WorldWideScience

Sample records for long-term perspective cost-utility

  1. Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Bünger, Cody E; Christiansen, Terkel

    2007-01-01

    STUDY DESIGN: Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up. OBJECTIVE: To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective. SUMMARY...... OF BACKGROUND DATA: The cost-effectiveness of circumferential fusion in a long-term perspective is uncertain but nonetheless highly relevant as the ISSLS prize winner 2006 in clinical studies reported the effect of circumferential fusion superior to the effect of posterolateral fusion. A recent trial found...... no significant difference between posterolateral and circumferential fusion reporting cost-effectiveness from a 2-year viewpoint. METHODS: A total of 146 patients were randomized to posterolateral or circumferential fusion and followed 4 to 8 years after surgery. The mean age of the cohort was 46 years (range...

  2. The long-term power purchase: Recovery of capacity costs

    International Nuclear Information System (INIS)

    Cross, P.S.

    1990-01-01

    As electric utilities increase their reliance on the long-term power purchase as an alternative to utility-owned generation, the appropriate rate treatment of the costs established in the purchase agreement assumes growing importance. In the November 9, 1989, issue, the authors examined the recent trend among state regulators to treat the long-term purchase in a manner similar to the addition by a utility of a new plant, including a full-scale prudence review. This installment will review recent rulings on the related issue of rate recovery of long-term capacity costs through the fuel cost adjustment clause

  3. A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy.

    Science.gov (United States)

    Berghout, Caspar C; Zevalkink, Jolien; Hakkaart-van Roijen, Leona

    2010-01-01

    Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility study, we examined the incremental cost-effectiveness ratio (ICER) of psychoanalysis versus psychoanalytic psychotherapy. Incremental costs and effects were estimated by means of cross-sectional measurements in a cohort design (psychoanalysis, n = 78; psychoanalytic psychotherapy, n = 104). Quality-adjusted life-years (QALYs) were estimated for each treatment strategy using the SF-6D. Total costs were calculated from a societal perspective (treatment costs plus other societal costs) and discounted at 4 percent. Psychoanalysis was more costly than psychoanalytic psychotherapy, but also more effective from a health-related quality of life perspective. The ICER--that is, the extra costs to gain one additional QALY by delivering psychoanalysis instead of psychoanalytic psychotherapy--was estimated at 52,384 euros per QALY gained. Our findings show that the cost-utility ratio of psychoanalysis relative to psychoanalytic psychotherapy is within an acceptable range. More research is needed to find out whether cost-utility ratios vary with different types of patients. We also encourage cost-utility analyses comparing psychoanalytic treatment to other forms of (long-term) treatment.

  4. Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

    Directory of Open Access Journals (Sweden)

    Evan S. Cole

    2016-09-01

    Full Text Available Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%. Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0, lengths of stay (61 versus 38 days, costs (US$143,898 versus US$115,056, but fewer discharges to the community (28.4% versus 51.8%. Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that

  5. Recovery of Utility Fixed Costs: Utility, Consumer, Environmental and Economist Perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Lisa [Inst. for Electric Innovation and The Edison Foundation, Washington DC (United States); Hemphill, Ross [RCHemphill Solutions, Columbus, OH (United States); Howat, John [National Consumer Law Center, Boston, MA (United States); Cavanagh, Ralph [Natural Resources Defense Council, New York, NY (United States); Borenstein, Severin [Univ. of California, Berkeley, CA (United States); Deason, Jeff [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-06-14

    Utilities recover costs for providing electric service to retail customers through a combination of rate components that together comprise customers’ monthly electric bills. Rates and rate designs are set by state regulators and vary by jurisdiction, utility and customer class. In addition to the fundamental tenet of setting fair and reasonable rates, rate design balances economic efficiency, equity and fairness, customer satisfaction, utility revenue stability, and customer price and bill stability.1 At the most basic level, retail electricity bills in the United States typically include a fixed monthly customer charge — a set dollar amount regardless of energy usage — and a volumetric energy charge for each kilowatt-hour consumed.2 The energy charge may be flat across all hours, vary by usage level (for example, higher rates at higher levels of usage), or vary based on time of consumption.3 While some utility costs, such as fuel costs, clearly vary according to electricity usage, other costs are “fixed” over the short run — generally, those that do not vary over the course of a year. Depending on your point of view, and whether the state’s electricity industry has been restructured or remains vertically integrated, the set of costs that are “fixed” may be quite limited. Or the set may extend to all capacity costs for generation, transmission and distribution. In the long run, all costs are variable. In the context of flat or declining loads in some regions, utilities are proposing a variety of changes to retail rate designs, particularly for residential customers, to recover fixed costs. In this report, authors representing utility (Chapter 1), consumer (Chapter 2), environmentalist (Chapter 3) and economist (Chapter 4) perspectives discuss fixed costs for electric utilities and set out their principles for recovering those costs. The table on the next page summarizes each author’s relative preferences for various options for fixed cost

  6. Impact of power purchases from non-utilities on the utility cost of capital

    International Nuclear Information System (INIS)

    Kahn, E.; Stoft, S.; Belden, T.

    1995-01-01

    The bond rating agencies in the USA have asserted that long-term power purchase contracts between non-utility generators and utilities are the equivalent of debt to the utilities, and therefore raise the cost of capital to the purchaser. Non-Utility generators claim that these contracts reduce risk to the utilities. This debate is reflected in the 1992 Energy Policy Act. This paper investigates this controversy from the perspective of the equity markets. Using a CAPM framework, various specifications of the cost of equity capital are estimated, to shed light on this question. No evidence is found for the hypothesis that non-utility generation contracts raise the cost of capital. There does appear to be a slight increase in this cost for those utilities seeking to build their own generation capacity as opposed to purchasing it from non-utility suppliers. (author)

  7. Impact of short-term severe accident management actions in a long-term perspective. Final Report

    International Nuclear Information System (INIS)

    2000-03-01

    The present systems for severe accident management are focused on mitigating the consequences of special severe accident phenomena and to reach a safe plant state. However, in the development of strategies and procedures for severe accident management, it is also important to consider the long-term perspective of accident management and especially to secure the safe state of the plant. The main reason for this is that certain short-term actions have an impact on the long-term scenario. Both positive and negative effects from short-term actions on the accident management in the long-term perspective have been included in this paper. Short-term actions are accident management measures taken within about 24 hours after the initiating event. The purpose of short-term actions is to reach a stable status of the plant. The main goal in the long-term perspective is to maintain the reactor in a stable state and prevent uncontrolled releases of activity. The purpose of this short Technical Note, deliberately limited in scope, is to draw attention to potential long-term problems, important to utilities and regulatory authorities, arising from the way a severe accident would be managed during the first hours. Its objective is to encourage discussions on the safest - and maybe also most economical - way to manage a severe accident in the long term by not making the situation worse through inappropriate short-term actions, and on the identification of short-term actions likely to make long-term management easier and safer. The Note is intended as a contribution to the knowledge base put at the disposal of Member countries through international collaboration. The scope of the work has been limited to a literature search. Useful further activities have been identified. However, there is no proposal, at this stage, for more detailed work to be undertaken under the auspices of the CSNI. Plant-specific applications would need to be developed by utilities

  8. Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix instrument.

    Science.gov (United States)

    Urquhart, J; Kennie, D C; Murdoch, P S; Smith, R G; Lennox, I

    1999-03-01

    to create a casemix measure with a limited number of categories which discriminate in terms of resource use and will assist in the development of a currency for contracting for the provision of health care. nursing staff completed a questionnaire providing clinical data and also gave estimates of relative patient resource use; ward-based costs were collected from appropriate unit managers. National Health Service continuing-care wards in 50 Scottish hospitals. 2783 long-stay patients aged 65 years and over. inter-rater reliability was assessed using 1402 patients; percentage agreement between raters for individual variables varied from 68% for feeding to 97% for clinically complex treatments. Nursing costs gave 62% agreement given categories of high, medium and low. The Scottish health service resource utilization groups (SHRUG) measure was developed using 606 cases, and 67% consistency was achieved for the five categories. The relative weights for the SHRUG categories ranged from 0.56 to 1.41. The five categories explain 35% of variance in costs. the five SHRUG casemix categories show good discrimination in terms of costs. The SHRUG measure compares favourably with diagnosis-related groups in the acute sector and with other casemix instruments for long-term care previously piloted in the UK. SHRUG is a useful measurement instrument in assessing the resource needs of elderly people in long-term care.

  9. Long-term cost-effectiveness of disease management in systolic heart failure.

    Science.gov (United States)

    Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

    2009-01-01

    Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

  10. Benefit-cost aspects of long-term isolation of uranium mill tailings

    International Nuclear Information System (INIS)

    Van Dyke, J.

    1983-11-01

    The Uranium Mill Tailings Radiation Control Act of 1978 provides for regulations for control of radon diffusion from uranium mill tailings to protect the public welfare. In developing these regulations, the Office of Nuclear Material Safety and Safeguards of the Nuclear Regulatory Commission has sought to establish the benefits and costs for alternative regulatory criteria. This report provides a perspective on some economic issues associated with long-term radiation effects from disposal of uranium mill tailings. The general problem of developing an economic rationale for regulating this activity is complicated by the very long-term and widespread effects which could result from radon gas diffusion associated with tailings piles. The economic issues are also complex because of the trade-offs between costs of disposal and intangible social values. When intergenerational implications were considered the traditional basis for discounting in a benefit-cost framework was found to shift. The appropriate rate of discount was found to depend on ethical assumptions and expectations about the relative welfare of future generations. 30 references, 1 figure, 2 tables

  11. Benefit-cost aspects of long-term isolation of uranium mill tailings

    Energy Technology Data Exchange (ETDEWEB)

    Van Dyke, J.

    1983-11-01

    The Uranium Mill Tailings Radiation Control Act of 1978 provides for regulations for control of radon diffusion from uranium mill tailings to protect the public welfare. In developing these regulations, the Office of Nuclear Material Safety and Safeguards of the Nuclear Regulatory Commission has sought to establish the benefits and costs for alternative regulatory criteria. This report provides a perspective on some economic issues associated with long-term radiation effects from disposal of uranium mill tailings. The general problem of developing an economic rationale for regulating this activity is complicated by the very long-term and widespread effects which could result from radon gas diffusion associated with tailings piles. The economic issues are also complex because of the trade-offs between costs of disposal and intangible social values. When intergenerational implications were considered the traditional basis for discounting in a benefit-cost framework was found to shift. The appropriate rate of discount was found to depend on ethical assumptions and expectations about the relative welfare of future generations. 30 references, 1 figure, 2 tables.

  12. Long-term health care utilisation and costs after spinal fusion in elderly patients

    DEFF Research Database (Denmark)

    Andersen, Thomas; Bünger, Cody; Søgaard, Rikke

    2012-01-01

    PURPOSE: Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the long-term effects in terms of health care use are largely unknown. The aim of the present study was to describe the long......-term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective. METHODS: 194 patients undergoing spinal fusion between 2001 and 2005 (70 men, 124 women) with a mean age of 70 years (range 59-88) at surgery were included. Average length of follow......-up was 6.2 years (range 0.3-9.0 years). Data on resource utilisation and costs were obtained from national registers providing complete coverage of all reimbursed contacts with primary- and secondary health care providers. Data were available from 3 years prior fusion surgery until the end of 2009. RESULTS...

  13. [Cost-effectiveness research in elderly residents in long-term care: prevention is better than cure, but not always cheaper].

    Science.gov (United States)

    Achterberg, Wilco P; Gussekloo, Jacobijn; van den Hout, Wilbert B

    2015-01-01

    Cost-effectiveness research in elderly residents in long-term care facilities is based on general principals of cost-effectiveness research; these have been developed primarily from the perspective of relatively healthy adults in curative medicine. These principals are, however, inadequate when evaluating interventions for the fragile elderly in long-term care, both in terms of the value attached to the health of patients and to the specific decision-making context of the institution. Here we discuss the pitfalls of cost-effectiveness research in long-term care facilities, illustrated by two prevention interventions for prevalent conditions in nursing homes: pressure ulcers and urinary tract infections. These turned out to be effective, but not cost-effective.

  14. Surrogate utility estimation by long-term partners and unfamiliar dyads.

    Science.gov (United States)

    Tunney, Richard J; Ziegler, Fenja V

    2015-01-01

    To what extent are people able to make predictions about other people's preferences and values?We report two experiments that present a novel method assessing some of the basic processes in surrogate decision-making, namely surrogate-utility estimation. In each experiment participants formed dyads who were asked to assign utilities to health related items and commodity items, and to predict their partner's utility judgments for the same items. In experiment one we showed that older adults in long-term relationships were able to accurately predict their partner's wishes. In experiment two we showed that younger adults who were relatively unfamiliar with one another were also able to predict other people's wishes. Crucially we demonstrated that these judgments were accurate even after partialling out each participant's own preferences indicating that in order to make surrogate utility estimations people engage in perspective-taking rather than simple anchoring and adjustment, suggesting that utility estimation is not the cause of inaccuracy in surrogate decision-making. The data and implications are discussed with respect to theories of surrogate decision-making.

  15. Surrogate utility estimation by long-term partners and unfamiliar dyads

    Directory of Open Access Journals (Sweden)

    Richard J Tunney

    2015-03-01

    Full Text Available To what extent are people able to make predictions about other people’s preferences and values? We report two experiments that present a novel method assessing some of the basic processes in surrogate decision-making, namely surrogate-utility estimation. In each experiment participants formed dyads who were asked to assign utilities to health related items and commodity items, and to predict their partner’s utility judgments for the same items. In experiment one we showed that older adults in long-term relationships were able to accurately predict their partner’s wishes. In experiment two we showed that younger adults who were relatively unfamiliar with one another were also able to predict other people’s wishes. Crucially we demonstrated that these judgments were accurate even after partialling out each participant’s own preferences indicating that in order to make surrogate utility estimations people engage in perspective-taking rather than simple anchoring and adjustment, suggesting that utility estimation is not the cause of inaccuracy in surrogate decision-making. The data and implications are discussed with respect to theories of surrogate decision-making.

  16. Long term plan of atomic energy development and utilization

    International Nuclear Information System (INIS)

    1982-01-01

    The atomic energy utilization and development in Japan have progressed remarkably, and already nuclear power generation has borne an important part in electric power supply, while radiation has been utilized in the fields of industry, agriculture, medicine and so on. Now, atomic energy is indispensable for national life and industrial activity. The former long term plan was decided in September, 1978, and the new long term plan should be established since the situation has changed largely. The energy substituting for petroleum has been demanded, and the expectation to nuclear power generation has heightened because it enables stable and economical power supply. The independently developed technology related to atomic energy must be put in practical use. The peaceful utilization of atomic energy must be promoted, while contributing to the nuclear non-proliferation policy. The Atomic Energy Commission of Japan decided the new long term plan to clearly show the outline of the important measures related to atomic energy development and utilization in 10 years hereafter, and the method of its promotion. The basic concept of atomic energy development and utilization, the long term prospect and the concept on the promotion, the method of promoting the development and utilization, and the problems of funds, engineers and location are described. (kako, I.)

  17. The stability of the international oil trade network from short-term and long-term perspectives

    Science.gov (United States)

    Sun, Qingru; Gao, Xiangyun; Zhong, Weiqiong; Liu, Nairong

    2017-09-01

    To examine the stability of the international oil trade network and explore the influence of countries and trade relationships on the trade stability, we construct weighted and unweighted international oil trade networks based on complex network theory using oil trading data between countries from 1996 to 2014. We analyze the stability of international oil trade network (IOTN) from short-term and long-term aspects. From the short-term perspective, we find that the trade volumes play an important role on the stability. Moreover, the weighted IOTN is stable; however, the unweighted networks can better reflect the actual evolution of IOTN. From the long-term perspective, we identify trade relationships that are maintained during the whole sample period to reveal the situation of the whole international oil trade. We provide a way to quantitatively measure the stability of complex network from short-term and long-term perspectives, which can be applied to measure and analyze trade stability of other goods or services.

  18. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  19. Evaluating the marginal utility principle for long-term hydropower scheduling

    International Nuclear Information System (INIS)

    Zhao, Tongtiegang; Zhao, Jianshi; Liu, Pan; Lei, Xiaohui

    2015-01-01

    Highlights: • Analysis of one-, two- and multi-period hydropower scheduling. • Derivation of marginal cost and marginal return of carry-over storage. • Evaluation of the marginal utility principle in a case study of the Three Gorges Reservoir. - Abstract: The conversion of the potential energy of dammed water into hydropower depends on both reservoir storage and release, which are the major difficulties in hydropower reservoir operation. This study evaluates the marginal utility principle, which determines the optimal carry-over storage between periods, for long-term hydropower scheduling. Increasing marginal cost and decreasing marginal return are two important characteristics that determine the marginal utility principle in water supply. However, the notion of decreasing marginal return is inapplicable in hydropower scheduling. Instead, the carry-over storage from one period has an increasing marginal contribution to the power generation in the next period. Although carry-over storage incurs an increasing marginal cost to the power generation in the current period, the marginal return is higher than the marginal cost. The marginal return from the carry-over storage further increases in the multi-period case. These findings suggest saving as much carry-over storage as possible, which is bounded by the operational constraints of storage capacity, environmental flow, and installed capacity in actual hydropower scheduling. The marginal utility principle is evaluated for a case study of the Three Gorges Reservoir, and the effects of the constraints are discussed. Results confirm the theoretical findings and show that the marginal return from carry-over storage is larger than the marginal cost. The operational constraints help determine the optimal carry-over storage.

  20. Preventing pressure ulcers in long-term care: a cost-effectiveness analysis.

    Science.gov (United States)

    Pham, Ba'; Stern, Anita; Chen, Wendong; Sander, Beate; John-Baptiste, Ava; Thein, Hla-Hla; Gomes, Tara; Wodchis, Walter P; Bayoumi, Ahmed; Machado, Márcio; Carcone, Steven; Krahn, Murray

    2011-11-14

    Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84). Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2). The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.

  1. Spot markets vs. long-term contracts - modelling tools for regional electricity generating utilities

    International Nuclear Information System (INIS)

    Grohnheit, P.E.

    1999-01-01

    A properly organised market for electricity requires that some information will be available for all market participants. Also a range of generally available modelling tools are necessary. This paper describes a set of simple models based on published data for analyses of the long-term revenues of regional utilities with combined heat and power generation (CHP), who will operate a competitive international electricity market and a local heat market. The future revenues from trade on the spot market is analysed using a load curve model, in which marginal costs are calculated on the basis of short-term costs of the available units and chronological hourly variations in the demands for electricity and heat. Assumptions on prices, marginal costs and electricity generation by the different types of generating units are studied for selected types of local electricity generators. The long-term revenue requirements to be met by long-term contracts are analysed using a traditional techno-economic optimisation model focusing on technology choice and competition among technologies over 20.30 years. A possible conclusion from this discussion is that it is important for the economic and environmental efficiency of the electricity market that local or regional generators of CHP, who are able to react on price signals, do not conclude long-term contracts that include fixed time-of-day tariff for sale of electricity. Optimisation results for a CHP region (represented by the structure of the Danish electricity and CHP market in 1995) also indicates that a market for CO 2 tradable permits is unlikely to attract major non-fossil fuel technologies for electricity generation, e.g. wind power. (au)

  2. Microfinance and rural development: a long-term perspective

    NARCIS (Netherlands)

    Moll, H.A.J.

    2006-01-01

    The long-term perspective on microfinance starts with a discussion of three central issues: first, views and policies, with two opposing views: "credit for target group" and "pushing the financial frontier"; second, the performance of microfinance institutions measured via two objectives: outreach

  3. Long-Term Monitoring of Utility-Scale Solar Energy Development and Application of Remote Sensing Technologies: Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Yuki [Argonne National Lab. (ANL), Argonne, IL (United States). Environmental Science Division; Grippo, Mark A. [Argonne National Lab. (ANL), Argonne, IL (United States). Environmental Science Division; Smith, Karen P. [Argonne National Lab. (ANL), Argonne, IL (United States). Environmental Science Division

    2014-09-30

    In anticipation of increased utility-scale solar energy development over the next 20 to 50 years, federal agencies and other organizations have identified a need to develop comprehensive long-term monitoring programs specific to solar energy development. Increasingly, stakeholders are requesting that federal agencies, such as the U.S. Department of the Interior Bureau of Land Management (BLM), develop rigorous and comprehensive long-term monitoring programs. Argonne National Laboratory (Argonne) is assisting the BLM in developing an effective long-term monitoring plan as required by the BLM Solar Energy Program to study the environmental effects of solar energy development. The monitoring data can be used to protect land resources from harmful development practices while at the same time reducing restrictions on utility-scale solar energy development that are determined to be unnecessary. The development of a long-term monitoring plan that incorporates regional datasets, prioritizes requirements in the context of landscape-scale conditions and trends, and integrates cost-effective data collection methods (such as remote sensing technologies) will translate into lower monitoring costs and increased certainty for solar developers regarding requirements for developing projects on public lands. This outcome will support U.S. Department of Energy (DOE) Sunshot Program goals. For this reason, the DOE provided funding for the work presented in this report.

  4. Cost-utility of collaborative care for major depressive disorder in primary care in the Netherlands.

    Science.gov (United States)

    Goorden, Maartje; Huijbregts, Klaas M L; van Marwijk, Harm W J; Beekman, Aartjan T F; van der Feltz-Cornelis, Christina M; Hakkaart-van Roijen, Leona

    2015-10-01

    Major depression is a great burden on society, as it is associated with high disability/costs. The aim of this study was to evaluate the cost-utility of Collaborative Care (CC) for major depressive disorder compared to Care As Usual (CAU) in a primary health care setting from a societal perspective. A cluster randomized controlled trial was conducted, including 93 patients that were identified by screening (45-CC, 48-CAU). Another 57 patients were identified by the GP (56-CC, 1-CAU). The outcome measures were TiC-P, SF-HQL and EQ-5D, respectively measuring health care utilization, production losses and general health related quality of life at baseline three, six, nine and twelve months. A cost-utility analysis was performed for patients included by screening and a sensitivity analysis was done by also including patients identified by the GP. The average annual total costs was €1131 (95% C.I., €-3158 to €750) lower for CC compared to CAU. The average quality of life years (QALYs) gained was 0.02 (95% C.I., -0.004 to 0.04) higher for CC, so CC was dominant from a societal perspective. Taking a health care perspective, CC was less cost-effective due to higher costs, €1173 (95% C.I., €-216 to €2726), of CC compared to CAU which led to an ICER of 53,717 Euro/QALY. The sensitivity analysis showed dominance of CC. The cost-utility analysis from a societal perspective showed that CC was dominant to CAU. CC may be a promising treatment for depression in the primary care setting. Further research should explore the cost-effectiveness of long-term CC. Netherlands Trial Register ISRCTN15266438. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Long term warranty and after sales service concept, policies and cost models

    CERN Document Server

    Rahman, Anisur

    2015-01-01

    This volume presents concepts, policies and cost models for various long-term warranty and maintenance contracts. It offers several numerical examples for estimating costs to both the manufacturer and consumer. Long-term warranties and maintenance contracts are becoming increasingly popular, as these types of aftersales services provide assurance to consumers that they can enjoy long, reliable service, and protect them from defects and the potentially high costs of repairs. Studying long-term warranty and service contracts is important to manufacturers and consumers alike, as offering long-term warranty and maintenance contracts produce additional costs for manufacturers / service providers over the product’s service life. These costs must be factored into the price, or the manufacturer / dealer will incur losses instead of making a profit. On the other hand, the buyer / consumer needs to weigh the cost of maintaining it over its service life and to decide whether or not these policies are worth purchasing....

  6. Global long-term cost dynamics of offshore wind electricity generation

    NARCIS (Netherlands)

    Gernaat, David E H J; Van Vuuren, Detlef P.; Van Vliet, Jasper; Sullivan, Patrick; Arent, Douglas J.

    2014-01-01

    Using the IMAGE/TIMER (The Targets IMage Energy Regional) long-term integrated assessment model, this paper explores the regional and global potential of offshore wind to contribute to global electricity production. We develop long-term cost supply curve for offshore wind, a representation of the

  7. Cost considerations for long-term ecological monitoring

    Science.gov (United States)

    Caughlan, L.; Oakley, K.L.

    2001-01-01

    For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program’s focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs, what dollars are spent on, and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program’s longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occurs during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost

  8. Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia

    Directory of Open Access Journals (Sweden)

    Dick Andrew

    2012-11-01

    Full Text Available Abstract Background Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI, and ventilator-associated pneumonia (VAP; the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. Methods Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR and healthcare utilization incidence ratios (IR were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status and Medicaid status (i.e., dual eligibility were controlled for in these models. Results In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P  Conclusions The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.

  9. Life after Kyoto? Exploration of long term strategies

    International Nuclear Information System (INIS)

    Van Vuuren, D.P.

    2001-01-01

    The current international climate negotiations (including CoP-6,recently held in The Hague, Netherlands) are mainly concerned with short term actions and barriers, and are experiencing considerable difficulties, as was once again revealed in The Hague. But we should not forget that keeping climate risks under control also demands a long term perspective. Such a perspective demands an estimate of both possible consequences and risks of climate change, and the possible solutions, in terms of strategies, policy measures, consequences and costs. 2 refs

  10. Can home care services achieve cost savings in long-term care for older people?

    Science.gov (United States)

    Greene, V L; Ondrich, J; Laditka, S

    1998-07-01

    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  11. A cost utility analysis of simeprevir used with peginterferon + ribavirin in the management of genotype 1 hepatitis C virus infection, from the perspective of the UK National Health Service.

    Science.gov (United States)

    Westerhout, Kirsten; Treur, Maarten; Mehnert, Angelika; Pascoe, Katie; Ladha, Imran; Belsey, Jonathan

    2015-01-01

    Triple therapy using a protease inhibitor (PI) with peginterferon and ribavirin (PR) is increasingly used in patients with chronic hepatitis C virus (HCV) infection. The most recently introduced PI, simeprevir (SMV), offers high levels of viral eradication combined with a reduced overall duration of therapy. The objective of this study was to compare the cost-effectiveness of SMV + PR vs PR alone or in combination with telaprevir (TVR) or boceprevir (BOC) in patients infected with genotype 1 HCV Method: A cost-utility model was constructed, incorporating two phases, capturing the efficacy of therapy in an initial treatment phase, followed by a long-term post-treatment Markov phase, capturing lifetime outcomes according to whether a sustained viral response (SVR) had been achieved on treatment. Dosage regimens were based on the EMA approved label for each treatment. SVR estimates and adverse event rates were derived from a mixed treatment comparison. Baseline characteristics were drawn from an analysis of a UK HCV data-set and clinician opinion. Health state transition probabilities, utilities, and health state costs were drawn from previously published economic analyses. The model considered direct health costs only, and the perspective was that of the UK National Health Service. The model yielded an ICER for SMV + PR vs PR alone of £9725/QALY for treatment-naïve and £7819/QALY for treatment-experienced. Benefit was driven by increased likelihood of achieving SVR, with consequent long-term utility gains. SMV + PR dominated TVR + PR and BOC + PR in both patient groups. This principally reflected the QALY benefit of an increased likelihood of SVR with SMV, combined with lower overall drug costs, due to reduced mean treatment duration. Compared to other currently licensed treatment options, SMV + PR represents a cost effective treatment option for patients with chronic genotype 1 HCV infection.

  12. Short-horizon regulation for long-term investors

    NARCIS (Netherlands)

    Shi, Z.; Werker, B.J.M.

    2012-01-01

    We study the effects of imposing repeated short-horizon regulatory constraints on long-term investors. We show that Value-at-Risk and Expected Shortfall constraints, when imposed dynamically, lead to similar optimal portfolios and wealth distributions. We also show that, in utility terms, the costs

  13. A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes

    Science.gov (United States)

    Ostermann, Julia K.; Witt, Claudia M.; Reinhold, Thomas

    2017-01-01

    Objectives This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months. Methods Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache. Results Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022–12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036–10,820] in the control group (phomeopathy: EUR 6,289 [6,118–6,460]; control: EUR 5,498 [5,326–5,670], phomeopathy: EUR 1,794 [1,770–1,818]; control: EUR 1,438 [1,414–1,462], phomeopathy patients generated higher costs than control patients. Conclusion The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group. PMID:28915242

  14. Communication on energy: who pays for the long-term costs of nuclear power

    International Nuclear Information System (INIS)

    Jeffery, J.W.

    1987-01-01

    The question in the title arises in making a fair comparison between a coal-fired station, which has no long-term costs, and a nuclear station, whose large long-term costs are discounted into insignificance by the present method of calculation. This problem was raised by the present author in his evidence to the Sizewell Inquiry, and has recently been discussed by the House of Commons Select Committee on Energy, who expressed grave disquiet that 'the costs of decommissioning become almost irrelevant to the current economics of nuclear power'. The present article analyses the bizarre effects of long-term discounting, and suggests a method of making a fair and symmetrical comparison between coal-fired and nuclear stations. (author)

  15. A cost-effectiveness analysis of long-term intermittent catheterisation with hydrophilic and uncoated catheters

    DEFF Research Database (Denmark)

    Clark, J F; Mealing, S J; Scott, D A

    2016-01-01

    includes the long-term sequelae of impaired renal function and urinary tract infection (UTI). SETTING: Analysis based on a UK perspective. METHODS: A probabilistic Markov decision model was constructed, to compare lifetime costs and quality-adjusted life years, taking renal and UTI health states...... into consideration, as well as other catheter-related events. UTI event rates for the primary data set were based on data from hospital settings to ensure controlled and accurate reporting. A sensitivity analysis was applied to evaluate best- and worst-case scenarios. RESULTS: The model predicts that a 36-year......-old SCI patient with chronic urinary retention will live an additional 1.4 years if using HC catheters compared with UC catheters, at an incremental cost of £2100. Moreover, the lifetime number of UTI events will be reduced by 16%. All best- and worst-case estimates were within the UK threshold of being...

  16. Long Term Cost Efficiency through Green Management Control Systems

    OpenAIRE

    Vukania Adda, Nancy; Qin, Xiaochen

    2012-01-01

    Title: Long term cost efficiency through green management control systems.Authors: Nancy Vukania &Xiaochen QinSupervisor: Åsa Karin-EngstrandBackground: The worldwide financial crisis of 2008 has reconfigured the economic turf leading to a more uncertain and turbulent playing field – a greater challenge for business strategy and the quest for optimization- The oil price hike of 2008 (Furlong 2010)1 caused its rippling effect to affect various cost categories including energy, labor and lo...

  17. Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France.

    Science.gov (United States)

    Roussel, Ronan; Martinez, Luc; Vandebrouck, Tom; Douik, Habiba; Emiel, Patrick; Guery, Matthieu; Hunt, Barnaby; Valentine, William J

    2016-01-01

    The present study aimed to compare the projected long-term clinical and cost implications associated with liraglutide, sitagliptin and glimepiride in patients with type 2 diabetes mellitus failing to achieve glycemic control on metformin monotherapy in France. Clinical input data for the modeling analysis were taken from two randomized, controlled trials (LIRA-DPP4 and LEAD-2). Long-term (patient lifetime) projections of clinical outcomes and direct costs (2013 Euros; €) were made using a validated computer simulation model of type 2 diabetes. Costs were taken from published France-specific sources. Future costs and clinical benefits were discounted at 3% annually. Sensitivity analyses were performed. Liraglutide was associated with an increase in quality-adjusted life expectancy of 0.25 quality-adjusted life years (QALYs) and an increase in mean direct healthcare costs of €2558 per patient compared with sitagliptin. In the comparison with glimepiride, liraglutide was associated with an increase in quality-adjusted life expectancy of 0.23 QALYs and an increase in direct costs of €4695. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio (ICER) of €10,275 per QALY gained vs sitagliptin and €20,709 per QALY gained vs glimepiride in France. Calculated ICERs for both comparisons fell below the commonly quoted willingness-to-pay threshold of €30,000 per QALY gained. Therefore, liraglutide is likely to be cost-effective vs sitagliptin and glimepiride from a healthcare payer perspective in France.

  18. Long Term Incentives for Residential Customers Using Dynamic Tariff

    DEFF Research Database (Denmark)

    Huang, Shaojun; Wu, Qiuwei; Nielsen, Arne Hejde

    2015-01-01

    This paper reviews several grid tariff schemes, including flat tariff, time-of-use, time-varying tariff, demand charge and dynamic tariff (DT), from the perspective of the long term incentives. The long term incentives can motivate the owners of flexible demands to change their energy consumption...... behavior in such a way that the power system operation issues, such as system balance and congestion, can be alleviated. From the comparison study, including analysis and case study, the DT scheme outperforms the other tariff schemes in terms of cost saving and network operation condition improving....

  19. Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

    Science.gov (United States)

    Eristina; Andayani, T. M.; Oetari, R. A.

    2017-11-01

    Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

  20. Resource utilization and costs associated with the diagnostic evaluation of nonrefluxing primary hydronephrosis in infants.

    Science.gov (United States)

    Akhavan, Ardavan; Shnorhavorian, Margarett; Garrison, Louis P; Merguerian, Paul A

    2014-09-01

    Long-term evaluation of postnatal nonrefluxing primary hydronephrosis presents a dilemma for urologists since most cases resolve without surgery. We report longitudinal resource utilization and costs associated with diagnostic evaluation of infants with isolated primary nonrefluxing hydronephrosis to determine the costs associated with diagnosing a surgical case, and we assess the implications using a cost-consequences analysis. A retrospective chart review was used to capture resource utilization for all patients younger than 6 months with hydronephrosis evaluated at our institution during a 5-year period. Infants with confounding urological diagnoses were excluded. Payer and societal perspectives were used. Costs were estimated from resource utilization, including radiographic imaging and clinical encounter types. Data were collected from first clinic visit until surgery or resolution or 3 years, whichever was shortest. Of 165 included patients surgical rates for hydronephrosis were 0% for grade I, 5% for grade II, 21% for grade III and 74% for grade IV. Median respective costs of identifying a single surgical case per increasing hydronephrosis grade 0 to IV were infinite, $37,600, $11,741 and $2,124 (p hydronephrosis is significantly more productive in terms of identifying patients requiring surgery vs evaluation of patients with lower grade disease. In patients with grades I and II hydronephrosis a more abbreviated diagnostic strategy than the current standard of care may be warranted. For the population in this analysis we project that a less intensive approach could save about 24% of costs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Comparative costs of electricity generation: a Canadian perspective

    International Nuclear Information System (INIS)

    Moore, B.; Guindon, S.

    1998-01-01

    The cost of generation will be a critical factor in the decision making process for electric power utilities in the years ahead as plans for new capacity are made under the pressures of a more competitive, deregulated market. Technologies with low capital, fuel and operating costs, short construction schedules, capacity closely matched to load growth and minimal regulatory/public acceptance problems are generally more attractive. As the Levelized Unit Energy Cost (LUEC) studies show, natural gas plants require ready access to low-cost supply of natural gas in order to compete. In areas with access to large supplies of low cost natural gas, it is therefore quite likely that natural gas turbines will be chosen, perhaps in combined cycles, for the next round of capacity increases in order to minimize financial risks. From a cost perspective, the challenge for the nuclear industry in Canada is to ensure, in the short to medium term, that the existing plants reach their full operating life and that they operate consistently at high capacity factors. In the longer term, improvements which lower the capital costs of nuclear plants, decrease construction times and increase capacity utilization factors will enhance the competitiveness of the nuclear option

  2. Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study.

    Science.gov (United States)

    van Heesch, Mirjam M J; Bonsel, Gouke J; Dumoulin, John C M; Evers, Johannes L H; van der Hoeven, Mark Ahbm; Severens, Johan L; Dykgraaf, Ramon H M; van der Veen, Fulco; Tonch, Nino; Nelen, Willianne L D M; van Zonneveld, Piet; van Goudoever, Johannes B; Tamminga, Pieter; Steiner, Katerina; Koopman-Esseboom, Corine; van Beijsterveldt, Catharina E M; Boomsma, Dorret I; Snellen, Diana; Dirksen, Carmen D

    2010-10-20

    Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. This is

  3. Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study

    Directory of Open Access Journals (Sweden)

    van Goudoever Johannes B

    2010-10-01

    Full Text Available Abstract Background Pregnancies induced by in vitro fertilisation (IVF often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year and long-term (5 and 18-year costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. Methods/Design A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children. Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children. Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the

  4. Costs of long-term carrying of extra mass in a songbird

    NARCIS (Netherlands)

    Atema, E.; Van Noordwijk, A.J.; Boonekamp, J. J.; Verhulst, S.

    2016-01-01

    Iteroparous organisms face a trade-off between reproduction and survival but knowledge of whether, how and when costs of long-term increases in workload are paid is scant. We increased locomotion costs for a whole year by equipping male great tits with a backpack during breeding, removing the

  5. Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers.

    Science.gov (United States)

    Bittman, Barry; Bruhn, Karl T; Stevens, Christine; Westengard, James; Umbach, Paul O

    2003-01-01

    This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.

  6. Cost benefit analysis of power plant database integration

    International Nuclear Information System (INIS)

    Wilber, B.E.; Cimento, A.; Stuart, R.

    1988-01-01

    A cost benefit analysis of plant wide data integration allows utility management to evaluate integration and automation benefits from an economic perspective. With this evaluation, the utility can determine both the quantitative and qualitative savings that can be expected from data integration. The cost benefit analysis is then a planning tool which helps the utility to develop a focused long term implementation strategy that will yield significant near term benefits. This paper presents a flexible cost benefit analysis methodology which is both simple to use and yields accurate, verifiable results. Included in this paper is a list of parameters to consider, a procedure for performing the cost savings analysis, and samples of this procedure when applied to a utility. A case study is presented involving a specific utility where this procedure was applied. Their uses of the cost-benefit analysis are also described

  7. Long-term potentiation and long-term depression: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Timothy V.P. Bliss

    2011-01-01

    Full Text Available Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

  8. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness.

    Science.gov (United States)

    van der Woude, J A D; Nair, S C; Custers, R J H; van Laar, J M; Kuchuck, N O; Lafeber, F P J G; Welsing, P M J

    2016-01-01

    In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90-95% for the younger age categories. A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient.

  9. An economic and legal perspective on electric utility transition costs

    Energy Technology Data Exchange (ETDEWEB)

    Rose, K.

    1996-07-01

    The issue of possibly unrecoverable cost incurred by a utility, or `stranded costs,` has emerged as a major obstacle to developing a competitive generation market. Stranded or transition costs are defined as costs incurred by a utility to serve its customers that were being recovered in rates but are no longer due to availability of lower-priced alternative suppliers. The idea of `stranded cost,` and more importantly arguments for its recovery, is a concept with little basis in economic theory, legal precedence, or precedence in other deregulated industries. The main argument recovery is that the ``regulatory compact`` requires it. This is based on the misconception that the regulator compact is simply: the utility incurs costs on behalf of its customers because of the ``obligation to serve`` so, therefore, customers are obligated to pay. This is a mischaracterization of what the compact was and how it developed. Another argument is that recovery is required for economic efficiency. This presumes, however, a very narrow definition of efficiency based on preventing ``uneconomic`` bypass of the utility and that utilities minimize costs. A broader definition of efficiency and the likelihood of cost inefficiencies in the industry suggest that the cost imposed on customers from inhibiting competition could exceed the gains from preventing uneconomic bypass. Both these issues are examined in this paper.

  10. Patient time and out-of-pocket costs for long-term prostate cancer survivors in Ontario, Canada.

    Science.gov (United States)

    de Oliveira, Claire; Bremner, Karen E; Ni, Andy; Alibhai, Shabbir M H; Laporte, Audrey; Krahn, Murray D

    2014-03-01

    Time and out-of-pocket (OOP) costs can represent a substantial burden for cancer patients but have not been described for long-term cancer survivors. We estimated these costs, their predictors, and their relationship to financial income, among a cohort of long-term prostate cancer (PC) survivors. A population-based, community-dwelling, geographically diverse sample of long-term (2-13 years) PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physicians. We obtained data on demographics, health care resource use, and OOP costs through mailed questionnaires and conducted chart reviews to obtain clinical data. We compared mean annual time and OOP costs (2006 Canadian dollars) across clinical and sociodemographic characteristics and examined the association between costs and four groups of predictors (patient, disease, system, symptom) using two-part regression models. Patients' (N = 585) mean age was 73 years; 77 % were retired, and 42 % reported total annual incomes less than $40,000. Overall, mean time costs were $838/year and mean OOP costs were $200/year. Although generally low, total costs represented approximately 10 % of income for lower income patients. No demographic variables were associated with costs. Radical prostatectomy, younger age, poor urinary function, current androgen deprivation therapy, and recent diagnosis were significantly associated with increased likelihood of incurring any costs, but only urinary function significantly affected total amount. Time and OOP costs are modest for most long-term PC survivors but can represent a substantial burden for lower income patients. Even several years after diagnosis, PC-specific treatments and treatment-related dysfunction are associated with increased costs. Time and out-of-pocket costs are generally manageable for long-term PC survivors but can be a significant burden mainly for lower income patients. The effects of PC

  11. Analysis on long-term perspectives of sustainable nuclear energy towards global warming protection

    International Nuclear Information System (INIS)

    Yamazawa, M.; Ichimura, E.; Shibata, Y.; Kobayashi, K.; Wajima, T.

    1998-01-01

    Study of long-term perspectives of the nuclear power generation was made from the point of views of both CO 2 emission constraints and sustainability of nuclear energy. To this end, STREAM (Semi-empirical TRiple E Analysis Model) program, as a social model, has been developed by Tokyo Electric Power Co. and Hitachi, Ltd. Using this program, long-term world demands of primary and nuclear energy were deduced, in view of the protection against the global warming due to the CO 2 gas accumulation. The inevitable conclusion has been drawn that nuclear energy plays an indispensable role in the reduction of green house effect. Evaluations were then made on conditions that the nuclear power system would be the long-term major sustainable energy source. (author)

  12. Long-term effects of oral clefts on health care utilization

    DEFF Research Database (Denmark)

    Pedersen, Morten Saaby; Wehby, George L; Pedersen, Dorthe Almind

    2015-01-01

    clefts use more health services than their unaffected siblings. Additional results show that the effects are driven primarily by congenital malformation-related hospitalizations and intake of anti-infectives. Although the absolute differences in most health care utilization diminish over time, affected......Oral clefts are among the most common birth defects affecting thousands of newborns each year, but little is known about their potential long-term consequences. In this paper, we explore the impact of oral clefts on health care utilization over most of the lifespan. To account for time...... individuals have slightly higher utilization of some health care services in adulthood (particularly for diseases of the nervous and respiratory system). These results have important implications for affected individuals, their families, and their health professionals....

  13. Cost-effectiveness of embryo transfer strategies: : A decision analytic model using long-term costs and consequences of singletons and multiples born as a consequence of IVF

    NARCIS (Netherlands)

    van Heesch, M. M. J.; van Asselt, A. D. I.; Evers, J. L. H.; van der Hoeven, M. A. H. B. M.; Dumoulin, J. C. M.; van Beijsterveldt, C. E. M.; Bonsel, G. J.; Dykgraaf, R. H. M.; van Goudoever, J. B.; Koopman-Esseboom, C.; Nelen, W. L. D. M.; Steiner, K.; Tamminga, P.; Tonch, N.; Torrance, H. L.; Dirksen, C. D.

    2016-01-01

    STUDY QUESTION: What is the cost-effectiveness of elective single embryo transfer (eSET) versus double embryo transfer (DET) strategies from a societal perspective, when applying a time horizon of 1, 5 and 18 years? SUMMARY ANSWER: From a short-term perspective (1 year) it is cost-effective to

  14. [The evaluation of cost-effectiveness and cost-utility of valganciclovir for the prophylaxis of cytomegalovirus disease to 200 days after kidney transplantation].

    Science.gov (United States)

    Kawalec, Paweł; Holko, Przemysław; Szkultecka-Debek, Monika; Paszulewicz, Anna; Boratyńska, Maria; Głyda, Maciej; Ignacak, Ewa; Maks, Justyna; Russel-Szymczyk, Monika; Kaweczyńska-Lasoń, Aneta

    2013-06-01

    cycles made it possible to assess long-term (assumed time horizon was median patient's life expectancy--23,5 years) costs and clinical effects of the compared technologies. The Incremental Cost-Effectiveness Ratio (ICER) was 39 669 008 PLN and The Incremental Cost-Utility Ratio (ICUR) was 48 008 PLN in the specified time horizon. The result is well below the accepted threshold of profitability in Poland (assuming tripled GDP per capita cost-utility threshold, i.e. 99 543 PLN), which means that the therapy is cost-effective. The results of the analysis confirmed that the 200 days use of valganciclovirin the prevention of CMV disease compared to standard 110 days therapy is economically justified from the Polish healthcare payer's perspective.

  15. Perspective of long term demand and supply of energy and general inspection of energy policy

    International Nuclear Information System (INIS)

    1983-01-01

    Since the oil crisis, Japanese energy policy was promoted to get rid of the excess dependence on petroleum and to attain energy security, but energy situation largely changed during the past ten years, and it has become necessary to make general inspection on the long term demand and supply of energy and the energy policy. After the second oil crisis, the worldwide demand of petroleum decreased drastically due to the rapid price rise, and the base price of crude oil was lowered for the first time. It is necessary to positively endeavor to reduce energy cost with new idea. The points of the general inspection are the correspondence of the energy policy to the large structural change of energy, the most desirable system for attaining the optimum structure of energy demand and supply and the utilization of market mechanism as far as possible. This report is the results of discussion held eight times since April, 1983. The change of energy situation in Japan and abroad and the perspective, the new problems in energy countermeasures and the trend of response, the preferential and effective promotion of general energy countermeasures and so on are reported. This report shows the fundamental direction of energy countermeasures hereafter, and the concrete and special examination must be made on many remaining problems. (Kako, I.)

  16. Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand.

    Science.gov (United States)

    Permsuwan, Unchalee; Chaiyakunapruk, Nathorn; Dilokthornsakul, Piyameth; Thavorn, Kednapa; Saokaew, Surasak

    2016-06-01

    Even though Insulin glargine (IGlar) has been available and used in other countries for more than a decade, it has not been adopted into Thai national formulary. This study aimed to evaluate the long-term cost effectiveness of IGlar versus neutral protamine Hagedorn (NPH) insulin in type 2 diabetes from the perspective of Thai Health Care System. A validated computer simulation model (the IMS CORE Diabetes Model) was used to estimate the long-term projection of costs and clinical outcomes. The model was populated with published characteristics of Thai patients with type 2 diabetes. Baseline risk factors were obtained from Thai cohort studies, while relative risk reduction was derived from a meta-analysis study conducted by the Canadian Agency for Drugs and Technology in Health. Only direct costs were taken into account. Costs of diabetes management and complications were obtained from hospital databases in Thailand. Both costs and outcomes were discounted at 3 % per annum and presented in US dollars in terms of 2014 dollar value. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were also performed. IGlar is associated with a slight gain in quality-adjusted life years (0.488 QALYs), an additional life expectancy (0.677 life years), and an incremental cost of THB119,543 (US$3522.19) compared with NPH insulin. The ICERs were THB244,915/QALY (US$7216.12/QALY) and THB176,525/life-year gained (LYG) (US$5201.09/LYG). The ICER was sensitive to discount rates and IGlar cost. At the acceptable willingness to pay of THB160,000/QALY (US$4714.20/QALY), the probability that IGlar was cost effective was less than 20 %. Compared to treatment with NPH insulin, treatment with IGlar in type 2 diabetes patients who had uncontrolled blood glucose with oral anti-diabetic drugs did not represent good value for money at the acceptable threshold in Thailand.

  17. The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury.

    Directory of Open Access Journals (Sweden)

    Gilles Clermont

    Full Text Available The pulmonary artery catheter (PAC remains widely used in acute lung injury (ALI despite known complications and little evidence of improved short-term mortality. Concurrent with NHLBI ARDS Clinical Trials Network Fluid and Catheters Treatment Trial (FACTT, we conducted a prospectively-defined comparison of healthcare costs and long-term outcomes for care with a PAC vs. central venous catheter (CVC. We explored if use of the PAC in ALI is justified by a beneficial cost-effectiveness profile.We obtained detailed bills for the initial hospitalization. We interviewed survivors using the Health Utilities Index Mark 2 questionnaire at 2, 6, 9 and 12 m to determine quality of life (QOL and post-discharge resource use. Outcomes beyond 12 m were estimated from federal databases. Incremental costs and outcomes were generated using MonteCarlo simulation.Of 1001 subjects enrolled in FACTT, 774 (86% were eligible for long-term follow-up and 655 (85% consented. Hospital costs were similar for the PAC and CVC groups ($96.8k vs. $89.2k, p = 0.38. Post-discharge to 12 m costs were higher for PAC subjects ($61.1k vs. 45.4k, p = 0.03. One-year mortality and QOL among survivors were similar in PAC and CVC groups (mortality: 35.6% vs. 31.9%, p = 0.33; QOL [scale: 0-1]: 0.61 vs. 0.66, p = 0.49. MonteCarlo simulation showed PAC use had a 75.2% probability of being more expensive and less effective (mean cost increase of $14.4k and mean loss of 0.3 quality-adjusted life years (QALYs and a 94.2% probability of being higher than the $100k/QALY willingness-to-pay threshold.PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI.www.clinicaltrials.gov NCT00234767.

  18. The Natural Gas Dilemma in New England's Electricity Sector: Experts' Perspectives on Long Term Climate Issues and Policy Opportunities

    Science.gov (United States)

    Griffith, Steven

    This thesis is an interpretive analysis of experts' perspectives on the climate implications of New England's reliance on natural gas for electricity generation. Specifically, this research, conducted through interviews and literature review, examines experts' opinions on the desired role of natural gas within the regional electricity sector, alternative energy resources, and state and regional policy opportunities toward the achievement of New England's ambitious long-term greenhouse gas reduction goals. Experts expressed concern about the climate dilemma posed by a dependence on natural gas. However, interviews revealed that short-term reliability and cost considerations are paramount for many experts, and therefore a reliance on natural gas is the existing reality. To incentivize renewable generation technologies for the purposes of long-term climate stabilization, experts advocated for the expanded implementation of renewable portfolio standard, net metering, and feed-in tariff policies. More broadly, interviewees expressed the need for an array of complementary state and regional policies.

  19. Long-term cost targets for nuclear energy

    International Nuclear Information System (INIS)

    Rogner, H.H.; McDonald, A.

    2004-01-01

    In 2000 the International Atomic Energy Agency (IAEA) began the International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO) to help guide nuclear R and D strategies targeted on anticipated mid-century energy system needs. One part of INPRO seeks to develop cost targets for new designs to be competitive in mid-century markets. The starting point was the 40 scenarios of the Special Report on Emissions Scenarios (SRES) of the Intergovernmental Panel on Climate Change. This paper summarizes four of the SRES scenarios, one from each of the four SRES scenario families. It discusses their implications for nuclear energy, including cost targets, and develops for each an 'aggressive nuclear' variant. The aggressive nuclear variants estimate the potential market for nuclear energy if, by improving faster than assumed by the SRES authors, nuclear energy can make inroads into vulnerable market shares projected for its competitors. In addition to projected demands for nuclear generated electricity, hydrogen and heat, the aggressive variants include prospective demand for nuclear desalination and use in upgrading fossil fuels. The paper then presents learning rates and implied cost targets consistent with the aggressive nuclear variants of the SRES scenarios. One provocative initial result is that many of the scenarios with substantial nuclear expansion do not seem to require big reductions in nuclear investment costs. One interpretation discussed at the end of the paper highlights the difference between cost reductions consistent with long-term energy system optimization based on perfect foresight, and cost reductions necessary to attract private investment in today's 'deregulating' and uncertain energy markets. (orig.)

  20. Long-term costs of introducing HPV-DNA post-treatment surveillance to national cervical cancer screening in Ireland.

    Science.gov (United States)

    Agapova, Maria; Duignan, Andrea; Smith, Alan; O'Neill, Ciaran; Basu, Anirban

    2015-01-01

    Co-testing (cytology plus human papillomavirus DNA testing) as part of cervical cancer surveillance in Ireland increases one-time testing costs. Of interest to policy makers was the long-term impact of these costs accompanied by decreases in intensity of recalls for women with no detected abnormalities. A cost analysis of cytology-only and co-testing strategy was implemented using decision analytic modeling, aggregating testing utilization and costs for each of the two strategies over 12 years. Aggregated incremental costs of the co-testing strategy were positive for the first 3 years but became negative thereafter, generating a cost savings of roughly €20 million in favor of the cytology-only strategy over a 12-year period. Results were robust over a range of sensitivity analyses with respect to discount and attrition rates. This analysis provided valuable information to policy makers contributing to the introduction of co-testing for post-treatment surveillance (PTS) in Ireland.

  1. Survey of state regulatory activities on least cost planning for gas utilities

    International Nuclear Information System (INIS)

    Goldman, C.A.; Hopkins, M.E.

    1991-04-01

    Integrated resource planning involves the creation of a process in which supply-side and demand-side options are integrated to create a resource mix that reliably satisfies customers' short-term and long-term energy service needs at the lowest cost. Incorporating the concept of meeting customer energy service needs entails a recognition that customers' costs must be considered along with the utility's costs in the economic analysis of energy options. As applied to gas utilities, an integrated resource plan seeks to balance cost and reliability, and should not be interpreted simply as the search for lowest commodity costs. All state commissions were surveyed to assess the current status of gas planning and demand-side management and to identify significant regulatory issues faced by commissions during the next several years. The survey was to determine the extent to which they have undertaken least-cost planning for gas utilities. The survey included the following topics: (1) status of state PUC least-cost planning regulations and practices for gas utilities; (2) type and scope ofnatural gas DSM programs in effect, includeing fuel substitution; (3) economic tests and analysis methods used to evaluate DSM programs; (4) relationship between prudence reviews of gas utility purchasing practices and integrated resource planning; and (5) key regulatory issues facing gas utilities during the next five years. 34 refs., 6 figs., 10 tabs

  2. Cost-effectiveness of embryo transfer strategies: a decision analytic model using long-term costs and consequences of singletons and multiples born as a consequence of IVF.

    Science.gov (United States)

    van Heesch, M M J; van Asselt, A D I; Evers, J L H; van der Hoeven, M A H B M; Dumoulin, J C M; van Beijsterveldt, C E M; Bonsel, G J; Dykgraaf, R H M; van Goudoever, J B; Koopman-Esseboom, C; Nelen, W L D M; Steiner, K; Tamminga, P; Tonch, N; Torrance, H L; Dirksen, C D

    2016-11-01

    What is the cost-effectiveness of elective single embryo transfer (eSET) versus double embryo transfer (DET) strategies from a societal perspective, when applying a time horizon of 1, 5 and 18 years? From a short-term perspective (1 year) it is cost-effective to replace DET with single embryo transfer; however when intermediate- (5 years) and long-term (18 years) costs and consequences are incorporated, DET becomes the most cost-effective strategy, given a ceiling ratio of €20 000 per quality-adjusted life years (QALY) gained. According to previous cost-effectiveness research into embryo transfer strategies, DET is considered cost-effective if society is willing to pay around €20 000 for an extra live birth. However, interpretation of those studies is complicated, as those studies fail to incorporate long-term costs and outcomes and used live birth as a measure of effectiveness instead of QALYs. With this outcome, both multiple and singletons were valued as one live birth, whereas costs of all children of a multiple were incorporated. A Markov model (cycle length: 1 year; time horizon: 1, 5 and 18 years) was developed comparing a maximum of: (i) three cycles of eSET in all patients; (ii) four cycles of eSET in all patients; (iii) five cycles of eSET in all patients; (iv) three cycles of standard treatment policy (STP), i.e. eSET in women costs were estimated for all comparators. Input parameters were derived from a retrospective cohort study, in which hospital resource data were collected (n=580) and a parental questionnaire was sent out (431 respondents). Probabilistic sensitivity analysis (5000 iterations) was performed. With a time horizon of 18 years, DETx3 is most effective (0.54 live births, 10.2 LYs and 9.8 QALYs) and expensive (€37 871) per couple starting IVF. Three cycles of eSET are least effective (0.43 live births, 7.1 LYs and 6.8 QALYs) and expensive (€25 563). We assumed that society is willing to pay €20 000 per QALY gained. With a time

  3. Perspectives for hydropower stations in Switzerland: long-term competitiveness and possibilities for improvement

    International Nuclear Information System (INIS)

    Filippini, M.; Banfi, S.; Luchsinger, C.; Wild, J.; Balmer, M.; Grand, D.; Henkels, L.; Semadeni, M.; Gnansounou, E.

    2001-01-01

    This first general study - which has the character of a preliminary study - examines the questions if the liberalisation of the electricity market will have a negative effect on the competitiveness of hydropower in the long-term and what measures can be taken against such effects. Long-term competitiveness is defined as the ability of a business in this sector to make investments in renewal in the long-term, i.e. after its concessions have expired. The three main aims of the study are: 1. Assessment of the long-term competitiveness of the sector and identification of the factors which could either have a negative effect on it or improve it, 2. Analysis of cost structures and presentation of measures through which the long-term competitiveness of the sector can be reinforced, 3. Presentation of possible political measures to be taken in this business area in order to improve the long-term competitiveness of hydropower stations. The study identifies the most important factors that determine future competitiveness as being the market prices for electricity and capital costs (depreciation and interest on own and borrowed capital). Further, water fees, taxes and regulations concerning residual water flow can be of great importance for investment decisions, in particular for those enterprises that operate close to their profitability limits. The results of the analysis indicate that, in the future, a considerable number of enterprises must be reckoned with that will refrain from renewing their plant. Such outcomes depend, of course, on developments in electricity market prices, specific investment costs, rates of interest and other economic, political, and legal conditions. Making a prognosis about the development of such parameters is linked with a high degree of uncertainty. By means of sensitivity calculations and the definition of various scenarios, attempts are made to take these uncertainties into account . Finally, the study makes reference to the fact that

  4. Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea

    OpenAIRE

    Jinjoo Oh, Ph.D., RN, GNP; Seieun Oh, Ph.D., RN

    2017-01-01

    Purpose: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for ...

  5. If you try to stop smoking, should we pay for it? The cost-utility of reimbursing smoking cessation support in the Netherlands

    NARCIS (Netherlands)

    Vemer, Pepijn; Rutten-van Mölken, Maureen P. M. H.; Kaper, Janneke; Hoogenveen, Rudolf T.; van Schayck, C. P.; Feenstra, Talitha L.

    Background Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost-utility is lacking. Objectives To evaluate long-term effects of

  6. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P; Gao, B [Powertech Labs. Inc., Surrey, BC (Canada)

    1994-12-31

    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  7. Investing in health: is social housing value for money? A cost-utility analysis.

    Science.gov (United States)

    Lawson, K D; Kearns, A; Petticrew, M; Fenwick, E A L

    2013-10-01

    There is a healthy public policy agenda investigating the health impacts of improving living conditions. However, there are few economic evaluations, to date, assessing value for money. We conducted the first cost-effectiveness analysis of a nationwide intervention transferring social and private tenants to new-build social housing, in Scotland. A quasi-experimental prospective study was undertaken involving 205 intervention households and 246 comparison households, over 2 years. A cost-utility analysis assessed the average cost per change in health utility (a single score summarising overall health-related quality of life), generated via the SF-6D algorithm. Construction costs for new builds were included. Analysis was conducted for all households, and by family, adult and elderly households; with estimates adjusted for baseline confounders. Outcomes were annuitised and discounted at 3.5%. The average discounted cost was £18, 708 per household, at a national programme cost of £ 28.4 million. The average change in health utility scores in the intervention group attributable to the intervention were +0.001 for all households, +0.001 for family households, -0.04 for adult households and -0.03 for elderly households. All estimates were statistically insignificant. At face value, the interventions were not value for money in health terms. However, because the policy rationale was the amenity provision of housing for disadvantaged groups, impacts extend beyond health and may be fully realised over the long term. Before making general value-for-money inferences, economic evaluation should attempt to estimate the full social value of interventions, model long-term impacts and explicitly incorporate equity considerations.

  8. Cost effectiveness of long-acting risperidone injection versus alternative antipsychotic agents in patients with schizophrenia in the USA.

    Science.gov (United States)

    Edwards, Natalie C; Locklear, Julie C; Rupnow, Marcia F T; Diamond, Ronald J

    2005-01-01

    The availability of long-acting risperidone injection may increase adherence and lead to improved clinical and economic outcomes for individuals with schizophrenia. The objective of this study was to assess the cost effectiveness of long-acting risperidone, oral risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol depot in patients with schizophrenia over 1 year from a healthcare system perspective. Published medical literature, unpublished data from clinical trials and a consumer health database, and a clinical expert panel were utilized to populate a decision analytical model comparing the seven treatment alternatives. The model captured rates of patient compliance, the rates, frequency and duration of relapse, incidence of adverse events, and healthcare resource utilization and associated costs. Primary outcomes were expressed in terms of percentage of patients relapsing per year, number of relapse days per year (number and duration of relapses per patient per year), and total direct 2003 medical cost per patient per year. On the basis of model projections, the proportions of patients experiencing a relapse requiring hospitalization in 1 year were 66% for haloperidol depot, 41% for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and 26% for long-acting risperidone, whereas the proportions of patients with an exacerbation not requiring hospitalization were 60% for haloperidol depot, 37% for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and 24% for long-acting risperidone. The mean number of days of relapse requiring hospitalization per patient per year were 28 for haloperidol depot, 18 for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and 11 for long-acting risperidone, whereas the mean number of days of exacerbation not requiring hospitalization were eight for haloperidol depot, five for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole

  9. Long-term capital planning considering nuclear plant life-cycle management

    International Nuclear Information System (INIS)

    Negin, C.A.; Simpson, J.M.; Hostetler, D.R.

    1992-09-01

    The creation of a Life Cycle Management (LCM) group at utilities to evaluate the long term capital refurbishment needs is gaining favor. Among the functions of such groups can be the responsibility for recommending long term capital planning projects based on results of evaluations of systems, structures, and components that are not only essential to achieving the full current license term of operation, but also to extend the service life of the plant. Making such recommendations, in content and timing, requires the ability to view all recommendations in the context of an overall capital budget and long range outage impacts. This report illustrates an approach for creating a Long-Term Capital Plan with methods for deciding on, compiling, integrating, and presenting projects from the perspective of an LCM program for a nuclear power plant. It also addresses a rationale for capitalization of LCM program activities that would not be allowed under current accounting treatment

  10. Comment 2 on workshop in economics - issues in benefit-cost analysis: Amplification channels and discounting long-term environmental damages

    International Nuclear Information System (INIS)

    Hanson, D.A.

    1992-01-01

    Many environmental problems have long-term effects. Acid rain has long-term effects on soils, forests, and exposed materials. Global climate change has even longer-term effects. This difference in timing - between the near-term cost of environmental protection and the long-term environmental effects - makes it difficult to conduct a cost-benefit analysis of any program designed to abate environmental damages. The rate at which to discount long-term environmental damages becomes a key question in comparisons of benefits and costs. This comment points out an important facet of the discounting issue. The discount rate for calculating the present value of future environmental benefits may be much lower than the rate of return on investment. Cost-benefit analysis is a framework in which to evaluate policies and decisions. Because global climate change is a complex problem, extensions of cost-benefit theory can be expected to add additional insights, particularly in the following areas: distinguishing distributional effects among nations, over time, and among generations; determining the rate of discount that is appropriate for long-term environmental damages and separating risk aspects from the rate of discount; and assessing amplification effects when policies involve large expenditures relative to the economy or when affected sectors are significant sectors of the economy

  11. Cost-effectiveness of different interferon beta products for relapsing-remitting and secondary progressive multiple sclerosis: Decision analysis based on long-term clinical data and switchable treatments.

    Science.gov (United States)

    Nikfar, Shekoufeh; Kebriaeezadeh, Abbas; Dinarvand, Rassoul; Abdollahi, Mohammad; Sahraian, Mohammad-Ali; Henry, David; Akbari Sari, Ali

    2013-06-22

    Multiple sclerosis (MS) is a highly debilitating immune mediated disorder and the second most common cause of neurological disability in young and middle-aged adults. Iran is amongst high MS prevalence countries (50/100,000). Economic burden of MS is a topic of important deliberation in economic evaluations study. Therefore determining of cost-effectiveness interferon beta (INF β) and their copied biopharmaceuticals (CBPs) and biosimilars products is significant issue for assessment of affordability in Lower-middle-income countries (LMICs). A literature-based Markov model was developed to assess the cost-effectiveness of three INF βs products compared with placebo for managing a hypothetical cohort of patients diagnosed with relapsing remitting MS (RRMS) in Iran from a societal perspective. Health states were based on the Kurtzke Expanded Disability Status Scale (EDSS). Disease progression transition probabilities for symptom management and INF β therapies were obtained from natural history studies and multicenter randomized controlled trials and their long term follow up for RRMS and secondary progressive MS (SPMS). A cross sectional study has been developed to evaluate cost and utility. Transitions among health states occurred in 2-years cycles for fifteen cycles and switching to other therapies was allowed. Calculations of costs and utilities were established by attachment of decision trees to the overall model. The incremental cost effectiveness ratio (ICER) of cost/quality adjusted life year (QALY) for all available INF β products (brands, biosimilars and CBPs) were considered. Both costs and utilities were discounted. Sensitivity analyses were done to assess robustness of model. ICER for Avonex, Rebif and Betaferon was 18712, 11832, 15768 US Dollars ($) respectively when utility attained from literature review has been considered. ICER for available CBPs and biosimilars in Iran was $847, $6964 and $11913. The Markov pharmacoeconomics model determined that

  12. Cost-Effectiveness of Different Interferon Beta Products for Relapsing-Remitting and Secondary Progressive Multiple Sclerosis: Decision Analysis Based on Long-Term Clinical Data and Switchable Treatments

    Directory of Open Access Journals (Sweden)

    Shekoufeh Nikfar

    2013-06-01

    Full Text Available Multiple sclerosis (MS is a highly debilitating immune mediated disorder and the second most common cause of neurological disability in young and middle-aged adults. Iran is amongst high MS prevalence countries (50/100,000. Economic burden of MS is a topic of important deliberation in economic evaluations study. Therefore determining of cost-effectiveness interferon beta (INF β and their copied biopharmaceuticals (CBPs and biosimilars products is significant issue for assessment of affordability in Lower-middle-income countries (LMICs.Methods:A literature-based Markov model was developed to assess the cost-effectiveness of three INF βs products compared with placebo for managing a hypothetical cohort of patients diagnosed with relapsing remitting MS (RRMS in Iran from a societal perspective. Health states were based on the Kurtzke Expanded Disability Status Scale (EDSS. Disease progression transition probabilities for symptom management and INF β therapies were obtained from natural history studies and multicenter randomized controlled trials and their long term follow up for RRMS and secondary progressive MS (SPMS. A cross sectional study has been developed to evaluate cost and utility. Transitions among health states occurred in 2-years cycles for fifteen cycles and switching to other therapies was allowed. Calculations of costs and utilities were established by attachment of decision trees to the overall model. The incremental cost effectiveness ratio (ICER of cost/quality adjusted life year (QALY for all available INF β products (brands, biosimilars and CBPs were considered. Both costs and utilities were discounted. Sensitivity analyses were done to assess robustness of model.Results:ICER for Avonex, Rebif and Betaferon was 18712, 11832, 15768 US Dollars ($ respectively when utility attained from literature review has been considered. ICER for available CBPs and biosimilars in Iran was $847, $6964 and $11913.Conclusions:The Markov

  13. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System.

    Science.gov (United States)

    Bertapelle, Maria Paola; Vottero, Mario; Popolo, Giulio Del; Mencarini, Marco; Ostardo, Edoardo; Spinelli, Michele; Giannantoni, Antonella; D'Ausilio, Anna

    2015-08-01

    To assess the relative cost-effectiveness of two therapeutic strategies: one starting with sacral neuromodulation (SNM) versus one starting with Botulinum toxin A (BTX-A) for the management of refractory incontinent idiopathic overactive bladder (OAB) patients, from the perspective of the Italian National Health Service (INHS). Direct medical costs (2011) and benefits (quality-adjusted life years-QALYs) were assessed over a ten-year time frame adapting to the Italian practice a published Markov model. Clinical inputs were based on the published literature and on the expert opinion. Resource consumption rates were provided by clinical experts; unit costs were collected from a single hospital accounting and from standard tariff lists and public prices. Interventional procedures and management of adverse events were costed through a micro-costing approach. The primary outcome was incremental costs per QALYs gained (i.e. differential costs divided by differential benefits). Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were conducted to assess the robustness of the model. Starting with SNM appears to be cost effective (i.e. under 40.000/QALY) from year three (21,259/QALY) onwards and becomes dominant (i.e. more effective and less costly) at year ten: cumulative costs were 32,975 for early SNM and 33,309 for early BTX-A, while cumulative QALYs were 7.52 and 6.93, respectively. At year ten, DSA suggests the results robustness and 99.8 % of the PSA iterations fell within the cost-effectiveness threshold. A therapeutic strategy starting with SNM may be considered cost effective in the midterm and cost saving in the long-term treatment of idiopathic OAB from the INHS perspective.

  14. Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.

    Science.gov (United States)

    Rudoler, David; de Oliveira, Claire; Jacob, Binu; Hopkins, Melonie; Kurdyak, Paul

    2018-01-01

    The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

  15. Efficient utilization of wind power: Long-distance transmission or local consumption?

    Science.gov (United States)

    Sun, Yuanzhang; Ma, Xiyuan; Xu, Jian; Bao, Yi; Liao, Siyang

    2017-09-01

    Excess wind power produced in wind-intensive areas is normally delivered to remote load centers via long-distance transmission lines. This paper presents a comparison between long-distance transmission, which has gained popularity, and local energy consumption, in which a fraction of the generated wind power can be locally consumed by energy-intensive industries. First, the challenges and solutions to the long-distance transmission and local consumption of wind power are presented. Then, the two approaches to the utilization of wind power are compared in terms of system security, reliability, cost, and capability to utilize wind energy. Finally, the economic feasibility and technical feasibility of the local consumption of wind power are demonstrated by a large and isolated industrial power system, or supermicrogrid, in China. The coal-fired generators together with the short-term interruptible electrolytic aluminum load in the supermicrogrid are able to compensate for the intermittency of wind power. In the long term, the transfer of high-energy-consumption industries to wind-rich areas and their local consumption of the available wind power are beneficial.

  16. Gauging the Purported Costs of Public Data Archiving for Long-Term Population Studies.

    Science.gov (United States)

    Evans, Simon Robin

    2016-04-01

    It was recently proposed that long-term population studies be exempted from the expectation that authors publicly archive the primary data underlying published articles. Such studies are valuable to many areas of ecological and evolutionary biological research, and multiple risks to their viability were anticipated as a result of public data archiving (PDA), ultimately all stemming from independent reuse of archived data. However, empirical assessment was missing, making it difficult to determine whether such fears are realistic. I addressed this by surveying data packages from long-term population studies archived in the Dryad Digital Repository. I found no evidence that PDA results in reuse of data by independent parties, suggesting the purported costs of PDA for long-term population studies have been overstated.

  17. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

    DEFF Research Database (Denmark)

    Lindholt, J S; Sørensen, J; Søgaard, Rikke

    2010-01-01

    The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....

  18. Costs and Benefits of a Shared Digital Long-Term Preservation System

    Directory of Open Access Journals (Sweden)

    Esa-Pekka Keskitalo

    2011-10-01

    Full Text Available This paper describes the cost-benefit analysis of digital long-term preservation (LTP that was carried out in the context of the Finnish National Digital Library Project (NDL in 2010. The analysis was based on the assumption that as many as 200 archives, libraries, and museums will share an LTP system. The term ‘system’ shall be understood as encompassing not only information technology, but also human resources, organizational structures, policies and funding mechanisms. The cost analysis shows that an LTP system will incur, over the first 12 years, cumulative costs of €42 million, i.e. an average of €3.5 million per annum. Human resources and investments in information technology are the major cost factors. After the initial stages, the analysis predicts annual costs of circa €4 million. The analysis compared scenarios with and without a shared LTP system. The results indicate that a shared system will have remarkable benefits. At the development and implementation stages, a shared system shows an advantage of €30 million against the alternative scenario consisting of five independent LTP solutions. During the later stages, the advantage is estimated at €10 million per annum. The cumulative cost benefit over the first 12 years would amount to circa €100 million.

  19. Long-term cost and life-expectancy consequences of hypertension.

    Science.gov (United States)

    Kiiskinen, U; Vartiainen, E; Puska, P; Aromaa, A

    1998-08-01

    To estimate hypertension's long-term cost and impact on life expectancy. A 19-year individual follow-up study. Subjects were categorized according to their baseline (1972) diastolic blood pressure (DBP) level into three groups: normotensive (DBP 104 mmHg). By using their social security identification numbers, we linked the subjects to a set of national registers covering hospital admissions, use of major drugs, absence due to sickness, disability pensions, and deaths. A random population sample of 10 284 men and women aged 25-59 years from the provinces of Kuopio and North Karelia in eastern Finland. The numbers of years of life and years of work lost, the cost of drugs and hospitalization, and the value of productivity lost due to disability and premature mortality. The difference in life expectancy between normotensive and severely hypertensive men was 2.7 years, of which 2.0 years was due to cardiovascular disease (CVD). Among women the corresponding differences were 2.0 and 1.5 years. Severely hypertensive men lost 2.6 years of work more than did normotensive men, of which 1.7 years was due to CVD. Among women the differences were 2.2 and 1.3 years. The mean undiscounted total costs (USA dollars at 1992 prices) were $132 500 among normotensive, $146 500 among mildly hypertensive, and $219 300 among severely hypertensive men, of which CVD accounted for 28, 39, and 43%, respectively. More than 90% of the total costs were indirect productivity losses. Among women the total costs were lower for all DBP categories, as were the shares of CVD-related costs. The proportional increase in costs on going from the lowest to the highest DBP category was, however, somewhat larger among women. On the population level, severe hypertension leads to considerable losses in terms of years of life lost, years of work lost, and costs. However, the overall impact of mild hypertension is much more limited.

  20. Fusion--fission energy systems, some utility perspectives

    International Nuclear Information System (INIS)

    Huse, R.A.; Burger, J.M.; Lotker, M.

    1974-01-01

    Some of the issues that are important in assessing fusion-- fission energy systems from a utility perspective are discussed. A number of qualitative systems-oriented observations are given along with some economic quantification of the benefits from fusion--fission hybrids and their allowed capital cost. (U.S.)

  1. Long-term damage management strategies for optimizing steam generator performance

    International Nuclear Information System (INIS)

    Egan, G.R.; Besuner, P.M.; Fox, J.H.; Merrick, E.A.

    1991-01-01

    Minimizing long-term impact of steam generator operating, maintenance, outage, and replacement costs is the goal of all pressurized water reactor utilities. Recent research results have led to deterministic controls that may be implemented to optimize steam generator performance and to minimize damage accumulation. The real dilemma that utilities encounter is the decision process that needs to be made in the face of uncertain data. Some of these decisions involve the frequency and extent of steam generator eddy current tube inspections; the definition of operating conditions to minimize the rate of corrosion reactions (T (hot) , T (cold) ; and the imposition of strict water quality management guidelines. With finite resources, how can a utility decide which damage management strategy provides the most return for its investment? Aptech Engineering Services, Inc. (APTECH) developed a damage management strategy that starts from a deterministic analysis of a current problem- primary water stress corrosion cracking (PWSCC). The strategy involves a probabilistic treatment that results in long-term performance optimization. By optimization, we refer to minimizing the total cost of operating the steam generator. This total includes the present value costs of operations, maintenance, outages, and replacements. An example of the application of this methodology is presented. (author)

  2. Long term contracts in portfolios of gas supply

    International Nuclear Information System (INIS)

    Burns, D.

    1992-01-01

    This paper promotes the idea of long-term contracting for natural gas local distributors and utilities. It presents a brief history of how the spot-market developed and the effects spot-marketing can have in times of supply shortages. This has also resulted in a drastic decrease in exploration and development in the gas industry as gas supplies have exceeding demand, driving the prices down. The paper proposes several methods to restabilize the long-term contracting of gas by considering volume and pricing flexibility. Some brief discussions of industry-wide statistics are presented to show reserve replacement costs which would be needed to preserve the industry in a profit-making situation

  3. Negotiated Settlements: Long-term Profits and Costs

    Directory of Open Access Journals (Sweden)

    G. Kent Fellows

    2012-05-01

    Full Text Available Over the last 20 years, utility regulators have relaxed their oversight of cost-ofservice regulation and this holds true for Alberta, where such regulation determines the fees associated with oil and gas pipeline usage. The traditional method has been for regulators to issue binding decisions on a firm’s cost of service after taking evidence at a formal hearing. Many regulators now prefer to encourage parties to settle a cost-of-service agreement through a negotiated settlement, which the regulator then approves. This process not only saves the cost of a hearing, it also permits firms and consumers to trade costs and benefits, settling on a final price more favourable to both. The author details how this arrangement can negatively impact future consumers by allowing the firm to defer the true burden of its depreciation expenses in return for inflated capital costs. Such a settlement lowers prices for the present but saddles future consumers with higher prices.

  4. Costs and benefits of alternatives for mill-tailings management: a perspective

    International Nuclear Information System (INIS)

    Chee, P.C.; Yuan, Y.C.; Roberts, C.J.

    1983-01-01

    Past milling of uranium and thorium ore in the United States has produced tailings that are stored at numerous sites around the country. Some of these storage sites are located near towns and cities, and the local populations are exposed to radiation and radioactive materials migrating off the sites. The federal government has initiated remedial action programs (for example the Uranium Mill Tailings Remedial Action Program and the Formerly Utilized Sites Remedial Action Program) to clean up land and buildings that have become contaminated with radioactive material and thus eliminate or reduce population exposure to radiation. The degree of long-term benefit from any reduction of the population dose will be different for each remedial action, as will the cost. To gain a perspective on the cost-benefit ratios of various alternatives (remedial actions), estimates are made of the potential radiation doses to affected populations near two inactive sites and of the costs associated with (1) onsite stabilization of radioactive tailings, and (2) transportation of tailings to remote locations for stabilization. The calculations presented in this paper were based on actual conditions at an inactive uranium mill tailings site (the Vitro site in Salt Lake City, Utah) and at a former thorium-processing facility (Kerr-McGee site in West Chicago, Illinois)

  5. The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Coy, Peter; Schaafsma, Joseph; Schofield, John A.

    2000-01-01

    Purpose: To compute cost-effectiveness/cost-utility (CE/CU) ratios, from the treatment clinic and societal perspectives, for high-dose palliative radiotherapy treatment (RT) for advanced non-small-cell lung cancer (NSCLC) against best supportive care (BSC) as comparator, and thereby demonstrate a method for computing CE/CU ratios when randomized clinical trial (RCT) data cannot be generated. Methods and Materials: Unit cost estimates based on an earlier reported 1989-90 analysis of treatment costs at the Vancouver Island Cancer Centre, Victoria, British Columbia, Canada, are updated to 1997-1998 and then used to compute the incremental cost of an average dose of high-dose palliative RT. The incremental number of life days and quality-adjusted life days (QALDs) attributable to treatment are from earlier reported regression analyses of the survival and quality-of-life data from patients who enrolled prospectively in a lung cancer management cost-effectiveness study at the clinic over a 2-year period from 1990 to 1992. Results: The baseline CE and CU ratios are $9245 Cdn per life year (LY) and $12,836 per quality-adjusted life year (QALY), respectively, from the clinic perspective; and $12,253/LY and $17,012/QALY, respectively, from the societal perspective. Multivariate sensitivity analysis for the CE ratio produces a range of $5513-28,270/LY from the clinic perspective, and $7307-37,465/LY from the societal perspective. Similar calculations for the CU ratio produce a range of $7205-37,134/QALY from the clinic perspective, and $9550-49,213/QALY from the societal perspective. Conclusion: The cost effectiveness and cost utility of high-dose palliative RT for advanced NSCLC compares favorably with the cost effectiveness of other forms of treatment for NSCLC, of treatments of other forms of cancer, and of many other commonly used medical interventions; and lies within the US $50,000/QALY benchmark often cited for cost-effective care

  6. Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

    Science.gov (United States)

    Blackburn, Justin; Locher, Julie L; Kilgore, Meredith L

    2016-04-01

    To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients. A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries. After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Cost-utility analysis of antithyroid drug therapy versus 131I therapy for Graves' disease

    International Nuclear Information System (INIS)

    Hayashi, Katsumi; Abe, Katsumi; Sakata, Ikuko; Sakaguchi, Chiharu; Yamamoto, Kentaro; Kosuda, Shigeru

    2005-01-01

    There is no comparative cost-utility study between 131 I therapy and antithyroid drugs (ATD) therapy for Graves' disease, though 131 I therapy has higher remission rate and less side effects. The objective of the study was to analyze the cost-utility of ATD therapy versus 131 I therapy by calculating life-long medical costs and utility, based on the responses of Graves' disease patients to questionnaires. To determine the expected cost and expected utility, a decision tree analysis was designed on the basis of the 2 competing strategies of ATD therapy versus 131 I therapy. A simulation of 1,000 female patients weighing≥50 kg who assumed to experience the onset of Graves' disease at the age of 30, to first complain of thyrotoxic symptoms and moderate goiter 2-3 mo. previously, and to undergo a 40-years-long cohort study, was created for each strategy using a decision tree and baselines of other relevant variables. The variables and costs were based on the literature and hospital bills. The maximum and minimum values of utility were defined as 1.0 and 0.0, respectively. Future costs and utilities were discounted 5%. The medical costs and utilities were 85,739-88,650 yen/patient/40 years and 16.47-16.56/patient/40 years, respectively, for the ATD therapy strategy, and 81,842 yen/patient/40 years and 17.41/patient/40 years, respectively, for the 131 I therapy strategy. These results quantitatively demonstrated that the 131 I therapy strategy was superior to the ATD therapy strategy in terms of both cost and utility. 131 I therapy should be used more widely in Japan because of its greater utility and lower cost. (author)

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

    Science.gov (United States)

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

    2015-05-01

    Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with

  9. Space ventures and society long-term perspectives

    Science.gov (United States)

    Brown, W. M.

    1985-01-01

    A futuristic evaluation of mankind's potential long term future in space is presented. Progress in space will not be inhibited by shortages of the Earth's physical resources, since long term economic growth will be focused on ways to constrain industrial productivity by changing social values, management styles, or government competence. Future technological progress is likely to accelerate with an emphasis on international cooperation, making possible such large joint projects as lunar colonies or space stations on Mars. The long term future in space looks exceedingly bright even in relatively pessimistic scenarios. The principal driving forces will be technological progress, commercial and public-oriented satellites, space industrialization, space travel, and eventually space colonization.

  10. Evaluation of the long-term cost-effectiveness of IDegLira versus liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the USA.

    Science.gov (United States)

    Hunt, B; Mocarski, M; Valentine, W J; Langer, J

    2017-07-01

    IDegLira, a fixed ratio combination of insulin degludec and glucagon-like peptide-1 receptor agonist liraglutide, utilizes the complementary mechanisms of action of these two agents to improve glycemic control with low risk of hypoglycemia and avoidance of weight gain. The aim of the present analysis was to assess the long-term cost-effectiveness of IDegLira vs liraglutide added to basal insulin, for patients with type 2 diabetes not achieving glycemic control on basal insulin in the US setting. Projections of lifetime costs and clinical outcomes were made using the IMS CORE Diabetes Model. Treatment effect data for patients receiving IDegLira and liraglutide added to basal insulin were modeled based on the outcomes of a published indirect comparison, as no head-to-head clinical trial data is currently available. Costs were accounted in 2015 US dollars ($) from a healthcare payer perspective. IDegLira was associated with small improvements in quality-adjusted life expectancy compared with liraglutide added to basal insulin (8.94 vs 8.91 discounted quality-adjusted life years [QALYs]). The key driver of improved clinical outcomes was the greater reduction in glycated hemoglobin associated with IDegLira. IDegLira was associated with mean costs savings of $17,687 over patient lifetimes vs liraglutide added to basal insulin, resulting from lower treatment costs and cost savings as a result of complications avoided. The present long-term modeling analysis found that IDegLira was dominant vs liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the US, improving clinical outcomes and reducing direct costs.

  11. A cost of long-term memory in Drosophila

    OpenAIRE

    Mery, Frederic; Kawecki, Tadeusz J.

    2005-01-01

    Two distinct forms of consolidated associative memory are known in Drosophila: long-term memory and so-called anesthesia-resistant memory. Long-term memory is more stable, but unlike anesthesia-resistant memory, its formation requires protein synthesis. We show that flies induced to form long-term memory become more susceptible to extreme stress (such as desiccation). In contrast, induction of anesthesia-resistant memory had no detectable effect on desiccation resistance. This finding may hel...

  12. A retrospective investigation of energy efficiency standards: policies may have accelerated long term declines in appliance costs

    International Nuclear Information System (INIS)

    Van Buskirk, R D; Kantner, C L S; Gerke, B F; Chu, S

    2014-01-01

    We perform a retrospective investigation of multi-decade trends in price and life-cycle cost (LCC) for home appliances in periods with and without energy efficiency (EE) standards and labeling polices. In contrast to the classical picture of the impact of efficiency standards, the introduction and updating of appliance standards is not associated with a long-term increase in purchase price; rather, quality-adjusted prices undergo a continued or accelerated long-term decline. In addition, long term trends in appliance LCCs—which include operating costs—consistently show an accelerated long term decline with EE policies. We also show that the incremental price of efficiency improvements has declined faster than the baseline product price for selected products. These observations are inconsistent with a view of EE standards that supposes a perfectly competitive market with static supply costs. These results suggest that EE policies may be associated with other forces at play, such as innovation and learning-by-doing in appliance production and design, that can affect long term trends in quality-adjusted prices and LCCs. (letter)

  13. Long-term perspectives of the worldwide use of nuclear power

    International Nuclear Information System (INIS)

    Jaek, W.

    1981-01-01

    The world energy scenarios developed by WEC and IIASA, which contain analyses and estimates on the long-term development perspectives of regional development areas, show that the worldwide energy requirement can no longer be met without the large-scale expansion of nuclear power. This implies an expansion on nuclear power in the next forty or fifty years to more than the 38 countries at present known to use or wanting to use nuclear power. With respect to the aspects of supply and non-proliferation, the question of the geographic distribution of future nuclear power plants is becoming more and more important. If the more global statements in the different world energy scenarios can be translated into information about the potential use of nuclear power in specific countries in the fifty years, this will allow a picture of a possible nuclear future to be sketched, on the basis of which considerations of non-proliferation and nuclear transfer can be put on a firm basis. This is not meant to be another set of long-term forecasts of nuclear power, but a concrete implementation of world energy scenarios and the consequences with respect to non-proliferation and transfer potentially arising from them. (orig.) [de

  14. Adjustment in property space markets: taking long-term leases and transaction costs seriously

    NARCIS (Netherlands)

    Englund, P.; Gunnelin, Å.; Hendershott, P.H.; Söderberg, B.

    2008-01-01

    Markets for property space adjust only gradually because tenants and landlords are constrained by long-term leases and transaction and information costs. Not only do rents adjust slowly, but space occupancy, which depends on historical rents, often differs from demand at current rent. This creates

  15. Locked into Copenhagen pledges - Implications of short-term emission targets for the cost and feasibility of long-term climate goals

    NARCIS (Netherlands)

    Riahi, Keywan; Kriegler, Elmar; Johnson, Nils; Bertram, Christoph; den Elzen, Michel; Eom, Jiyong; Schaeffer, Michiel; Edmonds, Jae; Isaac, Morna; Krey, Volker; Longden, Thomas; Luderer, Gunnar; Méjean, Aurélie; McCollum, David L.; Mima, Silvana; Turton, Hal; van Vuuren, Detlef P.; Wada, Kenichi; Bosetti, Valentina; Capros, Pantelis; Criqui, Patrick; Hamdi-Cherif, Meriem; Kainuma, Mikiko; Edenhofer, Ottmar

    2015-01-01

    This paper provides an overview of the AMPERE modeling comparison project with focus on the implications of near-term policies for the costs and attainability of long-term climate objectives. Nine modeling teams participated in the project to explore the consequences of global emissions following

  16. Costs and cost-effectiveness of periviable care.

    Science.gov (United States)

    Caughey, Aaron B; Burchfield, David J

    2014-02-01

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

  17. Efficient utilization of wind power: Long-distance transmission or local consumption?

    Institute of Scientific and Technical Information of China (English)

    Yuanzhang SUN; Xiyuan MA; Jian XU; Yi BAO; Siyang LIAO

    2017-01-01

    Excess wind power produced in wind-intensive areas is normally delivered to remote load centers via long-distance transmission lines.This paper presents a comparison between long-distance transmission,which has gained popularity,and local energy consumption,in which a fraction of the generated wind power can be locally consumed by energy-intensive industries.First,the challenges and solutions to the long-distance transmission and local consumption of wind power are presented.Then,the two approaches to the utilization of wind power are compared in terms of system security,reliability,cost,and capability to utilize wind energy.Finally,the economic feasibility and technical feasibility of the local consumption of wind power are demonstrated by a large and isolated industrial power system,or supermicrogrid,in China.The coal-fired generators together with the shortterm interruptible electrolytic aluminum load in the supermicrogrid are able to compensate for the intermittency of wind power.In the long term,the transfer of highenergy-consumption industries to wind-rich areas and their local consumption of the available wind power are beneficial.

  18. Calculating cost savings in utilization management.

    Science.gov (United States)

    MacMillan, Donna

    2014-01-01

    A major motivation for managing the utilization of laboratory testing is to reduce the cost of medical care. For this reason it is important to understand the basic principles of cost accounting in the clinical laboratory. The process of laboratory testing includes three distinct components termed the pre-analytic, analytic and post-analytic phases. Utilization management efforts may impact the cost structure of these three phases in different ways depending on the specific details of the initiative. Estimates of cost savings resulting from utilization management programs reported in the literature have often been fundamentally flawed due to a failure to understand basic concepts such as the difference between laboratory costs versus charges and the impact of reducing laboratory test volumes on the average versus marginal cost structure in the laboratory. This article will provide an overview of basic cost accounting principles in the clinical laboratory including both job order and process cost accounting. Specific examples will be presented to illustrate these concepts in various different scenarios. © 2013.

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

    Science.gov (United States)

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

    2018-04-12

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

  20. Modulation of working memory updating: Does long-term memory lexical association matter?

    Science.gov (United States)

    Artuso, Caterina; Palladino, Paola

    2016-02-01

    The aim of the present study was to investigate how working memory updating for verbal material is modulated by enduring properties of long-term memory. Two coexisting perspectives that account for the relation between long-term representation and short-term performance were addressed. First, evidence suggests that performance is more closely linked to lexical properties, that is, co-occurrences within the language. Conversely, other evidence suggests that performance is linked more to long-term representations which do not entail lexical/linguistic representations. Our aim was to investigate how these two kinds of long-term memory associations (i.e., lexical or nonlexical) modulate ongoing working memory activity. Therefore, we manipulated (between participants) the strength of the association in letters based on either frequency of co-occurrences (lexical) or contiguity along the sequence of the alphabet (nonlexical). Results showed a cost in working memory updating for strongly lexically associated stimuli only. Our findings advance knowledge of how lexical long-term memory associations between consonants affect working memory updating and, in turn, contribute to the study of factors which impact the updating process across memory systems.

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

    International Nuclear Information System (INIS)

    Mubayi, V.

    1995-05-01

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

  2. DSM and electric utility competitiveness: An Illinois perspective

    Energy Technology Data Exchange (ETDEWEB)

    Jackson, P.W.

    1994-12-31

    A predominant theme in the current electric utility industry literature is that competitive forces have emerged and may become more prominent. The wholesale bulk power market is alreadly competitive, as non-utility energy service providers already have had a significant impact on that market; this trend was accelerated by the Energy Policy Act of 1992. Although competition at the retail level is much less pervasive, electric utility customers increasingly have greater choice in selecting energy services. These choices may include, depending on the customer, the ability to self-generate, switch fuels, move to a new location, or rely more heavily on demand-side management as a means of controlling electric energy use. This paper explores the subject of how demand-side management (DSM) programs, which are often developed by a utility to satisfy resource requirements as a part of its least-cost planning process, can affect the utility`s ability to compete in the energy services marketplace. In this context, the term `DSM` is used in this paper to refer to those demand-side services and programs which provide resources to the utility`s system. Depending on one`s perspective, DSM programs (so defined) can be viewed either as an enhancement to the competitive position of a utility by enabling it to provide its customers with a broader menu of energy services, simultaneously satisfying the objectives of the utility as well as those of the customers, or as a detractor to a utility`s ability to compete. In the latter case, the concern is with respect to the potential for adverse rate impacts on customers who are not participants in DSM programs. The paper consists of an identification of the pros and cons of DSM as a competitive strategy, the tradeoff which can occur between the cost impacts and rate impacts of DSM, and an examination of alternative strategies for maximizing the utilization of DSM both as a resource and as a competitive strategy.

  3. The cost of long-term follow-up of high-risk infants for research studies.

    Science.gov (United States)

    Doyle, Lex W; Clucas, Luisa; Roberts, Gehan; Davis, Noni; Duff, Julianne; Callanan, Catherine; McDonald, Marion; Anderson, Peter J; Cheong, Jeanie L Y

    2015-10-01

    Neonatal intensive care is expensive, and thus it is essential that its long-term outcomes are measured. The costs of follow-up studies for high-risk children who survive are unknown. This study aims to determine current costs for the assessment of health and development of children followed up in our research programme. Costs were determined for children involved in the research follow-up programme at the Royal Women's Hospital, Melbourne, over the 6-month period between 1st January 2012 and 30th June 2012. The time required for health professionals involved in assessments in early and later childhood was estimated, and converted into dollar costs. Costs for equipment and data management were added. Estimated costs were compared with actual costs of running the research follow-up programme. A total of 134 children were assessed over the 6-month period. The estimated average cost per child assessed was $1184, much higher than was expected. The estimated cost to assess a toddler was $1149, whereas for an 11-year-old it was $1443, the difference attributable to the longer psychological and paediatric assessments. The actual average cost per child assessed was $1623. The shortfall of $439 between the actual and estimated average costs per child arose chiefly because of the need to pay staff even when participants were late or failed to attend. The average costs of assessing children at each age for research studies are much higher than expected. These data are useful for planning similar long-term follow-up assessments for high-risk children. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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

    Directory of Open Access Journals (Sweden)

    Christina Bächle

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

  5. Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival.

    Science.gov (United States)

    Geri, Guillaume; Fahrenbruch, Carol; Meischke, Hendrika; Painter, Ian; White, Lindsay; Rea, Thomas D; Weaver, Marcia R

    2017-06-01

    Bystander cardiopulmonary resuscitation (CPR) is associated with a greater likelihood of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA). However the long-term survival benefits in relationship to cost have not been well-studied. We evaluated bystander CPR, hospital-based costs, and long-term survival following OHCA in order to assess the potential cost-effectiveness of bystander CPR. We conducted a retrospective cohort study of consecutive EMS-treated OHCA patients >=12years who arrested prior to EMS arrival and outside a nursing facility between 2001 and 2010 in greater King County, WA. Utstein-style information was obtained from the EMS registry, including 5-year survival. Costs from the OHCA hospitalization were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Cost effectiveness was based on hospital costs divided by quality-adjusted life years (QALYs) for a 5-year follow-up window. Of the 4448 eligible patients, 18.5% (n=824) were discharged alive from hospital and 12.1% (n=539) were alive at 5 years. Five-year survival was higher in patients who received bystander CPR (14.3% vs. 8.7%, pbystander CPR. The average (SD) total cost of the initial acute care hospitalization was USD 19,961 (40,498) for all admitted patients and USD 75,175 (52,276) for patients alive at year 5. The incremental cost-effectiveness ratio associated with bystander CPR was USD 48,044 per QALY. Based on this population-based investigation, bystander CPR was positively associated with long-term survival and appears cost-effective. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD

    NARCIS (Netherlands)

    Hoogendoorn, Martine; Feenstra, Talitha L.; Hoogenveen, Rudolf T.; Rutten-van Molken, Maureen P. M. H.

    Background The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). Methods A systematic review was performed of randomised controlled trials on smoking cessation interventions in

  7. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); T.L. Feenstra (Talitha); R.T. Hoogenveen (Rudolf); M.P.M.H. Rutten-van Mölken (Maureen)

    2010-01-01

    textabstractBackground: The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). Methods: A systematic review was performed of randomised controlled trials on smoking cessation

  8. Opening remarks for a panel discussion on short-term vs long-term procurement

    International Nuclear Information System (INIS)

    Courtenay, R.H.

    1990-01-01

    Long-term contracting in the late 1970's and early 1980's is blamed for some of the inequities that plague the uranium industry today. Utilities are obliged to pay prices far above prevailing levels and relatively low cost producers are forced to shut down while watching less efficient suppliers stay in business thanks to their long term supply agreements. Furthermore, it is argued that long-term contracts have contributed to supply instability by forcing the buildup of surplus inventories and by supporting excess incremental production by suppliers who have a baseload of long-term contracts. The depressed prices resulting from this oversupply are in turn jeopardizing future resource development and damaging supply reliability. In summary, the author's argument is that supply reliability will be greatly enhanced by the assurance of adequate primary supply from traditional sources such as Canada. This will not happen without long-term contracts. This conclusion may not be expected coming from a representative of Canada's largest uranium producer. But the final comment is less self serving. Many of the critics of long term contracts apparently expect a continuing and plentiful supply of East Bloc uranium to the spot market. A further question is to what extent East Bloc suppliers will eventually require long-term contracts in order to maintain production facilitates in economies that are no longer centrally planned, and where there is open competition for capital. Ultimately, reliability of supply from the non-traditional suppliers may also depend on long-term contracts

  9. Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery : A randomised trial

    NARCIS (Netherlands)

    Dieleman, J. M.; de Wit, G. A.; Nierich, A. P.; Rosseel, P. M.; van der Maaten, J. M.; Hofland, J.; Diephuis, J. C.; de Lange, F.; Boer, C.; Neslo, R. E.; Moons, K. G.; van Herwerden, L. A.; Tijssen, J. G.; Kalkman, C. J.; van Dijk, D.

    Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre,

  10. Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery: a randomised trial

    NARCIS (Netherlands)

    Dieleman, J. M.; de Wit, G. A.; Nierich, A. P.; Rosseel, P. M.; van der Maaten, J. M.; Hofland, J.; Diephuis, J. C.; de Lange, F.; Boer, C.; Neslo, R. E.; Moons, K. G.; van Herwerden, L. A.; Tijssen, J. G.; Kalkman, C. J.; van Dijk, D.

    2017-01-01

    Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre,

  11. Long-term contracts vs. short-term trade of natural gas - a European perspective

    International Nuclear Information System (INIS)

    Neuhoff, Karsten; Hirschhausen, Christian von

    2005-01-01

    This paper analyses the economics of long-term gas contracts under changing institutional conditions, mainly gas sector liberalisation. The paper is motivated by the increasingly tense debate in continental Europe, UK and the US on the security of long-term gas supply. We discuss the main issues regarding long-term contracts, i.e. the changing role of the flexibility clause, the effect of abandoning the destination clause, and the strategic behaviour of producers between long-term sales and spot-sales. The literature suggests consumers and producers benefit from risk hedging through long-term contracts. Furthermore long-term contracts may reduce exercise of market power. Our analysis adds an additional benefit if the long-run demand elasticity is significantly lower than the short-run elasticity, both strategic producers and consumers benefit from lower prices and larger market volume. Some policy implications of the findings are also discussed. (Author)

  12. Committing to coal and gas: Long-term contracts, regulation, and fuel switching in power generation

    Science.gov (United States)

    Rice, Michael

    Fuel switching in the electricity sector has important economic and environmental consequences. In the United States, the increased supply of gas during the last decade has led to substantial switching in the short term. Fuel switching is constrained, however, by the existing infrastructure. The power generation infrastructure, in turn, represents commitments to specific sources of energy over the long term. This dissertation explores fuel contracts as the link between short-term price response and long-term plant investments. Contracting choices enable power plant investments that are relationship-specific, often regulated, and face uncertainty. Many power plants are subject to both hold-up in investment and cost-of-service regulation. I find that capital bias is robust when considering either irreversibility or hold-up due to the uncertain arrival of an outside option. For sunk capital, the rental rate is inappropriate for determining capital bias. Instead, capital bias depends on the regulated rate of return, discount rate, and depreciation schedule. If policies such as emissions regulations increase fuel-switching flexibility, this can lead to capital bias. Cost-of-service regulation can shorten the duration of a long-term contract. From the firm's perspective, the existing literature provides limited guidance when bargaining and writing contracts for fuel procurement. I develop a stochastic programming framework to optimize long-term contracting decisions under both endogenous and exogenous sources of hold-up risk. These typically include policy changes, price shocks, availability of fuel, and volatility in derived demand. For price risks, the optimal contract duration is the moment when the expected benefits of the contract are just outweighed by the expected opportunity costs of remaining in the contract. I prove that imposing early renegotiation costs decreases contract duration. Finally, I provide an empirical approach to show how coal contracts can limit

  13. DSM and electric utility competitiveness: An Illinois perspective

    International Nuclear Information System (INIS)

    Jackson, P.W.

    1994-01-01

    A predominant theme in the current electric utility industry literature is that competitive forces have emerged and may become more prominent. The wholesale bulk power market is alreadly competitive, as non-utility energy service providers already have had a significant impact on that market; this trend was accelerated by the Energy Policy Act of 1992. Although competition at the retail level is much less pervasive, electric utility customers increasingly have greater choice in selecting energy services. These choices may include, depending on the customer, the ability to self-generate, switch fuels, move to a new location, or rely more heavily on demand-side management as a means of controlling electric energy use. This paper explores the subject of how demand-side management (DSM) programs, which are often developed by a utility to satisfy resource requirements as a part of its least-cost planning process, can affect the utility's ability to compete in the energy services marketplace. In this context, the term 'DSM' is used in this paper to refer to those demand-side services and programs which provide resources to the utility's system. Depending on one's perspective, DSM programs (so defined) can be viewed either as an enhancement to the competitive position of a utility by enabling it to provide its customers with a broader menu of energy services, simultaneously satisfying the objectives of the utility as well as those of the customers, or as a detractor to a utility's ability to compete. In the latter case, the concern is with respect to the potential for adverse rate impacts on customers who are not participants in DSM programs. The paper consists of an identification of the pros and cons of DSM as a competitive strategy, the tradeoff which can occur between the cost impacts and rate impacts of DSM, and an examination of alternative strategies for maximizing the utilization of DSM both as a resource and as a competitive strategy

  14. The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria.

    Science.gov (United States)

    Schiller-Fruehwirth, Irmgard; Jahn, Beate; Einzinger, Patrick; Zauner, Günther; Urach, Christoph; Siebert, Uwe

    2017-09-01

    In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility.

    Science.gov (United States)

    Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

    2004-01-01

    The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

  16. Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial

    Directory of Open Access Journals (Sweden)

    de Kort Nelleke

    2011-08-01

    Full Text Available Abstract Background Low back pain (LBP, with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP. Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days, Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP and 12 months (evaluate the outcomes at long term. Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration ISRCTN: ISRCTN58719694

  17. A comparison of costs associated with utility management options for dry active waste

    Energy Technology Data Exchange (ETDEWEB)

    Hornibrook, C. [EPRI, Palo Alto, CA (United States)

    1995-12-31

    The economics of low level waste management is receiving more attention today than ever before. This is due to four factors: (1) the increases in the cost of processing of these wastes; (2) increases in the cost of disposal; (3) the addition of storage costs for those without access to disposal; and (4) the increasing competitive nature of the electric generation industry. These pressures are forcing the industry to update it`s evaluation of the mix of processing that will afford it the best long term economics and minimize it`s risks for unforeseen costs. Whether disposal is available or not, all utilities face the same challenge of minimizing the costs associated with the management of these wastes. There are a number of variables that will impact how a utility manages their wastes but the problem is the uncertainty of what will actually happen, i.e., will disposal be available, when and at what cost. Using the EPRI-developed WASTECOST: DAW code, this paper explores a variety of LLW management options available to utilities. Along with providing the costs and benefits, other technical considerations which play an important part in the management of these wastes are also addressed.

  18. Plastic mulching in agriculture. Trading short-term agronomic benefits for long-term soil degradation?

    Energy Technology Data Exchange (ETDEWEB)

    Steinmetz, Zacharias; Wollmann, Claudia; Schaefer, Miriam; Buchmann, Christian; David, Jan [Institute for Environmental Sciences, Group of Environmental and Soil Chemistry, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany); Tröger, Josephine [Department of Psychology, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany); Interdisciplinary Research Group on Environmental Issues, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany); Muñoz, Katherine [Institute for Environmental Sciences, Group of Environmental and Soil Chemistry, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany); Interdisciplinary Research Group on Environmental Issues, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany); Frör, Oliver [Institute for Environmental Sciences, Group of Environmental Economics, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany); Schaumann, Gabriele Ellen, E-mail: schaumann@uni-landau.de [Institute for Environmental Sciences, Group of Environmental and Soil Chemistry, University of Koblenz-Landau, Fortstraße 7, 76829 Landau (Germany)

    2016-04-15

    Plastic mulching has become a globally applied agricultural practice for its instant economic benefits such as higher yields, earlier harvests, improved fruit quality and increased water-use efficiency. However, knowledge of the sustainability of plastic mulching remains vague in terms of both an environmental and agronomic perspective. This review critically discusses the current understanding of the environmental impact of plastic mulch use by linking knowledge of agricultural benefits and research on the life cycle of plastic mulches with direct and indirect implications for long-term soil quality and ecosystem services. Adverse effects may arise from plastic additives, enhanced pesticide runoff and plastic residues likely to fragment into microplastics but remaining chemically intact and accumulating in soil where they can successively sorb agrochemicals. The quantification of microplastics in soil remains challenging due to the lack of appropriate analytical techniques. The cost and effort of recovering and recycling used mulching films may offset the aforementioned benefits in the long term. However, comparative and long-term agronomic assessments have not yet been conducted. Furthermore, plastic mulches have the potential to alter soil quality by shifting the edaphic biocoenosis (e.g. towards mycotoxigenic fungi), accelerate C/N metabolism eventually depleting soil organic matter stocks, increase soil water repellency and favour the release of greenhouse gases. A substantial process understanding of the interactions between the soil microclimate, water supply and biological activity under plastic mulches is still lacking but required to estimate potential risks for long-term soil quality. Currently, farmers mostly base their decision to apply plastic mulches rather on expected short-term benefits than on the consideration of long-term consequences. Future interdisciplinary research should therefore gain a deeper understanding of the incentives for farmers

  19. Plastic mulching in agriculture. Trading short-term agronomic benefits for long-term soil degradation?

    International Nuclear Information System (INIS)

    Steinmetz, Zacharias; Wollmann, Claudia; Schaefer, Miriam; Buchmann, Christian; David, Jan; Tröger, Josephine; Muñoz, Katherine; Frör, Oliver; Schaumann, Gabriele Ellen

    2016-01-01

    Plastic mulching has become a globally applied agricultural practice for its instant economic benefits such as higher yields, earlier harvests, improved fruit quality and increased water-use efficiency. However, knowledge of the sustainability of plastic mulching remains vague in terms of both an environmental and agronomic perspective. This review critically discusses the current understanding of the environmental impact of plastic mulch use by linking knowledge of agricultural benefits and research on the life cycle of plastic mulches with direct and indirect implications for long-term soil quality and ecosystem services. Adverse effects may arise from plastic additives, enhanced pesticide runoff and plastic residues likely to fragment into microplastics but remaining chemically intact and accumulating in soil where they can successively sorb agrochemicals. The quantification of microplastics in soil remains challenging due to the lack of appropriate analytical techniques. The cost and effort of recovering and recycling used mulching films may offset the aforementioned benefits in the long term. However, comparative and long-term agronomic assessments have not yet been conducted. Furthermore, plastic mulches have the potential to alter soil quality by shifting the edaphic biocoenosis (e.g. towards mycotoxigenic fungi), accelerate C/N metabolism eventually depleting soil organic matter stocks, increase soil water repellency and favour the release of greenhouse gases. A substantial process understanding of the interactions between the soil microclimate, water supply and biological activity under plastic mulches is still lacking but required to estimate potential risks for long-term soil quality. Currently, farmers mostly base their decision to apply plastic mulches rather on expected short-term benefits than on the consideration of long-term consequences. Future interdisciplinary research should therefore gain a deeper understanding of the incentives for farmers

  20. Lock-in and change: Distributed generation in Denmark in a long-term perspective

    International Nuclear Information System (INIS)

    Vleuten, Erik van der; Raven, Rob

    2006-01-01

    There is a renewed attention for distributed generation (DG) in European electricity sectors, but implementing DG is often problematic. This article studies the current relative success of DG in Denmark. We take into account not only recent drivers of change such as energy policy and green activism, but also long-term stability and change in the electricity supply sector. In particular we analyse the lock-in on centralized electricity supply, that still frustrates DG development elsewhere. We discuss three successive national electricity regimes, analysing regime lock-in and change in terms of technologies, actors, institutions and the position of DG. Our analysis shows that Danish energy policy as well as innovative activity by key actors indeed were crucial to the recent DG revival in Denmark. On the other hand, our long-term perspective shows that Danish energy policy and actor strategies were tuned to specifically Danish opportunities and barriers created during earlier regimes. These include experience with wind turbines and CHP as well as urban municipal and rural cooperative involvement. Copying the Danish energy policy model to other countries, regardless of national specific opportunities and barriers, will therefore not guarantee a similar outcome

  1. Cost-utility of laparoscopic Nissen fundoplication versus proton pump inhibitors for chronic and controlled gastroesophageal reflux disease: a 3-year prospective randomized controlled trial and economic evaluation.

    Science.gov (United States)

    Goeree, Ron; Hopkins, Rob; Marshall, John K; Armstrong, David; Ungar, Wendy J; Goldsmith, Charles; Allen, Christopher; Anvari, Mehran

    2011-01-01

    Very few randomized controlled trials (RCTs) have compared laparoscopic Nissen fundoplication (LNF) to proton pump inhibitors (PPI) medical management for patients with chronic gastroesophageal reflux disease (GERD). Larger RCTs have been relatively short in duration, and have reported mixed results regarding symptom control and effect on quality of life (QOL). Economic evaluations have reported conflicting results. To determine the incremental cost-utility of LNF versus PPI for treating patients with chronic and controlled GERD over 3 years from the societal perspective. Economic evaluation was conducted alongside a RCT that enrolled 104 patients from October 2000 to September 2004. Primary study outcome was GERD symptoms (secondary outcomes included QOL and cost-utility). Resource utilization and QOL data collected at regular follow-up intervals determined incremental cost/QALY gained. Stochastic uncertainty was assessed using bootstrapping and methodologic assumptions were assessed using sensitivity analysis. No statistically significant differences in GERD symptom scores, but LNF did result in fewer heartburn days and improved QOL. Costs were higher for LNF patients by $3205/patient over 3 years but QOL was also higher as measured by either QOL instrument. Based on total costs, incremental cost-utility of LNF was $29,404/QALY gained using the Health Utility Index 3. Cost-utility results were sensitive to the utility instrument used ($29,404/QALY for Health Utility Index 3, $31,117/QALY for the Short Form 6D, and $76,310/QALY for EuroQol 5D) and if current lower prices for PPIs were used in the analysis. Results varied depending on resource use/costs included in the analysis, the QOL instrument used, and the cost of PPIs; however, LNF was generally found to be a cost-effective treatment for patients with symptomatic controlled GERD requiring long-term management. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR

  2. Long-term availability of global uranium resources

    International Nuclear Information System (INIS)

    Monnet, Antoine

    2016-01-01

    From a global perspective, a low-carbon path to development driven by a growth of nuclear power production raises issues about the availability of uranium resources. Future technologies allowing nuclear reactors to overcome the need for natural uranium will take time to fully deploy. To address these issues, we analyze the conditions of availability of uranium in the 21. century. The first two conditions are technical accessibility and economic interest, both related to the cost of production. We study them using a model that estimates the ultimate uranium resources (amounts of both discovered and undiscovered resources) and their costs. This model splits the world into regions and the resource estimate for each region derives from the present knowledge of the deposits and economic filtering. The output is a long-term supply curve that illustrates the quantities of uranium that are technically accessible as a function of their cost of production. We identify the main uncertainties of these estimates and we show that with no regional breakdown, the ultimate resources are underestimated. The other conditions of availability of uranium covered in our study are related to the market dynamics, i.e. they derive from the supply and demand clearing mechanism. To assess their influence, they are introduced as dynamic constraints in a partial equilibrium model. This model of the uranium market is deterministic, and market players are represented by regions. For instance, it takes into account the short-term correlation between price and exploration expenditures, which is the subject of a dedicate econometric study. In the longer term, constraints include anticipation of demand by consumers and a gradual depletion of the cheapest ultimate resources. Through a series of prospective simulations, we demonstrate the strong influence on long-term price trends of both the growth rate of demand during the 21. century and its anticipation. Conversely, the uncertainties related to the

  3. Hip protector compliance: a 13-month study on factors and cost in a long-term care facility.

    Science.gov (United States)

    Burl, Jeffrey B; Centola, James; Bonner, Alice; Burque, Colleen

    2003-01-01

    To determine if a high compliance rate for wearing external hip protectors could be achieved and sustained in a long-term care population. A 13-month prospective study of daytime use of external hip protectors in an at-risk long-term care population. One hundred-bed not-for-profit long-term care facility. Thirty-eight ambulatory residents having at least 1 of 4 risk factors (osteoporosis, recent fall, positive fall screen, previous fracture). The rehabilitation department coordinated an implementation program. Members of the rehabilitation team met with eligible participants, primary caregivers, families, and other support staff for educational instruction and a description of the program. The rehabilitation team assumed overall responsibility for measuring and ordering hip protectors and monitoring compliance. By the end of the third month, hip protector compliance averaged greater than 90% daily wear. The average number of falls per month in the hip protector group was 3.9 versus 1.3 in nonparticipants. Estimated total indirect staff time was 7.75 hours. The total cost of the study (hip protectors and indirect staff time) was 6,300 US dollars. High hip protector compliance is both feasible and sustainable in an at-risk long-term care population. Achieving high compliance requires an interdisciplinary approach with one department acting as a champion. The cost of protectors could be a barrier to widespread use. Facilities might be unable to cover the cost until the product is paid for by third-party payers.

  4. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD.

    Science.gov (United States)

    Hoogendoorn, Martine; Feenstra, Talitha L; Hoogenveen, Rudolf T; Rutten-van Mölken, Maureen P M H

    2010-08-01

    The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). A systematic review was performed of randomised controlled trials on smoking cessation interventions in patients with COPD reporting 12-month biochemical validated abstinence rates. The different interventions were grouped into four categories: usual care, minimal counselling, intensive counselling and intensive counselling + pharmacotherapy ('pharmacotherapy'). For each category the average 12-month continuous abstinence rate and intervention costs were estimated. A dynamic population model for COPD was used to project the long-term (cost-) effectiveness (25 years) of 1-year implementation of the interventions for 50% of the patients with COPD who smoked compared with usual care. Uncertainty and one-way sensitivity analyses were performed for variations in the calculation of the abstinence rates, the type of projection, intervention costs and discount rates. Nine studies were selected. The average 12-month continuous abstinence rates were estimated to be 1.4% for usual care, 2.6% for minimal counselling, 6.0% for intensive counselling and 12.3% for pharmacotherapy. Compared with usual care, the costs per quality-adjusted life year (QALY) gained for minimal counselling, intensive counselling and pharmacotherapy were euro 16 900, euro 8200 and euro 2400, respectively. The results were most sensitive to variations in the estimation of the abstinence rates and discount rates. Compared with usual care, intensive counselling and pharmacotherapy resulted in low costs per QALY gained with ratios comparable to results for smoking cessation in the general population. Compared with intensive counselling, pharmacotherapy was cost saving and dominated the other interventions.

  5. Economical comparison of imported energy sources in terms of long-term production planning

    International Nuclear Information System (INIS)

    Gungor, Z.

    1999-01-01

    In this paper, the Turkish energy production sector is studied and power plants fueled by natural gas, imported coal and nuclear power are compared in terms of long-term (1996-2010) production economy. A net present value is used for comparing nuclear, coal and natural gas power plants. A scenario approach is utilized in establishing the effects of different factors, such as inflation rate, unit of investment costs, load factor change, discount rate and fuel price changes. Six different scenarios of interest are developed and discussed. The study ends with conclusions and recommendations based on a study of a reference scenario and alternative scenarios. (author)

  6. Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes.

    Directory of Open Access Journals (Sweden)

    Fei Xu

    Full Text Available Pulmonary artery catheters (PAC are used widely to monitor hemodynamics in patients undergoing coronary bypass graft (CABG surgery. However, recent studies have raised concerns regarding both the effectiveness and safety of PAC. Therefore, our aim was to determine the effects of the use of PAC on the short- and long-term health and economic outcomes of patients undergoing CABG.1361 Chinese patients who consecutively underwent isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital from June 1, 2012 to December 31, 2012 were included in this study. Of all the patients, 453 received PAC during operation (PAC group and 908 received no PAC therapy (control group. Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis and propensity score matched-pair analysis was used to yield two well-matched groups for further comparison.The patients who were managed with PAC more often received intraoperative vasoactive drugs dopamine (70.9% vs. 45.5%; P<0.001 and epinephrine (7.7% vs. 2.6%; P<0.001. In addition, costs for initial hospitalization were higher for PAC patients ($14,535 vs. $13,873, respectively, p = 0.004. PAC use was neither associated with the perioperative mortality or major complications, nor was it associated with long-term mortality and major adverse cardiac and cerebrovascular events. In addition, comparison between two well-matched groups showed no significant differences either in baseline characteristics or in short-term and long-term outcomes.There is no clear indication of any benefit or harm in managing CABG patients with PAC. However, use of PAC in CABG is more expensive. That is, PAC use increased costs without benefit and thus appears unjustified for routine use in CABG surgery.

  7. Two-part pricing structure in long-term gas sales contracts

    International Nuclear Information System (INIS)

    Slocum, J.C.; Lee, S.Y.

    1992-01-01

    Although the incremental electricity generation market has the potential to be a major growth area for natural gas demand in the U.S., it may never live up to such promise unless gas suppliers are more willing to enter into long-term gas sales agreements necessary to nurture this segment of the industry. The authors submit that producer reluctance to enter into such long-term sales agreements can be traced, at least in part to the differing contract price requirements between gas producers and buyers. This paper will address an evolving solution to this contracting dilemma - the development of a two-part pricing structure for the gas commodity. A two-part pricing structure includes a usage or throughput charge established in a way to yield a marginal gas cost competitive with electric utility avoided costs, and a reservation charge established to guarantee a minimum cash flow to the producer. Moreover, the combined effect of the two charges may yield total revenues that better reflect the producer's replacement cost of the reserves committed under the contract. 2 tabs

  8. [Deinstitutionalization of long-stay psychiatric patients in upper Austria -- utilization of healthcare resources and costs of outpatient care].

    Science.gov (United States)

    Haberfellner, Egon Michael; Grausgruber, Alfred; Grausgruber-Berner, Rosemarie; Ortmair, Margarethe; Schöny, Werner

    2006-03-01

    The study was intended to evaluate the therapeutic and healthcare services utilized by 116 former long-stay patients after an average of 42.9 months of deinstitutionalization during a follow-up time of (1/2) year and to calculate the costs thus incurred. 116 patients and their caregivers were interviewed during a period of 6 months using the German version of the Client Sociodemographic and Service Receipt Inventory. On average, 3.3 institutions/facilities were contacted per patient, most often by younger patients living in group homes and least often by patients in psychiatric nursing homes. During the 6-month follow-up time costs of euro 14,665 were incurred per patient. Of these costs, 87.2 % were for the residential facilities. The costs of outpatient care accounted for 41.4 % of the costs that would have been incurred for inpatient care in a psychiatric hospital. Deinstitutionalization of psychiatric long-stay patients in Upper Austria provided for considerable reductions in costs while maintaining a high quality of care.

  9. Short- and longer-term health-care resource utilization and costs associated with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Johnson BH

    2016-02-01

    .Conclusion: In addition to the substantial costs of the initial hospitalization of an AIS, these costs double within the year following this event. Given the high cost associated with AIS, new interventions reducing either the acute or longer-term burden of AIS are needed. Keywords: acute ischemic stroke, health-care resource utilization, health-care costs, readmissions

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

    Science.gov (United States)

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

    2017-12-01

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

  11. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility

    Energy Technology Data Exchange (ETDEWEB)

    LeBlance, R.J.; Allain, C.J.; Laughton, P.J.; Henry, J.G.

    2003-07-01

    The Greater Moncton Sewerage Commission's 115 000 m{sup 3}/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Universite de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and ''cumulative effects'' as part of the overall biosolids management strategy is also discussed. (author)

  12. Shifting the Paradigm for Long Term Monitoring at Legacy Sites to Improve Performance while Reducing Cost

    International Nuclear Information System (INIS)

    Eddy-Dilek, Carol A.; Looney, Brian B.; Seaman, John; Kmetz, Thomas

    2013-01-01

    A major issue facing many government and private industry sites that were previously contaminated with radioactive and chemical wastes is that often the sites cannot be cleaned up enough to permit unrestricted human access. These sites will require long-term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality in a cost effective manner. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site (SRS), the larger DOE complex, and many large federal and private sites. Currently, most monitoring strategies are focused on laboratory measurements of contaminants measured in groundwater samples collected from wells. This approach is expensive, and provides limited and lagging information about the effectiveness of cleanup activities and the behavior of the residual contamination. Over the last twenty years, DOE and other federal agencies have made significant investments in the development of various types of sensors and strategies that would allow for remote analysis of contaminants in groundwater, but these approaches do not promise significant reductions in risk or cost. Scientists at SRS have developed a new paradigm to simultaneously improve the performance of long term monitoring systems while lowering the overall cost of monitoring. This alternative approach incorporates traditional point measurements of contaminant concentration with measurements of controlling variables including boundary conditions, master variables, and traditional plume/contaminant variables. Boundary conditions are the overall driving forces that control plume movement and therefore provide leading indication to changes in plume stability. These variables include metrics associated with meteorology, hydrology, hydrogeology, and land use. Master variables are the key variables that control the chemistry of the

  13. Long Term Fuel Sustainable Fission Energy Perspective Relevant for Combating Climate Change

    International Nuclear Information System (INIS)

    Knapp, V.; Matijevic, M.; Pevec, D.; Crnobrnja, B.; Lale, D.

    2016-01-01

    In recent research we outlined climate relevant and immediately available proven light water nuclear strategy with a potential to contribute essentially and timely to reduction of carbon dioxide emission to the year 2065. We consider in this paper what is the perspective of fission energy after that year should its contribution be needed. Singling out two technologies with long term perspective which need no or small amounts of uranium, fast breeders and molten salt thorium reactors, we consider their main technical and safety characteristics. In both of these technologies it is essential to have starter nuclides as neither U238 nor Th232 are fissile. We investigated whether plutonium from spent fuel of light water reactors generated to the year 2065 would be present in quantities sufficient to continue operation on the same or similar level in both technologies. However in operational safety, proliferation risks, waste production, in our judgement we must give preference to thorium technology, if it would be ready in second half of the century.(author).

  14. Perspectives of survivors of traumatic brain injury and their caregivers on long-term social integration.

    Science.gov (United States)

    Lefebvre, Hélène; Cloutier, Geneviève; Josée Levert, Marie

    2008-07-01

    Traumatic brain injury (TBI) has damaging impacts on victims and family members' lives and their long-term social integration constitutes a major challenge. The objective of the study was to document the repercussions of TBI on victims' long-term social integration (10 years post-trauma) and the contribution made by the services received from the point of view of TBI victims and family caregivers. This article examines the determinants of long-term social integration as well as the impact of TBI on family caregivers. A qualitative design was used (semi-directed interviews). The sample consisted of 22 individuals who had sustained a moderate or severe TBI and 21 family caregivers. The results show that TBI is an experience that continues to present difficulties, even 10 years after the accident, and that different barriers contribute to this difficulty: not going back to work, depressive episodes, problems in relationships and sequellae. Family caregivers must help TBI victims confront the barriers in their path. This study adopts a longitudinal perspective to help professionals determine how to intervene with TBI victims and their families. It validates the importance of having clients and family caregivers describe their reality.

  15. New long-term plan of nuclear development and perspectives of nuclear fuel cycle policy

    International Nuclear Information System (INIS)

    Uchiyama, Yohji

    2005-01-01

    Japan's nuclear fuel cycle policy, recently issued as an interim report of the Council to Formulate the New Long-Term Nuclear Program of the Atomic Energy Commission, is summarized and briefly explained together with the concluding remarks from the sub-committee for discussing technical and economical problems on the spent nuclear fuels with the present state of the Rokkasho reprocessing plant in mind. As for the nuclear fuel treatment, the panel considered four scenarios: (1) total reprocessing (the reprocessing for spent fuel after an appropriate period of storage); (2) partial reprocessing (spent fuel is reprocessed, with direct disposal of any spent fuel in excess of reprocessing capacity); (3) total direct disposal (direct disposal of all spent fuel); and (4) temporary storage (spent fuel is temporarily stored, and in about 2060 a choice will be made about whether to reprocess it or directly dispose of it). These four scenarios were studied from various perspectives, namely: (1) ensuring safety; (2) energy security; (3) environmental compatibility; (4) economic efficiency; (5) nuclear nonproliferation; (6) technical feasibility; (7) social acceptance; (8) securing choices; (9) issues concerning change in policy; and (10) overseas trends. Regarding economic efficiency, the council in particular conducted detailed studies and reassessment of nuclear fuel cycle costs. Scenario 1 (total reprocessing) is about 0.5-0.7 yen/kWh higher than scenario 3 (total direct disposal). However, looking at the situation from the perspectives of energy security, that is the stable supply and moderate use of resources, and environmental compatibility, scenario 1 (total reprocessing) can be evaluated as superior to the other scenarios. And more importantly, if the fast-breeder reactor cycle is commercialized, this superiority increases considerably. (S. Ohno)

  16. Long-term Cost-Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies.

    Science.gov (United States)

    Bertoldi, Eduardo G; Stella, Steffan F; Rohde, Luis E; Polanczyk, Carisi A

    2016-05-01

    Several tests exist for diagnosing coronary artery disease, with varying accuracy and cost. We sought to provide cost-effectiveness information to aid physicians and decision-makers in selecting the most appropriate testing strategy. We used the state-transitions (Markov) model from the Brazilian public health system perspective with a lifetime horizon. Diagnostic strategies were based on exercise electrocardiography (Ex-ECG), stress echocardiography (ECHO), single-photon emission computed tomography (SPECT), computed tomography coronary angiography (CTA), or stress cardiac magnetic resonance imaging (C-MRI) as the initial test. Systematic review provided input data for test accuracy and long-term prognosis. Cost data were derived from the Brazilian public health system. Diagnostic test strategy had a small but measurable impact in quality-adjusted life-years gained. Switching from Ex-ECG to CTA-based strategies improved outcomes at an incremental cost-effectiveness ratio of 3100 international dollars per quality-adjusted life-year. ECHO-based strategies resulted in cost and effectiveness almost identical to CTA, and SPECT-based strategies were dominated because of their much higher cost. Strategies based on stress C-MRI were most effective, but the incremental cost-effectiveness ratio vs CTA was higher than the proposed willingness-to-pay threshold. Invasive strategies were dominant in the high pretest probability setting. Sensitivity analysis showed that results were sensitive to costs of CTA, ECHO, and C-MRI. Coronary CT is cost-effective for the diagnosis of coronary artery disease and should be included in the Brazilian public health system. Stress ECHO has a similar performance and is an acceptable alternative for most patients, but invasive strategies should be reserved for patients at high risk. © 2016 Wiley Periodicals, Inc.

  17. The long term agroecosystem research network - shared research strategy

    Science.gov (United States)

    Jean L. Steiner; Timothy Strickland; Peter J.A. Kleinman; Kris Havstad; Thomas B. Moorman; M.Susan Moran; Phil Hellman; Ray B. Bryant; David Huggins; Greg McCarty

    2016-01-01

    While current weather patterns and rapidly accelerated changes in technology often focus attention on short-term trends in agriculture, the fundamental demands on modern agriculture to meet society food, feed, fuel and fiber production while providing the foundation for a healthy environment requires long-term perspective. The Long- Term Agroecoystem Research Network...

  18. Hydrogen in a global long-term perspective

    International Nuclear Information System (INIS)

    Quakernaat, J.

    1994-01-01

    For many countries, the hydrogen economy offers an operational objective for their long-term energy structure. At the end of the next century, the world will depend on the predominate use of carbon-free and carbon-neutral sources of energy, such as flow energy, energy from modern biomass, and safe nuclear energy. The direct and indirect costs involved in the use of traditional energy supplies will increase sharply in the process of time, so that the economic feasibility of a less intensive use of energy and the introduction of alternative energy supply systems will no longer be insurmountable problems. The supply and demand structures of energy will be optimally blended by the use of hydrogen and electricity, an almost ideal combination of secondary energy carriers. With these carriers, practically every centralized or decentralized, environmentally sound energy supply can be permanently maintained, both within and outside of industrialized, metropolitan areas. The economic development of developing countries will depend on the predominate use of relatively 'cheap' fossil energy carriers (coal, petroleum and natural gas), as well as on the accompanying energy supplies structures. Yet those countries as well, similar to the wealthy industrial countries, will have to start using the highly capital intensive and very energy efficient energy supply systems and energy consumption technologies. This requires innovative strategies that are aimed at compensating developing countries (temporarily) for their lack of purchasing power and knowledge infrastructure. The costs involved in the hydrogen chain are still too high, and the world energy prices are still too low for such a transfer to take place. The attention, however, will focus on drastic energy saving, decarbonization of fossil fuels, substitution to natural gas, the opening up of flow energy, biomass production, and the development of inherent, safe nuclear energy. 49 refs

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

    Science.gov (United States)

    Cecchini, Michele; Sassi, Franco

    2015-07-01

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

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

    Science.gov (United States)

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

    2010-01-21

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

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

    Directory of Open Access Journals (Sweden)

    Carvalho Brendan

    2010-01-01

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

  2. HIV-related politics in long-term perspective.

    Science.gov (United States)

    Friedman, S R

    1998-06-01

    Some long-term, large-scale socio-economic changes may affect the politics of HIV and other emerging viruses such as hepatitis C. It is useful to ask why the potential peace dividend of the early 1990s failed to provide adequate resources for HIV-related social and medical service delivery in developed or developing nations. This failure can be understood by looking at long-term global economic trends and the pressures they put on governments and corporations. They have produced a period in which fundamental issues of political and economic structure are at stake and, often, the response is a divide-and-rule politics to promote stability. National politics differ in terms of the extent to which such a 'politics of scapegoating' is institutionalized and in terms of which groups are scapegoated. Groups such as drug injectors, gay and bisexual men and sex traders are particularly likely to be targeted both by the scapegoaters and by HIV. Given this framework, how should public health professionals and activists engaged in HIV-related issues respond? Under what circumstances should we orient efforts upwards towards corporate, political or bureaucratic leaders? Under what circumstances, and how, should we orient towards popular forces? Relatedly, we need to consider an issue we often ignore: What do we have to offer potential allies? That is, in terms of their goals, philosophies and needs, why should they ally with us?

  3. Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study

    Directory of Open Access Journals (Sweden)

    Pattaraporn Khongboon

    2018-01-01

    Full Text Available Background. Rural-urban inequality in long-term care (LTC services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand. Methods. The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs. Results. The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation. Conclusions. Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.

  4. Cost-utility analysis of adjuvant chemotherapy in patients with stage III colon cancer in Thailand.

    Science.gov (United States)

    Lerdkiattikorn, Panattharin; Chaikledkaew, Usa; Lausoontornsiri, Wirote; Chindavijak, Somjin; Khuhaprema, Thirawud; Tantai, Narisa; Teerawattananon, Yot

    2015-01-01

    In Thailand, there has been no economic evaluation study of adjuvant chemotherapy for stage III colon cancer patients after resection. This study aims to evaluate the cost-utility of all chemotherapy regimens currently used in Thailand compared with the adjuvant 5-fluorouracil/leucovorin (5-FU/LV) plus capecitabine as the first-line therapy for metastatic disease in patients with stage III colon cancer after resection. A cost-utility analysis was performed to estimate the relevant lifetime costs and health outcomes of chemotherapy regimens based on a societal perspective using a Markov model. The results suggested that the adjuvant 5-FU/LV plus capecitabine as the first-line therapy for metastatic disease would be the most cost-effective chemotherapy. The adjuvant FOLFOX and FOLFIRI as the first-line treatment for metastatic disease would be cost-effective with an incremental cost-effectiveness ratio of 299,365 Thai baht per QALY gained based on a societal perspective if both prices of FOLFOX and FOLFIRI were decreased by 40%.

  5. Experiences of long-term tranquillizer use

    DEFF Research Database (Denmark)

    Skinhoj, K T; Larsson, S; Helweg-Joergensen, S

    2001-01-01

    , the psychodynamic perspective is integrated within a multi-dimensional model that considers biological, cognitive, identity, gender and social learning factors. The analysis reveals the possibility of achieving a detailed understanding of the dynamic processes involved in the development of long-term tranquillizer...

  6. Shifting the Paradigm for Long Term Monitoring at Legacy Sites to Improve Performance while Reducing Costs - 13422

    International Nuclear Information System (INIS)

    Eddy-Dilek, Carol A; Looney, Brian B.; Gaughan, Thomas; Kmetz, Thomas; Seaman, John

    2013-01-01

    A major issue facing many government and private industry sites that were previously contaminated with radioactive and chemical wastes is that often the sites cannot be cleaned up enough to permit unrestricted human access. These sites will require long-term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality in a cost effective manner. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site (SRS), the larger DOE complex, and many large federal and private sites. Currently, most monitoring strategies are focused on laboratory measurements of contaminants measured in groundwater samples collected from wells. This approach is expensive, and provides limited and lagging information about the effectiveness of cleanup activities and the behavior of the residual contamination. Over the last twenty years, DOE and other federal agencies have made significant investments in the development of various types of sensors and strategies that would allow for remote analysis of contaminants in groundwater, but these approaches do not promise significant reductions in risk or cost. Scientists at SRS have developed a new paradigm to simultaneously improve the performance of long term monitoring systems while lowering the overall cost of monitoring. This alternative approach incorporates traditional point measurements of contaminant concentration with measurements of controlling variables including boundary conditions, master variables, and traditional plume/contaminant variables. Boundary conditions are the overall driving forces that control plume movement and therefore provide leading indication to changes in plume stability. These variables include metrics associated with meteorology, hydrology, hydrogeology, and land use. Master variables are the key variables that control the chemistry of the

  7. Shifting the Paradigm for Long Term Monitoring at Legacy Sites to Improve Performance while Reducing Costs - 13422

    Energy Technology Data Exchange (ETDEWEB)

    Eddy-Dilek, Carol A; Looney, Brian B. [Savannah River National Laboratory (United States); Gaughan, Thomas; Kmetz, Thomas [Savannah River Nuclear Solutions, LLC (United States); Seaman, John [Savannah River Ecology Laboratory (United States)

    2013-07-01

    A major issue facing many government and private industry sites that were previously contaminated with radioactive and chemical wastes is that often the sites cannot be cleaned up enough to permit unrestricted human access. These sites will require long-term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality in a cost effective manner. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site (SRS), the larger DOE complex, and many large federal and private sites. Currently, most monitoring strategies are focused on laboratory measurements of contaminants measured in groundwater samples collected from wells. This approach is expensive, and provides limited and lagging information about the effectiveness of cleanup activities and the behavior of the residual contamination. Over the last twenty years, DOE and other federal agencies have made significant investments in the development of various types of sensors and strategies that would allow for remote analysis of contaminants in groundwater, but these approaches do not promise significant reductions in risk or cost. Scientists at SRS have developed a new paradigm to simultaneously improve the performance of long term monitoring systems while lowering the overall cost of monitoring. This alternative approach incorporates traditional point measurements of contaminant concentration with measurements of controlling variables including boundary conditions, master variables, and traditional plume/contaminant variables. Boundary conditions are the overall driving forces that control plume movement and therefore provide leading indication to changes in plume stability. These variables include metrics associated with meteorology, hydrology, hydrogeology, and land use. Master variables are the key variables that control the chemistry of the

  8. Economics of carbon dioxide capture and utilization-a supply and demand perspective.

    Science.gov (United States)

    Naims, Henriette

    2016-11-01

    Lately, the technical research on carbon dioxide capture and utilization (CCU) has achieved important breakthroughs. While single CO 2 -based innovations are entering the markets, the possible economic effects of a large-scale CO 2 utilization still remain unclear to policy makers and the public. Hence, this paper reviews the literature on CCU and provides insights on the motivations and potential of making use of recovered CO 2 emissions as a commodity in the industrial production of materials and fuels. By analyzing data on current global CO 2 supply from industrial sources, best practice benchmark capture costs and the demand potential of CO 2 utilization and storage scenarios with comparative statics, conclusions can be drawn on the role of different CO 2 sources. For near-term scenarios the demand for the commodity CO 2 can be covered from industrial processes, that emit CO 2 at a high purity and low benchmark capture cost of approximately 33 €/t. In the long-term, with synthetic fuel production and large-scale CO 2 utilization, CO 2 is likely to be available from a variety of processes at benchmark costs of approx. 65 €/t. Even if fossil-fired power generation is phased out, the CO 2 emissions of current industrial processes would suffice for ambitious CCU demand scenarios. At current economic conditions, the business case for CO 2 utilization is technology specific and depends on whether efficiency gains or substitution of volatile priced raw materials can be achieved. Overall, it is argued that CCU should be advanced complementary to mitigation technologies and can unfold its potential in creating local circular economy solutions.

  9. Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes.

    Science.gov (United States)

    Hamar, G Brent; Rula, Elizabeth Y; Coberley, Carter; Pope, James E; Larkin, Shaun

    2015-04-22

    To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years. The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups. Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

  10. A Markov cost-utility analysis of escitalopram and duloxetine for the treatment of major depressive disorder.

    Science.gov (United States)

    Armstrong, Edward P; Malone, Daniel C; Erder, M Haim

    2008-04-01

    To estimate the costs and quality-adjusted life weeks of duloxetine and escitalopram. A probabilistic Markov cost-utility analysis with a time horizon of 1 year using data from placebo controlled randomized clinical trials for both products. Efficacy was defined as remission of depressive symptoms and converted to utilities. Side effects were incorporated using rates from clinical trials and converted to utilities to define treatment effectiveness. The effectiveness outcome was quality adjusted life weeks (QALWs). Estimates of effectiveness (efficacy and side effects) used beta distributions and costs used gamma distributions. Using a managed care perspective, medication costs and physician office visits were included in the model, along with costs associated with treatment failure. Antidepressant costs were obtained using average wholesale price minus 20%. Physician visit costs were obtained from the 2006 US Medicare fee schedule for physician services. A Monte Carlo simulation was conducted using 1000 trials with both first- and second-order sampling. Over 1 year, the estimated mean quality-adjusted life weeks was 41.0 (95% confidence interval [CI]: 40.7-41.3) for escitalopram and 38.2 (95% CI: 37.9-38.4) for duloxetine. The mean annual total medical cost for escitalopram was $907 (95% CI: $894-$919) and $1633 (95% CI: $1614-$1654) for duloxetine. Limitations to this analysis include using separate studies examining the efficacy and adverse events of either escitalopram or duloxetine, assuming the switch, augmentation, and titration rates for duloxetine to be similar to escitalopram, and using utility estimates from published literature for the antidepressant adverse events. This analysis suggests that escitalopram was more effective in terms of QALWs and less costly than duloxetine for treatment of depression.

  11. Thick film nickel plating - the alternative. Long-term experiences; Dickschichtvernickelung - die Alternative. Langzeiterfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Senff-Wollenberg, Ralf [Baumgarte Boiler Systems GmbH, Bielefeld (Germany). Technik; Ansey, Johann-Wilhelm [Baumgarte Boiler Systems GmbH, Bielefeld (Germany). Forschung und Entwicklung; Reinmoeller, Frank [Baumgarte Boiler Systems GmbH, Bielefeld (Germany)

    2013-03-01

    The ecologic and energetic demands on modern plants fort he thermal utilization of waste materials increase continuously. Beside low costs of investment, enhanced efficiencies, an enhanced availability, long journey times as well as low costs of operation and maintenance are important factors for the investment decision. The primary and secondary measures for the shrinkage of corrosion are decisive for achieving the factors for the decision of investment and maintenance. The authors of the contribution under consideration report on long-term experiences on the thick film nickel plating. Especially, the process of galvanic nickel plating, the fields of application as well as the operational experiences are described.

  12. Cost and quality of fuels for electric utility plants, 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-07-14

    This document presents an annual summary of statistics at the national, Census division, State, electric utility, and plant levels regarding the quantity, quality, and cost of fossil fuels used to produce electricity. Purpose of this publication is to provide energy decision-makers with accurate, timely information that may be used in forming various perspectives on issues regarding electric power.

  13. Long-term rate orientations: Development plan 1993

    International Nuclear Information System (INIS)

    1992-01-01

    Hydro-Quebec's preferred rate orientations for Quebec markets are presented. The background for a rate structure revision is outlined, followed by proposed changes to residential and general rates, and by a plan to implement the new rate structure. Some of the principles used in setting rates are described. The new rate structure proposals are intended to provide a better reflection of the utility's costs of supply and a clearer signal in favor of the rational use of electricity, thereby limiting long-term increases in both supply costs and electricity rates. It is proposed to use marginal costs to design rate structures, while the overall rate level will continue to reflect changes in average costs of supply. Also included in the proposed changes are time-of-use rates, which will help reduce costs by shifting loads from peak to off-peak periods and by encouraging the adoption of energy-conservation measures. Moreover, the integration of time-of-use options into the rate system will not only provide Hydro-Quebec with more powerful load-management tools but also give customers the opportunity to change their consumption patterns and thereby reduce their electricity bills. 11 figs., 11 tabs

  14. Are citizens not accurately informed about long-term societal costs of unsustainable travel or do they not care?

    NARCIS (Netherlands)

    Gärling, Tommy; Ettema, Dick; Friman, Margareta

    2015-01-01

    We argue that people think more about the short-term individual benefits of personal motorized travel than the long-term societal costs. One explanation is that people are more concerned about their own wellbeing and the wellbeing of their close relatives than the well-being of unknown others.

  15. A Literature Review on the Experience of Long-Term Mental Illness.

    Science.gov (United States)

    Collier, Elizabeth; Grant, Maria J

    2018-06-01

    To illuminate long-term experiences of mental illness from both research and autobiographical accounts. A literature review of English-language papers, 1950-2014, relating to the experience of long-term mental illness indexed in AgeInfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, PsycEXTRA, and PsychINFO. Twenty-five research papers and nine autobiographic accounts met the review criteria. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research Implications: There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length-of-time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the Western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples' perspectives. Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence-based services cannot be provided if we do not have an holistic understanding of long-term mental illness. Social Implications: This review questions our ability to provide effective support for those experiencing long-term mental illness, in particular older people and different cultural perspectives. There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.

  16. Long-term heavy marijuana users make costly decisions on a gambling task.

    Science.gov (United States)

    Whitlow, Christopher T; Liguori, Anthony; Livengood, L Brooke; Hart, Stephanie L; Mussat-Whitlow, Becky J; Lamborn, Corey M; Laurienti, Paul J; Porrino, Linda J

    2004-10-05

    Chronic marijuana use has been associated with impairments of learning, memory, and executive functions. Little is known, however, about the effects of marijuana use on other cognitive domains, such as decision-making, which are thought to play an important role in addiction and drug abuse. The purpose of the present study was to determine if long-term heavy marijuana users employ different decision-making strategies than individuals with minimal marijuana exposure. Volunteers were assigned to a cannabis (n = 10) or control group (n = 10) based upon history of prior marijuana use. Demographic and neuropsychological variables were evaluated, and a decision-making task--the gambling task (GT) was administered. Although few demographic and neuropsychological differences were noted between groups, marijuana users made more decisions that led to larger immediate gains despite more costly losses than controls. These data suggest that long-term heavy marijuana users may have specific deficits in the ability to balance rewards and punishments that may contribute to continued drug-taking behavior. It is unknown, however, whether the basis for such deficits might be attributed directly to marijuana exposure or pre-existing genetic or behavioral differences.

  17. Cost-utility analysis of memantine extended release added to cholinesterase inhibitors compared to cholinesterase inhibitor monotherapy for the treatment of moderate-to-severe dementia of the Alzheimer's type in the US.

    Science.gov (United States)

    Saint-Laurent Thibault, Catherine; Özer Stillman, Ipek; Chen, Stephanie; Getsios, Denis; Proskorovsky, Irina; Hernandez, Luis; Dixit, Shailja

    2015-01-01

    This study evaluates the cost-effectiveness of memantine extended release (ER) as an add-on therapy to acetylcholinesterase inhibitor (AChEI) [combination therapy] for treatment of patients with moderate-to-severe Alzheimer's disease (AD) from both a healthcare payer and a societal perspective over 3 years when compared to AChEI monotherapy in the US. A phase III trial evaluated the efficacy and safety of memantine ER for treatment of AD patients taking an AChEI. The analysis assessed the long-term costs and health outcomes using an individual patient simulation in which AD progression is modeled in terms of cognition, behavior, and functioning changes. Input parameters are based on patient-level trial data, published literature, and publicly available data sources. Changes in anti-psychotic medication use are incorporated based on a published retrospective cohort study. Costs include drug acquisition and monitoring, total AD-related medical care, and informal care associated with caregiver time. Incremental cost-utility ratio (ICUR), life years, care time for caregiver, time in community and institution, time on anti-psychotics, time by disease severity, and time without severe symptoms are reported. Costs and health outcomes are discounted at 3% per annum. Considering a societal perspective over 3 years, this analysis shows that memantine ER combined with an AChEI provides better clinical outcomes and lower costs than AChEI monotherapy. Discounted average savings were estimated at $18,355 and $20,947 per patient and quality-adjusted life-years (QALYs) increased by an average of 0.12 and 0.13 from a societal and healthcare payer perspective, respectively. Patients on combination therapy spent an average of 4 months longer living at home and spend less time in moderate-severe and severe stages of the disease. Combination therapy for patients with moderate-to-severe AD is a cost-effective treatment compared to AChEI monotherapy in the US.

  18. Determinants of first-time utilization of long-term care services in the Netherlands : An observational record linkage study

    NARCIS (Netherlands)

    Slobbe, L.C.J.; Wong, A.; Verheij, R.A.; Van Oers, J.A.M.; Polder, J.J.

    Background Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. Methods The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop

  19. Determinants of first-time utilization of long-term care services in the Netherlands: an observational record linkage study.

    NARCIS (Netherlands)

    Slobbe, L.C.J.; Wong, A.; Verheij, R.A.; Oers, H.J.A.M. van; Polder, J.J.

    2017-01-01

    Background: Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. Methods: The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to

  20. Bullying in Senior Living Facilities: Perspectives of Long-Term Care Staff.

    Science.gov (United States)

    Andresen, Felicia J; Buchanan, Jeffrey A

    2017-07-01

    Resident-to-resident bullying has attracted attention in the media, but little empirical literature exists related to the topic of senior bullying. The aim of the current study was to better understand resident-to-resident bullying from the perspective of staff who work with older adults. Forty-five long-term care staff members were interviewed regarding their observations of bullying. Results indicate that most staff members have observed bullying. Verbal bullying was the most observed type of bullying, but social bullying was also prevalent. Victims and perpetrators were reported to commonly have cognitive and physical disabilities. More than one half of participants had not received formal training and only 21% reported their facility had a formal policy to address bullying. The implications of these results support the need for detailed policies and training programs for staff to effectively intervene when bullying occurs. [Journal of Gerontological Nursing, 43(7), 34-41.]. Copyright 2017, SLACK Incorporated.

  1. The Relationship between Transformational Leadership and Organizational Commitment in Nonprofit Long Term Care Organizations: The Direct Care Worker Perspective

    Science.gov (United States)

    Porter, Jeanette A.

    2015-01-01

    The United States population is rapidly aging, and retaining direct care workers (DCWs) will continue to be a workforce concern for the industry in addressing the demand for long term care services. To date, scant literature exists that addresses the DCW perspective of leadership behaviors and their influence on organizational commitment. To…

  2. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    Science.gov (United States)

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

  3. Using Forecasting to Predict Long-Term Resource Utilization for Web Services

    Science.gov (United States)

    Yoas, Daniel W.

    2013-01-01

    Researchers have spent years understanding resource utilization to improve scheduling, load balancing, and system management through short-term prediction of resource utilization. Early research focused primarily on single operating systems; later, interest shifted to distributed systems and, finally, into web services. In each case researchers…

  4. Long-term congestion management by investment in gas-turbine generators : a cost-benefit analysis

    International Nuclear Information System (INIS)

    Tuan, L.A.; Bhattacharya, K.

    2007-01-01

    Load management is one of the most important tasks in the operation of an electric power system. Transmission congestion occurs whenever the grid has one or more violations of the physical, operation, or policy constraints under which it normally operates. In a deregulated electricity market, the independent system operator (ISO) must ensure that contracted power transactions are carried out reliably. Several schemes of congestion management run the risk of increasing electricity prices due to the market power of local generators in congested areas. An alternative is to manage congestion through the installation of reserve gas turbine generators which can be brought online to the system within a short time. The use of gas turbines at different buses in the system can enhance the system in ways of transmission relief during emergency events. This paper proposed a framework for the evaluation of long-term investment by the ISO on gas-turbine generators as a tool for providing transmission congestion relief in the dispatch stage based on cost-benefit analysis. The objective of the framework is to optimally decide the locations and sizes of the generators at different buses in the network in order to minimize the total cost of investment of gas turbines and to minimize total system congestion. A bus-wise cost-benefit analysis was carried out by solving the DC optimal power flow (dc-OPF) model. The CIGRE 32-Bus system was used for the case study. It was shown that network overloading can be significantly reduced with the support of gas turbines at selected buses. The long-term decision of the investment on gas-turbine would depend on the opportunity cost of the gas-turbine with respect to the congestion problem. The gas turbines could also reduce the amount of unserved energy during peak load conditions. 11 refs., 4 tabs., 3 figs

  5. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy

    DEFF Research Database (Denmark)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke

    2016-01-01

    . Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among......Objective: To estimate long-term socioeconomic consequences and health care costs of epilepsy with onset in childhood and adolescence. Methods: A historical prospective cohort study of Danish individuals with epilepsy, age up to 20 years at time of diagnosis between January 1981 and December 2012....... Information about marital status, parenthood, educational level, employment status, income, use of the health care system, and cost of medicine was obtained from nationwide administrative and health registers. Results: We identified 12,756 and 28,319 people with diagnosed with epilepsy, ages 0–5 and 6...

  6. [Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency].

    Science.gov (United States)

    Nüchtern, Elisabeth; Gansweid, Barbara; Gerber, Hans; von Mittelstaedt, Gert

    2017-01-01

    Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their

  7. Future of long-term care financing for the elderly in Korea.

    Science.gov (United States)

    Kwon, Soonman

    2008-01-01

    With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly longterm care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.

  8. Cost analysis of nursing home registered nurse staffing times.

    Science.gov (United States)

    Dorr, David A; Horn, Susan D; Smout, Randall J

    2005-05-01

    To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

  9. Value-based benefit-cost of local DSM

    International Nuclear Information System (INIS)

    Stein, V.

    1995-01-01

    Value-based benefits and costs of demand-side management (DSM) were discussed in the context of local electricity resource planning in downtown Toronto. The analysis considered the effects on local customer interruption as a result of DSM, and the deferment in need for local transmission and distribution upgrades. The life cycle and cash flow benefits and costs of DSM were discussed from the perspectives of the electric utility, the DSM-participating and non-participating customers, and society as a whole. Cashflow and lifecycle analyses results were reconciled. The Toronto Integrated Electrical Service (TIES) study, the basis for this paper, was described. Two main conclusions were reached, i.e. since the savings in the generationg system as a whole were far greater than the local savings,the value of a specific DSM program would be similar across a utility's service area, and (2) while cashflow analysis illustrated the short and medium term benefits and costs in a way most people intuitively understand, in effect,the lifecycle-cost estimates produce a clearer indicator of long-run economics

  10. Long-term air humidification therapy is cost-effective for patients with moderate or severe chronic obstructive pulmonary disease or bronchiectasis.

    Science.gov (United States)

    Milne, Richard J; Hockey, Hans; Rea, Harry

    2014-06-01

    To establish the cost-effectiveness of long-term humidification therapy (LTHT) added to usual care for patients with moderate or severe chronic obstructive pulmonary disease or bronchiectasis. Resource usage in a 12-month clinical trial of LTHT was estimated from hospital records, patient diaries, and the equipment supplier. Health state utility values were derived from the St. Georges Respiratory Questionnaire (SGRQ) total score. All patients who remained in the trial for 12 months and who had at least 90 days of diary records were included (87 of 108). Clinical costs were NZ $3973 (95% confidence interval [CI] $1614-$6332) for the control group and NZ $3331 (95% CI $948-$6920) for the intervention group. The mean health benefit per patient was -6.9 SGRQ units (95% CI -13.0 to -7.2; P < 0.05) or +0.0678 quality-adjusted life-years (95% CI 0.001-0.135). With the intervention costing NZ $2059 annually, the mean cost per quality-adjusted life-year was NZ $20,902 (US $18,907) and the bootstrap median was NZ $19,749 (2.5th percentile -$40,923, 97.5th percentile $221,275). At a willingness-to-pay (WTP) threshold of NZ $30,000, the probability of cost-effectiveness was 61%, ranging from 49% to 72% as the cost of LTHT was varied by ±30%. At a WTP of NZ $20,000, the probability was 49% (range 34%-61%). LTHT is moderately cost-effective for patients with moderate to severe chronic obstructive pulmonary disease or bronchiectasis at a WTP threshold that is acceptable for public funding of medicines in New Zealand. These findings must be interpreted with caution because of the modest size of the clinical study, necessary lack of blinding in the clinical trial, and uncertainty in estimating health state utility from the SQRQ. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    1984-11-01

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

  12. Short-Term and Long-Term Educational Mobility of Families: A Two-Sex Approach.

    Science.gov (United States)

    Song, Xi; Mare, Robert D

    2017-02-01

    We use a multigenerational perspective to investigate how families reproduce and pass their educational advantages to succeeding generations. Unlike traditional mobility studies that have typically focused on one-sex influences from fathers to sons, we rely on a two-sex approach that accounts for interactions between males and females-the process in which males and females mate and have children with those of similar educational statuses and jointly determine the educational status attainment of their offspring. Using data from the Panel Study of Income Dynamics, we approach this issue from both a short-term and a long-term perspective. For the short term, grandparents' educational attainments have a direct association with grandchildren's education as well as an indirect association that is mediated by parents' education and demographic behaviors. For the long term, initial educational advantages of families may benefit as many as three subsequent generations, but such advantages are later offset by the lower fertility of highly educated persons. Yet, all families eventually achieve the same educational distribution of descendants because of intermarriages between families of high- and low-education origin.

  13. Models of Disease Vector Control: When Can Aggressive Initial Intervention Lower Long-Term Cost?

    Science.gov (United States)

    Oduro, Bismark; Grijalva, Mario J; Just, Winfried

    2018-04-01

    Insecticide spraying of housing units is an important control measure for vector-borne infections such as Chagas disease. As vectors may invade both from other infested houses and sylvatic areas and as the effectiveness of insecticide wears off over time, the dynamics of (re)infestations can be approximated by [Formula: see text]-type models with a reservoir, where housing units are treated as hosts, and insecticide spraying corresponds to removal of hosts. Here, we investigate three ODE-based models of this type. We describe a dual-rate effect where an initially very high spraying rate can push the system into a region of the state space with low endemic levels of infestation that can be maintained in the long run at relatively moderate cost, while in the absence of an aggressive initial intervention the same average cost would only allow a much less significant reduction in long-term infestation levels. We determine some sufficient and some necessary conditions under which this effect occurs and show that it is robust in models that incorporate some heterogeneity in the relevant properties of housing units.

  14. Accessibility Long Term Perspectives

    Directory of Open Access Journals (Sweden)

    Kay Axhausen

    2008-11-01

    Full Text Available Improved accessibility and its correlate lower generalized cost of contact, travel and transport have been sought by dynamic human societies for their economic and social benefits through- out recorded history. The paper will reflect about this process at a number of different spatial and temporal scales based on a conceptual model. Looking back at European history, it will trace the interaction between Christaller's logic of local market areas and the idea of (low contact cost network cities. Focusing on Switzerland since 1950 it will show how network investment changed the relative distribution of population and employment and how this interacted with changes in the preferences of the travelers. Using a recent snapshot of how a substantial sample of Swiss maintain their social networks over often very large areas, it will try to answer the question of what will happen in the future, if the current trend of ever lower costs of contact will persist.

  15. [Long-term psychiatric hospitalizations].

    Science.gov (United States)

    Plancke, L; Amariei, A

    2017-02-01

    Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

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

    Directory of Open Access Journals (Sweden)

    Femke Jansen

    2016-01-01

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

  17. The economics of long-term operation of nuclear power plants

    International Nuclear Information System (INIS)

    Lokhov, Alexey; Huerta, Alejandro; Dufresne, Luc; Giraud, Anne; Osouf, Nicolas

    2012-01-01

    Refurbishment and long-term operation (LTO) of existing nuclear power plants (NPPs) today are crucial to the competitiveness of the nuclear industry in OECD countries as existing nuclear power plants produce base-load power at a reliable cost. A number of nuclear power plants, most notably 73 units in the United States (up to 2012), have been granted lifetime extensions of up to 60 years, a development that is being keenly watched in other OECD countries. In many of these (e.g. France, Switzerland), there is no legal end to the operating licence, but continued operation is based on the outcomes of periodic safety reviews. This study analyses technical and economic data on the upgrade and lifetime extension experience in OECD countries. A multi-criteria assessment methodology is used considering various factors and parameters reflecting current and future financial conditions of operation, political and regulatory risks, the state of the plants' equipment and the general role of nuclear power in the country's energy policy. The report shows that long-term operation of nuclear power plants has significant economic advantages for most utilities envisaging LTO programmes. In most cases, the continued operation of NPPs for at least ten more years is profitable even taking into account the additional costs of post-Fukushima modifications, and remains cost-effective compared to alternative replacement sources

  18. Long term performance degradation analysis and optimization of anode supported solid oxide fuel cell stacks

    International Nuclear Information System (INIS)

    Parhizkar, Tarannom; Roshandel, Ramin

    2017-01-01

    Highlights: • A degradation based optimization framework is developed. • The cost of electricity based on degradation of solid oxide fuel cells is minimized. • The effects of operating conditions on degradation mechanisms are investigated. • Results show 7.12% lower cost of electricity in comparison with base case. • Degradation based optimization is a beneficial concept for long term analysis. - Abstract: The main objective of this work is minimizing the cost of electricity of solid oxide fuel cell stacks by decelerating degradation mechanisms rate in long term operation for stationary power generation applications. The degradation mechanisms in solid oxide fuel cells are caused by microstructural changes, reactions between lanthanum strontium manganite and electrolyte, poisoning by chromium, carburization on nickel particles, formation of nickel sulfide, nickel coarsening, nickel oxidation, loss of conductivity and crack formation in the electrolyte. The rate of degradation mechanisms depends on the cell operating conditions (cell voltage and fuel utilization). In this study, the degradation based optimization framework is developed which determines optimum operating conditions to achieve a minimum cost of electricity. To show the effectiveness of the developed framework, optimization results are compared with the case that system operates at its design point. Results illustrate optimum operating conditions decrease the cost of electricity by 7.12%. The performed study indicates that degradation based optimization is a beneficial concept for long term performance degradation analysis of energy conversion systems.

  19. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy.

    Science.gov (United States)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke; Kjellberg, Jakob

    2016-07-01

    To estimate long-term socioeconomic consequences and health care costs of epilepsy with onset in childhood and adolescence. A historical prospective cohort study of Danish individuals with epilepsy, age up to 20 years at time of diagnosis between January 1981 and December 2012. Information about marital status, parenthood, educational level, employment status, income, use of the health care system, and cost of medicine was obtained from nationwide administrative and health registers. We identified 12,756 and 28,319 people with diagnosed with epilepsy, ages 0-5 and 6-20 years at onset, respectively. Using follow-up data for a maximum of 30 years, 1,394 of those ages 0-5 years at onset were compared with 2,897 controls persons without epilepsy, and 10,195 of those ages 6-20 years at onset were compared with 20,678 controls without epilepsy. Compared with people without the epilepsy, those with epilepsy tended to have a lower level of education, to be less likely to be married, to be more likely to live alone, and to have higher divorce and unemployment rates, lower employment rates, and people with epilepsy were more likely to receive disability pension and social security. Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among persons with epilepsy onset at 0-5 and 6-20 years, including costs for outpatient and inpatient services (hospital services), emergency room use, primary health care sector (general practice), and use of medication. The long-term negative effects on all aspects of health care and social domains, including marital status, parental socioeconomic status, educational level, employment status, and use of welfare benefits compared with controls without epilepsy calls for increased awareness on

  20. More efficient optimization of long-term water supply portfolios

    Science.gov (United States)

    Kirsch, Brian R.; Characklis, Gregory W.; Dillard, Karen E. M.; Kelley, C. T.

    2009-03-01

    The use of temporary transfers, such as options and leases, has grown as utilities attempt to meet increases in demand while reducing dependence on the expansion of costly infrastructure capacity (e.g., reservoirs). Earlier work has been done to construct optimal portfolios comprising firm capacity and transfers, using decision rules that determine the timing and volume of transfers. However, such work has only focused on the short-term (e.g., 1-year scenarios), which limits the utility of these planning efforts. Developing multiyear portfolios can lead to the exploration of a wider range of alternatives but also increases the computational burden. This work utilizes a coupled hydrologic-economic model to simulate the long-term performance of a city's water supply portfolio. This stochastic model is linked with an optimization search algorithm that is designed to handle the high-frequency, low-amplitude noise inherent in many simulations, particularly those involving expected values. This noise is detrimental to the accuracy and precision of the optimized solution and has traditionally been controlled by investing greater computational effort in the simulation. However, the increased computational effort can be substantial. This work describes the integration of a variance reduction technique (control variate method) within the simulation/optimization as a means of more efficiently identifying minimum cost portfolios. Random variation in model output (i.e., noise) is moderated using knowledge of random variations in stochastic input variables (e.g., reservoir inflows, demand), thereby reducing the computing time by 50% or more. Using these efficiency gains, water supply portfolios are evaluated over a 10-year period in order to assess their ability to reduce costs and adapt to demand growth, while still meeting reliability goals. As a part of the evaluation, several multiyear option contract structures are explored and compared.

  1. Long-term care policy for older Americans: building a continuum of care.

    Science.gov (United States)

    Palley, Howard A

    2003-01-01

    This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.

  2. Calculating utility prudency issue costs

    International Nuclear Information System (INIS)

    Nielsen, K.R.

    1985-01-01

    The nuclear industry, particularly utilities and their construction, engineering and vendor agents, is faced with a surging increase in prudency management audits. What started as primarily a nuclear project-oriented requirement has spread to encompass most significant utility capital construction projects. Such audits are often a precedent condition to commencement of rate hearings. The cost engineer, a primary major capital construction project participant, is required to develop or critique ''prudency issue'' costs as part of such audits. Although utility costs in the broadest sense are potentially at issue, this paper concentrates on the typical project/construction management costs. The costs of design, procurement and construction are all subject to the calculation process

  3. ERDA's long-term waste management goals and programs

    International Nuclear Information System (INIS)

    Perge, A.F.; Trice, V.G. Jr.; Walton, R.D. Jr.

    1976-01-01

    This paper presents an overview of the ERDA's major program for the long-term waste management of radioactive waste and provides a perspective for symposium participants with regard to the interrelationship of specific components of the program that are discussed in detail in other ERDA-sponsored papers. Needs, goals, and plans are reviewed for ERDA's management of the commercially generated wastes which are expected to be delivered to ERDA in accordance with Federal regulations. At present, ERDA responsibilities include long-term management of commercial-level wastes. Possible future regulations may give ERDA responsibility for the long-term management of commercial low-level solid wastes contaminated with transuranic nuclides. Primary planning goals and programs for the development of terminal storage facilities and waste processing technology to produce acceptable waste forms for long-term management are reviewed for each of the waste types identified above. The status of development programs for the long-term management of airborne radionuclides, which may be required at some time in the future, is also reviewed. (author)

  4. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  5. The determinants of long-term care utilization and equity of access to care among older adults in Dong-Ku of Incheon Metropolitan city, South Korea.

    Science.gov (United States)

    Park, J M

    2005-01-01

    Under the current health care system, around three percent of the elderly remain uninsured. Based on the 2003 Dong-Ku Health Status Survey and the Aday and Andersen Access Framework, the present study examined the social and behavioral determinants of long-term care utilization and the extent to which equity in the use of long-term care services for the elderly has been achieved. The results indicate that universal health insurance system has not yielded a fully equitable distribution of services. Type of coverage and resource availability do not remain predictors of long-term care utilization. The data suggest that a universal health insurance system exists in South Korea with significant access problems for the population without insurance. Access differences also arise from obstacles in expanding the scope and level of plan benefits due to financial disparity among insurers. Health policy reforms must continue to concentrate on extending insurance coverage to the uninsured and establishing long-term insurance system for the elderly.

  6. Alternative windpower ownership structures: Financing terms and project costs

    Energy Technology Data Exchange (ETDEWEB)

    Wiser, R.; Kahn, E.

    1996-05-01

    Most utility-scale renewable energy projects in the United States are developed and financed by private renewable energy companies. Electric output is then sold to investor-owned and public utilities under long-term contracts. Limited partnerships, sale/leaseback arrangements, and project-financing have historically been the dominant forms of finance in the windpower industry, with project-finance taking the lead more recently. Although private ownership using project-finance is still the most popular form of windpower development, alternative approaches to ownership and financing are becoming more prevalent. U.S. public and investor-owned electric utilities (IOUs) have begun to participate directly in windpower projects by owning and financing their own facilities rather than purchasing windpower from independent non-utility generators (NUGs) through power purchase agreements (PPAs). In these utility-ownership arrangements, the wind turbine equipment vendor/developer typically designs and constructs a project under a turnkey contract for the eventual project owner (the utility). The utility will also frequently sign an operations and maintenance (O&M) contract with the project developer/equipment vendor. There appear to be a number of reasons for utility involvement in recent and planned U.S. wind projects. One important claim is that utility ownership and self-finance provides substantial cost savings compared to contracting with private NUGs to supply wind-generated power. In this report, we examine that assertion.

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

    Science.gov (United States)

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

    2015-02-01

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

  8. Development of a cost-effective and flexible vibration DAQ system for long-term continuous structural health monitoring

    Science.gov (United States)

    Nguyen, Theanh; Chan, Tommy H. T.; Thambiratnam, David P.; King, Les

    2015-12-01

    In the structural health monitoring (SHM) field, long-term continuous vibration-based monitoring is becoming increasingly popular as this could keep track of the health status of structures during their service lives. However, implementing such a system is not always feasible due to on-going conflicts between budget constraints and the need of sophisticated systems to monitor real-world structures under their demanding in-service conditions. To address this problem, this paper presents a comprehensive development of a cost-effective and flexible vibration DAQ system for long-term continuous SHM of a newly constructed institutional complex with a special focus on the main building. First, selections of sensor type and sensor positions are scrutinized to overcome adversities such as low-frequency and low-level vibration measurements. In order to economically tackle the sparse measurement problem, a cost-optimized Ethernet-based peripheral DAQ model is first adopted to form the system skeleton. A combination of a high-resolution timing coordination method based on the TCP/IP command communication medium and a periodic system resynchronization strategy is then proposed to synchronize data from multiple distributed DAQ units. The results of both experimental evaluations and experimental-numerical verifications show that the proposed DAQ system in general and the data synchronization solution in particular work well and they can provide a promising cost-effective and flexible alternative for use in real-world SHM projects. Finally, the paper demonstrates simple but effective ways to make use of the developed monitoring system for long-term continuous structural health evaluation as well as to use the instrumented building herein as a multi-purpose benchmark structure for studying not only practical SHM problems but also synchronization related issues.

  9. Cost of care of haemophilia with inhibitors.

    Science.gov (United States)

    Di Minno, M N D; Di Minno, G; Di Capua, M; Cerbone, A M; Coppola, A

    2010-01-01

    In Western countries, the treatment of patients with inhibitors is presently the most challenging and serious issue in haemophilia management, direct costs of clotting factor concentrates accounting for >98% of the highest economic burden absorbed for the healthcare of patients in this setting. Being designed to address questions of resource allocation and effectiveness, decision models are the golden standard to reliably assess the overall economic implications of haemophilia with inhibitors in terms of mortality, bleeding-related morbidity, and severity of arthropathy. However, presently, most data analyses stem from retrospective short-term evaluations, that only allow for the analysis of direct health costs. In the setting of chronic diseases, the cost-utility analysis, that takes into account the beneficial effects of a given treatment/healthcare intervention in terms of health-related quality of life, is likely to be the most appropriate approach. To calculate net benefits, the quality adjusted life year, that significantly reflects such health gain, has to be compared with specific economic impacts. Differences in data sources, in medical practice and/or in healthcare systems and costs, imply that most current pharmacoeconomic analyses are confined to a narrow healthcare payer perspective. Long-term/lifetime prospective or observational studies, devoted to a careful definition of when to start a treatment; of regimens (dose and type of product) to employ, and of inhibitor population (children/adults, low-responding/high responding inhibitors) to study, are thus urgently needed to allow for newer insights, based on reliable data sources into resource allocation, effectiveness and cost-utility analysis in the treatment of haemophiliacs with inhibitors.

  10. A perspective on laboratory utilization management from Canada.

    Science.gov (United States)

    Naugler, Christopher

    2014-01-01

    Utilization, particularly in chemistry and molecular testing, is growing rapidly in Canada at a time when laboratory budgets are shrinking. Canadian laboratories face particular challenges as the prevailing funding model limits the scope for new revenue generation. Aggressive and coordinated interventions to reduce over-utilization will be necessary to ensure the long-term viability of the current system. © 2013.

  11. Minimum long-term cost solution for remote telecommunication stations on the basis of photovoltaic-based hybrid power systems

    International Nuclear Information System (INIS)

    Kaldellis, J.K.; Ninou, I.; Zafirakis, D.

    2011-01-01

    In the case of the telecommunication (T/C) services' expansion to rural and remote areas, the market generally responds with the minimum investments required. Considering the existing situation, cost-effective operation of the T/C infrastructure installed in these regions (i.e. remote T/C stations) becomes critical. However, since in most cases grid-connection is not feasible, the up-to-now electrification solution for remote T/C stations is based on the operation of costly, oil consuming and heavy polluting diesel engines. Instead, the use of photovoltaic (PV)-based hybrid power stations is currently examined, using as a case study a representative remote T/C station of the Greek territory. In this context, the present study is concentrated on the detailed cost-benefit analysis of the proposed solution. More precisely, the main part of the analysis is devoted to develop a complete electricity production cost model, accordingly applied for numerous oil consumption and service period scenarios. Note that in all cases examined, zero load rejections is a prerequisite while minimum long-term cost solutions designated are favorably compared with the diesel-only solution. Finally, a sensitivity analysis, demonstrating the impact of the main economic parameters on the energy production cost of optimum sized PV-diesel hybrid power stations, is also provided. - Research highlights: → Expansion of telecommunication (T/C) in remote areas is vital for their development. → Off-grid T/C stations employed in such areas operate on diesel engines. → The use of PV-diesel-battery hybrid power stations is currently examined. → A detailed long-term electricity production cost model is developed. → Cost-effectiveness of the proposed system is reflected for numerous configurations.

  12. The long-term benefits of director stock ownership

    Directory of Open Access Journals (Sweden)

    Brian Bolton

    2009-11-01

    Full Text Available In October 2009, the United States Treasury Department and Congress considered new regulations requiring executives and directors to receive much of their compensation in the form of long-term stock. One concern with this is that it may have negative consequences by entrenching managers and directors over the long term. This study compares the potential benefits of long-term director ownership with the potential costs of entrenchment. Using the dollar amount of stock owned by independent directors, the results suggest that the incentive effect dominates any costs related to entrenchment: firms with greater stock ownership outperform other firms, regardless of the degree of managerial entrenchment that may be present. The implication for policy-makers is that providing directors with incentives through stock ownership can be a very effective corporate governance mechanism.

  13. Long-term care: a substantive factor in financial planning.

    Science.gov (United States)

    Willis, D A

    2000-01-01

    More than 50 percent of women will enter a nursing home at some point in their lives. About one-third of men living to age 65 will also need nursing home care. Planning for long-term care is even more important since Medicare covers very little of the cost of such care. The Indiana Partnership Plan is one program designed to help fund the long-term care costs while allowing individuals protect other financial assets.

  14. Long-range goal setting in the nuclear utility industry

    International Nuclear Information System (INIS)

    Beard, P.M.

    1986-01-01

    The Institute of Nuclear Power Operation's (INPO's) programs support the industry's efforts to improve performance in nuclear plant safety and reliability. The success of these programs can best be measured by the progress of the industry. As utilities focused their attention on nuclear plant performance, the Institute's goal was to make sure its programs and activities provided the best possible support for these efforts. INPO continues to coordinate an industry-wide plant performance indicator program to assist member utilities in assessing station performance. Closely related to this effort is the nuclear industry's establishment of long-range plant performance goals. The US nuclear utility industry currently sends INPO quarterly data on 28 key performance indicators. INPO analyzes these data and provides periodic reports to its members and participants. Selected highlights of INPO's Performance Indicators for the US Nuclear Utility, dated June 1986, are discussed. Throughout 1985, INPO interacted with members, participants, and three external ad hoc review groups to refine the overall performance indicators and to develop background for each unit. By April 1986, each utility had developed long-term goals for each unit. By April 1986, each utility had developed long-term goals for most of the overall indicators. These goals represent a commitment to achievement of excellence when applied to the day-to-day conduct of plant operations, and provide a framework for action

  15. Cost-utility analysis of the National truth campaign to prevent youth smoking.

    Science.gov (United States)

    Holtgrave, David R; Wunderink, Katherine A; Vallone, Donna M; Healton, Cheryl G

    2009-05-01

    In 2005, the American Journal of Public Health published an article that indicated that 22% of the overall decline in youth smoking that occurred between 1999 and 2002 was directly attributable to the truth social marketing campaign launched in 2000. A remaining key question about the truth campaign is whether the economic investment in the program can be justified by the public health outcomes; that question is examined here. Standard methods of cost and cost-utility analysis were employed in accordance with the U.S. Panel on Cost-Effectiveness in Health and Medicine; a societal perspective was employed. During 2000-2002, expenditures totaled just over $324 million to develop, deliver, evaluate, and litigate the truth campaign. The base-case cost-utility analysis result indicates that the campaign was cost saving; it is estimated that the campaign recouped its costs and that just under $1.9 billion in medical costs was averted for society. Sensitivity analysis indicated that the basic determination of cost effectiveness for this campaign is robust to substantial variation in input parameters. This study suggests that the truth campaign not only markedly improved the public's health but did so in an economically efficient manner.

  16. Cost-utility of a six-month programmed sports therapy (PST) in patients with haemophilia.

    Science.gov (United States)

    Koeberlein-Neu, J; Runkel, B; Hilberg, T

    2018-03-30

    Recurrent musculoskeletal haemorrhages in people with haemophilia (PwH) lead to restrictions in the locomotor system and, as a result, in physical performance, too. Due to its physical and psychological benefits, sport is increasingly re-commended for haemophilic patients. Evidence on the cost-effectiveness of sports therapy is still lacking. The aim of this study was to determine the cost-effectiveness of a 6-month programmed sports therapy (PST). The cost-effectiveness of the 6-month PST was assessed from a societal perspective alongside a RCT using cost-utility analysis. The analysis included 50 PwH with moderate-to-severe haemophilia A and B and a training period over 6 months. The health-related quality of life was measured with the EuroQoL-domain questionnaire. Resource utilization was assessed by questionnaire before and after the intervention. A cost-effectiveness acceptability curve was constructed, and sensitivity analyses were performed. During the 6-month study period, mean adjusted total healthcare costs were lower (mean difference: -22 805 EUR; 95%-CI: -73 944-48 463; P = .59) and the number of QALYs was higher in the intervention group (mean difference: 0.3733; 95%-CI: 0.0014-0.0573; P = .04). The probability of an incremental cost-effectiveness ratio <50 000 EUR per QALY was 71%. The performed sensitivity analysis confirmed these results. Results showed that the PST is effective in terms of a significant gain of QALYs. Furthermore, results weakly indicate the potential of the PST to reduce healthcare costs. Future studies should expand the observation period to have a closer look at the influence of PST on lifetime costs. © 2018 John Wiley & Sons Ltd.

  17. Long-term Cost-effectiveness of Two GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus in the Italian Setting: Liraglutide Versus Lixisenatide.

    Science.gov (United States)

    Hunt, Barnaby; Kragh, Nana; McConnachie, Ceilidh C; Valentine, William J; Rossi, Maria C; Montagnoli, Roberta

    2017-07-01

    Maintaining glycemic control is the key treatment target for patients with type 2 diabetes mellitus. In addition, the glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with other favorable treatment characteristics, such as reduction in body weight and reduced risk of hypoglycemia compared with traditional diabetes interventions. The aim of the present analysis was to compare the long-term cost-effectiveness of 2 GLP-1 receptor agonists, liraglutide 1.8 mg and lixisenatide 20 μg (both administered once daily), in the treatment of patients with type 2 diabetes failing to achieve glycemic control with metformin monotherapy in the Italian setting. The IMS CORE Diabetes Model was used to project long-term clinical outcomes and subsequent costs (in 2015 Euros [€]) associated with liraglutide 1.8 mg versus lixisenatide 20 μg treatment in a cohort with baseline characteristics derived from the open-label LIRA-LIXI trial (Efficacy and Safety of Liraglutide Versus Lixisenatide as Add-on to Metformin in Subjects With Type 2 Diabetes; NCT01973231) over patient lifetimes from the perspective of a health care payer. Efficacy data were taken from the 26-week end points of the same trial, including changes in glycated hemoglobin, body mass index, serum lipid levels, and hypoglycemic event rates. Outcomes projected included life expectancy, quality-adjusted life expectancy, cumulative incidence and time to onset of diabetes-related complications, and direct medical costs. Outcomes were discounted at 3% annually, and sensitivity analyses were performed. Liraglutide 1.8 mg was associated with improved discounted life expectancy (14.07 vs 13.96 years) and quality-adjusted life expectancy (9.18 vs 9.06 quality-adjusted life years [QALYs]) compared with lixisenatide 20 μg. These improvements were mostly attributable to a greater reduction in glycated hemoglobin level with liraglutide 1.8 mg versus lixisenatide 20 μg, leading to reduced incidence and

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

    Science.gov (United States)

    Wang, Li Yan; Michael, Shannon L

    2015-02-01

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

  19. Long-term ecophysiological responses to climate change

    DEFF Research Database (Denmark)

    Boesgaard, Kristine Stove; Ro-Poulsen, Helge

    Plant physiology is affected by climate change. Acclimations of photosynthetic processes are induced by short-term changes in climatic conditions. Further acclimation can be caused by longterm adjustments to climate change due to ecosystem-feedbacks. The aim of this PhD was to investigate plant...... term responses of plant physiology to the climate change factors were investigated. In the CLIMAITE-experiment it has been shown that 2 years of treatment altered physiological responses in Deschampsiaand Calluna. In the work of this PhD similar responses were observed after 6 years of treatment...... physiological responses to climate change in a seasonal and long-term perspective. The effects of elevated CO2, passive night time warming and periodic summer drought as single factor and in combination, on plant physiology were investigated in the long-term multifactorial field experiment CLIMAITE in a Danish...

  20. An econometric study on long-term energy outlook and the implications of renewable energy utilization in Malaysia

    International Nuclear Information System (INIS)

    Gan, Peck Yean; Li, ZhiDong

    2008-01-01

    We developed a comprehensive econometric model to study the long-term outlook of Malaysia's economy, energy and environment to 2030. Our projections under the reference scenario indicated that Malaysia's gross domestic production (GDP) is expected to average 4.6% from 2004 to 2030, and total primary energy consumption will triple by 2030. Coal import will increase following governmental policy of intensifying its use for power generation. Oil import is predicted to take place by 2013 and reach 45 Mtoe in 2030. Hence, in the near future, Malaysia's energy import dependency will rise. Carbon emissions will triple by 2030. On the other hand, our projections under an alternative renewable energy (RE) scenario showed that the utilization of RE is a strategic option to improve the long-term energy security and environmental performance of Malaysia. However, substantial governmental involvements and support, as well as the establishment of a regulatory framework are necessary. (author)

  1. Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis.

    Science.gov (United States)

    Hannemann, Pascal F W; Essers, Brigitte A B; Schots, Judith P M; Dullaert, Koen; Poeze, Martijn; Brink, Peter R G

    2015-04-11

    Physical forces have been widely used to stimulate bone growth in fracture repair. Addition of bone growth stimulation to the conservative treatment regime is more costly than standard health care. However, it might lead to cost-savings due to a reduction of the total amount of working days lost. This economic evaluation was performed to assess the cost-effectiveness of Pulsed Electromagnetic Fields (PEMF) compared to standard health care in the treatment of acute scaphoid fractures. An economic evaluation was carried out from a societal perspective, alongside a double-blind, randomized, placebo-controlled, multicenter trial involving five centres in The Netherlands. One hundred and two patients with a clinically and radiographically proven fracture of the scaphoid were included in the study and randomly allocated to either active bone growth stimulation or standard health care, using a placebo. All costs (medical costs and costs due to productivity loss) were measured during one year follow up. Functional outcome and general health related quality of life were assessed by the EuroQol-5D and PRWHE (patient rated wrist and hand evaluation) questionnaires. Utility scores were derived from the EuroQol-5D. The average total number of working days lost was lower in the active PEMF group (9.82 days) compared to the placebo group (12.91 days) (p = 0.651). Total medical costs of the intervention group (€1594) were significantly higher compared to the standard health care (€875). The total amount of mean QALY's (quality-adjusted life year) for the active PEMF group was 0.84 and 0.85 for the control group. The cost-effectiveness plane shows that the majority of all cost-effectiveness ratios fall into the quadrant where PEMF is not only less effective in terms of QALY's but also more costly. This study demonstrates that the desired effects in terms of cost-effectiveness are not met. When comparing the effects of PEMF to standard health care in terms of QALY's, PEMF

  2. Interpersonal and group processes in long-term spaceflight crews: perspectives from social and organizational psychology.

    Science.gov (United States)

    Dion, Kenneth L

    2004-07-01

    The issues of interpersonal and group processes in long-term spacecrews from the perspectives of social and organizational psychology are considered here. A contrast between the Amundsen vs. Scott expeditions to the South Pole 90 yrs. ago highlights the importance of personnel selection and attention to interpersonal and group dynamics in expeditions to extreme and dangerous environments, such as long-term spaceflights today. Under the rubric of personnel selection, some further psychological "select-in" and "select-out" criteria are suggested, among them implicit measures of human motivation, intergroup attitudes ("implicit" and "explicit" measures of prejudice, social dominance orientation, and right-wing authoritarianism), attachment styles, and dispositional hardiness. The situational interview and the idea of "selection for teams," drawn from current advances in organizational psychology, are recommended for selecting members for future spacecrews. Under the rubrics of interpersonal and group processes, the social relations model is introduced as a technique for modeling and understanding interdependence among spacecrew members and partialling out variance in behavioral and perceptual data into actor/perceiver, partner/target, and relationship components. Group cohesion as a multidimensional construct is introduced, along with a consideration of the groupthink phenomenon and its controversial link to cohesion. Group composition issues are raised with examples concerning cultural heterogeneity and gender composition. Cultural value dimensions, especially power distance and individual-collectivism, should be taken into account at both societal and psychological levels in long-term space missions. Finally, intergroup processes and language issues in crews are addressed. The recategorization induction from the common ingroup identity model is recommended as a possible intervention for overcoming and inhibiting intergroup biases within spacecrews and between space

  3. Rebalancing for Long-Term Investors

    NARCIS (Netherlands)

    Driessen, Joost; Kuiper, Ivo

    2017-01-01

    In this study we show that the rebalance frequency of a multi-asset portfolio has only limited impact on the utility of a long-term passive investor. Although continuous rebalancing is optimal, the loss of a suboptimal strategy corresponds to up to only 30 basis points of the initial wealth of the

  4. A Novel Short-Term Maintenance Strategy for Power Transmission and Transformation Equipment Based on Risk-Cost-Analysis

    Directory of Open Access Journals (Sweden)

    Hang Yang

    2017-11-01

    Full Text Available Current studies on preventive condition-based maintenance of power transmission and transformation equipment mainly focus on mid-term or long-term maintenance, and cannot meet the requirements of short-term especially temporary maintenance. In order to solve the defects of the present preventive maintenance strategies, according to the engineering application and based on risk-cost analysis, a short-term maintenance strategy is proposed in this manuscript. For the equipment working in bad health condition, its active maintenance costs and operation risk costs are evaluated, respectively. Then the latest maintenance time is calculated in accordance with the principle that its operation risk costs are no higher than active maintenance costs. Utilizing the latest maintenance time, the best maintenance time is calculated by setting the maximum relative earnings of postponing maintenance as the target, which provides the operation staffs with comprehensive maintenance-decision support. In the end, different cases on the IEEE 24-bus system are simulated. The effectiveness and advantages of the proposed strategy are demonstrated by the simulation results.

  5. Effect of long construction times on utility financial requirements

    International Nuclear Information System (INIS)

    Francis, J.M.

    1981-01-01

    It is well-known that long construction times significantly increase the cost of an individual nuclear plant. Long construction times, however, are not confined to either a single plant or a single utility. Rather, they apparently occur in almost all nuclear plants currently under construction. The total financial requirement to complete the 82 nuclear plants currently under construction was assessed. The analysis was performed assuming a construction time of ten years in one case, and six years in another. It was found that decreasing the construction time from ten to six years will reduce the financial requirements of the utility industry by $89 billion

  6. Wind power development. Status and perspectives

    International Nuclear Information System (INIS)

    Morthorst, P.E.

    1998-09-01

    This is the final report on the status and long-term perspectives for the development of wind power, contributing to the Macro Task E1 on production cost for fusion and alternative technologies, part of the programme for Socio-Economic Research on Fusion. The report concentrates on the development of the production costs for wind power, limited to turbines connected to the public grid. The report shows status and perspectives for production costs for wind turbines until the year 2020-30. In general two trends have dominated the grid-connected wind turbine development until now: The average size of the turbines sold at the market place has increased substantially, while at the same time the efficiency of turbine electricity production has increased steadily. Together these trends have increased the cost-effectiveness of wind power by almost 45% over a time span of 9-10 years. Looking at perspectives, a substantial cut in wind power cost per kWh can be expected within the next 20-30 years. A survey performed for a number of long-term forecasts for the wind power technology in general shows a decrease in production costs of 2-2.5% p.a., which implies that the cost of wind-generated electricity would be halved by the year 2030, probably making it fully competitive to conventional fossil fuel based electricity production. (au)

  7. Budget impact and cost-utility analysis of universal infant rotavirus vaccination in Spain.

    Science.gov (United States)

    Imaz, Iñaki; Rubio, Beltrán; Cornejo, Ana M; González-Enríquez, Jesús

    2014-04-01

    Rotavirus is not included in the Spanish mass infant vaccination schedule but has also not been economically evaluated for its inclusion. We analysed cost-utility of the universal infant rotavirus vaccination using RotaTeq® versus no vaccination in Spain. We also carried out a budget impact analysis and determined the effect on results of different variables introduced in the model. A deterministic Markov model was built considering loss of quality of life for children and their parents, and introducing direct and indirect costs updated to 2011. The introduction of the vaccination using RotaTeq® as a universal infant vaccination would increase the annual health care budget in 10.43 million euro and would result in a gain of an additional Quality Adjusted Life Year at a cost of 280,338€ from the healthcare system perspective and 210,167€ from the societal perspective. The model was stable to variable modifications. To sum up, according to our model and estimates, the introduction of a universal infant rotavirus vaccination with RotaTeq® in Spain would cause a large impact on the health care budget and would not be efficient unless significant variations in vaccine price, vaccine efficacy and/or utilities took place. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Implications of the international reduction pledges on long-term energy system changes and costs in China and India

    International Nuclear Information System (INIS)

    Lucas, Paul L.; Shukla, P.R.; Chen, Wenying; Ruijven, Bas J. van; Dhar, Subash; Elzen, Michel G.J. den; Vuuren, Detlef P. van

    2013-01-01

    This paper analyses the impact of postponing global mitigation action on abatement costs and energy systems changes in China and India. It compares energy-system changes and mitigation costs from a global and two national energy-system models under two global emission pathways with medium likelihood of meeting the 2 °C target: a least-cost pathway and a pathway that postpones ambitious mitigation action, starting from the Copenhagen Accord pledges. Both pathways have similar 2010–2050 cumulative greenhouse gas emissions. The analysis shows that postponing mitigation action increases the lock-in in less energy efficient technologies and results in much higher cumulative mitigation costs. The models agree that carbon capture and storage (CCS) and nuclear energy are important mitigation technologies, while the shares of biofuels and other renewables vary largely over the models. Differences between India and China with respect to the timing of emission reductions and the choice of mitigation measures relate to differences in projections of rapid economic change, capital stock turnover and technological development. Furthermore, depending on the way it is implemented, climate policy could increase indoor air pollution, but it is likely to provide synergies for energy security. These relations should be taken into account when designing national climate policies. - highlights: • We analyze long-term impacts of the international pledges for China and India. • We compare a least-cost pathway with a pathway starting from the Copenhagen pledges. • Postponing mitigation action implies much higher cumulative mitigation costs. • Postponing increases fossil fuel dependence and requires deeper long-term reductions. • Countries differ mainly due to different periods of rapid economic change

  9. An econometric study on long-term energy outlook and the implications of renewable energy utilization in Malaysia

    Energy Technology Data Exchange (ETDEWEB)

    Gan, Peck Yean [Department of Engineering-Energy and Environment Science, Nagaoka University of Technology, 1603-1 Kamitomioka, Nagaoka, Niigata 940-2188 (Japan); Li, ZhiDong [Department of Management and Information System Science, Nagaoka University of Technology, 1603-1 Kamitomioka, Nagaoka, Niigata 940-2188 (Japan)

    2008-02-15

    We developed a comprehensive econometric model to study the long-term outlook of Malaysia's economy, energy and environment to 2030. Our projections under the reference scenario indicated that Malaysia's gross domestic production (GDP) is expected to average 4.6% from 2004 to 2030, and total primary energy consumption will triple by 2030. Coal import will increase following governmental policy of intensifying its use for power generation. Oil import is predicted to take place by 2013 and reach 45 Mtoe in 2030. Hence, in the near future, Malaysia's energy import dependency will rise. Carbon emissions will triple by 2030. On the other hand, our projections under an alternative renewable energy (RE) scenario showed that the utilization of RE is a strategic option to improve the long-term energy security and environmental performance of Malaysia. However, substantial governmental involvements and support, as well as the establishment of a regulatory framework are necessary. (author)

  10. A Cost-Utility Analysis of Prostate Cancer Screening in Australia.

    Science.gov (United States)

    Keller, Andrew; Gericke, Christian; Whitty, Jennifer A; Yaxley, John; Kua, Boon; Coughlin, Geoff; Gianduzzo, Troy

    2017-02-01

    The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years. A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used. PSA-based screening is not cost effective compared with Australia's assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the

  11. Comparative Cost-Effectiveness of Stereotactic Body Radiation Therapy Versus Intensity-Modulated and Proton Radiation Therapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Parthan, Anju; Pruttivarasin, Narin; Davies, Diane; Taylor, Douglas C. A.; Pawar, Vivek; Bijlani, Akash; Lich, Kristen Hassmiller; Chen, Ronald C.

    2012-01-01

    Objective: To determine the cost-effectiveness of several external beam radiation treatment modalities for the treatment of patients with localized prostate cancer. Methods: A lifetime Markov model incorporated the probabilities of experiencing treatment-related long-term toxicity or death. Toxicity probabilities were derived from published sources using meta-analytical techniques. Utilities and costs in the model were obtained from publicly available secondary sources. The model calculated quality-adjusted life expectancy and expected lifetime cost per patient, and derived ratios of incremental cost per quality-adjusted life year (QALY) gained between treatments. Analyses were conducted from both payer and societal perspectives. One-way and probabilistic sensitivity analyses were performed. Results: Compared to intensity-modulated radiation therapy (IMRT) and proton beam therapy (PT), stereotactic body radiation therapy (SBRT) was less costly and resulted in more QALYs. Sensitivity analyses showed that the conclusions in the base-case scenario were robust with respect to variations in toxicity and cost parameters consistent with available evidence. At a threshold of $50,000/QALY, SBRT was cost-effective in 75% and 94% of probabilistic simulations compared to IMRT and PT, respectively, from a payer perspective. From a societal perspective, SBRT was cost-effective in 75% and 96% of simulations compared to IMRT and PT, respectively, at a threshold of $50,000/QALY. In threshold analyses, SBRT was less expensive with better outcomes compared to IMRT at toxicity rates 23% greater than the SBRT base-case rates. Conclusion: Based on the assumption that each treatment modality results in equivalent long-term efficacy, SBRT is a cost-effective strategy resulting in improved quality-adjusted survival compared to IMRT and PT for the treatment of localized prostate cancer.

  12. Cost-effectiveness analysis of allopurinol versus febuxostat in chronic gout patients: a U.S. payer perspective.

    Science.gov (United States)

    Gandhi, Pranav K; Gentry, William M; Ma, Qinli; Bottorff, Michael B

    2015-02-01

    Gout is a chronic inflammatory condition associated with poor urate metabolism. Xanthine oxidase inhibitors such as allopurinol and febuxostat are recommended to reduce uric acid levels and to prevent gout attacks in adult patients. Under budget-driven constraints, health care payers are faced with the broader challenge of assessing the economic value of these agents for formulary placement. However, the economic value of allopurinol versus febuxostat has not be assessed in patients with gout over a 5-year time period in the United States. To evaluate the cost-effectiveness of allopurinol versus febuxostat in adult patients with gout over a 5-year time period from a U.S. health care payer's perspective. A Markov model was developed to compare the total direct costs and success of serum uric acid (sUA) level reduction associated with allopurinol and febuxostat. Treatment success was defined as patient achievement of a sUA level less than  6 mg/dL (0.36 mmol/L) at 6 months. Event probabilities were based on published phase III randomized clinical trials and included long-term sequelae from open-label extension studies. A hypothetical cohort of 1,000 adult gout patients with sUA levels of ≥ 8 mg/dL (0.48 mmol/L) who had received either allopurinol 300 mg or febuxostat 80 mg at model entry transitioned among the 4 health states defined by treatment success, treatment failure and switch, treatment dropout, and death. The length of each Markov cycle was 6 months. Costs were gathered from the RED BOOK, Medicare fee schedules, Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, and for a limited number of inputs, expert consultation. Direct costs included treatment drug costs, costs for prophylaxis drugs, diagnostic laboratory tests, and the treatment and management of acute gout flare. Resource utilization was based on clinical evidence and expert consultation. All costs were inflated to 2014 U.S. dollars and were discounted at 3% in the base case

  13. Cost-effectiveness analysis of vaccinating children in Malawi with RTS,S vaccines in comparison with long-lasting insecticide-treated nets.

    Science.gov (United States)

    Seo, Mikyung Kelly; Baker, Peter; Ngo, Karen Ngoc-Lan

    2014-02-24

    health service perspective. This result was robust to changes in most variables, including vaccine price and vaccine efficacy, but was sensitive to the duration of efficacy of the vaccine and LLINs. Given the best evidence currently available, vaccines can be considered as a very cost-effective component of Malawi's future malaria control programmes. However, long-term follow-up studies on both interventions are needed.

  14. R and D and Innovation Electric Utilities Challenges: the USA EPRI perspective and the European Horizon2020 framework

    Energy Technology Data Exchange (ETDEWEB)

    Tagle, J. A.; Garcia Martin, J.; Martin Gomez, M.

    2013-07-01

    The paper presents the real challenges for the utilities worldwide to move the scientific and technological knowledge existing in our hands out of the laboratory and put it into the market place as rapidly as possible to provide a global electrification needed for a better worldwide life. Six main issues have been identified and each one is confronted with top ten challenges: Long-term operation of future and existing assets; Renewable energies; Zero-emission technologies; Energy Efficiency; Smart grids and cities and Water resources management. The corresponding challenges for each issue are described from both sides the USA utilities perspective and the European strategy with special emphasis in the road map for future R and D and innovation efforts needed for a Nuclear Energy renaissance policy.

  15. R and D and Innovation Electric Utilities Challenges: the USA EPRI perspective and the European Horizon2020 framework

    International Nuclear Information System (INIS)

    Tagle, J. A.; Garcia Martin, J.; Martin Gomez, M.

    2013-01-01

    The paper presents the real challenges for the utilities worldwide to move the scientific and technological knowledge existing in our hands out of the laboratory and put it into the market place as rapidly as possible to provide a global electrification needed for a better worldwide life. Six main issues have been identified and each one is confronted with top ten challenges: Long-term operation of future and existing assets; Renewable energies; Zero-emission technologies; Energy Efficiency; Smart grids and cities and Water resources management. The corresponding challenges for each issue are described from both sides the USA utilities perspective and the European strategy with special emphasis in the road map for future R and D and innovation efforts needed for a Nuclear Energy renaissance policy.

  16. Long-term consequences of selected competitive strategies during deregulation of the United States electric utility industry: System dynamics modeling and simulation

    Science.gov (United States)

    Khalil, Yehia Fahim

    Currently, U.S. investor-owned utilities (IOUs) are facing major reforms in their business environment similar to the airlines, telecommunications, banking, and insurance industries. As a result, IOUs are gearing up for fierce price competition in the power generation sector, and are vying for electricity customers outside their franchised service territories. Energy experts predict that some IOUs may suffer fatal financial setbacks (especially those with nuclear plants), while others may thrive under competition. Both federal and state energy regulators anticipate that it may take from five to ten years to complete the transition of America's electric utility industry from a regulated monopoly to a market-driven business. During this transition, utility executives are pursuing aggressive business strategies to confront the upcoming price wars. The most compelling strategies focus on cutting operation and maintenance (O&M) costs of power production, downsizing the work force, and signing bilateral energy agreements with large price-sensitive customers to retain their business. This research assesses the impact of the three pivotal strategies on financial performance of utilities during transition to open market competition. A system-dynamics-based management flight simulator has been developed to predict the dynamic performance of a hypothetical IOU organization preparing for market competition. The simulation results show that while the three business strategies lead to short-lived gains, they also produce unanticipated long-term consequences that adversely impact the organization's operating revenues. Generally, the designed flight simulator serves as a learning laboratory which allows management to test new strategies before implementation.

  17. The electric utilities in 1989 - A perspective

    International Nuclear Information System (INIS)

    Studness, C.M.

    1990-01-01

    This article presents the performance of electric utilities financially and in the stock market. The performance of the utility stocks compared with industrial stocks and long term government bonds is addressed as well as an analysis of the reasons for the differences. The effect of rate increases granted versus the rate of inflation on per share earnings is examined. A concern was expressed that increases in demand substantially larger than those projected by the industry for 1989 may result in excess capacity disappearing much sooner than predicted by industry managements

  18. Long-term care financing through Federal tax incentives.

    Science.gov (United States)

    Moran, D W; Weingart, J M

    1988-12-01

    Congress and the Administration are currently exploring various methods of promoting access to long-term care. In this article, an inventory of recent legislative proposals for using the Federal tax code to expand access to long-term care services is provided. Proposals are arrayed along a functional typology that includes tax mechanisms to encourage accumulation of funds, promote purchase of long-term care insurance, or induce the diversion of funds accumulated for another purpose (such as individual retirement accounts). The proposals are evaluated against the public policy objective of encouraging risk pooling to minimize social cost.

  19. Risk assessment for long-term post-accident sequences

    International Nuclear Information System (INIS)

    Ellia-Hervy, A.; Ducamp, F.

    1987-11-01

    Probabilistic risk analysis, currently conducted by the CEA (French Atomic Energy Commission) for the French replicate series of 900 MWe power plants, has identified accident sequences requiring long-term operation of some systems after the initiating event. They have been named long-term sequences. Quantification of probabilities of such sequences cannot rely exclusively on equipment failure-on-demand data: it must also take into account operating failures, the probability of which increase with time. Specific studies have therefore been conducted for a number of plant systems actuated during these long-term sequences. This has required: - Definition of the most realistic equipment utilization strategies based on existing emergency procedures for 900 MWe French plants. - Evaluation of the potential to repair failed equipment, given accessibility, repair time, and specific radiation conditions for the given sequence. - Definition of the event bringing the long-term sequence to an end. - Establishment of an appropriate quantification method, capable of taking into account the evolution of assumptions concerning equipment utilization strategies or repair conditions over time. The accident sequence quantification method based on realistic scenarios has been used in the risk assessment of the initiating event loss of reactor coolant accident occurring at power and at shutdown. Compared with the results obtained from conventional methods, this method redistributes the relative weight of accident sequences and also demonstrates that the long term can be a significant contribution to the probability of core melt

  20. The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

    Science.gov (United States)

    Barlow, Brian T; McLawhorn, Alexander S; Westrich, Geoffrey H

    2017-05-03

    Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty. Markov model analysis was conducted from the societal perspective with use of direct and indirect costs. Costs, expressed in 2013 U.S. dollars, were derived from the literature, the National Inpatient Sample, and the Centers for Medicare & Medicaid Services. Effectiveness was expressed in quality-adjusted life years (QALYs). The model was populated with health state utilities and state transition probabilities derived from previously published literature. The analysis was performed for a patient's lifetime, and costs and effectiveness were discounted at 3% annually. The principal outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to explore relevant uncertainty. In the base case, DM total hip arthroplasty showed absolute dominance over conventional total hip arthroplasty, with lower accrued costs ($39,008 versus $40,031 U.S. dollars) and higher accrued utility (13.18 versus 13.13 QALYs) indicating cost-savings. DM total hip arthroplasty ceased being cost-saving when its implant costs exceeded those of conventional total hip arthroplasty by $1,023, and the cost-effectiveness threshold for DM implants was $5,287 greater than that for conventional implants. DM was not cost-effective when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29%. The probability of intraprosthetic dislocation exerted the most influence on model results. This model

  1. The case of value-based healthcare for people living with complex long-term conditions.

    Science.gov (United States)

    Elf, Marie; Flink, Maria; Nilsson, Marie; Tistad, Malin; von Koch, Lena; Ytterberg, Charlotte

    2017-01-11

    There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

  2. LightForce Photon-pressure Collision Avoidance: Efficiency Analysis in the Current Debris Environment and Long-Term Simulation Perspective

    Science.gov (United States)

    Yang, Fan Y.; Nelson, Bron; Carlino, Roberto; Perez, Andres D.; Faber, Nicolas; Henze, Chris; Karacahoglu, Arif G.; O'Toole, Conor; Swenson, Jason; Stupl, Jan

    2015-01-01

    This work provides an efficiency analysis of the LightForce space debris collision avoidance scheme in the current debris environment and describes a simulation approach to assess its impact on the long-term evolution of the space debris environment. LightForce aims to provide just-in-time collision avoidance by utilizing photon pressure from ground-based industrial lasers. These ground stations impart minimal accelerations to increase the miss distance for a predicted conjunction between two objects. In the first part of this paper we will present research that investigates the short-term effect of a few systems consisting of 10kW class lasers directed by 1.5 m diameter telescopes using adaptive optics. The results found such a network of ground stations to mitigate more than 85 percent of conjunctions and could lower the expected number of collisions in Low Earth Orbit (LEO) by an order of magnitude. While these are impressive numbers that indicate LightForce's utility in the short-term, the remaining 15 percent of possible collisions contain (among others) conjunctions between two massive objects that would add large amount of debris if they collide. Still, conjunctions between massive objects and smaller objects can be mitigated. Hence we choose to expand the capabilities of the simulation software to investigate the overall effect of a network of LightForce stations on the long-term debris evolution. In the second part of this paper, we will present the planed simulation approach for that effort.

  3. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

    Directory of Open Access Journals (Sweden)

    Emmanuel Njeuhmeli

    Full Text Available Voluntary medical male circumcision (VMMC has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0, of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation.

  4. Factors associated with utilization of dental services in a long-term care facility: a descriptive cross-sectional study.

    Science.gov (United States)

    Scannapieco, Frank A; Amin, Summar; Salme, Marc; Tezal, Mine

    2017-03-01

    To describe factors associated with the utilization of dental services in a long-term care facility (LTCF) in Western New York. A descriptive cross-sectional study reviewed the dental and medical records of residents of an LTCF discharged between January 1, 2008 and December 30, 2012. Information on demographic and health variables at admission was extracted from electronic health records. Information on oral health variables was extracted from patient charts. A total of 2,516 residents were discharged between 2008 and 2012. From those, 259 (10.3%) utilized dental services at least once during their stay. Those who utilized dental services were significantly older at admission (78.5 vs. 82.0 years, p dental services. Dental services appear to be underutilized by residents of LTCF. Significant differences exist in demographic and health variables between residents who utilize these services compared to those who do not. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

  5. Long-term fuel cycle scenarios for advanced utilization of plutonium from LWRs

    International Nuclear Information System (INIS)

    Sato, Osamu; Tatematsu, Kenji

    2005-01-01

    The Innovative Water Reactor for Flexible fuel cycle (FLWR) realizes multiple recycling and breeding of Pu, which enables effective utilization of the uranium resource, and is based on well-developed LWR technologies. This reactor offers flexibility for the future nuclear fuel cycle situation. Three scenarios were defined for future deployment of nuclear power generation and fuel cycle systems in Japan and analyzed from the view point of Pu recycle, natural uranium consumption and stock of spent fuels. The LWR with long-term Pu recycle with or without MOX fuel reprocessing needs uranium of about 9 thousands tons per year and accumulated uranium consumption of 1.5 million tons in 2150. If the FLWR with net conversion ratio of 0.89 and 1.04 would be introduced in 2025 and 2050 or 2030, it would suppress ultimate required natural uranium and control the uranium consumption about less than 1.2 million tons in 2150, while the FLWR in 2025 and FBR with breeding ratio of 1.16 in 2050 will at 0.9 million tons after in 2100. (T. Tanaka)

  6. Long-term wave measurements in a climate change perspective.

    Science.gov (United States)

    Pomaro, Angela; Bertotti, Luciana; Cavaleri, Luigi; Lionello, Piero; Portilla-Yandun, Jesus

    2017-04-01

    At present multi-decadal time series of wave data needed for climate studies are generally provided by long term model simulations (hindcasts) covering the area of interest. Examples, among many, at different scales are wave hindcasts adopting the wind fields of the ERA-Interim reanalysis of the European Centre for Medium-Range Weather Forecasts (ECMWF, Reading, U.K.) at the global level and by regional re-analysis as for the Mediterranean Sea (Lionello and Sanna, 2006). Valuable as they are, these estimates are necessarily affected by the approximations involved, the more so because of the problems encountered within modelling processes in small basins using coarse resolution wind fields (Cavaleri and Bertotti, 2004). On the contrary, multi-decadal observed time series are rare. They have the evident advantage of somehow representing the real evolution of the waves, without the shortcomings associated with the limitation of models in reproducing the actual processes and the real variability within the wave fields. Obviously, observed wave time series are not exempt of problems. They represent a very local information, hence their use to describe the wave evolution at large scale is sometimes arguable and, in general, it needs the support of model simulations assessing to which extent the local value is representative of a large scale evolution. Local effects may prevent the identification of trends that are indeed present at large scale. Moreover, a regular maintenance, accurate monitoring and metadata information are crucial issues when considering the reliability of a time series for climate applications. Of course, where available, especially if for several decades, measured data are of great value for a number of reasons and can be valuable clues to delve further into the physics of the processes of interest, especially if considering that waves, as an integrated product of the local climate, if available in an area sensitive to even limited changes of the

  7. The long-term effect of perspective change on the emotional intensity of autobiographical memories.

    Science.gov (United States)

    Sekiguchi, Takahiro; Nonaka, Saori

    2014-01-01

    Autobiographical memories can be recalled from either a field (first-person) or an observer (third-person) perspective. Previous studies have reported that field-to-observer perspective change reduced the emotional intensity of recalled events. In the present study, we examined whether this effect has a long duration by employing follow-up measurements. The participants were asked to recall the same events repeatedly across three sessions (S1, S2, and S3): S2 was conducted about three days after S1, and S3 was conducted about four weeks after S2. The results showed a reduction in the emotional intensity of the recalled events when the perspective was changed from field to observer at S2. More importantly, this reduction in emotional intensity persisted until S3. These effects were not observed under observer-to-field perspective change at S2. These results suggest that observer perspective taking can cause plastic change in the autobiographical memory system.

  8. Impact of phosphate-solubilizing bacteria inoculation methods on phosphorus transformation and long-term utilization in composting.

    Science.gov (United States)

    Wei, Yuquan; Zhao, Yue; Fan, Yuying; Lu, Qian; Li, Mingxiao; Wei, Qingbin; Zhao, Yi; Cao, Zhenyu; Wei, Zimin

    2017-10-01

    This study aimed to assess the effect of phosphate-solubilizing bacteria (PSB) application and inoculation methods on rock phosphate (RP) solubilization and bacterial community during composting. The results showed that PSB inoculation in different stages of composting, especially both in the beginning and cooling stages, not only improved the diversity and abundance of PSB and bacterial community, but also distinctly increased the content of potential available phosphorus. Redundancy analysis indicated that the combined inoculation of PSB in the initial stage with higher inoculation amount and in the cooling stage with lower inoculation amount was the best way to improve the inoculation effect and increase the solubilization and utilization of RP during composting. Besides, we suggested three methods to improve phosphorus transformation and long-term utilization efficiency in composts based on biological fixation of phosphates by humic substance and phosphate-accumulating organisms. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. 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

  10. Design and fabrication of a unique electromechanical machine for long-term fatigue testing

    International Nuclear Information System (INIS)

    Boling, K.W.

    1984-12-01

    An electromechanical machine has been designed and fabricated for performing long-term fatigue tests under conditions that simulate those in modern plants. The machine is now commercially available. Its advantages over current electrohydraulic machines are lower initial cost, minimum maintenance requirements, and greater reliability especially when performing long tests. The machine operates in closed-loop fashion by utilizing continuous feedback signals from the specimen extensometer or load cell, it is programmable for testing in strain or load control. The maximum ram rate is 0.056 mm/s (0.134 in./min), maximum ram travel is 102 mm (4 in.) and load capacity is +-44 (+-10 kips). Induction heating controls speciment temperatures to 1000 0 C

  11. Long term health care consumption and cost expenditure in systolic heart failure.

    Science.gov (United States)

    Mejhert, Märit; Lindgren, Peter; Schill, Owe; Edner, Magnus; Persson, Hans; Kahan, Thomas

    2013-04-01

    The prevalence, health care consumption, and mortality increase in elderly patients with heart failure. This study aimed to analyse long term cost expenditure and predictors of health care consumption in these patients. We included 208 patients aged 60 years or older and hospitalised with heart failure (NYHA class II-IV and left ventricular systolic dysfunction); 58% were men, mean age 76 years, and mean ejection fraction 0.34. Data on all hospital admissions, discharge diagnoses, lengths of stay, and outpatient visits were collected from the National Board of Health and Welfare. We obtained data of all health care consumption for each individual. After 8-12 years of prospective follow up 72% were dead (median survival 4.6 years). Main drivers of health care expenditure were non-cardiac (40%) and cardiac (29%) hospitalizations, and visits to primary care centres (16%), and hospital outpatient clinics (15%). On average, health care expenditures were € 36,447 per patient during follow up. The average yearly cost per patient was about 5,700€, in contrast to the estimated consumption of primary and hospital care in the general population: € 1,956 in 65-74 year olds and € 2,701 in 75-84 year olds. Poor quality of life (Nottingham Health Profile) was the strongest independent predictor of total health care consumption and costs (pheart failure are at least two-fold higher than in the general population. Quality of life is a strong independent predictor of health care consumption. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. [Ophthalmologic healthcare utilization of people in need of long-term care : Analyses of health insurance data of the AOK Baden-Württemberg].

    Science.gov (United States)

    Schuster, Alexander K; Pick, Julia; Saalmann, Frauke; Pfeiffer, Norbert

    2018-04-10

    Eye diseases causing visual impairment increase with age. Thus, seeking eye care has a higher probability in older people. In this study, the rate of utilization of outpatient eye care services in Germany was analyzed. The analyses focused on older persons and persons in need of either home-based or facility-based long-term care. A descriptive secondary data analysis of health insurance data of the AOK Baden-Württemberg from 2016 was conducted. The study population comprised all insured persons on 1 January 2016. The cohort of older persons (60 years+) was further stratified by the type of care (home-based/facility-based) and the level of care (0-3). The utilization of outpatient eye care services was defined by the reimbursement for an ophthalmologist's provision of service. While 39.3% of the study population 60+ years old sought eye care, the utilization rate was lower among people in need of home-based (33.0%) and facility-based care (19.3%). The utilization rates showed comparable age-dependent patterns, except for persons in need of facility-based care where rates were similar for all age groups. Utilization rates were negatively associated with increasing care levels. Only people with care level 0 showed lower utilization rates than people with care level 1. Utilization rates of eye healthcare services among older persons are considerably influenced by the need of long-term care, by the form of care as well as by the level of care.

  13. Long-term impacts of mega-projects: the discount rate

    NARCIS (Netherlands)

    Koopmans, C.; Rietveld, P.; Priemus, H.; van Wee, B.

    2013-01-01

    In social cost-benefit analysis (SCBA), discount rates are used to convert costs and benefits that occur at different points in time, to present values that can be added and subtracted. Especially if important costs and benefits occur in the long term (more than say 30 years), the discount rate may

  14. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

    Weile, Louise K K; Kahn, James G; Marseille, Elliot

    2015-01-01

    a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria...... and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...

  15. [Pay for performance (P4P). Long-term effects and perspectives].

    Science.gov (United States)

    Schrappe, M; Gültekin, N

    2011-02-01

    After 10 years of experience and research, a wide array of results on evaluation and long-term effects of pay for performance (P4P) programs have been published. These data do not only give insight into most of the problems of implementation, but also into aspects which, in part, may attenuate the high expectations at the beginning of the discussion. P4P programs exhibit a ceiling effect, some improvements are reversed after incentives are cancelled, and improvements show opportunity costs as absent improvements for indicators, which are not object to financial incentives (in some cases for the same disease). These observations can be explained by the hypothesis that P4P programs have characteristics of fee-for-service reimbursement, if symmetric information is available for insurance and provider. P4P programs are local instruments. While integration of healthcare is considered as an important issue, they should be combined with programs and incentives which foster further vertical and horizontal integration. For Germany, further research in the implementation and effects of P4P programs is necessary.

  16. AIMING FOR THE BULL'S EYE: The Cost-Utility of Screening for Hydroxychloroquine Retinopathy.

    Science.gov (United States)

    McClellan, Andrew J; Chang, Jonathan S; Smiddy, William E

    2016-10-01

    Throughout medicine, the cost of various treatments has been increasingly studied with the result that certain management guidelines might be reevaluated in their context. Cost-utility is a term referring to the expense of preventing the loss of quality of life, quantified in dollars per quality-adjusted life year. In 2002, the American Academy of Ophthalmology published hydroxychloroquine screening recommendations which were revised in 2011. The purpose of this report is to estimate the cost-utility of these recommendations. A hypothetical care model of screening for hydroxychloroquine retinopathy was formulated. The costs of screening components were calculated using 2016 Medicare fee schedules from the Centers for Medicare and Medicaid Services. The cost-utility of screening for hydroxychloroquine retinopathy with the 2011 American Academy of Ophthalmology guidelines was found to vary from 33,155 to 344,172 dollars per quality-adjusted life year depending on the type and number of objective screening tests chosen, practice setting, and the duration of hydroxychloroquine use. Screening had a more favorable cost-utility when the more sensitive and specific diagnostics were used, and for patients with an increased risk of toxicity. American Academy of Ophthalmology guidelines have a wide-ranging cost-utility. Prudent clinical judgment of risk stratification and tests chosen is necessary to optimize cost-utility without compromising the efficacy of screening.

  17. Near-Term Nuclear Power Revival? A U.S. and International Perspective

    International Nuclear Information System (INIS)

    Braun, C.

    2004-01-01

    In this paper I review the causes for the renewed interest in the near-term revival of nuclear power in the U.S. and internationally. I comment on the progress already made in the U.S. in restarting a second era of commercial nuclear power plant construction, and on what is required going forwards, from a utilities perspective, to commit to and implement new plant orders. I review the specific nuclear projects discussed and committed to in the U.S. and abroad in terms of utilities, sites, vendor and suppliers teams, and project arrangements. I will then offer some tentative conclusions regarding the prospects for a near-term U.S. and global nuclear power revival

  18. Influence of transportation cost on long-term retention in clinic for HIV patients in rural Haiti.

    Science.gov (United States)

    Sowah, Leonard A; Turenne, Franck V; Buchwald, Ulrike K; Delva, Guesly; Mesidor, Romaine N; Dessaigne, Camille G; Previl, Harold; Patel, Devang; Edozien, Anthony; Redfield, Robert R; Amoroso, Anthony

    2014-12-01

    With improved access to antiretroviral therapy in resource-constrained settings, long-term retention in HIV clinics has become an important means of reducing costs and improving outcomes. Published data on retention in HIV clinics beyond 24 months are, however, limited. In our clinic in rural Haiti, we hypothesized that individuals residing in locations with higher transportation costs to clinic would have poorer retention than those who had lower costs. We used a retrospective cohort design to evaluate potential predictors of HIV clinic retention. Patient information was abstracted from the electronic medical records. Cox proportional hazards regression was used to identify independent predictors of 4-year clinic retention. There were 410 patients in our cohort, 266 (64.9%) females and 144 (35.1%) males. Forty-five (11%) patients lived in locations with transportation costs >$2. Males were 1.5 times more likely to live in municipalities with transportation costs to clinic of >$2. Multivariate analysis suggested that age transportation cost were independent predictors of loss to follow-up (LTFU): risk ratio of 2.98, 95% confidence interval (CI): 1.73 to 4.96, P transportation costs greater than $2 were 1.9 times more likely to be lost to care compared with those who paid less for transportation. HIV treatment programs in resource-constrained settings may need to pay closer attention to issues related to transportation cost to improve patient retention.

  19. Comparative cost-effectiveness of stereotactic body radiation therapy versus intensity-modulated and proton radiation therapy for localized prostate cancer.

    Directory of Open Access Journals (Sweden)

    Anju eParthan

    2012-08-01

    Full Text Available Objective. To determine the cost-effectiveness of several external beam radiation treatment modalities for the treatment of patients with localized prostate cancer.Methods. A lifetime Markov model incorporated the probabilities of experiencing treatment-related long-term toxicity or death. Toxicity probabilities were derived from published sources using meta-analytical techniques. Utilities and costs in the model were obtained from publically available secondary sources. The model calculated quality-adjusted life expectancy and expected lifetime cost per patient, and derived ratios of incremental cost per quality-adjusted life year (QALY gained between treatments. Analyses were conducted from both a payer and societal perspectives. One-way and probabilistic sensitivity analyses were performed.Results. Compared to intensity modulated radiation therapy (IMRT and proton beam therapy (PT, stereotactic body radiation therapy (SBRT was less costly and resulted in more QALYs. Sensitivity analyses showed that the conclusions in the base-case scenario were robust with respect to variations in toxicity and cost parameters consistent with available evidence. At a threshold of $50,000/QALY, SBRT was cost effective in 75%, and 94% of probabilistic simulations compared to IMRT and PT, respectively, from a payer perspective. From a societal perspective, SBRT was cost-effective in 75%, and 96% of simulations compared to IMRT and PT, respectively, at a threshold of $50,000/QALY. In threshold analyses, SBRT was less expensive with better outcomes compared to IMRT at toxicity rates 23% greater than the SBRT base-case rates. Conclusions. Based on the assumption that each treatment modality results in equivalent long-term efficacy, SBRT is a cost-effective strategy resulting in improved quality-adjusted survival compared to IMRT and PT for the treatment of localized prostate cancer.

  20. Long-term commitment of Japanese gas utilities to PAFCs and SOFCs

    Science.gov (United States)

    Matsumoto, Kiyokazu; Kasahara, Komei

    Tokyo Gas and Osaka Gas have been committed to addressing the energy- and environment-related issues of Japan through promotion of natural gas, an energy friendly to the environment. Being aware of the diversifying market needs (e.g. efficient energy utilization, rising demand for electricity, etc.), active efforts have been made in marketing gas-fired air-conditioning and co-generation systems. In this process, a high priority has also been placed on fuel cells, particularly for realizing their market introduction. Since their participation in the TARGET Program in USA in 1972, the two companies have been involved with the field testing and operation of phosphoric acid fuel cells (PAFCs), whose total capacity has amounted to 12.4 MW. The two companies have played a vital role in promoting and accelerating fuel cell development through the following means: (1) giving incentives to manufacturers through purchase of units and testing, (2) giving feedback on required specifications and technical problems in operation, and (3) verifying and realizing long-term operation utilizing their maintenance techniques. It has been expected that the primary goal of the cumulative operation time of 40 000 h shall be achieved in the near future. Work has also been in progress to develop SOFC. In the joint R&D of a 25-kW solid oxide fuel cell (SOFC) with Westinghouse, the record operation time of 13 000 h has been achieved. Though still twice as much as the average price of competing equipment, the commercialization of PAFCs is close at hand. By utilizing government spending and subsidies for field testing, work will be continued to verify reliability and durability of PAFCs installed at users' sites. These activities have been expected to contribute to realizing economically viable systems and enhance market introduction. The superlative advantages of fuel cells, particularly their environment-friendly qualities, should be best taken advantage of at an appropriate time. In

  1. Designing and evaluating an electronic patient falls reporting system: perspectives for the implementation of health information technology in long-term residential care facilities.

    Science.gov (United States)

    Mei, Yi You; Marquard, Jenna; Jacelon, Cynthia; DeFeo, Audrey L

    2013-11-01

    Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT. In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders' perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users' physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings

  2. Impact of growing costs on the profitability of crop production in Poland in the mid-term perspective

    Directory of Open Access Journals (Sweden)

    Aldona SKARŻYŃSKA

    2016-02-01

    Full Text Available Main aim of this paper was to demonstrate the impact of cultivation intensity on economic of selected activities of crop production in Poland. The projection of income of these activities in mid-term perspective, i.e. in 2016, has also been developed. Studies have shown that for cultivation technology of low intensity, as compared to high, the economic results of examined activities were more favourable. The profitability of production, expressed as a ratio of the value of production to economic costs, was higher by 10.0 to 52.7%. According to the projection results, in the highly intensive cultivation, high costs and dynamics of growth, stronger than growth of income, had a negative impact on the level of income. It is expected, even with an exceptionally high yield, income level will be lower than in the cultivation of low intensity. The results show that the use of technological progress can reduce a negative impact of chemicals on the environment while maintaining the high economic efficiency of production.

  3. General interest and investment. Long-term marginal cost and pricing at Electricite de France (1948-1949)

    International Nuclear Information System (INIS)

    Yon, Guillaume

    2014-01-01

    The paper investigates the construction of a concept in economic theory, long-term marginal cost pricing. It does so by exploring the work done within electricite de France in 1948-1949 by a group of engineer-economists who came out with the notion while they were engaged in completely remaking the pricing policy of the new public monopoly. I will show that the concept envisages a large-scale reorganization of the national power generation capacity in order to enact a certain conception of the general interest in the electric sector

  4. Utilizing time-driven activity-based costing to understand the short- and long-term costs of treating localized, low-risk prostate cancer.

    Science.gov (United States)

    Laviana, Aaron A; Ilg, Annette M; Veruttipong, Darlene; Tan, Hung-Jui; Burke, Michael A; Niedzwiecki, Douglas R; Kupelian, Patrick A; King, Chris R; Steinberg, Michael L; Kundavaram, Chandan R; Kamrava, Mitchell; Kaplan, Alan L; Moriarity, Andrew K; Hsu, William; Margolis, Daniel J A; Hu, Jim C; Saigal, Christopher S

    2016-02-01

    Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer. Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy. The costs of materials, equipment, personnel, and space were calculated per unit of time and based on the relative proportion of capacity used. TDABC for each treatment was defined as the sum of its resources. Substantial cost variation was observed at 5 years, with costs ranging from $7,298 for AS to $23,565 for IMRT, and they remained consistent through 12 years of follow-up. LDR brachytherapy ($8,978) was notably cheaper than HDR brachytherapy ($11,448), and SBRT ($11,665) was notably cheaper than IMRT, with the cost savings attributable to shorter procedure times and fewer visits required for treatment. Both equipment costs and an inpatient stay ($2,306) contributed to the high cost of RALP ($16,946). Cryotherapy ($11,215) was more costly than LDR brachytherapy, largely because of increased single-use equipment costs ($6,292 vs $1,921). AS reached cost equivalence with LDR brachytherapy after 7 years of follow-up. The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments. © 2015

  5. Assessment of costs related to the implementation of management solutions on the long term for high and medium level long life radioactive wastes. ANDRA's proposition

    International Nuclear Information System (INIS)

    2014-10-01

    This huge document contains several volumes which propose detailed costing of the various parts of the Cigeo project after sketch studies (this project deals with the deep geological storage of high and medium level long life radioactive wastes). It notably states the various hypotheses regarding the inventory of radioactive wastes, the waste supply prediction, and works closure. This cost assessment takes the different project stages into account and a cost update. Various aspects are thus assessed, some related to investments (design studies, preliminary works, construction of the various installations, renewal of equipment during exploitation, installation dismantling and works closure, insurance, commissioning authority and engineering subcontracting), to exploitation (production and maintenance, support, activities related to safety, radiation protection and control of the environment, operating costs, utilities, storage containers, insurance), and to other expenses (tax, research and development, technological tests, control after closure)

  6. Japanese utilities' plutonium utilization program

    International Nuclear Information System (INIS)

    Matsuo, Yuichiro.

    1996-01-01

    Japan's 10 utility companies are working and will continue to work towards establishing a fully closed nuclear fuel cycle. The key goals of which are: (1) reprocessing spent fuel; (2) recycling recovered uranium and plutonium; and (3) commercializing fast breeder technology by around the year 2030. This course of action by the Japanese electric power industry is in full accordance with Japan's national policy outlined in the government's report ''The Long-Term Program for Research, Development, and Nuclear Energy,'' which was published in June 1994. The Japanese civilian nuclear program is a long-term program that looks into the 21st century and beyond. It is quite true that sustaining the recycling option for energy security and the global environment demands a large investment. For it to be accepted by the public, safety must be the highest priority and will be pursued at a great cost if necessary. In its history, Japan has learned that as technology advances, costs will come down. The Japanese utility industry will continue investment in technology without compromising safety until the recycling option becomes more competitive with other options. This effort will be equally applied to the development of the commercial FBRs. The Japanese utility industry is confident that Japan's stable policy and strong objective to develop competitive and peaceful technology will contribute to the global economy and the environment without increasing the threat of plutonium proliferation

  7. Walrus history around the North Water: Human-animal relations in a long-term perspective.

    Science.gov (United States)

    Gotfredsen, Anne Birgitte; Appelt, Martin; Hastrup, Kirsten

    2018-04-01

    This article highlights the relationship between walruses and humans in and around the North Water polynya in a long-term perspective. The present study draws on a combination of biological, archaeological, archaeo-zoological, historical, and ethnographic sources covering the period from the 8th century AD to the late 20th century. The study demonstrates that the walrus was an important resource of meat, blubber, and other products throughout all the studied periods, if always supplemented by other kinds of game. It is suggested that walrus distribution and behaviour, as well as hunting strategies and technologies historically constituted a powerful component not only in forming human action and social life in the region but also in serving as an imaginative resource. It is further argued that the walrus and the walrus hunt still play a significant role in the present community living on the edge of the North Water, even if the hunt is increasingly circumscribed due to changing ice conditions.

  8. Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study.

    Science.gov (United States)

    Poulsen, Chalotte H; Eplov, Lene F; Hjorthøj, Carsten; Hastrup, Lene H; Eliasen, Marie; Dantoft, Thomas M; Schröder, Andreas; Jørgensen, Torben

    2018-05-01

    Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population ( n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.

  9. A basic strategy for financing long term care.

    Science.gov (United States)

    Greenberg, J A; Leutz, W N

    1984-02-01

    As pressure mounts to contain Medicaid long term care spending, short-range "quick fixes" must be avoided. Three such false solutions in particular have shortcomings that may actually exacerbate long term care's financial dilemma because they are based on inadequate definitions of the problem. Two of these proposals--legislation to broaden family responsibility toward institutionalized elders on Medicaid and expanded state power to put liens on such elders' real property--err by trying to mandate "caring" and are predicated on a misunderstanding of the "spend-down" problem. The other proposal--to provide tax incentives to family members who care for elders--requires a large administrative apparatus, assumes an elasticity of supply that may not exist, and could disrupt the "gift relationship" on which family exchanges are often based. What is needed is a strategy with short term, intermediate, and long term objectives that move toward an insurance approach. The short term plan should lay the groundwork for intermediate strategy and control costs by changing rate-setting methods and putting limits on facility construction. The intermediate plan should change the problem's definition from one of merely controlling Medicaid long term care expenditures to one of efficiently managing state resources for the elderly through the development of state financing and local delivery systems that target older persons in greatest need. An effective means of doing this is through the creation of social/HMOs, which have five key features: integration of service responsibility and authority; flexibility in organizational design; balanced clientele; pooled prepaid funding; and financial risk for the provider organization. Finally, the long term strategy should transfer much of the long term care financial burden from individuals and state Medicaid agencies to insurance mechanisms. Many individuals would thus avoid impoverishment caused by health care spending and Medicaid would

  10. Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

    Directory of Open Access Journals (Sweden)

    Chan Wai

    2009-09-01

    Full Text Available Abstract Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.

  11. Smoking and long-term labour market outcomes.

    Science.gov (United States)

    Böckerman, Petri; Hyytinen, Ari; Kaprio, Jaakko

    2015-07-01

    To examine the long-term effects of smoking on labour market outcomes using twin data matched to register-based individual information on earnings. Twin data for Finnish men born 1945-1957 was used to remove the shared environmental and genetic factors. The results were subjected to extensive robustness testing. Lifetime cigarette consumption was measured by (cumulative) cigarette pack-years in early adulthood. The average of an individual's earnings (and, alternatively, taxable income) was measured over a subsequent 15-year period in later adulthood. Smokers have lower long-term income and earnings. For example, controlling for the shared environmental and genetic factors using the data on genetically identical twins, smoking is negatively associated with lifetime income (p=0.015). The negative association was also robust to the use of various covariates, such as education, health indicators and extraversion. Smoking is negatively related to long-term labour market outcomes. The provision of information about the indirect monetary costs of smoking may thus complement the policy efforts that aim at educating consumers about the health costs of smoking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Long-term effectiveness and cost-effectiveness of high versus low-to-moderate intensity resistance and endurance exercise interventions among cancer survivors

    NARCIS (Netherlands)

    Kampshoff, C. S.; van Dongen, J. M.; van Mechelen, W.; Schep, G.; Vreugdenhil, A.; Twisk, J. W.R.; Bosmans, J. E.; Brug, J.; Chinapaw, M. J.M.; Buffart, Laurien M.

    Purpose: This study aimed to evaluate the long-term effectiveness and cost-effectiveness of high intensity (HI) versus low-to-moderate intensity (LMI) exercise on physical fitness, fatigue, and health-related quality of life (HRQoL) in cancer survivors. Methods: Two hundred seventy-seven cancer

  13. Treating Type 1 Diabetes Mellitus with a Rapid-Acting Analog Insulin Regimen vs. Regular Human Insulin in Germany: A Long-Term Cost-Effectiveness Evaluation.

    Science.gov (United States)

    Valentine, William J; Van Brunt, Kate; Boye, Kristina S; Pollock, Richard F

    2018-06-01

    The aim of the present study was to evaluate the cost effectiveness of rapid-acting analog insulin relative to regular human insulin in adults with type 1 diabetes mellitus in Germany. The PRIME Diabetes Model, a patient-level, discrete event simulation model, was used to project long-term clinical and cost outcomes for patients with type 1 diabetes from the perspective of a German healthcare payer. Simulated patients had a mean age of 21.5 years, duration of diabetes of 8.6 years, and baseline glycosylated hemoglobin of 7.39%. Regular human insulin and rapid-acting analog insulin regimens reduced glycosylated hemoglobin by 0.312 and 0.402%, respectively. Compared with human insulin, hypoglycemia rate ratios with rapid-acting analog insulin were 0.51 (non-severe nocturnal) and 0.80 (severe). No differences in non-severe diurnal hypoglycemia were modeled. Discount rates of 3% were applied to future costs and clinical benefits accrued over the 50-year time horizon. In the base-case analysis, rapid-acting analog insulin was associated with an improvement in quality-adjusted life expectancy of 1.01 quality-adjusted life-years per patient (12.54 vs. 11.53 quality-adjusted life-years). Rapid-acting analog insulin was also associated with an increase in direct costs of €4490, resulting in an incremental cost-effectiveness ratio of €4427 per quality-adjusted life-year gained vs. human insulin. Sensitivity analyses showed that the base case was driven predominantly by differences in hypoglycemia; abolishing these differences reduced incremental quality-adjusted life expectancy to 0.07 quality-adjusted life-years, yielding an incremental cost-effectiveness ratio of €74,622 per quality-adjusted life-year gained. Rapid-acting analog insulin is associated with beneficial outcomes in patients with type 1 diabetes and is likely to be considered cost effective in the German setting vs. regular human insulin.

  14. Palbociclib in hormone receptor positive advanced breast cancer: A cost-utility analysis.

    Science.gov (United States)

    Raphael, J; Helou, J; Pritchard, K I; Naimark, D M

    2017-11-01

    The addition of palbociclib to letrozole improves progression-free survival in the first-line treatment of hormone receptor positive advanced breast cancer (ABC). This study assesses the cost-utility of palbociclib from the Canadian healthcare payer perspective. A probabilistic discrete event simulation (DES) model was developed and parameterised with data from the PALOMA 1 and 2 trials and other sources. The incremental cost per quality-adjusted life-month (QALM) gained for palbociclib was calculated. A time horizon of 15 years was used in the base case with costs and effectiveness discounted at 5% annually. Time-to- progression and time-to-death were derived from a Weibull and exponential distribution. Expected costs were based on Ontario fees and other sources. Probabilistic sensitivity analyses were conducted to account for parameter uncertainty. Compared to letrozole, the addition of palbociclib provided an additional 14.7 QALM at an incremental cost of $161,508. The resulting incremental cost-effectiveness ratio was $10,999/QALM gained. Assuming a willingness-to-pay (WTP) of $4167/QALM, the probability of palbociclib to be cost-effective was 0%. Cost-effectiveness acceptability curves derived from a probabilistic sensitivity analysis showed that at a WTP of $11,000/QALM gained, the probability of palbociclib to be cost-effective was 50%. The addition of palbociclib to letrozole is unlikely to be cost-effective for the treatment of ABC from a Canadian healthcare perspective with its current price. While ABC patients derive a meaningful clinical benefit from palbociclib, considerations should be given to increase the WTP threshold and reduce the drug pricing, to render this strategy more affordable. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China.

    Science.gov (United States)

    Zhang, Chunxiang; Zhang, Hongmei; Shi, Jinning; Wang, Dong; Zhang, Xiuwei; Yang, Jian; Zhai, Qizhi; Ma, Aixia

    2016-01-01

    Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system. Model technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs) were calculated. One-way and probabilistic sensitivity analyses (PSA) were performed. Our model suggested that the median progression-free survival (PFS) was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy. The icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.

  16. Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China.

    Directory of Open Access Journals (Sweden)

    Chunxiang Zhang

    Full Text Available Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC from the perspective of the Chinese healthcare system.Model technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs and incremental cost-utility ratios (ICURs were calculated. One-way and probabilistic sensitivity analyses (PSA were performed.Our model suggested that the median progression-free survival (PFS was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy.The icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.

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

    Science.gov (United States)

    Angevine, Peter D; Berven, Sigurd

    2014-10-15

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

  18. Allocating provider resources to diagnose and treat restless legs syndrome: a cost-utility analysis.

    Science.gov (United States)

    Padula, William V; Phelps, Charles E; Moran, Dane; Earley, Christopher

    2017-10-01

    Restless legs syndrome (RLS) is a neurological disorder that is frequently misdiagnosed, resulting in delays in proper treatment. The objective of this study was to analyze the cost-utility of training primary care providers (PCP) in early and accurate diagnosis of RLS. We used a Markov model to compare two strategies: one where PCPs received training to diagnose RLS (informed care) and one where PCPs did not receive training (standard care). This analysis was conducted from the US societal and health sector perspectives over one-year, five-year, and lifetime (50-year) horizons. Costs were adjusted to 2016 USD, utilities measured as quality-adjusted life-years (QALYs), and both measures were discounted annually at 3%. Cost, utilities, and probabilities for the model were obtained through a comprehensive review of literature. An incremental cost-effectiveness ratio (ICER) was calculated to interpret our findings at a willingness-to-pay threshold of $100,000/QALY. Univariate and multivariate analyses were conducted to test model uncertainty, in addition to calculating the expected value of perfect information. Providing training to PCPs to correctly diagnose RLS was cost-effective since it cost $2021 more and gained 0.44 QALYs per patient over the course of a lifetime, resulting in an ICER of $4593/QALY. The model was sensitive to the utility for treated and untreated RLS. The probabilistic sensitivity analysis revealed that at $100,000/QALY, informed care had a 65.5% probability of being cost-effective. A program to train PCPs to better diagnose RLS appears to be a cost-effective strategy for improving outcomes for RLS patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Perspectives for hydropower stations in Switzerland: long-term competitiveness and possibilities for improvement; Perspektiven fuer die Wasserkraftwerke in der Schweiz. Langfristige Wettbewerbsfaehigkeit und moegliche Verbesserungspotenziale

    Energy Technology Data Exchange (ETDEWEB)

    Filippini, M.; Banfi, S. [Istituto di Microeconomia e Economia Pubblica, MecoP, Universita della Svizzera Italiana, Lugano (Switzerland); Luchsinger, C.; Wild, J.; Balmer, M.; Grand, D.; Henkels, L.; Semadeni, M. [Swiss Federal Institute of Technology (ETHZ), Centre for Energy Policy and Economics (CEPE), Zuerich (Switzerland); Gnansounou, E. [Swiss Federal Institute of Technology (EPFL), Laboratoire de systemes energetiques (LASEN), Lausanne (Switzerland)

    2001-07-01

    This first general study - which has the character of a preliminary study - examines the questions if the liberalisation of the electricity market will have a negative effect on the competitiveness of hydropower in the long-term and what measures can be taken against such effects. Long-term competitiveness is defined as the ability of a business in this sector to make investments in renewal in the long-term, i.e. after its concessions have expired. The three main aims of the study are: 1. Assessment of the long-term competitiveness of the sector and identification of the factors which could either have a negative effect on it or improve it, 2. Analysis of cost structures and presentation of measures through which the long-term competitiveness of the sector can be reinforced, 3. Presentation of possible political measures to be taken in this business area in order to improve the long-term competitiveness of hydropower stations. The study identifies the most important factors that determine future competitiveness as being the market prices for electricity and capital costs (depreciation and interest on own and borrowed capital). Further, water fees, taxes and regulations concerning residual water flow can be of great importance for investment decisions, in particular for those enterprises that operate close to their profitability limits. The results of the analysis indicate that, in the future, a considerable number of enterprises must be reckoned with that will refrain from renewing their plant. Such outcomes depend, of course, on developments in electricity market prices, specific investment costs, rates of interest and other economic, political, and legal conditions. Making a prognosis about the development of such parameters is linked with a high degree of uncertainty. By means of sensitivity calculations and the definition of various scenarios, attempts are made to take these uncertainties into account . Finally, the study makes reference to the fact that

  20. Cost-effectiveness of ranibizumab versus aflibercept in the treatment of visual impairment due to diabetic macular edema: a UK healthcare perspective

    Directory of Open Access Journals (Sweden)

    Régnier SA

    2015-05-01

    Full Text Available Stephane A Régnier,1 William Malcolm,2 Jennifer Haig,3 Weiguang Xue41Novartis Pharma AG, Basel, Switzerland; 2Novartis Pharmaceuticals UK Ltd, Frimley Business Park, UK; 3Optum, Burlington, ON, Canada; 4Optum, Uxbridge, UKBackground: Ranibizumab and aflibercept are alternative anti-vascular endothelial growth factor agents approved for the treatment of visual impairment (VI due to diabetic macular edema (DME.Objective: To estimate, from a UK healthcare perspective, the cost-effectiveness of ranibizumab 0.5 mg pro re nata (PRN and ranibizumab 0.5 mg treat and extend (T&E compared with aflibercept 2 mg every 8 weeks after five initial monthly doses (2q8 in the treatment of VI due to DME.Methods: A Markov model previously reviewed by the National Institute for Health and Care Excellence was used to simulate the long-term outcomes and costs of treating DME. Health states were defined by increments of ten letters in best-corrected visual acuity (BCVA, with a 3-month cycle length. Patients could gain (or lose a maximum of two health states between cycles. A 3-year treatment time frame and a lifetime horizon were used. Future costs and health outcomes were discounted at 3.5% per annum. Patient baseline characteristics and the efficacy of ranibizumab PRN were derived using data from the RESTORE study. The relative efficacies of ranibizumab PRN, ranibizumab T&E, and aflibercept were assessed with a network meta-analysis. Different utilities were assigned based on BCVA and whether the treated eye was the better- or the worse-seeing eye. Sensitivity analyses tested the robustness of the model.Results: Lifetime costs per patient of treating DME were £20,019 for ranibizumab PRN, £22,930 for ranibizumab T&E, and £25,859 for aflibercept 2q8. Ranibizumab was dominant over aflibercept, with an incremental gain of 0.05 quality-adjusted life-years (QALYs and cost savings of £5,841 (PRN and £2,930 (T&E compared with aflibercept. Ranibizumab PRN and

  1. Strategies to meet the need for long-term data.

    Science.gov (United States)

    Chalmers, John; Woodward, Mark; Borghi, Claudio; Manolis, Athanasios; Mancia, Giuseppe

    2016-08-01

    Chronic diseases afflict patients for many years, often to the end of life, and there is increasing need for estimating lifelong risk and for evaluating the effects of treatment in the long term. Yet recommendations for lifelong treatment are most frequently based on findings from randomized clinical trials lasting only a few years. There is therefore a clear need for much longer term data, and here we present the advantages and disadvantages of many strategies, including the use of long-term posttrial follow-up, of long-term prospective cohort studies, registry databases, and of administrative databases. We also emphasize the need for long-term cost-effectiveness studies. One of the most promising strategies comes from linkage of data gathered through the ever-expanding pool of administrative databases worldwide with data from other sources, including randomized trials and the many forms of observational study.

  2. Long-term economic consequences of child maltreatment: a population-based study.

    Science.gov (United States)

    Thielen, Frederick W; Ten Have, Margreet; de Graaf, Ron; Cuijpers, Pim; Beekman, Aartjan; Evers, Silvia; Smit, Filip

    2016-12-01

    Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with

  3. A Methodology for Long-Term Analysis of Innovative Signalling Systems on Regional Rail Lines

    Directory of Open Access Journals (Sweden)

    Luca D'Acierno

    2016-10-01

    Full Text Available A rail system may be considered a useful tool for reducing vehicular flows on a road system (i.e. cars and trucks, especially in high-density contexts such as urban and metropolitan areas where greenhouse gas emissions need to be abated. In particular, since travellers maximise their own utility, variations in mobility choices can be induced only by significantly improving the level-of-service of public transport. Our specific proposal is to identify the economic and environmental effects of implementing an innovative signalling system (which would reduce passenger waiting times by performing a cost-benefit analysis based on a feasibility threshold approach. Hence, it is necessary to calculate long-term benefits and compare them with intervention costs. In this context, a key factor to be considered is travel demand estimation in current and future conditions. This approach was tested on a regional rail line in southern Italy to show the feasibility and utility of the proposed methodology.

  4. Long-dated evaluation of the external costs of the nuclear; L'evaluation des couts externes a long terme de la filiere nucleaire: interets et limites

    Energy Technology Data Exchange (ETDEWEB)

    Le Dars, A.; Schneider, T

    2002-09-01

    Since the middle of the years 1990, the European Commission developed an ''ExternE'' methodology to propose an homogenous evaluation of the sanitary and environmental external costs of the various energy sectors in Europe. This document discusses the taking into account of the long-dated and analyzes the interests and the limits of the monetary evaluation, in terms of external costs, of the nuclear choice. It is organized in three chapters: 1. a presentation and a discussion on the various evaluation of the ''ExternE'' methodology; 2. a description of the available methods for the monetary evaluation of the long-dated impacts and more particularly the analysis of the monetary values actualization principle; 3. highlighted of the impacts for which the monetary evaluations exist. (A.L.B.)

  5. Advances in low-cost long-wave infrared polymer windows

    Science.gov (United States)

    Weimer, Wayne A.; Klocek, Paul

    1999-07-01

    Recent improvements in engineered polymeric material compositions and advances in processing methodologies developed and patented at Raytheon Systems Company have produced long wave IR windows at exceptionally low costs. These UV stabilized, high strength windows incorporating subwavelength structured antireflection surfaces are enabling IR imaging systems to penetrate commercial markets and will reduce the cost of systems delivered to the military. The optical and mechanical properties of these windows will be discussed in detail with reference to the short and long-term impact on military IR imaging systems.

  6. A review of the clinical utility of duloxetine in the treatment of diabetic peripheral neuropathic pain

    Directory of Open Access Journals (Sweden)

    King JB

    2015-08-01

    Full Text Available Jordan B King, Marisa B Schauerhamer, Brandon K Bellows Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, USA Abstract: Diabetes mellitus is a world-wide epidemic with many long-term complications, with neuropathy being the most common. In particular, diabetic peripheral neuropathic pain (DPNP, can be one of the most distressing complications associated with diabetes, leading to decreases in physical and mental quality of life. Despite the availability of many efficient medications, DPNP remains a challenge to treat, and the optimal sequencing of pharmacotherapy remains unknown. Currently, there are only three medications approved by the US Food and Drug Administration specifically for the management of DPNP. Duloxetine (DUL, a selective serotonin-norepinephrine reuptake inhibitor, is one of these. With the goal of optimizing pharmacotherapy use in DPNP population, a review of current literature was conducted, and the clinical utility of DUL described. Along with early clinical trials, recently published observational studies and pharmacoeconomic models may be useful in guiding decision making by clinicians and managed care organizations. In real-world practice settings, DUL is associated with decreased or similar opioid utilization, increased medication adherence, and similar health care costs compared with current standard of care. DUL has consistently been found to be a cost-effective option over short time-horizons. Currently, the long-term cost-effectiveness of DUL is unknown. Evidence derived from randomized clinical trials, real-world observations, and economic models support the use of DUL as a first-line treatment option from the perspective of the patient, clinician, and managed care payer. Keywords: clinical trials, pharmacoeconomic studies, opioid-utilization, health care utilization, pregabalin, tricyclic antidepressants, gabapentin

  7. Long term socio-ecological research across temporal and spatial scales

    Science.gov (United States)

    Singh, S. J.; Haberl, H.

    2012-04-01

    Long term socio-ecological research across temporal and spatial scales Simron Jit Singh and Helmut Haberl Institute of Social Ecology, Vienna, Austria Understanding trajectories of change in coupled socio-ecological (or human-environment) systems requires monitoring and analysis at several spatial and temporal scales. Long-term ecosystem research (LTER) is a strand of research coupled with observation systems and infrastructures (LTER sites) aimed at understanding how global change affects ecosystems around the world. In recent years it has been increasingly recognized that sustainability concerns require extending this approach to long-term socio-ecological research, i.e. a more integrated perspective that focuses on interaction processes between society and ecosystems over longer time periods. Thus, Long-Term Socio-Ecological Research, abbreviated LTSER, aims at observing, analyzing, understanding and modelling of changes in coupled socio-ecological systems over long periods of time. Indeed, the magnitude of the problems we now face is an outcome of a much longer process, accelerated by industrialisation since the nineteenth century. The paper will provide an overview of a book (in press) on LTSER with particular emphasis on 'socio-ecological transitions' in terms of material, energy and land use dynamics across temporal and spatial scales.

  8. Evaluation of the long-term power generation mix: The case study of South Korea's energy policy

    International Nuclear Information System (INIS)

    Min, Daiki; Chung, Jaewoo

    2013-01-01

    This paper presents a practical portfolio model for the long-term power generation mix problem. The proposed model optimizes the power generation mix by striking a trade-off between the expected cost of power generation and its variability. We use Monte Carlo simulation techniques to consider the uncertainty associated with future electricity demand, fuel prices and their correlations, and the capital costs of power plants. Unlike in the case of conventional power generation mix models, we employ CVaR (Conditional Value-at-Risk) in designing variability to consider events that are rare but enormously expensive. A comprehensive analysis on South Korea's generation policy using the portfolio model shows that a large annual cost is additionally charged to substitute a portion of nuclear energy with other alternatives. Nonetheless, if Korea has to reduce its dependency on nuclear energy because of undermined social receptivity from the Fukushima disaster, it turns out that LNG or coal could be a secure candidate from an economic perspective. - Author-Highlights: • We develop a stochastic optimization model for long-term power generation mix. • Monte Carlo sampling method and scenario trees are used to solve the model. • The model is verified using the data provided by Korean government. • We evaluate Korea's existing nuclear expansion policy. • We analyze the cost of replacing nuclear energy with others in South Korea

  9. Cost effectiveness of liraglutide in type II diabetes: a systematic review.

    Science.gov (United States)

    Zueger, Patrick M; Schultz, Neil M; Lee, Todd A

    2014-11-01

    -related complication costs only) over a 30-year time horizon. Cost-utility analysis results reported base-case ICERs ranging from $US15,774 (vs. glimepiride) to $US40,128 (vs. rosiglitazone) per quality-adjusted life-year (QALY) ($US, year 2012) for liraglutide 1.2 mg and $US8,497 (vs. exenatide) to $US66,031 (vs. rosiglitazone)/QALY ($US, year 2012) for liraglutide 1.8 mg. Estimates were most sensitive to variations in time horizon and cardiovascular complication rates. Based on frequently cited, country-specific cost-utility thresholds, liraglutide was determined to have a probability of being cost effective of between 58 % (liraglutide 1.8 mg vs. sitagliptin) and 93 % (liraglutide 1.2 mg vs. glimepiride). Weaknesses of included studies related primarily to study model inputs that assumed long-term morbidity and mortality benefits in favor of liraglutide based on improvements in clinical biomarkers observed in short-term clinical trials. The exclusion of drug acquisition costs in two identified cost studies as well as the assumed lifetime duration of treatment with liraglutide in several cost-utility studies were also identified as weaknesses. The authors' review was limited by the possibility of incomplete literature retrieval, unintended omission of relevant data elements, and comparison of costs and ICERs generated from healthcare systems from differing countries. The current literature presents liraglutide as a cost-effective adjunct treatment for type II diabetes that may also be associated with a reduction in diabetes-related complication costs; however, ICER values are largely dependent on assumptions regarding the benefits of long-term liraglutide treatment and the time horizon of the analysis. Real-world use may make liraglutide unattractive from a payer and policy-maker perspective.

  10. Long-term biodosimetry Redux

    International Nuclear Information System (INIS)

    Simon, Steven L.; Bouville, Andre

    2016-01-01

    This paper revisits and reiterates the needs, purposes and requirements of bio-dosimetric assays for long-term dose and health risk assessments. While the most crucial need for bio-dosimetric assays is to guide medical response for radiation accidents, the value of such techniques for improving our understanding of radiation health risk by supporting epidemiological (long-term health risk) studies is significant. As new cohorts of exposed persons are identified and new health risk studies are undertaken with the hopes that studying the exposed will result in a deeper understanding of radiation risk, the value of reliable dose reconstruction is underscored. The ultimate application of biodosimetry in long-term health risk studies would be to completely replace model-based dose reconstruction-a complex suite of methods for retrospectively estimating dose that is commonly fraught with large uncertainties due to the absence of important exposure-related information, as well as imperfect models. While biodosimetry could potentially supplant model-based doses, there are numerous limitations of presently available techniques that constrain their widespread application in health risk research, including limited ability to assess doses received far in the past, high cost, great inter-individual variability, invasiveness, higher than preferred detection limits and the inability to assess internal dose (for the most part). These limitations prevent the extensive application of biodosimetry to large cohorts and should be considered a challenge to researchers to develop new and more flexible techniques that meet the demands of long-term health risk research. Events in recent years, e.g. the Fukushima reactor accident and the increased threat of nuclear terrorism, underscore that any event that results in significant radiation exposures of a group of people will also produce a much larger population, exposed at lower levels, but that likewise needs (or demands) an exposure

  11. Conceptual costing study for the long-term management of the Port Hope area low-level radioactive wastes

    International Nuclear Information System (INIS)

    1989-12-01

    Comparative conceptual cost estimates for several possible options for the long-term management of the Port Hope area low-level radioactive wastes have been developed. Five potentially applicable concepts were considered in the study: shallow land burial, using either unlined trenches, lined trenches or concrete canisters; engineered storage mounds; above-ground concrete vaults; below-ground concrete vaults; and intermediate-depth caverns using either open stopes or shrinkage mining. The objective was to develop comparative estimates. The differences in costs between concepts reflect the differences in handling methodology or costs of additional engineered barriers around the stored waste. An in situ waste volume of 805 000 m 3 , relatively favorable site conditions, a four-year disposal schedule and a consistent costing basis were assumed for each concept. Limited effort was made to optimize specific facility designs or disposal operations. The projected disposal costs vary from $68/m 3 of waste for shallow land burial in unlined trenches, to $312/m 3 of waste disposal in concrete canisters in trenches. The results of this study are reasonably consistent with previous estimates prepared for the low-level Radioactive Waste Management Office

  12. Long-term governance for sustainability

    International Nuclear Information System (INIS)

    Martell, M.

    2007-01-01

    Meritxell Martell spoke of the long-term aspects of radioactive waste management. She pointed out that decision-making processes need to be framed within the context of sustainability, which means that a balance should be sought between scientific considerations, economic aspects and structural conditions. Focusing on structural aspects, Working Group 3 of COWAM-Spain came to the conclusion that the activity of the regulator is a key factor of long-term management. Another finding is that from a sustainability perspective multi-level governance is more effective for coping with the challenges of radioactive waste management than one tier of government-making decisions. The working group also felt that the current Local Information Committees need to evolve towards more institutionalized and legitimized mechanisms for long-term involvement. Ms. Martell introduced a study comparing the efficiency of economic instruments to advance sustainable development in nuclear communities vs. municipalities in mining areas. The study found that funds transferred to nuclear zones had become a means to facilitate local acceptance of nuclear facilities rather than a means to promote socio-economic development. Another finding is that economic instruments are not sufficient guarantees of sustainable development by themselves; additional preconditions include leadership, vision and entrepreneur-ship on the part of community leaders, private or public investments, among others. Finally, Ms. Martell summarised the challenges faced by the Spanish radioactive waste management programme, which include the need for strategic thinking, designing the future in a participatory fashion, and working with local and regional governments and citizens to devise mechanisms for social learning, economic development and environmental protection. (author)

  13. Cost-utility analysis of varenicline, an oral smoking-cessation drug, in Japan.

    Science.gov (United States)

    Igarashi, Ataru; Takuma, Hiroki; Fukuda, Takashi; Tsutani, Kiichiro

    2009-01-01

    To conduct a cost-utility analysis of two 12-week smoking-cessation interventions in Japan: smoking-cessation counselling by a physician compared with use of varenicline, an oral smoking-cessation drug, in addition to counselling. A Markov model was constructed to analyse lifetime medical costs and QALYs from the perspective of the healthcare payer. The cycle length was 5 years. Both costs and QALYs were discounted at 3% annually. The cohort of smokers was classified by sex and age, and we assumed that smokers started smoking at the age of 20 years and received smoking-cessation therapy at the ages of 30, 40, 50, 60 or 70 years (five separate models were run). The healthcare costs and QALYs were calculated throughout the term until the age of 90 years. In the base-case analysis, success rates of varenicline plus counselling and counselling alone were assumed to be 37.9% and 25.5%, respectively, in male smokers, and 22.2% and 16.1%, respectively, in female smokers, based on a randomized controlled trial conducted in Japan. Both univariate and probabilistic sensitivity analyses were conducted. Prescribed varenicline was shown to be more effective and less costly than smoking-cessation counselling alone. Varenicline would save direct medical costs of Japanese Yen (yen)43 846 ($US381; $US1 = yen115; Oct 2007) and generate an increase of 0.094 QALYs in male smokers. In females the incremental cost-effectiveness ratio was yen346 143 per QALY gained. Varenicline is estimated to save yen23.7 billion ($US206 million) of the medical costs for tobacco-associated diseases for the whole population. Overall savings are yen9.5 billion. Sensitivity analyses suggested the robustness of the results. As with any data of this nature, there is some uncertainty in the results and further research is warranted. However, based on the results of this pharmacoeconomic evaluation, varenicline, the first non-nicotine, oral treatment developed for smoking cessation, appears to be cost

  14. An Integrated Modeling Approach for Forecasting Long-Term Energy Demand in Pakistan

    OpenAIRE

    Syed Aziz Ur Rehman; Yanpeng Cai; Rizwan Fazal; Gordhan Das Walasai; Nayyar Hussain Mirjat

    2017-01-01

    Energy planning and policy development require an in-depth assessment of energy resources and long-term demand forecast estimates. Pakistan, unfortunately, lacks reliable data on its energy resources as well do not have dependable long-term energy demand forecasts. As a result, the policy makers could not come up with an effective energy policy in the history of the country. Energy demand forecast has attained greatest ever attention in the perspective of growing population and diminishing fo...

  15. Long-term outcome after early repair of iatrogenic bile duct injury

    DEFF Research Database (Denmark)

    Stilling, Nicolaj M; Fristrup, Claus; Wettergren, André

    2015-01-01

    BACKGROUND: The aim of this retrospective study was to evaluate the peri-operative and long-term outcome after early repair with a hepaticojejunostomy (HJ). METHODS: Between 1995 and 2010, a nationwide, retrospective multi-centre study was conducted. All iatrogenic bile duct injury (BDI) sustained...... during a cholecystectomy and repaired with HJ in the five Hepato-Pancreatico-Biliary centres in Denmark were included. RESULTS: In total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Post...... with BDI repaired by early HJ we found a considerable risk of long-term complications (e.g. 30% stricture rate) and mortality in both the short- and the long-term perspective....

  16. Audit in radiation therapy: long-term survival and cost of treatment

    International Nuclear Information System (INIS)

    Stevens, G.; Firth, I.

    1997-01-01

    In order to determine the cost of radiation treatment and the survival rate of a cohort of patients treated in a 6 month period in 1988, estimates of the capital and recurrent costs of this service were made for the calendar year 1988, expressed as $A(1988). Data collected prospectively included workload statistics (including number of attendances), field treated and complexity of treatment. Patient and tumour-related data included tumour site, intent of treatment and survival. The survival rate of patients during this period was determined in June 1995. The cost per field in 1988 was estimated at $A44.32. The 1988 costs of courses of definitive, adjuvant and palliative radiation therapy were estimated at $A2545, $A2482 and $A929, respectively. The major contributor to the cost of salaries and consumables within the Radiation Oncology Department (81.6%), with capital costs accounting for 13.5%, overheads accounting for 4.5% of the costs and planned admissions accounting for 0.2%. The median survival time of 580 patients with malignant disease treated during this period in 1988 was 12.4 months. The overall 5 year survival rate was 27%. For 105 patients treated definitively with radiation therapy, the median and 5 year survival rate figures were 26.0 months and 40%. For 149 patients treated with adjuvant radiation therapy, the 5 year survival rate was 62% (median survival rate not reached). For 279 patients treated palliatively, median and 5 year survival rate figures were 5.2 months and 3%. The cost per month of survival for all patients with malignancy was $A67; the figures for definitive , adjuvant and palliative treatments being $A74, $A48 and $A105, respectively. A sensitivity analysis indicated that these figures were robust. The cost of radiation treatment per field was comparable to reports for other centres and emphasizes the utility of radiation therapy as a cost-effective cancer treatment modality. 7 refs., 6 tabs., 2 figs

  17. Cost-utility analysis of an adjunctive recombinant activated factor VIIa for on-demand treatment of bleeding episodes in dengue haemorrhagic fever.

    Science.gov (United States)

    Naing, Cho; Poovorawan, Yong; Mak, Joon Wah; Aung, Kyan; Kamolratankul, Pirom

    2015-06-01

    The present study aimed to assess the cost-utility analysis of using an adjunctive recombinant activated factor VIIa (rFVIIa) in children for controlling life-threatening bleeding in dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS). We constructed a decision-tree model, comparing a standard care and the use of an additional adjuvant rFVIIa for controlling life-threatening bleeding in children with DHF/DSS. Cost and utility benefit were estimated from the societal perspective. The outcome measure was cost per quality-adjusted life years (QALYs). Overall, treatment with adjuvant rFVIIa gained QALYs, but the total cost was higher. The incremental cost-utility ratio for the introduction of adjuvant rFVIIa was $4241.27 per additional QALY. Sensitivity analyses showed the utility value assigned for calculation of QALY was the most sensitive parameter. We concluded that despite high cost, there is a role for rFVIIa in the treatment of life-threatening bleeding in patients with DHF/DSS.

  18. Sensor System for Long-term Recording of Photovoltaic (PV) IV-curves

    DEFF Research Database (Denmark)

    Paasch, Kasper; Nymand, Morten; Haase, Frerk

    The purpose of this paper is to present a recording system for long-term investigation of PV panel dynamics under partial shading conditions. The system is intended to be a low-cost system deployable for stand-alone field use and long-term data recording at PV-plants. Passing clouds will affect...

  19. Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.

    Directory of Open Access Journals (Sweden)

    Anton Emmanuel

    Full Text Available People suffering from neurogenic bowel dysfunction (NBD and an ineffective bowel regimen often suffer from fecal incontinence (FI and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI has been shown to reduce these symptoms and improve quality of life.To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC.A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs, episodes of FI, urinary tract infections (UTIs, and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI, multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model.The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.

  20. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis.

    Science.gov (United States)

    Cotton, Cary C; Erim, Daniel; Eluri, Swathi; Palmer, Sarah H; Green, Daniel J; Wolf, W Asher; Runge, Thomas M; Wheeler, Stephanie; Shaheen, Nicholas J; Dellon, Evan S

    2017-06-01

    Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  1. Assessment Tools as Drivers for SPI: Short-term Benefits and Long-term Challenges

    DEFF Research Database (Denmark)

    Mûller, Sune Dueholm; Nørbjerg, Jacob; Cho, Hiu Ngan

    2007-01-01

    Full scale software process maturity assessments are costly, can have large organizational impact, and are carried out at long (12-24 months) intervals. Consequently, there is a need for techniques and tools to monitor and help manage an SPI project through inexpensive, ongoing progress assessments....... In this paper we present findings from two cases of using such a tool. We have found that the tool does provide useful snapshots of the status of SPI projects, but that long-term use of the tool introduces costs and challenges related to modifying and tailoring the tool to both the organizational context...

  2. An analysis of electric utility embedded power supply costs

    International Nuclear Information System (INIS)

    Kahal, M.; Brown, D.

    1998-01-01

    There is little doubt that for the vast majority of electric utilities the embedded costs of power supply exceed market prices, giving rise to the stranded cost problem. Beyond that simple generalization, there are a number of crucial questions, which this study attempts to answer. What are the regional patterns of embedded cost differences? To what extent is the cost problem attributable to nuclear power? How does the cost of purchased power compare to the cost of utility self-generation? What is the breakdown of utility embedded generation costs between operating costs - which are potentially avoidable--and ownership costs, which by definition are ''sunk'' and therefore not avoidable? How will embedded generation costs and market prices compare over time? These are the crucial questions for states as they address retail-restructuring proposal. This study presents an analysis of generation costs, which addresses these key questions. A computerized costing model was developed and applied using FERC Form 1 data for 1995. The model analyzed embedded power supply costs (i.e.; self-generation plus purchased power) for two groups of investor-owned utilities, 49 non-nuclear vs. 63 nuclear. These two subsamples represent substantially the entire US investor-owned electric utility industry. For each utility, embedded cost is estimated both at busbar and at meter

  3. Flexibility and reliability in long-term planning exercises dedicated to the electricity sector

    Energy Technology Data Exchange (ETDEWEB)

    Maizi, Nadia; Drouineau, Mathilde; Assoumou, Edi; Mazauric, Vincent

    2010-09-15

    Long-term planning models are useful to build plausible options for future energy systems and must consequently address the technological feasibility and associated cost of these options. This paper focuses on the electricity sector and on problems of flexibility and reliability in power systems in order to improve results provided by long-term planning exercises: flexibility needs are integrated as an additional criterion for new investment decisions and, reliability requirements are assessed through the level of electrical losses they induced and a related cost. These approaches are implemented in a long-term planning model and demonstrated through a study of the Reunion Island.

  4. Proposal of a molten-salt system for long-term energy production

    International Nuclear Information System (INIS)

    Berthou, V.; Slessarev, I.; Salvatores, M.

    2002-01-01

    Within the framework of nuclear waste management studies, the 'ose-composent' concept is considered to be an attractive option for the long-term perspective. This paper proposes a new system called TASSE ('Thorium-based Accelerator-drives System with Simplified fuel cycle for long-term Energy production') destined for the current French park renewal. The main idea of the TASSE concept is to simplify both the front end and the back end of the fuel cycle. Its major goal is to provide electricity with low waste production and economical competitiveness. (author)

  5. Designing indicators of long-term energy supply security

    International Nuclear Information System (INIS)

    Jansen, J.C.; Van Arkel, W.G.; Boots, M.G.

    2004-01-01

    To our knowledge, so far amazingly little research work has been undertaken to construct meaningful indicators of long-run energy supply security for a particular nation or region. Currently, in addressing energy supply security, policy makers tend to emphasise short-term supply disruptions. In contrast, this pre-study accords with the broader Sustainability Outlook in considering the long-term perspective. This report starts with taking stock, in a concise way, of the official EU energy outlook and issues related to the opportunities to administer changes in the energy mix at the level of major energy use categories. Then a brief survey of relevant literature is made on long-term strategies to ensure survival of systems - be it biological, social, etc. - in an environment largely characterised by high uncertainty and a lot of unchartered territory. We found the work of Andrew Stirling very inspiring in this context. Based on his work and considering the limitations of the present research activity, we retained the Shannon index as the best 'simple' indicator of diversity. In the core of the report, the Shannon index is elaborated into four indicators of long-term energy supply security. Stepwise, additional aspects of long-term energy supply security are introduced. These aspects are: Diversification of energy sources in energy supply; Diversification of imports with respect to imported energy sources; Long-term political stability in regions of origin; The resource base in regions of origin, including the home region/country itself. After small adjustments to allow for data availability, these indicators were applied to the reference year 2030 of four long-term scenarios with data of base year 1995 and projections for underlying variables provided by the Netherlands Environmental Assessment Agency (MNP). Preliminary interpretation of the results suggests the usefulness of the indicators presented in this report. A second activity undertaken in this report was

  6. Emergency planning and long-term care: least paid, least powerful, most responsible.

    Science.gov (United States)

    Covan, Eleanor Krassen; Fugate-Whitlock, Elizabeth

    2010-11-01

    As disasters can occur anywhere, planning to avoid emergencies is an international concern. Our research specifically addresses planning for the needs and safety of a vulnerable population, long-term care residents. Our initial purposes in this evaluation research were to assess the utility of a template to gather emergency management information for individual long-term care communities, to report on how prepared they are to cope with emergencies that have occurred elsewhere in areas like ours, and to assess the effectiveness of employing gerontology students in the planning process. As we began analyzing our data, we realized that it is imperative to consider whether it is possible for long-term care communities to respond effectively to disasters. In our findings we focus on the impact of gender in the planning process, the importance of size with regard to template utility, the positive and negative consequences of student aid, and the fact that gathering plans for individual long-term care communities may have detracted from collaborative community planning.

  7. RECAP, Replacement Energy Cost for Short-Term Reactor Plant Shut-Down

    International Nuclear Information System (INIS)

    VanKuiken, J.C.; Daun, C.J.; Jusko, M.J.

    1995-01-01

    default values for gross national product price deflators unless user-defined cost adjustment factors are entered. 3 - Restrictions on the complexity of the problem: Maximum of 25 case- study files. Care should be exercised in applying the replacement energy cost estimates to shutdowns of a year or more, because in such cases utilities would probably seek more-optimum solutions to the loss of a nuclear unit. Long-term adjustments of this nature are not included in this analysis

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

    Science.gov (United States)

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

    2014-06-01

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

  9. Short-term decisions under long-term uncertainty

    International Nuclear Information System (INIS)

    Tol, R.S.J.

    1998-01-01

    The behaviour of future policy-makers substantially influences future greenhouse gas emissions. Uncertainty about the motives of future policy-makers may thus strongly influence the climate policy strategies of current policy-makers. Analytical and numerical analyses in this paper confirm this hypothesis. If current policy-makers want to constrain emissions accumulated over a prolonged period of time, and if future policy-makers tend, with a certain chance, to a less ambitious climate policy, then current policy-makers should intensify their efforts to reduce emissions and the cost of emission reduction. In this setting, if current policy-makers want to meet a cumulative emission constraint in expectation, then the preferred policy trajectory does not qualitatively deviate from one suggested by a standard cost-effective trajectory. If, however, the constraint is to be met with a certain probability, then the importance of early action is enhanced relative to that of postponed action. Costs substantially increase if current policy-makers want to set long-term goals without the full cooperation of future policy-makers. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  10. Archive of Samples for Long-Term Preservation of RNA and Other Nucleic Acids

    Science.gov (United States)

    2016-05-15

    workflow can be developed for large scale blood collection , transport , and long-term archiving without the use of costly and unreliable cold chain...management, using commercially available biopreservation products. For the development of the automated workflow we have chosen Biomatrica’s commercially...This ambient workflow can be developed for large scale blood collection, transport and long-term nucleic acid archiving without the use of costly

  11. Cost Utility of Omalizumab Compared with Standard of Care for the Treatment of Chronic Spontaneous Urticaria.

    Science.gov (United States)

    Graham, Jonathan; McBride, Doreen; Stull, Donald; Halliday, Anna; Alexopoulos, Stamatia Theodora; Balp, Maria-Magdalena; Griffiths, Matthew; Agirrezabal, Ion; Zuberbier, Torsten; Brennan, Alan

    2016-08-01

    Chronic spontaneous urticaria (CSU) negatively impacts patient quality of life and productivity and is associated with considerable indirect costs to society. The aim of this study was to assess the cost utility of add-on omalizumab treatment compared with standard of care (SOC) in moderate or severe CSU patients with inadequate response to SOC, from the UK societal perspective. A Markov model was developed, consisting of health states based on Urticaria Activity Score over 7 days (UAS7) and additional states for relapse, spontaneous remission and death. Model cycle length was 4 weeks, and total model time horizon was 20 years in the base case. The model considered early discontinuation of non-responders (response: UAS7 ≤6) and retreatment upon relapse (relapse: UAS7 ≥16) for responders. Clinical and cost inputs were derived from omalizumab trials and published sources, and cost utility was expressed as incremental cost-effectiveness ratios (ICERs). Scenario analyses included no early discontinuation of non-responders and an altered definition of response (UAS7 omalizumab was associated with increased costs and benefits relative to SOC. Probabilistic sensitivity analysis supported this result. Productivity inputs were key model drivers, and individual scenarios without early discontinuation of non-responders and adjusted response definitions had little impact on results. ICERs were generally robust to changes in key model parameters and inputs. In this, the first economic evaluation of omalizumab in CSU from a UK societal perspective, omalizumab consistently represented a treatment option with societal benefit for CSU in the UK across a range of scenarios.

  12. The Myth That Insulating Boards Serves Long-Term Value

    OpenAIRE

    Bebchuk, Lucian Arye

    2013-01-01

    According to an influential view in corporate law writings and debates, pressure from shareholders leads companies to take myopic actions that are costly in the long term, and insulating boards from such pressure serves the long-term interests of companies as well as their shareholders. This board insulation claim has been regularly invoked in a wide range of contexts to support existing or tighter limits on shareholder rights and involvement. This paper subjects this view to a comprehensive ...

  13. Pricing in M/M/1 queues when cost of waiting in queue differs from cost of waiting in service

    Directory of Open Access Journals (Sweden)

    Görkem Sarıyer

    2016-11-01

    Full Text Available Service providers can adjust the entrance price to the state of the demand in real life service systems where the customers' decision to receive the service, is based on this price, state of demand and other system parameters. We analyzed service provider's short and long term pricing problems in unobservable M/M/1 queues having the rational customers, where, for customers, the unit cost of waiting in the queue is higher than unit cost of waiting in the service. We showed that waiting in the queue has a clear negative effect on customers’ utilities, hence the service provider's price values. We also showed that, in the short term, monopolistic pricing is optimal for congested systems with high server utilization levels, whereas in the long term, market capturing pricing is more profitable.

  14. Some aspects of hydrogen as a long-term energy carrier

    International Nuclear Information System (INIS)

    Quakernaat, J.; De Jong, K.P.; Van Wechem, H.M.H.; Okken, P.A.; Lako, P.; Ybema, J.R.

    1994-11-01

    Hydrogen as a secondary energy carrier received extensive and worldwide attention some ten to fifteen years ago. The developments in the energy market since then have reduced the interest in hydrogen. However, the increased concern for the environment and new technical options have brought hydrogen to the centre of attention once again. These considerations led to the organization of the National Hydrogen Seminar, held on 19 November 1993 at ECN, Petten, Netherlands. Eight experts in the field of hydrogen illustrated the possibilities and prospects of the production, storage and use of hydrogen as an energy carrier. In this report three of these contributions are presented, for which separate abstracts have been prepared. The first paper is on hydrogen in a global long-term perspective, in the second paper carbon is considered as a hydrogen carrier or as a disappearing skeleton, and in the third paper attention is paid to the cost effective integration of hydrogen in energy systems with CO 2 constraints

  15. Wind power planning: assessing long-term costs and benefits

    International Nuclear Information System (INIS)

    Kennedy, Scott

    2005-01-01

    In the following paper, a new and straightforward technique for estimating the social benefit of large-scale wind power production is presented. The social benefit is based upon wind power's energy and capacity services and the avoidance of environmental damages. The approach uses probabilistic load duration curves to account for the stochastic interaction between wind power availability, electricity demand, and conventional generator dispatch. The model is applied to potential offshore wind power development to the south of Long Island, NY. If natural gas combined cycle and integrated gasifier combined cycle (IGCC) are the alternative generation sources, wind power exhibits a negative social benefit due to its high capacity cost and the relatively low emissions of these advanced fossil-fuel technologies. Environmental benefits increase significantly if charges for CO 2 emissions are included. Results also reveal a diminishing social benefit as wind power penetration increases. The dependence of wind power benefits on CO 2 charges, and capital costs for wind turbines and IGCC plant is also discussed. The methodology is intended for use by energy planners in assessing the social benefit of future investments in wind power

  16. SHORT-TERM AND LONG-TERM WATER LEVEL PREDICTION AT ONE RIVER MEASUREMENT LOCATION

    Directory of Open Access Journals (Sweden)

    Rudolf Scitovski

    2012-12-01

    Full Text Available Global hydrological cycles mainly depend on climate changes whose occurrence is predominantly triggered by solar and terrestrial influence, and the knowledge of the high water regime is widely applied in hydrology. Regular monitoring and studying of river water level behavior is important from several perspectives. On the basis of the given data, by using modifications of general approaches known from literature, especially from investigation in hydrology, the problem of long- and short-term water level forecast at one river measurement location is considered in the paper. Long-term forecasting is considered as the problem of investigating the periodicity of water level behavior by using linear-trigonometric regression and short-term forecasting is based on the modification of the nearest neighbor method. The proposed methods are tested on data referring to the Drava River level by Donji Miholjac, Croatia, in the period between the beginning of 1900 and the end of 2012.

  17. Industry perspective on digital upgrades: A utility perspective on digital upgrades

    International Nuclear Information System (INIS)

    Blauw, R.J.

    1994-01-01

    Nuclear utilities face the need to upgrade aging and obsolete safety related and other critical equipment. This is the result of operation and maintenance concerns for reliability and maintainability. Digital technology is an option for these upgrades. A number of utilities have attempted exercising the digital option. The regulatory licensing results have been inconsistent and have raised a variety of issues. These issues and the subsequent licensing uncertainties have caused some utilities to temporarily drop digital technology as an upgrade option. Resolution of these issues and the need for regulatory stability is driving the development of industry standards and guidelines. These will provide guidance to support consistent design and implementation of digital upgrades. Successful completion of these documents is necessary for renewed consideration of the use of digital technology. This paper will present a utility perspective on how project management, configuration control, and a rigorous design process can serve to address the present regulatory issues. These issues include commercial grade dedication, reliability, electromagnetic interference, and failure and error management. This perspective is consistent with the standards and guidelines development effort

  18. Long-Term Perspectives of Family Quality of Life Following Music Therapy With Young Children on the Autism Spectrum: A Phenomenological Study.

    Science.gov (United States)

    Thompson, Grace A

    2018-01-13

    Parents of children on the autism spectrum have consistently reported feeling uncertain in their parenting role, and desire more practical advice from service providers about how to support their child in the home. There is growing recognition of the need for interventions to provide support to the family as well as fostering child development outcomes. This study explores mothers' follow-up perspectives of family-centered music therapy (FCMT) four years after participating in a 16-week home-based program, and therefore provides a unique long-term viewpoint on FCMT outcomes. Eight mothers who previously participated in FCMT sessions with their young children on the autism spectrum were interviewed to explore their perception of any long-term outcomes. A descriptive phenomenological analysis revealed five global themes, including: improvement in mothers' confidence to engage their child; rare opportunities for mutual mother-child enjoyment; improved child social communication and quality of life; mothers' new understanding of the child's interests and strengths; and more opportunities for continuing the child's interest in music. Mothers perceived long-term benefits to social relationships within the family, leading to perceived enrichment in child and family quality of life following music therapy sessions. © American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  19. Cost-Benefit Analyses of Transportation Investments

    DEFF Research Database (Denmark)

    Næss, Petter

    2006-01-01

    This paper discusses the practice of cost-benefit analyses of transportation infrastructure investment projects from the meta-theoretical perspective of critical realism. Such analyses are based on a number of untenable ontological assumptions about social value, human nature and the natural......-to-pay investigations. Accepting the ontological and epistemological assumptions of cost-benefit analysis involves an implicit acceptance of the ethical and political values favoured by these assumptions. Cost-benefit analyses of transportation investment projects tend to neglect long-term environmental consequences...

  20. 18 CFR 42.1 - Requirement that Transmission Organizations with Organized Electricity Markets Offer Long-Term...

    Science.gov (United States)

    2010-04-01

    ... prevailing cost allocation methods for upgrades or expansions. (4) Long-term firm transmission rights must be... other direct assignment of congestion costs for the period covered and quantity specified. Once... must have priority over non-load serving entities in the allocation of long-term firm transmission...

  1. The clinical utility of long-term humidification therapy in chronic airway disease.

    Science.gov (United States)

    Rea, Harold; McAuley, Sue; Jayaram, Lata; Garrett, Jeffrey; Hockey, Hans; Storey, Louanne; O'Donnell, Glenis; Haru, Lynne; Payton, Matthew; O'Donnell, Kevin

    2010-04-01

    Persistent airway inflammation with mucus retention in patients with chronic airway disorders such as COPD and bronchiectasis may lead to frequent exacerbations, reduced lung function and poor quality of life. This study investigates if long-term humidification therapy with high flow fully humidified air at 37 degrees C through nasal cannulae can improve these clinical outcomes in this group of patients. 108 patients diagnosed with COPD or bronchiectasis were randomised to daily humidification therapy or usual care for 12 months over which exacerbations were recorded. Lung function, quality of life, exercise capacity, and measures of airway inflammation were also recorded at baseline, 3 and 12 months. Patients on long-term humidification therapy had significantly fewer exacerbation days (18.2 versus 33.5 days; p = 0.045), increased time to first exacerbation (median 52 versus 27 days; p = 0.0495) and reduced exacerbation frequency (2.97/patient/year versus 3.63/patient/year; p = 0.067) compared with usual care. Quality of life scores and lung function improved significantly with humidification therapy compared with usual care at 3 and 12 months. Long-term humidification therapy significantly reduced exacerbation days, increased time to first exacerbation, improved lung function and quality of life in patients with COPD and bronchiectasis. Clinical trial registered with www.actr.org.au; Number ACTRN2605000623695. Copyright 2010 Elsevier Ltd. All rights reserved.

  2. Laboratory cost and utilization containment.

    Science.gov (United States)

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

    1991-01-01

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

  3. Cost-effectiveness of a long-term Internet-delivered worksite health promotion programme on physical activity and nutrition: A cluster randomized controlled trial

    NARCIS (Netherlands)

    S.J.W. Robroek (Suzan); S. Polinder (Suzanne); F.J. Bredt (Folef); A. Burdorf (Alex)

    2012-01-01

    textabstractThis study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the

  4. BALANCE OF SUPPLY AND DEMAND OF THE CEREAL AND INFLUENCING FACTORS IN CHINA: FROM THE PERSPECTIVE OF THE COST

    Directory of Open Access Journals (Sweden)

    Bingqiang Li

    2017-09-01

    Full Text Available The balanced supply and demand of the cereal is essential for achieving economic sustainable development in China. The wheat and products, the rice (including the milled equivalent, and the maize and products are three main cereals in China, the three cereals but the rice (including the milled equivalent in China were enerally seriously comparatively insufficient before 1997, and then became fully sufficient. The co-integrative test demonstrated that there existed long-term equilibrium between balance of supply and demand and influencing factors, and the correcting coefficient was about 2.2 percent. As for balance degree of supply and demand, increase of machinery cost, daily-average labor price and indirect cost would improve it, increase of fertilizer expenditure and labor-input quantity would deteriorate it at short-term. The Granger causality test implied that balance of supply and demand owned interactive effect with laborer-input quantity, but not with the other cost. The highlight of this article was evaluating hypothesis of “Who will feed China” and influencing factors from perspective of the cost, achieving that the above hypothesis was not a real problem in China.

  5. Variable Renewable Energy in Long-Term Planning Models: A Multi-Model Perspective

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Wesley [National Renewable Energy Lab. (NREL), Golden, CO (United States); Frew, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Mai, Trieu [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sun, Yinong [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bistline, John [Electric Power Research Inst. (EPRI), Knoxville, TN (United States); Blanford, Geoffrey [Electric Power Research Inst. (EPRI), Knoxville, TN (United States); Young, David [Electric Power Research Inst. (EPRI), Knoxville, TN (United States); Marcy, Cara [U.S. Energy Information Administration, Washington, DC (United States); Namovicz, Chris [U.S. Energy Information Administration, Washington, DC (United States); Edelman, Risa [US Environmental Protection Agency (EPA), Washington, DC (United States); Meroney, Bill [US Environmental Protection Agency (EPA), Washington, DC (United States); Sims, Ryan [US Environmental Protection Agency (EPA), Washington, DC (United States); Stenhouse, Jeb [US Environmental Protection Agency (EPA), Washington, DC (United States); Donohoo-Vallett, Paul [Dept. of Energy (DOE), Washington DC (United States)

    2017-11-01

    Long-term capacity expansion models of the U.S. electricity sector have long been used to inform electric sector stakeholders and decision-makers. With the recent surge in variable renewable energy (VRE) generators — primarily wind and solar photovoltaics — the need to appropriately represent VRE generators in these long-term models has increased. VRE generators are especially difficult to represent for a variety of reasons, including their variability, uncertainty, and spatial diversity. This report summarizes the analyses and model experiments that were conducted as part of two workshops on modeling VRE for national-scale capacity expansion models. It discusses the various methods for treating VRE among four modeling teams from the Electric Power Research Institute (EPRI), the U.S. Energy Information Administration (EIA), the U.S. Environmental Protection Agency (EPA), and the National Renewable Energy Laboratory (NREL). The report reviews the findings from the two workshops and emphasizes the areas where there is still need for additional research and development on analysis tools to incorporate VRE into long-term planning and decision-making. This research is intended to inform the energy modeling community on the modeling of variable renewable resources, and is not intended to advocate for or against any particular energy technologies, resources, or policies.

  6. Comparison of costs and outcomes of dapagliflozin with other glucose-lowering therapy classes added to metformin using a short-term cost-effectiveness model in the US setting.

    Science.gov (United States)

    Chakravarty, Abhiroop; Rastogi, Mohini; Dhankhar, Praveen; Bell, Kelly F

    2018-05-01

    To compare 1-year costs and benefits of dapagliflozin (DAPA), a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, with those of other treatments for type 2 diabetes (T2D), such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), sulfonylureas (SUs), thiazolidinediones (TZDs), and dipeptidyl peptidase-4 inhibitors (DPP-4i), all combined with metformin. A short-term decision-analytic model with a 1-year time horizon was developed from a payer's perspective in the United States setting. Costs and benefits associated with four clinical end-points (glycated hemoglobin [A1C], body weight, systolic blood pressure [SBP], and risk of hypoglycemia) were evaluated in the analysis. The impact of DAPA and other glucose-lowering therapy classes on these clinical end-points was estimated from a network meta-analysis (NMA). Data for costs and quality-adjusted life-years (QALYs) associated with a per-unit change in these clinical end-points were taken from published literature. Drug prices were taken from an annual wholesale price list. All costs were inflation-adjusted to December 2016 costs using the medical care component of the consumer price index. Total costs (both medical and drug costs), total QALYs, and incremental cost-effectiveness ratios (ICERs) were estimated. Sensitivity analyses (SA) were performed to explore uncertainty in the inputs. To assess face validity, results from the short-term model were compared with long-term models published for these drugs. The total annual medical cost for DAPA was less than that for GLP-1RA ($186 less), DPP-4i ($1,142 less), SU ($2,474 less), and TZD ($1,640 less). Treatment with DAPA resulted in an average QALY gain of 0.0107, 0.0587, 0.1137, and 0.0715 per treated patient when compared with GLP-1RA, DPP-4i, SU, and TZD, respectively. ICERs for DAPA vs SU and TZD were $19,005 and $25,835, respectively. DAPA was a cost-saving option when compared with GLP-1RAs and DPP-4is. Among all four clinical end-points, change in weight

  7. Long-term follow up of revascularization using platelet-rich fibrin.

    Science.gov (United States)

    Ray, Herbert L; Marcelino, Janel; Braga, Raquel; Horwat, Richard; Lisien, Michael; Khaliq, Shahryar

    2016-02-01

    Trauma is one of the primary causes of tooth loss and pulpal injury in adolescents and children. Prior to regenerative endodontics, treatment of necrotic, immature teeth with open apices was limited to long-term calcium hydroxide (Ca(OH)2 ) apexification and subsequent root canal therapy or extraction. Through revascularization, retention of these teeth can be achieved and the elimination of patient symptoms and the radiographic appearance of continued root development were obtained. This report illustrates a revascularization protocol through a case where platelet-rich fibrin (PRF) was utilized as an autologous scaffold for traumatized, necrotic, immature teeth with incomplete root development. Through consistent follow-up reports, comprising of both clinical examination and radiographs, marked improvement in the condition of the traumatized tooth was noted. This case demonstrates the feasibility of utilizing PRF as an effective treatment protocol for traumatized teeth in lieu of traditional treatment protocols, such as long-term calcium hydroxide (Ca(OH)2 ) apexification or extraction. The choice of utilizing PRF, as opposed to other platelet concentrates, such as platelet-rich plasma (PRP) or a blood clot, lies in PRF's ability to allow for a slow, long-term release of autologous growth factors. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Parametric Analysis of PWR Spent Fuel Depletion Parameters for Long-Term-Disposal Criticality Safety

    International Nuclear Information System (INIS)

    DeHart, M.D.

    1999-01-01

    Utilization of burnup credit in criticality safety analysis for long-term disposal of spent nuclear fuel allows improved design efficiency and reduced cost due to the large mass of fissile material that will be present in the repository. Burnup-credit calculations are based on depletion calculations that provide a conservative estimate of spent fuel contents (in terms of criticality potential), followed by criticality calculations to assess the value of the effective neutron multiplication factor (k(sub)eff) for the a spent fuel cask or a fuel configuration under a variety of probabilistically derived events. In order to ensure that the depletion calculation is conservative, it is necessary to both qualify and quantify assumptions that can be made in depletion models

  9. The coevolution of long-term pair bonds and cooperation.

    Science.gov (United States)

    Song, Z; Feldman, M W

    2013-05-01

    The evolution of social traits may not only depend on but also change the social structure of the population. In particular, the evolution of pairwise cooperation, such as biparental care, depends on the pair-matching distribution of the population, and the latter often emerges as a collective outcome of individual pair-bonding traits, which are also under selection. Here, we develop an analytical model and individual-based simulations to study the coevolution of long-term pair bonds and cooperation in parental care, where partners play a Snowdrift game in each breeding season. We illustrate that long-term pair bonds may coevolve with cooperation when bonding cost is below a threshold. As long-term pair bonds lead to assortative interactions through pair-matching dynamics, they may promote the prevalence of cooperation. In addition to the pay-off matrix of a single game, the evolutionarily stable equilibrium also depends on bonding cost and accidental divorce rate, and it is determined by a form of balancing selection because the benefit from pair-bond maintenance diminishes as the frequency of cooperators increases. Our findings highlight the importance of ecological factors affecting social bonding cost and stability in understanding the coevolution of social behaviour and social structures, which may lead to the diversity of biological social systems. © 2013 The Authors. Journal of Evolutionary Biology © 2013 European Society For Evolutionary Biology.

  10. Tapering off benzodiazepines in long-term users : an economic evaluation

    NARCIS (Netherlands)

    Oude Voshaar, Richard C; Krabbe, Paul F M; Gorgels, Wim J M J; Adang, Eddy M M; van Balkom, Anton J L M; van de Lisdonk, Eloy H; Zitman, Frans G

    2006-01-01

    BACKGROUND: Discontinuation of benzodiazepine usage has never been evaluated in economic terms. This study aimed to compare the relative costs and outcomes of tapering off long-term benzodiazepine use combined with group cognitive behavioural therapy (TO+CBT), tapering off alone (TOA) and usual

  11. Long vs. short-term energy storage:sensitivity analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Schoenung, Susan M. (Longitude 122 West, Inc., Menlo Park, CA); Hassenzahl, William V. (,Advanced Energy Analysis, Piedmont, CA)

    2007-07-01

    This report extends earlier work to characterize long-duration and short-duration energy storage technologies, primarily on the basis of life-cycle cost, and to investigate sensitivities to various input assumptions. Another technology--asymmetric lead-carbon capacitors--has also been added. Energy storage technologies are examined for three application categories--bulk energy storage, distributed generation, and power quality--with significant variations in discharge time and storage capacity. Sensitivity analyses include cost of electricity and natural gas, and system life, which impacts replacement costs and capital carrying charges. Results are presented in terms of annual cost, $/kW-yr. A major variable affecting system cost is hours of storage available for discharge.

  12. Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain

    Directory of Open Access Journals (Sweden)

    E. Molina-Cuadrado

    2014-07-01

    Full Text Available Objective: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. Methods: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of lifeadjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental costeffectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macro-costs strategy based on published literature and the survival tables for the Spanish population. Results: Treatment with Ticagrelor was associated to an incremental cost of 1,228 per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 and the cost per one gained life year of 7,435 . The sensitivity analysis showed consistent results. Conclusions: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain.

  13. Utilization of Plutonium and Higher Actinides in the HTGR as Possibility to Maintain Long-Term Operation on One Fuel Loading

    International Nuclear Information System (INIS)

    Tsvetkova, Galina V.; Peddicord, Kenneth L.

    2002-01-01

    Promising existing nuclear reactor concepts together with new ideas are being discussed worldwide. Many new studies are underway in order to identify prototypes that will be analyzed and developed further as systems for Generation IV. The focus is on designs demonstrating full inherent safety, competitive economics and proliferation resistance. The work discussed here is centered on a modularized small-size High Temperature Gas-cooled Reactor (HTGR) concept. This paper discusses the possibility of maintaining long-term operation on one fuel loading through utilization of plutonium and higher actinides in the small-size pebble-bed reactor (PBR). Acknowledging the well-known flexibility of the PBR design with respect to fuel composition, the principal limitations of the long-term burning of plutonium and higher actinides are considered. The technological challenges and further research are outlined. The results allow the identification of physical features of the PBR that significantly influence flexibility of the design and its applications. (authors)

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

    Science.gov (United States)

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

    2013-02-01

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

  15. An overview of Ontario's 2013 long term energy plan

    International Nuclear Information System (INIS)

    Jobe, C.

    2014-01-01

    Ontario's 2013 Long Term Energy /Plan (LTEP) takes a pragmatic approach. The plan is designed to balance the following five principles namely: Cost effectiveness, Reliability, Clean energy, Community engagement, and Emphasis on conservation and demand management before building new generation. By taking a pragmatic and flexible approach and balancing these principles, Ontario's 2013 Long Term Energy Plan builds on the foundation laid by the 2010 LTEP while also lowering the projected total system costs. The key elements of the 2013 LTEP are described in this paper by highlighting the major features of these elements. (author)

  16. Memory Reactivation Enables Long-Term Prevention of Interference.

    Science.gov (United States)

    Herszage, Jasmine; Censor, Nitzan

    2017-05-22

    The ability of the human brain to successively learn or perform two competing tasks constitutes a major challenge in daily function. Indeed, exposing the brain to two different competing memories within a short temporal offset can induce interference, resulting in deteriorated performance in at least one of the learned memories [1-4]. Although previous studies have investigated online interference and its effects on performance [5-13], whether the human brain can enable long-term prevention of future interference is unknown. To address this question, we utilized the memory reactivation-reconsolidation framework [2, 12] stemming from studies at the synaptic level [14-17], according to which reactivation of a memory enables its update. In a set of experiments, using the motor sequence learning task [18] we report that a unique pairing of reactivating the original memory (right hand) in synchrony with novel memory trials (left hand) prevented future interference between the two memories. Strikingly, these effects were long-term and observed a month following reactivation. Further experiments showed that preventing future interference was not due to practice per se, but rather specifically depended on a limited time window induced by reactivation of the original memory. These results suggest a mechanism according to which memory reactivation enables long-term prevention of interference, possibly by creating an updated memory trace integrating original and novel memories during the reconsolidation time window. The opportunity to induce a long-term preventive effect on memories may enable the utilization of strategies optimizing normal human learning, as well as recovery following neurological insults. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Workplace health promotion and utilization of health services: follow-up data findings.

    Science.gov (United States)

    Deitz, Diane; Cook, Royer; Hersch, Rebekah

    2005-01-01

    This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.

  18. Innovative Strategy For Long Term Monitoring Of Metal And Radionuclide Plumes

    International Nuclear Information System (INIS)

    Eddy-Dilek, Carol; Millings, Margaret R.; Looney, Brian B.; Denham, Miles E.

    2014-01-01

    Many government and private industry sites that were once contaminated with radioactive and chemical wastes cannot be cleaned up enough to permit unrestricted human access. The sites will require long term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality at these 'legacy' sites. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site, the larger DOE complex, and many large federal and private sites. There is a need to optimize the performance and manage the cost of long term surveillance and monitoring at their sites. Currently, SRNL is initiating a pilot field test using alternative protocols for long term monitoring of metals and radionuclides. A key component of the approach is that monitoring efforts are focused on measurement of low cost metrics related to hydrologic and chemical conditions that control contaminant migration. The strategy combines careful monitoring of hydrologic boundary conditions with measurement of master variables such as chemical surrogates along with a smaller number of standard well analyses. In plumes contaminated with metals, master variables control the chemistry of the groundwater system, and include redox variables (ORP, DO, chemicals), pH, specific conductivity, biological community (breakdown/decay products), and temperature. Significant changes in these variables will result in conditions whereby the plume may not be stable and therefore can be used to predict possible plume migration. Conversely, concentration measurements for all types of contaminants in groundwater are a lagging indicator plume movement - major changes contaminant concentrations indicate that contamination has migrated. An approach based on measurement of master variables and explicit monitoring of hydrologic boundary conditions combined with traditional metrics should lead

  19. Innovative Strategy For Long Term Monitoring Of Metal And Radionuclide Plumes

    Energy Technology Data Exchange (ETDEWEB)

    Eddy-Dilek, Carol; Millings, Margaret R.; Looney, Brian B.; Denham, Miles E.

    2014-01-08

    Many government and private industry sites that were once contaminated with radioactive and chemical wastes cannot be cleaned up enough to permit unrestricted human access. The sites will require long term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality at these "legacy" sites. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site, the larger DOE complex, and many large federal and private sites. There is a need to optimize the performance and manage the cost of long term surveillance and monitoring at their sites. Currently, SRNL is initiating a pilot field test using alternative protocols for long term monitoring of metals and radionuclides. A key component of the approach is that monitoring efforts are focused on measurement of low cost metrics related to hydrologic and chemical conditions that control contaminant migration. The strategy combines careful monitoring of hydrologic boundary conditions with measurement of master variables such as chemical surrogates along with a smaller number of standard well analyses. In plumes contaminated with metals, master variables control the chemistry of the groundwater system, and include redox variables (ORP, DO, chemicals), pH, specific conductivity, biological community (breakdown/decay products), and temperature. Significant changes in these variables will result in conditions whereby the plume may not be stable and therefore can be used to predict possible plume migration. Conversely, concentration measurements for all types of contaminants in groundwater are a lagging indicator plume movement - major changes contaminant concentrations indicate that contamination has migrated. An approach based on measurement of master variables and explicit monitoring of hydrologic boundary conditions combined with traditional metrics should lead

  20. Perspectives on the future of the electric utility industry

    International Nuclear Information System (INIS)

    Tonn, B.; Schaffhauser, A.

    1994-04-01

    This report offers perspectives on the future of the electric utility industry. These perspectives will be used in further research to assess the prospects for Integrated Resource Planning (IRP). The perspectives are developed first by examining economic, political and regulatory, societal, technological, and environmental trends that are (1) national and global in scope and (2) directly related to the electric utility industry. Major national and global trends include increasing global economic competition, increasing political and ethnic strife, rapidly changing technologies, and increasing worldwide concern about the environment. Major trends in the utility industry include increasing competition in generation; changing patterns of electricity demand; increasing use of information technology to control power systems; and increasing implementation of environmental controls. Ways in which the national and global trends may directly affect the utility industry are also explored. The trends are used to construct three global and national scenarios- ''business as usual,'' ''technotopia future,'' and ''fortress state'' -and three electric utility scenarios- ''frozen in headlights,'' ''megaelectric,'' and ''discomania.'' The scenarios are designed to be thought provoking descriptions of potential futures, not predictions of the future, although three key variables are identified that will have significant impacts on which future evolves-global climate change, utility technologies, and competition. While emphasis needs to be placed on understanding the electric utility scenarios, the interactions between the two sets of scenarios is also of interest

  1. Perspectives on the future of the electric utility industry

    Energy Technology Data Exchange (ETDEWEB)

    Tonn, B. [Oak Ridge National Lab., TN (United States); Schaffhauser, A. [Tennessee Univ., Knoxville, TN (United States)

    1994-04-01

    This report offers perspectives on the future of the electric utility industry. These perspectives will be used in further research to assess the prospects for Integrated Resource Planning (IRP). The perspectives are developed first by examining economic, political and regulatory, societal, technological, and environmental trends that are (1) national and global in scope and (2) directly related to the electric utility industry. Major national and global trends include increasing global economic competition, increasing political and ethnic strife, rapidly changing technologies, and increasing worldwide concern about the environment. Major trends in the utility industry include increasing competition in generation; changing patterns of electricity demand; increasing use of information technology to control power systems; and increasing implementation of environmental controls. Ways in which the national and global trends may directly affect the utility industry are also explored. The trends are used to construct three global and national scenarios- ``business as usual,`` ``technotopia future,`` and ``fortress state`` -and three electric utility scenarios- ``frozen in headlights,`` ``megaelectric,`` and ``discomania.`` The scenarios are designed to be thought provoking descriptions of potential futures, not predictions of the future, although three key variables are identified that will have significant impacts on which future evolves-global climate change, utility technologies, and competition. While emphasis needs to be placed on understanding the electric utility scenarios, the interactions between the two sets of scenarios is also of interest.

  2. Fusion energy in context: its fitness for the long term

    International Nuclear Information System (INIS)

    Holdren, J.P.

    1978-01-01

    Long-term limits to growth in energy will be imposed not by inability to expand supply, but by the rising environmental and social costs of doing so. These costs will therefore be cental issues in choosing long-term options. Fusion, like solar energy, is not one possibility but many, some with very attractive environmental characteristics and others perhaps little better in these regards than fission. None of the fusion options will be cheap, and none is likely to be widely available before the year 2010. The most attractive forms of fusion may require greater investments of time and money to achieve, but they are the real reason for wanting fusion at all

  3. Perspectives of the use of experience of preparation of reserve in cyclic disciplines in the system of the long-term training in team games

    Directory of Open Access Journals (Sweden)

    Maksimenko I.G.

    2012-06-01

    Full Text Available Purpose of work to define approaches to the construction of long-term preparation of reserve in cyclic disciplines. Also to ground perspective directions of their use in a training process in the playing types of sport. Questioning, conversations and questionnaires of leading specialists (17 trainers and sportsmen is conducted (80 athletes. It is marked that one of lacks of the traditional system of preparation of sportsmen is the insufficient providing of training process information technologies. It is set that in the cyclic types of sport the sharp is enough there is a problem of planning of loadings in macrocycle of training of young sportsmen. It is rotined that to the features of construction of training process in cyclic kinds it is necessary to take application of individual approach. The possible ways of decision of problem of optimization of long-term training of reserve are presented in sporting games. Attention is accented on the necessity of realization in practice of theoretical positions which are related to all of the stages of the long-term training.

  4. Public Perspectives Toward the Sexual Behavior of an Individual With Dementia Residing in Long-Term Care.

    Science.gov (United States)

    Yelland, Erin L; Cless, Adam W; Mallory, Allen B; Cless, Jessica D

    2018-06-01

    This study examines public perspectives toward sexual behavior within a heterosexually married couple in which one individual has dementia and resides in a long-term care facility. Respondents included 318 adults in the Southern United States. Paired sample t tests were used to understand how the diagnosis of dementia statistically influenced participants' responses, and a logistic regression model was used to understand how a vignette character's sex and respondent characteristics influenced attitudes. Fifty-eight percent of respondents believed that a sexual relationship should be permitted for an adult with dementia, and t tests revealed that dementia had a statistical effect on participants' responses. Sex of the vignette character was not a predictor of attitudes. Participant's qualitative rationales are offered for additional insight. Respondents who felt that a couple should not engage in a sexual relationship commonly cited consent-related issues as their primary concern. Implications for policy development are discussed.

  5. Vulnerable long-term psychiatric in- patients need screening for ...

    African Journals Online (AJOL)

    as prominent medical issues in long-term care and provide guidelines for their ..... described in the literature.7,28 These patients might benefit from a renewed emphasis on ..... costs associated with marijuana comorbidity. Drug & Alcohol.

  6. Long-Term Resource Adequacy, Long-Term Flexibility Requirements, and Revenue Sufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Milligan, Michael [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Bloom, Aaron P [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Townsend, Aaron [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Ela, Erik [Electric Power Research Institute; Botterud, Audun [Argonne National Laboratory; Levin, Todd [Argonne National Laboratory

    2018-02-15

    Variable generation (VG) can reduce market prices over time and also the energy that other suppliers can sell in the market. The suppliers that are needed to provide capacity and flexibility to meet the long-term reliability requirements may, therefore, earn less revenue. This chapter discusses the topics of resource adequacy and revenue sufficiency - that is, determining and acquiring the quantity of capacity that will be needed at some future date and ensuring that those suppliers that offer the capacity receive sufficient revenue to recover their costs. The focus is on the investment time horizon and the installation of sufficient generation capability. First, the chapter discusses resource adequacy, including newer methods of determining adequacy metrics. The chapter then focuses on revenue sufficiency and how suppliers have sufficient opportunity to recover their total costs. The chapter closes with a description of the mechanisms traditionally adopted by electricity markets to mitigate the issues of resource adequacy and revenue sufficiency and discusses the most recent market design changes to address these issues.

  7. Long-term development of nuclear maintenance service provider in Slovenia

    International Nuclear Information System (INIS)

    Androjna, A.; Racic, Z.; Balazic, D.

    2004-01-01

    In recent years, most utilities have been facing a challenge of optimizing maintenance costs, while maintaining or improving equipment reliability. As the equipment ages and maintenance skills within the plant staff may decline due to a generation exchange, the challenge becomes even stronger. Consequently, many plants are looking for possible solutions through partnering with maintenance service providers. The fact that there is only one nuclear power plant in Slovenia hinders the development of local maintenance contractors to some extent. Additionally, they have to face everincreasing technical and organizational requirements while a longer fuel cycle and shorter outage durations result in a narrower annual scope of outage activities. In such circumstances, it may be very difficult for local maintenance service providers to retain and improve skills and qualifications in the long run. Even more so, since they also face the need to rejuvenate their staff and the interest of subcontractors to participate diminishes. The paper presents a case on long-term development issues as experienced by NUMIP, the leading Slovenian nuclear maintenance service provider. Above all, we would like to contribute to a better understanding of efficient local maintenance support. NUMIP's future strategic options are explored in light of possible partnering relationship with the nuclear power plant, based on trust, win-win attitude and continuous improvement. Long-term benefits of the proposed partnering are indicated for both parties, the nuclear power plant and the local maintenance service provider. (author)

  8. Strategic alliance: adapting to the business environment in long-term care.

    Science.gov (United States)

    Mara, Cynthia Massie; Ziegenfuss, James T

    2002-01-01

    This article is addressed to long-term-care administrators and planners as well as purchasers of long-term care. Believing the current and future business environment will force continued adaptation in long-term-care organizations, the authors utilize nine categories to map pressures for change: cultural, technological, educational, political, legal, natural resource, demographic, sociologic, and economic. Long-term-care organizations, especially those that are not-for-profit, are becoming members of alliances as one way of addressing these pressures. This article describes and presents a case example of a composite alliance to demonstrate the advantages of membership in a strategic alliance. We also present examples of ways in which alliance members use strategic partnerships to improve their ability to manage these forces.

  9. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.

    Science.gov (United States)

    Naunheim, Matthew R; Song, Phillip C; Franco, Ramon A; Alkire, Blake C; Shrime, Mark G

    2017-03-01

    Endoscopic management of bilateral vocal fold paralysis (BVFP) includes cordotomy and arytenoidectomy, and has become a well-accepted alternative to tracheostomy. However, the costs and quality-of-life benefits of endoscopic management have not been examined with formal economic analysis. This study undertakes a cost-effectiveness analysis of tracheostomy versus endoscopic management of BVFP. Cost-effectiveness analysis. A literature review identified a range of costs and outcomes associated with surgical options for BVFP. Additional costs were derived from Medicare reimbursement data; all were adjusted to 2014 dollars. Cost-effectiveness analysis evaluated both therapeutic strategies in short-term and long-term scenarios. Probabilistic sensitivity analysis was used to assess confidence levels regarding the economic evaluation. The incremental cost effectiveness ratio for endoscopic management versus tracheostomy is $31,600.06 per quality-adjusted life year (QALY), indicating that endoscopic management is the cost-effective short-term strategy at a willingness-to-pay (WTP) threshold of $50,000/QALY. The probability that endoscopic management is more cost-effective than tracheostomy at this WTP is 65.1%. Threshold analysis demonstrated that the model is sensitive to both utilities and cost in the short-term scenario. When costs of long-term care are included, tracheostomy is dominated by endoscopic management, indicating the cost-effectiveness of endoscopic management at any WTP. Endoscopic management of BVFP appears to be more cost-effective than tracheostomy. Though endoscopic cordotomy and arytenoidectomy require expertise and specialized equipment, this model demonstrates utility gains and long-term cost advantages to an endoscopic strategy. These findings are limited by the relative paucity of robust utility data and emphasize the need for further economic analysis in otolaryngology. NA Laryngoscope, 127:691-697, 2017. © 2016 The American Laryngological

  10. Benefit/cost comparisons for utility SMES applications

    International Nuclear Information System (INIS)

    De Steese, J.G.; Dagle, J.E.

    1991-01-01

    This paper summarizes eight cases studies that account for the benefits and costs of superconducting magnetic energy storage (SMES) in system-specific utility applications. Four of these scenarios are hypothetical SMES application in the Pacific Northwest, where relatively low energy costs impose a stringent test on the viability of the concept. The other four scenarios address SMES applications on high-voltage, direct-current (HVDC) transmission lines. While estimated SMES benefits are based on a previously reported methodology, this paper presents results of an improved cost-estimating approach that includes an assumed reduction in the cost of the power conditioning system (PCS) from approximately $160/kW to $80/kW. The revised approach results in all the SMES scenarios showing higher benefit/cost ratios that those reported earlier. However, in all but two cases, the value of any single benefit is still less than the unit's levelized cost. This suggests, as a general principle, that the total value of multiple benefits should always be considered if SMES is to appear cost effective in may utility applications. These results should offer utilities further encouragement to conduct more detailed analyses of SMES benefits in scenarios that apply to individual systems

  11. Benefit/cost comparison for utility SMES applications

    Science.gov (United States)

    Desteese, J. G.; Dagle, J. E.

    1991-08-01

    This paper summarizes eight case studies that account for the benefits and costs of superconducting magnetic energy storage (SMES) in system-specific utility applications. Four of these scenarios are hypothetical SMES applications in the Pacific Northwest, where relatively low energy costs impose a stringent test on the viability of the concept. The other four scenarios address SMES applications on high-voltage, direct-current (HVDC) transmission lines. While estimated SMES benefits are based on a previously reported methodology, this paper presents results of an improved cost-estimating approach that includes an assumed reduction in the cost of the power conditioning system (PCS) from approximately $160/kW to $80/kW. The revised approach results in all the SMES scenarios showing higher benefit/cost ratios than those reported earlier. However, in all but two cases, the value of any single benefit is still less than the unit's levelized cost. This suggests, as a general principle, that the total value of multiple benefits should always be considered if SMES is to appear cost effective in many utility applications. These results should offer utilities further encouragement to conduct more detailed analyses of SMES benefits in scenarios that apply to individual systems.

  12. How many years should I be married: Long-term power contracts in the electric utility industry in Texas

    Science.gov (United States)

    Levy Ferre, Alberto

    1998-12-01

    This dissertation deals with the effects of long-term power contracts in the electric utility in Texas on consumer welfare, investigating economic and legal aspects of price formation. The study focuses on the institutions---vertical integration and contractual arrangements---that govern the transactions between the different links in the electricity provision chain and its effects on retail electricity prices for residential, commercial and industrial customers. The main hypothesis is that long-term power contracts serve as an uncertainty reduction mechanism to the buyer by clearly defining the conditions of the exchange for a significant period of time. In turn, this reduction of uncertainty is compensated by a premium to the seller in the form of higher prices. It is found that long-term wholesale power contracts present varying levels of flexibility in the terms of the exchange that are directly translated into prices and bills, providing support to the main hypothesis. Control variables include the role of new technologies, degree of competition and population demographics. Each control variable has differing impacts of different customer classes, depending on their demand elasticity. The study poses several interesting policy implications. First, the institutions that will govern and supervise the functioning of the market have an important weight in its success. The results indicate that competition cannot be a policy objective in itself There is a balancing act between the additional needs of a functional market in terms of infrastructure, information and coordination, and the inefficiencies that occur for lack of consumer options. Second, all customers are not equal. Some customer classes have fewer alternatives than others do, their consumption patterns differ and their dependence on electricity varies. Therefore, a policy that treats all customer classes the same will produce an inferior outcome. Third, the relevant environment matters. Legislative

  13. Cost of energy from utility-owned solar electric systems. A required revenue method for ERDA/EPRI evaluations

    Energy Technology Data Exchange (ETDEWEB)

    1976-06-01

    This methodology calculates the electric energy busbar cost from a utility-owned solar electric system. This approach is applicable to both publicly- and privately-owned utilities. Busbar cost represents the minimum price per unit of energy consistent with producing system-resultant revenues equal to the sum of system-resultant costs. This equality is expressed in present value terms, where the discount rate used reflects the rate of return required on invested capital. Major input variables describe the output capabilities and capital cost of the energy system, the cash flows required for system operation and maintenance, and the financial structure and tax environment of the utility.

  14. A United States perspective on long-term management of areas contaminated with radioactive materials.

    Science.gov (United States)

    Jones, C Rick

    2004-01-01

    The US has far-reaching and extensive experience in the long-term management of areas contaminated with radioactive materials. This experience base includes the Department of Energy's continued follow-up with Hiroshima and Nagasaki from the 1940s at the Radiological Effects Research Foundation in Hiroshima, Japan, the long-term management of the Marshall Islands Programme, the clean-up of the US nuclear weapons complex and the ongoing management of accident sites such as in Palomares, Spain. This paper discusses the lessons learnt and best practices gained from this far-reaching and extensive experience in the long-term management of areas contaminated with radioactive materials. Copyright 2004 Oxford University Press

  15. A United States perspective on long-term management of areas contaminated with radioactive materials

    International Nuclear Information System (INIS)

    Jones, C. R.

    2004-01-01

    The US has far-reaching and extensive experience in the long-term management of areas contaminated with radioactive materials. This experience base includes the Dept. of Energy's continued follow-up with Hiroshima and Nagasaki from the 1940's at the Radiological Effects Research Foundation in Hiroshima (Japan)), the long-term management of the Marshall Islands Programme, the clean-up of the US nuclear weapons complex and the ongoing management of accident sites such as in Palomares (Spain)). This paper discusses the lessons learnt and best practices gained from this far-reaching and extensive experience in the long-term management of areas contaminated with radioactive materials. (authors)

  16. Incremental Costs and Cost Effectiveness of Intensive Treatment in Individuals with Type 2 Diabetes Detected by Screening in the ADDITION-UK Trial: An Update with Empirical Trial-Based Cost Data.

    Science.gov (United States)

    Laxy, Michael; Wilson, Edward C F; Boothby, Clare E; Griffin, Simon J

    2017-12-01

    There is uncertainty about the cost effectiveness of early intensive treatment versus routine care in individuals with type 2 diabetes detected by screening. To derive a trial-informed estimate of the incremental costs of intensive treatment as delivered in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Europe (ADDITION) trial and to revisit the long-term cost-effectiveness analysis from the perspective of the UK National Health Service. We analyzed the electronic primary care records of a subsample of the ADDITION-Cambridge trial cohort (n = 173). Unit costs of used primary care services were taken from the published literature. Incremental annual costs of intensive treatment versus routine care in years 1 to 5 after diagnosis were calculated using multilevel generalized linear models. We revisited the long-term cost-utility analyses for the ADDITION-UK trial cohort and reported results for ADDITION-Cambridge using the UK Prospective Diabetes Study Outcomes Model and the trial-informed cost estimates according to a previously developed evaluation framework. Incremental annual costs of intensive treatment over years 1 to 5 averaged £29.10 (standard error = £33.00) for consultations with general practitioners and nurses and £54.60 (standard error = £28.50) for metabolic and cardioprotective medication. For ADDITION-UK, over the 10-, 20-, and 30-year time horizon, adjusted incremental quality-adjusted life-years (QALYs) were 0.014, 0.043, and 0.048, and adjusted incremental costs were £1,021, £1,217, and £1,311, resulting in incremental cost-effectiveness ratios of £71,232/QALY, £28,444/QALY, and £27,549/QALY, respectively. Respective incremental cost-effectiveness ratios for ADDITION-Cambridge were slightly higher. The incremental costs of intensive treatment as delivered in the ADDITION-Cambridge trial were lower than expected. Given UK willingness-to-pay thresholds in patients with screen

  17. Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea.

    Science.gov (United States)

    Oh, Jinjoo; Oh, Seieun

    2017-12-01

    The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea. Copyright © 2017. Published by Elsevier B.V.

  18. Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

    Science.gov (United States)

    Baltzer, H; Binhammer, P A

    2013-08-01

    In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

  19. Management challenges faced by managers of New Zealand long-term care facilities.

    Science.gov (United States)

    Madas, E; North, N

    2000-01-01

    This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.

  20. Utility view of the source term and air cleaning

    International Nuclear Information System (INIS)

    Littlefield, P.S.

    1985-01-01

    The utility view of the source term and air cleaning is discussed. The source term is made up of: (1) noble gases, which there has been a tendency to ignore in the past because it was thought there was nothing that could be done with them anyway, (2) the halogens, which have been dealt with in Air Cleaning Conferences in the past in terms of charcoal and other systems for removing them, and (3) the solid components of the source term which particulate filters are designed to handle. Air cleaning systems consist of filters, adsorbers, containment sprays, suppression pools in boiling water reactors and ice beds in ice condenser-equipped plants. The feasibility and cost of air cleaning systems are discussed

  1. Long-term disease-free survival in advanced melanomas treated with nitrosoureas: mechanisms and new perspectives.

    Science.gov (United States)

    Durando, Xavier; Thivat, Emilie; D'Incan, Michel; Sinsard, Anne; Madelmont, Jean-Claude; Chollet, Philippe

    2005-11-15

    Median survival of metastatic malignant melanoma is 6.0 to 7.5 months, with a 5-year survival of approximately 6.0%. Although long-term complete remissions are rare, few reports describe cases after chemotherapy. Fifty-three patients with metastatic melanoma were treated with Cystemustine, a chloroethyl nitrosourea (CENU) (60 or 90 mg/m2). We describe 5 cases, presenting with complete response with long-term disease-free survival of long-term remission of 14, 12, 9, 7 and 6 years after Cystemustine therapy alone. Long-term survival has already been described in literature, but in all cases they have been obtained after chemotherapy associated with or followed by surgery. But despite these noteworthy and encouraging but also rare results, it appears essential to increase Cystemustine efficiency.

  2. A Novel Unsupervised Adaptive Learning Method for Long-Term Electromyography (EMG) Pattern Recognition

    Science.gov (United States)

    Huang, Qi; Yang, Dapeng; Jiang, Li; Zhang, Huajie; Liu, Hong; Kotani, Kiyoshi

    2017-01-01

    Performance degradation will be caused by a variety of interfering factors for pattern recognition-based myoelectric control methods in the long term. This paper proposes an adaptive learning method with low computational cost to mitigate the effect in unsupervised adaptive learning scenarios. We presents a particle adaptive classifier (PAC), by constructing a particle adaptive learning strategy and universal incremental least square support vector classifier (LS-SVC). We compared PAC performance with incremental support vector classifier (ISVC) and non-adapting SVC (NSVC) in a long-term pattern recognition task in both unsupervised and supervised adaptive learning scenarios. Retraining time cost and recognition accuracy were compared by validating the classification performance on both simulated and realistic long-term EMG data. The classification results of realistic long-term EMG data showed that the PAC significantly decreased the performance degradation in unsupervised adaptive learning scenarios compared with NSVC (9.03% ± 2.23%, p < 0.05) and ISVC (13.38% ± 2.62%, p = 0.001), and reduced the retraining time cost compared with ISVC (2 ms per updating cycle vs. 50 ms per updating cycle). PMID:28608824

  3. A Novel Unsupervised Adaptive Learning Method for Long-Term Electromyography (EMG Pattern Recognition

    Directory of Open Access Journals (Sweden)

    Qi Huang

    2017-06-01

    Full Text Available Performance degradation will be caused by a variety of interfering factors for pattern recognition-based myoelectric control methods in the long term. This paper proposes an adaptive learning method with low computational cost to mitigate the effect in unsupervised adaptive learning scenarios. We presents a particle adaptive classifier (PAC, by constructing a particle adaptive learning strategy and universal incremental least square support vector classifier (LS-SVC. We compared PAC performance with incremental support vector classifier (ISVC and non-adapting SVC (NSVC in a long-term pattern recognition task in both unsupervised and supervised adaptive learning scenarios. Retraining time cost and recognition accuracy were compared by validating the classification performance on both simulated and realistic long-term EMG data. The classification results of realistic long-term EMG data showed that the PAC significantly decreased the performance degradation in unsupervised adaptive learning scenarios compared with NSVC (9.03% ± 2.23%, p < 0.05 and ISVC (13.38% ± 2.62%, p = 0.001, and reduced the retraining time cost compared with ISVC (2 ms per updating cycle vs. 50 ms per updating cycle.

  4. Long-term doctor-patient relationships: patient perspective from online reviews.

    Science.gov (United States)

    Detz, Alissa; López, Andrea; Sarkar, Urmimala

    2013-07-02

    Continuity of patient care is one of the cornerstones of primary care. To examine publicly available, Internet-based reviews of adult primary care physicians, specifically written by patients who report long-term relationships with their physicians. This substudy was nested within a larger qualitative content analysis of online physician ratings. We focused on reviews reflecting an established patient-physician relationship, that is, those seeing their physicians for at least 1 year. Of the 712 Internet reviews of primary care physicians, 93 reviews (13.1%) were from patients that self-identified as having a long-term relationship with their physician, 11 reviews (1.5%) commented on a first-time visit to a physician, and the remainder of reviews (85.4%) did not specify the amount of time with their physician. Analysis revealed six overarching domains: (1) personality traits or descriptors of the physician, (2) technical competence, (3) communication, (4) access to physician, (5) office staff/environment, and (6) coordination of care. Our analysis shows that patients who have been with their physician for at least 1 year write positive reviews on public websites and focus on physician attributes.

  5. Cost-Effectiveness and Cost-Utility Analysis of Ingenol Mebutate Versus Diclofenac 3% and Imiquimod 5% in the Treatment of Actinic Keratosis in Spain.

    Science.gov (United States)

    Elías, I; Ortega-Joaquín, N; de la Cueva, P; Del Pozo, L J; Moreno-Ramírez, D; Boada, A; Aguilar, M; Mirada, A; Mosquera, E; Gibbons, C; Oyagüez, I

    2016-01-01

    To perform a cost-effectiveness and cost-utility analysis of ingenol mebutate in the treatment of actinic keratosis in Spain. We used an adapted Markov model to simulate outcomes in a cohort of patients (mean age, 73 years) with actinic keratosis over a 5-year period. The comparators were diclofenac 3% and imiquimod 5%. The analysis was performed from the perspective of the Spanish National Health System based on direct costs (2015 retail price plus value added tax less the mandatory discount). A panel of experts estimated resources, taking unit costs from national databases. An annual discount rate of 3% was applied. Deterministic and probabilistic sensitivity analyses were performed. The effectiveness of ingenol mebutate-with 0.192 and 0.129 more clearances gained in treatments for face and scalp lesions and trunk and extremity lesions, respectively-was superior to diclofenac's. The total costs of treatment with ingenol mebutate were lower at € 551.50 (face and scalp) and € 622.27 (trunk and extremities) than the respective costs with diclofenac (€ 849.11 and € 844.93). The incremental cost-effectiveness and cost-utility ratios showed that ingenol mebutate was a dominant strategy vs diclofenac. Ingenol mebutate also proved to be more effective than imiquimod, based on 0.535 and 0.503 additional clearances, and total costs of € 551.50 and € 527.89 for the two drugs, respectively. The resulting incremental cost-effectiveness ratio was € 728.64 per clearance gained with ingenol mebutate vs imiquimod. Ingenol mebutate was a dominant treatment option vs diclofenac and was efficient vs imiquimod (i.e., more effective at a higher cost, achieving an incremental cost-utility ratio of<€30000/quality-adjusted life-years). Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  6. Cost-utility analysis of adjuvant goserelin (Zoladex and adjuvant chemotherapy in premenopausal women with breast cancer

    Directory of Open Access Journals (Sweden)

    Cheng Tsui

    2012-01-01

    Full Text Available Abstract Background Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer. Methods In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0, and to obtain the utility value by the standard gamble (SG and visual scale (VS methods. Total medical cost was assessed from the (National Health Insurance NHI payer's perspective. Results Survival at 11 years was significantly better in the groserelin group (P Conclusions Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.

  7. Long-term ecological research in the Czech Republic - case study with a 3-year project

    Czech Academy of Sciences Publication Activity Database

    Jelínková, E.; Straškrábová, Viera

    2001-01-01

    Roč. 20, č. 2 (2001), s. 50-56 ISSN 1335-342X. [Long-Term Ecological Research Current State and Perspectives in the Central and Eastern Europe ILTER Regional Workshop /3./. Nitra, 23.05.2000-25.05.2000] R&D Projects: GA ČR GA206/98/0727 Keywords : long-term ecological research * acidification * eutrophication Subject RIV: EH - Ecology, Behaviour Impact factor: 0.192, year: 2001

  8. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Science.gov (United States)

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

  9. Economic modeling of new stent platforms to evaluate cost effectiveness: analysis of the TAXUS Liberté versus TAXUS express stents.

    Science.gov (United States)

    Turco, Mark A; Kansal, Anuraag R; Stern, Sean; Amorosi, Stacey L; Underwood, Paul L; Lissovoy, Greg D E; Dawkins, Keith D

    2012-08-01

    With the changing health care environment, cost effectiveness is an important adjunct to clinical investigation when assessing new medical devices. This study presents an economic model to evaluate cost effectiveness of coronary stents. Markov modeling was developed comparing total costs (Medicare payer perspective) between TAXUS Liberté and TAXUS Express based on 3-year clinical outcomes from the TAXUS ATLAS Small Vessel and Long Lesion trials. The TAXUS Liberté 2.25-mm stent provided cost savings relative to TAXUS Express from a payer perspective ($17,605 vs. $20,281), driven by reduced target vessel revascularization (0.16 events/patient vs. 0.33 events/patient). In probabilistic sensitivity analyses, TAXUS Liberté was less costly with fewer major adverse cardiac events in over 99% of parameter sets. The TAXUS Liberté Long (38 mm) stent was cost neutral relative to TAXUS Express from a payer perspective ($18,545 vs. $18,551) with fewer myocardial infarctions and cardiac deaths. Accounting for angiography-driven revascularizations, TAXUS Liberté 2.25 mm still provided cost savings relative to TAXUS Express ($16,822 vs. $19,139), although TAXUS Liberté Long was more expensive than TAXUS Express ($17,886 vs. $17,652). From a hospital perspective, TAXUS Liberté Long provided cost savings up to a price premium of $671/stent, driven by fewer stents employed per patient. This analysis confirms the utility of economic modeling in assessing new stent platforms. TAXUS Liberté 2.25 mm is economically dominant relative to TAXUS Express when treating small vessels. TAXUS Liberté Long is cost neutral to modestly more costly than TAXUS Express 2.25 mm from a payer perspective. ©2012, Wiley Periodicals, Inc.

  10. Cost-Effectiveness of a Long-Term Internet-Delivered Worksite Health Promotion Programme on Physical Activity and Nutrition: A Cluster Randomized Controlled Trial

    Science.gov (United States)

    Robroek, Suzan J. W.; Polinder, Suzanne; Bredt, Folef J.; Burdorf, Alex

    2012-01-01

    This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the unit of randomization. The intervention was compared with a…

  11. Economics of solar energy: Short term costing

    Science.gov (United States)

    Klee, H.

    The solar economics based on life cycle costs are refuted as both imaginary and irrelevant. It is argued that predicting rates of inflation and fuel escalation, expected life, maintenance costs, and legislation over the next ten to twenty years is pure guesswork. Furthermore, given the high mobility level of the U.S. population, the average consumer is skeptical of long run arguments which will pay returns only to the next owners. In the short term cost analysis, the house is sold prior to the end of the expected life of the system. The cash flow of the seller and buyer are considered. All the relevant factors, including the federal tax credit and the added value of the house because of the solar system are included.

  12. Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Brynskov, Jørn; Thomsen, Ole

    2015-01-01

    .002. Figures were similar for patients having completed the 12-week trial as per protocol (50 % reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 % in algorithm-treated patients: $7......,056 versus $17,776; p year. Conclusion: Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year. Background: In Crohn’s disease patients failing infliximab therapy, interventions defined...... by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen. Aim: This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20...

  13. Long-term disease-free survival in advanced melanomas treated with nitrosoureas: mechanisms and new perspectives

    Directory of Open Access Journals (Sweden)

    Sinsard Anne

    2005-11-01

    Full Text Available Abstract Background Median survival of metastatic malignant melanoma is 6.0 to 7.5 months, with a 5-year survival of ~6.0%. Although long-term complete remissions are rare, few reports describe cases after chemotherapy. Fifty-three patients with metastatic melanoma were treated with Cystemustine, a chloroethyl nitrosourea (CENU (60 or 90 mg/m2. Case presentation We describe 5 cases, presenting with complete response with long-term disease-free survival of long-term remission of 14, 12, 9, 7 and 6 years after Cystemustine therapy alone. Conclusion Long-term survival has already been described in literature, but in all cases they have been obtained after chemotherapy associated with or followed by surgery. But despite these noteworthy and encouraging but also rare results, it appears essential to increase cystemustine efficiency.

  14. Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs.

    Science.gov (United States)

    Menditto, Enrica; Orlando, Valentina; Coretti, Silvia; Putignano, Daria; Fiorentino, Denise; Ruggeri, Matteo

    2015-01-01

    Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€). The market penetration of biosimilars was analyzed by year and quarterly. In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend was reversed, with a new increase in the consumption of the originators observed. Results show that the cost containment policies, applied to cut health expenditure "to cure and not to care", did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost containment are not successful; rather, a bottom

  15. Audit of long-term and short-term liabilities

    Directory of Open Access Journals (Sweden)

    Korinko M.D.

    2017-03-01

    Full Text Available The article determines the importance of long-term and short-term liabilities for the management of financial and material resources of an enterprise. It reviews the aim, objects and information generators for realization of audit of short-term and long-term obligations. The organizing and methodical providing of audit of long-term and short-term liabilities of an enterprise are generalized. The authors distinguish the stages of realization of audit of long-term and short-term liabilities, the aim of audit on each of the presented stages, and recommend methodical techniques. It is fixed that it is necessary to conduct the estimation of the systems of internal control and record-keeping of an enterprise by implementation of public accountant procedures for determination of volume and maintenance of selection realization. After estimating the indicated systems, a public accountant determines the methodology for realization of public accountant verification of long-term and short-term liabilities. The analytical procedures that public accountants are expedient to use for realization of audit of short-term and long-term obligations are determined. The authors suggest the classification of the educed defects on the results of the conducted public accountant verification of short-term and long-term obligations.

  16. Space Resource Utilization: Near-Term Missions and Long-Term Plans for Human Exploration

    Science.gov (United States)

    Sanders, Gerald B.

    2015-01-01

    A primary goal of all major space faring nations is to explore space: from the Earth with telescopes, with robotic probes and space telescopes, and with humans. For the US National Aeronautics and Space Administration (NASA), this pursuit is captured in three important strategic goals: 1. Ascertain the content, origin, and evolution of the solar system and the potential for life elsewhere, 2. Extend and sustain human activities across the solar system (especially the surface of Mars), and 3. Create innovative new space technologies for exploration, science, and economic future. While specific missions and destinations are still being discussed as to what comes first, it is imperative for NASA that it foster the development and implementation of new technologies and approaches that make space exploration affordable and sustainable. Critical to achieving affordable and sustainable human exploration beyond low Earth orbit (LEO) is the development of technologies and systems to identify, extract, and use resources in space instead of bringing everything from Earth. To reduce the development and implementation costs for space resource utilization, often called In Situ Resource Utilization (ISRU), it is imperative to work with terrestrial mining companies to spin-in/spin-off technologies and capabilities, and space mining companies to expand our economy beyond Earth orbit. In the last two years, NASA has focused on developing and implementing a sustainable human space exploration program with the ultimate goal of exploring the surface of Mars with humans. The plan involves developing technology and capability building blocks critical for sustained exploration starting with the Space Launch System (SLS) and Orion crew spacecraft and utilizing the International Space Station as a springboard into the solar system. The evolvable plan develops and expands human exploration in phases starting with missions that are reliant on Earth, to performing ever more challenging and

  17. Improving long term resistance of uranium mill tailings covers to hydrologic stress using RIPRAP: a preliminary assessment

    International Nuclear Information System (INIS)

    Walters, W.H.; Skaggs, R.L.

    1980-01-01

    The long term effectiveness of riprap to protect uranium mill tailings repositories against erosion by flowing water is currently being evaluated by Pacific Northwest Laboratory for the US Nuclear Regulatory Commission. The investigation is part of a comprehensive study to determine technically justified and cost effective alternatives for armoring of radon suppression covers. As a protective cover, riprap appears to be one of the most reliable methods because of its proven durability to resist channel bed scour around bridge piers and erosion of river banks. Damage to radon suppression covers by water could occur under similar circumstances where the erosion would be due to overland flow or a large flood event. The principal mechanisms of soil erosion by water are discussed with respect to earth surfaces of mounted or flat geometries. Since long time periods on the order of one thousand years may be involved, any riprap design procedure should consider allowances for partial failures of the cover. Design procedures are summarized and both advantages and disadvantages are discussed. Problems that may occur over long term storage of mill tailings are evaluated in order to put the use of riprap in proper perspective

  18. The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2017-07-01

    Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes3 1IGES Institut, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, School of Accounting, Economics and Finance, University of KwaZulu Natal, KwaZulu Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany Objective: To evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand. Methods: A cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS versus oral rehydration solution (ORS alone for acute diarrhea in children <5 years old. The decision tree Excel model evaluates the costs and effects (quality-adjusted life years over a 6-day time horizon from a public health care payer’s perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken. Results: According to the cost utility model, the intervention (R+ORS is less costly and more effective than the comparator (ORS for the base case with a dominant incremental cost-effectiveness ratio of −2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years, the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is −0.0027%, resulting in potential net cost savings of −35,632,482฿ over 5 years. Conclusion: Subject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system. Keywords: economic evaluation, cost utility, decision analysis, health technology assessment

  19. Methods for Analyzing the Benefits and Costs of Distributed Photovoltaic Generation to the U.S. Electric Utility System

    Energy Technology Data Exchange (ETDEWEB)

    Denholm, P.; Margolis, R.; Palmintier, B.; Barrows, C.; Ibanez, E.; Bird, L.; Zuboy, J.

    2014-09-01

    This report outlines the methods, data, and tools that could be used at different levels of sophistication and effort to estimate the benefits and costs of DGPV. In so doing, we identify the gaps in current benefit-cost-analysis methods, which we hope will inform the ongoing research agenda in this area. The focus of this report is primarily on benefits and costs from the utility or electricity generation system perspective. It is intended to provide useful background information to utility and regulatory decision makers and their staff, who are often being asked to use or evaluate estimates of the benefits and cost of DGPV in regulatory proceedings. Understanding the technical rigor of the range of methods and how they might need to evolve as DGPV becomes a more significant contributor of energy to the electricity system will help them be better consumers of this type of information. This report is also intended to provide information to utilities, policy makers, PV technology developers, and other stakeholders, which might help them maximize the benefits and minimize the costs of integrating DGPV into a changing electricity system.

  20. Economic Value of Li-ion Energy Storage System in Frequency Regulation Application from Utility Firm’s Perspective in Korea

    Directory of Open Access Journals (Sweden)

    Wonchang Hur

    2015-05-01

    Full Text Available Energy Storage Systems (ESSs have recently been highlighted because of their many benefits such as load-shifting, frequency regulation, price arbitrage, renewables, and so on. Among those benefits, we aim at evaluating their economic value in frequency regulation application. However, unlike previous literature focusing on profits obtained from participating in the ancillary service market, our approach concentrates on the cost reduction from the perspective of a utility firm that has an obligation to pay energy fees to a power exchange. More specifically, we focus on the payments between the power exchange market and the utility firm as a major source of economic benefits. The evaluation is done by cost- benefit analysis (CBA with a dataset of the Korean market while considering operational constraint costs as well as scheduled energy payments, and a simulation algorithm for the evaluation is provided. Our results show the potential for huge profits to be made by cost reduction. We believe that this research can provide a guideline for a utility firm considering investing in ESSs for frequency regulation application as a source of cost reduction.

  1. Sleep Quality, Short-Term and Long-Term CPAP Adherence

    Science.gov (United States)

    Somiah, Manya; Taxin, Zachary; Keating, Joseph; Mooney, Anne M.; Norman, Robert G.; Rapoport, David M.; Ayappa, Indu

    2012-01-01

    Study Objectives: Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence. Methods: 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST ( 4 h) and LT adherence ( 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups. Results: There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006). Conclusions: These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence. Citation: Somiah M; Taxin Z; Keating J; Mooney AM; Norman RG; Rapoport DM; Ayappa I. Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med 2012;8(5):489-500. PMID:23066359

  2. Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs.

    Science.gov (United States)

    Maru, Shoko; Byrnes, Joshua; Whitty, Jennifer A; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2015-02-01

    The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs. © The European Society of Cardiology 2014.

  3. Issues for the long term management of radioactive waste

    International Nuclear Information System (INIS)

    Schneider, T.; Schieber, C.; Lavelle, S.

    2006-01-01

    High-level radioactive waste are currently managed in interim storage installations, providing an adequate protection of the public and the workers for the short term period. However, the long-term persistence of the radioactivity of the waste gives a new timescale dimension, never experimented by the society for the development of protection systems. In the framework of the European Commission research project 'COWAM-2' (COmmunity WAste Management) dedicated to the governance of radioactive waste management, the issues of 'long term governance' have been addressed by exploring the elements which can contribute to a better integration of the technical and societal time dimensions, taking into account technical, ethical, economic and organizational considerations. The originality of this project is to address the various issues within working groups involving stakeholders from different origins and European countries together with a research team. After a discussion on the time dimensions to be taken into account from the technical and societal perspective, this paper presents, mainly based on the findings of the COWAM-2 project, a brief analysis of the ethical criteria to be considered when future generations are concerned as well as some performance criteria regarding long term governance. Finally, it proposes a discussion on the interest for the radiation protection experts to engage a process with stakeholders concerned by radioactive waste management in order to favour the emergence of a sustainable management responding to the issues at stake and including radiation protection considerations for long term periods. (authors)

  4. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

    Science.gov (United States)

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-10-07

    To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision

  5. A Cost-Effectiveness Analysis of Clopidogrel for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome in China.

    Science.gov (United States)

    Cui, Ming; Tu, Chen Chen; Chen, Er Zhen; Wang, Xiao Li; Tan, Seng Chuen; Chen, Can

    2016-09-01

    There are a number of economic evaluation studies of clopidogrel for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) published from the perspective of multiple countries in recent years. However, relevant research is quite limited in China. We aimed to estimate the long-term cost effectiveness for up to 1-year treatment with clopidogrel plus acetylsalicylic acid (ASA) versus ASA alone for NSTEACS from the public payer perspective in China. This analysis used a Markov model to simulate a cohort of patients for quality-adjusted life years (QALYs) gained and incremental cost for lifetime horizon. Based on the primary event rates, adherence rate, and mortality derived from the CURE trial, hazard functions obtained from published literature were used to extrapolate the overall survival to lifetime horizon. Resource utilization, hospitalization, medication costs, and utility values were estimated from official reports, published literature, and analysis of the patient-level insurance data in China. To assess the impact of parameters' uncertainty on cost-effectiveness results, one-way sensitivity analyses were undertaken for key parameters, and probabilistic sensitivity analysis (PSA) was conducted using the Monte Carlo simulation. The therapy of clopidogrel plus ASA is a cost-effective option in comparison with ASA alone for the treatment of NSTEACS in China, leading to 0.0548 life years (LYs) and 0.0518 QALYs gained per patient. From the public payer perspective in China, clopidogrel plus ASA is associated with an incremental cost of 43,340 China Yuan (CNY) per QALY gained and 41,030 CNY per LY gained (discounting at 3.5% per year). PSA results demonstrated that 88% of simulations were lower than the cost-effectiveness threshold of 150,721 CYN per QALY gained. Based on the one-way sensitivity analysis, results are most sensitive to price of clopidogrel, but remain well below this threshold. This analysis suggests that treatment with

  6. Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model.

    Science.gov (United States)

    Wang, Han-I; Aas, Eline; Howell, Debra; Roman, Eve; Patmore, Russell; Jack, Andrew; Smith, Alexandra

    2014-03-01

    Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network (www.hmrn.org). Overall, expected 5-year medical costs and life expectancy ranged from £8,170 to £81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  7. Exploration of life experiences of positive growth in long-term childhood cancer survivors.

    Science.gov (United States)

    Kim, Yoonjung

    2017-10-01

    The aim of this study was to explore experiences of positive growth in long-term childhood cancer survivors, from their perspective. Fifteen long-term survivors of childhood cancer provided descriptions of their experiences. Data were collected through face-to-face interviews and the analysis was based on Giorgi's phenomenological research method. The analysis of positive growth experienced by long-term childhood cancer survivors revealed three themes: self-directed life, normalcy in life, and inner maturity. Long-term survivors defined positive growth as a successful transition to a self-satisfactory life based on motivation acquired through their cancer experience and on subjective goal-setting, as well as becoming cancer-free and living a normal life within society. They seemed to have acquired optimistic, flexible, active attitudes toward life while demonstrating profound gratefulness and consideration of people around them, as well as prudent approaches to health. The findings of this study verified that long-term survivors of childhood cancer have grown positively due to their negative past experience. We expect these findings to contribute to the development of programs that promote positive growth in long-term childhood cancer survivors. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Short-term power plant operation scheduling in thermal systems with long-term boundary conditions

    International Nuclear Information System (INIS)

    Wolter, H.

    1990-01-01

    For the first time, the modeling of long-term quantitative conditions within the short-term planning of the application of power stations is made via their shadow prices. It corresponds to a decomposition of the quantitative conditions by means of the method of the Langrange relaxation. The shadow prices determined by the planning for energy application regarding long- term quantitative conditions pass into the short-term planning for power station application and subsidize or rather punish the application of limited amounts as for as they are not claimed for sufficiently or excessively. The clear advantage of this modeling is that the short-term planning of power station application can deviate from the envisioned energy application regarding the total optimum, because the shadow prices contain all information about the cost effect of the energy shifts in the residual total period, which become necessary due to the deviations in the short-term period to be planned in the current short-term period. (orig./DG) [de

  9. After Childhood Cancer: a Qualitative Study of Family Physician, Parent/Guardian, and Survivor Information Needs and Perspectives on Long-Term Follow-up and Survivorship Care Plans.

    Science.gov (United States)

    Keats, Melanie R; Shea, Kelsey; Parker, Louise; Stewart, Samuel A; Flanders, Annette; Bernstein, Mark

    2018-03-19

    Despite support for the provision of a survivorship care plan (SCP) to every cancer survivor, there is a lack of understanding of the needs and preferences of key stakeholders. We examined perspectives of a novel personalized SCP for childhood cancer survivors (CCS), their family, and family physicians (FP). We conducted semi-structured telephone interviews with a purposefully selected sample of CCS, parents/guardians, and FPs. Data included responses to stakeholder cancer care information needs, concerns with or gaps in communication, the perceived role of the FP in the long-term management of CCS care, utility of the SCP, preferred format, and suggestions for improvement. A deductive content analysis was conducted. Twenty-four participants including 8 CCS, 10 parents/guardians, and 6 FPs completed an interview. Four main and several sub-categories emerged. Core categories were coded as (1) informative reference, (2) coordination of follow-up, (3) barriers to follow-up care, and (4) suggestions for improvement and future implementation. The majority of participants preferred an electronic- or web-based format. Overall, the SCP was seen as an informative and concise resource. The SCP was thought to be a valuable tool to foster communication and empower CCSs to become more fully engaged in their own cancer-related health care. FPs viewed the SCP as a useful resource to facilitate and guide the long-term management of the CCS. In addition to the treatment summary, a comprehensive follow-up timeline, personalized lifestyle information, and details on how to access additional psychosocial support were highlighted as important components.

  10. Cost-utility analysis of treating out of hospital cardiac arrests in Jerusalem.

    Science.gov (United States)

    Ginsberg, Gary M; Kark, Jeremy D; Einav, Sharon

    2015-01-01

    Out-of-hospital cardiac arrest (OHCA) initiates a chain of responses including emergency medical service mobilization and medical treatment, transfer and admission first to a hospital Emergency Department (ED) and then usually to an intensive care unit and ward. Costly pre- and in-hospital care may be followed by prolonged post discharge expenditure on treatment of patients with severe neurological sequelae. We assessed the cost-effectiveness of treatment of OHCA by calculating the cost per Disability Adjusted Life Year (DALY) averted. We studied 3355 consecutive non-traumatic OHCAs (2005-2010) in Jerusalem, Israel, supplemented by hospital utilization data extracted from patient files (n = 570) and post-discharge follow-up (n = 196). Demographic, utilization and economic data were incorporated into a spreadsheet model to calculate the cost-utility ratio. Advanced life support was administered to 2264 of the 3355 OHCAs (67.5%) and 1048 (45.6%) patients were transferred to the ED. Of 676 (20.1%) patients who survived the ED and were admitted, there were 206 (6.1%) survivors to discharge, among them only 113 (3.4%) neurologically intact. Total cost ($39,100,000) per DALY averted (1353) was $28,864. The current package of OHCA interventions in Jerusalem appears to be very cost-effective as the cost per averted DALY of $28,864 is less than the Gross Domestic Product per capita ($33,261). This paper provides a basis for studying the effects of potential interventions that can be evaluated in terms of their incremental costs per averted DALY for treatment of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Long-term exports and use of interconnections: Development plan 1993

    International Nuclear Information System (INIS)

    1992-01-01

    The orientations, objectives, and strategies proposed for long-term exports of electricity from Quebec are presented, as well as the use of interconnections between Hydro-Quebec and northeastern US utilities. A recent historical overview shows that after a period of exporting large amounts of surplus energy in the late 1980s, most export sales are of firm power and energy. Export commitments signed for 1993-2000 amount to total exports of 11-14 TWh per year with revenues generated to be at least $4 billion. Hydro-Quebec originally had an export strategy with a target of 3,500 MW of firm power and energy exports by the year 2000. An economic recession, lower demand for power in the USA, new planning policies at US utilities emphasizing maximum flexibility, and competition from other electricity providers have revised this estimate downward. Over the short and medium term, neighboring US utilities will experience surpluses in both capacity and energy, and additional requirements indicated by their demand forecasts only appear after the year 2000. The situation is similar for neighboring Canadian utilities. In the long term, Hydro-Quebec's objective is to meet 15-20% of new requirements on neighboring US systems. New agreements could represent 1,500 MW by the year 2004, or ca 8.5 TWh/y. Hydro-Quebec also wants to be recognized as an active partner in the market for short-term transactions and to maximize use of its generation and interconnection facilities. The utility will examine transactions such as guaranteeing reserve capacity, energy banking, wheeling service, and pooling of generating capacities in order to offer the products best suited to customer needs. 3 figs., 3 tabs

  12. Recycling versus Long-Term Storage of Nuclear Fuel: Economic Factors

    Directory of Open Access Journals (Sweden)

    B. Yolanda Moratilla Soria

    2013-01-01

    Full Text Available The objective of the present study is to compare the associated costs of long-term storage of spent nuclear fuel—open cycle strategy—with the associated cost of reprocessing and recycling strategy of spent fuel—closed cycle strategy—based on the current international studies. The analysis presents cost trends for both strategies. Also, to point out the fact that the total cost of spent nuclear fuel management (open cycle is impossible to establish at present, while the related costs of the closed cycle are stable and known, averting uncertainties.

  13. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park

    2010-04-01

    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  14. Assessing the associative deficit of older adults in long-term and short-term/working memory.

    Science.gov (United States)

    Chen, Tina; Naveh-Benjamin, Moshe

    2012-09-01

    Older adults exhibit a deficit in associative long-term memory relative to younger adults. However, the literature is inconclusive regarding whether this deficit is attenuated in short-term/working memory. To elucidate the issue, three experiments assessed younger and older adults' item and interitem associative memory and the effects of several variables that might potentially contribute to the inconsistent pattern of results in previous studies. In Experiment 1, participants were tested on item and associative recognition memory with both long-term and short-term retention intervals in a single, continuous recognition paradigm. There was an associative deficit for older adults in the short-term and long-term intervals. Using only short-term intervals, Experiment 2 utilized mixed and blocked test designs to examine the effect of test event salience. Blocking the test did not attenuate the age-related associative deficit seen in the mixed test blocks. Finally, an age-related associative deficit was found in Experiment 3, under both sequential and simultaneous presentation conditions. Even while accounting for some methodological issues, the associative deficit of older adults is evident in short-term/working memory.

  15. Economic and clinical benefit of collagenase ointment compared to a hydrogel dressing for pressure ulcer debridement in a long-term care setting.

    Science.gov (United States)

    Waycaster, Curtis; Milne, Catherine

    2013-06-01

    The purpose of this study is to determine the cost-effectiveness of collagenase ointment relative to autolysis with a hydrogel dressing when debriding necrotic pressure ulcers in a long-term care setting. A Markov decision process model with 2 states (necrotic nonviable wound bed transitioning to a granulated viable wound bed) was developed using data derived from a prospective, randomized, 6-week, single-center trial of 27 institutionalized subjects with pressure ulcers that were ≥ 85% necrotic nonviable tissue. Direct medical costs from the payer perspective included study treatments, wound treatment supplies, and nursing time. Clinical benefit was measured as "granulation days" and was derived from the time-dependent debridement rates of the alternative products. The average cost per patient for 42 days of pressure ulcer care was $1,817 in 2012 for the collagenase group and $1,611 for the hydrogel group. Days spent with a granulated wound were 3.6 times higher for collagenase (23.4 vs 6.5) than with the hydrogel. The estimated cost per granulation day was > 3.2 times higher for hydrogel ($249) vs collagenase ($78). In this economic analysis based on a randomized, controlled clinical trial, collagenase ointment resulted in a faster time to complete debridement and was more cost-effective than hydrogel autolysis for pressure ulcers in a long-term care setting. Even though collagenase ointment has a higher acquisition cost than hydrogel, the clinical benefit offsets the initial cost difference, resulting in lower cost per granulation day to the nursing home over the course of the 42-day analysis.

  16. Justification of strategies for agricultural countermeasures in the long term after the Chernobyl accident based on a cost-benefit analysis

    International Nuclear Information System (INIS)

    Panov, A.V.; Fesenko, S.V.; Pakhomov, A.Y.; Alexakhin, R.M.

    2004-01-01

    In the long term after the Chernobyl accident the introduction of systems of countermeasures in agriculture must be based on the optimization principle. To implement this principle, a concept was used of evaluation of the effectiveness of countermeasures based on a cost-benefit analysis. Countermeasure options were developed separately for collective and private sectors of rural settlements. For each type of farming a range of countermeasures were defined and the optimal ones were identified. The effectiveness of countermeasures was estimated on the basis of integral criteria: cost of averted collective dose (1 man-Sv), overall costs needed for countermeasures introduction and time for fulfilling legal regulations. Based on the most effective countermeasures, optimal combinations (strategies) were developed. An assessment was given of the effectiveness of countermeasures aimed at reducing the radionuclide content in animal products from collective farms and lowering doses to rural residents affected by the Chernobyl accident, based on a comparative cost benefit analysis. A study into the dynamics of 1 man-Sv cost when applying different countermeasures in the collective and private sectors allowed an identification of the most optimal measures for various time periods after the accident. The situation in the private sector is more critical than in the collective one. This is demonstrated by higher costs of countermeasures and costs of potential averted doses in the course of their application, as well as difference in times of legal regulations fulfillment. To optimize costs of the rehabilitation of agricultural lands, the most optimal in terms of meeting the standards strategy was determined, which is an address application of countermeasures. (author)

  17. Who owns the long term? Perspectives from global business leaders.

    Science.gov (United States)

    Lévy, Maurice; Eskew, Mike; Bernotat, Wulf H; Barner, Marianne

    2007-01-01

    Day-to-day management is challenging enough for CEOs. How do they manage for the long term as well? We posed that question to four top executives of global companies. According to Maurice Levy, chairman and CEO of Publicis Groupe, building the future is really about building the present and keeping close to the front line--those who deal with your customers and markets. He also attributes his company's success in large part to knowing when to take action: In a market where clients' needs steer your long-term future, timing is everything. UPS Chairman and CEO Mike Eskew emphasizes staying true to your vision and values over the long run, despite meeting obstacles along the way. It took more than 20 years, and many lessons learned, to produce consistent profits in what is today the company's fastest-growing and most profitable business: international small packages. Wulf H. Bernotat, CEO of E.ON, examines the challenges facing business leaders and politicians as they try to balance energy needs against potential environmental damage. He calls for educating people about consumption and waste, and he maintains that a diverse and reliable mix of energy sources is the only way to ensure a secure supply while protecting our environment. Finally, Marianne Barner, the director of corporate communications and ombudsman for children's issues at IKEA, discusses how the company is taking steps to improve the environment and be otherwise socially responsible. For example, it's partnering with NGOs to address child labor issues and, on its own, is working to help mitigate climate change. IKEA's goals include using renewable sources for 100% of its energy needs and cutting its overall energy consumption by 25%.

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

    Science.gov (United States)

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

    2011-12-01

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

  19. Long-term perspectives on world metal use - a model-based approach

    NARCIS (Netherlands)

    Vuuren DP; Strengers BJ; Vries HJM de; MNV

    1999-01-01

    In this report, a system dynamics model is described, which simulates long-term trends in the production and consumption of metals (i.e. iron/steel and an aggregate of metals of medium abundance) in relation to impacts such as ore-grade decline, capital and energy requirements and waste flows. This

  20. Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care

    Directory of Open Access Journals (Sweden)

    Kool Rudolf B

    2010-04-01

    Full Text Available Abstract Background This study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index® Long-term Care, for measuring client experiences with long-term care in the Netherlands. Methods Three versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psychogeriatric residents and homecare clients. From July to November 2006 a pilot study was conducted among 2,697 clients of 68 nursing or residential care homes, 2,164 representatives of clients in 57 psychogeriatric care institutions, and 1,462 clients of 19 homecare organizations. We performed psychometric analyses and descriptive analyses, and evaluated the pilot study. Results The pilot study showed the feasibility and usability of the instruments, supported the multidimensionality of the questionnaires and showed first findings on client experiences and possibilities for quality improvement. Nine scales applied to all care settings: shared decision making, attitude and courtesy, information, body care, competence and safety of care, activities, autonomy, mental well-being, and availability of personnel. The pilot resulted in three optimized questionnaires and recommendations for nationwide implementation. Conclusions The CQ-index® Long-term Care provides a good basis to investigate the quality of nursing homes, residential care homes and homecare from the clients' perspective. This standardized instrument enables a nationwide comparison of the quality of long-term care for the purpose of transparency and quality assurance.

  1. Going Solar Yields Long-Term Economical, Educational Benefits

    Science.gov (United States)

    von Moos, Brian

    2009-01-01

    Going solar is not an easy decision, but a long-term investment with a potentially substantial up-front cost. While some schools have enough capital in reserve, can raise bond money, or can solicit sufficient donations, many schools rely on creative financial programs to make a solar energy system economically feasible. Thinking about going solar…

  2. Variable Renewable Energy in Long-Term Planning Models: A Multi-Model Perspective

    Energy Technology Data Exchange (ETDEWEB)

    Cole, Wesley J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Frew, Bethany A. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mai, Trieu T. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Sun, Yinong [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Bistline, John [Electric Power Research Inst., Palo Alto, CA (United States); Blanford, Geoffrey [Electric Power Research Inst., Palo Alto, CA (United States); Young, David [Electric Power Research Inst., Palo Alto, CA (United States); Marcy, Cara [Energy Information Administration, Washington, DC (United States); Namovicz, Chris [Energy Information Administration, Washington, DC (United States); Edelman, Risa [Environmental Protection Agency, Washington, DC (United States); Meroney, Bill [Environmental Protection Agency; Sims, Ryan [Environmental Protection Agency; Stenhouse, Jeb [Environmental Protection Agency; Donohoo-Vallett, Paul [U.S. Department of Energy

    2017-11-03

    Long-term capacity expansion models of the U.S. electricity sector have long been used to inform electric sector stakeholders and decision makers. With the recent surge in variable renewable energy (VRE) generators - primarily wind and solar photovoltaics - the need to appropriately represent VRE generators in these long-term models has increased. VRE generators are especially difficult to represent for a variety of reasons, including their variability, uncertainty, and spatial diversity. To assess current best practices, share methods and data, and identify future research needs for VRE representation in capacity expansion models, four capacity expansion modeling teams from the Electric Power Research Institute, the U.S. Energy Information Administration, the U.S. Environmental Protection Agency, and the National Renewable Energy Laboratory conducted two workshops of VRE modeling for national-scale capacity expansion models. The workshops covered a wide range of VRE topics, including transmission and VRE resource data, VRE capacity value, dispatch and operational modeling, distributed generation, and temporal and spatial resolution. The objectives of the workshops were both to better understand these topics and to improve the representation of VRE across the suite of models. Given these goals, each team incorporated model updates and performed additional analyses between the first and second workshops. This report summarizes the analyses and model 'experiments' that were conducted as part of these workshops as well as the various methods for treating VRE among the four modeling teams. The report also reviews the findings and learnings from the two workshops. We emphasize the areas where there is still need for additional research and development on analysis tools to incorporate VRE into long-term planning and decision-making.

  3. Reducing operating costs: A collaborative approach between industry and electric utilities

    International Nuclear Information System (INIS)

    Tyers, B.; Sibbald, L.

    1993-01-01

    The unit cost of electricity to industrial consumers is expected to increase at a rate of 5% annually in the 1990s. The partnership that has been created between Amoco Canada Petroleum Company and TransAlta Utilities to control the cost of electricity is described. To allow the company to receive lower rates for interruptible power, a number of measures have been taken. The Amoco Whitecourt plant has standby generators in reserve that can be used when utility power is not available. A Pembina compressor can be turned off for up to 12 hours, at 30 minutes notice, without affecting field pressure. At the East Crossfield plant sales gas can be compressed using electricity or a gas-driven engine. Spot market energy is used in a number of plants allowing electric drive alternatives to plant operators and offering short term energy markets. TransAlta invests in electrical equipment such as switchgear as well as transmission lines and transformers. New rate alternatives offered by TransAlta Utilities include review of the need for a demand ratchet, additional time of use rates, unbundling of rates allowing power purchase from alternative sources, rates that follow product costs, reduced rates for conversion of gas to electric drives certain circumstances, energy audits, and power factor credits. 5 figs

  4. Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea

    Directory of Open Access Journals (Sweden)

    Jinjoo Oh, Ph.D., RN, GNP

    2017-12-01

    Full Text Available Purpose: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. Methods: Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. Results: Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. Conclusion: The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea. Keywords: case management, focus groups, hospitalization, qualitative research, vulnerable populations

  5. The challenges of connecting generation to distribution systems: a utility perspective

    International Nuclear Information System (INIS)

    Kropp, F.

    2004-01-01

    'Full text:' This presentation discusses the technical, financial and regulatory barriers to connecting generation to Distribution Systems in Ontario. Case studies will be used to provide examples of the operational and technical challenges that impact the utility as well as a discussion on the site-specific advantages and disadvantages (to the utility) of the generation connections. These studies will include discussions on the problems and lessons learned with respect to the overall project implementation and the contractual agreements. The case studies will be complemented by an explanation of the financial constraints (both short term and long term) associated with the connections, and the regulatory issues that impact the financial recovery models including net and gross load billing. (author)

  6. Long-term energy futures: the critical role of technology

    International Nuclear Information System (INIS)

    Grubler, A.

    1999-01-01

    The paper briefly reviews the results of a 5-year study conducted by IIASA jointly with the World Energy Council (WEC) on long term-energy perspectives. After summarizing the study's main findings, the paper addresses the crucial role of technological change in the evolution of long-term energy futures and in responding to key long-term uncertainties in the domains of energy demand growth, economics, as well as environmental protection. Based on most recent empirical and methodological findings, long-term dynamics of technological change portray a number of distinct features that need to be taken account of in technology and energy policy. First, success of innovation efforts and ultimate outcomes of technological are uncertain. Second, new, improved technologies are not a free good, but require continued dedicated efforts. Third, technological knowledge (as resulting from R and D and accumulation of experience, i.e. technological learning) exhibits characteristics of (uncertain) increasing returns. Forth, due to innovation - diffusion lags, technological interdependence, and infrastructure needs (network externalities), rates of change in large-scale energy systems are necessarily slow. This implies acting sooner rather than later as a contigency policy to respond to long-term social, economic and environmental uncertainties, most notably possible climate change. Rather than picking technological 'winners' the results of the IIASA-WEC scenario studies are seen most appropriate to guide technology and R and D portfolio analysis. Nonetheless, robust persistent patterns of technological change invariably occur across all scenarios. Examples of primising groups of technologies are given. The crucial importance of meeting long-energy demand in developing countries, assuring large-scale infrastructure investments, maintaining a strong and diversified R AND D protfolio, as well as to dvise new institutional mechnisms for technology development and diffusion for instance

  7. Cost-effectiveness of becaplermin gel on wound healing of diabetic foot ulcers.

    Science.gov (United States)

    Gilligan, Adrienne M; Waycaster, Curtis R; Motley, Travis A

    2015-01-01

    We sought to determine the long-term cost effectiveness (payer's perspective) of becaplermin gel plus good wound care (BGWC) vs. good wound care (GWC) alone in terms of wound healing and risk of amputation in patients with diabetic foot ulcers (DFUs). Outcomes data were derived from a propensity score-matched cohort from the Curative Health Services database between 1998 and 2004, which was followed for 20 weeks. A four-state Markov model was used to predict costs and outcomes of wound healing and risk of amputation for BGWC vs. GWC alone over 1 year in patients with DFU. The primary outcome was closed-wound weeks. Transition probabilities for healing and amputation were derived from the aforementioned propensity score-matched cohorts. Ulcer recurrence was estimated from the medical literature. Utilization for becaplermin was calculated using the dosing algorithm in the product labeling. Of 24,898 eligible patients, 9.6% received BGWC. Based on the model, patients treated with BGWC had substantially more closed-wound weeks compared with GWC (16.1 vs. 12.5 weeks, respectively). More patients receiving BGWC had healed wounds at 1 year compared with those receiving GWC (48.1% vs. 38.3%). Risk of amputation was lower in the BGWC cohort (6.8% vs. 9.8%). Expected annual direct costs for DFU were $21,920 for BGWC and $24,640 for GWC. BGWC was economically dominant over GWC, providing better outcomes at a lower cost in patients with DFU. Compared with GWC alone, BGWC is more effective in healing wounds and lowering amputation risk, thereby decreasing long-term costs for DFU. © 2015 by the Wound Healing Society.

  8. Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study

    Directory of Open Access Journals (Sweden)

    Beecham Jennifer

    2011-10-01

    Full Text Available Abstract Background Conduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder. Methods A decision-analytic Markov model compares two scenarios: 1 a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2 the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted. Results Results strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at £16,435 per family, which compares with an intervention cost in the range of £952-£2,078 (2008/09 prices. Conclusions Effective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.

  9. Impact of depression on health care utilization and costs among multimorbid patients--from the MultiCare Cohort Study.

    Directory of Open Access Journals (Sweden)

    Jens-Oliver Bock

    Full Text Available OBJECTIVE: The objective of this study was to describe and analyze the effects of depression on health care utilization and costs in a sample of multimorbid elderly patients. METHOD: This cross-sectional analysis used data of a prospective cohort study, consisting of 1,050 randomly selected multimorbid primary care patients aged 65 to 85 years. Depression was defined as a score of six points or more on the Geriatric Depression Scale (GDS-15. Subjects passed a geriatric assessment, including a questionnaire for health care utilization. The impact of depression on health care costs was analyzed using multiple linear regression models. A societal perspective was adopted. RESULTS: Prevalence of depression was 10.7%. Mean total costs per six-month period were €8,144 (95% CI: €6,199-€10,090 in patients with depression as compared to €3,137 (95% CI: €2,735-€3,538; p<0.001 in patients without depression. The positive association between depression and total costs persisted after controlling for socio-economic variables, functional status and level of multimorbidity. In particular, multiple regression analyses showed a significant positive association between depression and pharmaceutical costs. CONCLUSION: Among multimorbid elderly patients, depression was associated with significantly higher health care utilization and costs. The effect of depression on costs was even greater than reported by previous studies conducted in less morbid patients.

  10. Perspectives of electricity supply

    International Nuclear Information System (INIS)

    1988-01-01

    The 7 papers read at the symposium discussed the following subjects: Effects of the CO 2 problems of fossil energy systems on the world climate; status and perspectives of the German electricity industry in terms of competitiveness; The European electricity market and the integrated power supply system; Power supply without nuclear power; Costs and rates for households and other customers; Renewable energy sources and their contribution to energy supply in the Federal Republic of Germany; Electricity utilities as service partners. (UA) [de

  11. Cost-effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective.

    Science.gov (United States)

    April, Michael D; Murray, Brian P

    2017-06-01

    Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation

  12. A discrete event modelling framework for simulation of long-term outcomes of sequential treatment strategies for ankylosing spondylitis.

    Science.gov (United States)

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

    2011-12-01

    To develop a modelling framework which can simulate long-term quality of life, societal costs and cost-effectiveness as affected by sequential drug treatment strategies for ankylosing spondylitis (AS). Discrete event simulation paradigm was selected for model development. Drug efficacy was modelled as changes in disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) and functional status (Bath Ankylosing Spondylitis Functional Index (BASFI)), which were linked to costs and health utility using statistical models fitted based on an observational AS cohort. Published clinical data were used to estimate drug efficacy and time to events. Two strategies were compared: (1) five available non-steroidal anti-inflammatory drugs (strategy 1) and (2) same as strategy 1 plus two tumour necrosis factor α inhibitors (strategy 2). 13,000 patients were followed up individually until death. For probability sensitivity analysis, Monte Carlo simulations were performed with 1000 sets of parameters sampled from the appropriate probability distributions. The models successfully generated valid data on treatments, BASDAI, BASFI, utility, quality-adjusted life years (QALYs) and costs at time points with intervals of 1-3 months during the simulation length of 70 years. Incremental cost per QALY gained in strategy 2 compared with strategy 1 was €35,186. At a willingness-to-pay threshold of €80,000, it was 99.9% certain that strategy 2 was cost-effective. The modelling framework provides great flexibility to implement complex algorithms representing treatment selection, disease progression and changes in costs and utilities over time of patients with AS. Results obtained from the simulation are plausible.

  13. Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery

    Directory of Open Access Journals (Sweden)

    Bastiaanssen Janneke M

    2008-05-01

    Full Text Available Abstract Background Pregnancy-related low back pain is considered an important health problem and potentially leads to long-lasting pain and disability. Investigators draw particular attention to biomedical factors but there is growing evidence that psychosocial and social factors might be important. It prompted us to start a large cohort study (n = 7526 during pregnancy until one year after delivery and a nested randomized controlled intervention study in the Netherlands. Methods A randomized controlled trial (n = 126 nested within a cohort study, of brief self-management techniques versus usual care for treatment of women with persisting non-specific pregnancy-related low back pain three weeks after delivery. Women in the intervention group were referred to a participating physiotherapist. Women in the usual care group were free to choose physiotherapy, guidance by a general practitioner or no treatment. Follow up took place at 3 months, 6 months and one year after delivery. Outcomes included change in limitations in activities (RDQ, pain (VAS, severity of main complaints (MC, global feeling of recovery (GPE, impact on participation and autonomy (IPA, pain-related fear (TSK, SF-36, EuroQol and a cost diary. For the outcome measures, series of mixed models were considered. For the outcome variable global perceived effect (GPE a logistic regression analysis is performed. Results Intention-to-treat outcomes showed a statistical significant better estimated regression coefficient RDQ -1.6 {-2.9;-0.5} associated with treatment, as well as better IPA subscale autonomy in self-care -1.0 {-1.9;-0.03} and TSK -2.4 {-3.8;-1.1} but were not clinical relevant over time. Average total costs in the intervention group were much lower than in usual care, primarily due to differences in utilization of sick leave but not statistically significant. Conclusion Brief self-management techniques applied in the first 3 months after delivery may be a more viable first

  14. Long-term perspectives of technical and social development in Germany. Visions for research and technology policy; Langfristige Perspektiven technischer und gesellschaftlicher Entwicklung in Deutschland. Visionen fuer die Forschungs- und Technologiepolitik

    Energy Technology Data Exchange (ETDEWEB)

    Baron, W; Zweck, A

    1995-12-01

    This publication contains six contributions discussing the medium- and long-term perspectives of technical, social and economic development in Germany. (UA) [Deutsch] Die vorliegende Publikation enthaelt 6 Vortraege, die sich mit mittel- und langfristigen Perspektiven der technischen, sozialen und wirtschaftlichen Entwicklung in Deutschland befassen. (UA)

  15. 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.

  16. Issues for the long term management of radioactive waste

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, T.; Schieber, C. [CEPN, 92 - Fontenay-aux-Roses (France); Lavelle, S. [ICAM, 59 - Lille (France)

    2006-07-01

    High-level radioactive waste are currently managed in interim storage installations, providing an adequate protection of the public and the workers for the short term period. However, the long-term persistence of the radioactivity of the waste gives a new timescale dimension, never experimented by the society for the development of protection systems. In the framework of the European Commission research project 'COWAM-2' (COmmunity WAste Management) dedicated to the governance of radioactive waste management, the issues of 'long term governance' have been addressed by exploring the elements which can contribute to a better integration of the technical and societal time dimensions, taking into account technical, ethical, economic and organizational considerations. The originality of this project is to address the various issues within working groups involving stakeholders from different origins and European countries together with a research team. After a discussion on the time dimensions to be taken into account from the technical and societal perspective, this paper presents, mainly based on the findings of the COWAM-2 project, a brief analysis of the ethical criteria to be considered when future generations are concerned as well as some performance criteria regarding long term governance. Finally, it proposes a discussion on the interest for the radiation protection experts to engage a process with stakeholders concerned by radioactive waste management in order to favour the emergence of a sustainable management responding to the issues at stake and including radiation protection considerations for long term periods. (authors)

  17. Agora Energiewende (2017). Future cost of onshore wind. Recent auction results, long-term outlook and implications for upcoming German auctions

    Energy Technology Data Exchange (ETDEWEB)

    Thomassen, Georg; Deutsch, Matthias

    2017-04-15

    The costs for electricity from renewable generation have been falling significantly in recent years, and record low bids at auctions around the world have grasped the attention of the public. Solar photovoltaics and offshore wind auctions, in particular, have attracted a lot of interest. The results for onshore wind, however, are just as impressive. The future cost development of onshore wind is of great relevance, since it is a key pillar of the energy system transformation in many parts of the world. However, the estimated long-term cost reductions vary significantly, as different studies value the cost drivers of wind differently. In Germany, the opaque and complex cost structure of onshore wind is the root of much controversy. International auction results with winning bids of less than half of the typical German pay rate left people questioning the costs of domestic wind power. However this discussion often fails to account adequately for differences in the quality of wind resources. In light of the upcoming, and first, German onshore wind auctions, we aim to contribute to the ongoing discussion by providing the necessary context for international auction results, a general outlook on the future cost of onshore wind, and by illustrating the existing potential and hindrances for cost reductions in the German market.

  18. Agora Energiewende (2017). Future cost of onshore wind. Recent auction results, long-term outlook and implications for upcoming German auctions

    International Nuclear Information System (INIS)

    Thomassen, Georg; Deutsch, Matthias

    2017-01-01

    The costs for electricity from renewable generation have been falling significantly in recent years, and record low bids at auctions around the world have grasped the attention of the public. Solar photovoltaics and offshore wind auctions, in particular, have attracted a lot of interest. The results for onshore wind, however, are just as impressive. The future cost development of onshore wind is of great relevance, since it is a key pillar of the energy system transformation in many parts of the world. However, the estimated long-term cost reductions vary significantly, as different studies value the cost drivers of wind differently. In Germany, the opaque and complex cost structure of onshore wind is the root of much controversy. International auction results with winning bids of less than half of the typical German pay rate left people questioning the costs of domestic wind power. However this discussion often fails to account adequately for differences in the quality of wind resources. In light of the upcoming, and first, German onshore wind auctions, we aim to contribute to the ongoing discussion by providing the necessary context for international auction results, a general outlook on the future cost of onshore wind, and by illustrating the existing potential and hindrances for cost reductions in the German market.

  19. Calculating the marginal costs of a district-heating utility

    International Nuclear Information System (INIS)

    Sjoedin, Joergen; Henning, Dag

    2004-01-01

    District heating plays an important role in the Swedish heat-market. At the same time, the price of district heating varies considerably among different district-heating utilities. A case study is performed here in which a Swedish utility is analysed using three different methods for calculating the marginal costs of heat supply: a manual spreadsheet method, an optimising linear-programming model, and a least-cost dispatch simulation model. Calculated marginal-costs, obtained with the three methods, turn out to be similar. The calculated marginal-costs are also compared to the actual heat tariff in use by the utility. Using prices based on marginal costs should be able to bring about an efficient resource-allocation. It is found that the fixed rate the utility uses today should be replaced by a time-of-use rate, which would give a more accurate signal for customers to change their heat consumptions. (Author)

  20. Decision E90057 re: ICG Utilities (Alberta) Ltd

    Energy Technology Data Exchange (ETDEWEB)

    1990-10-10

    ICG Utilities applied before the Alberta Public Utilities Board for determining a rate base and for fixing and approving interim and final rates for gas supplied to its customers in Alberta. A hearing was held to consider issues related to the application. In determining the rate base, the company's capital expenditures, acquisition of reserves, capitalization of administrative expenses, accumulated depreciation and related expense, and necessary working capital were taken into account. The fair return on the rate base was then fixed by considering the company's capital structure, long- and short- term debt rates, return on common equity, and foreign exchange rates. Utility revenue requirements were discussed in terms of cash operating expenses, cost of gas, income taxes, and non-cash operating expenses. Other matters treated at the hearing were the allocation of costs among ICG and affiliated companies, proposed amendments to ICG standards, regulations and practices, and the hearing costs reserve account. 5 tabs.

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

    Science.gov (United States)

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

    2010-01-01

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

  2. The potential benefits of a new poliovirus vaccine for long-term poliovirus risk management.

    Science.gov (United States)

    Duintjer Tebbens, Radboud J; Thompson, Kimberly M

    2016-12-01

    To estimate the incremental net benefits (INBs) of a hypothetical ideal vaccine with all of the advantages and no disadvantages of existing oral and inactivated poliovirus vaccines compared with current vaccines available for future outbreak response. INB estimates based on expected costs and polio cases from an existing global model of long-term poliovirus risk management. Excluding the development costs, an ideal poliovirus vaccine could offer expected INBs of US$1.6 billion. The ideal vaccine yields small benefits in most realizations of long-term risks, but great benefits in low-probability-high-consequence realizations. New poliovirus vaccines may offer valuable insurance against long-term poliovirus risks and new vaccine development efforts should continue as the world gathers more evidence about polio endgame risks.

  3. Damage cost of the Dan River coal ash spill

    International Nuclear Information System (INIS)

    Dennis Lemly, A.

    2015-01-01

    The recent coal ash spill on the Dan River in North Carolina, USA has caused several negative effects on the environment and the public. In this analysis, I report a monetized value for these effects after the first 6 months following the spill. The combined cost of ecological damage, recreational impacts, effects on human health and consumptive use, and esthetic value losses totals $295,485,000. Because the environmental impact and associated economic costs of riverine coal ash spills can be long-term, on the order of years or even decades, this 6-month assessment should be viewed as a short-term preview. The total cumulative damage cost from the Dan River coal ash spill could go much higher. - Highlights: • Six-month post-spill damage cost exceeded $295,000,000. • Components of cost include ecological, recreational, human health, property, and aesthetic values. • Attempts by the electric utility to “clean” the river left over 95% of coal ash behind. • Long-term impacts will likely drive the total damage cost much higher. - Damage costs of the Dan River coal ash spill are extensive and growing. The 6-month cost of that spill is valued at $295,485,000, and the long-term total cost is likely to rise substantially

  4. The changes in perception of visual illusions during long-term isolation

    Czech Academy of Sciences Publication Activity Database

    Šikl, Radovan; Šimeček, Michal; Lukavský, Jiří

    2009-01-01

    Roč. 2009, č. 38 (2009), s. 31-32 ISSN 0301-0066. [European Conference on Visual Perception. 24.08.2009-28.08.2009, Regensburg] R&D Projects: GA ČR GA406/09/2003 Institutional research plan: CEZ:AV0Z70250504 Keywords : long-term isolation * geometrical illusions * perspective Subject RIV: AN - Psychology http://www.perceptionweb.com/abstract.cgi?id=v090766

  5. A United States perspective on long term management of areas contaminated with radioactive materials

    International Nuclear Information System (INIS)

    Jones, C.R.

    2003-01-01

    Full text: The United States has far-reaching experience in the long-term management of areas contaminated with radioactive materials. The events resulting from the atmospheric testing of nuclear weapons in the Marshall Islands, follow-up from Hiroshima and Nagasaki, accidents, and the environmental cleanup of our weapons complex have resulted in an extensive body of lessons learned and best practices. The lack of trust created in the affected population, regardless of cause of the spread of radioactive material, creates the working environment for long-term management of the situation. The extent of advanced planning for such an event will define and bound your ultimate success in reaching a conclusion acceptable to the affected parties. The two key issues to be addressed in the long-term management of areas contaminated with radioactive materials are the two 'T's' - technical and trust. The technical issues to be resolved include: access to the affected area; infrastructure to support operations; local and imported staffing; health care for the affected population; and payment to name a few. In addressing the issue of trust it is critical to establish open, honest and inclusive communications and decision making with the affected population and stakeholders, with clear roles and responsibilities defined. Actions must be sensitive to local cultural issues and agreements reached with affected populations prior to actions being taken. Establishment of an alternative views resolution process helps build trust and allow actions to taken. Government to government relations and agreements must be established with an acceptance and understanding of the long term investment in time and resources needed. Planning ahead for such an eventuality and putting in place procedures, agreements and resources needed to address the technical and trust issues associated with the long-term management of areas contaminated with radioactive materials enhances success. (author)

  6. Concepts for reducing nuclear utility inventory carrying costs

    International Nuclear Information System (INIS)

    Graybill, R.E.; DiCola, F.E.; Solanas, C.H.

    1985-01-01

    Nuclear utilities are under pressure to reduce their operating and maintenance expenses such that the total cost of generating electricity through nuclear power remains an economically attractive option. One area in which expenses may be reduced is total inventory carrying cost. The total inventory carrying cost consists of financing an inventory, managing the inventory, assuring quality, engineering of acceptable parts specifications, and procuring initial and replenishment stock. Concepts and methodology must be developed to reduce the remaining expenses of a utility's total inventory carrying cost. Currently, two concepts exist: pooled inventory management system (PIMS), originally established by General Electric Company and a group of boiling water reactor owners, and Nuclear Parts Associates' (NUPA) shared inventory management program (SIMP). Both concepts share or pool parts and components among utilities. The SIMP program objectives and technical activities are summarized

  7. Long-Term Storage of Cryptosporidium parvum for In Vitro Culture

    NARCIS (Netherlands)

    Paziewska-Harris, A.; Schoone, G.; Schallig, H. D. F. H.

    2018-01-01

    The long-term storage of Cryptosporidium life-cycle stages is a prerequisite for in vitro culture of the parasite. Cryptosporidium parvum oocysts, sporozoites, and intracellular forms inside infected host cells were stored for 6-12 mo in liquid nitrogen utilizing different cryoprotectants (dimethyl

  8. Long Term Monitoring of Microbial Induced Soil Strengthening Processes

    Science.gov (United States)

    Saneiyan, S.; Ntarlagiannis, D.; Werkema, D. D., Jr.; Colwell, F. S.; Ohan, J.

    2016-12-01

    Soil strengthening/stabilization processes are used to address some of soil quality issues. Microbial induced calcite precipitation (MICP) is a promising soil stabilization process that could offer long term solution by overcoming problems of commonly used methods (e.g. injecting cement slurry). MICP can be applied in larger spatial scales, allowing the enhanced soils to be maintained in an economic sustainable and environmental friendly way. Methods are sought for the long term monitoring of MICP enhanced soils. The spectral induced polarization (SIP) method is one promising method due to sensitivity on such processes and the ability for long term, even autonomous, operation as well as cost effectiveness. Previous laboratory tests showed the sensitivity of the SIP method on soil strengthening as a result of abiotic calcite precipitation. We extended this work to biotic calcite precipitation through MICP. Early results suggest that the MICP formed calcite is denser and could provide improved strengthening capabilities. Our results are supported by geophysical (SIP and shear-wave velocity), geo-chemical and microbiological monitoring. Destructive analysis and visualization (scanning electron imaging - SEM) is expected to provide conclusive evidence on the MICP long term effectiveness.

  9. Are There Long-term Academic Benefits of Full-Day Kindergarten? A Population-Based Analysis

    Directory of Open Access Journals (Sweden)

    Marni Brownell

    2017-04-01

    Our findings indicate no apparent benefits of universal FDK, and limited benefits from targeted FDK, specifically long-term improvements in numeracy for low-income girls. No reductions in inequity were found. Decisions regarding FDK implementation should weigh the costs of this program against the limited long-term academic benefits.

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

    OpenAIRE

    Barbieri, Marco; Capri, Stefano

    2016-01-01

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

  11. The Impact of Policy Incentives on Long-Term Care Insurance and Medicaid Costs: Does Underwriting Matter?

    Science.gov (United States)

    Cornell, Portia Y; Grabowski, David C

    2018-05-16

    To test whether underwriting modifies the effect of state-based incentives on individuals' purchase of long-term care insurance. Health and Retirement Study (HRS), 1996-2012. We estimated difference-in-difference regression models with an interaction of state policy indicators with individuals' probabilities of being approved for long-term care insurance. We imputed probabilities of underwriting approval for respondents in the HRS using a model developed with underwriting decisions from two U.S. insurance firms. We measured the elasticity response to long-term care insurance price using changes in simulated after-tax price as an instrumental variable for premium price. Tax incentives and Partnership programs increased insurance purchase by 3.62 percentage points and 1.8 percentage points, respectively, among those with the lowest risk (highest approval probability). Neither had any statistically significant effects among the highest risk individuals. We show that ignoring the effects of underwriting may lead to biased estimates of the potential state budget savings of long-term care insurance tax incentives. If the private market is to play a role in financing long-term care, policies need to address the underlying adverse selection problems. © Health Research and Educational Trust.

  12. Long term aspects of uranium tailings management

    International Nuclear Information System (INIS)

    Bragg, K.

    1980-05-01

    This paper sets out the background issues which lead to the development of interim close-out criteria for uranium mill tailings. It places the current state-of-the-art for tailings management into both a national and international perspective and shows why such interim criteria are needed now. There are seven specific criteria proposed dealing with the need to have: passive barriers, limits on surface water recharge, durable systems, long term performance guarantees, limits to access, controls on water and airborne releases and finally to have a knowledge of exposure pathways. This paper is intended to serve as a focus for subsequent discussions with all concerned parties. (auth)

  13. Vitamin D and the Promotion of Long-Term Metabolic Health from a Programming Perspective

    Directory of Open Access Journals (Sweden)

    Saranya Palaniswamy

    2015-01-01

    Full Text Available Studies linking vitamin D and long-term metabolic health have generated much debate. Recommendations for the intake of vitamin D by the general public and by the health care professionals have been complicated by a number of inconsistencies in the literature. These caveats relate to the methodological approaches, differences in the populations (and the species of study, and the definitions used for thresholds of vitamin D status. This review addresses current evidence available for assessing the potential programming of long-term metabolic health of offspring by maternal vitamin D status in pregnancy. It summarizes knowledge on the early origins of metabolic health and analyzes evidence for an association between the vitamin D status in pregnancy and maternal and fetal health status. In addition, we analyze the link between the regulation of inflammation and the vitamin D status in the general population to inform on the general mechanisms through which early vitamin D might affect the programming of long-term health. The evidence suggests an association between the vitamin D status in early life and the programming of long-term health. However, to the best of our knowledge, the current finding is insufficient to draw a final conclusion for evidence-based preventive actions. The data warrant replication in prospective studies and additional research substantiating the causal factors and pathways.

  14. Long Term Inactive Well Program requirements : interim directive ID 97-08

    International Nuclear Information System (INIS)

    1997-01-01

    The Alberta Energy and Utilities Board and the petroleum industry have agreed that industry must take proactive measures to reduce the number of long term inactive wells in Alberta. This interim directive outlines the requirements of the Long Term Inactive Well Program, and provides a schedule for industry to reduce the number of inactive wells. EUB estimates that there are currently 35,000 inactive wells in Alberta, 10,000 of which have been inactive for more than 10 consecutive years. These wells pose a financial risk to the Abandonment Fund which was established to help fund the abandonment of orphan wells. The Long Term Inactive Well Program was created based on the recommendations of a joint government/industry committee, and will operate for five years. 5 tabs

  15. The cost effectiveness of long-acting/extended-release antipsychotics for the treatment of schizophrenia: a systematic review of economic evaluations.

    Science.gov (United States)

    Achilla, Evanthia; McCrone, Paul

    2013-04-01

    Antipsychotic medication is the mainstay of treatment in schizophrenia. Long-acting medication has potential advantages over daily medication in improving compliance and thus reducing hospitalization and relapse rates. The high acquisition and administration costs of such formulations raise the need for pharmacoeconomic evaluation. The aim of this article is to provide a comprehensive review of the available evidence on the cost effectiveness of long-acting/extended-release antipsychotic medication and critically appraise the strength of evidence reported in the studies from a methodological viewpoint. Relevant studies were identified by searching five electronic databases: PsycINFO, MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database (HTA). Search terms included, but were not limited to, 'long-acting injection', 'economic evaluation', 'cost-effectiveness' and 'cost-utility'. No limits were applied for publication dates and language. Full economic evaluations on long-acting/extended-release antipsychotics were eligible for inclusion. Observational studies and clinical trials were also checked for cost-effectiveness information. Conference abstracts and poster presentations on the cost effectiveness of long-acting antipsychotics were excluded. Thirty-two percent of identified studies met the selection criteria. Pertinent abstracts were reviewed independently by two reviewers. Relevant studies underwent data extraction by one reviewer and were checked by a second, with any discrepancies being clarified during consensus meetings. Eligible studies were assessed for methodological quality using the quality checklist for economic studies recommended by the NICE guideline on interventions in the treatment and management of schizophrenia. After applying the selection criteria, the final sample consisted of 28 studies. The majority of studies demonstrated that risperidone long-acting injection, relative to oral or other long

  16. Utility systems operation: Optimisation-based decision making

    International Nuclear Information System (INIS)

    Velasco-Garcia, Patricia; Varbanov, Petar Sabev; Arellano-Garcia, Harvey; Wozny, Guenter

    2011-01-01

    Utility systems provide heat and power to industrial sites. The importance of operating these systems in an optimal way has increased significantly due to the unstable and in the long term rising prices of fossil fuels as well as the need for reducing the greenhouse gas emissions. This paper presents an analysis of the problem for supporting operator decision making under conditions of variable steam demands from the production processes on an industrial site. An optimisation model has been developed, where besides for running the utility system, also the costs associated with starting-up the operating units have been modelled. The illustrative case study shows that accounting for the shut-downs and start-ups of utility operating units can bring significant cost savings. - Highlights: → Optimisation methodology for decision making on running utility systems. → Accounting for varying steam demands. → Optimal operating specifications when a demand change occurs. → Operating costs include start-up costs of boilers and other units. → Validated on a real-life case study. Up to 20% cost savings are possible.

  17. Effect of long-term storage of LWR spent fuel on Pu-thermal fuel cycle

    International Nuclear Information System (INIS)

    Kurosawa, Masayoshi; Naito, Yoshitaka; Suyama, Kenya; Itahara, Kuniyuki; Suzuki, Katsuo; Hamada, Koji

    1998-01-01

    According to the Long-term Program for Research, Development and Utilization of Nuclear Energy (June, 1994) in Japan, the Rokkasho Reprocessing Plant will be operated shortly after the year 2000, and the planning of the construction of the second commercial plant will be decided around 2010. Also, it is described that spent fuel storage has a positive meaning as an energy resource for the future utilization of Pu. Considering the balance between the increase of spent fuels and the domestic reprocessing capacity in Japan, it can be expected that the long-term storage of UO 2 spent fuels will be required. Then, we studied the effect of long-term storage of spent fuels on Pu-thermal fuel cycle. The burnup calculation were performed on the typical Japanese PWR fuel, and the burnup and criticality calculations were carried out on the Pu-thermal cores with MOX fuel. Based on the results, we evaluate the influence of extending the spent fuel storage term on the criticality safety, shielding design of the reprocessing plant and the core life time of the MOX core, etc. As the result of this work on long-term storage of LWR spent fuels, it becomes clear that there are few demerits regarding the lifetime of a MOX reactor core, and that there are many merits regarding the safety aspects of the fuel cycle facilities. Furthermore, long-term storage is meaningful as energy storage for effective utilization of Pu to be improved by technological innovation in future, and it will allow for sufficient time for the important policymaking of nuclear fuel cycle establishment in Japan. (author)

  18. Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

    Directory of Open Access Journals (Sweden)

    Menditto E

    2015-11-01

    Full Text Available Enrica Menditto,1 Valentina Orlando,1 Silvia Coretti,2 Daria Putignano,1 Denise Fiorentino,1 Matteo Ruggeri2 1CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, 2Postgraduate School of Health Economics and Management (ALTEMS, Università Cattolica del Sacro Cuore, School of Economics, Rome, Italy Background: Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. Methods: Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€.The market penetration of biosimilars was analyzed by year and quarterly. Results: In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend

  19. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

    Directory of Open Access Journals (Sweden)

    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  20. Medical therapy v. PCI in stable coronary artery disease: a cost-effectiveness analysis.

    Science.gov (United States)

    Wijeysundera, Harindra C; Tomlinson, George; Ko, Dennis T; Dzavik, Vladimir; Krahn, Murray D

    2013-10-01

    Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS) reduces angina and repeat procedures compared with optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset their increased costs and small increase in adverse events. Cost utility analysis of initial medical therapy v. PCI with either BMS or DES. . Markov cohort decision model. Data Sources. Propensity-matched observational data from Ontario, Canada, for baseline event rates. Effectiveness and utility data obtained from the published literature, with costs from the Ontario Case Costing Initiative. Patients with stable coronary artery disease, confirmed after angiography, stratified by risk of restenosis based on diabetic status, lesion size, and lesion length. Time Horizon. Lifetime. Perspective. Ontario Ministry of Health and Long Term Care. Interventions. Optimal medical therapy, PCI with BMS or DES. Lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). of Base Case Analysis. In the overall population, medical therapy had the lowest lifetime costs at $22,952 v. $25,081 and $25,536 for BMS and DES, respectively. Medical therapy had a quality-adjusted life expectancy of 10.1 v. 10.26 QALYs for BMS, producing an ICER of $13,271/QALY. The DES strategy had a quality-adjusted life expectancy of only 10.20 QALYs and was dominated by the BMS strategy. This ranking was consistent in all groups stratified by restenosis risk, except diabetic patients with long lesions in small arteries, in whom DES was cost-effective compared with medical therapy (ICER of $18,826/QALY). Limitations. There is the possibility of residual unobserved confounding. In patients with stable coronary artery disease, an initial BMS strategy is cost-effective.

  1. Long-term storage of spent nuclear fuel

    International Nuclear Information System (INIS)

    Kempe, T.F.; Martin, A.; Thorne, M.C.

    1980-06-01

    This report presents the results of a study on the storage of spent nuclear fuel, with particular reference to the options which would be available for long-term storage. Two reference programmes of nuclear power generation in the UK are defined and these are used as a basis for the projection of arisings of spent fuel and the storage capacity which might be needed. The characteristics of spent fuel which are relevant to long-term storage include the dimensions, materials and physical construction of the elements, their radioactive inventory and the associated decay heating as a function of time after removal from the reactor. Information on the behaviour of spent fuel in storage ponds is reviewed with particular reference to the corrosion of the cladding. The review indicates that, for long-term storage, both Magnox and AGR fuel would need to be packaged because of the high rate of cladding corrosion and the resulting radiological problems. The position on PWR fuel is less certain. Experience of dry storage is less extensive but it appears that the rate of corrosion of cladding is much lower than in water. Unit costs are discussed. Consideration is given to the radiological impact of fuel storage. (author)

  2. Assessing long-term QALYs gain from averting and reversing overweight and obesity in childhood.

    Science.gov (United States)

    Techakehakij, Win

    2016-10-01

    Interventions to tackle childhood obesity have been devised in response to the rising prevalence of childhood obesity. However, efficiency of these interventions remains a concern. Cost-utility analysis, representing health benefits in terms of quality-adjusted life years (QALYs), is a type of economic evaluation that has widely been recommended in assessing efficiency of health interventions. However, certain limitations in using QALYs remain specifically difficult in QALYs estimation. This study estimates the long-term QALYs gain from reversing childhood obesity in Thailand. An economic model was developed to estimate long-term QALYs of the youth aged 3-18 for the BMI status in childhood, which were categorized into three groups: normal weight, overweight, and obese. Long-term QALYs were estimated between ages 35 and 100, according to children's age, sex, and BMI status. Differences in QALYs between BMI status groups were calculated to represent the QALYs gain for youth from reversing obesity and overweight. The future outcomes were discounted at 3 % per annum in the base-case analysis; the discount rates of 0, 1.5, 3.5, and 5 % were also applied in the sensitivity analyses. QALYs gained from reversing childhood obesity increase with age, starting from 0.040 and 0.083 QALYs at age 3 to 0.590 and 0.553 QALYs at age 18 in boys and girls, respectively. Reversing overweight and obesity in girls produces more QALYs than in boys between ages 3 and 17. Efficiency is an important issue in allocating public healthcare resources to maximize social benefits. The results of this study facilitate long-term QALYs estimation with respect to BMI status in childhood, which could encourage more routine economic evaluation of child obesity interventions and maximize their health benefits.

  3. Cost-effectiveness of Tofacitinib in the Treatment of Moderate to Severe Rheumatoid Arthritis in South Korea.

    Science.gov (United States)

    Lee, Min-Young; Park, Sun-Kyeong; Park, Sun-Young; Byun, Ji-Hye; Lee, Sang-Min; Ko, Su-Kyoung; Lee, Eui-Kyung

    2015-08-01

    This study evaluated the cost-effectiveness of introducing tofacitinib, an oral Janus kinase inhibitor, to the treatment of Korean patients with rheumatoid arthritis (RA) and an inadequate response to conventional disease-modifying antirheumatic drugs. In this cost-utility analysis model, patients transitioned through treatment sequences based on Korean guidelines for RA patients with inadequate response to conventional disease-modifying antirheumatic drugs. Lifetime health-related quality of life and costs were evaluated. Characteristics of the model cohort were based on those reported by the Oral Rheumatoid Arthritis phase 3 triaL (ORAL) Standard randomized Controlled trial of tofacitinib or adalimumab versus placebo. Efficacy was assessed using American College of Rheumatology response rates, converted to the changes in Health Assessment Questionnaire-Disability Index (HAQ-DI) scores, based on tofacitinib clinical trials data. Published clinical trial data on discontinuation rates of the indicated drugs were incorporated in the model. The HAQ-DI scores were mapped onto utility values to calculate outcomes in terms of quality-adjusted life-years (QALYs); HAQ-DI-to-utility (EuroQoL 5D) mapping was based on data from 5 tofacitinib clinical trials. Costs were analyzed from a societal perspective, with values expressed in 2013 Korean won (KRW). Cost-effectiveness is presented in terms of incremental cost-effectiveness ratios (ICERs). One-way sensitivity analyses were performed to assess the robustness of the model. First-line tofacitinib used before the standard of care (base-case analysis) increased both treatment costs and QALYs gained versus the standard-of-care treatment sequence, resulting in an ICER of KRW 13,228,910 per QALY. Tofacitinib also increased costs and QALYs gained when incorporated as a second-, third-, or fourth-line therapy. The inclusion of first-line tofacitinib increased the duration of active immunomodulatory therapy from 9.4 to 13.2 years

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

    Science.gov (United States)

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

    2012-01-01

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

  5. What do short-term and long-term relationships look like? Building the relationship coordination and strategic timing (ReCAST) model.

    Science.gov (United States)

    Eastwick, Paul W; Keneski, Elizabeth; Morgan, Taylor A; McDonald, Meagan A; Huang, Sabrina A

    2018-05-01

    Close relationships research has examined committed couples (e.g., dating relationships, marriages) using intensive methods that plot relationship development over time. But a substantial proportion of people's real-life sexual experiences take place (a) before committed relationships become "official" and (b) in short-term relationships; methods that document the time course of relationships have rarely been applied to these contexts. We adapted a classic relationship trajectory-plotting technique to generate the first empirical comparisons between the features of people's real-life short-term and long-term relationships across their entire timespan. Five studies compared long-term and short-term relationships in terms of the timing of relationship milestones (e.g., flirting, first sexual intercourse) and the occurrence/intensity of important relationship experiences (e.g., romantic interest, strong sexual desire, attachment). As romantic interest was rising and partners were becoming acquainted, long-term and short-term relationships were indistinguishable. Eventually, romantic interest in short-term relationships plateaued and declined while romantic interest in long-term relationships continued to rise, ultimately reaching a higher peak. As relationships progressed, participants evidenced more features characteristic of the attachment-behavioral system (e.g., attachment, caregiving) in long-term than short-term relationships but similar levels of other features (e.g., sexual desire, self-promotion, intrasexual competition). These data inform a new synthesis of close relationships and evolutionary psychological perspectives called the Relationship Coordination and Strategic Timing (ReCAST) model. ReCAST depicts short-term and long-term relationships as partially overlapping trajectories (rather than relationships initiated with distinct strategies) that differ in their progression along a normative relationship development sequence. (PsycINFO Database Record (c

  6. Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines.

    Directory of Open Access Journals (Sweden)

    Manuel Alexander Haasis

    Full Text Available The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies.A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs in Philippine peso (Php per QALY gained (1 USD = 44.20 Php. Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty.With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13 due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program.The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.

  7. A model-based assessment of the cost-utility of strategies to identify Lynch syndrome in early-onset colorectal cancer patients.

    Science.gov (United States)

    Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

    2015-04-25

    Lynch syndrome is an autosomal dominant cancer predisposition syndrome caused by mutations in the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2. Individuals with Lynch syndrome have an increased risk of colorectal cancer, endometrial cancer, ovarian and other cancers. Lynch syndrome remains underdiagnosed in the UK. Reflex testing for Lynch syndrome in early-onset colorectal cancer patients is proposed as a method to identify more families affected by Lynch syndrome and offer surveillance to reduce cancer risks, although cost-effectiveness is viewed as a barrier to implementation. The objective of this project was to estimate the cost-utility of strategies to identify Lynch syndrome in individuals with early-onset colorectal cancer in the NHS. A decision analytic model was developed which simulated diagnostic and long-term outcomes over a lifetime horizon for colorectal cancer patients with and without Lynch syndrome and for relatives of those patients. Nine diagnostic strategies were modelled which included microsatellite instability (MSI) testing, immunohistochemistry (IHC), BRAF mutation testing (methylation testing in a scenario analysis), diagnostic mutation testing and Amsterdam II criteria. Biennial colonoscopic surveillance was included for individuals diagnosed with Lynch syndrome and accepting surveillance. Prophylactic hysterectomy with bilateral salpingo-oophorectomy (H-BSO) was similarly included for women diagnosed with Lynch syndrome. Costs from NHS and Personal Social Services perspective and quality-adjusted life years (QALYs) were estimated and discounted at 3.5% per annum. All strategies included for the identification of Lynch syndrome were cost-effective versus no testing. The strategy with the greatest net health benefit was MSI followed by BRAF followed by diagnostic genetic testing, costing £5,491 per QALY gained over no testing. The effect of prophylactic H-BSO on health-related quality of life (HRQoL) is uncertain and could outweigh

  8. Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome.

    Science.gov (United States)

    Lindfors, Perjohan; Unge, Peter; Nyhlin, Henry; Ljótsson, Brjánn; Björnsson, Einar S; Abrahamsson, Hasse; Simrén, Magnus

    2012-04-01

    Gut-directed hypnotherapy is considered to be an effective treatment in irritable bowel syndrome (IBS) but few studies report the long-term effects. This retrospective study aims to evaluate the long-term perceived efficacy of gut-directed hypnotherapy given outside highly specialized hypnotherapy centers. 208 patients, who all had received gut-directed hypnotherapy, were retrospectively evaluated. The Subjective Assessment Questionnaire (SAQ) was used to measure changes in IBS symptoms, and patients were classified as responders and non-responders. Patients were also asked to report changes in health-care seeking, use of drugs for IBS symptoms, use of alternative non-pharmacological treatments, and if they still actively used hypnotherapy. Immediately after hypnotherapy, 103 of 208 patients (49%) were responders and 75 of these (73%) had improved further at the follow-up 2-7 years after hypnotherapy (mean 4 years). A majority of the responders still used hypnotherapy on a regular basis at follow-up (73%), and the responders reported a greater reduction in health-care seeking than non-responders. A total of 87% of all patients reported that they considered gut-directed hypnotherapy to be worthwhile, and this differed between responders and non-responders (100% vs. 74%; p hypnotherapy in refractory IBS is an effective treatment option with long-lasting effects, also when given outside highly specialized hypnotherapy centers. Apart from the clinical benefits, the reduction in health-care utilization has the potential to reduce the health-care costs.

  9. State Regulatory responses to acid rain: Implications for electric utility operations

    International Nuclear Information System (INIS)

    Nagelhout, M.

    1990-01-01

    This article discusses the state regulatory responses to acid rain legislation and how this will affect electric utility operations. Topics discusses include planning and fuel procurement practices, least-cost planning, long-term supply contracts, fuel mix, cogeneration and small power production, qualifying facility contracts, avoided costs, environmental impact, lobbying expense, bill inserts, and forecasting models

  10. Rural-urban differences in the long-term care of the disabled elderly in China.

    Science.gov (United States)

    Li, Mei; Zhang, Yang; Zhang, Zhenyu; Zhang, Ying; Zhou, Litao; Chen, Kun

    2013-01-01

    In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively), but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

  11. Implementation of Provider Perspectives Resulted in Proper Health Care Resource Utilization

    National Research Council Canada - National Science Library

    Mclean, Hugh

    2001-01-01

    .... One such system is Provider Perspectives. This study shows that Provider Perspectives significantly decreased Emergency Room utilization and subsequently increased the usage of primary care clinics at Martin Army Community Hospital and Winn...

  12. Archiving Primary Data: Solutions for Long-Term Studies.

    Science.gov (United States)

    Mills, James A; Teplitsky, Céline; Arroyo, Beatriz; Charmantier, Anne; Becker, Peter H; Birkhead, Tim R; Bize, Pierre; Blumstein, Daniel T; Bonenfant, Christophe; Boutin, Stan; Bushuev, Andrey; Cam, Emmanuelle; Cockburn, Andrew; Côté, Steeve D; Coulson, John C; Daunt, Francis; Dingemanse, Niels J; Doligez, Blandine; Drummond, Hugh; Espie, Richard H M; Festa-Bianchet, Marco; Frentiu, Francesca; Fitzpatrick, John W; Furness, Robert W; Garant, Dany; Gauthier, Gilles; Grant, Peter R; Griesser, Michael; Gustafsson, Lars; Hansson, Bengt; Harris, Michael P; Jiguet, Frédéric; Kjellander, Petter; Korpimäki, Erkki; Krebs, Charles J; Lens, Luc; Linnell, John D C; Low, Matthew; McAdam, Andrew; Margalida, Antoni; Merilä, Juha; Møller, Anders P; Nakagawa, Shinichi; Nilsson, Jan-Åke; Nisbet, Ian C T; van Noordwijk, Arie J; Oro, Daniel; Pärt, Tomas; Pelletier, Fanie; Potti, Jaime; Pujol, Benoit; Réale, Denis; Rockwell, Robert F; Ropert-Coudert, Yan; Roulin, Alexandre; Sedinger, James S; Swenson, Jon E; Thébaud, Christophe; Visser, Marcel E; Wanless, Sarah; Westneat, David F; Wilson, Alastair J; Zedrosser, Andreas

    2015-10-01

    The recent trend for journals to require open access to primary data included in publications has been embraced by many biologists, but has caused apprehension amongst researchers engaged in long-term ecological and evolutionary studies. A worldwide survey of 73 principal investigators (Pls) with long-term studies revealed positive attitudes towards sharing data with the agreement or involvement of the PI, and 93% of PIs have historically shared data. Only 8% were in favor of uncontrolled, open access to primary data while 63% expressed serious concern. We present here their viewpoint on an issue that can have non-trivial scientific consequences. We discuss potential costs of public data archiving and provide possible solutions to meet the needs of journals and researchers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Long-Term Symbolic Learning

    National Research Council Canada - National Science Library

    Kennedy, William G; Trafton, J. G

    2007-01-01

    What are the characteristics of long-term learning? We investigated the characteristics of long-term, symbolic learning using the Soar and ACT-R cognitive architectures running cognitive models of two simple tasks...

  14. Mathematicians' Perspectives on the Utility of Software

    Science.gov (United States)

    Quinlan, James

    2016-01-01

    In this study, we examine mathematicians' perspectives of the utility of software in mathematics and the teaching of mathematics. In particular, we report findings from a survey questioning 422 mathematicians with respect to their beliefs regarding the usefulness of software in mathematics research, teaching, and learning; recommended software…

  15. Pediatric polytrauma : Short-term and long-term outcomes

    NARCIS (Netherlands)

    vanderSluis, CK; Kingma, J; Eisma, WH; tenDuis, HJ

    Objective: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. Materials and Methods: Ail pediatric polytrauma patients (Injury Severity Score of greater than or equal to 16, less than

  16. Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

    Science.gov (United States)

    Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

    2014-11-01

    Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

  17. Long-term storage of radioactive waste: IAEA perspectives on safety and sustainability

    International Nuclear Information System (INIS)

    Rowat, J.H.; Louvat, D.; Metcalf, P.E.

    2006-01-01

    As the amounts of radioactive waste in surface storage have increased, concern has grown over the safety and sustainability of storage in the long term. In response to increasing concerns, the International Atomic Energy Agency (IAEA) has included an action to address the safety implications of the long-term storage (LTS) of radioactive waste in its action plan for waste safety; the action plan was endorsed by the IAEA's Member States in 2001. In 2003, the IAEA published a position paper on the safety and sustainability of LTS as part fulfilment of the action in question. A key theme of the position paper is the contrast of safety and sustainability implications of LTS with those of disposal. The present paper provides a summary of the position paper, describes current IAEA activities that deal with the subject of LTS, and discusses findings from the 2004 Cordoba symposium on disposal of low activity radioactive waste that pertain to LTS. (author)

  18. Assessment of long-term leaching from waste incineration air-pollution-control residues

    DEFF Research Database (Denmark)

    Astrup, Thomas; Mosbæk, Hans; Christensen, Thomas Højlund

    2006-01-01

    Assessment of long-term leaching from MSWI air-pollution-control (APC) residues is discussed with respect to use in environmental impact assessment, such as life-cycle assessment (LCA). A method was proposed for estimating leaching as a function of the liquid-to-solid (L/S) ratio in a long......-term perspective (L/S 5000l/kg). Data for changes in residue pH as a function of L/S was used in combination with pH dependent leaching data to predict leachate concentrations of Al, Ca, Cd, Ba, Mg, Ni, Pb, S, Pb, V and Zn as a function of L/S. Mass balance calculations were used to determine the element fractions...... leached with respect to L/S. The estimated long-term leaching from a semi-dry residue and a fly ash was compared with short-term leaching determined by batch tests at L/S 10l/kg, both carbonated and non-carbonated versions of the residues were investigated. Generally, very high L/S ratios above 2000l...

  19. USE OF THE INFORMATION SYSTEM COSTS UNDER MANAGEMENT PROCESS

    Directory of Open Access Journals (Sweden)

    ECOBICI NICOLAE

    2014-12-01

    Full Text Available Decision-making takes place at all levels of the organization, taking into account both short-term outlook and long-term perspective. Plans are implemented by decisions whose purpose is materialized by formulating rational conclusions obtained as a result of financial and quantitative analysis. Thus, managerial accounting practice is deeply involved in decision making, a basic requirement of the existence of a solid managerial accounting information system cost, able to provide fundamental data.

  20. USE OF THE INFORMATION SYSTEM COSTS UNDER MANAGEMENT PROCESS

    Directory of Open Access Journals (Sweden)

    EC OBICI NICOLAE

    2014-12-01

    Full Text Available Decision-making takes place at all levels of the organization, taking into account both short-term outlook and long-term perspective. Plans are implemented by decisions whose purpose is materialized by formulating rational conclusions obtained as a result of financial and quantitative analysis. Thus, managerial accounting practice is deeply involved in decision making, a basic requirement of the existence of a solid managerial accounting information system cost, able to provide fundamental data

  1. Comparative study of short- and long-term indoor radon measurements

    Energy Technology Data Exchange (ETDEWEB)

    Al-Jarallah, M.I. [Department of Physics, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia)], E-mail: mibrahim@kfupm.edu.sa; Fazal-ur-Rehman,; Abdalla, Khalid [Department of Physics, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia)

    2008-08-15

    Short-term indoor radon measurements are used widely. Therefore, it is interesting to find out a correlation between these measurements and long-term measurements which reflect a better average radon concentration of individual measurement. To find the correlation between the two measurements of indoor radon concentrations at low radon levels, a study was carried out at 34 locations of King Fahd University of Petroleum and Minerals (KFUPM), Dhahran, Saudi Arabia using active and passive methods. In the short-term active method, a radon gas analyzer (AlphaGUARD) was used for a duration of 24 h in each measurement. In the long-term passive method, CR-39 based radon dosimeters were utilized for a period of 6 months, from January 2006 to June 2006. The short-term active measurements showed that the average, minimum and maximum radon concentrations were 19, 8 and 58Bqm{sup -3}, respectively, with a standard deviation of 8.6Bqm{sup -3}. The long-term passive measurements showed that the average, minimum and maximum radon concentrations were 25, 10 and 67Bqm{sup -3}, respectively, with a standard deviation of 12Bqm{sup -3}. The two measurements showed a poor correlation (R{sup 2}=0.38). The long-term measurements showed on the average higher concentrations by a factor of 1.3.

  2. Electric utility power plant construction costs, 1st Edition

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    New UDI report combines historical construction costs for more than 1,000 coal, oil, gas, nuclear and geothermal units that have entered commercial operation since 1966 and projected power plant construction costs for about 400 utility-owned generating units scheduled to enter commercial operation during the next 20 years. Key design characteristics and equipment suppliers, A/E, constructor and original installed cost data. Direct construction costs without AFUDC are provided where known. Historical construction cost data are also provided for about 130 utility-owned hydroelectric, gas turbine, combined-cycle and diesel units (these data are generally for units entering service after 1980)

  3. Being a long-term user of nicotine replacement therapy

    DEFF Research Database (Denmark)

    Borup, Gitte; Nørgaard, Lotte Stig; Tønnesen, Philip

    Background During recent years a gradual shift in the application of nicotine replacement therapy (NRT) has taken place from NRT-products only being recommended to achieve smoking cessation, to now including smoking reduction, and long-term substitution of tobacco with NRT has taken place. This has...... been promoted as a way of achieving harm-reduction in highly nicotine dependent smokers who are unwilling or incapable of quitting all nicotine products, as continued use of NRT is widely accepted as being far less hazardous than continued smoking. To our knowledge no previous research has been done...... of feeling addicted, cost of NRT products and fear of adverse health consequences. Aim of study • To get a thorough understanding of the lived experiences of nicotine dependent long-term NRT users. • To investigate what motivates or discourages quitting NRT. Method Semi-structured interviews with long...

  4. A proposed method for determining long term optimum utilization ...

    African Journals Online (AJOL)

    Application of utilization intensity as an experimental variable by the use of the pasture disc meter and the put- and take technique is recommended as an alternative to stocking rate experiments. Utilization intensity allows stocking rate to be used as a measure of pasture productivity and consequently the relationship ...

  5. Long-Term Engagement in Formal Volunteering and Well-Being: An Exploratory Indian Study.

    Science.gov (United States)

    Elias, Jereesh K; Sudhir, Paulomi; Mehrotra, Seema

    2016-09-27

    Sustained engagement in volunteering and its correlates have been examined in many studies across the globe. However, there is a dearth of research that explores the perspectives of long-term formal volunteers on the nature of changes perceived in oneself as a result of volunteering. Moreover, the linkages between psychological well-being and volunteering have been insufficiently explored. The present study was aimed at addressing these gaps. A heterogeneous sample of 20 long-term formal volunteer engaged in volunteering across different voluntary organisations in a southern metropolitan Indian city formed the primary sample for the study. In addition, a group of 21 short-term volunteers, matched on age, income and gender, was utilised for comparison with long-term volunteers on well-being indices. A semi structured interview schedule was used to explore self-perceived changes attributable to volunteering experience. In addition, a few standardised measures were used to comprehensively assess subjective well-being and psychological well-being. The interview data provided rich descriptions of perceived positive changes in self across cognitive, behavioral and emotional domains. Mirroring these patterns, the quantitative analyses indicated that long-term volunteers experienced higher levels of psychological well-being (sense of mastery and competence, self-acceptance and sense of engagement and growth) than short-term volunteers. The potential mechanisms involved in beneficial outcomes of long-term volunteering and implications for further research are highlighted.

  6. Cost-Effectiveness of Treatments for Relapsing Remitting Multiple Sclerosis: A French Societal Perspective.

    Directory of Open Access Journals (Sweden)

    Julie Chevalier

    Full Text Available The paper aimed to estimate the incremental cost-effectiveness ratio (ICER at the public published price for delayed-release dimethyl fumarate versus relevant Multiple Sclerosis disease-modifying therapies available in France in June 2015.The economic model was adapted to the French setting in accordance with the Haute Autorité de Santé guidelines using a model previously developed for NICE. A cohort of Relapsing Remitting Multiple Sclerosis patients was simulated over a 30-year time horizon. Twenty one health states were taken into account: Kurtzke Expanded Disability Status Scale (EDSS 0-9 for Relapsing Remitting Multiple Sclerosis patients, EDSS 0-9 for Secondary Progressive Multiple Sclerosis patients, and death. Estimates of relative treatment efficacy were determined using a mixed-treatment comparison. Probabilities of events were derived from the dimethyl fumarate pivotal clinical trials and the London Ontario Dataset. Costs and utilities were extracted from the published literature from both the payer and societal perspectives. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model results.From both perspectives, dimethyl fumarate and interferon beta-1a (IFN beta-1a 44 mcg were the two optimal treatments, as the other treatments (IFN beta-1a 30 mcg, IFN beta-1b 250 mcg, teriflunomide, glatiramer acetate, fingolimod were dominated on the efficiency frontier. From the societal perspective, dimethyl fumarate versus IFN beta-1a 44 mcg incurred an incremental cost of €3,684 and an incremental quality-adjusted life year (QALY of 0.281, corresponding to an ICER of €13,110/QALY.Despite no reference threshold for France, dimethyl fumarate can be considered as a cost-effective option as it is on the efficiency frontier.

  7. Cost-Effectiveness of Treatments for Relapsing Remitting Multiple Sclerosis: A French Societal Perspective.

    Science.gov (United States)

    Chevalier, Julie; Chamoux, Catherine; Hammès, Florence; Chicoye, Annie

    2016-01-01

    The paper aimed to estimate the incremental cost-effectiveness ratio (ICER) at the public published price for delayed-release dimethyl fumarate versus relevant Multiple Sclerosis disease-modifying therapies available in France in June 2015. The economic model was adapted to the French setting in accordance with the Haute Autorité de Santé guidelines using a model previously developed for NICE. A cohort of Relapsing Remitting Multiple Sclerosis patients was simulated over a 30-year time horizon. Twenty one health states were taken into account: Kurtzke Expanded Disability Status Scale (EDSS) 0-9 for Relapsing Remitting Multiple Sclerosis patients, EDSS 0-9 for Secondary Progressive Multiple Sclerosis patients, and death. Estimates of relative treatment efficacy were determined using a mixed-treatment comparison. Probabilities of events were derived from the dimethyl fumarate pivotal clinical trials and the London Ontario Dataset. Costs and utilities were extracted from the published literature from both the payer and societal perspectives. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model results. From both perspectives, dimethyl fumarate and interferon beta-1a (IFN beta-1a) 44 mcg were the two optimal treatments, as the other treatments (IFN beta-1a 30 mcg, IFN beta-1b 250 mcg, teriflunomide, glatiramer acetate, fingolimod) were dominated on the efficiency frontier. From the societal perspective, dimethyl fumarate versus IFN beta-1a 44 mcg incurred an incremental cost of €3,684 and an incremental quality-adjusted life year (QALY) of 0.281, corresponding to an ICER of €13,110/QALY. Despite no reference threshold for France, dimethyl fumarate can be considered as a cost-effective option as it is on the efficiency frontier.

  8. Long-term Nash equilibria in electricity markets

    International Nuclear Information System (INIS)

    Pozo, David; Contreras, Javier; Caballero, Angel; de Andres, Antonio

    2011-01-01

    In competitive electricity markets, companies simultaneously offer their productions to obtain the maximum profits on a daily basis. In the long run, the strategies utilized by the electric companies lead to various long-term equilibria that can be analyzed with the appropriate tools. We present a methodology to find plausible long-term Nash equilibria in pool-based electricity markets. The methodology is based on an iterative market Nash equilibrium model in which the companies can decide upon their offer strategies. An exponential smoothing of the bids submitted by the companies is applied to facilitate the convergence of the iterative procedure. In each iteration of the model the companies face residual demand curves that are accurately modeled by Hermite interpolating polynomials. We introduce the concept of meta-game equilibrium strategies to allow companies to have a range of offer strategies where several pure and mixed meta-game Nash equilibria are possible. With our model it is also possible to model uncertainty or to generate price scenarios for financial models that assess the value of a generating unit by real options analysis. The application of the proposed methodology is illustrated with several realistic case studies. (author)

  9. The Electrification of Energy: Long-Term Trends and Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Tsao, Jeffrey Y. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Fouquet, Roger [London School of Economics and Political Science (United Kingdom); Schubert, E. Fred [Rensselaer Polytechnic Inst., Troy, NY (United States)

    2017-11-01

    Here, we present and analyze three powerful long-term historical trends in energy, particularly electrical energy, as well as the opportunities and challenges associated with these trends. The first trend is from a world containing a diversity of energy currencies to one whose predominant currency is electricity, driven by electricity’s transportability, exchangeability, and steadily decreasing cost. The second trend is from electricity generated from a diversity of sources to electricity generated predominantly by free-fuel sources, driven by their steadily decreasing cost and long-term abundance. These trends necessitate a just-emerging third trend: from a grid in which electricity is transported uni-directionally, traded at near-static prices, and consumed under direct human control; to a grid in which electricity is transported bi-directionally, traded at dynamic prices, and consumed under human-tailored agential control. Early acceptance and appreciation of these trends will accelerate their remaking of humanity’s energy landscape into one in which energy is much more affordable, abundant and efficiently deployed than it is today; with major economic, geo-political, and environmental benefits to human society.

  10. Meaning in life: the perspective of long-term care residents.

    Science.gov (United States)

    Welsh, Darlene; Moore, Sharon L; Getzlaf, Beverley A

    2012-07-01

    A qualitative approach was used in the exploration of meaning in life for long-term care (LTC) residents. This hermeneutic phenomenological study, as described by van Manen, was conducted using semi-structured interviews with 11 LTC residents from a rural region in Atlantic Canada. Four themes emerged as enhancing meaning in life for the residents in this study: Connectedness, Survival Despite Declining Functional Capacity, Engaging in "Normal" Activities, and Seeking a Place of Refuge. In this article, we describe the emerging themes and the implications for LTC education, practice, and future research. Copyright 2012, SLACK Incorporated.

  11. Incentive-Based Primary Care: Cost and Utilization Analysis.

    Science.gov (United States)

    Hollander, Marcus J; Kadlec, Helena

    2015-01-01

    In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

  12. Multiyear Synthesis of Limnological Data from 1993 to 2001 for the Long Term Resource Monitoring Program

    National Research Council Canada - National Science Library

    Houser, Jeffrey N; Bierman, David W; Burdis, Robert M; Fischer, James R; Rogala, James T; Soeken-Gittinger, Lori A; Hoff, Kraig L; Harms, Erik

    2005-01-01

    .... The Long Term Resource Monitoring Program (LTRMP) provides a systemic perspective through the collection and analysis of monitoring data from six study reaches representing the upper, lower, and open river reaches of the UMRS...

  13. What is heartburn worth? A cost-utility analysis of management strategies.

    Science.gov (United States)

    Heudebert, G R; Centor, R M; Klapow, J C; Marks, R; Johnson, L; Wilcox, C M

    2000-03-01

    To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life.

  14. An economic model of long-term use of celecoxib in patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Rublee Dale

    2007-07-01

    Full Text Available Abstract Background Previous evaluations of the cost-effectiveness of the cyclooxygenase-2 selective inhibitor celecoxib (Celebrex, Pfizer Inc, USA have produced conflicting results. The recent controversy over the cardiovascular (CV risks of rofecoxib and other coxibs has renewed interest in the economic profile of celecoxib, the only coxib now available in the United States. The objective of our study was to evaluate the long-term cost-effectiveness of celecoxib compared with nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs in a population of 60-year-old osteoarthritis (OA patients with average risks of upper gastrointestinal (UGI complications who require chronic daily NSAID therapy. Methods We used decision analysis based on data from the literature to evaluate cost-effectiveness from a modified societal perspective over patients' lifetimes, with outcomes expressed as incremental costs per quality-adjusted life-year (QALY gained. Sensitivity tests were performed to evaluate the impacts of advancing age, CV thromboembolic event risk, different analytic horizons and alternate treatment strategies after UGI adverse events. Results Our main findings were: 1 the base model incremental cost-effectiveness ratio (ICER for celecoxib versus nsNSAIDs was $31,097 per QALY; 2 the ICER per QALY was $19,309 for a model in which UGI ulcer and ulcer complication event risks increased with advancing age; 3 the ICER per QALY was $17,120 in sensitivity analyses combining serious CV thromboembolic event (myocardial infarction, stroke, CV death risks with base model assumptions. Conclusion Our model suggests that chronic celecoxib is cost-effective versus nsNSAIDs in a population of 60-year-old OA patients with average risks of UGI events.

  15. Controlling Campylobacter in the chicken meat chain - Cost-effectiveness and cost-utility analysis

    NARCIS (Netherlands)

    Mangen MJJ; Havelaar AH; Nauta MJ; Koeijer AA de; Wit GA de; LEI; Animal Sciences Group; PZO; MGB

    2005-01-01

    The aim of this study was the estimation of cost-effectiveness and cost-utility of various interventions to control Campylobacter contamination of broiler meat. The relative risk, the intervention costs, the disease burden (expressed in Disability Adjusted Live Years (DALYs)) and the

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

    International Nuclear Information System (INIS)

    Cohen, D.R.; Patel, N.

    2010-01-01

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

  17. Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

    Science.gov (United States)

    Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

    2009-10-01

    The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

  18. The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

    NARCIS (Netherlands)

    Mazairac, A.H.; Blankestijn, P.J.; Grooteman, M.P.C.; Penne, E.L.; Weerd, N.C. van der; Hoedt, C.H. den; Buskens, E.; Dorpel, M.A. van den; Wee, P.M. ter; Nube, M.J.; Bots, M.L.; Wit, G.A. de; Hamersvelt, H.W. van; et al.,

    2013-01-01

    BACKGROUND: Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). METHODS: A cost-utility analysis was performed using a

  19. The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

    NARCIS (Netherlands)

    Mazairac, Albert H. A.; Blankestijn, Peter J.; Grooteman, Muriel P. C.; Penne, E. Lars; van der Weerd, Neelke C.; den Hoedt, Claire H.; Buskens, Erik; van den Dorpel, Marinus A.; ter Wee, Piet M.; Nube, Menso J.; Bots, Michiel L.; de Wit, G. Ardine

    Background. Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). Methods. A cost-utility analysis was performed using a

  20. Long-dated evaluation of the external costs of the nuclear

    International Nuclear Information System (INIS)

    Le Dars, A.; Schneider, T.

    2002-09-01

    Since the middle of the years 1990, the European Commission developed an ''ExternE'' methodology to propose an homogenous evaluation of the sanitary and environmental external costs of the various energy sectors in Europe. This document discusses the taking into account of the long-dated and analyzes the interests and the limits of the monetary evaluation, in terms of external costs, of the nuclear choice. It is organized in three chapters: 1. a presentation and a discussion on the various evaluation of the ''ExternE'' methodology; 2. a description of the available methods for the monetary evaluation of the long-dated impacts and more particularly the analysis of the monetary values actualization principle; 3. highlighted of the impacts for which the monetary evaluations exist. (A.L.B.)

  1. Utilization of fast reactor excess neutrons for burning long-lived fission products

    International Nuclear Information System (INIS)

    Kawashima, K.; Kobayashi, K.; Kaneto, K.

    1995-01-01

    An evaluation is made on a large MOX fuel fast reactor's capability of burning long lived fission product Tc-99, which dominates the long term radiotoxicity of the high level radioactive waste. The excess neutrons generated in the fast reactor core are utilized to transmute Tc-99 to stable isotopes due to neutron capture reaction. The fission product target assemblies which consist of Tc-99 are charged to the reactor core periphery. The fission product target neutrons are moderated to a great deal to pursue the possibility of enhancing the transmutation rate. Any impacts of loading the fission product target assemblies on the core nuclear performances are assessed. A long term Tc-99 accumulation scenario is considered in the mix of fission product burner fast reactor and non-burner LWRs. (author)

  2. Analysis of the Italian generic medicines retail market: recommendations to enhance long-term sustainability.

    Science.gov (United States)

    Dylst, Pieter; Vulto, Arnold; Simoens, Steven

    2015-02-01

    Italy is among the European countries with the lowest uptake of generic medicines. This paper provides a perspective on the Italian generic medicines retail market. Fast market entrance of generic medicines in Italy is hindered by several factors: the existence of Complementary Protection Certificates in the past, the large market for copies and multiple cases of patent linkage. Prices of generic medicines in Italy are low compared to other European countries. To contain pharmaceutical expenditure, pharmaceutical companies are currently forced to pay back in case of overspending, which disproportionally penalizes small and fast growing companies, to which most generic companies belong to. Current demand-side policies do not successfully stimulate the use of generic medicines. The current market environment surrounding the Italian generic medicines retail market (i.e., low prices, low volumes) threatens its long-term sustainability. Recommendations to enhance the long-term sustainability of the Italian generic medicines retail market round off this perspective paper.

  3. Long-term fish monitoring in large rivers: Utility of “benchmarking” across basins

    Science.gov (United States)

    Ward, David L.; Casper, Andrew F.; Counihan, Timothy D.; Bayer, Jennifer M.; Waite, Ian R.; Kosovich, John J.; Chapman, Colin; Irwin, Elise R.; Sauer, Jennifer S.; Ickes, Brian; McKerrow, Alexa

    2017-01-01

    In business, benchmarking is a widely used practice of comparing your own business processes to those of other comparable companies and incorporating identified best practices to improve performance. Biologists and resource managers designing and conducting monitoring programs for fish in large river systems tend to focus on single river basins or segments of large rivers, missing opportunities to learn from those conducting fish monitoring in other rivers. We briefly examine five long-term fish monitoring programs in large rivers in the United States (Colorado, Columbia, Mississippi, Illinois, and Tallapoosa rivers) and identify opportunities for learning across programs by detailing best monitoring practices and why these practices were chosen. Although monitoring objectives, methods, and program maturity differ between each river system, examples from these five case studies illustrate the important role that long-term monitoring programs play in interpreting temporal and spatial shifts in fish populations for both established objectives and newly emerging questions. We suggest that deliberate efforts to develop a broader collaborative network through benchmarking will facilitate sharing of ideas and development of more effective monitoring programs.

  4. Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint.

    Science.gov (United States)

    Polinder, S; Heijnen, E M E W; Macklon, N S; Habbema, J D F; Fauser, B J C M; Eijkemans, M J C

    2008-02-01

    BACKGROUND Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF. METHODS Four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. The main outcome measures are total costs of treatment within a 12 months period after randomization, and the relationship between total costs and proportion of cumulative pregnancies resulting in term live birth within 1 year of randomization. RESULTS Despite a significantly increased average number of IVF cycles (2.3 versus 1.7; P costs over a 12-month period (8333 versus euro10 745; P = 0.006) were observed using the mild strategy. This was mainly due to higher costs of the obstetric and post-natal period for the standard strategy, related to multiple pregnancies. The costs per pregnancy leading to term live birth were euro19 156 in the mild strategy and euro24 038 in the standard. The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was euro185 000 per extra pregnancy leading to term live birth. CONCLUSIONS Despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.

  5. Long-term care financing: lessons from France.

    Science.gov (United States)

    Doty, Pamela; Nadash, Pamela; Racco, Nathalie

    2015-06-01

    POLICY POINTS: France's model of third-party coverage for long-term services and supports (LTSS) combines a steeply income-adjusted universal public program for people 60 or older with voluntary supplemental private insurance. French and US policies differ: the former pay cash; premiums are lower; and take-up rates are higher, in part because employer sponsorship, with and without subsidization, is more common-but also because coverage targets higher levels of need and pays a smaller proportion of costs. Such inexpensive, bare-bones private coverage, especially if marketed as a supplement to a limited public benefit, would be more affordable to those Americans currently most at risk of "spending down" to Medicaid. An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long-term care could inform the United States' long-term care financing reform efforts. We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income

  6. Near-Term Actions to Address Long-Term Climate Risk

    Science.gov (United States)

    Lempert, R. J.

    2014-12-01

    Addressing climate change requires effective long-term policy making, which occurs when reflecting on potential events decades or more in the future causes policy makers to choose near-term actions different than those they would otherwise pursue. Contrary to some expectations, policy makers do sometimes make such long-term decisions, but not as commonly and successfully as climate change may require. In recent years however, the new capabilities of analytic decision support tools, combined with improved understanding of cognitive and organizational behaviors, has significantly improved the methods available for organizations to manage longer-term climate risks. In particular, these tools allow decision makers to understand what near-term actions consistently contribute to achieving both short- and long-term societal goals, even in the face of deep uncertainty regarding the long-term future. This talk will describe applications of these approaches for infrastructure, water, and flood risk management planning, as well as studies of how near-term choices about policy architectures can affect long-term greenhouse gas emission reduction pathways.

  7. A Comparison of the Long Term Interdependence of Southeast Asian Equity Markets

    Directory of Open Access Journals (Sweden)

    Raisul Islam

    2014-06-01

    Full Text Available The purpose of this paper is to examine the equity market crisis contagion in major Asian economic markets. A comparative assessment of Asian markets during the Asian Financial Crisis and Global Financial crisis may clearly identify the changing nature of long term integration of major Asian markets. The selection criteria of specific Asian markets of different peripheries depend particularly on the roles and structure of these markets. The impact of the global financial contagion and the lingering financial linkage in the aftermath of crisis will explain the reaction of the majority of Asian markets to global linkage. While majority of the studies focused on dynamic short term association in European and MENA contagions in the post global financial crisis period; after the global financial crisis, attention paid to long term Asian contagion adds new perspective to hitherto disorganized theories.

  8. Long-Term Fundamentals of the 2008 Economic Crisis

    OpenAIRE

    David Mayer-Foulkes

    2009-01-01

    The current economic crisis has long-term causes that are rooted in the economic dynamics of globalization. I construct a Solow-style endogenous model of capital accumulation, technological change, trade and cheap-factor-seeking foreign direct investment (FDI), based on myopic agents. Combining advanced technologies with low costs, FDI yields extraordinary profits that generate asymmetric innovation incentives that explain the following stylized facts. Globalization (a) increases capital accu...

  9. The effects of utility DSM programs on electricity costs and prices

    Energy Technology Data Exchange (ETDEWEB)

    Hirst, E.

    1991-11-01

    More and more US utilities are running more and larger demand-side management (DSM) programs. Assessing the cost-effectiveness of these programs raises difficult questions for utilities and their regulators. Should these programs aim to minimize the total cost of providing electric-energy services or should they minimize the price of electricity? This study offers quantitative estimates on the tradeoffs between total costs and electricity prices. This study uses a dynamic model to assess the effects of energy-efficiency programs on utility revenues, total resource costs, electricity prices, and electricity consumption for the period 1990 to 2010. These DSM programs are assessed under alternative scenarios. In these cases, fossil-fuel prices, load growth, the amount of excess capacity the utility has in 1990, planned retirements of power plants, the financial treatment of DSM programs, and the costs of energy- efficient programs vary. These analyses are conducted for three utilities: a ``base`` that is typical of US utilities; a ``surplus`` utility that has excess capacity, few planned retirements, and slow growth in fossil-fuel prices and incomes; and a ``deficit`` utility that has little excess capacity, many planned retirements, and rapid growth in fossil-fuel prices and incomes. 28 refs.

  10. Educational Credentialism and Elite Formation in Japan: A Long-term Perspective

    OpenAIRE

    Daiji Kawaguchi; Hiroshi Ono

    2013-01-01

    In spite of the significant restructuring of the university system in the postwar period, national universities continue to occupy the top end of the prestige hierarchy of universities in Japan. In this paper, we examine long-term trends in the educational credentials of Japanese corporate executives. We use high-quality data from the directory of corporate executives to assess whether the mechanisms of elite production has changed over time. We find that the fraction of corporate executives ...

  11. Long Term Financing of Infrastructure

    OpenAIRE

    Sinha, Sidharth

    2014-01-01

    Infrastructure projects, given their long life, require long term financing. The main sources of long term financings are insurance and pension funds who seek long term investments with low credit risk. However, in India household financial savings are mainly invested in bank deposits. Insurance and pension funds account for only a small percentage of household financial savings. In addition most infrastructure projects do not qualify for investment by insurance and pension funds because of t...

  12. Ministers of Health: short-term tenure for long-term goals?

    Science.gov (United States)

    Ferraz, Marcos Bosi; Azevedo, Rafael Teixeira

    2011-03-01

    Healthcare investments should consider short and long-term demands. The objectives here were to compare the average tenures of ministers of health in Brazil and in another 22 countries and to evaluate the relationship between ministers' tenures and a number of indicators. Descriptive study conducted at Centro Paulista de Economia da Saúde (CPES). Twenty-two countries with the highest Human Development Indices (HDIs) and Brazil were included. The number of ministers over the past 20 years was investigated through each country's Ministry of Health website. Pearson's correlation coefficient was used to compare the number of ministers in each country with that country's indicators. The Mann-Whitney test was used to compare ministers' tenures in Brazil and other countries. The mean tenure (standard deviation, SD) of Brazilian ministers of health was 15 (12) months, a period that is statistically significantly shorter than the mean tenure of 33 (18) months in the other 22 countries (P < 0.05). There was a moderate and statistically significant positive correlation between the number of ministers and mortality rates for several conditions. The number of ministers also presented moderate and statistically significant negative correlations with per capita total healthcare expenditure (r = -0.567) and with per capita government healthcare expenditure (r = -0.530). On average, ministers of health have extremely short tenures. There is an urgent need to think and plan healthcare systems from a long-term perspective.

  13. In the wake of liberalisation: long-term developments in the EU air transport market

    NARCIS (Netherlands)

    Burghouwt, G.; de Wit, J.G.

    2015-01-01

    Using a 24-year analysis period (1990-2013), a new perspective is offered on long-term first- and second-order developments following liberalisation of the intra-EU air transport market. The focus of the analysis is on supply-side issues, such as airline output, structure of supply, yields, business

  14. Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study.

    Science.gov (United States)

    van Buul, Laura W; van der Steen, Jenny T; Doncker, Sarah M M M; Achterberg, Wilco P; Schellevis, François G; Veenhuizen, Ruth B; Hertogh, Cees M P M

    2014-12-16

    Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors. Semi-structured qualitative interviews were conducted with physicians (n = 13) and nursing staff (n = 13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff. The analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians' perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients' family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics). Our interview study shows that several non-rational factors may affect antibiotic prescribing decision making in long-term care facilities, suggesting opportunities to reduce inappropriate antibiotic use. We developed a conceptual model that integrates the identified categories of influencing factors and shows the relationships between those categories. This model may be used as a practical tool in long-term care facilities to identify local factors potentially leading to inappropriate prescribing, and to subsequently

  15. Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons.

    Science.gov (United States)

    Chambers, G M; Lee, E; Hoang, V P; Hansen, M; Bower, C; Sullivan, E A

    2014-03-01

    Do singletons conceived following assisted reproduction technologies (ARTs) have significantly different hospital utilization, and therefore costs, compared with non-ART children during the first 5 years of life? ART singletons have longer hospital birth-admissions and a small increased risk of re-admission during the first 5 years of life resulting in higher costs of hospital care. ART singletons are at greater risk of adverse perinatal outcomes compared with non-ART singletons. Long-term physical and mental health outcomes of ART singletons are generally reassuring. There is a scarcity of information on health service utilization and the health economic impact of ART conceived children. A population cohort study using linked birth, hospital and death records. Perinatal outcomes, hospital utilization and costs, and mortality rates were compared for non-ART and ART singletons to 5 years. Adjustments were made for maternal age, parity, sex, birth year, socioeconomic status and funding source. Australian Diagnosis Related Groups cost-weights were used to derive costs. All costs are reported in 2009/2010 Australian dollars. All babies born in Western Australia between 1994 and 2003 were included; 224 425 non-ART singletons and 2199 ART conceived singletons. Hospital admission and death records in Western Australia linked to 2008 were used. Overall, ART singletons had a significantly longer length of stay during the birth-admission (mean difference 1.8 days, P birth-admission ($1473). The independent residual cost associated with ART conception was $342 during the birth-admission and an additional $548 up to 5 years of age, indicating that being conceived as an ART child predicts not only higher birth-admission costs but excess costs to at least 5 years of age. This study could not investigate the impact of different ART practices and techniques on perinatal outcomes or hospital utilization, nor could it adjust for parental characteristics such as cause of infertility

  16. Long-term outcomes of unilateral transtibial amputations.

    Science.gov (United States)

    Ebrahimzadeh, Mohamad H; Hariri, Sanaz

    2009-06-01

    the long-term outcomes of wartime transtibial amputations have not been well documented. The purpose of this case series is to present the long-term functional, social, and psychological outcomes of modern-day military unilateral transtibial amputees. the Iranian Veterans Administration of the Khorasan province invited their Iranian military amputees from the Iran-Iraq War (1980-1988) to its medical center for evaluation. The patients filled out a detailed questionnaire and were interviewed and examined by each team member. two hundred (77%) of the 260 invited amputees were willing and able to come back for follow-up. Ninety-six of these patients (48%) were unilateral transtibial amputation. The average follow-up was 17.4 years (range 15-22 years). Land mines were the leading cause of war injury necessitating a transtibial amputation (68%). The most common symptoms about their amputated limbs were phantom sensations (54%), phantom pain (17%), and stump pain (42%). Lower back pain, contralateral (nonamputated limb) knee pain, and ipsilateral (amputated limb) knee pain were reported by 44%, 38%, and 13% of subjects, respectively. Sixty-five percent of patients were employed or had been employed for multiple years after their war injury. All patients were married, and 97% had children. Fifty-four percent of amputees reported psychological problems; 26% were currently utilizing psychological support services. at long-term follow-up, most military transtibial amputees experienced phantom sensation or some type of stump pain. More than half had persistent psychiatric problems, but only about half of these patients were receiving psychological treatment. Although this case series reports the status of these amputees, the next step would be to prospectively follow modern wartime amputees using standardized, validated outcome measures. With the goal of optimizing long-term amputee outcomes, researchers should correlate outcomes with demographics, injury characteristics, and

  17. Adjuvant psychological therapy in long-term endocrine conditions.

    Science.gov (United States)

    Daniels, J; Turner-Cobb, J M

    2017-06-01

    Consideration of psychological distress in long-term endocrine conditions is of vital importance given the prevalence of anxiety and depression in such disorders. Poor mental health can lead to compromised self-care, higher utilization of health services, lower rates of adherence, reduced quality of life and ultimately poorer outcomes. Adjuvant psychological therapy offers an effective resource to reduce distress in endocrine conditions. While the vast majority of work in this area has focused on psychological screening and intervention in diabetes, identification and recognition of psychological distress are equally important in other endocrinological conditions, with supportive evidence in polycystic ovary syndrome and Addison's disease. Referral pathways and recommendations set out by UK guidelines and the Department of Health mandate requires greater attention across a wider range of long-term endocrine conditions to facilitate improved quality of life and health outcome. © 2017 John Wiley & Sons Ltd.

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

    International Nuclear Information System (INIS)

    2014-05-01

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

  19. Cost-effectiveness analysis of metformin+dipeptidyl peptidase-4 inhibitors compared to metformin+sulfonylureas for treatment of type 2 diabetes.

    Science.gov (United States)

    Kwon, Christina S; Seoane-Vazquez, Enrique; Rodriguez-Monguio, Rosa

    2018-02-01

    Patients with type 2 diabetes (T2D) typically use several drug treatments during their lifetime. There is a debate about the best second-line therapy after metformin monotherapy failure due to the increasing number of available antidiabetic drugs and the lack of comparative clinical trials of secondary treatment regimens. While prior research compared the cost-effectiveness of two alternative drugs, the literature assessing T2D treatment pathways is scarce. The purpose of this study was to evaluate the long-term cost-effectiveness of dipeptidyl peptidase-4 inhibitors (DPP-4i) compared to sulfonylureas (SU) as second-line therapy in combination with metformin in patients with T2D. A Markov model was developed with four health states, 1 year cycle, and a 25-year time horizon. Clinical and cost data were collected from previous studies and other readily available secondary data sources. The incremental cost-effectiveness ratio (ICER) was estimated from the US third party payer perspective. Both, costs and outcomes, were discounted at a 3% annual discount rate. One way and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainty on the base-case results. The discounted incremental cost of metformin+DPP-4i compared to metformin+SU was $11,849 and the incremental life-years gained were 0.61, resulting in an ICER of $19,420 per life-year gained for patients in the metformin+DPP-4i treatment pathway. The ICER estimated in the probabilistic sensitivity analysis was $19,980 per life-year gained. Sensitivity analyses showed that the results of the study were not sensitive to changes in the parameters used in base-case. The metformin+DPP-4i treatment pathway was cost-effective compared to metformin+SU as a long-term second-line therapy in the treatment of T2D from the US health care payer perspective. Study findings have the potential to provide clinicians and third party payers valuable evidence for the prescription and utilization of cost

  20. Healthcare Cost and Utilization Project (HCUP)

    Science.gov (United States)

    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  1. Long-term storage of Greater-Than-Class C Low-Level Waste

    International Nuclear Information System (INIS)

    Magleby, M.T.

    1990-01-01

    Under Federal law, the Department of Energy (DOE) is responsible for safe disposal of Greater-Than-Class C Low-Level Waste (GTCC LLW) generated by licenses of the Nuclear Regulatory commission (NRC) or Agreement States. Such waste must be disposed of in a facility licensed by the NRC. It is unlikely that licensed disposal of GTCC LLW will be available prior to the year 2010. Pending availability of disposal capacity, DOE is assessing the need for collective, long-term storage of GTCC LLW. Potential risks to public health and safety caused by long-term storage of GTCC LLW at the place of generation will be evaluated to determine if alternative facilities are warranted. If warranted, several options will be investigated to determine the preferred alternative for long-term storage. These options include modification of an existing DOE facility, development of a new DOE facility, or development of a facility by the private sector with or without DOE support. Reasonable costs for long-term storage would be borne by the waste generators. 5 refs., 1 fig

  2. Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives

    Directory of Open Access Journals (Sweden)

    Bankole K. Fasanya

    2016-06-01

    Conclusion: WPV is an epidemic problem that affects all health-care professionals. The findings of this study could help long-term medical care facilities' management identify the areas to focus on mitigating, controlling, and/or eliminating incidents of WPV.

  3. Total life cycle cost model for electric power stations

    International Nuclear Information System (INIS)

    Cardullo, M.W.

    1995-01-01

    The Total Life Cycle Cost (TLCC) model for electric power stations was developed to provide a technology screening model. The TLCC analysis involves normalizing cost estimates with respect to performance standards and financial assumptions and preparing a profile of all costs over the service life of the power station. These costs when levelized present a value in terms of a utility electricity rate. Comparison of cost and the pricing of the electricity for a utility shows if a valid project exists. Cost components include both internal and external costs. Internal costs are direct costs associated with the purchase, and operation of the power station and include initial capital costs, operating and maintenance costs. External costs result from societal and/or environmental impacts that are external to the marketplace and can include air quality impacts due to emissions, infrastructure costs, and other impacts. The cost stream is summed (current dollars) or discounted (constant dollars) to some base year to yield a overall TLCC of each power station technology on a common basis. While minimizing life cycle cost is an important consideration, it may not always be a preferred method for some utilities who may prefer minimizing capital costs. Such consideration does not always result in technology penetration in a marketplace such as the utility sector. Under various regulatory climates, the utility is likely to heavily weigh initial capital costs while giving limited consideration to other costs such as societal costs. Policy makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. The TLCC analysis model for power stations was developed to facilitate consideration of all perspectives

  4. Assessment of nuclear energy cost competitiveness against alternative energy sources in Romania envisaging the long-term national energy sustainability

    International Nuclear Information System (INIS)

    Margeanu, C. A.

    2016-01-01

    The paper includes some of the results obtained by RATEN ICN Pitesti experts in the IAEA.s Collaborative Project INPRO-SYNERGIES. The case study proposed to evaluate and analyze the nuclear capacity development and increasing of its share in the national energy sector, envisaging the long term national and regional energy sustainability by keeping collaboration options open for the future while bringing solutions to short/medium-term challenges. The following technologies, considered as future competing technologies for electric energy generation in Romania, were selected: nuclear technology (represented by PHWR CANDU Units 3 and 4 - CANDU new, advanced HWR - Adv. HWR, and advanced PWR - Adv. PWR) and, as alternative energy sources, classical technology (represented by Coal-fired power plant using lignite fossil fuel, with carbon capture - Coal_new, and Gas-fired power plant operating on combined cycle, with carbon capture - Gas_new). The study included assessment of specific economic indicators, sensitivity analyses being performed on Levelised Unit Energy Cost (LUEC) variation due to different perturbations (e.g. discount rate, overnight costs, etc). Robustness indices (RI) of LUEC were also calculated by considering simultaneous variation of input parameters for the considered power plants. The economic analyses have been performed by using the IAEA.s NEST program. The study results confirmed that in Romania, under the national specific conditions defined, electricity produced by nuclear power plants is cost competitive against coal and gas fired power plants electricity. The highest impact of considered perturbations on LUEC has been observed for capital intensive technologies (nuclear technologies) comparatively with the classic power plants, especially for discount rate changes. (authors)

  5. Long term prospects for world gas trade

    International Nuclear Information System (INIS)

    Linder, P.T.

    1991-01-01

    Results are presented from a world gas trade model used to forecast long term gas markets. Assumptions that went into the model are described, including the extent of current proven gas reserves, production ratios, total energy and gas demand, gas supply cost curves for each producing country, available gas liquefaction and transportation facilities, and liquefied natural gas (LNG) shipping costs. The results indicate that even with generally very low supply costs for most gas producing basins, gas trade will continue to be restricted by the relatively high cost of transportation, whether by pipeline or tanker. As a consequence, future gas trade will tend to be regionally oriented. United States gas imports will come mostly from Canada, Venezuela, and Mexico; Western Europe will largely be supplied by the Soviet Union and Africa, and Japan's requirements will generally be met by Pacific Rim producers. Although the Middle East has vast quantities of gas reserves, its export growth will continue to be hampered by its remote location from major markets. 16 figs

  6. Prediction of Sea Surface Temperature Using Long Short-Term Memory

    Science.gov (United States)

    Zhang, Qin; Wang, Hui; Dong, Junyu; Zhong, Guoqiang; Sun, Xin

    2017-10-01

    This letter adopts long short-term memory(LSTM) to predict sea surface temperature(SST), which is the first attempt, to our knowledge, to use recurrent neural network to solve the problem of SST prediction, and to make one week and one month daily prediction. We formulate the SST prediction problem as a time series regression problem. LSTM is a special kind of recurrent neural network, which introduces gate mechanism into vanilla RNN to prevent the vanished or exploding gradient problem. It has strong ability to model the temporal relationship of time series data and can handle the long-term dependency problem well. The proposed network architecture is composed of two kinds of layers: LSTM layer and full-connected dense layer. LSTM layer is utilized to model the time series relationship. Full-connected layer is utilized to map the output of LSTM layer to a final prediction. We explore the optimal setting of this architecture by experiments and report the accuracy of coastal seas of China to confirm the effectiveness of the proposed method. In addition, we also show its online updated characteristics.

  7. Rural-urban differences in the long-term care of the disabled elderly in China.

    Directory of Open Access Journals (Sweden)

    Mei Li

    Full Text Available BACKGROUND: In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. METHODS: This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. RESULTS: Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively, but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. CONCLUSIONS: The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

  8. LONG-TERM OUTCOME IN PEDIATRIC TRICHOTILLOMANIA.

    Science.gov (United States)

    Schumer, Maya C; Panza, Kaitlyn E; Mulqueen, Jilian M; Jakubovski, Ewgeni; Bloch, Michael H

    2015-10-01

    To examine long-term outcome in children with trichotillomania. We conducted follow-up clinical assessments an average of 2.8 ± 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the Massachusetts General Hospital Hairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. None of the participants continued to take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused pulling at baseline assessment were associated with poor long-term prognosis. Our findings suggest that few children with trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms may be associated with poorer long-term prognosis. © 2015 Wiley Periodicals, Inc.

  9. Long-term allocation of power from the Snettisham Project

    International Nuclear Information System (INIS)

    1993-01-01

    The Alaska Power Administration (APA) has prepared an Environmental Assessment (EA) (DOE/EA-0839) evaluating the Final Marketing Plan for the Snettisham Project that establishes long-term allocation and sales of power. The proposed long-term sales contract will replace a 20-year sales agreement that expires at the end of December, 1993. The EA evaluates the proposed alternative and the no action alternative. The proposed alternative replaces the expiring contract with a new 20-year contract with the same terms, conditions and allocation as the previous long-term contract. No other alternatives were developed, as there is only one utility in the Juneau area. The divestiture of this Federal project is expected to be approved by Congress; the present contractor would then assume the ownership and operation of the Snettisham Project. The EA identified no actions associated with the proposal that will cause significant environmental or socioeconomic impacts. The Final Marketing Plan for the Snettisham Project deals with the replacement of an expiring contract. The Final Marketing Plan does not include the addition of any major new resources, service to discrete major new loads, or major changes in operating parameters. No changes in rates are proposed in the Final Marketing Plan

  10. Consideration of environmental externality costs in electric utility resource selections and regulation

    International Nuclear Information System (INIS)

    Ottinger, R.L.

    1990-01-01

    A surprising number of state electric utility regulatory commissions (half) have started to require consideration of environmental externality costs in utility planning and resource selection. The principal rationale for doing so is that electric utility operations impose very real and large damages to human health and the environment which are not taken into account by traditional utility least cost planning, resource selection procedures, or by government pollution regulation. These failures effectively value the residual environmental costs to society of utility operations at zero. The likely future prospect for more stringent governmental pollution regulation renders imprudent the selection of resources without taking environmental externality costs into consideration. Most regulatory commissions requiring environmental externality consideration have left it to the utilities to compute the societal costs, although a few have either set those costs themselves or used a proxy adder to polluting resource costs (or bonus for non-polluting resources). These commissions have used control or pollution mitigation costs, rather than societal damage costs, in their regulatory computations. This paper recommends that damage costs be used where adequate studies exist to permit quantification, discusses the methodologies for their measurement, and describes the means that have been and might be used for their incorporation

  11. The effects of utility DSM programs on electricity costs and prices

    Energy Technology Data Exchange (ETDEWEB)

    Hirst, E.

    1991-11-01

    More and more US utilities are running more and larger demand-side management (DSM) programs. Assessing the cost-effectiveness of these programs raises difficult questions for utilities and their regulators. Should these programs aim to minimize the total cost of providing electric-energy services or should they minimize the price of electricity This study offers quantitative estimates on the tradeoffs between total costs and electricity prices. This study uses a dynamic model to assess the effects of energy-efficiency programs on utility revenues, total resource costs, electricity prices, and electricity consumption for the period 1990 to 2010. These DSM programs are assessed under alternative scenarios. In these cases, fossil-fuel prices, load growth, the amount of excess capacity the utility has in 1990, planned retirements of power plants, the financial treatment of DSM programs, and the costs of energy- efficient programs vary. These analyses are conducted for three utilities: a base'' that is typical of US utilities; a surplus'' utility that has excess capacity, few planned retirements, and slow growth in fossil-fuel prices and incomes; and a deficit'' utility that has little excess capacity, many planned retirements, and rapid growth in fossil-fuel prices and incomes. 28 refs.

  12. Cost-Utility Analysis of Heberprot-P as an Add-on Therapy to Good Wound Care for Patients in Slovakia with Advanced Diabetic Foot Ulcer

    Directory of Open Access Journals (Sweden)

    Tomas Tesar

    2017-12-01

    Full Text Available Objectives: To explore whether Heberprot-P (an epidermal growth factor is a cost-effective option for the treatment of advanced diabetic foot ulcer as an add-on therapy to good wound care (GWC in Slovakia from the perspective of health care payers.Methods: A Markov model was constructed to compare the costs and effects of Heberprot-P plus GWC to those of GWC alone from the perspective of health care payers. The 52-week clinical trial period was extended to 5- and 10-year time horizons. Transition probabilities were calculated based on a previous clinical trial of Heberprot, utility values were derived from the scientific literature, and cost vectors were collected from the General Health Insurance Fund database in Slovakia. A one-way deterministic sensitivity analysis was employed to explore the influence of uncertainty for each input parameter on the incremental cost-effectiveness ratio (ICER.Results: Based on the ICER threshold of €30,030 per quality-adjusted life year (QALY recommended by the Slovak Ministry of Health, Heberprot-P therapy plus GWC is not a cost-effective alternative to GWC alone over a 10-year time horizon. The ICER increases if a longer time horizon is applied, as the incremental costs are similar, but the aggregated utility gain from avoided amputation is lower. Based on the sensitivity analysis, the utility multiplier for the health state “no ulcer after small amputation” had the most impact on the ICER; however, the model was robust to changes in all input parameters.Conclusions: Heberprot-P, as an add-on therapy to GWC in the treatment of advanced diabetic foot ulcer, is not a cost-effective alternative to GWC alone. However, if the unit cost of Heberprot-P were to be reduced to <€273, its ICER would be <€30,030.

  13. Alternative routes to improved fuel utilization: Analysis of near-term economic incentives

    International Nuclear Information System (INIS)

    Salo, J.P.; Vieno, T.; Vira, J.

    1984-01-01

    The potential for savings in the nuclear fuel cycle costs is discussed from the point of view of a single utility. The analysis is concentrated on the existing and near-term economic incentives for improved fuel utilization, and the context is that of a small country without domestic fuel cycle services. In the uranium fuel cycle the extended burnup produces savings in the uranium feed as well as in the fuel fabrication and waste management requirements. The front-end fuel cycle cost impact is evaluated for BWRs. In the back-end part the situation is more specific of the concrete back-end solution. Estimates for savings in the cost of direct disposal of spent fuel are presented for a Finnish case. The economics of recycle is reviewed from a recent study on the use of MOX fuel in the Finnish BWRs. The results from a comparison with once-through alternative show that spent fuel reprocessing with consequent recycle of uranium and plutonium would be economically justified only with very high uranium prices. (author)

  14. Long-term biatrial recordings in post-operative atrial fibrillation.

    Science.gov (United States)

    Masè, M; Graffigna, A; Sinelli, S; Pallaoro, G; Nollo, G; Ravelli, F

    2010-01-01

    Although atrial fibrillation (AF) is a common complication of cardiac surgery, its pathophysiology remains unclear. The study of post-operative AF demands for the recording of cardiac electrical activity in correspondence of AF onset and progression. Long-term recordings in post-surgery patients could provide this information, but, to date, have been limited to surface signals, which precludes a characterization of the arrhythmic triggers and substrate. In this study we demonstrate the feasibility of a continuous long-term recording of atrial electrical activities from the right and left atria in post-surgery patients. Local atrial epicardial electrograms are acquired by positioning temporary pacing wires in the right and left atria at the end of the intervention, while three day recordings are obtained by a digital holter recorder, adapted to epicardial signal features. The capability of the system to map local atrial activity and the possibility to obtain quantitative information on atrial rate and synchronization from the processed epicardial signals are proven in representative examples. The quantitative description of local atrial properties opens new perspective in the investigation of post-surgery AF.

  15. Effects of long-term price increases for oil

    International Nuclear Information System (INIS)

    Voehringer, F.; Mueller, A.; Boehringer, C.

    2007-03-01

    This comprehensive report for the Swiss Federal Office of Energy (SFOE) takes a look at the effects of higher oil prices in the long-term. Scenarios examined include those with high oil prices of 80 to 140 dollars per barrel and those with drastic shortages resulting from peak extraction in the years 2010 and 2020. Long-term economic balances form the basis of the report, short-term influences and psychological effects are not addressed. The possible dangers for the earth's climate caused by the substitution of oil by coal-based products are discussed, as well as the sequestration of carbon dioxide. Ethanol and the associated conflicts of land use are examined and the decreasing cost-effectiveness of co-generation power generation is looked at. Alternatives such as atomic power, hydropower, solar energy, geothermal energy, biogas and wind power are discussed. The effect of the changing energy scene on economic growth and welfare aspects in Switzerland are examined. The authors conclude that high oil prices have considerable impacts on the economy and are not a substitute for an internationally co-ordinated climate policy

  16. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  17. Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study

    OpenAIRE

    Kourlaba, Georgia; Vlachopoulos, Charalambos; Parissis, John; Kanakakis, John; Gourzoulidis, George; Maniadakis, Nikos

    2015-01-01

    Background To conduct an economic evaluation comparing ranolazine as add-on therapy to standard-of-care (SoC) with SoC alone in patients with stable angina who did not respond adequately to first line therapy, in Greece. Methods A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of ranolazine during a 6-month period. The analysis was conducted from a third-party payer perspective. The clinical inputs were extracted from the published literature. The co...

  18. Barriers to ethical nursing practice for older adults in long-term care facilities.

    Science.gov (United States)

    Choe, Kwisoon; Kang, Hyunwook; Lee, Aekyung

    2018-03-01

    To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. To provide this population with quality care, a solid moral foundation should be emphasised to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analysed using qualitative content analysis. Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients and friction between nurses and nursing assistants. This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. Support programmes and educational opportunities are needed for nurses who experience emotional distress and lack of competency to strengthen their resilience towards some of the negative aspects of care and being a nurse that were identified in this study. © 2017 John Wiley & Sons Ltd.

  19. Case Studies on Newly-emerging Long- and Medium-term Strategic Planning and Its Reference to Beijing

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Responding to the significant impacts brought by social, political, economic and environmental changes, some countries, regions and cities in the world have introduced new forms of long- and medium-term strategic planning since 2000, so as to promote the sustainable development of the cities or regions through a higher-level thoughts and a wider-perspective exploration. Taking America 2050, Future Ruhr 2030, New York 2030 and some other long- and medium-term strategic plans as examples, the paper analyzes the evolution of long- and medium-term strategic planning from the aspects of plan-making methods, analyzing techniques, research contents development trends etc. at the state, regional, and city levels. Based on international experience, this paper puts forward the necessity for Beijing to launch a new long-term strategic planning study "Beijing 2049." The innovation, challenges and development direction of "Beijing 2049" is also expounded in the paper.

  20. Cost Effectiveness of Paliperidone Long-Acting Injectable Versus Other Antipsychotics for the Maintenance Treatment of Schizophrenia in France.

    Science.gov (United States)

    Druais, Sylvain; Doutriaux, Agathe; Cognet, Magali; Godet, Annabelle; Lançon, Christophe; Levy, Pierre; Samalin, Ludovic; Guillon, Pascal

    2016-04-01

    French clinical recommendations suggest prescribing long-acting injectable (LAI) antipsychotics to patients with a maintenance treatment indication in schizophrenia. Despite this, and due to their relatively high acquisition and administration costs, LAIs are still underused in clinical practice in France, thus highlighting the need for pharmacoeconomic evaluations. Our objective was to estimate the cost effectiveness of paliperidone LAI (or paliperidone palmitate), a once-monthly second-generation LAI antipsychotic, compared with the most common antipsychotic medications for the maintenance treatment of schizophrenia in France. A Markov model was developed to simulate the progression of a cohort of schizophrenic patients through four health states (stable treated, stable non-treated, relapse and death) and to consider up to three lines of treatment to account for changes in treatment management. Paliperidone LAI was compared with risperidone LAI, aripiprazole LAI, olanzapine LAI, haloperidol LAI (or haloperidol decanoate) and oral olanzapine. Costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over 5 years based on 3-month cycles with a discount rate of 4% and from a French health insurance perspective. Patients were considered to be stabilised after a schizophrenic episode and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on real-life French data to capture adherence effects. Safety and utility data were derived from international publications. Additionally, costs were retrieved from French health insurance databases and publications. Finally, expert opinion was used for validation purposes or in case of gaps in data. The robustness of results was assessed through deterministic and