WorldWideScience

Sample records for included total costs

  1. The total assessment profile, volume 1. [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

    A methodology is described for the evaluation of societal impacts associated with the implementation of a new technology. Theoretical foundations for the methodology, called the total assessment profile, are established from both the economic and social science perspectives. The procedure provides for accountability of nonquantifiable factors and measures through the use of a comparative value matrix by assessing the impacts of the technology on the value system of the society.

  2. 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 .

  3. Total Cost of Ownership

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2007-01-01

    Total Cost of Ownership (TCO), som giver et bud på, hvordan virksomheder kan opnå en bedre indsigt i, hvilke leverandører der forårsager hvilke omkostninger og dermed danne et forbedret beslutningsgrundlag for besparelser i leverandørleddet. I artiklen argumenteres først og fremmest for, hvorfor TCO er...

  4. 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

  5. Total generating costs: coal and nuclear plants

    International Nuclear Information System (INIS)

    1979-02-01

    The study was confined to single and multi-unit coal- and nuclear-fueled electric-generating stations. The stations are composed of 1200-MWe PWRs; 1200-MWe BWRs; 800-and 1200-MWe High-Sulfur Coal units, and 800- and 1200-MWe Low-Sulfur Coal units. The total generating cost estimates were developed for commercial operation dates of 1985 and 1990; for 5 and 8% escalation rates, for 10 and 12% discount rates; and, for capacity factors of 50, 60, 70, and 80%. The report describes the methodology for obtaining annualized capital costs, levelized coal and nuclear fuel costs, levelized operation and maintenance costs, and the resulting total generating costs for each type of station. The costs are applicable to a hypothetical Middletwon site in the Northeastern United States. Plant descriptions with general design parameters are included. The report also reprints for convenience, summaries of capital cost by account type developed in the previous commercial electric-power cost studies. Appropriate references are given for additional detailed information. Sufficient detail is given to allow the reader to develop total generating costs for other cases or conditions

  6. Total Cost of Ownership and Cost-to-Serve

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2007-01-01

    Artiklen reviewer den eksisterende litteratur vedrørende økonomistyringsværktøjerne Total Cost of Ownership (TCO) og Cost-to-Serve (CtS). Herefter kortlægges det, hvordan TCO og CtS bidrager til en identificering af direkte omkostninger såvel som indirekte omkostninger henholdsvis up-stream og down...

  7. The total cost of father desertion.

    Science.gov (United States)

    Winking, Jeffrey; Gurven, Michael

    2011-01-01

    The benefits of paternal investment have long been explored by assessing the impact of father's presence on child wellbeing. Previous studies, however, have only examined the average effect of father's presence on child survivorship. Here we assess the total fitness cost to men of deserting (or the benefit of staying), by considering effects on the entire progeny. We estimate the total number of children that a deserting father can expect to lose due to reduced survivorship over the life course in five populations, and compare this loss to the benefit gains from remarrying a younger wife. We compiled the observed impacts of father's absence, as well as mortality and fertility schedules, for five foraging or foraging/horticultural populations. We calculate how many additional children a man can expect to lose due to father's absence throughout a marriage. We then calculate the minimum age difference between a first and second spouse that would be necessary to overcome this cost. Because child mortality rates drop so rapidly, the costs that men experience from desertion due to augmented child mortality are modest throughout marriage. Even hypothetically inflated father effects can be overcome with modest age differences between first and second spouses. Returns to paternal investment in terms of increased child survival are not substantial compared to those received by successfully practicing a serial mating strategy. This suggests that factors other than the ability to enhance child survival, such as female choice, are important to the evolutionary history and continued adaptive functioning of men's unique reproductive strategies. Copyright © 2011 Wiley-Liss, Inc.

  8. 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.

  9. The total lifetime costs of smoking

    DEFF Research Database (Denmark)

    Rasmussen, S.R.; Prescott, E.; Sørensen, T.I.A.

    2004-01-01

    Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy.......Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy....

  10. Cost-identification analysis of total laryngectomy: an itemized approach to hospital costs.

    Science.gov (United States)

    Dedhia, Raj C; Smith, Kenneth J; Weissfeld, Joel L; Saul, Melissa I; Lee, Steve C; Myers, Eugene N; Johnson, Jonas T

    2011-02-01

    To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Case series with chart review. Large tertiary care teaching hospital system. Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Mean total hospital costs were $29,563 (range, $10,915 to $120,345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6-43), and median Charlson comorbidity index score was 8 (2-16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46,831 vs $24,601, P cost differences with stratification based on previous radiation therapy ($27,598 vs $29,915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29,483 vs $29,609 without readmission, P = .97). This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.

  11. Enterprise Achitecture versus Total Cost of Ownership

    OpenAIRE

    Holm Larsen, Michael; Holck, Jesper; Kühn Pedersen, Mogens

    2004-01-01

    Abstract: The paper presents an explorative study of Open Source Software (OSS) focusing on the managerial decisions for acquisition of OSS. Based on three case studies we argue that whereas small organizations often may chose adoption of OSS expecting significant cost savings, a major barrier for larger organizations’ adoption of OSS lies in the organizations’ consolidation of the enterprise architectures, in addition to that OSS will not be adopted before satisfactory delivery and procureme...

  12. Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation

    NARCIS (Netherlands)

    Eekman, D.A.; ter Wee, M.M.; Coupe, V.M.H.; Erisek-Demirtas, S.; Kramer, M.H.; Lems, W.F.

    2014-01-01

    Data on direct and indirect costs of clinical fractures in 116 osteoporotic patients 50 years and older were prospectively collected using cost diaries. Indirect costs accounted for roughly half of the total costs, with a contribution of at least 81 % of these costs in employed patients.

  13. Economics of human performance and systems total ownership cost.

    Science.gov (United States)

    Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z

    2012-01-01

    Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.

  14. The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

    2018-02-21

    In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

  15. Total Ownership Cost Reduction Case Study: AEGIS Radar Phase Shifters

    National Research Council Canada - National Science Library

    Bridger, Wray W; Ruiz, Mark D

    2006-01-01

    The goal of this research is to provide a case study that captures the production and design processes and program management solutions used to reduce total ownership costs of AEGIS Radar Phase Shifters...

  16. Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

    International Nuclear Information System (INIS)

    Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

    1989-01-01

    The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

  17. Total cost of ownership: the role of clinical engineering.

    Science.gov (United States)

    Hockel, Dale; Kintner, Michael

    2014-06-01

    Hospitals often incur substantial hidden costs associated with service agreements that they enter into with original equipment manufacturers at the time of equipment purchase. Hospitals should perform an analysis of the total cost of ownership (TCO) of their organizations' medical equipment to identify opportunities for performance improvement and savings. The findings of the TCO analysis can point to areas where clinical engineering service management can be improved through investments in technology, training, and teamwork.

  18. [Total knee and hip prosthesis: variables associated with costs].

    Science.gov (United States)

    Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

    2013-01-01

    The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

  19. evaluation of total annual costs of heat exchanger networks using

    African Journals Online (AJOL)

    This study presents pinch analysis of some heat exchanger networks (HENs) problems using Hint integration (HINT) software. Three examples reported to have been solved using different approaches by various researchers to obtain the least possible total annual cost (TAC) were solved using the Hint software. In this work ...

  20. evaluation of total annual costs of heat exchanger networks using

    African Journals Online (AJOL)

    user

    This study presents pinch analysis of some heat exchanger networks (HENs) problems using Hint integration. (HINT) software. ... after solving the first problem using RPA based heat integration gave a minimum total annual cost (TAC) of $237,. 510 /yr. which .... with continuous variables, whereas HENs problems comprise ...

  1. Animal board invited review: Dairy cow lameness expenditures, losses and total cost.

    Science.gov (United States)

    Dolecheck, K; Bewley, J

    2018-03-20

    Lameness is one of the most costly dairy cow diseases, yet adoption of lameness prevention strategies remains low. Low lameness prevention adoption might be attributable to a lack of understanding regarding total lameness costs. In this review, we evaluated the contribution of different expenditures and losses to total lameness costs. Evaluated expenditures included labor for treatment, therapeutic supplies, lameness detection and lameness control and prevention. Evaluated losses included non-saleable milk, reduced milk production, reduced reproductive performance, increased animal death, increased animal culling, disease interrelationships, lameness recurrence and reduced animal welfare. The previous literature on total lameness cost estimates was also summarized. The reviewed studies indicated that previous estimates of total lameness costs are variable and inconsistent in the expenditures and losses they include. Many of the identified expenditure and loss categories require further research to accurately include in total lameness cost estimates. Future research should focus on identifying costs associated with specific lameness conditions, differing lameness severity levels, and differing stages of lactation at onset of lameness to provide better total lameness cost estimates that can be useful for decision making at both the herd and individual cow level.

  2. Total cost-effectiveness of mammography screening strategies.

    Science.gov (United States)

    Mittmann, Nicole; Stout, Natasha K; Lee, Pablo; Tosteson, Anna N A; Trentham-Dietz, Amy; Alagoz, Oguzhan; Yaffe, Martin J

    2015-12-01

    Breast cancer screening technology and treatment have improved over the past decade. This analysis evaluates the total cost-effectiveness of various breast cancer screening strategies in Canada. Using the Wisconsin Cancer Intervention and Surveillance Monitoring Network (CISNET) breast cancer simulation model adapted to the Canadian context, costs and quality-adjusted life years (QALY) were evaluated for 11 mammography screening strategies that varied by start/stop age and screening frequency for the general population. Incremental cost-effectiveness ratios are presented, and sensitivity analyses are used to assess the robustness of model conclusions. Incremental cost-effectiveness analysis showed that triennial screening at ages 50 to 69 was the most cost-effective at $94,762 per QALY. Biennial ($97,006 per QALY) and annual ($226,278 per QALY) strategies had higher incremental ratios. The benefits and costs of screening rise with the number of screens per woman. Decisions about screening strategies may be influenced by willingness to pay and the rate of recall for further examination after positive screens.

  3. Internal Logistics System Selection with Total Cost of Ownership Analysis

    Science.gov (United States)

    Araújo, Inês; Pimentel, Carina; Godina, Radu; Matias, João C. O.

    2017-06-01

    In this paper a methodology was followed in order to support the decision-making of one industrial unit regarding its internal logistics system. The addressed factory was facing issues with their internal logistics approach. Some alternatives were pointed out and a proper total cost of ownership (TCO) analysis was developed. This analysis was taken in order to demonstrate the more cost-effective solution for the internal logistics system. This tool is more and more valued by the companies, due to their willing to reduce the costs that are associated with the way of doing business. Despite the proposal of the best choice for the internal logistics system of the enterprise, this study also intends to present some conclusions about the match between the nature of the industrial unit and the logistics systems that best fit the requirements of those.

  4. En differentieret tilgang til total cost of ownership (TCO)

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2010-01-01

    Økonomistyring er en nødvendig brik i forsøget på at kunne styre dele af eller hele forsyningskæden, og til dette bruges diverse økonomistyringsværktøjer. Denne artikel omhandler økonomistyringsværktøjet 'total cost of ownership', og hvordan dette kan bruges til at forbedre samarbejdet med...

  5. Association of Hospital Costs With Complications Following Total Gastrectomy for Gastric Adenocarcinoma.

    Science.gov (United States)

    Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E

    2017-10-01

    Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD

  6. Evaluation of the Total Cost of Ownership of Fuel Cell-Powered Material Handling Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Ramsden, T.

    2013-04-01

    This report discusses an analysis of the total cost of ownership of fuel cell-powered and traditional battery-powered material handling equipment (MHE, or more typically 'forklifts'). A number of fuel cell MHE deployments have received funding support from the federal government. Using data from these government co-funded deployments, DOE's National Renewable Energy Laboratory (NREL) has been evaluating the performance of fuel cells in material handling applications. NREL has assessed the total cost of ownership of fuel cell MHE and compared it to the cost of ownership of traditional battery-powered MHE. As part of its cost of ownership assessment, NREL looked at a range of costs associated with MHE operation, including the capital costs of battery and fuel cell systems, the cost of supporting infrastructure, maintenance costs, warehouse space costs, and labor costs. Considering all these costs, NREL found that fuel cell MHE can have a lower overall cost of ownership than comparable battery-powered MHE.

  7. 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.

  8. 20 CFR 410.410 - Total disability due to pneumoconiosis, including statutory presumption.

    Science.gov (United States)

    2010-04-01

    ... FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Total Disability or Death Due to Pneumoconiosis § 410.410 Total disability due to pneumoconiosis, including statutory... their death. (For benefits to the eligible survivors of miners whose deaths are determined to have been...

  9. Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

    International Nuclear Information System (INIS)

    Strauss, Jonathan B.; Chen, Sea S.; Shah, Anand P.; Coon, Alan B.; Dickler, Adam

    2008-01-01

    Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered

  10. Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

    Science.gov (United States)

    Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

    2015-12-01

    The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs.

    Science.gov (United States)

    Gray, Susan H; Trudell, Emily K; Emans, S Jean; Woods, Elizabeth R; Berry, Jay G; Vernacchio, Louis

    2015-10-01

    Accountable care payment models aim to reduce total direct medical expenses for high-cost patients through improved quality of care and preventive health services. Little is known about health care expenditures of privately insured adolescents, especially those who incur high costs. To assess health care expenditures for high-cost adolescents and to describe the patient characteristics associated with high medical costs. A retrospective cohort analysis was conducted of data from January 1 to December 31, 2012, of 13,103 privately insured adolescents aged 13 to 21 years (mean [SD] age, 16.3 [2.4] years; 6764 [51.6%] males) at 82 independent pediatric primary care practices in Massachusetts. Analysis was conducted from April 1, 2014, to April 1, 2015. We compared demographic (age, sex, median income by zip code) and clinical (obesity, behavioral health problem, complex chronic condition) characteristics between high-cost (top 1%) and non-high-cost adolescents. We assigned high-cost adolescents to clinical categories using software from the Agency for Healthcare Research and Quality to describe clinically relevant patterns of spending. Total direct medical expenses were $41.2 million for the entire cohort and a median $1167 per patient. A total of 132 (1.0%) patients with the highest costs accounted for 23.6% of expenses of the cohort, with a median $52,577 per patient. Mental health disorders were the most common diagnosis in high-cost patients; 78 (59.1%) of these patients had at least 1 behavioral health diagnosis. Pharmacy costs accounted for 28.4% of total direct medical expenses of high-cost patients; primary care accounted for 1.0%. Characteristics associated with being a high-cost patient included having 1 complex chronic condition (relative risk [RR], 6.5; 95% CI, 4.7-9.0), having 2 or more complex chronic conditions (RR, 23.5; 95% CI, 14.2-39.1), having any behavioral health diagnosis (RR, 3.6; 95% CI, 2.6-5.1), and obesity (RR, 2.0; 95% CI, 1.3-3.0). Total

  12. 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....

  13. Cost Savings of Nuclear Power with Total Fuel Reprocessing

    International Nuclear Information System (INIS)

    Solbrig, Charles W.; Benedict, Robert W.

    2006-01-01

    The cost of fast reactor (FR) generated electricity with pyro-processing is estimated in this article. It compares favorably with other forms of energy and is shown to be less than that produced by light water reactors (LWR's). FR's use all the energy in natural uranium whereas LWR's utilize only 0.7% of it. Because of high radioactivity, pyro-processing is not open to weapon material diversion. This technology is ready now. Nuclear power has the same advantage as coal power in that it is not dependent upon a scarce foreign fuel and has the significant additional advantage of not contributing to global warming or air pollution. A jump start on new nuclear plants could rapidly allow electric furnaces to replace home heating oil furnaces and utilize high capacity batteries for hybrid automobiles: both would reduce US reliance on oil. If these were fast reactors fueled by reprocessed fuel, the spent fuel storage problem could also be solved. Costs are derived from assumptions on the LWR's and FR's five cost components: 1) Capital costs: LWR plants cost $106/MWe. FR's cost 25% more. Forty year amortization is used. 2) The annual O and M costs for both plants are 9% of the Capital Costs. 3) LWR fuel costs about 0.0035 $/kWh. Producing FR fuel from spent fuel by pyro-processing must be done in highly shielded hot cells which is costly. However, the five foot thick concrete walls have the advantage of prohibiting diversion. LWR spent fuel must be used as feedstock for the FR initial core load and first two reloads so this FR fuel costs more than LWR fuel. FR fuel costs much less for subsequent core reloads ( 6 /MWe. The annual cost for a 40 year licensed plant would be 2.5 % of this or less if interest is taken into account. All plants will eventually have to replace those components which become radiation damaged. FR's should be designed to replace parts rather than decommission. The LWR costs are estimated to be 2.65 cents/kWh. FR costs are 2.99 cents/kWh for the first

  14. Least-Total-Cost Analysis for Earthquake Design Levels.

    Science.gov (United States)

    1980-06-01

    aid. I -n~..r d Idenify by blorA ... ber) Earthquakes, Structural design, Costs, Damae, Least cost, Optimal design Seismic risk. M0 ABSTRACT ( Continuo ...Oct 2-3, 1975, University of Illinois, Urbana, Ill. 16. University of California. EERC 75-27: Identification of research needs for improving aseismic

  15. Opportunities for Reducing Total Maximum Daily Load (TMDL) compliance costs: lessons from the Chesapeake Bay.

    Science.gov (United States)

    Wainger, Lisa A

    2012-09-04

    The Chesapeake Bay Total Maximum Daily Load (TMDL) program is an unprecedented opportunity to restore the Chesapeake Bay, yet program costs threaten to undermine its complete implementation. Analyses of Bay TMDL program design and implementation were used to relate program cost-effectiveness to choices in (1) compliance definitions, (2) geographic load allocations, and (3) approaches to engaging unregulated sources. A key finding was that many design choices require choosing an acceptable level of risk of achieving water quality outcomes, and a lack of data can lead to precautionary choices, which increase compliance costs. Furthermore, although some choices managed costs, others decisions may have reduced the potential for cost savings from water quality trading and payment programs. In particular, the choice by some states to distribute the portion of load reductions that improve water quality in the Bay mainstem to many small basins is likely to diminish the potential for market development or reduce funding for the most cost-effective nutrient and sediment reduction practices. Strategies for reducing costs of future TMDLs include considering diminishing marginal returns early in the TMDL design to balance costs and risks in regulatory goal setting and to design rules and incentives that promote innovation and cost-effective compliance strategies.

  16. Electrochromic Windows: Process and Fabrication Improvements for Lower Total Costs

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burdis; Neil Sbar

    2007-03-31

    The overall goal with respect to the U.S. Department of Energy (DOE) is to achieve significant national energy savings through maximized penetration of EC windows into existing markets so that the largest cumulative energy reduction can be realized. The speed with which EC windows can be introduced and replace current IGU's (and current glazings) is clearly a strong function of cost. Therefore, the aim of this project was to investigate possible improvements to the SageGlass{reg_sign} EC glazing products to facilitate both process and fabrication improvements resulting in lower overall costs. The project was split into four major areas dealing with improvements to the electrochromic layer, the capping layer, defect elimination and general product improvements. Significant advancements have been made in each of the four areas. These can be summarized as follows: (1) Plasma assisted deposition for the electrochromic layer was pursued, and several improvements made to the technology for producing a plasma beam were made. Functional EC devices were produced using the new technology, but there are still questions to be answered regarding the intrinsic properties of the electrochromic films produced by this method. (2) The capping layer work was successfully implemented into the existing SageGlass{reg_sign} product, thereby providing a higher level of transparency and somewhat lower reflectivity than the 'standard' product. (3) Defect elimination is an ongoing effort, but this project spurred some major defect reduction programs, which led to significant improvements in yield, with all the implicit benefits afforded. In particular, major advances were made in the development of a new bus bar application process aimed at reducing the numbers of 'shorts' developed in the finished product, as well as making dramatic improvements in the methods used for tempering the glass, which had previously been seen to produce a defect which appeared as a

  17. 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...

  18. Total cost estimates for large-scale wind scenarios in UK

    International Nuclear Information System (INIS)

    Dale, Lewis; Milborrow, David; Slark, Richard; Strbac, Goran

    2004-01-01

    The recent UK Energy White Paper suggested that the Government should aim to secure 20% of electricity from renewable sources by 2020. A number of estimates of the extra cost of such a commitment have been made, but these have not necessarily included all the relevant cost components. This analysis sets out to identify these and to calculate the extra cost to the electricity consumer, assuming all the renewable electricity is sourced from wind energy. This enables one of the more controversial issues--the implications of wind intermittency--to be addressed. The basis of the assumptions associated with generating costs, extra balancing costs and distribution and transmission system reinforcement costs are all clearly identified and the total costs of a '20% wind' scenario are compared with a scenario where a similar amount of energy is generated by gas-fired plant. This enables the extra costs of the renewables scenario to be determined. The central estimate of the extra costs to electricity consumers is just over 0.3 p/kW h in current prices (around 5% extra on average domestic unit prices). Sensitivity analyses examine the implications of differing assumptions. The extra cost would rise if the capital costs of wind generation fall slower than anticipated, but would fall if gas prices rise more rapidly than has been assumed, or if wind plant are more productive. Even if it is assumed that wind has no capacity displacement value, the added cost to the electricity consumer rises by less than 0.1 p/kW h. It is concluded that there does not appear to be any technical reason why a substantial proportion of the country's electricity requirements could not be delivered by wind

  19. Impact Of Total Quality Management (TQM), Activity Based Costing ...

    African Journals Online (AJOL)

    Time (JIT), and Total Quality Management (TQM) as strategic initiatives lead to improved financial performance in the Turkish textile industry. Strong evidence emerged that there is a strong positive association between using ABC, JIT or TQM ...

  20. HIGH ECCENTRICITY EOQ TOTAL COST FUNCTION YIELDS JIT RESULTs

    Directory of Open Access Journals (Sweden)

    Willian Roach

    2010-06-01

    Full Text Available No estoque de bens perecíveis, o custo de armazenamento H é muito maior do que o previsto na fórmula clássica do lote econômico do pedido (EOQ. Para bens perecíveis, a função custo total no EOQ é um pico e não uma reta horizontal. Esta forma pontiaguda leva o modelo EOQ a produzir entregas just in time (JIT - resultados semelhantes. O efeito pontiagudo (excentricidade da curva de custo total do lote econômico EOQ depende apenas do custo de armazenamento (H e não da demanda anual (D ou do custo do pedido (S. D e S determinam o nível (altura da curva de custo total do estoque (TC, mas não a forma.

  1. 47 CFR 36.621 - Study area total unseparated loop cost.

    Science.gov (United States)

    2010-10-01

    ..., REVENUES, EXPENSES, TAXES AND RESERVES FOR TELECOMMUNICATIONS COMPANIES 1 Universal Service Fund Calculation of Loop Costs for Expense Adjustment § 36.621 Study area total unseparated loop cost. (a) For the...

  2. Revision Total Hip Arthroplasty-Reducing Hospital Cost Through Fixed Implant Pricing.

    Science.gov (United States)

    Collins, Kristopher D; Chen, Kevin K; Ziegler, Jacob D; Schwarzkopf, Ran; Bosco, Joseph A; Iorio, Richard

    2017-09-01

    A large component of the cost of revision total hip arthroplasty (THA) is the cost of the implants. We examined the pricing of revision THA implants to determine the possible savings of different pricing models. From our institutional database, all revision THAs done from 9/1/2013 to 8/31/2014 were identified. The cost of the implants was analyzed as a percentage of the total cost of the hospitalization and compared to direct to hospital and fixed implant pricing models. Of 153 revision THAs analyzed, the cost of implants amounted to 36% of the total hospital cost. The direct to hospital cost and fixed implant pricing models would reduce the cost of an all-component revision to $4395 (saving $8962 per case) and $5000 (saving $8357 per case). Both fixed implant pricing and the direct to hospital pricing models would result in a decrease in revision implant costs. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. The total lifetime health cost savings of smoking cessation to society

    DEFF Research Database (Denmark)

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

    2005-01-01

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

  4. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative.

    Science.gov (United States)

    Ferket, Bart S; Feldman, Zachary; Zhou, Jing; Oei, Edwin H; Bierma-Zeinstra, Sita M A; Mazumdar, Madhu

    2017-03-28

    minimal loss of 0.008 (-0.056 to 0.043) QALYs compared with current practice. These findings were reproduced among patients with knee osteoarthritis from the MOST cohort and were robust against various scenarios including increased rates of total knee replacement and mortality and inclusion of non-healthcare costs but were sensitive to increased deterioration in quality of life without surgery. In a threshold analysis, total knee replacement would become cost effective in patients with SF-12 PCS scores ≤40 if the associated hospital admission costs fell below $14 000 given a cost effectiveness threshold of $200 000/QALY. Conclusion  Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use. 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.

  5. The adoption of total cost of ownership for sourcing decisions - a structural equations analysis

    NARCIS (Netherlands)

    Wouters, Marc; Anderson, James C.; Wynstra, Finn

    2005-01-01

    This study investigates the adoption of total cost of ownership (TCO) analysis to improve sourcing decisions. TCO can be seen as an application of activity based costing (ABC) that quantifies the costs that are involved in acquiring and using purchased goods or services. TCO supports purchasing

  6. A decision-making framework for total ownership cost management of complex systems: A Delphi study

    Science.gov (United States)

    King, Russel J.

    This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

  7. Definition of total mesorectal excision, including the perineal phase : Technical considerations

    NARCIS (Netherlands)

    Havenga, Klaas; Grossmann, Irene; DeRuiter, Marco; Wiggers, Theo

    2007-01-01

    Background: Total mesorectal excision (TME) has contributed to a decline in local recurrence. The operation is difficult because of the complicated anatomy of the pelvis and the narrow spaces in the pelvis. We review the anatomy related to TME and we present our surgical technique. Anatomy: The

  8. 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.

  9. 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

  10. Total life-cycle cost analysis of conventional and alternative fueled vehicles

    International Nuclear Information System (INIS)

    Cardullo, M.W.

    1993-01-01

    Total Life-Cycle Cost (TLCC) Analysis can indicate whether paying higher capital costs for advanced technology with low operating and/or environmental costs is advantageous over paying lower capital costs for conventional technology with higher operating and/or environmental costs. While minimizing total life-cycle cost is an important consideration, the consumer often identifies non-cost-related benefits or drawbacks that make more expensive options appear more attractive. The consumer is also likely to heavily weigh initial capital costs while giving limited consideration to operating and/or societal costs, whereas policy-makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. This paper summarizes a TLCC model which was developed to facilitate consideration of the various factors involved in both individual and societal policy decision making. The model was developed as part of a US Department of Energy Contract and has been revised to reflect changes necessary to make the model more realistic. The model considers capital, operating, salvage, and environmental costs for cars, vans, and buses using conventional and alternative fuels. The model has been developed to operate on an IBM or compatible personal computer platform using the commercial spreadsheet program MicroSoft Excell reg-sign Version 4 for Windows reg-sign and can be easily kept current because its modular structure allows straightforward access to embedded data sets for review and update

  11. 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.

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

    National Research Council Canada - National Science Library

    Reed, Danny

    2003-01-01

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

  13. Use of predefined biochemical admission profiles does not reduce the number of tests or total cost

    DEFF Research Database (Denmark)

    Pareek, Manan; Haidl, Felix; Folkestad, Lars

    2014-01-01

    The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost....

  14. Determining the total cost of reverse supply chain operations for original equipment manufacturers

    DEFF Research Database (Denmark)

    Larsen, Samuel Brüning; Jacobsen, Peter

    2014-01-01

    When original equipment manufacturers (OEM) examine whether or not to invest in a reverse supply chain (RSC), managers need insight into not only the cost savings and new revenue streams the RSC enables, but also the total cost of the RSC itself. Using case study research the study examines what...

  15. The effectiveness of a hospital-based strategy to reduce the cost of total joint implants.

    Science.gov (United States)

    Zuckerman, J D; Kummer, F J; Frankel, V H

    1994-06-01

    Our hospital implemented an integrated cost-containment program designed to address the increasing disparity between the cost of orthopaedic implants used for total joint replacements and the amount of hospital reimbursement provided for these procedures. This program was divided into four phases: (1) the analysis of the specific usage of total hip and total knee implants at our institution, (2) the development of surgeons' awareness of the problem and the enlistment of their participation in the process of cost containment, (3) the initiation of a competitive bidding system to select standard prostheses that would be available for general use within the institution, and (4) the establishment of a prosthesis-utilization committee to monitor the process and to make decisions concerning the use of non-standard prostheses. Using this cost-containment program, our hospital greatly reduced the number of vendors and implant systems used; all implants were purchased on a consignment basis, which minimized the cost of implant inventory. The average cost reductions in the first year were 14 per cent for total hip implants and 24 per cent for total knee implants. Over-all implant costs were reduced by an estimated $706,477, or 23 per cent of the budget for implants for the previous year.

  16. Relationship between clinical results of total hip replacement and postoperative activities including weeding and snow shovelling.

    Science.gov (United States)

    Kijima, Hiroaki; Yamada, Shin; Konishi, Natsuo; Kubota, Hitoshi; Tazawa, Hiroshi; Tani, Takayuki; Suzuki, Norio; Kamo, Keiji; Okudera, Yoshihiko; Sasaki, Ken; Kawano, Tetsuya; Miyakoshi, Naohisa; Shimada, Yoichi

    2017-09-07

    Weeding or snow shovelling is indispensable for life in farm villages of northern countries. Clarifying the relationships between the degrees of these activities after total hip replacement (THR) and the clinical results of THR may enable us to predict the results of THR for high-level activity patients. The relationships between work activities after THR and the results were investigated. The subjects were 95 post-THR patients, who consulted 6 hospitals in August 2012. First, the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) and a questionnaire on postoperative activity were administered. Then, the Japanese Orthopaedic Association hip score (JOA score) was evaluated. The subjects' average age was 68 years. The average period after surgery was 4 years and 5 months. Weeding and snow shovelling were performed after THR in 44.2% and 40.0% of cases, respectively. The rate of farming after surgery (25.6%) was greater than that of swimming (21.1%). Both the JOA score and JHEQ were higher in those who played sports after THR than in those who did not (p = 0.003, p = 0.0046). The JOA score of those who performed work activities after THR was higher than that of those who did not (p = 0.0295). Nearly half of patients performed weeding or snow shovelling after THR, and about 1/4 of the patients engaged in farming after THR. The clinical results in cases doing sports and work activities after THR were better than those of cases not doing such activities. Therefore, these activities may be positively recommended.

  17. 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.

  18. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program

    International Nuclear Information System (INIS)

    1989-05-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 -- a fee levied on electricity generated in commercial nuclear power plants -- is sufficient to cover the cost of the program. This report provides cost estimates for the sixth annual evaluation of the adequacy of the fee and is consistent with the program strategy and plans contained in the DOE's Draft 1988 Mission Plan Amendment. The total-system cost for the system with a repository at Yucca Mountain, Nevada, a facility for monitored retrievable storage (MRS), and a transportation system is estimated at $24 billion (expressed in constant 1988 dollars). In the event that a second repository is required and is authorized by the Congress, the total-system cost is estimated at $31 to $33 billion, depending on the quantity of spent fuel to be disposed of. The $7 billion cost savings for the single-repository system in comparison with the two-repository system is due to the elimination of $3 billion for second-repository development and $7 billion for the second-repository facility. These savings are offset by $2 billion in additional costs at the first repository and $1 billion in combined higher costs for the MRS facility and transportation. 55 refs., 2 figs., 24 tabs

  19. Determining the cost-effectiveness of hospital nursing interventions for patients undergoing a total hip replacement.

    Science.gov (United States)

    Lee, Mikyoung; Moorhead, Sue; Clancy, Thomas

    2014-10-01

    The purposes of the study were to (i) identify the types and amounts of nursing interventions and (ii) estimate the cost-effectiveness of nursing interventions for complications the patients experienced when undergoing a total hip replacement (THR). There has been little cost-effectiveness research into nursing interventions in hospitals, resulting in an inability to explain the economic value of hospital nursing interventions. The direct effects of nursing interventions on hospital direct costs and complication rates were analysed using path modelling, controlling for multiple factors (patient characteristics and nursing contexts) influencing nursing care. Then, cost-effectiveness ratios and the cost-effectiveness plane were used to identify cost-effective interventions. Intramuscular (IM)/Subcutaneous (SC) Administration was the most cost-effective nursing intervention, followed by Orthotics Management. The study findings can be used to promote nurses' knowledge and attitudes about the economic value of nursing and cost-effective care delivery. A sensitivity analysis with actual cost per nursing intervention and for specific complications will be necessary. It is important for nurse administrators to support nurses' clear documentation in order to make nursing information available. Utilizing study methods and findings, nurse managers can compare the cost-effectiveness of new nursing interventions or manage dosages of nursing interventions to provide the most cost-effective nursing interventions. © 2013 John Wiley & Sons Ltd.

  20. Effect of Body Mass Index and Psychosocial Traits on Total Knee Replacement Costs in Patients with Osteoarthritis.

    Science.gov (United States)

    Waimann, Christian A; Fernandez-Mazarambroz, Rodrigo J; Cantor, Scott B; Lopez-Olivo, Maria A; Barbo, Andrea G; Landon, Glenn C; Siff, Sherwin J; Lin, Heather; Suarez-Almazor, Maria E

    2016-08-01

    Clinical and psychosocial attributes are associated with clinical outcomes after total knee replacement (TKR) surgery in patients with osteoarthritis (OA), but their relationship with TKR-related costs is less clear. Our objective was to evaluate the effect of clinical and psychosocial attributes on TKR costs. We conducted a 6-month prospective cohort study of patients with knee OA who underwent TKR. We examined baseline demographic, clinical [body mass index (BMI) and comorbidities], and psychosocial attributes (social support, locus of control, coping, depression, anxiety, stress, and self-efficacy); baseline and 6-month OA clinical outcomes [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function]; and 6-month direct and indirect TKR-related costs. Multiple regression was performed to identify determinants of TKR-related costs. We included 212 patients; 66% were women, 71% were white, and the mean age was 65.2 years. The mean baseline WOMAC pain score was 55 (SD 19) and WOMAC function score was 54 (SD 20). Mean total TKR-related costs were US$30,831 (SD $9893). Multivariate regression analyses showed that increasing BMI and anxiety levels and decreasing levels of positive social interactions were associated with increased costs. A lower cost scenario with a lower range of normal BMI (19.5), highest positive social interaction, and no anxiety predicted TKR costs to be $22,247. Predicted costs in obese patients (BMI 36) with lowest positive social interaction and highest anxiety were $58,447. Increased baseline BMI, anxiety, and poor social support lead to higher TKR-related costs in patients with knee OA. Preoperative interventions targeting these factors may reduce TKR-related costs, and therefore be cost-effective.

  1. The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

    Directory of Open Access Journals (Sweden)

    Ali KURT

    2016-03-01

    Full Text Available Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between cost leadership strategy, total quality management applications and firms’ financial performance has been gathered. In addition, the relationship between TQM applications and financial performance has also been gathered.

  2. Total costs and benefits of biomass in selected regions of the European Union - BioCosts

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, A. de; Costa, F.B. [Coimbra Univ. (Portugal). Inst. de Sistemas e Robotica; Bauen, A. [London Univ. (United Kingdom). Div. of Life Sciences] [and others

    1998-11-01

    In the BioCosts project, representative biomass-to-electricity and biomass-to-transport-service fuel cycles located at different sites within the European Union have been evaluated concerning their environmental and economic performance. Each case study was compared to a fossil-fuel fired reference case. The case studies examined comprise: utilisation of forestry residues in the Naessjoe circulating fluidized bed combustion plant, Sweden, versus the use of Polish coal in the same plant; utilisation of forestry residues and short-rotation coppice for industrial combined heat and power production in Mangualde, Portugal, versus the use of fuel oil in an engine generating heat and power; production of biogas from manure slurry for municipal combined heat and power generation at Hashoej, Denmark, versus the use of Danish natural gas in the same engine; gasification of woody biomass for combined heat and power generation in Vaernamo, Sweden, and Eggborough, UK, versus the use of coal in the Naessjoe plant mentioned above and a UK power plant; production of cold-pressed rape-seed oil and its use in a cogeneration plant at Weissenburg, Germany, versus the use of diesel fuel in a similar engine; production of rape-seed oil methyl ester and its use for goods transport in Germany, versus the use of diesel fuel in the same fleet of trucks; production of ethyl tertiary butyl ether from sugar beets and sweet sorghum for transport applications in France, versus the use of methyl tertiary butyl ether from fossil sources for the same purpose 130 refs, 25 figs, 42 tabs. Research funded in part by the European Commission in the JOULE III programme

  3. Energy and cost total cost management discussion: The global gas industry

    International Nuclear Information System (INIS)

    Batten, R.M.

    1995-01-01

    Gas has emerged as one of the most desirable fuels for a wide range of applications that previously have been supplied by oil, coal, or nuclear energy. Compared to these, it is environmentally clean and burns at efficiencies far in excess of competitive fuels. The penetration of gas as the fuel of choice in most parts of the world is still modest. This is particularly true in newly-developed countries that are engaged in rapid industrialization and where rates of growth in the gross domestic products are two or three times greater than in the Organization for Economic Cooperation and Development (OECD) countries. I will not attempt here to survey the world gas scene comprehensively. I will, however, attempt to focus on some aspects of the industry that could be the trigger points for global development. These triggers are occurring all along the gas chain, by which I mean the entire process of bringing gas to the customer from discovery through delivery. The chain includes exploration and production, power generation, transmission, and distribution. I describe an industry that is on the verge of truly global status, which is fast overcoming the remaining obstacles to transnational trade, and which has unusually exciting long-term prospects. It does have a good way to go before it achieves the maturity of the international oil industry, but in the last few years there has been a tremendous growth of confidence among both investors and users. The global gas industry is certainly developing at a fast pace, and the world can only benefit from the wider availability of this clean, economic, and efficient hydrocarbon

  4. Bearing Procurement Analysis Method by Total Cost of Ownership Analysis and Reliability Prediction

    Science.gov (United States)

    Trusaji, Wildan; Akbar, Muhammad; Sukoyo; Irianto, Dradjad

    2018-03-01

    In making bearing procurement analysis, price and its reliability must be considered as decision criteria, since price determines the direct cost as acquisition cost and reliability of bearing determine the indirect cost such as maintenance cost. Despite the indirect cost is hard to identify and measured, it has high contribution to overall cost that will be incurred. So, the indirect cost of reliability must be considered when making bearing procurement analysis. This paper tries to explain bearing evaluation method with the total cost of ownership analysis to consider price and maintenance cost as decision criteria. Furthermore, since there is a lack of failure data when bearing evaluation phase is conducted, reliability prediction method is used to predict bearing reliability from its dynamic load rating parameter. With this method, bearing with a higher price but has higher reliability is preferable for long-term planning. But for short-term planning the cheaper one but has lower reliability is preferable. This contextuality can give rise to conflict between stakeholders. Thus, the planning horizon needs to be agreed by all stakeholder before making a procurement decision.

  5. Managing the total cost of risk exposures through risk mapping techniques

    International Nuclear Information System (INIS)

    Unione, A.J.; Rode, D.M.

    1998-01-01

    In a competitive power market, power producers are exposed to an increasingly broad spectrum of financial risks. The cumulative impact of these financial risks is known collectively as the Total of Cost of Risk. The concept of Total of Cost of Risk presents the business reality of a company's exposure to potentially devastating financial consequences in an integrated and useful way. In this way, a strategy of managing Total Cost of Risk in the most cost effective way can become a means of ensuring long term business health and security. This paper will examine the use of risk mapping as a tool for visually understanding Total Cost of Risk, thus creating an enhanced situational awareness and an integrated basis for risk management decision. The evaluation process, available through the use of risk maps allows the power producers to pro-actively implement prudent business decisions concerning the design, operation and maintenance of power plants. Risk mapping is thus a means for harmonizing operational objectives, such as improved plant reliability, with corporate strategies and goals in terms of an effective risk management program

  6. Hybrid Cloud Computing Architecture Optimization by Total Cost of Ownership Criterion

    Directory of Open Access Journals (Sweden)

    Elena Valeryevna Makarenko

    2014-12-01

    Full Text Available Achieving the goals of information security is a key factor in the decision to outsource information technology and, in particular, to decide on the migration of organizational data, applications, and other resources to the infrastructure, based on cloud computing. And the key issue in the selection of optimal architecture and the subsequent migration of business applications and data to the cloud organization information environment is the question of the total cost of ownership of IT infrastructure. This paper focuses on solving the problem of minimizing the total cost of ownership cloud.

  7. The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

    OpenAIRE

    Ali KURT; Cemal ZEHİR

    2016-01-01

    Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between ...

  8. Linking the spare parts management with the total costs of ownership: An agenda for future research

    International Nuclear Information System (INIS)

    Duran, O.; Roda, I.; Macchi, M.

    2016-01-01

    Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  9. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Directory of Open Access Journals (Sweden)

    Orlando Duran

    2016-12-01

    Full Text Available Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC. Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view. Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO. Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  10. [Fuel Rod Consolidation Project]: The estimated total life cycle cost for the 30-year operation of prototypical consolidation demonstration equipment: Volume 4, Phase 2

    International Nuclear Information System (INIS)

    1987-01-01

    The Total Life Cycle Costs have been developed for the construction, operation and decommissioning of a single line of hot-cell-enclosed production consolidation equipment operating on spent fuel at the rate of 750 MTU/year for 30 years. The cost estimate is for a single production line that is part of an overall facility at either a Monitored Retrievable Storage or a Repository facility. This overall facility would include other capabilities and possibly other consolidation lines. However, no costs were included in the cost estimate for other portions of the plant, except that staff costs include an overhead charge that reflects the overhead support services in an overall facility

  11. A METHOD OF THE MINIMIZING OF THE TOTAL ACQUISITIONS COST WITH THE INCREASING VARIABLE DEMAND

    Directory of Open Access Journals (Sweden)

    ELEONORA IONELA FOCȘAN

    2015-12-01

    Full Text Available Over time, mankind has tried to find different ways of costs reduction. This subject which we are facing more often nowadays, has been detailed studied, without reaching a general model, and also efficient, regarding the costs reduction. Costs reduction entails a number of benefits over the entity, the most important being: increase revenue and default to the profit, increase productivity, a higher level of services / products offered to clients, and last but not least, the risk mitigation of the economic deficit. Therefore, each entity search different modes to obtain most benefits, for the company to succeed in a competitive market. This article supports the companies, trying to make known a new way of minimizing the total cost of acquisitions, by presenting some hypotheses about the increasing variable demand, proving them, and development of formulas for reducing the costs. The hypotheses presented in the model described below, can be maximally exploited to obtain new models of reducing the total cost, according to the modes of the purchase of entities which approach it.

  12. Total cost of ownership in the services sector: A case study

    NARCIS (Netherlands)

    K. Hurkens (Krisje); W. van der Valk (Wendy); J.Y.F. Wynstra (Finn)

    2006-01-01

    textabstractFew detailed studies exist of the trade-offs to be made when developing a comprehensive, strategically focused total cost of ownership (TCO) model. Moreover, most studies of TCO have been conducted in manufacturing firms, with little or no TCO research directed toward service

  13. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland.

    Science.gov (United States)

    Retèl, Valesca P; van den Boer, Cindy; Steuten, Lotte M G; Okła, Sławomir; Hilgers, Frans J; van den Brekel, Michiel W

    2015-09-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

  14. Permanent magnet design for magnetic heat pumps using total cost minimization

    Science.gov (United States)

    Teyber, R.; Trevizoli, P. V.; Christiaanse, T. V.; Govindappa, P.; Niknia, I.; Rowe, A.

    2017-11-01

    The active magnetic regenerator (AMR) is an attractive technology for efficient heat pumps and cooling systems. The costs associated with a permanent magnet for near room temperature applications are a central issue which must be solved for broad market implementation. To address this problem, we present a permanent magnet topology optimization to minimize the total cost of cooling using a thermoeconomic cost-rate balance coupled with an AMR model. A genetic algorithm identifies cost-minimizing magnet topologies. For a fixed temperature span of 15 K and 4.2 kg of gadolinium, the optimal magnet configuration provides 3.3 kW of cooling power with a second law efficiency (ηII) of 0.33 using 16.3 kg of permanent magnet material.

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

    Science.gov (United States)

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

    2016-09-01

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

  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. Using Electromagnetic Algorithm for Total Costs of Sub-contractor Optimization in the Cellular Manufacturing Problem

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Shahriari

    2016-12-01

    Full Text Available In this paper, we present a non-linear binary programing for optimizing a specific cost in cellular manufacturing system in a controlled production condition. The system parameters are determined by the continuous distribution functions. The aim of the presented model is to optimize the total cost of imposed sub-contractors to the manufacturing system by determining how to allocate the machines and parts to each seller. In this system, DM could control the occupation level of each machine in the system. For solving the presented model, we used the electromagnetic meta-heuristic algorithm and Taguchi method for determining the optimal algorithm parameters.

  18. 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,...

  19. Infrastructure expenditures and costs. Practical guidelines to calculate total infrastructure costs for five modes of transport. Final report

    International Nuclear Information System (INIS)

    2005-11-01

    Transport infrastructures in general, and the Trans European Transport Network (TEN-T) in particular, play an important role in achieving the medium and long-term objectives of the European Union. In view of this, the Commission has recently adopted a revision of the guidelines for the TEN-T. The main consequences of this revision are the need for a better understanding of the investments made by the member states in the TEN-T and the need for ensuring optimal consistency in the reporting by the Members States of such investments. With Regulation number 1108/70 the Council of the European Communities introduced an accounting system for expenditure on infrastructure in respect of transport by rail, road and inland waterways. The purpose of this regulation is to introduce a standard and permanent accounting system for infrastructure expenditures. However maritime and aviation infrastructure were not included. Further, the need for an effective and easy to apply classification for infrastructure investments concerning all five transport modes was still pending. Therefore, DG TREN has commissioned ECORYS Transport and CE Delft to study the expenditures and costs of infrastructure, to propose an adequate classification of expenditures, and to propose a method for translating data on expenditures into data on costs. The objectives of the present study are threefold: To set out a classification of infrastructure expenditures, in order to increase knowledge of expenditures related to transport infrastructures. This classification should support a better understanding of fixed and variable infrastructure costs; To detail the various components of such expenditures for five modes of transportation, which would enable the monitoring of infrastructure expenditures and costs; and to set up a methodology to move from annual series of expenditures to costs, including fixed and variable elements.

  20. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia.

    Science.gov (United States)

    Herling, Suzanne F; Palle, Connie; Møller, Ann M; Thomsen, Thordis; Sørensen, Jan

    2016-03-01

    The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy. The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost-drivers, the analysis showed that the robotic-assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic-assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs. For women with endometrial cancer or atypical complex hyperplasia, robotic-assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Andreasen, Signe E; Holm, Henriette B; Jørgensen, Mira

    2017-01-01

    BACKGROUND: Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast......-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare...... this between 2 departments with different logistical set-ups. METHODS: Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish...

  2. Analysis of short-term total hospital costs and current primary cost drivers of coiling versus clipping for unruptured intracranial aneurysms.

    Science.gov (United States)

    Duan, Yifei; Blackham, Kristine; Nelson, Jeff; Selman, Warren; Bambakidis, Nicholas

    2015-08-01

    No randomized controlled trial has successfully compared outcomes between endovascular coiling and microsurgical clipping for unruptured intracranial aneurysms (UIAs). To perform a cost comparison between index hospitalizations of patients with UIAs treated with coil embolization or surgical clipping to identify the current primary drivers of costs of either management approach. We obtained index hospitalization costs for 125 cases of UIAs treated with coiling or clipping from 2010 to 2012 at our institution. Comparisons were stratified based on patient age, gender, aneurysm size, and aneurysm location. Using linear regressions, we identified clinical parameters that drive total hospital costs. 69 cases were treated with clipping and 56 cases were treated with coiling. Morbidity and length of stay for patients treated with clipping was higher. Total hospital costs and variable direct costs for clipping were significantly lower than for coiling (p=0.003, p<0.001, respectively). Fixed direct costs and fixed indirect costs for clipping were higher than for coiling (p<0.001, p<0.001, respectively). Variable direct costs comprised 50.5% and 68.6% of total hospital costs for clipping and coiling, respectively (p<0.001). Length of stay, aneurysm size, and patient age drove total hospital costs for clipping. Length of stay was a weak driver of total hospital costs for coiling. Total index hospitalization costs for clipping are lower than for coiling. Costs of clipping and coiling are driven by different clinical variables. The cost of coils and devices is the predominant contributor to the higher total costs of coiling. 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.

  3. Indications, cost and safety implications of traditional post-operative radiography following total hip replacement

    International Nuclear Information System (INIS)

    Mulhall, K.J.; Khan, Y.; Masterson, E.; Burke, T.E.

    2003-01-01

    Purpose: As routine check radiographs obtained in the recovery room following total hip arthroplasty present issues of concern regarding quality, cost and safety of both staff and patient, we wished to determine the usefulness and indications for this investigation as a screening tool for post-operative dislocation. MethodsA 10-year retrospective analysis of all total hip replacements performed in a single Regional Orthopaedic Hospital, considering the total number of hip arthroplasties performed and the number of acute recovery room dislocations using theatre records and patient notes. We then randomly selected the recovery room and departmental radiographs of 100 patients and compared them with regard to the need for repeat radiographs and subsequent costs generated. ResultsRecovery room radiographs were not statistically superior to clinical assessment in the diagnosis of acute post-operative dislocations (P=0.7), and these were associated with increased costs because it was necessary to repeat poor quality films (P=0.008). The use of recovery room radiography was also therefore associated with significant safety implications for patients and staff. ConclusionsThe conclusion was that recovery room radiographs are neither a safe, effective nor economical method of screening for dislocation. Furthermore, they fail to provide reliable or reproducible information and expose patients and staff to extra radiation. It is recommended therefore that recovery room radiographs should only be obtained for clinical indications, with most routine post-operative radiography being performed in a standardised fashion in the radiology department

  4. Changes in Energy Cost and Total External Work of Muscles in Elite Race Walkers Walking at Different Speeds

    Directory of Open Access Journals (Sweden)

    Chwała Wiesław

    2014-12-01

    Full Text Available The aim of the study was to assess energy cost and total external work (total energy depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers.

  5. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M

    2016-01-01

    professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...... in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy. RESULTS: The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7......INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...

  6. Leveraging Real-World Evidence in Disease-Management Decision-Making with a Total Cost of Care Estimator.

    Science.gov (United States)

    Nguyen, Thanh-Nghia; Trocio, Jeffrey; Kowal, Stacey; Ferrufino, Cheryl P; Munakata, Julie; South, Dell

    2016-12-01

    Health management is becoming increasingly complex, given a range of care options and the need to balance costs and quality. The ability to measure and understand drivers of costs is critical for healthcare organizations to effectively manage their patient populations. Healthcare decision makers can leverage real-world evidence to explore the value of disease-management interventions in shifting total cost trends. To develop a real-world, evidence-based estimator that examines the impact of disease-management interventions on the total cost of care (TCoC) for a patient population with nonvalvular atrial fibrillation (NVAF). Data were collected from a patient-level real-world evidence data set that uses the IMS PharMetrics Health Plan Claims Database. Pharmacy and medical claims for patients meeting the inclusion or exclusion criteria were combined in longitudinal cohorts with a 180-day preindex and 360-day follow-up period. Descriptive statistics, such as mean and median patient costs and event rates, were derived from a real-world evidence analysis and were used to populate the base-case estimates within the TCoC estimator, an exploratory economic model that was designed to estimate the potential impact of several disease-management activities on the TCoC for a patient population with NVAF. Using Microsoft Excel, the estimator is designed to compare current direct costs of medical care to projected costs by varying assumptions on the impact of disease-management activities and applying the associated changes in cost trends to the affected populations. Disease-management levers are derived from literature-based concepts affecting costs along the NVAF disease continuum. The use of the estimator supports analyses across 4 US geographic regions, age, cost types, and care settings during 1 year. All patients included in the study were continuously enrolled in their health plan (within the IMS PharMetrics Health Plan Claims Database) between July 1, 2010, and June 30

  7. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

    Science.gov (United States)

    Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

    2016-01-01

    Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

  8. 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.

  9. Methodology of Evaluation of the Impact of Picking Area Location on the Total Costs of Warehouse

    Directory of Open Access Journals (Sweden)

    Apsalons Raitis

    2017-12-01

    Full Text Available The picking system and the layout of the picking area are the key drivers for the evaluation of a warehouse picking cost. There are five variants for organizing the picking process of orders in a warehouse. The choice of a specific variant depends on the total cost of picking. The picking cost is evaluated within an uninterrupted picking process. It means that no stock out occurs in the time period of the picking process. The storing area and the picking area are created as two separate zones for picking quantities of the customer’s orders; the principle of division of orders is observed strictly. Referring to the locations of stock keeping units (SKU, two approaches of the layout of SKU in the picking area can be estimated. The first one is the single picking location for each single SKU, where replenishment is realized in the picking process. The second one - various picking locations for each single SKU, and the replenishment here is realized just only prior to a picking process or after it. The main benefits of the economy of the picking cost as far as these two approaches are concerned are the shortest picking route in the first case and one common replenishment option in the second case.

  10. 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.

  11. Cost-effectivness analysis of total thyroidectomy vs radioiodine for Graves disease

    Directory of Open Access Journals (Sweden)

    Prokić Anđelka

    2013-01-01

    Full Text Available Among the patients suffering from hyperthyroidism 60-80% have Graves' disease. The initial therapy of Graves's disease are antithyroid drugs. If the remission is not achieved after 12-18 months, the patients should be directed to surgical treatment or to the therapy with radioactive iodine. The aim of this study was to compare cost/effectiveness ratios for radioactive iodine and total thyroidectomy. The analysis was made using Markov model, from the perspective of Republic Fund for Health Insurance in Serbia. Duration of one cycle in the model is six months, and the time horizon is 30 years. Monte Carlo simulation was performed for 1000 virtual patients as well as the analysis of sensitivity with the variation of parameters ± 50%. For total thyroidectomy the insurance should provide 138.389,72 RSD / 57, 83 QALY i.e. 2.393,04 dinars for one quality-adjusted life year, and for radioactive iodine the insurance should provide 110.043,64 RSD / 57,82 QALY i.e. 1.903,37 dinars for one quality-adjusted life year. This economic analysis showed that radioactive iodine has better ratio of costs to clinical effectiveness as opposed to total thyroidectomy.

  12. 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.

  13. Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

    Science.gov (United States)

    Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

    2016-03-01

    The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

  14. 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.

  15. 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.

  16. Total staff costs to implement a decision support system in nursing.

    Science.gov (United States)

    Castilho, Valéria; Lima, Antônio Fernandes Costa; Fugulin, Fernanda Maria Togeiro; Peres, Heloisa Helena Ciqueto; Gaidzinski, Raquel Rapone

    2014-01-01

    to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP). the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources. considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.

  17. Total staff costs to implement a decision support system in nursing

    Directory of Open Access Journals (Sweden)

    Valéria Castilho

    2014-01-01

    Full Text Available OBJECTIVE: to identify the direct labor (DL costs to put in practice a decision support system (DSS in nursing at the University Hospital of the University of São Paulo (HU-USP. METHOD: the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. RESULTS: the DL cost corresponded to R$ 752,618.56 (100%, R$ 26,000.00 (3.45% of which were funded by a funding agency, while R$ 726,618.56 (96,55% came from Hospital and University resources. CONCLUSION: considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.

  18. Social profile and cost analysis of deep infection following total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Vera Lucia Frazão

    Full Text Available ABSTRACT OBJECTIVE: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. METHODS: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. RESULTS: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. CONCLUSION: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.

  19. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: executive summary

    International Nuclear Information System (INIS)

    1985-04-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's Civilian Radioactive Waste Management Progrram is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 is sufficient to cover the cost of the program. This report is an input into the third evaluation of the adequacy of the fee. The total-system cost for the reference waste-management program in this analysis is estimated to be 24 to 30 billion (1984) dollars. For the sensitivity cases studied in this report, the costs could be as high as 35 billion dollars and as low as 21 billion dollars. Because factors like repository location, the quantity of waste generated, transportation-cask technology, and repository startup dates exert substantial impacts on total-system costs, there are several tradeoffs between these factors, and these tradeoffs can greatly influence the total cost of the program. The total-system cost for the reference program described in this report is higher by 3 to 5 billion dollars, or 15 to 20%, than the cost for the reference program of the TSLCC analysis of April 1984. More than two-thirds of this increase is in the cost of repository construction and operation. These repository costs have increased because of changing design concepts, different assumptions about the effort required to perform the necessary activities, and a change in the source data on which the earlier analysis was based. Development and evaluation costs have similarly increased because of a net addition to the work content. Transportation costs have increased because of different assumptions about repository locations and several characteristics of the transportation system. It is expected that the estimates of total-system costs will continue to change in response to both an evolving program strategy and better definition of the work required to achieve the program objectives

  20. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program. Volume 1. The analysis and its results

    International Nuclear Information System (INIS)

    1986-04-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 is sufficient to cover the cost of the program. This report provides cost estimates for the fourth evaluation of the adequacy of the fee. The total-system cost for the reference authorized-system program is estimated to be 24 to 32 billion (1985) dollars. The total-system cost for the reference improved-performance system is estimated to be 26 to 34 billion dollars. A number of sensitivity cases were analyzed. For the authorized system, the costs for the sensitivity cases studied range from 21 to 39 billion dollars. For the improved-performance system, which includes a facility for monitored retrievable storage, the total-system cost in the sensitivity cases is estimated to be as high as 41 billion dollars. The factors that affect costs more than any other single factor for both the authorized and the improved-performance systems are delays in repository startup. A preliminary analysis of the impact of extending the burnup of nuclear fuel in the reactor was also performed; its results indicate that the impact is insignificant: the total-system cost is essentially unchanged from the comparable constant-burnup cases. The current estimate of the the total-system cost for the reference authorized system is zero to 3 billion dollars (9%) higher than the estimate for the reference system in the January 1985 TSLCC analysis

  1. Distributed Flexibility Management Targeting Energy Cost and Total Power Limitations in Electricity Distribution Grids

    DEFF Research Database (Denmark)

    Bessler, Sanford; Kemal, Mohammed Seifu; Silva, Nuno

    2018-01-01

    Demand Management uses the interaction and information exchange between multiple control functions in order to achieve goals that can vary in different application contexts. Since there are several stakeholders involved, these may have diverse objectives and even use different architectures...... to actively manage power demand. This paper utilizes an existing distributed demand management architecture in order to provide the following contributions: (1) It develops and evaluates a set of algorithms that combine the optimization of energy costs in scenarios of variable day-ahead prices with the goal...... to improve distribution grid operation reliability, here implemented by a total Power limit. (2) It evaluates the proposed scheme as a distributed system where flexibility information is exchanged with the existing industry standard OpenADR. A Hardware-in-the-Loop testbed realization demonstrates...

  2. Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.

    Science.gov (United States)

    Nichols, Christine I; Vose, Joshua G; Nunley, Ryan M

    2017-09-01

    In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  3. Noninvasive Hemoglobin Monitoring: A Rapid, Reliable, and Cost-Effective Method Following Total Joint Replacement.

    Science.gov (United States)

    Martin, J Ryan; Camp, Christopher L; Stitz, Amber; Young, Ernest Y; Abdel, Matthew P; Taunton, Michael J; Trousdale, Robert T

    2016-03-02

    Noninvasive hemoglobin (nHgb) monitoring was initially introduced in the intensive care setting as a means of rapidly assessing Hgb values without performing a blood draw. We conducted a prospective analysis to compare reliability, cost, and patient preference between nHgb monitoring and invasive Hgb (iHgb) monitoring performed via a traditional blood draw. We enrolled 100 consecutive patients undergoing primary or revision total hip or total knee arthroplasty. On postoperative day 1, nHgb and iHgb values were obtained within thirty minutes of one another. iHgb and nHgb values, cost, patient satisfaction, and the duration of time required to obtain each reading were recorded. The concordance correlation coefficient (CCC) was utilized to evaluate the agreement of the two Hgb measurement methods. Paired t tests and Wilcoxon signed-rank tests were utilized to compare mean Hgb values, time, and pain for all readings. The mean Hgb values did not differ significantly between the two measurement methods: the mean iHgb value (and standard deviation) was 11.3 ± 1.4 g/dL (range, 8.2 to 14.3 g/dL), and the mean nHgb value was 11.5 ± 1.8 g/dL (range, 7.0 to 16.0 g/dL) (p = 0.11). The CCC between the two Hgb methods was 0.69. One hundred percent of the patients with an nHgb value of ≥ 10.5 g/dL had an iHgb value of >8.0 g/dL. The mean time to obtain an Hgb value was 0.9 minute for the nHgb method and 51.1 minutes for the iHgb method (p measurement, resulting in a savings of $26 per Hgb assessment when the noninvasive method is used. Noninvasive Hgb monitoring was found to be more efficient, less expensive, and preferred by patients compared with iHgb monitoring. Providers could consider screening total joint arthroplasty patients with nHgb monitoring and only order iHgb measurement if the nHgb value is protocol had been applied to the first blood draw in our 100 patients, approximately $2000 would have been saved. Extrapolated to the U.S. total joint arthroplasty practice

  4. 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.

  5. Analysis of refiners' total barrel costs and revenues from the sale of petroleum products, 1976 to 1979

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-11-01

    In this report, the Economic Regulatory Administration has evaluated refiners' costs and revenues from the sale of major petroleum products from July 1976 through December 1979. This report represents a continuing effort to assess No. 2 heating oil prices and margins in that it updates prior middle distillate studies through March 1980. The analysis examines selling prices and costs associated with each major petroleum product category and a combination of petroleum products (total barrel) from a sample of nine refiners. The total barrel approach was adopted to reduce distortions caused by varying methods of allocation of costs among regulated and unregulated products by refiners. This report determines the extent to which increased costs were recovered on controlled products and whether refiners obtained greater cost recoupment on decontrolled products than would have been allowed under continued controls. The principal methods of measurement used to evaluate product pricing levels for the nine refiners surveyed were cost recoupment (Chapter III), gross margins (Chapter IV), and net margins (Chapter V). Gross margins were derived by subtracting average crude oil costs from average product selling prices for individual product categories and the total barrel. Net margins were derived by subtracting average crude oil costs as well as average marketing, manufacturing, and purchased product costs from average selling prices for individual product categories and the total barrel.

  6. Feasibility studies to improve plant availability and reduce total installed cost in IGCC plants

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, Kevin [General Electric Company, Houston, TX (United States); Anasti, William [General Electric Company, Houston, TX (United States); Fang, Yichuan [General Electric Company, Houston, TX (United States); Subramanyan, Karthik [General Electric Company, Houston, TX (United States); Leininger, Tom [General Electric Company, Houston, TX (United States); Zemsky, Christine [General Electric Company, Houston, TX (United States)

    2015-03-30

    The main purpose of this project is to look at technologies and philosophies that would help reduce the costs of an Integrated Gasification Combined Cycle (IGCC) plant, increase its availability or do both. GE’s approach to this problem is to consider options in three different areas: 1) technology evaluations and development; 2) constructability approaches; and 3) design and operation methodologies. Five separate tasks were identified that fall under the three areas: Task 2 – Integrated Operations Philosophy; Task 3 – Slip Forming of IGCC Components; Task 4 – Modularization of IGCC Components; Task 5 – Fouling Removal; and Task 6 – Improved Slag Handling. Overall, this project produced results on many fronts. Some of the ideas could be utilized immediately by those seeking to build an IGCC plant in the near future. These include the considerations from the Integrated Operations Philosophy task and the different construction techniques of Slip Forming and Modularization (especially if the proposed site is in a remote location or has a lack of a skilled workforce). Other results include ideas for promising technologies that require further development and testing to realize their full potential and be available for commercial operation. In both areas GE considers this project to be a success in identifying areas outside the core IGCC plant systems that are ripe for cost reduction and ity improvement opportunities.

  7. Total Intravenous Anesthesia Including Ketamine versus Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury

    Science.gov (United States)

    2008-07-01

    Total vent days†‡ 2 (1–6) 2 (0–6) 0.31 Total ICU days†‡ 5 (3–10) 5 (2–9) 0.19 Total hospitalization days†‡ 10 (5–24) 8 (4–16) 0.21 GOS* 3.4 1.4 4...activated; FFP given fresh frozen plasma administered intraoperatively; GOS Glasgow Outcome Score; ICP intracranial pressure; ICU intensive care...in neonatal rats. ANESTHESIOLOGY 2004; 101:695–703 24. Strebel S, Lam AM, Matta B, Mayberg TS, Aaslid R, Newell DW: Dynamic and static cerebral

  8. 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.

  9. 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.

  10. Total costs of ownership - a comparison between incineration plant and landfill placed in the metropolian area of Sao Paulo; Kostenvergleich einer Deponie mit einer ''Waste to Energy'' Anlage im Grossraum Sao Paulo nach der Methode des Total Costs of Ownership

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, W.P. [IA GmbH - Wissensmanagement und Ingenieurleistungen (Germany); Koenig, T. [GfA - Gemeinsames Kommunalunternehmen fuer Abfallwirtschaft Anstalt des oeffentlichen Rechts der Landkreise Fuerstenfeldbruck und Dachau (Germany); Scholz, W. [Bayerisches Ministerium fuer Umwelt, Gesundheit und Verbraucherschutz (Germany). Technisches Kooperationsprojekt Bayern - Sao Paulo

    2006-11-15

    This paper describes a study which offers a decision support for executives, who compare in a draft both systems according to the method of Total Costs of Ownership (TCO), regarding the total life time and including the aftercare of landfill. Description of the proceeding to calculate the TCO of an incineration plant and a landfill. Investments and operational costs of the landfill and the incineration plant are described and the results of the calculation are shown and interpreted. (orig.)

  11. Variation in the cost of care for primary total knee arthroplasties

    Directory of Open Access Journals (Sweden)

    Derek A. Haas, MBA

    2017-03-01

    Conclusions: The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

  12. Costs from a healthcare and societal perspective among cancer patients after total laryngectomy: are they related to patient activation?

    Science.gov (United States)

    Jansen, Femke; Coupé, Veerle M H; Eerenstein, Simone E J; Leemans, C René; Verdonck-de Leeuw, Irma M

    2018-04-01

    The aim of this study is to investigate the associations between patient activation and total costs in cancer patients treated with total laryngectomy (TL). All members of the Dutch Patients' Association for Laryngectomees were asked to participate in this cross-sectional study. TL patients who wanted to participate were asked to complete a survey. Costs were measured using the medical consumption and productivity cost questionnaire and patient activation using the Patient Activation Measure (PAM). Sociodemographic and clinical characteristics were self-reported, and health status measured using the EQ-5D. The difference in total costs from a healthcare and societal perspective among four groups with different PAM levels were compared using (multiple) regression analyses (5000 bootstrap replications). In total, 248 TL patients participated. Patients with a higher (better) PAM (levels 2, 3, and 4) had a probability of 70, 80, and 93% that total costs from a healthcare perspective were lower than in patients with the lowest PAM level (difference €-375 to €-936). From a societal perspective, this was 73, 87, and 82% (difference €-468 to €-719). After adjustment for time since TL, education, and sex, the probability that total costs were lower in patients with a higher PAM level compared to patients with the lowest PAM level changed to 62-91% (healthcare) and 63-92% (societal). After additional adjustment for health status, the probability to be less costly changed to 35-71% (healthcare) and 31-48% (societal). A better patient activation is likely to be associated with lower total costs from a healthcare and societal perspective.

  13. Estimated total costs from non-fatal and fatal bicycle crashes in the USA: 1997-2013.

    Science.gov (United States)

    Gaither, Thomas W; Sanford, Thomas A; Awad, Mohannad A; Osterberg, E Charles; Murphy, Gregory P; Lawrence, Bruce A; Miller, Ted R; Breyer, Benjamin N

    2018-04-01

    Emergency department visits and hospital admissions resulting from adult bicycle trauma have increased dramatically. Annual medical costs and work losses of these incidents last were estimated for 2005 and quality-of-life losses for 2000. We estimated costs associated with adult bicycle injuries in the USA using 1997-2013 non-fatal incidence data from the National Electronic Injury Surveillance System with cost estimates from the Consumer Product Safety Commission's Injury Cost Model, and 1999-2013 fatal incidence data from the National Vital Statistics System costed by similar methods. Approximately 3.8 million non-fatal adult bicycle injuries were reported during the study period and 9839 deaths. In 2010 dollars, estimated adult bicycle injury costs totalled $24.4 billion in 2013. Estimated injury costs per mile bicycled fell from $2.85 in 2001 to $2.35 in 2009. From 1999 to 2013, total estimated costs were $209 billion due to non-fatal bicycle injuries and $28 billion due to fatal injuries. Inflation-free annual costs in the study period increased by 137% for non-fatal injuries and 23% for fatal injuries. The share of non-fatal costs associated with injuries to riders age 45 and older increased by 1.6% (95% CI 1.4% to 1.9%) annually. The proportion of costs due to incidents that occurred on a street or highway steadily increased by 0.8% (95% CI 0.4% to 1.3%) annually. Inflation-free costs per case associated with non-fatal bicycle injuries are increasing. The growth in costs is especially associated with rising ridership, riders 45 and older, and street/highway crashes. 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/.

  14. Systems of differential forms, including Kuranishi's theory of total prolongations. Technical report No. 2

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, H.H.

    1956-01-01

    The theory of differential forms and their integral manifolds was created by E. Cartan in order to study the differential equations which occur in Lie groups and differential geometry. We present here a modern outline of this theory using refinements and notations taken from recent papers of Y. Matsushima and M. Kuranishi. Section III is devoted to an exposition of a paper of Kuranishi on total prolongations which was presented at the 1956 Summer Institute in Differential Geometry at the University of Washington.

  15. Risk and Cost of 90-Day Complications in Morbidly and Superobese Patients After Total Knee Arthroplasty.

    Science.gov (United States)

    Meller, Menachem M; Toossi, Nader; Johanson, Norman A; Gonzalez, Mark H; Son, Min-Sun; Lau, Edmund C

    2016-10-01

    This study investigated the risk and cost of postoperative complications associated with morbid and super obesity after total knee arthroplasty (TKA). A retrospective cohort study was conducted of patients who underwent TKA using Medicare hospital claims data. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code V85.4x was used to identify morbidly obese patients (body mass index [BMI] ≥40 kg/m(2)) and superobese patients (BMI ≥50 kg/m(2)) in 2011-2013. Patients without any BMI-related diagnosis codes were used as controls. Twelve complications occurred in the 90-day period after TKA were analyzed using multivariate Cox models, adjusting for patient demographic, morbidity, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through subsequent 90 days. Morbidly obese patients showed a significantly elevated risk in most complications examined, with a 2-fold or higher risk in dislocation and wound dehiscence. In addition, death, periprosthetic joint infection, acute renal failure, and knee revision had significant hazard ratios between 1.5 and 2.0. However, risk of deep vein thrombosis and acute myocardial infarction did not increase for the morbidly obese patients. Superobese patients had significant increase in risk of infection, wound dehiscence, acute renal failures, revisions, death, and readmission compared with patients with BMI 40-49 kg/m(2). Significant dose-response trend was found between the level of BMI and risk for death, dislocation, implant failure, infection, readmission, revision, wound dehiscence, and acute renal failure. Controlling for patient and institutional factors, each TKA had an average total hospital charges of $75,884 among superobese patients, compared to $65,118 for the control group, a difference of $10,767. Medicare payment for the superobese patients was also higher, but only by $2703. Morbidly obese patients pose a significantly

  16. 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.

  17. Total Health-related Costs Due to Absenteeism, Presenteeism, and Medical and Pharmaceutical Expenses in Japanese Employers.

    Science.gov (United States)

    Nagata, Tomohisa; Mori, Koji; Ohtani, Makoto; Nagata, Masako; Kajiki, Shigeyuki; Fujino, Yoshihisa; Matsuda, Shinya; Loeppke, Ronald

    2018-02-13

    This study aimed to examine a detailed breakdown of costs (absenteeism, presenteeism, and medical/pharmaceutical expenses), of the employees in four pharmaceutical companies in Japan. This is a cross-sectional study. Absenteeism and presenteeism were measured by a self-administered questionnaire for workers, and their costs were estimated using the human capital approach. Presenteeism was evaluated by the degree affected quality and quantity of work. Medical and pharmaceutical expenses were obtained by insurance claims. The monetary value due to absenteeism was $520 per person per year (11%), that of presenteeism was $3,055 (64%) and medical/pharmaceutical expenses were $1,165 (25%). Two of the highest total cost burdens from chronic illness were related to mental (behavioral) health conditions and musculoskeletal disorders. A total cost approach can help employers set priorities for occupational health, safety and population health management initiatives.

  18. Total cross-sections for reactions of high energy particles (including elastic, topological, inclusive and exclusive reactions). Subvol. b

    International Nuclear Information System (INIS)

    Schopper, H.; Moorhead, W.G.; Morrison, D.R.O.

    1988-01-01

    The aim of this report is to present a compilation of cross-sections (i.e. reaction rates) of elementary particles at high energy. The data are presented in the form of tables, plots and some fits, which should be easy for the reader to use and may enable him to estimate cross-sections for presently unmeasured energies. We have analyzed all the data published in the major Journals and Reviews for momenta of the incoming particles larger than ≅ 50 MeV/c, since the early days of elementary particle physics and, for each reaction, we have selected the best cross-section data available. We have restricted our attention to integrated cross-sections, such as total cross-sections, exclusive and inclusive cross-sections etc., at various incident beam energies. We have disregarded data affected by geometrical and/or kinematical cuts which would make them not directly comparable to other data at different energies. Also, in the case of exclusive reactions, we have left out data where not all of the particles in the final state were unambiguously identified. This work contains reactions induced by neutrinos, gammas, charged pions, kaons, nucleons, antinucleons and hyperons. (orig./HSI)

  19. Preliminary estimates of the total-system cost for the restructured program: An addendum to the May 1989 analysis of the total-system life cycle cost for the Civilian Radioactive Waste Management Program

    International Nuclear Information System (INIS)

    1990-12-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 - a fee levied on electricity generated and sold by commercial nuclear power plants - is sufficient to cover the cost of the program. This report provides cost estimates for the sixth annual evaluation of the adequacy of the fee. The costs contained in this report represent a preliminary analysis of the cost impacts associated with the Secretary of Energy's Report to Congress on Reassessment of the Civilian Radioactive Waste Management Program issued in November 1989. The major elements of the restructured program announced in this report which pertain to the program's life-cycle costs are: a prioritization of the scientific investigations program at the Yucca Mountain candidate site to focus on identification of potentially adverse conditions, a delay in the start of repository operations until 2010, the start of limited waste acceptance at the monitored retrievable storage (MRS) facility in 1998, and the start of waste acceptance at the full-capability MRS facility in 2,000. Based on the restructured program, the total-system cost for the system with a repository at the candidate site at Yucca Mountain in Nevada, a facility for monitored retrievable storage (MRS), and a transportation system is estimated at $26 billion (expressed in constant 1988 dollars). In the event that a second repository is required and is authorized by the Congress, the total-system cost is estimated at $34 to $35 billion, depending on the quantity of spent fuel and high-level waste (HLW) requiring disposal. 17 figs., 17 tabs

  20. Is total pancreatectomy as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy? A single center, prospective, observational study.

    Science.gov (United States)

    Casadei, Riccardo; Ricci, Claudio; Taffurelli, Giovanni; Guariniello, Anna; Di Gioia, Anthony; Di Marco, Mariacristina; Pagano, Nico; Serra, Carla; Calculli, Lucia; Santini, Donatella; Minni, Francesco

    2016-09-01

    Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy. A single center, prospective, observational trial, regarding postoperative outcomes, long-term results, and cost-effectiveness, in a tertiary referral center was conducted, comparing consecutive patients who underwent elective total pancreatectomy and/or pancreaticoduodenectomy. Seventy-three consecutive elective total pancreatectomies and 184 pancreaticoduodenectomies were compared. There were no significant differences regarding postoperative outcomes and overall survival. The quality of life, evaluated in 119 patients according to the EQ-5D-5L questionnaire, showed that there were no significant differences regarding the five items considered. The mean EQ-5D-5L score was similar in the two procedures (total pancreatectomy = 0.872, range 0.345-1.000; pancreaticoduodenectomy = 0.832, range 0.393-1.000; P = 0.320). The impact of diabetes according to the Problem Areas in Diabetes (PAID) questionnaire did not show any significant differences except for question 13 (total pancreatectomy = 0.60; pancreaticoduodenectomy = 0.19; P = 0.022). The cost-effectiveness analysis suggested that the quality-adjusted life year was not significantly different between the two procedures (total pancreatectomy = 0.910, range 0.345-1.000; pancreaticoduodenectomy = 0.910, range -0.393-1.000; P = 0.320). From this study, it seems reasonable to suggest that total pancreatectomy can be considered as safe, feasible, and efficacious as PD and acceptable in terms of cost-effectiveness.

  1. Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

    Science.gov (United States)

    Gosse, Conrad A.; Clarens, Andres F.

    2013-03-01

    Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users.

  2. Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

    International Nuclear Information System (INIS)

    Gosse, Conrad A; Clarens, Andres F

    2013-01-01

    Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users. (letter)

  3. Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy

    NARCIS (Netherlands)

    Peters, Max; Piena, Marjanne A; Steuten, Lotte M G; van der Voort van Zyp, Jochem R N; Moerland, Rien; van Vulpen, Marco

    2016-01-01

    PURPOSE: Focal salvage (FS) iodine 125 ((125)I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study

  4. Evaluation of the Influence of the Logistic Operations Reliability on the Total Costs of a Supply Chain

    Directory of Open Access Journals (Sweden)

    Lukinskiy Valery

    2016-12-01

    Full Text Available Nowadays in logistics integral processes between the material and related flows in supply chains are getting developed more and more. However, in spite of increasing volume of statistical data which reflect the integral processes, the influence evaluation issues of the logistic operations reliability indexes on the total logistics costs remain open and require the corresponding researches implementation.

  5. Reducing Customers’ Total Cost of Ownership Within a Software Supply Network

    NARCIS (Netherlands)

    Slinger, S.R.L.; Rijsemus, W.

    2006-01-01

    This paper describes how the company Cordys avoids the ERP problems from the last 15 years by improving the software release, delivery, deployment, and maintenance processes. These ERP problems, such as costly ERP migrations and highly complex maintenance procedures, are circumvented by the

  6. RANKED SET SAMPLING FOR ECOLOGICAL RESEARCH: ACCOUNTING FOR THE TOTAL COSTS OF SAMPLING

    Science.gov (United States)

    Researchers aim to design environmental studies that optimize precision and allow for generalization of results, while keeping the costs of associated field and laboratory work at a reasonable level. Ranked set sampling is one method to potentially increase precision and reduce ...

  7. Multi-Product Total Cost Functions for Higher Education: The Case of Chinese Research Universities

    Science.gov (United States)

    Longlong, Hou; Fengliang, Li; Weifang, Min

    2009-01-01

    This paper empirically investigates the economies of scale and economies of scope for the Chinese research universities by employing the flexible fixed cost quadratic (FFCQ) function. The empirical results show that both economies of scale and economies of scope exist in the Chinese higher education system and support the common belief of…

  8. Distributed Flexibility Management Targeting Energy Cost and Total Power Limitations in Electricity Distribution Grids

    DEFF Research Database (Denmark)

    Bessler, Sanford; Kemal, Mohammed Seifu; Silva, Nuno

    2018-01-01

    to actively manage power demand. This paper utilizes an existing distributed demand management architecture in order to provide the following contributions: (1) It develops and evaluates a set of algorithms that combine the optimization of energy costs in scenarios of variable day-ahead prices with the goal...

  9. Total and Marginal Cost Analysis for a High School Based Bystander Intervention

    Science.gov (United States)

    Bush, Joshua L.; Bush, Heather M.; Coker, Ann L.; Brancato, Candace J.; Clear, Emily R.; Recktenwald, Eileen A.

    2018-01-01

    Costs of providing the Green Dot bystander-based intervention, shown to be effective in the reduction of sexual violence among Kentucky high school students, were estimated based on data from a large cluster-randomized clinical trial. Rape Crisis Center Educators were trained to provide Green Dot curriculum to students. Implementing Green Dot in…

  10. Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications.

    Science.gov (United States)

    Wilches, C; Sulbarán, J D; Fernández, J E; Gisbert, J M; Bausili, J M; Pelfort, X

    To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Total cost of ownership of CHP SOFC systems: Effect of installation context

    International Nuclear Information System (INIS)

    Arduino, Francesco; Santarelli, Massimo

    2016-01-01

    Solid oxide fuel cells (SOFC) are one of the most interesting between the emerging technologies for energy production. Although some information about the production cost of these devices are already known, their operational cost has not been studied yet with sufficient accuracy. This paper presents a life cycle cost (LCC) analysis of CHP (combined heat and power) SOFC systems performed in hospitals located in various cities of the US and one in Italy. In this study the strong effects of the installation context will be analyzed using a customized use phase model for each location. The cost effectiveness of these devices has been proved without credits in Mondovi (IT), New York (NY) and Minneapolis (MN) where the payback time goes from 10 to 7 years. Considering the credits, it is possible to obtain economic feasibility also in Chicago (IL) and reduce the payback for other cities to values from 4 to 6 years. In other cities like Phoenix (AZ) and Houston (TX) the payback can’t be reached in any case. The life cycle impact assessment analysis has shown how, even in the cities with cleaner electricity grid, there is a reduction in the emissions of both greenhouse gases and pollutants. - Highlights: •Life cycle cost analysis has been performed for CHP SOFC systems. •The strong effects of the installation context have been analyzed. •Economic feasibility has been proven in new york, Minneapolis and Mondovi. •Economic feasibility can’t be reached in phoenix and Houston. •SOFC always provide a reduction in the emissions of greenhouse gases and pollutant.

  12. Total cost of ownership of electric vehicles compared to conventional vehicles: A probabilistic analysis and projection across market segments

    International Nuclear Information System (INIS)

    Wu, Geng; Inderbitzin, Alessandro; Bening, Catharina

    2015-01-01

    While electric vehicles (EV) can perform better than conventional vehicles from an environmental standpoint, consumers perceive them to be more expensive due to their higher capital cost. Recent studies calculated the total cost of ownership (TCO) to evaluate the complete cost for the consumer, focusing on individual vehicle classes, powertrain technologies, or use cases. To provide a comprehensive overview, we built a probabilistic simulation model broad enough to capture most of a national market. Our findings indicate that the comparative cost efficiency of EV increases with the consumer's driving distance and is higher for small than for large vehicles. However, our sensitivity analysis shows that the exact TCO is subject to the development of vehicle and operating costs and thus uncertain. Although the TCO of electric vehicles may become close to or even lower than that of conventional vehicles by 2025, our findings add evidence to past studies showing that the TCO does not reflect how consumers make their purchase decision today. Based on these findings, we discuss policy measures that educate consumers about the TCO of different vehicle types based on their individual preferences. In addition, measures improving the charging infrastructure and further decreasing battery cost are discussed. - Highlights: • Calculates the total cost of ownership across competing vehicle technologies. • Uses Monte Carlo simulation to analyse distributions and probabilities of outcomes. • Contains a comprehensive assessment across the main vehicle classes and use cases. • Indicates that cost efficiency of technology depends on vehicle class and use case. • Derives specific policy measures to facilitate electric vehicle diffusion

  13. Ranking periodic ordering models on the basis of minimizing total inventory cost

    Directory of Open Access Journals (Sweden)

    Mohammadali Keramati

    2015-06-01

    Full Text Available This paper aims to provide proper policies for inventory under uncertain conditions by comparing different inventory policies. To review the efficiency of these algorithms it is necessary to specify the area in which each of them is applied. Therefore, each of the models has been reviewed under different forms of retailing and they are ranked in terms of their expenses. According to the high values of inventories and their impacts on the costs of the companies, the ranking of various models using the simulation annealing algorithm are presented, which indicates that the proposed model of this paper could perform better than other alternative ones. The results also indicate that the suggested algorithm could save from 4 to 29 percent on costs of inventories.

  14. Total educational costs of an integrated nursing curriculum Costos educacionales totales del currículo integrado de enfermería Custos educacionais totais de currículo integrado de enfermagem

    Directory of Open Access Journals (Sweden)

    Maria Cristina Cescatto Bobroff

    2009-02-01

    Full Text Available Innovative changes in undergraduate Nursing programs have brought about new methodologies and the need for cost evaluation. This study aims to develop a model for cost estimation, and to estimate educational costs of an integrated Nursing curriculum at a public university. This is a case study conducted in stages: model development, data collection, analysis and interpretation. The cost-construction model consisted of six steps: data collection; educational and support activity costs; four-year course educational costs; educational support costs; joint product costs and total educational costs. Findings showed a total educational cost per student/year US$ 3,788.82. Course team faculty included 97 members. The cost analysis in faculty contact hours is the most appropriate cost unit as it most consistently reflects faculty time devoted to teaching. The knowledge about educational costs provided information that may be useful for a different approach to the integrated curriculum management, with a view to putting its educational objectives in practice.Para enfrentar los cambios innovadores en los cursos de Enfermería, fue necesario incorporar nuevas metodologías y evaluar los costos. Los objetivos de este estudio fueron construir un modelo y estimar los costos educativos del currículo integrado de Enfermería en una universidad pública, a través de la metodología de estudio de caso - construcción de modelo, recolección, análisis e interpretación de los datos. El modelo construido tuvo las siguientes etapas: recolección de datos, costos educativos por serie y costos de las actividades de apoyo, costos educativos de las cuatro series y de soportes educacionales, costos compartidos y costos educativos totales. Los resultados y la discusión muestran que el costo educacional total anual/alumno fue de US$ 3.788,82. Participaron del curso 97 docentes. El análisis de costos en horas-contacto docente es la unidad de costo que proporciona el

  15. 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.

  16. 12 CFR Appendix K to Part 226 - Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions

    Science.gov (United States)

    2010-01-01

    ... is the property value at consummation, σ is the assumed annual rate of appreciation for the dwelling..., including all costs and fees incurred by the consumer (including any shared appreciation or shared equity... dwelling at consummation: $100,000 Assumed annual dwelling appreciation rate: 4% P10 = Min (103,385.84, 137...

  17. TOTAL COST OF HOSPITALIZATION OF PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY RELATED TO NUTRITIONAL STATUS.

    Science.gov (United States)

    Menezes, Francisco Julimar Correia de; Menezes, Lara Gadelha Luna de; Silva, Guilherme Pinheiro Ferreira da; Melo-Filho, Antônio Aldo; Melo, Daniel Hardy; Silva, Carlos Antonio Bruno da

    2016-01-01

    In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p estado nutricional, segundo o IMC, com custo de internação de colecistectomias videolaparoscópicas. Coleta de dados dos prontuários sobre: avaliação de risco nutricional, estado nutricional e custo de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva no período de janeiro de 2012 a dezembro de 2014. Foram analisados 814 procedimentos. A idade média foi de 39,15 (±12,16) anos; 47 (78,3%) eram mulheres. O custo de internação foi, em média, de R$ 6.167,32 (±1.830,85) para 4,06 (±2,76) dias de internação. Quarenta e um (68,4%) pacientes apresentavam algum grau de sobrepeso; o IMC médio foi 28,07 (±5,41) kg/m²; seis (10%) indivíduos apresentavam risco nutricional ≥3. Houve correlação fraca (r=0,2) e não significativa (pque não tiveram intercorrência, mas sem correlação com o estado nutricional. Em relação aos com IMC normal, houve correlação forte e estatisticamente significante com o custo para tempo de internação, reforçando que há provável distribuição normal

  18. Direct and Total Benefits of Irrigation in India and its Implications to Irrigation Financing and Cost Recovery

    OpenAIRE

    Bhattarai, Madhusudan; Narayanamoorthy, Annasamy; Barker, Randolph

    2006-01-01

    Who benefits from irrigation development in an economy and who should pay for the cost? This question so far has not been well addressed in the irrigation literature. To answer this question we need to know, in addition to the information on farmers' level benefits (increased crop productivity), the magnitude of the total economy wide benefits derived by the farm and non-farm sector in the economy from irrigation development. In this study, taking an example from India, we have estimated the ...

  19. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study.

    Science.gov (United States)

    Eibich, Peter; Dakin, Helen A; Price, Andrew James; Beard, David; Arden, Nigel K; Gray, Alastair M

    2018-04-10

    To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS). Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases. UK secondary care. Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year. EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement. Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution. Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with

  20. Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

    Science.gov (United States)

    Demos, Harry A; Lin, Zilan X; Barfield, William R; Wilson, Sylvia H; Robertson, Dawn C; Pellegrini, Vincent D

    2017-08-01

    Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation. TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed. Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting

    Directory of Open Access Journals (Sweden)

    Zindel Sonja

    2012-07-01

    Full Text Available Abstract Background Patients undergoing major orthopaedic surgery (MOS, such as total hip (THR or total knee replacement (TKR, are at high risk of developing venous thromboembolism (VTE. For thromboembolism prophylaxis, the oral anticoagulant rivaroxaban has recently been included in the German diagnosis related group (DRG system. However, the cost-effectiveness of rivaroxaban is still unclear from both the German statutory health insurance (SHI and the German hospital perspective. Objectives To assess the cost-effectiveness of rivaroxaban from the German statutory health insurance (SHI perspective and to analyse financial incentives from the German hospital perspective. Methods Based on data from the RECORD trials and German cost data, a decision tree was built. The model was run for two settings (THR and TKR and two perspectives (SHI and hospital per setting. Results Prophylaxis with rivaroxaban reduces VTE events (0.02 events per person treated after TKR; 0.007 after THR compared with enoxaparin. From the SHI perspective, prophylaxis with rivaroxaban after TKR is cost saving (€27.3 saving per patient treated. However, the cost-effectiveness after THR (€17.8 cost per person remains unclear because of stochastic uncertainty. From the hospital perspective, for given DRGs, the hospital profit will decrease through the use of rivaroxaban by €20.6 (TKR and €31.8 (THR per case respectively. Conclusions Based on our findings, including rivaroxaban for reimbursement in the German DRG system seems reasonable. Yet, adequate incentives for German hospitals to use rivaroxaban are still lacking.

  2. Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan.

    Science.gov (United States)

    Ward, M A; Xu, Y; Viswanathan, H N; Stolshek, B S; Clay, B; Adams, J L; Kallich, J D; Fine, S; Saag, K G

    2013-04-01

    We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among Medicare Advantage Prescription Drug (MAPD) plan members. Treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs. Overall adherence remained low. We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among MAPD plan members in a large US health plan. We conducted a retrospective cohort study of MAPD plan members aged≥50 years newly initiated on an osteoporosis medication between 1 January 2006 and 31 December 2008. Members were identified as having or not having an osteoporosis treatment change within 12 months after initiating osteoporosis medication. Logistic regression analyses and difference-in-difference (DID) generalized linear models were used to investigate the association between osteoporosis treatment change and (1) adherence to treatment, (2) incident fracture, and (3) healthcare costs at 12 and 24 months follow-up. Of the 33,823 members newly initiated on osteoporosis treatment, 3,573 (10.6%) changed osteoporosis treatment within 12 months. After controlling for covariates, osteoporosis treatment change was associated with significantly higher odds of being adherent (medication possession ratio [MPR]≥0.8) at 12 months (odds ratio [OR]=1.18) and 24 months (OR=1.13) follow-up. However, overall adherence remained low (MPR=0.59 and 0.51 for the change cohort and MPR=0.51 and 0.44 for the no-change cohort at 12 and 24 months, respectively). Osteoporosis treatment change was not significantly associated with incident fracture (OR=1.00 at 12 months and OR=0.98 at 24 months) or total direct healthcare costs (p>0.4) in the DID analysis, but was associated with higher pharmacy costs (p<0.004). Osteoporosis treatment change was associated with a small but significant

  3. Minimizing total costs of forest roads with computer-aided design ...

    Indian Academy of Sciences (India)

    angle to protect stream channels, and maximum allowable heights for cuts and fills to decrease potential soil ... provides the required input data, including the high-resolution digital elevation model (DEM), soil types, and ... illustrates the geometry of a vertical crest curve, generated based on three consecutive control points.

  4. 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

  5. A Total Cost of Ownership Model for Low Temperature PEM Fuel Cells in Combined Heat and Power and Backup Power Applications

    Energy Technology Data Exchange (ETDEWEB)

    University of California, Berkeley; Wei, Max; Lipman, Timothy; Mayyas, Ahmad; Chien, Joshua; Chan, Shuk Han; Gosselin, David; Breunig, Hanna; Stadler, Michael; McKone, Thomas; Beattie, Paul; Chong, Patricia; Colella, Whitney; James, Brian

    2014-06-23

    A total cost of ownership model is described for low temperature proton exchange membrane stationary fuel cell systems for combined heat and power (CHP) applications from 1-250kW and backup power applications from 1-50kW. System designs and functional specifications for these two applications were developed across the range of system power levels. Bottom-up cost estimates were made for balance of plant costs, and detailed direct cost estimates for key fuel cell stack components were derived using design-for-manufacturing-and-assembly techniques. The development of high throughput, automated processes achieving high yield are projected to reduce the cost for fuel cell stacks to the $300/kW level at an annual production volume of 100 MW. Several promising combinations of building types and geographical location in the U.S. were identified for installation of fuel cell CHP systems based on the LBNL modelling tool DER CAM. Life-cycle modelling and externality assessment were done for hotels and hospitals. Reduced electricity demand charges, heating credits and carbon credits can reduce the effective cost of electricity ($/kWhe) by 26-44percent in locations such as Minneapolis, where high carbon intensity electricity from the grid is displaces by a fuel cell system operating on reformate fuel. This project extends the scope of existing cost studies to include externalities and ancillary financial benefits and thus provides a more comprehensive picture of fuel cell system benefits, consistent with a policy and incentive environment that increasingly values these ancillary benefits. The project provides a critical, new modelling capacity and should aid a broad range of policy makers in assessing the integrated costs and benefits of fuel cell systems versus other distributed generation technologies.

  6. Cost-effectiveness of timely versus delayed primary total hip replacement in Germany: A social health insurance perspective

    Directory of Open Access Journals (Sweden)

    Ruben E. Mujica-Mota

    2017-10-01

    Full Text Available Without clinical guideline on the optimal timing for primary total hip replacement (THR, patients often receive the operation with delay. Delaying THR may negatively affect long-term health-related quality of life, but its economic effects are unclear. We evaluated the costs and health benefits of timely primary THR for functionally independent adult patients with end-stage osteoarthritis (OA compared to non-surgical therapy followed by THR after progression to functional dependence (delayed THR, and non-surgical therapy alone (Medical Therapy, from a German Social Health Insurance (SHI perspective. Data from hip arthroplasty registers and a systematic review of the published literature were used to populate a tunnel-state modified Markov lifetime model of OA treatment in Germany. A 5% annual discount rate was applied to costs (2013 prices and health outcomes (Quality Adjusted Life Years, QALY. The expected future average cost of timely THR, delayed THR and medical therapy in women at age 55 were €27,474, €27,083 and €28,263, and QALYs were 20.7, 16.7, and 10.3, respectively. QALY differences were entirely due to health-related quality of life differences. The discounted cost per QALY gained by timely over delayed (median delay of 11 years THR was €1270 and €1338 in women treated at age 55 and age 65, respectively, and slightly higher than this for men. Timely THR is cost-effective, generating large quality of life benefits for patients at low additional cost to the SHI. With declining healthcare budgets, research is needed to identify the characteristics of those able to benefit the most from timely THR.

  7. Growth, antioxidant capacity and total carotene of Dunaliella salina DCCBC15 in a low cost enriched natural seawater medium.

    Science.gov (United States)

    Tran, Duc; Doan, Nguyen; Louime, Clifford; Giordano, Mario; Portilla, Sixto

    2014-01-01

    Dunaliella is currently drawing worldwide attention as an alternative source of nutraceuticals. Commercially, β-carotene making up over 10% of Dunaliella biomass is generating the most interest. These compounds, because of their non-toxic properties, have found applications in the food, drug and cosmetic industry. The β-carotene content of Dunaliella cells, however, depends heavily on the growth conditions and especially on the availability of nutrients, salinity, irradiance and temperature in the growth medium. A chemically well defined medium is usually required, which significantly contributes to the cost of pigment production; hence a desire for low cost marine media. The present study aimed at evaluating the suitability of six different media, especially exploiting local potential resources, for the mass production of Dunaliella salina DCCBC15 as functional food and medicine. The efficacy of a new selected low-cost enriched natural seawater medium (MD4), supplemented with industrial N-P-K fertilizer, was investigated with respect to biomass production, chlorophyll, antioxidant capacity, and total carotene by Dunaliella though culture conditions were not optimized yet. This new medium (MD4) appears extremely promising, since it affords a higher production of Dunaliella biomass and pigments compared with the control, a common artificial medium (MD1), while allowing a substantial reduction in the production costs. The medium is also recommended for culturing other marine algae.

  8. Benefits of using customized instrumentation in total knee arthroplasty: results from an activity-based costing model.

    Science.gov (United States)

    Tibesku, Carsten O; Hofer, Pamela; Portegies, Wesley; Ruys, C J M; Fennema, Peter

    2013-03-01

    The growing demand for total knee arthroplasty (TKA) associated with the efforts to contain healthcare expenditure by advanced economies necessitates the use of economically effective technologies in TKA. The present analysis based on activity-based costing (ABC) model was carried out to estimate the economic value of patient-matched instrumentation (PMI) compared to standard surgical instrumentation in TKA. The costs of the two approaches, PMI and standard instrumentation in TKA, were determined by the use of ABC which measures the cost of a particular procedure by determining the activities involved and adding the cost of each activity. Improvement in productivity due to increased operating room (OR) turn-around times was determined and potential additional revenue to the hospital by the efficient utilization of gained OR time was estimated. Increased efficiency in the usage of OR and utilization of surgical trays were noted with patient-specific approach. Potential revenues to the hospital were estimated with the use of PMI by efficient utilization of time saved in OR. Additional revenues of 78,240 per year were estimated considering utilization of gained OR time to perform surgeries other than TKA. The analysis suggests that use of PMI in TKA is economically effective when compared to standard instrumentation.

  9. 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

  10. Integrated batch production and maintenance scheduling for multiple items processed on a deteriorating machine to minimize total production and maintenance costs with due date constraint

    Directory of Open Access Journals (Sweden)

    Zahedi Zahedi

    2016-04-01

    Full Text Available This paper discusses an integrated model of batch production and maintenance scheduling on a deteriorating machine producing multiple items to be delivered at a common due date. The model describes the trade-off between total inventory cost and maintenance cost as the increase of production run length. The production run length is a time bucket between two consecutive preventive maintenance activities. The objective function of the model is to minimize total cost consisting of in process and completed part inventory costs, setup cost, preventive and corrective maintenance costs and rework cost. The problem is to determine the optimal production run length and to schedule the batches obtained from determining the production run length in order to minimize total cost.

  11. A Giant Hepatic Hemangioma Complicated by Kasabach-Merritt Syndrome: Findings of Tc-99m RBC Scintigraphy and SPECT Including a Total Body Blood Pool Imaging Study

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Myung Hee; Jeong, Hwan Jeong; Lim, Seok Tae; Kim, Dong Wook; Yim, Chang Yeol [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2009-02-15

    Kasabach-Merritt syndrome (KMS) consists of thrombocytopenia, microangiopathic hemolytic anemia, and localized consumption coagulopathy that develops within vascular hemangioma. This syndrome may also be associated with occult hemangiomas located at various sites. Tc-99m RBC scintigraphy and SPECT have proven to be reliable for confirming or excluding hemangioma. Total body blood pool imaging study during the scintigraphy also provides a means of screening for occult lesions. The authors report the case of a 29-year-old man who presented with a giant hepatic hemangioma complicated by KMS, and underwent Tc-99m RBC scintigraphy and SPECT including a total body blood pool imaging study.

  12. 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

  13. 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...

  14. A Flexible Job Shop Scheduling Problem with Controllable Processing Times to Optimize Total Cost of Delay and Processing

    Directory of Open Access Journals (Sweden)

    Hadi Mokhtari

    2015-11-01

    Full Text Available In this paper, the flexible job shop scheduling problem with machine flexibility and controllable process times is studied. The main idea is that the processing times of operations may be controlled by consumptions of additional resources. The purpose of this paper to find the best trade-off between processing cost and delay cost in order to minimize the total costs. The proposed model, flexible job shop scheduling with controllable processing times (FJCPT, is formulated as an integer non-linear programming (INLP model and then it is converted into an integer linear programming (ILP model. Due to NP-hardness of FJCPT, conventional analytic optimization methods are not efficient. Hence, in order to solve the problem, a Scatter Search (SS, as an efficient metaheuristic method, is developed. To show the effectiveness of the proposed method, numerical experiments are conducted. The efficiency of the proposed algorithm is compared with that of a genetic algorithm (GA available in the literature for solving FJSP problem. The results showed that the proposed SS provide better solutions than the existing GA.

  15. 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

  16. Expressions For Total Energy And Relativistic Kinetic Energy At Low Speeds In Special Relativity Must Include Rotational And Vibrational As Well As Linear Kinetic Energies

    Science.gov (United States)

    Brekke, Stewart

    2017-09-01

    Einstein calculated the total energy at low speeds in the Special Theory of Relativity to be Etotal =m0c2 + 1 / 2m0v2 . However, the total energy must include the rotational and vibrational kinetic energies as well as the linear kinetic energies. If 1 / 2 Iω2 is the expression for the rotational kinetic energy of mass and 1 / 2 kx02 is the vibrational kinetic energy expression of a typical mass, the expression for the total energy of a mass at low speeds must be Etotal =m0c2 + 1 / 2m0v2 + 1 / 2 Iω2 + 1 / 2 kx02 . If this expression is correct, the relativistic kinetic energy of a mass. at low speeds must include the rotational and vibrational kinetic energies as well as the linear kinetic energies since according to Einstein K = (m -m0) c2 and therefore, K = 1 / 2m0v2 + 1 / 2 Iω2 + 1 / 2 kx02 .

  17. Estimación de los costes totales de los operadores logísticos de frío. ¿Son relevantes los costes externos en el transporte de alimentos perecederos?

    OpenAIRE

    Andrés González-Moralejo, Silvia

    2011-01-01

    [EN] In this paper we analyze the total costs generated to low-temperature distribution companies by the transport in part load of perishable freight. Using the data of 2008, which have been directly obtained from a sample of transport companies, the social costs and the tariff system are estimated with the aim of accentuating the difference between the external costs and producer costs, and comparing them with final prices. According to those calculations we can state that curren...

  18. 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

  19. Autologous Stem Cell Transplantation in Patients With Multiple Myeloma: An Activity-based Costing Analysis, Comparing a Total Inpatient Model Versus an Early Discharge Model.

    Science.gov (United States)

    Martino, Massimo; Console, Giuseppe; Russo, Letteria; Meliado', Antonella; Meliambro, Nicola; Moscato, Tiziana; Irrera, Giuseppe; Messina, Giuseppe; Pontari, Antonella; Morabito, Fortunato

    2017-08-01

    Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs. The TIM and EDOM models involved a total cost of €28,615.15 and €16,499.43, respectively. In the TIM model, the phase with the greatest economic impact was the posttransplant (recovery and hematologic engraftment) with 36.4% of the total cost, whereas in the EDOM model, the phase with the greatest economic impact was the pretransplant (chemo-mobilization, apheresis procedure, cryopreservation, and storage) phase, with 60.4% of total expenses. In an analysis of each episode, the TIM model comprised a higher absorption than the EDOM. In particular, the posttransplant represented 36.4% of the total costs in the TIM and 17.7% in EDOM model, respectively. The estimated reduction in cost per patient using an EDOM model was over €12,115.72. The repayment of the DRG in Calabrian Region for the ASCT procedure is €59,806. Given the real cost of the transplant, the estimated cost saving per patient is €31,190.85 in the TIM model and €43,306.57 in the EDOM model. In conclusion, the actual repayment of the DRG does not correspond to the real cost of the ASCT procedure in Italy. Moreover, using the EDOM, the cost of ASCT is approximately the half of the TIM model. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients

    Directory of Open Access Journals (Sweden)

    Benditz A

    2016-12-01

    Full Text Available Achim Benditz,1 Felix Greimel,1 Patrick Auer,2 Florian Zeman,3 Antje Göttermann,4 Joachim Grifka,1 Winfried Meissner,4 Frederik von Kunow1 1Department of Orthopedics, University Medical Center Regensburg, 2Clinic for anesthesia, Asklepios Klinikum Bad Abbach, Bad Abbach, 3Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, 4Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany Background: The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.Methods: All patients included in the study had undergone total hip arthroplasty (THA. Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS. A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.Results: From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0 on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2. Over time, the maximum pain score decreased (mean 3.0, ±2.0, whereas patient satisfaction

  1. The effect of fiscal incentives on market penetration of electric vehicles: A pairwise comparison of total cost of ownership

    International Nuclear Information System (INIS)

    Lévay, Petra Zsuzsa; Drossinos, Yannis; Thiel, Christian

    2017-01-01

    An important barrier to electric vehicle (EV) sales is their high purchase price compared to internal combustion engine (ICE) vehicles. We conducted total cost of ownership (TCO) calculations to study how costs and sales of EVs relate to each other and to examine the role of fiscal incentives in reducing TCO and increasing EV sales. We composed EV-ICE vehicle pairs that allowed cross-segment and cross-country comparison in eight European countries. Actual car prices were used to calculate the incentives for each model in each country. We found a negative TCO-sales relationship that differs across car segments. Compared to their ICE vehicle pair, big EVs have lower TCO, higher sales, and seem to be less price responsive than small EVs. Three country groups can be distinguished according to the level of fiscal incentives and their impact on TCO and EV sales. In Norway, incentives led to the lowest TCO for the EVs. In the Netherlands, France, and UK the TCO of EVs is close to the TCO of the ICE pairs. In the other countries the TCO of EVs exceeds that of the ICE vehicles. We found that exemptions from flat taxes favour big EVs, while lump-sum subsidies favour small EVs. - Highlights: • Pairwise comparison of EV and ICE vehicle TCO and sales in eight European countries. • In NO, EV TCO is lower than ICE TCO; in NL, FR, and UK, EV TCO is slightly higher. • Compared to ICE vehicles, big EVs have lower TCO and higher sales than small EVs. • Exemptions from flat taxes favour big EVs, lump-sum subsidies favour small EVs. • Most popular EV models: Tesla Model S, Nissan Leaf, Mitsubishi Outlander PHEV.

  2. 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

  3. Joint estimation of vertical total electron content (VTEC) and satellite differential code biases (SDCBs) using low-cost receivers

    Science.gov (United States)

    Zhang, Baocheng; Teunissen, Peter J. G.; Yuan, Yunbin; Zhang, Hongxing; Li, Min

    2018-04-01

    Vertical total electron content (VTEC) parameters estimated using global navigation satellite system (GNSS) data are of great interest for ionosphere sensing. Satellite differential code biases (SDCBs) account for one source of error which, if left uncorrected, can deteriorate performance of positioning, timing and other applications. The customary approach to estimate VTEC along with SDCBs from dual-frequency GNSS data, hereinafter referred to as DF approach, consists of two sequential steps. The first step seeks to retrieve ionospheric observables through the carrier-to-code leveling technique. This observable, related to the slant total electron content (STEC) along the satellite-receiver line-of-sight, is biased also by the SDCBs and the receiver differential code biases (RDCBs). By means of thin-layer ionospheric model, in the second step one is able to isolate the VTEC, the SDCBs and the RDCBs from the ionospheric observables. In this work, we present a single-frequency (SF) approach, enabling the joint estimation of VTEC and SDCBs using low-cost receivers; this approach is also based on two steps and it differs from the DF approach only in the first step, where we turn to the precise point positioning technique to retrieve from the single-frequency GNSS data the ionospheric observables, interpreted as the combination of the STEC, the SDCBs and the biased receiver clocks at the pivot epoch. Our numerical analyses clarify how SF approach performs when being applied to GPS L1 data collected by a single receiver under both calm and disturbed ionospheric conditions. The daily time series of zenith VTEC estimates has an accuracy ranging from a few tenths of a TEC unit (TECU) to approximately 2 TECU. For 73-96% of GPS satellites in view, the daily estimates of SDCBs do not deviate, in absolute value, more than 1 ns from their ground truth values published by the Centre for Orbit Determination in Europe.

  4. 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.

  5. Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes

    Science.gov (United States)

    van Hasselt, Martijn; McCall, Nancy; Keyes, Vince; Wensky, Suzanne G; Smith, Kevin W

    2015-01-01

    Objective To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Data Sources Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. Study Design This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008–June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Data Collection Methods Individual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Principal Findings Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. Conclusions This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. PMID:25077375

  6. Quantifying a Total Non-Methane Hydrocarbon Signal using Low-Cost VOC Sensors in an Effort to Help Communities Learn More About their Air Quality

    Science.gov (United States)

    Collier, A. M.; Hannigan, M.; Piedrahita, R.; Casey, J. G.; Johnston, J.; Chiang, S.

    2016-12-01

    The growing accessibility of low-cost air quality monitoring technologies has led to their increased usage among community-based organizations, particularly for the monitoring of pollutants dangerous to human health (e.g., hazardous air pollutants or HAPS). However, often these low-cost sensors are `off-the-shelf' and are being utilized in a manner that differs from their intended purpose - necessitating high quality calibrations. For example, VOC sensors intended for the detection of high levels of a particular compound in an industrial setting may instead be used for ambient monitoring of a group of VOCs. Academic/community partnerships can be an ideal way to improve this type of sensor quantification while providing a community with not only the opportunity to use these technologies with additional support around data quality, but also the opportunity for education around the abilities and applications of low-cost sensors. In the spring of 2016, our lab at the University of Colorado, Boulder partnered with communities in Los Angeles and Kern County to deploy low-cost air quality monitors for the purpose of quantifying methane and non-methane hydrocarbon signals in an effort to learn more about potential impacts from local sources (e.g., nearby highways and oil & gas development). The monitoring platform was developed in our lab and is capable of logging multiple gas phase species as well as some environmental parameters. The monitors include two different metal oxide VOC sensors - each with slightly different sensing capabilities. Calibration was achieved using a pre- and post-deployment field normalization to reference monitoring equipment maintained by the South Coast Air Quality Management District. Monitors were then deployed at locations throughout the community. We will present results on our efforts to quantify a total non-methane hydrocarbon signal, observations from the field data, and recommendations for academic/community partnerships formed around

  7. Comparison of approaches to Total Quality Management. Including an examination of the Department of Energy`s position on quality management

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, C.T.

    1994-03-01

    This paper presents a comparison of several qualitatively different approaches to Total Quality Management (TQM). The continuum ranges from management approaches that are primarily standards -- with specific guidelines, but few theoretical concepts -- to approaches that are primarily philosophical, with few specific guidelines. The approaches to TQM discussed in this paper include the International Organization for Standardization (ISO) 9000 Standard, the Malcolm Baldrige National Quality Award, Senge`s the Learning Organization, Watkins and Marsick`s approach to organizational learning, Covey`s Seven Habits of Highly Successful People, and Deming`s Fourteen Points for Management. Some of these approaches (Deming and ISO 9000) are then compared to the DOE`s official position on quality management and conduct of operations (DOE Orders 5700.6C and 5480.19). Using a tabular format, it is shown that while 5700.6C (Quality Assurance) maps well to many of the current approaches to TQM, DOE`s principle guide to management Order 5419.80 (Conduct of Operations) has many significant conflicts with some of the modern approaches to continuous quality improvement.

  8. The advanced launch system: Application of total quality management principles to low-cost space transportation system development

    Science.gov (United States)

    Wolfe, M. G.; Rothwell, T. G.; Rosenberg, D. A.; Oliver, M. B.

    Recognizing that a major inhibitor of man's rapid expansion of the use of space is the high cost (direct and induced) of space transportation, the U.S. has embarked on a major national program to radically reduce the cost of placing payloads into orbit while, at the same time, making equally radical improvements inlaunch system operability. The program is entitled "The Advanced Launch System" (ALS) and is a joint Department of Defense/National Aeronautics and Space Administration (DoD/NASA) program which will provide launch capability in the post 2000 timeframe. It is currently in Phase II (System Definition), which began in January 1989, and will serve as a major source of U.S. launch system technology over the next several years. The ALS is characterized by a new approach to space system design, development, and operation. The practices that are being implemented by the ALS are expected to affect the management and technical operation of all future launch systems. In this regard, the two most significant initiatives being implemented on the ALS program are the practices of Total Quality Management (TQM) and the Unified Information System (Unis). TQM is a DoD initiative to improve the quality of the DoD acquisition system, contractor management systems, and the technical disciplines associated with the design, development, and operation of major systems. TQM has been mandated for all new programs and affects the way every group within the system currently does business. In order to implement the practices of TQM, new methods are needed. A program on the scale of the ALS generates vast amounts of information which must be used effectively to make sound decisions. Unis is an information network that will connect all ALS participants throughout all phases of the ALS development. Unis is providing support for project management and system design, and in following phases will provide decision support for launch operations, computer integrated manufacturing, automated

  9. 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.

  10. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

    Science.gov (United States)

    Copanitsanou, Panagiota; Valkeapää, Kirsi; Cabrera, Esther; Katajisto, Jouko; Leino-Kilpi, Helena; Sigurdardottir, Arun K; Unosson, Mitra; Zabalegui, Adelaida; Lemonidou, Chryssoula

    2017-04-01

    Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research. © 2016 Wiley Periodicals, Inc.

  11. Estimating Total Program Cost of a Long-Term, High-Technology, High-Risk Project with Task Durations and Costs That May Increase Over Time

    National Research Council Canada - National Science Library

    Brown, Gerald G; Grose, Roger T; Koyak, Robert A

    2006-01-01

    .... Each task suffers some risk of delay and changed cost. Ignoring budget constraints, we use Monte Carlo simulation of the duration of each task in the project to infer the probability distribution of the project completion time...

  12. Estimating Total Program Cost of a Long-Term, High-Technology, High-Risk Project with Task Durations and Costs That May Increase Over Time

    National Research Council Canada - National Science Library

    Brown, Gerald G; Grose, Roger T; Koyak, Robert A

    2006-01-01

    .... Each task in the project can begin only when all its predecessor tasks have been completed, and each task has a range of feasible durations with a month-by-month cost profile for each duration...

  13. Energy management for cost reduction in the production. TEEM - Total Energy Efficiency Management; Energiemanagement zur Kostensenkung in der Produktion. TEEM - Total Energy Efficiency Management

    Energy Technology Data Exchange (ETDEWEB)

    Westkaemper, Engelbert; Verl, Alexander (eds.)

    2009-07-01

    Within the workshop of the Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Stuttgart, Federal Republic of Germany) at 6th October, 2009, in Stuttgart the following lectures were held: (1) Presentation of Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Engelbert Westkaemper); (2) TEEM - Total Energy Efficiency Management - ''With energy management to an energy efficient production'' (Alexander Schloske); (3) DIN EN 16001 Introduction of an energy management system - utilization and advantages for companies (Sylvia Wahren); (4) Analysis of the energy efficiency with power flow - Support and implementation at factory planning and optimization of production (Klaus Erlach); (5) Total Energy Efficiency Management - Approaches at the company Kaercher in injection moulding for example (Axel Leschtar); (6) Modelling the embodied product energy (Shahin Rahimifard); (7) Acquisition of energy data in the production - Technologies and possibilities (Joachim Neher); (8) Active energy management by means of an ''energy control centre'' - Analysis of the real situation and upgrading measures in the production using coating plants as an example (Wolfgang Klein); (9) Visualisation and simulation of energy values in the digital factory (Carmen Constantinescu, Axel Bruns).

  14. Predictors for total hospital and cardiology cost claims among patients with atrial fibrillation initiating dabigatran or acenocoumarol in the Netherlands

    NARCIS (Netherlands)

    Jacobs, M S; van Leent, M W J; Tieleman, R G; Jansman, F G A; Cao, Q; Postma, M J; van Hulst, M

    2017-01-01

    Aims: The prevalence of atrial fibrillation (AF) has increased over the past years due to aging of the population, and healthcare costs associated with AF reflect a significant financial burden. The aim of this study was to explore predictors for the real-world AF-related in-hospital costs in

  15. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

    NARCIS (Netherlands)

    Retèl, Valesca P.; van den Boer, Cindy; Steuten, Lotte M. G.; Okła, Sławomir; Hilgers, Frans J.; van den Brekel, Michiel W.

    2015-01-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore,

  16. Total costs of injury from accidents in the home and during education, sports and leisure activities: estimates for Norway with assessment of uncertainty.

    Science.gov (United States)

    Veisten, Knut; Nossum, Ase; Akhtar, Juned

    2009-07-01

    Injury accidents occurring in the home, during educational, sports or leisure activities were estimated from samples of hospital data, combined with fatality data from vital statistics. Uncertainty of estimated figures was assessed in simulation-based analysis. Total economic costs to society from injuries and fatalities due to such accidents were estimated at approximately NOK 150 billion per year. The estimated costs reveal the scale of the public health problem and lead to arguments for the establishment of a proper injury register for the identification of preventive measures to reduce the costs to society.

  17. Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model.

    Directory of Open Access Journals (Sweden)

    Hideki Higashi

    Full Text Available BACKGROUND: Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. METHODOLOGY/PRINCIPAL FINDINGS: We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively. However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. CONCLUSIONS/SIGNIFICANCE: Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements.

  18. Determination of sulfur forms in wine including free and total sulfur dioxide based on molecular absorption of carbon monosulfide in the air-acetylene flame.

    Science.gov (United States)

    Huang, Mao Dong; Becker-Ross, Helmut; Florek, Stefan; Heitmann, Uwe; Okruss, Michael; Patz, Claus-Dieter

    2008-01-01

    A new method for the determination of sulfur forms in wine, i.e., free SO(2), total SO(2), bound SO(2), total S, and sulfate, is presented. The method is based on the measurement of the carbon monosulfide (CS) molecular absorption produced in a conventional air-acetylene flame using high-resolution continuum source absorption spectrometry. Individual sulfur forms can be distinguished because of the different sensitivities of the corresponding CS molecular absorption. The sensitivity of free SO(2) is about three times higher than the value for bound SO(2) and sulfate. The method makes use of procedures similar to those used in classic reference methods. Its performance is verified by analyzing six wine samples. Relative standard deviations are between 5 and 13% for free SO(2) and between 1 and 3% for total SO(2). For the validation of the accuracy of the new method, the results are compared with those of reference methods. The agreement of the values for total SO(2) with values of the classic method is satisfactory: five out of six samples show deviations less than 16%. Due to the instability of free SO(2) in wine and the known problems of the used reference method, serious deviations of the free SO(2) results are found for three samples. The evaluation of the limits of detection focuses on the value for free SO(2), which is the sulfur form having by far the lowest concentration in wine. Here, the achievable limit of detection is 1.8 mg L(-1). [figure: see text] Detection of non-metal elements using continuum source flame absorption spectrometry.

  19. Inventory Policy Determination for Raw Materials in ILY Pharmaceutical using Periodic Review (R, s, S and Periodic Review (R, S Method to Minimize Total Inventory Cost

    Directory of Open Access Journals (Sweden)

    Mely Permatasari Puteri

    2017-01-01

    Full Text Available ILY Pharmaceutical is one of the pharmaceutical industry in Bandung that produces various type of medicines. In managing the raw materials for production, ILY Pharmaceutical is not using any standardize calculation for the inventory policy of the raw materials. That condition caused the raw materials to be overstocked and made the total inventory cost to be higher. The objective of this research is to minimize the total inventory cost in ILY Pharmaceutical by giving an inventory policy proposal. Based on the classification of the raw materials using ABC analysis, two inventory policy will be used. Periodic review (R, s, S for A category and periodic review (R, S for B and C category. The proposed inventory policy able to reduce the total inventory cost by 42% from $12.194,98 to $7.029,29. The reduced cost is mainly caused by the quantity of the raw materials that is stored in the warehouse is smaller than the existing condition. Even though the frequency of the order is increased thus increasing the order cost but the quantity ordered is smaller because in the proposed condition, there are a maximum inventory level so, the quantity ordered cannot exceed that level.

  20. [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.

  1. It Is a Brave New World: Alternative Payment Models and Value Creation in Total Joint Arthroplasty: Creating Value for TJR, Quality and Cost-Effectiveness Programs.

    Science.gov (United States)

    Chen, Kevin K; Harty, Jonathan H; Bosco, Joseph A

    2017-06-01

    The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty. These methods are to: (1) improve outcomes greater than the increased costs to achieve this improvement, (2) decrease costs without affecting outcomes, and (3) decrease costs while simultaneously improving outcomes. Following these guidelines will help practitioners thrive in a bundled care environment. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly.

    Science.gov (United States)

    Osterhoff, Georg; O'Hara, Nathan N; D'Cruz, Jennifer; Sprague, Sheila A; Bansback, Nick; Evaniew, Nathan; Slobogean, Gerard P

    2017-03-01

    There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis. On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure. In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA. Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. 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.

  4. 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

  5. Defense Manpower Commission Staff Studies and Supporting Papers. Volume 2. The Total Force and Its Manpower Requirements Including Overviews of Each Service

    Science.gov (United States)

    1976-05-01

    III, DMC Filial Report.) E. MANPOWER BUDCETINC WITHIN THE DEPARTMENT OF DEFENSE, by Audrey J. Page. (Related to Chapter III, DMC Final Report.) F...y *i E»V ■ X 1 m -10- Maneuver battalions (counting other non-dlvlslonal combat unlta of Amor and Infantry aa wall at thoaa Included In tht... Amor Schools, wiU continue In those "school troop" roles at Fort Banning and Fort Knox, respectively. Additionally, there are soae very serious

  6. Institutionalization of Reduction of Total Ownership Costs (R-TOC) Principles. Part 1: Lessons Learned from Special Interest Programs

    Science.gov (United States)

    2010-12-01

    10.0% 20.0% 30.0% 40.0% 50.0% 60.0% R ep or te d Sa vi ng s/ Av oi da nc es LCC % Savings FY05 % Savings FY05 Goal P ro gr am D ro pp ed P ro gr am...cost drivers, readiness degraders and maintenance and supply issues are important, especially in the highest dollar vale expenditure areas. These

  7. Amino acid profiles of rumen undegradable protein: a comparison between forages including cereal straws and alfalfa and their respective total mixed rations.

    Science.gov (United States)

    Wang, B; Jiang, L S; Liu, J X

    2017-10-06

    Optimizing the amino acid (AA) profile of rumen undegradable protein (RUP) can positively affect the amount of milk protein. This study was conducted to improve knowledge regarding the AA profile of rumen undegradable protein from corn stover, rice straw and alfalfa hay as well as the total mixed ratio diets (TMR) based on one of them as forage source [forage-to-concentrate ratio of 45:55 (30% of corn stover (CS), 30% of rice straw (RS), 23% of alfalfa hay (AH) and dry matter basis)]. The other ingredients in the three TMR diets were similar. The RUP of all the forages and diets was estimated by incubation for 16 hr in the rumen of three ruminally cannulated lactating cows. All residues were corrected for microbial colonization, which was necessary in determining the AA composition of RUP from feed samples using in situ method. Compared with their original AA composition, the AA pattern of forages and forage-based diets changed drastically after rumen exposure. In addition, the extent of ruminal degradation of analysed AA was not constant among the forages. The greatest individual AA degradability of alfalfa hay and corn stover was Pro, but was His of rice straw. A remarkable difference was observed between microbial attachment corrected and uncorrected AA profiles of RUP, except for alfalfa hay and His in the three forages and TMR diets. The ruminal AA degradability of cereal straws was altered compared with alfalfa hay but not for the TMR diets. In summary, the AA composition of forages and TMR-based diets changed significantly after ruminal exposure, indicating that the original AA profiles of the feed cannot represent its AA composition of RUP. The AA profile of RUP and ruminal AA degradability for corn stover and rice straw contributed to missing information in the field. © 2017 Blackwell Verlag GmbH.

  8. Cost-Effectiveness of Five Commonly Used Prosthesis Brands for Total Knee Replacement in the UK: A Study Using the NJR Dataset.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available There is a lack of evidence on the effectiveness or cost-effectiveness of alternative brands of prosthesis for total knee replacement (TKR. We compared patient-reported outcomes, revision rates, and costs, and estimated the relative cost-effectiveness of five frequently used cemented brands of unconstrained prostheses with fixed bearings (PFC Sigma, AGC Biomet, Nexgen, Genesis 2, and Triathlon.We used data from three national databases for patients who had a TKR between 2003 and 2012, to estimate the effect of prosthesis brand on post-operative quality of life (QOL (EQ-5D-3L in 53 126 patients at six months. We compared TKR revision rates by brand over 10 years for 239 945 patients. We used a fully probabilistic Markov model to estimate lifetime costs and quality-adjusted life years (QALYs, incremental cost effectiveness ratios (ICERs, and the probability that each prosthesis brand is the most cost effective at alternative thresholds of willingness-to-pay for a QALY gain.Revision rates were lowest with the Nexgen and PFC Sigma (2.5% after 10 years in 70-year-old women. Average lifetime costs were lowest with the AGC Biomet (£9 538; mean post-operative QOL was highest with the Nexgen, which was the most cost-effective brand across all patient subgroups. For example, for 70-year-old men and women, the ICERs for the Nexgen compared to the AGC Biomet were £2 300 per QALY. At realistic cost per QALY thresholds (£10 000 to £30 000, the probabilities that the Nexgen is the most cost-effective brand are about 98%. These results were robust to alternative modelling assumptions.AGC Biomet prostheses are the least costly cemented unconstrained fixed brand for TKR but Nexgen prostheses lead to improved patient outcomes, at low additional cost. These results suggest that Nexgen should be considered as a first choice prosthesis for patients with osteoarthritis who require a TKR.

  9. Pengaruh Inventory Turnover Ratio, Account Payable to Cost of Goods Sold Ratio, Net Working Capital to Total Asset Ratio, dan Debt Ratio Terhadap Gross Profit Margin

    OpenAIRE

    Fransisca, Maria

    2015-01-01

    The purpose of this study was to determine whether the Inventory Turnover Ratio, Accounts Payable to Cost of Goods Sold Ratio, Net Working Capital to Total Assets Ratio, and Debt Ratio influence simultaneously and partially on the gross profit margin in the consumer goods sector of manufacture companies listed on the Indonesia Stock Exchange . This research is a type of associative causal research with research population are the consumer goods sector of manufacture companies listed on...

  10. 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).

  11. Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

    Directory of Open Access Journals (Sweden)

    Umer Chaudhry Muhammad

    2011-05-01

    Full Text Available Abstract Background & Purpose Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery. Methodology This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5% knees (group-I had received tranexamic acid (by surgeon preference while the remaining fifty-two patients with 66 (51.5% knees (group-II had did not received any tranexamic acid either pre- or post-operatively. Results The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral and 2695 ml (bilateral. In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral and 1.94 gm/dl (bilateral, with a mean drainage of 826 ml (unilateral and 1288 ml (bilateral (p-value Interpretation Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

  12. Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.

    Science.gov (United States)

    Skaar, Daniel D; Park, Taehwan; Swiontkowski, Marc F; Kuntz, Karen M

    2015-11-01

    Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis. A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies. The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures. The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  13. 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

    . Besides this, an additional set of measures has been defined, which will result in an extra 10 Mton emission reduction. The Dutch government wants to realise a reduction of 25 Mton in other countries. Without additional policy the emission of greenhouse gases in 2030 will, from a policy point of view, be about twice that preferred; Up to 2010 emissions of pollutants causing acidification will decrease, thanks to partly already implemented policies. The 2010 targets of the National Environmental Policy Plan will not be met: emission levels will be about 30% higher. The UN-ECE targets are less stringent, except for SO2. Neither will these targets be met. After 2010 emissions will stabilise or increase unless additional policies are implemented. Costs to avoid emissions of NH3, NOx, and SO2 will increase: the cheap measures have already been introduced, while the more expensive ones have not. In almost all sectors, measures additional to those introduced as a result of current policies are available. These are cheaper than the relatively expensive transport measures that will be taken in response to current policy. Emissions of pollutants causing local air quality problems will show a strong decrease, PM10 being the most important exception. In the next decade emissions of PM10 will stabilise. PM10 is one of the most important pollutants expected to cause health impacts. In the period up to 2030 total noise emissions from road, rail and air transport will increase. Noise emissions from passenger cars will either not or hardly decrease. Emissions from lorries will decrease marginally. This decrease is not enough to compensate for the increase in road transport. refs

  14. A CIRCLELESS "2D/3D TOTAL STATION": A LOW COST INSTRUMENT FOR SURVEYING, RECORDING POINT CLOUDS, DOCUMENTATION, IMAGE ACQUISITION AND VISUALISATION

    Directory of Open Access Journals (Sweden)

    M. Scherer

    2013-07-01

    Full Text Available Hardware and software of the universally applicable instrument - referred to as a 2D/3D total station – are described here, as well as its practical use. At its core it consists of a 3D camera – often also called a ToF camera, a pmd camera or a RIM-camera – combined with a common industrial 2D camera. The cameras are rigidly coupled with their optical axes in parallel. A new type of instrument was created mounting this 2D/3D system on a tripod in a specific way. Because of it sharing certain characteristics with a total station and a tacheometer, respectively, the new device was called a 2D/3D total station. It may effectively replace a common total station or a laser scanner in some respects. After a brief overview of the prototype's features this paper then focuses on the methodological characteristics for practical application. Its usability as a universally applicable stand-alone instrument is demonstrated for surveying, recording RGB-coloured point clouds as well as delivering images for documentation and visualisation. Because of its limited range (10m without reflector and 150 m to reflector prisms and low range accuracy (ca. 2 cm to 3 cm compared to present-day total stations and laser scanners, the practical usage of the 2D/3D total station is currently limited to acquisition of accidents, forensic purpuses, speleology or facility management, as well as architectural recordings with low requirements regarding accuracy. However, the author is convinced that in the near future advancements in 3D camera technology will allow this type of comparatively low cost instrument to replace the total station as well as the laser scanner in an increasing number of areas.

  15. Plerixafor mobilization leads to a lower ratio of CD34+ cells to total nucleated cells which results in greater storage costs.

    Science.gov (United States)

    Tanhehco, Yvette C; Adamski, Jill; Sell, Mary; Cunningham, Kathleen; Eisenmann, Christa; Magee, Deborah; Stadtmauer, Edward A; O'Doherty, Una

    2010-01-01

    Plerixafor (Mozobil, AMD3100) with granulocyte-colony stimulating factor (G-CSF) mobilizes more CD34+ cells/kg compared to G-CSF alone. Given that plerixafor enhances mobilization of multiple white blood cell lineages, we determined if more storage space is required for products collected from patients mobilized with plerixafor. A review of the medical records of 15 patients mobilized with chemotherapy and G-CSF (control) and 14 patients mobilized with plerixafor plus G-CSF (plerixafor) was performed. Data on demographics, baseline characteristics, CD34+ cells/kg, total nucleated cells, total mononuclear cells, total apheresis sessions, and total bags for storage were collected. Mean values were determined and compared using Student's t-test. We found that the proportion of CD34+ cells among total nucleated cells was less in the plerixafor group compared to the control group (P = 0.0427). More nucleated cells (10.7 x 10(10) vs. 7.1 x 10(10), P =0.0452) and mononuclear cells (9.7 x 10(10) vs. 5.9 x 10(10), P = 0.0059) were mobilized with plerixafor plus G-CSF. However, there was no significant difference in CD34+ cells/kg, total CD34+ cells or the proportion of mononuclear cells among total nucleated cells between the two groups. More storage bags were required for the plerixafor group compared to the control group (15 vs. 9, P = 0.0299). Mobilization with plerixafor plus G-CSF resulted in a smaller proportion of CD34+ cells collected and a greater number of storage bags. An increase in the number of bags required for stem cell storage may be logistically problematic and will also lead to increased costs for storage of stem cells.

  16. 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

  17. The Impact of Solid Organ Transplant History on Inpatient Complications, Mortality, Length of Stay, and Cost for Primary Total Hip Arthroplasty Admissions in the United States.

    Science.gov (United States)

    Navale, Suparna M; Szubski, Caleb R; Klika, Alison K; Schiltz, Nicholas K; Desai, Pratik P; Barsoum, Wael K

    2017-04-01

    As the prevalence of and life expectancy after solid organ transplantation increases, some of these patients will require total hip arthroplasty (THA). Immunosuppressive therapy, metabolic disorders, and post-transplant medications may place transplant patients at higher risk of adverse events following surgery. The objective of this study was to compare inpatient complications, mortality, length of stay (LOS), and costs for THA patients with and without solid organ transplant history. A retrospective cross-sectional analysis was conducted using 1998-2011 Nationwide Inpatient Sample. Primary THA patients were queried (n = 3,175,456). After exclusions, remaining patients were assigned to transplant (n = 7558) or non-transplant groups (n = 2,772,943). After propensity score matching, adjusted for patient and hospital characteristics, logistic regression and paired t-tests examined the effect of transplant history on outcomes. Between 1998 and 2011, THA volume among transplant patients grew approximately 48%. The overall prevalence of one or more complications following THA was greater in the transplant group than in the non-transplant group (32.0% vs 22.1%; P history was associated with increased complication risk (odds ratio, 1.56) after THA, longer hospital LOS (+0.64 days; P < .001), and increased admission costs (+$887; P = .005). Transplant patients exhibited increased odds of inpatient complications, longer LOS, and greater admission costs after THA compared with non-transplant patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality

    Directory of Open Access Journals (Sweden)

    Jimenez-Trujillo Isabel

    2011-02-01

    Full Text Available Abstract Background Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS, costs and in-hospital mortality (IHM of patients undergoing primary total hip arthroplasty (THA over an 8-year study period in Spain. Methods We selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51 between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index. Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM. Results We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p Conclusions The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.

  19. An integer batch scheduling model considering learning, forgetting, and deterioration effects for a single machine to minimize total inventory holding cost

    Science.gov (United States)

    Yusriski, R.; Sukoyo; Samadhi, T. M. A. A.; Halim, A. H.

    2018-03-01

    This research deals with a single machine batch scheduling model considering the influenced of learning, forgetting, and machine deterioration effects. The objective of the model is to minimize total inventory holding cost, and the decision variables are the number of batches (N), batch sizes (Q[i], i = 1, 2, .., N) and the sequence of processing the resulting batches. The parts to be processed are received at the right time and the right quantities, and all completed parts must be delivered at a common due date. We propose a heuristic procedure based on the Lagrange method to solve the problem. The effectiveness of the procedure is evaluated by comparing the resulting solution to the optimal solution obtained from the enumeration procedure using the integer composition technique and shows that the average effectiveness is 94%.

  20. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    International Nuclear Information System (INIS)

    Kickuth, Ralph; Anderson, Suzanne; Peter-Salonen, Kristiina; Laemmle, Bernhard; Eggli, Stefan; Triller, Juergen

    2006-01-01

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. Physical and chemical characteristics including total and geochemical forms of phosphorus in sediment from the top 30 centimeters of cores collected in October 2006 at 26 sites in Upper Klamath Lake, Oregon

    Science.gov (United States)

    Simon, Nancy S.; Ingle, Sarah N.

    2011-01-01

    μThis study of phosphorus (P) cycling in eutrophic Upper Klamath Lake (UKL), Oregon, was conducted by the U.S. Geological Survey in cooperation with the U.S. Bureau of Reclamation. Lakebed sediments from the upper 30 centimeters (cm) of cores collected from 26 sites were characterized. Cores were sampled at 0.5, 1.5, 2.5, 3.5, 4.5, 10, 15, 20, 25, and 30 cm. Prior to freezing, water content and sediment pH were determined. After being freeze-dried, all samples were separated into greater than 63-micron (μm) particle-size (coarse) and less than 63-μm particle-size (fine) fractions. In the surface samples (0.5 to 4.5 cm below the sediment water interface), approximately three-fourths of the particles were larger than 63-μm. The ratios of the coarse particle-size fraction (>63 μm) and the fine particle-size fraction (determination of total concentrations of aluminum (Al), calcium (Ca), carbon (C), iron (Fe), poorly crystalline Fe, nitrogen (N), P, and titanium (Ti). Total Fe concentrations were the largest in sediment from the northern portion of UKL, Howard Bay, and the southern portion of the lake. Concentrations of total Al, Ca, and Ti were largest in sediment from the northern, central, and southernmost portions of the lake and in sediment from Howard Bay. Concentrations of total C and N were largest in sediment from the embayments and in sediment from the northern arm and southern portion of the lake in the general region of Buck Island. Concentrations of total C were larger in the greater than 63-μm particle-size fraction than in the less than 63-μm particle-size fraction. Sediments were sequentially extracted to determine concentrations of inorganic forms of P, including loosely sorbed P, P associated with poorly crystalline Fe oxides, and P associated with mineral phases. The difference between the concentration of total P and sum of the concentrations of inorganic forms of P is referred to as residual P. Residual P was the largest fraction of P in all

  6. 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.

  7. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

    Science.gov (United States)

    Van Dongen, Hans P A.; Maislin, Greg; Mullington, Janet M.; Dinges, David F.

    2003-01-01

    were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h (s.e. 0.73 h). CONCLUSIONS: Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign. Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses, but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions. This suggests that sleep debt is perhaps best understood as resulting in additional wakefulness that has a neurobiological "cost" which accumulates over time.

  8. 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.

  9. 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.

  10. 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...

  11. Urine circulating-tumor DNA (ctDNA) detection of acquired EGFR T790M mutation in non-small-cell lung cancer: An outcomes and total cost-of-care analysis.

    Science.gov (United States)

    Sands, Jacob; Li, Qianyi; Hornberger, John

    2017-08-01

    Third-generation tyrosine kinase inhibitors (TKIs) have proven effective in patients with the acquired EGFR T790M resistance mutation who progress on prior EGFR TKI therapy. Median progression-free survival (PFS) on a 3rd-gen TKI was 9-10 months for T790M+ patients compared to 2.8 months for T790M- patients. PFS is similar regardless of the specimen used to assess T790M, such as tissue, plasma, or urine ctDNA. This study aimed to assess the total cost of care of a urine-testing strategy (UTS) versus a tissue-testing strategy (TTS) for T790M detection, in patients with EGFR-mutation positive lung adenocarcinoma and progression on prior TKI therapy. Long-term outcomes and economic implications were assessed from a US payer perspective. Endpoints were PFS, overall survival (OS), medical resource use and related costs. We included published randomized drug trials and Medicare fee schedules. A state-transition analysis and Markov model tracked patients from stable disease to progression and death. Univariate and multivariate sensitivity analyses were performed to assess the robustness of findings and identify factors that most influenced outcomes and costs. UTS increased the rate of detection of patients with T790M mutation eligible for treatment with 3rd generation TKI by 7% compared with TTS; urine ctDNA testing detected T790M mutation in some patients for whom biopsy could not be performed or when tissue testing yielded indeterminate results. Due to enhanced targeting of TKI therapy, UTS increased PFS and OS by 0.44 and 0.35 months, respectively. UTS yields a savings of $1243-$1680 per patient due to avoidance of biopsy, potential biopsy-associated complications, and tissue-based molecular testing in approximately 55.6% of patients. Probability of T790M detection by tissue and cost of biopsy procedure were the most influential factors. UTS prolonged PFS/OS due to increased detection of T790M mutation and decreased biopsies and complication-related costs. Copyright

  12. [Are Higher Prices for Larger Femoral Heads in Total Hip Arthroplasty Justified from the Perspective of Health Care Economics? An Analysis of Costs and Effects in Germany].

    Science.gov (United States)

    Grunert, R; Schleifenbaum, S; Möbius, R; Sommer, G; Zajonz, D; Hammer, N; Prietzel, T

    2017-02-01

    Background: In total hip arthroplasty (THA), femoral head diameter has not been regarded as a key parameter which should be restored when reconstructing joint biomechanics and geometry. Apart from the controversial discussion on the advantages and disadvantages of using larger diameter heads, their higher cost is another important reason that they have only been used to a limited extent. The goal of this study was to analyse the price structure of prosthetic heads in comparison to other components used in THA. A large group of patients with hip endoprostheses were evaluated with respect to the implanted socket diameter and thus the theoretically attainable head diameter. Materials and Methods: The relative prices of various THA components (cups, inserts, stems and ball heads) distributed by two leading German manufacturers were determined and analysed. Special attention was paid to different sizes and varieties in a series of components. A large patient population treated with THA was evaluated with respect to the implanted cup diameter and therefore the theoretically attainable head diameter. Results: The pricing analysis of the THA components of two manufacturers showed identical prices for cups, inserts and stems in a series. In contrast to this, the prices for prosthetic heads with a diameter of 36-44 mm were 11-50 % higher than for 28 mm heads. Identical prices for larger heads were the exception. The distribution of the head diameter in 2719 THA cases showed significant differences between the actually implanted and the theoretically attainable heads. Conclusion: There are proven advantages in using larger diameter ball heads in THA and the remaining problems can be solved. It is therefore desirable to correct the current pricing practice of charging higher prices for larger components. Instead, identical prices should be charged for all head diameters in a series, as is currently established practice for all other THA components. Thus when

  13. 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

  14. User instructions for levelized power generation cost codes using an IBM-type PC

    International Nuclear Information System (INIS)

    Coen, J.J.; Delene, J.G.

    1989-01-01

    Programs for the calculation of levelized power generation costs using an IBM or compatible PC are described. Cost calculations for nuclear plants and coal-fired plants include capital investment cost, operation and maintenance cost, fuel cycle cost, decommissioning cost, and total levelized power generation cost. 7 refs., 36 figs., 4 tabs

  15. Effects of adding food by-products mainly including noodle waste to total mixed ration silage on fermentation quality, feed intake, digestibility, nitrogen utilization and ruminal fermentation in wethers.

    Science.gov (United States)

    Ishida, Kyohei; Yani, Srita; Kitagawa, Masayuki; Oishi, Kazato; Hirooka, Hiroyuki; Kumagai, Hajime

    2012-11-01

    Four wethers were used in a 4 × 4 Latin square design experiment to evaluate the applicability of two types of total mixed ration (TMR) silage with food by-products. Four food by-products (i.e., potato waste, soy sauce cake, soybean curd residue and noodle waste) were obtained and mixed with commercial concentrate (CC) as TMR silage. The two types of TMR silage, T1 and T2, each contained CC, in addition to all by-products for T1 (TRE1), and soy sauce cake and noodle waste for T2 (TRE2) on a dry matter (DM) basis. The silage was well-fermented with low pH values and high lactic acid concentration. As the experimental treatments, T1, T2 and CC (CTL) were fed with a basal diet. The result showed that the digestibility of DM and organic matter (OM) were higher for T1 than for CC (P < 0.05), while crude protein digestibility was not significantly different among T1, T2 and CC. The retained nitrogen was not affected by inclusion of food by-products. Ruminal pH in TRE1 and TRE2 immediately decreased compared to that in CTL. The study suggested that the two types of TMR silage, including food by-products, might be used as a substitute for commercial concentrate. © 2012 The Authors. Animal Science Journal © 2012 Japanese Society of Animal Science.

  16. Cost optimization for buildings with hybrid ventilation systems

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Kun; Lu, Yan

    2018-02-13

    A method including: computing a total cost for a first zone in a building, wherein the total cost is equal to an actual energy cost of the first zone plus a thermal discomfort cost of the first zone; and heuristically optimizing the total cost to identify temperature setpoints for a mechanical heating/cooling system and a start time and an end time of the mechanical heating/cooling system, based on external weather data and occupancy data of the first zone.

  17. A systematic literature review of the cost-effectiveness of erythropoietin in orthopedic surgery : There is a need for differentiation between total hip and knee arthroplasty

    NARCIS (Netherlands)

    Degener, F.; Postma, M.J.

    2015-01-01

    OBJECTIVES: Erythropoietin has been widely adapted into clinical practice in orthopedic surgery to prevent anemia and ultimately lower the use of allogeneic blood transfusions. Its safety and efficacy has been shown in various randomized clinical trials. Questions regarding the cost-effectiveness of

  18. A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip.

    Science.gov (United States)

    de Verteuil, R; Imamura, M; Zhu, S; Glazener, C; Fraser, C; Munro, N; Hutchison, J; Grant, A; Coyle, D; Coyle, K; Vale, L

    2008-06-01

    To assess the clinical effectiveness and cost-effectiveness of minimal incision approaches to total hip replacement (THR) for arthritis of the hip. Major electronic databases were searched from 1966 to 2007. Relevant websites were also examined and experts in the field were consulted. Studies of minimal (one or two) incision THR compared with standard THR were assessed for inclusion in the review of clinical effectiveness. A systematic review of economic evaluations comparing a minimal incision approach to standard THR was also performed and the estimates from the systematic review of clinical effectiveness were incorporated into an economic model. Utilities data were sourced to estimate quality-adjusted life-years (QALYs). Due to lack of data, no economic analysis was conducted for the two mini-incision surgical method. Nine randomised controlled trials (RCTs), 17 non-randomised comparative studies, six case series and one registry were found to be useful for the comparison of single mini-incision THR with standard THR. One RCT compared two mini-incision THR with standard THR, and two RCTs, five non-randomised comparative studies and two case series compared two mini-incision with single mini-incision THR. The RCTs were of moderate quality. Most had fewer than 200 patients and had a follow-up period of less than 1 year. The single mini-incision THR may have some perioperative advantages, e.g. blood loss [weighted mean difference (WMD) -57.71 ml, panalysis. With respect to the two-incision approach, data were suggestive of shorter recovery compared with single-incision THR, but conclusions must be treated with caution. The costs to the health service, per patient, of single mini-incision THR depend upon assumptions made, but are similar at one year (7060 pounds sterling vs 7350 pounds sterling for standard THR). For a 40-year time horizon the costs were 11,618 pounds sterling for mini-incision and 11,899 pounds sterling for standard THR. Two existing economic

  19. Analysis of the relationship cost-effectiveness of the myocardial gammagraphy studies and the impact to the total expenditure by diagnostic of ischemic cardiopathy

    International Nuclear Information System (INIS)

    Valenzuela F, A.G.; Perez C, J.P.; Arreola O, H.; Valenzuela F, A.A.; Soto M, H.; Arguero S, R.

    2005-01-01

    Recent advances in pharmacology, diagnostic and invasive procedures provide a series of modalities that diminish the morbidity and increase the long term survival in the patients that have suffered a heart attack to myocardium. The stratification by risk is an essential element for the handling of the survivors of heart attack to myocardium. In their attention it is looked for to optimize the therapeutic benefit, to diminish the unnecessary diagnostic and therapeutic procedures and to improve the efficiency. For example, a coronariography in sick with heart attack to myocardium it is not cost-effective if not is clinically suitable. Of there that from the institutional point of view, this is, of the Mexican Institute of the Public Health, they are required of appropriate reference approaches and counter reference to grant to the sick person, the best service that is the one in this case the diagnostic and the handling of the ischemic cardiopathy with the smallest waste of resources. The estimation of the annual survival is the base of the stratification, it constitutes the angular stone of the early handling of the heart attack to myocardium. The goal for the clinical would be to identify patients with intermediate risk, since, this risk makes them candidates to therapy interventionist. As long as those with low risk won't require intervention. This would allow the decrease of rates by revenues of heart attack to myocardium, and therefore to diminish the hospital staying rates. The Nuclear Cardiology (myocardial gammagraphy) it is not the only invasive method available to evaluate the myocardial perfusion in sick in who coronary illness is suspected. When the myocardial gammagraphy is carried out in appropriate population, the cost it diminishes because it restricts the necessity of additional invasive evaluations. This because the nuclear cardiology has predictive value so much for the mortality like to detect myocardial viability. Based on these probabilities

  20. A Cost-Effective High-Throughput Plasma and Serum Proteomics Workflow Enables Mapping of the Molecular Impact of Total Pancreatectomy with Islet Autotransplantation

    DEFF Research Database (Denmark)

    Bennike, Tue Bjerg; Stensballe, Allan

    2018-01-01

    acquisition liquid chromatography/mass spectrometry; the data were queried using feature quantification with Spectronaut. To show the applicability of our workflow to serum, we analyzed a unique set of samples from 48 chronic pancreatitis patients, pre and post total pancreatectomy with islet...

  1. Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy : Protocol of a multi-center randomized controlled trial

    NARCIS (Netherlands)

    Jansen, Femke; Cnossen, Ingrid C; Eerenstein, Simone E J; Coupé, Veerle M H; Witte, Birgit I.; van Uden-Kraan, Cornelia F.; Doornaert, Patricia; Braunius, Weibel W; de Bree, Remco; Hardillo, José A U; Honings, Jimmie; Halmos, György B; Leemans, C René; Verdonck-de Leeuw, Irma M

    2016-01-01

    Background: Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to

  2. Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy: protocol of a multi-center randomized controlled trial

    NARCIS (Netherlands)

    Jansen, Femke; Cnossen, Ingrid C; Eerenstein, Simone E J; Coupé, Veerle M H; Witte, Birgit I; van Uden-Kraan, Cornelia F; Doornaert, Patricia; Braunius, Weibel W; De Bree, Remco; Hardillo, José A U; Honings, Jimmie; Halmos, György B; Leemans, C René; Verdonck-de Leeuw, Irma M

    2016-01-01

    BACKGROUND: Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to

  3. Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy: Protocol of a multi-center randomized controlled trial

    NARCIS (Netherlands)

    F. Jansen (Femke); I.C. Cnossen (Ingrid C.); S.E.J. Eerenstein (Simone); V.M.H. Coupé (Veerle); B.I. Witte (Birgit); C.F. van Uden-Kraan (Cornelia F.); P. Doornaert (Patricia); W.W. Braunius; R. de Bree (Remco); J.A.U. Hardillo (José); J. Honings (Jimmie); G.B. Halmos (Gyorgy); C.R. Leemans (René); I.M. Verdonck-De Leeuw (Irma)

    2016-01-01

    textabstractBackground: Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is

  4. Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy : protocol of a multi-center randomized controlled trial

    NARCIS (Netherlands)

    Jansen, Femke; Cnossen, Ingrid C.; Eerenstein, Simone E. J.; Coupe, Veerle M. H.; Witte, Birgit I.; van Uden-Kraan, Cornelia F.; Doornaert, Patricia; Braunius, Weibel W.; De Bree, Remco; Hardillo, Jose A. U.; Honings, Jimmie; Halmos, Gyorgy B.; Leemans, C. Rene; Leeuw, Irma M. Verdonck-de

    2016-01-01

    Background: Total laryngectomy with or without adjuvant (chemo) radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to

  5. Rapid and Cost-Effective Quantification of Glucosinolates and Total Phenolic Content in Rocket Leaves by Visible/Near-Infrared Spectroscopy

    Directory of Open Access Journals (Sweden)

    Eva María Toledo-Martín

    2017-05-01

    Full Text Available The potential of visible-near infrared spectroscopy to predict glucosinolates and total phenolic content in rocket (Eruca vesicaria leaves has been evaluated. Accessions of the E. vesicaria species were scanned by NIRS as ground leaf, and their reference values regressed against different spectral transformations by modified partial least squares (MPLS regression. The coefficients of determination in the external validation (R2VAL for the different quality components analyzed in rocket ranged from 0.59 to 0.84, which characterize those equations as having from good to excellent quantitative information. These results show that the total glucosinolates, glucosativin and glucoerucin equations obtained, can be used to identify those samples with low and high contents. The glucoraphanin equation obtained can be used for rough predictions of samples and in case of total phenolic content, the equation showed good correlation. The standard deviation (SD to standard error of prediction ratio (RPD and SD to range (RER were variable for the different quality compounds and showed values that were characteristic of equations suitable for screening purposes or to perform accurate analyses. From the study of the MPLS loadings of the first three terms of the different equations, it can be concluded that some major cell components such as protein and cellulose, highly participated in modelling the equations for glucosinolates.

  6. Rapid and Cost-Effective Quantification of Glucosinolates and Total Phenolic Content in Rocket Leaves by Visible/Near-Infrared Spectroscopy.

    Science.gov (United States)

    Toledo-Martín, Eva María; Font, Rafael; Obregón-Cano, Sara; De Haro-Bailón, Antonio; Villatoro-Pulido, Myriam; Del Río-Celestino, Mercedes

    2017-05-20

    The potential of visible-near infrared spectroscopy to predict glucosinolates and total phenolic content in rocket ( Eruca vesicaria ) leaves has been evaluated. Accessions of the E. vesicaria species were scanned by NIRS as ground leaf, and their reference values regressed against different spectral transformations by modified partial least squares (MPLS) regression. The coefficients of determination in the external validation (R²VAL) for the different quality components analyzed in rocket ranged from 0.59 to 0.84, which characterize those equations as having from good to excellent quantitative information. These results show that the total glucosinolates, glucosativin and glucoerucin equations obtained, can be used to identify those samples with low and high contents. The glucoraphanin equation obtained can be used for rough predictions of samples and in case of total phenolic content, the equation showed good correlation. The standard deviation (SD) to standard error of prediction ratio (RPD) and SD to range (RER) were variable for the different quality compounds and showed values that were characteristic of equations suitable for screening purposes or to perform accurate analyses. From the study of the MPLS loadings of the first three terms of the different equations, it can be concluded that some major cell components such as protein and cellulose, highly participated in modelling the equations for glucosinolates.

  7. Methods of analysis by the U.S. Geological Survey National Water Quality Laboratory; determination of the total phosphorus by a Kjeldahl digestion method and an automated colorimetric finish that includes dialysis

    Science.gov (United States)

    Patton, Charles J.; Truitt, Earl P.

    1992-01-01

    A method to determine total phosphorus (TP) in the same digests prepared for total Kjeldahl nitrogen (TKN) determinations is desribed. The batch, high-temperature (block digester), HG(II)-catalyzed digestion step is similar to U.S. Geological Survey methods I-2552-85/I-4552-85 and U.S. Environmental Protection Agency method 365.4 except that sample and reagent volumes are halved. Prepared digests are desolvated at 220 degrees Celsius and digested at 370 degrees Celsius in separate block digesters set at these temperatures, rather than in a single, temperature-programmed block digester. This approach is used in the method escribed here, which permits 40 calibrants, reference waters, and smaples to be digested and resolvated in about an hour. Orthophosphate ions originally present in samples, along with those released during the digestion step, are determined colorimetrically at a rate of 90 tests per hour by an automated version of the phosphoantimonylmolybdenum blue procedure. About 100 microliters of digest are required per determination. The upper concentration limit is 2 milligrams per liter (mg/L) with a method detection limt of 0.01 mg/L. Repeatability for a sample containing approximately 1.6 mg/L of TP in a high suspended-solids matrix is 0.7 percent. Between-day precision for the same sample is 5.0 percent. A dialyzer in the air-segmented continuous flow analyzer provides on-line digest cleanup, eliminated particulates that otherwise would interfere in the colorimetric finish. An single-channel analyzer can process the resolvated digests from two pairs of block digesters each hour. Paired t-test analysis of TP concentrations for approximately 1,600 samples determined by the new method (U.S. Geologial Survey methods I-2610-91 and I-4610-91) and the old method (U.S. Geological Survey methods I-2600-85 and I-4600-85) revealed positive bias in the former of 0.02 to 0.04 mg/L for surface-water samples in agreement with previous studies. Concentrations of total

  8. Total protein

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...

  9. The importance of the property total cost on the formulation of the policy for acquisition of the government enterprises from the energy sector; A importancia do custo total de propriedade na formulacao da politica de aquisicao das empresas estatais do setor de energia

    Energy Technology Data Exchange (ETDEWEB)

    Melo, Andre Cristiano Silva; Ignacio, Anibal Alberto Vilcapoma; Fernandes, Elton; Sampaio, Lea Maria Dantas; Araujo, Renato Samuel Barbosa de [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Nucleo de Estudos de Tecnologia, Gestao e Logistica; Cardoso, Flavio Correa; Moreira, Pedro de Souza; Silva, Sergio Vargas da [FURNAS Centrais Eletricas S.A., Rio de Janeiro, RJ (Brazil). Dept. de Aquisicoes de Materiais

    2006-07-01

    This article discusses the approach to total cost of the property (TCP) as an instrument for the formulation of policies for acquisitions of the Brazilian electric sector enterprises. Also the article discusses legal aspects which rules the acquisition processes such as the Law 8666/93, the Decree 2745/98 and the Law Sarbanes and Oxley which regulates the enterprises which stocks in the US stock exchanges. This article points out in the direction to alternatives and perspectives for the formulation of a new policy of acquisition not priorizing the less buying price, but also the life cycle of the product, viewing the reduction of the total costs of the enterprises assets, as the high investments are forecasted for the electric sector.

  10. 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

  11. 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.

  12. 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

  13. Supply disruption cost for power network planning

    International Nuclear Information System (INIS)

    Kjoelle, G.H.

    1992-09-01

    A description is given of the method of approach to calculate the total annual socio-economic cost of power supply disruption and non-supplied energy, included the utilities' cost for planning. The total socio-economic supply disruption cost is the sum of the customers' disruption cost and the utilities' cost for failure and disruption. The mean weighted disruption cost for Norway for one hour disruption is NOK 19 per kWh. The customers' annual disruption cost is calculated with basis in the specific disruption cost referred to heavy load (January) and dimensioning maximum loads. The loads are reduced by factors taking into account the time variations of the failure frequency, duration, the loads and the disruption cost. 6 refs

  14. Total algorithms

    NARCIS (Netherlands)

    Tel, G.

    We define the notion of total algorithms for networks of processes. A total algorithm enforces that a "decision" is taken by a subset of the processes, and that participation of all processes is required to reach this decision. Total algorithms are an important building block in the design of

  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. 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.

  19. 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)

  20. TOTAL HIP REPLACEMENTS AT KIKUYU HOSPITAL, KENYA

    African Journals Online (AJOL)

    Total hip arthroplasty has been done in Kenya for many years (1). There are only a few medical institutions that are in a position to perform this demanding procedure. The main reasons include: lack of adequate equipments, few trained personnel and the high cost of implants. It is mainly in the teaching and referral hospitals ...

  1. Total Ownership Cost - Tools and Discipline

    Science.gov (United States)

    2011-03-16

    higher reliability and back-up capability. The MUIRS focus helps ensure that TOC elements are addressed in design and test. The traceability from user...Pallet Management System  PBL (4)  Privatization-NOSL/NAWCI  RFID (6)  Risk Analysis for Performance-based Logistics  R-TOC AEGIS Microwave

  2. 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.

  3. Reconciling quality and cost: A case study in interventional radiology.

    Science.gov (United States)

    Zhang, Li; Domröse, Sascha; Mahnken, Andreas

    2015-10-01

    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

  4. Totally James

    Science.gov (United States)

    Owens, Tom

    2006-01-01

    This article presents an interview with James Howe, author of "The Misfits" and "Totally Joe". In this interview, Howe discusses tolerance, diversity and the parallels between his own life and his literature. Howe's four books in addition to "The Misfits" and "Totally Joe" and his list of recommended books with lesbian, gay, bisexual, transgender,…

  5. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

    Science.gov (United States)

    Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

    2015-05-17

    Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

  6. 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.

  7. Outpatient Total Joint Arthroplasty.

    Science.gov (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam

    2017-12-01

    Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

  8. Cost-analysis of an oral health outreach program for preschool children in a low socioeconomic multicultural area in Sweden

    DEFF Research Database (Denmark)

    Wennhall, Inger; Norlund, Anders; Matsson, Lars

    2010-01-01

    of materials, rental facilities and equipment based on accounting data. The cost for fillings was extracted from a specified per diem list. Overhead costs were assumed to correspond to 50% of salaries and all costs were calculated as net present value per participating child in the program and expressed......The aim was to calculate the total and the net costs per child included in a 3-year caries preventive program for preschool children and to make estimates of expected lowest and highest costs in a sensitivity analysis. The direct costs for prevention and dental care were applied retrospectively...... in Euro. The results revealed an estimated total cost of 310 Euro per included child (net present value) in the 3-year program. Half of the costs were attributed to the first year of the program and the costs of manpower constituted 45% of the total costs. When the total cost was reduced with the cost...

  9. Charging generators for waste management costs

    International Nuclear Information System (INIS)

    Berry, J.B.; Homan, F.J.

    1987-01-01

    DOE-Oak Ridge Operations (DOE-ORO) has recognized that an effective waste management program focuses on control at the source and that the burden for responsible waste management can be placed on generators by charging for waste management costs. The principle of including the waste management costs in the total cost of the product, even when the product is research and development, is being implemented at Oak Ridge National Laboratory (ORNL). Charging waste management costs to the pollutor creates an incentive to optimize processes so that less waste is produced and provides a basis for determining the cost effectiveness. 2 refs., 1 fig., 1 tab

  10. Societal costs of multiple sclerosis in Ireland.

    Science.gov (United States)

    Carney, Peter; O'Boyle, Derek; Larkin, Aidan; McGuigan, Christopher; O'Rourke, Killian

    2018-02-07

    This paper evaluates the impact of multiple sclerosis (MS) in Ireland, and estimates the associated direct, indirect, and intangible costs to society based on a large nationally representative sample. A questionnaire was developed to capture the demographics, disease characteristics, healthcare use, informal care, employment, and wellbeing. Referencing international studies, standardized survey instruments were included (e.g. CSRI, MFIS-5, EQ-5D) or adapted (EDSS) for inclusion in an online survey platform. Recruitment was directed at people with MS via the MS Society mailing list and social media platforms, as well as in traditional media. The economic costing was primarily conducted using a 'bottom-up' methodology, and national estimates were achieved using 'prevalence-based' extrapolation. A total of 594 people completed the survey in full. The sample had geographic, disease, and demographic characteristics indicating good representativeness. At an individual level, average societal cost was estimated at €47,683; the average annual costs for those with mild, moderate, and severe MS were calculated as €34,942, €57,857, and €100,554, respectively. For a total Irish MS population of 9,000, the total societal costs of MS amounted to €429m. Direct costs accounted for just 30% of the total societal costs, indirect costs amounted to 50% of the total, and intangible or QoL costs represented 20%. The societal cost associated with a relapse in the sample is estimated as €2,438. The findings highlight that up to 70% of the total costs associated with MS are not routinely counted. These "hidden" costs are higher in Ireland than the rest of Europe, due in part to significantly lower levels of workforce participation, a higher likelihood of permanent workforce withdrawal, and higher levels of informal care needs. The relationship between disease progression and costs emphasize the societal importance of managing and slowing the progression of the illness.

  11. Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.

    Science.gov (United States)

    Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J

    2016-01-01

    Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost

  12. 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.

  13. Total quality accounting

    Directory of Open Access Journals (Sweden)

    Andrijašević Maja

    2008-01-01

    Full Text Available The focus of competitive "battle" shifted from the price towards non-price instruments, above all, towards quality that became the key variable for profitability increase and achievement of better comparative position of a company. Under such conditions, management of a company, which, according to the established and certified system of total quality, strives towards achieving of a better market position, faces the problem of quality cost measurement and determination. Management, above all, cost accounting can help in solving of this problem, but the question is how much of its potential is being used for that purpose.

  14. 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

  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. Reconciling quality and cost: A case study in interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Li; Mahnken, Andreas [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic and Interventional Radiology, Baldinger Strasse, Marburg (Germany); Domroese, Sascha [University Hospital Giessen and Marburg, Philipps University of Marburg, Division of Controlling, Baldinger Strasse, Marburg (Germany)

    2015-10-15

    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 EUR to 294 EUR, and marginal delay costs from approximately 2000 EUR to 500 EUR, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 EUR. The yearly delay cost saved was approximately 150,000 EUR. With increased revenue of 10,000 EUR in project phase 2, the yearly total cost saved was approximately 290,000 EUR. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. (orig.)

  17. Reconciling quality and cost: A case study in interventional radiology

    International Nuclear Information System (INIS)

    Zhang, Li; Mahnken, Andreas; Domroese, Sascha

    2015-01-01

    To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 EUR to 294 EUR, and marginal delay costs from approximately 2000 EUR to 500 EUR, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 EUR. The yearly delay cost saved was approximately 150,000 EUR. With increased revenue of 10,000 EUR in project phase 2, the yearly total cost saved was approximately 290,000 EUR. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. (orig.)

  18. Economic cost of tobacco use in India, 2004.

    Science.gov (United States)

    John, R M; Sung, H-Y; Max, W

    2009-04-01

    To estimate the tobacco-attributable costs of diseases separately for smoked and smokeless tobacco use in India. The prevalence-based attributable-risk approach was used to estimate the economic cost of tobacco using healthcare expenditure data from the National Sample Survey, a nationally representative household sample survey conducted in India in 2004. Four major categories of tobacco-related disease-tuberculosis, respiratory diseases, cardiovascular diseases and neoplasms-were considered. Direct medical costs of treating tobacco related diseases in India amounted to $907 million for smoked tobacco and $285 million for smokeless tobacco. The indirect morbidity costs of tobacco use, which includes the cost of caregivers and value of work loss due to illness, amounted to $398 million for smoked tobacco and $104 million for smokeless tobacco. The total economic cost of tobacco use amounted to $1.7 billion. Tuberculosis accounted for 18% of tobacco-related costs ($311 million) in India. Of the total cost of tobacco, 88% was attributed to men. The cost of tobacco use was many times more than the expenditures on tobacco control by the government of India and about 16% more than the total tax revenue from tobacco. The tobacco-attributable cost of tuberculosis was three times higher than the expenditure on tuberculosis control in India. The economic costs estimated here do not include the costs of premature mortality from tobacco use, which is known to comprise roughly 50% to 80% of the total economic cost of tobacco in many countries.

  19. Catalog of total excitation-emission and total synchronous fluorescence maps with synchronous fluorescence spectra of homologated fluorescent pesticides in large use in Morocco: development of a spectrometric low cost and direct analysis as an alert method in case of massive contamination of soils and waters by fluorescent pesticides.

    Science.gov (United States)

    Foudeil, S; Hassoun, H; Lamhasni, T; Ait Lyazidi, S; Benyaich, F; Haddad, M; Choukrad, M; Boughdad, A; Bounakhla, M; Bounouira, H; Duarte, R M B O; Cachada, A; Duarte, A C

    2015-05-01

    The purpose of this research is to develop a direct spectrometric approach to monitor soils and waters, at a lower cost than the widely used chromatographic techniques; a spectrometric approach that is effective, reliable, fast, easy to implement, and without any use of organic solvents whose utilization is subject to law limitation. It could be suitable at least as an alert method in case of massive contamination. Here, we present for the first time a catalog of excitation-emission and total synchronous fluorescence maps that may be considered as fingerprints of a series of homologated pesticides, in large use in Morocco, aiming at a direct detection of their remains in agricultural soils and neighboring waters. After a large survey among farmers, agricultural workers and product distributors in two important agricultural regions of Morocco (Doukkala-Abda and Sebou basin), 48 commercial pesticides, which are fluorescent, were chosen. A multi-component spectral database of these targeted commercial pesticides was elaborated. For each pesticide, dissolved in water at the lowest concentration giving a no-noise fluorescence spectrum, the total excitation-emission matrix (TEEM), the total synchronous fluorescence matrix (TSFM) in addition to synchronous fluorescence spectra (SFS) at those offsets giving the highest fluorescence intensity were recorded. To test this preliminary multi-component database, two real soil samples, collected at a wheat field and at a vine field in the region of Doukkala, were analyzed. Remains of the commercial Pirimor (Carbamate) and Atlantis (Sulfonylurea) were identified by comparison of the recorded TEEM, TSFM, and SFS to those of the preliminary catalog at one hand, and on the basis of the results of a field pre-survey. The developed approach seems satisfactory, and the fluorimetric fingerprint database is under extension to a higher number of fluorescent pesticides in common use among the Moroccan agricultural regions.

  20. The cost of hemodialysis in a large hemodialysis center

    Directory of Open Access Journals (Sweden)

    Khalid Al Saran

    2012-01-01

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

  1. A new reliable, transposable and cost-effective assay for absolute quantification of total plasmatic bevacizumab by LC-MS/MS in human plasma comparing two internal standard calibration approaches.

    Science.gov (United States)

    Legeron, Rachel; Xuereb, Fabien; Chaignepain, Stephane; Gadeau, Alain-Pierre; Claverol, Stephane; Dupuy, Jean-William; Djabarouti, Sarah; Couffinhal, Thierry; Schmitter, Jean-Marie; Breilh, Dominique

    2017-12-01

    The quantification of monoclonal antibodies (mAbs) such as bevacizumab, a recombinant humanized immunoglobulin G1 (hIgG1), in biological fluids, is an essential prerequisite to any pharmacokinetic preclinical and clinical study. To date, reference techniques used to quantify mAbs rely on enzyme-linked immunosorbent assay (ELISA) lacking specificity. Furthermore, the commercially available ELISA kit to quantify bevacizumab in human plasma only assesses the free fraction of the drug. However, the conditions of storage and analysis of plasma samples could alter the physiological equilibrium between the free, bound and partially bound forms of bevacizumab and this could result in over- or underestimation of drug concentration. We developed a new assay for absolute quantification of total fraction of bevacizumab by liquid chromatography tandem mass spectrometry (LC-MS/MS) basing identification and quantification of bevacizumab on two specific peptides. In this report we compare our assay with two internal standard (IS) calibration approaches: one using a different human mAb (Trastuzumab) and the other using a stable isotope labeled specific peptide. After enrichment by affinity chromatography on protein A and concentration by ultrafiltration, human plasma samples were proteolyzed by trypsin. Linearity was established from 12.5 to 500μg/mL with an interday accuracy ranging from 101.7 to 110.6% and precision from 7.0% to 9.9%. This study demonstrates the importance of the choice of the IS in quantifying bevacizumab in human plasma and highlights the difficulty of reaching a reliable proteolysis with a sufficient recovery. We developed a reliable and cost-effective LC-MS/MS method to quantify total plasmatic fraction of bevacizumab in human plasma. Through our development we proposed a generic methodology easily transposable to quantify all IgG1 subclass very useful for clinical pharmacokinetics studies. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Unit costs of waste management operations

    International Nuclear Information System (INIS)

    Kisieleski, W.E.; Folga, S.M.; Gillette, J.L.; Buehring, W.A.

    1994-04-01

    This report provides estimates of generic costs for the management, disposal, and surveillance of various waste types, from the time they are generated to the end of their institutional control. Costs include monitoring and surveillance costs required after waste disposal. Available data on costs for the treatment, storage, disposal, and transportation of spent nuclear fuel and high-level radioactive, low-level radioactive, transuranic radioactive, hazardous, mixed (low-level radioactive plus hazardous), and sanitary wastes are presented. The costs cover all major elements that contribute to the total system life-cycle (i.e., ''cradle to grave'') cost for each waste type. This total cost is the sum of fixed and variable cost components. Variable costs are affected by operating rates and throughput capacities and vary in direct proportion to changes in the level of activity. Fixed costs remain constant regardless of changes in the amount of waste, operating rates, or throughput capacities. Key factors that influence cost, such as the size and throughput capacity of facilities, are identified. In many cases, ranges of values for the key variables are presented. For some waste types, the planned or estimated costs for storage and disposal, projected to the year 2000, are presented as graphics

  3. COST ANALYSIS OF PERIPHERALLY INSERTED CENTRAL CATHETER IN PEDIATRIC PATIENTS.

    Science.gov (United States)

    Dong, Zhaoxin; Connolly, Bairbre L; Ungar, Wendy J; Coyte, Peter C

    2018-01-01

    A peripherally inserted central catheter (PICC) is a useful option in providing secure venous access, which enables patients to be discharged earlier with the provision of home care. The objective was to identify the costs associated with having a PICC from a societal perspective, and to identify factors that are associated with total PICC costs. Data were obtained from a retrospective cohort of 469 hospitalized pediatric patients with PICCs inserted. Both direct and indirect costs were estimated from a societal perspective. Insertion costs, complication costs, nurse and physician assessment costs, inpatient ward costs, catheter removal costs, home care costs, travel costs, and the cost associated with productivity losses incurred by parents were included in this study. Based on catheter dwell time, the median total cost associated with a PICC per patient per day (including inpatient hospital costs) was $3,133.5 ($2,210.7-$9,627.0) in 2017 Canadian dollars ($1.00USD = $1.25CAD in 2017). The adjusted mean cost per patient per day was $2,648.2 ($2,402.4-$2,920.4). Excluding inpatient ward costs, the median total and adjusted costs per patient per day were $198.8 ($91.8-$2,475.8) and $362.7($341.0-$386.0), respectively. Younger age, occurrence of complications, more catheter dwell days, wards with more intensive care, and the absence of home care were significant factors associated with higher total PICC costs. This study has demonstrated the costs associated with PICCs. This information may be helpful for healthcare providers to understand PICC related cost in children and resource implications.

  4. Total Thyroidectomy

    Directory of Open Access Journals (Sweden)

    Lopez Moris E

    2016-06-01

    Full Text Available Total thyroidectomy is a surgery that removes all the thyroid tissue from the patient. The suspect of cancer in a thyroid nodule is the most frequent indication and it is presume when previous fine needle puncture is positive or a goiter has significant volume increase or symptomes. Less frequent indications are hyperthyroidism when it is refractory to treatment with Iodine 131 or it is contraindicated, and in cases of symptomatic thyroiditis. The thyroid gland has an important anatomic relation whith the inferior laryngeal nerve and the parathyroid glands, for this reason it is imperative to perform extremely meticulous dissection to recognize each one of these elements and ensure their preservation. It is also essential to maintain strict hemostasis, in order to avoid any postoperative bleeding that could lead to a suffocating neck hematoma, feared complication that represents a surgical emergency and endangers the patient’s life.It is essential to run a formal technique, without skipping steps, and maintain prudence and patience that should rule any surgical act.

  5. 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)

  6. Total quality accounting

    OpenAIRE

    Andrijašević Maja

    2008-01-01

    The focus of competitive "battle" shifted from the price towards non-price instruments, above all, towards quality that became the key variable for profitability increase and achievement of better comparative position of a company. Under such conditions, management of a company, which, according to the established and certified system of total quality, strives towards achieving of a better market position, faces the problem of quality cost measurement and determination. Management, above all,...

  7. 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

  8. Production of solidified high level wastes: a cost comparison of solidification processes

    International Nuclear Information System (INIS)

    1977-06-01

    Differential cost estimates of the annual operating and maintenance costs and the capital costs for five HLW Waste Solidification Alternates were developed. The annual operating and maintenance cost estimates included the cost of labor, consumables, utilities, shipping casks, shipping and disposal at a federal repository. The capital cost included the cost of the component, installation and building. The differential cost estimates do not include equipment and facilities which are either shared with the reprocessing facility or are common between all of the alternates. Total annual cost differential between the five waste form alternates is summarized in tabular form. The Borosilicate Glass Alternate has the lowest total annual cost. The other alternates have higher costs which range from $6.6 M to $7.4 M per year higher than the Glass alternate with the Supercalcine being the highest cost at $7.4 M per year differential. The major items in the cost estimates are then disposal costs in the operating cost estimates and the HLW Storage Tanks in the capital cost estimates. The Supercalcine Multibarrier Alternate ships 180 canisters per year more than the other alternates and consequently has a significantly higher operating cost. However, off-setting this the Supercalcine Multibarrier Alternate does not require HLW Storage Tanks for decay because of the high heat conductivity of this product and correspondingly the capital cost for this alternate is significantly lower than the other alternates. The radiological risk values are correlated with the cost evaluation normalized to cost ($)/MWe-yr

  9. 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

  10. [Comparison of the safety and the costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and BillrothII(+Braun reconstruction--a single center prospective cohort study].

    Science.gov (United States)

    Wang, Yinkui; Li, Ziyu; Shan, Fei; Zhang, Lianhai; Li, Shuangxi; Jia, Yongning; Chen, Yufan; Xue, Kan; Miao, Rulin; Li, Zhemin; Gao, Xiangyu; Yan, Chao; Li, Shen; Wu, Zhouqiao; Ji, Jiafu

    2018-03-25

    To compare the short-term safety and costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and Billroth II((BII() + Braun reconstruction after radical gastrectomy of distal gastric cancer. Clinical data from our prospective database of radical gastrectomy were systematically analyzed. The patients who underwent laparoscopic gastrectomy with uncut Roux-en-Y or BII(+ Braun reconstruction between March 1st, 2015 and June 30th, 2017 were screened out for further analysis. Both the reconstructions were completed by linear staplers. Uncut Roux-en-Y reconstruction was performed with a 45 mm no-knife linear stapler (ATS45NK) on the afferent loop below the gastrojejunostomy. Continuous variables were compared using independent samples t test or Mann-Whitney U. The frequencies of categorical variables were compared using Chi-squared or Fisher exact test. Eighty-one patients were in uncut Roux-en-Y group and 58 patients were in BII(+Braun group. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in median age (56.0 years vs. 56.5 years, P=0.757), gender (male/female, 52/29 vs. 46/12, P=0.054), history of abdominal surgery (yes/no, 10/71 vs. 4/54, P=0.293), neoadjuvant chemotherapy (yes/no, 21/60 vs. 11/47, P=0.336), BMI (thin/normal/overweight/obesity, 2/49/26/3 vs. 3/39/14/2, P=0.591), NRS 2002 score (1/2/3/4, 58/15/5/3 vs. 47/5/3/3, P=0.403), pathological stage (0/I(/II(/III(, 3/41/20/17 vs. 1/28/13/16, P=0.755), median tumor diameter in long axis (2.5 cm vs. 3.0 cm, P=0.278), median tumor diameter in short axis (2.0 cm vs. 2.0 cm, P=0.126) and some other clinical and pathological characteristics. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in morbidity of postoperative complication more severe than grade I([12.3% (10/81) vs. 17.2% (10/58), P=0.417], morbidity of anastomotic complication [1.2%(1/81) vs. 0, P=1.000] or hospitalization costs [(94000±14000) yuan vs.(95000

  11. Determining the economic cost of ICU treatment: a prospective "micro-costing" study.

    LENUS (Irish Health Repository)

    McLaughlin, Anne Marie

    2012-02-01

    OBJECTIVE: To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of "severity of illness" scores in estimating ICU cost. METHODS AND DESIGN: A prospective study costing 64 consecutive admissions over a 2-month period in a mixed medical\\/surgical ICU. RESULTS: The median daily ICU cost (interquartile range, IQR) was 2,205 euro (1,932 euro-3,073 euro), and the median total ICU cost (IQR) was 10,916 euro (4,294 euro-24,091 euro). ICU survivors had a lower median daily ICU cost at 2,164 per day, compared with 3,496 euro per day for ICU non-survivors (P = 0.08). The requirements for continuous haemodiafiltration, blood products and anti-fungal agents were associated with higher daily and overall ICU costs (P = 0.002). Each point increase in SAPS3 was associated with a 305 euro (95% CI 31 euro-579 euro) increase in total ICU cost (P = 0.029). However, SAPS3 accounted for a small proportion of the variance in this model (R (2) = 0.08), limiting its usefulness as a stand-alone predictor of cost in clinical practice. A model including haemodiafiltration, blood products and anti-fungal agents explained 54% of the variance in total ICU cost. CONCLUSION: This bottom-up costing study highlighted the considerable individual variation in costs between ICU patients and identified the major factors contributing to cost. As the requirement for expensive interventions was the main driver for ICU cost, "severity of illness" scores may not be useful as stand-alone predictors of cost in the ICU.

  12. Incorporating psychological influences in probabilistic cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kujawski, Edouard; Alvaro, Mariana; Edwards, William

    2004-01-08

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

  13. Rising Trade Costs? Agglomeration and Trade with Endogenous Transaction Costs

    OpenAIRE

    Gilles Duranton; Michael Storper

    2005-01-01

    costs. In a model of industry location with endogenous transaction costs that seeks to replicate features from the machinery industry, we show how and under which conditions a decline in transport costs can lead to an increase in the total cost of trade. The subtle relationship between (endogenous) transport costs and the sensitivity of trade to distance is also explored.

  14. The cost of chronic constipation.

    Science.gov (United States)

    Pekmezaris, Renée; Aversa, Lorraine; Wolf-Klein, Gisele; Cedarbaum, Jesse; Reid-Durant, Marie

    2002-01-01

    This study investigates the cost of chronic constipation care. A consecutive sample of 31 chronically constipated elderly patients. A not-for-profit long-term care facility in New Hyde Park, New York. Patient demographics and functional status, including activity of daily living scores, diagnosis, and medications were recorded. All constipation medication costs were obtained using the average wholesale price obtained from the Redbook (November 1999). All subjects were closely monitored for constipation care during two shifts a day (from 7:00 AM to 11:00 PM), over a 6-week period resulting in the collection of 1,860 shift reports. Each component of constipation treatment cost, namely drugs and staff time for drug administration, was identified and analyzed. The average number of nursing interactions for constipation treatment was 23.3 per month. The average cost per day for care specifically for the treatment of constipation was 2.11 US dollars. Fleet Enema trade mark and milk of magnesia accounted for 49% of all treatments. Administration (staffing) costs accounted for 70% of total drug costs. Although laxatives are the most frequently prescribed drugs used in long-term care settings, drug utilization patterns and associated costs in the treatment of chronic constipation have not been systematically reported. Our study identified staffing as the major cost factor in constipation care.

  15. 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...

  16. Logistics costs of the enterprise

    OpenAIRE

    Andrea Rosová

    2007-01-01

    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...

  17. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model

    Science.gov (United States)

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We ...

  18. 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

  19. 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.

  20. Costing in Radiotherapy. Chapter 18

    International Nuclear Information System (INIS)

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

    2017-01-01

    represents only part of the total cost involved in running the department over a period of ten years. Training of personnel, salaries, maintenance and amortization can represent three times the initial investment in that period. But even when including all these costs, radiotherapy is a relatively inexpensive treatment modality, which can, as discussed later, be extremely cost effective.

  1. Cost analysis of flexible ureterorenoscopy.

    Science.gov (United States)

    Collins, J W; Keeley, F X; Timoney, A

    2004-05-01

    To assess the costs of flexible ureterorenoscopy. Data were collected prospectively for 100 cases using a new flexible ureteroscope (DUR8, Circon ACMI, Stamford, USA), including the indications for flexible ureterorenoscopy, use of laser probes, disposable instrumentation, and the cost and timing of ureteroscope repair. Of the 100 procedures 68 were for stone disease, 21 for known or suspected transitional cell carcinoma (TCC), six were diagnostic only and five were for pelvi-ureteric junction obstruction. The ureteroscope was repaired after the 29th and 88th cases. The ability of the ureteroscope to deflect was maintained throughout. At the time of purchase the ureteroscope was listed at pound 15 000 and each repair/exchange currently costs pound 4200, thus the total expenditure on the ureteroscope was pound 23 400. Total expenditure on ancillary equipment was pound 28 727, of which pound 22 927 was on disposables and pound 5800 on 10 laser probes. In this series the costs of the ancillary equipment exceeded the purchase and maintenance of the ureteroscope, and we expect this trend to continue in the long term. The advent of more durable ureteroscopes may ultimately reduce the frequency of costly repairs. The cost of disposables should be considered in planning the budget.

  2. 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.

  3. Cost of neonatal care.

    OpenAIRE

    Ryan, S; Sics, A; Congdon, P

    1988-01-01

    A six month evaluation of the costs of a regional neonatal medical and surgical unit was carried out. The total cost for six months was pounds 970,000 and this covered 4349 inpatient days and 282 admissions. For medical cases the cost ranged from pounds 132 to pounds 27,600 and the mean daily cost for different weight groups ranged from pounds 159 to pounds 274. The average daily cost for regional patients at pounds 258 was greater than for district patients who cost pounds 199. Altogether 23...

  4. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

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

    2017-08-01

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

  5. 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.

  6. Total 2004 fact book

    International Nuclear Information System (INIS)

    2004-01-01

    This report presents the activities and results of the Group Total-Fina-Elf for the year 2004. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)

  7. Total Factbook 2003

    International Nuclear Information System (INIS)

    2003-01-01

    This report presents the activities and results of the Group Total-Fina-Elf for the year 2003. It brings information and economic data on the following topics: the corporate and business; the upstream activities with the reserves, the costs, standardized measure and changes of discounted future net cash flow,oil and gas acreage, drilling, liquefied natural gas, pipelines; downstream activities with refining and marketing maps, refinery, petroleum products, sales, retail gasoline outlets; chemicals with sales and operating income by sector, major applications, base chemicals and polymers, intermediates and performance polymers. (A.L.B.)

  8. Genoptraening efter total knaealloplastik

    DEFF Research Database (Denmark)

    Holm, Bente; Kehlet, Henrik

    2009-01-01

    The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty....

  9. Genoptraening efter total knaealloplastik

    DEFF Research Database (Denmark)

    Holm, Bente; Kehlet, Henrik

    2009-01-01

    The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty. Udgivelsesdato: 2009-Feb-23...

  10. 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.

  11. Development of geological disposal system; localization of element cost data and cost evaluation on the HLW repository

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Sik; Kim, Kil Jung; Yang, Young Jin; Kim, Sung Chun [KOPEC, Taejeon (Korea)

    2002-03-01

    To estimate Total Life Cycle Cost (TSLCC) for Korea HLW Repository through localization of element cost data, we review and re-organize each basic element cost data for reference repository system, localize various element cost and finally estimate TSLCC considering economic parameters. As results of the study, TSLCC is estimated as 17,167,689 million won, which includes costs for site preparation, surface facilities, underground facilities and management/integration. Since HLW repository Project is an early stage of pre-conceptual design at present, the information of design and project information are not enough to perform cost estimate and cost localization for the Project. However, project cost structure is re-organized based on the local condition and Total System Life Cycle Cost is estimated using the previous cost data gathered from construction experience of the local nuclear power plant. Project results can be used as basic reference data to assume total construction cost for the local HLW repository and should be revised to more reliable cost data with incorporating detail project design information into the cost estimate in a future. 20 refs. (Author)

  12. Economic Competitiveness of U.S. Utility-Scale Photovoltaics Systems in 2015: Regional Cost Modeling of Installed Cost ($/W) and LCOE ($/kWh)

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Ran; James, Ted L.; Chung, Donald; Gagne, Douglas; Lopez, Anthony; Dobos, Aron

    2015-06-14

    Utility-scale photovoltaics (PV) system growth is largely driven by the economic metrics of total installed costs and levelized cost of electricity (LCOE), which differ by region. This study details regional cost factors, including environment (wind speed and snow loads), labor costs, material costs, sales taxes, and permitting costs using a new system-level bottom-up cost modeling approach. We use this model to identify regional all-in PV installed costs for fixed-tilt and one-axis tracker systems in the United States with consideration of union and non-union labor costs in 2015. LCOEs using those regional installed costs are then modeled and spatially presented. Finally, we assess the cost reduction opportunities of increasing module conversion efficiencies on PV system costs in order to indicate the possible economic impacts of module technology advancements and help future research and development (R&D) effects in the context of U.S. SunShot targets.

  13. 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

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

    Science.gov (United States)

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

    2011-09-30

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

  15. The economic costs of alcohol consumption in Thailand, 2006.

    Science.gov (United States)

    Thavorncharoensap, Montarat; Teerawattananon, Yot; Yothasamut, Jomkwan; Lertpitakpong, Chanida; Thitiboonsuwan, Khannika; Neramitpitagkul, Prapag; Chaikledkaew, Usa

    2010-06-09

    There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006. This is a prevalence-based, cost-of-illness study. The estimated costs in this study included both direct and indirect costs. Direct costs included health care costs, costs of law enforcement, and costs of property damage due to road-traffic accidents. Indirect costs included costs of productivity loss due to premature mortality, and costs of reduced productivity due to absenteeism and presenteeism (reduced on-the-job productivity). The total economic cost of alcohol consumption in Thailand in 2006 was estimated at 156,105.4 million baht (9,627 million US$ PPP) or about 1.99% of the total Gross Domestic Product (GDP). Indirect costs outweigh direct costs, representing 96% of the total cost. The largest cost attributable to alcohol consumption is that of productivity loss due to premature mortality (104,128 million baht/6,422 million US$ PPP), followed by cost of productivity loss due to reduced productivity (45,464.6 million baht/2,804 million US$ PPP), health care cost (5,491.2 million baht/339 million US$ PPP), cost of property damage as a result of road traffic accidents (779.4 million baht/48 million US$ PPP), and cost of law enforcement (242.4 million baht/15 million US$ PPP), respectively. The results from the sensitivity analysis revealed that the cost ranges from 115,160.4 million baht to 214,053.0 million baht (7,102.1 - 13,201 million US$ PPP

  16. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

    International Nuclear Information System (INIS)

    Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

    2015-01-01

    Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system

  17. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

    Science.gov (United States)

    Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

    2015-10-01

    Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system

  18. Evolution of Costs of Inflammatory Bowel Disease over Two Years of Follow-Up.

    Science.gov (United States)

    van der Valk, Mirthe E; Mangen, Marie-Josée J; Severs, Mirjam; van der Have, Mike; Dijkstra, Gerard; van Bodegraven, Ad A; Fidder, Herma H; de Jong, Dirk J; van der Woude, C Janneke; Romberg-Camps, Mariëlle J L; Clemens, Cees H M; Jansen, Jeroen M; van de Meeberg, Paul C; Mahmmod, Nofel; van der Meulen-de Jong, Andrea E; Ponsioen, Cyriel Y; Bolwerk, Clemens; Vermeijden, J Reinoud; Siersema, Peter D; Leenders, Max; Oldenburg, Bas

    2016-01-01

    With the increasing use of anti-TNF therapy in inflammatory bowel disease (IBD), a shift of costs has been observed with medication costs replacing hospitalization and surgery as major cost driver. We aimed to explore the evolution of IBD-related costs over two years of follow-up. In total 1,307 Crohn's disease (CD) patients and 915 ulcerative colitis (UC) patients were prospectively followed for two years by three-monthly web-based questionnaires. Changes of healthcare costs, productivity costs and out-of-pocket costs over time were assessed using mixed model analysis. Multivariable logistic regression analysis was used to identify costs drivers. In total 737 CD patients and 566 UC were included. Total costs were stable over two years of follow-up, with annual total costs of €7,835 in CD and €3,600 in UC. However, within healthcare costs, the proportion of anti-TNF therapy-related costs increased from 64% to 72% in CD (pyears in UC (adj. OR 4.72 (95% CI 1.61-13.86)). BD-related costs remained stable over two years. However, the proportion of anti-TNF-related healthcare costs increased, while hospitalization costs decreased. Factors associated with increased costs were penetrating disease course in CD and age <40 in UC.

  19. 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...

  20. 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.

  1. Diabetes: cost of illness in Norway

    Directory of Open Access Journals (Sweden)

    Jenssen Trond

    2010-09-01

    Full Text Available Abstract Background Diabetes mellitus places a considerable burden on patients in terms of morbidity and mortality and on society in terms of costs. Costs related to diabetes are expected to increase due to increasing prevalence of type 2 diabetes. The aim of this study was to estimate the health care costs attributable to type 1 and type 2 diabetes in Norway in 2005. Methods Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, medical equipment, nutrition guidance, physiotherapy, acupuncture, foot therapy and indirect costs were collected from national registers and responses to a survey of 584 patients with diabetes. The study was performed with a prevalence approach. Uncertainty was explored by means of bootstrapping. Results When hospital stays with diabetes as a secondary diagnosis were excluded, the total costs were €293 million, which represents about 1.4% of the total health care expenditure. Pharmaceuticals accounted for €95 million (32%, disability pensions €48 million (16%, medical devices €40 million (14% and hospital admissions €21 million (7%. Patient expenditures for acupuncture, physiotherapy and foot therapy were many times higher than expenditure for nutritional guidance. Indirect costs (lost production from job absenteeism accounted for €70.1 million (24% of the €293 million and included sick leave (€16.7 million, disability support and disability pensions (€48.2 million and other indirect costs (€5.3 million. If all diabetes related hospital stays are included (primary- and secondary diagnosis total costs amounts to €535 million, about 2.6% of the total health care expenditure in Norway. Conclusions Diabetes represents a considerable burden to society in terms of health care costs and productivity losses.

  2. Total Value of Phosphorus Recovery.

    Science.gov (United States)

    Mayer, Brooke K; Baker, Lawrence A; Boyer, Treavor H; Drechsel, Pay; Gifford, Mac; Hanjra, Munir A; Parameswaran, Prathap; Stoltzfus, Jared; Westerhoff, Paul; Rittmann, Bruce E

    2016-07-05

    Phosphorus (P) is a critical, geographically concentrated, nonrenewable resource necessary to support global food production. In excess (e.g., due to runoff or wastewater discharges), P is also a primary cause of eutrophication. To reconcile the simultaneous shortage and overabundance of P, lost P flows must be recovered and reused, alongside improvements in P-use efficiency. While this motivation is increasingly being recognized, little P recovery is practiced today, as recovered P generally cannot compete with the relatively low cost of mined P. Therefore, P is often captured to prevent its release into the environment without beneficial recovery and reuse. However, additional incentives for P recovery emerge when accounting for the total value of P recovery. This article provides a comprehensive overview of the range of benefits of recovering P from waste streams, i.e., the total value of recovering P. This approach accounts for P products, as well as other assets that are associated with P and can be recovered in parallel, such as energy, nitrogen, metals and minerals, and water. Additionally, P recovery provides valuable services to society and the environment by protecting and improving environmental quality, enhancing efficiency of waste treatment facilities, and improving food security and social equity. The needs to make P recovery a reality are also discussed, including business models, bottlenecks, and policy and education strategies.

  3. 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.

  4. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sørensen, Jan; Waldorff, Frans B

    2009-01-01

    . This study assessed the total economic costs associated with a multifaceted intervention for mild Alzheimer's disease, including an estimate of the ratio of public to private costs. METHODS: The study sample comprised 163 dyads of patients and caregivers who received a multifaceted intervention...... in access to health care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN74848736....

  5. The cost of borderline personality disorder: societal cost of illness in BPD-patients.

    Science.gov (United States)

    van Asselt, A D I; Dirksen, C D; Arntz, A; Severens, J L

    2007-09-01

    Borderline personality disorder (BPD) is a highly prevalent, chronic condition. Because of its very problematic nature BPD is expected to be associated with substantial societal costs, although this has never been comprehensively assessed. Estimate the societal cost of BPD in the Netherlands. We used a prevalence-based bottom-up approach with a sample of 88 BPD patients who enrolled in a multicenter clinical trial comparing two kinds of outpatient psychotherapy. Costs were assessed by means of a structured interview, covering all healthcare costs, medication, informal care, productivity losses, and out-of-pocket expenses. Only BPD-related costs were included. All costs were expressed in Euros for the year 2000. A bootstrap procedure was performed to determine statistical uncertainty. All patients had been diagnosed with BPD using DSM-IV criteria. Mean age was 30.5 years and 92% was female. Based on a prevalence of 1.1% and an adult population of 11,990,942, we derived that there were 131,900 BPD patients in the Netherlands. Total bootstrapped yearly cost of illness was 2,222,763,789 euros (1,372,412,403-3,260,248,300 euros), only 22% was healthcare-related. Costs per patient were 16,852 euros. Although healthcare costs of non-institutionalized Borderline patients might not be disproportionate, total societal costs are substantial.

  6. 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.

  7. The costs of hepatitis A infections in South Korea

    Science.gov (United States)

    Kim, Kyohyun; Jeong, Baek-Geun; Ki, Moran; Park, Mira; Park, Jin Kyung; Choi, Bo Youl; Yoo, Weon-Seob

    2014-01-01

    OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate. PMID:25139060

  8. Effect of water treatment on the comparative costs of evaporative and dry cooled power plants

    International Nuclear Information System (INIS)

    Gold, H.; Goldstein, D.J.; Yung, D.

    1976-07-01

    The report presents the results of a study on the relative cost of energy from a nominal 1000 Mwe nuclear steam electric generating plant using either dry or evaporative cooling at four sites in the United States: Rochester, New York; Sheridan, Wyoming; Gallup, New Mexico and Dallas, Texas. Previous studies have shown that because of lower efficiencies the total annual evaluated costs for dry cooling systems exceeds the total annual evaluated costs of evaporative cooling systems, not including the cost of water. The cost of water comprises the cost of supplying the makeup water, the cost of treatment of the makeup and/or the circulating water in the tower, and the cost of treatment and disposal of the blowdown in an environmentally acceptable manner. The purpose of the study is to show the effect of water costs on the comparative costs of dry and evaporative cooled towers

  9. 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...

  10. 42 CFR 413.53 - Determination of cost of services to beneficiaries.

    Science.gov (United States)

    2010-10-01

    ... newborn days; but including total private room days). Average cost per diem for hospital intensive care... separate average cost per diem for general routine patient care areas as defined in paragraph (b) of this section, taking into account, in hospitals, a separate average cost per diem for each intensive care unit...

  11. Cost And Returns Analysis Of Artisanal Fishing In Oguta Lga, Imo ...

    African Journals Online (AJOL)

    The result of the gross margin analysis showed that the gross revenue was N354, 530.00, gross variable cost was N160,667.23, total fixed cost was 32, 408.25 while the net returns was N161, 444.52. The constraints identified to impede artisanal fishing include the following among others', high cost of fishing gears, ...

  12. Cost-prioritized droop schemes for autonomous microgrids

    DEFF Research Database (Denmark)

    Nutkani, Inam Ullah; Loh, Poh Chiang; Blaabjerg, Frede

    2013-01-01

    centralized optimal dispatch control. To better adapt to this non-uniformity, an alternative viewpoint based on reducing the Total Generation Cost (TGC including fuel cost, emission penalty and other operational concerns) of the microgrid is discussed, from which two new cost-prioritized droop schemes...... are developed. The schemes operate by tuning the dispatch priorities of the DGs and curve shapes of their resulting active power versus frequency plots. Their effective reduction of TGC has been verified through simulation....

  13. Surgeon dependent variation in adenotonsillectomy costs in children.

    Science.gov (United States)

    Meier, Jeremy D; Duval, Melanie; Wilkes, Jacob; Andrews, Seth; Korgenski, E Kent; Park, Albert H; Srivastava, Rajendu

    2014-05-01

    To (1) identify the major expenses for same-day adenotonsillectomy (T&A) and the costs for postoperative complication encounters in a children's hospital and (2) compare differences for variations in costs by surgeon. Observational cohort study. Tertiary children's hospital. A standardized activity-based hospital accounting system was used to determine total hospital costs per encounter (not including professional fees for surgeons or anesthetists) for T&A cases at a tertiary children's hospital from 2007 to 2012. Hospital costs were subdivided into categories, including operating room (OR), OR supplies, postanesthesia care unit (PACU), same-day services (SDS), anesthesia, pharmacy, and other. Costs for postoperative complication encounters were included to identify a mean total cost per case per surgeon. The study cohort included 4824 T&As performed by 14 different surgeons. The mean cost per T&A was $1506 (95% confidence interval, $1492-$1519, with a range of $1156-$1828 for the lowest and highest cost per case per surgeon; P expenses are due to OR and supply costs. Significant differences in costs between surgeons for outpatient T&A were identified. Studies to understand the reasons for this variation and the impact on outcomes are needed. If this variation does not affect patient outcomes, then reducing this variation may improve health care value by limiting waste.

  14. Environmentally based Cost-Benefit Analysis

    International Nuclear Information System (INIS)

    Magnell, M.

    1993-11-01

    The fundamentals of the basic elements of a new comprehensive economic assessment, MILA, developed in Sweden with inspiration from the Total Cost Assessment-model are presented. The core of the MILA approach is an expanded cost and benefit inventory. But MILA also includes a complementary addition of an internal waste stream analysis, a tool for evaluation of environmental conflicts in monetary terms, an extended time horizon and direct allocation of costs and revenues to products and processes. However, MILA does not ensure profitability for environmentally sound projects. Essentially, MILA is an approach of refining investment and profitability analysis of a project, investment or product. 109 refs., 38 figs

  15. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

    Directory of Open Access Journals (Sweden)

    Virta Lena

    2012-02-01

    Full Text Available Abstract Background Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. Methods The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. Results 204 (103 women patients, mean age 48 (SD 11 years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16% remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389 during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. Conclusions The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

  16. An Analytical Cost Estimation Procedure

    National Research Council Canada - National Science Library

    Jayachandran, Toke

    1999-01-01

    Analytical procedures that can be used to do a sensitivity analysis of a cost estimate, and to perform tradeoffs to identify input values that can reduce the total cost of a project, are described in the report...

  17. Project schedule and cost estimate report

    International Nuclear Information System (INIS)

    1988-03-01

    All cost tables represent obligation dollars, at both a constant FY 1987 level and an estimated escalation level, and are based on the FY 1989 DOE Congressional Budget submittal of December 1987. The cost tables display the total UMTRA Project estimated costs, which include both Federal and state funding. The Total Estimated Cost (TEC) for the UMTRA Project is approximately $992.5 million (in 1987 escalated dollars). Project schedules have been developed that provide for Project completion by September 1994, subject to Congressional approval extending DOE's authorization under Public Law 95-604. The report contains site-specific demographic data, conceptual design assumptions, preliminary cost estimates, and site schedules. A general project overview is also presented, which includes a discussion of the basis for the schedule and cost estimates, contingency assumptions, work breakdown structure, and potential project risks. The schedules and cost estimates will be revised as necessary to reflect appropriate decisions relating to relocation of certain tailings piles, or other special design considerations or circumstances (such as revised EPA groundwater standards), and changes in the Project mission. 27 figs', 97 tabs

  18. Decommissioning and disposal costs in Switzerland

    International Nuclear Information System (INIS)

    Zurkinden, Auguste

    2003-01-01

    Introduction Goal: Secure sufficient financial resources. Question: How much money is needed? Mean: Concrete plans for decommissioning and waste disposal. - It is the task of the operators to elaborate these plans and to evaluate the corresponding costs - Plans and costs are to be reviewed by the authorities Decommissioning Plans and Costs - Comprise decommissioning, dismantling and management (including disposal) of the waste. - New studies 2001 for each Swiss nuclear power plant (KKB 2 x 380 MWe, KKM 370 MWe, KKG 1020 MWe, KKL 1180 MWe). - Studies performed by NIS (D). - Last developments taken into account (Niederaichbach, Gundremmingen, Kahl). Decommissioning: Results and Review Results: Total cost estimates decreasing (billion CHF) 1994 1998 2001 13.7 13.1 11.8 Lower costs for spent fuel conditioning and BE/HAA/LMA repository (Opalinus Clay) Split in 2025: 5.6 bil. CHF paid by NPP 6.2 billion CHF in Fund Review: Concentrates on disposal, ongoing

  19. Managing airlines: the cost of complexity

    Energy Technology Data Exchange (ETDEWEB)

    Trapote-Barreira, C.; Deutschmann, A.; Robuste, F.

    2016-07-01

    This paper is dedicated to the structure of airline networks as a sink of efficient airline operations. Parameters of complexity were derived and mirrored on level of service as well as efficiency parameters. Airlines usually considerers an operational overhead to predict the total flight operation cost. This parameter includes the expected cost for disruptions and delays. When an airline has to mobilize an aircraft in a base for recovering the service or for breaking an emergent dynamic, then it is running extra costs. The cost of managing complexity in the airline industry has a direct impact on profit and loss account. Therefore, this paper presents an integrated approach to evaluate this cost, based on padding and aircrafts dedicated to recover disruptions. Finally, some additional indicators are derived to evaluate reliability improvement as part of complex performance. (Author)

  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. 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

  2. Project cost analysis under risk

    Directory of Open Access Journals (Sweden)

    Florica LUBAN

    2010-12-01

    Full Text Available In this paper, an integrated approach based on Monte Carlo simulation and Six Sigma methodology is used to analyze the risk associated with a project's total cost. Monte Carlo simulation is applied to understand the variability in total cost caused by the probabilistic cost items. By Six Sigma methodology the range of variation of the project cost can be reduced by operating on the input factors with the greatest impact on total cost to cover the variation of 6 between the limits that were established in the design phase of Six Sigma.

  3. 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.

  4. 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...

  5. [Socio-economic costs of mental health in the Canary Islands, Spain, in 2002].

    Science.gov (United States)

    López-Bastida, J; Serrano-Aguilar, P; Duque-González, B

    2004-06-15

    To evaluate the economic impact in terms of direct and indirect costs of the mental health in Canary Islands (Spain) in 2002. The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 2002. The human capital theory approach has been used. Canary Islands, Spain, including primary health care and inpatient care. Mental health patients. Direct health costs (inpatients, ambulatory care, primary health care, and drugs). Indirect costs (premature death, short-term illness, and permanent disability). The total costs of mental health were 189.59 million euros. The direct health costs were 81.67 million euros, constituting 43% of the total costs and 5.2% of the total public health care budget in this region. The indirect costs of mental health were 107.92 million euros, representing 57% of the total costs. Although this study adopts a conservative approach, the high socio-economic cost of the mental health helps us to define better the dimension of the problem to establish priorities besides opening a way towards cost-effectiveness studies that allow a more transparent debate on this topic.

  6. Annual Costs of Care for Pediatric Irritable Bowel Syndrome, Functional Abdominal Pain, and Functional Abdominal Pain Syndrome.

    Science.gov (United States)

    Hoekman, Daniël R; Rutten, Juliette M T M; Vlieger, Arine M; Benninga, Marc A; Dijkgraaf, Marcel G W

    2015-11-01

    To estimate annual medical and nonmedical costs of care for children diagnosed with irritable bowel syndrome (IBS) or functional abdominal pain (syndrome; FAP/FAPS). Baseline data from children with IBS or FAP/FAPS who were included in a multicenter trial (NTR2725) in The Netherlands were analyzed. Patients' parents completed a questionnaire concerning usage of healthcare resources, travel costs, out-of-pocket expenses, productivity loss of parents, and supportive measures at school. Use of abdominal pain related prescription medication was derived from case reports forms. Total annual costs per patient were calculated as the sum of direct and indirect medical and nonmedical costs. Costs of initial diagnostic investigations were not included. A total of 258 children, mean age 13.4 years (±5.5), were included, and 183 (70.9%) were female. Total annual costs per patient were estimated to be €2512.31. Inpatient and outpatient healthcare use were major cost drivers, accounting for 22.5% and 35.2% of total annual costs, respectively. Parental productivity loss accounted for 22.2% of total annual costs. No difference was found in total costs between children with IBS or FAP/FAPS. Pediatric abdominal pain related functional gastrointestinal disorders impose a large economic burden on patients' families and healthcare systems. More than one-half of total annual costs of IBS and FAP/FAPS consist of inpatient and outpatient healthcare use. Netherlands Trial Registry: NTR2725. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. 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.

  8. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

    Directory of Open Access Journals (Sweden)

    Waldorff Frans

    2009-01-01

    Full Text Available Abstract Background Alzheimer's disease is the leading cause of dementia and affects about 25 million people worldwide. Recent studies have evaluated the effect of early interventions for dementia, but few studies have considered private time and transportation costs associated with the intervention. This study assessed the total economic costs associated with a multifaceted intervention for mild Alzheimer's disease, including an estimate of the ratio of public to private costs. Methods The study sample comprised 163 dyads of patients and caregivers who received a multifaceted intervention of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. Results The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109. The total cost (including private costs was estimated at EUR 2,020 (95% CI 1,929;2,106 i.e. the ratio of private to public costs was almost 1:1. Conclusion Intervention for mild Alzheimer's disease can be undertaken at a relatively low cost to public funds. However, policy planners should pay attention to the significant private costs associated with an intervention, which may ultimately pose a threat to equity in access to health care. Trial registration Current Controlled Trials ISRCTN74848736.

  9. A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan.

    Science.gov (United States)

    Yagi, Mitsuru; Ames, Christopher P; Keefe, Malla; Hosogane, Naobumi; Smith, Justin S; Shaffrey, Christopher I; Schwab, Frank; Lafage, Virginie; Shay Bess, R; Matsumoto, Morio; Watanabe, Kota

    2018-03-01

    Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP). Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data. JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p cost and revision frequency, the US had greater total cost ($92,133 vs. $49,647) and cost/QALY ($511,840 vs. $225,668) at 2-year follow-up (p costs and cost-effectiveness of ASD surgery in the US vs JP demonstrated that the total direct costs and cost/QALY were substantially higher in the US than JP. Variations in patient cohort, healthcare costs, revision frequencies, and HRQOL improvement influenced the cost/QALY differential between these countries.

  10. Analysis of the relationship cost-effectiveness of the myocardial gammagraphy studies and the impact to the total expenditure by diagnostic of ischemic cardiopathy; Analisis de la relacion costo-efectividad de los estudios de gamagrafia miocardica e impacto al gasto total por diagnostico de cardiopatia isquemica

    Energy Technology Data Exchange (ETDEWEB)

    Valenzuela F, A.G.; Perez C, J.P. [Servicio de Cardiologia Nuclear, Hospital cardiologia CMN, IMSS, Mexico D.F. (Mexico); Arreola O, H. [Fundacion Mexicana para la Salud, Mexico D.F. (Mexico); Valenzuela F, A.A. [Unidad de Epidemiologia Hospitalaria, IMSS, Mexico D.F. (Mexico); Soto M, H. [UAEM, Toluca, Estado de Mexico (Mexico); Arguero S, R. [Director del Hospital de Cardiologia, IMSS, Mexico D.F. (Mexico)

    2005-07-01

    Recent advances in pharmacology, diagnostic and invasive procedures provide a series of modalities that diminish the morbidity and increase the long term survival in the patients that have suffered a heart attack to myocardium. The stratification by risk is an essential element for the handling of the survivors of heart attack to myocardium. In their attention it is looked for to optimize the therapeutic benefit, to diminish the unnecessary diagnostic and therapeutic procedures and to improve the efficiency. For example, a coronariography in sick with heart attack to myocardium it is not cost-effective if not is clinically suitable. Of there that from the institutional point of view, this is, of the Mexican Institute of the Public Health, they are required of appropriate reference approaches and counter reference to grant to the sick person, the best service that is the one in this case the diagnostic and the handling of the ischemic cardiopathy with the smallest waste of resources. The estimation of the annual survival is the base of the stratification, it constitutes the angular stone of the early handling of the heart attack to myocardium. The goal for the clinical would be to identify patients with intermediate risk, since, this risk makes them candidates to therapy interventionist. As long as those with low risk won't require intervention. This would allow the decrease of rates by revenues of heart attack to myocardium, and therefore to diminish the hospital staying rates. The Nuclear Cardiology (myocardial gammagraphy) it is not the only invasive method available to evaluate the myocardial perfusion in sick in who coronary illness is suspected. When the myocardial gammagraphy is carried out in appropriate population, the cost it diminishes because it restricts the necessity of additional invasive evaluations. This because the nuclear cardiology has predictive value so much for the mortality like to detect myocardial viability. Based on these

  11. 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

  12. Design and Optimization of Capacitated Supply Chain Networks Including Quality Measures

    Directory of Open Access Journals (Sweden)

    Krystel K. Castillo-Villar

    2014-01-01

    Full Text Available This paper presents (1 a novel capacitated model for supply chain network design which considers manufacturing, distribution, and quality costs (named SCND-COQ model and (2 five combinatorial optimization methods, based on nonlinear optimization, heuristic, and metaheuristic approaches, which are used to solve realistic instances of practical size. The SCND-COQ model is a mixed-integer nonlinear problem which can be used at a strategic planning level to design a supply chain network that maximizes the total profit subject to meeting an overall quality level of the final product at minimum costs. The SCND-COQ model computes the quality-related costs for the whole supply chain network considering the interdependencies among business entities. The effectiveness of the proposed solution approaches is shown using numerical experiments. These methods allow solving more realistic (capacitated supply chain network design problems including quality-related costs (inspections, rework, opportunity costs, and others within a reasonable computational time.

  13. Cost Analysis for Therapy of Colorectal Cancer

    OpenAIRE

    Kocábková, Eliška

    2011-01-01

    The aim of thesis is to identify and quantify the cost for therapy of colorectal cancer. The aim is to quantify the cost of individual treatments normally used in different stages of the disease and the total cost of treatment.

  14. Lifetime costs of cerebral palsy

    DEFF Research Database (Denmark)

    Kruse, Marie; Michelsen, Susan Ishøy; Flachs, Esben Meulengracht

    2009-01-01

    This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs...... in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about euro860 000 for men and about euro800 000 for women. The largest component was social care costs......, particularly during childhood. A sensitivity analysis found that alterations in social care costs had a small effect, whereas lowering the discount rate from 5 to 3 per cent markedly increased total lifetime costs. Discounting decreases the value of costs in the future compared with the present. The high...

  15. Ranking of energy resources within the analysis of total costs for the IRP (Integrated Resources Planning for Energy Resources); Ranqueamento de recursos energeticos dentro da analise de custos completos para o PIR (Planejamento Integrado de Recursos Energeticos)

    Energy Technology Data Exchange (ETDEWEB)

    Reinig, Alexandre Orrico; Cicone Junior, Decio; Galvao, Luiz Claudio Ribeiro [Universidade de Sao Paulo (USP), SP (Brazil). Dept. de Energia e Automacao Eletricas. Grupo de Energia; Udaeta, Miguel Edgar Morales [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Eletrotecnica e Energia

    2008-07-01

    The objective of this work is to demonstrate the application of the Analytic Hierarchy Process (PAH) with the support of computational tools in the Complete Costs Evaluation (ACC) to classify energy resources, emphasizing as this important method of decision making can be used with the ACC inside of the integrated resources planning for energy resources (PIR). The use of the methodology in question inside of the PIR has as permanent goal to interrelate the complete technical valuation of the resources and its qualitative valuation carried through by the involved and interested (En-In) of the PIR, as well as the evaluation of the resources inside of multidimensional criteria of the ACC. For this the way is presented the way as the evaluation of the social dimension of the ACC in the PIR in the Aracatuba's Administrative Region (RAA) was made and ranking generated with the application of the PAH inside of the ACC. The main result is the validation of the AHP with the use of the Decision Lens for the ACC in the PIR, and from that conclude that the ranking of many energy resources using Decision Lens facilitates the process of PIR in the posterior Wallet of Resources and preferential plan determination. (author)

  16. Costs of endometriosis in Austria: a survey of direct and indirect costs.

    Science.gov (United States)

    Prast, Johanna; Oppelt, Peter; Shamiyeh, Andreas; Shebl, Omar; Brandes, Iris; Haas, Dietmar

    2013-09-01

    The literature includes a wealth of medical data on endometriosis, but the economic significance of the condition has so far been neglected. An analysis of hospital costs for endometriosis in Austria was, therefore, carried out for economic purposes. Seventy-three patients with endometriosis were included in the study. A bottom-up approach was used to collect data on the average hospital costs of an endometriosis patient over a time period of 1 year. In addition, a prevalence approach was used that allows subsequent estimation of the total costs of endometriosis for the health-care system in Austria for that period. Retrospective questionnaire survey was conducted. The average annual costs of one case of endometriosis are 7,712, with 5,605.55 attributable to direct costs and 2,106.34 to indirect costs. This indicates an overall economic burden of 328 million. In-patient care (45 %) and loss of productivity (27 %) were identified as the major cost factors. The patients themselves pay for 13 % of the costs (through out-of-pocket payments). This study impressively demonstrates the financial burden on the economy and on each individually affected patient caused by the disease of endometriosis. The massive consumption of resources represents a high level of usage of the medical services provided. The question arises as to whether more timely diagnosis, followed by better-targeted treatment, might have the potential to reduce these costs. The overall economic burden of endometriosis in Austria is currently comparable with that of Parkinson's disease.

  17. Economic Dispatch for Operating Cost Minimization under Real Time Pricing in Droop Controlled DC Microgrid

    DEFF Research Database (Denmark)

    Li, Chendan; Federico, de Bosio; Chen, Fang

    2017-01-01

    In this paper, an economic dispatch problem for total operation cost minimization in DC microgrids is formulated. An operating cost is associated with each generator in the microgrid, including the utility grid, combining the cost-efficiency of the system with demand response requirements...... consumption and electricity prices, the proposed method can successfully reduce the operating cost by dispatching economically the resources in the microgrid....

  18. Historical plant cost and annual production expenses for selected electric plants, 1982

    International Nuclear Information System (INIS)

    1984-01-01

    This publication is a composite of the two prior publications, Hydroelectric Plant Construction Cost and Annual Production Expenses and Thermal-Electric Plant Construction Cost and Annual Production Expenses. Beginning in 1979, Thermal-Electric Plant Construction Cost and Annual Production Expenses contained information on both steam-electric and gas-turbine electric plant construction cost and annual production expenses. The summarized historical plant cost described under Historical Plant Cost in this report is the net cumulative-to-date actual outlays or expenditures for land, structures, and equipment to the utility. Historical plant cost is the initial investment in plant (cumulative to the date of initial commercial operation) plus the costs of all additions to the plant, less the value of retirements. Thus, historical plant cost includes expenditures made over several years, as modifications are made to the plant. Power Production Expenses is the reporting year's plant operation and maintenance expenses, including fuel expenses. These expenses do not include annual fixed charges on plant cost (capital costs) such as interest on debt, depreciation or amortization expenses, and taxes. Consequently, total production expenses and the derived unit costs are not the total cost of producing electric power at the various plants. This publication contains data on installed generating capacity, net generation, net capability, historical plant cost, production expenses, fuel consumption, physical and operating plant characteristics, and other relevant statistical information for selected plants

  19. Distribution system costs associated with the deployment of photovoltaic systems

    Energy Technology Data Exchange (ETDEWEB)

    Horowitz, Kelsey A. W.; Palmintier, Bryan; Mather, Barry; Denholm, Paul

    2018-07-01

    The broadening of our energy system to include increasing amounts of wind and solar has led to significant debate about the total costs and benefits associated with different types of generators - with potentially far-reaching policy implications. This has included debate about the cost associated with integrating these generators onto the electric grid. For photovoltaics (PV), this encompasses costs incurred on both the bulk power and distribution systems, as well as the value provided to them. These costs and benefits, in particular those associated with integrating PV onto the distribution system, are not well understood. We seek to advance the state of understanding of 'grid integration costs' for the distribution system by reviewing prior literature and outlining a transparent, bottom-up approach that can be used to calculate these costs. We provide a clear delineation of costs to integrate PV in to the distribution system within the larger context of total costs and benefits associated with PV generators. We emphasize that these costs are situationally dependent, and that a single 'cost of integration' cannot be obtained. We additionally emphasize that benefits must be considered when evaluating the competitiveness of the technology in a given situation.

  20. The cost of antiretroviral therapy in Haiti

    Directory of Open Access Journals (Sweden)

    Fitzgerald Daniel W

    2008-02-01

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

  1. Migraine Nurses in Primary Care: Costs and Benefits.

    Science.gov (United States)

    van den Berg, Jan S P; Steiner, Timothy J; Veenstra, Petra J L; Kollen, Boudewijn J

    2017-09-01

    We examined the costs and benefits of introducing migraine nurses into primary care. Migraine is one of the most costly neurological diseases. We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with costs related to lost days of household activities or days of costs were €281.11 in the control group against €332.23 in the intervention group (mean difference -51.12; 95% CI: -113.20-15.56; P = .134); the indirect costs were €1985.51 in the control group against €1631.75 in the intervention group (mean difference 353.75; 95% CI: -355.53-1029.82; P = .334); and total costs were €2266.62 in the control group, against €1963.99 in the intervention group (mean difference 302.64; 95% CI: -433.46-1001.27; P = .438). When costs attributable to lost household productivity were included, total costs increased to €6076.62 in the control group and €5048.15 in the intervention group (mean difference 1028.47; 95% CI: -590.26-2603.67; P = .219). Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile. © 2017 American Headache Society.

  2. 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

  3. Multivariable parametric cost model for space and ground telescopes

    Science.gov (United States)

    Stahl, H. Philip; Henrichs, Todd

    2016-09-01

    Parametric cost models can be used by designers and project managers to perform relative cost comparisons between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. This paper hypothesizes a single model, based on published models and engineering intuition, for both ground and space telescopes: OTA Cost (X) D (1.75 +/- 0.05) λ (-0.5 +/- 0.25) T-0.25 e (-0.04) Y Specific findings include: space telescopes cost 50X to 100X more ground telescopes; diameter is the most important CER; cost is reduced by approximately 50% every 20 years (presumably because of technology advance and process improvements); and, for space telescopes, cost associated with wavelength performance is balanced by cost associated with operating temperature. Finally, duplication only reduces cost for the manufacture of identical systems (i.e. multiple aperture sparse arrays or interferometers). And, while duplication does reduce the cost of manufacturing the mirrors of segmented primary mirror, this cost savings does not appear to manifest itself in the final primary mirror assembly (presumably because the structure for a segmented mirror is more complicated than for a monolithic mirror).

  4. 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.

  5. Low-Cost, Light Weight, Thin Film Solar Concentrator

    Science.gov (United States)

    Ganapathi, G.; Palisoc, A.; Nesmith, B.; Greschik, G.; Gidanian, K.; Kindler, A.

    2013-01-01

    This research addresses a cost barrier towards achieving a solar thermal collector system with an installed cost of $75/sq m and meet the Department of Energy's (DOE's) performance targets for optical errors, operations during windy conditions and lifetime. Current concentrators can cost as much as 40-50% of the total installed costs for a CSP plant. In order to reduce the costs from current $200-$250/sq m, it is important to focus on the overall system. The reflector surface is a key cost driver, and our film-based polymer reflector will help significantly in achieving DOE's cost target of $75/sq m. The ease of manufacturability, installation and replacement make this technology a compelling one to develop. This technology can be easily modified for a variety of CSP options including heliostats, parabolic dishes and parabolic troughs.

  6. Hydro-Quebec's survey on outage cost in industries

    International Nuclear Information System (INIS)

    Naggar, R.

    1990-01-01

    In 1989 Hydro-Quebec completed a survey on the cost of power interruptions to its industrial customers. A total of 11,000 firms formed the base of the survey, which was reduced to 1,647 for analysis purposes. The questionnaire was designed around the concept of representation of knowledge. The costs of various situations were inferred for every enterprise on the basis of knowledge obtained through the surveys. The results of the survey describe the variation in costs of interruption as a function of time of occurrence, duration and advance notice. These costs are expressed in terms of a reference case by the equivalent hourly cost. The magnitude of the cost of the reference interruption is designated the reference cost of undelivered energy. This paper describes the methodology of the survey but does not include survey results. 4 refs., 2 tabs

  7. Cost analysis of telerehabilitation after arthroscopic subacromial decompression.

    Science.gov (United States)

    Pastora-Bernal, Jose Manuel; Martín-Valero, Rocío; Barón-López, Francisco Javier

    2017-01-01

    Background Subacromial impingement syndrome poses a substantial socioeconomic burden, leading to significant consumption of healthcare. Health systems are calling for greater evidence of economic impacts of particular healthcare services. Telerehabilitation programmes have the potential to reduce costs and improve patient access as an alternative to traditional care. Cost analysis has been traditionally included in study protocols and results, although the reliability and research methodology have frequently been under debate. The aim of this study was to compare costs related to a telerehabilitation programme versus conventional physiotherapy following subacromial decompression surgery (ASD). Methods The study was embedded in a randomised controlled trial. The economic analysis was based on the perspective of the health sector and the human capital method. Only the costs associated with the provision of physiotherapy services were taken into account. Costs were measured during the intervention period between baseline and 12 weeks for both groups. Student's t-test was used to compare independent variables between the two groups, with a 95% confidence interval for the estimates and real costs. Results The estimated total cost analysis shows a preliminary cost differential in favour of the telerehabilitation group, meaning that for each participant's total intervention, telerehabilitation saves 29.8% of the costs. Real cost analysis, only for received treatments, shows a cost differential in favour of telerehabilitation, meaning that for each participant's total intervention, telerehabilitation saves 22.15% of the costs incurred for conventional rehabilitation. Conclusions Our study provides direct and meaningful information about telerehabilitation opportunities and can be an essential component in further cost evaluations for different strategies after surgical procedures. This study demonstrates that there was a trend towards lower healthcare costs after ASD

  8. 48 CFR 16.405-1 - Cost-plus-incentive-fee contracts.

    Science.gov (United States)

    2010-10-01

    ... total allowable costs to total target costs. This contract type specifies a target cost, a target fee... in fee above target fee when total allowable costs are less than target costs, and decreases in fee below target fee when total allowable costs exceed target costs. This increase or decrease is intended...

  9. 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

  10. Cost analysis of a coal-fired power plant using the NPV method

    Science.gov (United States)

    Kumar, Ravinder; Sharma, Avdhesh Kr.; Tewari, P. C.

    2015-06-01

    The present study investigates the impact of various factors affecting coal-fired power plant economics of 210 MW subcritical unit situated in north India for electricity generation. In this paper, the cost data of various units of thermal power plant in terms of power output capacity have been fitted using power law with the help of the data collected from a literature search. To have a realistic estimate of primary components or equipment, it is necessary to include the latest cost of these components. The cost analysis of the plant was carried out on the basis of total capital investment, operating cost and revenue. The total capital investment includes the total direct plant cost and total indirect plant cost. Total direct plant cost involves the cost of equipment (i.e. boiler, steam turbine, condenser, generator and auxiliary equipment including condensate extraction pump, feed water pump, etc.) and other costs associated with piping, electrical, civil works, direct installation cost, auxiliary services, instrumentation and controls, and site preparation. The total indirect plant cost includes the cost of engineering and set-up. The net present value method was adopted for the present study. The work presented in this paper is an endeavour to study the influence of some of the important parameters on the lifetime costs of a coal-fired power plant. For this purpose, parametric study with and without escalation rates for a period of 35 years plant life was evaluated. The results predicted that plant life, interest rate and the escalation rate were observed to be very sensitive on plant economics in comparison to other factors under study.

  11. 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

  12. Depreciation cost for the capital investment of a pyroprocess facility

    International Nuclear Information System (INIS)

    Kim, S. K.; Lee, S. H.; Ko, W. I.

    2015-01-01

    The pyroprocess produces U/TRU metal ingots using four important processes, pretreatment, electrochemical reduction, electrorefining and electrowinning, in order to recycle spent fuel. KAPF+'s capacity is shown the cost that is injected into the KAPF+. The pyroprocess unit cost is data that are essential for inputting to calculate the pyroprocess-Sodiumcooled Fast Reactor (SFR) nuclear fuel cycle cost. Moreover, since the pyroprocess facility's depreciation cost is included in the manufacturing indirect cost of the pyroprocess cost, it can become an important element for judging the pyroprocess' economic viability. Since the pyroprocess unit cost calculates the sum of the costs that are incurred each year by dividing with the total amount of U/TRU ingot produced, the pyroprocess unit cost uncertainty increases as well when the uncertainty of the costs incurred by each year increases. KAPF+, which is a commercialization facility, was set as the cost object, and the existing methods (straightline method and fixed percentage of declining-balance method) used today and the depreciation cost of the ADDM were subjected to a comparative analysis. The results are as follows. First, in case of the straight-line method that calculated the durable period as 40 years, and in case of ADDM that factored in a 5% deceleration rate, the difference in the depreciation costs of $65.26/kgHM and $119.05/kgHM resulted during the first and last years, respectively. Accordingly, it was analyzed that there is a significant difference in terms of the cost of the capital investment every year depending on the depreciation method. Secondly, since the depreciation cost is a component of the manufacturing indirect cost, it is necessary to maintain a trend that is similar to that of the direct labor cost in addition to the direct material cost

  13. Update on Multi-Variable Parametric Cost Models for Ground and Space Telescopes

    Science.gov (United States)

    Stahl, H. Philip; Henrichs, Todd; Luedtke, Alexander; West, Miranda

    2012-01-01

    Parametric cost models can be used by designers and project managers to perform relative cost comparisons between major architectural cost drivers and allow high-level design trades; enable cost-benefit analysis for technology development investment; and, provide a basis for estimating total project cost between related concepts. This paper reports on recent revisions and improvements to our ground telescope cost model and refinements of our understanding of space telescope cost models. One interesting observation is that while space telescopes are 50X to 100X more expensive than ground telescopes, their respective scaling relationships are similar. Another interesting speculation is that the role of technology development may be different between ground and space telescopes. For ground telescopes, the data indicates that technology development tends to reduce cost by approximately 50% every 20 years. But for space telescopes, there appears to be no such cost reduction because we do not tend to re-fly similar systems. Thus, instead of reducing cost, 20 years of technology development may be required to enable a doubling of space telescope capability. Other findings include: mass should not be used to estimate cost; spacecraft and science instrument costs account for approximately 50% of total mission cost; and, integration and testing accounts for only about 10% of total mission cost.

  14. Collider Scaling and Cost Estimation

    International Nuclear Information System (INIS)

    Palmer, R.B.

    1986-01-01

    This paper deals with collider cost and scaling. The main points of the discussion are the following ones: 1) scaling laws and cost estimation: accelerating gradient requirements, total stored RF energy considerations, peak power consideration, average power consumption; 2) cost optimization; 3) Bremsstrahlung considerations; 4) Focusing optics: conventional, laser focusing or super disruption. 13 refs

  15. Distribution of variable vs fixed costs of hospital care.

    Science.gov (United States)

    Roberts, R R; Frutos, P W; Ciavarella, G G; Gussow, L M; Mensah, E K; Kampe, L M; Straus, H E; Joseph, G; Rydman, R J

    1999-02-17

    Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. Cost analysis. A large urban public teaching hospital. All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

  16. The Cost of Youth Suicide in Australia

    Directory of Open Access Journals (Sweden)

    Irina Kinchin

    2018-04-01

    Full Text Available Suicide is the leading cause of death among Australians between 15 and 24 years of age. This study seeks to estimate the economic cost of youth suicide (15–24 years old for Australia using 2014 as a reference year. The main outcome measure is monetized burden of youth suicide. Costs, in 2014 AU$, are measured and valued as direct costs, such as coronial inquiry, police, ambulance, and funeral expenses; indirect costs, such as lost economic productivity; and intangible costs, such as bereavement. In 2014, 307 young Australians lost their lives to suicide (82 females and 225 males. The average age at time of death was 20.4 years, representing an average loss of 62 years of life and close to 46 years of productive capacity. The average cost per youth suicide is valued at $2,884,426, including $9721 in direct costs, $2,788,245 as the value of lost productivity, and $86,460 as the cost of bereavement. The total economic loss of youth suicide in Australia is estimated at $22 billion a year (equivalent to US$ 17 billion, ranging from $20 to $25 billion. These findings can assist decision-makers understand the magnitude of adverse outcomes associated with youth suicide and the potential benefits to be achieved by investing in effective suicide prevention strategies.

  17. Cost of Oil Dependence: A 2000 Update

    Energy Technology Data Exchange (ETDEWEB)

    Greene, D.L.; Tishchishyna, N.I.

    2000-05-01

    Oil dependence remains a potentially serious economic and strategic problem for the United States. This report updates previous estimates of the costs of oil dependence to the U.S. economy and introduces several methodological enhancements. Estimates of the costs to the U.S. economy of the oil market upheavals of the last 30 years are in the vicinity of $7 trillion, present value 1998 dollars, about as large as the sum total of payments on the national debt over the same period. Simply adding up historical costs in 1998 dollars without converting to present value results in a Base Case cost estimate of $3.4 trillion. Sensitivity analysis indicates that cost estimates are sensitive to key parameters. A lower bound estimate of $1.7 trillion and an upper bound of $7.1 trillion (not present value) indicate that the costs of oil dependence have been large under almost any plausible set of assumptions. These cost estimates do not include military, strategic or political costs associated with U.S. and world dependence on oil imports.

  18. Costs of Oil Dependence: A 2000 Update

    Energy Technology Data Exchange (ETDEWEB)

    Greene, D.L.

    2000-05-17

    Oil dependence remains a potentially serious economic and strategic problem for the United States. This report updates previous estimates of the costs of oil dependence to the U.S. economy and introduces several methodological enhancements. Estimates of the costs to the U.S. economy of the oil market upheavals of the last 30 years are in the vicinity of $7 trillion, present value 1998 dollars, about as large as the sum total of payments on the national debt over the same period. Simply adding up historical costs in 1998 dollars without converting to present value results in a Base Case cost estimate of $3.4 trillion. Sensitivity analysis indicates that cost estimates are sensitive to key parameters. A lower bound estimate of $1.7 trillion and an upper bound of $7.1 trillion (not present value) indicate that the costs of oil dependence have been large under almost any plausible set of assumptions. These cost estimates do not include military, strategic or political costs associated with U.S. and world dependence on oil imports.

  19. Costs of Oil Dependence: A 2000 Update

    International Nuclear Information System (INIS)

    Greene, D.L.; Tishchishyna, N.I.

    2000-01-01

    Oil dependence remains a potentially serious economic and strategic problem for the United States. This report updates previous estimates of the costs of oil dependence to the U.S. economy and introduces several methodological enhancements. Estimates of the costs to the U.S. economy of the oil market upheavals of the last 30 years are in the vicinity of $7 trillion, present value 1998 dollars, about as large as the sum total of payments on the national debt over the same period. Simply adding up historical costs in 1998 dollars without converting to present value results in a Base Case cost estimate of $3.4 trillion. Sensitivity analysis indicates that cost estimates are sensitive to key parameters. A lower bound estimate of $1.7 trillion and an upper bound of $7.1 trillion (not present value) indicate that the costs of oil dependence have been large under almost any plausible set of assumptions. These cost estimates do not include military, strategic or political costs associated with U.S. and world dependence on oil imports

  20. The cost of engineered disposal facilities

    International Nuclear Information System (INIS)

    Mallory, C.W.; Razor, J.E.; Mills, D.

    1987-01-01

    An improved disposal trench was designed, constructed and placed into operation at the Maxey Flats Disposal Site during the period April 1985 through July 1986. With the improved trench design, the waste packages are placed in clusters and the surrounding space is filled with gravel and grouted with a sand/cement mixture to form walls and cells that surround the waste package. The walls provide structural support for a poly-ethylene reinforced soil beam which in turn supports a multi-layer protective cap. About 2,700 drums of waste (20,250 CF) were placed into the trench. The total cost of the improved trench was $193,500 and the unit cost was $9.56 per cubic foot not including the placement of the waste. The engineered features of the trench (i.e., sidewall infiltration barrier, grout backfill and the soil beam) cost $82,600 for a unit cost of $4.08 per cubic foot of waste. This is compared to the cost of concrete cannisters used for radioactive waste disposal. On a production basis the cannisters are estimated to cost about $1,260. Depending upon the type waste, the cost of the cannisters will range from $2 to $12 per cubic foot of waste. The slightly higher cost of the concrete cannisters is offset by certain performance advantages

  1. [Outpatient treatment of uncomplicated acute diverticulitis: Impact on healthcare costs].

    Science.gov (United States)

    Lorente, Leyre; Cots, Francesc; Alonso, Sandra; Pascual, Marta; Salvans, Silvia; Courtier, Ricard; Gil, M José; Grande, Luis; Pera, Miguel

    2013-10-01

    Outpatient treatment of uncomplicated acute diverticulitis is safe and effective. The aim of this study was to determine the impact of outpatient treatment on the reduction of healthcare costs. A retrospective cohort study comparing 2 groups was performed. In the outpatient treatment group, patients diagnosed with uncomplicated acute diverticulitis were treated with oral antibiotics at home. In the hospital treatment group, patients met the criteria for outpatient treatment but were admitted to hospital and received intravenous antibiotic therapy. Cost estimates have been made using the hospital cost accounting system based on total costs, the sum of all variable costs (direct costs) plus overhead expenses divided by activity (indirect costs). A total of 136 patients were included, 90 in the outpatient treatment group and 46 in the hospital group. There were no differences in the characteristics of the patients in both groups. There were also no differences in the treatment failure rate in both groups (5.5% vs. 4.3%; P=.7). The total cost per episode was significantly lower in the outpatient treatment group (882 ± 462 vs. 2.376 ± 830 euros; P=.0001). Outpatient treatment of acute diverticulitis is not only safe and effective but also reduces healthcare costs by more than 60%. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  2. A level playing field: Obtaining consistent cost estimates for advanced reactor designs

    International Nuclear Information System (INIS)

    Hudson, C.R. II; Rohm, H.H.; Humphreys, J.R. Jr.

    1987-01-01

    Rules and guidelines for developing cost estimates are given which provide a means for presenting cost estimates for advanced concepts on a consistent and equitable basis. For advanced reactor designs, the scope of a cost estimate includes the plant capital cost, the operating and maintenance cost, the fuel cycle cost, and the cost of decommissioning. Each element is subdivided as is necessary to provide a common reporting format for all power plant concepts. The total generation cost is taken to be a suitable choice for a summary figure of merit. To test the application of the rules and guidelines as well as developing reference costs for current technologies, several different sized coal and pressurized water reactor plant cost estimates have been prepared

  3. A level playing field: Obtaining consistent cost estimates for advanced reactor designs

    Energy Technology Data Exchange (ETDEWEB)

    Hudson, C.R. II; Rohm, H.H.; Humphreys, J.R. Jr.

    1987-01-01

    Rules and guidelines for developing cost estimates are given which provide a means for presenting cost estimates for advanced concepts on a consistent and equitable basis. For advanced reactor designs, the scope of a cost estimate includes the plant capital cost, the operating and maintenance cost, the fuel cycle cost, and the cost of decommissioning. Each element is subdivided as is necessary to provide a common reporting format for all power plant concepts. The total generation cost is taken to be a suitable choice for a summary figure of merit. To test the application of the rules and guidelines as well as developing reference costs for current technologies, several different sized coal and pressurized water reactor plant cost estimates have been prepared. (LEW)

  4. The economic burden of injury: Health care and productivity costs of injuries in the Netherlands.

    Science.gov (United States)

    Polinder, Suzanne; Haagsma, Juanita; Panneman, Martien; Scholten, Annemieke; Brugmans, Marco; Van Beeck, Ed

    2016-08-01

    Detailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex. Injury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model. Total costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15-54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15-24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient. Our detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. 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

    nonmonetary variables was developed. In it the radiologist, radiographer and examination-specific equipment costs were allocated to the examinations applying estimated cost equivalents. Some minor cost items were replaced by a general cost factor (GCF). The program is suitable for internal cost accounting of radiological departments as well as regional planning. If more accurate cost information is required, cost assignment employing the actual consumption of the resources and applying the principles of activity-based cost accounting is recommended. As an application of the cost accounting formula the average costs of the radiological examinations were calculated. In conventional radiography the average proportion of the cost factors in the total material was: personnel costs 43%, equipment costs 26%, material costs 7%, real estate costs 11%, administration and overheads 14%. The average total costs including radiologist costs in the hospitals were (FIM): conventional roentgen examinations 188, contrast medium examinations 695, ultrasound 296, mammography 315, roentgen examinations with mobile equipment 1578. The average total costs without radiologist costs in the public health centres were (FIM): conventional roentgen examinations 107, contrast medium examinations 988, ultrasound 203, mammography 557. The average currency rate of exchange in 1991 was USD 1 = FIM 4.046. The following formula is proposed for calculating the cost of a radiological examination (or a group of examinations) performed with a certain piece of equipment during a period of time (e.g. 1 year): a2/ sigma ax*ax+ b2/ sigma bx*bx+ d1/d5*dx+ e1 + [(c1+ c2) + d4 + (e2 - e3) + f5 + g1+ g2+ i]/n.

  6. The cost of providing methadone maintenance treatment in Ontario, Canada.

    Science.gov (United States)

    Zaric, Gregory S; Brennan, Andrew W; Varenbut, Michael; Daiter, Jeff M

    2012-11-01

    To estimate the cost of providing methadone maintenance treatment in Ontario, Canada, from the perspective of the public payer. We analyzed a database of all patient clinic visits, laboratory tests for urine toxicology screening, and methadone scripts from a group of methadone clinics in Ontario. The database consisted of patient visits and visit information from 1 January 2003 to 31 December 2009. We estimated the cost of providing methadone maintenance treatment as the sum of physician costs, laboratory costs for urine samples (toxicology screens), methadone costs, and pharmacy costs. Pharmacy costs include dispensing fees and markups. All costs are expressed in 2010 Canadian dollars. The database consisted of 9479 unique patients. The average age on the date of the first recorded visit was 34.3, and among the patients 62.3% were male. There were 6,425,937 patient days of treatment and the total cost of all treatment-related services was approximately $99,491,000. The total cost was comprised of physician billing (9.8%), pharmacy costs (39.8%), methadone (3.8%), and performing urine toxicology screens (46.7%). The average cost per day for treatment was $15.48, corresponding to $5651per year if patients were to remain in treatment continuously. The cost of providing methadone maintenance treatment in Ontario is comparable to estimates from the United States and Australia. This information is important to policy makers for planning and budgeting purposes and as part of a full cost-benefit or cost-effectiveness analysis of methadone treatment.

  7. Review of nuclear power costs around the world

    International Nuclear Information System (INIS)

    Bennett, L.L.; Karousakis, P.M.; Moynet, G.

    1983-01-01

    This paper presents highlights of nuclear power costs around the world from studies carried out by the IAEA and by UNIPEDE. Emphasis is placed on trends within each country of key parameters which affect both investment costs and total power generation costs, including construction and project durations, size of units, regulatory environment, scope of project, fuel cycle costs and general economic conditions. A synthesis of these trends, taking into consideration both nuclear and coal-fired plant capital and fuel costs as they are estimated to evolve in the near and medium term, is presented in terms of nuclear-to-coal cost ratios for both plant investment costs and total generating costs. The plant investment costs are expressed as ''overnight'' or ''fore'' costs, in constant money, for plants expected to enter commercial operation in the early 1990s. Pertinent assumptions are based on conditions prevailing in the particular country under review. These studies indicate that in most countries nuclear plant investment costs are rising more rapidly than the costs for coal-fired plants. A major cause for the rapid rise in nuclear plant costs is the drastic lengthening of project duration in most countries. France, as a notable exception, has been able to maintain a stable and reasonably short project time. In spite of the rapidly escalating nuclear plant investment costs, nuclear electricity generation has an economic advantage over coal in Europe and Canada and is competitive with coal in the eastern and midwestern parts of the United States of America (USA). The availability of abundant, low-cost coal gives coal-fired generation an economic advantage in the western USA. (author)

  8. The societal cost of bipolar disorder in Sweden.

    Science.gov (United States)

    Ekman, Mattias; Granström, Ola; Omérov, Sead; Jacob, Johanna; Landén, Mikael

    2013-10-01

    There is a lack of comprehensive cost-of-illness studies in bipolar disorder, in particular studies based on patient-level data. The purpose of this study was to estimate the societal cost of bipolar disorder and to relate costs to disease severity, depressive episodes, hospitalisation and patient functioning. Retrospective resource use data in inpatient and outpatient care during 2006-2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF) scores, were obtained from the Northern Stockholm psychiatric clinic with a catchment area including 47% of the adult inhabitants in Stockholm. This dataset was combined with national register data on prescription pharmaceuticals and sick leave to estimate the societal cost of bipolar disorder. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method. The average annual cost per patient was 28,011 in 2008 (n = 1,846). Indirect costs due to sick leave and early retirement represented 75%, inpatient costs 13%, outpatient costs 8%, pharmaceuticals 2% and community care another 2% of the total cost. Total costs were considerably higher during mood episodes (six times higher than in remission), for hospitalised patients (55,500 vs. 22,200) and for patients with low GAF scores. The high cost of bipolar disorder is driven primarily by indirect costs. Costs were strongly associated with mood episodes, hospitalisations and low GAF scores. This suggests that treatment that reduces the risk for relapses and hospitalizations and improve functioning may decrease both the societal cost of bipolar disorder and patient suffering.

  9. Bridging environmental and financial cost of dairy production: A case study of Irish agricultural policy.

    Science.gov (United States)

    Chen, Wenhao; Holden, Nicholas M

    2018-02-15

    The Irish agricultural policy 'Food Harvest 2020' is a roadmap for sectoral expansion and Irish dairy farming is expected to intensify, which could influence the environmental and economic performance of Irish milk production. Evaluating the total environmental impacts and the real cost of Irish milk production is a key step towards understanding the possibility of sustainable production. This paper addresses two main issues: aggregation of environmental impacts of Irish milk production by monetization, to understand the real cost of Irish milk production, including the environmental costs; and the effect of the agricultural policy 'Food Harvest 2020' on total cost (combining financial cost and environmental cost) of Irish milk production. This study used 2013 Irish dairy farming as a baseline, and defined 'bottom', 'target' and 'optimum' scenarios, according to the change of elementary inputs required to meet agricultural policy ambitions. The study demonstrated that the three monetization methods, Stepwise 2006, Eco-cost 2012 and EPS 2000, could be used for aggregating different environmental impacts into monetary unit, and to provide an insight for evaluating policy related to total environmental performance. The results showed that the total environmental cost of Irish milk production could be greater than the financial cost (up to €0.53/kg energy corrected milk). The dairy expansion policy with improved herbage utilization and fertilizer application could reduce financial cost and minimize the total environmental cost of per unit milk produced. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Cost Estimating Handbook for Environmental Restoration

    International Nuclear Information System (INIS)

    1993-01-01

    Environmental restoration (ER) projects have presented the DOE and cost estimators with a number of properties that are not comparable to the normal estimating climate within DOE. These properties include: An entirely new set of specialized expressions and terminology. A higher than normal exposure to cost and schedule risk, as compared to most other DOE projects, due to changing regulations, public involvement, resource shortages, and scope of work. A higher than normal percentage of indirect costs to the total estimated cost due primarily to record keeping, special training, liability, and indemnification. More than one estimate for a project, particularly in the assessment phase, in order to provide input into the evaluation of alternatives for the cleanup action. While some aspects of existing guidance for cost estimators will be applicable to environmental restoration projects, some components of the present guidelines will have to be modified to reflect the unique elements of these projects. The purpose of this Handbook is to assist cost estimators in the preparation of environmental restoration estimates for Environmental Restoration and Waste Management (EM) projects undertaken by DOE. The DOE has, in recent years, seen a significant increase in the number, size, and frequency of environmental restoration projects that must be costed by the various DOE offices. The coming years will show the EM program to be the largest non-weapons program undertaken by DOE. These projects create new and unique estimating requirements since historical cost and estimating precedents are meager at best. It is anticipated that this Handbook will enhance the quality of cost data within DOE in several ways by providing: The basis for accurate, consistent, and traceable baselines. Sound methodologies, guidelines, and estimating formats. Sources of cost data/databases and estimating tools and techniques available at DOE cost professionals

  11. Cost Estimating Handbook for Environmental Restoration

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1990-09-01

    Environmental restoration (ER) projects have presented the DOE and cost estimators with a number of properties that are not comparable to the normal estimating climate within DOE. These properties include: An entirely new set of specialized expressions and terminology. A higher than normal exposure to cost and schedule risk, as compared to most other DOE projects, due to changing regulations, public involvement, resource shortages, and scope of work. A higher than normal percentage of indirect costs to the total estimated cost due primarily to record keeping, special training, liability, and indemnification. More than one estimate for a project, particularly in the assessment phase, in order to provide input into the evaluation of alternatives for the cleanup action. While some aspects of existing guidance for cost estimators will be applicable to environmental restoration projects, some components of the present guidelines will have to be modified to reflect the unique elements of these projects. The purpose of this Handbook is to assist cost estimators in the preparation of environmental restoration estimates for Environmental Restoration and Waste Management (EM) projects undertaken by DOE. The DOE has, in recent years, seen a significant increase in the number, size, and frequency of environmental restoration projects that must be costed by the various DOE offices. The coming years will show the EM program to be the largest non-weapons program undertaken by DOE. These projects create new and unique estimating requirements since historical cost and estimating precedents are meager at best. It is anticipated that this Handbook will enhance the quality of cost data within DOE in several ways by providing: The basis for accurate, consistent, and traceable baselines. Sound methodologies, guidelines, and estimating formats. Sources of cost data/databases and estimating tools and techniques available at DOE cost professionals.

  12. Cost estimate guidelines for advanced nuclear power technologies

    International Nuclear Information System (INIS)

    Delene, J.G.; Hudson, C.R. II.

    1993-05-01

    Several advanced power plant concepts are currently under development. These include the Modular High Temperature Gas Cooled Reactors, the Advanced Liquid Metal Reactor and the Advanced Light Water Reactors. One measure of the attractiveness of a new concept is its cost. Invariably, the cost of a new type of power plant will be compared with other alternative forms of electrical generation. This report provides a common starting point, whereby the cost estimates for the various power plants to be considered are developed with common assumptions and ground rules. Comparisons can then be made on a consistent basis. This is the second update of these cost estimate guidelines. Changes have been made to make the guidelines more current (January 1, 1992) and in response to suggestions made as a result of the use of the previous report. The principal changes are that the reference site has been changed from a generic Northeast (Middletown) site to a more central site (EPRI's East/West Central site) and that reference bulk commodity prices and labor productivity rates have been added. This report is designed to provide a framework for the preparation and reporting of costs. The cost estimates will consist of the overnight construction cost, the total plant capital cost, the operation and maintenance costs, the fuel costs, decommissioning costs and the power production or busbar generation cost

  13. Predictors of micro-costing components in liver transplantation

    Directory of Open Access Journals (Sweden)

    Luciana Bertocco de Paiva Haddad

    Full Text Available OBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.

  14. [Costs in hand amputations derived from labor injuries].

    Science.gov (United States)

    Castañeda-Borrayo, Yaocihuatl; Mireles-Pérez, Ana Bárbara Isabel; González-Ramos, Ana Margarita; Pérez-García, Cindy; Navarro-Trujillo, Luz Rocío

    2010-01-01

    Hand injuries by labor accidents are first rank. It is necessary to have a multidisciplinary medical approach to frequently generated temporary and permanent disabilities that affect costs to an institution and to enterprise. To determine the direct cost (DC) and the indirect cost (IC) of complete and partial amputations in hand caused by labor injuries. An observational study was performed. The data was obtained from labor injuries with amputation of a finger or hand that received multidisciplinary management. The costs were calculated according to the list of Institutional Unit Costs. The IC were obtained with the "safety pays" program. We included 48 cases. The average age was 32.17 years; the cost of surgical operations was $767,470; and the payment of a partial disability permanent was $1,032,670; the DC of the sample of 48 workers was $2,955,007 with an IC of $3,250,507 and a total cost of $6,205,515, the average cost per worker of $51,741 for DC, $56,915 for IC and $108,657 for the total cost. Costs of hand injures requires the creation of prevention programs.

  15. 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...

  16. 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.

  17. Total Product Life Cycle (TPLC)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Total Product Life Cycle (TPLC) database integrates premarket and postmarket data about medical devices. It includes information pulled from CDRH databases...

  18. 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

  19. 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.

  20. Cost of rheumatoid arthritis in a selected population from Argentina in the prebiologic therapy era

    Directory of Open Access Journals (Sweden)

    Catay E

    2012-08-01

    Full Text Available Erika Catay,1 Cecilia Castel del Cid,1 Lorena Narváez,1 Edson J Velozo,1 Javier E Rosa,1,2 Luis J Catoggio,1,2 Enrique R Soriano1,21Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, 2University Institute Hospital Italiano de Buenos Aires, School of Medicine, PM Catoggio Foundation, Buenos Aires, ArgentinaBackground: The present study aimed to estimate the cost of rheumatoid arthritis and its components in a university hospital-based health management organization in Argentina, during the prebiologic era.Methods: A one-year (2002 observational prevalence, cost-of illness study of patients with rheumatoid arthritis from the societal perspective was performed in a hospital-based health management organization population. Direct medical costs were obtained using administrative databases. Direct nonmedical and indirect costs were obtained from a semistructured questionnaire. Indirect costs included work absenteeism, permanent work disability, and housework lost for housewives, using the human capital approach. Costs are expressed in 2002 US dollars per patient per year.Results: A total of 165 patients (84% females, of mean age 61 ± 15 years and with a mean disease duration of 8.5 ± 8.3 years were included. Mean total direct medical costs were US$1862 (95% confidence interval [CI] 828–2899. Mean direct nonmedical costs were US$222 (95% CI 149–294. Mean indirect costs were US$1008 (95% CI 606–1412. The annual mean total cost was US$3093 without biologics. Hospitalizations represented 73% of total direct medical costs while drugs and outpatient procedures represented 16% and 8% of total direct medical costs, respectively. Sixty percent of the total costs were related to direct medical costs, while indirect costs represented 33% of total costs.Conclusion: In our population, annual mean total costs in the prebiologic therapy era were mainly driven by direct medical costs. Even without the use of biologic agents

  1. 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

  2. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. 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/

  3. 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.

  4. [Direct and indirect costs of fractures due to osteoporosis in Austria].

    Science.gov (United States)

    Dimai, H-P; Redlich, K; Schneider, H; Siebert, U; Viernstein, H; Mahlich, J

    2012-10-01

    We examined the financial burden of osteoporosis in Austria. We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries, this is the first comprehensive study for Austria. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria. Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is 707.4 million €. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 29% of total costs, is the opportunity cost of informal care. The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers. © Georg Thieme Verlag KG Stuttgart · New York.

  5. 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/...

  6. The Hidden Cost of Regulation: The Administrative Cost of Reporting Serious Reportable Events.

    Science.gov (United States)

    Blanchfield, Bonnie B; Acharya, Bijay; Mort, Elizabeth

    2018-04-01

    More than half of the 50 states (27) and the District of Columbia require reporting of Serous Reportable Events (SREs). The goal is to hold providers accountable and improve patient safety, but there is little information about the administrative cost of this reporting requirement. This study was conducted to identify costs associated with investigating and reporting SREs. This qualitative study used case study methods that included interviewing staff and review of data and documents to investigate each SRE occurring at one academic medical center during fiscal year 2013. A framework of tasks and a model to categorize costs was created. Time was summarized and costs were estimated for each SRE. The administrative cost to process 44 SREs was estimated at $353,291, an average cost of $8,029 per SRE, ranging $6,653 for an environmental-related SRE to $21,276 for a device-related SRE. Care management SREs occurred most frequently, costing an average $7,201 per SRE. Surgical SREs, the most expensive on average, cost $9,123 per SRE. Investigation of events accounted for 64.5% of total cost; public reporting, 17.2%; internal reporting, 10.2%; finance and administration, 6.0%; and 2.1%, other. Even with 26 states mandating reporting, the 17.2% incremental cost of public reporting is substantial. Policy makers should consider the opportunity costs of these resources, averaging $8,029 per SRE, when mandating reporting. The benefits of public reporting should be collectively reviewed to ensure that the incremental costs in this resource-constrained environment continue to improve patient safety and that trade-offs are acknowledged. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-11-01

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

  8. 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.

  9. Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis.

    Science.gov (United States)

    Hill, Andrew; Redd, Christopher; Gotham, Dzintars; Erbacher, Isabelle; Meldrum, Jonathan; Harada, Ryo

    2017-01-20

    The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs. This research was carried out in a non-clinical research setting using secondary data. There were no human participants in the study. Four drugs were selected for the study: bortezomib, dasatinib, everolimus and gefitinib. These medications were selected according to their clinical importance, novel pharmaceutical actions and the availability of generic price data. Target costs for treatment were to be generated for each indication for each treatment. The primary outcome measure was the target cost according to a production cost calculation algorithm. The secondary outcome measure was the target cost as the lowest available generic price; this was necessary where export data were not available to generate an estimate from our cost calculation algorithm. Other outcomes included patent expiry dates and total eligible treatment populations. Target prices were £411 per cycle for bortezomib, £9 per month for dasatinib, £852 per month for everolimus and £10 per month for gefitinib. Compared with current list prices in England, these target prices would represent reductions of 74-99.6%. Patent expiry dates were bortezomib 2014-22, dasatinib 2020-26, everolimus 2019-25 and gefitinib 2017. The total global eligible treatment population in 1 year is 769 736. Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research. 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/.

  10. On total disc replacement.

    Science.gov (United States)

    Berg, Svante

    2011-02-01

    Low back pain consumes a large part of the community's resources dedicated to health care and sick leave. Back disorders also negatively affect the individual leading to pain suffering, decreased quality-of-life and disability. Chronic low back pain (CLBP) due to degenerative disc disease (DDD) is today often treated with fusion when conservative treatment has failed and symptoms are severe. This treatment is as successful as arthroplasty is for hip arthritis in restoring the patient's quality of life and reducing disability. Even so, there are some problems with this treatment, one of these being recurrent CLBP from an adjacent segment (ASD) after primarily successful surgery. This has led to the development of alternative surgical treatments and devices that maintain or restore mobility, in order to reduce the risk for ASD. Of these new devices, the most frequently used are the disc prostheses used in Total Disc Replacement (TDR). This thesis is based on four studies comparing total disc replacement with posterior fusion. The studies are all based on a material of 152 patients with DDD in one or two segments, aged 20-55 years that were randomly treated with either posterior fusion or TDR. The first study concerned clinical outcome and complications. Follow-up was 100% at both one and two years. It revealed that both treatment groups had a clear benefit from treatment and that patients with TDR were better in almost all outcome scores at one-year follow-up. Fusion patients continued to improve during the second year. At two-year follow-up there was a remaining difference in favour of TDR for back pain. 73% in the TDR group and 63% in the fusion group were much better or totally pain-free (n.s.), while twice as many patients in the TDR group were totally pain free (30%) compared to the fusion group (15%). Time of surgery and total time in hospital were shorter in the TDR group. There was no difference in complications and reoperations, except that seventeen of the

  11. 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

  12. New York State interim waste management cost evaluation

    International Nuclear Information System (INIS)

    Ma, M.S.; Watts, R.J.; Jorgensen, J.R.; Rochester Gas and Electric Corp., NY)

    1985-01-01

    The purpose of this study is to investigate and quantify the comparative costs associated with including or excluding Class A utility wastes at a centralized interim waste management facility in New York State. The objective of the study is to assess the unit costs and total statewide costs associated with two distinct scenarios: (1) the case where non-utility Class A LLRW is received, incinerated and stored at the centralized interim facility, and utility Class A wastes are held without incineration at respective nuclear power plant interim onsite facilities without incineration; and (2) the alternative case where both utility and non-utility Class A wastes are accepted, incinerated and stored at the centralized facility. Unit costs to waste generators are estimated for each of the two cases described. This is followed by an estimation of the statewide cost impact to the public. The cost impact represents the cost differential resulting from the exclusion of utility Class A waste from the centralized NYS interim waste management facility. The principal factors comprising the cost differential include (1) higher unit disposal fees charged to non-utility waste generators, which are passed along in the costs of products and services; and (2) costs to utilities due to construction of additional onsite storage capacity, which in turn are charged to electric rate payers

  13. The social cost of illicit drugs use in Spain.

    Science.gov (United States)

    Rivera, Berta; Casal, Bruno; Currais, Luis

    2017-06-01

    Illegal drugs consumption not only has a notable impact on the population's health, but also leads to major socio-economic costs. A significant characteristic of drug consumers is that the majority are of working age. The main aim of this study is to estimate the economic impact of drug consumption in Spain from a social perspective. A cost-of-illness methodology is carried out and a distinction is made between health-related and non-health related direct costs, as well as indirect costs. Among the direct health care costs included are hospitalisations, primary and emergency care, support programmes and HIV outpatient care. Expenditure on prevention, law enforcement and research was included as direct costs falling outside of health care. Productivity losses due to premature deaths attributed to substance abuse and patient hospitalisation formed part of indirect costs. For 2012, the total social cost related to drug consumption in Spain was somewhere between 1,436 and 1,651 million euros. The minimum cost of this consumption represented 0.14% of Spain's GDP for that year. The present cost estimations provide a measure of the social burden that illegal drug consumption represents for the community. When it comes to allocating resources, the obtained results quantify the potential economic returns that could be achieved from effective policies and programmes aimed at reducing the consumption of illegal drugs. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Cost of illness of atrial fibrillation: a nationwide study of societal impact.

    Science.gov (United States)

    Johnsen, Søren Paaske; Dalby, Lene Worsaae; Täckström, Tomas; Olsen, Jens; Fraschke, Anina

    2017-11-10

    The prevalence of atrial fibrillation is increasing rapidly; however, to date, population-based data are lacking on the attributable cost of illness of atrial fibrillation from a societal perspective, including both direct and indirect costs. The study was an incidence-based cost-of-illness study based on national registries covering the entire population of Denmark. We identified all patients with a first-time hospital diagnosis of atrial fibrillation between 2001 and 2012. For every atrial fibrillation patient, we identified three age- and sex-matched controls from the general population. Both the total and the attributable costs of atrial fibrillation were estimated based on individual level information on hospital care (in- and out-patient contacts), primary sector care, use of prescription drugs and productivity loss. Average 3-year societal costs per patient attributable to atrial fibrillation were estimated to be €20,403-26,544 during the study period. The costs were highest during the first year after diagnosis of atrial fibrillation. Admission costs constituted the largest cost component, whereas primary sector costs and medicine costs only constituted minor components. The attributable costs were more than two-fold higher among patients experiencing a stroke. The total 3-year cost attributable to atrial fibrillation in Denmark was estimated to be €219-295 million. The societal costs attributable to atrial fibrillation are significant. Reducing the need for hospitalizations, in particular from stroke, is a key factor in controlling the costs.

  15. Australian quad bike fatalities: what is the economic cost?

    Science.gov (United States)

    Lower, Tony; Pollock, Kirrily; Herde, Emily

    2013-04-01

    To determine the economic costs associated with all quad bike-related fatalities in Australia, 2001 to 2010. A human capital approach to establish the economic costs of quad bike related fatalities to the Australian economy. The model included estimates on loss of earnings due to premature death and direct costs based on coronial records for ambulance, police, hospital, premature funeral, coronial and work safety authority investigation, and death compensation costs. All costs were calculated to 2010 dollars. The estimated total economic cost associated with quad bike fatalities over this period was $288.1 million, with an average cost for each fatality of $2.3 million. When assessing the average cost of incidents between age cohorts, those aged 25-34 years had the lowest number of fatalities but had the highest average cost ($4.2 million). Quad bike fatalities have a significant economic impact on Australian society that is increasing. Implications : Given the high cost to society, interventions to address quad bike fatalities have the potential to be highly cost-effective. Such interventions should focus on design approaches to improve the safety of quad bikes in terms of stability and protection in the event of a rollover. Additionally, relevant policy (e.g. no children under 16 years riding quads, no passengers) and intervention approaches (e.g. training and use of helmets) must also support the design modifications. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

  16. Probabilistic cost estimating of nuclear power plant construction projects

    International Nuclear Information System (INIS)

    Finch, W.C.; Perry, L.W.; Postula, F.D.

    1978-01-01

    This paper shows how to identify and isolate cost accounts by developing probability trees down to component levels as justified by value and cost uncertainty. Examples are given of the procedure for assessing uncertainty in all areas contributing to cost: design, factory equipment pricing, and field labor and materials. The method of combining these individual uncertainties is presented so that the cost risk can be developed for components, systems and the total plant construction project. Formats which enable management to use the probabilistic cost estimate information for business planning and risk control are illustrated. Topics considered include code estimate performance, cost allocation, uncertainty encoding, probabilistic cost distributions, and interpretation. Effective cost control of nuclear power plant construction projects requires insight into areas of greatest cost uncertainty and a knowledge of the factors which can cause costs to vary from the single value estimates. It is concluded that probabilistic cost estimating can provide the necessary assessment of uncertainties both as to the cause and the consequences

  17. Total Ownership Cost a Decade Into the 21st Century

    Science.gov (United States)

    2012-09-30

    Development The traceability from user-stated requirements through scenario development to test-case development provides a powerful communication and...Privatization-NOSL/NAWCI  RFID (6)  Risk Analysis for Performance-based Logistics  R-TOC AEGIS Microwave Power Tubes  Sense-and-Respond Logistics Network

  18. Total Ownership Cost Reduction Case Study: AEGIS Radar Phase Shifters

    National Research Council Canada - National Science Library

    Bridger, Wray W; Ruiz, Mark D

    2006-01-01

    ...., consolidated purchasing, lean and six sigma, productivity improvement projects, etc. This case study was conducted with the sponsorship and assistance of the Acquisition Research Program, Graduate School of Business and Public Policy, Naval Postgraduate School, Monterey, CA.

  19. BIM (Building Information Modeling) and TCO (Total Cost of Ownership)

    Science.gov (United States)

    Christensen, Douglas K.

    2009-01-01

    There are some words in the building industry that seem to be clear and understandable to say, yet they need some help in understanding the depth of the meaning. When the term maintenance is talked about there seems to be some agreement that it does not mean building a new building. Maintenance as a term covers many areas and if not clarified…

  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. 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.

  3. Health Expenditure Concentration and Characteristics of High-Cost Enrollees in CHIP

    Directory of Open Access Journals (Sweden)

    Bisakha Sen PhD

    2016-04-01

    Full Text Available Devising effective cost-containment strategies in public insurance programs requires understanding the distribution of health care spending and characteristics of high-cost enrollees. The aim was to characterize high-cost enrollees in a state’s public insurance program and determine whether expenditure inequality changes over time, or with changes in cost-sharing policies or program eligibility. We use 1999-2011 claims and enrollment data from the Alabama Children’s Health Insurance Program, ALL Kids. All children enrolled in ALL Kids were included in our study, including multiple years of enrollment (N = 1,031,600 enrollee-months. We examine the distribution of costs over time, whether this distribution changes after increases in cost sharing and expanded eligibility, patient characteristics that predict high-cost status, and examine health services used by high-cost children to identify what is preventable. The top 10% (1% of enrollees account for about 65.5% (24.7% of total program costs. Inpatient and outpatient costs are the largest components of costs incurred by high-cost utilizers. Non-urgent emergency department costs are a relatively small portion. Average expenditure increases over time, particularly after expanded eligibility, and the share of costs incurred by the top 10% and 1% increases slightly. Multivariable logistic regression results indicate that infants and older teens, Caucasian children, and those with chronic conditions are more likely to be high-cost utilizers. Increased cost sharing does not reduce cost concentration or average expenditure among high-cost utilizers. These findings suggest that identifying and targeting potentially preventable costs among high-cost utilizers are called for to help reduce costs in public insurance programs.

  4. Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

    Science.gov (United States)

    Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U

    2017-10-01

    The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

  5. Cost of allergy immunotherapy: sublingual vs subcutaneous administration.

    Science.gov (United States)

    Seiberling, Kristin; Hiebert, Jared; Nyirady, Janice; Lin, Sandra; Chang, Dennis

    2012-11-01

    Allergy immunotherapy is an effective way to manage the allergic patient and may be administered either through the subcutaneous route (SCIT) or the sublingual route (SLIT). Both have been proven efficacious; however, SLIT is currently not covered by insurance companies and is an out-of-pocket expense. The goal of the current study is to compare the costs of SCIT to SLIT. For SCIT, a total of 9 different insurance groups were studied including 8 preferred provider organizations (PPOs) and Medicare. Costs were broken down according to the percentage of coverage for the injections, serum vial fees, weekly co-pay, and deductibles. Total yearly cost for SCIT was calculated for the varying insurance plans and compared to the yearly cost of SLIT. PPO plans covered between 60% and 100% of allergy immunotherapy treatment with a range of weekly co-pay between $0 and $50. Deductibles ranged between $0 and $7000. Medicare had a flat rate of 80% coverage costing the insurer $807.20 for the year of therapy. None of the above costs include loss of work productivity and travel expense. The cost of SLIT ranged from $500 to $2100 depending on the allergy practice and number on antigens treated. The cost of SCIT varies dramatically according to insurance plan whereas the cost of SLIT varies between practices. When loss of productivity and travel expense are added into the cost of SCIT, SLIT might be comparable in cost and more convenient for the patient. Although the lack of insurance coverage for SLIT currently makes it more expensive than SCIT, we have found that the financial gap is much smaller than initially thought, especially when indirect costs and plans with less than 80% coverage or high weekly co-pay are factored into the equation. Copyright © 2012 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  6. 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.

  7. Cost analysis of microtia treatment in the Netherlands.

    Science.gov (United States)

    Kolodzynski, M N; van Hövell Tot Westerflier, C V A; Kon, M; Breugem, C C

    2017-09-01

    Ear reconstruction for microtia is a challenging procedure. Although analyzing esthetic outcome is crucial, there is a paucity of information with regard to financial aspects of microtia reconstruction. This study was conducted to analyze the costs associated with ear reconstruction with costal cartilage in patients with microtia. Ten consecutive children with autologous ear reconstruction of a unilateral microtia were included in this analysis. All patients had completed their treatment protocol for ear reconstruction. Direct costs (admission to hospital, diagnostics, and surgery) and indirect cost (travel expenses and absence from work) were obtained retrospectively. The overall mean cumulative cost per patient was €14,753. Direct and indirect costs were €13,907 and €846, respectively. Hospital admission and surgery cover 55% and 32% of all the costs, respectively. This study analyzes the costs for autologous ear reconstruction. Hospital admission and surgery are the most important factors of the total costs. Total costs could be decreased by possibly decreasing admission days and surgical time. These data can be used for choosing and developing future treatment strategies. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. The economic impact and cost of visual impairment in Australia

    Science.gov (United States)

    Taylor, H R; Pezzullo, M L; Keeffe, J E

    2006-01-01

    Aims To quantify the total economic costs of vision loss in Australia. Methods Prevalence data of visual impairment, unpublished data on indirect costs, and national healthcare cost databases were used. Results Vision disorders cost Australia an estimated A$9.85 billion in 2004. A$4.8 billion is the loss of wellbeing (years of life lost as a result of disability and premature mortality). Vision disorders rank seventh and account for 2.7% of the national loss of wellbeing. Direct health system costs total A$1.8 billion. They have increased by A$1 billion over the last 10 years and will increase a further A$1–2 billion in the next 10 years. Cataract, the largest direct cost, takes 18% of expenditure. The health system costs place vision disorders seventh, ahead of coronary heart disease, diabetes, depression, and stroke. Indirect costs, A$3.2 billion, include carers' costs, low vision aids, lost earnings, and other welfare payments and taxes. Conclusions Even a developed economy such as Australia's cannot afford avoidable vision loss. Priority needs to be given to prevent preventable vision loss; to treat treatable eye diseases; and to increase research into vision loss that can be neither prevented nor treated. PMID:16488942

  9. Pharmaceutical cost-containment policies and sustainability: recent Irish experience.

    Science.gov (United States)

    Kenneally, Martin; Walshe, Valerie

    2012-01-01

    Our objective is to review and assess the main pharmaceutical cost-containment policies used in Ireland in recent years, and to highlight how a policy that improved fiscal sustainability but worsened economic sustainability could have improved both if an option-based approach was implemented. The main public pharmaceutical cost-containment policy measures including reducing the ex-factory price of drugs, pharmacy dispensing fees and community drug scheme coverage, and increasing patient copayments are outlined along with the resulting savings. We quantify the cost implications of a new policy that restricts the entitlement to free prescription drugs of persons older than 70 years and propose an alternative option-based policy that reduces the total cost to both the state and the patient. This set of policy measures reduced public spending on community drugs by an estimated €380m in 2011. The policy restricting free prescription drugs for persons older than 70 years, though effective in reducing public cost, increased the total cost of the drugs supplied. The policy-induced cost increase stems from a fees anomaly between the two main community drugs schemes which is circumvented by our alternative option-based policy. Our findings highlight the need for policymakers, even when absorbed with reducing cost, to design cost-containment policies that are both fiscally and economically sustainable. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. Health Services Cost Analyzing in Tabriz Health Centers 2008

    Directory of Open Access Journals (Sweden)

    Massumeh gholizadeh

    2015-08-01

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

  11. [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.

  12. Using Illness Rating Systems to Predict Discharge Location Following Total Knee Arthroplasty

    Science.gov (United States)

    Dattilo, Jonathan R.; Liu, Jiabin; Clements, Ari; Nelson, Charles L.; Kamath, Atul F.

    2018-01-01

    Purpose Total knee arthroplasty (TKA) is increasing in frequency and cost. Optimization of discharge location may reduce total expenditure while maximizing patient outcomes. Although preoperative illness rating systems—including the American Society for Anesthesiologists Physical Classification System (ASA), severity of illness scoring system (SOI), and Mallampati rating scale (MP)—are associated with patient morbidity and mortality, their predictive value for discharge location, length of stay (LOS), and total costs remains unclear. Materials and Methods We conducted a retrospective analysis of 677 TKA patients (550 primary and 127 revision) treated at a single institution. The influence of ASA, SOI, and MP scores on discharge locations, LOS, and total costs was assessed using multivariable regression analyses. Results None of the systems were significant predictors of discharge location following TKA. SOI scores of major or higher (β=2.08 days, pscores. Total costs were also significantly predicted by SOI scores of major or higher (β=$6,155, p=0.022) and minor (β=−$1,163, p=0.007). Conclusions SOI scores may be harnessed as a predictive tool for LOS and total costs following TKA, but other mechanisms are necessary to predict discharge location. PMID:29482304

  13. 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.)

  14. Cost of diabetic foot in France, Spain, Italy, Germany and United Kingdom: A systematic review.

    Science.gov (United States)

    Tchero, Huidi; Kangambega, Pauline; Lin, Lucien; Mukisi-Mukaza, Martin; Brunet-Houdard, Solenne; Briatte, Christine; Retali, Gerald Reparate; Rusch, Emmanuel

    2018-04-01

    Cost estimates for diabetic foot are available for developed countries based on cost data for different years. This study aimed to provide a comparison of the cost of diabetic foot in E5 (France, Spain, Italy, Germany, and the United Kingdom) and its characteristics across different conditions. PubMed, Central and Embase databases were searched in February 2017 for English language publications. Bibliographies of relevant papers were also searched manually. Reviews and research papers from E5 regions reporting on cost of diabetic foot were included. Reported cost was converted to equivalent 2016 $ for comparison purposes. All the costs presented are mean cost per patient per year in 2016 $. Nine studies were included in the analysis. The total cost of amputation ranged from $ 15,046 in 2001 to $ 38,621 in 2005. The direct cost of amputation ranged from $ 13,842 in 2001 to $ 83,728 during 2005-2009. Indirect cost of amputation was more uniform, ranging from between $ 1,043 to $ 1,442. The direct cost of gangrene ranged from $ 3,352 in 2003 to $ 8,818 in Germany. Although, for the same year, 2003, the cost for Spain was almost double that for Germany. The total cost of an uninfected ulcer was $ 6,174 in 2002, but increased to $ 14,441 in 2005; for an infected ulcer the cost increased from $ 2,637 to $ 2,957. The different countries showed variations in the components used to calculate the cost of diabetic foot. The E5 incurs a heavy cost from diabetic foot and its complications. There is an unmet need for the identification of cost-cutting strategies, as diabetic foot costs more than major cardiac diseases. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  16. Implementation of a Cost-Accounting System for Visibility of Weapon Systems Life-Cycle Costs

    National Research Council Canada - National Science Library

    Ugone, Mary

    2001-01-01

    ... costs through activity-based costing and management. The system must deliver timely, integrated data for management purposes to permit understanding of total weapon costs, provide a basis for estimating costs of future systems, and feed other tools for life-cycle cost management.

  17. Total iron binding capacity

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003489.htm Total iron binding capacity To use the sharing features on this page, please enable JavaScript. Total iron binding capacity (TIBC) is a blood test to ...

  18. Technique of total thyroidectomy

    International Nuclear Information System (INIS)

    Rao, R.S.

    1999-01-01

    It is essential to define the various surgical procedures that are carried out for carcinoma of the thyroid gland. They are thyroid gland, subtotal lobectomy, total thyroidectomy and near total thyroidectomy

  19. Total parenteral nutrition

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000177.htm Total parenteral nutrition To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  20. Total parenteral nutrition - infants

    Science.gov (United States)

    ... medlineplus.gov/ency/article/007239.htm Total parenteral nutrition - infants To use the sharing features on this page, please enable JavaScript. Total parenteral nutrition (TPN) is a method of feeding that bypasses ...

  1. Systems/cost summary

    International Nuclear Information System (INIS)

    Grand, P.; Danby, G.; Keane, J.; Spiro, J.; Sutter, D.; Cole, F.; Hoyer, E.; Freytag, K.; Burke, R.

    1977-01-01

    The purpose of the meeting was to discuss and develop cost-estimating methods for heavy-ion fusion accelerator systems. The group did not consider that its purpose was to make technical judgements on proposed systems, but to develop methods for making reasonable cost estimates of these systems. Such estimates will, it is hoped, provide material for systems studies, will help in guiding research and development efforts by identifying ''high-leverage'' subsystems (areas that account for a significant part of total system cost and that might be reduced in cost by further technical development) and to begin to provide data to aid in an eventual decision on the optimum type of accelerator for heavy-ion fusion

  2. Determinants of societal costs in Alzheimer's disease: GERAS study baseline results.

    Science.gov (United States)

    Dodel, Richard; Belger, Mark; Reed, Catherine; Wimo, Anders; Jones, Roy W; Happich, Michael; Argimon, Josep M; Bruno, Giuseppe; Vellas, Bruno; Haro, Josep Maria

    2015-08-01

    To identify the main factors associated with societal costs of Alzheimer's disease (AD) in community-dwelling patients across three European countries. Baseline cost data from a prospective, observational study were used. Assessments included patients' cognition, activities of daily living (ADLs) and behavioral symptoms, and caregiver burden. Cost calculations (2010) from the societal perspective were based on patient/caregiver resource use. Generalized linear models estimated factors associated with costs. Mean monthly costs per patient differed for France (€1881), Germany (€2349), and the UK (€2016), with informal care costs accounting for 50% to 61%. Independent factors associated with costs across all countries were ADL total score, patient living arrangements, caregiver working status, and caregiver burden (all P caregiver factors, including factors associated with informal care, should be included when evaluating care options for patients with AD. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  3. Cost-effectiveness analysis of robotic-assisted laparoscopy for newly diagnosed uterine cancers

    Science.gov (United States)

    Leitao, Mario M; Bartashnik, Aleksandra; Wagner, Isaac; Lee, Stephen J; Caroline, Ari; Hoskins, William J; Thaler, Howard T; Abu-Rustum, Nadeem R; Sonoda, Yukio; Brown, Carol L; Jewell, Elizabeth L; Barakat, Richard R; Gardner, Ginger J

    2015-01-01

    Objective We assessed the direct costs of 3 surgical approaches in uterine cancer and the cost impact of incorporating robot-assisted surgery. Methods A cost system that allocates the actual cost of resources used to treat each patient, as opposed to borrowing cost data from a billing system, was used to determine direct costs for patients who underwent surgery for uterine cancer from 2009–2010. These costs included all aspects of surgical care up to 6 months after discharge. Total amortized direct costs (AC) included the capital cost of 3 dual console DaVinci Si platforms with 5 years of service contracts. Non-amortized costs (NAC) were also calculated (excluded capital costs). Modeling was performed to estimate the mean cost of surgical care for patients presenting with endometrial cancer from 2007–2010 Results Of 436 cases (132 laparoscopic, 262 robotic, 42 laparotomy), total mean AC/case was $20,489 (laparoscopy), $23,646 (robot), and $24,642 (laparotomy) (P<0.05 [robot vs laparoscopy]; P=0.6 [robot vs laparotomy]). Total NAC/case was $20,289, $20,467, and $24,433, respectively (P=0.9 [robot vs laparoscopy]; P=0.03 [robot vs laparotomy]). The planned surgical approach in 2007 was laparoscopy-68%, robot-8%, and laparotomy-24% compared to 26%, 64%, and 9%, respectively, in 2010 (P<0.001). The modeled mean AC/case was $21,738 in 2007 and $22,678 in 2010 (+$940). NAC was $21,298 in 2007 and $20,573 in 2010 (−$725). Conclusion Laparoscopy is least expensive when including capital acquisition costs. Laparoscopy and robotic surgery are comparable if upfront costs are excluded. There is cost neutralization with the robot when it helps decrease laparotomy rates. PMID:24785856

  4. The costs of nuclear power

    International Nuclear Information System (INIS)

    Vestenhaug, O.; Sauar, T.O.; Nielsen, P.O.

    1979-01-01

    A study has been made by Scandpower A/S of the costs of nuclear power in Sweden. It is based on the known costs of existing Swedish nuclear power plants and forecasts of the expected costs of the Swedish nuclear power programme. special emphasis has been put on the fuel cycle costs and future costs of spent fuel processing, waste disposal and decommissioning. Costs are calculated in 1978 Swedish crowns, using the retail price index. An actual interest rate of 4% is used, with depreciation period of 25 years and a plant lifetime of 30 years. Power production costs are estimated to be about 7.7 oere/kWh in 1978, rising to 10.5 oere/kWh in 2000. The cost is distributed with one third each to capital costs, operating costs and fuel costs, the last rising to 40% of the total at the end of the century. The main single factor in future costs is the price of uranium. If desired, Sweden can probably be self-sufficient in uranium in 2000 at a lower cost than assumed here. National research costs which, in Scandpower's opinion, can be debited to the commercial nuclear power programme are about 0.3 oere/kWh. (JIW)

  5. Total well dominated trees

    DEFF Research Database (Denmark)

    Finbow, Arthur; Frendrup, Allan; Vestergaard, Preben D.

    cardinality then G is a total well dominated graph. In this paper we study composition and decomposition of total well dominated trees. By a reversible process we prove that any total well dominated tree can both be reduced to and constructed from a family of three small trees....

  6. Reemplazo total de cadera

    OpenAIRE

    Sánchez Vergel, Alfredo; Fundación Valle de Lili

    2002-01-01

    Definición/Tipos de prótesis/ ¿Qué pacientes se podrían beneficiar de un reemplazo total de cadera?/Artrosis de cadera/Tipos de artrosis de cadera/Alternativas al reemplazo total de cadera/Preguntas frecuentes sobre el reemplazo total de cadera.

  7. The many costs of sex.

    Science.gov (United States)

    Lehtonen, Jussi; Jennions, Michael D; Kokko, Hanna

    2012-03-01

    Explaining the evolution of sex is challenging for biologists. A 'twofold cost' compared with asexual reproduction is often quoted. If a cost of this magnitude exists, the benefits of sex must be large for it to have evolved and be maintained. Focusing on benefits can be misleading, as this sidelines important questions about the cost of sex: what is the source of the twofold cost: males, genome dilution or both? Does the cost deviate from twofold? What other factors make sex costly? How should the costs of sex be empirically measured? The total cost of sex and how it varies in different contexts must be known to determine the benefits needed to account for the origin and maintenance of sex. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. 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.

  9. Delivery cost analysis of a reactive mass cholera vaccination campaign: a case study of Shanchol™ vaccine use in Lake Chilwa, Malawi.

    Science.gov (United States)

    Ilboudo, Patrick G; Le Gargasson, Jean-Bernard

    2017-12-19

    Cholera is a diarrheal disease that produces rapid dehydration. The infection is a significant cause of mortality and morbidity. Oral cholera vaccine (OCV) has been propagated for the prevention of cholera. Evidence on OCV delivery cost is insufficient in the African context. This study aims to analyze Shanchol vaccine delivery costs, focusing on the vaccination campaign in response of a cholera outbreak in Lake Chilwa, Malawi. The vaccination campaign was implemented in two rounds in February and March 2016. Structured questionnaires were used to collect costs incurred for each vaccination related activity, including vaccine procurement and shipment, training, microplanning, sensitization, social mobilization and vaccination rounds. Costs collected, including financial and economic costs were analyzed using Choltool, a standardized cholera cost calculator. In total, 67,240 persons received two complete doses of the vaccine. Vaccine coverage was higher in the first round than in the second. The two-dose coverage measured with the immunization card was estimated at 58%. The total financial cost incurred in implementing the campaign was US$480275 while the economic cost was US$588637. The total financial and economic costs per fully vaccinated person were US$7.14 and US$8.75, respectively, with delivery costs amounting to US$1.94 and US$3.55, respectively. Vaccine procurement and shipment accounted respectively for 73% and 59% of total financial and economic costs of the total vaccination campaign costs while the incurred personnel cost accounted for 13% and 29% of total financial and economic costs. Cost for delivering a single dose of Shanchol was estimated at US$0.97. This study provides new evidence on economic and financial costs of a reactive campaign implemented by international partners in collaboration with MoH. It shows that involvement of international partners' personnel may represent a substantial share of campaign's costs, affecting unit and vaccine

  10. The cost of autism spectrum disorders.

    Directory of Open Access Journals (Sweden)

    Chiara Horlin

    Full Text Available A diagnosis of an autism spectrum disorders is usually associated with substantial lifetime costs to an individual, their family and the community. However, there remains an elusive factor in any cost-benefit analysis of ASD diagnosis, namely the cost of not obtaining a diagnosis. Given the infeasibility of estimating the costs of a population that, by its nature, is inaccessible, the current study compares expenses between families whose children received a formal ASD diagnosis immediately upon suspecting developmental atypicality and seeking advice, with families that experienced a delay between first suspicion and formal diagnosis.A register based questionnaire study covering all families with a child with ASD in Western Australia.Families with one or more children diagnosed with an ASD, totalling 521 children diagnosed with an ASD; 317 records were able to be included in the final analysis.The median family cost of ASD was estimated to be AUD $34,900 per annum with almost 90% of the sum ($29,200 due to loss of income from employment. For each additional symptom reported, approximately $1,400 cost for the family per annum was added. While there was little direct influence on costs associated with a delay in the diagnosis, the delay was associated with a modest increase in the number of ASD symptoms, indirectly impacting the cost of ASD.A delay in diagnosis was associated with an indirect increased financial burden to families. Early and appropriate access to early intervention is known to improve a child's long-term outcomes and reduce lifetime costs to the individual, family and society. Consequently, a per symptom dollar value may assist in allocation of individualised funding amounts for interventions rather than a nominal amount allocated to all children below a certain age, regardless of symptom presentation, as is the case in Western Australia.

  11. [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.

  12. 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

  13. 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.

  14. Cost effectiveness of fine needle aspiration cytology for breast masses

    African Journals Online (AJOL)

    The total cost for FNAC and histopathology as well as cost saving between FNAC and histopathology for the 110 patients were calculated. Result: The total cost for FNAC procedure and cytological evaluation of each smear was one thousand, seven hundred naira (N1,700.00 = US$11). The total cost for open surgical ...

  15. Total disc replacement.

    Science.gov (United States)

    Vital, J-M; Boissière, L

    2014-02-01

    Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach, lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  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. Benchmarking in pathology: development of an activity-based costing model.

    Science.gov (United States)

    Burnett, Leslie; Wilson, Roger; Pfeffer, Sally; Lowry, John

    2012-12-01

    Benchmarking in Pathology (BiP) allows pathology laboratories to determine the unit cost of all laboratory tests and procedures, and also provides organisational productivity indices allowing comparisons of performance with other BiP participants. We describe 14 years of progressive enhancement to a BiP program, including the implementation of 'avoidable costs' as the accounting basis for allocation of costs rather than previous approaches using 'total costs'. A hierarchical tree-structured activity-based costing model distributes 'avoidable costs' attributable to the pathology activities component of a pathology laboratory operation. The hierarchical tree model permits costs to be allocated across multiple laboratory sites and organisational structures. This has enabled benchmarking on a number of levels, including test profiles and non-testing related workload activities. The development of methods for dealing with variable cost inputs, allocation of indirect costs using imputation techniques, panels of tests, and blood-bank record keeping, have been successfully integrated into the costing model. A variety of laboratory management reports are produced, including the 'cost per test' of each pathology 'test' output. Benchmarking comparisons may be undertaken at any and all of the 'cost per test' and 'cost per Benchmarking Complexity Unit' level, 'discipline/department' (sub-specialty) level, or overall laboratory/site and organisational levels. We have completed development of a national BiP program. An activity-based costing methodology based on avoidable costs overcomes many problems of previous benchmarking studies based on total costs. The use of benchmarking complexity adjustment permits correction for varying test-mix and diagnostic complexity between laboratories. Use of iterative communication strategies with program participants can overcome many obstacles and lead to innovations.

  18. Manufacturing Cost Levelization Model – A User’s Guide

    Energy Technology Data Exchange (ETDEWEB)

    Morrow, William R. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shehabi, Arman [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Smith, Sarah Josephine [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-08-01

    The Manufacturing Cost Levelization Model is a cost-performance techno-economic model that estimates total large-scale manufacturing costs for necessary to produce a given product. It is designed to provide production cost estimates for technology researchers to help guide technology research and development towards an eventual cost-effective product. The model presented in this user’s guide is generic and can be tailored to the manufacturing of any product, including the generation of electricity (as a product). This flexibility, however, requires the user to develop the processes and process efficiencies that represents a full-scale manufacturing facility. The generic model is comprised of several modules that estimate variable costs (material, labor, and operating), fixed costs (capital & maintenance), financing structures (debt and equity financing), and tax implications (taxable income after equipment and building depreciation, debt interest payments, and expenses) of a notional manufacturing plant. A cash-flow method is used to estimate a selling price necessary for the manufacturing plant to recover its total cost of production. A levelized unit sales price ($ per unit of product) is determined by dividing the net-present value of the manufacturing plant’s expenses ($) by the net present value of its product output. A user defined production schedule drives the cash-flow method that determines the levelized unit price. In addition, an analyst can increase the levelized unit price to include a gross profit margin to estimate a product sales price. This model allows an analyst to understand the effect that any input variables could have on the cost of manufacturing a product. In addition, the tool is able to perform sensitivity analysis, which can be used to identify the key variables and assumptions that have the greatest influence on the levelized costs. This component is intended to help technology researchers focus their research attention on tasks

  19. Societal costs of fetal alcohol syndrome in Sweden.

    Science.gov (United States)

    Ericson, Lisa; Magnusson, Lennart; Hovstadius, Bo

    2017-06-01

    To estimate the annual societal cost of fetal alcohol syndrome (FAS) in Sweden, focusing on the secondary disabilities thought feasible to limit via early interventions. Prevalence-based cost-of-illness analysis of FAS in Sweden for 2014. Direct costs (societal support, special education, psychiatric disorders and alcohol/drug abuse) and indirect costs (reduced working capacity and informal caring), were included. The calculations were based on published Swedish studies, including a register-based follow-up study of adults with FAS, reports and databases, and experts. The annual total societal cost of FAS was estimated at €76,000 per child (0-17 years) and €110,000 per adult (18-74 years), corresponding to €1.6 billion per year in the Swedish population using a prevalence of FAS of 0.2 %. The annual additional cost of FAS (difference between the FAS group and a comparison group) was estimated at €1.4 billion using a prevalence of 0.2 %. The major cost driver was the cost of societal support. The cost burden of FAS on the society is extensive, but likely to be underestimated. A reduction in the societal costs of FAS, both preventive and targeted interventions to children with FAS, should be prioritized. That is, the cost of early interventions such as placement in family homes or other forms of housing, and special education, represent unavoidable costs. However, these types of interventions are highly relevant to improve the individual's quality of life and future prospects, and also, within a long-term perspective, to limit the societal costs and personal suffering.

  20. Charging generators for waste management costs

    International Nuclear Information System (INIS)

    Berry, J.B.; Homan, F.J.

    1988-01-01

    The Department of Energy (DOE) has recognized the need for waste management that incorporates improved waste-handling techniques and more stringent regulatory requirements to prevent future liabilities such as Superfund sites. DOE-Oak Ridge Operations (DOE-ORO) has recognized that an effective waste management program focuses on control at the source and that the burden for responsible waste management can be placed on generators by charging for waste management costs. The principle of including the waste management costs in the total cost of the product, even when the product is research and development, is being implemented at Oak Ridge National Laboratory (ORNL). This paper summarizes a plan to charge waste generators, the administrative structure of the plan, a comparison between the rate structure and changes in waste disposal operations, and issues that have surfaced as the plan is implemented

  1. Software Estimates Costs of Testing Rocket Engines

    Science.gov (United States)

    Smith, C. L.

    2003-01-01

    Simulation-Based Cost Model (SiCM), a discrete event simulation developed in Extend , simulates pertinent aspects of the testing of rocket propulsion test articles for the purpose of estimating the costs of such testing during time intervals specified by its users. A user enters input data for control of simulations; information on the nature of, and activity in, a given testing project; and information on resources. Simulation objects are created on the basis of this input. Costs of the engineering-design, construction, and testing phases of a given project are estimated from numbers and labor rates of engineers and technicians employed in each phase, the duration of each phase; costs of materials used in each phase; and, for the testing phase, the rate of maintenance of the testing facility. The three main outputs of SiCM are (1) a curve, updated at each iteration of the simulation, that shows overall expenditures vs. time during the interval specified by the user; (2) a histogram of the total costs from all iterations of the simulation; and (3) table displaying means and variances of cumulative costs for each phase from all iterations. Other outputs include spending curves for each phase.

  2. Morbidity and cost of odontogenic infections.

    Science.gov (United States)

    Eisler, Lindsay; Wearda, Kaitlin; Romatoski, Kelsey; Odland, Rick M

    2013-07-01

    Cost analysis of deep neck space infections from odontogenic origin and review of the morbidity of potentially preventable complications. Case series with chart review. Level 1 trauma center and academic safety net hospital. Patients treated for deep neck space infections due to an odontogenic source between 2001 and 2010 were reviewed. Two hundred patients were included in the study. Ninety-eight patients required inpatient admission. Twelve percent of these patients had difficult airways, and 16% had at least 1 day in the intensive care unit. Cost data were available only for the later 3.5 years of the study period. The overall cost of treatment for these 71 individuals exceeded $1.1 million. The cost of treatment for odontogenic infections is staggering. Based on assumptions of the percentage of infections in the metropolitan area captured at Hennepin County Medical Center, extrapolation to the total national cost of inpatient care approaches $200 million annually. This study highlights the importance of access to medical and preventative dental care for the general population and demonstrates the cost benefit that could be achieved through prevention of disease and, therefore, avoidance of its complications.

  3. 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.

  4. 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...

  5. 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.

  6. Software for Estimating Costs of Testing Rocket Engines

    Science.gov (United States)

    Hines, Merlon M.

    2004-01-01

    A high-level parametric mathematical model for estimating the costs of testing rocket engines and components at Stennis Space Center has been implemented as a Microsoft Excel program that generates multiple spreadsheets. The model and the program are both denoted, simply, the Cost Estimating Model (CEM). The inputs to the CEM are the parameters that describe particular tests, including test types (component or engine test), numbers and duration of tests, thrust levels, and other parameters. The CEM estimates anticipated total project costs for a specific test. Estimates are broken down into testing categories based on a work-breakdown structure and a cost-element structure. A notable historical assumption incorporated into the CEM is that total labor times depend mainly on thrust levels. As a result of a recent modification of the CEM to increase the accuracy of predicted labor times, the dependence of labor time on thrust level is now embodied in third- and fourth-order polynomials.

  7. Social costs of road crashes: An international analysis.

    Science.gov (United States)

    Wijnen, Wim; Stipdonk, Henk

    2016-09-01

    This paper provides an international overview of the most recent estimates of the social costs of road crashes: total costs, value per casualty and breakdown in cost components. The analysis is based on publications about the national costs of road crashes of 17 countries, of which ten high income countries (HICs) and seven low and middle income countries (LMICs). Costs are expressed as a proportion of the gross domestic product (GDP). Differences between countries are described and explained. These are partly a consequence of differences in the road safety level, but there are also methodological explanations. Countries may or may not correct for underreporting of road crashes, they may or may not use the internationally recommended willingness to pay (WTP)-method for estimating human costs, and there are methodological differences regarding the calculation of some other cost components. The analysis shows that the social costs of road crashes in HICs range from 0.5% to 6.0% of the GDP with an average of 2.7%. Excluding countries that do not use a WTP- method for estimating human costs and countries that do not correct for underreporting, results in average costs of 3.3% of GDP. For LMICs that do correct for underreporting the share in GDP ranges from 1.1% to 2.9%. However, none of the LMICs included has performed a WTP study of the human costs. A major part of the costs is related to injuries: an average share of 50% for both HICs and LMICs. The average share of fatalities in the costs is 23% and 30% respectively. Prevention of injuries is thus important to bring down the socio-economic burden of road crashes. The paper shows that there are methodological differences between countries regarding cost components that are taken into account and regarding the methods used to estimate specific cost components. In order to be able to make sound comparisons of the costs of road crashes across countries, (further) harmonization of cost studies is recommended. This can be

  8. 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

  9. Totalization Data Exchange (TDEX)

    Data.gov (United States)

    Social Security Administration — The Totalization Data Exchange (TDEX) process is an exchange between SSA and its foreign country partners to identify deaths of beneficiaries residing abroad. The...

  10. Cost-allocation principles for pipeline capacity and usage

    International Nuclear Information System (INIS)

    Salant, D.J.; Watkins, G.C.

    1996-01-01

    The issue of cost sharing among multiple users of transmission facilities, such as pipelines, was discussed. The various ways in which a fair and reasonable pipeline cost-allocation scheme can be implemented were examined. It was suggested that no method exists for allocating costs that will achieve all major policy goals. The advantages and disadvantages of a system of uniform rates, such as postage stamp tolls, was discussed in the context of a natural gas pipeline system. A postage stamp system is one in which all users pay the same amount per unit of capacity, regardless of transport distances. This rate structure, while sometimes appropriate, is inefficient if total costs are distance-sensitive or if there is a significant variation in the sources of demand. Two commonly accepted minimal principles that a cost allocation should satisfy include: (1) the stand-alone cost test, and (2) the incremental cost test. This means that no one should pay costs in excess of their stand-alone costs and no one should pay less than their incremental costs. Postage stamp tolls were found to fail the minimal set of commonly applied principles. More optimal ways in which to allocate pipeline network costs among users were presented. The nucleolus is a unique cost allocation that is consistent, symmetric and homogeneous. The nucleolus is calculated by splitting the costs equally among users of a common facility. Another effective cost allocation system is the Shapley value which can be derived from a set of axioms which differ slightly from those that identify the nucleolus. 2 refs., 1 tab

  11. Healthcare costs of burn patients from homes without fire sprinklers.

    Science.gov (United States)

    Banfield, Joanne; Rehou, Sarah; Gomez, Manuel; Redelmeier, Donald A; Jeschke, Marc G

    2015-01-01

    The treatment of burn injuries requires high-cost services for healthcare and society. Automatic fire sprinklers are a preventive measure that can decrease fire injuries, deaths, property damage, and environmental toxins. This study's aim was to conduct a cost analysis of patients with burn or inhalation injuries caused by residential fires and to compare this with the cost of implementing residential automatic fire sprinklers. We conducted a cohort analysis of adult burn patients admitted to our provincial burn center (1995-2012). Patient demographics and injury characteristics were collected from medical records and clinical and coroner databases. Resource costs included average cost per day at our intensive care and rehabilitation program, transportation, and property loss. During the study period, there were 1557 residential fire-related deaths province-wide and 1139 patients were admitted to our provincial burn center as a result of a flame injury occurring at home. At our burn center, the average cost was CAN$84,678 per patient with a total cost of CAN$96,448,194. All resources totaled CAN$3,605,775,200. This study shows the considerable healthcare costs of burn patients from homes without fire sprinklers.

  12. Total quality management in orthodontic practice.

    Science.gov (United States)

    Atta, A E

    1999-12-01

    Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.

  13. 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...

  14. 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...

  15. 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...

  16. 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.

  17. Cost analysis of nonoperative management of acute appendicitis in children.

    Science.gov (United States)

    Mudri, Martina; Coriolano, Kamary; Bütter, Andreana

    2017-05-01

    The purpose of this study was to determine if nonoperative management of acute appendicitis in children is more cost effective than appendectomy. A retrospective review of children (6-17years) with acute appendicitis treated nonoperatively (NOM) from May 2012 to May 2015 was compared to similar patients treated with laparoscopic appendectomy (OM) (IRB#107535). Inclusion criteria included symptoms ≤48h, localized peritonitis, and ultrasound confirmation of acute appendicitis. Variables analyzed included failure rates, complications, length of stay (LOS), and cost analysis. 26 NOM patients (30% female, mean age 12) and 26 OM patients (73% female, mean age 11) had similar median initial LOS (24.5h (NOM) vs 16.5h (OM), p=0.076). Median total LOS was significantly longer in the NOM group (34.5h (NOM) vs 17.5 (OM), p=0.01). Median cost of appendectomy was $1416.14 (range $781.24-$2729.97). 9/26 (35%) NOM patients underwent appendectomy for recurrent appendicitis. 4/26 (15%) OM patients were readmitted (postoperative abscess (n=2), Clostridium difficile colitis (n=1), postoperative nausea/vomiting (n=1)). Median initial hospital admission costs were significantly higher in the OM group ($3502.70 (OM) vs $1870.37 (NOM), p=0.004)). However, median total hospital costs were similar for both groups ($3708.68 (OM) vs $2698.99 (NOM), p=0.065)). Although initial costs were significantly less in children with acute appendicitis managed nonoperatively, total costs were similar for both groups. The high failure rate of nonoperative management in this series contributed to the total increased cost in the NOM group. 3b. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. 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

  19. Costs of F-18-FDG PET: experience with a satellite concept

    International Nuclear Information System (INIS)

    Lottes, G.; Kuwert, T.; Schober, O.; Gorschlueter, P.; Adam, D.

    1998-01-01

    Aim: One of the main arguments against the acceptance and introduction of FDG PET as a regular benefit in the statutory Medical Insurance system in Germany are its (alleged) high costs. The aim of the present study has been to determine empirically over a period of twelve months the costs of FDG PET, making use of a satellite concept. Methods: Documentation on performance and consumption data have been assembled for purposes of cost analysis. After analysis these data provided the basis for an assessment of the costs. In view of the high proportion of fixed overheads and strong fluctuations in consumption values, it was not possible to allocate reliably in an individual FDG PET investigation the various types of costs to individual causes. A monthly cost assessment procedure was therefore adopted. For this purpose data were recorded in the Department for Nuclear Medicine, while the statistical assessment of the consumption data and analysis of the costs were undertaken in the Institute of Industrial and Hospital Management. Results: Over the twelve month observation period (November 1995 to October 1996, 177 working days) 433 patients were included in the study: 244 with brain diseases, 37 cardiac patients, 130 whole body studies and 22 combined studies (brain and whole body scans). The non volume based costs, maintenance charges and depreciation accounted for the highest proportion of the total costs (48%). The FDG-related costs accounted for 41% of the total costs, while the personnel costs amounted to 11% and the film costs to only 0.45%. The total costs incurred amounted to DM 1,205,050. Conclusion: These data represent a first empirical cost analysis for FDG PET based on a satellite concept and form a starting point for a cost/benefit analysis of this procedure. (orig.) [de

  20. Total Synthesis of Avrainvilleol.

    Science.gov (United States)

    Wegener, Aaron; Miller, Kenneth A

    2017-11-03

    The first total synthesis of the marine natural product avrainvilleol is reported. The total synthesis features the first application of the transition-metal-free coupling of a tosyl hydrazone and a boronic acid to the preparation of a complex natural product, and the first example of this coupling with a hindered diortho substituted hydrazone substrate.

  1. New benchmarks for costs and cost-efficiency of school-based feeding programs in food-insecure areas.

    Science.gov (United States)

    Gelli, Aulo; Cavallero, Andrea; Minervini, Licia; Mirabile, Mariana; Molinas, Luca; de la Mothe, Marc Regnault

    2011-12-01

    School feeding is a popular intervention that has been used to support the education, health and nutrition of school children. Although the benefits of school feeding are well documented, the evidence on the costs of such programs is remarkably thin. Address the need for systematic estimates of the cost of different school feeding modalities, and of the determinants of the considerable cost variation among countries. WFP project data, including expenditures and number of schoolchildren covered, were collected for 78 projects in 62 countries through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. The standardized yearly average school feeding cost per child, not including school-level costs, was US$48. The yearly costs per child were lowest at US$23 for biscuit programs reaching school-going children and highest at US$75 for take-home rations programs reaching families of schoolgoing children. The average cost of programs combining on-site meals with extra take-home rations for children from vulnerable households was US$61. Commodity costs were on average 58% of total costs and were highest for biscuit and take-home rations programs (71% and 68%, respectively). Fortified biscuits provided the most cost-efficient option in terms of micronutrient delivery, whereas take-home rations were more cost-efficient in terms of food quantities delivered. Both costs and effects should be considered carefully when designing school feeding interventions. The average costs of school feeding estimated here are higher than those found in earlier studies but fall within the range of costs previously reported. Because this analysis does not include school-level costs, these

  2. Cost of illness for chronic stable angina patients enrolled in a self-management education trial

    Science.gov (United States)

    McGillion, Michael; Croxford, Ruth; Watt-Watson, Judy; LeFort, Sandra; Stevens, Bonnie; Coyte, Peter

    2008-01-01

    BACKGROUND: Chronic stable angina (CSA) is a major debilitating health problem in Canada. A paucity of relevant cardiovascular data sets has precluded a detailed examination of the impact of interventions on CSA-related costs and its broader economic burden. OBJECTIVES: As part of a larger clinical trial, the authors sought to determine the short-term impact of a standardized self-management training program on CSA-related costs. A secondary objective was to estimate the total annualized cost of CSA per patient from a societal perspective. METHODS: Pre- and three-month post-test cost data were collected on 117 participants using the Ambulatory Home Care Record. Mean annualized direct, indirect and system-related CSA costs (2003 to 2005) were estimated; total per-patient CSA costs from a societal perspective were calculated as the sum of these costs. RESULTS: The mean (± SD) age of participants was 68±11 years; 80% were male. The program did not impact costs in the short-term. Direct annual out-of-pocket costs, including money paid for health care, travel to appointments, medication, equipment and home support totaled $3,267. Indirect costs, reflecting the value of all unpaid time spent by those engaged in angina-related care, were $12,963. System costs, including costs paid by public and private insurers, were $2,979. Total estimated annual CSA costs from a societal perspective were $19,209 per patient. CONCLUSIONS: These data suggest that CSA imposes a major economic burden, comparable with other prevalent conditions such as chronic noncancer pain. Advancements in self-management training research are needed to help reduce the economic burden of CSA in Canada. PMID:18841254

  3. Cost benefit analysis of recycling nuclear fuel cycle in Korea

    International Nuclear Information System (INIS)

    Lee, Jewhan; Chang, Soonheung

    2012-01-01

    Nuclear power has become an essential part of electricity generation to meet the continuous growth of electricity demand. The importance if nuclear waste management has been the main issue since the beginning of nuclear history. The recycling nuclear fuel cycle includes the fast reactor, which can burn the nuclear wastes, and the pyro-processing technology, which can reprocess the spent nuclear fuel. In this study, a methodology using Linear Programming (LP) is employed to evaluate the cost and benefits of introducing the recycling strategy and thus, to see the competitiveness of recycling fuel cycle. The LP optimization involves tradeoffs between the fast reactor capital cost with pyro-processing cost premiums and the total system uranium price with spent nuclear fuel management cost premiums. With the help of LP and sensitivity analysis, the effect of important parameters is presented as well as the target values for each cost and price of key factors

  4. Switching Costs in Accounting Services

    Directory of Open Access Journals (Sweden)

    Fatih Koç

    2015-06-01

    Full Text Available Switching cost is defined as possible costs that customers may encounter when they want to change the firm they buy service, and an important subject in terms of accounting services. Particularly, small business entrepreneurs’ not having knowledge about accounting procedures, and sharing private information with accounting firms make switching costs more important for accounting services. Thus, the aim of this study is to investigate the concept of switching costs (relational cost, procedural cost and financial cost, its determinants (perceived service quality, service importance, and service failures, and consequences (re-purchasing, and recommen ding to others. Theresearch was conducted on small business entrepreneurs in down-town of Balıkesir in Turkey. Total 405 small business entrepreneur owners were interviewed. According to results of the study, perceived service quality positively affects all dimensions of switching costs, significance of service positively affects procedural and relational costs, and service failures negatively affect procedural and relational costs. The results showed that while procedural and relational costs positively affect re-purchasing and recommending to others variables, financial cost did not have any effect on these variables.

  5. Total Site Heat Integration Considering Pressure Drops

    Directory of Open Access Journals (Sweden)

    Kew Hong Chew

    2015-02-01

    Full Text Available Pressure drop is an important consideration in Total Site Heat Integration (TSHI. This is due to the typically large distances between the different plants and the flow across plant elevations and equipment, including heat exchangers. Failure to consider pressure drop during utility targeting and heat exchanger network (HEN synthesis may, at best, lead to optimistic energy targets, and at worst, an inoperable system if the pumps or compressors cannot overcome the actual pressure drop. Most studies have addressed the pressure drop factor in terms of pumping cost, forbidden matches or allowable pressure drop constraints in the optimisation of HEN. This study looks at the implication of pressure drop in the context of a Total Site. The graphical Pinch-based TSHI methodology is extended to consider the pressure drop factor during the minimum energy requirement (MER targeting stage. The improved methodology provides a more realistic estimation of the MER targets and valuable insights for the implementation of the TSHI design. In the case study, when pressure drop in the steam distribution networks is considered, the heating and cooling duties increase by 14.5% and 4.5%.

  6. Pharmaceutical costs of assisted reproduction in Spain.

    Science.gov (United States)

    Lorente, Maria-Reyes; Hernández, Juana; Antoñanzas, Fernando

    2013-11-01

    Assisted reproduction is one of the health services currently being considered for possible limitation or exclusion from the public health services portfolio in Spain. One of the main reasons claimed for this is the impact on the budget for pharmaceutical expenditure. The objective of this study was to assess the significance of the pharmaceutical costs of assisted reproduction in Spain. This study focused on medical practice in Spain, and is based on the opinions of experts in assisted reproduction and the results provided by professional societies' publications. The reference year is 2012 and the setting was secondary care. We have included all existing pharmaceutical modalities for assisted reproduction, as well as the most common drug for each modality. We have considered the pharmaceutical cost per cycle for artificial insemination, in vitro fertilisation with or without intracytoplasmic sperm injection (IVF_ICSI), and cryotransfer and donated fresh oocytes reception. In Spain, artificial insemination has a pharmaceutical cost per cycle of between €69.36 and €873.79. This amounts to an average cycle cost of €364.87 for partner's sperm and €327.10 for donor sperm. The pharmaceutical cost of IVF_ICSI ranges between €278.16 and €1,902.66, giving an average cost per cycle of €1,139.65. In the case of cryotransfer and donated fresh oocytes reception, the pharmaceutical cost per cycle is between €22.61 and €58.73, yielding an average cost of €40.67. The budgetary impact of pharmaceutical expenditure for assisted reproduction in Spain for the year 2012 was estimated at €98.7 million. In Spain, the total pharmaceutical cost of assisted reproduction is substantial. According to our results, we can say that about 29% of the total pharmaceutical expenditure for assisted reproduction techniques is funded by the National Health System and the rest represents 2.4% of the total annual out-of-pocket family expenditure on drugs.

  7. <