WorldWideScience

Sample records for indirect costs resulting

  1. Indirect Cost Reimbursement: An Industrial View.

    Science.gov (United States)

    Bolton, Robert

    1987-01-01

    The meaning of indirect costs in an industrial environment is discussed. Other factors considered are corporate policies; nature of work being supported; the uniqueness of the work; who is doing the negotiating for industry; and indirect rates. Suggestions are offered for approaches to indirect cost reimbursement. (Author/MLW)

  2. INDIRECT LABOR COSTS AND IMPLICATIONS FOR OVERHEAD ALLOCATION

    OpenAIRE

    Bea Chiang

    2013-01-01

    Cost accounting typically allocates indirect labor cost to cost object based on direct labor hours. The allocation process implicitly assumes that indirect labor costs vary proportionally with direct labor hours. The assumption of a linear relationship between indirect and direct labor is particularly suspicious at low production volume levels because there tends to be a fixed component in indirect labor. The linearity assumption is also challenged by recent increasing complexity of indirect ...

  3. The Indirect cost of illness in Africa

    Directory of Open Access Journals (Sweden)

    Joses Muthuri Kirigia

    2018-06-01

    Full Text Available Background: The current study estimated (a the indirect costs associated with non-fatal disability and premature death across a wide range of diseases and health conditions in Africa in 2015 and (b the potential savings that could be accrued if countries were to meet the 3 health targets of the substainable development goal (SDG compared to the costs under the status quo. Methods: This study used the lost output or human capital approach to quantify the gross domestic product (GDP losses associated with the disability-adjusted-life-years (DALYs lost due to all causes by age group as well as by country economic classification (Group 1: 10 high/upper-middle income countries; Group 2: 17 lower-middle income countries; and Group 3: 27 low income countries. Results: The expected indirect cost of the 704,765,879 DALYs lost in Africa in 2015 was Int$ 2,983,187,560,197. Of this amount, 25.17%, 57.84% and 16.99% were incurred by the economies of the countries comprising Group 1, Group 2 and Group 3, respectively. Of the total continental indirect cost, 36.9%, 10.5%, 13.7%, 17.0%, 7.6%, 6.8% and 7.5% were associated with people aged 0-4, 5-14, 15-29, 30-49, 50-59, 60-69 and 70 years or older, respectively. Most of the total indirect cost (56.61% was attributable to maternal conditions, AIDS, tuberculosis (TB, malaria, neglected tropicald diseases (NTDs, non-communicable diseases and traffic injuries. Approximately half (47% of this cost could be avoided (or saved every year if the 3 (health targets of the SDG were fully met. Conclusion: The study estimated the total indirect cost of illness due to all causes by age group and country economic classification. The annual indirect cost is substantial. The findings contained in this paper suggest that health system strengthening should focus on both rich and poor countries, people of all ages and specific disease categories.

  4. The direct and indirect costs of Dravet Syndrome.

    Science.gov (United States)

    Whittington, Melanie D; Knupp, Kelly G; Vanderveen, Gina; Kim, Chong; Gammaitoni, Arnold; Campbell, Jonathan D

    2018-03-01

    The objective of this study was to estimate the annual direct and indirect costs associated with Dravet Syndrome (DS). A survey was electronically administered to the caregivers of patients with DS treated at Children's Hospital Colorado. Survey domains included healthcare utilization of the patient with DS and DS caregiver work productivity and activity impairment. Patient healthcare utilization was measured using modified questions from the National Health Interview Survey; caregiver work productivity and activity impairment were measured using modified questions from the Work Productivity and Activity Impairment questionnaire. Direct costs were calculated by multiplying the caregiver-reported healthcare utilization rates by the mean unit cost for each healthcare utilization category. Indirect costs included lost productivity, income loss, and lost leisure time. The indirect costs were a function of caregiver-reported hours spent caregiving and an hourly unit cost. The survey was emailed to 60 DS caregivers, of which 34 (57% response rate) responded. Direct costs on average were $27,276 (95% interval: $15,757, $41,904) per patient with DS. Hospitalizations ($11,565 a year) and in-home medical care visits ($9894 a year) were substantial cost drivers. Additionally, caregivers reported extensive time spent providing care to an individual with DS. This caregiver time resulted in average annual indirect costs of $81,582 (95% interval: $57,253, $110,151), resulting in an average total annual financial burden of $106,378 (95% interval: $78,894, $137,906). Dravet Syndrome results in substantial healthcare utilization, financial burden, and time commitment. Establishing evidence on the financial burden of DS is essential to understanding the overall impact of DS, identifying potential areas for support needs, and assessing the impact of novel treatments as they become available. Based on the study findings, in-home visits, hospitalizations, and lost productivity and

  5. Smoking Cessation Is Associated With Lower Indirect Costs.

    Science.gov (United States)

    Baker, Christine L; Bruno, Marianna; Emir, Birol; Li, Vicky W; Goren, Amir

    2018-06-01

    This study quantified differences in indirect costs due to decreased work productivity between current and former smokers. Former smokers were further categorized by number of years since quitting to assess corresponding differences. Data on employed individuals were obtained from the 2013 US National Health and Wellness Survey (NHWS; N = 75,000). Indirect costs were calculated for current smokers and former smokers from weekly wages based on age and sex. The annual total indirect costs for current smokers were $1327.53, $1560.18, and $1839.87 higher than for those who quit 0 to 4 years, 5 to 10 years, and more than or equal to 11 years prior, respectively. There were no significant differences in mean total indirect costs between the former smoker groups. Current smokers showed significantly higher total annual indirect costs compared with former smokers, independently of the number of years since quitting smoking.

  6. The hidden costs: Identification of indirect costs associated with acute gastrointestinal illness in an Inuit community

    Science.gov (United States)

    Vriezen, Rachael; Edge, Victoria L.; Ford, James; Wood, Michele; Harper, Sherilee

    2018-01-01

    Background Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities’ unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs. Methods A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs. Results/Significance The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs. PMID:29768456

  7. 10 CFR 602.15 - Indirect cost limitations.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Indirect cost limitations. 602.15 Section 602.15 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS EPIDEMIOLOGY AND OTHER HEALTH STUDIES FINANCIAL ASSISTANCE PROGRAM § 602.15 Indirect cost limitations. Awards issued under this part for conferences and...

  8. 10 CFR 605.16 - Indirect cost limitations.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Indirect cost limitations. 605.16 Section 605.16 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS THE OFFICE OF ENERGY RESEARCH FINANCIAL ASSISTANCE PROGRAM § 605.16 Indirect cost limitations. Awards issued under this part for conferences and scientific...

  9. Estimating direct and indirect costs of premenstrual syndrome.

    Science.gov (United States)

    Borenstein, Jeff; Chiou, Chiun-Fang; Dean, Bonnie; Wong, John; Wade, Sally

    2005-01-01

    To quantify the economic impact of premenstrual syndrome (PMS) on the employer. Data were collected from 374 women aged 18-45 with regular menses. Direct costs were quantified using administrative claims of these patients and the Medicare Fee Schedule. Indirect costs were quantified by both self-reported days of work missed and lost productivity at work. Regression analyses were used to develop a model to project PMS-related direct and indirect costs. A total of 29.6% (n = 111) of the participants were diagnosed with PMS. A PMS diagnosis was associated with an average annual increase of $59 in direct costs (P increase in direct medical costs and a large increase in indirect costs.

  10. The indirect costs of ankylosing spondylitis: a systematic review and meta-analysis.

    Science.gov (United States)

    Malinowski, Krzysztof Piotr; Kawalec, Paweł

    2015-04-01

    The aim of this systematic review was to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with ankylosing spondylitis. The search was conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2013 prices USD using the consumer price index and purchasing power parity. Identified studies were then analyzed to assess their possible inclusion in the meta-analysis. We identified 32 records. The average annual indirect cost per patient varies among all the identified results from US$660.95 to 45,953.87. The mean annual indirect per patient equals US$6454.76. This systematic review summarizes current data related to indirect costs generated by ankylosing spondylitis; it revealed the great economic burden of the disease for society. We observed a great variety of the considered components of indirect costs and their definitions.

  11. The Indirect Costs of Financial Distress in Indonesia

    Directory of Open Access Journals (Sweden)

    Wijantini Wijantini

    2007-06-01

    Full Text Available This paper presents quantitative estimates of the indirect cost of financial distress and its determinants. In order to measure the cost, this study estimates the annualized changes in industry-adjusted operation profit and sales from a year before the onset of distress to the resolution year. Using those approaches, the median of indirect financial distress cost is estimated between three and 11 percent annually. To the extent that the direct cost of financial distress reduces reported operating income, the estimated costs are overstated. The simple regressions analysis suggest that the indirect cost of financial distress significantly increases with size, leverage, number of creditors, and poor industry performance, but is not related to degree of bank loan reliance. The findings provide a weak support for the financial distress theory which suggests that conflicts of interest render the costs of financial distress.

  12. Lifestyle factors, direct and indirect costs for a Brazilian airline company

    Science.gov (United States)

    Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

    2014-01-01

    OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. PMID:26039398

  13. Lifestyle factors, direct and indirect costs for a Brazilian airline company.

    Science.gov (United States)

    Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

    2014-12-01

    OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

  14. Lifestyle factors, direct and indirect costs for a Brazilian airline company

    Directory of Open Access Journals (Sweden)

    Fabiana Maluf Rabacow

    2014-12-01

    Full Text Available OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking, was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

  15. Indirect costs of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Filip Raciborski

    2015-12-01

    Full Text Available It is estimated that in Poland about 400,000 persons in general suffer from inflammatory joint diseases, including rheumatoid arthritis (RA. Epidemiological surveys documenting the frequency and disturbance of musculoskeletal disorders in the Polish population are few in number. Most of the estimations are based on epidemiological data from other countries (prevalence of 0.5–1%. According to the data of the National Health Fund in Poland 135,000–157,000 persons in total are treated because of rheumatoid arthritis per year [ICD10 (International Statistical Classification of Diseases and Related Health Problems: M05, M06]. In the case of this group of diseases indirect costs significantly outweigh the direct costs. Indirect costs increase together with activity level of the disease. The cost analysis of productivity loss of RA patients indicates that sickness absenteeism and informal care are the most burdensome. At the national level it amounts in total from 1.2 billion to 2.8 billion PLN per year, depending on the method of analysis. These costs could be significantly reduced through early diagnosis and introduction of effective treatment.

  16. The Indirect Costs of Financial Distress in Indonesia

    OpenAIRE

    Wijantini, Wijantini

    2007-01-01

    This paper presents quantitative estimates of the indirect cost of financial distress and its determinants. In order to measure the cost, this study estimates the annualized changes in industry-adjusted operation profit and sales from a year before the onset of distress to the resolution year. Using those approaches, the median of indirect financial distress cost is estimated between three and 11 percent annually. To the extent that the direct cost of financial distress reduces reported opera...

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

    Science.gov (United States)

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

    2012-01-01

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

  18. 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

  19. 48 CFR 31.203 - Indirect costs.

    Science.gov (United States)

    2010-10-01

    ... fiscal year used for financial reporting purposes in accordance with generally accepted accounting... contract or other work, indirect costs are those remaining to be allocated to intermediate or two or more... basis of the benefits accruing to intermediate and final cost objectives. When substantially the same...

  20. Issues connected with indirect cost quantification: a focus on the transportation system

    Science.gov (United States)

    Křivánková, Zuzana; Bíl, Michal; Kubeček, Jan; Vodák, Rostislav

    2017-04-01

    Transportation and communication networks in general are vital parts of modern society. The economy relies heavily on transportation system performance. A number of people commutes to work regularly. Stockpiles in many companies are being reduced as the just-in-time production process is able to supply resources via the transportation network on time. Natural hazards have the potential to disturb transportation systems. Earthquakes, flooding or landsliding are examples of high-energetic processes which are capable of causing direct losses (i.e. physical damage to the infrastructure). We have focused on quantification of the indirect cost of natural hazards which are not easy to estimate. Indirect losses can also emerge as a result of meteorological hazards with low energy which only seldom cause direct losses, e.g. glaze, snowfall. Whereas evidence of repair work and general direct costs usually exist or can be estimated, indirect costs are much more difficult to identify particularly when they are not covered by insurance agencies. Delimitations of alternative routes (detours) are the most frequent responses to blocked road links. Indirect costs can then be related to increased fuel consumption and additional operating costs. Detours usually result in prolonged travel times. Indirect costs quantification has to therefore cover the value of the time. The costs from the delay are a nonlinear function of travel time, however. The existence of an alternative transportation pattern may also result in an increased number of traffic crashes. This topic has not been studied in depth but an increase in traffic crashes has been reported when people suddenly changed their traffic modes, e.g. when air traffic was not possible. The lost user benefit from those trips that were cancelled or suppressed is also difficult to quantify. Several approaches, based on post-event questioner surveys, have been applied to communities and companies affected by transportation accessibility

  1. Productivity loss due to overweight and obesity: a systematic review of indirect costs.

    Science.gov (United States)

    Goettler, Andrea; Grosse, Anna; Sonntag, Diana

    2017-10-05

    The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity. A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality. Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies. The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. The indirect costs and benefits of greenhouse gas mitigation

    International Nuclear Information System (INIS)

    Markandya, A.

    1998-01-01

    The indirect costs of GHG projects are very important in the evaluation of such projects. In many cases they are more important than the direct costs. This paper has shown what such costs consist of and how they may be estimated. As countries prepare their mitigation strategies, it is very important that they develop tools for the assessment of these indirect costs and use these tools in the appropriate manner. Hopefully, this paper will point them in the right direction. (au) 11 refs

  3. [Methodologies for estimating the indirect costs of traffic accidents].

    Science.gov (United States)

    Carozzi, Soledad; Elorza, María Eugenia; Moscoso, Nebel Silvana; Ripari, Nadia Vanina

    2017-01-01

    Traffic accidents generate multiple costs to society, including those associated with the loss of productivity. However, there is no consensus about the most appropriate methodology for estimating those costs. The aim of this study was to review methods for estimating indirect costs applied in crash cost studies. A thematic review of the literature was carried out between 1995 and 2012 in PubMed with the terms cost of illness, indirect cost, road traffic injuries, productivity loss. For the assessment of costs we used the the human capital method, on the basis of the wage-income lost during the time of treatment and recovery of patients and caregivers. In the case of premature death or total disability, the discount rate was applied to obtain the present value of lost future earnings. The computed years arose by subtracting to life expectancy at birth the average age of those affected who are not incorporated into the economically active life. The interest in minimizing the problem is reflected in the evolution of the implemented methodologies. We expect that this review is useful to estimate efficiently the real indirect costs of traffic accidents.

  4. Indirect costs of teaching in Canadian hospitals.

    Science.gov (United States)

    MacKenzie, T A; Willan, A R; Cox, M A; Green, A

    1991-01-01

    We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

  5. Indirect reciprocity can overcome free-rider problems on costly moral assessment.

    Science.gov (United States)

    Sasaki, Tatsuya; Okada, Isamu; Nakai, Yutaka

    2016-07-01

    Indirect reciprocity is one of the major mechanisms of the evolution of cooperation. Because constant monitoring and accurate evaluation in moral assessments tend to be costly, indirect reciprocity can be exploited by cost evaders. A recent study crucially showed that a cooperative state achieved by indirect reciprocators is easily destabilized by cost evaders in the case with no supportive mechanism. Here, we present a simple and widely applicable solution that considers pre-assessment of cost evaders. In the pre-assessment, those who fail to pay for costly assessment systems are assigned a nasty image that leads to them being rejected by discriminators. We demonstrate that considering the pre-assessment can crucially stabilize reciprocal cooperation for a broad range of indirect reciprocity models. In particular for the most leading social norms, we analyse the conditions under which a prosocial state becomes locally stable. © 2016 The Authors.

  6. Indirect reciprocity provides a narrow margin of efficiency for costly punishment

    Science.gov (United States)

    Iwasa, Yoh; Nowak, Martin A.

    2008-01-01

    Indirect reciprocity1-5 is a key mechanism for the evolution of human cooperation. Our behavior toward other people depends not only on what they have done to us, but also on what they have done to others. Indirect reciprocity works via reputation5-17. The standard model of indirect reciprocity offers a binary choice: people can either cooperate or defect. Cooperation implies a cost for the donor and a benefit for the recipient. Defection has no cost and yields no benefit. Currently there is considerable interest in studying the effect of costly (or altruistic) punishment on human behavior18-25. Punishment implies a cost for the punished person. Costly punishment means that the punisher also pays a cost. It has been suggested that costly punishment between individuals can promote cooperation. Here we study the role of costly punishment in an explicit model of indirect reciprocity. We analyze all social norms, which depend on the action of the donor and the reputation of the recipient. We allow errors in assigning reputation and study gossip as a mechanism for establishing coherence. We characterize all strategies that allow the evolutionary stability of cooperation. Some of those strategies use costly punishment, while others do not. We find that punishment strategies typically reduce the average payoff of the population. Consequently, there is only a small parameter region where costly punishment leads to an efficient equilibrium. In most cases, the population does better by not using costly punishment. The efficient strategy for indirect reciprocity is to withhold help for defectors rather than punish them. PMID:19122640

  7. 48 CFR 52.216-15 - Predetermined Indirect Cost Rates.

    Science.gov (United States)

    2010-10-01

    .... (c) Allowability of costs and acceptability of cost allocation methods shall be determined in...) the period for which the rates apply, and (4) the specific items treated as direct costs or any changes in the items previously agreed to be direct costs. The indirect cost rate agreement shall not...

  8. Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.

    Science.gov (United States)

    Robinson, Luke Steven; Sarkies, Mitchell; Brown, Ted; O'Brien, Lisa

    2016-12-01

    Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic

  9. 23 CFR 140.907 - Overhead and indirect construction costs.

    Science.gov (United States)

    2010-04-01

    ... accounting principles; (2) The costs included in the distribution are limited to costs actually incurred by...), part 31, Contract Cost Principles and Procedures, relating to contracts with commercial organizations... 23 Highways 1 2010-04-01 2010-04-01 false Overhead and indirect construction costs. 140.907...

  10. Estimating two indirect logging costs caused by accelerated erosion.

    Science.gov (United States)

    Glen O. Klock

    1976-01-01

    In forest areas where high soil erosion potential exists, a comparative yarding cost estimate, including the indirect costs determined by methods proposed here, shows that the total cost of using "advanced" logging methods may be less than that of "traditional" systems.

  11. 48 CFR 49.303-4 - Adjustment of indirect costs.

    Science.gov (United States)

    2010-10-01

    ... costs. 49.303-4 Section 49.303-4 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Cost-Reimbursement Contracts... compute indirect costs for other contracts performed during the applicable accounting period. [48 FR 42447...

  12. The indirect costs of multiple sclerosis: systematic review and meta-analysis.

    Science.gov (United States)

    Stawowczyk, Ewa; Malinowski, Krzysztof Piotr; Kawalec, Paweł; Moćko, Paweł

    2015-01-01

    The aim of this systematic review is to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with multiple sclerosis. Searches were conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2014 prices US$ using the consumer price index and purchasing power parity (scenario 1) and expressed as proportion of specific gross domestic product in current local currency unit to adjust for country's development (scenario 2). Identified studies were then analyzed in order to assess their possible inclusion in the meta-analysis. The authors identified 63 records, of which 23 were eligible for meta-analysis. Overall indirect cost per patient calculated in scenario 1 was as high as US$20,167 with US$22,197 in Europe, US$17,382 in North America and US$153 in Asia. Overall indirect cost per patient calculated in scenario 2 was equal to US$16,939, with US$19,612 in Europe, US$11,592 in North America and US$899 in Asia. Overall indirect costs varied from US$3726 for patients with EDSS score less than 3 to US$19,264 for patients with Expanded Disability Status Scale score grater that 7. This review revealed the great economic burden of multiple sclerosis on society. The authors observed a great variety of the considered components of indirect costs and their definitions. Costs were higher for Europe than for other continents and were also higher for patients with a higher Expanded Disability Status Scale score.

  13. How to Prepare an Indirect Cost Rate Proposal for a Non-profit Organization

    Science.gov (United States)

    The indirect cost rate proposal is the documentation prepared by a grantee organization, in accordance with applicable federal cost principles, to substantiate its claim for the reimbursement of indirect costs.

  14. The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

    Science.gov (United States)

    Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Tzanakis, Nikos; Toumbis, Michalis; Vassilakopoulos, Theodoros

    2017-01-01

    COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

  15. Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

    Science.gov (United States)

    Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

    2017-03-01

    To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  16. Utility loss and indirect costs after stroke in Sweden.

    Science.gov (United States)

    Lindgren, Peter; Glader, Eva-Lotta; Jönsson, Bengt

    2008-04-01

    Currently little data exist on the development of quality of life over time in patients suffering from stroke, in particular using instruments that can be adapted in economic studies. The purpose of the study was to assess the utility loss and indirect costs following a stroke in Sweden. A cross-sectional mail survey. In collaboration with the National Stroke registry (RIKS-STROKE), a questionnaire consisting of the EuroQol-5D and questions regarding the present working status and the status prior to the stroke was mailed to patients below 76 years of age at six participating centres. The questionnaire was mailed to 393 patients in total, divided into groups with 3, 6, 9 or 12 months having passed since the stroke. The EuroQol-5D scores were converted to utility scores using the UK social tariff. Indirect costs were valued according to the average salary+employer contributions. A total of 275 questionnaires (70%) were returned. Utility scores were similar over time: 0.65, 0.75, 0.63, and 0.67 at 3, 6, 9 and 12 months, respectively. Regression analyses revealed a tendency for lower utility scores among women, but no significant differences overall. Among patients in the working ages, a stroke caused 18.5 work weeks lost, corresponding to an indirect cost of 120,000 Swedish Kronor (SEK) (13,200euro, 95% confidence interval 82,541-160,050 SEK, 9080-17 605euro). Stroke causes a significant reduction in utility and causes high indirect costs. A substantial improvement was not noted over time, which is important to consider in economic models.

  17. Indirect Costs: Daily Bread, Cake, or Cracker.

    Science.gov (United States)

    Lucas, Robert A.

    1988-01-01

    The tradition of negotiating indirect costs in grants should be abandoned, and research administrators should instead offer different levels of service depending on what the sponsor wants to spend. Three levels of overhead rate are suggested (super, regular, and economy) and their corresponding levels of service are defined. (MSE)

  18. Indirect costs of diabetes and its impact on the public finance: the case of Poland.

    Science.gov (United States)

    Torój, Andrzej; Mela, Aneta

    2018-02-01

    Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues. This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012-2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office. Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively. Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.

  19. Indirect costs of inflammatory bowel diseases: Crohn's disease and ulcerative colitis. A systematic review.

    Science.gov (United States)

    Kawalec, Paweł

    2016-04-01

    Crohn's disease and ulcerative colitis are lifelong illnesses which have a significant impact on quality of life and personal burden through a reduction in the ability to work, sick leave and restrictions of leisure time. The aim of this study was to conduct a systematic review of the indirect costs of Crohn's disease and ulcerative colitis. The search was carried out in Medline, EMBASE, the Centre for Reviews and Dissemination, and reference lists of identified articles and reference lists of identified articles were also handsearched. All costs were adjusted to 2013 USD values by using the consumer price index and purchasing power parity. Identified studies were then analysed in order to assess their heterogeneity and possibility of inclusion in the meta-analysis. Eleven of the identified publications presented indirect costs of Crohn's disease or ulcerative colitis. The range of estimated yearly indirect costs per patient was large, from $1 159.09 for loss of earnings to $14 135.64 for lost productivity and sick leave for Crohn's disease. The values for ulcerative colitis ranged from $926.49 to $6 583.17. Because of the imprecise definition of methods of indirect cost calculations as well as heterogeneity of indirect cost components, a meta-analysis was not performed. The indirect costs of ulcerative colitis seem to be slightly lower than in the case of Crohn's disease. A small number of studies referring to indirect costs of Crohn's disease and ulcerative colitis were identified, which indicates the need to conduct further investigations on this problem.

  20. Direct and indirect economic costs among private-sector employees with osteoarthritis.

    Science.gov (United States)

    Berger, Ariel; Hartrick, Craig; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

    2011-11-01

    To estimate direct and indirect economic costs among private-sector employees with osteoarthritis (OA). Using a large US employer benefits database, we identified all employees with evidence of OA during calendar year 2007, and compared their costs of health care and work loss to age-and-sex-matched employees without evidence of OA in that year. Private-sector employees with OA (n = 2399) averaged 62.9 days of absenteeism versus 36.7 days among matched comparators (n = 2399) (P Private-sector employees with OA have higher direct and indirect costs than those without this condition.

  1. 78 FR 53425 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2013-08-29

    ... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct... allocation method for the development of the FY 2012 indirect cost rates. The DARRP's Indirect Cost Rates and... accounting system and allocation practices; recommend the appropriate indirect cost allocation methodology...

  2. Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain, according to disability

    Directory of Open Access Journals (Sweden)

    Gubieras Laura

    2006-11-01

    Full Text Available Abstract Background Multiple sclerosis (MS is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia and grouped according to their disability (EDSS. Methods We analysed data from 200 MS patients, who answered a questionnaire on resource consumption, employment and economical status. Mean age was 41.6 years, mean EDSS 2.7, 65.5% of patients were female, 79.5% had a relapsing-remitting course, and 67.5% of them were receiving immunomodulatory treatment (IT. Patients were grouped into five EDSS stages. Data from the questionnaires, hospital charts, Catalan Health Service tariffs, and figures from Catalan Institute of Statistics were used to calculate the direct and indirect costs. The cost-of-illness method, and the human capital approach for indirect costs, were applied. Sensitivity analyses were performed to strengthen results. Results The mean total annual cost of MS per patient results 24272 euros. This cost varied according to EDSS: 14327 euros (EDSS = 0, 18837 euros (EDSS = 1–3, 27870 euros (EDSS = 3.5–5.5, 41198 euros (EDSS = 6–7 and 52841 euros (EDSS>7.5. When the mean total annual costs was adjusted by the mean % of patients on IT in our Unit (31% the result was 19589 euros. The key-drivers for direct costs were IT in low EDSS stages, and caregiver costs in high stages. Indirect costs were assessed in terms of the loss of productivity when patients stop working. Direct costs accounted for around 60% of total costs in all EDSS groups. IT accounts from 78% to 11% of direct costs, and decreased as disability progressed. Conclusion The total mean social costs of MS in a

  3. [Prevalence and indirect costs of headache in a Brazilian Company].

    Science.gov (United States)

    Vincent, M; Rodrigues, A de J; De Oliveira, G V; De Souza, K F; Doi, L M; Rocha, M B; Saporta, M A; Orleans, R B; Kotecki, R; Estrela, V V; De Medeiros, V A; Borges, W I

    1998-12-01

    Employees from a Brazilian oil company research centre (n = 993) were interviewed on the occurrence of headache during a 30 days period. Headache prevalence was 49.8%, with a mean frequency of 4.3 +/- 7.0 attacks per month, lasting 12.2 +/- 21.4 hours each. According to the International Headache Society diagnostic criteria, migraine (5.5%), episodic tension-type headache (26.4%), chronic tension-type headache (1.7%) and headaches not fulfilling the criteria for such disorders (16.2%) were observed. Women suffered comparatively more headache and specifically migraine than men. The pain interfered with work productivity in 10% of the subjects, corresponding to 538.75 hours off. According to an indirect costs estimation for each headache, the company may loose up to US$125.98 per employee annually. Since among headaches migraine has the highest indirect cost, migraine prevention and treatment is particularly important at the working environment. Migraine frequency may be prevented to a large extent, resulting on positive effects in both the quality of life and productivity. The cost-benefit ratio clearly favours therapeutic and preventive programs against chronic headaches.

  4. Large and abundant flowers increase indirect costs of corollas: a study of coflowering sympatric Mediterranean species of contrasting flower size.

    Science.gov (United States)

    Teixido, Alberto L; Valladares, Fernando

    2013-09-01

    Large floral displays receive more pollinator visits but involve higher production and maintenance costs. This can result in indirect costs which may negatively affect functions like reproductive output. In this study, we explored the relationship between floral display and indirect costs in two pairs of coflowering sympatric Mediterranean Cistus of contrasting flower size. We hypothesized that: (1) corolla production entails direct costs in dry mass, N and P, (2) corollas entail significant indirect costs in terms of fruit set and seed production, (3) indirect costs increase with floral display, (4) indirect costs are greater in larger-flowered sympatric species, and (5) local climatic conditions influence indirect costs. We compared fruit set and seed production of petal-removed flowers and unmanipulated control flowers and evaluated the influence of mean flower number and mean flower size on relative fruit and seed gain of petal-removed and control flowers. Fruit set and seed production were significantly higher in petal-removed flowers in all the studied species. A positive relationship was found between relative fruit gain and mean individual flower size within species. In one pair of species, fruit gain was higher in the large-flowered species, as was the correlation between fruit gain and mean number of open flowers. In the other pair, the correlation between fruit gain and mean flower size was also higher in the large-flowered species. These results reveal that Mediterranean environments impose significant constraints on floral display, counteracting advantages of large flowers from the pollination point of view with increased indirect costs of such flowers.

  5. Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands

    Directory of Open Access Journals (Sweden)

    Kincler Naomi

    2009-08-01

    Full Text Available Abstract Background In low tuberculosis (TB incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. Methods A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1–6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. Results In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted €353. Most costs were spent when being hospitalized. Time loss (mean 81 days was mainly due to hospitalization (19 days and additional work days lost (60 days, and corresponded with a cost estimation of €2603. Conclusion Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

  6. Development of subcontractor indirect cost and other direct cost at the DOE Fernald Site

    International Nuclear Information System (INIS)

    Cossman, R.L.

    1994-01-01

    The Fernald Environmental Restoration Management Corporation (FERMCO) took great strides in the development of cost estimates at Fernald. There have been many opportunities to improve on how the policies and procedures pertaining to cost estimates were to be implemented. As FERMCO took over the existing Fernald facility, the Project Controls Division began to format the estimating procedures and tools to do business at Fernald. The Estimating Department looked at the problems that pre-existed at the site. One of the key problems that FERMCO encountered was how to summarized the direct and indirect accounts of each subcontracted estimate. Direct costs were broken down by prime and sub-prime accounts. This presented a level of detail that had not been experienced at the site before; it also created many issues concerning accounts and definitions to be applied to ''all other accounts associated with a project.'' Existing subcontract indirect cost accounts were reviewed from existing historical estimates. It was found that some were very detailed and some were not. The Estimating Department was given the task of standardizing the accounts and percentages for each of the subcontractor indirect costs. Then, as the project progressed, the percentages could be revised with actual estimates, subcontract comparisons, or with level of effort (LOE) accounts, which would represent qualified people assigned a task for the completion of each project. The approach is to assign particular employees to perform a specific task within a project from start to finish, and then to reassign the individual(s) to a new project (if it was available) integrating the expertise available with the skills required by the other operable units

  7. Lifestyle factors, direct and indirect costs for a Brazilian airline company

    NARCIS (Netherlands)

    F.M. Rabacow (Fabiana Maluf); O. Do Carmo Luiz (Olinda); A.M. Malik (Ana Maria); A. Burdorf (Alex)

    2014-01-01

    textabstractObjective: To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. Methods: In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave

  8. Indirect health costs in ulcerative colitis and Crohn's disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Kawalec, Paweł; Malinowski, Krzysztof Piotr

    2015-04-01

    The aim of this systematic review was to collect all current data on indirect costs related to inflammatory bowel disease as well as assessing homogeneity and comparability, and conducting a meta-analysis. Costs were collected using databases from Medline, Embase and Centre for Reviews and Dissemination databases, then average annual cost per patient was calculated and expressed in 2013-rate USD using the consumer price index and purchasing power parity (scenario 1) and then adjusted to specific gross domestic product (scenario 2) to make them comparable. The studies were then included in quantitative synthesis using the meta-analysis and bootstrap methods. This systematic review was carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. From 18 publications, overall annual indirect costs per patient as a result of the quantitative synthesis among all studies eligible for meta-analysis ranged from US$2425.01-US$9622.15 depending on the scenario and model used for analysis. The cost of presenteeism was assessed in only two studies. Considering heterogeneity among all identified studies random-effect model presented the most accurate results of meta-analysis equal to US$7189.27 and US$9622.15 per patient per year for scenario 1 and scenario 2, respectively. This systematic review revealed the existence of a relatively small number of studies that reported on the great economic burden of the disease upon society. A great variety of methodologies and cost components resulted in a very large discrepancy in indirect costs and made meta-analysis difficult to perform, so two scenarios were considered and meta-analysis conducted in subgroups to make data more comparable.

  9. 77 FR 63804 - Federal Acquisition Regulation; Information Collection; Indirect Cost Rates

    Science.gov (United States)

    2012-10-17

    ... cost accounting information normally prepared by organizations under sound management and accounting...; Information Collection; Indirect Cost Rates AGENCY: Department of Defense (DOD), General Services... Paperwork Reduction Act, the Regulatory Secretariat will be submitting to the Office of Management and...

  10. Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.

    Science.gov (United States)

    Hamuryudan, Vedat; Direskeneli, Haner; Ertenli, Ihsan; Inanc, Murat; Karaaslan, Yasar; Oksel, Fahrettin; Ozbek, Suleyman; Pay, Salih; Terzioglu, Ender; Balkan Tezer, Dilara; Hacibedel, Basak; Akkoc, Nurullah

    2016-01-01

    To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696). RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

  11. [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.

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

    Science.gov (United States)

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

    2012-06-13

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

  13. Indirect costs and workplace productivity loss associated with non-Hodgkin lymphoma.

    Science.gov (United States)

    Yu, Justin S; Hansen, Ryan N; Valderrama, Adriana; Carlson, Josh J

    2016-11-01

    The objective of this study was to examine indirect costs and workplace productivity loss (defined as an aggregate measure of absenteeism, short-term disability, and long-term disability days) associated with non-Hodgkin lymphoma (NHL) from a societal perspective in a commercially insured working-age United States population. The MarketScan(®) Commercial Claims and Encounters and Health and Productivity Management Databases (2007-2013) were used in this study, with controls matched 3:1 to NHL patients. In comparison to controls, NHL patients incurred significantly more workplace productivity loss (31.99 days; 95% CI: 25.24 days, 38.73 days; p workplace productivity and higher associated indirect costs.

  14. 76 FR 65182 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-20

    ... determined that the most appropriate indirect allocation method continues to be the Direct Labor Cost Base... Cost Base is the most appropriate indirect allocation method for the development of the FY 2009 and FY... the Direct Labor Cost Base allocation methodology. The FY 2009 rates will be applied to all damage...

  15. Direct and indirect patient costs of dermatology clinic visits and their impact on access to care and provider preference.

    Science.gov (United States)

    Rothstein, Brooke E; Gonzalez, Jessica; Cunningham, Kiera; Saraiya, Ami; Dornelles, Adriana C; Nguyen, Bichchau M

    2017-12-01

    The direct and indirect costs of dermatology clinic visits are infrequently quantified. Indirect costs, such as the time spent traveling to and from appointments and the value of lost earnings from time away from work, are substantial costs that often are not included in economic analyses but may pose barriers to receiving care. Due to the national shortage of dermatologists, patients may have to wait longer for appointments or travel further to see dermatologists outside of their local community, resulting in high time and travel costs for patients. Patients' lost time and earnings comprise the opportunity cost of obtaining care. A monetary value for this opportunity cost can be calculated by multiplying a patient's hourly wage by the number of hours that the patient dedicated to attending the dermatology appointment. Using a single institution survey, this study quantified the direct and indirect patient costs, including opportunity costs and time burden, associated with dermatology clinic visits to better appreciate the impact of these factors on health care access and dermatologic provider preference.

  16. 78 FR 25443 - Federal Acquisition Regulation; Submission for OMB Review; Indirect Cost Rates

    Science.gov (United States)

    2013-05-01

    ... supporting cost data are the cost accounting information normally prepared by organizations under sound management and accounting practices. The proposal and supporting data is used by the contracting official and...; Submission for OMB Review; Indirect Cost Rates AGENCY: Department of Defense (DOD), General Services...

  17. Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

    Science.gov (United States)

    Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

    2014-01-01

    Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD. PMID:24672234

  18. STEM Faculty and Indirect Costs: What Administrators Need to Know

    Science.gov (United States)

    Gossman, Susan

    2016-01-01

    The focus of this single site, qualitative case study was on public research university STEM (science, technology, engineering and mathematics) faculty and their perspectives on, and behavior towards, indirect cost recovery. The explanatory scheme was derived from anthropological theory and incorporated organizational culture, resource dependency…

  19. Prospective evaluation of indirect costs due to acute rotavirus gastroenteritis in Spain: the ROTACOST study

    Directory of Open Access Journals (Sweden)

    Sánchez-Lastres Juan

    2011-09-01

    Full Text Available Abstract Background The effect of rotavirus in developed countries is mainly economic. This study aimed to assess the indirect costs induced by rotavirus acute gastroenteritis (RVAGE in Spain. Methods A prospective observational study was conducted from October 2008 to June 2009. It included 682 children up to 5 years of age with acute gastroenteritis (AGE who attended primary care (n = 18 and emergency room/hospital settings (n = 10, covering the regions of Galicia and Asturias (North-west Spain. All non-medical expenses incurred throughout the episode were recorded in detail using personal interviews and telephone contact. Results Among the 682 enrolled children, 207 (30.4% were rotavirus positive and 170 (25% had received at least one dose of rotavirus vaccine. The mean (standard deviation indirect cost caused by an episode of AGE was estimated at 135.17 (182.70 Euros. Costs were 1.74-fold higher when AGE was caused by rotavirus compared with other etiologies: 192.7 (219.8 Euros vs. 111.6 (163.5 Euros (p Conclusions Rotavirus generates a significant indirect economic burden. Our data should be considered in the decision-making process of the eventual inclusion of rotavirus vaccine in the national immunization schedule of well developed countries.

  20. Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

    Directory of Open Access Journals (Sweden)

    Patel JG

    2014-03-01

    Full Text Available Jeetvan G Patel,1,2 Saurabh P Nagar,2 Anand A Dalal2 1Pharmacy Administration and Public Health, University of Houston, Houston, TX, 2US Health Outcomes, GlaxoSmithKline, Durham, NC, USA Objective: To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD in the US. Methods: Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results: Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars with COPD ($1,521–$3,348 in 2010 [US dollars] and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions: COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability

  1. 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.

  2. Indirect cost of maternal deaths in the WHO African Region in 2010.

    Science.gov (United States)

    Kirigia, Joses Muthuri; Mwabu, Germano Mwige; Orem, Juliet Nabyonga; Muthuri, Rosenabi Deborah Karimi

    2014-08-31

    An estimated 147,741 maternal deaths occurred in 2010 in 45 of the 47 countries in the African Region of the World Health Organization (WHO). The objective of this study was to estimate the indirect cost of maternal deaths in the Region to provide data for use in advocacy for increased domestic and external investment in multisectoral policy interventions to curb maternal mortality. This study used the cost-of-illness method to estimate the indirect cost of maternal mortality, i.e. the loss in non-health gross domestic product (GDP) attributable to maternal deaths. Estimates on maternal mortality for 2010 from Trends in maternal mortality: 1990 to 2010 published by WHO, UNICEF, UNFPA and the World Bank were used in these calculations. Values for future non-health GDP lost were converted into their present values by applying a 3% discount rate. One-way sensitivity analysis at 5% and 10% discount rates assessed the impact on non-health GDP loss. Indirect cost analysis was undertaken for the countries, categorized under three income groups. Group 1 consisted of nine high and upper middle income countries, Group 2 of 12 lower middle income countries, and Group 3 of 26 low income countries. Estimates for Seychelles in Group 1 and South Sudan in Group 3 were not provided in the source used. The 147,741 maternal deaths that occurred in 45 countries in the African Region in 2010 resulted in a total non-health GDP loss of Int$ 4.5 billion (PPP). About 24.5% of the loss was in Group 1 countries, 44.9% in Group 2 countries and 30.6% in Group 3 countries. This translated into losses in non-health GDP of Int$ 139,219, Int$ 35,440 and Int$ 16,397 per maternal death, respectively, for the three groups. Using discount rates of 5% and 10% reduced the total non-health GDP loss by 19.1% and 47.7%, respectively. Maternal mortality is responsible for a noteworthy level of non-health GDP loss among the countries in the African Region. There is urgent need, therefore, to increase

  3. Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands.

    Science.gov (United States)

    Kik, Sandra V; Olthof, Sandra P J; de Vries, Jonie T N; Menzies, Dick; Kincler, Naomi; van Loenhout-Rooyakkers, Joke; Burdo, Conny; Verver, Suzanne

    2009-08-05

    In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1-6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted euro353. Most costs were spent when being hospitalized. Time loss (mean 81 days) was mainly due to hospitalization (19 days) and additional work days lost (60 days), and corresponded with a cost estimation of euro2603. Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

  4. 77 FR 8219 - Notice of Indirect Cost Rates for the Office of National Marine Sanctuaries for Fiscal Years 2008...

    Science.gov (United States)

    2012-02-14

    ... requirements. C&C also determined that the most appropriate indirect allocation method was the Direct Labor... most appropriate indirect allocation method for the development of the FY 2008 and 2009 indirect cost... October 1, 2008 and present, using the Direct Labor Cost base allocation methodology. For cases that have...

  5. Assessment of indirect losses and costs of emergency for project planning of alpine hazard mitigation

    Science.gov (United States)

    Amenda, Lisa; Pfurtscheller, Clemens

    2013-04-01

    By virtue of augmented settling in hazardous areas and increased asset values, natural disasters such as floods, landslides and rockfalls cause high economic losses in Alpine lateral valleys. Especially in small municipalities, indirect losses, mainly stemming from a breakdown of transport networks, and costs of emergency can reach critical levels. A quantification of these losses is necessary to estimate the worthiness of mitigation measures, to determine the appropriate level of disaster assistance and to improve risk management strategies. There are comprehensive approaches available for assessing direct losses. However, indirect losses and costs of emergency are widely not assessed and the empirical basis for estimating these costs is weak. To address the resulting uncertainties of project appraisals, a standardized methodology has been developed dealing with issues of local economic effects and emergency efforts needed. In our approach, the cost-benefit-analysis for technical mitigation of the Austrian Torrent and Avalanche Control (TAC) will be optimized and extended using the 2005-debris flow as a design event, which struggled a small town in the upper Inn valley in southwest Tyrol (Austria). Thereby, 84 buildings were affected, 430 people were evacuated and due to this, the TAC implemented protection measures for 3.75 million Euros. Upgrading the method of the TAC and analyzing to what extent the cost-benefit-ratio is about to change, is one of the main objectives of this study. For estimating short-run indirect effects and costs of emergency on the local level, data was collected via questionnaires, field mapping, guided interviews, as well as intense literature research. According to this, up-to-date calculation methods were evolved and the cost-benefit-analysis of TAC was recalculated with these new-implemented results. The cost-benefit-ratio will be more precise and specific and hence, the decision, which mitigation alternative will be carried out

  6. Indirect Transportation Cost in the border crossing process: The United States–Mexico trade

    Directory of Open Access Journals (Sweden)

    Carlos Obed Figueroa Ortiz

    2015-12-01

    Full Text Available Using a Social Accounting Matrix as database, a Computable General Equilibrium model is implemented in order to estimate the Indirect Transportations Costs (ITC present in the border crossing for the U.S.–Mexico bilateral trade. Here, an “iceberg–type” transportation function is assumed to determine the amount of loss that must be faced as a result of border crossing process through the ports of entry existing between the two countries. The study period covers annual data from 1995 to 2009 allowing the analysis of the trend of these costs considering the trade liberalisation that is experienced. Results show that the ITC have experienced a decrease of 12% during the period.Test

  7. The indirect costs of psoriatic arthritis: systematic review and meta-analysis.

    Science.gov (United States)

    Kawalec, Paweł; Malinowski, Krzysztof Piotr

    2015-02-01

    The aim of this systematic review is to collect all current data on the indirect costs (IC) related to psoriatic arthritis (PsA). The search was conducted using MEDLINE (via PubMed), Embase and Centre for Reviews and Dissemination databases. We considered original studies, systematic reviews, economic evaluations, conference abstracts and posters. All collected data were recalculated to average annual cost per patient, expressed using the consumer price index for 2013 and converted to US dollars using purchasing power parity. Eight of the identified publications presented IC of PsA. Average annual IC per patient calculated using the friction cost approach range from US$1693.83 to $12,318.45, while using the human capital approach they range from US$1750.68 to $50,270.52. Result of the meta-analysis was a basis for calculating cost of work disability equaled US$10,754.04 per patient per year in 2013 prices. This systematic review revealed a great economic burden of the disease to the society. A small number of studies on IC in PsA justify further investigations.

  8. Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

    Science.gov (United States)

    Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

    2017-11-01

    Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Secukinumab Significantly Reduces Psoriasis-Related Work Impairment and Indirect Costs Compared With Ustekinumab and Etanercept in the United Kingdom.

    Science.gov (United States)

    Warren, R B; Halliday, A; Graham, C N; Gilloteau, I; Miles, L; McBride, D

    2018-05-30

    Psoriasis causes work productivity impairment that increases with disease severity. Whether differential treatment efficacy translates into differential indirect cost savings is unknown. To assess work hours lost and indirect costs associated with secukinumab versus ustekinumab and etanercept in the United Kingdom (UK). This was a post hoc analysis of work impairment data collected in the CLEAR study (secukinumab vs. ustekinumab) and applied to the FIXTURE study (secukinumab vs. etanercept). Weighted weekly and annual average indirect costs per patient per treatment were calculated from (1) overall work impairment derived from Work Productivity and Activity Impairment data collected in CLEAR at 16 and 52 weeks by Psoriasis Area and Severity Index (PASI) response level; (2) weekly/annual work productivity loss by PASI response level; (3) weekly and annual indirect costs by PASI response level, based on hours of work productivity loss; and (4) weighted average indirect costs for each treatment. In the primary analysis, work impairment data for employed patients in CLEAR at Week 16 were used to compare secukinumab and ustekinumab. Secondary analyses were conducted at different timepoints and with patient cohorts, including FIXTURE. In CLEAR, 452 patients (67%) were employed at baseline. At Week 16, percentages of weekly work impairment/mean hours lost decreased with higher PASI: PASI hours; PASI 50-74: 13.3%/4.45 hours; PASI 75-89: 6.4%/2.14 hours; PASI ≥90: 4.9%/1.65 hours. Weighted mean weekly/annual work hours lost were significantly lower for secukinumab than ustekinumab (1.96/102.51 vs. 2.40/125.12; P=0.0006). Results were consistent for secukinumab versus etanercept (2.29/119.67 vs. 3.59/187.17; Ρreduced work impairment and associated indirect costs of psoriasis compared with ustekinumab and etanercept at Week 16 through 52 in the UK. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Health-Related Quality of Life Impairment and Indirect Cost of Crohn’s Disease: A Self-Report Study in Poland

    Science.gov (United States)

    Kawalec, Paweł; Mossakowska, Małgorzata; Pilc, Andrzej

    2016-01-01

    Background and Aims Evidence on indirect cost of Crohn’s disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity). Methods A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients’ characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient’s version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients’ productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients’ productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders. Results The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (pabsenteeism, 41% (p = 0.030) for presenteeism, 76% (pproductivity loss at unpaid work, and 75% (p<0.001) for informal care. Conclusions Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland. PMID:27992531

  11. Effect of adalimumab on work productivity and indirect costs in moderate to severe Crohn’s disease: A meta-analysis

    Science.gov (United States)

    Binion, David G; Louis, Edouard; Oldenburg, Bas; Mulani, Parvez; Bensimon, Arielle G; Yang, Mei; Chao, Jingdong

    2011-01-01

    OBJECTIVE: To assess the effect of adalimumab on work productivity and indirect costs in patients with Crohn’s disease (CD) using a meta-analysis of clinical trials. METHODS: Study-level results were pooled from all clinical trials of adalimumab for moderate to severe CD in which work productivity outcomes were evaluated. Work Productivity and Activity Impairment Questionnaire outcomes (absenteeism, presenteeism and total work productivity impairment [TWPI]) were extracted from adalimumab trials. Meta-analyses were used to estimate pooled averages and 95% CIs of one-year accumulated reductions in work productivity impairment with adalimumab. Pooled averages were multiplied by the 2008 United States national average annual salary ($44,101) to estimate per-patient indirect cost savings during the year following adalimumab initiation. RESULTS: The four included trials (ACCESS, CARE, CHOICE and EXTEND) represented a total of 1202 employed adalimumab-treated patients at baseline. Each study followed patients for a minimum of 20 weeks. Pooled estimates (95% CIs) of one-year accumulated work productivity improvements were as follows: −9% (−10% to −7%) for absenteeism; −22% (−26% to −18%) for presenteeism; and −25% (−30% to −20%) for TWPI. Reductions in absenteeism and TWPI translated into per-patient indirect cost savings (95% CI) of $3,856 ($3,183 to $4,529) and $10,964 ($8,833 to $13,096), respectively. CONCLUSION: Adalimumab provided clinically meaningful improvements in work productivity among patients with moderate to severe CD, which may translate into substantial indirect cost savings from an employer’s perspective. PMID:21912760

  12. Marginal cost and congestion in the Italian electricity market: An indirect estimation approach

    International Nuclear Information System (INIS)

    Bigerna, Simona; Andrea Bollino, Carlo; Polinori, Paolo

    2015-01-01

    In this paper we construct an indirect measure of the supply marginal cost function for the main generators from the observed bid data in the Italian electricity market in the period 2004–2007. We compute the residual demand function for each generator, taking explicitly into account the issue of transmission line congestion. This procedure allows recovering correct zonal Lerner index and the implied measure of the marginal cost function. We find evidence of a stable U-shaped marginal cost function for three main Italian generators, but a flat function for ENEL, the former national monopolist. The policy relevance of our approach lies in the possibility to offer some empirical knowledge of the marginal cost function of each generator to the regulator to design appropriate policy measures geared to the promotion of competitive market conditions. We propose a new market surveillance mechanism, which is based on the principle of sanctioning excessive deviations from the estimated measure of the marginal cost function presented in this work. -- Highlights: •We construct an indirect measure of the supply marginal cost function. •We compute the residual demand function taking into account transmission line congestion. •We find a general evidence of a stable U-shaped marginal cost function for Italian generators. •We find flat marginal cost function for the former national monopolist. •We use excessive deviations from estimated marginal cost function as a new market surveillance mechanism

  13. Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

    Directory of Open Access Journals (Sweden)

    Darbà J

    2015-07-01

    Full Text Available Josep Darbà,1 Lisette Kaskens2 1Department of Economics, University of Barcelona, 2BCN Health Economics and Outcomes Research SL, Barcelona, Spain Objective: The objectives of this analysis were to examine how patients' dependence on others relates to costs of care and explore the incremental effects of patient dependence measured by the Dependence Scale on costs for patients with Alzheimer's disease (AD in Spain. Methods: The Co-Dependence in Alzheimer's Disease study is an 18 multicenter, cross-sectional, observational study among patients with AD according to the clinical dementia rating score and their caregivers in Spain. This study also gathered data on resource utilization for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. The data of 343 patients and their caregivers were collected through the completion of a clinical report form during one visit/assessment at an outpatient center or hospital, where all instruments were administered. The data collected (in addition to clinical measures also included sociodemographic data concerning the patients and their caregivers. Cost analysis was based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. Resource unit costs were applied to value direct medical-, social-, and indirect-care costs. A replacement cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale, and the Cumulative Index Rating Scale was administered to the patient to assess multi-morbidity. Multivariate regression analysis was used to model the effects of dependence and other sociodemographic and clinical variables on cost of care. Results: The mean (standard deviation costs per patient

  14. Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

    Science.gov (United States)

    Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho

    2015-01-01

    OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797

  15. Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2014-10-30

    No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

  16. Direct and indirect costs of surgically treated pelvic fractures.

    Science.gov (United States)

    Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

    2016-03-01

    Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p fractures are associated with both high direct costs and substantial productivity loss.

  17. 76 FR 61089 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-03

    ... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct....gov . Cotton reaffirmed that the Direct Labor Cost Base is the most appropriate indirect allocation... Natural Resources (GCNR).... 83.93 49.49 These rates are based on the Direct Labor Cost Base allocation...

  18. Understanding the direct and indirect costs of patients with schizophrenia [v2; ref status: indexed, http://f1000r.es/5ow

    Directory of Open Access Journals (Sweden)

    Kazuhiro Tajima-Pozo

    2015-08-01

    Full Text Available Background: Schizophrenia is a disabling mental disorder with high prevalence and that usually  requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. Objective: The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. Results: Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even moreimportant part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. Conclusions: Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them.

  19. U.S. Department of Education Indirect Cost Determination Guidance for State and Local Government Agencies.

    Science.gov (United States)

    Department of Education, Washington, DC. Office of the Chief Financial and Chief Information Officer.

    This guide provides new direction in financial management and oversight practices for accounting and charging administrative costs as they relate to programs administered by the U.S. Department of Education. The document is divided into six sections. Section 1, which presents general information, offers details on definitions; indirect-cost rates;…

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

    Science.gov (United States)

    Macioch, Tomasz; Hermanowski, Tomasz

    2011-12-01

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

  1. [Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries].

    Science.gov (United States)

    Cid, Camilo; Herrera, Cristian; Rodríguez, Rodrigo; Bastías, Gabriel; Jiménez, Jorge

    2016-08-02

    This paper aims to determine the economic impact that cancer represents to Chile, exploring the share of costs for the most important cancers and the differences between the public and private sector. We used the cost of illness methodology, through the assessment of the direct and indirect costs associated with cancer treatment. Data was obtained from 2009 registries of the Chilean Ministry of Health and the Superintendence of Health. Indirect costs were calculated by days of job absenteeism and potential years of life lost. Over US$ 2.1 billion were spent on cancer in 2009, which represents almost 1% of Chile’s Gross Domestic Product. The direct per capita cost was US$ 47. Indirect costs were 1.92 times more than direct costs. The three types of cancer that embody the highest share of costs were gastric cancer (17.6%), breast cancer (7%) and prostate cancer (4.2%) in the public sector, and breast cancer (14%), lung cancer (7.5%) and prostate cancer (4.1%) in the private sector. On average men spent 30.33% more than women. There are few studies of this kind in Chile and the region. The country can be classified as having a cancer economic impact below the average of those in European Union countries. We expect that this information can be used to develop access policies and resource allocation decision making, and as a first step into further cancer-costing studies in Chile and the Latin American and Caribbean region.

  2. Life-Cycle Costing of Food Waste Management in Denmark: Importance of Indirect Effects

    DEFF Research Database (Denmark)

    Martinez Sanchez, Veronica; Tonini, Davide; Møller, Flemming

    2016-01-01

    assessment combined with life-cycle assessment, to evaluate food waste management. Both life-cycle costing assessments included direct and indirect effects. The latter are related to income effects, accounting for the marginal consumption induced when alternative scenarios lead to different household......Prevention has been suggested as the preferred food waste management solution compared to alternatives such as conversion to animal fodder or to energy. In this study we used societal life-cycle costing, as a welfare economic assessment, and environmental life-cycle costing, as a financial...... be included whenever alternative scenarios incur different financial costs. Furthermore, it highlights that food prevention measures should not only demote the purchase of unconsumed food but also promote a low-impact use of the savings generated....

  3. The economic impact of chronic fatigue syndrome in Georgia: direct and indirect costs

    Directory of Open Access Journals (Sweden)

    Brimmer Dana J

    2011-01-01

    Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a debilitating chronic illness affecting at least 4 million people in the United States. Understanding its cost improves decisions regarding resource allocation that may be directed towards treatment and cure, and guides the evaluation of clinical and community interventions designed to reduce the burden of disease. Methods This research estimated direct and indirect costs of CFS and the impact on educational attainment using a population-based, case-control study between September 2004 and July 2005, Georgia, USA. Participants completed a clinical evaluation to confirm CFS, identify other illnesses, and report on socioeconomic factors. We estimated the effect of CFS on direct medical costs (inpatient hospitalizations, provider visits, prescription medication spending, other medical supplies and services and loss in productivity (employment and earnings with a stratified sample (n = 500 from metropolitan, urban, and rural Georgia. We adjusted medical costs and earnings for confounders (age, sex, race/ethnicity, education, and geographic strata using econometric models and weighted estimates to reflect response-rate adjusted sampling rates. Results Individuals with CFS had mean annual direct medical costs of $5,683. After adjusting for confounding factors, CFS accounted for $3,286 of these costs (p Conclusions Study results indicate that chronic fatigue syndrome may lead to substantial increases in healthcare costs and decreases in individual earnings. Studies have estimated up to 2.5% of non-elderly adults may suffer from CFS. In Georgia, a state with roughly 5.5 million people age 18-59, illness could account for $452 million in total healthcare expenditures and $1.2 billion of lost productivity.

  4. The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

    Directory of Open Access Journals (Sweden)

    Laetitia C. Rispel

    2015-05-01

    Full Text Available Background: Globally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals. Objective: The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods: Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices. Results: In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million. The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467 and at Hospital 2 the value was R300,121 (US$42,874, thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion

  5. DROUGHTS IN THE TIETÊ-PARANÁ WATERWAY: IMPACTS ON THE DIRECT, INDIRECT AND HIDDEN COSTS IN THE TRANSPORTATION OF SOYBEAN.

    Directory of Open Access Journals (Sweden)

    Rodrigo Carlo Toloi

    2016-05-01

    Full Text Available Brazil's agricultural economy is growing and increasing productivity. Therefore, it has required transportation systems with high load capacity and lower transportation costs. However, with the drought in the Southeast region of Brazil, the waterway Tietê-Paraná closed since May 2014 generating a loss of more than 30 million last year. Thus, this study investigates the impacts on direct, indirect and hidden costs resulting from this change of route for soy transport. The methodology consists of an exploratory, descriptive and bibliographic research that seeks to raise the main costs. The results show that failing to ensure the production of soybeans by the Tiete-Parana waterway and using the highway transportation costs for waterway users are increased by US$ 37,760,146.86.

  6. A HALF-WAY RIGHT: FREE EDUCATION, INDIRECT COSTS, AND EDUCATIONAL POLICY

    Directory of Open Access Journals (Sweden)

    Mariano Fernández Enguita

    2014-12-01

    Full Text Available This paper examines those indirect costs of education associated to state funded schooling that come to be privately financed by families, specially those linked to mandatory or mandated provision schooling. Discussion is more detailed about textbooks, school meals and academic support activities. Then we study the consequences of this private spending for gratuity and its effects related to educational and social equality or inequality. Finally, we analyze the implications related to sectional interests at stake and educational policies.

  7. A half-way right: free education, indirect costs, and educational policy

    Directory of Open Access Journals (Sweden)

    Mariano Fernández Enguita

    2014-12-01

    Full Text Available This paper examines those indirect costs of education associated to state funded schooling that come to be privately financed by families, specially those linked to mandatory or mandated provision schooling. Discussion is more detailed about textbooks, school meals and academic support activities. Then we study the consequences of this private spending for gratuity and its effects related to educational and social equality or inequality. Finally, we analyze the implications related to sectional interests at stake and educational policies.

  8. Injury rate and socioeconomic costs resulting from sports injuries in Flanders: data derived from sports insurance statistics 2003.

    Science.gov (United States)

    Cumps, E; Verhagen, E; Annemans, L; Meeusen, R

    2008-09-01

    This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders. Epidemiological cohort designs and a human capital method were set up to measure respectively the medical direct and indirect cost of sports injuries. 72 out of 82 Flemish sports federations participated. Insurance statistics from 2003 were used to determine the overall rate of injury and injury localisations. Using these data, the medical direct cost and the impact sports injuries have on indirect costs were estimated. The indirect costs were determined by multiplying the days of absence from work with the daily cost resulting from a loss of production, being 200 euros. The total direct medical cost extrapolated for the Flemish sports participants was 15,027,423 euros, which amounted to 0.07% to 0.08% of the total budget spent on healthcare. The indirect cost extrapolated for the Flemish sports participants was 111,420,813 euros, which is about 3.4% of the costs arising from absenteeism from work. Of the 14 in-depth analysed sports, the rate of injury was highest in European team handball (8.96%; 95% confidence interval (CI) 8.95-8.96) and lowest in swimming (0.62%; 95% CI 0.62-0.62). The highest direct medical cost was found for anterior cruciate ligament (ACL) injuries (1358 euros per injury) and the lowest for foot injuries (52 euros per injury). The costs calculated in this study could become critical statistics in medical care debates. Data obtained here will enable a cost-benefit analysis of the impact of preventive measures to be made.

  9. Life-Cycle Costing of Food Waste Management in Denmark: Importance of Indirect Effects.

    Science.gov (United States)

    Martinez-Sanchez, Veronica; Tonini, Davide; Møller, Flemming; Astrup, Thomas Fruergaard

    2016-04-19

    Prevention has been suggested as the preferred food waste management solution compared to alternatives such as conversion to animal fodder or to energy. In this study we used societal life-cycle costing, as a welfare economic assessment, and environmental life-cycle costing, as a financial assessment combined with life-cycle assessment, to evaluate food waste management. Both life-cycle costing assessments included direct and indirect effects. The latter are related to income effects, accounting for the marginal consumption induced when alternative scenarios lead to different household expenses, and the land-use-changes effect, associated with food production. The results highlighted that prevention, while providing the highest welfare gains as more services/goods could be consumed with the same income, could also incur the highest environmental impacts if the monetary savings from unpurchased food commodities were spent on goods/services with a more environmentally damaging production than that of the (prevented) food. This was not the case when savings were used, e.g., for health care, education, and insurances. This study demonstrates that income effects, although uncertain, should be included whenever alternative scenarios incur different financial costs. Furthermore, it highlights that food prevention measures should not only demote the purchase of unconsumed food but also promote a low-impact use of the savings generated.

  10. Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

    Science.gov (United States)

    Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

    2016-01-20

    Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Regional economic activity and absenteeism: a new approach to estimating the indirect costs of employee productivity loss.

    Science.gov (United States)

    Bankert, Brian; Coberley, Carter; Pope, James E; Wells, Aaron

    2015-02-01

    This paper presents a new approach to estimating the indirect costs of health-related absenteeism. Productivity losses related to employee absenteeism have negative business implications for employers and these losses effectively deprive the business of an expected level of employee labor. The approach herein quantifies absenteeism cost using an output per labor hour-based method and extends employer-level results to the region. This new approach was applied to the employed population of 3 health insurance carriers. The economic cost of absenteeism was estimated to be $6.8 million, $0.8 million, and $0.7 million on average for the 3 employers; regional losses were roughly twice the magnitude of employer-specific losses. The new approach suggests that costs related to absenteeism for high output per labor hour industries exceed similar estimates derived from application of the human capital approach. The materially higher costs under the new approach emphasize the importance of accurately estimating productivity losses.

  12. Disease activity, quality of life and indirect costs of reduced productivity at work, generated by Polish patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Paweł Kawalec

    2016-02-01

    Full Text Available Objectives: The aim of the study was to investigate the association between activity of ankylosing spondylitis (AS and decrease in quality of life as well as productivity loss of affected patients in a specified group of patients in the Polish setting. Material and methods : An questionnaire survey was conducted using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI to assess disease activity, as well as the Work Productivity and Activity Impairment Questionnaires to assess productivity loss; quality of life was presented as utility calculated using the EuroQol 5 questionnaire and also measured on a visual analogue scale (VAS. Indirect costs were assessed with the human capital approach implying gross domestic product per capita or gross value added per worker in Poland in 2014 and were expressed in Polish zlotys (PLN as well as in euros. Correlation was presented using Spearman’s rank correlation coefficient. Results : We performed our analysis based on 78 full questionnaires collected. A mean BASDAI score of 5.91 in the analysed group of patients was detected and mean utility of 0.5135 was observed. Average quality of life measured on the visual analogue scale was 46.55. Mean number of days off work was 45.26 days per year and mean on-the-job productivity loss was 49.29%. Average annual indirect costs per patient were €4241 (17 686 PLN calculated using gross domestic product and €10 172 (42 417 PLN estimated using gross value added. Total productivity loss was significantly correlated with disease activity (strong correlation of 0.6005 and utility (moderate correlation of –0.3698. Conclusions : Ankylosing spondylitis causes a great decrease in quality of life as well as patients’ productivity loss associated with both absenteeism and presenteeism. The greater the disease activity is, the lower is the utility, the lower is the quality of life measured on the VAS, and the greater are the total annual indirect costs. Total

  13. Tuberculosis patients in the Dominican Republic face severe direct and indirect costs and need social protection

    NARCIS (Netherlands)

    Mauch, V.M.C.; Melgen, R.; Marcelino, B.; Acosta, I.; Klinkenberg, E.; Suarez, P.

    2013-01-01

    OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to

  14. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

    Science.gov (United States)

    Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

    2018-05-01

    The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data. This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and

  15. Prospective evaluation of indirect costs due to acute rotavirus gastroenteritis in Spain: the ROTACOST study.

    Science.gov (United States)

    Bouzón-Alejandro, Marta; Redondo-Collazo, Lorenzo; Sánchez-Lastres, Juan Manuel; Martinón-Torres, Nazareth; Martinón-Sánchez, José María; Martinón-Torres, Federico

    2011-09-14

    The effect of rotavirus in developed countries is mainly economic. This study aimed to assess the indirect costs induced by rotavirus acute gastroenteritis (RVAGE) in Spain. A prospective observational study was conducted from October 2008 to June 2009. It included 682 children up to 5 years of age with acute gastroenteritis (AGE) who attended primary care (n = 18) and emergency room/hospital settings (n = 10), covering the regions of Galicia and Asturias (North-west Spain). All non-medical expenses incurred throughout the episode were recorded in detail using personal interviews and telephone contact. Among the 682 enrolled children, 207 (30.4%) were rotavirus positive and 170 (25%) had received at least one dose of rotavirus vaccine. The mean (standard deviation) indirect cost caused by an episode of AGE was estimated at 135.17 (182.70) Euros. Costs were 1.74-fold higher when AGE was caused by rotavirus compared with other etiologies: 192.7 (219.8) Euros vs. 111.6 (163.5) Euros (p purchase of material. Patients with RVAGE were admitted to hospital more frequently than those with other etiologies (47.8% vs 14%, p decision-making process of the eventual inclusion of rotavirus vaccine in the national immunization schedule of well developed countries.

  16. Productivity loss and resource utilization, and associated indirect and direct costs in individuals providing care for adults with schizophrenia in the EU5

    Directory of Open Access Journals (Sweden)

    Gupta S

    2015-11-01

    Full Text Available Shaloo Gupta,1 Gina Isherwood,2 Kevin Jones,3 Kristel Van Impe4 1Kantar Health, Princeton, NJ, USA; 2Kantar Health, Epsom, Surrey, UK; 3European Federation of Associations of Families of People with Mental Illness, Diestsevest, Leuven, Belgium; 4Janssen-Cilag GmbH, Neuss, Germany Objective: This study aimed to understand the impact of providing care for adults with schizophrenia on productivity, resource utilization, and costs in the EU5 (France, Germany, Italy, Spain, and UK. Methods: Data from the 2010, 2011, and 2013 EU5 National Health and Wellness Survey, an online questionnaire of a nationwide sample of adults, were analyzed. Schizophrenia caregivers (n=398 were matched to noncaregivers (n=158,989 and other caregivers (n=14,341 via propensity scores. Outcome measures included health care utilization, Work Productivity and Activity Impairment questionnaire-based scores, and associated direct and indirect costs (estimated from the literature. Significant differences between schizophrenia caregivers vs noncaregivers and other caregivers (eg, cancer and Alzheimer's disease were examined. Results: After matching, schizophrenia caregivers reported greater activity impairment (38.4% vs 26.1%, provider visits (8.0 vs 5.7, emergency room visits (0.9 vs 0.2, hospitalizations (0.8 vs 0.1, and direct costs (€2,258 vs €617 than noncaregivers, all P<0.001. Employed schizophrenia caregivers reported greater absenteeism, presenteeism, overall work impairment (35.0% vs 20.7%, and indirect costs (€6,667 vs €3,795 than noncaregivers, all P<0.001. Schizophrenia caregivers (vs other caregivers reported greater activity impairment (38.4% vs 32.3% and provider visits (8.0 vs 6.6, P<0.05. A greater proportion of schizophrenia caregivers (vs other caregivers reported at least one emergency room visit (26.1% vs 20.2% and hospitalization (20.4% vs 14.3%, P<0.05. Employed schizophrenia caregivers incurred greater indirect costs than other caregivers (€6

  17. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...

  18. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both

    Directory of Open Access Journals (Sweden)

    Ghushchyan V

    2014-12-01

    Full Text Available Vahram Ghushchyan,1,2 Kavita V Nair,2 Robert L Page II2,3 1College of Business and Economics, American University of Armenia, Yerevan, Armenia; 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA; 3Department of Physical Medicine, School of Medicine, University of Colorado, Aurora, CO, USA Background: The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS alone and with common cardiovascular comorbidities. Methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF, ACS with heart failure (HF, and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Results: Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191 followed by ACS with HF ($32,871±2,853, ACS with AF ($25,192±2,253, and ACS only ($17,954±563. Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719–9,427, $11,297 (95% CI 5,610–16,985, and $15,761 (95% CI 4,784–26,738 higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767, when compared with patients

  19. The logic of indirect speech

    Science.gov (United States)

    Pinker, Steven; Nowak, Martin A.; Lee, James J.

    2008-01-01

    When people speak, they often insinuate their intent indirectly rather than stating it as a bald proposition. Examples include sexual come-ons, veiled threats, polite requests, and concealed bribes. We propose a three-part theory of indirect speech, based on the idea that human communication involves a mixture of cooperation and conflict. First, indirect requests allow for plausible deniability, in which a cooperative listener can accept the request, but an uncooperative one cannot react adversarially to it. This intuition is supported by a game-theoretic model that predicts the costs and benefits to a speaker of direct and indirect requests. Second, language has two functions: to convey information and to negotiate the type of relationship holding between speaker and hearer (in particular, dominance, communality, or reciprocity). The emotional costs of a mismatch in the assumed relationship type can create a need for plausible deniability and, thereby, select for indirectness even when there are no tangible costs. Third, people perceive language as a digital medium, which allows a sentence to generate common knowledge, to propagate a message with high fidelity, and to serve as a reference point in coordination games. This feature makes an indirect request qualitatively different from a direct one even when the speaker and listener can infer each other's intentions with high confidence. PMID:18199841

  20. A finite and stable exponential growth-adjusted indirect cost of cancer associated with discounted years of life lost in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Omar B. Da'ar

    2018-05-01

    Conclusion: Our findings reveal evidence of indirect cost associated with cancer premature deaths in Saudi Arabia. In order to develop cancer control actions, the results of this study can inform health system policymakers not only of the extent of the enormous economic burden but also drawing attention to epidemiological and economic factors that explain the variability of the burden.

  1. 77 FR 57074 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2012-09-17

    ... information on these rates and the DARRP policy can be found at the DARRP web site at: http://www.darrp.noaa.gov/library/12_b.html FOR FURTHER INFORMATION CONTACT: For further information, contact LaTonya... develop indirect cost rates for its component organizations and formulate policies on the recovery of...

  2. The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals.

    Science.gov (United States)

    Rispel, Laetitia C; Moorman, Julia

    2015-01-01

    Globally, flexible work arrangements - through the use of temporary nursing staff - are an important strategy for dealing with nursing shortages in hospitals. The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Hospital managers and policy-makers need to address the effective

  3. Forecasting of indirect consumables for a Job Shop

    Science.gov (United States)

    Shakeel, M.; Khan, S.; Khan, W. A.

    2016-08-01

    A job shop has an arrangement where similar machines (Direct consumables) are grouped together and use indirect consumables to produce a product. The indirect consumables include hack saw blades, emery paper, painting brush etc. The job shop is serving various orders at a particular time for the optimal operation of job shop. Forecasting is required to predict the demand of direct and indirect consumables in a job shop. Forecasting is also needed to manage lead time, optimize inventory cost and stock outs. The objective of this research is to obtain the forecast for indirect consumables. The paper shows how job shop can manage their indirect consumables more accurately by establishing a new technique of forecasting. This results in profitable use of job shop by multiple users.

  4. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both.

    Science.gov (United States)

    Ghushchyan, Vahram; Nair, Kavita V; Page, Robert L

    2015-01-01

    The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities. A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions. ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.

  5. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea.

    Science.gov (United States)

    Buono, Jessica L; Carson, Robyn T; Flores, Natalia M

    2017-02-14

    Irritable bowel syndrome (IBS) affects 10-15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population. Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics. In total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p work productivity loss (20.7% vs. 13.2%; p work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.

  6. Injury rate and socioeconomic costs resulting from sports injuries in Flanders: data derived from sports insurance statistics 2003

    NARCIS (Netherlands)

    Cumps, E.D.; Verhagen, E.A.L.M.; Annemans, L.; Meeusen, R.

    2008-01-01

    Objective: This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders. Setting: Epidemiological cohort designs and a human capital method were set up to measure respectively the medical direct and indirect cost of sports injuries.

  7. The indirect costs and benefits of greenhouse gas limitations: Hungary Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Zilahy, G.; Zsoka, A.N.; Szeszler, A.; Urge-Vorsatz, D.; Markandya, A.; Hunt, A.

    2000-05-01

    A methodology has been developed which provides a framework for the assessment of the wider impacts arising from GHG limitation projects, and advice on how to incorporate them into the decision-making framework. The purpose of this report is to apply the methodology to a set of selected GHG limitation projects currently being considered for implementation in Hungary. In total, four GHG limitation projects were selected for application of the methodology. This second phase of the research in Hungary, concentrated on four mitigation options in the household sector: Specifically, the selected GHG limitation projects involve: 1. The installation of new, better insulated windows. 2. The installation of water saving devices on water taps. 3. The installation of active solar cells to prepare domestic hot water. 4. The replacement of traditional light bulbs by compact fluorescent bulbs. This study has shown the potential, as well as the current pratical limitations, of the methodology. The value of the employment created has been estimated by adding gains in income effects with health effects. The environmental effects that have been quantified suggest that the reduction of pollution and associated health effects would be significant. The options that have been investigated are too small-scale to generate distributional impacts or macro-economic effects but the estimated effects on sustainability are positive and significant. The principal policy conclusion that can be drawn from the analysis thus far is that it is imperative to consider indirect effects. It is possible that inclusion of indirect effects will make the net economic cost of an option negative thereby making it much more easy to 'sell' as a policy measure - though the assumptions will have to be made explicit and therefore defensible. It is important for policy makers to note that whilst there is a general pattern of lower economic costs derived from this analysis, the reductions are not uniform and

  8. The indirect costs and benefits of greenhouse gas limitations: Hungary Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Zilahy, G; Zsoka, A N; Szeszler, A; Urge-Vorsatz, D; Markandya, A; Hunt, A

    2000-05-01

    A methodology has been developed which provides a framework for the assessment of the wider impacts arising from GHG limitation projects, and advice on how to incorporate them into the decision-making framework. The purpose of this report is to apply the methodology to a set of selected GHG limitation projects currently being considered for implementation in Hungary. In total, four GHG limitation projects were selected for application of the methodology. This second phase of the research in Hungary, concentrated on four mitigation options in the household sector: Specifically, the selected GHG limitation projects involve: 1. The installation of new, better insulated windows. 2. The installation of water saving devices on water taps. 3. The installation of active solar cells to prepare domestic hot water. 4. The replacement of traditional light bulbs by compact fluorescent bulbs. This study has shown the potential, as well as the current pratical limitations, of the methodology. The value of the employment created has been estimated by adding gains in income effects with health effects. The environmental effects that have been quantified suggest that the reduction of pollution and associated health effects would be significant. The options that have been investigated are too small-scale to generate distributional impacts or macro-economic effects but the estimated effects on sustainability are positive and significant. The principal policy conclusion that can be drawn from the analysis thus far is that it is imperative to consider indirect effects. It is possible that inclusion of indirect effects will make the net economic cost of an option negative thereby making it much more easy to 'sell' as a policy measure - though the assumptions will have to be made explicit and therefore defensible. It is important for policy makers to note that whilst there is a general pattern of lower economic costs derived from this analysis, the reductions are not uniform and

  9. New Federal Cost Accounting Regulations

    Science.gov (United States)

    Wolff, George J.; Handzo, Joseph J.

    1973-01-01

    Discusses a new set of indirect cost accounting procedures which must be followed by school districts wishing to recover any indirect costs of administering federal grants and contracts. Also discusses the amount of indirect costs that may be recovered, computing indirect costs, classifying project costs, and restricted grants. (Author/DN)

  10. Direct benefits of choosing a high-fitness mate can offset the indirect costs associated with intralocus sexual conflict.

    Science.gov (United States)

    Pischedda, Alison; Chippindale, Adam K

    2017-06-01

    Intralocus sexual conflict generates a cost to mate choice: high-fitness partners transmit genetic variation that confers lower fitness to offspring of the opposite sex. Our earlier work in the fruit fly, Drosophila melanogaster, revealed that these indirect genetic costs were sufficient to reverse potential "good genes" benefits of sexual selection. However, mate choice can also confer direct fitness benefits by inducing larger numbers of progeny. Here, we consider whether direct benefits through enhanced fertility could offset the costs associated with intralocus sexual conflict in D. melanogaster. Using hemiclonal analysis, we found that females mated to high-fitness males produced 11% more offspring compared to those mated to low-fitness males, and high-fitness females produced 34% more offspring than low-fitness females. These direct benefits more than offset the reduction in offspring fitness caused by intralocus sexual conflict, creating a net fitness benefit for each sex to pairing with a high-fitness partner. Our findings highlight the need to consider both direct and indirect effects when investigating the fitness impacts of mate choice. Direct fitness benefits may shelter sexually antagonistic alleles from selection, suggesting a novel mechanism for the maintenance of fitness variation. © 2017 The Author(s). Evolution © 2017 The Society for the Study of Evolution.

  11. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Science.gov (United States)

    2010-10-01

    ... Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS.... The indirect teaching adjustment factor equals [e (raised to the power of .2822×the ratio of residents...

  12. Mechanical work as an indirect measure of subjective costs influencing human movement.

    Directory of Open Access Journals (Sweden)

    Karl E Zelik

    Full Text Available To descend a flight of stairs, would you rather walk or fall? Falling seems to have some obvious disadvantages such as the risk of pain or injury. But the preferred strategy of walking also entails a cost for the use of active muscles to perform negative work. The amount and distribution of work a person chooses to perform may, therefore, reflect a subjective valuation of the trade-offs between active muscle effort and other costs, such as pain. Here we use a simple jump landing experiment to quantify the work humans prefer to perform to dissipate the energy of landing. We found that healthy normal subjects (N = 8 preferred a strategy that involved performing 37% more negative work than minimally necessary (P<0.001 across a range of landing heights. This then required additional positive work to return to standing rest posture, highlighting the cost of this preference. Subjects were also able to modulate the amount of landing work, and its distribution between active and passive tissues. When instructed to land softly, they performed 76% more work than necessary (P<0.001, with a higher proportion from active muscles (89% vs. 84%, P<0.001. Stiff-legged landings, performed by one subject for demonstration, exhibited close to the minimum of work, with more of it performed passively through soft tissue deformations (at least 30% in stiff landings vs. 16% preferred. During jump landings, humans appear not to minimize muscle work, but instead choose to perform a consistent amount of extra work, presumably to avoid other subjective costs. The degree to which work is not minimized may indirectly quantify the relative valuation of costs that are otherwise difficult to measure.

  13. Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study

    DEFF Research Database (Denmark)

    Gaede, Peter; Valentine, William J; Palmer, Andrew J

    2008-01-01

    and account Danish-specific costs to project life expectancy, quality-adjusted life expectancy (QALE), and lifetime direct medical costs expressed in year 2005 Euros. Clinical and cost outcomes were projected over patient lifetimes and discounted at 3% annually. Sensitivity analyses were performed. RESULTS...... gained. This is considered a conservative estimate because accounting prescription of generic drugs and capturing indirect costs would further favor intensified therapy. CONCLUSIONS: From a health care payer perspective in Denmark, intensive therapy was more cost-effective than conventional treatment...

  14. Assessing the indirect effects due to natural hazards on a mesoscale

    Science.gov (United States)

    Pfurtscheller, C.; Schwarze, R.

    2009-04-01

    Measuring indirect economic costs and other effects from natural hazards, especially floods in alpine and other mountainous regions, are a necessary part of a comprehensive economic assessment. Their omission seriously affects the relative economic benefits of structural or non structural measures of flood defence. Surpassing controversial, IO-model-based economic estimates, analysing indirect economic effects lead to the key question of identifying and evaluating the drivers of indirect economic effects and resilience to system effects in the regional economy, i.e. at the meso-level. This investigation takes place for the catastrophic floods in summer 2005 in the provinces of Tyrol and Vorarlberg, Austria, which caused an estimated € 670 Mio direct loss on private and public assets and severe interruptions in lifeline services. The paper starts out with differentiating the concept of indirect economic costs from direct costs, examing different temporal (short vs. long-term) and spatial (macro-, meso- vs. microeconomic) system boundaries. It surveys common theories of economic resilience and vulnerability at the regional economy level. Indirect effects at the regional economy level can be defined as interferences of the economic exchange of goods and services triggered by breakdowns of transport lines and critical production inputs. The extent and persistence of indirect effects of natural hazards is not only by parameters of the extreme event, such as duration and amplitude of the flood, but much more by resilience parameters of the regional economy such as size of enterprises, the network structure (linkages) of the regional economy, availability of insurance and relief funds, and the stock of inventory. These effects can only be dissected by means of expert judgement and event studies. This paper presents the results of a survey conducted among business practioneers, members of chamber of commerce, civil protection agencies to identify and scale the drivers of

  15. Development of a simple, low cost, indirect ion beam fluence measurement system for ion implanters, accelerators

    Science.gov (United States)

    Suresh, K.; Balaji, S.; Saravanan, K.; Navas, J.; David, C.; Panigrahi, B. K.

    2018-02-01

    We developed a simple, low cost user-friendly automated indirect ion beam fluence measurement system for ion irradiation and analysis experiments requiring indirect beam fluence measurements unperturbed by sample conditions like low temperature, high temperature, sample biasing as well as in regular ion implantation experiments in the ion implanters and electrostatic accelerators with continuous beam. The system, which uses simple, low cost, off-the-shelf components/systems and two distinct layers of in-house built softwarenot only eliminates the need for costly data acquisition systems but also overcomes difficulties in using properietry software. The hardware of the system is centered around a personal computer, a PIC16F887 based embedded system, a Faraday cup drive cum monitor circuit, a pair of Faraday Cups and a beam current integrator and the in-house developed software include C based microcontroller firmware and LABVIEW based virtual instrument automation software. The automatic fluence measurement involves two important phases, a current sampling phase lasting over 20-30 seconds during which the ion beam current is continuously measured by intercepting the ion beam and the averaged beam current value is computed. A subsequent charge computation phase lasting 700-900 seconds is executed making the ion beam to irradiate the samples and the incremental fluence received by the sampleis estimated usingthe latest averaged beam current value from the ion beam current sampling phase. The cycle of current sampling-charge computation is repeated till the required fluence is reached. Besides simplicity and cost-effectiveness, other important advantages of the developed system include easy reconfiguration of the system to suit customisation of experiments, scalability, easy debug and maintenance of the hardware/software, ability to work as a standalone system. The system was tested with different set of samples and ion fluences and the results were verified using

  16. Caregiver burden, productivity loss, and indirect costs associated with caring for patients with poststroke spasticity

    Science.gov (United States)

    Ganapathy, Vaidyanathan; Graham, Glenn D; DiBonaventura, Marco D; Gillard, Patrick J; Goren, Amir; Zorowitz, Richard D

    2015-01-01

    Objective Many stroke survivors experience poststroke spasticity and the related inability to perform basic activities, which necessitates patient management and treatment, and exerts a considerable burden on the informal caregiver. The current study aims to estimate burden, productivity loss, and indirect costs for caregivers of stroke survivors with spasticity. Methods Internet survey data were collected from 153 caregivers of stroke survivors with spasticity including caregiving time and difficulty (Oberst Caregiver Burden Scale), Work Productivity and Activity Impairment measures, and caregiver and patient characteristics. Fractional logit models examined predictors of work-related restriction, and work losses were monetized (2012 median US wages). Results Mean Oberst Caregiver Burden Scale time and difficulty scores were 46.1 and 32.4, respectively. Employed caregivers (n=71) had overall work restriction (32%), absenteeism (9%), and presenteeism (27%). Caregiver characteristics, lack of nursing home coverage, and stroke survivors’ disability predicted all work restriction outcomes. The mean total lost-productivity cost per employed caregiver was US$835 per month (>$10,000 per year; 72% attributable to presenteeism). Conclusion These findings demonstrate the substantial burden of caring for stroke survivors with spasticity illustrating the societal and economic impact of stroke that extends beyond the stroke survivor. PMID:26609225

  17. The health economics of ankle and foot sprains and fractures: A systematic review of English-language published papers. Part 2: The direct and indirect costs of injury.

    Science.gov (United States)

    Bielska, Iwona A; Wang, Xiang; Lee, Raymond; Johnson, Ana P

    2017-07-20

    Ankle and foot sprains and fractures are prevalent injuries, which may result in substantial physical and economic consequences for the patient and place a financial burden on the health care system. Therefore, the objectives of this paper are to examine the direct and indirect costs of treating ankle and foot injuries (sprains, dislocations, fractures), as well as to provide an overview of the outcomes of full economic analyses of different treatment strategies. A systematic review was carried out among seven databases to identify English language publications on the health economics of ankle and foot injury treatment published between 1980 and 2014. The direct and indirect costs were abstracted by two independent reviewers. All costs were adjusted for inflation and reported in 2016 US dollars (USD). Among 2047 identified studies, 32 were selected for analysis. The direct costs of ankle sprain management ranged from $292 to $2268 per patient (2016 USD), depending on the injury severity and treatment strategy. The direct costs of managing ankle fractures were higher ($1908-$19,555). Foot fracture treatment had similar direct costs ranging from $998 to $21,801. The economic evaluations were conducted from the societal or payer's perspectives. The costs of treating ankle and foot sprains and fractures varied among the studies, mostly due to differences in injury type and study characteristics, which impacted the ability of directly comparing the financial burden of treatment. Nonetheless, the review showed that the costs experienced by the patient and the health care system increased with injury complexity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  19. Maintenance cost models in deregulated power systems under opportunity costs

    International Nuclear Information System (INIS)

    Al-Arfaj, K.; Dahal, K.; Azaiez, M.N.

    2007-01-01

    In a centralized power system, the operator is responsible for scheduling maintenance. There are different types of maintenance, including corrective maintenance; predictive maintenance; preventive maintenance; and reliability-centred maintenance. The main cause of power failures is poor maintenance. As such, maintenance costs play a significant role in deregulated power systems. They include direct costs associated with material and labor costs as well as indirect costs associated with spare parts inventory, shipment, test equipment, indirect labor, opportunity costs and cost of failure. In maintenance scheduling and planning, the cost function is the only component of the objective function. This paper presented the results of a study in which different components of maintenance costs were modeled. The maintenance models were formulated as an optimization problem with single and multiple objectives and a set of constraints. The maintenance costs models could be used to schedule the maintenance activities of power generators more accurately and to identify the best maintenance strategies over a period of time as they consider failure and opportunity costs in a deregulated environment. 32 refs., 4 tabs., 4 figs

  20. Indirect Comprehensive Review Board (ICRB). Final Report

    International Nuclear Information System (INIS)

    1996-12-01

    Lockheed Martin Idaho Technologies Company (LMITCO) used a systems engineering approach to take the first step toward defining a requirements baseline for all indirect work at the Idaho National Engineering Laboratory. The intent of this effort was to define the requirements for indirect work, identify the activities necessary to meet the requirements, and to produce defensible cost estimates for the work. The result of this effort is a scrubbed-down, defensible budget for all indirect work in FY 1997. Buying power for each dollar of direct work was increased by $.02. Recommendations are identified for improvements to this process in FY 1998. The purpose of this report is twofold. First is to report the final results of the 1996 ICRB process, and second is to document the process used such that incremental improvements may be made in future years. Objectives, processes, and approaches are described to provide a trail for future boards. Appendices contain copies of board composition, documentation of the process, as well as the actual training materials

  1. Cost-benefit analysis of a green electricity system in Japan considering the indirect economic impacts of tropical cyclones

    International Nuclear Information System (INIS)

    Esteban, Miguel; Zhang, Qi; Longarte-Galnares, Gorka

    2012-01-01

    Global warming is likely to profoundly influence future weather patterns, and one consequence of this is the likelihood of an increase in tropical cyclone intensity. The present paper presents a cost-benefit analysis of introducing significant amounts of green energy in the electricity system in Japan in the light of the economic damage that an increase in tropical cyclone intensity could have on GDP growth between 2010 and 2085. Essentially the passage of a tropical cyclone will result not only in physical damage but also on a decrease in economic productivity due to precautionary cessation of the economic activity, which has an effect on GDP growth. By comparing the economic performance of different electricity system scenarios with the indirect economic damage of tropical cyclones from 2010 to 2085, based on the yearly economic data of green electricity, fossil fuel, GDP and population, it can be seen that the green scenarios are generally a cost-effective way of mitigating the effects of these weather systems, despite the large amount of initial investments necessary. - Highlights: ► Climate change is likely to increase the future strength of tropical cyclones. ► An increase in tropical cyclone strength would reduce GDP growth in Japan. ► Reducing green-house gas emissions is a cost-effective mitigation strategy.

  2. An update of “Cost-effectiveness of rotavirus vaccination in the Netherlands: the results of a Consensus Rotavirus Vaccine model”

    Directory of Open Access Journals (Sweden)

    Tu Hong Anh T

    2013-01-01

    Full Text Available Abstract Background To update a cost-effectiveness analysis of rotavirus vaccination in the Netherlands previously published in 2011. Methods The rotavirus burden of disease and the indirect protection of older children and young adults (herd protection were updated. Results When updated data was used, routine infant rotavirus vaccination in the Netherlands would potentially become an even more cost-effective strategy than previously estimated with the incremental cost per QALY at only €3,000-4,000. Break-even total vaccination costs were indicated at €92–122, depending on the applied threshold. Conclusions We concluded that the results on potentially favourable cost-effectiveness in the previous study remained valid, however, the new data suggested that previous results might represent an underestimation of the economic attractiveness of rotavirus vaccination.

  3. Indirect costs of absenteeism due to rheumatoid arthritis, psoriasis, multiple sclerosis, insulin-dependent diabetes mellitus, and ulcerative colitis in 2012: a study based on real-life data from the Social Insurance Institution in Poland.

    Science.gov (United States)

    Malinowski, Krzysztof Piotr; Kawalec, Paweł Piotr; Moćko, Paweł

    2016-01-01

    The aim of this study is to assess the indirect costs of six major autoimmune diseases including seropositive rheumatoid arthritis, other types of rheumatoid arthritis, psoriasis, multiple sclerosis, Type 1 diabetes, and ulcerative colitis. Relevant data for 2012 on sick leave and short- and long-term work disabilities were obtained from the Social Insurance Institution in Poland. Indirect costs were estimated using the human capital approach based on gross domestic product per capita, gross value added per worker, and gross income per worker in Poland in 2012 and expressed in euro. We recorded data on the total number of 45,500 patients. The total indirect costs were EUR 146,862,569; 353,683,508; and 108,154,271, calculated using gross domestic product, gross value added, and gross income, respectively. Considering only data on absenteeism collected by the Social Insurance Institution in Poland, we can conclude that the selected autoimmune diseases are associated with great indirect costs.

  4. Preliminary Experimental Results for Indirect Vector-Control of Induction Motor Drives with Forced Dynamics

    Directory of Open Access Journals (Sweden)

    Jan Vittek

    2003-01-01

    Full Text Available The contribution presents an extension of indirect vector control of electric drives employing induction motors to 'Forced Dynamic Control'. This method of control offers an accurate realisation of dynamic response profiles, which can be selected by the user. The developed system can be integrated into a drive with a shaft position encoder or a shaft sensoriess drive, in which only the stator currents are measured. The applied stator voltages are determined by a computed inverter switching algorithm. Simulation results and preliminary experimental results for indirect vector control of an idle running induction motor indicate good agreement with the theoretical predictions.

  5. Indirect Reciprocity with Optional Interactions and Private Information

    Directory of Open Access Journals (Sweden)

    Jason Olejarz

    2015-09-01

    Full Text Available We consider indirect reciprocity with optional interactions and private information. A game is offered between two players and accepted unless it is known that the other person is a defector. Whenever a defector manages to exploit a cooperator, his or her reputation is revealed to others in the population with some probability. Therefore, people have different private information about the reputation of others, which is a setting that is difficult to analyze in the theory of indirect reciprocity. Since a defector loses a fraction of his social ties each time he exploits a cooperator, he is less efficient at exploiting cooperators in subsequent rounds. We analytically calculate the critical benefit-to-cost ratio above which cooperation is successful in various settings. We demonstrate quantitative agreement with simulation results of a corresponding Wright–Fisher process with optional interactions and private information. We also deduce a simple necessary condition for the critical benefit-to-cost ratio.

  6. 21 CFR 570.13 - Indirect food additives resulting from packaging materials prior sanctioned for animal feed and...

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Indirect food additives resulting from packaging... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS FOOD ADDITIVES General Provisions § 570.13 Indirect food additives resulting from packaging materials...

  7. 21 CFR 570.14 - Indirect food additives resulting from packaging materials for animal feed and pet food.

    Science.gov (United States)

    2010-04-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS FOOD ADDITIVES General Provisions § 570.14 Indirect food additives resulting from packaging materials for animal feed and... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Indirect food additives resulting from packaging...

  8. Mastitis therapy: Direct and indirect costs

    OpenAIRE

    Boboš, S.; Radinović, M.; Vidić, B.; Pajić, M.; Vidić, V.; Galfi, A.

    2013-01-01

    One of the most important problems in milk production, causing great economic loses is certainly mastitis. In order to minimize economic losses from mastitis dairy farms introduce different mastitis management programs. These programs include mastitis therapy and prevention. In mastitis control prevention is most important and when mastitis occurs cost of therapy and milk discharge is very important. In our study we examined cost of mastitis treatment and m...

  9. Direct and indirect punishment among strangers in the field.

    Science.gov (United States)

    Balafoutas, Loukas; Nikiforakis, Nikos; Rockenbach, Bettina

    2014-11-11

    Many interactions in modern human societies are among strangers. Explaining cooperation in such interactions is challenging. The two most prominent explanations critically depend on individuals' willingness to punish defectors: In models of direct punishment, individuals punish antisocial behavior at a personal cost, whereas in models of indirect reciprocity, they punish indirectly by withholding rewards. We investigate these competing explanations in a field experiment with real-life interactions among strangers. We find clear evidence of both direct and indirect punishment. Direct punishment is not rewarded by strangers and, in line with models of indirect reciprocity, is crowded out by indirect punishment opportunities. The existence of direct and indirect punishment in daily life indicates the importance of both means for understanding the evolution of cooperation.

  10. Assessment of compliance costs resulting from implementation of the proposed Great Lakes water quality guidance

    International Nuclear Information System (INIS)

    Fenner, K.; Podar, M.; Snyder, B.

    1993-01-01

    The primary purpose of the study was to develop an estimate of the incremental cost to direct dischargers resulting from the implementation of the proposed Great Lakes Water Quality Guidance (GLWQG). This estimate reflects the incremental cost of complying with permit requirements developed using the Implementation Procedures and water quality criteria proposed in the GLWQG versus permit requirements based on existing State water quality standards. Two secondary analyses were also performed, one to develop a preliminary estimate of the costs that would be incurred by indirect dischargers to publicly owned treatment works (POTWs), and another to evaluate the cost-effectiveness of the GLWQG. Finally, several sensitivity analyses were performed to evaluate the impact of several major assumptions on the estimated compliance costs. To estimate compliance costs, permit limitations and conditions based on existing State water quality standards were compared to water quality-based limitations and conditions based on the proposed GLWQG criteria and Implementation Procedures for a sample of plants. The control measures needed to comply with the proposed GLWQG-based effluent limitations were evaluated. Individual plant compliance costs were estimated for these control measures based on information on treatment technology and cost analyses available in the literature. An overall compliance cost was projected from the sample based on statistical methods

  11. Predonation Direct and Indirect Costs Incurred by Adults Who Donated a Kidney: Findings From the KDOC Study.

    Science.gov (United States)

    Rodrigue, J R; Schold, J D; Morrissey, P; Whiting, J; Vella, J; Kayler, L K; Katz, D; Jones, J; Kaplan, B; Fleishman, A; Pavlakis, M; Mandelbrot, D A

    2015-09-01

    Limited information exists on the predonation costs incurred by eventual living kidney donors (LKDs). Expenses related to completion of the donation evaluation were collected from 194 LKDs participating in the multi-center, prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 187, 96%) reported one or more direct costs, including ground transportation (80%), healthcare (24%), lodging (17%) and air transportation (14%), totaling $101 484 (USD; mean = $523 ± 942). Excluding paid vacation or sick leave, donor and companion lost wages totaled $35 918 (mean = $187 ± 556) and $14 378 (mean = $76 ± 311), respectively. One-third of LKDs used paid vacation or sick leave to avoid incurring lost wages. Few LKDs reported receiving financial support from the transplant candidate (6%), transplant candidate's family (3%), a nonprofit organization (3%), the National Living Donor Assistance Center (7%), or transplant center (3%). Higher total costs were significantly associated with longer distance traveled to the transplant center (p costs were not associated with age, sex, race/ethnicity, household income, marital status, insurance status, or transplant center. Moderate predonation direct and indirect costs are common for adults who complete the donation evaluation. Potential LKDs should be advised of these possible costs, and the transplant community should examine additional strategies to reimburse donors for them. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  12. Costs and results of federal incentives for commercial nuclear energy

    International Nuclear Information System (INIS)

    Bezdek, R.H.; Wendling, R.M.

    1991-01-01

    This paper (1) estimates the total costs of federal expenditures in support of incentives for the development of commercial nuclear energy through 1988, and (2) analyzes the results and benefits to the nation of this federal investment. The federal incentives analyzed include research and development, regulation of commercial nuclear energy, tax incentives, waste management and disposal, enrichment plants, liability insurance, the uranium mining industry, and all other federal support activities. The authors estimate that net federal incentives totaled about $45-50 billion (1988 dollars). They estimate the results of the federal incentives, focusing on six categories, namely, electric energy produced, the total (direct plus indirect) economic benefits of the industry created, R and D program benefits, value of energy imports displaced, environmental effects, and health, safety, and risk effects. The results total $1.9 trillion, with approximately $250-300 billion identified as net benefits. The authors conclude that the high return on the investment justified federal incentives for nuclear energy development over the past four decades and that the federal government and the nation have received a significant return on the incentives investment

  13. Caregiver burden, productivity loss, and indirect costs associated with caring for patients with poststroke spasticity

    Directory of Open Access Journals (Sweden)

    Ganapathy V

    2015-11-01

    Full Text Available Vaidyanathan Ganapathy,1 Glenn D Graham,2 Marco D DiBonaventura,3 Patrick J Gillard,1 Amir Goren,3 Richard D Zorowitz41Allergan, Irvine, CA, USA; 2Department of Veterans Affairs, San Francisco, CA, USA; 3Health Outcomes Practice, Kantar Health, New York, NY, USA; 4Johns Hopkins Bayview Medical Center, Baltimore, MD, USAObjective: Many stroke survivors experience poststroke spasticity and the related inability to perform basic activities, which necessitates patient management and treatment, and exerts a considerable burden on the informal caregiver. The current study aims to estimate burden, productivity loss, and indirect costs for caregivers of stroke survivors with spasticity.Methods: Internet survey data were collected from 153 caregivers of stroke survivors with spasticity including caregiving time and difficulty (Oberst Caregiver Burden Scale, Work Productivity and Activity Impairment measures, and caregiver and patient characteristics. Fractional logit models examined predictors of work-related restriction, and work losses were monetized (2012 median US wages.Results: Mean Oberst Caregiver Burden Scale time and difficulty scores were 46.1 and 32.4, respectively. Employed caregivers (n=71 had overall work restriction (32%, absenteeism (9%, and presenteeism (27%. Caregiver characteristics, lack of nursing home coverage, and stroke survivors’ disability predicted all work restriction outcomes. The mean total lost-productivity cost per employed caregiver was US$835 per month (>$10,000 per year; 72% attributable to presenteeism.Conclusion: These findings demonstrate the substantial burden of caring for stroke survivors with spasticity illustrating the societal and economic impact of stroke that extends beyond the stroke survivor.Keywords: burden, caregiver, productivity, spasticity, stroke

  14. An experimental test for indirect benefits in Drosophila melanogaster

    Directory of Open Access Journals (Sweden)

    Ödeen Anders

    2007-03-01

    Full Text Available Abstract Background Despite much empirical attention, tests for indirect benefits of mate choice have rarely considered the major components of sexual and nonsexual offspring fitness relevant to a population. Here we use a novel experimental design to test for the existence of any indirect benefits in a laboratory adapted population of D. melanogaster. Our experiment compared the fitness (mating success, longevity, and productivity of individuals possessing genomes that derived two generations previously from males that were either entirely successful (studs or wholly unsuccessful (duds at achieving mates in three subsequent rounds of mating trials. Results Males from the stud treatment were 30% more successful on average at securing mates than males from the dud treatment. In contrast, we found no difference between treatments in measures of productivity or of longevity when measured in a mixed-sex environment. In the absence of females, however, males in the stud treatment outlived males in the dud treatment. Conclusion Our results suggest that mating with successful males in this population provides an indirect benefit to females and that, at least in this environment, the benefit arises primarily through the production of more attractive male offspring. However, it is unclear whether this represents solely a traditional sexy sons benefit or whether there is an additional good genes component (with male offspring simply allocating their surplus condition to traits that enhance their mating success. The lack of any detectable differences in female fitness between the two treatments suggests the former, although the longevity advantage of males in the stud treatment when females were absent is consistent with the latter. Determining the effect of this indirect benefit on the evolution of female mate preferences (or resistance will require comparable data on the direct costs of mating with various males, and an understanding of how these costs

  15. Cost-of-illness studies.

    Science.gov (United States)

    Oderda, Gary M

    2003-01-01

    Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. These studies should take the societal perspective and include both direct and indirect costs. Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.

  16. Allocation base of general production costs as optimization of prime costs

    Directory of Open Access Journals (Sweden)

    Levytska I.O.

    2017-03-01

    Full Text Available Qualified management aimed at optimizing financial results is the key factor in today's society. Effective management decisions depend on the necessary information about the costs of production process in all its aspects – their structure, types, accounting policies of reflecting costs. General production costs, the so-called indirect costs that are not directly related to the production process, but provide its functioning in terms of supporting structural divisions and create the necessary conditions of production, play a significant role in calculating prime costs of goods (works, services. However, the accurate estimate of prime costs of goods (works, services should be determined with the value of indirect costs (in other words, general production costs, and properly determined with the base of their allocation. The choice of allocation base of general production costs is the significant moment, depending on the nature of business, which must guarantee fair distribution regarding to the largest share of direct expenses in the total structure of production costs. The study finds the essence of general production costs based on the analysis of key definitions of leading Ukrainian economists. The optimal allocation approach of general production costs is to calculate these costs as direct production costs within each subsidiary division (department separately without selecting a base as the main one to the their total amount.

  17. Cost analysis of a commercial pyroprocess facility on the basis of a conceptual design in Korea

    International Nuclear Information System (INIS)

    Kim, S.K.; Ko, W.I.; Youn, S.R.; Gao, Ruxing

    2015-01-01

    Highlights: • Pyroprocess facility’s direct cost was calculated based on the conceptual design. • The unit cost of pyroprocess was calculated as $781/kgHM. • The unit cost was increased by 3%, considering labor allocation standards. • The operating and maintenance cost was identified as a main cost driver. - Abstract: This study postulated a commercial pyroprocess facility (KAPF+: Korea Advanced Pyroprocess Facility Plus) with a processing capacity of 400 tons/year as a cost object, and utilized an engineering cost estimation method based on a conceptual design to present the results of the total cost and unit cost estimation. According to the calculation results, the total cost and unit cost were calculated with k$779,386 and $781/kgHM, respectively. Moreover, the key cost driver was manifested as the operating and maintenance costs. In particular, equipment replacement cost was identified as an important cost driver. In addition, for an increasingly accurate cost estimation, the calculation results and allocation method of the indirect cost were reanalyzed. Finally the pyroprocess unit cost increased $5 when calculated the indirect cost using the labor time as the allocation standard. Meanwhile, the pyroprocess unit cost increased $22 as a result of allocating the indirect cost using the uniform labor cost as the cost allocation standard. Accordingly, an indirect cost allocation standard was manifested as the factor that exerts a significant effect on the pyroprocess unit cost

  18. European Union-28: An annualised cost-of-illness model for venous thromboembolism.

    Science.gov (United States)

    Barco, Stefano; Woersching, Alex L; Spyropoulos, Alex C; Piovella, Franco; Mahan, Charles E

    2016-04-01

    Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5-2.2 billion, €1.0-1.5 billion, €0.5-1.1 billion and €0.2-0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8-3.3 billion, €1.2-2.4 billion, €0.6-1.8 billion and €0.2-0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0-8.5 billion, €2.2-6.2 billion, €1.1-4.6 billion and €0.5-1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5-13.2 billion, €1.0-9.7 billion, €0.5-7.3 billion and €0.2-6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28's healthcare systems and that significant savings could be realised if better preventive measures are applied.

  19. External costs of atmospheric lead emissions from a waste-to-energy plant: a follow-up assessment of indirect neurotoxic impacts via topsoil ingestion

    DEFF Research Database (Denmark)

    Pizzol, Massimo; Møller, Flemming; Thomsen, Marianne

    2013-01-01

    The link between anthropogenic emissions and the monetary value of their impacts, so-called external cost, can be determined via the impact pathway approach. This method is used in the present study to calculate the indirect costs, via topsoil ingestion, of lead emitted into atmosphere from a waste......-to-energy facility in Denmark. The Operational Meteorological air-quality model, the Simplified Fate and Speciation Model, and the Age Dependent Biokinetic Model are used to determine the metals’ atmospheric transport, its deposition and accumulation in topsoil, and its bio-accumulation in the human body...

  20. The 'indirect costs' of underfunding foreign partners in global health research: A case study.

    Science.gov (United States)

    Crane, Johanna T; Andia Biraro, Irene; Fouad, Tamer M; Boum, Yap; R Bangsberg, David

    2017-09-16

    This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work. MGH: Massachusetts General Hospital; MUST: Mbarara University of Science and Technology; NIH: National Institutes of Health; UCSF: University of California San Francisco; URI: Uganda Research Institute.

  1. The cost of tuberculosis in Denmark

    DEFF Research Database (Denmark)

    Fløe, Andreas; Hilberg, Ole; Wejse, Christian

    Hypothesis: Tuberculosis (TB) patients carry higher direct health-related and indirect costs than the general population. Objective: To calculate the economic burden of TB in Denmark, including the health-related costs of treatment and the indirect costs for society in a national retrospective case...

  2. 48 CFR 1631.203 - Indirect costs.

    Science.gov (United States)

    2010-10-01

    ... Section 1631.203 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND... general practice in the insurance industry. [70 FR 31391, June 1, 2005] ...

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

    Directory of Open Access Journals (Sweden)

    Diego M. Castro

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

  4. Indirect reciprocity with optional interactions.

    Science.gov (United States)

    Ghang, Whan; Nowak, Martin A

    2015-01-21

    Indirect reciprocity is a mechanism for the evolution of cooperation that is relevant for prosocial behavior among humans. Indirect reciprocity means that my behavior towards you also depends on what you have done to others. Indirect reciprocity is associated with the evolution of social intelligence and human language. Most approaches to indirect reciprocity assume obligatory interactions, but here we explore optional interactions. In any one round a game between two players is offered. A cooperator accepts a game unless the reputation of the other player indicates a defector. For a game to take place, both players must accept. In a game between a cooperator and a defector, the reputation of the defector is revealed to all players with probability Q. After a sufficiently large number of rounds the identity of all defectors is known and cooperators are no longer exploited. The crucial condition for evolution of cooperation can be written as hQB>1, where h is the average number of rounds per person and B=(b/c)-1 specifies the benefit-to-cost ratio. We analyze both stochastic and deterministic evolutionary game dynamics. We study two extensions that deal with uncertainty: hesitation and malicious gossip. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. The costs of hepatitis A infections in South Korea

    Directory of Open Access Journals (Sweden)

    Kyohyun Kim

    2014-08-01

    Full Text Available 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.

  6. New Approaches in Reuseable Booster System Life Cycle Cost Modeling

    Science.gov (United States)

    Zapata, Edgar

    2013-01-01

    This paper presents the results of a 2012 life cycle cost (LCC) study of hybrid Reusable Booster Systems (RBS) conducted by NASA Kennedy Space Center (KSC) and the Air Force Research Laboratory (AFRL). The work included the creation of a new cost estimating model and an LCC analysis, building on past work where applicable, but emphasizing the integration of new approaches in life cycle cost estimation. Specifically, the inclusion of industry processes/practices and indirect costs were a new and significant part of the analysis. The focus of LCC estimation has traditionally been from the perspective of technology, design characteristics, and related factors such as reliability. Technology has informed the cost related support to decision makers interested in risk and budget insight. This traditional emphasis on technology occurs even though it is well established that complex aerospace systems costs are mostly about indirect costs, with likely only partial influence in these indirect costs being due to the more visible technology products. Organizational considerations, processes/practices, and indirect costs are traditionally derived ("wrapped") only by relationship to tangible product characteristics. This traditional approach works well as long as it is understood that no significant changes, and by relation no significant improvements, are being pursued in the area of either the government acquisition or industry?s indirect costs. In this sense then, most launch systems cost models ignore most costs. The alternative was implemented in this LCC study, whereby the approach considered technology and process/practices in balance, with as much detail for one as the other. This RBS LCC study has avoided point-designs, for now, instead emphasizing exploring the trade-space of potential technology advances joined with potential process/practice advances. Given the range of decisions, and all their combinations, it was necessary to create a model of the original model

  7. New Approaches in Reusable Booster System Life Cycle Cost Modeling

    Science.gov (United States)

    Zapata, Edgar

    2013-01-01

    This paper presents the results of a 2012 life cycle cost (LCC) study of hybrid Reusable Booster Systems (RBS) conducted by NASA Kennedy Space Center (KSC) and the Air Force Research Laboratory (AFRL). The work included the creation of a new cost estimating model and an LCC analysis, building on past work where applicable, but emphasizing the integration of new approaches in life cycle cost estimation. Specifically, the inclusion of industry processes/practices and indirect costs were a new and significant part of the analysis. The focus of LCC estimation has traditionally been from the perspective of technology, design characteristics, and related factors such as reliability. Technology has informed the cost related support to decision makers interested in risk and budget insight. This traditional emphasis on technology occurs even though it is well established that complex aerospace systems costs are mostly about indirect costs, with likely only partial influence in these indirect costs being due to the more visible technology products. Organizational considerations, processes/practices, and indirect costs are traditionally derived ("wrapped") only by relationship to tangible product characteristics. This traditional approach works well as long as it is understood that no significant changes, and by relation no significant improvements, are being pursued in the area of either the government acquisition or industry?s indirect costs. In this sense then, most launch systems cost models ignore most costs. The alternative was implemented in this LCC study, whereby the approach considered technology and process/practices in balance, with as much detail for one as the other. This RBS LCC study has avoided point-designs, for now, instead emphasizing exploring the trade-space of potential technology advances joined with potential process/practice advances. Given the range of decisions, and all their combinations, it was necessary to create a model of the original model

  8. Desensitizing bioactive agents improves bond strength of indirect resin-cemented restorations: preliminary results

    Directory of Open Access Journals (Sweden)

    Fernanda de Carvalho Panzeri Pires-de-Souza

    2007-04-01

    Full Text Available OBJECTIVE: The aim of this study was to assess the bond strength of indirect composite restorations cemented with a resin-based cement associated with etch-and-rinse and self-etching primer adhesive systems to dentin treated or not with a bioactive material. MATERIALS AND METHOD: Twenty bovine incisor crowns had the buccal enamel removed and the dentin ground flat. The teeth were assigned to 4 groups (n=5: Group I: acid etching + Prime & Bond NT (Dentsply; Group II: application of a bioactive glass (Biosilicato®+ acid etching + Prime & Bond NT; Group III: One-up Bond F (J Morita; Group IV: Biosilicato® + One-up Bond F. Indirect composite resin (Artglass, Kulzer cylinders (6x10mm were fabricated and cemented to the teeth with a dual-cure resin-based cement (Enforce, Dentsply. After cementation, the specimens were stored in artificial saliva at 37ºC for 30 days and thereafter tested in tensile strength in a universal testing machine (EMIC with 50 kgf load cell at a crosshead speed of 1 mm/min. Failure modes were assessed under scanning electron microscopy. Data were analyzed statistically by ANOVA and Tukey's test (95% level of confidence. RESULTS: Groups I, II and III had statistically similar results (p>0.05. Group IV had statistically significant higher bond strength means (p<0.05 than the other groups. The analysis of the debonded surfaces showed a predominance of adhesive failure mode for Group III and mixed failure mode for the other groups. CONCLUSION: The use of desensitizing agent did not affect negatively the bonding of the indirect composite restorations to dentin, independently of the tested adhesive systems.

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

    Science.gov (United States)

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

    2012-01-01

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

  10. Integrating Life-cycle Assessment into Transport Cost-benefit Analysis

    DEFF Research Database (Denmark)

    Manzo, Stefano; Salling, Kim Bang

    2016-01-01

    Traditional transport Cost-Benefit Analysis (CBA) commonly ignores the indirect environmental impacts of an infrastructure project deriving from the overall life-cycle of the different project components. Such indirect impacts are instead of key importance in order to assess the long......-term sustainability of a transport infrastructure project. In the present study we suggest to overcome this limit by combining a conventional life-cycle assessment approach with standard transport cost-benefit analysis. The suggested methodology is tested upon a case study project related to the construction of a new...... fixed link across the Roskilde fjord in Frederikssund (Denmark). The results are then compared with those from a standard CBA framework. The analysis shows that indirect environmental impacts represent a relevant share of the estimated costs of the project, clearly affecting the final project evaluation...

  11. Estimated cost of overactive bladder in Thailand.

    Science.gov (United States)

    Prasopsanti, Kriangsak; Santi-Ngamkun, Apirak; Pornprasit, Kanokwan

    2007-11-01

    To estimate the annual direct and indirect costs of overactive bladder (OAB) in indigenous Thai people aged 18 years and over in the year 2005. Economically based models using diagnostic and treatment algorithms from clinical practice guidelines and current disease prevalence data were used to estimate direct and indirect costs of OAB. Prevalence and event probability estimates were obtained from the literature, national data sets, and expert opinion. Costs were estimated from a small survey using a cost questionnaire and from unit costs of King Chulalongkorn Memorial Hospital. The annual cost of OAB in Thailand is estimated as 1.9 billion USD. It is estimated to consume 1.14% of national GDP The cost includes 0.33 billion USD for direct medical costs, 1.3 billion USD for direct, nonmedical costs and 0.29 billion USD for indirect costs of lost productivity. The largest costs category was direct treatment costs of comorbidities associated with OAB. Costs of OAB medication accountedfor 14% of the total costs ofOAB.

  12. The cost of vision loss in Canada. 2. Results.

    Science.gov (United States)

    Cruess, Alan F; Gordon, Keith D; Bellan, Lorne; Mitchell, Scott; Pezzullo, M Lynne

    2011-08-01

    This study was conducted to provide the financial underpinnings necessary for effective planning for the provision of eye health services in Canada. Canada is facing an aging demographic and all the major eye diseases are diseases associated with aging. It is essential that we have information based on the best available data to support national and provincial vision health plans. The design associated with the prevalence-based approach used in this study was outlined previously in detail in The Cost of Vision Loss in Canada: Methodology. The methods associated with the prevalence-based approach used in this study were previously outlined in detail in The Cost of Vision Loss in Canada: Methodology. The financial cost of VL in Canada in 2007 was estimated to be $15.8 billion per annum: $8.6 billion (54.6%) represents direct health system expenditure; $4.4 billion (28.0%) was productivity lost due to lower employment, higher absenteeism, and premature death of Canadians with VL; $1.8 billion (11.1%) was the dead weight losses (DWL) from transfers including welfare payments and taxation forgone; $0.7 billion (4.4%) was the value of the care for people with VL; $305 million (1.9%) was other indirect costs such as aids and home modifications and the bring forward of funeral costs. Additionally, the value of the lost well-being (disability and premature death) was estimated at a further $11.7 billion. In per capita terms, this amounts to a financial cost of $19370 per person with VL per annum. Including the value of lost well-being, the cost is $33704 per person per annum. There is a growing awareness in Canada and around the world of the impact of VL on health costs and on the economy in general. This awareness is supported by the growing number of independent studies on the cost of vision loss both nationally and globally. Because most of these studies are limited by the minimal amount of available data, the overall cost of vision loss is likely underestimated

  13. Relevance of indirect transmission for wildlife disease surveillance

    Directory of Open Access Journals (Sweden)

    Martin Lange

    2016-11-01

    Full Text Available Epidemiological models of infectious diseases are essential tools in support of risk assessment, surveillance design and contingency planning in public and animal health. Direct pathogen transmission from host to host is an essential process of each host-pathogen system and respective epidemiological modelling concepts. It is widely accepted that numerous diseases involve indirect transmission through pathogens shed by infectious hosts to their environment. However, epidemiological models largely do not represent pathogen persistence outside the host explicitly. We hypothesize that this simplification might bias management-related model predictions for disease agents that can persist outside their host for a certain time span. We adapted an individual-based, spatially explicit epidemiological model that can mimic both transmission processes. One version explicitly simulated indirect pathogen transmission through a contaminated environment. A second version simulated direct host-to-host transmission only. We aligned the model variants by the transmission potential per infectious host (i.e. basic reproductive number R0 and the spatial transmission kernel of the infection to allow unbiased comparison of predictions. The quantitative model results are provided for the example of surveillance plans for early detection of foot-and-mouth disease in wild boar, a social host.We applied systematic sampling strategies on the serological status of randomly selected host individuals in both models. We compared between the model variants the time to detection and the area affected prior to detection, measures that strongly influence mitigation costs. Moreover, the ideal sampling strategy to detect the infection in a given time frame was compared between both models.We found the simplified, direct transmission model to underestimate necessary sample size by up to one order of magnitude, but to overestimate the area put under control measures. Thus, the model

  14. The friction cost method: a comment.

    Science.gov (United States)

    Johannesson, M; Karlsson, G

    1997-04-01

    The friction cost method has been proposed as an alternative to the human-capital approach of estimating indirect costs. We argue that the friction cost method is based on implausible assumptions not supported by neoclassical economic theory. Furthermore consistently applying the friction cost method would mean that the method should also be applied in the estimation of direct costs, which would mean that the costs of health care programmes are substantially decreased. It is concluded that the friction cost method does not seem to be a useful alternative to the human-capital approach in the estimation of indirect costs.

  15. Application Anti Microbial Activity Test and Direct Inoculation of Urinary Specimen Test to Increase the Quality of Results and Decrease the Production Cost in Clinical Microbiology Laboratory, Sanglah General Hospital Hospital, Bali-Indonesia

    Directory of Open Access Journals (Sweden)

    Nyoman Sri-Budayanti

    2012-05-01

    Full Text Available Objective: Urinary tract infection (UTI is the most common bacterial infection in general practice and in hospitals. Fast and accurate urine culture and sensitivity test are needed for adequate therapy. Anti Microbial Activity test (AMA test that is used to detect the presence of antibiotics in urine specimens is not commonly used in clinical microbiology laboratories. Some laboratories are still using indirect inoculation technique using enriched media before inoculating onto the agar media. The aim of this research is to compare results of urinary examination of direct inoculation technique with AMA test with indirect inoculation technique without AMA test.Methods: A number of 210 urine specimens were collected in Clinical Microbiology Laboratory at Sanglah General Hospital within a time period between 16 June until 16 July 2009.Results: Antibiotics were detected in 40% of the urinary specimens; whereas 48.1% showed no evidence of UTI, that is negative AMA test and sterile urinary culture or colony growth < 105 CFU/ml. Only 11.9% of the specimens indicates urinary tract infections. The examination can be completed within 2-3 days which is shorter than indirect inoculation test which require 5-7 days. Direct inoculation technique can reduce the cost of production three-fold the costs require for an indirect inoculation test.Conclusions: Application of AMA test and direct inoculation technique can give results more rapidly, reliable and useful for clinicians. This also decrease the laboratory’s cost of production.

  16. NATIONAL SCIENCE FOUNDATION. Preliminary Observations on Indirect Costs for Research

    Science.gov (United States)

    2017-05-24

    involvement between NSF and the awardee in carrying out the activity supported by the award. 2Office of Management and Budget , Uniform Administrative...NSF’s Award Cash Management $ervice—NSF’s online approach to award payments and post-award financial processes—does not collect data about indirect...percent. 16NSF’s Award Cash Management $ervice implements the OMB-approved form for awardees to report financial data on their federal awards. The

  17. Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results

    Directory of Open Access Journals (Sweden)

    David Cuesta-Peredo

    2018-02-01

    Full Text Available Introduction: Hip fracture is a health problem that presents high morbidity and mortality, negatively influencing the patient’s quality of life and generating high costs. Structured analysis of quality indicators can facilitate decision-making, cost minimization, and improvement of the quality of care. Methods: We studied 1571 patients aged 70 years and over with the diagnosis of hip fracture at Hospital Universitario de la Ribera in the period between 1 January 2012 and 31 December 2016. Demographic, clinical, functional, and quality indicator variables were studied. An indirect analysis of the costs associated with adverse events arising during hospital admission was made. A tool based on the “Minimum Basic Data Set (CMBD” was designed to monitor the influence of patient risk factors on the incidence of adverse effects (AE and their associated costs. Results: The average age of the patients analysed was 84.15 years (SD 6.28, with a length of stay of 8.01 days (SD 3.32, a mean preoperative stay of 43.04 h (SD 30.81, and a mortality rate of 4.2%. Likewise, the percentage of patients with AE was 41.44%, and 11.01% of patients changed their cost as a consequence of these AEs suffered during hospital admission. The average cost of patients was €8752 (SD: 1,864 and the average cost increase in patients with adverse events was €2321 (SD: 3,164. Conclusions: Through the analysis of the main clinical characteristics and the indirect estimation of the complexity of the patients, a simple calculation of the average cost of the attention and its adverse events can be designed in patients who are admitted due to hip fracture. Additionally, this tool can fit the welfare quality indicators by severity and cost.

  18. Selective Cooperation in the Supermarket : Field Experimental Evidence for Indirect Reciprocity.

    Science.gov (United States)

    Lange, Florian; Eggert, Frank

    2015-12-01

    Numerous laboratory experiments suggest that mechanisms of indirect reciprocity might account for human cooperation. However, conclusive field data supporting the predictions of indirect reciprocity in everyday life situations is still scarce. Here, we attempt to compensate for this lack by examining the determinants of cooperative behavior in a German supermarket. Our methods were as follows: Confederates of the experimenter lined up at the checkout, apparently to buy a single item. As an act of cooperation, the waiting person in front (the potential helper) could allow the confederate to go ahead. By this means, the potential helper could take a cost (additional waiting time) by providing the confederate with a benefit (saved waiting time). We recorded the potential helpers' behavior and the number of items they purchased as a quantitative measure proportional to the confederate's benefit. Moreover, in a field experimental design, we varied the confederates' image by manipulating the item they purchased (beer vs. water). As predicted, the more waiting time they could save, the more likely the confederates were to receive cooperation. This relationship was moderated by the confederates' image. Cost-to-benefit ratios were required to be more favorable for beer-purchasing individuals to receive cooperation. Our results demonstrate that everyday human cooperation can be studied unobtrusively in the field and that cooperation among strangers is selective in a way that is consistent with current models of indirect reciprocity.

  19. [Macroeconomic costs of eye diseases].

    Science.gov (United States)

    Hirneiß, C; Kampik, A; Neubauer, A S

    2014-05-01

    Eye diseases that are relevant regarding their macroeconomic costs and their impact on society include cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors. The aim of this article is to provide a comprehensive overview of direct and indirect costs for major eye disease categories for Germany, based on existing literature and data sources. A semi-structured literature search was performed in the databases Medline and Embase and in the search machine Google for relevant original papers and reviews on costs of eye diseases with relevance for or transferability to Germany (last research date October 2013). In addition, manual searching was performed in important national databases and information sources, such as the Federal Office of Statistics and scientific societies. The direct costs for these diseases add up to approximately 2.6 billion Euros yearly for the Federal Republic of Germany, including out of the pocket payments from patients but excluding optical aids (e.g. glasses). In addition to those direct costs there are also indirect costs which are caused e.g. by loss of employment or productivity or by a reduction in health-related quality of life. These indirect costs can only be roughly estimated. Including the indirect costs for the eye diseases investigated, a total yearly macroeconomic cost ranging between 4 and 12 billion Euros is estimated for Germany. The costs for the eye diseases cataract, diabetic retinopathy, age-related maculopathy, glaucoma and refractive errors have a macroeconomic relevant dimension. Based on the predicted demographic changes with an ageing society an increase of the prevalence and thus also an increase of costs for eye diseases is expected in the future.

  20. ANALYSIS OF THE COST OF THE DISEASE — PROBLEMS AND SOLUTIONS

    Directory of Open Access Journals (Sweden)

    V.V. Omel'yanovskii

    2011-01-01

    Full Text Available The article discusses the estimation of the disease value, which includes direct, indirect and «intangible» costs. Advantages and disadvantages of different approaches to cost accounting, including the method of direct costs microcalculation compared with established norms of reimbursement are presented. It is demonstrated that disease’s cost not only reveals the burden of a pathology, but also allows the State to rationally allocate resources. The authors conclude that lack of comparability of the results of studies with different approaches to cost accounting does not allow their use in health care management. To solve this problem is necessary to develop a common methodology for analyzing the cost of the disease.Key words: cost of illness study, clinical and economical analysis, direct cost, indirect cost, impalpable costs, microcalculation of costs, human capital method, friction costs method, absenteeism, presenteeism.

  1. The Global Economic Cost of Osteoarthritis: How the UK Compares

    Directory of Open Access Journals (Sweden)

    A. Chen

    2012-01-01

    Full Text Available Aims. To examine all relevant literature on the economic costs of osteoarthritis in the UK, and to compare such costs globally. Methods. A search of MEDLINE was performed. The search was expanded beyond peer-reviewed journals into publications by the department of health, national orthopaedic associations, national authorities and registries, and arthritis charities. Results. No UK studies were identified in the literature search. 3 European, 6 North American, and 2 Asian studies were reviewed. Significant variation in direct and indirect costs were seen in these studies. Costs for topical and oral NSAIDs were estimated to be £19.2 million and £25.65 million, respectively. Cost of hip and knee replacements was estimated to exceed £850 million, arthroscopic surgery for osteoarthritis was estimated to be £1.34 million. Indirect costs from OA caused a loss of economic production over £3.2 billion, £43 million was spent on community services and £215 million on social services for osteoarthritis. Conclusions. While estimates of economic costs can be made using information from non-published data, there remains a lack of original research looking at the direct or indirect costs of osteoarthritis in the UK. Differing methodology in calculating costs from overseas studies makes direct comparison with the UK difficult.

  2. Development of a Practical Costing Method for Hospitals

    OpenAIRE

    Cao, Pengyu; Toyabe, Shin-ichi; Akazawa, Kouhei

    2006-01-01

    To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate r...

  3. Economic Cost of Breast Cancer in Ghana: The Komfo Anokye ...

    African Journals Online (AJOL)

    The aim is to assist in the efficient and effective allocation of scarce health ... Again, the study found the direct annual cost per patient to be GH¢2,070.83 and the indirect ... Cost, Breast Cancer, Direct Cost, Indirect Cost, Human Capital Method ...

  4. A Novel Design Method for Optimizing an Indirect Forced Circulation Solar Water Heating System Based on Life Cycle Cost Using a Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Myeong Jin Ko

    2015-10-01

    Full Text Available To maximize the energy performance and economic benefits of solar water heating (SWH systems, the installation and operation-related design variables as well as those related to capacity must be optimized. This paper presents a novel design method for simultaneously optimizing the various design variables of an indirect forced-circulation SWH system that is based on the life cycle cost and uses a genetic algorithm. The effectiveness of the proposed method is assessed by evaluating the long-term performance corresponding to four cases, which are optimized using different annual solar fractions and sets of the design variables. When the installation and operation-related design variables were taken into consideration, it resulted in an efficient and economic design and an extra cost reduction of 3.2%–6.1% over when only the capacity-related design variables were considered. In addition, the results of parametric studies show that the slope and mass flow rate of the collector have a significant impact on the energy and economic performances of SWH systems. In contrast, the mass flow rate in the secondary circuit and the differences in the temperatures of the upper and lower dead bands of the differential controller have a smaller impact.

  5. Operating cost model for local service airlines

    Science.gov (United States)

    Anderson, J. L.; Andrastek, D. A.

    1976-01-01

    Several mathematical models now exist which determine the operating economics for a United States trunk airline. These models are valuable in assessing the impact of new aircraft into an airline's fleet. The use of a trunk airline cost model for the local service airline does not result in representative operating costs. A new model is presented which is representative of the operating conditions and resultant costs for the local service airline. The calculated annual direct and indirect operating costs for two multiequipment airlines are compared with their actual operating experience.

  6. Costs of dementia in the Czech Republic.

    Science.gov (United States)

    Holmerová, Iva; Hort, Jakub; Rusina, Robert; Wimo, Anders; Šteffl, Michal

    2017-11-01

    The aim of this study was to estimate the cost of dementia in the Czech Republic. One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables. The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p Republic. Both total and indirect care costs increased significantly the cognition declined.

  7. Cost Analysis of Direct versus Indirect and Individual versus Group Modes of Manual-Based Speech-and-Language Therapy for Primary School-Age Children with Primary Language Impairment

    Science.gov (United States)

    Dickson, Kirstin; Marshall, Marjorie; Boyle, James; McCartney, Elspeth; O'Hare, Anne; Forbes, John

    2009-01-01

    Background: The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech-and-language therapy for children with primary language impairment. Aims: To compare the short-run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a…

  8. 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

  9. Economic evaluation of indirect use activities in a private natural heritage reserve

    Directory of Open Access Journals (Sweden)

    Keila Lima Sanches

    2011-06-01

    Full Text Available This study aimed to evaluate the economic viability of indirect use activities as developed in a private natural heritage reserve (RPPN. Activities developed in the RPPN include Adventure Tourism and an Ecological Trail. Data were obtained relating to annual number of people visiting the reserve, prices paid to participate in activities, cost of land, maintenance costs and labor costs. Economic criteria used include Net Present Value (VPL and Equivalent Periodic Benefit (BPE. In the 1996-2008 period the number of visitors increased by 6% a year, and the average annual number of visitors to the RPPN was 8,889. It was concluded that indirect use activities in the RPPN are economically viable and can coexist with other direct soil use activities such as eucalyptus cultivation.

  10. Monitoring and Controlling Engineering and Construction Management Cost Performance Within the Corps of Engineers

    Science.gov (United States)

    1988-12-01

    COST MANAGEMENT The CMIF approach addresses total costs but does not permit the analysis of indirect costs. We found that indirect costs vary...responsibility USACE/divisions Increasing CMIF Districts/divisions level of by fund type detail G&A, technical indirect, burden Districts by fund type

  11. The indirect costs and benefits of greenhouse gas limitations

    Energy Technology Data Exchange (ETDEWEB)

    Markandya, A

    1999-12-31

    The purpose of this report is to evaluate GHG limitation issues in a broader context. This includes the impacts of projects on vulnerable groups, the impacts on the environment more generally and the impacts on sustainability in a wider sense. It also offers some advice on how a decision-making framework can bring together these different dimensions. The structure of the guidelines is as follows. Section 2 introduces essential cost concepts and discusses the adjustments needed to the financial costs of different components, to arrive at the true economic costs. Section 3 looks at the macro-economic impacts of different GHG limitation project/policies. Section 4 discusses the way in which the sustainability concerns of such projects/policies can be monitored. Section 5 brings these different components together and looks at different methods of project selection. Section 6 provides a basic framework of impacts that are likely to arise in different GHG-related projects/policies, and what kind of method of estimation is available for these different impacts. Sections 7 to 9 go into greater depth on specific impacts. Sections 7 and 8 look at the employment and distributional effects respectively, and how they might be estimated. Section 9 evaluates the benefits in terms of changes in environmental damage resulting from GHG projects/policies. Section 10 provides three case studies in which the methods outlined in the report are applied. These case studies consider a biogas plant in Tanzania, a forestry project in the Russian Federation, and an energy efficiency project in Thailand. Section 11 concludes the report. (au) 59 refs.

  12. The indirect costs and benefits of greenhouse gas limitations

    Energy Technology Data Exchange (ETDEWEB)

    Markandya, A.

    1998-12-31

    The purpose of this report is to evaluate GHG limitation issues in a broader context. This includes the impacts of projects on vulnerable groups, the impacts on the environment more generally and the impacts on sustainability in a wider sense. It also offers some advice on how a decision-making framework can bring together these different dimensions. The structure of the guidelines is as follows. Section 2 introduces essential cost concepts and discusses the adjustments needed to the financial costs of different components, to arrive at the true economic costs. Section 3 looks at the macro-economic impacts of different GHG limitation project/policies. Section 4 discusses the way in which the sustainability concerns of such projects/policies can be monitored. Section 5 brings these different components together and looks at different methods of project selection. Section 6 provides a basic framework of impacts that are likely to arise in different GHG-related projects/policies, and what kind of method of estimation is available for these different impacts. Sections 7 to 9 go into greater depth on specific impacts. Sections 7 and 8 look at the employment and distributional effects respectively, and how they might be estimated. Section 9 evaluates the benefits in terms of changes in environmental damage resulting from GHG projects/policies. Section 10 provides three case studies in which the methods outlined in the report are applied. These case studies consider a biogas plant in Tanzania, a forestry project in the Russian Federation, and an energy efficiency project in Thailand. Section 11 concludes the report. (au) 59 refs.

  13. 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.

  14. Assessing the aerosol direct and first indirect effects using ACM/GCM simulation results

    Science.gov (United States)

    Huang, H.; Gu, Y.; Xue, Y.; Lu, C. H.

    2016-12-01

    Atmospheric aerosols have been found to play an important role in global climate change but there are still large uncertainty in evaluating its role in the climate system. The aerosols generally affect global and regional climate through the scattering and the absorption of solar radiation (direct effect) and through their influences on cloud particle, number and sizes (first indirect effect). The indirect effect will further affects cloud water content, cloud top albedo and surface precipitations. In this study, we investigate the global climatic effect of aerosols using a coupled NCEP Global Forecast System (GFS) and a land surface model (SSiB2) The OPAC (Optical Properties of Aerosols and Clouds) database is used for aerosol effect. The OPAC data provides the optical properties (i.e., the extinction, scattering and absorption coefficient, single-scattering albedo, asymmetry factor and phase function) of ten types of aerosols under various relative humidity conditions for investigating the global direct and first indirect effects of dust aerosols. For indirect forcings due to liquid water, we follow the approach presented by Jiang et al (2011), in which a parameterization of cloud effective radius was calculated to describe its variance with convective strength and aerosol concentration. Since the oceans also play an important role on aerosol climatic effect, we also design a set of simulations using a coupled atmosphere/ocean model (CFS) to evaluate the sensitivity of aerosol effect with two-way atmosphere-ocean interactions.

  15. Deception Undermines the Stability of Cooperation in Games of Indirect Reciprocity.

    Science.gov (United States)

    Számadó, Szabolcs; Szalai, Ferenc; Scheuring, István

    2016-01-01

    Indirect reciprocity is often claimed as one of the key mechanisms of human cooperation. It works only if there is a reputational score keeping and each individual can inform with high probability which other individuals were good or bad in the previous round. Gossip is often proposed as a mechanism that can maintain such coherence of reputations in the face of errors of transmission. Random errors, however, are not the only source of uncertainty in such situations. The possibility of deceptive communication, where the signallers aim to misinform the receiver cannot be excluded. While there is plenty of evidence for deceptive communication in humans the possibility of deception is not yet incorporated into models of indirect reciprocity. Here we show that when deceptive strategies are allowed in the population it will cause the collapse of the coherence of reputations and thus in turn it results the collapse of cooperation. This collapse is independent of the norms and the cost and benefit values. It is due to the fact that there is no selection for honest communication in the framework of indirect reciprocity. It follows that indirect reciprocity can be only proposed plausibly as a mechanism of human cooperation if additional mechanisms are specified in the model that maintains honesty.

  16. Deception Undermines the Stability of Cooperation in Games of Indirect Reciprocity.

    Directory of Open Access Journals (Sweden)

    Szabolcs Számadó

    Full Text Available Indirect reciprocity is often claimed as one of the key mechanisms of human cooperation. It works only if there is a reputational score keeping and each individual can inform with high probability which other individuals were good or bad in the previous round. Gossip is often proposed as a mechanism that can maintain such coherence of reputations in the face of errors of transmission. Random errors, however, are not the only source of uncertainty in such situations. The possibility of deceptive communication, where the signallers aim to misinform the receiver cannot be excluded. While there is plenty of evidence for deceptive communication in humans the possibility of deception is not yet incorporated into models of indirect reciprocity. Here we show that when deceptive strategies are allowed in the population it will cause the collapse of the coherence of reputations and thus in turn it results the collapse of cooperation. This collapse is independent of the norms and the cost and benefit values. It is due to the fact that there is no selection for honest communication in the framework of indirect reciprocity. It follows that indirect reciprocity can be only proposed plausibly as a mechanism of human cooperation if additional mechanisms are specified in the model that maintains honesty.

  17. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Presuming cost-effectiveness results. 436.13 Section 436... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit to...

  18. How do dispersal costs and habitat selection influence realized population connectivity?

    Science.gov (United States)

    Burgess, Scott C; Treml, Eric A; Marshall, Dustin J

    2012-06-01

    Despite the importance of dispersal for population connectivity, dispersal is often costly to the individual. A major impediment to understanding connectivity has been a lack of data combining the movement of individuals and their survival to reproduction in the new habitat (realized connectivity). Although mortality often occurs during dispersal (an immediate cost), in many organisms costs are paid after dispersal (deferred costs). It is unclear how such deferred costs influence the mismatch between dispersal and realized connectivity. Through a series of experiments in the field and laboratory, we estimated both direct and indirect deferred costs in a marine bryozoan (Bugula neritina). We then used the empirical data to parameterize a theoretical model in order to formalize predictions about how dispersal costs influence realized connectivity. Individuals were more likely to colonize poor-quality habitat after prolonged dispersal durations. Individuals that colonized poor-quality habitat performed poorly after colonization because of some property of the habitat (an indirect deferred cost) rather than from prolonged dispersal per se (a direct deferred cost). Our theoretical model predicted that indirect deferred costs could result in nonlinear mismatches between spatial patterns of potential and realized connectivity. The deferred costs of dispersal are likely to be crucial for determining how well patterns of dispersal reflect realized connectivity. Ignoring these deferred costs could lead to inaccurate predictions of spatial population dynamics.

  19. Converting a conventional wired-halogen illuminated indirect ophthalmoscope to a wireless-light emitting diode illuminated indirect ophthalmoscope in less than 1000/- rupees

    Directory of Open Access Journals (Sweden)

    Mihir Kothari

    2015-01-01

    Full Text Available Aim: To report the "do it yourself" method of converting an existing wired-halogen indirect ophthalmoscope (IO to a wireless-light emitting diode (LED IO and report the preferences of the patients and the ophthalmologists. Subjects and Methods: In this prospective observational study, a conventional IO was converted to wireless-LED IO using easily available, affordable electrical components. Conventional and the converted IO were then used to perform photo-stress test and take the feedback of subjects and the ophthalmologists regarding its handling and illumination characteristics. Results: The cost of conversion to wireless-LED was 815/- rupees. Twenty-nine subjects, mean age 34.3 ΁ 10 years with normal eyes were recruited in the study. Between the two illumination systems, there was no statistical difference in the magnitude of the visual acuity loss and the time to recovery of acuity and the bleached vision on photo-stress test, although the visual recovery was clinically faster with LED illumination. The heat sensation was more with halogen illumination than the LED (P = 0.009. The ophthalmologists rated wireless-LED IO higher than wired-halogen IO on the handling, examination comfort, patient′s visual comfort and quality of the image. Twenty-two (81% ophthalmologists wanted to change over to wireless-LED IO. Conclusions: Converting to wireless-LED IO is easy, cost-effective and preferred over a wired-halogen indirect ophthalmoscope.

  20. Turning lights into flights: Estimating direct and indirect rebound effects for UK households

    International Nuclear Information System (INIS)

    Chitnis, Mona; Sorrell, Steve; Druckman, Angela; Firth, Steven K.; Jackson, Tim

    2013-01-01

    Energy efficiency improvements by households lead to rebound effects that offset the potential energy and emissions savings. Direct rebound effects result from increased demand for cheaper energy services, while indirect rebound effects result from increased demand for other goods and services that also require energy to provide. Research to date has focused upon the former, but both are important for climate change. This study estimates the combined direct and indirect rebound effects from seven measures that improve the energy efficiency of UK dwellings. The methodology is based upon estimates of the income elasticity and greenhouse gas (GHG) intensity of 16 categories of household goods and services, and allows for the embodied emissions of the energy efficiency measures themselves, as well as the capital cost of the measures. Rebound effects are measured in GHG terms and relate to the adoption of these measures by an average UK household. The study finds that the rebound effects from these measures are typically in the range 5–15% and arise mostly from indirect effects. This is largely because expenditure on gas and electricity is more GHG-intensive than expenditure on other goods and services. However, the anticipated shift towards a low carbon electricity system in the UK may lead to much larger rebound effects. - Highlights: ► We estimate the direct and indirect rebound effects from energy efficiency improvements by UK households. ► We allow for the capital cost of the improvement, together with the emissions embodied in the relevant equipment. ► We find rebound effects to be relatively modest, in the range 5–15%. ► The anticipated shift towards a low carbon electricity system will lead to larger rebound effects

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

    Directory of Open Access Journals (Sweden)

    Thitiboonsuwan Khannika

    2010-06-01

    Full Text Available Abstract Background 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. Methods 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. Results 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

  2. Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results from PROTECT AF vs. PREVAIL

    Science.gov (United States)

    Freeman, James V.; Hutton, David W.; Barnes, Geoffrey D.; Zhu, Ruo P.; Owens, Douglas K.; Garber, Alan M.; Go, Alan S.; Hlatky, Mark A.; Heidenreich, Paul A.; Wang, Paul J.; Al-Ahmad, Amin; Turakhia, Mintu P.

    2016-01-01

    Background Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost-effectiveness compared to anticoagulation has not been evaluated using all available contemporary trial data. Methods and Results We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost-effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of PROTECT AF and PREVAIL randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios (ICER) compared to warfarin and dabigatran were $20,486 and $23,422 per quality adjusted life year (QALY), respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 QALYs, respectively) and more costly. At a willingness-to-pay-threshold of $50,000 per QALY, LAA closure was cost-effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Conclusions Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost-effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer term trial results and post-marketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice. PMID:27307517

  3. Cost Allocation Plans for Municipalities for Internal Management and Grant Programs.

    Science.gov (United States)

    1981-03-01

    21 3. Indirect Cost --------------------------------- 23 4. S ummary--------------------------------------- 25 D. RESPONSIBILITY ACCOUNTING ...depart- ments or operating units. Z-7:6747 In Cost Accounting - A Managerial Emphasis by Charles T. Horngren the word direct refers to the practicable...INDIRECT COST POOL -- COST ALLOCATION BASE -- COST FINDING In Cost Accounting : A Managerial Emphasis, Charles T. Horngren states: There are

  4. [Estimation on the indirect economic burden of disease-related premature deaths in China, 2012].

    Science.gov (United States)

    Yang, Juan; Feng, Luzhao; Zheng, Yaming; Yu, Hongjie

    2014-11-01

    To estimate the indirect economic burden of disease-related premature deaths in China, 2012. Both human capital approach and friction cost methods were used to compute the indirect economic burden of premature deaths from the following sources: mortality from the national disease surveillance system in 2012, average annual income per capita from the China Statistic Yearbook in 2012, population size from the 2010 China census, and life expectancy in China from the World Health Organization life table. Data from the Human Capital Approach Estimates showed that the indirect economic burden of premature deaths in China was 425.1 billion in 2012, accounting for 8‰ of the GDP. The indirect economic burden of chronic non-communicable diseases associated premature deaths was accounted for the highest proportion(67.1%, 295.4 billion), followed by those of injuries related premature deaths (25.6% , 108.9 billion), infectious diseases, maternal and infants diseases, and malnutrition related deaths (6.4% , 26.9 billion). The top five premature deaths that cause the indirect economic burden were malignancy, cardiovascular diseases, unintentional injuries, intentional injuries, and diseases of the respiratory system. The indirect economic burden of premature deaths mainly occurred in the population of 20-59 year-olds. Under the Friction Cost method, the estimates appeared to be 0.11%-3.49% of the total human capital approach estimates. Premature death caused heavy indirect economic burden in China. Chronic non-communicable diseases and injuries seemed to incur the major disease burden. The indirect economic burden of premature deaths mainly occurred in the working age group.

  5. The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies.

    Science.gov (United States)

    Idler, Nadja; Teuner, Christina M; Hunger, Matthias; Holle, Rolf; Ortlieb, Sandra; Schulz, Holger; Bauer, Carl-Peter; Hoffmann, Ute; Koletzko, Sibylle; Lehmann, Irina; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Heinrich, Joachim; Wolfenstetter, Silke B

    2015-04-29

    Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children. Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥ 7 h/week) versus a lower (physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group. The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥ 7 h/week) compared with lower MVPA (physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.

  6. Interactive indirect illumination using adaptive multiresolution splatting.

    Science.gov (United States)

    Nichols, Greg; Wyman, Chris

    2010-01-01

    Global illumination provides a visual richness not achievable with the direct illumination models used by most interactive applications. To generate global effects, numerous approximations attempt to reduce global illumination costs to levels feasible in interactive contexts. One such approximation, reflective shadow maps, samples a shadow map to identify secondary light sources whose contributions are splatted into eye space. This splatting introduces significant overdraw that is usually reduced by artificially shrinking each splat's radius of influence. This paper introduces a new multiresolution approach for interactively splatting indirect illumination. Instead of reducing GPU fill rate by reducing splat size, we reduce fill rate by rendering splats into a multiresolution buffer. This takes advantage of the low-frequency nature of diffuse and glossy indirect lighting, allowing rendering of indirect contributions at low resolution where lighting changes slowly and at high-resolution near discontinuities. Because this multiresolution rendering occurs on a per-splat basis, we can significantly reduce fill rate without arbitrarily clipping splat contributions below a given threshold-those regions simply are rendered at a coarse resolution.

  7. Cost of illness and determinants of costs among patients with gout.

    Science.gov (United States)

    Spaetgens, Bart; Wijnands, José M A; van Durme, Caroline; van der Linden, Sjef; Boonen, Annelies

    2015-02-01

    To estimate costs of illness in a cross-sectional cohort of patients with gout attending an outpatient rheumatology clinic, and to evaluate which factors contribute to higher costs. Altogether, 126 patients with gout were clinically assessed. They completed a series of questionnaires. Health resource use was collected using a self-report questionnaire that was cross-checked with the electronic patient file. Productivity loss was assessed by the Work Productivity and Activity Impairment Questionnaire, addressing absenteeism and presenteeism. Resource use and productivity loss were valued by real costs, and annual costs per patient were calculated. Factors contributing to incurring costs above the median were explored using logistic univariable and multivariable regression analysis. Mean (median) annual direct costs of gout were €5647 (€1148) per patient. Total costs increased to €6914 (€1279) or €10,894 (€1840) per patient per year when adding cost for absenteeism or both absenteeism and presenteeism, respectively. Factors independently associated with high direct and high indirect costs were a positive history of cardiovascular disease, functional limitations, and female sex. In addition, pain, gout concerns, and unmet gout treatment needs were associated with high direct costs. The direct and indirect costs-of-illness of gout are primarily associated with cardiovascular disease, functional limitations, and female sex.

  8. Stability Concerns for Indirect Consumer Control in Smart Grids

    DEFF Research Database (Denmark)

    Juelsgaard, Morten; Andersen, Palle; Wisniewski, Rafal

    2013-01-01

    by an external third party, and indirect consumer control through incentives and price signals. In this work we present a simple formulation of indirect control, where the behavior of each consumer, is governed by local optimization of energy consumption. The local optimization accounts for both cost of energy...... and distribution losses, as well as any discomfort incurred by consumers from any shift in energy consumption. Our work will illustrate that in the simplest formulation of indirect control, the stability is greatly affected of both the behavior of consumers, and the number of consumers to include. We will show how......Demand side management will be an important tool for maintaining a balanced electrical grid in the future, when the penetration of volatile resources, such as wind and solar energy increases. Recent research focuses on two different management approaches, namely direct consumer control...

  9. U.S. DOE indirect coal liquefaction program: An overview

    Energy Technology Data Exchange (ETDEWEB)

    Shen, J.; Schmetz, E.; Winslow, J.; Tischer, R. [Dept. of Energy, Germantown, MD (United States); Srivastava, R.

    1997-12-31

    Coal is the most abundant domestic energy resource in the United States. The Fossil Energy Organization within the US Department of Energy (DOE) has been supporting a coal liquefaction program to develop improved technologies to convert coal to clean and cost-effective liquid fuels to complement the dwindling supply of domestic petroleum crude. The goal of this program is to produce coal liquids that are competitive with crude at $20 to $25 per barrel. Indirect and direct liquefaction routes are the two technologies being pursued under the DOE coal liquefaction program. This paper will give an overview of the DOE indirect liquefaction program. More detailed discussions will be given to the F-T diesel and DME fuels which have shown great promises as clean burning alternative diesel fuels. The authors also will briefly discuss the economics of indirect liquefaction and the hurdles and opportunities for the early commercial deployment of these technologies. Discussions will be preceded by two brief reviews on the liquid versus gas phase reactors and the natural gas versus coal based indirect liquefaction.

  10. Can chronic disease management programs for patients with type 2 diabetes reduce productivity-related indirect costs of the disease? Evidence from a randomized controlled trial.

    Science.gov (United States)

    Adepoju, Omolola E; Bolin, Jane N; Ohsfeldt, Robert L; Phillips, Charles D; Zhao, Hongwei; Ory, Marcia G; Forjuoh, Samuel N

    2014-04-01

    The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; Pmanagement programs examined in this trial affect indirect productivity losses.

  11. Photovoltaic energy cost limit

    International Nuclear Information System (INIS)

    Coiante, D.

    1992-01-01

    Referring to a photovoltaic system for grid connected applications, a parametric expression of kWh cost is derived. The limit of kWh cost is carried out extrapolating the values of cost components to their lowest figure. The reliability of the forecast is checked by disaggregating kWh cost in direct and indirect costs and by discussing the possible cost reduction of each component

  12. 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...

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

    Science.gov (United States)

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

    2013-10-01

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

  14. The cost of severe haemophilia in Europe: the CHESS study.

    Science.gov (United States)

    O'Hara, Jamie; Hughes, David; Camp, Charlotte; Burke, Tom; Carroll, Liz; Diego, Daniel-Anibal Garcia

    2017-05-31

    Severe haemophilia is associated with major psychological and economic burden for patients, caregivers, and the wider health care system. This burden has been quantified and documented for a number of European countries in recent years. However, few studies have taken a standardised methodology across multiple countries simultaneously, and sought to amalgamate all three levels of burden for severe disease. The overall aim of the 'Cost of Haemophilia in Europe: a Socioeconomic Survey' (CHESS) study was to capture the annualised economic and psychosocial burden of severe haemophilia in five European countries. A cross-section of haemophilia specialists (surveyed between January and April 2015) provided demographic and clinical information and 12-month ambulatory and secondary care activity for patients via an online survey. In turn, patients provided corresponding direct and indirect non-medical cost information, including work loss and out-of-pocket expenses, as well as information on quality of life and adherence. The direct and indirect costs for the patient sample were calculated and extrapolated to population level. Clinical reports for a total of 1,285 patients were received. Five hundred and fifty-two patients (43% of the sample) provided information on indirect costs and health-related quality of life via the PSC. The total annual cost of severe haemophilia across the five countries for 2014 was estimated at EUR 1.4 billion, or just under EUR 200,000 per patient. The highest per-patient costs were in Germany (mean EUR 319,024) and the lowest were in the United Kingdom (mean EUR 129,365), with a study average of EUR 199,541. As expected, consumption of clotting factor replacement therapy represented the vast majority of costs (up to 99%). Indirect costs are driven by patient and caregiver work loss. The results of the CHESS study reflect previous research findings suggesting that costs of factor replacement therapy account for the vast majority of the cost

  15. Cost Accounting for Decision Makers.

    Science.gov (United States)

    Kaneklides, Ann L.

    1985-01-01

    Underscores the importance of informed decision making through accurate anticipation of cost incurrence in light of changing economic and environmental conditions. Explains the concepts of cost accounting, full allocation of costs, the selection of an allocation base, the allocation of indirect costs, depreciation, and implications for community…

  16. Indirect effects in dual radiation action

    International Nuclear Information System (INIS)

    Zaider, M.; Rossi, H.H.

    1988-01-01

    The basic aim in this paper is to establish the link between indirect effects of radiation action and the spatial distribution of radicals at the time of energy deposition as well as throughout subsequent diffusion and interaction. The fact that radicals diffuse for a finite distance before damaging a biomolecule has dramatic effects on their subsequent probability to result in lesions. Thus at very low DMSO concentrations, where p = 0.5, one expects - all other things being equal - some 75% of the lesions to result from indirect or semidirect lesions. The number calculated here is lower (15%), a direct result of the fact that such lesions involve proximity functions modulated by diffusion. At higher DMSO concentrations this percentage becomes progressively smaller, as expected. It appears thus that for low-LET radiation, the relative amount of indirect damage in single tracks (also termed intratrack or single events) action is very small. By contrast, intertrack (or two-event) contributions will have the ratio between direct and (indirect + semidirect) contributions given by p 2 /(1-p 2 ). The reason for this is that sublesions from different tracks are uniformly distributed throughout the cell nucleus; their probability of interaction should not depend on any previous diffusional processes. For the example given above (p = 0.5) they do expect 65% of intertrack (two-hit) lesions to have resulted from indirect or semidirect mechanisms. This contrast between the almost exclusively direct character of intratrack lesions and the dominant role of indirect action in intertrack lesions produced by low-LET radiation is an important conclusion of this study

  17. 73 Activity Based Costing and Product Pricing Decision: the Nigerian Case

    Directory of Open Access Journals (Sweden)

    Ebipanipre Gabriel Mieseigha

    2014-06-01

    Full Text Available This paper examined activity based costing and product pricing decisions in Nigeria so as to ascertain whether activity based costing have the ability to enhance profitability and control cost of manufacturing firms. Towards this end, a multiple correlation and regression estimation technique was used in analyzing the data obtained in the study. The study found that activity based costing affects product costing and pricing decision. In addition, the results showed that improved profitability and cost control can be achieved by implementing activity based costing approach by manufacturing firms. The implication is that traditional costing approach fails in many pricing situations by arbitrarily allocating indirect cost and activity based costing helps in allocating indirect cost accurately. Thus, it was recommended amongst others that activity based costing need to be practiced, maintained and implemented by manufacturing firms since it has a broad range of uses for a wide variety of company functions and operations in the area of process analysis, strategy support, time-based accounting, monitoring wastage, as well as quality and productivity management.

  18. Excess costs of social anxiety disorder in Germany.

    Science.gov (United States)

    Dams, Judith; König, Hans-Helmut; Bleibler, Florian; Hoyer, Jürgen; Wiltink, Jörg; Beutel, Manfred E; Salzer, Simone; Herpertz, Stephan; Willutzki, Ulrike; Strauß, Bernhard; Leibing, Eric; Leichsenring, Falk; Konnopka, Alexander

    2017-04-15

    Social anxiety disorder is one of the most frequent mental disorders. It is often associated with mental comorbidities and causes a high economic burden. The aim of our analysis was to estimate the excess costs of patients with social anxiety disorder compared to persons without anxiety disorder in Germany. Excess costs of social anxiety disorder were determined by comparing two data sets. Patient data came from the SOPHO-NET study A1 (n=495), whereas data of persons without anxiety disorder originated from a representative phone survey (n=3213) of the general German population. Missing data were handled by "Multiple Imputation by Chained Equations". Both data sets were matched using "Entropy Balancing". Excess costs were calculated from a societal perspective for the year 2014 using general linear regression with a gamma distribution and log-link function. Analyses considered direct costs (in- and outpatient treatment, rehabilitation, and professional and informal care) and indirect costs due to absenteeism from work. Total six-month excess costs amounted to 451€ (95% CI: 199€-703€). Excess costs were mainly caused by indirect excess costs due to absenteeism from work of 317€ (95% CI: 172€-461€), whereas direct excess costs amounted to 134€ (95% CI: 110€-159€). Costs for medication, unemployment and disability pension was not evaluated. Social anxiety disorder was associated with statistically significant excess costs, in particular due to indirect costs. As patients in general are often unaware of their disorder or its severity, awareness should be strengthened. Prevention and early treatment might reduce long-term indirect costs. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Supplementary insurance as a switching cost for basic health insurance: Empirical results from the Netherlands.

    Science.gov (United States)

    Willemse-Duijmelinck, Daniëlle M I D; van de Ven, Wynand P M M; Mosca, Ilaria

    2017-10-01

    Nearly everyone with a supplementary insurance (SI) in the Netherlands takes out the voluntary SI and the mandatory basic insurance (BI) from the same health insurer. Previous studies show that many high-risks perceive SI as a switching cost for BI. Because consumers' current insurer provides them with a guaranteed renewability, SI is a switching cost if insurers apply selective underwriting to new applicants. Several changes in the Dutch health insurance market increased insurers' incentives to counteract adverse selection for SI. Tools to do so are not only selective underwriting, but also risk rating and product differentiation. If all insurers use the latter tools without selective underwriting, SI is not a switching cost for BI. We investigated to what extent insurers used these tools in the periods 2006-2009 and 2014-2015. Only a few insurers applied selective underwriting: in 2015, 86% of insurers used open enrolment for all their SI products, and the other 14% did use open enrolment for their most common SI products. As measured by our indicators, the proportion of insurers applying risk rating or product differentiation did not increase in the periods considered. Due to the fear of reputation loss insurers may have used 'less visible' tools to counteract adverse selection that are indirect forms of risk rating and product differentiation and do not result in switching costs. So, although many high-risks perceive SI as a switching cost, most insurers apply open enrolment for SI. By providing information to high-risks about their switching opportunities, the government could increase consumer choice and thereby insurers' incentives to invest in high-quality care for high-risks. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. [Cost of lost productivity in pharmacoeconomics analysis. Part II. Survey in the expert group].

    Science.gov (United States)

    Wrona, Witold; Hermanowski, Tomasz; Jakubczyk, Michał; Golicki, Dominik; Czech, Marcin; Niewada, Maciej; Kolasa, Katarzyna

    2011-01-01

    The aim of the survey was to collect data on practice and preferences of decision-makers and experts in health economics concerning the role of indirect costs in Poland. The questionnaire contained 18 questions covering the need for indirect costs calculation in economic evaluations and measures used to calculate indirect cost. Fifty four respondents related to health economics returned completed questionnaires. Mean age of respondents was 33,3 years; mean experience in health economics 4.7 years; 43% (23/54) of responders had non-economic background; 30% each were users and doers of health technology assessment reports. All (excluding one) responders indicated that indirect costs should be calculated in pharmacoeconomic studies. Twenty three (i.e., 43%) responders indicated human capital approach as the best method to estimate costs from societal perspective; friction cost method came second best 11%; 42% respondents had no opinion. The doers of economics evaluations pointed to GDP per capita (61%, 11/18), average salary (61%, 11/18), and costs of sick pay or injury benefit (61%, 11/18) as measures which could be used to value production losses. Indirect costs are considered important component of economic evaluations of healthcare interventions in Poland. The lack of widely accepted methods for indirect cost evaluation support further research.

  1. CONTRIBUTION OF INDIRECT TAXES

    Directory of Open Access Journals (Sweden)

    CHIRCULESCU MARIA FELICIA

    2015-08-01

    Full Text Available The work is based on the fact that at any time and in any society, taxation is regarded as undesirable for all taxpayers. The existence and it's manifestation is justified, because the operation of any company involves costs that must be covered by sufficient resources. Since ancient times, each state has adopted its own tax system, more or less perfected, as the state has experienced a greater or lesser economic and military power At the base of this work stays the fact that tax systems are a key factor influencing the overall efficiency of the economy. They determine the size tendency to save, invest and work, influencing the increase in production and employment, which is essential sights integral economic strategy, making tax reform an important component of economic reform. This paper aims to analyze the indirect taxes and their contribution to the public revenues in Romania, the purpose paper contains an analysis based on statistical series as indirect taxation is where tax harmonization was possible. Through analyzes, the paper aims to provide answers to the problem of the contradiction between the growing need for budgetary revenues, which entails a continuous amplification and diversification of taxation, on the one hand, and the need to stimulate economic development, on the other hand. The harmonization of indirect taxation had been achieved since this touches the free movement of goods and the freedom to supply services, not being able to say the same thing about direct taxation, which is why the European Community Treaty does not specify expressly the alignment of direct taxation, considering that direct taxation is a matter of Internal Policies that, for a country free option.

  2. Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL.

    Science.gov (United States)

    Freeman, James V; Hutton, David W; Barnes, Geoffrey D; Zhu, Ruo P; Owens, Douglas K; Garber, Alan M; Go, Alan S; Hlatky, Mark A; Heidenreich, Paul A; Wang, Paul J; Al-Ahmad, Amin; Turakhia, Mintu P

    2016-06-01

    Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost effectiveness compared with anticoagulation has not been evaluated using all available contemporary trial data. We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation (PROTECT AF) and Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation (PREVAIL) randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios compared with warfarin and dabigatran were $20 486 and $23 422 per quality-adjusted life year, respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 quality-adjusted life years, respectively) and more costly. At a willingness-to-pay threshold of $50 000 per quality-adjusted life year, LAA closure was cost effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer-term trial results and postmarketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical

  3. Indirect land use change and biofuel policy

    International Nuclear Information System (INIS)

    Kocoloski, Matthew; Griffin, W Michael; Matthews, H Scott

    2009-01-01

    Biofuel debates often focus heavily on carbon emissions, with parties arguing for (or against) biofuels solely on the basis of whether the greenhouse gas emissions of biofuels are less than (or greater than) those of gasoline. Recent studies argue that land use change leads to significant greenhouse gas emissions, making some biofuels more carbon intensive than gasoline. We argue that evaluating the suitability and utility of biofuels or any alternative energy source within the limited framework of plus and minus carbon emissions is too narrow an approach. Biofuels have numerous impacts, and policy makers should seek compromises rather than relying solely on carbon emissions to determine policy. Here, we estimate that cellulosic ethanol, despite having potentially higher life cycle CO 2 emissions (including from land use) than gasoline, would still be cost-effective at a CO 2 price of $80 per ton or less, well above estimated CO 2 mitigation costs for many alternatives. As an example of the broader approach to biofuel policy, we suggest the possibility of using the potential cost reductions of cellulosic ethanol relative to gasoline to balance out additional carbon emissions resulting from indirect land use change as an example of ways in which policies could be used to arrive at workable solutions.

  4. Indirect land use change and biofuel policy

    Science.gov (United States)

    Kocoloski, Matthew; Griffin, W. Michael; Matthews, H. Scott

    2009-09-01

    Biofuel debates often focus heavily on carbon emissions, with parties arguing for (or against) biofuels solely on the basis of whether the greenhouse gas emissions of biofuels are less than (or greater than) those of gasoline. Recent studies argue that land use change leads to significant greenhouse gas emissions, making some biofuels more carbon intensive than gasoline. We argue that evaluating the suitability and utility of biofuels or any alternative energy source within the limited framework of plus and minus carbon emissions is too narrow an approach. Biofuels have numerous impacts, and policy makers should seek compromises rather than relying solely on carbon emissions to determine policy. Here, we estimate that cellulosic ethanol, despite having potentially higher life cycle CO2 emissions (including from land use) than gasoline, would still be cost-effective at a CO2 price of 80 per ton or less, well above estimated CO2 mitigation costs for many alternatives. As an example of the broader approach to biofuel policy, we suggest the possibility of using the potential cost reductions of cellulosic ethanol relative to gasoline to balance out additional carbon emissions resulting from indirect land use change as an example of ways in which policies could be used to arrive at workable solutions.

  5. Comparison of viral RNA electrophoresis and indirect ELISA methods in the diagnosis of human rotavirus infection

    International Nuclear Information System (INIS)

    Avendano, L.F.; Dubinovsky, S.

    1984-01-01

    A total of 177 stool samples from Chilean diarrhea patients under two years of age were tested for rotavirus by two methods - the indirect enzyme-linked immunosorbent assay (indirect ELISA) and viral RNA electrophoresis in agarose gels (v RNA EPH). Fifty of the specimens came from patients with acute diarrhea and 127 came from patients with protracted diarrhea. The indirect ELISA testing was performed at the National Institutes of Health in the United States: the electrophoretic testing was carried out in Santiago, Chile by the authors. The electrophoretic method detected rotavirus in 36% of the acute samples and 25% of the samples from protracted cases, while the indirect ELISA method detected rotavirus in higher percentages of samples - 46% and 38%, respectively. These results support the conclusion that v RNA EPH is a less sensitive method for detecting rotavirus than the indirect ELISA. Nevertheless, the former method's high specificity, ease of application, and low cost make it a worthwhile alternative to indirect ELISA. Thus, considering the important role played by rotavirus in infant diarrhea and the need for a diagnostic technique that can be incorporated into the routines of medical center laboratories in developing countries, there is good reason to conclude that v RNA EPH is a useful tool for studying rotavirus diarrhea. (author)

  6. Indirect and non-medical economic burden, quality-of-life, and disabilities of the myelofibrosis disease in Spain.

    Science.gov (United States)

    Gimenez, Emmanuel; Besses, Carles; Boque, Concepcion; Velez, Patricia; Kerguelen, Ana; Cervantes, Francisco; Ferrer-Marin, Francisca; Perez-Encinas, Manuel; Rodriguez, Mercedes; Gonzalez, Juan Diego; Calzada, Reyes; Hernandez-Boluda, Juan Carlos

    2014-06-01

    Myelofibrosis is a non-frequent chronic myeloproliferative Philadelphia-negative chromosome neoplasm. It is a heavy incapacitating orphan disease and associated with high morbidity and mortality. In this context, indirect and non-medical costs are expected to be high. The main objective of this project is to estimate the economic burden of this disease in Spain. Thirty-three patients with a diagnosis of myelofibrosis for at least 1 year participated in a questionnaire in three Spanish centers. The study consisted of analyzing in various aspects the cost and impact of the disease; indeed, daily life time limitations with a need of informal care, symtomatology. Additionally, information concerning the clinical management of the disease was collected through a focus group of eight experts. The mean age was 65 years. 15 of 33 patients were at their productive stage. Six had difficulties at work and eight have received informal care. Bone and muscular pain were the main symptoms of patients (72%). The estimated global indirect and non-medical costs of the disease were 86,315€ per patient (20% working and 80% informal care), which reached 104,153€ at productive stage patients (45%) and 168,459€ for more symptomatic patients. The economic burden of indirect and non-medical costs of myelofibrosis are important (15,142€/annual) as a result, and should be considered in economic evaluation, as well as in preventive plans for patients and caregivers, despite the fact that studies with larger numbers of patients should be done.

  7. Pedal indirect lymphangiography

    International Nuclear Information System (INIS)

    Lee, Kil Woo; Hong, Myung Sun; Kim, In Jae

    1994-01-01

    Recently, indirect lymphangiography has been developed as a relatively good and noninvasive imaging modality of the lymphatic system at extremities. But the disadvantage of the indirect lymphangiography is a low contrast ratio between the surrounding tissues and the contrast media in lymphatic vessels, because dimeric nonionic contrast media is water soluble and diluted in the proximal leg lymphatic vessels. We could have relatively better image than previously published images for the leg lymphatic system, when we injected contrast media with adequate high pressure in intradermal space of the interdigital areas at the foot dorsum. So, we would like to report the results. We could study all 9 lymphedemas(primary: 6, secondary: 3) from April 1990 to May 1993 on outpatient base. They were diagnosed as lymphedema clinically and radiologically. Ten ml of dimeric nonionic aget, iotrolan(Isovist 300) was injected into intradermal space with five 30-gauge needles. The injection speed was more than 0.2 ml/min. We have done one side pedal lymphangiogram in 30 minutes. The evaluation of the anterior superficial lymphatics was according to the criteria of the Weissleder. The results were as follows: 1. All lymphatic vessels from foot to inguinal area could be visualized. 2. Two or three inferior inguinal lymph nodes could be visualized about 42%. 3. The most common abnormal finding of the lymphedma was the neovascularization of the lymphatics on indirect pedal lymphangiogram. If we use adequate technique relatively high pressure injection, correct intradermal needle insertion, adequate soft tissue exposure technique indirect lymphangiography is considered to be a safe and noninvasive imaging modality for the evaluation of the lymphedema of lower extremity lymphatics including inferior inguinal lymph nodes

  8. Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp

    Science.gov (United States)

    Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K.; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M.; Thirumurthy, Harsha

    2015-01-01

    Background: Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Methods: Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant. Results: The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices. Conclusions: EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization. PMID:26017658

  9. Indirect zirconia-reinforced lithium silicate ceramic CAD/CAM restorations: Preliminary clinical results after 12 months.

    Science.gov (United States)

    Zimmermann, Moritz; Koller, Christina; Mehl, Albert; Hickel, Reinhard

    2017-01-01

    No clinical data are available for the new computer-aided design/computer-assisted manufacture (CAD/CAM) material zirconia-reinforced lithium silicate (ZLS) ceramic. This study describes preliminary clinical results for indirect ZLS CAD/CAM restorations after 12 months. Indirect restorations were fabricated, using the CEREC method and intraoral scanning (CEREC Omnicam, CEREC MCXL). Sixty-seven restorations were seated adhesively (baseline). Sixty restorations were evaluated after 12 months (follow-up), using modified FDI criteria. Two groups were established, according to ZLS restorations' post-processing procedure prior to adhesive seating: group I (three-step polishing, n = 32) and group II (fire glazing, n = 28). Statistical analysis was performed with Mann-Whitney U test and Wilcoxon test (P  .05). Statistically significant differences were found for criteria surface gloss for group I and group II (Mann-Whitney U test, P < .05). This study demonstrates ZLS CAD/CAM restorations have a high clinical success rate after 12 months. A longer clinical evaluation period is necessary to draw further conclusions.

  10. 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

  11. Cost of epilepsy: a systematic review.

    Science.gov (United States)

    Strzelczyk, Adam; Reese, Jens Peter; Dodel, Richard; Hamer, Hajo M

    2008-01-01

    The objective of this review was to overview published cost-of-illness (COI) studies of epilepsy and their methodological approaches. Epilepsy imposes a substantial burden on individuals and society as a whole. The mean prevalence of epilepsy is estimated at 0.52% in Europe, 0.68% in the US, and peaks up to 1.5% in developing countries. Estimation of the economic burden of epilepsy is of pivotal relevance to enable a rational distribution of healthcare resources. This is especially so with the introduction of the newer antiepileptic drugs (AEDs), the marketing of vagal-nerve stimulators and the resurgence of new surgical treatment options, which have the potential to considerably increase the costs of treating epilepsy.A systematic literature review was performed to identify studies that evaluated direct and indirect costs of epilepsy. Using a standardized assessment form, information on the study design, methodological framework and data sources were extracted from each publication and systematically reported. We identified 22 studies worldwide on costs of epilepsy. The majority of the studies reflected the costs of epilepsy in Europe (three studies each for the UK and Italy, one study each for Germany, the Netherlands, Switzerland, France and the EU) and the US (four studies), but studies were also available from India (two), Hong Kong, Oman, Burundi, Chile and Mexico. The studies utilized different frameworks to evaluate costs. All used a bottom-up approach; however, only 12 studies (55%) evaluated direct as well as indirect costs. The range for the mean annual direct costs lay between 40 International Dollar purchasing power parities (PPP-$) in rural Burundi and PPP-$4748 (adjusted to 2006 values) in a German epilepsy centre. Recent studies suggest AEDs are becoming the main contributor to direct costs. The mean indirect costs ranged between 12% and 85% of the total annual costs. Epilepsy is a cost-intensive disorder. A reliable comparison of the different COI

  12. The economic costs of childhood disability.

    Science.gov (United States)

    Stabile, Mark; Allin, Sara

    2012-01-01

    Childhood disabilities entail a range of immediate and long-term economic costs that have important implications for the well-being of the child, the family, and society but that are difficult to measure. In an extensive research review, Mark Stabile and Sara Allin examine evidence about three kinds of costs-direct, out-of-pocket costs incurred as a result of the child's disability; indirect costs incurred by the family as it decides how best to cope with the disability; and long-term costs associated with the child's future economic performance. Not surprisingly, the evidence points to high direct costs for families with children with disabilities, though estimates vary considerably within these families. Out-of-pocket expenditures, particularly those for medical costs, for example, are higher among families with children with a special health care need. An important indirect cost for these families involves decisions about employment. Stabile and Allin examine several studies that, taken together, show that having a child with disabilities increases the likelihood that the mother (and less often the father) will either curtail hours of work or stop working altogether. Researchers also find that having a child with disabilities can affect a mother's own health and put substantial strains on the parents' relationship. In the longer term, disabilities also compromise a child's schooling and capacity to get and keep gainful employment as an adult, according to the studies Stabile and Allin review. Negative effects on future well-being appear to be much greater, on average, for children with mental health problems than for those with physical disabilities. Stabile and Allin calculate that the direct costs to families, indirect costs through reduced family labor supply, direct costs to disabled children as they age into the labor force, and the costs of safety net programs for children with disabilities average $30,500 a year per family with a disabled child. They note

  13. The household costs of visceral leishmaniasis care in south-eastern Nepal.

    Directory of Open Access Journals (Sweden)

    Surendra Uranw

    Full Text Available BACKGROUND AND OBJECTIVES: Visceral leishmaniasis (VL is an important public health problem in south-eastern Nepal affecting very poor rural communities. Since 2005, Nepal is involved in a regional initiative to eliminate VL. This study assessed the economic impact of VL on households and examined whether the intensified VL control efforts induced by the government resulted in a decrease in household costs. METHODS: Between August and September 2010, a household survey was conducted among 168 patients that had been treated for VL within 12 months prior to the survey in five districts in south-eastern Nepal. We collected data on health-seeking behaviour, direct and indirect costs and coping strategies. RESULTS: The median total cost of one episode of VL was US$ 165 or 11% of annual household income. The median delay between the onset of symptoms and presentation to a qualified provider was 25 days. Once the patient presented to a qualified provider, the delay to correct diagnosis was minimal (median 3 days. Direct and indirect costs (income losses represented 47% and 53% of total costs respectively. Households used multiple strategies to cope with the cost of illness, mainly mobilizing cash/savings (71% or taking a loan (56%. CONCLUSIONS: The provision of free VL diagnosis and drugs by the Nepalese control programme has been an important policy measure to reduce the cost of VL to households. But despite the free VL drugs, the economic burden is still important for households. More effort should be put into reducing indirect costs, in particular the length of treatment, and preventing the transmission of VL through vector control.

  14. The cost of clinical mastitis in the first 30 days of lactation: An economic modeling tool.

    Science.gov (United States)

    Rollin, E; Dhuyvetter, K C; Overton, M W

    2015-12-01

    Clinical mastitis results in considerable economic losses for dairy producers and is most commonly diagnosed in early lactation. The objective of this research was to estimate the economic impact of clinical mastitis occurring during the first 30 days of lactation for a representative US dairy. A deterministic partial budget model was created to estimate direct and indirect costs per case of clinical mastitis occurring during the first 30 days of lactation. Model inputs were selected from the available literature, or when none were available, from herd data. The average case of clinical mastitis resulted in a total economic cost of $444, including $128 in direct costs and $316 in indirect costs. Direct costs included diagnostics ($10), therapeutics ($36), non-saleable milk ($25), veterinary service ($4), labor ($21), and death loss ($32). Indirect costs included future milk production loss ($125), premature culling and replacement loss ($182), and future reproductive loss ($9). Accurate decision making regarding mastitis control relies on understanding the economic impacts of clinical mastitis, especially the longer term indirect costs that represent 71% of the total cost per case of mastitis. Future milk production loss represents 28% of total cost, and future culling and replacement loss represents 41% of the total cost of a case of clinical mastitis. In contrast to older estimates, these values represent the current dairy economic climate, including milk price ($0.461/kg), feed price ($0.279/kg DM (dry matter)), and replacement costs ($2,094/head), along with the latest published estimates on the production and culling effects of clinical mastitis. This economic model is designed to be customized for specific dairy producers and their herd characteristics to better aid them in developing mastitis control strategies. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  15. 48 CFR 31.202 - Direct costs.

    Science.gov (United States)

    2010-10-01

    ... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 31.202 Direct... amount as an indirect cost if the accounting treatment— (1) Is consistently applied to all final cost... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Direct costs. 31.202...

  16. Estimating the cost-savings associated with bundling maternal and child health interventions: a proposed methodology.

    Science.gov (United States)

    Adesina, Adebiyi; Bollinger, Lori A

    2013-01-01

    There is a pressing need to include cost data in the Lives Saved Tool (LiST). This paper proposes a method that combines data from both the WHO CHOosing Interventions that are Cost-Effective (CHOICE) database and the OneHealth Tool (OHT) to develop unit costs for delivering child and maternal health services, both alone and bundled. First, a translog cost function is estimated to calculate factor shares of personnel, consumables, other direct (variable or recurrent costs excluding personnel and consumables) and indirect (capital or investment) costs. Primary source facility level data from Kenya, Namibia, South Africa, Uganda, Zambia and Zimbabwe are utilized, with separate analyses for hospitals and health centres. Second, the resulting other-direct and indirect factor shares are applied to country unit costs from the WHO CHOICE unit cost database to calculate those portions of unit cost. Third, the remainder of the costs is calculated using default data from the OHT. Fourth, we calculate the effect of bundling services by assuming that a LiST intervention visit takes an average of 20 minutes when delivered alone but only incremental time in addition to the basic visit when delivered in a bundle. Personnel costs account for the greatest share of costs for both hospitals and health centres at 50% and 38%, respectively. The percentages differ between hospitals and health centres for consumables (21% versus 17%), other direct (7.5% versus 6.75%), and indirect (22% versus 23%) costs. Combining the other-direct and indirect factor shares with the WHO CHOICE database and the other costs from OHT provides a comprehensive cost estimate of LiST interventions. Finally, the cost of six recommended antenatal care (ANC) interventions is $69.76 when delivered alone, but $61.18 when delivered as a bundle, a savings of $8.58 (12.2%). This paper proposes a method for estimating a comprehensive cost of providing child and maternal health interventions by combining labor

  17. Cost analysis of in vitro fertilization.

    Science.gov (United States)

    Stern, Z; Laufer, N; Levy, R; Ben-Shushan, D; Mor-Yosef, S

    1995-08-01

    In vitro fertilization (IVF) has become a routine tool in the arsenal of infertility treatments. Assisted reproductive techniques are expensive, as reflected by the current "take home baby" rate of about 15% per cycle, implying the need for repeated attempts until success is achieved. Israel, today is facing a major change in its health care system, including the necessity to define a national package of health care benefits. The issue of infertility and whether its treatment should be part of the "health basket" is in dispute. Therefore an exact cost analysis of IVF is important. Since the cost of an IVF cycle varies dramatically between countries, we sought an exact breakdown of the different components of the costs involved in an IVF cycle and in achieving an IVF child in Israel. The key question is not how much we spend on IVF cycles but what is the cost of a successful outcome, i.e., a healthy child. This study intends to answer this question, and to give the policy makers, at various levels of the health care system, a crucial tool for their decision-making process. The cost analysis includes direct and indirect costs. The direct costs are divided into fixed costs (labor, equipment, maintenance, depreciation, and overhead) and variable costs (laboratory tests, chemicals, disposable supplies, medications, and loss of working days by the couples). The indirect costs are the costs of premature IVF babies, hospitalization of the IVF pregnant women in a high risk unit, and the cost of complications of the procedure. According to our economic analysis, an IVF cycle in Israel costs $2,560, of which fixed costs are about 50%. The cost of a "take home baby" is $19,267, including direct and indirect costs.

  18. The costs of breast cancer in a Mexican public health institution

    Directory of Open Access Journals (Sweden)

    Jacobo Alejandro Gómez-Rico

    2008-11-01

    Full Text Available Jacobo Alejandro Gómez-Rico1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Consuelo Rubio-Poo21Universidad Autónoma Metropolitano–Xochimilco (UAM-X, Departments: Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS; 2Universidad Nacional Autónoma de México (UNAM, Faculty of Professional Studies-Zaragoza (FES-ZaragozaAbstract: Breast cancer (BC is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94 were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.Keywords: breast cancer, Mexican women, direct and indirect costs

  19. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

    Science.gov (United States)

    2012-01-01

    Background Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. Methods PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). Results Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. Conclusion TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment

  20. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review

    Directory of Open Access Journals (Sweden)

    Barter Devra M

    2012-11-01

    Full Text Available Abstract Background Tuberculosis (TB is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. Methods PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$. Results Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. Conclusion TB patients and households in sub-Saharan Africa often incurred high costs

  1. 10 CFR 600.30 - Cost sharing.

    Science.gov (United States)

    2010-01-01

    ... research and development except where: (1) A research or development activity of a basic or fundamental... with the applicable cost principles: (i) Cash; (ii) Personnel costs; (iii) The value of a service... circular of the Office of Management and Budget; (iv) Indirect costs or facilities and administrative costs...

  2. An Indirect Route for Ethanol Production

    Energy Technology Data Exchange (ETDEWEB)

    Eggeman, T.; Verser, D.; Weber, E.

    2005-04-29

    The ZeaChem indirect method is a radically new approach to producing fuel ethanol from renewable resources. Sugar and syngas processing platforms are combined in a novel way that allows all fractions of biomass feedstocks (e.g. carbohydrates, lignins, etc.) to contribute their energy directly into the ethanol product via fermentation and hydrogen based chemical process technologies. The goals of this project were: (1) Collect engineering data necessary for scale-up of the indirect route for ethanol production, and (2) Produce process and economic models to guide the development effort. Both goals were successfully accomplished. The projected economics of the Base Case developed in this work are comparable to today's corn based ethanol technology. Sensitivity analysis shows that significant improvements in economics for the indirect route would result if a biomass feedstock rather that starch hydrolyzate were used as the carbohydrate source. The energy ratio, defined as the ratio of green energy produced divided by the amount of fossil energy consumed, is projected to be 3.11 to 12.32 for the indirect route depending upon the details of implementation. Conventional technology has an energy ratio of 1.34, thus the indirect route will have a significant environmental advantage over today's technology. Energy savings of 7.48 trillion Btu/yr will result when 100 MMgal/yr (neat) of ethanol capacity via the indirect route is placed on-line by the year 2010.

  3. Household-based costs and benefits of vaccinating healthy children in daycare against influenza virus: results from a pilot study.

    Science.gov (United States)

    Pisu, Maria; Meltzer, Martin I; Hurwitz, Eugene S; Haber, Michael

    2005-01-01

    Vaccinating children against influenza virus may reduce infections in immunised children and household contacts, thereby reducing the household-based cost associated with respiratory illnesses. To evaluate the impact of influenza virus vaccination of daycare children on costs of respiratory illnesses of the children and their household contacts from the household and societal perspective. Cost analysis of data from a randomised controlled trial covering the period November to April of 1996-7 and 1998-9. Children (127 in 1996-7 and 133 in 1998-9) from daycare centres in Californian (USA) naval bases received influenza virus vaccine (inactivated) or hepatitis A virus vaccination. Direct and indirect costs (1997 and 1999 US dollars) of respiratory illnesses in households of vaccinated and not vaccinated daycare children, excluding the cost of vaccination. There were no statistically significant differences in household costs of respiratory illness between households with or without influenza virus-vaccinated children (USD 635 vs USD 492: p = 0.98 [1996-7]; USD 412.70 vs USD 499.50: p = 0.42 [1998-9]). In 1996-7, adult and 5- to 17-year-old contacts of vaccinated children had lower household costs than contacts of unvaccinated children (USD 58.50 vs USD 83.20, p = 0.01 and USD 32.80 vs USD 59.50, p = 0.04, respectively), while vaccinated children 0-4 years old had higher household costs than unvaccinated children in the same age group (USD 383 vs USD 236, p = 0.05). In 1998-9, there were no differences within individual age groups. Results from societal perspective were similar. Overall, from both the household and societal perspectives, there were no economic benefits to households from vaccinating daycare children against influenza virus. However, we found some over-time inconsistency in results; this should be considered if changing recommendations about routine influenza virus vaccination of healthy children. Our study size may limit the generalisability of the

  4. Economic Costs Attributable to Smoking in China: Update and an 8-year Comparison, 2000–2008

    Science.gov (United States)

    Yang, Lian; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Rao, Keqin

    2013-01-01

    Objective To estimate the health-related economic costs attributable to smoking in China for persons aged 35 and older in 2003 and in 2008 and to compare these costs with the respective results from 2000. Methods A prevalence-based, disease-specific approach was used to estimate smoking-attributable direct and indirect economic costs. The primary data source was the 2003 and 2008 China National Health Services Survey, which contains individual participant’s smoking status, healthcare utilization, and expenditures. Results The total economic cost of smoking in China amounted to $17.1 billion in 2003 and $28.9 billion in 2008 (both measured in 2008 constant US dollars). Direct smoking-attributable healthcare costs in 2003 and 2008 were $4.2 billion and $6.2 billion, respectively. Indirect economic costs in 2003 and 2008 were $12.9 billion and $22.7 billion, respectively. Compared to 2000, the direct costs of smoking rose by 72% in 2003 and 154% in 2008, while the indirect costs of smoking rose by 170% in 2003 and 376% in 2008. Conclusion The economic burden of cigarette smoking has increased substantially in China during the past decade and is expected to continue to increase as the national economy and the price of healthcare services grow. Stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking. PMID:21339491

  5. Direct and indirect costs of dinitrogen fixation in Crocosphaera watsonii WH8501 and possible implications for the nitrogen cycle

    Directory of Open Access Journals (Sweden)

    Tobias eGroßkopf

    2012-07-01

    Full Text Available The recent detection of heterotrophic nitrogen (N2 fixation in deep waters of the southern Californian and Peruvian OMZ questions our current understanding of marine N2 fixation as a process confined to oligotrophic surface waters of the oceans. In experiments with Crocosphaera watsonii WH8501, a marine unicellular diazotrophic (N2-fixing cyanobacterium, we demonstrated that the presence of high nitrate concentrations (up to 800 µM had no inhibitory effect on growth and N2 fixation over a period of two weeks. In contrast, the environmental oxygen concentration significantly influenced rates of N2 fixation and respiration, as well as carbon and nitrogen cellular content of C. watsonii over a 24 hour period. Cells grown under lowered oxygen atmosphere (5% had a higher nitrogenase activity and respired less carbon during the dark cycle than under normal oxygen atmosphere (20%. Respiratory oxygen drawdown during the dark period could be fully explained (104% by energetic needs due to basal metabolism and N2 fixation at low oxygen, while at normal oxygen these two processes could only account for 40% of the measured respiration rate. Our results revealed that under normal oxygen concentration most of the energetic costs during N2 fixation (~60% are not derived from the process of N2 fixation per se but rather from the indirect costs incurred for the removal of intracellular oxygen or by the reversal of oxidative damage (e.g. nitrogenase de novo synthesis. Theoretical calculations suggest a slight energetic advantage of N2 fixation relative to assimilatory nitrate uptake for heterotrophic and phototrophic growth, when oxygen supply is in balance with the oxygen requirement for cellular respiration (i.e. energy generation for basal metabolism and N2 fixation. Taken together our results imply the existence of a niche for diazotrophic organisms inside oxygen minimum zones, which are predicted to further expand in the future ocean.

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

    Directory of Open Access Journals (Sweden)

    Kyung-Rae Hyun

    2014-09-01

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

  7. Search Results | Page 64 | IDRC - International Development ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Results 631 - 640 of 8519 ... Quantifying the direct and indirect effects of Dissolved Organic Matter (DOM) ... open economy models to study international trade transmission, the ... towards creating a low cost, user-friendly risk mapping system that ...

  8. Search Results | Page 72 | IDRC - International Development ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Results 711 - 720 of 8584 ... Quantifying the direct and indirect effects of Dissolved Organic Matter (DOM) ... open economy models to study international trade transmission, the ... towards creating a low cost, user-friendly risk mapping system that ...

  9. Indirection and computer security.

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Michael J.

    2011-09-01

    The discipline of computer science is built on indirection. David Wheeler famously said, 'All problems in computer science can be solved by another layer of indirection. But that usually will create another problem'. We propose that every computer security vulnerability is yet another problem created by the indirections in system designs and that focusing on the indirections involved is a better way to design, evaluate, and compare security solutions. We are not proposing that indirection be avoided when solving problems, but that understanding the relationships between indirections and vulnerabilities is key to securing computer systems. Using this perspective, we analyze common vulnerabilities that plague our computer systems, consider the effectiveness of currently available security solutions, and propose several new security solutions.

  10. Household costs of leprosy reactions (ENL in rural India.

    Directory of Open Access Journals (Sweden)

    David J Chandler

    2015-01-01

    Full Text Available Erythema nodosum leprosum (ENL is a common immune-mediated complication of lepromatous (LL and borderline lepromatous (BL leprosy. Most patients experience chronic or multiple acute ENL over many years during an economically active period of their lives. Understanding the economic burden of ENL is essential to provide effective patient support, yet this area has not been investigated.Ninety-one patients with LL or BL leprosy attending a leprosy hospital in Purulia district of West Bengal, India, were interviewed using a structured questionnaire. Cases (n = 53 were identified as those who had one or more episodes of ENL within the last 3 years. Controls (n = 38 had LL or BL leprosy but no history of ENL. Data were collected on household income, direct and indirect costs, and coping strategies.The total household cost was Rs 1543 per month or 27.9% (IQR 13.2-52.6 of monthly household income for cases, and Rs 237 per month or 4.9% (IQR 1.7-13.4 of monthly household income for controls. Indirect costs accounted for 65% of total household costs for cases. Direct costs accounted for the remaining 35% of household costs, and resulted almost entirely from treatment-seeking in the private sector. Total household costs exceeded 40% of household income for 37.7% of cases (n = 20 and 2.6% of controls (n = 1 [1 USD = 59 INR].Households affected by ENL face significant economic burden and are at risk of being pushed further into poverty. Health policy should acknowledge the importance of private sector provision and the significant contribution to total household costs of lost productivity (indirect cost. Further work is needed to explore this area and identify solutions.

  11. Cost of opioid intravenous patient-controlled analgesia: results from a hospital database analysis and literature assessment

    Directory of Open Access Journals (Sweden)

    Palmer P

    2014-06-01

    Full Text Available Pamela Palmer,1 Xiang Ji,2 Jennifer Stephens21AcelRx Pharmaceuticals, Inc., Redwood City, CA, 2Pharmerit International, Bethesda, MD, USABackground: Intravenous patient-controlled analgesia (PCA equipment and opioid cost analyses on specific procedures are lacking. This study estimates the intravenous PCA hospital cost for the first 48 postoperative hours for three inpatient surgeries.Methods: Descriptive analyses using the Premier database (2010–2012 of more than 500 US hospitals were conducted on cost (direct acquisition and indirect cost for the hospital, such as overhead, labor, pharmacy services of intravenous PCA after total knee/hip arthroplasty (TKA/THA or open abdominal surgery. Weighted average cost of equipment and opioid drug and the literature-based cost of adverse events and complications were aggregated for total costs.Results: Of 11,805,513 patients, 272,443 (2.3%, 139,275 (1.2%, and 195,062 (1.7% had TKA, THA, and abdominal surgery, respectively, with approximately 20% of orthopedic and 29% of abdominal patients having specific intravenous PCA database cost entries. Morphine (57% and hydromorphone (44% were the most frequently used PCA drugs, with a mean cost per 30 cc syringe of $16 (30 mg and $21 (6 mg, respectively. The mean number of syringes used for morphine and hydromorphone in the first 48 hours were 1.9 and 3.2 (TKA, 2.0 and 4.2 (THA, and 2.5 and 3.9 (abdominal surgery, respectively. Average costs of PCA pump, intravenous tubing set, and drug ranged from $46 to $48, from $20 to $22, and from $33 to $46, respectively. Pump, tubing, and saline required to maintain patency of the intravenous PCA catheter over 48 hours ranged from $9 to $13, from $8 to $9, and from $20 to $22, respectively. Supplemental non-PCA opioid use ranged from $56 for THA to $87 for abdominal surgery. Aggregated mean intravenous PCA equipment and opioid cost per patient were $196 (THA, $204 (TKA, and $243 (abdominal surgery. Total costs, including

  12. Computerized cost estimation spreadsheet and cost data base for fusion devices

    International Nuclear Information System (INIS)

    Hamilton, W.R.; Rothe, K.E.

    1985-01-01

    Component design parameters (weight, surface area, etc.) and cost factors are input and direct and indirect costs are calculated. The cost data base file derived from actual cost experience within the fusion community and refined to be compatible with the spreadsheet costing approach is a catalog of cost coefficients, algorithms, and component costs arranged into data modules corresponding to specific components and/or subsystems. Each data module contains engineering, equipment, and installation labor cost data for different configurations and types of the specific component or subsystem. This paper describes the assumptions, definitions, methodology, and architecture incorporated in the development of the cost estimation spreadsheet and cost data base, along with the type of input required and the output format

  13. Estimating Power Outage Cost based on a Survey for Industrial Customers

    Science.gov (United States)

    Yoshida, Yoshikuni; Matsuhashi, Ryuji

    A survey was conducted on power outage cost for industrial customers. 5139 factories, which are designated energy management factories in Japan, answered their power consumption and the loss of production value due to the power outage in an hour in summer weekday. The median of unit cost of power outage of whole sectors is estimated as 672 yen/kWh. The sector of services for amusement and hobbies and the sector of manufacture of information and communication electronics equipment relatively have higher unit cost of power outage. Direct damage cost from power outage in whole sectors reaches 77 billion yen. Then utilizing input-output analysis, we estimated indirect damage cost that is caused by the repercussion of production halt. Indirect damage cost in whole sectors reaches 91 billion yen. The sector of wholesale and retail trade has the largest direct damage cost. The sector of manufacture of transportation equipment has the largest indirect damage cost.

  14. The cost of dementia in an unequal country: The case of Chile.

    Directory of Open Access Journals (Sweden)

    Daniel A Hojman

    Full Text Available We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES. We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver's burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests; direct social costs (social service, daycare; and indirect costs (mostly associated to informal care. The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver's burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559 is lower in comparison to high-income countries (US$ 39,595 and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent. SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.

  15. Customer interruption cost and results

    Energy Technology Data Exchange (ETDEWEB)

    Eua-Arporn, B.; Bisarnbutra, S. [Chulalongkorn Univ., Bangkok (Thailand)

    1997-12-31

    Results of a comprehensive study on short-term direct impacts and consumer interruption costs, incurred as a result of power supply interruption, were discussed. The emphasis was on questionnaire development, general responses and the average customer damage function of some selected sectors. The customer damage function was established for each category of customers (agriculture, industry, mining, wholesale, retail merchandising, residential, etc) as well as for different locations. Results showed that the average customer damage function depended mostly on customer category. Size and location were not significant factors. 5 refs., 7 tabs.

  16. High temperature and bacteriophages can indirectly select for bacterial pathogenicity in environmental reservoirs.

    Directory of Open Access Journals (Sweden)

    Ville-Petri Friman

    2011-03-01

    Full Text Available The coincidental evolution hypothesis predicts that traits connected to bacterial pathogenicity could be indirectly selected outside the host as a correlated response to abiotic environmental conditions or different biotic species interactions. To investigate this, an opportunistic bacterial pathogen, Serratia marcescens, was cultured in the absence and presence of the lytic bacteriophage PPV (Podoviridae at 25°C and 37°C for four weeks (N = 5. At the end, we measured changes in bacterial phage-resistance and potential virulence traits, and determined the pathogenicity of all bacterial selection lines in the Parasemia plantaginis insect model in vivo. Selection at 37°C increased bacterial motility and pathogenicity but only in the absence of phages. Exposure to phages increased the phage-resistance of bacteria, and this was costly in terms of decreased maximum population size in the absence of phages. However, this small-magnitude growth cost was not greater with bacteria that had evolved in high temperature regime, and no trade-off was found between phage-resistance and growth rate. As a result, phages constrained the evolution of a temperature-mediated increase in bacterial pathogenicity presumably by preferably infecting the highly motile and virulent bacteria. In more general perspective, our results suggest that the traits connected to bacterial pathogenicity could be indirectly selected as a correlated response by abiotic and biotic factors in environmental reservoirs.

  17. FORMALIZING PRODUCT COST DISTORTION: The Impact of Volume-Related Allocation Bases on Cost Information

    Directory of Open Access Journals (Sweden)

    Johnny Jermias

    2003-09-01

    Full Text Available The purpose o f this study is to formally analyze product cost distortions resulting from the process of allocating costs to products based on Activity-Based Costing (ABC and the conventional product costing systems. The model developed in this paper rigorously shows the impact of treating costs that are not volume related as if they are. The model demonstrates that the source of product cost distortion is the difference between the proportion of driver used by each product in ABC and the proportion of the base used by the same product in the conventional costing systems. The difference arises because the conventional costing systems ignore the existence of batch-related and product-related costs. The model predicts a positive association between volume and size diversity with product cost distortions. When interaction between volume and size diversity exists, the distortion is either mitigated or exacerbated. The magnitude of the distortion is jointly determined by the size of the differences and the size of the total indirect costs.

  18. INDIRECT COSTS ALLOCATION AND DECISION MAKING IN AGRICULTURAL PRODUCTION

    Directory of Open Access Journals (Sweden)

    M. Karić

    2001-06-01

    Full Text Available The paper introduces a research on the changes occurred inside the accounting system of agricultural organisations in the transitional period. Changes of structure and accounting information system being results of privatisation processes were analysed. The introduction of modern methods in the preparation of relevant management information represents one of the preconditions for development of the privatised agricultural organisation during the transition period. Information prepared by the accounting, especially adapted to management requirements, is essential for rational decision making. Modern management system of reporting is fundamental task of management and a precondition for securing competitive production in agricultural industry. For this reason, it is necessary to define areas of responsibility and to enable application of a modern techniques for calculating expenses. The purpose of this paper is to emphasise the specialised use of accounting information by managers and to develop methods of management reporting in agricultural organisations. We propose an emphasis upon the application of modern management accounting techniques rather than financial accounting reporting approach. We support the contention that the need for high-quality management accounting is not debatable and tend to explain how and why accounting information is developed for the individual parts of a business entity, that is for each department or enterprise of an agricultural organisation. The responsibility accounting system should be introduced in agricultural business entities within our conditions, especially in larger organisations, as a measure of securing competitive production. We emphasise the importance of distinguishing between direct and indirect expenses and of using appropriate methods to allocate expenses among departments or enterprises. The research is based on information directly received from the largest agricultural companies in the area of

  19. Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial.

    Science.gov (United States)

    Hedman, Erik; Andersson, Erik; Ljótsson, Brjánn; Andersson, Gerhard; Rück, Christian; Lindefors, Nils

    2011-11-01

    Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n=64) or CBGT (n=62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Indirect estimators in US federal programs

    CERN Document Server

    1996-01-01

    In 1991, a subcommittee of the Federal Committee on Statistical Methodology met to document the use of indirect estimators - that is, estimators which use data drawn from a domain or time different from the domain or time for which an estimate is required. This volume comprises the eight reports which describe the use of indirect estimators and they are based on case studies from a variety of federal programs. As a result, many researchers will find this book provides a valuable survey of how indirect estimators are used in practice and which addresses some of the pitfalls of these methods.

  1. 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

  2. Costs and Burden Associated with Loss of Labor Productivity in Informal Caregivers of People with Dementia: Results from Spain.

    Science.gov (United States)

    Farré, Marta; Kostov, Belchin; Haro, Josep Maria; Cabrera, Esther; Risco, Ester; Alvira, MCarmen; Miguel, Susana; Zabalegui, Adelaida

    2017-11-13

    We analyzed indirect costs related to loss of labor productivity (LLP) in informal caregivers (ICs) of people with dementia (PwD) and the associated caregiver burden and patients' clinical variables. Multicenter cohort study of PwD and their ICs (n = 287) focused on two groups: (1) home care and (2) institutional long-term care. The costs of LLP were assessed using the Resource Utilization Dementia instrument and a human capital approach. The cost for LLP was 378&OV0556;/month or 4.536&OV0556;/year. Greater disease severity increased the likelihood of reducing working hours and missing a working day. There was a significant association between partial absenteeism and burden in employed informal caregiver in both the home and institutional setting. Cognitive impairment contributes to the cost of LLP in IC especially in home-care. LLP has a negative impact on IC burden.

  3. Activity-based costing methodology as tool for costing in hematopathology laboratory

    Directory of Open Access Journals (Sweden)

    Gujral Sumeet

    2010-01-01

    Full Text Available Background: Cost analysis in laboratories represents a necessary phase in their scientific progression. Aim: To calculate indirect cost and thus total cost per sample of various tests at Hematopathology laboratory (HPL Settings and Design: Activity-based costing (ABC method is used to calculate per cost test of the hematopathology laboratory. Material and Methods: Information is collected from registers, purchase orders, annual maintenance contracts (AMCs, payrolls, account books, hospital bills and registers along with informal interviews with hospital staff. Results: Cost per test decreases as total number of samples increases. Maximum annual expense at the HPL is on reagents and consumables followed by manpower. Cost per test is higher for specialized tests which interpret morphological or flow data and are done by a pathologist. Conclusions: Despite several limitations and assumptions, this was an attempt to understand how the resources are consumed in a large size government-run laboratory. The rate structure needs to be revised for most of the tests, mainly for complete blood counts (CBC, bone marrow examination, coagulation tests and Immunophenotyping. This costing exercise is laboratory specific and each laboratory needs to do its own costing. Such an exercise may help a laboratory redesign its costing structure or at least understand the economics involved in the laboratory management.

  4. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa--a systematic review.

    Science.gov (United States)

    Barter, Devra M; Agboola, Stephen O; Murray, Megan B; Bärnighausen, Till

    2012-11-14

    Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.

  5. Comparison of viral RNA electrophoresis and indirect ELISA methods in the diagnosis of human rotavirus infection

    Energy Technology Data Exchange (ETDEWEB)

    Avendano, L F; Dubinovsky, S; James, Jr, H D

    1984-01-01

    A total of 177 stool samples from Chilean diarrhea patients under two years of age were tested for rotavirus by two methods - the indirect enzyme-linked immunosorbent assay (indirect ELISA) and viral RNA electrophoresis in agarose gels (v RNA EPH). Fifty of the specimens came from patients with acute diarrhea and 127 came from patients with protracted diarrhea. The indirect ELISA testing was performed at the National Institutes of Health in the United States: the electrophoretic testing was carried out in Santiago, Chile by the authors. The electrophoretic method detected rotavirus in 36% of the acute samples and 25% of the samples from protracted cases, while the indirect ELISA method detected rotavirus in higher percentages of samples - 46% and 38%, respectively. These results support the conclusion that v RNA EPH is a less sensitive method for detecting rotavirus than the indirect ELISA. Nevertheless, the former method's high specificity, ease of application, and low cost make it a worthwhile alternative to indirect ELISA. Thus, considering the important role played by rotavirus in infant diarrhea and the need for a diagnostic technique that can be incorporated into the routines of medical center laboratories in developing countries, there is good reason to conclude that v RNA EPH is a useful tool for studying rotavirus diarrhea. 18 refs, 3 tabs. Also published in the Bol. Oficina Sanit. Panam. (1984) v. 97(1), p. 1-7 (In Spanish).

  6. Estimating the Cost of Early Infant Male Circumcision in Zimbabwe: Results From a Randomized Noninferiority Trial of AccuCirc Device Versus Mogen Clamp.

    Science.gov (United States)

    Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K; Madidi, Ngonidzashe; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M; Thirumurthy, Harsha

    2015-08-15

    Safe and cost-effective programs for implementing early infant male circumcision (EIMC) in Africa need to be piloted. We present results on a relative cost analysis within a randomized noninferiority trial of EIMC comparing the AccuCirc device with Mogen clamp in Zimbabwe. Between January and June 2013, male infants who met inclusion criteria were randomized to EIMC through either AccuCirc or Mogen clamp conducted by a doctor, using a 2:1 allocation ratio. We evaluated the overall unit cost plus the key cost drivers of EIMC using both AccuCirc and Mogen clamp. Direct costs included consumable and nonconsumable supplies, device, personnel, associated staff training, and environmental costs. Indirect costs comprised capital and support personnel costs. In 1-way sensitivity analyses, we assessed potential changes in unit costs due to variations in main parameters, one at a time, holding all other values constant. The unit costs of EIMC using AccuCirc and Mogen clamp were $49.53 and $55.93, respectively. Key cost drivers were consumable supplies, capacity utilization, personnel costs, and device price. Unit prices are likely to be lowest at full capacity utilization and increase as capacity utilization decreases. Unit prices also fall with lower personnel salaries and increase with higher device prices. EIMC has a lower unit cost when using AccuCirc compared with Mogen clamp. To minimize unit costs, countries planning to scale-up EIMC using AccuCirc need to control costs of consumables and personnel. There is also need to negotiate a reasonable device price and maximize capacity utilization.

  7. Societal costs and burden of otitis media in Portugal

    Directory of Open Access Journals (Sweden)

    Speets AM

    2011-04-01

    Full Text Available Anouk Speets1, Judith Wolleswinkel1, Cristina Cardoso21Pallas health research and consultancy, Rotterdam, the Netherlands; 2GlaxoSmithKline, Algés, PortugalAbstract: This study aimed to estimate the resource consumption and societal impact of otitis media (OM in children younger than five years of age in Portugal. An Internet survey on generic childhood symptoms and diseases was administered to a sample of parents. This self-report survey had been previously implemented in other European countries. Medically confirmed OM was defined as symptoms of earache or “running ear” and/or a diagnosis of OM provided by a medical doctor. Direct medical, nonmedical, and indirect nonmedical costs were calculated for individual cases. Mean total costs per OM episode were estimated at €334. This corresponds to an estimated societal impact of 72 million €/year, of which 39% were indirect nonmedical costs. An epidemiological study should help to confirm the results of this study, and evaluate whether an intervention to reduce the occurrence and/or duration of OM may have an impact on societal costs and quality of life for affected families.Keywords: otitis media, costs, societal burden, Portugal

  8. The health-related social costs of alcohol in Belgium.

    Science.gov (United States)

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

    2017-12-16

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

  9. Merging Children's Oncology Group Data with an External Administrative Database Using Indirect Patient Identifiers: A Report from the Children's Oncology Group.

    Directory of Open Access Journals (Sweden)

    Yimei Li

    Full Text Available Clinical trials data from National Cancer Institute (NCI-funded cooperative oncology group trials could be enhanced by merging with external data sources. Merging without direct patient identifiers would provide additional patient privacy protections. We sought to develop and validate a matching algorithm that uses only indirect patient identifiers.We merged the data from two Phase III Children's Oncology Group (COG trials for de novo acute myeloid leukemia (AML with the Pediatric Health Information Systems (PHIS. We developed a stepwise matching algorithm that used indirect identifiers including treatment site, gender, birth year, birth month, enrollment year and enrollment month. Results from the stepwise algorithm were compared against the direct merge method that used date of birth, treatment site, and gender. The indirect merge algorithm was developed on AAML0531 and validated on AAML1031.Of 415 patients enrolled on the AAML0531 trial at PHIS centers, we successfully matched 378 (91.1% patients using the indirect stepwise algorithm. Comparison to the direct merge result suggested that 362 (95.7% matches identified by the indirect merge algorithm were concordant with the direct merge result. When validating the indirect stepwise algorithm using the AAML1031 trial, we successfully matched 157 out of 165 patients (95.2% and 150 (95.5% of the indirectly merged matches were concordant with the directly merged matches.These data demonstrate that patients enrolled on COG clinical trials can be successfully merged with PHIS administrative data using a stepwise algorithm based on indirect patient identifiers. The merged data sets can be used as a platform for comparative effectiveness and cost effectiveness studies.

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S. K.; Lee, S. H.; Ko, W. I. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    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.

  11. 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

  12. An Ownership/Lease Cost Comparison Analysis of Heavy Equipment Motor Vehicles in Air Force Materiel Command

    Science.gov (United States)

    1994-09-01

    costs are the costs associated with a particular piece of equipment that do not change despite change in variable operating cost ( Horngren and Foster...The Operating and maintenance costs account for direct and indirect costs associated with their respective functions and vary with the utilization of...each vehicle. The operating direct cost includes all on-base and off- base fuel cost . Indirect operations costs account for bench 28 stock items

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

    Science.gov (United States)

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

    2018-03-20

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

  14. Economic costs attributable to smoking in China: update and an 8-year comparison, 2000-2008.

    Science.gov (United States)

    Yang, Lian; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Rao, Keqin

    2011-07-01

    To estimate the health-related economic costs attributable to smoking in China for persons aged 35 and older in 2003 and in 2008 and to compare these costs with the respective results from 2000. A prevalence-based, disease-specific approach was used to estimate smoking-attributable direct and indirect economic costs. The primary data source was the 2003 and 2008 China National Health Services Survey, which contains individual participant's smoking status, healthcare use and expenditures. The total economic cost of smoking in China amounted to $17.1 billion in 2003 and $28.9 billion in 2008 (both measured in 2008 constant US$). Direct smoking-attributable healthcare costs in 2003 and 2008 were $4.2 billion and $6.2 billion, respectively. Indirect economic costs in 2003 and 2008 were $12.9 billion and $22.7 billion, respectively. Compared to 2000, the direct costs of smoking rose by 72% in 2003 and 154% in 2008, while the indirect costs of smoking rose by 170% in 2003 and 376% in 2008. The economic burden of cigarette smoking has increased substantially in China during the past decade and is expected to continue to increase as the national economy and the price of healthcare services grow. Stronger intervention measures against smoking should be taken without delay to reduce the health and financial losses caused by smoking.

  15. Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

    Directory of Open Access Journals (Sweden)

    Zhao Xie

    2015-01-01

    Full Text Available Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123 who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%, followed by vertebral fracture (34.2%. The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients’ ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture.

  16. Direct and indirect economic and health consequences of COPD in Denmark

    DEFF Research Database (Denmark)

    Løkke, Anders; Hilberg, Ole; Tønnesen, Philip

    2014-01-01

    and higher socioeconomic costs. The employment and the income rates of employed patients with COPD were significantly lower compared with controls. The annual net costs, including social transfers were €8572 for patients with COPD. These consequences were present up to 11 years before first-time diagnosis...... national databases. PARTICIPANTS: 131 811 patients with COPD were identified and compared with 131 811 randomly selected controls matched for age, gender, educational level, residence and marital status. PRIMARY AND SECONDARY OUTCOME MEASURES: Direct and indirect economic and health consequences of COPD...... in Denmark in the time period 1998-2010. RESULTS: Patients with COPD had a poor survival. The average (95% CI) 12-year survival rate was 0.364 (0.364 to 0.368) compared with 0.686 among controls (0.682 to 0.690). COPD was associated with significantly higher rates of health-related contacts, medication use...

  17. Cost-of-illness analysis of type 2 diabetes mellitus in Iran.

    Directory of Open Access Journals (Sweden)

    Mehdi Javanbakht

    Full Text Available Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM and its complications in Iran in 2009 year.This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups.The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD including 2.04±0.28 billion direct (medical and non-medical costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9% and drugs (23.8% were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost, nephropathy (23% and ophthalmic complications (14%. Indirect costs include temporarily disability (335.7 million, permanent disability (452.4 million and reduced productivity due to premature mortality (950.3 million.T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority.

  18. 20 CFR 633.304 - Section 402 cost allocation.

    Science.gov (United States)

    2010-04-01

    ... accounted for as follows: (1) Administration. Administration costs consist of all direct and indirect costs... direct program administrative positions such as supervisors, program analysts, labor market analysts, and... to participants, classroom space and utility costs; job search assistance, labor market orientation...

  19. The Economic Burden of Obesity in Germany: Results from the Population-Based KORA Studies

    Directory of Open Access Journals (Sweden)

    Nichola Yates

    2016-12-01

    Full Text Available Objective: To estimate the excess costs of obese compared to normal-weight persons in Germany based on self-reported resource utilisation and work absence. Methods: Five cross sectional surveys of cohort studies in southern Germany were pooled resulting in 9,070 observations for 6,731 individuals (31-96 years. BMI was measured in the study centre. Self-reported health care utilisation and work absence was used to estimate direct and indirect costs for the year 2011 based on unit costs. Using regression analyses, adjusted costs for different BMI groups were calculated. Results: Overweight and obese people showed significantly higher odds of health care utilisation and productivity losses compared with normal-weight people in most categories. Total direct/indirect costs were significantly higher with increasing severity of obesity (pre-obese (1.05 (0.90-1.23 / 1.38 (1.11-1.71, obesity level I (1.18 (1.00-1.39 / 1.33 (1.02-1.73, obesity level II (1.46 (1.14-1.87 / 1.77 (1.18-2.65 or level III (2.04 (1.40-2.97 / 1.99 (1.20-3.30 compared to normal-weight participants. In particular, higher obesity classes were significantly associated with increased costs for medication, general practitioner utilisation and work absence. Conclusion: Our results show that overweight and obesity are associated with enormous societal direct and indirect costs in Germany. This supports the evidence from previous top-down studies, but provides important new information based on a large pooled data set and measured BMI.

  20. NPP construction cost in Canada

    International Nuclear Information System (INIS)

    Gorshkov, A.L.

    1988-01-01

    The structure of capital costs during NPP construction in Canada is considered. Capital costs comprise direct costs (cost of the ground and ground rights, infrastructure, reactor equipment, turbogenerators, electrotechnical equipment, auxiliary equipment), indirect costs (construction equipment and services, engineering works and management services, insurance payments, freight, training, operating expenditures), capital per cents for the period of construction and cost of heavy water storages. It proceeds from the analysis of the construction cost structure for a NPP with the CANDU reactor of unit power of 515, 740 and 880 MW, that direct costs make up on the average 62%

  1. PET-CT in oncological patients: analysis of informal care costs in cost-benefit assessment.

    Science.gov (United States)

    Orlacchio, Antonio; Ciarrapico, Anna Micaela; Schillaci, Orazio; Chegai, Fabrizio; Tosti, Daniela; D'Alba, Fabrizio; Guazzaroni, Manlio; Simonetti, Giovanni

    2014-04-01

    The authors analysed the impact of nonmedical costs (travel, loss of productivity) in an economic analysis of PET-CT (positron-emission tomography-computed tomography) performed with standard contrast-enhanced CT protocols (CECT). From October to November 2009, a total of 100 patients referred to our institute were administered a questionnaire to evaluate the nonmedical costs of PET-CT. In addition, the medical costs (equipment maintenance and depreciation, consumables and staff) related to PET-CT performed with CECT and PET-CT with low-dose nonenhanced CT and separate CECT were also estimated. The medical costs were 919.3 euro for PET-CT with separate CECT, and 801.3 euro for PET-CT with CECT. Therefore, savings of approximately 13% are possible. Moreover, savings in nonmedical costs can be achieved by reducing the number of hospital visits required by patients undergoing diagnostic imaging. Nonmedical costs heavily affect patients' finances as well as having an indirect impact on national health expenditure. Our results show that PET-CT performed with standard dose CECT in a single session provides benefits in terms of both medical and nonmedical costs.

  2. KrF laser cost/performance model for ICF commercial applications

    International Nuclear Information System (INIS)

    Harris, D.B.; Pendergrass, J.H.

    1985-01-01

    Simple expressions suitable for use in commercial-applications plant parameter studies for the direct capital cost plus indirect field costs and for the efficiency as a function of repetition rate were developed for pure-optical-compression KrF laser fusion drivers. These simple expressions summarize estimates obtained from detailed cost-performance studies incorporating recent results of ongoing physics, design, and cost studies. Contributions of KrF laser capital charges and D and M costs to total levelized constant-dollar (1984) unit ICF power generation cost are estimated as a function of plant size and driver pulse energy using a published gain for short-wavelength lasers and representative values of plant parameters

  3. Recalculating the Economic Cost of Suicide

    Science.gov (United States)

    Yang, Bijou; Lester, David

    2007-01-01

    These authors argue that estimates of the net economic cost of suicide should go beyond accounting for direct medical costs and indirect costs from loss of earnings by those who commit suicide. There are potential savings from (a) not having to treat the depressive and other psychiatric disorders of those who kill themselves; (b) avoidance of…

  4. Modeling the cost-effectiveness of infant vaccination with pneumococcal conjugate vaccines in Germany.

    Science.gov (United States)

    Kuhlmann, Alexander; von der Schulenburg, J-Matthias Graf

    2017-04-01

    In 2009, the European Medicines Agency granted approval for two higher-valent pneumococcal conjugate vaccines. This study aims to evaluate the cost-effectiveness of universal infant (historical vaccination scheme in infants as well as indirect herd effects and replacement disease. We used German epidemiological data to calculate episodes of IPD, PNE, and AOM, as well as direct and indirect effects of the vaccination. Parameter uncertainty was tested in univariate and probabilistic sensitivity analyses. In the base-case analysis, the ICER of PCV13 versus PCV10 infant vaccination was EUR 9826 per quality-adjusted life-year (QALY) gained or EUR 5490 per life-year (LY) gained from the societal perspective and EUR 3368 per QALY gained or EUR 1882 per LY gained from the perspective of the German statutory health insurance. The results were particularly sensitive to the magnitude of indirect effects of both vaccines. Universal infant vaccination with PCV13 is likely to be a cost-effective intervention compared with PCV10 within the German health care system, if additional net indirect effects of PCV13 vaccination are significant.

  5. Dynamic modelling of costs and health consequences of school closure during an influenza pandemic

    Directory of Open Access Journals (Sweden)

    Xue Yiting

    2012-11-01

    Full Text Available Abstract Background The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations. Methods We developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school and closure durations (1–10 weeks, given pandemics with basic reproductive number of 1.5, 2.0 or 2.5. Results The cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility, closing schools would not be cost-effective, regardless of the age target of school children. Conclusions School closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism.

  6. State and force observers based on multibody models and the indirect Kalman filter

    Science.gov (United States)

    Sanjurjo, Emilio; Dopico, Daniel; Luaces, Alberto; Naya, Miguel Ángel

    2018-06-01

    The aim of this work is to present two new methods to provide state observers by combining multibody simulations with indirect extended Kalman filters. One of the methods presented provides also input force estimation. The observers have been applied to two mechanism with four different sensor configurations, and compared to other multibody-based observers found in the literature to evaluate their behavior, namely, the unscented Kalman filter (UKF), and the indirect extended Kalman filter with simplified Jacobians (errorEKF). The new methods have some more computational cost than the errorEKF, but still much less than the UKF. Regarding their accuracy, both are better than the errorEKF. The method with input force estimation outperforms also the UKF, while the method without force estimation achieves results almost identical to those of the UKF. All the methods have been implemented as a reusable MATLAB® toolkit which has been released as Open Source in https://github.com/MBDS/mbde-matlab.

  7. Pediatric cryptosporidiosis: An evaluation of health care and societal costs in Peru, Bangladesh and Kenya.

    Directory of Open Access Journals (Sweden)

    Ellen R Rafferty

    Full Text Available Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01, followed by Peru ($23.32, and Bangladesh ($7.62. The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M, followed by Kenya ($37.4M; range $1.6-$804.5M and Bangladesh ($9.6M, range $0.28-$91.5M. For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.

  8. Pediatric cryptosporidiosis: An evaluation of health care and societal costs in Peru, Bangladesh and Kenya.

    Science.gov (United States)

    Rafferty, Ellen R; Schurer, Janna M; Arndt, Michael B; Choy, Robert K M; de Hostos, Eugenio L; Shoultz, David; Farag, Marwa

    2017-01-01

    Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.

  9. Prevalência e custos indiretos das cefaléias em uma empresa brasileira Prevalence and indirect costs of headache in a Brazilian company

    Directory of Open Access Journals (Sweden)

    MAURICE VINCENT

    1998-12-01

    indirect costs estimation for each headache, the company may loose up to US$125.98 per employee annually. Since among headaches migraine has the highest indirect cost, migraine prevention and treatment is particularly important at the working environment. Migraine frequency may be prevented to a large extent, resulting on positive effects in both the quality of life and productivity. The cost-benefit ratio clearly favours therapeutic and preventive programs against chronic headaches.

  10. Refined analysis results for multimedia network costs and profits

    DEFF Research Database (Denmark)

    Tahkokorpi, M.; Falch, Morten; Skouby, Knud Erik

    This deliverable describes the techno-economic business model developed in EURORIM WP3 and presents the refined results of the multimedia service delivery cost-profit calculations......This deliverable describes the techno-economic business model developed in EURORIM WP3 and presents the refined results of the multimedia service delivery cost-profit calculations...

  11. Cruel intentions on television and in real life: can viewing indirect aggression increase viewers' subsequent indirect aggression?

    Science.gov (United States)

    Coyne, Sarah M; Archer, John; Eslea, Mike

    2004-07-01

    Numerous studies have shown that viewing violence in the media can influence an individual's subsequent aggression, but none have examined the effect of viewing indirect aggression. This study examines the immediate effect of viewing indirect and direct aggression on subsequent indirect aggression among 199 children ages 11 to 14 years. They were shown an indirect, direct, or no-aggression video and their subsequent indirect aggression was measured by negative evaluation of a confederate and responses to a vignette. Participants viewing indirect or direct aggression gave a more negative evaluation of and less money to a confederate than participants viewing no-aggression. Participants viewing indirect aggression gave less money to the confederate than those viewing direct aggression. Participants viewing indirect aggression gave more indirectly aggressive responses to an ambiguous situation and participants viewing direct aggression gave more directly aggressive responses. This study provides the first evidence that viewing indirect aggression in the media can have an immediate impact on subsequent aggression.

  12. 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.

  13. Design of different types of indirect cooling systems in supermarkets - Comparison of energy use and costs

    Energy Technology Data Exchange (ETDEWEB)

    Haglund Stignor, Caroline

    2007-08-15

    A case study has been performed comparing 11 different cases of indirect cooling systems in supermarkets. The influence of the selection of cooling-coil/heat exchanger design, display cabinets, type of secondary refrigerant, types of valves, types of pumps and type of system design has been investigated. The cases have been selected to be representative for a large number of supermarkets in Sweden. However, some of the cases are only hypothetical and do no not exist in reality so far. The results show that savings of both energy and money can be significant, by the selection of efficient components and system design. An iterative procedure, for finding the optimal operating point (liquid inlet temperature and liquid flow rate) is suggested. This procedure has been evaluated with good results

  14. 49 CFR 594.9 - Fee for reimbursement of bond processing costs and costs for processing offers of cash deposits...

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Fee for reimbursement of bond processing costs and costs for processing offers of cash deposits or obligations of the United States in lieu of sureties on... indirect costs the agency incurs for receipt, processing, handling, and disbursement of cash deposits or...

  15. Epilepsy in Sweden: health care costs and loss of productivity--a register-based approach.

    Science.gov (United States)

    Bolin, Kristian; Lundgren, Anders; Berggren, Fredrik; Källén, Kristina

    2012-12-01

    The objective was to estimate health care costs and productivity losses due to epilepsy in Sweden and to compare these estimates to previously published estimates. Register data on health care utilisation, pharmaceutical sales, permanent disability and mortality were used to calculate health care costs and costs that accrue due to productivity losses. By linkage of register information, we were able to distinguish pharmaceuticals prescribed against epilepsy from prescriptions that were prompted by other indications. The estimated total cost of epilepsy in Sweden in 2009 was 441 million, which corresponds to an annual per-patient cost of 8,275. Health care accounted for about 16% of the estimated total cost, and drug costs accounted for about 7% of the total cost. The estimated health care cost corresponded to about 0.2% of the total health care cost in Sweden in 2009. Indirect costs were estimated at 370 million, 84% of which was due to sickness absenteeism. Costs resulting from epilepsy-attributable premature deaths or permanent disability to work accounted for about 1% of the total indirect cost in Sweden in 2009. The per-patient cost of epilepsy is substantial. Thus, even though the prevalence of the illness is relatively small, the aggregated cost that epilepsy incurs on society is significant.

  16. Cost reduction at NSP using IPE results

    International Nuclear Information System (INIS)

    Asmus, T.J.

    1995-01-01

    Operating nuclear power generating facilities are under increasing pressure to reduce costs to be able to compete successfully in the competitive electric sales market of today. With the completion of the individual plant evaluations (IPEs), numerous opportunities exist for application of probabilistic risk assessment methodology to reduce production costs. This paper presents two nontraditional methods in which IPE results can be used to help reduce nuclear insurance coverage limits and local property taxes. Significant savings can be realized through use of either of these two methods

  17. Converting a conventional wired-halogen illuminated indirect ophthalmoscope to a wireless-light emitting diode illuminated indirect ophthalmoscope in less than 1000/- rupees.

    Science.gov (United States)

    Kothari, Mihir; Kothari, Kedar; Kadam, Sanjay; Mota, Poonam; Chipade, Snehal

    2015-01-01

    To report the "do it yourself" method of converting an existing wired-halogen indirect ophthalmoscope (IO) to a wireless-light emitting diode (LED) IO and report the preferences of the patients and the ophthalmologists. In this prospective observational study, a conventional IO was converted to wireless-LED IO using easily available, affordable electrical components. Conventional and the converted IO were then used to perform photo-stress test and take the feedback of subjects and the ophthalmologists regarding its handling and illumination characteristics. The cost of conversion to wireless-LED was 815/- rupees. Twenty-nine subjects, mean age 34.3 [formula in text] 10 years with normal eyes were recruited in the study. Between the two illumination systems, there was no statistical difference in the magnitude of the visual acuity loss and the time to recovery of acuity and the bleached vision on photo-stress test, although the visual recovery was clinically faster with LED illumination. The heat sensation was more with halogen illumination than the LED (P = 0.009). The ophthalmologists rated wireless-LED IO higher than wired-halogen IO on the handling, examination comfort, patient's visual comfort and quality of the image. Twenty-two (81%) ophthalmologists wanted to change over to wireless-LED IO. Converting to wireless-LED IO is easy, cost-effective and preferred over a wired-halogen indirect ophthalmoscope.

  18. Comparative TEA for Indirect Liquefaction Pathways to Distillate-Range Fuels via Oxygenated Intermediates

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Eric; Snowden-Swan, Lesley J.; Talmadge, Michael; Dutta, Abhijit; Jones, Susanne; Ramasamy, Karthikeyan; Gray, Michael; Dagle, Robert; Padmaperuma, Asanga; Gerber, Mark; Sahir, Asad; Tao, Ling; Zhang, Yanan

    2017-03-03

    This paper presents a comparative techno-economic analysis of five conversion pathways from biomass to gasoline-, jet-, and diesel-range hydrocarbons via indirect liquefaction with specific focus on pathways utilizing oxygenated intermediates (derived either via thermochemical or biochemical conversion steps). The four emerging pathways of interest are compared with one conventional pathway (Fischer-Tropsch) for the production of the hydrocarbon blendstocks. The processing steps of the four emerging pathways include: biomass-to-syngas via indirect gasification, gas cleanup, conversion of syngas to alcohols/oxygenates, followed by conversion of alcohols/oxygenates to hydrocarbon blendstocks via dehydration, oligomerization, and hydrogenation. We show that the emerging pathways via oxygenated intermediates have the potential to be cost competitive with the conventional Fischer-Tropsch process. The evaluated pathways and the benchmark process generally exhibit similar fuel yields and carbon conversion efficiencies. The resulting minimum fuel selling prices are comparable to the benchmark at approximately $3.60 per gallon-gasoline equivalent, with potential for two new pathways to be more economically competitive. Additionally, the coproduct values can play an important role in the economics of the processes with oxygenated intermediates derived via syngas fermentation. Major cost drivers for the integrated processes are tied to achievable fuel yields and conversion efficiency of the intermediate steps, i.e., the production of oxygenates/alcohols from syngas and the conversion of oxygenates/alcohols to hydrocarbon fuels.

  19. Excess costs from functional somatic syndromes in Germany - An analysis using entropy balancing.

    Science.gov (United States)

    Grupp, Helen; Kaufmann, Claudia; König, Hans-Helmut; Bleibler, Florian; Wild, Beate; Szecsenyi, Joachim; Herzog, Wolfgang; Schellberg, Dieter; Schäfert, Rainer; Konnopka, Alexander

    2017-06-01

    The aim of this study was to calculate disorder-specific excess costs in patients with functional somatic syndromes (FSS). We compared 6-month direct and indirect costs in a patient group with FSS (n=273) to a control group of the general adult population in Germany without FSS (n=2914). Data on the patient group were collected between 2007 and 2009 in a randomized controlled trial (speciAL). Data on the control group were obtained from a telephone survey, representative for the general German population, conducted in 2014. Covariate balance between the patient group and the control group was achieved using entropy balancing. Excess costs were calculated by estimating generalized linear models and two-part models for direct costs and indirect costs. Further, we estimated excess costs according to the level of somatic symptom severity (SSS). FSS patients differed significantly from the control group regarding 6-month costs of outpatient physicians (+€280) and other outpatient providers (+€74). According to SSS, significantly higher outpatient physician costs were found for mild (+€151), moderate (+€306) and severe (+€376) SSS. We also found significantly higher costs of other outpatient providers in patients with mild, moderate and severe SSS. Regarding costs of rehabilitation and hospital treatments, FSS patients did not differ significantly from the control group for any level of SSS. Indirect costs were significantly higher in patients with severe SSS (+€760). FSS were of major importance in the outpatient sector. Further, we found significantly higher indirect costs in patients with severe SSS. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Assessment of gas cooled fast reactor with indirect supercritical CO2 cycle

    International Nuclear Information System (INIS)

    Hejzlar, P.; Driscoll, M. J.; Dostal, V.; Dumaz, P.; Poullennec, G.; Alpy, N.

    2006-01-01

    Various indirect power cycle options for a helium cooled Gas cooled Fast Reactor (GFR) with particular focus on a supercritical CO 2 (SCO 2 ) indirect cycle are investigated as an alternative to a helium cooled direct cycle GFR. The Balance Of Plant (BOP) options include helium-nitrogen Brayton cycle, supercritical water Rankine cycle, and SCO 2 recompression Brayton power cycle in three versions: (1) basic design with turbine inlet temperature of 550 .deg. C, (2) advanced design with turbine inlet temperature of 650 .deg. C and (3) advanced design with the same turbine inlet temperature and reduced compressor inlet temperature. The indirect SCO 2 recompression cycle is found attractive since in addition to easier BOP maintenance it allows significant reduction of core outlet temperature, making design of the primary system easier while achieving very attractive efficiencies comparable to or slightly lower than, the efficiency of the reference GFR direct cycle design. In addition, the indirect cycle arrangement allows significant reduction of the GFR 'proximate-containment' and the BOP for the SCO 2 cycle is very compact. Both these factors will lead to reduced capital cost

  1. Self-Punishment Promotes Forgiveness in the Direct and Indirect Reciprocity Contexts.

    Science.gov (United States)

    Zhu, Ruida; Shen, Xueyi; Tang, Honghong; Ye, Peixia; Wang, Huagen; Mai, Xiaoqin; Liu, Chao

    2017-06-01

    Most previous studies regarding self-punishment have focused on the correlation between moral emotion and self-punishment. Only a few studies have attempted to understand self-punishment from the perspective of seeking forgiveness, and no study has yet directly tested whether wrongdoers' self-punishment promotes others to forgive the wrongdoers. In three studies, the participants judged the wrongdoers' self-punishment behaviors following an unfair allocation and reported the extent to which they forgave the wrongdoers. The results demonstrated that self-punishment did promote forgiveness in both the direct (Studies 1 and 2) and indirect reciprocity (Study 3) contexts. Consistent with costly signaling theory, the costlier the self-punishment was, the stronger the effect it had on forgiveness. Moreover, communicative self-punishment had a better effect than silent self-punishment when the cost was relatively high in the direct-reciprocity studies. These findings can guide us regarding how to address a damaged relationship via self-punishment when compensation is not feasible or acceptable.

  2. Determination production costs using PBC method

    Directory of Open Access Journals (Sweden)

    Todić Vladimir V.

    2014-01-01

    Full Text Available Basic characteristics of modern markets make requirements in quality increasing, decreasing prices and shortening delivery of products. In the middle of this requirements are production costs for whose determination are developed many traditional and alternative methods including PBC method (Process Based Costing. This method enables precisely locating and calculating indirect production costs, and with determined direct costs enables determination of total production costs. This paper shows usage of PBC method for determination production costs for three forms of processing cutting tools.

  3. Cost assessment of natural hazards in Europe - state-of-the-art, knowledge gaps and recommendations

    Science.gov (United States)

    Meyer, V.; Becker, N.; Markantonis, V.; Schwarze, R.; van den Bergh, J. C. J. M.; Bouwer, L. M.; Bubeck, P.; Ciavola, P.; Thieken, A. H.; Genovese, E.; Green, C.; Hallegatte, S.; Kreibich, H.; Lequeux, Q.; Viavattenne, C.; Logar, I.; Papyrakis, E.; Pfurtscheller, C.; Poussin, J.; Przyluski, V.

    2012-04-01

    Effective and efficient reduction of natural hazard risks requires a thorough understanding of the costs of natural hazards in order to develop sustainable risk management strategies. The current methods that assess the costs of different natural hazards employ a diversity of terminologies and approaches for different hazards and impacted sectors. This makes it difficult to arrive at robust, comprehensive and comparable cost figures. The CONHAZ (Costs of Natural Hazards) project aimed to compile and synthesise current knowledge on cost assessment methods in order to strengthen the role of cost assessments in the development of integrated natural hazard management and adaptation planning. In order to achieve this, CONHAZ has adopted a comprehensive approach, considering natural hazards ranging from droughts, floods and coastal hazards to Alpine hazards, as well as different impacted sectors and cost types. Its specific objectives have been 1) to compile the state-of-the-art methods for cost assessment; 2) to analyse and assess these methods in terms of technical aspects, as well as terminology, data quality and availability, and research gaps; and 3) to synthesise resulting knowledge into recommendations and to identify further research needs. This presentation summarises the main results of CONHAZ. CONHAZ differentiates between direct tangible damages, losses due to business interruption, indirect damages, intangible effects, and costs of risk mitigation. It is shown that the main focus of cost assessment methods and their application in practice is on direct costs, while existing methods for assessing intangible and indirect effects are rather rarely applied and methods for assessing indirect effects often cannot be used on the scale of interest (e.g. the regional scale). Furthermore, methods often focus on single sectors and/or hazards, and only very few are able to reflect several sectors or multiple hazards. Process understanding and its use in cost assessment

  4. An approximate fractional Gaussian noise model with computational cost

    KAUST Repository

    Sørbye, Sigrunn H.

    2017-09-18

    Fractional Gaussian noise (fGn) is a stationary time series model with long memory properties applied in various fields like econometrics, hydrology and climatology. The computational cost in fitting an fGn model of length $n$ using a likelihood-based approach is ${\\\\mathcal O}(n^{2})$, exploiting the Toeplitz structure of the covariance matrix. In most realistic cases, we do not observe the fGn process directly but only through indirect Gaussian observations, so the Toeplitz structure is easily lost and the computational cost increases to ${\\\\mathcal O}(n^{3})$. This paper presents an approximate fGn model of ${\\\\mathcal O}(n)$ computational cost, both with direct or indirect Gaussian observations, with or without conditioning. This is achieved by approximating fGn with a weighted sum of independent first-order autoregressive processes, fitting the parameters of the approximation to match the autocorrelation function of the fGn model. The resulting approximation is stationary despite being Markov and gives a remarkably accurate fit using only four components. The performance of the approximate fGn model is demonstrated in simulations and two real data examples.

  5. Financial implications of ventral hernia repair: a hospital cost analysis.

    Science.gov (United States)

    Reynolds, Drew; Davenport, Daniel L; Korosec, Ryan L; Roth, J Scott

    2013-01-01

    Complicated ventral hernias are often referred to tertiary care centers. Hospital costs associated with these repairs include direct costs (mesh materials, supplies, and nonsurgeon labor costs) and indirect costs (facility fees, equipment depreciation, and unallocated labor). Operative supplies represent a significant component of direct costs, especially in an era of proprietary synthetic meshes and biologic grafts. We aim to evaluate the cost-effectiveness of complex abdominal wall hernia repair at a tertiary care referral facility. Cost data on all consecutive open ventral hernia repairs (CPT codes 49560, 49561, 49565, and 49566) performed between 1 July 2008 and 31 May 2011 were analyzed. Cases were analyzed based upon hospital status (inpatient vs. outpatient) and whether the hernia repair was a primary or secondary procedure. We examined median net revenue, direct costs, contribution margin, indirect costs, and net profit/loss. Among primary hernia repairs, cost data were further analyzed based upon mesh utilization (no mesh, synthetic, or biologic). Four-hundred and fifteen patients underwent ventral hernia repair (353 inpatients and 62 outpatients); 173 inpatients underwent ventral hernia repair as the primary procedure; 180 inpatients underwent hernia repair as a secondary procedure. Median net revenue ($17,310 vs. 10,360, p costs for cases performed without mesh were $5,432; median direct costs for those using synthetic and biologic mesh were $7,590 and 16,970, respectively (p financial loss was $8,370. Outpatient ventral hernia repairs, with and without synthetic mesh, resulted in median net losses of $1,560 and 230, respectively. Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost

  6. The Cost of Blindness in the Republic of Ireland 2010–2020

    Directory of Open Access Journals (Sweden)

    D. Green

    2016-01-01

    Full Text Available Aims. To estimate the prevalence of blindness in the Republic of Ireland and the associated financial and total economic cost between 2010 and 2020. Methods. Estimates for the prevalence of blindness in the Republic of Ireland were based on blindness registration data from the National Council for the Blind of Ireland. Estimates for the financial and total economic cost of blindness were based on the sum of direct and indirect healthcare and nonhealthcare costs. Results. We estimate that there were 12,995 blind individuals in Ireland in 2010 and in 2020 there will be 17,997. We estimate that the financial and total economic costs of blindness in the Republic of Ireland in 2010 were €276.6 million and €809 million, respectively, and will increase in 2020 to €367 million and €1.1 billion, respectively. Conclusions. Here, ninety-eight percent of the cost of blindness is borne by the Departments of Social Protection and Finance and not by the Department of Health as might initially be expected. Cost of illness studies should play a role in public policy making as they help to quantify the indirect or “hidden” costs of disability and so help to reveal the true cost of illness.

  7. Preschool children's behavioral tendency toward social indirect reciprocity.

    Directory of Open Access Journals (Sweden)

    Mayuko Kato-Shimizu

    Full Text Available Social indirect reciprocity seems to be crucial in enabling large-scale cooperative networks among genetically unrelated individuals in humans. However, there are relatively few studies on social indirect reciprocity in children compared to adults. Investigating whether young children have a behavioral tendency toward social indirect reciprocity will help us understand how and when the fundamental ability to form cooperative relationships among adults is acquired. Using naturalistic observation at a nursery school, this study examined whether 5- to 6-year-olds show a behavioral tendency to engage in social indirect reciprocity in response to their peers' prosocial behavior toward a third party. The results revealed that bystander children tended to display prosocial behavior toward their peers more frequently after observing these peers' prosocial behavior toward third-party peers, compared with control situations; this suggests that 5- to 6-year-olds may have an essential behavioral tendency to establish social indirect reciprocity when interacting with peers in their daily lives. In addition, bystanders tended to display affiliative behavior after observing focal children's prosocial behavior. In other words, observing peers' prosocial behavior toward third-party peers evoked bystanders' positive emotions toward the helpers. Considering both the present results and previous findings, we speculate that in preschoolers, such positive emotions might mediate the increase in the bystander's prosocial behavior toward the helper. In addition, an intuitional emotional process plays an important role in the preschooler's behavioral tendency toward social indirect reciprocity in natural interactions with peers.

  8. Preschool children's behavioral tendency toward social indirect reciprocity.

    Science.gov (United States)

    Kato-Shimizu, Mayuko; Onishi, Kenji; Kanazawa, Tadahiro; Hinobayashi, Toshihiko

    2013-01-01

    Social indirect reciprocity seems to be crucial in enabling large-scale cooperative networks among genetically unrelated individuals in humans. However, there are relatively few studies on social indirect reciprocity in children compared to adults. Investigating whether young children have a behavioral tendency toward social indirect reciprocity will help us understand how and when the fundamental ability to form cooperative relationships among adults is acquired. Using naturalistic observation at a nursery school, this study examined whether 5- to 6-year-olds show a behavioral tendency to engage in social indirect reciprocity in response to their peers' prosocial behavior toward a third party. The results revealed that bystander children tended to display prosocial behavior toward their peers more frequently after observing these peers' prosocial behavior toward third-party peers, compared with control situations; this suggests that 5- to 6-year-olds may have an essential behavioral tendency to establish social indirect reciprocity when interacting with peers in their daily lives. In addition, bystanders tended to display affiliative behavior after observing focal children's prosocial behavior. In other words, observing peers' prosocial behavior toward third-party peers evoked bystanders' positive emotions toward the helpers. Considering both the present results and previous findings, we speculate that in preschoolers, such positive emotions might mediate the increase in the bystander's prosocial behavior toward the helper. In addition, an intuitional emotional process plays an important role in the preschooler's behavioral tendency toward social indirect reciprocity in natural interactions with peers.

  9. Chemistry of cost effective water treatment programme in HWP (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Laxmana Prasad, K.

    2008-01-01

    In order to develop a water treatment programme following points must be kept in mind: Effectiveness to achieve desired water quality objectives; Compliance with regulatory requirements; Cost minimization; Safety; Easy operation and protection to equipments. Heavy Water Plant (Manuguru) laboratory has developed treatment programs to treat raw water and cooling water which satisfy the above requirements and has been in use for last several years successfully without any problem. These treatment programs have been given to other plants in Heavy Water Board for implementation. This paper describes the chemistry of the treatment program and cost minimization achieved. Further these treatments have helped the plant in achieving ΦZero Discharge and indirectly reduced the production cost. The chemistry parameters are monitored regularly to ascertain the effectiveness of these treatments. The areas where significant benefits derived are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and development of in-house cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments helped the plant in achieving Zero discharge and indirectly reduced production cost of heavy water. The dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15 - 20 Lakhs in a year besides other advantages. The changeover of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs. 1.4 Crore a year along with other advantages. The change over of proprietary formulation to in-house formulation in cooling water treatment has resulted a saving about Rs. 11 Lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored (author)

  10. Application of activity-based costing (ABC) for a Peruvian NGO healthcare provider.

    Science.gov (United States)

    Waters, H; Abdallah, H; Santillán, D

    2001-01-01

    This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries.

  11. Impact of evergreening on patients and health insurance: a meta analysis and reimbursement cost analysis of citalopram/escitalopram antidepressants.

    Science.gov (United States)

    Alkhafaji, Ali A; Trinquart, Ludovic; Baron, Gabriel; Desvarieux, Moïse; Ravaud, Philippe

    2012-11-20

    "Evergreening" refers to the numerous strategies whereby owners of pharmaceutical products use patent laws and minor drug modifications to extend their monopoly privileges on the drug. We aimed to evaluate the impact of evergreening through the case study of the antidepressant citalopram and its chiral switch form escitalopram by evaluating treatment efficacy and acceptability for patients, as well as health insurance costs for society. To assess efficacy and acceptability, we performed meta-analyses for efficacy and acceptability. We compared direct evidence (meta-analysis of results of head-to-head trials) and indirect evidence (adjusted indirect comparison of results of placebo-controlled trials). To assess health insurance costs, we analyzed individual reimbursement data from a representative sample of the French National Health Insurance Inter-regime Information System (SNIIR-AM) from 2003 to 2010, which allowed for projecting these results to the whole SNIIR-AM population (53 million people). In the meta-analysis of seven head-to-head trials (2,174 patients), efficacy was significantly better for escitalopram than citalopram (combined odds ratio (OR) 1.60 (95% confidence interval 1.05 to 2.46)). However, for the adjusted indirect comparison of 10 citalopram and 12 escitalopram placebo-controlled trials, 2,984 and 3,777 patients respectively, efficacy was similar for the two drug forms (combined indirect OR 1.03 (0.82 to 1.30)). Because of the discrepancy, we could not combine direct and indirect data (test of inconsistency, P = 0.07). A similar discrepancy was found for treatment acceptability. The overall reimbursement cost burden for the citalopram, escitalopram and its generic forms was 120.6 million Euros in 2010, with 96.8 million Euros for escitalopram. The clinical benefit of escitalopram versus citalopram remains uncertain. In our case of evergreening, escitalopram represented a substantially high proportion of the overall reimbursement cost burden as

  12. The economic burden of adult asthma in Cyprus; a prevalence-based cost of illness study

    Directory of Open Access Journals (Sweden)

    Savvas Zannetos

    2017-03-01

    Full Text Available Abstract Background Asthma is one of the main non-infectious diseases of the respiratory system with substantial economic burden worldwide. The objective of this study was to estimate the economic burden of adult asthma in Cyprus during 2015. Methods A retrospective probabilistic prevalence-based cost of illness model was developed to calculate the economic burden of asthma including direct and indirect costs. The bottom-up approach (person-based data was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, bootstrapped sensitivity analysis with 1000 bootstrap simulations was performed in order to calculate a 95% Confidence Interval (CI. Results Mean patient cost of asthma in Cyprus in 2015 was estimated at €579.64 (95% CI: €376.90–€813.68. Direct costs accounted for 82.08% of the overall expenses, €475.75 per patient (95% CI: €296.94–€697.69. Indirect costs of €103.89 (95% CI: €49.59–€181.46 accounted for 17.92% of the overall expenses. Conclusion This was the first study in Cyprus, which used bootstrapped prevalence-based cost of illness model to estimate the cost of asthma. This study confirms that asthma is an expensive disease for the society. In addition, it provides important information and analysis of the economic consequences of asthma to policy makers in order to strengthen surveillance of the disease as well as draft the national health policy accordingly.

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

    Science.gov (United States)

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

    2010-12-01

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

  14. Indirect Comorbidity in Childhood and Adolescence

    Directory of Open Access Journals (Sweden)

    William eCopeland

    2013-11-01

    Full Text Available Objective: Comorbidity between psychiatric disorders is common, but pairwise associations between two disorders may be explained by the presence of other diagnoses that are associated with both disorders or indirect comorbidity. Method: Comorbidities of common childhood psychiatric disorders were tested in three community samples of children ages 6 to 17 (8931 observations of 2965 subjects. Psychiatric disorder status in all three samples was assessed with the Child and Adolescent Psychiatric Assessment. Indirect comorbidity was defined as A-B associations that decreased from significance to nonsignificance after adjusting for other disorders. Results: All tested childhood psychiatric disorders were positively associated in bivariate analyses. After adjusting for comorbidities, many ssociations involving a behavioral disorder and an emotional disorder were attenuated suggesting indirect comorbidity. Generalized anxiety and depressive disorders displayed a very high level of overlap (adjusted OR=37.9. All analyses were rerun with depressive disorders grouped with generalized anxiety disorder in a single distress disorders category. In these revised models, all associations between and emotional disorder and a behavior disorder met our criteria for indirect comorbidity except for the association of oppositional defiant disorder with distress disorders (OR=11.3. Follow-up analyses suggested that the indirect associations were primarily accounted for by oppositional defiant disorder and the distress disorder category. There was little evidence of either sex differences or differences by developmental period Conclusions: After accounting for the overlap between depressive disorders with generalized anxiety disorder, direct comorbidity between emotional and behavioral disorders was uncommon. When there was evidence of indirect comorbidity, ODD and distress disorders were the key intermediary diagnoses accounting for the apparent associations.

  15. 20 CFR 632.37 - Allowable costs.

    Science.gov (United States)

    2010-04-01

    ... otherwise indicated below, direct and indirect costs shall be charged in accordance with 41 CFR 29-70 and 41... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Allowable costs. 632.37 Section 632.37 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR INDIAN AND NATIVE AMERICAN...

  16. Indirect taxation in the European Union

    OpenAIRE

    Ene, Sebastian; Micuda, Dan

    2007-01-01

    Indirect taxes are levied on the production and consumption of goods and services. They influence the retail price, and hence affect patterns of trade and consumption. Indirect taxes are ultimately paid by the final consumer. Sales and turnover taxes, excise duties and tariffs are the basic indirect taxes. In contrast with direct taxes, indirect taxes are seldom progressive. The principles for the levying of these taxes will be considered before the analysis of indirect taxes.

  17. The social costs of alcohol misuse in Estonia.

    Science.gov (United States)

    Saar, Indrek

    2009-01-01

    The aim of this study was to estimate the social costs of alcohol misuse in Estonia in 2006. Using a prevalence-based cost-of-illness approach, both direct and indirect costs were considered, including tangible costs associated with health care, criminal justice, rescue services, damage to property, premature mortality, incarceration, incapability of working due to illnesses, and lower labor productivity. The results show that alcohol misuse cost Estonia more than EUR 200 million in 2006. The costs involved are estimated to represent 1.6% of the gross domestic product (GDP), which is relatively high in comparison with many other countries. In addition, the state receives less receipts from the alcohol excise tax than the costs that it incurs as a consequence of alcohol misuse, which points to the existence of economic inefficiency with respect to the alcohol market. The results of this study suggest that there is definitely a need for further cost-benefit analysis to reach a conclusion regarding the possible utility of government intervention. Copyright 2008 S. Karger AG, Basel.

  18. Comparing methodologies for the allocation of overhead and capital costs to hospital services.

    Science.gov (United States)

    Tan, Siok Swan; van Ineveld, Bastianus Martinus; Redekop, William Ken; Hakkaart-van Roijen, Leona

    2009-06-01

    Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

  19. Perineal tap water burns in the elderly: at what cost?

    Science.gov (United States)

    Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

    2017-11-01

    Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

  20. Cost-Effectiveness of Rotavirus Vaccination in France-Accounting for Indirect Protection.

    Science.gov (United States)

    Yamin, Dan; Atkins, Katherine E; Remy, Vanessa; Galvani, Alison P

    Vaccination against rotavirus has shown great potential for reducing the primary cause of severe childhood gastroenteritis. Previous economic evaluations of rotavirus vaccination in France have not modeled the potential impact of vaccines on disease burden via reduced transmission. To determine the cost-effectiveness of the introduction of pentavalent rotavirus vaccination into the French infant vaccination schedule. We developed an age-structured model of rotavirus transmission calibrated to 6 years of French gastroenteritis incidence and vaccine clinical trial data. We evaluated the cost-effectiveness of pentavalent rotavirus vaccination considering that 75% of infants would receive the three-dose vaccine course. Our model predicts that rotavirus vaccination will decrease rotavirus gastroenteritis incidence and associated clinical outcomes in vaccinated and unvaccinated individuals, delay the seasonal peak of infection, and increase the age of infection. From the societal perspective, our base-case scenario predicts that vaccination coverage would be cost-effective at €115 or €135 per vaccine course at €28,500 and €39,500/quality-adjusted life-year (QALY) gained, respectively, and suggests that almost 95% of the financial benefits will be recouped within the first 5 years following vaccination implementation. From the third-party payer perspective, incremental cost-effectiveness ratios ranged from €12,500 to €20,000/QALY, respectively. Our uncertainty analysis suggests that findings were sensitive to various assumptions including the number of hospitalizations, outpatient visits, and the extent of QALY losses per rotavirus episode. Introducing pentavalent rotavirus vaccination into the French infant vaccination schedule would significantly reduce the burden of rotavirus disease in children, and could be cost-effective under plausible conditions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by

  1. 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.

  2. Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010.

    Science.gov (United States)

    Bhuiyan, Mejbah Uddin; Luby, Stephen P; Alamgir, Nadia Ishrat; Homaira, Nusrat; Sturm-Ramirez, Katharine; Gurley, Emily S; Abedin, Jaynal; Zaman, Rashid Uz; Alamgir, Asm; Rahman, Mahmudur; Ortega-Sanchez, Ismael R; Azziz-Baumgartner, Eduardo

    2017-06-01

    Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children 50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV-associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7-16 million), the median indirect cost was US$ 3.0 million (IQR: 2-5 million) in 2010. RSV-associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship.

  3. Identification of a gene expression profile that discriminates indirect-acting genotoxins from direct-acting genotoxins

    Energy Technology Data Exchange (ETDEWEB)

    Hu Ting; Gibson, David P.; Carr, Gregory J.; Torontali, Suzanne M.; Tiesman, Jay P.; Chaney, Joel G.; Aardema, Marilyn J

    2004-05-18

    During the safety evaluation process of new drugs and chemicals, a battery of genotoxicity tests is conducted starting with in vitro genotoxicity assays. Obtaining positive results in in vitro genotoxicity tests is not uncommon. Follow-up studies to determine the biological relevance of positive genotoxicity results are costly, time consuming, and utilize animals. More efficient methods, especially for identifying a putative mode of action like an indirect mechanism of genotoxicity (where DNA molecules are not the initial primary targets), would greatly improve the risk assessment for genotoxins. To this end, we are participating in an International Life Sciences Institute (ILSI) project involving studies of gene expression changes caused by model genotoxins. The purpose of the work is to evaluate gene expression tools in general, and specifically for discriminating genotoxins that are direct-acting from indirect-acting. Our lab has evaluated gene expression changes as well as micronuclei (MN) in L5178Y TK{sup +/-} mouse lymphoma cells treated with six compounds. Direct-acting genotoxins (where DNA is the initial primary target) that were evaluated included the DNA crosslinking agents, mitomycin C (MMC) and cisplatin (CIS), and an alkylating agent, methyl methanesulfonate (MMS). Indirect-acting genotoxins included hydroxyurea (HU), a ribonucleotide reductase inhibitor, taxol (TXL), a microtubule inhibitor, and etoposide (ETOP), a DNA topoisomerase II inhibitor. Microarray gene expression analysis was conducted using Affymetrix mouse oligonucleotide arrays on RNA samples derived from cells which were harvested immediately after the 4 h chemical treatment, and 20 h after the 4 h chemical treatment. The evaluation of these experimental results yields evidence of differentially regulated genes at both 4 and 24 h time points that appear to have discriminating power for direct versus indirect genotoxins, and therefore may serve as a fingerprint for classifying chemicals

  4. Indirect detection methods: Looking for what is not there

    International Nuclear Information System (INIS)

    Yeung, E.S.

    1989-01-01

    Indirect detection allows one to monitor species that normally do not give a response. It has grown from an intellectual curiosity to become an extremely useful tool. For volume displacement, polarimetry gives the best results. For charge displacement, ion chromatography and capillary zone electrophoresis are ideal situations for applying indirect fluorescence detection. LOD surpasses all but the most specialized detection schemes. Future developments in systems specially designed for indirect detection should make these schemes even more powerful

  5. Assessing the cost-effectiveness of seismic risk reduction options in oil industry

    International Nuclear Information System (INIS)

    Nasserasadi, K.; Ghafory-Ashtiany, M.

    2007-01-01

    An integrated probabilistic methodology for cost-efficiency estimation of different sort of seismic risk management measures are introduced by adding Cost Benefit Analysis (CBA) module to an integrated seismic risk assessment model. An oil refinery in Iran has been selected for case study and cost-efficiency of software and hardware mitigation measures are evaluated. The results have shown that: (1) software mitigation measures have more benefit than hardware ones, (2) considering indirect loss in CBA lead to more benefit-cost ratio and (3) although increase of discount ratio decreases the benefit-cost ratio, the arrangement of mitigation measures from benefit-cost viewpoint are constant. (authors)

  6. The association between reality-based beliefs and indirectly experienced traumatization.

    Science.gov (United States)

    Shiri, Shimon; Wexler, Isaiah D; Schwartz, Isabella; Kadari, Michal; Kreitler, Shulamith

    2010-12-01

    The purpose of the study was to examine the association between belief types and the magnitude of indirect traumatization. Specific types of beliefs were defined in terms of the cognitive orientation theory, which is a cognitive-motivational approach to the understanding, predicting, and changing of behaviors. Belief types that were analyzed included beliefs about self, general beliefs, beliefs about norms, and goal beliefs as they relate to personal growth. Study participants included 38 rescuers (body handlers), 37 nurses, and 31 rehabilitation workers who treated injured civilians that had been exposed to politically motivated violence. The Cognitive Orientation for Posttraumatic Growth Scale was used to assess beliefs about personal growth. The Revised Posttraumatic Stress Disorder Inventory was administered to evaluate indirect traumatization. The results indicate that three of the four belief types related to personal growth were associated with the level of indirect traumatization. Optimistic and positive beliefs about self and general beliefs were associated with a lower level of indirect traumatization symptomatology, suggesting that these types of beliefs may counteract indirect traumatization. On the other hand, stronger goal beliefs were associated with greater indirect traumatization. The negative association between positive goal beliefs and indirect trauma may be related to the gap the individual perceives between the hoped-for ideals and the trauma-stricken reality. These results indicate the importance of cognitive beliefs and their possible role in determining the response to indirect traumatization.

  7. Distance, Transaction Costs, and Preferences in European Trade

    DEFF Research Database (Denmark)

    Kokko, Ari; Tingvall, Patrik Gustavsson

    2014-01-01

    Beckerman (1956) and Linder (1961) have suggested that international trade is not determined by supply-side factors alone—perceptions about foreign countries and country preferences matter. We explore the relation between exports, cultural distance, and country preferences in Europe. The results ...... channels, both indirectly through transaction costs and more directly, as countries seem to prefer some trade partners before others....

  8. Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012.

    Science.gov (United States)

    Hennessee, Ian; Chinkhumba, Jobiba; Briggs-Hagen, Melissa; Bauleni, Andy; Shah, Monica P; Chalira, Alfred; Moyo, Dubulao; Dodoli, Wilfred; Luhanga, Misheck; Sande, John; Ali, Doreen; Gutman, Julie; Lindblade, Kim A; Njau, Joseph; Mathanga, Don P

    2017-10-02

    With 71% of Malawians living on malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi. A cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June-August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level. Out of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs. Although malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect

  9. Costs of examinations performed in a hospital laboratory in Chile.

    Science.gov (United States)

    Andrade, Germán Lobos; Palma, Carolina Salas

    2018-01-01

    To determine the total average costs related to laboratory examinations performed in a hospital laboratory in Chile. Retrospective study with data from July 2014 to June 2015. 92 examinations classified in ten groups were selected according to the analysis methodology. The costs were estimated as the sum of direct and indirect laboratory costs and indirect institutional factors. The average values obtained for the costs according to examination group (in USD) were: 1.79 (clinical chemistry), 10.21 (immunoassay techniques), 13.27 (coagulation), 26.06 (high-performance liquid chromatography), 21.2 (immunological), 3.85 (gases and electrolytes), 156.48 (cytogenetic), 1.38 (urine), 4.02 (automated hematological), 4.93 (manual hematological). The value, or service fee, returned to public institutions who perform laboratory services does not adequately reflect the true total average production costs of examinations.

  10. Altruism and Indirect Reciprocity: The Interaction of Person and Situation in Prosocial Behavior

    Science.gov (United States)

    Simpson, Brent; Willer, Robb

    2008-01-01

    A persistent puzzle in the social and biological sciences is the existence of prosocial behavior, actions that benefit others, often at a cost to oneself. Recent theoretical models and empirical studies of indirect reciprocity show that actors behave prosocially in order to develop an altruistic reputation and receive future benefits from third…

  11. Effects of worksite health interventions involving reduced work hours and physical exercise on sickness absence costs.

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Hasson, Henna

    2012-05-01

    To investigate the effects of physical exercise during work hours (PE) and reduced work hours (RWH) on direct and indirect costs associated with sickness absence (SA). Sickness absence and related costs at six workplaces, matched and randomized to three conditions (PE, RWH, and referents), were retrieved from company records and/or estimated using salary conversion methods or value-added equations on the basis of interview data. Although SA days decreased in all conditions (PE, 11.4%; RWH, 4.9%; referents, 15.9%), costs were reduced in the PE (22.2%) and RWH (4.9%) conditions but not among referents (10.2% increase). Worksite health interventions may generate savings in SA costs. Costs may not be linear to changes in SA days. Combing the friction method with indirect cost estimates on the basis of value-added productivity may help illuminate both direct and indirect SA costs.

  12. Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure.

    Science.gov (United States)

    Spearing, N M; Jensen, A; McCall, B J; Neill, A S; McCormack, J G

    2000-02-01

    Nosocomial outbreaks of Salmonella infections in Australia are an infrequent but significant source of morbidity and mortality. Such an outbreak results in direct, measurable expenses for acute care management, as well as numerous indirect (and less quantifiable) costs to those affected, the hospital, and the wider community. This article describes the significant direct costs incurred as a result of a nosocomial outbreak of Salmonella infection involving patients and staff. Information on costs incurred by the hospital was gathered from a number of sources. The data were grouped into 4 sections (medical costs, investigative costs, lost productivity costs, and miscellaneous) with use of an existing tool for calculating the economic impact of foodborne illness. The outbreak cost the hospital more than AU $120, 000. (US $95,000). This amount is independent of more substantial indirect costs. Salmonella infections are preventable. Measures to aid the prevention of costly outbreaks of nosocomial salmonellosis, although available, require an investment of both time and money. We suggest that dedication of limited resources toward such preventive strategies as education is a practical and cost-effective option for health care facilities.

  13. The costs and benefits of a vaccination programme for Haemophilus ...

    African Journals Online (AJOL)

    Costs were calculated by summing the estimated direct medical care costs together with the indirect costs of Hib disease. The latter were calculated by valuing human life using alternative, and conservative human capital and willingness-to-pay measures. The difference between Hib disease costs (Le. the benefits which ...

  14. Technical and economic analyses of hydrogen production via indirectly heated gasification and pyrolysis

    Energy Technology Data Exchange (ETDEWEB)

    Mann, M.K. [National Renewable Energy Laboratory, Golden, CO (United States)

    1995-09-01

    Technoeconomic analyses have been conducted on two processes to produce hydrogen from biomass: indirectly-heated gasification of biomass followed by steam reforming of the syngas, and biomass pyrolysis followed by steam reforming of the pyrolysis oil. The analysis of the gasification-based process was highly detailed, including a process flowsheet, material and energy balances calculated with a process simulation program, equipment cost estimation, and the determination of the necessary selling price of hydrogen. The pyrolysis-based process analysis was of a less detailed nature, as all necessary experimental data have not been obtained; this analysis is a follow-up to the preliminary economic analysis presented at the 1994 Hydrogen Program Review. A coproduct option in which pyrolysis oil is used to produce hydrogen and a commercial adhesive was also studied for economic viability. Based on feedstock availability estimates, three plant sizes were studied: 907 T/day, 272 T/day, and 27 T/day. The necessary selling price of hydrogen produced by steam reforming syngas from the Battelle Columbus Laboratories indirectly heated biomass gasifier falls within current market values for the large and medium size plants within a wide range of feedstock costs. Results show that the small scale plant does not produce hydrogen at economically competitive prices, indicating that if gasification is used as the upstream process to produce hydrogen, local refueling stations similar to current gasoline stations, would probably not be feasible.

  15. Learning and transfer of category knowledge in an indirect categorization task.

    Science.gov (United States)

    Helie, Sebastien; Ashby, F Gregory

    2012-05-01

    Knowledge representations acquired during category learning experiments are 'tuned' to the task goal. A useful paradigm to study category representations is indirect category learning. In the present article, we propose a new indirect categorization task called the "same"-"different" categorization task. The same-different categorization task is a regular same-different task, but the question asked to the participants is about the stimulus category membership instead of stimulus identity. Experiment 1 explores the possibility of indirectly learning rule-based and information-integration category structures using the new paradigm. The results suggest that there is little learning about the category structures resulting from an indirect categorization task unless the categories can be separated by a one-dimensional rule. Experiment 2 explores whether a category representation learned indirectly can be used in a direct classification task (and vice versa). The results suggest that previous categorical knowledge acquired during a direct classification task can be expressed in the same-different categorization task only when the categories can be separated by a rule that is easily verbalized. Implications of these results for categorization research are discussed.

  16. Assessing Cost-Effectiveness in Obesity (ACE-Obesity: an overview of the ACE approach, economic methods and cost results

    Directory of Open Access Journals (Sweden)

    Swinburn Boyd

    2009-11-01

    Full Text Available Abstract Background The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study. Methods The Assessing Cost Effectiveness (ACE approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'. Results The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum and when expressed as a 'cost per child' estimate (from Conclusion The use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and

  17. Recovery of Indirect Costs in the Pricing of Equitable Adjustments and Terminations for Convenience

    Science.gov (United States)

    1988-05-01

    HORNGREN , COST ACCOUNTING , A MANAGERIAL EMPHASIS, 21 (5th ed. 1982). 2 6FAR Part 31, Contract Cost Principles and Procedures. 2 7 L. ANDERSON...O WOIRECT COSTS /0 5. TYPE OF REPORT & PERIOD COVERED T$0, PEIK~ O ITPA3L-, AO s ~tjQr5 AfJI0 MS THESIS p O12T0MIPJTIOOZ P 0 o, CO V rJiC I rL)C .. S ... Accounting Standards (CAS) 13 C. The Cost Principles 14 D. Measurement of Cost 15 E. Accounting Systems 16 F. Allocation of Costs 17 1. Direct Costs

  18. Indirect Self-Destructiveness and Emotional Intelligence.

    Science.gov (United States)

    Tsirigotis, Konstantinos

    2016-06-01

    While emotional intelligence may have a favourable influence on the life and psychological and social functioning of the individual, indirect self-destructiveness exerts a rather negative influence. The aim of this study has been to explore possible relations between indirect self-destructiveness and emotional intelligence. A population of 260 individuals (130 females and 130 males) aged 20-30 (mean age of 24.5) was studied by using the Polish version of the chronic self-destructiveness scale and INTE, i.e., the Polish version of the assessing emotions scale. Indirect self-destructiveness has significant correlations with all variables of INTE (overall score, factor I, factor II), and these correlations are negative. The intensity of indirect self-destructiveness differentiates significantly the height of the emotional intelligence and vice versa: the height of the emotional intelligence differentiates significantly the intensity of indirect self-destructiveness. Indirect self-destructiveness has negative correlations with emotional intelligence as well as its components: the ability to recognize emotions and the ability to utilize emotions. The height of emotional intelligence differentiates the intensity of indirect self-destructiveness, and vice versa: the intensity of indirect self-destructiveness differentiates the height of emotional intelligence. It seems advisable to use emotional intelligence in the prophylactic and therapeutic work with persons with various types of disorders, especially with the syndrome of indirect self-destructiveness.

  19. Estimating the costs of induced abortion in Uganda: A model-based analysis

    Science.gov (United States)

    2011-01-01

    Background The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda. Methods A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct non-medical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty. Results The average societal cost per induced abortion (95% credibility range) was $177 ($140-$223). This is equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 ($49-86) and the average direct non-medical cost was $19 ($16-$23). The average indirect cost was $92 ($57-$139). Patients incurred $62 ($46-$83) on average while government incurred $14 ($10-$20) on average. Conclusion Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers--that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical. PMID:22145859

  20. Comparative costs and activity from a sample of UK clinical trials units.

    Science.gov (United States)

    Hind, Daniel; Reeves, Barnaby C; Bathers, Sarah; Bray, Christopher; Corkhill, Andrea; Hayward, Christopher; Harper, Lynda; Napp, Vicky; Norrie, John; Speed, Chris; Tremain, Liz; Keat, Nicola; Bradburn, Mike

    2017-05-02

    The costs of medical research are a concern. Clinical Trials Units (CTUs) need to better understand variations in the costs of their activities. Representatives of ten CTUs and two grant-awarding bodies pooled their experiences in discussions over 1.5 years. Five of the CTUs provided estimates of, and written justification for, costs associated with CTU activities required to implement an identical protocol. The protocol described a 5.5-year, nonpharmacological randomized controlled trial (RCT) conducted at 20 centres. Direct and indirect costs, the number of full time equivalents (FTEs) and the FTEs attracting overheads were compared and qualitative methods (unstructured interviews and thematic analysis) were used to interpret the results. Four members of the group (funding-body representatives or award panel members) reviewed the justification statements for transparency and information content. Separately, 163 activities common to trials were assigned to roles used by nine CTUs; the consistency of role delineation was assessed by Cohen's κ. Median full economic cost of CTU activities was £769,637 (range: £661,112 to £1,383,323). Indirect costs varied considerably, accounting for between 15% and 59% (median 35%) of the full economic cost of the grant. Excluding one CTU, which used external statisticians, the total number of FTEs ranged from 2.0 to 3.0; total FTEs attracting overheads ranged from 0.3 to 2.0. Variation in directly incurred staff costs depended on whether CTUs: supported particular roles from core funding rather than grants; opted not to cost certain activities into the grant; assigned clerical or data management tasks to research or administrative staff; employed extensive on-site monitoring strategies (also the main source of variation in non-staff costs). Funders preferred written justifications of costs that described both FTEs and indicative tasks for funded roles, with itemised non-staff costs. Consistency in role delineation was fair (κ

  1. Impact of evergreening on patients and health insurance: a meta analysis and reimbursement cost analysis of citalopram/escitalopram antidepressants

    Directory of Open Access Journals (Sweden)

    Alkhafaji Ali A

    2012-11-01

    Full Text Available Abstract Background "Evergreening" refers to the numerous strategies whereby owners of pharmaceutical products use patent laws and minor drug modifications to extend their monopoly privileges on the drug. We aimed to evaluate the impact of evergreening through the case study of the antidepressant citalopram and its chiral switch form escitalopram by evaluating treatment efficacy and acceptability for patients, as well as health insurance costs for society. Methods To assess efficacy and acceptability, we performed meta-analyses for efficacy and acceptability. We compared direct evidence (meta-analysis of results of head-to-head trials and indirect evidence (adjusted indirect comparison of results of placebo-controlled trials. To assess health insurance costs, we analyzed individual reimbursement data from a representative sample of the French National Health Insurance Inter-regime Information System (SNIIR-AM from 2003 to 2010, which allowed for projecting these results to the whole SNIIR-AM population (53 million people. Results In the meta-analysis of seven head-to-head trials (2,174 patients, efficacy was significantly better for escitalopram than citalopram (combined odds ratio (OR 1.60 (95% confidence interval 1.05 to 2.46. However, for the adjusted indirect comparison of 10 citalopram and 12 escitalopram placebo-controlled trials, 2,984 and 3,777 patients respectively, efficacy was similar for the two drug forms (combined indirect OR 1.03 (0.82 to 1.30. Because of the discrepancy, we could not combine direct and indirect data (test of inconsistency, P = 0.07. A similar discrepancy was found for treatment acceptability. The overall reimbursement cost burden for the citalopram, escitalopram and its generic forms was 120.6 million Euros in 2010, with 96.8 million Euros for escitalopram. Conclusions The clinical benefit of escitalopram versus citalopram remains uncertain. In our case of evergreening, escitalopram represented a substantially

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

    Science.gov (United States)

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

    2017-08-30

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

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

    Directory of Open Access Journals (Sweden)

    Sase Yuji

    2011-09-01

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

  4. An indirect comparison and cost per responder analysis of adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis.

    Science.gov (United States)

    Betts, Keith A; Griffith, Jenny; Friedman, Alan; Zhou, Zheng-Yi; Signorovitch, James E; Ganguli, Arijit

    2016-01-01

    Apremilast was recently approved for the treatment of active psoriatic arthritis (PsA). However, no studies compare apremilast with methotrexate or biologic therapies, so its relative comparative efficacy remains unknown. This study compared the response rates and incremental costs per responder associated with methotrexate, apremilast, and biologics for the treatment of active PsA. A systematic literature review was performed to identify phase 3 randomized controlled clinical trials of approved biologics, methotrexate, and apremilast in the methotrexate-naïve PsA population. Using Bayesian methods, a network meta-analysis was conducted to indirectly compare rates of achieving a ≥20% improvement in American College of Rheumatology component scores (ACR20). The number needed to treat (NNT) and the incremental costs per ACR20 responder (2014 US$) relative to placebo were estimated for each of the therapies. Three trials (MIPA for methotrexate, PALACE-4 for apremilast, and ADEPT for adalimumab) met all inclusion criteria. The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. Among methotrexate-naïve PsA patients, the 16 week incremental costs per ACR20 responder were $3622 for methotrexate, $26,316 for adalimumab, and $45,808 for apremilast. The incremental costs per ACR20 responder were $222,488 for apremilast vs. methotrexate. Among methotrexate-naive PsA patients, adalimumab was found to have the lowest NNT for one additional ACR20 response and methotrexate was found to have the lowest incremental costs per ACR20 responder. There was no statistical evidence of greater efficacy for apremilast vs. methotrexate. A head-to-head trial between apremilast and methotrexate is recommended to confirm this finding.

  5. The Economic impact of ME/CFS: Individual and societal costs

    OpenAIRE

    Jason, Leonard A; Benton, Mary C; Valentine, Lisa; Johnson, Abra; Torres-Harding, Susan

    2008-01-01

    Background ME/CFS is characterized by debilitating fatigue in addition to other physical and cognitive symptoms. It is estimated to affect over 800,000 adults in the U.S. ME/CFS often results in diminished functionality and increased economic impact. The economic impact of an illness is generally divided into two categories: direct and indirect costs. Despite high prevalence rates and the disabling nature of the illness, few studies have examined the costs of ME/CFS at the individual and soci...

  6. Optimal Control for Bufferbloat Queue Management Using Indirect Method with Parametric Optimization

    Directory of Open Access Journals (Sweden)

    Amr Radwan

    2016-01-01

    Full Text Available Because memory buffers become larger and cheaper, they have been put into network devices to reduce the number of loss packets and improve network performance. However, the consequences of large buffers are long queues at network bottlenecks and throughput saturation, which has been recently noticed in research community as bufferbloat phenomenon. To address such issues, in this article, we design a forward-backward optimal control queue algorithm based on an indirect approach with parametric optimization. The cost function which we want to minimize represents a trade-off between queue length and packet loss rate performance. Through the integration of an indirect approach with parametric optimization, our proposal has advantages of scalability and accuracy compared to direct approaches, while still maintaining good throughput and shorter queue length than several existing queue management algorithms. All numerical analysis, simulation in ns-2, and experiment results are provided to solidify the efficiency of our proposal. In detailed comparisons to other conventional algorithms, the proposed procedure can run much faster than direct collocation methods while maintaining a desired short queue (≈40 packets in simulation and 80 (ms in experiment test.

  7. Resource costing for multinational neurologic clinical trials: methods and results.

    Science.gov (United States)

    Schulman, K; Burke, J; Drummond, M; Davies, L; Carlsson, P; Gruger, J; Harris, A; Lucioni, C; Gisbert, R; Llana, T; Tom, E; Bloom, B; Willke, R; Glick, H

    1998-11-01

    We present the results of a multinational resource costing study for a prospective economic evaluation of a new medical technology for treatment of subarachnoid hemorrhage within a clinical trial. The study describes a framework for the collection and analysis of international resource cost data that can contribute to a consistent and accurate intercountry estimation of cost. Of the 15 countries that participated in the clinical trial, we collected cost information in the following seven: Australia, France, Germany, the UK, Italy, Spain, and Sweden. The collection of cost data in these countries was structured through the use of worksheets to provide accurate and efficient cost reporting. We converted total average costs to average variable costs and then aggregated the data to develop study unit costs. When unit costs were unavailable, we developed an index table, based on a market-basket approach, to estimate unit costs. To estimate the cost of a given procedure, the market-basket estimation process required that cost information be available for at least one country. When cost information was unavailable in all countries for a given procedure, we estimated costs using a method based on physician-work and practice-expense resource-based relative value units. Finally, we converted study unit costs to a common currency using purchasing power parity measures. Through this costing exercise we developed a set of unit costs for patient services and per diem hospital services. We conclude by discussing the implications of our costing exercise and suggest guidelines to facilitate more effective multinational costing exercises.

  8. Indirect Catastrophic Injuries in Olympic Styles of Wrestling in Iran

    OpenAIRE

    Kordi, Ramin; Ziaee, Vahid; Rostami, Mohsen; Wallace, W. Angus

    2011-01-01

    Background: Data on indirect catastrophic injuries in wrestling are scarce. Objectives: To develop a profile of indirect catastrophic injuries in international styles of wrestling and to describe possible risk factors. Study Design: Retrospective case series; Level of evidence, 3. Methods: Indirect catastrophic injuries that occurred in wrestling clubs in Iran from July 1998 to June 2005 were identified by contacting several sources. The cases were retrospectively reviewed. Results: The injur...

  9. Social Dilemmas and Indirect Reciprocity: A systematic review

    Directory of Open Access Journals (Sweden)

    Cristian Acosta

    2014-08-01

    Full Text Available Indirect reciprocity is an evolutionary theory of altruism and cooperation in social dilemmas. Its explanation of cooperation incorporates information on the reputation people hold of other people regarding whether they are cooperative or not. This study systematically reviewed the current empirical literature on indirect reciprocity in social dilemma situations. The following databases were consulted: ScienceDirect, EBSCO, and OVID, using has key words "indirect reciprocity" AND "dilemma" OR "cooperation" OR "charity". Twenty-three articles were selected which met the inclusion criteria (papers written in English and studies whose methodology was based on experimental games and the theories, objectives, the main types of samples used, and main results were analyzed. The results show that the games used were the indirect reciprocity and public goods games, which may vary according to the objectives. It was found that reputation is a key variable that helps to promote cooperation. In turn, information on previous cooperation helps to build reputation, which is subsequently involved in the decision to cooperate with others. Finally, we highlight the need for more experimental studies that incorporate other explanatory variables and evaluate them in new contexts.

  10. Computerized cost estimation spreadsheet and cost data base for fusion devices

    International Nuclear Information System (INIS)

    Hamilton, W.R.; Rothe, K.E.

    1985-01-01

    An automated approach to performing and cataloging cost estimates has been developed at the Fusion Engineering Design Center (FEDC), wherein the cost estimate record is stored in the LOTUS 1-2-3 spreadsheet on an IBM personal computer. The cost estimation spreadsheet is based on the cost coefficient/cost algorithm approach and incorporates a detailed generic code of cost accounts for both tokamak and tandem mirror devices. Component design parameters (weight, surface area, etc.) and cost factors are input, and direct and indirect costs are calculated. The cost data base file derived from actual cost experience within the fusion community and refined to be compatible with the spreadsheet costing approach is a catalog of cost coefficients, algorithms, and component costs arranged into data modules corresponding to specific components and/or subsystems. Each data module contains engineering, equipment, and installation labor cost data for different configurations and types of the specific component or subsystem. This paper describes the assumptions, definitions, methodology, and architecture incorporated in the development of the cost estimation spreadsheet and cost data base, along with the type of input required and the output format

  11. Indirect methods for reference interval determination - review and recommendations.

    Science.gov (United States)

    Jones, Graham R D; Haeckel, Rainer; Loh, Tze Ping; Sikaris, Ken; Streichert, Thomas; Katayev, Alex; Barth, Julian H; Ozarda, Yesim

    2018-04-19

    Reference intervals are a vital part of the information supplied by clinical laboratories to support interpretation of numerical pathology results such as are produced in clinical chemistry and hematology laboratories. The traditional method for establishing reference intervals, known as the direct approach, is based on collecting samples from members of a preselected reference population, making the measurements and then determining the intervals. An alternative approach is to perform analysis of results generated as part of routine pathology testing and using appropriate statistical techniques to determine reference intervals. This is known as the indirect approach. This paper from a working group of the International Federation of Clinical Chemistry (IFCC) Committee on Reference Intervals and Decision Limits (C-RIDL) aims to summarize current thinking on indirect approaches to reference intervals. The indirect approach has some major potential advantages compared with direct methods. The processes are faster, cheaper and do not involve patient inconvenience, discomfort or the risks associated with generating new patient health information. Indirect methods also use the same preanalytical and analytical techniques used for patient management and can provide very large numbers for assessment. Limitations to the indirect methods include possible effects of diseased subpopulations on the derived interval. The IFCC C-RIDL aims to encourage the use of indirect methods to establish and verify reference intervals, to promote publication of such intervals with clear explanation of the process used and also to support the development of improved statistical techniques for these studies.

  12. Circumventing resistance: using values to indirectly change attitudes.

    Science.gov (United States)

    Blankenship, Kevin L; Wegener, Duane T; Murray, Renee A

    2012-10-01

    Most research on persuasion examines messages that directly address the attitude of interest. However, especially when message recipients are inclined to resist change, indirect methods might be more effective. Because values are rarely attacked and defended, value change could serve as a useful indirect route for attitude change. Attitudes toward affirmative action changed more when the value of equality was attacked (indirect change) than when affirmative action was directly attacked using the same message (Experiments 1-2). Changes in confidence in the value were responsible for the indirect change when the value was attacked (controlling for changes in favorability toward the value), whereas direct counterarguments to the message were responsible for the relative lack of change when the attitude was attacked directly (Experiment 2). Attacking the value of equality influenced attitudes toward policies related to the value but left policy attitudes unrelated to the value unchanged (Experiment 3). Finally, a manipulation of value confidence that left attitudes toward the value intact demonstrated similar confidence-based influences on policies related to the value of freedom (Experiment 4). Undermined value confidence also resulted in less confidence in the resulting policy attitudes controlling for the changes in the policy attitudes themselves (Experiments 3 and 4). Therefore, indirect change through value attacks presented a double threat--to both the policy attitudes and the confidence with which those policy attitudes were held (potentially leaving them open to additional influence).

  13. Lives Saved Tool (LiST costing: a module to examine costs and prioritize interventions

    Directory of Open Access Journals (Sweden)

    Lori A. Bollinger

    2017-11-01

    Full Text Available Abstract Background Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST has been used widely to calculate the impact of maternal, neonatal and child health (MNCH interventions for program planning and multi-country estimation in several Lancet Series commissions. As use of the LiST model increases, many have expressed a desire to cost interventions within the model, in order to support budgeting and prioritization of interventions by countries. A limited LiST costing module was introduced several years ago, but with gaps in cost types. Updates to inputs have now been added to make the module fully functional for a range of uses. Methods This paper builds on previous work that developed an initial version of the LiST costing module to provide costs for MNCH interventions using an ingredients-based costing approach. Here, we update in 2016 the previous econometric estimates from 2013 with newly-available data and also include above-facility level costs such as program management. The updated econometric estimates inform percentages of intervention-level costs for some direct costs and indirect costs. These estimates add to existing values for direct cost requirements for items such as drugs and supplies and required provider time which were already available in LiST Costing. Results Results generated by the LiST costing module include costs for each intervention, as well as disaggregated costs by intervention including drug and supply costs, labor costs, other recurrent costs, capital costs, and above-service delivery costs. These results can be combined with mortality estimates to support prioritization of interventions by countries. Conclusions The LiST costing module provides an option for countries to identify resource requirements for scaling up a maternal, neonatal, and child health program, and to examine the financial impact of different

  14. Economic costs associated with an MS relapse

    LENUS (Irish Health Repository)

    O'Connell, K.

    2014-09-01

    This was an prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration, expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner\\'s loss of earnings, childcare, meals and travel costs.

  15. Indirect reciprocity with negative assortment and limited information can promote cooperation.

    Science.gov (United States)

    Brush, Eleanor; Brännström, Åke; Dieckmann, Ulf

    2018-04-14

    Cooperation is ubiquitous in biological and social systems, even though cooperative behavior is often costly and at risk of exploitation by non-cooperators. Several studies have demonstrated that indirect reciprocity, whereby some members of a group observe the behaviors of their peers and use this information to discriminate against previously uncooperative agents in the future, can promote prosocial behavior. Some studies have shown that differential propensities of interacting among and between different types of agents (interaction assortment) can increase the effectiveness of indirect reciprocity. No previous studies have, however, considered differential propensities of observing the behaviors of different types of agents (information assortment). Furthermore, most previous studies have assumed that discriminators possess perfect information about others and incur no costs for gathering and storing this information. Here, we (1) consider both interaction assortment and information assortment, (2) assume discriminators have limited information about others, and (3) introduce a cost for information gathering and storage, in order to understand how the ability of discriminators to stabilize cooperation is affected by these steps toward increased realism. We report the following findings. First, cooperation can persist when agents preferentially interact with agents of other types or when discriminators preferentially observe other discriminators, even when they have limited information. Second, contrary to intuition, increasing the amount of information available to discriminators can exacerbate defection. Third, introducing costs of gathering and storing information makes it more difficult for discriminators to stabilize cooperation. Our study is one of only a few studies to date that show how negative interaction assortment can promote cooperation and broadens the set of circumstances in which it is know that cooperation can be maintained. Copyright © 2018

  16. Dynamic Modeling of Cost-effectiveness of Rotavirus Vaccination, Kazakhstan

    Science.gov (United States)

    Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children <5 years of age. Indirect protection accounted for 40% and 60% reduction in severe and mild rotavirus gastroenteritis, respectively. Cost per life year gained was US $18,044 from a societal perspective and US $23,892 from a health care perspective. Comparing the 2 key parameters of cost-effectiveness, mortality rates and vaccine cost at costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study. PMID:24378188

  17. Comment traduire en japonais les styles indirect et indirect libre de Madame Bovary ?

    Directory of Open Access Journals (Sweden)

    Hisaki Sawasaki

    2012-03-01

    Full Text Available Parmi les difficultés rencontrées lors de la traduction des textes littéraires occidentaux, en japonais, nous examinons le problème des styles indirect et indirect libre. Pour cela, en effectuant une petite mise au point grammaticale, nous comparons sept traductions de Madame Bovary de Gustave Flaubert, dont les dates de parution s’étendent sur une cinquantaine d’années. Cette période s’apparente, de notre point de vue, à un long itinéraire pour assimiler la notion occidentale des styles direct et indirect, tout en la conciliant avec les particularités du japonais. D’un autre côté, ce travail acharné des traducteurs a influencé quelque peu la langue japonaise. On trouve dans l’annexe tous les textes en japonais examinés.We will examine the difficulties met when translating Western literary texts in Japanese, in particular the problem of indirect and free indirect styles. We will define the grammatical issue and compare seven translations of Madame Bovary, published over a fifty year period. This time can be likened to a long path taken to digest the Western notion of direct and indirect styles, while reconciling it with Japanese language characteristics. On the other hand the translators’ relentless work has somewhat influenced the Japanese language. The annex will present all the Japanese texts examined.

  18. Language shifts in free indirect discourse

    NARCIS (Netherlands)

    Maier, Emar

    Free indirect discourse is a way of reporting what a protagonist thinks or says that is distinct from both direct and indirect discourse. In particular, while pronouns and tenses are presented from the narrator's perspective, as in indirect discourse, other indexical and expressive elements reflect

  19. Directe en indirecte werknemersparticipatie in Europa

    NARCIS (Netherlands)

    van Houten, Gijs; Akkerman, Agnes; Sluiter, Roderick; Jansen, Giedo; Vermeylen, Greet

    2016-01-01

    This study looks at different forms of direct and indirect employee participation in the EU. The research questions are: (1) which forms of direct and indirect employee participation can we distinguish?; (2) to what extent do forms of direct and indirect employee participation coincide within

  20. Economic consequences of legal and illegal drugs: The case of social costs in Belgium.

    Science.gov (United States)

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

    2017-06-01

    Legal and illegal drugs impose a considerable burden to the individual and to society. The misuse of addictive substances results in healthcare and law enforcement costs, loss of productivity and reduced quality of life. A social cost study was conducted to estimate the substance-attributable costs of alcohol, tobacco, illegal drugs and psychoactive medication to Belgian society in 2012. The cost-of-illness framework with prevalence-based and human capital approach was applied. Three cost components were considered: direct, indirect and intangible costs related to substance misuse. The direct and indirect cost of addictive substances was estimated at 4.6 billion euros in Belgium (419 euros per capita or 1.19% of the GDP) and more than 515,000 healthy years are lost due to substance misuse. The Belgian social cost study reaffirms that alcohol and tobacco impose the highest cost to society compared to illegal drugs. Health problems are the main driver of the social cost of legal drugs. Law enforcement expenditure exceed the healthcare costs but only in the case of illegal drugs. Estimating social costs of addictive substances is complex because it is difficult to determine to what extent the societal harm is caused by substances. It can be argued that social cost studies take only a 'snapshot' of the monetary consequences of substance misuse. Nevertheless, the current study offers the most comprehensive analysis thus far of the social costs of substance misuse in Belgium. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Direct and indirect welfare chauvinism as party strategies

    DEFF Research Database (Denmark)

    Careja, Romana; Elmelund-Præstekær, Christian; Klitgaard, Michael Baggesen

    2016-01-01

    welfare chauvinism occurs as a result of legislative changes that explicitly exclude recipients from social protection or reduce the level thereof on the basis of ethnicity. Indirect welfare chauvinism is the result of policy measures that apply to both natives and immigrants, but which deliberately...... and deliberate policy-making strategies of the party. It shows that the distinction between direct and indirect chauvinism is a useful theoretical tool for understanding how the Danish People's Party can fulfill the expectations of both its electorate and its coalition partners, even if they point in different...

  2. An Analysis of Unit Costs at a Consolidated Supply Depot

    Science.gov (United States)

    1990-12-01

    Not-For-Profit Setting,"The Accounting Review,July 1990. Horngren , C. T., Cost Accountinq:A Managerial Emphasis,3rd ed, Prentice-Hall Inc.,1972...sector has used concepts of unit costs for 4 decades. Any managerial or cost accounting text discusses in some length unit costs . For Defense contractors...the Cost Accounting Standards Board (CASB) provides guidance for contract costs . Unit costs include direct, indirect, and general and administrative

  3. Costs of Medically Attended Acute Gastrointestinal Infections: The Polish Prospective Healthcare Utilization Survey.

    Science.gov (United States)

    Czech, Marcin; Rosinska, Magdalena; Rogalska, Justyna; Staszewska, Ewa; Stefanoff, Pawel

    The burden of acute gastrointestinal infections (AGIs) on the society has not been well studied in Central European countries, which prevents the implementation of effective, targeted public health interventions. We investigated patients of 11 randomly selected general practices and 8 hospital units. Each patient meeting the international AGI case definition criteria was interviewed on costs incurred related to the use of health care resources. Follow-up interview with consenting patients was conducted 2 to 4 weeks after the general practitioner (GP) visit or discharge from hospital, collecting information on self-medication costs and indirect costs. Costs were recalculated to US dollars by using the purchasing power parity exchange rate for Poland. Weighting the inpatient costs by age-specific probability of hospital referral by GPs, the societal cost of a medically attended AGI case was estimated to be US $168. The main cost drivers of direct medical costs were cost of hospital bed days (US $28), cost of outpatient pharmacotherapy (US $20), and cost of GP consultation (US $10). Patients covered only the cost of outpatient pharmacotherapy. Considering the AGI population GP consultation rate, the age-adjusted societal cost of medically attended AGI episodes was estimated at US $2222 million, of which 53% was attributable to indirect costs. Even though AGIs generate a low cost for individuals, they place a high burden on the society, attributed mostly to indirect costs. Higher resources could be allocated to the prevention and control of AGIs. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  4. Indirect searches for dark matter

    Indian Academy of Sciences (India)

    The current status of indirect searches for dark matter has been reviewed in a schematic way here. The main relevant experimental results of the recent years have been listed and the excitements and disappointments that their phenomenological interpretations in terms of almost-standard annihilating dark matter have ...

  5. Indirect taxes on food in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Denize Mirian da Silva

    2013-12-01

    Full Text Available The objective of this paper is to estimate the indirect tax burden on food for ten income classes, based on income and household total expenditure in southern Brazil. Thus it can be seen as indirect taxes on foods affect the monetary income and consumption pattern of households. To reach the objectives proposed, will be used the Pintos-Payeras (2008 model. The database iscomposed by microdata from the Household Budgeting Survey (POF 2008-2009 and the tax regulations of the country and the southern states of Brazil. The results show that indirect taxes on food in Southern Brazil is regressive when based on income and expenditure of household , ie , the poorest people pay proportionately more taxes and have their consumption pattern highest taxed ICMS (Brazilian value added tax is the tax that contributes most to the regressivity.

  6. Cost effectiveness of open versus laparoscopic living-donor nephrectomy

    DEFF Research Database (Denmark)

    Hamidi, Vida; Andersen, Marit Helen; Oyen, Ole

    2009-01-01

    , and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN. METHODS: Kidney donors were randomized to laparoscopic (n=63) or open surgery...... (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated...... into utilities by means of Brazier's 6D algorithm. RESULTS: The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0...

  7. Indirect self-destructiveness in individuals with schizophrenia

    Directory of Open Access Journals (Sweden)

    Konstantinos Tsirigotis

    2017-06-01

    Full Text Available Objective: To explore the indirect self-destructiveness syndrome in patients with schizophrenia. Methods: Two hundred individuals with paranoid schizophrenia (117 men and 83 women, mean age 37.15 years, all in remission, were examined using the Polish version of the Chronic Self-Destructiveness Scale. Two hundred well-matched healthy individuals served as a control group. Results: The intensity of indirect self-destructiveness was greater in the schizophrenia group than in controls. The intensity of each manifestation was as follows (in decreasing order: helplessness and passiveness in the face of difficulties (A5, personal and social neglects (A3, lack of planfulness (A4, poor health maintenance (A2, transgression and risk (A1. Conclusion: Patients with schizophrenia displayed more behaviors that were indirectly self-destructive than healthy controls; they scored better than healthy controls only on caring for their own health. The patients showed the lowest intensity of behaviors connected with the active form of indirect self-destructiveness, and the highest intensity of behaviors connected with the passive form. These findings may enable delivery of more effective forms of pharmacological and psychosocial help to patients with schizophrenia.

  8. The dominance of indirect taxes in Estonian state budget. Summary:Kaudsete maksude dominant Eesti riigieelarve tuludes

    Directory of Open Access Journals (Sweden)

    Olev Raju

    2013-09-01

    Full Text Available Recession has sharply erected the question of tax burden and the optimal proportion of different kinds of taxes among the incomes of the budget. Indirect taxes and consumption taxes, which proportion is different according to different methodologies, dominate in Estonian state budget. The buoyancy of a tax system based on taxes of that kind is especially weak during the recession. The purpose of Estonian government’s economic policy during the highest peak of crisis was to keep the budget in balance. Instead of recovering economy the taxes were arisen and costs were reduced. The results of such a policy aren’t still clear. Difficulties concerning the incomes of budget have arisen the necessity for lifting taxes, which is possible as the tax burden is low now. But a sharp question of the optimal level of taxes is going to be raised. A formula for indirect tax optimum according to Ramsey taxes and Slutski decomposition has been proposed in the article

  9. The cost of the tax transaction in the commercial enterprises of the province of Tungurahua

    OpenAIRE

    Edgar Fabian Mera Bozano; Gina Elizabeth Vargas Núñez; Santiago Xavier Flores Brito

    2017-01-01

    The present article includes an important contribution for the tax administration, since it allows identifying the indirect cost to taxpayers when complying with tax obligations, the cost that is doctrinally known as indirect tax pressure, although the obligations are Several, Not all of them fall on the same obligated subject, the tendency in Ecuador is the reduction of the costs of tracking, hence the value given by the Internal Revenue service to the use of information technologies, throug...

  10. Costs of construction, operation and maintenance of nuclear power plants - determinant factors

    International Nuclear Information System (INIS)

    Silva, R.A. da

    1981-01-01

    A study about the construction costs of the Angra-1 nuclear power plant, including direct costs, equipment costs, installation and indirect costs such as: engineering, job-training and administration is presented. The operation and maintenance costs of the Angra-1 nuclear power plant and costs of energy generation are still studied. (E.G.) [pt

  11. Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective

    Science.gov (United States)

    2013-01-01

    Background Cholera poses a substantial health burden to developing countries such as Bangladesh. In this study, the objective is to estimate the economic burden of cholera treatments incurred by households. The study was carried out in the context of a large vaccine trial in an urban area of Bangladesh. Methods The study used a combination of prospective and retrospective incidence-based cost analyses of cholera illness per episode per household. A total of 394 confirmed cholera hospitalized cases were identified and treated in the study area during June–October 2011. Households with cholera patients were interviewed within 15 days after discharge from hospitals or clinics. To estimate the total cost of cholera illness a structured questionnaire was used, which included questions on direct medical costs, non-medical costs, and the indirect costs of patients and caregivers. Results The average total household cost of treatment for an episode of cholera was US$30.40. Total direct and indirect costs constituted 24.6% (US$7.40) and 75.4% (US$23.00) of the average total cost, respectively. The cost for children under 5 years of age (US$21.50) was higher than that of children aged 5–14 years (US$17.50). The direct cost of treatment was similar for male and female patients, but the indirect cost was higher for males. Conclusion Our study suggests that by preventing one cholera episode (3 days on an average), we can avert a total cost of 2,278.50 BDT (US$30.40) per household. Among medical components, medicines are the largest cost driver. No clear socioeconomic gradient emerged from our study, but limited demographic patterns were observed in the cost of illness. By preventing cholera cases, large production losses can be reduced. PMID:24188717

  12. Two distinct neural mechanisms underlying indirect reciprocity.

    Science.gov (United States)

    Watanabe, Takamitsu; Takezawa, Masanori; Nakawake, Yo; Kunimatsu, Akira; Yamasue, Hidenori; Nakamura, Mitsuhiro; Miyashita, Yasushi; Masuda, Naoki

    2014-03-18

    Cooperation is a hallmark of human society. Humans often cooperate with strangers even if they will not meet each other again. This so-called indirect reciprocity enables large-scale cooperation among nonkin and can occur based on a reputation mechanism or as a succession of pay-it-forward behavior. Here, we provide the functional and anatomical neural evidence for two distinct mechanisms governing the two types of indirect reciprocity. Cooperation occurring as reputation-based reciprocity specifically recruited the precuneus, a region associated with self-centered cognition. During such cooperative behavior, the precuneus was functionally connected with the caudate, a region linking rewards to behavior. Furthermore, the precuneus of a cooperative subject had a strong resting-state functional connectivity (rsFC) with the caudate and a large gray matter volume. In contrast, pay-it-forward reciprocity recruited the anterior insula (AI), a brain region associated with affective empathy. The AI was functionally connected with the caudate during cooperation occurring as pay-it-forward reciprocity, and its gray matter volume and rsFC with the caudate predicted the tendency of such cooperation. The revealed difference is consistent with the existing results of evolutionary game theory: although reputation-based indirect reciprocity robustly evolves as a self-interested behavior in theory, pay-it-forward indirect reciprocity does not on its own. The present study provides neural mechanisms underlying indirect reciprocity and suggests that pay-it-forward reciprocity may not occur as myopic profit maximization but elicit emotional rewards.

  13. QUANTIFYING BENEFITS FOR COST-BENEFIT ANALYSIS

    OpenAIRE

    Attila GYORGY; Nicoleta VINTILA; Florian GAMAN

    2014-01-01

    Cost Benefit Analysis is one of the most widely used financial tools to select future investment projects in public and private sector. This method is based on comparing costs and benefits in terms of constant prices. While costs are easier to predict and monetize, the benefits should be identified not only in direct relation with the investment, but also widening the sphere of analysis to indirect benefits experienced by the community from the neighbourhood or the whole society. During finan...

  14. The Shuttle Cost and Price model

    Science.gov (United States)

    Leary, Katherine; Stone, Barbara

    1983-01-01

    The Shuttle Cost and Price (SCP) model was developed as a tool to assist in evaluating major aspects of Shuttle operations that have direct and indirect economic consequences. It incorporates the major aspects of NASA Pricing Policy and corresponds to the NASA definition of STS operating costs. An overview of the SCP model is presented and the cost model portion of SCP is described in detail. Selected recent applications of the SCP model to NASA Pricing Policy issues are presented.

  15. [Costing nuclear medicine diagnostic procedures].

    Science.gov (United States)

    Markou, Pavlos

    2005-01-01

    To the Editor: Referring to a recent special report about the cost analysis of twenty-nine nuclear medicine procedures, I would like to clarify some basic aspects for determining costs of nuclear medicine procedure with various costing methodologies. Activity Based Costing (ABC) method, is a new approach in imaging services costing that can provide the most accurate cost data, but is difficult to perform in nuclear medicine diagnostic procedures. That is because ABC requires determining and analyzing all direct and indirect costs of each procedure, according all its activities. Traditional costing methods, like those for estimating incomes and expenses per procedure or fixed and variable costs per procedure, which are widely used in break-even point analysis and the method of ratio-of-costs-to-charges per procedure may be easily performed in nuclear medicine departments, to evaluate the variability and differences between costs and reimbursement - charges.

  16. Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL trial

    Directory of Open Access Journals (Sweden)

    Suzanne Polinder

    2016-11-01

    Full Text Available Abstract Background The use of Fall-Risk-Increasing-Drugs (FRIDs has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus ‘care as usual’ on health-related quality of life (HRQoL, costs, and cost-utility in community-dwelling older fallers. Methods In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with ‘care as usual’ in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural and indirect costs (travel costs were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance. Results We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs did not differ significantly between the intervention group and the control group (€2204 versus €2285. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02. The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups. Conclusions Withdrawal of FRID’s in older

  17. 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

  18. 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

  19. Computing Cost Price for Cataract Surgery by Activity Based Costing (ABC Method at Hazrat-E-Zahra Hospital, Isfahan University of Medical Sciences, 2014

    Directory of Open Access Journals (Sweden)

    Masuod Ferdosi

    2016-10-01

    Full Text Available Background: Hospital managers need to have accurate information about actual costs to make efficient and effective decisions. In activity based costing method, first, activities are recognized and then direct and indirect costs are computed based on allocation methods. The aim of this study was to compute the cost price for cataract surgery by Activity Based Costing (ABC method at Hazrat-e-Zahra Hospital, Isfahan University of Medical Sciences. Methods: This was a cross- sectional study for computing the costs of cataract surgery by activity based costing technique in Hazrat-e-Zahra Hospital in Isfahan University of Medical Sciences, 2014. Data were collected through interview and direct observation and analyzed by Excel software. Results: According to the results of this study, total cost in cataract surgery was 8,368,978 Rials. Personnel cost included 62.2% (5,213,574 Rials of total cost of cataract surgery that is the highest share of surgery costs. The cost of consumables was 7.57% (1,992,852 Rials of surgery costs. Conclusion: Based on the results, there was different between cost price of the services and public Tariff which appears as hazards or financial crises to the hospital. Therefore, it is recommended to use the right methods to compute the costs relating to Activity Based Costing. Cost price of cataract surgery can be reduced by strategies such as decreasing the cost of consumables.

  20. Indirect genetic effects and kin recognition

    DEFF Research Database (Denmark)

    Alemu, Setegn Worku; Berg, Peer; Janss, Luc

    2014-01-01

    Social interactions among individuals are widespread, both in natural and domestic populations. As a result, trait values of individuals may be affected by genes in other individuals, a phenomenon known as indirect genetic effects (IGEs). IGEs can be estimated using linear mixed models. The tradi......Social interactions among individuals are widespread, both in natural and domestic populations. As a result, trait values of individuals may be affected by genes in other individuals, a phenomenon known as indirect genetic effects (IGEs). IGEs can be estimated using linear mixed models...... present a reduced model that yields estimates of the total heritable effects on kin, on non-kin and on all social partners of an individual, as well as the total heritable variance for response to selection. Finally we discuss the consequences of analysing data in which IGEs depend on relatedness using...

  1. Indirect Calorimetry in Mechanically Ventilated Patients

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Kondrup, Jens; Perner, Anders

    2017-01-01

    Background and Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so...... using a gold-standard, modified Tissot bell-spirometer method in mechanically ventilated patients who were hemodynamically, respiratory, and metabolically stable. Methods: We studied 30 patients undergoing general anesthesia and major gynecological surgery. We measured oxygen consumption ((Formula...... of 77 (167) with limits of agreement −249 to 404 kcal/d. Conclusions: The QUARK RMR ICU Indirect Calorimeter compared better with the gold standard for values of (Formula presented.) O2 and REE than did the CCM Express Indirect Calorimeter in mechanically ventilated patients who were circulatory...

  2. COST ACCOUNTING AS A METHOD OF SUPPORTING DECISIONS IN FARMS IN POLAND

    Directory of Open Access Journals (Sweden)

    Aldona Skarżyńska

    2014-09-01

    Full Text Available Agricultural accounting is the most important information system in farms. The paper presents the degree of utilization of information derived from cost accounting in decision-making in farms. The study was conducted in 2011 through direct interviews with farmers in 475 individual farms located throughout the country. The results indicate that farmers making decisions with the use of information from the cost accounting most often do not use only one cost system. The most common is the full cost accounting (i.e. direct and indirect cost jointly, followed by accounting of direct costs and the accounting of variable and fixed costs. The share of farms using other sources of information was only 1.1%. In two farms, farmers did not use any system of cost accounting.

  3. Lives Saved Tool (LiST) costing: a module to examine costs and prioritize interventions.

    Science.gov (United States)

    Bollinger, Lori A; Sanders, Rachel; Winfrey, William; Adesina, Adebiyi

    2017-11-07

    Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST) has been used widely to calculate the impact of maternal, neonatal and child health (MNCH) interventions for program planning and multi-country estimation in several Lancet Series commissions. As use of the LiST model increases, many have expressed a desire to cost interventions within the model, in order to support budgeting and prioritization of interventions by countries. A limited LiST costing module was introduced several years ago, but with gaps in cost types. Updates to inputs have now been added to make the module fully functional for a range of uses. This paper builds on previous work that developed an initial version of the LiST costing module to provide costs for MNCH interventions using an ingredients-based costing approach. Here, we update in 2016 the previous econometric estimates from 2013 with newly-available data and also include above-facility level costs such as program management. The updated econometric estimates inform percentages of intervention-level costs for some direct costs and indirect costs. These estimates add to existing values for direct cost requirements for items such as drugs and supplies and required provider time which were already available in LiST Costing. Results generated by the LiST costing module include costs for each intervention, as well as disaggregated costs by intervention including drug and supply costs, labor costs, other recurrent costs, capital costs, and above-service delivery costs. These results can be combined with mortality estimates to support prioritization of interventions by countries. The LiST costing module provides an option for countries to identify resource requirements for scaling up a maternal, neonatal, and child health program, and to examine the financial impact of different resource allocation strategies. It can be a useful tool for

  4. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system: results from a 5-year follow-up cohort study.

    Science.gov (United States)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra; Ziebe, Søren; Mikkelsen Englund, Anne L; Hald, Finn; Boivin, Jacky; Schmidt, Lone

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Specialized public fertility clinics in Denmark. Seven hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics were abstracted from medical records. Flow diagrams were drawn for different standard treatment cycles and direct costs at each stage in the flow charts were measured and valued by a bottom-up procedure. Indirect costs were distributed to each treatment cycle on the basis of number of visits as basis. Costs were adjusted to 2012 prices using a constructed medical price index. Live birth, costs. Total costs per live birth in 2012 prices were estimated to 10,755€. Costs per treated couple - irrespective of whether the treatment was terminated by a live birth or not - were estimated at 6607€. Costs per live birth of women <35 years at treatment initiation were 9338€ and 15,040€ for women ≥35 years. The public costs for live births after conception with medically assisted reproduction treatment are relatively modest. The results can be generalized to public fertility treatment in Denmark and to other public treatment settings with similar limitations in numbers of public treatment cycles offered. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Indirect Optimization of Three-Dimensional Multiple-Impulse Moon-to-Earth Transfers

    Science.gov (United States)

    Shen, Hong-Xin; Casalino, Lorenzo

    2014-11-01

    This paper illustrates an indirect method to optimize multiple-impulse trajectories from circular lunar orbit to Earth. Optimization is performed in the circular restricted three-body problem, and the necessary optimality conditions are found through optimal control theory. In order to overcome the difficulty of initial adjoints estimation, a homotopic approach, which is based on an auxiliary optimization problem with known solution, is developed; this approach proves to be robust and efficient. Examples are presented for a range of lunar orbit orientations to assess the impact on velocity impulse requirements. Optimization results for trajectories with different number of impulses are also compared. The developed procedure can support fast and accurate evaluation of the transfer costs for Moon-to-Earth trajectories both in nominal conditions and for contingency plans.

  6. Social cost of heavy drinking and alcohol dependence in high-income countries.

    Science.gov (United States)

    Mohapatra, Satya; Patra, Jayadeep; Popova, Svetlana; Duhig, Amy; Rehm, Jürgen

    2010-06-01

    A comprehensive review of cost drivers associated with alcohol abuse, heavy drinking, and alcohol dependence for high-income countries was conducted. The data from 14 identified cost studies were tabulated according to the potential direct and indirect cost drivers. The costs associated with alcohol abuse, alcohol dependence, and heavy drinking were calculated. The weighted average of the total societal cost due to alcohol abuse as percent gross domestic product (GDP)--purchasing power parity (PPP)--was 1.58%. The cost due to heavy drinking and/or alcohol dependence as percent GDP (PPP) was estimated to be 0.96%. On average, the alcohol-attributable indirect cost due to loss of productivity is more than the alcohol-attributable direct cost. Most of the countries seem to incur 1% or more of their GDP (PPP) as alcohol-attributable costs, which is a high toll for a single factor and an enormous burden on public health. The majority of alcohol-attributable costs incurred as a consequence of heavy drinking and/or alcohol dependence. Effective prevention and treatment measures should be implemented to reduce these costs.

  7. Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions.

    Science.gov (United States)

    Khandelwal, Nita; Benkeser, David; Coe, Norma B; Engelberg, Ruth A; Teno, Joan M; Curtis, J Randall

    2016-11-01

    Terminal intensive care unit (ICU) stays represent an important target to increase value of care. To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Secondary analysis of an intervention study to improve quality of care for critically ill patients. 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models.

  8. The Complexity of Indirect Translation

    DEFF Research Database (Denmark)

    Wenjie, L. I.

    2017-01-01

    its complex nature, and thus determined that many facets of ITr remain to be studied. The present article will try to encompass the complexity of ITr by looking into the reasons for translating indirectly, the challenge of finding out mediating texts (MTs), indirectness in both translation...... of which have been translated and interpreted indirectly through major languages like English, will be employed as examples. Hopefully, this study will offer more insights into the nature of translation as a social activity and raise further interests in studying translation as a complex phenomenon....

  9. A simplified indirect bonding technique

    Directory of Open Access Journals (Sweden)

    Radha Katiyar

    2014-01-01

    Full Text Available With the advent of lingual orthodontics, indirect bonding technique has become an integral part of practice. It involves placement of brackets initially on the models and then their transfer to teeth with the help of transfer trays. Problems encountered with current indirect bonding techniques used are (1 the possibility of adhesive flash remaining around the base of the brackets which requires removal (2 longer time required for the adhesive to gain enough bond strength for secure tray removal. The new simplified indirect bonding technique presented here overcomes both these problems.

  10. Health-resource use and costs associated with fibromyalgia in France, Germany, and the United States

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Chandran, Arthi; Zlateva, Gergana; Winkelmann, Andreas; Perrot, Serge

    2013-01-01

    Background Fibromyalgia (FM) is a chronic disorder characterized by widespread, persistent pain. Prospective and retrospective studies have demonstrated substantial health-care costs associated with FM in a number of countries. This study evaluated and compared health-resource use (HRU) and associated costs related to FM in routine clinical practice across the US, France, and Germany. Methods Two separate, cross-sectional, observational studies of subjects with FM were conducted: one in the US and one in France and Germany. HRU related to prescription medication, physician office visits, diagnostic tests, and hospitalizations was abstracted from chart review; patient out-of-pocket costs and lost productivity were collected via subject self-report. Costs were assigned to HRU based on standard algorithms. Direct and indirect costs were evaluated and compared by simple linear regression. Results A total of 442 subjects (203 US, 70 France, 169 Germany) with FM were analyzed. The mean (standard deviation) age in the US, France, and Germany was 47.9 (10.9), 51.2 (9.5), and 49.2 (9.8), respectively (P = 0.085). Most subjects were female (95% US, 83% France, 80% Germany) (P < 0.001). Adjusted annual direct costs per subject for FM were significantly higher in the US ($7087) than in France ($481, P < 0.001) or Germany ($2417, P < 0.001). Adjusted mean annual indirect costs per subject for FM were lower in the US ($6431) than in France ($8718) or Germany ($10,001), but represented a significant proportion of total costs in all countries. Conclusion The significant HRU and costs associated with FM in the US, France, and Germany documented in this study highlight the substantial global economic burden of FM. Indirect costs represented a significant proportion of the total costs, particularly in Europe. Comparisons between the three countries show differences in HRU, with significantly higher direct costs in the US compared with France and Germany. PMID:23637545

  11. Development of a practical costing method for hospitals.

    Science.gov (United States)

    Cao, Pengyu; Toyabe, Shin-Ichi; Akazawa, Kouhei

    2006-03-01

    To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.

  12. Activity-based costing methodology as tool for costing in hematopathology laboratory.

    Science.gov (United States)

    Gujral, Sumeet; Dongre, Kanchan; Bhindare, Sonal; Subramanian, P G; Narayan, Hkv; Mahajan, Asim; Batura, Rekha; Hingnekar, Chitra; Chabbria, Meenu; Nair, C N

    2010-01-01

    Cost analysis in laboratories represents a necessary phase in their scientific progression. To calculate indirect cost and thus total cost per sample of various tests at Hematopathology laboratory (HPL). Activity-based costing (ABC) method is used to calculate per cost test of the hematopathology laboratory. Information is collected from registers, purchase orders, annual maintenance contracts (AMCs), payrolls, account books, hospital bills and registers along with informal interviews with hospital staff. Cost per test decreases as total number of samples increases. Maximum annual expense at the HPL is on reagents and consumables followed by manpower. Cost per test is higher for specialized tests which interpret morphological or flow data and are done by a pathologist. Despite several limitations and assumptions, this was an attempt to understand how the resources are consumed in a large size government-run laboratory. The rate structure needs to be revised for most of the tests, mainly for complete blood counts (CBC), bone marrow examination, coagulation tests and Immunophenotyping. This costing exercise is laboratory specific and each laboratory needs to do its own costing. Such an exercise may help a laboratory redesign its costing structure or at least understand the economics involved in the laboratory management.

  13. Economic cost and burden of dengue during epidemics and non-epidemic years in Taiwan

    Directory of Open Access Journals (Sweden)

    Dih-Ling Luh

    2018-03-01

    Full Text Available Background: Determining the disease and economic burden of dengue is critical for the allocation of public health resources. Several studies have used disability-adjusted life-years (DALYs to estimate the disease burden of dengue in different regions. However, there are no published studies discussing the estimates of dengue-related economic and disease burden specifically in Taiwan. Objectives: We assessed the economic cost and disease burden of dengue infections in Taiwan for the period 1998–2014, and compared these during epidemic and non-epidemic years. Methods: We estimated the annual DALYs per million population using the disability weights for dengue fever (DF, dengue hemorrhagic fever (DHF, dengue shock syndrome (DSS, and death cases. Economic costs were estimated and divided into direct (medical costs and indirect costs (lost work days and caregiver fees. Results: For the period 1998–2014, a mean of 115.3 (range: 6.3–934.3 DALYs per million population annually were lost to dengue. In epidemic years, direct costs associated with dengue resulted mostly from hospitalization (86.09%, emergency (7.77%, outpatient (6.10%, and drug costs (0.03%. For indirect costs, lost productivity due to death (70.76% was the dominant contributor. Overall, the costs were 12.3 times higher in epidemic years than in non-epidemic years (Wilcoxon rank sum test, p < 0.05. Conclusions: This study is the first to evaluate the economic costs and disease burden of dengue infections for this period in Taiwan, and reveals significant differences in economic impact between epidemic and non-epidemic years. Keywords: Economic cost of disease, Disease burden, Disability-adjusted life years (DALYs, Dengue, Epidemic

  14. Stochasticity in economic losses increases the value of reputation in indirect reciprocity.

    Science.gov (United States)

    dos Santos, Miguel; Placì, Sarah; Wedekind, Claus

    2015-12-14

    Recent theory predicts harsh and stochastic conditions to generally promote the evolution of cooperation. Here, we test experimentally whether stochasticity in economic losses also affects the value of reputation in indirect reciprocity, a type of cooperation that is very typical for humans. We used a repeated helping game with observers. One subject (the "Unlucky") lost some money, another one (the "Passer-by") could reduce this loss by accepting a cost to herself, thereby building up a reputation that could be used by others in later interactions. The losses were either stable or stochastic, but the average loss over time and the average efficiency gains of helping were kept constant in both treatments. We found that players with a reputation of being generous were generally more likely to receive help by others, such that investing into a good reputation generated long-term benefits that compensated for the immediate costs of helping. Helping frequencies were similar in both treatments, but players with a reputation to be selfish lost more resources under stochastic conditions. Hence, returns on investment were steeper when losses varied than when they did not. We conclude that this type of stochasticity increases the value of reputation in indirect reciprocity.

  15. Indirect Fabrication of Lattice Metals with Thin Sections Using Centrifugal Casting.

    Science.gov (United States)

    Mun, Jiwon; Ju, Jaehyung; Thurman, James

    2016-05-14

    One of the typical methods to manufacture 3D lattice metals is the direct-metal additive manufacturing (AM) process such as Selective Laser Melting (SLM) and Electron Beam Melting (EBM). In spite of its potential processing capability, the direct AM method has several disadvantages such as high cost, poor surface finish of final products, limitation in material selection, high thermal stress, and anisotropic properties of parts. We propose a cost-effective method to manufacture 3D lattice metals. The objective of this study is to provide a detailed protocol on fabrication of 3D lattice metals having a complex shape and a thin wall thickness; e.g., octet truss made of Al and Cu alloys having a unit cell length of 5 mm and a cell wall thickness of 0.5 mm. An overall experimental procedure is divided into eight sections: (a) 3D printing of sacrificial patterns (b) melt-out of support materials (c) removal of residue of support materials (d) pattern assembly (e) investment (f) burn-out of sacrificial patterns (g) centrifugal casting (h) post-processing for final products. The suggested indirect AM technique provides the potential to manufacture ultra-lightweight lattice metals; e.g., lattice structures with Al alloys. It appears that the process parameters should be properly controlled depending on materials and lattice geometry, observing the final products of octet truss metals by the indirect AM technique.

  16. Development of a New Technique to Assess Susceptibility to Predation Resulting from Sublethal Stresses (Indirect Mortality)

    Energy Technology Data Exchange (ETDEWEB)

    Cada, G.F.

    2003-08-25

    Fish that pass through a hydroelectric turbine may not be killed directly, but may nonetheless experience sublethal stresses that will increase their susceptibility to predators (indirect mortality). There is a need to develop reliable tests for indirect mortality so that the full consequences of passage through turbines (and other routes around a hydroelectric dam) can be assessed. We evaluated a new technique for assessing indirect mortality, based on a behavioral response to a startling stimulus (akin to perceiving an approaching predator). We compare this technique to the standard predator preference test. The behavioral response is a rapid movement commonly referred to as a startle response, escape response, or C-shape, based on the characteristic body position assumed by the fish. When viewed from above, a startled fish bends into a C-shape, then springs back and swims away in a direction different from its original orientation. This predator avoidance (escape) behavior can be compromised by sublethal stresses that temporarily stun or disorient the fish. We subjected striped shiners and fathead minnows to varying intensities of either turbulence (10-, 20- or 30-min) or 2-min exposures to a fish anesthetic (100 or 200 mg/L of tricaine methanesulfonate), and evaluated their subsequent behavior. Individual fish were given a startle stimulus and filmed with a high-speed video camera. Each fish was startled and filmed twice before being stressed, and then at 1-, 5-, 15-, and 30-min post-exposure. The resulting image files were analyzed for a variety of behavioral measures including: presence of a response, time to first reaction, duration of reaction, time to formation of maximum C-shape, time to completion of C-shape, and completeness of C-shape. The most immediate measure of potential changes in fish behavior was whether stressed fish exhibited a startle response. For striped shiners, the number of fish not responding to the stimulus was significantly different

  17. Capital-cost behavior: is nuclear different

    International Nuclear Information System (INIS)

    Lotze, C.D.; Riordan, B.J.

    1978-01-01

    The capital costs of coal-fired and nuclear power plants are found to be comparable when costs for pollution control are included. Trends in capital costs reveal a similar rate gain that retains the same economic balance. Graphs of selected cost indices are used to show that the rapid increase in direct construction costs is not unique to nuclear plants, those of hydroelectric plants as well as coal-fired having the same pattern. Comparisons of indirect capital costs, based on analyses of direct capital and total capital costs, show estimated average growth rates of total costs to be 14% for coal and 13.6% for nuclear, while direct cost growth rates are 10.2% and 10.4%. The economics of market competition can be expected to push alternative energy source projects into balance

  18. An improved recommendation algorithm via weakening indirect linkage effect

    International Nuclear Information System (INIS)

    Chen Guang; Qiu Tian; Shen Xiao-Quan

    2015-01-01

    We propose an indirect-link-weakened mass diffusion method (IMD), by considering the indirect linkage and the source object heterogeneity effect in the mass diffusion (MD) recommendation method. Experimental results on the MovieLens, Netflix, and RYM datasets show that, the IMD method greatly improves both the recommendation accuracy and diversity, compared with a heterogeneity-weakened MD method (HMD), which only considers the source object heterogeneity. Moreover, the recommendation accuracy of the cold objects is also better elevated in the IMD than the HMD method. It suggests that eliminating the redundancy induced by the indirect linkages could have a prominent effect on the recommendation efficiency in the MD method. (paper)

  19. Environmental effects of indirect subsidies

    International Nuclear Information System (INIS)

    Van Beers, C.P.; De Moor, A.P.G.; Van den Bergh, J.C.J.M.; Oosterhuis, F.H.

    2003-01-01

    The aim of the study on the title subject is to develop a transparent integrated method to determine and analyze the environmental impacts of indirect subsidies, applied in the sectors agriculture, energy, mobility, and tourism. From the results it appears that the hazardous effects of subsidies are big. Examples are milk, the regulating energy levy, and kerosene [nl

  20. [Estimation of economic costs for the care of patients with nosocomial pneumonia in a regional peruvian hospital, 2009-2011].

    Science.gov (United States)

    Dámaso-Mata, Bernardo; Chirinos-Cáceres, Jesús; Menacho-Villafuerte, Luz

    2016-06-01

    To estimate and compare the economic costs for the care of patients with and without nosocomial pneumonia at Hospital II Huánuco EsSalud during 2009-2011, in Peru. This was a partial economic evaluation of paired cases and controls. A collection sheet was used. nosocomial pneumonia. direct health costs, direct non-health costs, indirect costs, occupation, age, comorbidities, sex, origin, and education level. A bivariate analysis was performed. Forty pairs of cases and controls were identified. These patients were hospitalized for >2 weeks and prescribed more than two antibiotics. The associated direct health costs included those for hospitalization, antibiotics, auxiliary examinations, specialized assessments, and other medications. The direct non-health costs and associated indirect costs included those for transportation, food, housing, foregone payroll revenue, foregone professional fee revenue, extra-institutional expenses, and payment to caregivers during hospitalization and by telephone. The direct health costs for nosocomial pneumonia patients were more than three times and the indirect costs were more than two times higher than those for the controls. Variables with the greatest impact on costs were identified.

  1. 48 CFR 52.216-26 - Payments of Allowable Costs Before Definitization.

    Science.gov (United States)

    2010-10-01

    ... and placed in the production process for use on the contract; (iii) Direct labor; (iv) Direct travel; (v) Other direct in-house costs; and (vi) Properly allocable and allowable indirect costs as shown on... Costs Before Definitization. 52.216-26 Section 52.216-26 Federal Acquisition Regulations System FEDERAL...

  2. Direct and indirect effects of body weight on adult wages.

    Science.gov (United States)

    Han, Euna; Norton, Edward C; Powell, Lisa M

    2011-12-01

    Previous estimates of the association between body weight and wages in the literature have been conditional on education and occupation. In addition to the effect of current body weight status (body mass index (BMI) or obesity) on wages, this paper examines the indirect effect of body weight status in the late-teenage years on wages operating through education and occupation choice. Using the National Longitudinal Survey of Youth 1979 data, for women, we find that a one-unit increase in BMI is directly associated with 1.83% lower hourly wages whereas the indirect BMI wage penalty is not statistically significant. Neither a direct nor an indirect BMI wage penalty is found for men. However, results based on clinical weight classification reveal that the indirect wage penalty occurs to a larger extent at the upper tail of the BMI distribution for both men and women via the pathways of education and occupation outcomes. Late-teen obesity is indirectly associated with 3.5% lower hourly wages for both women and men. These results are important because they imply that the total effect of obesity on wages is significantly larger than has been estimated in previous cross-sectional studies. 2011 Elsevier B.V. All rights reserved.

  3. Indirect Reciprocity; A Field Experiment.

    Science.gov (United States)

    van Apeldoorn, Jacobien; Schram, Arthur

    2016-01-01

    Indirect reciprocity involves cooperative acts towards strangers, either in response to their kindness to third parties (downstream) or after receiving kindness from others oneself (upstream). It is considered to be important for the evolution of cooperative behavior amongst humans. Though it has been widely studied theoretically, the empirical evidence of indirect reciprocity has thus far been limited and based solely on behavior in laboratory experiments. We provide evidence from an online environment where members can repeatedly ask and offer services to each other, free of charge. For the purpose of this study we created several new member profiles, which differ only in terms of their serving history. We then sent out a large number of service requests to different members from all over the world. We observe that a service request is more likely to be rewarded for those with a profile history of offering the service (to third parties) in the past. This provides clear evidence of (downstream) indirect reciprocity. We find no support for upstream indirect reciprocity (in this case, rewarding the service request after having previously received the service from third parties), however. Our evidence of downstream indirect reciprocity cannot be attributed to reputational effects concerning one's trustworthiness as a service user.

  4. Grid-scale Indirect Radiative Forcing of Climate due to aerosols over the northern hemisphere simulated by the integrated WRF-CMAQ model: Preliminary results

    Science.gov (United States)

    In this study, indirect aerosol effects on grid-scale clouds were implemented in the integrated WRF3.3-CMAQ5.0 modeling system by including parameterizations for both cloud droplet and ice number concentrations calculated from the CMAQ-predicted aerosol particles. The resulting c...

  5. Mate-sampling costs and sexy sons.

    Science.gov (United States)

    Kokko, H; Booksmythe, I; Jennions, M D

    2015-01-01

    Costly female mating preferences for purely Fisherian male traits (i.e. sexual ornaments that are genetically uncorrelated with inherent viability) are not expected to persist at equilibrium. The indirect benefit of producing 'sexy sons' (Fisher process) disappears: in some models, the male trait becomes fixed; in others, a range of male trait values persist, but a larger trait confers no net fitness advantage because it lowers survival. Insufficient indirect selection to counter the direct cost of producing fewer offspring means that preferences are lost. The only well-cited exception assumes biased mutation on male traits. The above findings generally assume constant direct selection against female preferences (i.e. fixed costs). We show that if mate-sampling costs are instead derived based on an explicit account of how females acquire mates, an initially costly mating preference can coevolve with a male trait so that both persist in the presence or absence of biased mutation. Our models predict that empirically detecting selection at equilibrium will be difficult, even if selection was responsible for the location of the current equilibrium. In general, it appears useful to integrate mate sampling theory with models of genetic consequences of mating preferences: being explicit about the process by which individuals select mates can alter equilibria. © 2014 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2014 European Society For Evolutionary Biology.

  6. System reliability worth assessment at a midwest utility-survey results for residential customers

    Energy Technology Data Exchange (ETDEWEB)

    Chowdhury, A.A.; Mielnik, T.C. [Electric System Planning, MidAmerican Energy Company, Davenport, Iowa (United States); Lawton, L.E.; Sullivan, M.J.; Katz, A. [Population Research Systems, San Francisco, CA (United States)

    2005-12-01

    This paper presents the overall results of a residential customer survey conducted in service areas of MidAmerican Energy Company, a Midwest utility. A similar survey was conducted concurrently in the industrial, commercial and institutional sectors and the survey results are presented in a companion paper. The results of this study are compared with the results of other studies performed in the high cost areas of the US east and west coasts. This is the first ever study of this nature performed for the residential customers in the US Midwest region. Methodological differences in the study design compared to coastal surveys are discussed. Customer survey costing techniques can be categorized into three main groups: contingent valuation techniques, direct costing techniques and indirect costing techniques. Most customer surveys conducted by different organizations in the last two decades used a combination of all three techniques. The selection of a technique is mainly dependent on the type of customer being surveyed. In this MidAmerican study, contingent valuation techniques and an indirect costing technique have been used, as most consequences of power outages to residential users are related to inconvenience or disruption of housekeeping and leisure activities that are intangible in nature. The major contribution of this paper is that particulars of Midwest residential customers compared to residential customers of coastal utilities are noted and customer responses on power quality issues that are important to customers are summarized. (author)

  7. Cost of disorders of the brain in Denmark

    DEFF Research Database (Denmark)

    Olesen, J.; Sobocki, P.; Truelsen, T.

    2008-01-01

    The cost of brain disorders in Denmark is unknown and such information is important to decision makers. The aims of the study were to estimate the total number of subjects with brain diseases, and the associated direct and indirect expenses in Denmark. This was part of a larger pan-European study...... drug consumption was used for treatment of brain diseases. Expenses to brain diseases constituted 3% of the gross domestic product. Brain disorders are very prevalent in Denmark and they cause high societal and personal cost Udgivelsesdato: 2008......The cost of brain disorders in Denmark is unknown and such information is important to decision makers. The aims of the study were to estimate the total number of subjects with brain diseases, and the associated direct and indirect expenses in Denmark. This was part of a larger pan-European study......,000 and 340,000 patients, respectively. The total expenses for all selected brain diseases were 37.3 billion DKR. Affective disorders, dependency, dementia and stroke were the most costly diseases. An estimated 12% of all direct costs in the Danish health system were spent on brain diseases; 9% of the total...

  8. Cost of Illness of Chronic Hepatitis B Infection in Vietnam

    NARCIS (Netherlands)

    Tu, Hong Anh T.; Woerdenbag, Herman J.; Riewpaiboon, Arthorn; Kane, Sumit; Le, Diep M.; Postma, Maarten J.; Li, Shu Chuen

    2012-01-01

    To estimate the total financial burden of chronic hepatitis B virus (HBV) infection for Vietnam by quantifying the direct medical, the direct nonmedical, and indirect costs among patients with various stages of chronic HBV infection. Direct medical cost data were retrieved retrospectively from

  9. Indirect Determination of the sigma - omega

    DEFF Research Database (Denmark)

    Ulfkjær, J. P.; Brincker, Rune

    . The beams where submitted to three-point bending in a servo-controlled materials testing system. The constitutive parameters in the fictitious crack model were determined by using three different indirect techniques, which are described and evaluated. The results show that the fracture energy is increasing...

  10. Indirect Solar Water Heating in Single-Family, Zero Energy Ready Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, Robb [Consortium for Advanced Residential Buildings, Norwalk, CT (United States)

    2016-02-17

    Solar water heating systems are not new, but they have not become prevalent in most of the U.S. Most of the country is cold enough that indirect solar thermal systems are required for freeze protection, and average installed cost of these systems is $9,000 to $10,000 for typical systems on single-family homes. These costs can vary significantly in different markets and with different contractors, and federal and regional incentives can reduce these up-front costs by 50% or more. In western Massachusetts, an affordable housing developer built a community of 20 homes with a goal of approaching zero net energy consumption. In addition to excellent thermal envelopes and PV systems, the developer installed a solar domestic water heating system (SDHW) on each home. The Consortium for Advanced Residential Buildings (CARB), a research consortium funded by the U.S. Department of Energy Building America program, commissioned some of the systems, and CARB was able to monitor detailed performance of one system for 28 months.

  11. The cost of infection in severe open tibial fractures treated with a free flap

    DEFF Research Database (Denmark)

    Olesen, Ulrik Kähler; Pedersen, Nicolas Jones; Eckardt, Henrik

    2017-01-01

    procedures performed, including medications and intensive care. We analysed indirect cost in terms of absenteeism and unemployment benefits. The primary goal was to establish the extra cost incurred by an infection. RESULTS: We analysed 46 injuries in 45 patients. Infection increased the LOS from 41 to 74...... rate from 60 to 27 %. CONCLUSIONS: Severe open tibial fractures covered with free flaps, cause over a year of absenteeism. Infection increases direct cost of treatment over 60 % and roughly doubles LOS. Early soft-tissue cover and correct antibiotics have been shown to improve outcomes...

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

    Science.gov (United States)

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

    2017-08-01

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

  13. The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families.

    Science.gov (United States)

    Burke, Rachel M; Rebolledo, Paulina A; Embrey, Sally R; Wagner, Laura Danielle; Cowden, Carter L; Kelly, Fiona M; Smith, Emily R; Iñiguez, Volga; Leon, Juan S

    2013-08-02

    Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs. From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages). Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (pcosts to families were significantly higher for inpatients as compared to outpatients of urban (pcosts made up a large proportion of total costs. Forty-five percent of patients' families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden. This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.

  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. Supersymmetric dark matter: Indirect detection

    International Nuclear Information System (INIS)

    Bergstroem, L.

    2000-01-01

    Dark matter detection experiments are improving to the point where they can detect or restrict the primary particle physics candidates for non baryonic dark matter. The methods for detection are usually categorized as direct, i.e., searching for signals caused by passage of dark matter particles in terrestrial detectors, or indirect. Indirect detection methods include searching for antimatter and gamma rays, in particular gamma ray lines, in cosmic rays and high-energy neutrinos from the centre of the Earth or Sun caused by accretion and annihilation of dark matter particles. A review is given of recent progress in indirect detection, both on the theoretical and experimental side

  16. Production costs of liquid fuels from biomass

    International Nuclear Information System (INIS)

    Bridgwater, A.V.; Double, J.M.

    1994-01-01

    This project was undertaken to provide a consistent and thorough review of the full range of processes for producing liquid fuels from biomass to compare both alternative technologies and processes within those technologies in order to identify the most promising opportunities that deserve closer attention. Thermochemical conversion includes both indirect liquefaction through gasification, and direct liquefaction through pyrolysis and liquefaction in pressurized solvents. Biochemical conversion is based on a different set of feedstocks. Both acid and enzyme hydrolysis are included followed by fermentation. The liquid products considered include gasoline and diesel hydrocarbons and conventional alcohol fuels of methanol and ethanol. Results are given both as absolute fuel costs and as a comparison of estimated cost to market price. In terms of absolute fuel costs, thermochemical conversion offers the lowest cost products, with the least complex processes generally having an advantage. Biochemical routes are the least attractive. The most attractive processes from comparing production costs to product values are generally the alcohol fuels which enjoy a higher market value. (author)

  17. Examining the association of smoking with work productivity and associated costs in Japan.

    Science.gov (United States)

    Suwa, Kiyomi; Flores, Natalia M; Yoshikawa, Reiko; Goto, Rei; Vietri, Jeffrey; Igarashi, Ataru

    2017-09-01

    Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment. The data source was the 2011 Japan National Health and Wellness Survey (n = 30,000). Respondents aged 20-64 were used in the analyses (n = 23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs. Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs. Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers

  18. 45 CFR 30.18 - Interest, penalties, and administrative costs.

    Science.gov (United States)

    2010-10-01

    ... delinquency, or as otherwise provided by law. For debts not paid by the date specified in the written demand... direct (personnel, supplies, etc.) and indirect collection costs, including the cost of providing a... consideration of waiver if statute prohibits collection of the debt during this period. (i) Common law or other...

  19. Social Cost of Substance Abuse in Russia.

    Science.gov (United States)

    Potapchik, Elena; Popovich, Larisa

    2014-09-01

    To summarize results of studies that estimate the social costs of alcohol, tobacco, and illicit drug abuse in Russia. The purpose of these studies was to inform policymakers about the real economic burden of risky behaviors and to provide conditions for evidence-based and well-informed decision making in this area. The cost-of-illness method was applied to estimate the social cost of substance abuse. The intangible cost was not included in estimation. A prevalence-based approach was applied to estimate the tangible cost. For the estimation of direct costs, a top-down method was used. Indirect costs were estimated using two methods: the human capital and the friction cost. In 2008, the social cost of substance abuse in Russia comprised 677.2 billion rubles if the friction cost method is applied and 1965.9 billion rubles if the human capital method is used. The social cost of substance abuse is defined to the greatest extent by alcohol consumption, comprising about 45% of the economic burden. Illicit drug use comprises about 30% of the economic burden and tobacco consumption 25%. The results of economic studies demonstrated that psychoactive substances impose a considerable economic burden on society. Analysis of the substance abuse social cost pattern shows that the main losses that society bears because of these behavioral risk factors fall outside the health care system and lay in other sectors of the economy such as social care, law enforcement, and productivity losses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  20. The importance of ecological costs for the evolution of plant defense against herbivory.

    Science.gov (United States)

    van Velzen, Ellen; Etienne, Rampal S

    2015-05-07

    Plant defense against herbivory comes at a cost, which can be either direct (reducing resources available for growth and reproduction) or indirect (through reducing ecological performance, for example intraspecific competitiveness). While direct costs have been well studied in theoretical models, ecological costs have received almost no attention. In this study we compare models with a direct trade-off (reduced growth rate) to models with an ecological trade-off (reduced competitive ability), using a combination of adaptive dynamics and simulations. In addition, we study the dependence of the level of defense that can evolve on the type of defense (directly by reducing consumption, or indirectly by inducing herbivore mortality (toxicity)), and on the type of herbivore against which the plant is defending itself (generalists or specialists). We find three major results: First, for both direct and ecological costs, defense only evolves if the benefit to the plant is direct (through reducing consumption). Second, the type of cost has a major effect on the evolutionary dynamics: direct costs always lead to a single optimal strategy against herbivores, but ecological costs can lead to branching and the coexistence of non-defending and defending plants; however, coexistence is only possible when defending against generalist herbivores. Finally, we find that fast-growing plants invest less than slow-growing plants when defending against generalist herbivores, as predicted by the Resource Availability Hypothesis, but invest more than slow-growing plants when defending against specialists. Our results clearly show that assumptions about ecological interactions are crucial for understanding the evolution of defense against herbivores. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. 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.

  2. Can cost utility evaluations inform decision making about interventions for low back pain?

    Science.gov (United States)

    Dagenais, Simon; Roffey, Darren M; Wai, Eugene K; Haldeman, Scott; Caro, Jaime

    2009-11-01

    Low back pain (LBP) is associated with high health-care utilization and lost productivity. Numerous interventions are routinely used, although few are supported by strong evidence. Cost utility analyses (CUAs) may be helpful to inform decision makers. To conduct a systematic review of CUAs of interventions for LBP. Systematic review. A search strategy combining medical subject headings and free text related to LBP and health economic evaluations was executed in MEDLINE. Cost utility analyses combined with randomized controlled trials for LBP were included. Studies that were published before 1998, non-English, decision analyses, and duplicate reports were excluded. Search results were evaluated by two reviewers, who extracted data independently related to clinical study design, economic study design, direct cost components, utility results, cost results, and CUA results. The search produced 319 citations, and of these 15 met eligibility criteria. Most were from the United Kingdom (n=8), published in the past 3 years (n=12), studied chronic LBP or radiculopathy (n=13), and had a follow-up >12 months (n=13). Combined, there were 33 study groups who received a mean 2.1 interventions, most commonly education (n=17), exercise therapy (n=13), spinal manipulation therapy (n=7), surgery (n=7), and usual care from a general practitioner (n=7). Mean baseline utility was 0.57, improving to 0.67 at follow-up; the mean difference in utility improvement between study groups was 0.04. Based on available data and converted to US dollars, the cost per quality-adjusted life year ranged from $304 to 579,527 dollars, with a median of 13,015 dollars. Few CUAs were identified for LBP, and there was heterogeneity in the interventions compared, direct cost components measured, indirect costs, other methods, and results. Reporting quality was mixed. Currently published CUAs do not provide sufficient information to assist decision makers. Future CUAs should attempt to measure all known

  3. 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.

  4. Direct and Indirect Costs Following Living Kidney Donation: Findings From the KDOC Study.

    Science.gov (United States)

    Rodrigue, J R; Schold, J D; Morrissey, P; Whiting, J; Vella, J; Kayler, L K; Katz, D; Jones, J; Kaplan, B; Fleishman, A; Pavlakis, M; Mandelbrot, D A

    2016-03-01

    Some living kidney donors (LKDs) incur costs associated with donation, although these costs are not well characterized in the United States. We collected cost data in the 12 mo following donation from 182 LKDs participating in the multicenter prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 167, 92%) had one direct cost or more following donation, including ground transportation (86%), health care (41%), meals (53%), medications (36%), lodging (23%), and air transportation (12%). LKDs missed 33 072 total work hours, 40% of which were unpaid and led to $302 175 in lost wages (mean $1660). Caregivers lost $68 655 in wages (mean $377). Although some donors received financial assistance, 89% had a net financial loss in the 12-mo period, with one-third (33%) reporting a loss exceeding $2500. Financial burden was higher for those with greater travel distance to the transplant center (Spearman's ρ = 0.26, p neutrality for LKDs must be an immediate priority for the transplant community, governmental agencies, insurance companies, nonprofit organizations, and society at large. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  5. 26 CFR 1.471-3 - Inventories at cost.

    Science.gov (United States)

    2010-04-01

    ... article, including in such indirect production costs an appropriate portion of management expenses, but... and manufacturers who by a single process or uniform series of processes derive a product of two or...

  6. Analysis of indirect taxation in Ukraine

    Directory of Open Access Journals (Sweden)

    Khodyakova Olga V.

    2014-01-01

    Full Text Available The goal of the article is analysis of the structure and dynamics of indirect taxes for the previous five years and also the influence of indirect taxation upon formation of income of the State Budget of Ukraine. The article analyses the modern state of indirect taxation in Ukraine. Specific weight of the value added tax, excise tax and customs duty are considered in the structure of tax receipts of the consolidated budget of Ukraine as indirect taxes. The article shows that receipts of the State Budget of Ukraine are mostly provided by indirect taxes. The Ukrainian taxation system is mostly a factor of reduction of the level of economic growth and investment activity in the country and the existing system of administering is not completely capable of excluding the possibility of tax evasion. The prospect of further studies in this direction is improvement of organisation of tax control in Ukraine and differentiation of the value added tax rates depending on the level of consumption of goods and level of income of consumers.

  7. Determining infertility treatment costs and out of pocket payments ...

    African Journals Online (AJOL)

    The greatest portion of indirect costs was related to accommodation expenses and the least was due to travel costs (4.898.099 and 2.738.491 rial). ... Conclusion: Due to the high expenditures related to infertility treatment services also lack of insurance coverage, policy makers should pay a particular attention on meeting ...

  8. Direct versus Indirect and Individual versus Group Modes of Language Therapy for Children with Primary Language Impairment: Principal Outcomes from a Randomized Controlled Trial and Economic Evaluation

    Science.gov (United States)

    Boyle, James M.; McCartney, Elspeth; O'Hare, Anne; Forbes, John

    2009-01-01

    Background: Many school-age children with language impairments are enrolled in mainstream schools and receive indirect language therapy, but there have been, to the authors' knowledge, no previous controlled studies comparing the outcomes and costs of direct and indirect intervention delivered by qualified therapists and therapy assistants, and…

  9. Manifestations and intensity of indirect self-destructiveness in patients with psoriasis vulgaris

    Directory of Open Access Journals (Sweden)

    Wojciech Bienias

    2016-07-01

    Full Text Available Introduction: Psoriasis is a chronic systemic disease which often significantly reduces the quality of life in extreme situations can provide to severe depression and even suicide. Indirect self-destructiveness is a generalized trend of behavior consisting of taking steps to increase the likelihood of negative and reduce the likelihood of positive consequences for the entity within a general manifestations such as transgression of norms and risk, addictions, poor health maintenance, personal and social neglect, lack of planfulness, helplessness and passiveness. Polish and world literature has no publications on indirect self-destructiveness in psoriasis nor in any skin diseases. The main aim of this study was to investigate the intensity and symptoms of indirect self-destructiveness in population of patients with psoriasis vulgaris Material and methods: The material consisted of 82 patients with psoriasis vulgaris hospitalized in the Department of Dermatology, Pediatric Dermatology and Oncology in 2013-2014. For the achievement of the objectives of the research socio-demographic questionnaire (own authorship and Indirect Chronic Self-Destructiveness Scale by Kelley in Polish adaptation of Suchańska (version for men and women – each containing 52 issues was used. Results: The results showed that in a population of people with psoriasis overall severity of indirect self-destructiveness was in the lower range of the average results. The dominant class of indirect self-destructiveness was helplessness and passivity that preceded the poor health maintenance and lack of planning. Conclusions: The results will enrich the existing knowledge about the harmful conduct of psoriasis and a better approach to the patient.

  10. 14 CFR Appendix A to Subpart 1214... - Costs for Which NASA Shall Be Reimbursed

    Science.gov (United States)

    2010-01-01

    ... Foreign Users Who Have Made Substantial Investment in the STS Program Pt. 1214, Subpt. 1214.2, App. A.... Total Operating Costs include all direct and indirect costs, excluding costs of composing the use charge. Such costs include direct program charges for manpower, expended hardware, refurbishment of hardware...

  11. Cost of care of atopic dermatitis in India

    Directory of Open Access Journals (Sweden)

    Sanjeev Handa

    2015-01-01

    Full Text Available Background: Atopic dermatitis (AD is a common dermatologic condition with a prevalence varying from 5% to 15%, and it has been rising over time. Several studies from developed countries have revealed the substantial economic burden of AD on health care budgets. There has been no research however on the cost of care of AD from India a country where health care is self-funded with no health insurance or social security provided by the government. Aim: The aim of our study was to assess prospectively the cost of care of AD in children in an outpatient hospital setting in India. Methods: A total of 40 children with AD, <10 years of age, registered in the pediatric dermatology clinic at our institute were enrolled for the study. All patients were followed-up for 6 months. Demographic information, clinical profile, severity, and the extent of AD were recorded in predesigned performa. Caregivers were asked to fill up a cost assessment questionnaire specially designed for the study. It had a provision for measuring direct, indirect, and provider costs. Results: Of the 40 patients, 37 completed the study. Mean total cost for AD was Rs. 6235.00 ± 3514.00. Direct caregiver cost was Rs. 3022.00 ± 1620.00 of which treatment cost constituted 77.2 ± 11.1%. The total provider cost (cost of consultation, nursing/paramedical staff and infrastructure was Rs. 948.00, which was 15.2% of the total cost of care and the mean indirect cost calculated by adding loss of earnings of parents due to hospital visits was Rs. 2264.00 ± 2392.00 (range: 0-13,332. The mean total cost depending on the severity of AD was Rs. 3579.00 ± 948.00, Rs. 6806.00 ± 3676.00 and Rs. 8991.00 ± 3129.00 for mild, moderate and severe disease, respectively. Conclusions: AD causes a considerable drain on the financial resources of families in India since the treatment is mostly self-funded. Cost of care of AD is high and comparable to those of chronic physical illness, such as diabetes

  12. A wood-waste fuelled, indirectly-fired gas turbine cogeneration plant for sawmill application. Phase 1. Preliminary engineering design and financial evaluation

    Energy Technology Data Exchange (ETDEWEB)

    1986-02-01

    Most sawmills generate more than enough wood waste to be potentially self-sufficient in both dry-kiln heat and electricity requirements. It is not generally economically viable to use conventional steam/electricty cogeneration systems at the sawmill scale of operation. As a result, Canadian sawmills are still large consumers of purchased fuels and electricity. The overall objective of this project was to develop a cost-effective wood waste-fired power generation and lumber drying system for sawmill applications. The system proposed and evaluated in this project is a wood waste-fuelled, indirectly-fired gas turbine cogeneration plant. Research, design, and development of the system has been planned to take place in a number of phases. Phase 1 consists of a preliminary engineering design and financial evaluation of the system, the subjects of this report. The results indicate that the proposed indirectly-fired gas turbine cogeneration system is both technically and financially feasible under a variety of conditions. 8 figs., 8 tabs.

  13. Cost-Effectiveness Analysis of Regorafenib for Gastrointestinal Stromal Tumour (GIST) in Germany.

    Science.gov (United States)

    Tamoschus, David; Draexler, Katja; Chang, Jane; Ngai, Christopher; Madin-Warburton, Matthew; Pitcher, Ashley

    2017-06-01

    No study has compared the cost-effectiveness of active treatment options for unresectable or metastatic gastrointestinal stromal tumours in patients who progressed on or are intolerant to prior treatment with imatinib and sunitinib. The aim of this study was to estimate the cost-effectiveness of regorafenib compared to imatinib rechallenge in this setting in Germany. Hazard ratios for progression-free (PFS) and overall survival (OS) with regorafenib versus imatinib rechallenge were estimated by indirect comparison. A state distribution model was used to simulate progression, mortality and treatment costs over a lifetime horizon. Drug acquisition costs and utilities were derived from clinical trial data and published literature; non-drug costs were not included. The outcomes measured were treatment costs, life-years (LYs) and quality-adjusted life-years (QALYs). The indirect comparison suggested that median PFS and OS were longer with regorafenib compared to imatinib but results were not statistically significant. Regorafenib versus imatinib rechallenge was estimated to have hazard ratios of 0.58 (95% CI 0.31-1.11) for PFS and 0.77 (95% CI 0.34-1.77) for OS, with substantial uncertainty due to the rarity of the disease and small number of patients within the trials. Regorafenib treatment per patient over a lifetime horizon provided an additional 0.61 LYs and 0.42 QALYs over imatinib rechallenge, with additional direct drug costs of €8,773. The incremental cost-effectiveness ratio was €21,127 per QALY gained. At a cost-effectiveness threshold of €50,000 per QALY, regorafenib had a 67% probability of being cost-effective. Based on the currently available clinical data, this analysis suggests that regorafenib is cost-effective compared with imatinib rechallenge in Germany.

  14. Indirect Reciprocity under Incomplete Observation

    Science.gov (United States)

    Nakamura, Mitsuhiro; Masuda, Naoki

    2011-01-01

    Indirect reciprocity, in which individuals help others with a good reputation but not those with a bad reputation, is a mechanism for cooperation in social dilemma situations when individuals do not repeatedly interact with the same partners. In a relatively large society where indirect reciprocity is relevant, individuals may not know each other's reputation even indirectly. Previous studies investigated the situations where individuals playing the game have to determine the action possibly without knowing others' reputations. Nevertheless, the possibility that observers of the game, who generate the reputation of the interacting players, assign reputations without complete information about them has been neglected. Because an individual acts as an interacting player and as an observer on different occasions if indirect reciprocity is endogenously sustained in a society, the incompleteness of information may affect either role. We examine the game of indirect reciprocity when the reputations of players are not necessarily known to observers and to interacting players. We find that the trustful discriminator, which cooperates with good and unknown players and defects against bad players, realizes cooperative societies under seven social norms. Among the seven social norms, three of the four suspicious norms under which cooperation (defection) to unknown players leads to a good (bad) reputation enable cooperation down to a relatively small observation probability. In contrast, the three trustful norms under which both cooperation and defection to unknown players lead to a good reputation are relatively efficient. PMID:21829335

  15. Reconsidering Money: Monetary Exchange with Additive Transaction Costs

    DEFF Research Database (Denmark)

    Schröder, Philipp

    2001-01-01

    Under the assumption of purely additive transaction costs in exchange, the literature on money has a standard example of direct exchange dominating indirect (monetary) exchange. From here it is frequently concluded that subadditive costs (e.g. search costs) must be examined in order to explain...... money. In contrast, this paper presents an additive transaction costs model in which the mere absence of double coincidences of wants suffices to motivate monetary exchange. Furthermore it is found that not all commodity moneys, that are collectively desirable, qualify for the core, but that all fiat...

  16. Malaria treatment in Northern Ghana: What is the treatment cost per ...

    African Journals Online (AJOL)

    kemrilib

    indirect cost accounts for 71 percent of total cost of a malaria episode. While cost of malaria ... 2007; 14:70-79]. Introduction. Malaria ... episodes outside the formal health system, which can be a substantial ... in southern Ghana) of people live below the poverty line [13] .... ¢4,000 (US$1.07) for male and female respectively.

  17. A study of a high temperature nuclear power plant incorporating a non-integrated indirect cycle gas turbine

    International Nuclear Information System (INIS)

    Sarlos, G.; Helbling, W.; Zollinger, E.; Gregory, N.; Luchsinger, H.

    1982-04-01

    In connection with the HHT-project, the Swiss Federal Institute for Reactor Research has performed a study of a 1640-MWth HTR-plant incorporating a non-integrated indirect cycle gas turbine with two-stage intercooling, as a possibility of simplifying and reducing the cost of the HHT-demonstration plant. In this paper, the plant design is described and compared with the HHT-demonstration plant (a CCGT integrated plant with single stage intercooling). Also included is an evaluation of the various advantages and disadvantages of this design together with the presentation of some of the sensitivity results. (Auth.)

  18. Types of suggestibility: Relationships among compliance, indirect, and direct suggestibility.

    Science.gov (United States)

    Polczyk, Romuald; Pasek, Tomasz

    2006-10-01

    It is commonly believed that direct suggestibility, referring to overt influence, and indirect suggestibility, in which the intention to influence is hidden, correlate poorly. This study demonstrates that they are substantially related, provided that they tap similar areas of influence. Test results from 103 students, 55 women and 48 men, were entered into regression analyses. Indirect suggestibility, as measured by the Sensory Suggestibility Scale for Groups, and compliance, measured by the Gudjonsson Compliance Scale, were predictors of direct suggestibility, assessed with the Barber Suggestibility Scale. Spectral analyses showed that indirect suggestibility is more related to difficult tasks on the BSS, but compliance is more related to easy tasks on this scale.

  19. HTGR high temperature process heat design and cost status report

    International Nuclear Information System (INIS)

    1981-12-01

    This report describes the status of the studies conducted on the 850 0 C ROT indirect cycle and the 950 0 C ROT direct cycle through the end of Fiscal Year 1981. Volume I provides summaries of the design and optimization studies and the resulting capital and product costs, for the HTGR/thermochemical pipeline concept. Additionally, preliminary evaluations are presented for coupling of candidate process applications to the HTGR system

  20. Participation costs can suppress the evolution of upstream reciprocity.

    Science.gov (United States)

    Peña, Jorge; Pestelacci, Enea; Berchtold, André; Tomassini, Marco

    2011-03-21

    Indirect reciprocity, one of the many mechanisms proposed to explain the evolution of cooperation, is the idea that altruistic actions can be rewarded by third parties. Upstream or generalized reciprocity is one type of indirect reciprocity in which individuals help someone if they have been helped by somebody else in the past. Although empirically found to be at work in humans, the evolution of upstream reciprocity is difficult to explain from a theoretical point of view. A recent model of upstream reciprocity, first proposed by Nowak and Roch (2007) and further analyzed by Iwagami and Masuda (2010), shows that while upstream reciprocity alone does not lead to the evolution of cooperation, it can act in tandem with mechanisms such as network reciprocity and increase the total level of cooperativity in the population. We argue, however, that Nowak and Roch's model systematically leads to non-uniform interaction rates, where more cooperative individuals take part in more games than less cooperative ones. As a result, the critical benefit-to-cost ratios derived under this model in previous studies are not invariant with respect to the addition of participation costs. We show that accounting for these costs can hinder and even suppress the evolution of upstream reciprocity, both for populations with non-random encounters and graph-structured populations. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. CONCEPT-5 user's manual. [Power plant costs

    Energy Technology Data Exchange (ETDEWEB)

    Hudson, C.R. II

    1979-01-01

    The CONCEPT computer code package was developed to provide conceptual capital cost estimates for nuclear-fueled and fossil-fired power plants. Cost estimates can be made as a function of plant type, size, location, and date of initial operation. The output includes a detailed breakdown of the estimate into direct and indirect costs similar to the accounting system described in document NUS--531. Cost models are currently provided in CONCEPT 5 for single- and multiunit pressurized-water reactors, boiling-water reactors, and cost-fired plants with and without flue gas desulfurization equipment.

  2. Activity-based Management of Logistic Costs in a Manufacturing Company: A Case of Increased Visibility of Logistics Costs in a Slovenian Paper Manufacturing Company

    OpenAIRE

    Julijana Krajnc; Klavdij Logožar; Bojana Korošec

    2012-01-01

    Both the transparent reporting of logistics costs and the related accounting of their cost drivers present a significant factor for the successful management of material flows and the related logistics activities in production companies. These costs, which are mainly reported as part of overhead (indirect) costs in such companies, usually remain hidden or are not explicitly visible when the traditional method of accounting is applied. The aim of this research is to create a model of activity-...

  3. The burden of prenatal exposure to alcohol: revised measurement of cost.

    Science.gov (United States)

    Stade, Brenda; Ali, Alaa; Bennett, Dainel; Campbell, Douglas; Johnston, Mary; Lens, Cynthia; Tran, Sofia; Koren, Gideon

    2009-01-01

    In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. Only one study has examined the cost of FASD in Canada. In that study we did not include prospective data for infants under the age of one year, costs for adults beyond 21 years or costs for individuals living in institutions. To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level. Cross-sectional study design was used. Two-hundred and fifty (250) participants completed the study tool. Participants included caregivers of children, youth and adults, with FASD, from day of birth to 53 years, living in urban and rural communities throughout Canada participated. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs for each in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD. Total adjusted annual costs associated with FASD at the individual level was $21,642 (95% CI, $19,842; $24,041), compared to $14,342 (95% CI, $12,986; $15,698) in the first study. Severity of the individual's condition, age, and relationship of the individual to the caregiver (biological, adoptive, foster) were significant determinants of costs (p Cost of FASD annually to Canada of those from day of birth to 53 years old, was $5.3 billion (95% CI, $4.12 billion; $6.4 billion). Study results demonstrated the cost burden of FASD in Canada was profound. Inclusion of infants aged 0 to 1 years, adults beyond the age of 21 years

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

    Science.gov (United States)

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

    2011-11-08

    The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Costs of publicly provided maternity services in Rosario, Argentina

    Directory of Open Access Journals (Sweden)

    Borghi Josephine

    2003-01-01

    Full Text Available OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999 of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57 is five times greater than that of a normal vaginal delivery ($105.61. A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94% of the total cost and drugs and medical supplies between 4-26%. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  7. Diverting indirect subsidies from the nuclear industry to the photovoltaic industry: Energy and financial returns

    International Nuclear Information System (INIS)

    Zelenika-Zovko, I.; Pearce, J.M.

    2011-01-01

    Nuclear power and solar photovoltaic energy conversion often compete for policy support that governs economic viability. This paper compares current subsidization of the nuclear industry with providing equivalent support to manufacturing photovoltaic modules. Current U.S. indirect nuclear insurance subsidies are reviewed and the power, energy and financial outcomes of this indirect subsidy are compared to equivalent amounts for indirect subsidies (loan guarantees) for photovoltaic manufacturing using a model that holds economic values constant for clarity. The preliminary analysis indicates that if only this one relatively ignored indirect subsidy for nuclear power was diverted to photovoltaic manufacturing, it would result in more installed power and more energy produced by mid-century. By 2110 cumulative electricity output of solar would provide an additional 48,600 TWh over nuclear worth $5.3 trillion. The results clearly show that not only does the indirect insurance liability subsidy play a significant factor for nuclear industry, but also how the transfer of such an indirect subsidy from the nuclear to photovoltaic industry would result in more energy over the life cycle of the technologies. - Highlights: → The indirect insurance liability subsidy has been quantified over the life cycle of the U.S. nuclear fleet. → It was found to play a significant factor in the economics of the nuclear industry. → A transfer of such an indirect subsidy from the nuclear to photovoltaic industry would result in significantly more energy over the life cycle of the technologies.

  8. Bioelectrochemical Systems for Indirect Biohydrogen Production

    KAUST Repository

    Regan, John M.

    2014-01-01

    Bioelectrochemical systems involve the use of exoelectrogenic (i.e., anode-reducing) microbes to produce current in conjunction with the oxidation of reduced compounds. This current can be used directly for power in a microbial fuel cell, but there are alternate uses of this current. One such alternative is the production of hydrogen in a microbial electrolysis cell (MEC), which accomplishes cathodic proton reduction with a slight applied potential by exploiting the low redox potential produced by exoelectrogens at the anode. As an indirect approach to biohydrogen production, these systems are not subject to the hydrogen yield constraints of fermentative processes and have been proven to work with virtually any biodegradable organic substrate. With continued advancements in reactor design to reduce the system internal resistance, increase the specific surface area for anode biofilm development, and decrease the material costs, MECs may emerge as a viable alternative technology for biohydrogen production. Moreover, these systems can also incorporate other value-added functionalities for applications in waste treatment, desalination, and bioremediation.

  9. The societal costs of insomnia

    Directory of Open Access Journals (Sweden)

    Alan G Wade

    2010-12-01

    Full Text Available Alan G WadeCPS Research, Glasgow, ScotlandObjective: Insomnia can be broadly defined as difficulty initiating or maintaining sleep, or sleep that is not refreshing or of poor quality with negative effect on daytime function. Insomnia can be a primary condition or comorbid to an underlying disorder. Subjective measures of insomnia used in population studies, usually based on complaints of unsatisfactory sleep, put the prevalence at about 10%. Insomnia is more common in the elderly and in women, and is often associated with medical and psychiatric disorders. This review examines the measures used to assess quality of sleep (QOS and daytime functioning and the impact of insomnia on society using these measures.Methods: Literature searches were performed to identify all studies of insomnia (primary and comorbid in adults (aged 18–64 years and the elderly (aged ≥ 65 years with baseline and/or outcomes relating to QOS or daytime functioning. The impact of poor QOS on quality of life (QOL, psychomotor and cognitive skills, health care resource utilization, and other societal effects was examined.Results: Although definitions and measurement scales used to assess sleep quality vary widely, it is clear that the societal consequences of insomnia are substantial and include impaired QOL and increased health care utilization. The impact of poor QOS and impaired daytime functioning common in insomnia can lead to indirect effects such as lower work productivity, increased sick leave, and a higher rate of motor vehicle crashes.Conclusions: Insomnia is associated with substantial direct and indirect costs to society. It is almost impossible to separate the costs associated with primary and comorbid insomnia. More studies are required which control for the severity of any primary disorder to accurately evaluate the costs of comorbid insomnia. Development of standardized diagnostic and assessment scales will enable more accurate quantification of the true

  10. Performance comparison of direct and indirect lighting systems

    International Nuclear Information System (INIS)

    Rubinstein, F.; Morse, O.; Clark, T.

    1993-01-01

    The performance of a retrofitted indirect lighting system was compared to the performance of a typical de-lamped direct lighting system in a partitioned office space. Power, illuminance and luminance measurements were made for the de-lamped direct lighting system and after installation of the indirect lighting system with various lamp and ballast combinations. Using the same lamps and ballasts, average workplace illuminance was slightly higher with indirect lighting than with direct lighting. With indirect lighting, workplace lumen efficacy was 4.5% lower due to the higher power draw of the lamps in the more open and cooler indirect fixtures. Indirect lighting with 36 watt T-8 lamps and electronic ballasts achieved an initial average workplace illuminance of 45 foot-candles in the partitioned office space at only 1.1 w/ft 2

  11. Direct and indirect mortality in Florida during the 2004 hurricane season

    Science.gov (United States)

    McKinney, Nathan; Houser, Chris; Meyer-Arendt, Klaus

    2011-07-01

    Previous studies have shown that natural disasters, and hurricanes in particular, have led to more deaths than those usually documented in short post-storm surveys. Such indirect deaths, thought to be related to dietary, stress or pre-existing medical conditions, can exceed the number of direct deaths and may persist for weeks or even months beyond the event itself. In the present study, cumulative sum of deviations plots are used to quantify the number of direct and indirect deaths resulting from Hurricanes Charley, Frances, Ivan and Jeanne that made landfall in Florida in 2004. Results suggest that there was an elevated mortality for up to 2 months following each storm, resulting in a total of 624 direct and indirect deaths attributable to the storm. Trauma-related deaths that can be associated directly with the storm account for only ˜4% of the total storm-related mortality, while indirect mortality accounts for most storm-related deaths. Specifically, a large percentage of the elevated mortality was associated with heart (34%) and cancer-related deaths (19%), while diabetes (5%) and accident-related deaths (9%) account for a smaller but still significant percentage of the elevated mortality. The results further suggest that the elevated mortality was the result of additional deaths that would not have otherwise occurred within that 5 month period, and not simply a clustering of deaths that were inevitable between 1 August and 31 December 2004. The elevated mortality identified in this study is significantly greater than the official count of 31 direct and 113 indirect deaths resulting from the four hurricanes combined. This suggests a need for improved mortality counts and surveillance in order to better evaluate and identify effective prevention policies, and to identify preventable deaths.

  12. Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial.

    Science.gov (United States)

    Polinder, Suzanne; Boyé, Nicole D A; Mattace-Raso, Francesco U S; Van der Velde, Nathalie; Hartholt, Klaas A; De Vries, Oscar J; Lips, Paul; Van der Cammen, Tischa J M; Patka, Peter; Van Beeck, Ed F; Van Lieshout, Esther M M

    2016-11-04

    The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers. In a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with 'care as usual' in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance. We included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups. Withdrawal of FRID's in older persons who visited an emergency department due to a fall, did not lead to

  13. Transaction costs of unilateral CDM projects in India-results from an empirical survey

    International Nuclear Information System (INIS)

    Krey, Matthias

    2005-01-01

    Recently, transaction costs in the context of the Clean Development Mechanism (CDM) gained considerable attention as they were generally perceived to be significantly higher than for the other Kyoto Mechanisms. However, empirical evidence on the amount of transaction costs of CDM projects is very scarce. This paper presents the results from an empirical survey designed to quantify transaction costs of potential non-sink CDM projects in India. The definition of transaction costs of CDM projects was derived from recent literature and observations made in the current market for Certified Emission Reductions (CERs). During the survey, parts of transaction costs of 15 projects were quantified. An assessment of the results showed that specific transaction costs depend, to a large extent, on economies of scale in terms of total amount of CERs generated over the crediting period. Total transaction costs were quantified for seven projects. The costs range from 0.07 to 0.47 dollar/t CO 2 . As the projects have an emission reduction between 0.24 Mt CO 2 and 5.00 Mt CO 2 over the crediting period, the results support the assumption of Michaelowa et al. (Climate Policy 3 (2003) 273) that projects with emission reductions smaller than 0.20 Mt CO 2 are not economically viable at current CER prices

  14. Pharmacoeconomic Analysis of Drugs Used in the Treatment of Pneumonia in Paediatric Population in a Tertiary Care Hospital in India—A Cost-of-Illness Study

    Directory of Open Access Journals (Sweden)

    Lekha Saha

    2017-12-01

    Full Text Available Aims and objectives: The cost of antibiotic therapy for the treatment of pneumonia in the inpatient paediatric population can have a major impact on the healthcare expenditure. We planned to assess the direct and indirect costs of diagnosis and medical treatment of paediatric patients with community acquired pneumonia who are hospitalized in a tertiary care hospital in India. Methods: 125 children with a diagnosis of pneumonia who were admitted to the inpatient department of a paediatric hospital receiving antibiotic treatment were observed. Data on clinical presentation and resources consumed were collected and the costs of pneumonia treatment were calculated. Descriptive statistics (mean ± standard deviation (SD were used to evaluate data regarding demographics, drugs prescribed and cost (direct and indirect cost. Multivariate regression analysis was used to find out predictors of direct and indirect cost. Results: Among all pneumonia admissions, mild-to-moderate pneumonia constitutes 76.8%, and 23.2% children were admitted with severe pneumonia; 105 children out of 125 (84% were suffering from associated disorders along with pneumonia. The majority of antibiotics prescribed belonged to beta lactams (52% followed by aminoglycosides (19%, macrolides (13% and peptides (11%. Parenteral routes of administration were used in a majority of patients as compared to oral. The average cost per patient in management of pneumonia was 12245 ± 593 INR ($187.34 ± 9.07.

  15. Comparative cost of illness analysis and assessment of health care burden of Duchenne and Becker muscular dystrophies in Germany.

    Science.gov (United States)

    Schreiber-Katz, Olivia; Klug, Constanze; Thiele, Simone; Schorling, Elisabeth; Zowe, Janet; Reilich, Peter; Nagels, Klaus H; Walter, Maggie C

    2014-12-18

    Our study aimed to determine the burden of illness in dystrophinopathy type Duchenne (DMD) and Becker (BMD), both leading to progressive disability, reduced working capacity and high health care utilization. A micro-costing method was used to examine the direct, indirect and informal care costs measuring the economic burden of DMD in comparison to BMD on patients, relatives, payers and society in Germany and to determine the health care burden of these diseases. Standardized questionnaires were developed based on predefined structured interview guidelines to obtain data directly from patients and caregivers using the German dystrophinopathy patient registry. The health-related quality of life (HRQOL) was analyzed using PedsQL™ Measurement Model. In total, 363 patients with genetically confirmed dystrophinopathies were enrolled. Estimated annual disease burden including direct medical/non-medical, indirect and informal care costs of DMD added up to € 78,913 while total costs in BMD were € 39,060. Informal care costs, indirect costs caused by loss of productivity and absenteeism of patients and caregivers as well as medical costs of rehabilitation services and medical aids were identified as the most important cost drivers. Total costs notably increased with disease progression and were consistent with the clinical severity; however, patients' HRQOL declined with disease progression. In conclusion, early assessments of economic aspects and the disease burden are essential to gain extensive knowledge of a distinct disease and above all play an important role in funding drug development programs for rare diseases. Therefore, our results may help to accelerate payer negotiations such as the pricing and reimbursement of new therapies, and will hopefully contribute to facilitating the efficient translation of innovations from clinical research over marketing authorization to patient access to a causative treatment.

  16. THE POSSIBILITIES AND RESULTS OF INDIRECT COMPARISON OF BIOLOGICAL AGENTS IN ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    Sh. F. Erdes

    2016-01-01

    Full Text Available The paper analyzes two matching-adjusted indirect comparison-based investigations of the efficacy of adalimumab (ADA and secukinumab (SCM in active ankylosing spondylitis, which have been recently reported at the EULAR Congress (London, 2016. One study sponsored by AbbVie was conducted to determine the short-term (16-week comparative clinical and economic efficacy of the test drugs and the other was supported by Novartis to reveal long-term (52-week, only clinical efficacy. Both studies have shown that the short-term efficacy ofADAand SCM is practically similar; however, the latter has a better long-term clinical efficacy. A pharmacoeconomic analysis of both drugs used during the first 12 weeks has demonstrated some advantage ofADA. 

  17. Integrating Efficiency of Industry Processes and Practices Alongside Technology Effectiveness in Space Transportation Cost Modeling and Analysis

    Science.gov (United States)

    Zapata, Edgar

    2012-01-01

    This paper presents past and current work in dealing with indirect industry and NASA costs when providing cost estimation or analysis for NASA projects and programs. Indirect costs, when defined as those costs in a project removed from the actual hardware or software hands-on labor; makes up most of the costs of today's complex large scale NASA space/industry projects. This appears to be the case across phases from research into development into production and into the operation of the system. Space transportation is the case of interest here. Modeling and cost estimation as a process rather than a product will be emphasized. Analysis as a series of belief systems in play among decision makers and decision factors will also be emphasized to provide context.

  18. Direct and indirect two-photon processes in semiconductors

    International Nuclear Information System (INIS)

    Hassan, A.R.

    1986-07-01

    The expressions describing direct and indirect two-photon absorption in crystals are given. They are valid both near and far from the energy gap. A perturbative approach through two different band models is adopted. The effects of the non-parabolicity and the degeneracy of the energy bands are considered. The numerical results are compared with the other theories and with a recent experimental data in Zn and AgCl. It is shown that the dominant transition mechanisms are of the allowed-allowed type near and far from the gap for both direct and indirect processes. (author)

  19. Indirect N2O emission due to atmospheric N deposition for the Netherlands

    International Nuclear Information System (INIS)

    Denier van der Gon, H.; Bleeker, A.

    2005-10-01

    Nitrous oxide (N2O) is a potent greenhouse gas produced in soils and aquatic systems. The UNFCCC requires participants to report 'indirect' N2O emissions, following from agricultural N losses to ground- and surface water and N deposition on (other) ecosystems due to agricultural sources. Indirect N2O emission due to atmospheric N deposition is presently not reported by the Netherlands. In this paper, we quantify the consequences of various tiers to estimate indirect N2O due to deposition for a country with a high agricultural N use and discuss the reliability and potential errors in the IPCC methodology. A literature review suggests that the current IPCC default emission factor for indirect N2O from N deposition is underestimated by a factor 2. Moreover, considering anthropogenic N emissions from agriculture only and not from e.g., traffic and industry, results in further underestimation of indirect N2O emissions. We calculated indirect N2O emissions due to Dutch anthropogenic N emissions to air by using official Dutch N emission data as input in an atmospheric transport and deposition model in combination with land use databases. Next, land use-specific emission factors were used to estimate the indirect N2O emission. This revealed that (1) for some countries, like the Netherlands, most agricultural N emitted will be deposited on agricultural soils, not on natural ecosystems and, (2) indirect N2O emissions are at least 20% higher because more specific emission factors can be applied that are higher than the IPCC default. The results suggest that indirect N2O emission due to deposition is underestimated in current N2O budgets

  20. Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study

    Directory of Open Access Journals (Sweden)

    Konnopka Alexander

    2012-09-01

    Full Text Available Abstract Background Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design. Methods A sample of 531 back pain patients was interviewed after an initial disc surgery (T0, 3 months (T1 and 15 months (T2 using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques. Results Psychiatric comorbidity was associated with significantly (p  Conclusion Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

  1. 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

  2. What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

    Science.gov (United States)

    Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

    2016-01-01

    Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

  3. Comparison of a direct and indirect ELISA for quantitating antisperm antibody in semen.

    Science.gov (United States)

    Lynch, D M; Howe, S E

    1987-01-01

    A direct and an indirect quantitative ELISA for antisperm antibody were compared using the spermatozoa and cell-free seminal fluid of 66 infertile males. The normal concentration of sperm binding immunoglobulin was less than or equal to 1.5 fg Ig per spermatozoon for the indirect seminal plasma assay and less than or equal to 1.5 fg Ig per spermatozoon by the direct assay. Of the 66 infertile males, 21% (14/66) had elevated levels of antisperm antibody in their seminal plasma and 26% (17/66) had elevated levels bound directly to their spermatozoa. The direct correlation between the results of these assays was 94%. A simple linear regression analysis between the indirect and direct measurements of antisperm antibody resulted in a correlation coefficient of r = 0.907. There was no statistically significant difference between results from the direct and indirect methods of the patients as a group. However, there was evidence of autospecificity in a small percentage of males who had elevated levels of antisperm antibody by the direct assay that was not detected by the indirect assay using pooled donor spermatozoa.

  4. Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mohammad Ashraf Wani

    2013-01-01

    Materials and Methods: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. Results: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96. This includes expenditure incurred both by the hospital and the patient (out of pocket. Conclusion: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

  5. Ballistic fractures: indirect fracture to bone.

    Science.gov (United States)

    Dougherty, Paul J; Sherman, Don; Dau, Nathan; Bir, Cynthia

    2011-11-01

    Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Twenty-eight fresh frozen cadaveric diaphyseal tibia (2) and femurs (26) were implanted into ordnance gelatin blocks. Shots were fired using 9- and 5.56-mm bullets traversing through the gelatin only, passing close to the edge of the bone, but not touching, to produce an indirect fracture. High-speed video of the impact event was collected at 20,000 frames/s. Acquisition of the strain data were synchronized with the video at 20,000 Hz. The exact time of fracture was determined by analyzing and comparing the strain gauge output and video. Twenty-eight shots were fired, 2 with 9-mm bullets and 26 with 5.56-mm bullets. Eight indirect fractures that occurred were of a simple (oblique or wedge) pattern. Comparison of the average distance of the projectile from the bone was 9.68 mm (range, 3-20 mm) for fractured specimens and 15.15 mm (range, 7-28 mm) for nonfractured specimens (Student's t test, p = 0.036). In this study, indirect fractures were produced after passage of the projectile. Thus, the temporary cavity, not the sonic wave, was responsible for the indirect fractures.

  6. Applying Activity Based Costing (ABC) Method to Calculate Cost Price in Hospital and Remedy Services.

    Science.gov (United States)

    Rajabi, A; Dabiri, A

    2012-01-01

    Activity Based Costing (ABC) is one of the new methods began appearing as a costing methodology in the 1990's. It calculates cost price by determining the usage of resources. In this study, ABC method was used for calculating cost price of remedial services in hospitals. To apply ABC method, Shahid Faghihi Hospital was selected. First, hospital units were divided into three main departments: administrative, diagnostic, and hospitalized. Second, activity centers were defined by the activity analysis method. Third, costs of administrative activity centers were allocated into diagnostic and operational departments based on the cost driver. Finally, with regard to the usage of cost objectives from services of activity centers, the cost price of medical services was calculated. The cost price from ABC method significantly differs from tariff method. In addition, high amount of indirect costs in the hospital indicates that capacities of resources are not used properly. Cost price of remedial services with tariff method is not properly calculated when compared with ABC method. ABC calculates cost price by applying suitable mechanisms but tariff method is based on the fixed price. In addition, ABC represents useful information about the amount and combination of cost price services.

  7. RESEMBLANCE OF INDIRECTNESS IN POLITENESS OF EFL LEARNERS’ REQUEST REALIZATIONS

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    Indawan Syahri

    2013-07-01

    Full Text Available Abstract: Politeness principles are universally utilized by the speakers of any language when realizing various speech acts. However, the speakers of particular languages relatively apply politeness due to the cultural norms embedded. The present study attempts to delineate how the Indonesian learners of English (ILE apply the politeness principles in request realizations. Specifically it devotes to the types of politeness strategies applied and resemblance of the indirectness in politeness strategies in requesting acts. The FTAs and indirectness are the theoretical bases used to trace the typologies of both politeness and request strategies. The data werere collected by means of certain elicitation techniques, i.e. DCTs and Role-plays. The analyses werere done through three stages; determining request strategies, politeness strategies, and resemblance of indirectness in politeness. The results show that the indirectness generally is parallel to politeness. Besides, some pragmatic transfers are found in terms of applying native-culture norms in realizing target speech acts.

  8. Cost of initial management of musculoskeletal injuries due to road traffic crashes: A register-based study from North-West India

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    Bhanu Awasthi

    2017-01-01

    Full Text Available Background: There is a paucity of information on the actual costs incurred by the family as a result of musculoskeletal injuries due to road traffic crash from our part of India. This study was conducted with the objective to ascertain the costs of initial management of musculoskeletal injuries due to road traffic crashes. Materials and Methods: This prospective study was conducted as a register-based descriptive study in a tertiary care teaching hospital in a rural area (with a predominantly mountainous terrain of North-West India. All patients with nonfatal musculoskeletal injuries due to road traffic crashes, presenting between 2014 and 2015 and agreeing to participate in the study were included in the study. Results: Of 313 cases, 116 were managed conservatively, whereas in 189 cases, operative intervention was required. In 8 cases, both the modalities of management were required. The average cost of management was Rs. 20,386 in operative group. The average cost in the conservative group was Rs. 3726. Average cost calculated for patients in whom both modality of treatment was required was Rs. 24,000. It was observed that the indirect cost of management was proportionately higher in conservative group. Conclusions: The initial cost of management for patients managed conservatively is less than those managed by operative intervention. Importantly, however, the indirect cost of management is a major contributor to the total cost of management.

  9. Indirect effects of recreation on wildlife

    Science.gov (United States)

    David N. Cole; Peter B. Landres

    1995-01-01

    Most of this book focuses on direct impacts to wildlife that result from contact with people. The purpose of our chapter is to provide a broad overview of the indirect influences that recreation has on wildlife. Recreational activities can change the habitat of an animal. This, in turn, affects the behavior, survival, reproduction, and distribution of individuals....

  10. Expression of future prospective in indirect speech

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    Bodnaruk Elena Vladimirovna

    2015-03-01

    Full Text Available The article analyzes the characteristics and use of grammatical semantics and lexical and grammatical means used to create future prospects in double indirect discourse. The material for the study were epic works by contemporary German writers. In the analysis of the empirical material it has been pointed out that indirect discourse has preterial basis and is the kind of most frequent inner speech of characters. The most widely used form with future semantics in preterial indirect speech is conditional I, formally having a conjunctive basis, but is mostly used with the indicative semantics. Competitive to conditional I in indirect speech is preterial indicative. A characteristic feature of the indirect speech is the use of modal verbs, which, thanks to its semantics is usually referred as an action at a later term, creating the prospect of future statements. The most frequent were modal verbs wollen and sollen in the form of the preterite, more rare verbs were m ssen and k nnen. German indirect speech distinguishes the ability to use forms on the basis of conjunctive: preterite and plusquamperfect of conjunctive. Both forms express values similar to those of the indicative. However, conjunctive forms the basis of the data shown in a slightly more pronounced seme of uncertainty that accompanies future uses of these forms in indirect speech. In addition, plusquamperfect conjunctive differs from others by the presence of the seme of completeness.

  11. Synchronization of indirectly coupled Lorenz oscillators

    Indian Academy of Sciences (India)

    Synchronization of indirectly coupled Lorenz oscillators: An experimental study. Amit Sharma Manish Dev Shrimali. Synchronization, Coupled Systems and Networks Volume 77 Issue 5 November 2011 pp 881-889 ... The in-phase and anti-phase synchronization of indirectly coupled chaotic oscillators reported in Phys. Rev ...

  12. The Economic Costs of Type 2 Diabetes: A Global Systematic Review.

    Science.gov (United States)

    Seuring, Till; Archangelidi, Olga; Suhrcke, Marc

    2015-08-01

    There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis

  13. Groupwise information sharing promotes ingroup favoritism in indirect reciprocity

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    Nakamura Mitsuhiro

    2012-11-01

    Full Text Available Abstract Background Indirect reciprocity is a mechanism for cooperation in social dilemma situations. In indirect reciprocity, an individual is motivated to help another to acquire a good reputation and receive help from others afterwards. Another aspect of human cooperation is ingroup favoritism, whereby individuals help members in their own group more often than those in other groups. Ingroup favoritism is a puzzle for the theory of cooperation because it is not easily evolutionarily stable. In the context of indirect reciprocity, ingroup favoritism has been shown to be a consequence of employing a double standard when assigning reputations to ingroup and outgroup members. An example of such a double standard is the situation in which helping an ingroup member is regarded as good, whereas the same action toward an outgroup member is regarded as bad. Results We analyze a computational model of indirect reciprocity in which information sharing is conducted groupwise. In our model, individuals play social dilemma games within and across groups, and the information about their reputations is shared within each group. We show that evolutionarily stable ingroup favoritism emerges even if all the players use the same reputation assignment rule regardless of group (i.e., a single standard. Two reputation assignment rules called simple standing and stern judging yield ingroup favoritism; under these rules, cooperation with (defection against good individuals is regarded as good (bad and defection against bad individuals is regarded as good. Stern judging induces much stronger ingroup favoritism than does simple standing. Simple standing and stern judging are evolutionarily stable against each other when groups employing different assignment rules compete and the number of groups is sufficiently large. In addition, we analytically show as a limiting case that homogeneous populations of reciprocators that use reputations are unstable when individuals

  14. [Calculation of workers' health care costs].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2006-01-01

    In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference

  15. Technical and economic assessment of producing hydrogen by reforming syngas from the Battelle indirectly heated biomass gasifier

    International Nuclear Information System (INIS)

    Mann, M.K.

    1995-08-01

    The technical and economic feasibility of producing hydrogen from biomass by means of indirectly heated gasification and steam reforming was studied. A detailed process model was developed in ASPEN Plus trademark to perform material and energy balances. The results of this simulation were used to size and cost major pieces of equipment from which the determination of the necessary selling price of hydrogen was made. A sensitivity analysis was conducted on the process to study hydrogen price as a function of biomass feedstock cost and hydrogen production efficiency. The gasification system used for this study was the Battelle Columbus Laboratory (BCL) indirectly heated gasifier. The heat necessary for the endothermic gasification reactions is supplied by circulating sand from a char combustor to the gasification vessel. Hydrogen production was accomplished by steam reforming the product synthesis gas (syngas) in a process based on that used for natural gas reforming. Three process configurations were studied. Scheme 1 is the full reforming process, with a primary reformer similar to a process furnace, followed by a high temperature shift reactor and a low temperature shift reactor. Scheme 2 uses only the primary reformer, and Scheme 3 uses the primary reformer and the high temperature shift reactor. A pressure swing adsorption (PSA) system is used in all three schemes to produce a hydrogen product pure enough to be used in fuel cells. Steam is produced through detailed heat integration and is intended to be sold as a by-product

  16. Societal costs of multiple sclerosis in Ireland.

    Science.gov (United States)

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

    2018-05-01

    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.

  17. Indirect Competitive Enzyme-Linked Immunosorbent Assay (ELISA).

    Science.gov (United States)

    Kohl, Thomas O; Ascoli, Carl A

    2017-07-05

    The indirect competitive ELISA (indirect cELISA) pits plate-immobilized antigen against antigens in solution for binding to antigen-specific antibody. The antigens in solution are in the test sample and are first incubated with antigen-specific antibody. These antibody-antigen complexes are then added to microtiter plates whose wells have been coated with purified antigen. The wells are washed to remove unbound antigen-antibody complexes and free antigen. A reporter-labeled secondary antibody is then added followed by the addition of substrate. Substrate hydrolysis yields a signal that is inversely proportional to antigen concentration within the sample. This is because when antigen concentration is high in the test sample, most of the antibody is bound before adding the solution to the plate. Most of the antibody remains in solution (as complexes) and is thus washed away before the addition of the reporter-labeled secondary antibody and substrate. Thus, the higher the antigen concentration in the test sample, the weaker the resultant signal in the detection step. The indirect cELISA is often used for competitive detection and quantification of antibodies against viral diseases in biological samples. © 2017 Cold Spring Harbor Laboratory Press.

  18. 2 CFR Appendix E to Part 225 - State and Local Indirect Cost Rate Proposals

    Science.gov (United States)

    2010-01-01

    ... organizational structure of the agency during the period for which the proposal applies, along with a functional... grantee department or agency, depreciation or use allowances on buildings and equipment, the costs of... period, usually the governmental unit's fiscal year. This rate is based on an estimate of the costs to be...

  19. THE INDIRECT OBJECT (IO) – ALBANIAN AND ENGLISH

    OpenAIRE

    Shkelqim Millaku; Xhevahire Topanica

    2016-01-01

    The aim of this study is too corporate the function of the indirect object between Albanian and English language. The function and the Albanian typical case for indirect object are dative and ablative. This grammatical phenomena is the full contrast between two languages because in English language doesn’t exist dative and ablative us in Albanian. In Albanian and English language, the indirect object is more heterogenic than the direct object. The indirect (direct) object in both of languages...

  20. An improved recommendation algorithm via weakening indirect linkage effect

    Science.gov (United States)

    Chen, Guang; Qiu, Tian; Shen, Xiao-Quan

    2015-07-01

    We propose an indirect-link-weakened mass diffusion method (IMD), by considering the indirect linkage and the source object heterogeneity effect in the mass diffusion (MD) recommendation method. Experimental results on the MovieLens, Netflix, and RYM datasets show that, the IMD method greatly improves both the recommendation accuracy and diversity, compared with a heterogeneity-weakened MD method (HMD), which only considers the source object heterogeneity. Moreover, the recommendation accuracy of the cold objects is also better elevated in the IMD than the HMD method. It suggests that eliminating the redundancy induced by the indirect linkages could have a prominent effect on the recommendation efficiency in the MD method. Project supported by the National Natural Science Foundation of China (Grant No. 11175079) and the Young Scientist Training Project of Jiangxi Province, China (Grant No. 20133BCB23017).

  1. The cost of community-managed viral respiratory illnesses in a cohort of healthy preschool-aged children

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    Allen Kelly M

    2008-01-01

    Full Text Available Abstract Background Acute respiratory illnesses (ARIs during childhood are often caused by respiratory viruses, result in significant morbidity, and have associated costs for families and society. Despite their ubiquity, there is a lack of interdisciplinary epidemiologic and economic research that has collected primary impact data, particularly associated with indirect costs, from families during ARIs in children. Methods We conducted a 12-month cohort study in 234 preschool children with impact diary recording and PCR testing of nose-throat swabs for viruses during an ARI. We used applied values to estimate a virus-specific mean cost of ARIs. Results Impact diaries were available for 72% (523/725 of community-managed illnesses between January 2003 and January 2004. The mean cost of ARIs was AU$309 (95% confidence interval $263 to $354. Influenza illnesses had a mean cost of $904, compared with RSV, $304, the next most expensive single-virus illness, although confidence intervals overlapped. Mean carer time away from usual activity per day was two hours for influenza ARIs and between 30 and 45 minutes for all other ARI categories. Conclusion From a societal perspective, community-managed ARIs are a significant cost burden on families and society. The point estimate of the mean cost of community-managed influenza illnesses in healthy preschool aged children is three times greater than those illnesses caused by RSV and other respiratory viruses. Indirect costs, particularly carer time away from usual activity, are the key cost drivers for ARIs in children. The use of parent-collected specimens may enhance ARI surveillance and reduce any potential Hawthorne effect caused by compliance with study procedures. These findings reinforce the need for further integrated epidemiologic and economic research of ARIs in children to allow for comprehensive cost-effectiveness assessments of preventive and therapeutic options.

  2. Special considerations regarding indirect expropriation in international economic law

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