pathways. The two measures of offsite consequences, latent cancers and costs, are inversely related and the choice of an interdiction limit is, in effect, a trade-off between these two measures. By monetizing the health effects (through ascribing a monetary value to life lost), the costs of the two consequence measures vary with the interdiction limit, the health effect costs increasing as the limit is relaxed and the protective action costs decreasing. The minimum of the total cost curve can be used to calculate an optimal long term interdiction limit. The calculation of such an optimal limit is presented for each of five US nuclear power plants which were analyzed for severe accident risk in the NUREG-1150 program by the Nuclear Regulatory Commission

  19. Technical meeting on lessons learned with respect to SAT implementation, including development of trainers and use of cost effective training methods

    International Nuclear Information System (INIS)

    2002-01-01

    The past years have brought some significant changes in the world energy market, where the nuclear power plants and utilities are operating. Part of NPPs is privatised now; the electricity markets are liberalized and become more and more international. Due to the increase of competition, the power production costs are now monitored more closely than before. The opening of electricity markets has led the nuclear power plants to be under the serious economic pressure with a demand for continuous cost reduction. All these require from NPPs to make their personnel training more cost-effective. In addition, based on modern technology, a great amount of new training tools, aids and technologies have been introduced during the last 2-3 years, these new opportunities can be quite useful for training cost optimization. On the basis of experience gained worldwide in the application of the systematic approach to training (SAT), SAT based training is now a broad integrated approach emphasizing not only technical knowledge and skills but also human factor related knowledge, skills and attitudes. In this way, all competency requirements for attaining and maintaining personnel competence and qualification can be met, thus promoting and strengthening quality culture and safety culture, which should be fostered throughout the initial and continuing training programmes. The subject of the present technical meeting was suggested by the members of the Technical Working Group on Training and Qualification of NPP Personnel (TWG-T and Q) and supported by a number of the IAEA meetings on NPP personnel training. The technical Meeting on 'Lessons Learned with Respect to SAT Implementation, Including Development of Trainers and Use of Cost Effective Training Methods' was organized by the IAEA in co-operation with the Tecnatom A.S. and was held from 21 to 24 October 2002 in San Sebastian de los Reyes/ Madrid, Spain. The main objective of the meeting was to provide an international forum for

  20. Impact on total population health and societal cost, and the implication on the actual cost-effectiveness of including tumour necrosis factor-α antagonists in management of ankylosing spondylitis: a dynamic population modelling study.

    Science.gov (United States)

    Tran-Duy, An; Boonen, Annelies; van de Laar, Mart A F J; Severens, Johan L

    2015-01-01

    Sequential treatment of ankylosing spondylitis (AS) that includes tumour necrosis factor-α antagonists (anti-TNF agents) has been applied in most of the Western countries. Existing cost-effectiveness (CE) models almost exclusively presented the incremental CE of anti-TNF agents using a closed cohort while budget impact studies are mainly lacking. Notwithstanding, information on impact on total population health and societal budget as well as on actual incremental CE for a given decision time span are important for decision makers. This study aimed at quantifying, for different decision time spans starting from January 1, 2014 in the Dutch society, (1) impact of sequential drug treatment strategies without and with inclusion of anti-TNF agents (Strategies 1 and 2, respectively) on total population health and societal cost, and (2) the actual incremental CE of Strategy 2 compared to Strategy 1. Dynamic population modelling was used to capture total population health and cost, and the actual incremental CE. Distinguishing the prevalent AS population on January 1, 2014 and the incident AS cohorts in the subsequent 20 years, the model tracked individually an actual number of AS patients until death or end of the simulation time. During the simulation, data on patient characteristics, history of drug use, costs and health at discrete time points were generated. In Strategy 1, five nonsteroidal anti-inflammatory drugs (NSAIDs) were available but anti-TNF agents withdrawn. In Strategy 2, five NSAIDs and two anti-TNF agents continued to be available. The predicted size of the prevalent AS population in the Dutch society varied within the range of 67,145-69,957 with 44-46 % of the patients receiving anti-TNF agents over the period 2014-2034. The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54-205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58-31.21 million Euros) and in annual costs of

  1. Bounding the marginal cost of producing potable water including the use of seawater desalinization as a backstop potable water production technology

    Energy Technology Data Exchange (ETDEWEB)

    Dooley, James J.

    2014-04-01

    The analysis presented in this technical report should allow for the creation of high, medium, and low cost potable water prices for GCAM. Seawater reverse osmosis (SWRO) based desalinization should act as a backstop for the cost of producing potable water (i.e., the literature seems clear that SWRO should establish an upper bound for the plant gate cost of producing potable water). Transporting water over significant distances and having to lift water to higher elevations to reach end-users can also have a significant impact on the cost of producing water. The three potable fresh water scenarios describe in this technical report are: low cost water scenario ($0.10/m3); medium water cost scenario ($1.00/m3); and high water cost scenario ($2.50/m3).

  2. Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-03-01

    Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

  3. Cost and quality effectiveness of objective-based and statistically-based quality control for volatile organic compounds analyses of gases

    International Nuclear Information System (INIS)

    Bennett, J.T.; Crowder, C.A.; Connolly, M.J.

    1994-01-01

    Gas samples from drums of radioactive waste at the Department of Energy (DOE) Idaho National Engineering Laboratory are being characterized for 29 volatile organic compounds to determine the feasibility of storing the waste in DOE's Waste Isolation Pilot Plant (WIPP) in Carlsbad, New Mexico. Quality requirements for the gas chromatography (GC) and GC/mass spectrometry chemical methods used to analyze the waste are specified in the Quality Assurance Program Plan for the WIPP Experimental Waste Characterization Program. Quality requirements consist of both objective criteria (data quality objectives, DQOs) and statistical criteria (process control). The DQOs apply to routine sample analyses, while the statistical criteria serve to determine and monitor precision and accuracy (P ampersand A) of the analysis methods and are also used to assign upper confidence limits to measurement results close to action levels. After over two years and more than 1000 sample analyses there are two general conclusions concerning the two approaches to quality control: (1) Objective criteria (e.g., ± 25% precision, ± 30% accuracy) based on customer needs and the usually prescribed criteria for similar EPA- approved methods are consistently attained during routine analyses. (2) Statistical criteria based on short term method performance are almost an order of magnitude more stringent than objective criteria and are difficult to satisfy following the same routine laboratory procedures which satisfy the objective criteria. A more cost effective and representative approach to establishing statistical method performances criteria would be either to utilize a moving average of P ampersand A from control samples over a several month time period or to determine within a sample variation by one-way analysis of variance of several months replicate sample analysis results or both. Confidence intervals for results near action levels could also be determined by replicate analysis of the sample in

  4. NATO Independent Cost Estimating and the Role of Life Cycle Cost Analysis in Managing the Defence Enterprise (Estimation independante des couts de l’OTAN et role de l’analyse des couts globaux de possesssion au sen de l’OTAN)

    Science.gov (United States)

    2012-08-01

    system O&S costs. VA- MOSC provides the direct O&S costs of weapon systems, some linked indirect costs (e.g., ship depot overhead), and related non...Rotterdam and Johann de Witt were selected and their data pulled from VA- MOSC . • The work breakdown structures (WBS) for each element were analysed so

  5. Landscape features influence gene flow as measured by cost-distance and genetic analyses: a case study for giant pandas in the Daxiangling and Xiaoxiangling Mountains

    Directory of Open Access Journals (Sweden)

    Wei Fuwen

    2010-07-01

    Full Text Available Abstract Background Gene flow maintains genetic diversity within a species and is influenced by individual behavior and the geographical features of the species' habitat. Here, we have characterized the geographical distribution of genetic patterns in giant pandas (Ailuropoda melanoleuca living in four isolated patches of the Xiaoxiangling and Daxiangling Mountains. Three geographic distance definitions were used with the "isolation by distance theory": Euclidean distance (EUD, least-cost path distance (LCD defined by food resources, and LCD defined by habitat suitability. Results A total of 136 genotypes were obtained from 192 fecal samples and one blood sample, corresponding to 53 unique genotypes. Geographical maps plotted at high resolution using smaller neighborhood radius definitions produced large cost distances, because smaller radii include a finer level of detail in considering each pixel. Mantel tests showed that most correlation indices, particularly bamboo resources defined for different sizes of raster cell, were slightly larger than the correlations calculated for the Euclidean distance, with the exception of Patch C. We found that natural barriers might have decreased gene flow between the Xiaoxiangling and Daxiangling regions. Conclusions Landscape features were found to partially influence gene flow in the giant panda population. This result is closely linked to the biological character and behavior of giant pandas because, as bamboo feeders, individuals spend most of their lives eating bamboo or moving within the bamboo forest. Landscape-based genetic analysis suggests that gene flow will be enhanced if the connectivity between currently fragmented bamboo forests is increased.

  6. Landscape features influence gene flow as measured by cost-distance and genetic analyses: a case study for giant pandas in the Daxiangling and Xiaoxiangling Mountains.

    Science.gov (United States)

    Zhu, Lifeng; Zhan, Xiangjiang; Meng, Tao; Zhang, Shanning; Wei, Fuwen

    2010-07-23

    Gene flow maintains genetic diversity within a species and is influenced by individual behavior and the geographical features of the species' habitat. Here, we have characterized the geographical distribution of genetic patterns in giant pandas (Ailuropoda melanoleuca) living in four isolated patches of the Xiaoxiangling and Daxiangling Mountains. Three geographic distance definitions were used with the "isolation by distance theory": Euclidean distance (EUD), least-cost path distance (LCD) defined by food resources, and LCD defined by habitat suitability. A total of 136 genotypes were obtained from 192 fecal samples and one blood sample, corresponding to 53 unique genotypes. Geographical maps plotted at high resolution using smaller neighborhood radius definitions produced large cost distances, because smaller radii include a finer level of detail in considering each pixel. Mantel tests showed that most correlation indices, particularly bamboo resources defined for different sizes of raster cell, were slightly larger than the correlations calculated for the Euclidean distance, with the exception of Patch C. We found that natural barriers might have decreased gene flow between the Xiaoxiangling and Daxiangling regions. Landscape features were found to partially influence gene flow in the giant panda population. This result is closely linked to the biological character and behavior of giant pandas because, as bamboo feeders, individuals spend most of their lives eating bamboo or moving within the bamboo forest. Landscape-based genetic analysis suggests that gene flow will be enhanced if the connectivity between currently fragmented bamboo forests is increased.

  7. Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program

    Science.gov (United States)

    2014-01-01

    Background Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys’ vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys. Methods A Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation). Results At an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000). Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs – only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost

  8. Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program.

    Science.gov (United States)

    Pearson, Amber L; Kvizhinadze, Giorgi; Wilson, Nick; Smith, Megan; Canfell, Karen; Blakely, Tony

    2014-06-26

    Similar to many developed countries, vaccination against human papillomavirus (HPV) is provided only to girls in New Zealand and coverage is relatively low (47% in school-aged girls for dose 3). Some jurisdictions have already extended HPV vaccination to school-aged boys. Thus, exploration of the cost-utility of adding boys' vaccination is relevant. We modeled the incremental health gain and costs for extending the current girls-only program to boys, intensifying the current girls-only program to achieve 73% coverage, and extension of the intensive program to boys. A Markov macro-simulation model, which accounted for herd immunity, was developed for an annual cohort of 12-year-olds in 2011 and included the future health states of: cervical cancer, pre-cancer (CIN I to III), genital warts, and three other HPV-related cancers. In each state, health sector costs, including additional health costs from extra life, and quality-adjusted life-years (QALYs) were accumulated. The model included New Zealand data on cancer incidence and survival, and other cause mortality (all by sex, age, ethnicity and deprivation). At an assumed local willingness-to-pay threshold of US$29,600, vaccination of 12-year-old boys to achieve the current coverage for girls would not be cost-effective, at US$61,400/QALY gained (95% UI $29,700 to $112,000; OECD purchasing power parities) compared to the current girls-only program, with an assumed vaccine cost of US$59 (NZ$113). This was dominated though by the intensified girls-only program; US$17,400/QALY gained (95% UI: dominant to $46,100). Adding boys to this intensified program was also not cost-effective; US$128,000/QALY gained, 95% UI: $61,900 to $247,000).Vaccination of boys was not found to be cost-effective, even for additional scenarios with very low vaccine or program administration costs - only when combined vaccine and administration costs were NZ$125 or lower per dose was vaccination of boys cost-effective. These results suggest that

  9. Environmental externalities: Applying the concept to Asian coal-based power generation. [Includes external environmental and societal costs and methods of evaluating them

    Energy Technology Data Exchange (ETDEWEB)

    Szpunar, C.B.; Gillette, J.L.

    1993-03-01

    This report examines the concept of environmental externality. It discusses various factors -- the atmospheric transformations, relationship of point-source emissions to ambient air quality, dose-response relationships, applicable cause-and-effect principles, and risk and valuation research -- that are considered by a number of state utilities when they apply the environmental externality concept to energy resource planning. It describes a methodology developed by Argonne National Laboratory for general use in resource planning, in combination with traditional methods that consider the cost of electricity production. Finally, it shows how the methodology can be applied in Indonesia, Thailand, and Taiwan to potential coal-fired power plant projects that will make use of clean coal technologies.

  10. Cost-effective and rapid lysis of Saccharomyces cerevisiae cells for quantitative western blot analysis of proteins, including phosphorylated eIF2α.

    Science.gov (United States)

    Lee, Su Jung; Ramesh, Rashmi; de Boor, Valerie; Gebler, Jan M; Silva, Richard C; Sattlegger, Evelyn

    2017-09-01

    The common method for liberating proteins from Saccharomyces cerevisiae cells involves mechanical cell disruption using glass beads and buffer containing inhibitors (protease, phosphatase and/or kinase inhibitors), followed by centrifugation to remove cell debris. This procedure requires the use of costly inhibitors and is laborious, in particular when many samples need to be processed. Also, enzymatic reactions can still occur during harvesting and cell breakage. As a result low-abundance and labile proteins may be degraded, and enzymes such as kinases and phosphatases may still modify proteins during and after cell lysis. We believe that our rapid sample preparation method helps overcome the above issues and offers the following advantages: (a) it is cost-effective, as no inhibitors and breaking buffer are needed; (b) cell breakage is fast (about 15 min) since it only involves a few steps; (c) the use of formaldehyde inactivates endogenous proteases prior to cell lysis, dramatically reducing the risk of protein degradation; (d) centrifugation steps only occur prior to cell lysis, circumventing the problem of losing protein complexes, in particular if cells were treated with formaldehyde intended to stabilize and capture large protein complexes; and (e) since formaldehyde has the potential to instantly terminate protein activity, this method also allows the study of enzymes in live cells, i.e. in their true physiological environment, such as the short-term effect of a drug on enzyme activity. Taken together, the rapid sample preparation procedure provides a more accurate snapshot of the cell's protein content at the time of harvesting. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Renewable vs. fossil electricity systems. A cost comparison. Power world 2050. Analysis of renewable, coal and gas-based electricity systems; Erneuerbare vs. fossile Stromsysteme. Ein Kostenvergleich. Stromwelten 2050. Analyse von Erneuerbaren, kohle- und gasbasierten Elektrizitaetssystemen

    Energy Technology Data Exchange (ETDEWEB)

    Graichen, Patrick; Kleiner, Mara Martha [Agora Energiewende, Berlin (Germany); Matthes, Felix Christian; Heinemann, Christoph [Oeko-Institut e.V. - Institut fuer Angewandte Oekologie, Berlin (Germany)

    2017-01-15

    The decarbonisation of the energy and, above all, the power system is the core component of any consistent climate protection strategy. For the electricity sector, this means, in the final analysis, the transition from a power supply based on lignite, hard coal, natural gas and other fossil fuels to one (almost) completely based on renewable energies by 2050. The fundamental technical feasibility of such a system, more than 90 percent of which would generate electricity from renewable energies, is no longer disputable today. The explanation for this is the partly rapid technological advances made in recent years, particularly those involving wind (on- and offshore) and solar energy, as well as the foreseeable further developments of central flexibility options (including flexible demand, battery storage and power-to-gas technologies). However, the question of the costs of this new electricity system has not yet been fully resolved. These cost calculations need to take into account, on the one hand, the total costs of an electricity system based on renewable energies and, on the other hand, the comparison to a power system that remains based on fossil fuels. Against this background, the present study provides a numerical analysis of the following questions: What are the technical and cost structures for a power system when 90 percent or more of the electricity is generated from renewable energies in 2050? How do the costs for different storage strategies (batteries vs. power-to-gas) differ? What technical, cost and emission structures result for a hypothetical fossil-based power system in 2050 if the further construction of electricity production plants based on wind and solar energy is immediately abandoned? How do the costs for various fossil-based power systems differ (conventional mix of lignite/hard coal/natural gas power plants vs. an electricity system based purely on natural gas)? For this purpose, a large number of model calculations with different

  12. Emission and costs up to and including 2030 for the current environmental policy. Background information for the National Environmental Outlook 5

    International Nuclear Information System (INIS)

    Van Wee, G.P.; Kuijpers-Linde, M.A.J.; Van Gerwen, O.J.

    2001-03-01

    Every four years the Dutch National Institute of Public Health and the Environment (RIVM) publishes an Environmental Outlook in preparation for the National Environmental Policy Plan (NEPP). The fifth National Environmental Outlook (NEOS) describes developments in the quality of the environment in the Netherlands for 2000-2030 against a background of developments on the European and global scales. The two macro-economic scenarios of the Netherlands Bureau for Economic and Policy Analysis (CPB) used are the European Coordination (EC) scenario and the Global Competition scenario (GC). Consequences for public health, nature and the human physical environment are also indicated. 'Fixed policy' scenarios are used in the Environmental Outlook for the Netherlands. In 'fixed policy' scenarios it is assumed that all policy measures agreed on by the year 2000 will be implemented, but no new measures taken. In this way the Outlook offers baseline scenarios that can be compared with targets and objectives to facilitate the development of new policy. The Fifth National Environmental Outlook was realised with the assistance of many other Dutch research institutes. This background document to NEOS presents estimated levels of energy use, emissions and costs of environmental measures for the 1995-2020 period. The main conclusions are: The environmental problems most difficult to tackle are climate change and noise nuisance. These problems are highly related to energy use and transportation; The policy as presented in the 'Uitvoeringsnota Klimaatbeleid', a document describing the Dutch Kyoto-related climate policy, results in a reduction of greenhouse gases of 15 Mton CO2 equivalents (GS scenario) with respect to the pre-Kyoto policy in 2010. To meet the Kyoto agreements a further reduction of approximately 45 Mton CO2 equivalents is needed. If policies in the 'Uitvoeringsnota Klimaatbeleid' are further instrumentalised and made concrete, an extra reduction of 10 Mton is possible

  13. A Tutorial for Analysing the Cost-effectiveness of Alternative Methods for Assessing Chemical Toxicology: The Case of Acute Oral Toxicity Prediction

    NARCIS (Netherlands)

    Norlen, H.; Worth, A.P.; Gabbert, S.G.M.

    2014-01-01

    Compared with traditional animal methods for toxicity testing, in vitro and in silico methods are widely considered to permit a more cost-effective assessment of chemicals. However, how to assess the cost-effectiveness of alternative methods has remained unclear. This paper offers a user-oriented

  14. Cost Analyses after a single intervention using a computer application (DIAGETHER in the treatment of diabetic patients admitted to a third level hospital

    Directory of Open Access Journals (Sweden)

    César Carballo Cardona

    2018-01-01

    Full Text Available Goals: To quantify the savings that could be made by the hospital implementation of a computer application (DIAGETHER®, which advises the treatment of hyperglycemia of the diabetic patient in the emergency department when this patient is admitted to a third level hospital. Methods: A multicenter interventional study was designed, including patients in two arms, one in the conventional treatment prescribed by the physician and the other applied the treatment indicated by the computer application DIAGETHER®. The days of hospitalization were collected in the two arms of intervention. Results: A total of 183 patients were included, 86 received treatment with the computer application, and 97 received conventional treatment. The mean blood glucose level on the first day of admission in the GLIKAL group was 178.56 (59.53, compared to 212.93 (62.23 in the conventional group (p <0.001 and on the second day 173.86 (58.86 versus 196.37 (66.60 (p = 0.017. There was no difference in the frequency of hypoglycemia reported in each group (p = 0.555. A reduction in mean stay was observed in patients treated with DIAGETHER. The days of admission were 7 (2-39 days for the GLIKAL group and 10 (2-53 days for the PCH group (p <0.001. Conclusions: The annual savings that could be generated with the use of the computer tool (DIAGETHER®, with the volume of diabetic patients admitted to the hospital, could decrease hospitalization days by 26,147 (14,134 patients for 1.85 days of stay reduction, this would generate a saving of 8,811,842 million euros per year (cost of stay / day of the diabetic patient, for the savings days generated.

  15. Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong.

    Science.gov (United States)

    Li, X; Chan, N S; Tam, A W; Hung, I F N; Chan, E W

    2017-10-01

    The purpose of this investigation was to evaluate the budget impact and cost-effectiveness of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection in Hong Kong. A decision analytic model was developed to compare short-term costs and health outcomes of patients with chronic HCV genotype 1 infection in Hong Kong who were treated with an interferon (INF)-based treatment (dual therapy of pegylated interferon and ribavirin) or DAA-based treatments (sofosbuvir or ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir plus dasabuvir). Compared to INF-based treatment, DAA-based treatments yielded an incremental cost of $24,677-$31,171 per course while improving the rate of sustained virologic response (SVR) from 59-66% to 82.3-99.8%. The incremental cost-effective ratios of DAA-based treatments ranged from $9724 to $29,189 per treatment success, which were all below the cost-effectiveness threshold of local GDP per capita ($42,423 in 2015). Introducing DAAs resulted in a 126.1% ($383.7 million) budget increase on HCV infection management over 5 years. A 50% change in DAA medication costs reflected a change in the incremental budget from $55.2 to $712.3 million. DAA-based treatments are cost-effective alternatives to INF-based treatment in Hong Kong. Introducing DAAs to the public hospital formulary yields a considerable budget increase but is still economically favorable to the local government.

  16. A tutorial for analysing the cost-effectiveness of alternative methods for assessing chemical toxicity: the case of acute oral toxicity prediction.

    Science.gov (United States)

    Norlen, Hedvig; Worth, Andrew P; Gabbert, Silke

    2014-05-01

    Compared with traditional animal methods for toxicity testing, in vitro and in silico methods are widely considered to permit a more cost-effective assessment of chemicals. However, how to assess the cost-effectiveness of alternative methods has remained unclear. This paper offers a user-oriented tutorial for applying cost-effectiveness analysis (CEA) to alternative (non-animal) methods. The purpose is to illustrate how CEA facilitates the identification of the alternative method, or the combination of methods, that offers the highest information gain per unit of cost. We illustrate how information gains and costs of single methods and method combinations can be assessed. By using acute oral toxicity as an example, we apply CEA to a set of four in silico methods (ToxSuite, TOPKAT, TEST, ADMET Predictor), one in vitro method (the 3T3 Neutral Red Uptake cytotoxicity assay), and various combinations of these methods. Our results underline that in silico tools are more cost-effective than the in vitro test. Battery combinations of alternative methods, however, do not necessarily outperform single methods, because additional information gains from the battery are easily outweighed by additional costs. 2014 FRAME.

  17. A cost-effective fulfilment of Denmark's reduction commitments. Documentation of projection and analyses of the energy sector; En omkostningseffektiv opfyldelse af Danmarks reduktionsforpligtelse - dokumentation af fremskrivning og analyser pae energiomraedet

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-02-01

    This documentation report describes the projections and analyses that formed the basis of an interdepartmental report 'En omkostningseffektiv klimastrategi' prepared by the Danish Ministry of Finance, the Danish Ministry of the Environment, the Danish Ministry of Economics and Business Affairs and the Danish Ministry of Taxation. The report contains: Projections of fuel prices, emissions and estimations of additional environmental impacts; Documentation for projections of future greenhouse gas emissions in the energy field; Documentation of the analyses of undertakings in the energy field. (ba)

  18. Heavy-metal contamination of soils in Saxony/Germany by foundry fumes and low-cost rapid analyses of contaminated soils by XRF

    Science.gov (United States)

    Mucke, D.

    2012-04-01

    spectrometry (XRF) with a handheld instrument. Approx. 40 elements hereby are determined in a focussed X-ray spot of 3 mm of diameters. The device can be put directly on a section of the soil or measure loose substrata in a PVC bag through or in a cuvette. The measurement time is 30 seconds. In connection with the input of information, the relocating and the sample preparation 20 measurings can be carried out per hour. This leads at personnel expenditures of € 50/hour at a price of € 2.50/analysis of simultaneous 40 components. At requirement the transfer of the files from the instrument in Excel tables still would rise expenses. XRF is a fast low-cost method for the first assessment of the contamination of soils and the delimitation of areas of different contaminations. When exact laboratory analyses are still requested, the interesting areas from which bulk samples have to be taken for the laboratory examinations, with XRF can be fixed. The contamination with arsenic and toxic heavy metals is only subordinated by modern flue gas treatment in metallurgical plants and renunciation of thermal methods with hut smoke today. The whereabouts of arsenic and lead in the soil shows, though, that the soil has protected the groundwater against the contamination. GEOMONTAN has examined the Saxonian areas with radioactive fallout of the Chernobyl accident in the order of the BGR Hannover 1993. In the results of the analysis by BGR Cs-134 was already disintegrated and Cs-137 only 13 cm deep in the uppermost soil layers infiltrated during the 8 years after the accident. This means that soil protects groundwater against contaminations out of the air too. In the last years some German federal state governments decided the end of mine water winning for the public water supply and deregulated the water protection zones. The water supply was converted in water of water supply dams. The hazard of contamination of this open reservoirs by accidents or terrorism is increasing. Underground water

  19. Should vitamin B12 tablets be included in more Canadian drug formularies? An economic model of the cost-saving potential from increased utilisation of oral versus intramuscular vitamin B12 maintenance therapy for Alberta seniors.

    Science.gov (United States)

    Houle, Sherilyn K D; Kolber, Michael R; Chuck, Anderson W

    2014-05-02

    The aim of this study was to estimate the cost-savings attainable if all patients aged ≥65 years in Alberta, Canada, currently on intramuscular therapy were switched to oral therapy, from the perspective of a provincial ministry of health. Primary care setting in Alberta, Canada. Seniors of age 65 years and older currently receiving intramuscular vitamin B12 therapy. Oral vitamin B12 therapy at 1000 μg/day versus intramuscular therapy at 1000 μg/month. Cost saving from oral therapy over intramuscular therapy, from the perspective of the Alberta Ministry of Health, including drug costs, dispensing fees, injection administration fees, additional laboratory monitoring and physician visit fees. Over 5 years, if all Albertans aged 65 years and older who currently receive intramuscular B12 are switched to oral therapy, our model found that $C13 975 883 can be saved. Even if no additional physician visits are billed for among patients receiving intramuscular therapy, $C8 444 346 could be saved from reduced administration costs alone. Oral B12 therapy has been shown to be an effective therapeutic option for patients with vitamin B12 deficiency, yet only three provinces and the Non-Insured Health Benefits program include oral tablets on their formulary rather than the parenteral preparation. To ensure judicious use of limited health resources, clinicians and formulary committees are encouraged to adopt oral B12 therapy as a clinically and cost-effective first-line therapy for vitamin B12 deficiency.

  20. Peer Review of “LDT Weight Reduction Study with Crash Model, Feasibility and Detailed Cost Analyses – Chevrolet Silverado 1500 Pickup”

    Science.gov (United States)

    The contractor will conduct an independent peer review of FEV’s light-duty truck (LDT) mass safety study, “Light-Duty Vehicle Weight Reduction Study with Crash Model, Feasibility and Detailed Cost Analysis – Silverado 1500”, and its corresponding computer-aided engineering (CAE) ...

  1. Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Luitjes Susanne HE

    2010-09-01

    Full Text Available Abstract Background Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG has developed evidence-based guidelines on the management of hypertension in pregnancy and chronic hypertension. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in the different hospitals. An explanation is that the NVOG has no general strategy of practical implementation and evaluation of its guidelines. The development of an effective and cost effective implementation strategy to improve adherence to the guidelines on hypertension in pregnancy is needed. Methods/Design The objective of this study is to assess the cost effectiveness of an innovative implementation strategy of the NVOG guidelines on hypertension including a computerised decision support system (BOS compared to a common strategy of professional audit and feedback. A cluster randomised controlled trial with an economic evaluation alongside will be performed. Both pregnant women who develop severe hypertension or pre-eclampsia and professionals involved in the care for these women will participate. The main outcome measures are a combined rate of major maternal complications and process indicators extracted from the guidelines. A total of 472 patients will be included in both groups. For analysis, descriptive as well as regression techniques will be used. A cost effectiveness and cost utility analysis will be performed according to the intention-to-treat principle and from a societal perspective. Cost effectiveness ratios will be calculated using bootstrapping techniques.

  2. Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy.

    Science.gov (United States)

    Restelli, Umberto; Saibene, Gabriella; Nardulli, Patrizia; Di Turi, Roberta; Bonizzoni, Erminio; Scolari, Francesca; Perrone, Tania; Croce, Davide; Celio, Luigi

    2017-08-01

    To evaluate the efficiency of resources allocation and sustainability of the use of netupitant+palonosetron (NEPA) for chemotherapy-induced nausea and vomiting (CINV) prophylaxis assuming the Italian National Health Service (NHS) perspective. A published Markov model was adapted to assess the incremental cost-utility ratio of NEPA compared with aprepitant (APR) + palonosetron (PALO), fosaprepitant (fAPR) + PALO, APR + ondansetron (ONDA), fAPR + ONDA in patients receiving a highly emetogenic chemotherapy (HEC) and with APR + PALO and fAPR + PALO in patients receiving a moderately emetogenic chemotherapy (MEC). Oncology hospital department in Italy. A Markov model was used to determine the impact of NEPA on the budget of the Italian NHS on a 5-day time horizon, corresponding to the acute and delayed CINV prophylaxis phases. Direct medical costs considered were related to antiemetic drugs, adverse events management, CINV episodes management. Clinical and quality of life data referred to previously published works. The budget impact analysis considered the aforementioned therapies plus PALO alone (for HEC and MEC) on a 5-year time horizon, comparing two scenarios: one considering the use of NEPA and one not considering its use. Incremental cost per quality adjusted life year (QALY) and differential economic impact for the Italian NHS between the two scenarios considered. NEPA is more effective and less expensive (dominant) compared with APR + PALO (for HEC and MEC), fAPR + PALO (for HEC and MEC), APR + ONDA (for HEC), fAPR + ONDA (for HEC). The use of NEPA would lead to a 5-year cost decrease of €63.7 million (€42.7 million for HEC and €20.9 million for MEC). NEPA allows an efficient allocation of resources for the Italian NHS and it is sustainable, leading to a cost decrease compared with a scenario which does not consider its use. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  3. Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan.

    Science.gov (United States)

    Waning, Brenda; Maddix, Jason; Soucy, Lyne

    2010-07-13

    Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007). Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with ups. Medicine mark-ups needed for sustainability were greater than originally envisioned by network administration. In 2005, 55%, 35%, and 10% of the network's top 50 products revealed mark-ups of 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of ups > 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy

  4. Cost accounting in ECN

    International Nuclear Information System (INIS)

    Wout, E.L.; Bever Donker, J.M. van.

    1979-01-01

    A five year planning is made in which the available money is distributed to the expected programmes. This five year plan is used as basis for working plan and budget for the next year. In the working plan all financial means are divided into kinds of costs, cost centres and cost units. Based on this working plan and the relevant budgets the tariffs are calculated per working centre (cost centre). The tariffs are fixed for a whole year. Up till now these tariffs are also basis for the cost unit accounting at the end of the year together with the results of the time registration. The estimated work shop services for the working centres are included in the tariffs. For the allocation of overhead costs ECN uses dynamic keys. Depreciation costs with respect to instruments, investments etc. are determined per working centre according to a computer programme. The cost unit related costs are charged directly to cost unit. This implies that project related in instruments are looked upon as running costs. In the future we will try to refine the present cost accounting system still further in this way that we will look upon a cost centre as a profit centre. Furthermore we will try to analyse the tariff and calculation deviations and under/over occupation deviations afterwards (post calculation). The information provided to the management knows a hierachic construction: project information to projectleader, programme (compound projects) information to programme coordinator, cost centre summary to department heads, attention area (compound programme) information to programme coordinator and managing director, ECN research (compound attention areas) information to general management, information re kind of costs to relevant persons, f.e. surveys of expenditure for part time personnel to personnel bureau. The information is provided by the department of Finance and Administrative Organisation. The entire scope of cost accounting is the responsibility of the head of the department

  5. Evaluation of a low-cost procedure for sampling, long-term storage, and extraction of RNA from blood for qPCR analyses

    DEFF Research Database (Denmark)

    Mærkedahl, Rasmus Baadsgaard; Frøkiær, Hanne; Lauritzen, Lotte

    2015-01-01

    -extraction. We investigated the use of lysis buffer for long-term storage of blood samples for qPCR analysis. Methods: Blood was collected from 13 healthy adults and diluted in MagMAX lysis/binding solution or PAXgene Blood RNA tubes and stored at -20 °C for 0, 1, or 4 months before RNA extraction....../binding solution over time and between samples stored and extracted by the two systems. Conclusions: The MagMAX system can be used for storage of human blood for up to 4 months and is equivalent to the PAXgene system for RNA extraction. It furthermore, provides a means for significant cost reduction in large......Abstract Background: In large clinical trials, where RNA cannot be extracted immediately after sampling, preserving RNA in whole blood is a crucial initial step in obtaining robust qPCR data. The current golden standard for RNA preservation is costly and designed for time-consuming column-based RNA...

  6. Search and switching costs

    NARCIS (Netherlands)

    Siekman, Wilhelm Henricus

    2016-01-01

    This thesis analyses markets with search and with switching costs. It provides insights in several important issues in search markets, including how loss aversion may affect consumer behavior and firm conduct, and how prices, welfare, and profits may change when an intermediating platform orders

  7. A conceptual framework for formulating a focused and cost-effective fire protection program based on analyses of risk and the dynamics of fire effects

    International Nuclear Information System (INIS)

    Dey, M.K.

    1999-01-01

    This paper proposes a conceptual framework for developing a fire protection program at nuclear power plants based on probabilistic risk analysis (PRA) of fire hazards, and modeling the dynamics of fire effects. The process for categorizing nuclear power plant fire areas based on risk is described, followed by a discussion of fire safety design methods that can be used for different areas of the plant, depending on the degree of threat to plant safety from the fire hazard. This alternative framework has the potential to make programs more cost-effective, and comprehensive, since it will allow a more systematic and broader examination of fire risk, and provide a means to distinguish between high and low risk fire contributors. (orig.)

  8. Operating cost analysis of anaesthesia: Activity based costing (ABC analysis

    Directory of Open Access Journals (Sweden)

    Majstorović Branislava M.

    2011-01-01

    Full Text Available Introduction. Cost of anaesthesiology represent defined measures to determine a precise profile of expenditure estimation of surgical treatment, which is important regarding planning of healthcare activities, prices and budget. Objective. In order to determine the actual value of anaestesiological services, we started with the analysis of activity based costing (ABC analysis. Methods. Retrospectively, in 2005 and 2006, we estimated the direct costs of anestesiological services (salaries, drugs, supplying materials and other: analyses and equipment. of the Institute of Anaesthesia and Resuscitation of the Clinical Centre of Serbia. The group included all anesthetized patients of both sexes and all ages. We compared direct costs with direct expenditure, “each cost object (service or unit” of the Republican Health-care Insurance. The Summary data of the Departments of Anaesthesia documented in the database of the Clinical Centre of Serbia. Numerical data were utilized and the numerical data were estimated and analyzed by computer programs Microsoft Office Excel 2003 and SPSS for Windows. We compared using the linear model of direct costs and unit costs of anaesthesiological services from the Costs List of the Republican Health-care Insurance. Results. Direct costs showed 40% of costs were spent on salaries, (32% on drugs and supplies, and 28% on other costs, such as analyses and equipment. The correlation of the direct costs of anaestesiological services showed a linear correlation with the unit costs of the Republican Healthcare Insurance. Conclusion. During surgery, costs of anaesthesia would increase by 10% the surgical treatment cost of patients. Regarding the actual costs of drugs and supplies, we do not see any possibility of costs reduction. Fixed elements of direct costs provide the possibility of rationalization of resources in anaesthesia.

  9. [Operating cost analysis of anaesthesia: activity based costing (ABC analysis)].

    Science.gov (United States)

    Majstorović, Branislava M; Kastratović, Dragana A; Vučović, Dragan S; Milaković, Branko D; Miličić, Biljana R

    2011-01-01

    Cost of anaesthesiology represent defined measures to determine a precise profile of expenditure estimation of surgical treatment, which is important regarding planning of healthcare activities, prices and budget. In order to determine the actual value of anaestesiological services, we started with the analysis of activity based costing (ABC) analysis. Retrospectively, in 2005 and 2006, we estimated the direct costs of anestesiological services (salaries, drugs, supplying materials and other: analyses and equipment.) of the Institute of Anaesthesia and Resuscitation of the Clinical Centre of Serbia. The group included all anesthetized patients of both sexes and all ages. We compared direct costs with direct expenditure, "each cost object (service or unit)" of the Republican Healthcare Insurance. The Summary data of the Departments of Anaesthesia documented in the database of the Clinical Centre of Serbia. Numerical data were utilized and the numerical data were estimated and analyzed by computer programs Microsoft Office Excel 2003 and SPSS for Windows. We compared using the linear model of direct costs and unit costs of anaesthesiological services from the Costs List of the Republican Healthcare Insurance. Direct costs showed 40% of costs were spent on salaries, (32% on drugs and supplies, and 28% on other costs, such as analyses and equipment. The correlation of the direct costs of anaestesiological services showed a linear correlation with the unit costs of the Republican Healthcare Insurance. During surgery, costs of anaesthesia would increase by 10% the surgical treatment cost of patients. Regarding the actual costs of drugs and supplies, we do not see any possibility of costs reduction. Fixed elements of direct costs provide the possibility of rationalization of resources in anaesthesia.

  10. Cost Benefit Analyses of Developing a Legislation to Attract Non-Resident High Net Worth Individuals to Use Estonian Private Foundation Platform

    Directory of Open Access Journals (Sweden)

    Urmas Kaarlep

    2017-05-01

    Full Text Available On a global level, the high net worth population is expanding, and the wealth of high net worth individuals (HNWI is increasing rapidly. For various reasons, high net worth families and individuals are searching for vehicles to assist them in safeguarding and conveniently managing their wealth. Private foundations represent one useful avenue for achieving this end, and the use of private foundations has become increasingly popular in recent years, particularly in European countries. Many countries have laws which regulate private foundations and several are looking for adjusting or introducing legislation. In this article, authors analysing benefits for a country like Estonia in case the country increases the attractiveness of its jurisdiction for non-residents who are looking for establishment of a private foundation. The article comes to the conclusion that to be competitive, a country cannot collect tax revenues from private foundations established by non-residents except from income originated in the very same country. However, the country can earn benefits from revenues received by companies rendering services to non-residents and their private foundations. The article demonstrates that service fees a country earns and taxes collected from these fees would be substantial enough to make necessary changes to legislation beneficial for a country.

  11. Species-delimitation and phylogenetic analyses of some cosmopolitan species of Hypnea (Rhodophyta) reveal synonyms and misapplied names to H. cervicornis, including a new species from Brazil.

    Science.gov (United States)

    de Jesus, Priscila Barreto; Nauer, Fabio; Lyra, Goia de Mattos; Cassano, Valéria; Oliveira, Mariana Cabral; Nunes, José Marcos de Castro; Schnadelbach, Alessandra Selbach

    2016-10-01

    Hypnea has an intricate nomenclatural history due to a wide pantropical distribution and considerable morphological variation. Recent molecular studies have provided further clarification on the systematics of the genus; however, species of uncertain affinities remain due to flawed taxonomic identification. Detailed analyses coupled with literature review indicated a strong relationship among H. aspera, H. cervicornis, H. flexicaulis, and H. tenuis, suggesting a need for further taxonomic studies. Here, we analyzed sequences from two molecular markers (COI-5P and rbcL) and performed several DNA-based delimitation methods (mBGD, ABGD, SPN, PTP and GMYC). These molecular approaches were contrasted with morphological and phylogenetic evidence from type specimens and/or topotype collections of related species under a conservative approach. Our results demonstrate that H. aspera and H. flexicaulis represent heterotypic synonyms of H. cervicornis and indicate the existence of a misidentified Hypnea species, widely distributed on the Brazilian coast, described here as a new species: H. brasiliensis. Finally, inconsistencies observed among our results based on six different species delimitation methods evidence the need for adequate sampling and marker choice for different methods. © 2016 Phycological Society of America.

  12. Analysis of health trait data from on-farm computer systems in the U.S. II: Comparison of genomic analyses including two-stage and single-step methods

    Science.gov (United States)

    The development of genomic selection methodology, with accompanying substantial gains in reliability for low-heritability traits, may dramatically improve the feasibility of genetic improvement of dairy cow health. Many methods for genomic analysis have now been developed, including the “Bayesian Al...

  13. Invasive urodynamic testing prior to surgical treatment for stress urinary incontinence in women: cost-effectiveness and value of information analyses in the context of a mixed methods feasibility study.

    Science.gov (United States)

    Homer, Tara; Shen, Jing; Vale, Luke; McColl, Elaine; Tincello, Douglas G; Hilton, Paul

    2018-01-01

    INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?) was a mixed methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing (IUT) prior to surgery for stress urinary incontinence (SUI) in women. Here we report one of the study's five components, with the specific objectives of (i) exploring the cost-effectiveness of IUT compared with clinical assessment plus non-invasive tests (henceforth described as 'IUT' and 'no IUT' respectively) in women with SUI or stress-predominant mixed urinary incontinence (MUI) prior to surgery, and (ii) determining the expected net gain (ENG) from additional research. Study participants were women with SUI or stress-predominant MUI who had failed to respond to conservative treatments recruited from seven UK urogynaecology and female urology units. They were randomised to receive either 'IUT' or 'no IUT' before undergoing further treatment. Data from 218 women were used in the economic analysis. Cost utility, net benefit and value of information (VoI) analyses were performed within a randomised controlled pilot trial. Costs and quality-adjusted life years (QALYs) were estimated over 6 months to determine the incremental cost per QALY of 'IUT' compared to 'no IUT'. Net monetary benefit informed the VoI analysis. The VoI estimated the ENG and optimal sample size for a future definitive trial. At 6 months, the mean difference in total average cost was £138 ( p  = 0.071) in favour of 'IUT'; there was no difference in QALYs estimated from the SF-12 (difference 0.004; p  = 0.425) and EQ-5D-3L (difference - 0.004; p  = 0.725); therefore, the probability of IUT being cost-effective remains uncertain. The estimated ENG was positive for further research to address this uncertainty with an optimal sample size of 404 women. This is the largest economic evaluation of IUT. On average, up to 6 months after treatment, 'IUT' may

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

    Science.gov (United States)

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

    2016-02-01

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

  15. Valuation of Green Walls and Green Roofs as Soundscape Measures: Including Monetised Amenity Values Together with Noise-attenuation Values in a Cost-benefit Analysis of a Green Wall Affecting Courtyards

    Directory of Open Access Journals (Sweden)

    Jian Kang

    2012-10-01

    Full Text Available Economic unit values of soundscape/acoustic effects have been based on changes in the number of annoyed persons or on decibel changes. The normal procedure has been the application of these unit values to noise-attenuation measures affecting the noisier façade of a dwelling. Novel modular vegetation-based soundscape measures, so-called green walls, might be relevant for both noisy and quieter areas. Moreover, their benefits will comprise noise attenuation as well as non-acoustic amenity effects. One challenge is to integrate the results of some decades of non-acoustic research on the amenity value of urban greenery into design of the urban sound environment, and incorporate these non-acoustic properties in the overall economic assessment of noise control and overall sound environment improvement measures. Monetised unit values for green walls have been included in two alternative cases, or demonstration projects, of covering the entrances to blocks of flats with a green wall. Since these measures improve the noise environment on the quiet side of the dwellings and courtyards, not the most exposed façade, adjustment factors to the nominal quiet side decibel reductions to arrive at an estimate of the equivalent overall acoustic improvement have been applied. A cost-benefit analysis of the green wall case indicates that this measure is economically promising, when valuing the noise attenuation in the quieter area and adding the amenity/aesthetic value of the green wall.

  16. Valuation of Green Walls and Green Roofs as Soundscape Measures: Including Monetised Amenity Values Together with Noise-attenuation Values in a Cost-benefit Analysis of a Green Wall Affecting Courtyards

    Science.gov (United States)

    Veisten, Knut; Smyrnova, Yuliya; Klæboe, Ronny; Hornikx, Maarten; Mosslemi, Marjan; Kang, Jian

    2012-01-01

    Economic unit values of soundscape/acoustic effects have been based on changes in the number of annoyed persons or on decibel changes. The normal procedure has been the application of these unit values to noise-attenuation measures affecting the noisier façade of a dwelling. Novel modular vegetation-based soundscape measures, so-called green walls, might be relevant for both noisy and quieter areas. Moreover, their benefits will comprise noise attenuation as well as non-acoustic amenity effects. One challenge is to integrate the results of some decades of non-acoustic research on the amenity value of urban greenery into design of the urban sound environment, and incorporate these non-acoustic properties in the overall economic assessment of noise control and overall sound environment improvement measures. Monetised unit values for green walls have been included in two alternative cases, or demonstration projects, of covering the entrances to blocks of flats with a green wall. Since these measures improve the noise environment on the quiet side of the dwellings and courtyards, not the most exposed façade, adjustment factors to the nominal quiet side decibel reductions to arrive at an estimate of the equivalent overall acoustic improvement have been applied. A cost-benefit analysis of the green wall case indicates that this measure is economically promising, when valuing the noise attenuation in the quieter area and adding the amenity/aesthetic value of the green wall. PMID:23202816

  17. Valuation of green walls and green roofs as soundscape measures: including monetised amenity values together with noise-attenuation values in a cost-benefit analysis of a green wall affecting courtyards.

    Science.gov (United States)

    Veisten, Knut; Smyrnova, Yuliya; Klæboe, Ronny; Hornikx, Maarten; Mosslemi, Marjan; Kang, Jian

    2012-10-24

    Economic unit values of soundscape/acoustic effects have been based on changes in the number of annoyed persons or on decibel changes. The normal procedure has been the application of these unit values to noise-attenuation measures affecting the noisier façade of a dwelling. Novel modular vegetation-based soundscape measures, so-called green walls, might be relevant for both noisy and quieter areas. Moreover, their benefits will comprise noise attenuation as well as non-acoustic amenity effects. One challenge is to integrate the results of some decades of non-acoustic research on the amenity value of urban greenery into design of the urban sound environment, and incorporate these non-acoustic properties in the overall economic assessment of noise control and overall sound environment improvement measures. Monetised unit values for green walls have been included in two alternative cases, or demonstration projects, of covering the entrances to blocks of flats with a green wall. Since these measures improve the noise environment on the quiet side of the dwellings and courtyards, not the most exposed façade, adjustment factors to the nominal quiet side decibel reductions to arrive at an estimate of the equivalent overall acoustic improvement have been applied. A cost-benefit analysis of the green wall case indicates that this measure is economically promising, when valuing the noise attenuation in the quieter area and adding the amenity/aesthetic value of the green wall.

  18. Cornerstone Third Party Alternative Cost Study

    Energy Technology Data Exchange (ETDEWEB)

    Vrieling, P. Douglas [Sandia National Lab. (SNL-CA), Livermore, CA (United States)

    2013-10-15

    The attached cost analyses sheets have been developed for use in planning during the Third Party Alternative study currently underway for the Sandia CREATE project. This cost analysis builds upon the previously submitted base estimate dated June 14, 2013 and includes comparison information collected during a Market Validation exercise conducted in August/September 2013.

  19. Troubleshooting Costs

    Science.gov (United States)

    Kornacki, Jeffrey L.

    Seventy-six million cases of foodborne disease occur each year in the United States alone. Medical and lost productivity costs of the most common pathogens are estimated to be 5.6-9.4 billion. Product recalls, whether from foodborne illness or spoilage, result in added costs to manufacturers in a variety of ways. These may include expenses associated with lawsuits from real or allegedly stricken individuals and lawsuits from shorted customers. Other costs include those associated with efforts involved in finding the source of the contamination and eliminating it and include time when lines are shut down and therefore non-productive, additional non-routine testing, consultant fees, time and personnel required to overhaul the entire food safety system, lost market share to competitors, and the cost associated with redesign of the factory and redesign or acquisition of more hygienic equipment. The cost associated with an effective quality assurance plan is well worth the effort to prevent the situations described.

  20. How environmental costs impact DSM

    International Nuclear Information System (INIS)

    Sim, S.R.

    1991-01-01

    This article examines the impacts of environmental costs of electricity generation into utility planning of demand side management (DSM) programs. The topics include approach and assumptions, overview of spreadsheet approach, results of the analyses, and the application of this approach to other areas of utility management such as new generation projects, sales of new generation capacity, and utility liability and management prudency

  1. UN ECE-Convention on long-range transboundary air pollution. Task Force on Reactive Nitrogen. Systematic cost-benefit analysis of mitigation measures for agricultural ammonia emissions, supporting national costing analysis; UN ECE-Luftreinhaltekonvention. Task Force on Reactive Nitrogen. Systematische Kosten-Nutzen-Analyse von Minderungsmassnahmen fuer Ammoniakemissionen in der Landwirtschaft fuer nationale Kostenabschaetzung

    Energy Technology Data Exchange (ETDEWEB)

    Doehler, Helmut; Eurich-Menden, Brigitte; Roessler, Regina; Vandre, Robert; Wulf, Sebastian [Kuratorium fuer Technik und Bauwesen in der Landwirtschaft e.V. (KTBL), Darmstadt (Germany)

    2011-07-01

    In this project, the methods for the determination of the expenses for the reduction of agricultural ammonia emissions were updated, and the costs of selected, representative mitigation measures suitable for Germany's agriculture were newly calculated. The reduction costs are determined based on the ratio of the extra costs for the reduction measure and the emission reduction in comparison with a reference system. Protein-adapted feeding in pig fattening generally leads to lower expenses for feedstuff, which provides negative reduction costs (- Euro 3.5 to - Euro 13.5 per kg of NH{sub 3} depending on the reference system). Pig fattening in naturally ventilated housing causes reduction costs of Euro 9.2 per kg of NH{sub 3} as compared with forced-ventilated animal houses. However, this amount cannot always be exclusively attributed to ammonia emission reduction (allocation) because naturally ventilated houses are generally built for the improvement of animal welfare and animal health. Single and multiple-stage air purification techniques in forced-ventilated pig fattening houses are a technically efficient, though costintensive reduction measure (Euro 4,6 - Euro 8,6 per kg of NH{sub 3}). Solid covers for pig slurry stores (concrete ceiling, tent) are characterized by high investment expenses and a long service life causes moderate reduction costs (Euro 1.1 - Euro 2.5 per kg of NH{sub 3}). Floating covers (plastic sheet, granules) are almost cost-neutral given reduction costs of Euro 0.3 to Euro 0.9 per kg of NH{sub 3} (pig slurry) if the fertilizer value of the conserved nitrogen is included in the calculation. Cattle slurry requires significantly higher extra costs for the covering of slurry stores because the natural floating cover itself reduces emissions (Euro 1.3 to Euro 12 per kg of NH{sub 3}). If annual spreading performances are low (1,000 to 3,000 m{sup 3}/a), only promptly incorporation of cattle and pig slurry is cost-effective. If spreading

  2. A 256-channel pulse-height analyser

    International Nuclear Information System (INIS)

    Berset, J.C.; Delavallade, G.; Lindsay, J.

    1975-01-01

    The design, construction, and testing of a small, low-cost 256-channel pulse-height analyser is briefly discussed. The analyser, intended for use in the setting up of experiments in high-energy physics, is fully compatible with the CERN/NIM nucleonic instrumentation. It has a digital display of channel and content as well as outputs for printing, plotting, and binary transfer. The logic circuitry is made with TTL integrated circuits and has a static random-access MOS memory. Logic and timing diagrams are given. Detailed specifications are also included. (Author)

  3. Cost Model for Digital Preservation: Cost of Digital Migration

    Directory of Open Access Journals (Sweden)

    Ulla Bøgvad Kejser

    2011-03-01

    Full Text Available The Danish Ministry of Culture has funded a project to set up a model for costing preservation of digital materials held by national cultural heritage institutions. The overall objective of the project was to increase cost effectiveness of digital preservation activities and to provide a basis for comparing and estimating future cost requirements for digital preservation. In this study we describe an activity-based costing methodology for digital preservation based on the Open Archice Information System (OAIS Reference Model. Within this framework, which we denote the Cost Model for Digital Preservation (CMDP, the focus is on costing the functional entity Preservation Planning from the OAIS and digital migration activities. In order to estimate these costs we have identified cost-critical activities by analysing the functions in the OAIS model and the flows between them. The analysis has been supplemented with findings from the literature, and our own knowledge and experience. The identified cost-critical activities have subsequently been deconstructed into measurable components, cost dependencies have been examined, and the resulting equations expressed in a spreadsheet. Currently the model can calculate the cost of different migration scenarios for a series of preservation formats for text, images, sound, video, geodata, and spreadsheets. In order to verify the model it has been tested on cost data from two different migration projects at the Danish National Archives (DNA. The study found that the OAIS model provides a sound overall framework for the cost breakdown, but that some functions need additional detailing in order to cost activities accurately. Running the two sets of empirical data showed among other things that the model underestimates the cost of manpower-intensive migration projects, while it reinstates an often underestimated cost, which is the cost of developing migration software. The model has proven useful for estimating the

  4. Cost of schizophrenia in England.

    Science.gov (United States)

    Mangalore, Roshni; Knapp, Martin

    2007-03-01

    Despite the wide-ranging financial and social burdens associated with schizophrenia, there have been few cost-of-illness studies of this illness in the UK. To provide up-to-date, prevalence based estimate of all costs associated with schizophrenia for England. A bottom-up approach was adopted. Separate cost estimates were made for people living in private households, institutions, prisons and for those who are homeless. The costs included related to: health and social care, informal care, private expenditures, lost productivity, premature mortality, criminal justice services and other public expenditures such as those by the social security system. Data came from many sources, including the UK-SCAP (Schizophrenia Care and Assessment Program) survey, Psychiatric Morbidity Surveys, Department of Health and government publications. The estimated total societal cost of schizophrenia was 6.7 billion pounds in 2004/05. The direct cost of treatment and care that falls on the public purse was about 2 billion pounds; the burden of indirect costs to the society was huge, amounting to nearly 4.7 billion pounds. Cost of informal care and private expenditures borne by families was 615 million pounds. The cost of lost productivity due to unemployment, absence from work and premature mortality of patients was 3.4 billion pounds. The cost of lost productivity of carers was 32 million pounds. Estimated cost to the criminal justice system was about 1 million pounds. It is estimated that about 570 million pounds will be paid out in benefit payments and the cost of administration associated with this is about 14 million pounds. It is difficult to compare estimates from previous cost-of-illness studies due to differences in the methods, scope of analyses and the range of costs covered. Costs estimated in this study are detailed, cover a comprehensive list of relevant items and allow for different levels of disaggregation. The main limitation of the study is that data came from a

  5. Towards a broader weighing and regulating framework for investments in interconnectors. The societal cost benefit analysis; Naar een breder afwegings- en reguleringskader voor investeringen in interconnectoren. De Maatschappelijke Kosten-Baten Analyse (MKBA)

    Energy Technology Data Exchange (ETDEWEB)

    Sijm, J.P.M.; Welle, A.J. van der [ECN Policy Studies, Petten (Netherlands); Tieben, B.; Hof, B.; Kocsis, V. [SEO Economisch Onderzoek, Amsterdam (Netherlands)

    2013-04-15

    Interconnectors that link national grids are important for further integration of the European electricity grid. Against this background, the main question of this study is as follows: What does a broadened assessment and regulatory framework for investments in interconnectors look like which secures optimal contribution of these investments to the social welfare of the involved countries? To answer this question, the broadened assessment framework is developed first, i.e. the Social Cost-Benefit Analysis (SCBA). Next, the implications for the regulatory framework are analysed with regard to the following three aspects: (1) cost allocation, (2) network planning, and (3) efficiency versus investment incentives. Finally, a case study is conducted of a 'fictitious but realistic' investment project in interconnection to illustrate how certain social effects from the developed SCBA framework can be practically and concretely established [Dutch] Interconnectoren voor de verbinding tussen nationale netwerken zijn belangrijk voor de verdere integratie van het Europese elektriciteitsnetwerk. In het huidige afwegingskader worden investeringsbeslissingen ten aanzien van interconnectoren in Nederland genomen door de nationale netwerkbeheerder, TenneT, na goedkeuring door het Ministerie van Economische Zaken (EZ), gebaseerd op een advies van de Nederlandse Mededingingsautoriteit (NMa). Binnen dit kader baseert TenneT zijn investeringsbeslissingen in het bijzonder op de kosten en handelseffecten van de interconnector. Een belangrijke beperking van dit kader is dat er relatief weinig aandacht wordt besteed aan andere overwegingen en (externe) effecten, zowel positief als negatief, zoals de effecten op meer marktintegratie en concurrentie, de voorzienings- en leveringszekerheid van elektriciteit, de inpassing van duurzame elektriciteit in het net, milieueffecten, de effecten op netwerkcongestie en op investeringen in nieuwe productiecapaciteit. De vraag is nu hoe zowel

  6. Electricity costs in liberalized market

    International Nuclear Information System (INIS)

    Barkans, J.; Junghans, G.

    2006-01-01

    In the liberalized electricity market the flexible demand determines the operation of power plants. Under market conditions the producers are forced to compete, and their power plants are normally loaded in order of increasing prices. The electricity costs consist of fixed and variable components, and the competition among producers simulates minimization of both the components. Considering the fixed costs (including maintenance, depreciation, capital costs and other permanent costs not depending on production) to be known, the total electricity costs in different operating conditions are based on the economic characteristics and the equipment load of a power plant. The paper describes the method for determination of electricity costs for condensing thermal power plants with permanent steam take-off for regeneration purposes and adjustable steam take-off for the needs of local heat energy consumers. The marginal costs for CHP plants are determined considering a number of different steam take-off from a turbine. At the electricity cost determination, auxiliary services also are taken into account. These can be reduced by adjusting the rotational speed of electric motors. The paper also shows how to determine the electricity costs for gas turbines, combined cycle gas turbines, and nuclear power plants. The position of hydro power plants among other PPs in the free market is also analysed. (authors)

  7. Cost estimation for decommissioning of research reactors

    International Nuclear Information System (INIS)

    Grossi, Pablo Andrade; Tello, Cledola Cassia Oliveira de; Segabinaze, Roberto de Oliveira; Daniska, Vladimir

    2013-01-01

    In the case of research reactors, the limited data that is available tends to provide only overall decommissioning costs, without any breakdown of the main cost elements. In order to address this subject, it is important to collect and analyse all available data of decommissioning costs for the research reactors. The IAEA has started the DACCORD Project focused on data analysis and costing of research reactors decommissioning. Data collection is organized in accordance with the International Structure for Decommissioning Costing (ISDC), developed jointly by the IAEA, the OECD Nuclear Energy Agency and the European Commission. The specific aims of the project include the development of representative and comparative data and datasets for preliminary costing for decommissioning. This paper will focus on presenting a technique to consider several representative input data in accordance with the ISDC structure and using the CERREX (Cost Estimation for Research Reactors in Excel) software developed by IAEA. (author)

  8. Modelling the Costs of Preserving Digital Assets

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad; Nielsen, Anders Bo; Thirifays, Alex

    2012-01-01

    and the benefits accrued by preserving the assets. Cost data is also needed for optimizing activities and comparing the costs of different preservation alternatives. The purpose of this study is to analyse generic requirements for modelling the cost of preserving digital assets. The analysis was based......Information is increasingly being produced in digital form, and some of it must be preserved for the longterm. Digital preservation includes a series of actively managed activities that require on-going funding. To obtain sufficient resources, there is a need for assessing the costs...... on experiences from a Danish project to develop a cost model. It was found that a generic cost model should account for the nature of the organisation and the assets to be preserved, and for all major preservation activities and cost drivers. In addition, it should describe accounting principles. It was proposed...

  9. Cost analysis methodology of spent fuel storage

    International Nuclear Information System (INIS)

    1994-01-01

    The report deals with the cost analysis of interim spent fuel storage; however, it is not intended either to give a detailed cost analysis or to compare the costs of the different options. This report provides a methodology for calculating the costs of different options for interim storage of the spent fuel produced in the reactor cores. Different technical features and storage options (dry and wet, away from reactor and at reactor) are considered and the factors affecting all options defined. The major cost categories are analysed. Then the net present value of each option is calculated and the levelized cost determined. Finally, a sensitivity analysis is conducted taking into account the uncertainty in the different cost estimates. Examples of current storage practices in some countries are included in the Appendices, with description of the most relevant technical and economic aspects. 16 figs, 14 tabs

  10. Developing a standardized healthcare cost data warehouse.

    Science.gov (United States)

    Visscher, Sue L; Naessens, James M; Yawn, Barbara P; Reinalda, Megan S; Anderson, Stephanie S; Borah, Bijan J

    2017-06-12

    Research addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients. The warehouse is based on a National Institutes of Research-funded research infrastructure containing the linked health records and medical care administrative data of two healthcare providers and their affiliated hospitals. Since all patients are identified in the data warehouse, their costs can be linked to other systems and databases, such as electronic health records, tumor registries, and disease or treatment registries. We describe the two institutions' administrative source data; the reference files, which include Medicare fee schedules and cost reports; the process of creating standardized costs; and the warehouse structure. The costing algorithm can create inflation-adjusted standardized costs at the service line level for defined study cohorts on request. The resulting standardized costs contained in the data warehouse can be used to create detailed, bottom-up analyses of professional and facility costs of procedures, medical conditions, and patient care cycles without revealing business-sensitive information. After its creation, a standardized cost data warehouse is relatively easy to maintain and can be expanded to include data from other providers. Individual investigators who may not have sufficient knowledge about administrative data do not have to try to create their own standardized costs on a project-by-project basis because our data

  11. Economic cost of fecal incontinence.

    Science.gov (United States)

    Xu, Xiao; Menees, Stacy B; Zochowski, Melissa K; Fenner, Dee E

    2012-05-01

    Despite its prevalence and deleterious impact on patients and families, fecal incontinence remains an understudied condition. Few data are available on its economic burden in the United States. The aim of this study was to quantify per patient annual economic costs associated with fecal incontinence. A mail survey of patients with fecal incontinence was conducted in 2010 to collect information on their sociodemographic characteristics, fecal incontinence symptoms, and utilization of medical and nonmedical resources for fecal incontinence. The analysis was conducted from a societal perspective and included both direct and indirect (ie, productivity loss) costs. Unit costs were determined based on standard Medicare reimbursement rates, national average wholesale prices of medications, and estimates from other relevant sources. All cost estimates were reported in 2010 US dollars. This study was conducted at a single tertiary care institution. The analysis included 332 adult patients who had fecal incontinence for more than a year with at least monthly leakage of solid, liquid, or mucous stool. The primary outcome measured was the per patient annual economic costs associated with fecal incontinence. The average annual total cost for fecal incontinence was $4110 per person (median = $1594; interquartile range, $517-$5164). Of these costs, direct medical and nonmedical costs averaged $2353 (median, $1176; interquartile range, $294-$2438) and $209 (median, $75; interquartile range, $17-$262), whereas the indirect cost associated with productivity loss averaged $1549 per patient annually (median, $0; interquartile range, $0-$813). Multivariate regression analyses suggested that greater fecal incontinence symptom severity was significantly associated with higher annual direct costs. This study was based on patient self-reported data, and the sample was derived from a single institution. Fecal incontinence is associated with substantial economic cost, calling for more

  12. Why the energy turnaround will be economically beneficial. An analysis of the cost and profits of renewable energy sources in Germany; Warum sich die Energiewende rechnet. Eine Analyse von Kosten und Nutzen der Erneuerbaren Energien in Deutschland

    Energy Technology Data Exchange (ETDEWEB)

    Tietjen, Oliver; Arikas, Damian; Austrup, Tobias; Bals, Christoph

    2011-05-15

    This is a meta-study comprising the current state of scientific knowledge on the cost and profits of renewable energy sources in Germany. It is based on official publications of the BMU and BMWi and of specialized research institutes. It is shown thatrenewable energy sources will soon produce electric power at less cost than conventional power plants. A comprehensive cost-profit analysis of electric power supply in Germany today shows that even now renewables generathe economic value generated by renewables is higher than the additional cost resulting from EEG specifications. Further, the payback period for investments in renewable energy sources will be only a few years.

  13. Cost variation in diabetes care delivered in English hospitals

    DEFF Research Database (Denmark)

    Kristensen, Troels; Laudicella, Mauro; Ejersted, Charlotte

    2010-01-01

    care for all English hospitals for the financial year 2005/06. Our sample includes 31,371 patients admitted to 148 hospitals. We apply a multilevel approach. We analyse the relationship between patient costs and patient characteristics. We estimate the average cost of being treated in each hospital......Aims: We analyse the in-hospital costs of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained by patient and hospital characteristics. Methods: We use Hospital Episode Statistics and reference costs for all patients admitted to diabetes...... after controlling for patient characteristics. Second, we explore why these average costs vary across hospitals. Results: Much of the variation in the costs of controlling diabetes is driven by the Healthcare Resource Group to which the patient is allocated, but costs are also higher for patients who...

  14. Including investment risk in large-scale power market models

    DEFF Research Database (Denmark)

    Lemming, Jørgen Kjærgaard; Meibom, P.

    2003-01-01

    can be included in large-scale partial equilibrium models of the power market. The analyses are divided into a part about risk measures appropriate for power market investors and a more technical part about the combination of a risk-adjustment model and a partial-equilibrium model. To illustrate...... the analyses quantitatively, a framework based on an iterative interaction between the equilibrium model and a separate risk-adjustment module was constructed. To illustrate the features of the proposed modelling approach we examined how uncertainty in demand and variable costs affects the optimal choice...

  15. Development of mathematical models to elaborate strategies, select alternatives and development of plans for adaptation of communities to climate change in different geographical areas including costs to implement it

    Science.gov (United States)

    Anton, J. M.; Grau, J. B.; Tarquis, A. M.; Andina, D.; Cisneros, J. M.

    2012-04-01

    There is evidence that the climate changes and that now, the change is influenced and accelerated by the CO2 augmentation in atmosphere due to combustion by humans. Such "Climate change" is on the policy agenda at the global level, with the aim of understanding and reducing its causes and to mitigate its consequences. In most countries and international organisms UNO (e.g. Rio de Janeiro 1992), OECD, EC, etc … the efforts and debates have been directed to know the possible causes, to predict the future evolution of some variable conditioners, and trying to make studies to fight against the effects or to delay the negative evolution of such. The Protocol of Kyoto 1997 set international efforts about CO2 emissions, but it was partial and not followed e.g. by USA and China …, and in Durban 2011 the ineffectiveness of humanity on such global real challenges was set as evident. Among all that, the elaboration of a global model was not boarded that can help to choose the best alternative between the feasible ones, to elaborate the strategies and to evaluate the costs, and the authors propose to enter in that frame for study. As in all natural, technological and social changes, the best-prepared countries will have the best bear and the more rapid recover. In all the geographic areas the alternative will not be the same one, but the model must help us to make the appropriated decision. It is essential to know those areas that are more sensitive to the negative effects of climate change, the parameters to take into account for its evaluation, and comprehensive plans to deal with it. The objective of this paper is to elaborate a mathematical model support of decisions, which will allow to develop and to evaluate alternatives of adaptation to the climatic change of different communities in Europe and Latin-America, mainly in especially vulnerable areas to the climatic change, considering in them all the intervening factors. The models will consider criteria of physical

  16. Social and Private Costs of Youth Joblessness.

    Science.gov (United States)

    Passmore, David L.

    1983-01-01

    Reviews the literature concerning the costs of youth joblessness: (1) analyzes social costs, (2) discusses the private costs, (3) synthesizes the analyses of private and social costs, and (4) discusses the implications for policy and research. (JOW)

  17. Japanese Cost Accounting Systems - analysis of the cost accounting systems of the Japanese cost accounting standard

    OpenAIRE

    Peter, Winter

    2005-01-01

    This paper aims at providing an insight into Japanese cost accounting. Firstly, the development of cost accounting in Japan is delineated. Subsequently, the cost accounting systems codified in the Japanese cost accounting standard are analysed based on the classification according to Hoitsch/Schmitz. Lastly, a critical appraisal of the cost accounting systems of the Japanese cost accounting standard as well as a comparison to German and American cost accounting systems are conducted.

  18. Methodological challenges in carbohydrate analyses

    Directory of Open Access Journals (Sweden)

    Mary Beth Hall

    2007-07-01

    Full Text Available Carbohydrates can provide up to 80% of the dry matter in animal diets, yet their specific evaluation for research and diet formulation is only now becoming a focus in the animal sciences. Partitioning of dietary carbohydrates for nutritional purposes should reflect differences in digestion and fermentation characteristics and effects on animal performance. Key challenges to designating nutritionally important carbohydrate fractions include classifying the carbohydrates in terms of nutritional characteristics, and selecting analytical methods that describe the desired fraction. The relative lack of information on digestion characteristics of various carbohydrates and their interactions with other fractions in diets means that fractions will not soon be perfectly established. Developing a system of carbohydrate analysis that could be used across animal species could enhance the utility of analyses and amount of data we can obtain on dietary effects of carbohydrates. Based on quantities present in diets and apparent effects on animal performance, some nutritionally important classes of carbohydrates that may be valuable to measure include sugars, starch, fructans, insoluble fiber, and soluble fiber. Essential to selection of methods for these fractions is agreement on precisely what carbohydrates should be included in each. Each of these fractions has analyses that could potentially be used to measure them, but most of the available methods have weaknesses that must be evaluated to see if they are fatal and the assay is unusable, or if the assay still may be made workable. Factors we must consider as we seek to analyze carbohydrates to describe diets: Does the assay accurately measure the desired fraction? Is the assay for research, regulatory, or field use (affects considerations of acceptable costs and throughput? What are acceptable accuracy and variability of measures? Is the assay robust (enhances accuracy of values? For some carbohydrates, we

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

    Science.gov (United States)

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

    2017-09-01

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

  20. Nuclear enterprises at the Institute for Energy Technology - IFE. A socio-economic cost/benefit analysis; Nukleaere virksomheter ved Institutt for energiteknikk - IFE. En samfunnsoekonomisk kost/nytte-analyse

    Energy Technology Data Exchange (ETDEWEB)

    2008-03-15

    A cost-benefit analysis concerning the research reactors JEEP II at Kjeller and the Halden Reactor in Halden, operated by the Institute for Energy Technology. It is concluded for both of the reactors that the benefits of continued operations are outweigh the cost. Financing, accident risk, waste management and nuclear competence are some of the aspects treated. The Norwegian Ministry of Trade and Industry initiated the evaluation on behalf of the Norwegian Government

  1. Fitness cost

    DEFF Research Database (Denmark)

    Nielsen, Karen L.; Pedersen, Thomas M.; Udekwu, Klas I.

    2012-01-01

    phage types, predominantly only penicillin resistant. We investigated whether isolates of this epidemic were associated with a fitness cost, and we employed a mathematical model to ask whether these fitness costs could have led to the observed reduction in frequency. Bacteraemia isolates of S. aureus...... from Denmark have been stored since 1957. We chose 40 S. aureus isolates belonging to phage complex 83A, clonal complex 8 based on spa type, ranging in time of isolation from 1957 to 1980 and with varyous antibiograms, including both methicillin-resistant and -susceptible isolates. The relative fitness...... of each isolate was determined in a growth competition assay with a reference isolate. Significant fitness costs of 215 were determined for the MRSA isolates studied. There was a significant negative correlation between number of antibiotic resistances and relative fitness. Multiple regression analysis...

  2. Laser Beam Focus Analyser

    DEFF Research Database (Denmark)

    Nielsen, Peter Carøe; Hansen, Hans Nørgaard; Olsen, Flemming Ove

    2007-01-01

    the obtainable features in direct laser machining as well as heat affected zones in welding processes. This paper describes the development of a measuring unit capable of analysing beam shape and diameter of lasers to be used in manufacturing processes. The analyser is based on the principle of a rotating...... mechanical wire being swept through the laser beam at varying Z-heights. The reflected signal is analysed and the resulting beam profile determined. The development comprised the design of a flexible fixture capable of providing both rotation and Z-axis movement, control software including data capture...... and finally data analysis based on the ISO approach. The device was calibrated and tested on commercially available laser systems. It showed good reproducibility. It was the target to be able to measure CW lasers with a power up to 200 W, focused down to spot diameters in the range of 10µm. In order...

  3. Intelligent distributed control for nuclear power plants. Final (third annual) technical progress report, September 1991--June 1993 (September 1989--June 1993): Includes no-cost extension period from September 1992--June 1993

    Energy Technology Data Exchange (ETDEWEB)

    Klevans, E.H.

    1993-12-31

    This project was initiated in September 1989 as a three year project to develop and demonstrate Intelligent Distributed Control (IDC) for Nuclear Power Plants. There were two primary goals of this research project. The first goal was to combine diagnostics and control to achieve a highly automated power plant as described by M.A. Schultz. The second goal was to apply this research to develop a prototype demonstration on an actual power plant system, the EBR-2 steam plant. Described in this Final (Third Annual) Technical Progress Report is the accomplishment of the project`s final milestone, an in-plant intelligent control experiment conducted on April 1, 1993. The development of the experiment included: simulation validation, experiment formulation and final programming, procedure development and approval, and experimental results. Other third year developments summarized in this report are: (1) a theoretical foundation for Reconfigurable Hybrid Supervisory Control, (2) a steam plant diagnostic system, (3) control console design tools and (4) other advanced and intelligent control.

  4. Historic analysis of energy costs and revenues for the Dutch energy supply. Comparison with European Union member states; Historische analyse kosten en opbrengsten Nederlandse energievoorziening. Vergelijking met EU-lidstaten

    Energy Technology Data Exchange (ETDEWEB)

    Wetzelaer, B.J.H.W.; Volkers, C.H. [ECN Beleidstudies, Petten (Netherlands)

    2006-12-15

    The present study covers a historic analysis of energy costs and energy revenues for the Dutch energy supply. Four perspectives (macro-economy, households, companies and Dutch government) are used to study the economic significance of the Dutch energy supply. Whenever possible a comparison has been made with six selected EU Member States (Belgium, Germany, France, United Kingdom, Sweden and Poland). The macroeconomic perspective shows a limited contribution of energy related activities in Dutch GDP, with a positive relation between oil price and GDP. The households perspective indicates that the energy share in the consumption has risen from 3.5% in 2001 to 4.2% in 2005. This is a result of increasing electricity and gas prices and higher taxes. The fact that the Netherlands is less dependent on the import of gas, is not expressed in the lowest price for gas in comparison to the other selected EU Member States. From the companies perspective it can be concluded that the Dutch companies are confronted with low gas prices, but high electricity prices. There is an imbalance between government revenues and government expenditures. Annual revenues are between euro 12 billion and euro 19 billion, while expenditures total euro 1.4 billion. Due to the high oil price, the revenues from natural gas end up at a record level of euro 9.7 billion in 2005. Finally, this study described the theoretical effects of a high oil price in the Netherlands. For households and companies prices for oil products, gas and electricity significantly rise. The macroeconomic effects are varied and are not associated with large negative economic growth figures in the Netherlands. [Dutch] Deze studie bevat een analyse voor de afgelopen jaren van energiekosten, energieopbrengsten en het belang van de energiesector voor de Nederlandse economie. Er blijken veel gegevens beschikbaar te zijn maar vaak niet volledig en er ontbreken op detailniveau data. Het blijkt nog wel een probleem om een consistent

  5. EEG analyses with SOBI.

    Energy Technology Data Exchange (ETDEWEB)

    Glickman, Matthew R.; Tang, Akaysha (University of New Mexico, Albuquerque, NM)

    2009-02-01

    The motivating vision behind Sandia's MENTOR/PAL LDRD project has been that of systems which use real-time psychophysiological data to support and enhance human performance, both individually and of groups. Relevant and significant psychophysiological data being a necessary prerequisite to such systems, this LDRD has focused on identifying and refining such signals. The project has focused in particular on EEG (electroencephalogram) data as a promising candidate signal because it (potentially) provides a broad window on brain activity with relatively low cost and logistical constraints. We report here on two analyses performed on EEG data collected in this project using the SOBI (Second Order Blind Identification) algorithm to identify two independent sources of brain activity: one in the frontal lobe and one in the occipital. The first study looks at directional influences between the two components, while the second study looks at inferring gender based upon the frontal component.

  6. Net Energy, CO2 Emission and Land-Based Cost-Benefit Analyses of Jatropha Biodiesel: A Case Study of the Panzhihua Region of Sichuan Province in China

    Directory of Open Access Journals (Sweden)

    Xiangzheng Deng

    2012-06-01

    Full Text Available Bioenergy is currently regarded as a renewable energy source with a high growth potential. Forest-based biodiesel, with the significant advantage of not competing with grain production on cultivated land, has been considered as a promising substitute for diesel fuel by many countries, including China. Consequently, extracting biodiesel from Jatropha curcas has become a growing industry. However, many key issues related to the development of this industry are still not fully resolved and the prospects for this industry are complicated. The aim of this paper is to evaluate the net energy, CO2 emission, and cost efficiency of Jatropha biodiesel as a substitute fuel in China to help resolve some of the key issues by studying data from this region of China that is well suited to growing Jatropha. Our results show that: (1 Jatropha biodiesel is preferable for global warming mitigation over diesel fuel in terms of the carbon sink during Jatropha tree growth. (2 The net energy yield of Jatropha biodiesel is much lower than that of fossil fuel, induced by the high energy consumption during Jatropha plantation establishment and the conversion from seed oil to diesel fuel step. Therefore, the energy efficiencies of the production of Jatropha and its conversion to biodiesel need to be improved. (3 Due to current low profit and high risk in the study area, farmers have little incentive to continue or increase Jatropha production. (4 It is necessary to provide more subsidies and preferential policies for Jatropha plantations if this industry is to grow. It is also necessary for local government to set realistic objectives and make rational plans to choose proper sites for Jatropha biodiesel development and the work reported here should assist that effort. Future research focused on breading high-yield varieties, development of efficient field

  7. Future costs in cost effectiveness analysis.

    Science.gov (United States)

    Lee, Robert H

    2008-07-01

    This paper resolves several controversies in CEA. Generalizing [Garber, A.M., Phelps, C.E., 1997. Economic foundations of cost-effectiveness analysis. Journal of Health Economics 16 (1), 1-31], the paper shows accounting for unrelated future costs distorts decision making. After replicating [Meltzer, D., 1997. Accounting for future costs in medical cost-effectiveness analysis. Journal of Health Economics 16 (1), 33-64] quite different conclusion that unrelated future costs should be included in CEA, the paper shows that Meltzer's findings result from modeling the budget constraint as an annuity, which is problematic. The paper also shows that related costs should be included in CEA. This holds for a variety of models, including a health maximization model. CEA should treat costs in the manner recommended by Garber and Phelps.

  8. Application of the new cost analysis to wave power extraction at breakwaters

    International Nuclear Information System (INIS)

    Kondo, Hideo; Sugioka, I.; Watabe, Tomiji; Osanai, Senji; Ozawa, S.

    1992-01-01

    Cost of wave power extracted with systems installed in breakwater has been analysed with the approach which includes environmental cost. A case study shows the power extraction at breakwaters is now a promising one from the viewpoint of cost effectiveness. (author)

  9. Review of storage battery system cost estimates

    Energy Technology Data Exchange (ETDEWEB)

    Brown, D.R.; Russell, J.A.

    1986-04-01

    Cost analyses for zinc bromine, sodium sulfur, and lead acid batteries were reviewed. Zinc bromine and sodium sulfur batteries were selected because of their advanced design nature and the high level of interest in these two technologies. Lead acid batteries were included to establish a baseline representative of a more mature technology.

  10. Costs of reducing nutrient losses in Denmark

    DEFF Research Database (Denmark)

    Jacobsen, Brian H.; Abildtrup, Jens; Jensen, Jørgen Dejgård

    The economic calculations carried out prior to the Plan for the Aquatic Environment III included a comparison of regulation systems aimed at reducing nitrogen leaching, analyses of measures for reducing phosphorus losses and estimation of administrative costs. The conclusions were that taxation o...

  11. COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

    Directory of Open Access Journals (Sweden)

    Moisello Anna Maria

    2012-07-01

    total cost of ownership (TCO. Moreover the activity based analyses reveals the opportunities for rationalizing the supply related activities and containing costs and it enables the effective involvement of the supplier in the process of target costing when he provides activity based information on the costs sustained to produce the product/service: the purchaser can evaluate the impact, in terms of cost, of the activities requested of the supplier and, as a result, he has the chance to rationalize these activities by reducing their number or intensity and enables the effective involvement of the supplier in the process of target costing. The paper gives a contribution in the advancement of costing methodologies applicable to the target costing, proposing the use of a flexible model that supports the decision process according to different time horizons so that effectively supports target costing. The model is suitable for production characterized by high complexity in terms of number and intensity of activities

  12. OOTW COST TOOLS

    Energy Technology Data Exchange (ETDEWEB)

    HARTLEY, D.S.III; PACKARD, S.L.

    1998-09-01

    This document reports the results of a study of cost tools to support the analysis of Operations Other Than War (OOTW). It recommends the continued development of the Department of Defense (DoD) Contingency Operational Support Tool (COST) as the basic cost analysis tool for 00TWS. It also recommends modifications to be included in future versions of COST and the development of an 00TW mission planning tool to supply valid input for costing.

  13. Costs of reducing nutrient losses in Denmark

    DEFF Research Database (Denmark)

    Jacobsen, Brian H.; Abildtrup, Jens; Jensen, Jørgen Dejgård

    The economic calculations carried out prior to the Plan for the Aquatic Environment III included a comparison of regulation systems aimed at reducing nitrogen leaching, analyses of measures for reducing phosphorus losses and estimation of administrative costs. The conclusions were that taxation...... of the N-surplus introduced at the sector level was the most cost effective regulation when compared with administrative regulation and set a side. For phosphorus a balance between incoming and outgoing phosphorus is very costly as this requires that much slurry is transported from the western...... to the eastern part of Denmark. The final plan for the Aquatic Environment III from 2004 included a 13% reduction of N-leaching until 2015 based on cost effective administrative measures like wetlands and catch crops. Also a tax on mineral phosphorus in feedstuffs was included in order to half the phosphorus...

  14. Cost Risk Analysis Based on Perception of the Engineering Process

    Science.gov (United States)

    Dean, Edwin B.; Wood, Darrell A.; Moore, Arlene A.; Bogart, Edward H.

    1986-01-01

    In most cost estimating applications at the NASA Langley Research Center (LaRC), it is desirable to present predicted cost as a range of possible costs rather than a single predicted cost. A cost risk analysis generates a range of cost for a project and assigns a probability level to each cost value in the range. Constructing a cost risk curve requires a good estimate of the expected cost of a project. It must also include a good estimate of expected variance of the cost. Many cost risk analyses are based upon an expert's knowledge of the cost of similar projects in the past. In a common scenario, a manager or engineer, asked to estimate the cost of a project in his area of expertise, will gather historical cost data from a similar completed project. The cost of the completed project is adjusted using the perceived technical and economic differences between the two projects. This allows errors from at least three sources. The historical cost data may be in error by some unknown amount. The managers' evaluation of the new project and its similarity to the old project may be in error. The factors used to adjust the cost of the old project may not correctly reflect the differences. Some risk analyses are based on untested hypotheses about the form of the statistical distribution that underlies the distribution of possible cost. The usual problem is not just to come up with an estimate of the cost of a project, but to predict the range of values into which the cost may fall and with what level of confidence the prediction is made. Risk analysis techniques that assume the shape of the underlying cost distribution and derive the risk curve from a single estimate plus and minus some amount usually fail to take into account the actual magnitude of the uncertainty in cost due to technical factors in the project itself. This paper addresses a cost risk method that is based on parametric estimates of the technical factors involved in the project being costed. The engineering

  15. Pneumonia prevention: Cost-effectiveness analyses of two vaccines among refugee children aged under two years, Haemophilus influenzae type b-containing and pneumococcal conjugate vaccines, during a humanitarian emergency, Yida camp, South Sudan.

    Science.gov (United States)

    Gargano, Lisa M; Hajjeh, Rana; Cookson, Susan T

    2017-01-11

    By September 2013, war between Sudan and South Sudan resulted in >70,000 Sudanese refugees and high pneumonia incidence among the 20,000 refugees in Yida camp, South Sudan. Using Médecins Sans Frontières (MSF)-provided data and modifying our decision-tree models, we estimated if administering Haemophilus influenzae type b (Hib)-containing (pentavalent vaccine, also with diphtheria pertussis and tetanus [DPT] and hepatitis B) and pneumococcal conjugate (PCV) vaccines were cost-effective against hospitalized pneumonia. Among children vaccination, one- and two-doses of combined Hib-containing and PCV would avert an estimated 118 and 125 pneumonia cases, and 8.5 and 9.1 deaths, respectively. The cost per Disability-Adjusted-Life-Year averted for administering combined one- and two-doses was US$125 and US$209, respectively. MSF demonstrated that it was possible to administer these vaccines during an emergency and our analysis found it was highly cost-effective, even with just one-dose of either vaccine. Despite unknown etiology, there is strong field and now economic rationale for administering Hib and PCV during at least one humanitarian emergency. Published by Elsevier Ltd.

  16. The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost-utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up.

    Science.gov (United States)

    Walsh, Timothy S; Stanworth, Simon; Boyd, Julia; Hope, David; Hemmatapour, Sue; Burrows, Helen; Campbell, Helen; Pizzo, Elena; Swart, Nicholas; Morris, Stephen

    2017-10-01

    At present, red blood cells (RBCs) are stored for up to 42 days prior to transfusion. The relative effectiveness and safety of different RBC storage times prior to transfusion is uncertain. To assess the clinical effectiveness and cost-effectiveness of transfusing fresher RBCs (stored for ≤ 7 days) compared with current standard-aged RBCs in critically ill patients requiring blood transfusions. The international Age of BLood Evaluation (ABLE) trial was a multicentre, randomised, blinded trial undertaken in Canada, the UK, the Netherlands and France. The UK trial was funded to contribute patients to the international trial and undertake a UK-specific health economic evaluation. Twenty intensive care units (ICUs) in the UK, as part of 64 international centres. Critically ill patients aged ≥ 18 years (≥ 16 years in Scotland) expected to require mechanical ventilation for ≥ 48 hours and requiring a first RBC transfusion during the first 7 days in the ICU. All decisions to transfuse RBCs were made by clinicians. One patient group received exclusively fresh RBCs stored for ≤ 7 days whenever transfusion was required from randomisation until hospital discharge. The other group received standard-issue RBCs throughout their hospital stay. The primary outcome was 90-day mortality. Secondary outcomes included development of organ dysfunction, new thrombosis, infections and transfusion reactions. The primary economic evaluation was a cost-utility analysis. The international trial took place between March 2009 and October 2014 (UK recruitment took place between January 2012 and October 2014). In total, 1211 patients were assigned to receive fresh blood and 1219 patients to receive standard-aged blood. RBCs were stored for a mean of 6.1 days [standard deviation (SD) ± 4.9 days] in the group allocated to receive fresh blood and 22.0 days (SD ± 8.4 days) in the group allocated to receive standard-aged blood. Patients received a mean of 4.3 RBC units

  17. Economic costs of rabies post exposure prophylaxis

    Directory of Open Access Journals (Sweden)

    Ravish Shankaraiah Hardanahalli

    2017-05-01

    Full Text Available Background: The highest financial expenditure for Rabies in any country is the cost of rabies post-exposure prophylaxis. The type of vaccine and route of administration, as well as type of immunoglobulin used, all significantly influences the cost of treatment. Aims & Objective: To analyse the direct and indirect cost of the rabies post exposure prophylaxis. Material & Methods: The study was conducted at anti-rabies clinics of Government Hospital, where PEP is provided free of cost and a private medical college hospital, where PEP is provided for a cost. 290 animal bite victims who completed the PEP were included in the study. After obtaining written informed consent from the study subjects, data regarding socio-demographic profile, details of animal bite exposure, cost incurred for PEP i.e, direct and indirect cost were collected. Results were expressed as proportions, median and inter-quartile range (Q1-Q3. Results: The total median cost incurred by the bite victims for PEP in Government hospitals was Rs.585 with Q1-Q3 of Rs.444-725 and the cost spent by the government was Rs. 1031; whereas the total cost incurred in private hospital was Rs.5200 with Q1-Q3 of Rs.4900-5701.Conclusion: PEP has a significant economic burden to the bite victims, especially for poor people living of the developing World.

  18. Delay and environmental costs of truck crashes

    Science.gov (United States)

    2013-03-01

    This report presents estimates of certain categories of costs of truck- and bus-involved crashes. Crash related costs estimated as part of this study include vehicle delay costs, emission costs, and fuel consumption costs. In addition, this report al...

  19. Pump apparatus including deconsolidator

    Energy Technology Data Exchange (ETDEWEB)

    Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew

    2014-10-07

    A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

  20. Linking quality of care and training costs

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G; Tabor, Ann; Madsen, Mette E

    2015-01-01

    ), as compared with obstetricians. METHODS: The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost-effectiveness ratio (ICER) and (iv) estimating cost-effectiveness probability for different willingness to pay (WTP......OBJECTIVE: To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM......) values. To provide a model example, we conducted a randomised cost-effectiveness trial. Midwives were randomised to CLM training (midwife-performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention-group participants underwent simulation...

  1. Optical modulator including grapene

    Science.gov (United States)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  2. Costs of traffic injuries

    DEFF Research Database (Denmark)

    Kruse, Marie

    2015-01-01

    OBJECTIVE: The aim of this study was to analyse the socioeconomic costs of traffic injuries in Denmark, notably the healthcare costs and the productivity costs related to traffic injuries, in a bottom-up, register-based perspective. METHOD: Traffic injury victims were identified using national...... emergency room data and police records. Victims were matched with five controls per case by means of propensity score, nearest-neighbour matching. In the cohort, consisting of the 52 526 individuals that experienced a traffic injury in 2000 and 262 630 matched controls, attributable healthcare costs were...... assessed using Danish national healthcare registers. Productivity costs were computed using duration analysis (Cox regression models). In a subanalysis, cost per severe traffic injury was computed for the 12 995 individuals that experienced a severe injury. RESULTS: The socioeconomic cost of a traffic...

  3. Biomass feedstock analyses

    Energy Technology Data Exchange (ETDEWEB)

    Wilen, C.; Moilanen, A.; Kurkela, E. [VTT Energy, Espoo (Finland). Energy Production Technologies

    1996-12-31

    The overall objectives of the project `Feasibility of electricity production from biomass by pressurized gasification systems` within the EC Research Programme JOULE II were to evaluate the potential of advanced power production systems based on biomass gasification and to study the technical and economic feasibility of these new processes with different type of biomass feed stocks. This report was prepared as part of this R and D project. The objectives of this task were to perform fuel analyses of potential woody and herbaceous biomasses with specific regard to the gasification properties of the selected feed stocks. The analyses of 15 Scandinavian and European biomass feed stock included density, proximate and ultimate analyses, trace compounds, ash composition and fusion behaviour in oxidizing and reducing atmospheres. The wood-derived fuels, such as whole-tree chips, forest residues, bark and to some extent willow, can be expected to have good gasification properties. Difficulties caused by ash fusion and sintering in straw combustion and gasification are generally known. The ash and alkali metal contents of the European biomasses harvested in Italy resembled those of the Nordic straws, and it is expected that they behave to a great extent as straw in gasification. Any direct relation between the ash fusion behavior (determined according to the standard method) and, for instance, the alkali metal content was not found in the laboratory determinations. A more profound characterisation of the fuels would require gasification experiments in a thermobalance and a PDU (Process development Unit) rig. (orig.) (10 refs.)

  4. Possible future HERA analyses

    International Nuclear Information System (INIS)

    Geiser, Achim

    2015-12-01

    A variety of possible future analyses of HERA data in the context of the HERA data preservation programme is collected, motivated, and commented. The focus is placed on possible future analyses of the existing ep collider data and their physics scope. Comparisons to the original scope of the HERA pro- gramme are made, and cross references to topics also covered by other participants of the workshop are given. This includes topics on QCD, proton structure, diffraction, jets, hadronic final states, heavy flavours, electroweak physics, and the application of related theory and phenomenology topics like NNLO QCD calculations, low-x related models, nonperturbative QCD aspects, and electroweak radiative corrections. Synergies with other collider programmes are also addressed. In summary, the range of physics topics which can still be uniquely covered using the existing data is very broad and of considerable physics interest, often matching the interest of results from colliders currently in operation. Due to well-established data and MC sets, calibrations, and analysis procedures the manpower and expertise needed for a particular analysis is often very much smaller than that needed for an ongoing experiment. Since centrally funded manpower to carry out such analyses is not available any longer, this contribution not only targets experienced self-funded experimentalists, but also theorists and master-level students who might wish to carry out such an analysis.

  5. 42 CFR 417.540 - Enrollment costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Enrollment costs. 417.540 Section 417.540 Public... PLANS Medicare Payment: Cost Basis § 417.540 Enrollment costs. (a) Principle. Enrollment costs are... of costs included. Enrollment costs include, but are not limited to, reasonable costs incurred in...

  6. The cost of systemic therapy for metastatic colorectal carcinoma in Slovenia: discrepancy analysis between cost and reimbursement.

    Science.gov (United States)

    Mesti, Tanja; Boshkoska, Biljana Mileva; Kos, Mitja; Tekavčič, Metka; Ocvirk, Janja

    2015-06-01

    The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to €3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was €1,900,757.80. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was €1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used

  7. IMOP: randomised placebo controlled trial of outpatient cervical ripening with isosorbide mononitrate (IMN prior to induction of labour – clinical trial with analyses of efficacy, cost effectiveness and acceptability

    Directory of Open Access Journals (Sweden)

    Greer Ian

    2006-07-01

    Full Text Available Abstract Background There is increasing interest in carrying out pre-induction cervical ripening on an outpatient basis. However, there are concerns about the use of prostaglandins, the agents commonly used in hospital settings for this indication, because prostaglandins induce uterine contractions that may lead to fetal hypoxia. Indeed, in a recent study we demonstrated abnormalities in 9% of fetal heart rate tracings performed following prostaglandin induced cervical ripening at term. In contrast, we confirmed in the same study that isosorbide mononitrate (IMN (administered on an inpatient basis was both effective in inducing cervical ripening at term, and was associated with no associated fetal heart rate abnormalities. Methods/design The aim of this study is to determine whether IMN self administered by women on an outpatient basis improves the process of induction of labour. Specifically, we hypothesise that the use of outpatient IMN will result in a shorter inpatient stay before delivery, decreased costs to the health service and greater maternal satisfaction with ripening and induction of labour, compared with placebo treatment. In the study described here (the "IMOP" study, women scheduled for induction of labour at term, and who require pre-induction cervical ripening will be randomised to self-administer at home either IMN 40 mg, or a placebo, each vaginally, at 48 hours, 32 hours and 16 hours before scheduled hospital admission. After admission to hospital, treatment will revert to the usual induction of labour protocol. We will compare the primary outcomes of the elapsed time interval from hospital admission to vaginal delivery, the costs to the health service of induction of labour, and women's experience of induction of labour in the two groups. Discussion This trial will provide evidence on the efficacy of outpatient IMN for pre-induction cervical ripening at term. We will study a formulation of IMN which is cheap and widely

  8. Cardiopulmonary resuscitation: what cost to cheat death?

    Science.gov (United States)

    Lee, K H; Angus, D C; Abramson, N S

    1996-12-01

    To review the various outcomes from cardiopulmonary resuscitation (CPR), the factors that influence these outcomes, the costs associated with CPR, and the application of cost-analyses to CPR. Data used to prepare this article were drawn from published articles and work in progress. Articles were selected for their relevance to the subjects of CPR and cost-analysis by MEDLINE keyword search. The authors extracted all applicable data from the English literature. Cost-analysis studies of CPR programs are limited by the high variation in resources consumed and attribution of cost to these resources. Furthermore, cost projections have not been adjusted to reflect patient-dependent variation in outcome. Variation in the patient's underlying condition, presenting cardiac rhythm, time to provision of definitive CPR, and effective perfusion all influence final outcome and, consequently, influence the cost-effectiveness of CPR programs. Based on cost data from previous studies, preliminary estimates of the cost-effectiveness of CPR programs for all 6-month survivors of a large international multicenter collaborative trial are $406,605.00 per life saved (range $344,314.00 to $966,759.00), and $225,892.00 per quality-adjusted-life-year (range $191,286.00 to $537,088.00). Reported outcome from CPR has varied from reasonable rates of good recovery, including return to full employment to 100% mortality. Appropriate CPR is encouraged, but continued widespread application appears extremely expensive.

  9. Least-cost Paths - Some Methodological Issues

    Directory of Open Access Journals (Sweden)

    Irmela Herzog

    2014-06-01

    Full Text Available This article deals with methodological issues connected with least-cost path (LCP calculations in archaeology. The number of LCP studies in archaeology has increased rapidly during the last couple of years, but not all of the approaches applied are based on an appropriate model and implementation. Many archaeologists rely on standard GIS software with default settings for calculating LCPs and are not aware of possible alternatives and the pitfalls that are described in this article. After briefly introducing the aims and applications of LCP methods in archaeology, LCP algorithms are discussed. The outcome of the LCP calculations depends not only on the algorithm but also on the cost model, which often includes several cost components. The discussion of the cost components has a focus on slope, because nearly all archaeological LCP studies take this cost component into account and because several methodological issues are connected with slope-based cost models. Other possible cost components are: the load of the walker, vegetation cover, wetlands or other soil properties, travelling and transport on water, water as barrier and as attractor, aspect, altitude, and social or cultural cost components. Eventually, advantages and disadvantages of different ways of combining cost components are presented. Based on the methodological issues I conclude that both validation checks and variations of the model are necessary to analyse the reliability of archaeological LCP results.

  10. The value of magnetic resonance imaging (MRI) in the treatment planning of vertebral metastasis considering economic aspects. A cost benefit-analysis; Die Wertigkeit der Magnetresonanztomographie (MRT) unter oekonomischen Aspekten bei der Bestrahlungsplanung von Wirbelkoerpermetastasen. Eine Kosten-Nutzen-Analyse

    Energy Technology Data Exchange (ETDEWEB)

    Prott, F.J.; Schlehuber, E.; Scharding, B.J.; Rinast, E. [Strahlentherapie Wiesbaden, St.-Josefs-Hospital (Germany); Micke, O. [Klinik und Poliklinik fuer Strahlentherapie - Radioonkologie, Universitaetsklinikum Muenster (Germany)

    2002-05-01

    Is magnetic resonance imaging (MRI) based target volume definition for treatment planning of vertebral metastasis effective under economic considerations.From 1994 to 1999, a total of 137 patients with bone metastases affecting the vertebral column underwent MRI of the cercival, thoracic, or lumbar spine for the treatment planning of palliative radiation therapy. The following radiation treatment consisted in a irradiation of the affected vertebral region up to a total dose of 30-40 Gy.The cost calculation for radiotherapy and magnetic resonance tomography was done using the common tariff model (EBM) of the German Health Insurances.In 73% of patients (101 patients), magnetic resonance imaging resulted in marked corrections of the irradiation fields which would have resulted in the necessity of treatment for recurrence in the case of treatment planning without MRI.Consequently, the higher cost of MRI of 345.00 DEM (176,40 EUR) lead to a saving of 497.00 DEM (254,11 EUR) compared to a recurrence treatment of 10 fractions and of 1,428.00 DEM (730,12 EUR) compared to 20 fractions. The transport expenses for the second treatment could be saved as well.Even under economic considerations MRI is effective. (orig.) [German] Ist eine MRT-gestuetzte Zielvolumendefinition bei der Strahlentherapie von Knochenmetastasen ein sinnvolles Vorgehen unter oekonomischen Gesichtspunkten?1994-1999 wurde bei 137 Patienten mit einem ossaer metastasierenden Tumor und Befall der Wirbelsaeule eine Magnetresonanztomographie (MRT) zur Planung einer palliativen Radiatio durchgefuehrt. Die nachfolgende Strahlentherapie bestand aus einer Radiatio des betroffenen Wirbelkoerperabschnitts bis zu einer Gesamtherddosis von 30-40 Gy. Fuer die Berechnung der Kosten wurde der einheitliche Bewertungsmassstab der Deutschen Krankenkassen zugrunde gelegt.Aufgrund der MRT-Untersuchungen wurde bei 73% der Patienten eine Veraenderung des Bestrahlungsfeldes vorgenommen, die im Falle einer nicht MRT

  11. Integrated waste management system costs in a MPC system

    International Nuclear Information System (INIS)

    Supko, E.M.

    1995-01-01

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

  12. Ventilation cost and air cleaning

    Science.gov (United States)

    Goodfellow, H. D.

    The components associated with the costs of the purchase of pollution control equipment are discussed. These include the capital cost to purchase the equipment and installation, and the costs incurred to operate the control device on an annual basis. Although the capital costs can represent a significant outlay of money, typically these costs are spread out over the life of the equipment. In general, this amortized cost is combined with the operating cost and is referred to as an 'annualized cost'. The annualized cost is a commonly used indicator to demonstrate the actual year to year cost that the equipment and operation will represent. Values and methods used to estimate costs, typical cost indicators, and sources of computerized costing models are presented. A comparison of the capital cost expenditure required for a model case (a cement kiln operation), using three control device alternatives is made.

  13. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...

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

    Directory of Open Access Journals (Sweden)

    Femke Jansen

    2016-01-01

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

  15. Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

    Science.gov (United States)

    Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

    2015-07-15

    Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle

  16. Renewable Energy Cost Modeling. A Toolkit for Establishing Cost-Based Incentives in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Gifford, Jason S. [Sustainable Energy Advantage, LLC, Framington, MA (United States); Grace, Robert C. [Sustainable Energy Advantage, LLC, Framington, MA (United States); Rickerson, Wilson H. [Meister Consultants Group, Inc., Boston, MA (United States)

    2011-05-01

    This report serves as a resource for policymakers who wish to learn more about levelized cost of energy (LCOE) calculations, including cost-based incentives. The report identifies key renewable energy cost modeling options, highlights the policy implications of choosing one approach over the other, and presents recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, FITs, or similar policies. These recommendations shaped the design of NREL's Cost of Renewable Energy Spreadsheet Tool (CREST), which is used by state policymakers, regulators, utilities, developers, and other stakeholders to assist with analyses of policy and renewable energy incentive payment structures. Authored by Jason S. Gifford and Robert C. Grace of Sustainable Energy Advantage LLC and Wilson H. Rickerson of Meister Consultants Group, Inc.

  17. Incorporating indirect costs into a cost-benefit analysis of laparoscopic adjustable gastric banding.

    Science.gov (United States)

    Finkelstein, Eric A; Allaire, Benjamin T; Dibonaventura, Marco Dacosta; Burgess, Somali M

    2012-01-01

    The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account. Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings. By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included. This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  18. A simple beam analyser

    International Nuclear Information System (INIS)

    Lemarchand, G.

    1977-01-01

    (ee'p) experiments allow to measure the missing energy distribution as well as the momentum distribution of the extracted proton in the nucleus versus the missing energy. Such experiments are presently conducted on SACLAY's A.L.S. 300 Linac. Electrons and protons are respectively analysed by two spectrometers and detected in their focal planes. Counting rates are usually low and include time coincidences and accidentals. Signal-to-noise ratio is dependent on the physics of the experiment and the resolution of the coincidence, therefore it is mandatory to get a beam current distribution as flat as possible. Using new technologies has allowed to monitor in real time the behavior of the beam pulse and determine when the duty cycle can be considered as being good with respect to a numerical basis

  19. Cost analysis of new and retrofit hot-air type solar assisted heating systems

    Science.gov (United States)

    Stewart, R. D.; Hawkins, B. J.

    1978-01-01

    A detailed cost analysis/cost improvement study was performed on two Department of Energy/National Aeronautics and Space Administration operational test sites to determine actual costs and potential cost improvements of new and retrofit hot air type, solar assisted heating and hot water systems for single family sized structures. This analysis concentrated on the first cost of a system which included procurement, installation, and integration of a solar assisted heating and hot water system on a new or retrofit basis; it also provided several cost projections which can be used as inputs to payback analyses, depending upon the degree of optimism or future improvements assumed. Cost definitions were developed for five categories of cost, and preliminary estimates were developed for each. The costing methodology, approach, and results together with several candidate low cost designs are described.

  20. Study of China's coal supply cost

    International Nuclear Information System (INIS)

    Schneider, K.

    1998-01-01

    The Department of Primary Industries and Energy is funding a joint research project between ABARE and the Energy Research Institute of China's State Planning Commission, China's leading organisation undertaking policy-related energy sector research. Together, the two organisations will analyse the economic costs and impacts of moving large quantities of coal from China's northern coal fields to, power stations in the rapidly growing south-eastern coastal provinces. The study will also compare the true economic costs of using domestic coal - including the costs of subsidies on coal production and transport - with the costs of using imported coal. ABARE will use its dynamic model, MEGABARE, to undertake ky parts of the study, taking into account the complex linkages between sectors in an economy and between different economies

  1. Uncertainty Analyses and Strategy

    International Nuclear Information System (INIS)

    Kevin Coppersmith

    2001-01-01

    The DOE identified a variety of uncertainties, arising from different sources, during its assessment of the performance of a potential geologic repository at the Yucca Mountain site. In general, the number and detail of process models developed for the Yucca Mountain site, and the complex coupling among those models, make the direct incorporation of all uncertainties difficult. The DOE has addressed these issues in a number of ways using an approach to uncertainties that is focused on producing a defensible evaluation of the performance of a potential repository. The treatment of uncertainties oriented toward defensible assessments has led to analyses and models with so-called ''conservative'' assumptions and parameter bounds, where conservative implies lower performance than might be demonstrated with a more realistic representation. The varying maturity of the analyses and models, and uneven level of data availability, result in total system level analyses with a mix of realistic and conservative estimates (for both probabilistic representations and single values). That is, some inputs have realistically represented uncertainties, and others are conservatively estimated or bounded. However, this approach is consistent with the ''reasonable assurance'' approach to compliance demonstration, which was called for in the U.S. Nuclear Regulatory Commission's (NRC) proposed 10 CFR Part 63 regulation (64 FR 8640 [DIRS 101680]). A risk analysis that includes conservatism in the inputs will result in conservative risk estimates. Therefore, the approach taken for the Total System Performance Assessment for the Site Recommendation (TSPA-SR) provides a reasonable representation of processes and conservatism for purposes of site recommendation. However, mixing unknown degrees of conservatism in models and parameter representations reduces the transparency of the analysis and makes the development of coherent and consistent probability statements about projected repository

  2. Historical construction costs of global nuclear power reactors

    International Nuclear Information System (INIS)

    Lovering, Jessica R.; Yip, Arthur; Nordhaus, Ted

    2016-01-01

    The existing literature on the construction costs of nuclear power reactors has focused almost exclusively on trends in construction costs in only two countries, the United States and France, and during two decades, the 1970s and 1980s. These analyses, Koomey and Hultman (2007); Grubler (2010), and Escobar-Rangel and Lévêque (2015), study only 26% of reactors built globally between 1960 and 2010, providing an incomplete picture of the economic evolution of nuclear power construction. This study curates historical reactor-specific overnight construction cost (OCC) data that broaden the scope of study substantially, covering the full cost history for 349 reactors in the US, France, Canada, West Germany, Japan, India, and South Korea, encompassing 58% of all reactors built globally. We find that trends in costs have varied significantly in magnitude and in structure by era, country, and experience. In contrast to the rapid cost escalation that characterized nuclear construction in the United States, we find evidence of much milder cost escalation in many countries, including absolute cost declines in some countries and specific eras. Our new findings suggest that there is no inherent cost escalation trend associated with nuclear technology. - Highlights: •Comprehensive analysis of nuclear power construction cost experience. •Coverage for early and recent reactors in seven countries. •International comparisons and re-evaluation of learning. •Cost trends vary by country and era; some experience cost stability or decline.

  3. Management and cost accounting

    CERN Document Server

    Drury, Colin

    1992-01-01

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

  4. A Cost Evaluation of a Donation after Cardiac Death Program: How Cost per Organ Compares to Other Donor Types.

    Science.gov (United States)

    Lindemann, Jessica; Dageforde, Leigh Anne; Vachharajani, Neeta; Stahlschmidt, Emily; Brockmeier, Diane; Wellen, Jason R; Khan, Adeel; Chapman, William C; Doyle, Majella

    2018-03-02

    Donation after cardiac death (DCD) is one method of organ donation. Nationally, more than half of evaluated DCD donors do not yield transplantable organs. There is no algorithm for predicting which DCD donors will be appropriate for organ procurement. DCD program costs from an organ procurement organization (OPO) accounting for all evaluated donors have not been reported. Hospital, transportation, and supply costs of potential DCD donors evaluated at a single OPO from January 2009 to June 2016 were collected. Average costs per donor and per organ were calculated. Cost of DCD donors that did not yield a transplantable organ were included in cost analyses resulting in total cost of the DCD program. DCD donor costs were compared to costs of in hospital donation after brain death (DBD) donors. There were 289 organs transplanted from 264 DCD donors evaluated. Average cost per DCD donor yielding transplantable organs was $9,306. However, 127 donors yielded no organs at an average cost of $8,794 per donor. The total cost of the DCD program was $32,020 per donor and $15,179 per organ. The average cost for an in hospital DBD donor was $33,546 and $9,478 per organ transplanted. Average organ yield for DBD donors was 3.54 versus 2.21 for DCD donors (porgan 63% of the cost of a DCD organ. The average cost per DCD donor is comparable to DBD donors however, individual cost of DCD organs increases by almost forty percent when all costs of an entire DCD program are included. Copyright © 2018. Published by Elsevier Inc.

  5. Development of cost estimation tools for total occupational safety and health activities and occupational health services: cost estimation from a corporate perspective.

    Science.gov (United States)

    Nagata, Tomohisa; Mori, Koji; Aratake, Yutaka; Ide, Hiroshi; Ishida, Hiromi; Nobori, Junichiro; Kojima, Reiko; Odagami, Kiminori; Kato, Anna; Tsutsumi, Akizumi; Matsuda, Shinya

    2014-01-01

    The aim of the present study was to develop standardized cost estimation tools that provide information to employers about occupational safety and health (OSH) activities for effective and efficient decision making in Japanese companies. We interviewed OSH staff members including full-time professional occupational physicians to list all OSH activities. Using activity-based costing, cost data were obtained from retrospective analyses of occupational safety and health costs over a 1-year period in three manufacturing workplaces and were obtained from retrospective analyses of occupational health services costs in four manufacturing workplaces. We verified the tools additionally in four workplaces including service businesses. We created the OSH and occupational health standardized cost estimation tools. OSH costs consisted of personnel costs, expenses, outsourcing costs and investments for 15 OSH activities. The tools provided accurate, relevant information on OSH activities and occupational health services. The standardized information obtained from our OSH and occupational health cost estimation tools can be used to manage OSH costs, make comparisons of OSH costs between companies and organizations and help occupational health physicians and employers to determine the best course of action.

  6. Network class superposition analyses.

    Directory of Open Access Journals (Sweden)

    Carl A B Pearson

    Full Text Available Networks are often used to understand a whole system by modeling the interactions among its pieces. Examples include biomolecules in a cell interacting to provide some primary function, or species in an environment forming a stable community. However, these interactions are often unknown; instead, the pieces' dynamic states are known, and network structure must be inferred. Because observed function may be explained by many different networks (e.g., ≈ 10(30 for the yeast cell cycle process, considering dynamics beyond this primary function means picking a single network or suitable sample: measuring over all networks exhibiting the primary function is computationally infeasible. We circumvent that obstacle by calculating the network class ensemble. We represent the ensemble by a stochastic matrix T, which is a transition-by-transition superposition of the system dynamics for each member of the class. We present concrete results for T derived from boolean time series dynamics on networks obeying the Strong Inhibition rule, by applying T to several traditional questions about network dynamics. We show that the distribution of the number of point attractors can be accurately estimated with T. We show how to generate Derrida plots based on T. We show that T-based Shannon entropy outperforms other methods at selecting experiments to further narrow the network structure. We also outline an experimental test of predictions based on T. We motivate all of these results in terms of a popular molecular biology boolean network model for the yeast cell cycle, but the methods and analyses we introduce are general. We conclude with open questions for T, for example, application to other models, computational considerations when scaling up to larger systems, and other potential analyses.

  7. Financial relationships in economic analyses of targeted therapies in oncology.

    Science.gov (United States)

    Valachis, Antonis; Polyzos, Nikolaos P; Nearchou, Andreas; Lind, Pehr; Mauri, Davide

    2012-04-20

    A potential financial relationship between investigators and pharmaceutical manufacturers has been associated with an increased likelihood of reporting favorable conclusions about a sponsor's proprietary agent in pharmacoeconomic studies. The purpose of this study is to investigate whether there is an association between financial relationships and outcome in economic analyses of new targeted therapies in oncology. We searched PubMed (last update June 2011) for economic analyses of targeted therapies (including monoclonal antibodies, tyrosine-kinase inhibitors, and mammalian target of rapamycin inhibitors) in oncology. The trials were qualitatively rated regarding the cost assessment as favorable, neutral, or unfavorable on the basis of prespecified criteria. Overall, 81 eligible studies were identified. Economic analyses that were funded by pharmaceutical companies were more likely to report favorable qualitative cost estimates (28 [82%] of 34 v 21 [45%] of 47; P = .003). The presence of an author affiliated with manufacturer was not associated with study outcome. Furthermore, if only studies including a conflict of interest statement were included (66 of 81), studies that reported any financial relationship with manufacturers (author affiliation and/or funding and/or other financial relationship) were more likely to report favorable results of targeted therapies compared with studies without financial relationship (32 [71%] of 45 v nine [43%] of 21; P = .025). Our study reveals a potential threat for industry-related bias in economic analyses of targeted therapies in oncology in favor of analyses with financial relationships between authors and manufacturers. A more balanced funding of economic analyses from other sources may allow greater confidence in the interpretation of their results.

  8. Nuclear power generating costs

    International Nuclear Information System (INIS)

    Srinivasan, M.R.; Kati, S.L.; Raman, R.; Nanjundeswaran, K.; Nadkarny, G.V.; Verma, R.S.; Mahadeva Rao, K.V.

    1983-01-01

    Indian experience pertaining to investment and generation costs of nuclear power stations is reviewed. The causes of investment cost increases are analysed and the increases are apportioned to escalation, design improvements and safety related adders. The paper brings out the fact that PHWR investment costs in India compare favourably with those experienced in developed countries in spite of the fact that the programme and the unit size are relatively much smaller in India. It brings out that in India at current prices a nuclear power station located over 800 km from coal reserves and operating at 75% capacity factor is competitive with thermal power at 60% capacity factor. (author)

  9. Economic costs of adult obesity: a review of recent European studies with a focus on subgroup-specific costs.

    Science.gov (United States)

    von Lengerke, Thomas; Krauth, Christian

    2011-07-01

    This review aims to provide an update on economic costs of obesity in Europe with a focus on costs in subgroups defined by relevant third variables such as sex, age, socio-economic status, and morbidity factors. A structured search using MeSH-vocabulary and Title/Abstract-searches was conducted in PubMed for 2007 to 2010. All cost categories except intangible costs were considered. N = 19 primary cost of illness studies on adults from Europe which had included at least one cost category as an outcome were identified. Nine studies reported costs in specific subgroups. Two studies (both from Germany) took a societal perspective, with total (direct and indirect) costs of obesity accounting for 0.47-0.61% of gross domestic product. Excess per-capita direct costs ranged from € 117 to € 1873, depending on cost categories and comparison group (normal weight, non-obese). One study estimated lower lifetime health care costs given obesity. Regarding subgroups, higher costs of obesity were generally found in men, groups with higher socio-economic status (regarding costs of severe obesity), and groups with co-existing abdominal obesity, diabetes (especially type 1), elevated HbA1c (among patients with type 2 diabetes), and physical co-morbidities given BMI ≥ 27 (compared to a "BMI ≥ 30 only"-group). In conclusion, while substantial obesity costs were found in most studies, subgroup analyses and lifetime perspectives call for a differentiated approach to the costs of obesity. Findings such as the higher health care costs in severely obese groups with higher socio-economic status (despite fewer co-morbidities), and lower lifetime long-term care costs in obese groups (due to reduced life expectancy), may generate hypotheses both on under- vs. overuse of services, and target groups for interventions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Marginal cost calculation of energy production in hydro thermoelectric systems considering the transmission system

    International Nuclear Information System (INIS)

    Pereira, M.V.F.; Gorenstin, B.G.; Alvarenga Filho, S.

    1989-01-01

    The alternatives for calculation of energy marginal cost in hydroelectric systems, considering the transmission one, was analysed, including fundamental concepts; generation/transmission systems, represented by linear power flow model; production marginal costs in hydrothermal systems and computation aspects. (C.G.C.). 11 refs, 5 figs

  11. Permeable treatment wall design and cost analysis

    International Nuclear Information System (INIS)

    Manz, C.; Quinn, K.

    1997-01-01

    A permeable treatment wall utilizing the funnel and gate technology has been chosen as the final remedial solution for one industrial site, and is being considered at other contaminated sites, such as a closed municipal landfill. Reactive iron gates will be utilized for treatment of chlorinated VOCs identified in the groundwater. Alternatives for the final remedial solution at each site were evaluated to achieve site closure in the most cost effective manner. This paper presents the remedial alternatives and cost analyses for each site. Several options are available at most sites for the design of a permeable treatment wall. Our analysis demonstrates that the major cost factor's for this technology are the design concept, length, thickness, location and construction methods for the reactive wall. Minimizing the amount of iron by placement in the most effective area and construction by the lowest cost method is critical to achieving a low cost alternative. These costs dictate the design of a permeable treatment wall, including selection of a variety of alternatives (e.g., a continuous wall versus a funnel and gate system, fully penetrating gates versus partially penetrating gates, etc.). Selection of the appropriate construction methods and materials for the site can reduce the overall cost of the wall

  12. Logistics costs of the enterprise

    Directory of Open Access Journals (Sweden)

    Andrea Rosová

    2007-06-01

    Full Text Available The article describe a problem of specification and systematization of enterprise’s logistics costs. With in a growing division of labour, also logistics costs increase their part in enterprises total costs.Almost all decisions about products and production in general, influence logistics processes even logistics costs and performances.In present is not clear enough, which of the cost-particles are relevant fot logistics costs, because some of logistics cost-particles accounts within overhead are charged together with costs of other sorts.Substantive step in the process of the monitoring and evidence of logistics costs is definition of this, that costs of enterprise´s processes will be inclusive in logistics costs and determining points of contact with the others departments (acquisition, production, sale etc.. After the specification of meditation processes, there is a need to choose applicable parameters for the expression of logistics performances. Besides logistics costs is needed to know logistics performances equivalent herewith at a cost of, therefore from the control side have for enterprise bigger value indices expressive correlation costs and performances(e.g. share of logistics unit costs performance.At the proposal and evidence of logistics costs and performances is needed consistently entertain an individual conditions of enterprise. Because the area of processes included strongly affects the size of account logistics costs and its share part in total costs of enterprise. Logistics costs are flow line between economy and logistics of the enterprise.

  13. Cost per severe accident as an index for severe accident consequence assessment and its applications

    International Nuclear Information System (INIS)

    Silva, Kampanart; Ishiwatari, Yuki; Takahara, Shogo

    2014-01-01

    The Fukushima Accident emphasizes the need to integrate the assessments of health effects, economic impacts, social impacts and environmental impacts, in order to perform a comprehensive consequence assessment of severe accidents in nuclear power plants. “Cost per severe accident” is introduced as an index for that purpose. The calculation methodology, including the consequence analysis using level 3 probabilistic risk assessment code OSCAAR and the calculation method of the cost per severe accident, is proposed. This methodology was applied to a virtual 1,100 MWe boiling water reactor. The breakdown of the cost per severe accident was provided. The radiation effect cost, the relocation cost and the decontamination cost were the three largest components. Sensitivity analyses were carried out, and parameters sensitive to cost per severe accident were specified. The cost per severe accident was compared with the amount of source terms, to demonstrate the performance of the cost per severe accident as an index to evaluate severe accident consequences. The ways to use the cost per severe accident for optimization of radiation protection countermeasures and for estimation of the effects of accident management strategies are discussed as its applications. - Highlights: • Cost per severe accident is used for severe accident consequence assessment. • Assessments of health, economic, social and environmental impacts are included. • Radiation effect, relocation and decontamination costs are important cost components. • Cost per severe accident can be used to optimize radiation protection measures. • Effects of accident management can be estimated using the cost per severe accident

  14. A high dutycycle low cost multichannel analyser for electron spectroscopy

    International Nuclear Information System (INIS)

    Norell, K.E.; Baltzer, P.

    1983-03-01

    A high dutycycle multichannel analyzer has been designed and used in time-of-flight electron spectroscopy. The memory capacity is 64k counts. The number of channels is 8192 with a time resolution of 100 ns. An oscilloscope is used to display the spectra synchronous with the counting. The unit has been built with standard electronic components. (author)

  15. Cost-benefit analyse af oplysninger i årsrapporten

    DEFF Research Database (Denmark)

    Riise Johansen, Thomas; Plenborg, Thomas

    2012-01-01

    regnskabsproducenter, har afdækket områder, hvor der forekommer ubalancer i årsrapporterne. Det gælder eksempelvis CRS og Corporate Governance, hvor efterspørgslen er begrænset og langt fra står mål med de anvendte ressourcer. Til gengæld efterspørges der information om teknisk vanskelige områder med et væsentligt...

  16. Seismic fragility analyses

    International Nuclear Information System (INIS)

    Kostov, Marin

    2000-01-01

    In the last two decades there is increasing number of probabilistic seismic risk assessments performed. The basic ideas of the procedure for performing a Probabilistic Safety Analysis (PSA) of critical structures (NUREG/CR-2300, 1983) could be used also for normal industrial and residential buildings, dams or other structures. The general formulation of the risk assessment procedure applied in this investigation is presented in Franzini, et al., 1984. The probability of failure of a structure for an expected lifetime (for example 50 years) can be obtained from the annual frequency of failure, β E determined by the relation: β E ∫[d[β(x)]/dx]P(flx)dx. β(x) is the annual frequency of exceedance of load level x (for example, the variable x may be peak ground acceleration), P(fI x) is the conditional probability of structure failure at a given seismic load level x. The problem leads to the assessment of the seismic hazard β(x) and the fragility P(fl x). The seismic hazard curves are obtained by the probabilistic seismic hazard analysis. The fragility curves are obtained after the response of the structure is defined as probabilistic and its capacity and the associated uncertainties are assessed. Finally the fragility curves are combined with the seismic loading to estimate the frequency of failure for each critical scenario. The frequency of failure due to seismic event is presented by the scenario with the highest frequency. The tools usually applied for probabilistic safety analyses of critical structures could relatively easily be adopted to ordinary structures. The key problems are the seismic hazard definitions and the fragility analyses. The fragility could be derived either based on scaling procedures or on the base of generation. Both approaches have been presented in the paper. After the seismic risk (in terms of failure probability) is assessed there are several approaches for risk reduction. Generally the methods could be classified in two groups. The

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

    Science.gov (United States)

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

    1983-01-01

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

  18. Teacher Costs

    OpenAIRE

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

    2015-01-01

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

  19. Rethinking sunk costs

    International Nuclear Information System (INIS)

    Capen, E.C.

    1991-01-01

    As typically practiced in the petroleum/ natural gas industry, most economic calculations leave out sunk costs. Integrated businesses can be hurt by the omission of sunk costs because profits and costs are not allocated properly among the various business segments. Not only can the traditional sunk-cost practice lead to predictably bad decisions, but a company that operates under such a policy will have no idea how to allocate resources among its operating components; almost none of its calculated returns will be correct. This paper reports that the solution is to include asset value as part of the investment in the calculation

  20. Cost of dengue outbreaks: literature review and country case studies.

    Science.gov (United States)

    Stahl, Hans-Christian; Butenschoen, Vicki Marie; Tran, Hien Tinh; Gozzer, Ernesto; Skewes, Ronald; Mahendradhata, Yodi; Runge-Ranzinger, Silvia; Kroeger, Axel; Farlow, Andrew

    2013-11-06

    Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save--through early response activities--resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems.The country case studies--conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control

  1. Cost of dengue outbreaks: literature review and country case studies

    Science.gov (United States)

    2013-01-01

    Background Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Methods Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Results Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems. The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the

  2. The cost of making compensation payments to local forest ...

    African Journals Online (AJOL)

    tion projects in Madagascar, including the one analysed in this pa- ... The cost of making compensation payments to local forest populations in a REDD+ pilot project in. Madagascar. Madagascar Conservation & Development 1 2, 1 : xx–xx. http://dx.doi.org/1 ... maining natural forest of the island (S. Desbureaux 2014, pers.

  3. Cost Model for Digital Preservation: Cost of Digital Migration

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad; Nielsen, Anders Bo; Thirifays, Alex

    2011-01-01

    The Danish Ministry of Culture has funded a project to set up a model for costing preservation of digital materials held by national cultural heritage institutions. The overall objective of the project was to increase cost effectiveness of digital preservation activities and to provide a basis...... for comparing and estimating future cost requirements for digital preservation. In this study we describe an activity-based costing methodology for digital preservation based on the Open Archice Information System (OAIS) Reference Model. Within this framework, which we denote the Cost Model for Digital...... Preservation (CMDP), the focus is on costing the functional entity Preservation Planning from the OAIS and digital migration activities. In order to estimate these costs we have identified cost-critical activities by analysing the functions in the OAIS model and the flows between them. The analysis has been...

  4. Cost Model for Digital Preservation: Cost of Digital Migration

    DEFF Research Database (Denmark)

    Kejser, Ulla Bøgvad; Nielsen, Anders Bo; Thirifays, Alex

    2011-01-01

    for comparing and estimating future cost requirements for digital preservation. In this study we describe an activity-based costing methodology for digital preservation based on the Open Archice Information System (OAIS) Reference Model. Within this framework, which we denote the Cost Model for Digital......The Danish Ministry of Culture has funded a project to set up a model for costing preservation of digital materials held by national cultural heritage institutions. The overall objective of the project was to increase cost effectiveness of digital preservation activities and to provide a basis...... Preservation (CMDP), the focus is on costing the functional entity Preservation Planning from the OAIS and digital migration activities. In order to estimate these costs we have identified cost-critical activities by analysing the functions in the OAIS model and the flows between them. The analysis has been...

  5. Pawnee Nation Energy Option Analyses

    Energy Technology Data Exchange (ETDEWEB)

    Matlock, M.; Kersey, K.; Riding In, C.

    2009-07-21

    Pawnee Nation of Oklahoma Energy Option Analyses In 2003, the Pawnee Nation leadership identified the need for the tribe to comprehensively address its energy issues. During a strategic energy planning workshop a general framework was laid out and the Pawnee Nation Energy Task Force was created to work toward further development of the tribe’s energy vision. The overarching goals of the “first steps” project were to identify the most appropriate focus for its strategic energy initiatives going forward, and to provide information necessary to take the next steps in pursuit of the “best fit” energy options. Description of Activities Performed The research team reviewed existing data pertaining to the availability of biomass (focusing on woody biomass, agricultural biomass/bio-energy crops, and methane capture), solar, wind and hydropower resources on the Pawnee-owned lands. Using these data, combined with assumptions about costs and revenue streams, the research team performed preliminary feasibility assessments for each resource category. The research team also reviewed available funding resources and made recommendations to Pawnee Nation highlighting those resources with the greatest potential for financially-viable development, both in the near-term and over a longer time horizon. Findings and Recommendations Due to a lack of financial incentives for renewable energy, particularly at the state level, combined mediocre renewable energy resources, renewable energy development opportunities are limited for Pawnee Nation. However, near-term potential exists for development of solar hot water at the gym, and an exterior wood-fired boiler system at the tribe’s main administrative building. Pawnee Nation should also explore options for developing LFGTE resources in collaboration with the City of Pawnee. Significant potential may also exist for development of bio-energy resources within the next decade. Pawnee Nation representatives should closely monitor

  6. Rehabilitation costs

    International Nuclear Information System (INIS)

    Kubo, Arthur S.

    1986-01-01

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

  7. Cost analysis guidelines

    International Nuclear Information System (INIS)

    Strait, R.S.

    1996-01-01

    The first phase of the Depleted Uranium Hexafluoride Management Program (Program)--management strategy selection--consists of several program elements: Technology Assessment, Engineering Analysis, Cost Analysis, and preparation of an Environmental Impact Statement (EIS). Cost Analysis will estimate the life-cycle costs associated with each of the long-term management strategy alternatives for depleted uranium hexafluoride (UF6). The scope of Cost Analysis will include all major expenditures, from the planning and design stages through decontamination and decommissioning. The costs will be estimated at a scoping or preconceptual design level and are intended to assist decision makers in comparing alternatives for further consideration. They will not be absolute costs or bid-document costs. The purpose of the Cost Analysis Guidelines is to establish a consistent approach to analyzing of cost alternatives for managing Department of Energy's (DOE's) stocks of depleted uranium hexafluoride (DUF6). The component modules that make up the DUF6 management program differ substantially in operational maintenance, process-options, requirements for R and D, equipment, facilities, regulatory compliance, (O and M), and operations risk. To facilitate a consistent and equitable comparison of costs, the guidelines offer common definitions, assumptions or basis, and limitations integrated with a standard approach to the analysis. Further, the goal is to evaluate total net life-cycle costs and display them in a way that gives DOE the capability to evaluate a variety of overall DUF6 management strategies, including commercial potential. The cost estimates reflect the preconceptual level of the designs. They will be appropriate for distinguishing among management strategies

  8. Cost of radon-barrier systems for uranium mill tailings

    International Nuclear Information System (INIS)

    Baker, E.G.; Hartley, J.N.

    1982-08-01

    This report deals specifically with the cost of three types of radon barrier systems, earthen covers, asphalt emulsion covers, and multilayer covers, which could meet standards proposed by the Environmental Protection Agency to stabilize uranium mill tailings located primarily in the western US. In addition, the report includes a sensitivity analysis of various factors which significantly effect the overall cost of the three systems. These analyses were based on a generic disposal site. Four different 3m thick earthen covers were tested and cost an average of $27/m 2 . The least expensive earthen cover cost was about $21/m 2 . The asphalt cover system (6 to 7 cm of asphalt topped with 0.6m of overburden) cost about $28/m 2 . The four multilayer covers averaged $57/m 2 , but materials handling problems encountered during the test inflated this cost above what was anticipated and significant cost reductions should be possible. The least expensive multilayer cover cost $43/m 2 . Based on the results of the Grand Junction field test we estimated the cost of covering the tailings from three high priority sites, Durango, Shiprock, and Salt Lake City (Vitro). The cost of a 3m earthen cover ranged from $18 to 33/m 2 for the seven disposal sites (two or three at each location) studied. The cost of asphalt cover systems were $23 to 28/m 2 and the multilayer cover costs were between $31 to 36/m 2 . The earthen cover costs are less than the Grand Junction field test cost primarily because cover material is available at or near most of the disposal sites selected. Earthen material was imported from 6 to 10 miles for the field test. Assuming more efficienct utilization of materials significantly reduced the cost of the multilayer covers

  9. Gas–liquid chromatographic method for analysing complex mixtures of fatty acids including conjugated linoleic acids (cis9trans11 and trans10cis12 isomers) and long-chain (n-3 or n-6) polyunsaturated fatty acids: Application to the intramuscular fat of beef meat

    OpenAIRE

    Aldai, Noelia; Osoro, Koldo; Barrón, L.J. (L.); Nájera, A.I. (A.)

    2012-01-01

    The optimisation and validation of a gas–liquid chromatographic (GLC) method using direct saponification with KOH/methanol followed by a derivatization with (trimethylsilyl)diazomethane was carried out trying to overcome all the difficulties posed by the analysis of complex mixtures of fatty acids (FAs) in animal fat tissues. The presented method allowed sensitive, selective and simultaneous determination of a wide range of different FAs, including short-chain FAs, branched-chain FAs and conj...

  10. Cost comparisons

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    How much does the LHC cost? And how much does this represent in other currencies? Below we present a table showing some comparisons with the cost of other projects. Looking at the figures, you will see that the cost of the LHC can be likened to that of three skyscrapers, or two seasons of Formula 1 racing! One year's budget of a single large F1 team is comparable to the entire materials cost of the ATLAS or CMS experiments.   Please note that all the figures are rounded for ease of reading.    CHF € $   LHC 4.6 billions 3 billions  4 billions   Space Shuttle Endeavour (NASA) 1.9 billion 1.3 billion 1.7 billion   Hubble Space Telescope (cost at launch – NASA/...

  11. Does Coordinated Postpartum Care Influence Costs?

    Directory of Open Access Journals (Sweden)

    Elisabeth Zemp

    2017-03-01

    Full Text Available Questions under study: To investigate changes to health insurance costs for post-discharge postpartum care after the introduction of a midwife-led coordinated care model. Methods: The study included mothers and their newborns insured by the Helsana health insurance group in Switzerland and who delivered between January 2012 and May 2013 in the canton of Basel Stadt (BS (intervention canton. We compared monthly post-discharge costs before the launch of a coordinated postpartum care model (control phase, n = 144 to those after its introduction (intervention phase, n = 92. Costs in the intervention canton were also compared to those in five control cantons without a coordinated postpartum care model (cross-sectional control group: n = 7, 767. Results: The average monthly post-discharge costs for mothers remained unchanged in the seven months following the introduction of a coordinated postpartum care model, despite a higher use of midwife services (increasing from 72% to 80%. Likewise, monthly costs did not differ between the intervention canton and five control cantons. In multivariate analyses, the ambulatory costs for mothers were not associated with the post-intervention phase. Cross-sectionally, however, they were positively associated with midwifery use. For children, costs in the post-intervention phase were lower in the first month after hospital discharge compared to the pre-intervention phase (difference of –114 CHF [95%CI –202 CHF to –27 CHF], yet no differences were seen in the cross-sectional comparison. Conclusions: The introduction of a coordinated postpartum care model was associated with decreased costs for neonates in the first month after hospital discharge. Despite increased midwifery use, costs for mothers remained unchanged.

  12. [Pricing system for costly equipment. Cost allocation adapted to technical operating costs].

    Science.gov (United States)

    Alies-Patin, A

    1990-10-01

    1. Our study consists on analysing annual technical operating costs (excluding professional fees) of computed tomography and extracorporeal lithotripsy in order to define a pricing system able to provide proper reimbursements of technical costs for costly equipment. 2. Economic and utilization data have been collected from physicians responsible for facilities and from equipment current manufacturers. Annual charges are assessed in function of annual volume of procedures. 3. Definition of mean costs (total mean cost, mean cost of one more procedure) and mean cost distribution analysis according to annual volume of procedures lead to propose a method for financing costly technical medical activities based on a two-price rate: until a defined number of procedures is reached, a full-rate reimbursement is applied and then, it is replaced by a reduced-rate reimbursement. 4. Such a pricing system is easy to manage and allows to fit annual technical receipts to annual technical expenditure on a wide range of patient procedure volume.

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

    Directory of Open Access Journals (Sweden)

    Bunea-Bontaş Cristina Aurora

    2013-04-01

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

  14. [The cost of sepsis].

    Science.gov (United States)

    Moerer, O; Burchardi, H

    2006-06-01

    In recent years great efforts in clinical sepsis research have led to a better understanding of the underlying pathophysiology and new therapeutic approaches including drugs and supportive care. Despite this success, severe sepsis remains a serious health care problem. Each year approximately 75,000 patients in Germany and approximately 750,000 patients in the USA suffer from severe sepsis. The length of stay and the cost of laborious therapies lead to high intensive care unit (ICU) costs. Sepsis causes a significant national socioeconomic burden if indirect costs due to productivity loss are included and in Germany severe sepsis has been estimated to generate costs between 3.6 and 7.7 billion Euro annually. Thus, this complex and life-threatening disease has been identified as a high cost driver not only for the ICU, but also from the perspectives of hospitals and society. To improve the outcome of severe sepsis, innovative drugs and treatment strategies are urgently needed. Some drugs and strategies already offer promising results and will probably play a major role in the future. Even though their cost-effectiveness is likely, intensive care medicine has to carry a substantial economic burden. This article summarizes studies focusing on the evaluation of direct or indirect costs of sepsis and the cost-effectiveness of new therapies.

  15. Cost of illness in colorectal cancer: an international review.

    Science.gov (United States)

    Kriza, Christine; Emmert, Martin; Wahlster, Philip; Niederländer, Charlotte; Kolominsky-Rabas, Peter

    2013-07-01

    Given the current-and increasing-pressure to limit expenditure on health care provision in many countries, a better understanding of the cost burden of colorectal cancer is needed. Cost-of-illness studies and reviews thereof can be a useful tool for analysing and critically evaluating the cost-related development of colorectal cancer, and they highlight important cost drivers. A systematic review was conducted from 2002 to 2012 to identify cost-of-illness studies related to colorectal cancer, searching the Medline, PubMed, Science Direct, Cochrane Library and the York CRD databases. Among the 10 studies (from France, the US, Ireland and Taiwan) included in the review, 6 studies reported prevalence-based estimates and 4 studies focussed on incidence-based data. In the studies included in the review, long-term costs for colorectal cancer of up to $50,175 per patient (2008 values) were estimated. Most of the studies in the review showed that the initial and terminal phases of colorectal cancer care are the most expensive, with continuing treatment being the least costly phase. One study also highlighted that stage I CRC disease was the least costly and stage III the most costly of all 4 stages, due to the high cost impact of biological agents. This review has highlighted a trend for rising costs associated with CRC, which is linked to the increasing use of targeted biological therapies. COI studies in colorectal cancer can identify specific components and areas of care that are especially costly, thereby focussing attention on more cost-effective approaches, which is especially relevant to the increased use of biological agents in the field of personalised medicine. COI studies are an important tool for further health economic evaluations of personalised medicine.

  16. Avoidable waste management costs

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.

    1995-01-01

    This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP.

  17. Avoidable waste management costs

    International Nuclear Information System (INIS)

    Hsu, K.; Burns, M.; Priebe, S.; Robinson, P.

    1995-01-01

    This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP

  18. An Analysis of Rocket Propulsion Testing Costs

    Science.gov (United States)

    Ramirez-Pagan, Carmen P.; Rahman, Shamim A.

    2009-01-01

    The primary mission at NASA Stennis Space Center (SSC) is rocket propulsion testing. Such testing is generally performed within two arenas: (1) Production testing for certification and acceptance, and (2) Developmental testing for prototype or experimental purposes. The customer base consists of NASA programs, DOD programs, and commercial programs. Resources in place to perform on-site testing include both civil servants and contractor personnel, hardware and software including data acquisition and control, and 6 test stands with a total of 14 test positions/cells. For several business reasons there is the need to augment understanding of the test costs for all the various types of test campaigns. Historical propulsion test data was evaluated and analyzed in many different ways with the intent to find any correlation or statistics that could help produce more reliable and accurate cost estimates and projections. The analytical efforts included timeline trends, statistical curve fitting, average cost per test, cost per test second, test cost timeline, and test cost envelopes. Further, the analytical effort includes examining the test cost from the perspective of thrust level and test article characteristics. Some of the analytical approaches did not produce evidence strong enough for further analysis. Some other analytical approaches yield promising results and are candidates for further development and focused study. Information was organized for into its elements: a Project Profile, Test Cost Timeline, and Cost Envelope. The Project Profile is a snap shot of the project life cycle on a timeline fashion, which includes various statistical analyses. The Test Cost Timeline shows the cumulative average test cost, for each project, at each month where there was test activity. The Test Cost Envelope shows a range of cost for a given number of test(s). The supporting information upon which this study was performed came from diverse sources and thus it was necessary to

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

    Science.gov (United States)

    Lääperi, A L

    1996-01-01

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

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

    African Journals Online (AJOL)

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

  1. Periodic safety analyses

    International Nuclear Information System (INIS)

    Gouffon, A.; Zermizoglou, R.

    1990-12-01

    The IAEA Safety Guide 50-SG-S8 devoted to 'Safety Aspects of Foundations of Nuclear Power Plants' indicates that operator of a NPP should establish a program for inspection of safe operation during construction, start-up and service life of the plant for obtaining data needed for estimating the life time of structures and components. At the same time the program should ensure that the safety margins are appropriate. Periodic safety analysis are an important part of the safety inspection program. Periodic safety reports is a method for testing the whole system or a part of the safety system following the precise criteria. Periodic safety analyses are not meant for qualification of the plant components. Separate analyses are devoted to: start-up, qualification of components and materials, and aging. All these analyses are described in this presentation. The last chapter describes the experience obtained for PWR-900 and PWR-1300 units from 1986-1989

  2. Cost variation in diabetes care delivered in English hospitals

    DEFF Research Database (Denmark)

    Kristensen, Troels

    2009-01-01

    the hospital fixed effect and adjust for hospital characteristics such as number of patients treated, factor prices and number of specialties involved in diabetes care. We rank hospitals by their adjusted fixed effect, which measures the extent to which their costs vary from the average after controlling...... for patient and hospital characteristics. We conduct sensitivity analysis to alternative specifications including different sets of covariates and subsamples. Data: We use Hospital Episode Statistics and reference costs for all patients admitted to diabetes care for all English hospitals for the financial......Background: Many diabetic patients are admitted to hospital, where care is costly and where there may be scope to improve efficiency. Aims: We analyse the costs and characteristics of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained...

  3. Contesting Citizenship: Comparative Analyses

    DEFF Research Database (Denmark)

    Siim, Birte; Squires, Judith

    2007-01-01

    importance of particularized experiences and multiple ineequality agendas). These developments shape the way citizenship is both practiced and analysed. Mapping neat citizenship modles onto distinct nation-states and evaluating these in relation to formal equality is no longer an adequate approach....... Comparative citizenship analyses need to be considered in relation to multipleinequalities and their intersections and to multiple governance and trans-national organisinf. This, in turn, suggests that comparative citizenship analysis needs to consider new spaces in which struggles for equal citizenship occur...

  4. Military construction program economic analysis manual: Sample economic analyses: Hazardous Waste Remedial Actions Program

    International Nuclear Information System (INIS)

    1987-12-01

    This manual enables the US Air Force to comprehensively and systematically analyze alternative approaches to meeting its military construction requirements. The manual includes step-by-step procedures for completing economic analyses for military construction projects, beginning with determining if an analysis is necessary. Instructions and a checklist of the tasks involved for each step are provided; and examples of calculations and illustrations of completed forms are included. The manual explains the major tasks of an economic analysis, including identifying the problem, selecting realistic alternatives for solving it, formulating appropriate assumptions, determining the costs and benefits of the alternatives, comparing the alternatives, testing the sensitivity of major uncertainties, and ranking the alternatives. Appendixes are included that contain data, indexes, and worksheets to aid in performing the economic analyses. For reference, Volume 2 contains sample economic analyses that illustrate how each form is filled out and that include a complete example of the documentation required

  5. U.S. Department of Energy Hydrogen Storage Cost Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Law, Karen; Rosenfeld, Jeffrey; Han, Vickie; Chan, Michael; Chiang, Helena; Leonard, Jon

    2013-03-11

    The overall objective of this project is to conduct cost analyses and estimate costs for on- and off-board hydrogen storage technologies under development by the U.S. Department of Energy (DOE) on a consistent, independent basis. This can help guide DOE and stakeholders toward the most-promising research, development and commercialization pathways for hydrogen-fueled vehicles. A specific focus of the project is to estimate hydrogen storage system cost in high-volume production scenarios relative to the DOE target that was in place when this cost analysis was initiated. This report and its results reflect work conducted by TIAX between 2004 and 2012, including recent refinements and updates. The report provides a system-level evaluation of costs and performance for four broad categories of on-board hydrogen storage: (1) reversible on-board metal hydrides (e.g., magnesium hydride, sodium alanate); (2) regenerable off-board chemical hydrogen storage materials(e.g., hydrolysis of sodium borohydride, ammonia borane); (3) high surface area sorbents (e.g., carbon-based materials); and 4) advanced physical storage (e.g., 700-bar compressed, cryo-compressed and liquid hydrogen). Additionally, the off-board efficiency and processing costs of several hydrogen storage systems were evaluated and reported, including: (1) liquid carrier, (2) sodium borohydride, (3) ammonia borane, and (4) magnesium hydride. TIAX applied a bottom-up costing methodology customized to analyze and quantify the processes used in the manufacture of hydrogen storage systems. This methodology, used in conjunction with ® software and other tools, developed costs for all major tank components, balance-of-tank, tank assembly, and system assembly. Based on this methodology, the figure below shows the projected on-board high-volume factory costs of the various analyzed hydrogen storage systems, as designed. Reductions in the key cost drivers may bring hydrogen storage system costs closer to this DOE target

  6. The effects of patient cost sharing on inpatient utilization, cost, and outcome.

    Directory of Open Access Journals (Sweden)

    Yuan Xu

    Full Text Available Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR data in China provides us a unique opportunity to study this topic.Four years (2010 to 2014 of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses.After risk adjustment, patients with more generous health insurance coverage (higher RR were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed.Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.

  7. Hidden costs of low-cost screening mammography

    International Nuclear Information System (INIS)

    Cyrlak, D.

    1987-01-01

    Twenty-two hundred women in Orange County, California, took part in a low-cost mammography screening project sponsored by the American Cancer Society and the KCBS-TV. Patients were followed up by telephone and questioned about actual costs incurred as a result of screening mammography, including costs of repeated and follow-up mammograms, US examinations and surgical consultations. The total number of biopsies, cancers found, and the costs involved were investigated. The authors' results suggest that particularly in centers with a high positive call rate, the cost of screening mammograms accounts for only a small proportion of the medical costs

  8. Dialogisk kommunikationsteoretisk analyse

    DEFF Research Database (Denmark)

    Phillips, Louise Jane

    2018-01-01

    analysemetode, der er blevet udviklet inden for dialogisk kommunikationsforskning - The Integrated Framework for Analysing Dialogic Knowledge Production and Communication (IFADIA). IFADIA-metoden bygger på en kombination af Bakhtins dialogteori og Foucaults teori om magt/viden og diskurs. Metoden er beregnet...

  9. Probabilistic safety analyses (PSA)

    International Nuclear Information System (INIS)

    1997-01-01

    The guide shows how the probabilistic safety analyses (PSA) are used in the design, construction and operation of light water reactor plants in order for their part to ensure that the safety of the plant is good enough in all plant operational states

  10. Meta-analyses

    NARCIS (Netherlands)

    Hendriks, Maria A.; Luyten, Johannes W.; Scheerens, Jaap; Sleegers, P.J.C.; Scheerens, J

    2014-01-01

    In this chapter results of a research synthesis and quantitative meta-analyses of three facets of time effects in education are presented, namely time at school during regular lesson hours, homework, and extended learning time. The number of studies for these three facets of time that could be used

  11. Analysing Access Control Specifications

    DEFF Research Database (Denmark)

    Probst, Christian W.; Hansen, René Rydhof

    2009-01-01

    . Recent events have revealed intimate knowledge of surveillance and control systems on the side of the attacker, making it often impossible to deduce the identity of an inside attacker from logged data. In this work we present an approach that analyses the access control configuration to identify the set...

  12. Wavelet Analyses and Applications

    Science.gov (United States)

    Bordeianu, Cristian C.; Landau, Rubin H.; Paez, Manuel J.

    2009-01-01

    It is shown how a modern extension of Fourier analysis known as wavelet analysis is applied to signals containing multiscale information. First, a continuous wavelet transform is used to analyse the spectrum of a nonstationary signal (one whose form changes in time). The spectral analysis of such a signal gives the strength of the signal in each…

  13. Filmstil - teori og analyse

    DEFF Research Database (Denmark)

    Hansen, Lennard Højbjerg

    Filmstil påvirker på afgørende vis vores oplevelse af film. Men filmstil, måden, de levende billeder organiserer fortællingen på fylder noget mindre end filmens handling, når vi taler om film. Filmstil - teori og analyse er en rigt eksemplificeret præsentation, kritik og videreudvikling af...

  14. Risico-analyse brandstofpontons

    NARCIS (Netherlands)

    Uijt de Haag P; Post J; LSO

    2001-01-01

    Voor het bepalen van de risico's van brandstofpontons in een jachthaven is een generieke risico-analyse uitgevoerd. Er is een referentiesysteem gedefinieerd, bestaande uit een betonnen brandstofponton met een relatief grote inhoud en doorzet. Aangenomen is dat de ponton gelegen is in een

  15. Minimizing Costs Can Be Costly

    Directory of Open Access Journals (Sweden)

    Rasmus Rasmussen

    2010-01-01

    Full Text Available A quite common practice, even in academic literature, is to simplify a decision problem and model it as a cost-minimizing problem. In fact, some type of models has been standardized to minimization problems, like Quadratic Assignment Problems (QAPs, where a maximization formulation would be treated as a “generalized” QAP and not solvable by many of the specially designed softwares for QAP. Ignoring revenues when modeling a decision problem works only if costs can be separated from the decisions influencing revenues. More often than we think this is not the case, and minimizing costs will not lead to maximized profit. This will be demonstrated using spreadsheets to solve a small example. The example is also used to demonstrate other pitfalls in network models: the inability to generally balance the problem or allocate costs in advance, and the tendency to anticipate a specific type of solution and thereby make constraints too limiting when formulating the problem.

  16. Electric power monthly, September 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-17

    The purpose of this report is to provide energy decision makers with accurate and timely information that may be used in forming various perspectives on electric issues. The power plants considered include coal, petroleum, natural gas, hydroelectric, and nuclear power plants. Data are presented for power generation, fuel consumption, fuel receipts and cost, sales of electricity, and unusual occurrences at power plants. Data are compared at the national, Census division, and state levels. 4 figs., 52 tabs. (CK)

  17. Costs of diabetes and its complications in Poland.

    Science.gov (United States)

    Leśniowska, Joanna; Schubert, Agata; Wojna, Michał; Skrzekowska-Baran, Iwona; Fedyna, Marta

    2014-07-01

    Diabetes mellitus (DM) is a major health problem with severe complications and a significant impact on quality of life. It constitutes an enormous burden of disease due to high prevalence, severe co-morbidities and high costs for society. This study is the first comprehensive study on the direct and indirect costs of DM (type 1 and type 2) and associated complications in Poland. In order to estimate the direct medical costs of DM and its complications, including the costs of medical consultation, hospitalisation, rehabilitation, drugs and medical equipment, data from the National Health Fund were used. Indirect costs on loss of productivity due to diabetes and its complications were based on data obtained from the ZUS (Social Insurance Institution) and from GUS (Poland's Central Statistical Office). Attributable risk methodology was used to assess the burden of DM complications. A continuous increase of the direct costs of diabetes has been observed since the year 2005. In the analysed time period (2005-2009) the direct costs of medical services for both types of DM doubled. DM is a cause of significant sickness absence and incapacity for work and therefore is associated with a growing productivity decline in Poland. The highest direct costs and indirect costs are associated with treatment of diabetes-related complications. Direct costs of hospital complication treatment were EUR 332 million, which exceeded by more than five times the direct costs of hospital treatment of diabetes per se, which in the same year amounted to EUR 58.5 million. The indirect costs of diabetes-related complications were higher by 41% compared with indirect costs related to DM itself. Total costs of health care services for DM and its complications amounted to EUR 654 million, which constitutes a 2.8% of total health care costs in Poland. Total DM cost in Poland in 2009 amounted EURO 1.5 billion. DM is causing a growing economic burden on the health care system and on Polish society in

  18. Technology, safety and costs of decommissioning a reference small mixed oxide fuel fabrication plant. Volume 1. Main report

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, C. E.; Murphy, E. S.; Schneider, K J

    1979-01-01

    Detailed technology, safety and cost information are presented for the conceptual decommissioning of a reference small mixed oxide fuel fabrication plant. Alternate methods of decommissioning are described including immediate dismantlement, safe storage for a period of time followed by dismantlement and entombment. Safety analyses, both occupational and public, and cost evaluations were conducted for each mode.

  19. Workers' marginal costs of commuting

    DEFF Research Database (Denmark)

    van Ommeren, Jos; Fosgerau, Mogens

    2009-01-01

    This paper applies a dynamic search model to estimate workers' marginal costs of commuting, including monetary and time costs. Using data on workers' job search activity as well as moving behaviour, for the Netherlands, we provide evidence that, on average, workers' marginal costs of one hour...

  20. Hydrogen Station Cost Estimates: Comparing Hydrogen Station Cost Calculator Results with other Recent Estimates

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Penev, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-09-01

    This report compares hydrogen station cost estimates conveyed by expert stakeholders through the Hydrogen Station Cost Calculation (HSCC) to a select number of other cost estimates. These other cost estimates include projections based upon cost models and costs associated with recently funded stations.

  1. Quality assessment of published health economic analyses from South America.

    Science.gov (United States)

    Machado, Márcio; Iskedjian, Michael; Einarson, Thomas R

    2006-05-01

    Health economic analyses have become important to healthcare systems worldwide. No studies have previously examined South America's contribution in this area. To survey the literature with the purpose of reviewing, quantifying, and assessing the quality of published South American health economic analyses. A search of MEDLINE (1990-December 2004), EMBASE (1990-December 2004), International Pharmaceutical Abstracts (1990-December 2004), Literatura Latino-Americana e do Caribe em Ciências da Saúde (1982-December 2004), and Sistema de Informacion Esencial en Terapéutica y Salud (1980-December 2004) was completed using the key words cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-minimization analysis (CMA), and cost-benefit analysis (CBA); abbreviations CEA, CUA, CMA, and CBA; and all South American country names. Papers were categorized by type and country by 2 independent reviewers. Quality was assessed using a 12 item checklist, characterizing scores as 4 (good), 3 (acceptable), 2 (poor), 1 (unable to judge), and 0 (unacceptable). To be included in our investigation, studies needed to have simultaneously examined costs and outcomes. We retrieved 25 articles; one duplicate article was rejected, leaving 24 (CEA = 15, CBA = 6, CMA = 3; Brazil = 9, Argentina = 5, Colombia = 3, Chile = 2, Ecuador = 2, 1 each from Peru, Uruguay, Venezuela). Variability between raters was less than 0.5 point on overall scores (OS) and less than 1 point on all individual items. Mean OS was 2.6 (SD 1.0, range 1.4-3.8). CBAs scored highest (OS 2.8, SD 0.8), CEAs next (OS 2.7, SD 0.7), and CMAs lowest (OS 2.0, SD 0.5). When scored by type of question, definition of study aim scored highest (OS 3.0, SD 0.8), while ethical issues scored lowest (OS 1.5, SD 0.9). By country, Peru scored highest (mean OS 3.8) and Uruguay had the lowest scores (mean OS 2.2). A nonsignificant time trend was noted for OS (R2 = 0.12; p = 0.104). Quality scores of health economic analyses

  2. On the transition to sustainability: an analysis of the costs of school feeding compared with the costs of primary education.

    Science.gov (United States)

    Bundy, Donald; Burbano, Carmen; Gelli, Aulo; Risley, Claire; Neeser, Kristie

    2011-09-01

    The current food, fuel, and financial crises have highlighted the importance of school feeding programs both as a social safety net for children living in poverty and food insecurity, and as part of national educational policies and plans. To examine the costs of school feeding, in terms of both the absolute cost per child and the cost per child relative to overall education expenditure and gross domestic product (GDP) in low-, middle-, and high-income countries. Data on the costs of school feeding in different countries were collected from multiple sources, including World Food Programme project data, reports from government ministries, and, where such searches failed, newspaper articles and other literature obtained from internet searches. Regression models were then used to analyze the relationships between school feeding costs, the per capita costs of primary education and GDP per capita. School feeding programs in low-income countries exhibit large variations in cost, with concomitant opportunities for cost containment. As countries get richer, however, school feeding costs become a much smaller proportion of the investment in education. The per capita costs of feeding relative to education decline nonlinearly with increasing GDP. These analyses suggest that the main reason for this decline in the relative cost of school feeding versus primary education is a greatly increased investment per child in primary education as GDP rises, but a fairly flat investment in food. The analyses also show that there appears to be a transitional discontinuity at the interface between the lower- and middle-income countries, which tends to coincide with changes in the capacity of governments to take over the management and funding of programs. Further analysis is required to define these relationships, but an initial conclusion is that supporting countries to maintain an investment in school feeding through this transition may emerge as a key role for development partners.

  3. Distribution costs -- the cost of local delivery

    International Nuclear Information System (INIS)

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

    2000-01-01

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

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

    Directory of Open Access Journals (Sweden)

    F. Beichelt

    2014-01-01

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

  5. Digital vs conventional radiography: cost and revenue analysis

    International Nuclear Information System (INIS)

    Dalla Palma, L.; Cuttin, R.; Rimondini, A.; Grisi, G.

    1999-01-01

    The objective of this study was to analyse and compare the operating and investment costs of two radiographic systems, a conventional and a digital one, and to evaluate the cost/revenue ratio of the two systems. The radiological activity over 1 year for chest and skeletal exams was evaluated: 13,401 chest and 7,124 skeletal exams were considered. The following parameters of variable costs were evaluated: the difference between variable proportional costs of the two technologies, the effective variable cost of any size film, including the chemicals, and for different sizes of digital film, variable costs of chest plus skeletal exams performed with the two techniques. Afterwards the economical effect was considered taking into account depreciation during a time of utilization ranging between 8 and 4 years. In the second part of the analysis the total cost and the revenues of the two technologies were determined. The comparison between the digital and conventional systems has shown the following aspects: 1. Digital radiography system has a much higher investment cost in comparison with the conventional one. 2. Operating costs of digital equipment are higher or lower depending on the film size used. Evaluating chest X-ray we reach a breakeven point after 1 year and 10,000 exams only if displayed over 8 x 10-in. film and after 30,000 if displayed over a 11 x 14-in. film. 3. The total cost (variable cost, technology cost, labour cost) of digital technology is lower than that of the conventional system by 20 % on average using 8 x 10-in. film size. 4. Digital technology also allows lesser film waste and lesser film per exam (orig.)

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

    Science.gov (United States)

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

    2010-12-14

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

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

    Directory of Open Access Journals (Sweden)

    Jochen Profit

    2010-12-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  9. 45 CFR 602.22 - Allowable costs.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Allowable costs. 602.22 Section 602.22 Public... Requirements § 602.22 Allowable costs. (a) Limitation on use of funds. Grant funds may be used only for: (1) The allowable costs of the grantees, subgrantees and cost-type contractors, including allowable costs...

  10. 40 CFR 791.50 - Costs.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Costs. 791.50 Section 791.50 Protection...) DATA REIMBURSEMENT Basis for Proposed Order § 791.50 Costs. (a) All costs reasonable and necessary to... tests, are eligible for reimbursement. Necessary costs include: (1) Direct and indirect costs of...

  11. 49 CFR 266.11 - Allowable costs.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Allowable costs. 266.11 Section 266.11... TRANSPORTATION ACT § 266.11 Allowable costs. Allowable costs include only the following costs which are properly allocable to the work performed: Planning and program operation costs which are allowed under Federal...

  12. Investigations into the Nature of Halogen Bonding Including Symmetry Adapted Perturbation Theory Analyses

    Czech Academy of Sciences Publication Activity Database

    Riley, Kevin Eugene; Hobza, Pavel

    2008-01-01

    Roč. 4, č. 2 (2008), s. 232-242 ISSN 1549-9618 R&D Projects: GA MŠk LC512; GA AV ČR IAA400550510 Institutional research plan: CEZ:AV0Z40550506 Keywords : halogen bonding * SAPT * molecular complexes Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 4.274, year: 2008

  13. Hemoglobin analyses in the Netherlands reveal more than 80 different variants including six novel ones.

    Science.gov (United States)

    van Zwieten, Rob; Veldthuis, Martijn; Delzenne, Barend; Berghuis, Jeffrey; Groen, Joke; Ait Ichou, Fatima; Clifford, Els; Harteveld, Cornelis L; Stroobants, An K

    2014-01-01

    More than 20,000 blood samples of individuals living in The Netherlands and suspected of hemolytic anemia or diabetes were analyzed by high resolution cation exchange high performance liquid chromatography (HPLC). Besides common disease-related hemoglobins (Hbs), rare variants were also detected. The variant Hbs were retrospectively analyzed by capillary zone electrophoresis (CZE) and by isoelectric focusing (IEF). For unambiguous identification, the globin genes were sequenced. Most of the 80 Hb variants detected by initial screening on HPLC were also separated by capillary electrophoresis (CE), but a few variants were only detectable with one of these methods. Some variants were unstable, had thalassemic properties or increased oxygen affinity, and some interfered with Hb A2 measurement, detection of sickle cell Hb or Hb A1c quantification. Two of the six novel variants, Hb Enschede (HBA2: c.308G  > A, p.Ser103Asn) and Hb Weesp (HBA1: c.301C > T, p.Leu101Phe), had no clinical consequences. In contrast, two others appeared clinically significant: Hb Ede (HBB: c.53A > T, p.Lys18Met) caused thalassemia and Hb Waterland (HBB: c.428C > T, pAla143Val) was related to mild polycytemia. Hb A2-Venlo (HBD: c.193G > A, p.Gly65Ser) and Hb A2-Rotterdam (HBD: c.38A > C, p.Asn13Thr) interfered with Hb A2 quantification. This survey shows that HPLC analysis followed by globin gene sequencing of rare variants is an effective method to reveal Hb variants.

  14. Electric Power Monthly, August 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-29

    The Electric Power Monthly (EPM) presents monthly summaries of electric utility statistics at the national, Census division, and State level. The purpose of this publication is to provide energy decisionmakers with accurate and timely information that may be used in forming various perspectives on electric issues that lie ahead. Data includes generation by energy source (coal, oil, gas, hydroelectric, and nuclear); generation by region; consumption of fossil fuels for power generation; sales of electric power, cost data; and unusual occurrences. A glossary is included.

  15. Nuclear power generation cost methodology

    International Nuclear Information System (INIS)

    Delene, J.G.; Bowers, H.I.

    1980-08-01

    A simplified calculational procedure for the estimation of nuclear power generation cost is outlined. The report contains a discussion of the various components of power generation cost and basic equations for calculating that cost. An example calculation is given. The basis of the fixed-charge rate, the derivation of the levelized fuel cycle cost equation, and the heavy water charge rate are included as appendixes

  16. Patient cost-sharing for ambulatory neuropsychiatric services in Abu Dhabi, UAE.

    Science.gov (United States)

    Hamidi, Samer; Abouallaban, Yousef; Alhamad, Sultan; Meirambayeva, Aizhan

    2016-01-01

    Neuropsychiatric disorders are of high concern and burden of disease in the United Arab Emirates (UAE). The aim of this study is to describe patient cost-sharing patterns, insurance coverage of ambulatory neuropsychiatric disorders, and utilization of neuropsychiatric services in Abu Dhabi. The study utilized the data published by Health Authority-Abu Dhabi (HAAD) and the American Center for Psychiatry and Neurology (ACPN) records in Abu Dhabi. The data were collected from the ACPN to describe patterns of insurance coverage and patient cost-sharing. The data included information on patient visits to the ACPN from January 1, 2010 till May 16, 2013. The data also included insurance coverage, total cost of treatment for each patient and the amount of coinsurances and deductibles paid by each patient. Additionally, the study utilized data published by HAAD on health services utilization, and health insurance plans in 2014. The percentage of total costs paid by patients and insurance were calculated by insurance groups and health service. Insurance plans with different patient cost-sharing arrangements for mental health treatment benefits were divided into three groups. ANOVA and MANOVA analyses were performed to test for differences among three categories of neuropsychiatric services (neurology, psychiatry and psychotherapy) in terms of the total costs and patient cost-sharing. The data were analysed using STATA version 12. About 36 % of the total costs on ambulatory neuropsychiatric services was paid directly by patients; 1 % of total costs was covered by patients as co-insurances and deductibles, and 63 % of total costs was covered by insurance providers. The average cost per visit was about 485 AED ($132), including 304 AED ($83) paid by insurance and 181 AED ($49) paid by patient. About 44 % of total costs was related to psychiatry services, 28 % of total costs was related to neurology services, and 28 % of total costs was related to psychotherapy services

  17. AMS analyses at ANSTO

    International Nuclear Information System (INIS)

    Lawson, E.M.

    1998-01-01

    The major use of ANTARES is Accelerator Mass Spectrometry (AMS) with 14 C being the most commonly analysed radioisotope - presently about 35 % of the available beam time on ANTARES is used for 14 C measurements. The accelerator measurements are supported by, and dependent on, a strong sample preparation section. The ANTARES AMS facility supports a wide range of investigations into fields such as global climate change, ice cores, oceanography, dendrochronology, anthropology, and classical and Australian archaeology. Described here are some examples of the ways in which AMS has been applied to support research into the archaeology, prehistory and culture of this continent's indigenous Aboriginal peoples. (author)

  18. Systematization of Cost Factors for Cost Management at Industrial Enterprises

    Directory of Open Access Journals (Sweden)

    N. Y.

    2017-12-01

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

  19. Supporting analyses and assessments

    Energy Technology Data Exchange (ETDEWEB)

    Ohi, J. [National Renewable Energy Lab., Golden, CO (United States)

    1995-09-01

    Supporting analysis and assessments can provide a sound analytic foundation and focus for program planning, evaluation, and coordination, particularly if issues of hydrogen production, distribution, storage, safety, and infrastructure can be analyzed in a comprehensive and systematic manner. The overall purpose of this activity is to coordinate all key analytic tasks-such as technology and market status, opportunities, and trends; environmental costs and benefits; and regulatory constraints and opportunities-within a long-term and systematic analytic foundation for program planning and evaluation. Within this context, the purpose of the project is to help develop and evaluate programmatic pathway options that incorporate near and mid-term strategies to achieve the long-term goals of the Hydrogen Program. In FY 95, NREL will develop a comprehensive effort with industry, state and local agencies, and other federal agencies to identify and evaluate programmatic pathway options to achieve the long-term goals of the Program. Activity to date is reported.

  20. General presentation including new structure

    Science.gov (United States)

    Soons, A.

    2002-12-01

    Electrical, electronic and electro-mechanical components play an essential role in the functional performance, quality, life cycle and costs of space systems. Their standardisation, product specification, development, evaluation, qualification and procurement must be based on a coherent and efficient approach, paying due attention to present and prospective European space policies and must be commensurate with user needs, market developments and technology trends. The European Space Components Coordination (ESCC) is established with the objective of harmonising the efforts concerning the various aspects of EEE space components by ESA. European national and international public space organisations, the component manufacturers and the user industries. The goal of the ESCC is to improve the availability of strategic EEE space components with the required performance and at affordable costs for institutional and commercial space programmes. It is the objective of ESCC to achieve this goal by harmonising the resources and development efforts for space components in the ESA Member States and by providing a single and unified system for the standardisation, product specification, evaluation, qualification and procurement of European EEE space components and for the certification of components and component manufacturers.

  1. Register-based studies of healthcare costs

    DEFF Research Database (Denmark)

    Kruse, Marie; Christiansen, Terkel

    2011-01-01

    Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided...... into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders...... a comprehensive data material, often in the form of time series, which is very useful in health economic analyses. The disadvantage of register-based data is the use of tariffs, charges, or market prices as proxies for costs in the computation of healthcare costs....

  2. Projected costs of generating electricity - 2010 edition

    International Nuclear Information System (INIS)

    2010-01-01

    This joint report by the International Energy Agency (IEA) and the OECD Nuclear Energy Agency (NEA) is the seventh in a series of studies on electricity generating costs. It presents the latest data available for a wide variety of fuels and technologies, including coal and gas (with and without carbon capture), nuclear, hydro, onshore and offshore wind, biomass, solar, wave and tidal as well as combined heat and power (CHP). It provides levelised costs of electricity (LCOE) per MWh for almost 200 plants, based on data covering 21 countries (including four major non-OECD countries), and several industrial companies and organisations. For the first time, the report contains an extensive sensitivity analysis of the impact of variations in key parameters such as discount rates, fuel prices and carbon costs on LCOE. Additional issues affecting power generation choices are also examined. The study shows that the cost competitiveness of electricity generating technologies depends on a number of factors which may vary nationally and regionally. Readers will find full details and analyses, supported by over 130 figures and tables, in this report which is expected to constitute a valuable tool for decision makers and researchers concerned with energy policies and climate change

  3. Cost restructuring

    International Nuclear Information System (INIS)

    Schmidt, J.A.

    1991-01-01

    This paper reports on the cost restructuring of the petroleum industry. This current decade is likely to be one of the most challenging for the petroleum industry. Though petroleum remains among the world's biggest businesses, news of consolidations, restructuring, and layoffs permeates the oil patch from the Gulf of Mexico to the Arctic Isles. The recessionary economy has accelerated these changes, particularly in the upstream sector. Today, even the best-managed companies are transforming their cost structures, and companies that fail to do likewise probably won't survive as independent companies. Indeed, significant consolidation took place during the 1980s. More consolidations can be expected in this decade for companies that do not adapt to the economic realities of the mature business

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

    Directory of Open Access Journals (Sweden)

    Peter J Neumann

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

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Cost-Based Decision in Public Sector

    Directory of Open Access Journals (Sweden)

    Carmen Cretu

    2011-10-01

    Full Text Available Management decision must be based on relevant costs (costs that allow for the best measures for business management, recognized by their forecasting characteristics which records hidden or opportunity costs, social costs and outsourced costs. Correctly predicted a profit is to build costs for possible revenue. The cost is a sacrifice, resource consumption. Because decisions aimed at future activities, the management calls in this respect, detailed information on future costs, some of which are not included in accounting data collection system. The power of decision maker on costs is therefore limited.d

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

    Directory of Open Access Journals (Sweden)

    Jensen Lotte

    2008-11-01

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

  8. Analyse af elbilers forbrug

    DEFF Research Database (Denmark)

    Andersen, Ove; Krogh, Benjamin Bjerre; Torp, Kristian

    2014-01-01

    Denne rapport undersøger GPS og CAN bus datagrundlaget opsamlet ved kørsel med elbiler og analysere på elbilers forbrug. Analyserne er baseret på godt 133 millioner GPS og CAN bus målinger opsamlet fra 164 elbiler (Citroen C-Zero, Mitsubishi iMiev og Peugeot Ion) i kalenderåret 2012....... For datagrundlaget kan det konstateres, at der er behov for væsentlige, men simple opstramninger for fremadrettet at gøre det nemmere at anvende GPS/CAN bus data fra elbiler i andre analyser. Brugen af elbiler er sammenlignet med brændstofbiler og konklusionen er, at elbiler generelt kører 10-15 km/t langsommere på...

  9. Analyse de "La banlieue"

    Directory of Open Access Journals (Sweden)

    Nelly Morais

    2006-11-01

    Full Text Available 1. Préambule - Conditions de réalisation de la présente analyse Un groupe d'étudiants de master 1 de FLE de l'université Paris 3 (donc des étudiants en didactique des langues se destinant à l'enseignement du FLE a observé le produit au cours d'un module sur les TIC (Technologies de l'Information et de la Communication et la didactique des langues. Une discussion s'est ensuite engagée sur le forum d'une plate-forme de formation à distance à partir de quelques questions posées par l'enseigna...

  10. Analysing health outcomes.

    Science.gov (United States)

    Dowie, J

    2001-08-01

    If we cross-classify the absolutist-consequentialist distinction with an intuitive-analytical one we can see that economists probably attract the hostility of those in the other three cells as a result of being analytical consequentialists, as much as because of their concern with "costs". Suggesting that some sources of utility (either "outcome" or "process" in origin) are to be regarded as rights cannot, says the analytical consequentialist, overcome the fact that fulfilling and respecting rights is a resource-consuming activity, one that will inevitably have consequences, in resource-constrained situations, for the fulfillment of the rights of others. Within the analytical consequentialist framework QALY-type measures of health outcome have the unique advantage of allowing technical and allocative efficiency to be addressed simultaneously, while differential weighting of QALYs accruing to different groups means that efficiency and equity can be merged into the necessary single maximand. But what if such key concepts of the analytical consequentialist are not part of the discursive equipment of others? Are they to be disqualified from using them on this ground? Is it ethical for intuition to be privileged in ethical discourse, or is the analyst entitled to "equal opportunities" in the face of "analysisism", the cognitive equivalent of "racism" and "sexism"?

  11. Acute mental health care according to recent mental health legislation Part II. Activity-based costing.

    Science.gov (United States)

    Janse van Rensburg, A B; Jassat, W

    2011-03-01

    This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services, staff salaries) and variable recurrent costs (including laboratory' 'pharmacy') were calculated. Cost per day, per user and per diagnostic group was calculated. While the unit accounted for 4.6% of the hospital's total clinical activity (patient days), the cost of R8.12 million incurred represented only 2.4% of the total hospital expenditure (R341.36 million). Fixed costs constituted 90% of the total cost. For the total number of 520 users that stayed on average 15.4 days, the average cost was R1,023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35%) of the cost, while the care of users with dementia was the most expensive (R23,360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit, projected an average increase of 103% in recurrent costs (R5.1 million), with the bulk (a 267% increase) for nursing. In the absence of other guidelines, aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC, its continued application will require time, infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres.

  12. Cost/Benefit Prioritization for Advanced Safeguards Research and Development

    International Nuclear Information System (INIS)

    DeMuth, S.F.; Adeli, R.; Thomas, K.E.

    2008-01-01

    A system level study utilizing commercially available Extend TM software, has been initiated to perform cost/benefit analyses for advanced safeguards research and development. The methodology is focused on estimating standard error in the inventory difference (SEID) for reprocessing and fuel fabrication facilities, for various proposed advanced safeguards measurement technologies. The inventory duration, and consequent number of inventories per year, is dictated by the detection of a significant quantity of special nuclear material (SNM). Detection is limited by the cumulative measurement uncertainty for the entire system. The cost of inventories is then compared with the cost of advanced instrumentation and/or process design changes. Current progress includes development of the methodology, future efforts will be focused on ascertaining estimated costs and performance. Case studies will be provided as examples of the methodology. (author)

  13. Recommendations for Methicillin-Resistant Staphylococcus aureus Prevention in Adult ICUs: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Whittington, Melanie D; Atherly, Adam J; Curtis, Donna J; Lindrooth, Richard C; Bradley, Cathy J; Campbell, Jonathan D

    2017-08-01

    Patients in the ICU are at the greatest risk of contracting healthcare-associated infections like methicillin-resistant Staphylococcus aureus. This study calculates the cost-effectiveness of methicillin-resistant S aureus prevention strategies and recommends specific strategies based on screening test implementation. A cost-effectiveness analysis using a Markov model from the hospital perspective was conducted to determine if the implementation costs of methicillin-resistant S aureus prevention strategies are justified by associated reductions in methicillin-resistant S aureus infections and improvements in quality-adjusted life years. Univariate and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. ICU. Hypothetical cohort of adults admitted to the ICU. Three prevention strategies were evaluated, including universal decolonization, targeted decolonization, and screening and isolation. Because prevention strategies have a screening component, the screening test in the model was varied to reflect commonly used screening test categories, including conventional culture, chromogenic agar, and polymerase chain reaction. Universal and targeted decolonization are less costly and more effective than screening and isolation. This is consistent for all screening tests. When compared with targeted decolonization, universal decolonization is cost-saving to cost-effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction. Results were robust to sensitivity analyses. As compared with screening and isolation, the current standard practice in ICUs, targeted decolonization, and universal decolonization are less costly and more effective. This supports updating the standard practice to a decolonization approach.

  14. Cost effectiveness of home ultraviolet B phototherapy for psoriasis : economic evaluation of a randomised controlled trial (PLUTO study)

    NARCIS (Netherlands)

    Koek, Mayke B. G.; Sigurdsson, Vigfus; van Weelden, Huib; Steegmans, Paul H. A.; Bruijnzeel-Koomen, Carla A. F. M.; Buskens, Erik

    2010-01-01

    Objective To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. Design Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised

  15. Smart Antenna Skins, including Conformal Array, MMICs and Applications

    NARCIS (Netherlands)

    Bogaart, F.L.M. van den

    2000-01-01

    Low-cost technologies are presented for future space-borne and airborne SAR systems. These technologies include state-of-the art highly integrated circuits to miniaturise front-end, solutions to lower-cost interconnection technologies, new beamforming aspects and new architectures. The MMICs address

  16. Website-analyse

    DEFF Research Database (Denmark)

    Thorlacius, Lisbeth

    2009-01-01

    eller blindgyder, når han/hun besøger sitet. Studier i design og analyse af de visuelle og æstetiske aspekter i planlægning og brug af websites har imidlertid kun i et begrænset omfang været under reflektorisk behandling. Det er baggrunden for dette kapitel, som indleder med en gennemgang af æstetikkens......Websitet er i stigende grad det foretrukne medie inden for informationssøgning,virksomhedspræsentation, e-handel, underholdning, undervisning og social kontakt. I takt med denne voksende mangfoldighed af kommunikationsaktiviteter på nettet, er der kommet mere fokus på at optimere design og...... planlægning af de funktionelle og indholdsmæssige aspekter ved websites. Der findes en stor mængde teori- og metodebøger, som har specialiseret sig i de tekniske problemstillinger i forbindelse med interaktion og navigation, samt det sproglige indhold på websites. Den danske HCI (Human Computer Interaction...

  17. A channel profile analyser

    International Nuclear Information System (INIS)

    Gobbur, S.G.

    1983-01-01

    It is well understood that due to the wide band noise present in a nuclear analog-to-digital converter, events at the boundaries of adjacent channels are shared. It is a difficult and laborious process to exactly find out the shape of the channels at the boundaries. A simple scheme has been developed for the direct display of channel shape of any type of ADC on a cathode ray oscilliscope display. This has been accomplished by sequentially incrementing the reference voltage of a precision pulse generator by a fraction of a channel and storing ADC data in alternative memory locations of a multichannel pulse height analyser. Alternative channels are needed due to the sharing at the boundaries of channels. In the flat region of the profile alternate memory locations are channels with zero counts and channels with the full scale counts. At the boundaries all memory locations will have counts. The shape of this is a direct display of the channel boundaries. (orig.)

  18. Activity-based costing evaluation of [18F]-fludeoxyglucose production

    International Nuclear Information System (INIS)

    Krug, Bruno; Pirson, Anne-Sophie; Borght, Thierry vander; Zanten, Annie van; Crott, Ralph

    2008-01-01

    As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [ 18 F]-fludeoxyglucose ( 18 F-FDG) studies is mainly influenced by the price of the radiopharmaceutical, which may vary throughout Europe from 300 to 500 Euro per patient dose (370 MBq). The aim of the current study is to conduct an activity-based costing (ABC) estimation of 18 F-FDG production in Europe to better identify the different cost components and to analyse their relative contribution to the total cost. Financial data were collected on capital expense and global operating costs through interviews with industry experts, PET centre managers, evaluation of prior studies, and review of expenses incurred at the University Medical Centre in Groningen (The Netherlands). After mapping the activities, we divided the cost in five categories: wage, equipment, consumables, overhead and space costs. A sensitivity analysis was performed for key cost components, including the compliance with regulatory requirements. The critical factor for profitability was throughput. Including the European regulation procedure, the cost for 370 MBq 18 F-FDG patient dose, 3 h EOS without delivery cost, ranges between 155 and 177 Euro/dose for two production runs and between 210 and 237 Euro/dose for one production run. These costs are predominantly determined by personnel and equipment costs, although the cost for quality assurance increases steadily. The ABC analysis provides significant insight into the production cost components of 18 F-FDG through different operating configurations. Reductions in equipment prices, increased availability of radiopharmaceuticals, growth in demand, and improvements in reimbursement will all contribute to the financial viability of this imaging technique. (orig.)

  19. Activity-based costing evaluation of [18F]-fludeoxyglucose production.

    Science.gov (United States)

    Krug, Bruno; Van Zanten, Annie; Pirson, Anne-Sophie; Crott, Ralph; Vander Borght, Thierry

    2008-01-01

    As healthcare expenses are escalating in many countries, the sector faces a new challenge of becoming more cost efficient. There is an urgent need for more accurate data on the costs of healthcare procedures. The cost of Positron Emission Tomography (PET) with [(18)F]-fludeoxyglucose ((18)F-FDG) studies is mainly influenced by the price of the radiopharmaceutical, which may vary throughout Europe from 300 to 500 Euro per patient dose (370 MBq). The aim of the current study is to conduct an activity-based costing (ABC) estimation of (18)F-FDG production in Europe to better identify the different cost components and to analyse their relative contribution to the total cost. Financial data were collected on capital expense and global operating costs through interviews with industry experts, PET centre managers, evaluation of prior studies, and review of expenses incurred at the University Medical Centre in Groningen (The Netherlands). After mapping the activities, we divided the cost in five categories: wage, equipment, consumables, overhead and space costs. A sensitivity analysis was performed for key cost components, including the compliance with regulatory requirements. The critical factor for profitability was throughput. Including the European regulation procedure, the cost for 370 MBq (18)F-FDG patient dose, 3 h EOS without delivery cost, ranges between 155 and 177 Euro/dose for two production runs and between 210 and 237 Euro/dose for one production run. These costs are predominantly determined by personnel and equipment costs, although the cost for quality assurance increases steadily. The ABC analysis provides significant insight into the production cost components of (18)F-FDG through different operating configurations. Reductions in equipment prices, increased availability of radiopharmaceuticals, growth in demand, and improvements in reimbursement will all contribute to the financial viability of this imaging technique.

  20. Costs of illness for melanoma and nonmelanoma skin cancer in Denmark.

    Science.gov (United States)

    Bentzen, Joan; Kjellberg, Jakob; Thorgaard, Camilla; Engholm, Gerda; Phillip, Anja; Storm, Hans H

    2013-11-01

    Incidences of melanoma and nonmelanoma skin cancer are high and increasing in many countries including Denmark. The diseases are highly preventable. We have estimated the healthcare costs of these cancers by comparing costs for cohorts of patients and matched controls in a national register-based study in Denmark. All incident patients with a diagnosis of melanoma, basal cell carcinoma, or squamous cell carcinoma in the period 2004-2008 were included. Four control individuals for each case were matched in terms of sex, age, and area of residence. Healthcare costs and productivity loss for patients and controls were estimated using Danish health and social registries 3 years before and 3 years after diagnosis. The healthcare costs of melanoma and nonmelanoma skin cancer were &OV0556;33.3 million in the 3-year period after diagnosis, with male patients inducing the highest costs for all three cancers and costs increasing with age. The diagnoses of basal cell carcinoma and melanoma had almost the same healthcare costs, but per patient average healthcare costs were higher for melanoma. The costs of melanoma and nonmelanoma skin cancers, which can be prevented by sensible sun habits, exceed the costs of the preventive measures of the Danish SunSmart campaign manifold. Costs of melanoma and nonmelanoma skin cancer are expected to increase in the future with populations aging in the western world. The analyses provide a strong argument for the societal rationale of skin cancer prevention in Denmark.

  1. Cost Optimization of Product Families using Analytic Cost Models

    DEFF Research Database (Denmark)

    Brunø, Thomas Ditlev; Nielsen, Peter

    2012-01-01

    This paper presents a new method for analysing the cost structure of a mass customized product family. The method uses linear regression and backwards selection to reduce the complexity of a data set describing a number of historical product configurations and incurred costs. By reducing the data...... set, the configuration variables which best describe the variation in product costs are identified. The method is tested using data from a Danish manufacturing company and the results indicate that the method is able to identify the most critical configuration variables. The method can be applied...... in product family redesign projects focusing on cost reduction to identify which modules contribute the most to cost variation and should thus be optimized....

  2. Nuclear energy cost data base: A reference data base for nuclear and coal-fired powerplant power generation cost analysis

    International Nuclear Information System (INIS)

    1988-09-01

    A reference data base and standard methodology are needed for performing comparative nuclear and fossil power generation cost analyses for the Department of Energy, Office of Nuclear Energy. This report contains such a methodology together with reference assumptions and data to be used with the methodology. It is intended to provide basic guidelines or a starting point for analyses and to serve as a focal point in establishing parameters and methods to be used in economic comparisons of nuclear systems with alternatives. The data base is applicable for economic comparisons of new base load light-water reactors on a once-through cycle, and high- and low-sulfur coal-fired plants, and oil- and natural gas-fired electric generating plants coming on line around the turn of the century. In addition to current generation light-water reactors and fossil fuel-fired plants, preliminary cost information is also presented on improved and advanced light-water reactors, liquid metal reactor plants and fuel cycle facilities. This report includes an updated data base containing proposed technical and economic assumptions to be used in analyses, discussions of a recommended methodology to be used in calculating power generation costs, a sample calculation for illustrative and benchmark purposes and projected power generation costs for fission and coal-fired alternatives. Effects of the 1986 Tax Reform Act are included. 126 refs., 17 figs., 47 tabs

  3. The healthcare costs of secondhand smoke exposure in rural China.

    Science.gov (United States)

    Yao, Tingting; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Max, Wendy

    2015-10-01

    The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥ 19) in rural China. We analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach. The total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including $559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income. The adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Stranded costs and exit fees

    International Nuclear Information System (INIS)

    2002-01-01

    The New Brunswick Market Design Committee has been directed to examine the issue of stranded costs since it is a major component of restructuring within the electricity sector. When regulated monopolies are faced with competition, they could find that some of their embedded costs cannot be recovered. These costs are referred to as stranded costs. Common sources include large capital investments in uneconomic plants or expensive power purchase contracts or fuel supply contracts. In general, stranded costs do not include gains or losses associated with normal business risks experienced by regulated utilities. This report presents recommendations for mitigation of stranded costs, valuation methodologies and cost-recovery mechanisms. It also presents a summary of experience with stranded costs in other jurisdictions such as California, Rhode Island, Pennsylvania and Ontario. Stranded costs are often recovered through an obligatory charge on all customers, particularly in jurisdictions where retail competition exists. In the New Brunswick market, however, the only customers who can create stranded costs are those eligible to choose their own suppliers. It is argued that since most customers will not have a choice of electricity suppliers, they cannot generate stranded costs and therefore, should not have to pay costs stranded by others. A method to quantify stranded costs is presented, along with a review of transmission-related stranded costs in New Brunswick. Expansion of self-generation in New Brunswick could strand transmission assets. Currently, self-generators only contribute a small amount to fixed charges of the transmission system. However, under new recommended tariffs, the amount could increase. It is likely that the net amount of stranded transmission costs will not be large. 2 refs., 1 fig

  5. 26 CFR 1.263A-1 - Uniform capitalization of costs.

    Science.gov (United States)

    2010-04-01

    ... costs and direct labor costs. (A) Direct material costs include the costs of those materials that become... property produced. (B) Direct labor costs include the costs of labor that can be identified or associated.... Direct labor costs include all elements of compensation other than employee benefit costs described in...

  6. Applied mediation analyses

    DEFF Research Database (Denmark)

    Lange, Theis; Hansen, Kim Wadt; Sørensen, Rikke

    2017-01-01

    In recent years, mediation analysis has emerged as a powerful tool to disentangle causal pathways from an exposure/treatment to clinically relevant outcomes. Mediation analysis has been applied in scientific fields as diverse as labour market relations and randomized clinical trials of heart...... disease treatments. In parallel to these applications, the underlying mathematical theory and computer tools have been refined. This combined review and tutorial will introduce the reader to modern mediation analysis including: the mathematical framework; required assumptions; and software implementation...

  7. Direct costs of radiotherapy for rectal cancer: a microcosting study.

    Science.gov (United States)

    Hanly, Paul; Céilleachair, Alan Ó; Skally, Máiréad; O'Neill, Ciaran; Sharp, Linda

    2015-05-02

    Radiotherapy provides significant benefits in terms of reducing risk of local recurrence and death from rectal cancer. Despite this, up-to-date cost estimates for radiotherapy are lacking, potentially inhibiting policy and decision-making. Our objective was to generate an up-to-date estimate of the cost of traditional radiotherapy for rectal cancer and model the impact of a range of potential efficiency improvements. Microcosting methods were used to estimate total direct radiotherapy costs for long- (assumed at 45-50 Gy in 25 daily fractions over a 5 week period) and short-courses (assumed at 25 Gy in 5 daily fractions over a one week period). Following interviews and on-site visits to radiotherapy departments in two designated cancer centers, a radiotherapy care pathway for a typical rectal cancer patient was developed. Total direct costs were derived by applying fixed and variable unit costs to resource use within each care phase. Costs included labor, capital, consumables and overheads. Sensitivity analyses were performed. Radiotherapy treatment was estimated to cost between €2,080 (5-fraction course) and €3,609 (25-fraction course) for an average patient in 2012. Costs were highest in the treatment planning phase for the short-course (€1,217; 58% of total costs), but highest in the radiation treatment phase for the long-course (€1,974: 60% of total costs). By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354). Traditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment.

  8. Analysis for the high-level waste disposal cost object

    International Nuclear Information System (INIS)

    Kim, S. K.; Lee, J. R.; Choi, J. W.; Han, P. S.

    2003-01-01

    The purpose of this study is to analyse the ratio of cost object in terms of the disposal cost estimation. According to the result, the ratio of operating cost is the most significant object in total cost. There are a lot of differences between the disposal costs and product costs in view of their constituents. While the product costs may be classified by the direct materials cost, direct manufacturing labor cost, and factory overhead the disposal cost factors should be constituted by the technical factors and the non-technical factors

  9. The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model

    Science.gov (United States)

    Kahn, James G.; Jiwani, Aliya; Gomez, Gabriela B.; Hawkes, Sarah J.; Chesson, Harrell W.; Broutet, Nathalie; Kamb, Mary L.; Newman, Lori M.

    2014-01-01

    Background Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million disability-adjusted life years (DALYs) and $309 million in medical costs. Syphilis screening and treatment is simple, effective, and affordable, yet, worldwide, most pregnant women do not receive these services. We assessed cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in various programmatic, epidemiologic, and economic contexts. Methods and Findings We modeled the cost, health impact, and cost-effectiveness of expanded syphilis screening and treatment in ANC, compared to current services, for 1,000,000 pregnancies per year over four years. We defined eight generic country scenarios by systematically varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare. We calculated program and net costs, DALYs averted, and net costs per DALY averted over four years in each scenario. Program costs are estimated at $4,142,287 – $8,235,796 per million pregnant women (2010 USD). Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program averts an estimated 5,754 – 93,484 DALYs, yielding net savings in four scenarios, and a cost per DALY averted of $24 – $111 in the four scenarios with net costs. Results were robust in sensitivity analyses. Conclusions Eliminating MTCT of syphilis through expanded screening and treatment in ANC is likely to be highly cost-effective by WHO-defined thresholds in a wide range of settings. Countries with high prevalence, low current service coverage, and high healthcare cost would benefit most. Future analyses can be

  10. Maintenance cost models in deregulated power systems under opportunity costs

    International Nuclear Information System (INIS)

    Al-Arfaj, K.; Dahal, K.; Azaiez, M.N.

    2007-01-01

    In a centralized power system, the operator is responsible for scheduling maintenance. There are different types of maintenance, including corrective maintenance; predictive maintenance; preventive maintenance; and reliability-centred maintenance. The main cause of power failures is poor maintenance. As such, maintenance costs play a significant role in deregulated power systems. They include direct costs associated with material and labor costs as well as indirect costs associated with spare parts inventory, shipment, test equipment, indirect labor, opportunity costs and cost of failure. In maintenance scheduling and planning, the cost function is the only component of the objective function. This paper presented the results of a study in which different components of maintenance costs were modeled. The maintenance models were formulated as an optimization problem with single and multiple objectives and a set of constraints. The maintenance costs models could be used to schedule the maintenance activities of power generators more accurately and to identify the best maintenance strategies over a period of time as they consider failure and opportunity costs in a deregulated environment. 32 refs., 4 tabs., 4 figs

  11. (including travel dates) Proposed itinerary

    Indian Academy of Sciences (India)

    Ashok

    31 July to 22 August 2012 (including travel dates). Proposed itinerary: Arrival in Bangalore on 1 August. 1-5 August: Bangalore, Karnataka. Suggested institutions: Indian Institute of Science, Bangalore. St Johns Medical College & Hospital, Bangalore. Jawaharlal Nehru Centre, Bangalore. 6-8 August: Chennai, TN.

  12. Cost-benefit

    International Nuclear Information System (INIS)

    1975-01-01

    A critical review of the cost benefit analysis is given for the LMFBR-type reactor development program given in an environmental impact statement of AEC. Several methodological shortcomings are signalled. As compared with a HTGR-type/LWR-type mix of reactors the LMFBR-type reactor will not be competitive until the U 3 O 8 prices reach a level of $ 50/lb which is not likely to happen before the year 2020. It is recommended to review the draft of the ZEC document and include timing as one of the issues. Deferal of the LMFBR-type reactor development program if necessary will not be intolerably costly

  13. Microwave power transmission system studies. Volume 2: Introduction, organization, environmental and spaceborne systems analyses

    Science.gov (United States)

    Maynard, O. E.; Brown, W. C.; Edwards, A.; Haley, J. T.; Meltz, G.; Howell, J. M.; Nathan, A.

    1975-01-01

    Introduction, organization, analyses, conclusions, and recommendations for each of the spaceborne subsystems are presented. Environmental effects - propagation analyses are presented with appendices covering radio wave diffraction by random ionospheric irregularities, self-focusing plasma instabilities and ohmic heating of the D-region. Analyses of dc to rf conversion subsystems and system considerations for both the amplitron and the klystron are included with appendices for the klystron covering cavity circuit calculations, output power of the solenoid-focused klystron, thermal control system, and confined flow focusing of a relativistic beam. The photovoltaic power source characteristics are discussed as they apply to interfacing with the power distribution flow paths, magnetic field interaction, dc to rf converter protection, power distribution including estimates for the power budget, weights, and costs. Analyses for the transmitting antenna consider the aperture illumination and size, with associated efficiencies and ground power distributions. Analyses of subarray types and dimensions, attitude error, flatness, phase error, subarray layout, frequency tolerance, attenuation, waveguide dimensional tolerances, mechanical including thermal considerations are included. Implications associated with transportation, assembly and packaging, attitude control and alignment are discussed. The phase front control subsystem, including both ground based pilot signal driven adaptive and ground command approaches with their associated phase errors, are analyzed.

  14. Health economic implications of complications associated with pancreaticoduodenectomy at a University Hospital: a retrospective cohort cost study.

    Science.gov (United States)

    Wang, Jason; Ma, Ronald; Eleftheriou, Paul; Churilov, Leonid; Debono, David; Robbins, Ray; Nikfarjam, Mehrdad; Christophi, Chris; Weinberg, Laurence

    2017-12-13

    A cost analyses of complications following pancreaticoduodenectomy (PD) was performed in a high volume hepato-biliary-pancreatic service. We hypothesised that costs are increased with both severity and number of complications; we investigated the relationship between complications and specific cost centres. 100 patients from 2011 to 2016 were included. Data relating to their perioperative course were collected. Complications were documented by the Clavien-Dindo classification and costs were inflated and converted to 2017 USD. Mean hospital costs in complicated patients more than doubled those of uncomplicated patients ($28 330 vs. $57 150, p costs significantly increased with both severity and number of complications. This cost increase was influenced by medical consult, pathology, pharmacy, radiology, ward, intensive care, and allied health costs, but not operating theatre or anaesthesia costs. Postoperative pancreatic fistula, postoperative haemorrhage, delayed gastric emptying and infection were associated with cost differentials of $65 438, $74 079, $35 620 and $46 316 respectively over uncomplicated patients. The development of complications following PD is common, costly and associated with increased length of stay. Costs increased with greater complication severity, and specific complications. The in-depth breakdown of hospital costs suggests specific targets for cost containment. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  15. The Effects of Quality of Care on Costs: A Conceptual Framework

    Science.gov (United States)

    Nuckols, Teryl K; Escarce, José J; Asch, Steven M

    2013-01-01

    Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed

  16. Malignant lymphomas (including myeloproliferative disorders)

    International Nuclear Information System (INIS)

    Todd, I.D.H.

    1985-01-01

    This chapter deals with the radiotherapy and cytotoxic chemotherapy of the malignant lymphomas. Included within this group are Hodgkin's disease, non-Hodgkin's lymphoma, mycosis fungoides, and chronic lymphatic leukaemia. A further section deals with the myeloproliferative disorders, including granulocytic leukaemia, polycythaemia vera, and primary thrombocythaemia. Excluded are myeloma and reticulum cell sarcoma of bone and acute leukaemia. With regard to Hodgkin's disease, the past 25 years have seen general recognition of the curative potential of radiotherapy, at least in the local stages, and, more recently, awareness of the ability to achieve long-term survival after combination chemotherapy in generalised or in recurrent disease. At the same time the importance of staging has become appreciated and the introduction of procedures such as lymphography, staging laparotomy, and computer tomography (CT) has enormously increased its reliability. Advances have not been so dramatic in the complex group of non-Hodgkins's lymphomas, but are still very real

  17. Cost Accounting: Production and Equipment Services.

    Science.gov (United States)

    Schmid, William T.

    Cost accounting for audiovisual productions should include direct costs, and, in some cases, the media administrator may have to calculate a per-hour surcharge for general operating overhead as well. Such procedures enable the administrator to determine cost effectiveness, to control cost overruns, and to generate more staff efficiency. Cost…

  18. 10 CFR 600.30 - Cost sharing.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Cost sharing. 600.30 Section 600.30 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS FINANCIAL ASSISTANCE RULES General § 600.30 Cost sharing. In...-Federal contribution: (1) Base the non-Federal contribution on total project costs, including the cost of...

  19. 7 CFR 330.107 - Costs.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 5 2010-01-01 2010-01-01 false Costs. 330.107 Section 330.107 Agriculture Regulations...; GARBAGE General Provisions § 330.107 Costs. All costs (including those incurred under § 330.106 of this... usual places of duty shall be furnished without cost to the person requesting the services, unless a...

  20. 24 CFR 700.115 - Program costs.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Program costs. 700.115 Section 700... PUBLIC AND INDIAN HOUSING PROGRAMS) CONGREGATE HOUSING SERVICES PROGRAM § 700.115 Program costs. (a) Allowable costs. (1) Allowable costs for direct provision of supportive services includes the provision of...

  1. 24 CFR 35.1135 - Eligible costs.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Eligible costs. 35.1135 Section 35....1135 Eligible costs. A PHA may use financial assistance received under the modernization program (CIAP....112 of this title. Eligible costs include: (a) Evaluation and insurance costs. Evaluation and hazard...

  2. 34 CFR 642.40 - Allowable costs.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Allowable costs. 642.40 Section 642.40 Education...? § 642.40 Allowable costs. Allowable project costs may include the following costs reasonably related to carrying out a Training Program project: (a) Rental of space, if space is not available at a sponsoring...

  3. Forage Harvest and Transport Costs

    Energy Technology Data Exchange (ETDEWEB)

    Butler, J.; Downing, M.; Turhollow, A.

    1998-12-01

    An engineering-economic approach is used to calculate harvest, in-field transport, and over-the-road transport costs for hay as bales and modules, silage, and crop residues as bales and modules. Costs included are equipment depreciation interest; fuel, lube, and oil; repairs; insurance, housing, and taxes; and labor. Field preparation, pest control, fertilizer, land, and overhead are excluded from the costs calculated Equipment is constrained by power available, throughput or carrying capacity, and field speed.

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

    Science.gov (United States)

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

    2016-07-27

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

  5. The full costs of thermal power production in Eastern Canada

    International Nuclear Information System (INIS)

    Venema, H.D.; Barg, S.

    2003-07-01

    This study examines the public health and global warming costs associated with generating electricity with fossil fuels such as coal, oil or natural gas. A Full Cost Accounting approach was used to determine the costs for Eastern Canada. The electricity sector is chosen because it is a large emitter of air pollutants and greenhouse gases. The sector it will undergo potentially significant structural changes as Canada complies with the Kyoto Protocol. Alternative investments in nonpolluting sources of electricity should include analysis of full costs. Two types of factors are evaluated in this study: the public health costs caused by emissions of sulphur and nitrogen oxides and volatile organic carbon (VOC) in Eastern Canada, and the marginal climate change damages caused by the emissions of greenhouse gasses (GHGs) in Eastern Canada. The major contribution of this study is the application of the impact-pathway approach to power sector emissions. Recent Canadian studies have reported either the pollutant emission rates for different power generation technologies and fuels, or the health costs of ambient air pollution not specifically attributable to the power sector. This study isolates the component of air pollution attributable to the power sector and analyses its geographic distribution. It was concluded that coal-fired generation should be closely monitored because the externalities burden is the same magnitude as the marginal production cost. 77 refs., 20 tabs., 21 figs

  6. Uncertainty and Sensitivity Analyses Plan

    International Nuclear Information System (INIS)

    Simpson, J.C.; Ramsdell, J.V. Jr.

    1993-04-01

    Hanford Environmental Dose Reconstruction (HEDR) Project staff are developing mathematical models to be used to estimate the radiation dose that individuals may have received as a result of emissions since 1944 from the US Department of Energy's (DOE) Hanford Site near Richland, Washington. An uncertainty and sensitivity analyses plan is essential to understand and interpret the predictions from these mathematical models. This is especially true in the case of the HEDR models where the values of many parameters are unknown. This plan gives a thorough documentation of the uncertainty and hierarchical sensitivity analysis methods recommended for use on all HEDR mathematical models. The documentation includes both technical definitions and examples. In addition, an extensive demonstration of the uncertainty and sensitivity analysis process is provided using actual results from the Hanford Environmental Dose Reconstruction Integrated Codes (HEDRIC). This demonstration shows how the approaches used in the recommended plan can be adapted for all dose predictions in the HEDR Project

  7. Cost forecasting using RCF : a case study for planning public building projects costs in Turkey

    NARCIS (Netherlands)

    Bayram, Savas; Al-Jibouri, Saad

    2017-01-01

    Many construction projects are perceived to perform badly since the majority of them suffer cost overruns. This paper analyses cost estimates produced by two most commonly used estimation methods for building projects in Turkey, namely unit area cost (UAC) and unit price analysis (UPA). It also

  8. Linking quality of care and training costs: cost-effectiveness in health professions education.

    Science.gov (United States)

    Tolsgaard, Martin G; Tabor, Ann; Madsen, Mette E; Wulff, Camilla B; Dyre, Liv; Ringsted, Charlotte; Nørgaard, Lone N

    2015-12-01

    To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians. The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost-effectiveness ratio (ICER) and (iv) estimating cost-effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost-effectiveness trial. Midwives were randomised to CLM training (midwife-performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention-group participants underwent simulation-based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre-term labour. Outcomes for women managed by intervention and control-group participants were compared. These data were then used for the remaining steps of the cost-effectiveness model. Intervention-group participants needed a mean 268.2 (95% confidence interval [CI], 140.2-392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4-10.3) supervised scans to attain proficiency. Women who were scanned by intervention-group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3-65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute(-1) . For WTP values less than EUR 0.26 minute(-1) , obstetrician-performed CLM was the most cost-effective strategy, whereas midwife-performed CLM was cost-effective for WTP values above EUR 0.73 minute(-1) . Cost-effectiveness models can be used to link quality of care to

  9. Comparative analyses of seven technologies to facilitate the integration of fluctuating renewable energy sources

    DEFF Research Database (Denmark)

    Mathiesen, Brian Vad; Lund, Henrik

    2009-01-01

    An analysis of seven different technologies is presented. The technologies integrate fluctuating renewable energy sources (RES) such as wind power production into the electricity supply, and the Danish energy system is used as a case. Comprehensive hour-by-hour energy system analyses are conducted...... of a complete system meeting electricity, heat and transport demands, and including RES, power plants, and combined heat and power production (CHP) for district heating and transport technologies. In conclusion, the most fuel-efficient and least-cost technologies are identified through energy system...... and feasibility analyses. Large-scale heat pumps prove to be especially promising as they efficiently reduce the production of excess electricity. Flexible electricity demand and electric boilers are low-cost solutions, but their improvement of fuel efficiency is rather limited. Battery electric vehicles...

  10. Economic analyses: Cost-benefit analysis in occupational health: a comparison of intervention scenarios for occupational asthma and rhinitis among bakery workers. Oral presentations: Day 1: Wednesday, September 7, 2011. 22nd International Conference on Epidemiology in Occupational Health EPICOH 2011 September 7-9, 2011, Oxford, UK

    NARCIS (Netherlands)

    Meijster, T.; Duuren-Stuurman, B. van; Heederik, D.; Warren, N.; Houba, R.; Koningsveld, E.; Tielemans, E.

    2011-01-01

    Objectives Recently developed quantitative health impact assessment (HIA) methods provide insight into the impact of interventions on the population burden of disease. This information might subsequently be used in a cost-benefit analysis. In this study we developed a method that allocates costs and

  11. Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

    Science.gov (United States)

    Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

    2013-01-01

    Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding

  12. Molecular ecological network analyses

    Directory of Open Access Journals (Sweden)

    Deng Ye

    2012-05-01

    Full Text Available Abstract Background Understanding the interaction among different species within a community and their responses to environmental changes is a central goal in ecology. However, defining the network structure in a microbial community is very challenging due to their extremely high diversity and as-yet uncultivated status. Although recent advance of metagenomic technologies, such as high throughout sequencing and functional gene arrays, provide revolutionary tools for analyzing microbial community structure, it is still difficult to examine network interactions in a microbial community based on high-throughput metagenomics data. Results Here, we describe a novel mathematical and bioinformatics framework to construct ecological association networks named molecular ecological networks (MENs through Random Matrix Theory (RMT-based methods. Compared to other network construction methods, this approach is remarkable in that the network is automatically defined and robust to noise, thus providing excellent solutions to several common issues associated with high-throughput metagenomics data. We applied it to determine the network structure of microbial communities subjected to long-term experimental warming based on pyrosequencing data of 16 S rRNA genes. We showed that the constructed MENs under both warming and unwarming conditions exhibited topological features of scale free, small world and modularity, which were consistent with previously described molecular ecological networks. Eigengene analysis indicated that the eigengenes represented the module profiles relatively well. In consistency with many other studies, several major environmental traits including temperature and soil pH were found to be important in determining network interactions in the microbial communities examined. To facilitate its application by the scientific community, all these methods and statistical tools have been integrated into a comprehensive Molecular Ecological

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

    Science.gov (United States)

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

    2013-10-01

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

  14. Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research.

    Science.gov (United States)

    2002-02-15

    Economic evaluations are increasingly common in the critical care literature, although approaches to their conduct are not standardized. The American Thoracic Society convened a workshop to address methodologic and reporting issues for economic analyses in critical care and to determine how guidelines from the U.S. Public Health Service Panel on Cost-effectiveness in Health and Medicine (PCEHM) were applicable to critical care. We identified several issues that hamper cost-effectiveness analyses (CEAs) in the critically ill. Data on the effectiveness of intensive care unit (ICU) interventions are often lacking; ICU patients are complex, with multiple concurrent problems and interventions; most ICU therapies are only supportive, and therefore may not individually result in improved outcome; accurate cost data are not commonly available and are difficult to obtain; there is no standardized approach for measuring or valuing costs across countries; typical outcomes in ICU studies (e.g., short-term mortality) are not ideal for CEAs while preferred outcomes for CEAs (e.g., long-term quality-adjusted survival) are rarely collected; valuing the importance of appropriate end-of-life care, an important aspect of ICU care, is difficult, and the burden of critical illness on family members is not easily captured in a CEA. Nevertheless, many of these problems are not unique to critical care, and we believe the PCEHM guidelines can be adapted to the critical care setting. We recommend all CEAs in the critically ill include a PCEHM reference case, where the cost-effectiveness ratio is calculated by adopting a societal perspective, estimating long-term costs and quality of life after ICU care, applying a 3% annual discount rate to costs and effects, and conducting multiway sensitivity analyses. Because elements of the reference case, such as long-term costs and quality of life, may only be estimated using modeling and assumptions, we also recommend inclusion of a "data-rich" case

  15. Cost evaluation to optimise radiation therapy implementation in different income settings: A time-driven activity-based analysis.

    Science.gov (United States)

    Van Dyk, Jacob; Zubizarreta, Eduardo; Lievens, Yolande

    2017-11-01

    With increasing recognition of growing cancer incidence globally, efficient means of expanding radiotherapy capacity is imperative, and understanding the factors impacting human and financial needs is valuable. A time-driven activity-based costing analysis was performed, using a base case of 2-machine departments, with defined cost inputs and operating parameters. Four income groups were analysed, ranging from low to high income. Scenario analyses included department size, operating hours, fractionation, treatment complexity, efficiency, and centralised versus decentralised care. The base case cost/course is US$5,368 in HICs, US$2,028 in LICs; the annual operating cost is US$4,595,000 and US$1,736,000, respectively. Economies of scale show cost/course decreasing with increasing department size, mainly related to the equipment cost and most prominent up to 3 linacs. The cost in HICs is two or three times as high as in U-MICs or LICs, respectively. Decreasing operating hours below 8h/day has a dramatic impact on the cost/course. IMRT increases the cost/course by 22%. Centralising preparatory activities has a moderate impact on the costs. The results indicate trends that are useful for optimising local and regional circumstances. This methodology can provide input into a uniform and accepted approach to evaluating the cost of radiotherapy. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  16. Device including a contact detector

    DEFF Research Database (Denmark)

    2011-01-01

    The present invention relates to a probe for determining an electrical property of an area of a surface of a test sample, the probe is intended to be in a specific orientation relative to the test sample. The probe may comprise a supporting body defining a first surface. A plurality of cantilever...... of cantilever arms (12) contacting the surface of the test sample when performing the movement....... arms (12) may extend from the supporting body in co-planar relationship with the first surface. The plurality of cantilever arms (12) may extend substantially parallel to each other and each of the plurality of cantilever arms (12) may include an electrical conductive tip for contacting the area...

  17. Estimation of the cost of large-scale school deworming programmes with benzimidazoles.

    Science.gov (United States)

    Montresor, A; Gabrielli, A F; Diarra, A; Engels, D

    2010-02-01

    This study estimates the cost of distributing benzimidazole tablets in the context of school deworming programmes: we analysed studies reporting the cost of school deworming from seven countries in four WHO regions. The estimated cost for drug procurement to cover one million children (including customs clearance and international transport) is approximately US$20000. The estimated financial costs (including the cost of training of personnel, drug transport, social mobilization and monitoring) is, on average, equivalent to US$33000 per million school-age children with minimal variation in different countries and continents. The estimated economic costs of distribution (including the time spent by teachers, and health personnel at central, provincial and district level) to cover one million children approximately corresponds to US$19000. This study shows the minimal cost of school deworming activities, but also shows the significant contribution (corresponding to a quarter of the entire cost of the programme) provided by health and education systems in endemic countries even in the case of drug donations and donor support of distribution costs. Copyright 2009 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

  18. Database system for analysing and managing coiled tubing drilling data

    Science.gov (United States)

    Suh, J.; Choi, Y.; Park, H.; Choe, J.

    2009-05-01

    This study present a prototype of database system for analysing and managing petrophysical data from coiled tubing drilling in the oil and gas industry. The characteristics of coiled tubing drilling data from cores were analyzed and categorized according to the whole drilling process and data modeling including object relation diagram, class diagram was carried out to design the schema of effective database system such as the relationships between tables and key index fields to create the relationships. The database system called DrillerGeoDB consists of 22 tables and those are classified with 4 groups such as project information, stratum information, drilling/logging information and operation evaluate information. DrillerGeoDB provide all sort of results of each process with a spreadsheet such as MS-Excel via application of various algorithm of logging theory and statistics function of cost evaluation. This presentation describes the details of the system development and implementation.

  19. The costs of rape.

    Science.gov (United States)

    Perilloux, Carin; Duntley, Joshua D; Buss, David M

    2012-10-01

    The current study examined costs experienced by victims of completed rape (n=49) and attempted sexual assault (n=91) using quantitative analyses of 13 domains: health, self-esteem, self-perceived attractiveness, self-perceived mate value, family relationships,work life, social life, social reputation, sexual reputation, desire to have sex, frequency of sex, enjoyment of sex, and long-term, committed relationships. Women also provided descriptive accounts of their experiences, and we used these to illustrate the costs in the victims' own words.Compared to victims of an attempted sexual assault, victims of a completed rape reported significantly more negative outcomes in 11 of the 13 domains. The most negatively affected domains were self-esteem, sexual reputation, frequency of sex, desire to have sex, and self-perceived mate value. Although victims of rape experienced more negative effects than victims of attempted sexual assault,both groups of victims reported negative effects in every domain.Discussion focuses on the implications of the differing degrees and patterns of the costs of attempted and completed sexual victimization.

  20. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

    Science.gov (United States)

    Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

    2017-01-01

    To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  1. Costs and cost-effectiveness of training traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival study (LUNESP).

    Science.gov (United States)

    Sabin, Lora L; Knapp, Anna B; MacLeod, William B; Phiri-Mazala, Grace; Kasimba, Joshua; Hamer, Davidson H; Gill, Christopher J

    2012-01-01

    The Lufwanyama Neonatal Survival Project ("LUNESP") was a cluster randomized, controlled trial that showed that training traditional birth attendants (TBAs) to perform interventions targeting birth asphyxia, hypothermia, and neonatal sepsis reduced all-cause neonatal mortality by 45%. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness, and factors that might improve cost-effectiveness. We calculated LUNESP's financial and economic costs and the economic cost of implementation for a forecasted ten-year program (2011-2020). In each case, we calculated the incremental cost per death avoided and disability-adjusted life years (DALYs) averted in real 2011 US dollars. The forecasted 10-year program analysis included a base case as well as 'conservative' and 'optimistic' scenarios. Uncertainty was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. The estimated financial and economic costs of LUNESP were $118,574 and $127,756, respectively, or $49,469 and $53,550 per year. Fixed costs accounted for nearly 90% of total costs. For the 10-year program, discounted total and annual program costs were $256,455 and $26,834 respectively; for the base case, optimistic, and conservative scenarios, the estimated cost per death avoided was $1,866, $591, and $3,024, and cost per DALY averted was $74, $24, and $120, respectively. Outcomes were robust to variations in local costs, but sensitive to variations in intervention effect size, number of births attended by TBAs, and the extent of foreign consultants' participation. Based on established guidelines, the strategy of using trained TBAs to reduce neonatal mortality was 'highly cost effective'. We strongly recommend consideration of this approach for other remote rural populations with limited access to health care.

  2. The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units.

    Science.gov (United States)

    Lefrant, Jean-Yves; Garrigues, Bernard; Pribil, Céline; Bardoulat, Isabelle; Courtial, Frédéric; Maurel, Frédérique; Bazin, Jean-Étienne

    2015-06-01

    To estimate the daily cost of intensive care unit (ICU) stays via micro-costing. A multicentre, prospective, observational, cost analysis study was carried out among 21 out of 23 French ICUs randomly selected from French National Hospitals. Each ICU randomly enrolled 5 admitted adult patients with a simplified acute physiology II score ≥ 15 and with at least one major intensive care medical procedure. All health-care human resources used by each patient over a 24-hour period were recorded, as well as all medications, laboratory analyses, investigations, tests, consumables and administrative expenses. All resource costs were estimated from the hospital's perspective (reference year 2009) based on unitary cost data. One hundred and four patients were included (mean age: 62.3 ± 14.9 years, mean SAPS II: 51.5 ± 16.1, mean SOFA on the study day: 6.9 ± 4.3). Over 24 hours, 29 to 186 interventions per patient were performed by different caregivers, leading to a mean total time spent for patient care of 13:32 ± 05:00 h. The total daily cost per patient was € 1425 ± € 520 (95% CI = € 1323 to € 1526). ICU human resources represented 43% of total daily cost. Patient-dependent expenses (€ 842 ± € 521) represented 59% of the total daily cost. The total daily cost was correlated with the daily SOFA score (r = 0.271, P = 0.006) and the bedside-time given by caregivers (r = 0.716, P average cost of one day of ICU care in French National Hospitals is strongly correlated with the duration of bedside-care carried out by human resources. Copyright © 2015. Published by Elsevier Masson SAS.

  3. Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital

    Directory of Open Access Journals (Sweden)

    Mishra Vinod

    2012-08-01

    Full Text Available Abstract Background The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD. Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG-reimbursement. Method Cost data of 20 LVAD implantations (VentrAssist™ from 2005-2009 (period 1 were analyzed together with costs from nine patients using another LVAD (HeartWare™ from 2009-June 2011 (period 2. For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. Results The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299, and the corresponding DRG- reimbursement (2009 was $ 143, 192 . The mean LOS was 54 days (range 12- 127. For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664 and the corresponding DRG- reimbursement (2010 was $ 136, 963. The mean LOS was 49 days (range 31- 93. The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14

  4. The cost-effectiveness of OM-85 in managing respiratory tract infections in China.

    Science.gov (United States)

    Xuan, Jianwei; Wang, Lijie; Yin, Hongjun; Xuan, Dennis; Zhou, Yan; Hu, Shanlian

    2015-03-01

    To demonstrate the health economic impact of OM-85, a bacterial lysates based immunostimulant, for its approved indications in China. A cost-effectiveness decision tree model was constructed comparing OM-85 with the best supportive care/placebo therapy for managing the acute exacerbation of chronic bronchitis and rhinosinusitis in the Chinese population. Clinical efficacy and adverse events (AE) data were included in the model based on a thorough literature review. All localized direct treatment costs, including drug cost, AE costs, and medical treatment costs for underlining diseases were included from a Chinese third party payer perspective. A Key Opinion Leaders (KOL) survey was conducted with 20 senior physicians specialized in respiratory, ENT, allergy, and immunology fields from tertiary hospitals in Beijing, Shanghai, Guangzhou, Hangzhou, Shenyang, and Wuhan to validate the local treatment costs. Incremental cost-effectiveness ratio (ICER) was calculated based on the above efficacy and cost information. OM-85 is a cost-effective therapy when compared with placebo (standard care). OM-85 can treat/prevent one additional full episode exacerbation of chronic bronchitis and one additional full episode exacerbation of rhinosinusitis with only additional costs of RMB 653 and RMB 1182.84, respectively. In comparison, each acute exacerbation of chronic bronchitis will cost RMB 4510.10, and each acute exacerbation of rhinosinuisitis will cost RMB 1807.21 in a Chinese clinical management setting. One-way sensitivity analyses were performed and the ICER result was demonstrated to be consistent. OM 85 reduces acute exacerbations among patients with chronic bronchitis and chronic rhinosinusitis when compared with Placebo (standard care). From a Chinese payer perspective, OM 85 is a cost-effective therapy in the clinical management of both chronic bronchitis and rhinosinusitis in the adult population.

  5. CECP, Decommissioning Costs for PWR and BWR

    International Nuclear Information System (INIS)

    Bierschbach, M.C.

    1997-01-01

    1 - Description of program or function: The Cost Estimating Computer Program CECP, designed for use on an IBM personal computer or equivalent, was developed for estimating the cost of decommissioning boiling water reactor (BWR) and light-water reactor (PWR) power stations to the point of license termination. 2 - Method of solution: Cost estimates include component, piping, and equipment removal costs; packaging costs; decontamination costs; transportation costs; burial volume and costs; and manpower staffing costs. Using equipment and consumables costs and inventory data supplied by the user, CECP calculates unit cost factors and then combines these factors with transportation and burial cost algorithms to produce a complete report of decommissioning costs. In addition to costs, CECP also calculates person-hours, crew-hours, and exposure person-hours associated with decommissioning. 3 - Restrictions on the complexity of the problem: The program is designed for a specific waste charge structure. The waste cost data structure cannot handle intermediate waste handlers or changes in the charge rate structures. The decommissioning of a reactor can be divided into 5 periods. 200 different items for special equipment costs are possible. The maximum amount for each special equipment item is 99,999,999$. You can support data for 10 buildings, 100 components each; ESTS1071/01: There are 65 components for 28 systems available to specify the contaminated systems costs (BWR). ESTS1071/02: There are 75 components for 25 systems available to specify the contaminated systems costs (PWR)

  6. FORECAST: Regulatory effects cost analysis software manual -- Version 4.1. Revision 1

    International Nuclear Information System (INIS)

    Lopez, B.; Sciacca, F.W.

    1996-07-01

    The FORECAST program was developed to facilitate the preparation of the value-impact portion of NRC regulatory analyses. This PC program integrates the major cost and benefit considerations that may result from a proposed regulatory change. FORECAST automates much of the calculations typically needed in a regulatory analysis and thus reduces the time and labor required to perform these analyses. More importantly, its integrated and consistent treatment of the different value-impact considerations should help assure comprehensiveness, uniformity, and accuracy in the preparation of NRC regulatory analyses. The Current FORECAST Version 4.1 has been upgraded from the previous version and now includes an uncertainty package, an automatic cost escalation package, and other improvements. In addition, it now explicitly addresses public health impacts, occupational health impacts, onsite property damage, and government costs. Thus, FORECAST Version 4.1 can treat all attributes normally quantified in a regulatory analysis

  7. Exergoeconomic and environmental analyses of CO2/NH3 cascade refrigeration systems equipped with different types of flash tank intercoolers

    International Nuclear Information System (INIS)

    Mosaffa, A.H.; Farshi, L. Garousi; Infante Ferreira, C.A.; Rosen, M.A.

    2016-01-01

    Highlights: • CO 2 /NH 3 cascade refrigeration cycles with flash intercoolers are investigated. • Exergoeconomic factors of components are determined to assess their relative significances. • An environmental analysis is applied to determine the penalty cost of GHG emission. • The effects of operating parameters on COP, exergy efficiency and total cost rate are investigated. • An optimization is applied based on the maximum COP and the minimum total cost rate. - Abstract: Exergoeconomic and environmental analyses are presented for two CO 2 /NH 3 cascade refrigeration systems equipped with (1) two flash tanks and (2) a flash tank along with a flash intercooler with indirect subcooler. A comparative study is performed for the proposed systems, and optimal values of operating parameters of the system are determined that maximize the coefficient of performance (COP) and exergy efficiency and minimize the total annual cost. The operating parameters considered include condensing temperatures of NH 3 in the condenser and CO 2 in the cascade heat exchanger, the evaporating temperature of CO 2 in the evaporator, the temperature difference in the cascade heat exchanger, the intermediate pressure of the flash tank in the CO 2 low-temperature circuit, the mass flow rate ratio in the flash intercooler and the degree of superheating of the CO 2 at the evaporator outlet. The total annual cost includes the capital, operating and maintenance costs and the penalty cost of GHG emission. The results show that, the total annual cost rate for system 1 is 11.2% and 11.9% lower than that for system 2 referring to thermodynamic and economic optimizations, respectively. For thermodynamic and cost optimal design condition the COP and exergy efficiency of both systems are almost the same. Finally, in order to obtain the best balance between exergy destruction cost and capital cost, the exergoeconomic factor is defined for each component of proposed systems, for cases in which the

  8. Realistic costs of carbon capture

    Energy Technology Data Exchange (ETDEWEB)

    Al Juaied, Mohammed (Harvard Univ., Cambridge, MA (US). Belfer Center for Science and International Affiaris); Whitmore, Adam (Hydrogen Energy International Ltd., Weybridge (GB))

    2009-07-01

    excluding transport and storage costs appears to be US$100-150/tCO2 for first-of-a-kind plants and perhaps US$30-50/tCO2 for nth-of-a-kind plants.The estimates for FOAK and NOAK costs appear to be broadly consistent in the light of estimates of the potential for cost reductions with increased experience. Cost reductions are expected from increasing scale, learning on individual components, and technological innovation including improved plant integration. Innovation and integration can both lower costs and increase net output with a given cost base. These factors are expected to reduce abatement costs by approximately 65% by 2030. The range of estimated costs for NOAK plants is within the range of plausible future carbon prices, implying that mature technology would be competitive with conventional fossil fuel plants at prevailing carbon prices.

  9. Life Cycle Costing: An Introduction

    DEFF Research Database (Denmark)

    Rödger, Jan-Markus; Kjær, Louise Laumann; Pagoropoulos, Aris

    2018-01-01

    The chapter gives an introduction to life cycle costing (LCC) and how it can be used to support decision-making. It can form the economic pillar in a full life cycle sustainability assessment, but often system delimitations differ depending on the goal and scope of the study. To provide a profound...... understanding this chapter describes several approaches and terms, fundamental principles and different types of costs. A brief introduction is given to conventional LCC and societal LCC but the main focus is on environmental Life Cycle Costing (eLCC) as the LCC approach that is compatible with environmental...... Life Cycle Assessment (LCA) in terms of system delimitation. Differences are explained and addressed, and an overview is given of the main cost categories to consider from different user perspectives. As inventory data is often sensitive in financial analyses, a list of relevant databases is provided...

  10. 48 CFR 252.215-7002 - Cost estimating system requirements.

    Science.gov (United States)

    2010-10-01

    ... historical costs, and other analyses used to generate cost estimates. (b) General. The Contractor shall... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Cost estimating system... of Provisions And Clauses 252.215-7002 Cost estimating system requirements. As prescribed in 215.408...

  11. 10 CFR 436.12 - Life cycle cost methodology.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Life cycle cost methodology. 436.12 Section 436.12 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION FEDERAL ENERGY MANAGEMENT AND PLANNING PROGRAMS Methodology and Procedures for Life Cycle Cost Analyses § 436.12 Life cycle cost methodology. The life cycle cost methodology...

  12. A generic tool for cost estimating in aircraft design

    NARCIS (Netherlands)

    Castagne, S.; Curran, R.; Rothwell, A.; Price, M.; Benard, E.; Raghunathan, S.

    2008-01-01

    A methodology to estimate the cost implications of design decisions by integrating cost as a design parameter at an early design stage is presented. The model is developed on a hierarchical basis, the manufacturing cost of aircraft fuselage panels being analysed in this paper. The manufacturing cost

  13. A time-driven, activity-based costing methodology for determining the costs of red blood cell transfusion in patients with beta thalassaemia major.

    Science.gov (United States)

    Burns, K E; Haysom, H E; Higgins, A M; Waters, N; Tahiri, R; Rushford, K; Dunstan, T; Saxby, K; Kaplan, Z; Chunilal, S; McQuilten, Z K; Wood, E M

    2018-04-10

    To describe the methodology to estimate the total cost of administration of a single unit of red blood cells (RBC) in adults with beta thalassaemia major in an Australian specialist haemoglobinopathy centre. Beta thalassaemia major is a genetic disorder of haemoglobin associated with multiple end-organ complications and typically requiring lifelong RBC transfusion therapy. New therapeutic agents are becoming available based on advances in understanding of the disorder and its consequences. Assessment of the true total cost of transfusion, incorporating both product and activity costs, is required in order to evaluate the benefits and costs of these new therapies. We describe the bottom-up, time-driven, activity-based costing methodology used to develop process maps to provide a step-by-step outline of the entire transfusion pathway. Detailed flowcharts for each process are described. Direct observations and timing of the process maps document all activities, resources, staff, equipment and consumables in detail. The analysis will include costs associated with performing these processes, including resources and consumables. Sensitivity analyses will be performed to determine the impact of different staffing levels, timings and probabilities associated with performing different tasks. Thirty-one process maps have been developed, with over 600 individual activities requiring multiple timings. These will be used for future detailed cost analyses. Detailed process maps using bottom-up, time-driven, activity-based costing for determining the cost of RBC transfusion in thalassaemia major have been developed. These could be adapted for wider use to understand and compare the costs and complexities of transfusion in other settings. © 2018 British Blood Transfusion Society.

  14. Incidence of dose escalation and impact on biologic costs among patients with rheumatoid arthritis treated with three intravenous agents.

    Science.gov (United States)

    Nadkarni, Anagha; McMorrow, Donna; Patel, Chad; Fowler, Robert; Smith, David

    2017-11-01

    Evaluation of dose escalation and costs among rheumatoid arthritis patients treated with intravenous abatacept, intravenous infliximab or intravenous tocilizumab. Adults with rheumatoid arthritis and biologic treatment were identified from the MarketScan ® Research databases. Study outcomes included dose escalation, per-patient per-month (PPPM) biologic costs and PPPM all-cause total healthcare costs. Impact of dose escalation on biologic costs was estimated using multivariate analyses. The sample included 6181 patients. Infliximab and tocilizumab cohorts had significantly higher likelihood for dose escalation than abatacept cohort; incremental PPPM impacts of dose escalation on costs were statistically significant for each biologic (p < 0.01). Patients initiating abatacept were least likely to escalate dose and had lowest incremental impact of dose escalation on cost compared with patients with infliximab or tocilizumab.

  15. Enhancing value of information analyses

    NARCIS (Netherlands)

    Janssen, Mart P.; Koffijberg, Hendrik

    Objective: The aim of this study was to demonstrate that it is feasible and recommendable to present value of information (VOI) outcomes in terms of underlying costs and effects in addition to costs alone. Methods: The benefits of collecting additional information on health economic outcomes before

  16. Mandatory cost and other cost coming from the adoption of quality certifications in the hospitality business

    OpenAIRE

    Sanchez Rebull, M. Victoria; Hernandez, Ana Betriz; Banchieri, Lucia; Campa Planas, Fernando; Ginieis, Matias

    2011-01-01

    The adaptation to the regulation of hospitality business implies a relevant cost in the profit and loss account. Additionally, some companies in this business decide to add some voluntary quality and environmental certification systems, which also yields to increased costs. The purpose of this paper is to quantify these costs and to analyse if the hotel size influences them. A total of 67 different costs were considered in hotels of all sizes, in the region of Catalonia as one of the most rel...

  17. Wind power costs in Portugal

    Energy Technology Data Exchange (ETDEWEB)

    Saleiro, C. [Univ. of Minho, Dept. of Biological Engineering (Portugal); Araujo, M.; Ferreira, P. [Univ. of Minho, Dept. of Production and Systems (Portugal)

    2007-05-15

    In a way to reduce the external energy dependence, increasing also the investments in renewable energy sources and aiming for the concretization of the European renewable objectives, the Portuguese government defined a goal of 5100 MW of installed wind power, up to 2012. If the drawn objectives are accomplished, by 2010 the wind power share may reach values comparable to leading countries like Denmark, Germany or Spain. The Portuguese forecasts also indicate a reinforcement of the natural gas fired generation in particular through the use of the combined cycle technology, following the European tendency. This analysis sets out to evaluate the total generating cost of wind power and CCGT in Portugal. A life cycle cost analysis was conducted, including investment costs, O and M costs, fuel costs and external costs of emissions, for each type of technology. For the evaluation of the externalities ExternE values were used. The results show that presently the wind power production cost is higher than the CCGT one, at least from the strictly financial point of view. CCGT costs increase significantly when charges for externalities are included. However, they only reach levels higher than the equivalents for wind power for high externality costs estimations. This partially results from the low load factor of the wind farms in Portugal and also from the low emission levels of the gas fired technology used in the comparison. A sensitive analysis of the technical and economical parameters was also conducted. Particular attention was given to the natural gas prices due to the possible increase over time. The fuel escalation rate is the parameter that has larger effects on the final costs. It was verified that the total cost of wind plant is more influenced by the load factor than the total cost of CCGT. (au)

  18. COSTS CALCULATION OF TARGET COSTING METHOD

    OpenAIRE

    Sebastian UNGUREANU

    2014-01-01

    Cost information system plays an important role in every organization in the decision making process. An important task of management is ensuring control of the operations, processes, sectors, and not ultimately on costs. Although in achieving the objectives of an organization compete more control systems (production control, quality control, etc.), the cost information system is important because monitors results of the other. Detailed analysis of costs, production cost calculation, quantifi...

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

    Science.gov (United States)

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

    2012-05-01

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

  20. Cost analysis of periodontitis management in public sector specialist dental clinics.

    Science.gov (United States)

    Mohd-Dom, Tuti; Ayob, Rasidah; Mohd-Nur, Amrizal; Abdul-Manaf, Mohd R; Ishak, Noorlin; Abdul-Muttalib, Khairiyah; Aljunid, Syed M; Ahmad-Yaziz, Yuhaniz; Abdul-Aziz, Hanizah; Kasan, Noordin; Mohd-Asari, Ahmad S

    2014-05-20

    The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components. Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4). A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P sector specialist settings were substantial and comparable with some non-communicable diseases. These findings provide basis for identifying potential cost-reducing strategies, estimating economic burden of periodontitis management and performing economic evaluation of the specialist periodontal programme.

  1. Cost analysis of Periodontitis management in public sector specialist dental clinics

    Science.gov (United States)

    2014-01-01

    Background The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components. Methods Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4). Results A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P periodontitis patients at public sector specialist settings were substantial and comparable with some non-communicable diseases. These findings provide basis for identifying potential cost-reducing strategies, estimating economic burden of periodontitis management and performing economic

  2. Cost analysis of the treatment of severe acute malnutrition in West Africa.

    Science.gov (United States)

    Isanaka, Sheila; Menzies, Nicolas A; Sayyad, Jessica; Ayoola, Mudasiru; Grais, Rebecca F; Doyon, Stéphane

    2017-10-01

    We present an updated cost analysis to provide new estimates of the cost of providing community-based treatment for severe acute malnutrition, including expenditure shares for major cost categories. We calculated total and per child costs from a provider perspective. We categorized costs into three main activities (outpatient treatment, inpatient treatment, and management/administration) and four cost categories within each activity (personnel; therapeutic food; medical supplies; and infrastructure and logistical support). For each category, total costs were calculated by multiplying input quantities expended in the Médecins Sans Frontières nutrition program in Niger during a 12-month study period by 2015 input prices. All children received outpatient treatment, with 43% also receiving inpatient treatment. In this large, well-established program, the average cost per child treated was €148.86, with outpatient and inpatient treatment costs of €75.50 and €134.57 per child, respectively. Therapeutic food (44%, €32.98 per child) and personnel (35%, €26.70 per child) dominated outpatient costs, while personnel (56%, €75.47 per child) dominated in the cost of inpatient care. Sensitivity analyses suggested lowering prices of medical treatments, and therapeutic food had limited effect on total costs per child, while increasing program size and decreasing use of expatriate staff support reduced total costs per child substantially. Updated estimates of severe acute malnutrition treatment cost are substantially lower than previously published values, and important cost savings may be possible with increases in coverage/program size and integration into national health programs. These updated estimates can be used to suggest approaches to improve efficiency and inform national-level resource allocation. © 2016 John Wiley & Sons Ltd.

  3. Road crash costs.

    NARCIS (Netherlands)

    2010-01-01

    Road crashes result in all kinds of social costs, such as medical costs, production loss, human losses, property damage, settlement costs and costs due to congestion. Studies into road crash costs and their trends are carried out quite regularly. In 2009, the costs amounted to € 12.5 billion, or

  4. 2010 Cost of Wind Energy Review

    Energy Technology Data Exchange (ETDEWEB)

    Tegen, S.; Hand, M.; Maples, B.; Lantz, E.; Schwabe, P.; Smith, A.

    2012-04-01

    This document provides a detailed description of NREL's levelized cost of wind energy equation, assumptions and results in 2010, including historical cost trends and future projections for land-based and offshore utility-scale wind.

  5. 2010 Cost of Wind Energy Review

    Energy Technology Data Exchange (ETDEWEB)

    Tegen, S. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hand, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Maples, B. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Lantz, E. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Schwabe, P. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Smith, A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2012-04-01

    This document provides a detailed description of NREL's levelized cost of wind energy equation, assumptions, and results in 2010, including historical cost trends and future projections for land-based and offshore utility-scale wind.

  6. 44 CFR 204.42 - Eligible costs.

    Science.gov (United States)

    2010-10-01

    ... activities. (d) Travel and per diem costs. Eligible costs include: (1) Travel and per diem of employees who... Assistance Directorate , the State should immediately notify the Regional Administrator of its intention to...

  7. Cost Estimate for Gun Liner Emplacement

    Science.gov (United States)

    2011-08-01

    the gun tube. (The Rowan cost estimate includes the extra thermal soak for the explosive bonding process.) The cost for the extra stress relief... nuts for optimum performance. GUIDANCE SYSTEM:  Cylinder guidance is provide by the rod bushing

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

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

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

  9. Economic burden of schizophrenia: empirical analyses from a survey in Thailand.

    Science.gov (United States)

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

    2012-03-01

    Evidence consistently indicates that schizophrenia is a costly disease although it is not a high prevalence disorder. There are a few studies in developing countries but no study in Thailand reporting the cost of schizophrenia from a societal perspective. Health policy makers need to be aware of the cost of health care for people with schizophrenia as well as the economic burden on patients and families. This study aims to provide a detailed breakdown of the costs attributed to schizophrenia including the consumption of public health care resources by people with schizophrenia and the negative consequences on patients and families due to productivity losses. Data from a survey conducted in 2008 among people in treatment for schizophrenia were used to estimate annual medical costs for treatment including outpatient services, hospitalization and patient travel. Indirect costs were estimated for reported productivity losses of patients and families. Uncertainty analysis was performed using Monte Carlo simulation methods. We tested the sensitivity of varying assumptions about market wages to estimate productivity losses. All cost estimates are adjusted to 2008 using the Consumer Price Index and reported in Thai baht (THB). The average annual exchange rate of Thai baths to one US dollar was 33.5 in 2008. The annual overall cost of schizophrenia was estimated to be THB 87 000 (USD 2600) (95% CI: 83 000, 92 000) per person or THB 31 000 million (USD 925 million) (95% CI: 26 000, 37 000) for the entire population with schizophrenia in Thailand. Indirect costs due to high unemployment, absenteeism and presenteeism of patients and families accounted for 61% of the total economic burden of schizophrenia. The largest component of direct medical cost was for hospitalizations (50%), followed by outpatient services and drug costs. Sensitivity analyses suggest that using labor force survey and socioeconomic status survey provided similar results, while lost productivity when the

  10. Implementing Suicide Prevention Programs: Costs and Potential Life Years Saved in Canada.

    Science.gov (United States)

    Vasiliadis, Helen-Maria; Lesage, Alain; Latimer, Eric; Seguin, Monique

    2015-09-01

    Little is known about the costs and effects of suicide prevention programs at the population level. We aimed to determine (i) the costs associated with a suicide death and using prospective values (ii) the costs and effects of transferring, into a Canadian context, the results of the European Nuremberg Alliance against Depression (NAD) trial with the addition of 4 community-based suicide prevention strategies. These included the training of family physicians in the detection and treatment of depression, population campaigns aimed at increasing awareness about depression, the training of community leaders among first responders and follow-up of individuals who attempted suicide. This study includes a prospective value implementation study design. Using published data and information from interviews with Canadian decision makers, we assessed the costs of a suicide death in the province of Quebec and the costs of potentially implementing the NAD multi-modal suicide prevention programs, and the incremental cost-effectiveness ratio (ICER), from a health care system and societal perspective, associated with the NAD program while considering the friction cost method (FCM) and human capital approach (HCA) (discounted at 3%.) The costs considered included those incurred for the suicide prevention program and direct medical and non-medical costs as well as those related to a police investigation and funeral costs. Indirect costs associated with loss of productivity and short term disability were also considered. Sensitivity analyses were also carried out. Costs presented were in 2010 dollars. The annual total cost of implementing the suicide prevention programs in Quebec reached CAD23,982,293. The most expensive components of the program included the follow-up of individuals who had attempted suicide and psychotherapy for bereaved individuals. These accounted for 39% and 34% of total costs. The ICER associated with the implementation of the programs reached on average CAD3

  11. Cost-effectiveness of rotavirus vaccination in Kenya and Uganda.

    Science.gov (United States)

    Sigei, Charles; Odaga, John; Mvundura, Mercy; Madrid, Yvette; Clark, Andrew David

    2015-05-07

    Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda. In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda. Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective). Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national

  12. The cost of care of systemic lupus erythematosus (SLE) in the UK: annual direct costs for adult SLE patients with active autoantibody-positive disease.

    Science.gov (United States)

    Khamashta, M A; Bruce, I N; Gordon, C; Isenberg, D A; Ateka-Barrutia, O; Gayed, M; Donatti, C; Guillermin, A-L; Foo, J; Perna, A

    2014-03-01

    The aim of the Systemic LUpus Erythematosus Cost of Care In Europe (LUCIE) study was to evaluate the annual direct medical costs of managing adults with active autoantibody-positive disease on medication for SLE in secondary care. This paper presents the UK analyses only. A cost-of-illness study was conducted from the perspective of the National Health Service. Health resource utilization data were retrieved over a two-year period from four centres in England and unit cost data were taken from published sources. At baseline, 86 patients were included, 38 (44.2%) had severe SLE and 48 (55.8%) had non-severe SLE. The mean (SD) SELENA-SLEDAI score was 7.7 (5.7). The mean (SD) annual direct medical cost of was estimated at £3231 (£2333) per patient and was 2.2 times higher in patients with severe SLE compared with patients with non-severe SLE (p < 0.001). Multivariate model analyses showed that renal disease involvement (p = 0.0016) and severe flares (p = 0.0001) were associated with higher annual direct costs. Improvement of the overall stability of SLE and early intervention to minimize the impact of renal disease may be two approaches to mitigate the long-term direct cost of managing SLE patients in the UK.

  13. Costs of illness due to cholera, costs of immunization and cost-effectiveness of an oral cholera mass vaccination campaign in Zanzibar.

    Directory of Open Access Journals (Sweden)

    Christian Schaetti

    Full Text Available BACKGROUND: The World Health Organization (WHO recommends oral cholera vaccines (OCVs as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. METHODOLOGY/PRINCIPAL FINDINGS: Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER per death, per case and per disability-adjusted life-year (DALY averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3. CONCLUSIONS/SIGNIFICANCE: Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria

  14. Costs of illness due to cholera, costs of immunization and cost-effectiveness of an oral cholera mass vaccination campaign in Zanzibar.

    Science.gov (United States)

    Schaetti, Christian; Weiss, Mitchell G; Ali, Said M; Chaignat, Claire-Lise; Khatib, Ahmed M; Reyburn, Rita; Duintjer Tebbens, Radboud J; Hutubessy, Raymond

    2012-01-01

    The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3). Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness under certain circumstances, especially in high

  15. Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar

    Science.gov (United States)

    Schaetti, Christian; Weiss, Mitchell G.; Ali, Said M.; Chaignat, Claire-Lise; Khatib, Ahmed M.; Reyburn, Rita; Duintjer Tebbens, Radboud J.; Hutubessy, Raymond

    2012-01-01

    Background The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. Methodology/Principal Findings Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3). Conclusions/Significance Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost

  16. A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes

    Science.gov (United States)

    Ostermann, Julia K.; Witt, Claudia M.; Reinhold, Thomas

    2017-01-01

    Objectives This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months. Methods Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache. Results Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022–12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036–10,820] in the control group (phomeopathy: EUR 6,289 [6,118–6,460]; control: EUR 5,498 [5,326–5,670], phomeopathy: EUR 1,794 [1,770–1,818]; control: EUR 1,438 [1,414–1,462], phomeopathy patients generated higher costs than control patients. Conclusion The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group. PMID:28915242

  17. Cost-benefit considerations in regulatory analysis

    International Nuclear Information System (INIS)

    Mubayi, V.; Sailor, V.; Anandalingam, G.

    1995-10-01

    Justification for safety enhancements at nuclear facilities, e.g., a compulsory backfit to nuclear power plants, requires a value-impact analysis of the increase in overall public protection versus the cost of implementation. It has been customary to assess the benefits in terms of radiation dose to the public averted by the introduction of the safety enhancement. Comparison of such benefits with the costs of the enhancement then requires an estimate of the monetary value of averted dose (dollars/person rem). This report reviews available information on a variety of factors that affect this valuation and assesses the continuing validity of the figure of $1000/person-rem averted, which has been widely used as a guideline in performing value-impact analyses. Factors that bear on this valuation include the health risks of radiation doses, especially the higher risk estimates of the BEIR V committee, recent calculations of doses and offsite costs by consequence codes for hypothesized severe accidents at U.S. nuclear power plants under the NUREG-1150 program, and recent information on the economic consequences of the Chernobyl accident in the Soviet Union and estimates of risk avoidance based on the willingness-to-pay criterion. The report analyzes these factors and presents results on the dollars/person-rem ratio arising from different assumptions on the values of these factors

  18. [ARCSTERILE: A COST-EFFECTIVE LUXURY].

    Science.gov (United States)

    Fenoll, Maria Andreu

    2015-05-01

    The aim of this study is to evaluate the safety, economic profitability, and cost-effectiveness of the controlled ambient surgical cabin ArcSterile. Retrospective observational study comparing the profitability of surgical procedures using the ArcSterile* with those using the operating room throughout a 12-month period by analysing the following variables: total number of treated patients, delay in surgical assistance delay and the cost per procedure. Throughout a 12-month period, a total number of 2011 surgical procedures were performed with the ArcSterile, and 1736 surgical procedures were performed in the conventional operating room. Minor ocular surgeries including chalazia, pterigium, intravitreal injections and others were considered, whereas cataract and vitrectomy surgeries were disregarded. The use of the ArcSterile* was associated with an increase of 14% in the number of surgeries. The cost per hour of the use of the ArcSterile* was 30.75 euro, whereas it was 142.78 euro for the coriventional operating room. The ArcSterile* may allow to treat more patients and to treat them earlier compared with the conventional operating room, optimizing the use of the latest for patients who need a more complex surgery. We estimated an economic impact of 134 121.39 euro savings during the 12-month period of analysis. The use of the ArcSterile* surgical cabin for outpatient ocularsurgery may represent an effective and efficient alternative to the operating room with many clinical and economic benefits.

  19. Cost-benefit considerations in regulatory analysis

    Energy Technology Data Exchange (ETDEWEB)

    Mubayi, V.; Sailor, V.; Anandalingam, G.

    1995-10-01

    Justification for safety enhancements at nuclear facilities, e.g., a compulsory backfit to nuclear power plants, requires a value-impact analysis of the increase in overall public protection versus the cost of implementation. It has been customary to assess the benefits in terms of radiation dose to the public averted by the introduction of the safety enhancement. Comparison of such benefits with the costs of the enhancement then requires an estimate of the monetary value of averted dose (dollars/person rem). This report reviews available information on a variety of factors that affect this valuation and assesses the continuing validity of the figure of $1000/person-rem averted, which has been widely used as a guideline in performing value-impact analyses. Factors that bear on this valuation include the health risks of radiation doses, especially the higher risk estimates of the BEIR V committee, recent calculations of doses and offsite costs by consequence codes for hypothesized severe accidents at U.S. nuclear power plants under the NUREG-1150 program, and recent information on the economic consequences of the Chernobyl accident in the Soviet Union and estimates of risk avoidance based on the willingness-to-pay criterion. The report analyzes these factors and presents results on the dollars/person-rem ratio arising from different assumptions on the values of these factors.

  20. Improving Climate Communication through Comprehensive Linguistic Analyses Using Computational Tools

    Science.gov (United States)

    Gann, T. M.; Matlock, T.

    2014-12-01

    An important lesson on climate communication research is that there is no single way to reach out and inform the public. Different groups conceptualize climate issues in different ways and different groups have different values and assumptions. This variability makes it extremely difficult to effectively and objectively communicate climate information. One of the main challenges is the following: How do we acquire a better understanding of how values and assumptions vary across groups, including political groups? A necessary starting point is to pay close attention to the linguistic content of messages used across current popular media sources. Careful analyses of that information—including how it is realized in language for conservative and progressive media—may ultimately help climate scientists, government agency officials, journalists and others develop more effective messages. Past research has looked at partisan media coverage of climate change, but little attention has been given to the fine-grained linguistic content of such media. And when researchers have done detailed linguistic analyses, they have relied primarily on hand-coding, an approach that is costly, labor intensive, and time-consuming. Our project, building on recent work on partisan news media (Gann & Matlock, 2014; under review) uses high dimensional semantic analyses and other methods of automated classification techniques from the field of natural language processing to quantify how climate issues are characterized in media sources that differ according to political orientation. In addition to discussing varied linguistic patterns, we share new methods for improving climate communication for varied stakeholders, and for developing better assessments of their effectiveness.

  1. Multisite cost analysis of a school-based voluntary alcohol and drug prevention program.

    Science.gov (United States)

    Kilmer, Beau; Burgdorf, James R; D'Amico, Elizabeth J; Miles, Jeremy; Tucker, Joan

    2011-09-01

    This article estimates the societal costs of Project CHOICE, a voluntary after-school alcohol and other drug prevention program for adolescents. To our knowledge, this is the first cost analysis of an after-school program specifically focused on reducing alcohol and other drug use. The article uses microcosting methods based on the societal perspective and includes a number of sensitivity analyses to assess how the results change with alternative assumptions. Cost data were obtained from surveys of participants, facilitators, and school administrators; insights from program staff members; program expenditures; school budgets; the Bureau of Labor Statistics; and the National Center for Education Statistics. From the societal perspective, the cost of implementing Project CHOICE in eight California schools ranged from $121 to $305 per participant (Mdn = $238). The major cost drivers included labor costs associated with facilitating Project CHOICE, opportunity costs of displaced class time (because of in-class promotions for Project CHOICE and consent obtainment), and other efforts to increase participation. Substituting nationally representative cost information for wages and space reduced the range to $100-$206 (Mdn = $182), which is lower than the Substance Abuse and Mental Health Services Administration's estimate of $262 per pupil for the "average effective school-based program in 2002." Denominating national Project CHOICE costs by enrolled students instead of participants generates a median per-pupil cost of $21 (range: $14-$28). Estimating the societal costs of school-based prevention programs is crucial for efficiently allocating resources to reduce alcohol and other drug use. The large variation in Project CHOICE costs across schools highlights the importance of collecting program cost information from multiple sites.

  2. Direct-Acting Antiviral Agents for Patients With Hepatitis C Virus Genotype 1 Infection Are Cost-Saving.

    Science.gov (United States)

    Chhatwal, Jagpreet; He, Tianhua; Hur, Chin; Lopez-Olivo, Maria A

    2017-06-01

    Direct-acting antivirals (DAAs) are effective in treatment of hepatitis C virus (HCV) genotype 1 infection, but their cost and value have been debated. We performed a systematic review of published cost-effectiveness analyses of DAAs, synthesized their results with updated drug prices, and calculated the maximum price at which DAA therapy for HCV genotype 1 infection is cost-effective (increased quality-adjusted life-years [QALYs] and increased cost that the society is willing to pay) and cost-saving (increased QALYs and decreased costs). We conducted a systematic review of the PubMed, Medline, EMBASE, Cochrane library, EconLit, Database of Abstracts of Reviews of Effects, National Health Service Economic Evaluation Database, Health Technology Assessment, and Tufts University databases for cost-effectiveness analyses published from 2011 through 2015. Our analysis included cost effectiveness of DAAs versus previous standard-of-care regimens (peginterferon and ribavirin, boceprevir and telaprevir), or no treatment, performed for patients with HCV genotype 1 infection. We excluded studies that were not written in English or those that did not report QALYs. Reported incremental cost-effectiveness ratios (ICERs) and treatment costs for each comparison were extracted; the threshold price was estimated for each analysis in which regimens were found to be cost-effective (ICER ≤$100,000/QALY) or cost-saving (ICER <$0), those that decreased costs and increased QALYs. We identified 24 cost-effectiveness studies that reported 170 ICERs for combinations of 11 drugs, from 11 countries. Of those, 81 ICERs were determined for first-generation DAAs (boceprevir and telaprevir) and 89 ICERs were determined for second-generation DAAs (drugs approved after the first-generation DAAs) as a primary intervention. The median threshold prices at which first-generation and second-generation DAAs became cost-effective were estimated as $120,100 (interquartile range, $90,700-$176,800) and

  3. The cost of first-ever stroke in Valle d’Aosta, Italy: linking clinical registries and administrative data

    Directory of Open Access Journals (Sweden)

    Bottacchi Edo

    2012-10-01

    Full Text Available Abstract Background Stroke is one of the most relevant reasons of death and disability worldwide. Many cost of illness studies have been performed to evaluate direct and indirect costs of ischaemic stroke, especially within the first year after the acute episode, using different methodologies. Methods We conducted a longitudinal, retrospective, bottom-up cost of illness study, to evaluate clinical and economic outcomes of a cohort of patients affected by a first cerebrovascular event, including subjects with ischaemic, haemorrhagic or transient episodes. The analysis intended to detect direct costs, within 1, 2 and 3 years from the index event. Clinical patient data collected in regional disease registry were integrated and linked to regional administrative databases to perform the analysis. Results The analysis of costs within the first year from the index event included 800 patients. The majority of patients (71.5% were affected by ischaemic stroke. Overall, per patient costs were €7,079. Overall costs significantly differ according to the type of stroke, with costs for haemorrhagic stroke and ischaemic stroke amounting to €9,044 and €7,289. Hospital costs, including inpatient rehabilitation, were driver of expenditure, accounting for 89.5% of total costs. The multiple regression model showed that sex, level of physical disability and level of neurological deficit predict direct healthcare costs within 1 year. The analysis at 2 and 3 years (per patient costs: €7,901 and €8,874, respectively showed that majority of costs are concentrated in the first months after the acute event. Conclusions This cost analysis highlights the importance to set up significant prevention programs to reduce the economic burden of stroke, which is mostly attributable to hospital and inpatient rehabilitation costs immediately after the acute episode. Although some limitation typical of retrospective analyses the approach of linking clinical and

  4. Food irradiation : estimates of cost of processing

    International Nuclear Information System (INIS)

    Krishnamurthy, K.; Bongirwar, D.R.

    1987-01-01

    For estimating the cost of food irradiation, three factors have to be taken into consideration. These are : (1) capital cost incurred on irradiation device and its installation, (2) recurring or running cost which includes maintenance cost and operational expenditure, and (3) product specific cost dependent on the factors specific to the food item to be processed, its storage, handling and distribution. A simple method is proposed to provide estimates of capital costs and running costs and it is applied to prepare a detailed estimate of costs for irradiation processing of onions and fish in India. The cost of processing onions worked out to be between Rs. 40 to 120 per 1000 Kg and for fish Rs 354 per 1000 Kg. These estimates do not take into account transparation costs and fluctuations in marketing procedures. (M.G.B.). 7 tables

  5. The Quality Costs

    Directory of Open Access Journals (Sweden)

    Arsenie Constantin PAULICĂ

    2005-10-01

    Full Text Available Quality has a cost and this fact cannot be denied. In the same time, it is true that non-quality is more expensive. Quality is considered asbeing expensive because no one tries to calculate non-quality costs. Out of the final cost of a product, non-quality stands for 20% up to 35%.According to this idea all the economic sectors contain error costs caused by the mistakes made during the production process. To have a realconsummation situation, it is necessary to know the cost quantum. The final quality cost is the result of the following costs: prevention costs,necessary to preclude errors; evaluation costs, as results of a final product evaluation, and failure costs, generated by the non – attainment ofproduct’s purpose. The gross of these costs stand for the total quality costs. Nowadays, the problem inheres in how much this quality cost representsout of the final cost.

  6. Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali.

    Science.gov (United States)

    Maccario, Roberta; Rouhani, Saba; Drake, Tom; Nagy, Annie; Bamadio, Modibo; Diarra, Seybou; Djanken, Souleymane; Roschnik, Natalie; Clarke, Siân E; Sacko, Moussa; Brooker, Simon; Thuilliez, Josselin

    2017-06-12

    The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN), and Intermittent Parasite Clearance in schools (IPCs) in southern Mali. Costs were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children). A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed. The economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41) with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%), $5.53 (53.3%) and $2.72 (26.2%) per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child. A comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

  7. Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali

    Directory of Open Access Journals (Sweden)

    Roberta Maccario

    2017-06-01

    Full Text Available Abstract Background The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN, and Intermittent Parasite Clearance in schools (IPCs in southern Mali. Methods Costs were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children. A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed. Results The economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41 with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%, $5.53 (53.3% and $2.72 (26.2% per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child. Conclusions A comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

  8. Measles: who pays the cost?

    OpenAIRE

    Hastings, A; Hostler, A; Solen, A

    1987-01-01

    An epidemic of measles resulting in 164 cases in a Leicester group practice was analysed by means of a case-control study and a questionnaire. Estimates were made of the physical, social, and financial costs to children, parents, and family doctors. On average each child was ill for 10.8 days and the illness cost his parents pounds 11.06. His family doctor spent 26 minutes providing care. These results provide an additional stimulus to the primary care team to promote the uptake of measles va...

  9. TARGET COSTING FUNCTIONS

    OpenAIRE

    OFILEANU Dimi

    2015-01-01

    This article aims to highlight the concept of Target Costing. Based on the characteristics of Target Costing, identified in specialized literature, the article presents its main advantages and disadvantages. Also, a comparison is being made between Target Cost and Traditional Cost (in its traditional form, the cost represents an independent variable on the basis of which the sell price is established; and in the Target Cost form the cost represents a dependent variable which is determined on ...

  10. Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness.

    Science.gov (United States)

    Bassett, Ingrid V; Govindasamy, Darshini; Erlwanger, Alison S; Hyle, Emily P; Kranzer, Katharina; van Schaik, Nienke; Noubary, Farzad; Paltiel, A David; Wood, Robin; Walensky, Rochelle P; Losina, Elena; Bekker, Linda-Gail; Freedberg, Kenneth A

    2014-01-01

    Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%-58%, females 49%-58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be "very cost-effective" when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8,200 in 2012). We projected that, with medical facility-based testing, the discounted (undiscounted) HIV-infected population life expectancy was 132.2 (197.7) months; this increased to 140.7 (211.7) months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS). Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities. The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and

  11. Mobile HIV screening in Cape Town, South Africa: clinical impact, cost and cost-effectiveness.

    Directory of Open Access Journals (Sweden)

    Ingrid V Bassett

    Full Text Available Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa.We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I computer simulation model to evaluate two HIV screening strategies in Cape Town: 1 medical facility-based testing (the current standard of care and 2 addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%, mean CD4 count at diagnosis (males 423/µL, females 516/µL, CD4 count-dependent linkage to care rates (males 31%-58%, females 49%-58%, mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result. We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER of the intervention compared to medical facility-based testing. We considered the intervention to be "very cost-effective" when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP ($8,200 in 2012. We projected that, with medical facility-based testing, the discounted (undiscounted HIV-infected population life expectancy was 132.2 (197.7 months; this increased to 140.7 (211.7 months with the addition of the mobile unit. The ICER for the mobile unit was $2,400/year of life saved (YLS. Results were most sensitive to the previously undiagnosed HIV prevalence, linkage to care rates, and frequency of HIV testing at medical facilities.The addition of mobile HIV screening to current testing programs can improve survival and be very cost-effective in South Africa and

  12. Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature.

    Science.gov (United States)

    Wu, C-H; Kao, I-J; Hung, W-C; Lin, S-C; Liu, H-C; Hsieh, M-H; Bagga, S; Achra, M; Cheng, T-T; Yang, R-S

    2018-02-19

    Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023-$28,800 US dollars (USD) in Japan to $14,513-$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed

  13. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.

    Science.gov (United States)

    Taylor, Penny; Pezzullo, Lynne; Grant, Suzanne J; Bensoussan, Alan

    2014-09-01

    Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta-analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost-effectiveness analysis were the incremental cost-effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability-adjusted life-year (DALY) saved. The WHO benchmark for a very highly cost-effective intervention is one that costs less than gross domestic product per capita per quality-adjusted life-year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP. © 2013 World Institute of Pain.

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

    Directory of Open Access Journals (Sweden)

    Nyhuis Allen W

    2009-05-01

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

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

    Science.gov (United States)

    Faries, Douglas E; Nyhuis, Allen W; Ascher-Svanum, Haya

    2009-05-27

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

  16. Nuclear power production costs

    International Nuclear Information System (INIS)

    Erramuspe, H.J.

    1988-01-01

    The economic competitiveness of nuclear power in different highly developed countries is shown, by reviewing various international studies made on the subject. Generation costs (historical values) of Atucha I and Embalse Nuclear Power Plants, which are of the type used in those countries, are also included. The results of an international study on the economic aspects of the back end of the nuclear fuel cycle are also reviewed. This study shows its relatively low incidence in the generation costs. The conclusion is that if in Argentina the same principles of economic racionality were followed, nuclear energy would be economically competitive in the future, as it is today. This is of great importance in view of its almost unavoidable character of alternative source of energy, and specially since we have to expect an important growth in the consumption of electricity, due to its low share in the total consumption of energy, and the low energy consumption per capita in Argentina. (Author) [es

  17. COSTS CALCULATION OF TARGET COSTING METHOD

    Directory of Open Access Journals (Sweden)

    Sebastian UNGUREANU

    2014-06-01

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

  18. Costing in Radiotherapy. Chapter 18

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  19. Multiple Imputation for Network Analyses

    NARCIS (Netherlands)

    Krause, Robert; Huisman, Mark; Steglich, Christian; Snijders, Thomas

    2016-01-01

    Missing data on network ties is a fundamental problem for network analyses. The biases induced by missing edge data, even when missing completely at random (MCAR), are widely acknowledged and problematic for network analyses (Kossinets, 2006; Huisman & Steglich, 2008; Huisman, 2009). Although

  20. Grey literature in meta-analyses.

    Science.gov (United States)

    Conn, Vicki S; Valentine, Jeffrey C; Cooper, Harris M; Rantz, Marilyn J

    2003-01-01

    In meta-analysis, researchers combine the results of individual studies to arrive at cumulative conclusions. Meta-analysts sometimes include "grey literature" in their evidential base, which includes unpublished studies and studies published outside widely available journals. Because grey literature is a source of data that might not employ peer review, critics have questioned the validity of its data and the results of meta-analyses that include it. To examine evidence regarding whether grey literature should be included in meta-analyses and strategies to manage grey literature in quantitative synthesis. This article reviews evidence on whether the results of studies published in peer-reviewed journals are representative of results from broader samplings of research on a topic as a rationale for inclusion of grey literature. Strategies to enhance access to grey literature are addressed. The most consistent and robust difference between published and grey literature is that published research is more likely to contain results that are statistically significant. Effect size estimates of published research are about one-third larger than those of unpublished studies. Unfunded and small sample studies are less likely to be published. Yet, importantly, methodological rigor does not differ between published and grey literature. Meta-analyses that exclude grey literature likely (a) over-represent studies with statistically significant findings, (b) inflate effect size estimates, and (c) provide less precise effect size estimates than meta-analyses including grey literature. Meta-analyses should include grey literature to fully reflect the existing evidential base and should assess the impact of methodological variations through moderator analysis.

  1. Integration efficiency for model reduction in micro-mechanical analyses

    Science.gov (United States)

    van Tuijl, Rody A.; Remmers, Joris J. C.; Geers, Marc G. D.

    2017-11-01

    Micro-structural analyses are an important tool to understand material behavior on a macroscopic scale. The analysis of a microstructure is usually computationally very demanding and there are several reduced order modeling techniques available in literature to limit the computational costs of repetitive analyses of a single representative volume element. These techniques to speed up the integration at the micro-scale can be roughly divided into two classes; methods interpolating the integrand and cubature methods. The empirical interpolation method (high-performance reduced order modeling) and the empirical cubature method are assessed in terms of their accuracy in approximating the full-order result. A micro-structural volume element is therefore considered, subjected to four load-cases, including cyclic and path-dependent loading. The differences in approximating the micro- and macroscopic quantities of interest are highlighted, e.g. micro-fluctuations and stresses. Algorithmic speed-ups for both methods with respect to the full-order micro-structural model are quantified. The pros and cons of both classes are thereby clearly identified.

  2. Life cycle cost analysis rehabilitation costs.

    Science.gov (United States)

    2015-07-01

    This study evaluates data from CDOTs Cost Data books and Pavement Management Program. Cost : indices were used to normalize project data to year 2014. Data analyzed in the study was obtained from : the CDOTs Cost Data books and the Pavement Man...

  3. An empirical analysis of the cost of rearing dairy heifers from birth to first calving and the time taken to repay these costs.

    Science.gov (United States)

    Boulton, A C; Rushton, J; Wathes, D C

    2017-08-01

    Rearing quality dairy heifers is essential to maintain herds by replacing culled cows. Information on the key factors influencing the cost of rearing under different management systems is, however, limited and many farmers are unaware of their true costs. This study determined the cost of rearing heifers from birth to first calving in Great Britain including the cost of mortality, investigated the main factors influencing these costs across differing farming systems and estimated how long it took heifers to repay the cost of rearing on individual farms. Primary data on heifer management from birth to calving was collected through a survey of 101 dairy farms during 2013. Univariate followed by multivariable linear regression was used to analyse the influence of farm factors and key rearing events on costs. An Excel spreadsheet model was developed to determine the time it took for heifers to repay the rearing cost. The mean±SD ages at weaning, conception and calving were 62±13, 509±60 and 784±60 days. The mean total cost of rearing was £1819±387/heifer with a mean daily cost of £2.31±0.41. This included the opportunity cost of the heifer and the mean cost of mortality, which ranged from £103.49 to £146.19/surviving heifer. The multivariable model predicted an increase in mean cost of rearing of £2.87 for each extra day of age at first calving and a decrease in mean cost of £6.06 for each percentile increase in time spent at grass. The model also predicted a decrease in the mean cost of rearing in autumn and spring calving herds of £273.20 and £288.56, respectively, compared with that in all-year-round calving herds. Farms with herd sizes⩾100 had lower mean costs of between £301.75 and £407.83 compared with farms with economic analysis suggest that management decisions on key reproduction events and grazing policy significantly influence the cost of rearing and the time it takes for heifers to start making a profit for the farm.

  4. Climate change adaptation, damages and fossil fuel dependence. An RETD position paper on the costs of inaction

    Energy Technology Data Exchange (ETDEWEB)

    Katofsky, Ryan; Stanberry, Matt; Hagenstad, Marca; Frantzis, Lisa

    2011-07-15

    The Renewable Energy Technology Deployment (RETD) agreement initiated this project to advance the understanding of the ''Costs of Inaction'', i.e. the costs of climate change adaptation, damages and fossil fuel dependence. A quantitative estimate was developed as well as a better understanding of the knowledge gaps and research needs. The project also included some conceptual work on how to better integrate the analyses of mitigation, adaptation, damages and fossil fuel dependence in energy scenario modelling.

  5. COST OF QUALITY MANAGEMENT

    OpenAIRE

    Milan Vukčević

    2008-01-01

    Cost of quality are part of structure a total cost of organisation. Cost of quality management is important aspect of successful organization. In this paper, models are analised and key aspects cost of quality are given. Problem a cost of quality management particularly is investigated.

  6. Shining examples analysed within the EBC Annex 56 project

    DEFF Research Database (Denmark)

    Christen Mørck, Ove; Almeida, Manuela; Ferreira, Marco

    2016-01-01

    The International Energy Agency established an Implementing Agreement within the Energy in Buildings and Communities Program to undertake research and provide an international focus on “Cost Effective Energy and Carbon Emissions Optimization in Building Renovation” (EBC Annex 56). The project aims...... at developing a new methodology to enable cost effective renovation of existing buildings while optimizing energy consumption and carbon emissions reduction. Several case studies were gathered to develop and validate the methodology, and a selection of “Shining Examples” was made to encourage decision makers...... to promote efficient and cost effective renovations. This paper presents the results of the analyses made on these Shining Examples....

  7. Robust Unit Commitment Including Frequency Stability Constraints

    Directory of Open Access Journals (Sweden)

    Felipe Pérez-Illanes

    2016-11-01

    Full Text Available An increased use of variable generation technologies such as wind power and photovoltaic generation can have important effects on system frequency performance during normal operation as well as contingencies. The main reasons are the operational principles and inherent characteristics of these power plants like operation at maximum power point and no inertial response during power system imbalances. This has led to new challenges for Transmission System Operators in terms of ensuring system security during contingencies. In this context, this paper proposes a Robust Unit Commitment including a set of additional frequency stability constraints. To do this, a simplified dynamic model of the initial system frequency response is used in combination with historical frequency nadir data during contingencies. The proposed approach is especially suitable for power systems with cost-based economic dispatch like those in most Latin American countries. The study is done considering the Northern Interconnected System of Chile, a 50-Hz medium size isolated power system. The results obtained were validated by means of dynamic simulations of different system contingencies.

  8. Potential costs of breast augmentation mammaplasty.

    Science.gov (United States)

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

    2016-01-01

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

  9. Cost-effective smoke-free multiunit housing media campaigns: connecting with local communities.

    Science.gov (United States)

    Modayil, Mary V; Consolacion, Theodora B; Isler, Jonathan; Soria, Sandra; Stevens, Colleen

    2011-11-01

    Presented are cost-effective paid media strategies to educate Californians to advocate for stronger smoke-free multiunit housing (SF-MUH) policies between 2006 and 2008. Included is a summary of general market and specific ethnic market costs that correspond to SF-MUH attitudes and home smoking bans. Statewide questionnaires indicated that half of the intended general market saw an antitobacco TV ad and half of the intended ethnic markets heard radio ads. Analyses indicated that it cost $0.67 and $0.78 per person to see Caution Tape and Apartment TV ads, respectively. Slightly higher per capita costs corresponded with positive attitudes toward SF-MUH: $0.87 for Caution Tape and $1.00 for Apartment. Lessons learned from this cam