Maximum power demand cost

International Nuclear Information System (INIS)

Biondi, L.

1998-01-01

The charging for a service is a supplier's remuneration for the expenses incurred in providing it. There are currently two charges for electricity: consumption and maximum demand. While no problem arises about the former, the issue is more complicated for the latter and the analysis in this article tends to show that the annual charge for maximum demand arbitrarily discriminates among consumer groups, to the disadvantage of some [it

Cost effectiveness of tobacco control policies in Vietnam: the case of population-level interventions.

Science.gov (United States)

Higashi, Hideki; Truong, Khoa D; Barendregt, Jan J; Nguyen, Phuong K; Vuong, Mai L; Nguyen, Thuy T; Hoang, Phuong T; Wallace, Angela L; Tran, Tien V; Le, Cuong Q; Doran, Christopher M

2011-05-01

Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries. The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam. Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis. All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector. All four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.

Cost-effectiveness of population-level physical activity interventions: a systematic review.

Science.gov (United States)

Laine, Johanna; Kuvaja-Köllner, Virpi; Pietilä, Eija; Koivuneva, Mikko; Valtonen, Hannu; Kankaanpää, Eila

2014-01-01

This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity. A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus. Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded. Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace. The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account. The most efficient interventions to increase physical activity were community rail-trails ($.006/MET-h), pedometers ($.014/MET-h), and school health education programs ($.056/MET-h). Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

Dynamic Programming and Error Estimates for Stochastic Control Problems with Maximum Cost

International Nuclear Information System (INIS)

Bokanowski, Olivier; Picarelli, Athena; Zidani, Hasnaa

2015-01-01

This work is concerned with stochastic optimal control for a running maximum cost. A direct approach based on dynamic programming techniques is studied leading to the characterization of the value function as the unique viscosity solution of a second order Hamilton–Jacobi–Bellman (HJB) equation with an oblique derivative boundary condition. A general numerical scheme is proposed and a convergence result is provided. Error estimates are obtained for the semi-Lagrangian scheme. These results can apply to the case of lookback options in finance. Moreover, optimal control problems with maximum cost arise in the characterization of the reachable sets for a system of controlled stochastic differential equations. Some numerical simulations on examples of reachable analysis are included to illustrate our approach

Dynamic Programming and Error Estimates for Stochastic Control Problems with Maximum Cost

Energy Technology Data Exchange (ETDEWEB)

Bokanowski, Olivier, E-mail: boka@math.jussieu.fr [Laboratoire Jacques-Louis Lions, Université Paris-Diderot (Paris 7) UFR de Mathématiques - Bât. Sophie Germain (France); Picarelli, Athena, E-mail: athena.picarelli@inria.fr [Projet Commands, INRIA Saclay & ENSTA ParisTech (France); Zidani, Hasnaa, E-mail: hasnaa.zidani@ensta.fr [Unité de Mathématiques appliquées (UMA), ENSTA ParisTech (France)

2015-02-15

This work is concerned with stochastic optimal control for a running maximum cost. A direct approach based on dynamic programming techniques is studied leading to the characterization of the value function as the unique viscosity solution of a second order Hamilton–Jacobi–Bellman (HJB) equation with an oblique derivative boundary condition. A general numerical scheme is proposed and a convergence result is provided. Error estimates are obtained for the semi-Lagrangian scheme. These results can apply to the case of lookback options in finance. Moreover, optimal control problems with maximum cost arise in the characterization of the reachable sets for a system of controlled stochastic differential equations. Some numerical simulations on examples of reachable analysis are included to illustrate our approach.

Perspectives on Performance Indicators: GCE Advanced Level and Differences Between Institution Types in Cost Effectiveness.

Science.gov (United States)

Fielding, A.

1998-01-01

Applies multilevel models of cost-effectiveness to numerous types of (British) institutions providing courses of instruction in the General Certificate of Education at Advanced Level. Different impressions may be gained about an institution's relative effectiveness when cost considerations are combined with outcome measures. Data evaluation needs…

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

NARCIS (Netherlands)

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

2007-01-01

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

Effect of migration based on strategy and cost on the evolution of cooperation

International Nuclear Information System (INIS)

Li, Yan; Ye, Hang

2015-01-01

Highlights: •Propose a migration based on strategy and cost in the Prisoner’s Dilemma Game. •The level of cooperation without mutation is higher than that with mutation. •Increased costs have no effect on the level of cooperation without mutation. •The level of cooperation decreases with the increase in cost with mutation. •An optimal density value ρ resulting in the maximum level of cooperation exists. -- Abstract: Humans consider not only their own ability but also the environment around them during the process of migration. Based on this fact, we introduce migration based on strategy and cost into the Spatial Prisoner’s Dilemma Game on a two-dimensional grid. The migration means that agents cannot move when all of the neighbors are cooperators; otherwise, agents move with a probability related to payoff and cost. The result obtained by the computer simulation shows that the moving mechanism based on strategy and cost improves the level of cooperation in a wide parameter space. This occurs because movement based on strategy effectively keeps the cooperative clusters and because movement based on cost effectively regulates the rate of movement. Both types of movement provide a favorable guarantee for the evolution of stable cooperation under the mutation rate q = 0.0. In addition, we discuss the effectiveness of the migration mechanism in the evolution of cooperation under the mutation rate q = 0.001. The result indicates that a higher level of cooperation is obtained at a lower migration cost, whereas cooperation is suppressed at a higher migration cost. Our work may provide an effective method for understanding the emergence of cooperation in our society

A novel minimum cost maximum power algorithm for future smart home energy management

Directory of Open Access Journals (Sweden)

A. Singaravelan

2017-11-01

Full Text Available With the latest development of smart grid technology, the energy management system can be efficiently implemented at consumer premises. In this paper, an energy management system with wireless communication and smart meter are designed for scheduling the electric home appliances efficiently with an aim of reducing the cost and peak demand. For an efficient scheduling scheme, the appliances are classified into two types: uninterruptible and interruptible appliances. The problem formulation was constructed based on the practical constraints that make the proposed algorithm cope up with the real-time situation. The formulated problem was identified as Mixed Integer Linear Programming (MILP problem, so this problem was solved by a step-wise approach. This paper proposes a novel Minimum Cost Maximum Power (MCMP algorithm to solve the formulated problem. The proposed algorithm was simulated with input data available in the existing method. For validating the proposed MCMP algorithm, results were compared with the existing method. The compared results prove that the proposed algorithm efficiently reduces the consumer electricity consumption cost and peak demand to optimum level with 100% task completion without sacrificing the consumer comfort.

Cost effective radiation risk management in a generic nuclear plant design

International Nuclear Information System (INIS)

Maan, M.A.

1982-11-01

To determine whether any further dose reduction measures are justified, a method appropriate for cost effective radiation risk management has been developed. This new method is based on the radiation detriment optimization measures advocated in the revised (1977) ALARA concept. The methodology includes the determination of available alternatives, and the determination of the variable monetary ceiling on expenditures to reduce the radiological detriment (both occupational and public). The method used to determine the maximum justifiable expenditure for additional reduction of detriment takes into account the economic and social climate, administrative/legal exposure limits, and the actual magnitude of risk. All these factors may vary from country to country. The variable monetary ceiling, sensitive to an actual level of risk, provides a handy measure allowing designers to make a decision whether or not the modification of design is necessary and/or cost effective. This will ensure rationally and consistently that the utilities and their customers (public) get maximum benefit for their safety dollars

40 CFR 141.51 - Maximum contaminant level goals for inorganic contaminants.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Maximum contaminant level goals for inorganic contaminants. 141.51 Section 141.51 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Maximum Contaminant Level...

40 CFR 141.50 - Maximum contaminant level goals for organic contaminants.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Maximum contaminant level goals for organic contaminants. 141.50 Section 141.50 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Maximum Contaminant Level...

40 CFR 141.52 - Maximum contaminant level goals for microbiological contaminants.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Maximum contaminant level goals for microbiological contaminants. 141.52 Section 141.52 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Maximum Contaminant Level...

Can a Costly Intervention Be Cost-effective?

Science.gov (United States)

Foster, E. Michael; Jones, Damon

2009-01-01

Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

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

International Nuclear Information System (INIS)

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

1984-11-01

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

The maximum ground level concentration of air pollutant and the effect of plume rise on concentration estimates

International Nuclear Information System (INIS)

Mayhoub, A.B.; Azzam, A.

1991-01-01

The emission of an air pollutant from an elevated point source according to Gaussian plume model has been presented. An elementary theoretical treatment for both the highest possible ground-level concentration and the downwind distance at which this maximum occurs for different stability classes has been constructed. The effective height release modification was taken into consideration. An illustrative case study, namely, the emission from the research reactor in Inchas, has been studied. The results of these analytical treatments and of the derived semi-empirical formulae are discussed and presented in few illustrative diagrams

The determinants of cost-effectiveness potential: an historical perspective on lipid-lowering therapies.

Science.gov (United States)

Refoios Camejo, Rodrigo; McGrath, Clare; Miraldo, Marisa; Rutten, Frans

2013-05-01

The concept of cost effectiveness emerged in an attempt to link the prices of new healthcare technologies to the immediate value they provide, with payers defining the acceptable cost per unit of incremental effect over the alternatives available. It has been suggested that such measures allow developers to assess potential market profitability in an early stage of development, but may result in discouraging investment in efficient research if not used appropriately. The objective of this study is to identify the pattern of the factors determining cost effectiveness and assess the evolution of cost-effectiveness potential for drugs in development using lipid-lowering therapy as a case study. The study is based on observational clinical and market data covering a 20-year period (from 1990 to 2010) in the UK. Real-life clinical data including total cholesterol laboratory test results were extracted from the Clinical Practice Research Datalink (CPRD) and are used to illustrate how the clinical effectiveness of existing standard care changed over time in patients managed in clinical practice. Prescription Cost Analysis (PCA) data were extracted and the average price of the drug mix used was computed throughout the study period. Using this information, the maximum clinical benefit and cost savings to be had were estimated for each year of the analysis using a cost-effectiveness model. Subsequently, the highest price a new technology providing the maximum clinical effectiveness possible (i.e. eliminating cardiovascular risk from high cholesterol levels) could achieve under current cost-effectiveness rules was calculated and used as a measure of the potential cost effectiveness of drugs in development. The results in this study show that the total cholesterol values of patients managed in clinical practice moved steadily towards recommended clinical targets. Overall, the absolute potential for incremental health-related quality of life decreased by approximately 78

The Effects of a Maximal Power Training Cycle on the Strength, Maximum Power, Vertical Jump Height and Acceleration of High-Level 400-Meter Hurdlers

Science.gov (United States)

Balsalobre-Fernández, Carlos; Tejero-González, Carlos Mª; del Campo-Vecino, Juan; Alonso-Curiel, Dionisio

2013-01-01

The aim of this study was to determine the effects of a power training cycle on maximum strength, maximum power, vertical jump height and acceleration in seven high-level 400-meter hurdlers subjected to a specific training program twice a week for 10 weeks. Each training session consisted of five sets of eight jump-squats with the load at which each athlete produced his maximum power. The repetition maximum in the half squat position (RM), maximum power in the jump-squat (W), a squat jump (SJ), countermovement jump (CSJ), and a 30-meter sprint from a standing position were measured before and after the training program using an accelerometer, an infra-red platform and photo-cells. The results indicated the following statistically significant improvements: a 7.9% increase in RM (Z=−2.03, p=0.021, δc=0.39), a 2.3% improvement in SJ (Z=−1.69, p=0.045, δc=0.29), a 1.43% decrease in the 30-meter sprint (Z=−1.70, p=0.044, δc=0.12), and, where maximum power was produced, a change in the RM percentage from 56 to 62% (Z=−1.75, p=0.039, δc=0.54). As such, it can be concluded that strength training with a maximum power load is an effective means of increasing strength and acceleration in high-level hurdlers. PMID:23717361

The Cost-Effectiveness of Lowering Permissible Noise Levels Around U.S. Airports

Directory of Open Access Journals (Sweden)

Boshen Jiao

2017-12-01

Full Text Available Aircraft noise increases the risk of cardiovascular diseases and mental illness. The allowable limit for sound in the vicinity of an airport is 65 decibels (dB averaged over a 24-h ‘day and night’ period (DNL in the United States. We evaluate the trade-off between the cost and the health benefits of changing the regulatory DNL level from 65 dB to 55 dB using a Markov model. The study used LaGuardia Airport (LGA as a case study. In compliance with 55 dB allowable limit of aircraft noise, sound insulation would be required for residential homes within the 55 dB to 65 dB DNL. A Markov model was built to assess the cost-effectiveness of installing sound insulation. One-way sensitivity analyses and Monte Carlo simulation were conducted to test uncertainty of the model. The incremental cost-effectiveness ratio of installing sound insulation for residents exposed to airplane noise from LGA was $11,163/QALY gained (95% credible interval: cost-saving and life-saving to $93,054/QALY gained. Changing the regulatory standard for noise exposure around airports from 65 dB to 55 dB comes at a very good value.

Maximum penetration level of distributed generation without violating voltage limits

NARCIS (Netherlands)

Morren, J.; Haan, de S.W.H.

2009-01-01

Connection of Distributed Generation (DG) units to a distribution network will result in a local voltage increase. As there will be a maximum on the allowable voltage increase, this will limit the maximum allowable penetration level of DG. By reactive power compensation (by the DG unit itself) a

A guide for the calculation of the maximum permissible costs for shelters

International Nuclear Information System (INIS)

Schwarzlose, H.

1981-01-01

Among other things, this paper has the aim to define the scope which is reasonable for shelter costs as well as to inform about their real amount. Various assumptions have been made and examples have been given which seldom coincide with the specific facts. Thus, the possibility of how to find solutions which are precisely appropriate for persons is shown in a formula. The less the income, life expectancy and the number of persons to be considered the less are the maximum permissible costs for shelters. Under certain conditions the permissible costs are lower than the real costs. Thus, taking those assumptions into account, the shelter is not profitable any more. This case, for example, really applies to a couple, 57 years old, without children, with an income of 40,000 DM/year who intend to build an interior shelter. For a family with children who are under age, however, it is always profitable to build an interior basic shelter. (orig.) [de

The 5-year cost-effectiveness of two-level anterior cervical discectomy and fusion or cervical disc replacement: a Markov analysis.

Science.gov (United States)

Overley, Samuel C; McAnany, Steven J; Brochin, Robert L; Kim, Jun S; Merrill, Robert K; Qureshi, Sheeraz A

2018-01-01

Anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are both acceptable surgical options for the treatment of cervical myelopathy and radiculopathy. To date, there are limited economic analyses assessing the relative cost-effectiveness of two-level ACDF versus CDR. The purpose of this study was to determine the 5-year cost-effectiveness of two-level ACDF versus CDR. The study design is a secondary analysis of prospectively collected data. Patients in the Prestige cervical disc investigational device exemption (IDE) study who underwent either a two-level CDR or a two-level ACDF were included in the study. The outcome measures were cost and quality-adjusted life years (QALYs). A Markov state-transition model was used to evaluate data from the two-level Prestige cervical disc IDE study. Data from the 36-item Short Form Health Survey were converted into utilities using the short form (SF)-6D algorithm. Costs were calculated from the payer perspective. QALYs were used to represent effectiveness. A probabilistic sensitivity analysis (PSA) was performed using a Monte Carlo simulation. The base-case analysis, assuming a 40-year-old person who failed appropriate conservative care, generated a 5-year cost of $130,417 for CDR and $116,717 for ACDF. Cervical disc replacement and ACDF generated 3.45 and 3.23 QALYs, respectively. The incremental cost-effectiveness ratio (ICER) was calculated to be $62,337/QALY for CDR. The Monte Carlo simulation validated the base-case scenario. Cervical disc replacement had an average cost of $130,445 (confidence interval [CI]: $108,395-$152,761) with an average effectiveness of 3.46 (CI: 3.05-3.83). Anterior cervical discectomy and fusion had an average cost of $116,595 (CI: $95,439-$137,937) and an average effectiveness of 3.23 (CI: 2.84-3.59). The ICER was calculated at $62,133/QALY with respect to CDR. Using a $100,000/QALY willingness to pay (WTP), CDR is the more cost-effective strategy and would be selected

Effect of canister size on costs of disposal of SRP high-level wastes

International Nuclear Information System (INIS)

McDonell, W.R.

1982-01-01

The current plan for managing the high-level nuclear wastes at the Savannah River Plant (SRP) calls for processing them into solid forms contained in stainless steel canisters for eventual disposal in a federal geologic repository. A new SRP facility called the Defense Waste Processing Facility (DWPF) is being designed for the onsite waste processing operations. Preliminary evaluations indicate that costs of the overall disposal operation will depend significantly on the size of the canisters, which determines the number of waste forms to be processed. The objective of this study was to evaluate the effects of canister size on costs of DWPF process operations, including canister procurement, waste solidification, and interim storage, on offsite transport, and on repository costs of disposal, including provision of suitable waste packages

25(OHD3 Levels Relative to Muscle Strength and Maximum Oxygen Uptake in Athletes

Directory of Open Access Journals (Sweden)

Książek Anna

2016-04-01

Full Text Available Vitamin D is mainly known for its effects on the bone and calcium metabolism. The discovery of Vitamin D receptors in many extraskeletal cells suggests that it may also play a significant role in other organs and systems. The aim of our study was to assess the relationship between 25(OHD3 levels, lower limb isokinetic strength and maximum oxygen uptake in well-trained professional football players. We enrolled 43 Polish premier league soccer players. The mean age was 22.7±5.3 years. Our study showed decreased serum 25(OHD3 levels in 74.4% of the professional players. The results also demonstrated a lack of statistically significant correlation between 25(OHD3 levels and lower limb muscle strength with the exception of peak torque of the left knee extensors at an angular velocity of 150°/s (r=0.41. No significant correlations were found between hand grip strength and maximum oxygen uptake. Based on our study we concluded that in well-trained professional soccer players, there was no correlation between serum levels of 25(OHD3 and muscle strength or maximum oxygen uptake.

Maximum power point tracking

International Nuclear Information System (INIS)

Enslin, J.H.R.

1990-01-01

A well engineered renewable remote energy system, utilizing the principal of Maximum Power Point Tracking can be m ore cost effective, has a higher reliability and can improve the quality of life in remote areas. This paper reports that a high-efficient power electronic converter, for converting the output voltage of a solar panel, or wind generator, to the required DC battery bus voltage has been realized. The converter is controlled to track the maximum power point of the input source under varying input and output parameters. Maximum power point tracking for relative small systems is achieved by maximization of the output current in a battery charging regulator, using an optimized hill-climbing, inexpensive microprocessor based algorithm. Through practical field measurements it is shown that a minimum input source saving of 15% on 3-5 kWh/day systems can easily be achieved. A total cost saving of at least 10-15% on the capital cost of these systems are achievable for relative small rating Remote Area Power Supply systems. The advantages at larger temperature variations and larger power rated systems are much higher. Other advantages include optimal sizing and system monitor and control

The Influence of Red Fruit Oil on Creatin Kinase Level at Maximum Physical Activity

Science.gov (United States)

Apollo Sinaga, Fajar; Hotliber Purba, Pangondian

2018-03-01

Heavy physical activities can cause the oxidative stress which resulting in muscle damage with an indicator of elevated levels of Creatin Kinase (CK) enzyme. The oxidative stress can be prevented or reduced by antioxidant supplementation. One of natural resources which contain antioxidant is Red Fruit (Pandanus conoideus) Oil (RFO). This study aims to see the effect of Red Fruit Oil on Creatin Kinase (CK) level at maximum physical activity. This study is an experimental research by using the design of randomized control group pretest-posttest. This study was using 24 male mice divided into four groups, the control group was given aquadest, the treatment groups P1, P2, and P3 were given the RFO orally of 0.15 ml/kgBW, 0.3 ml/kgBW, and 0.6 ml/kgBW, respectively, for a month. The level of CK was checked for all groups at the beginning of study and after the maximum physical activity. The obtained data were then tested statistically by using t-test and ANOVA. The result shows the RFO supplementation during exercise decreased the CK level in P1, P2, and P3 groups with p<0.05, and the higher RFO dosage resulted in decreased CK level at p<0.05. The conclusion of this study is the Red Fruit Oil could decrease the level of CK at maximum physical activity.

Manufacturing Cost Levelization Model – A User’s Guide

Energy Technology Data Exchange (ETDEWEB)

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

2015-08-01

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

LPGC, Levelized Steam Electric Power Generator Cost

International Nuclear Information System (INIS)

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

1994-01-01

1 - Description of program or function: LPGC is a set of nine microcomputer programs for estimating power generation costs for large steam-electric power plants. These programs permit rapid evaluation using various sets of economic and technical ground rules. The levelized power generation costs calculated may be used to compare the relative economics of nuclear and coal-fired plants based on life-cycle costs. Cost calculations include capital investment cost, operation and maintenance cost, fuel cycle cost, decommissioning cost, and total levelized power generation cost. These programs can be used for quick analyses of power generation costs using alternative economic parameters, such as interest rate, escalation rate, inflation rate, plant lead times, capacity factor, fuel prices, etc. The two major types of electric generating plants considered are pressurized-water reactor (PWR) and pulverized coal-fired plants. Data are also provided for the Large Scale Prototype Breeder (LSPB) type liquid metal reactor. Costs for plant having either one or two units may be obtained. 2 - Method of solution: LPGC consists of nine individual menu-driven programs controlled by a driver program, MAINPWR. The individual programs are PLANTCAP, for calculating capital investment costs; NUCLOM, for determining operation and maintenance (O and M) costs for nuclear plants; COALOM, for computing O and M costs for coal-fired plants; NFUEL, for calculating levelized fuel costs for nuclear plants; COALCOST, for determining levelized fuel costs for coal-fired plants; FCRATE, for computing the fixed charge rate on the capital investment; LEVEL, for calculating levelized power generation costs; CAPITAL, for determining capitalized cost from overnight cost; and MASSGEN, for generating, deleting, or changing fuel cycle mass balance data for use with NFUEL. LPGC has three modes of operation. In the first, each individual code can be executed independently to determine one aspect of the total

Effect of a therapeutic maximum allowable cost (MAC) program on the cost and utilization of proton pump inhibitors in an employer-sponsored drug plan in Canada.

Science.gov (United States)

Mabasa, Vincent H; Ma, Johnny

2006-06-01

Therapeutic maximum allowable cost (MAC) is a managed care intervention that uses reference pricing in a therapeutic class or category of drugs or an indication (e.g., heartburn). Therapeutic MAC has not been studied in Canada or the United States. The proton pump inhibitor (PPI) rabeprazole was used as the reference drug in this therapeutic MAC program based on prices for PPIs in the province of Ontario. No PPI is available over the counter in Canada. To evaluate the utilization and anticipated drug cost savings for PPIs in an employer-sponsored drug plan in Canada that implemented a therapeutic MAC program for PPIs. An employer group with an average of 6,300 covered members, which adopted the MAC program for PPIs in June 2003, was compared with a comparison group comprising the book of business throughout Canada (approximately 5 million lives) without a PPI MAC program (non-MAC group). Pharmacy claims for PPIs were identified using the first 6 characters of the generic product identifier (GPI 492700) for a 36-month period from June 1, 2002, through May 31, 2005. The primary comparison was the year prior to the intervention (from June 1, 2002, through May 31, 2003) and the first full year following the intervention (June 1, 2004, through May 31, 2005). Drug utilization was evaluated by comparing the market share of each of the PPIs for the 2 time periods and by the days of PPI therapy per patient per year (PPPY) and days of therapy per prescription (Rx). Drug cost was defined as the cost of the drug (ingredient cost), including allowable provincial pharmacy markup but excluding pharmacy dispense fee. Cost savings were calculated from the allowed drug cost per claim, allowed cost per day, and allowed cost PPPY. (All amounts are in Canadian dollars.) The MAC intervention group experienced an 11.7% reduction in the average cost per day of PPI drug therapy, from 2.14 US dollars in the preperiod to 1.89 US dollars in the postperiod, compared with a 3.7% reduction in

The costs, effects and cost-effectiveness of counteracting overweight on a population level. A scientific base for policy targets for the Dutch national plan for action.

NARCIS (Netherlands)

Bemelmans, W.; Baal, van P.; Wendel-Vos, G.C.W.; Schuit, J.; Feskens, E.J.M.; Ament, A.; Hoogenveen, R.

2008-01-01

Objectives. To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive

High-Level Disinfection of Otorhinolaryngology Clinical Instruments: An Evaluation of the Efficacy and Cost-effectiveness of Instrument Storage.

Science.gov (United States)

Yalamanchi, Pratyusha; Yu, Jason; Chandler, Laura; Mirza, Natasha

2018-01-01

Objectives Despite increasing interest in individual instrument storage, risk of bacterial cross-contamination of otorhinolaryngology clinic instruments has not been assessed. This study is the first to determine the clinical efficacy and cost-effectiveness of standard high-level disinfection and clinic instrument storage. Methods To assess for cross-contamination, surveillance cultures of otorhinolaryngology clinic instruments subject to standard high-level disinfection and storage were obtained at the start and end of the outpatient clinical workday. Rate of microorganism recovery was compared with cultures of instruments stored in individual peel packs and control cultures of contaminated instruments. Based on historical clinic data, the direct allocation method of cost accounting was used to determine aggregate raw material cost and additional labor hours required to process and restock peel-packed instruments. Results Among 150 cultures of standard high-level disinfected and co-located clinic instruments, 3 positive bacterial cultures occurred; 100% of control cultures were positive for bacterial species ( P cost of individual semicritical instrument storage at $97,852.50 per year. Discussion With in vitro inoculation of >200 otorhinolaryngology clinic instruments, this study demonstrates that standard high-level disinfection and storage are equally efficacious to more time-consuming and expensive individual instrument storage protocols, such as peel packing, with regard to bacterial contamination. Implications for Practice Standard high-level disinfection and storage are equally effective to labor-intensive and costly individual instrument storage protocols.

Impact of maximum TF magnetic field on performance and cost of an advanced physics tokamak

International Nuclear Information System (INIS)

Reid, R.L.

1983-01-01

Parametric studies were conducted using the Fusion Engineering Design Center (FEDC) Tokamak Systems Code to investigate the impact of variation in the maximum value of the field at the toroidal field (TF) coils on the performance and cost of a low q/sub psi/, quasi-steady-state tokamak. Marginal ignition, inductive current startup plus 100 s of inductive burn, and a constant value of epsilon (inverse aspect ratio) times beta poloidal were global conditions imposed on this study. A maximum TF field of approximately 10 T was found to be appropriate for this device

Effects of employer-sponsored health insurance costs on Social Security taxable wages.

Science.gov (United States)

Burtless, Gary; Milusheva, Sveta

2013-01-01

The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.

Lowering the UK domestic radon action level to reduce radiation-induced lung cancer in general population: when and where is it cost effective?

International Nuclear Information System (INIS)

Denman, A.R.; Phillips, P.S.

2008-01-01

Case studies have shown that radon gas can be present within domestic properties at sufficiently high levels that it can significantly increase the risk of lung cancer in occupants. Recently, Darby et al. (2006) have shown that this risk exists at radon concentrations as low as 100 Bq·m -3 , which is below the UK domestic Action Level of 200 Bq·m -3 . As a result, there have been suggestions that national domestic Action Levels should be reduced. This paper considers the benefits and costs of the domestic radon remediation programmes in the UK, when a range of Action Levels from 125 Bq·m -3 to 600 Bq·m -3 are applied. The variations of total cost, cost-effectiveness, dose reduction and lung cancers saved for each proposed action level, and the proportion of houses over the proposed action level, were estimated. The study shows that, for an Action Level above 200 Bq·m -3 , a completed domestic radon remediation programme in Northamptonshire, where 6.3% of existing houses have initial radon levels over 200 Bq·m -3 , will cost less and will target those most at risk, but will be less cost effective. In addition, a higher Action Level leaves a higher residual dose and greater risk of cancer in the population living in unremediated homes. Reducing the Action Level below 200 Bq·m -3 will prevent more cancers, but at significantly higher cost. It will be less cost-effective, because a significant number of houses with moderate radon levels will be remediated with modest health benefit to occupants. The study suggests that a completed radon remediation programme is most cost-effective with an action level of around 250 to 300 Bq·m -3 . The finding appears to be independent of the percentage of houses over the Action Level. This has clear implications for future health policy. (author)

Effect of heliostat size on the levelized cost of electricity for power towers

Science.gov (United States)

Pidaparthi, Arvind; Hoffmann, Jaap

2017-06-01

The objective of this study is to investigate the effects of heliostat size on the levelized cost of electricity (LCOE) for power tower plants. These effects are analyzed in a power tower with a net capacity of 100 MWe, 8 hours of thermal energy storage and a solar multiple of 1.8 in Upington, South Africa. A large, medium and a small size heliostat with a total area of 115.56 m2, 43.3 m2 and 15.67 m2 respectively are considered for comparison. A radial-staggered pattern and an external cylindrical receiver are considered for the heliostat field layouts. The optical performance of the optimized heliostat field layouts has been evaluated by the Hermite (analytical) method using SolarPILOT, a tool used for the generation and optimization of the heliostat field layout. The heliostat cost per unit is calculated separately for the three different heliostat sizes and the effects due to size scaling, learning curve benefits and the price index is included. The annual operation and maintenance (O&M) costs are estimated separately for the three heliostat fields, where the number of personnel required in the field is determined by the number of heliostats in the field. The LCOE values are used as a figure of merit to compare the different heliostat sizes. The results, which include the economic and the optical performance along with the annual O&M costs, indicate that lowest LCOE values are achieved by the medium size heliostat with an area of 43.3 m2 for this configuration. This study will help power tower developers determine the optimal heliostat size for power tower plants currently in the development stage.

A hospital-level cost-effectiveness analysis model for toxigenic Clostridium difficile detection algorithms.

Science.gov (United States)

Verhoye, E; Vandecandelaere, P; De Beenhouwer, H; Coppens, G; Cartuyvels, R; Van den Abeele, A; Frans, J; Laffut, W

2015-10-01

Despite thorough analyses of the analytical performance of Clostridium difficile tests and test algorithms, the financial impact at hospital level has not been well described. Such a model should take institution-specific variables into account, such as incidence, request behaviour and infection control policies. To calculate the total hospital costs of different test algorithms, accounting for days on which infected patients with toxigenic strains were not isolated and therefore posed an infectious risk for new/secondary nosocomial infections. A mathematical algorithm was developed to gather the above parameters using data from seven Flemish hospital laboratories (Bilulu Microbiology Study Group) (number of tests, local prevalence and hospital hygiene measures). Measures of sensitivity and specificity for the evaluated tests were taken from the literature. List prices and costs of assays were provided by the manufacturer or the institutions. The calculated cost included reagent costs, personnel costs and the financial burden following due and undue isolations and antibiotic therapies. Five different test algorithms were compared. A dynamic calculation model was constructed to evaluate the cost:benefit ratio of each algorithm for a set of institution- and time-dependent inputted variables (prevalence, cost fluctuations and test performances), making it possible to choose the most advantageous algorithm for its setting. A two-step test algorithm with concomitant glutamate dehydrogenase and toxin testing, followed by a rapid molecular assay was found to be the most cost-effective algorithm. This enabled resolution of almost all cases on the day of arrival, minimizing the number of unnecessary or missing isolations. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Evaluation of Uniform Cost Accounting System to Fully Capture Depot Level Repair Costs.

Science.gov (United States)

1985-12-01

RD-RI65 522 EVALUATION OF UNIFORM COST ACCOUNTING SYSTEM TO FULLY i/I CAPTURE DEPOT LEVEL REPAIR COSTS (U) NAVAL POSTGRADUATE SCHOOL MONTEREY CA D R...8217.LECTE B ,- THESIS EVALUATION OF UNIFORM COST ACCOUNTING SYSTEM 0TO FULLY CAPTURE DEPOT LEVEL REPAIR COSTS Jby __jDavid Richmond O’Brien lj,,, December...Include Security Classification) EVALUATION OF UNIFORM COST ACCOUNTING SYSTEM TO FULLY CAPTURE DEPOT LEVEL REPAIR COSTS 12 PERSONAL AUTHOR(S) O’Brien- David

Effects of waste content of glass waste forms on Savannah River high-level waste disposal costs

International Nuclear Information System (INIS)

McDonell, W.R.; Jantzen, C.M.

1985-01-01

Effects of the waste content of glass waste forms of Savannah River high-level waste disposal costs are evaluated by their impact on the number of waste canisters produced. Changes in waste content affect onsite Defense Waste Processing Facility (DWPF) costs as well as offsite shipping and repository emplacement charges. A nominal 1% increase over the 28 wt % waste loading of DWPF glass would reduce disposal costs by about $50 million for Savannah River wastes generated to the year 2000. Waste form modifications under current study include adjustments of glass frit content to compensate for added salt decontamination residues and increased sludge loadings in the DWPF glass. Projected cost reductions demonstrate significant incentives for continued optimization of the glass waste loadings. 13 refs., 3 figs., 3 tabs

Maximum potential cost-savings attributable to generic substitution ...

African Journals Online (AJOL)

D. Husselmann

community. ... Conclusions: Potential economic benefits can be generated with generic substitution. ... Available online at www.sciencedirect.com ... supply of safe, cost-effective drugs of acceptable quality to all citizens of South Africa, and the rational use of drugs by .... different types of schizophrenic diagnosis) with a claim.

Costs and effects in lumbar spinal fusion

DEFF Research Database (Denmark)

Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel

2007-01-01

of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted...... areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited......Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient...

Cost-effectiveness of root caries preventive treatments.

Science.gov (United States)

Schwendicke, Falk; Göstemeyer, Gerd

2017-01-01

With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments. Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed. In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option. Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations. Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries. Copyright © 2016 Elsevier Ltd. All rights reserved.

The costs, efects and cost-effetiveness of counteracting overweight on a population level.

NARCIS (Netherlands)

Bemelmans, W.; van Baal, P; Wendel-Vos, W.; Schuit, A.J.; Feskens, E.; Ament, A.; Hoogenveen, R.

2008-01-01

Objectives: To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive

Cost effectiveness of detritiating water with resin columns

International Nuclear Information System (INIS)

Drake, R.H.; Williams, D.S.

1997-10-01

There are technologies in use for cleaning up concentrated tritiated process water. These are not cost effective for tritiated water with low concentrations of tritium. There are currently no cost-effective technologies for cleaning up low-tritium-concentration tritiated water, such as most tritiated groundwater, spent fuel storage basin water, or underground storage tank water. Resin removal of tritium from tritiated water at low concentrations (near the order of magnitude of drinking water standard maximums) is being tested on TA-SO (Los Alamos National Laboratory's Liquid Radioactive Waste Treatment Facility) waste streams. There are good theoretical and test indications that this may be a technologically effective means of removing tritium from tritiated water. Because of likely engineering design similarity, it is reasonable to anticipate that a resin column system's costs will be similar to some common commercial water treatment systems. Thus, the potential cost effectiveness of a resin treatment system offers hope for treating tritiated water at affordable costs. The TA-50 resin treatment cost projection of $18 per 1,000 gallons is within the same order of magnitude as cost data for typical commercial groundwater cleanup projects. The prospective Los Alamos National Laboratory (LANL) resin treatment system at $18 per 1,000 gallons appears to have a likely cost advantage of at least an order of magnitude over the competing, developmental, water detritiation technologies

Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

Science.gov (United States)

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

Cost-effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon–Kuskokwim delta region of Alaska

Science.gov (United States)

Atkins, Charisma Y.; Thomas, Timothy K.; Lenaker, Dane; Day, Gretchen M.; Hennessy, Thomas W.; Meltzer, Martin I.

2016-01-01

Objective We conducted a cost-effectiveness analysis of five specific dental interventions to help guide resource allocation. Methods We developed a spreadsheet-based tool, from the healthcare payer perspective, to evaluate the cost effectiveness of specific dental interventions that are currently used among Alaska Native children (6-60 months). Interventions included: water fluoridation, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children caries treatments completed by a dental provider in the dental chair, while 161 children received FMDRs completed by a dental surgeon in an operating room. The average cost of treating dental caries in the dental chair was $1,467 (~258,000 per year); while the cost of treating FMDRs was $9,349 (~1.5 million per year). All interventions were shown to prevent caries and FMDRs; however tooth brushing prevented the greatest number of caries at minimum and maximum effectiveness with 1,433 and 1,910, respectively. Tooth brushing also prevented the greatest number of FMDRs (159 and 211) at minimum and maximum effectiveness. Conclusions All of the dental interventions evaluated were shown to produce cost savings. However, the level of that cost saving is dependent on the intervention chosen. PMID:26990678

A new approach to hierarchical data analysis: Targeted maximum likelihood estimation for the causal effect of a cluster-level exposure.

Science.gov (United States)

Balzer, Laura B; Zheng, Wenjing; van der Laan, Mark J; Petersen, Maya L

2018-01-01

We often seek to estimate the impact of an exposure naturally occurring or randomly assigned at the cluster-level. For example, the literature on neighborhood determinants of health continues to grow. Likewise, community randomized trials are applied to learn about real-world implementation, sustainability, and population effects of interventions with proven individual-level efficacy. In these settings, individual-level outcomes are correlated due to shared cluster-level factors, including the exposure, as well as social or biological interactions between individuals. To flexibly and efficiently estimate the effect of a cluster-level exposure, we present two targeted maximum likelihood estimators (TMLEs). The first TMLE is developed under a non-parametric causal model, which allows for arbitrary interactions between individuals within a cluster. These interactions include direct transmission of the outcome (i.e. contagion) and influence of one individual's covariates on another's outcome (i.e. covariate interference). The second TMLE is developed under a causal sub-model assuming the cluster-level and individual-specific covariates are sufficient to control for confounding. Simulations compare the alternative estimators and illustrate the potential gains from pairing individual-level risk factors and outcomes during estimation, while avoiding unwarranted assumptions. Our results suggest that estimation under the sub-model can result in bias and misleading inference in an observational setting. Incorporating working assumptions during estimation is more robust than assuming they hold in the underlying causal model. We illustrate our approach with an application to HIV prevention and treatment.

The integrated business information system: using automation to monitor cost-effectiveness of park operations

Science.gov (United States)

Dick Stanley; Bruce Jackson

1995-01-01

The cost-effectiveness of park operations is often neglected because information is laborious to compile. The information, however, is critical if we are to derive maximum benefit from scarce resources. This paper describes an automated system for calculating cost-effectiveness ratios with minimum effort using data from existing data bases.

Effects of different feeding levels on moulting, growth, food conversion efficiency and biochemical composition of the prawn, metapenaeus monoceros (Fabricius)

Digital Repository Service at National Institute of Oceanography (India)

Sumitra-Vijayaraghavan; Royan, J.P.; Rao, T.S.S.

food/g prawn/day represented the maintenance, optimum and maximum feeding levels Specific dynamic action increased twice at the observed maximum feeding level (20%) than at optimum feeding level (12%), indicating that the energy cost of converting food...

Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment

DEFF Research Database (Denmark)

Phillips, Andrew N; Cambiano, Valentina; Miners, Alec

2014-01-01

BACKGROUND: With continued roll-out of antiretroviral therapy (ART) in resource-limited settings, evidence is emerging of increasing levels of transmitted drug-resistant HIV. We aimed to compare the effectiveness and cost-effectiveness of different potential public health responses to substantial...

Diagnostic staging laparoscopy in gastric cancer treatment: A cost-effectiveness analysis.

Science.gov (United States)

Li, Kevin; Cannon, John G D; Jiang, Sam Y; Sambare, Tanmaya D; Owens, Douglas K; Bendavid, Eran; Poultsides, George A

2018-05-01

Accurate preoperative staging helps avert morbidity, mortality, and cost associated with non-therapeutic laparotomy in gastric cancer (GC) patients. Diagnostic staging laparoscopy (DSL) can detect metastases with high sensitivity, but its cost-effectiveness has not been previously studied. We developed a decision analysis model to assess the cost-effectiveness of preoperative DSL in GC workup. Analysis was based on a hypothetical cohort of GC patients in the U.S. for whom initial imaging shows no metastases. The cost-effectiveness of DSL was measured as cost per quality-adjusted life-year (QALY) gained. Drivers of cost-effectiveness were assessed in sensitivity analysis. Preoperative DSL required an investment of $107 012 per QALY. In sensitivity analysis, DSL became cost-effective at a threshold of $100 000/QALY when the probability of occult metastases exceeded 31.5% or when test sensitivity for metastases exceeded 86.3%. The likelihood of cost-effectiveness increased from 46% to 93% when both parameters were set at maximum reported values. The cost-effectiveness of DSL for GC patients is highly dependent on patient and test characteristics, and is more likely when DSL is used selectively where procedure yield is high, such as for locally advanced disease or in detecting peritoneal and superficial versus deep liver lesions. © 2017 Wiley Periodicals, Inc.

Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease.

Science.gov (United States)

Ament, Jared D; Yang, Zhuo; Nunley, Pierce; Stone, Marcus B; Kim, Kee D

2014-12-01

Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis, while preserving motion. While anterior cervical discectomy and fusion (ACDF) has been the standard of care for 2-level disease, a randomized clinical trial (RCT) suggested similar outcomes. Cost-effectiveness of this intervention has never been elucidated. To determine the cost-effectiveness of CTDR compared with ACDF. Data were derived from an RCT that followed up 330 patients over 24 months. The original RCT consisted of multi-institutional data including private and academic institutions. Using linear regression for the current study, health states were constructed based on the stratification of the Neck Disability Index and a visual analog scale. Data from the 12-item Short-Form Health Survey questionnaires were transformed into utilities values using the SF-6D mapping algorithm. Costs were calculated by extracting Diagnosis-Related Group codes from institutional billing data and then applying 2012 Medicare reimbursement rates. The costs of complications and return-to-work data were also calculated. A Markov model was built to evaluate quality-adjusted life-years (QALYs) for both treatment groups. The model adopted a third-party payer perspective and applied a 3% annual discount rate. Patients included in the original RCT had to be diagnosed as having radiculopathy or myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment for at least 6 weeks or demonstrated progressive symptoms. Incremental cost-effectiveness ratio of CTDR compared with ACDF. A strong correlation (R2 = 0.6864; P sensitivity analysis, the incremental cost-effectiveness ratio value stays below the threshold of $50,000 per QALY in most scenarios (range, -$58,194 to $147,862 per QALY). The incremental cost-effectiveness ratio of CTDR compared with traditional ACDF is lower than the commonly accepted threshold of $50,000 per QALY. This remains true with varying input

Cost-effectiveness analysis for sector-wide priority setting in health

NARCIS (Netherlands)

R.C.W. Hutubessy (Raymond)

2003-01-01

textabstractCost-effectiveness analysis (CEA) provides one means by which decision-makers may assess and potentially improve the performance of health systems. The process can help to ensure that resources devoted to health systems are achieving the maximum possible benefit in terms of outcomes

Maximum coherent superposition state achievement using a non-resonant pulse train in non-degenerate three-level atoms

International Nuclear Information System (INIS)

Deng, Li; Niu, Yueping; Jin, Luling; Gong, Shangqing

2010-01-01

The coherent superposition state of the lower two levels in non-degenerate three-level Λ atoms is investigated using the accumulative effects of non-resonant pulse trains when the repetition period is smaller than the decay time of the upper level. First, using a rectangular pulse train, the accumulative effects are re-examined in the non-resonant two-level atoms and the modified constructive accumulation equation is analytically given. The equation shows that the relative phase and the repetition period are important in the accumulative effect. Next, under the modified equation in the non-degenerate three-level Λ atoms, we show that besides the constructive accumulation effect, the use of the partial constructive accumulation effect can also achieve the steady state of the maximum coherent superposition state of the lower two levels and the latter condition is relatively easier to manipulate. The analysis is verified by numerical calculations. The influence of the external levels in such a case is also considered and we find that it can be avoided effectively. The above analysis is also applicable to pulse trains with arbitrary envelopes.

Is dibotermin alfa a cost-effective substitute for autologous iliac crest bone graft in single level lumbar interbody spine fusion?

Science.gov (United States)

Svedbom, Axel; Paech, Daniel; Leonard, Catherine; Donnell, David; Song, Fujian; Boszcyk, Bronek; Rothenfluh, Dominique A; Lloyd, Andrew; Borgman, Benny

2015-11-01

To evaluate the cost-effectiveness of dibotermin alfa compared with autologous iliac crest bone graft (ICBG) for patients undergoing single level lumbar interbody spinal fusion in a UK hospital setting. An individual patient data (IPD) meta-analysis of six randomized controlled clinical trials and two single arm trials compared dibotermin alfa on an absorbable collagen implantation matrix (ACIM) (n = 456) and ICBG (n = 244) on resource use, re-operation rates, and SF-6D (Short form 6-dimension) health utility (total N = 700). Failure-related second surgery, operating time, post-operative hospital stay, and quality-adjusted life years (QALYs) derived from the IPD meta-analysis were included as inputs in an economic evaluation undertaken to assess the cost-effectiveness of dibotermin alfa/ACIM versus ICBG for patients undergoing single level lumbar interbody spinal fusion. A four year time horizon and the United Kingdom (UK) National Health Service (NHS) and Personal Social Services (PSS) perspective was adopted in the base case, with sensitivity analyses performed to gauge parameter uncertainty. In the base case analysis, patients treated using dibotermin alfa/ACIM (12 mg pack) accrued 0.055 incremental QALYs at an incremental cost of £ 737, compared with patients treated with ICBG. This resulted in an incremental cost-effectiveness ratio (ICER) of £ 13,523, indicating that at a willingness-to-pay threshold of £ 20,000, dibotermin alfa/ACIM is a cost-effective intervention relative to ICBG from the NHS and PSS perspective. In a UK hospital setting, dibotermin alfa/ACIM is a cost-effective substitute for ICBG for patients who require lumbar interbody arthrodesis.

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

Ventilation cost impact of reduced radon-daughter working levels

International Nuclear Information System (INIS)

Bates, R.C.

1981-01-01

Published information on costs of radon-daughter control in uranium mines was analyzed to develop estimates of the cost per ton for any level of radiation exposure control. All data were converted to 1967 cost of living index to provide a common analysis base. Results of the analysis show that the cost per ton increases exponentially as the radiation level is lowered. A linear relationship with the cost of living index is assumed, and equations and graphs are provided to estimate control cost per ton for any exposure control level and cost of living index

Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

Science.gov (United States)

Fleck, Leonard M

2018-04-01

Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

State-Level Estimates of Cancer-Related Absenteeism Costs

Science.gov (United States)

Tangka, Florence K.; Trogdon, Justin G.; Nwaise, Isaac; Ekwueme, Donatus U.; Guy, Gery P.; Orenstein, Diane

2016-01-01

Background Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. Methods In analyses of data from the 2004–2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. Results We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. Conclusions The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. PMID:23969498

Cost effectiveness of reducing radon exposure in Spanish dwellings

International Nuclear Information System (INIS)

Colgan, P.A.; Gutierrez, J.

1996-01-01

Published information on the distribution of radon levels in Spanish single family dwellings is used to evaluate the cost-effectiveness of three different intervention scenarios: remediation of existing dwellings, radon proofing of all future dwellings and the targetting of areas with higher than average indoor radon concentrations. Analysis is carried out on the basis of a Reference Level of 400 Bq m -3 for the existing housing stock and 200 Bq m -3 for new dwellings. Certain assumptions are made about the effectiveness and durability of the measures applied and annualised costs are used to calculate the costs per lung cancer death averted. The results reveal that targetting future housing is a more cost-effective option than remediation of existing dwellings with radon concentrations above the Reference Level -the costs per lung cancer death averted are typically $145000. In high-risk areas, these costs can be considerably less, depending on the percentage of dwellings expected to exceed the Reference Level and the average savings in exposure as a result of the intervention. The costs of intervention to reduce lung cancer deaths following exposure to radon compare favourably with those of other health programmes in other countries. (Author)

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.

Cost-effectiveness thresholds: pros and cons.

Science.gov (United States)

Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

2016-12-01

Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

Comparative costs and cost-effectiveness of behavioural interventions as part of HIV prevention strategies.

Science.gov (United States)

Hsu, Justine; Zinsou, Cyprien; Parkhurst, Justin; N'Dour, Marguerite; Foyet, Léger; Mueller, Dirk H

2013-01-01

Behavioural interventions have been widely integrated in HIV/AIDS social marketing prevention strategies and are considered valuable in settings with high levels of risk behaviours and low levels of HIV/AIDS awareness. Despite their widespread application, there is a lack of economic evaluations comparing different behaviour change communication methods. This paper analyses the costs to increase awareness and the cost-effectiveness to influence behaviour change for five interventions in Benin. Cost and cost-effectiveness analyses used economic costs and primary effectiveness data drawn from surveys. Costs were collected for provider inputs required to implement the interventions in 2009 and analysed by 'person reached'. Cost-effectiveness was analysed by 'person reporting systematic condom use'. Sensitivity analyses were performed on all uncertain variables and major assumptions. Cost-per-person reached varies by method, with public outreach events the least costly (US$2.29) and billboards the most costly (US$25.07). Influence on reported behaviour was limited: only three of the five interventions were found to have a significant statistical correlation with reported condom use (i.e. magazines, radio broadcasts, public outreach events). Cost-effectiveness ratios per person reporting systematic condom use resulted in the following ranking: magazines, radio and public outreach events. Sensitivity analyses indicate rankings are insensitive to variation of key parameters although ratios must be interpreted with caution. This analysis suggests that while individual interventions are an attractive use of resources to raise awareness, this may not translate into a cost-effective impact on behaviour change. The study found that the extensive reach of public outreach events did not seem to influence behaviour change as cost-effectively when compared with magazines or radio broadcasts. Behavioural interventions are context-specific and their effectiveness influenced by a

Selecting cost-effective areas for restoration of ecosystem services.

Science.gov (United States)

Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

2015-04-01

Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services. © 2014 Society for Conservation Biology.

ECONOMIC REASONING MAXIMUM SLOPE IN DESIGN HIGH-SPEED LINES

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CHERNYSHOVA O. S.

2016-04-01

Full Text Available Raising of problem The worldwide design standards high-speed lines are somewhat different. This is due to several reasons: different levels of design speed, differences of characteristics of rolling stock and, in particular, the features of the design plan and longitudinal profile, that are associated primarily with the conditions of the relief. In the design of high-speed railways in Ukraine should take into account these features and determine what the maximum slope values can be used in difficult conditions, as well as how it will affect the operational and capital costs. Purpose. To determine the optimal design parameters of the longitudinal profile. Conclusion. The results are based not only on technical, but also economic indicators and allow the assessment of the necessary capital expenditures and expected cost of the railway in the future. Analytical dependences, to predict the expected operating costs of the railway, depending on the maximum slope, its length and the total length of the section.

Cost-effectiveness analysis and innovation.

Science.gov (United States)

Jena, Anupam B; Philipson, Tomas J

2008-09-01

While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

Bayesian models for cost-effectiveness analysis in the presence of structural zero costs.

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Baio, Gianluca

2014-05-20

Bayesian modelling for cost-effectiveness data has received much attention in both the health economics and the statistical literature, in recent years. Cost-effectiveness data are characterised by a relatively complex structure of relationships linking a suitable measure of clinical benefit (e.g. quality-adjusted life years) and the associated costs. Simplifying assumptions, such as (bivariate) normality of the underlying distributions, are usually not granted, particularly for the cost variable, which is characterised by markedly skewed distributions. In addition, individual-level data sets are often characterised by the presence of structural zeros in the cost variable. Hurdle models can be used to account for the presence of excess zeros in a distribution and have been applied in the context of cost data. We extend their application to cost-effectiveness data, defining a full Bayesian specification, which consists of a model for the individual probability of null costs, a marginal model for the costs and a conditional model for the measure of effectiveness (given the observed costs). We presented the model using a working example to describe its main features. © 2013 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd.

Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial.

Science.gov (United States)

Pizzi, Laura T; Seligman, Neil S; Baxter, Jason K; Jutkowitz, Eric; Berghella, Vincenzo

2014-05-01

Preterm birth (PTB) is a costly public health problem in the USA. The PREGNANT trial tested the efficacy of vaginal progesterone (VP) 8 % gel in reducing the likelihood of PTB among women with a short cervix. We calculated the costs and cost effectiveness of VP gel versus placebo using decision analytic models informed by PREGNANT patient-level data. PREGNANT enrolled 459 pregnant women with a cervical length of 10-20 mm and randomized them to either VP 8 % gel or placebo. We used a cost model to estimate the total cost of treatment per mother and a cost-effectiveness model to estimate the cost per PTB averted with VP gel versus placebo. Patient-level trial data informed model inputs and included PTB rates in low- and high-risk women in each study group at <28 weeks gestation, 28-31, 32-36, and ≥37 weeks. Cost assumptions were based on 2010 US healthcare services reimbursements. The cost model was validated against patient-level data. Sensitivity analyses were used to test the robustness of the cost-effectiveness model. The estimated cost per mother was $US23,079 for VP gel and $US36,436 for placebo. The cost-effectiveness model showed savings of $US24,071 per PTB averted with VP gel. VP gel realized cost savings and cost effectiveness in 79 % of simulations. Based on findings from PREGNANT, VP gel was associated with cost savings and cost effectiveness compared with placebo. Future trials designed to include cost metrics are needed to better understand the value of VP.

State-Level Estimates of Obesity-Attributable Costs of Absenteeism

Science.gov (United States)

Andreyeva, Tatiana; Luedicke, Joerg; Wang, Y. Claire

2014-01-01

Objective To provide state-level estimates of obesity-attributable costs of absenteeism among working adults in the U.S. Methods Nationally-representative data from the National Health and Nutrition Examination Survey (NHANES) for 1998–2008 and from the Behavioral Risk Factor Surveillance System (BRFSS) for 2012 are examined. The outcome is obesity-attributable workdays missed in the previous year due to health, and their costs to states. Results Obesity, but not overweight, is associated with a significant increase in workdays absent, from 1.1 to 1.7 extra days missed annually compared to normal weight employees. Obesity-attributable absenteeism among American workers costs the nation an estimated $8.65 billion per year. Conclusion Obesity imposes a considerable financial burden on states, accounting for 6.5%–12.6% of total absenteeism costs in the workplace. State legislature and employers should seek effective ways to reduce these costs. PMID:25376405

Cost-effectiveness of a central venous catheter care bundle.

Directory of Open Access Journals (Sweden)

Kate A Halton

Full Text Available BACKGROUND: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI. Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. METHODS AND FINDINGS: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters, or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. CONCLUSIONS: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision

Dynamic evaluation of the levelized cost of wind power generation

International Nuclear Information System (INIS)

Díaz, Guzmán; Gómez-Aleixandre, Javier; Coto, José

2015-01-01

Highlights: • Conventional levelized cost of energy is static and does not consider flexibility. • This paper defines a dynamic version by means of stochastic programming. • A penalty for early exercising is proposed to differentiate static and dynamic. • Results show the effects of feed-in tariff support in low wind sites. • Policy implications are derived on the basis of the static and dynamic measures. - Abstract: This paper discusses an alternative computation method of the levelized cost of energy of distributed wind power generators. Unlike in the conventional procedures, it includes time of commencement as an optimization variable. For that purpose, a methodology from Longstaff and Schwartz’s dynamic program for pricing financial American options is derived, which provides the ability to find the optimum time and value while coping with uncertainty revenues from energy sales and variable capital costs. The results obtained from the analysis of wind records of 50 sites entail that the conventional levelized cost of energy can be broken down into an optimum, minimum (time-dependent) value and a penalty for early exercising, which can be employed to define investment strategies and support policies

Patient level costing in Ireland: process, challenges and opportunities.

Science.gov (United States)

Murphy, A; McElroy, B

2015-03-01

In 2013, the Department of Health released their policy paper on hospital financing entitled Money Follows the Patient. A fundamental building block for the proposed financing model is patient level costing. This paper outlines the patient level costing process, identifies the opportunities and considers the challenges associated with the process in the Irish hospital setting. Methods involved a review of the existing literature which was complemented with an interview with health service staff. There are considerable challenges associated with implementing patient level costing including deficits in information and communication technologies and financial expertise as well as timeliness of coding. In addition, greater clinical input into the costing process is needed compared to traditional costing processes. However, there are long-term benefits associated with patient level costing; these include empowerment of clinical staff, improved transparency and price setting and greater fairness, especially in the treatment of outliers. These can help to achieve the Government's Health Strategy. The benefits of patient level costing need to be promoted and a commitment to investment in overcoming the challenges is required.

What is known about the cost-effectiveness of orphan drugs? Evidence from cost-utility analyses.

Science.gov (United States)

Picavet, E; Cassiman, D; Simoens, S

2015-06-01

In times of financial and economic hardship, governments are looking to contain pharmaceutical expenditure by focusing on cost-effective drugs. Because of their high prices and difficulties in demonstrating effectiveness in small patient populations, orphan drugs are often perceived as not able to meet traditional reimbursement threshold value for money. The aim of this study was to provide an overview of the available evidence on the cost-effectiveness of orphan drugs. All orphan drugs listed as authorized on the website of the European Medicines Agency on 21 November 2013 were included in the analysis. Cost-utility analyses (CUAs) were identified by searching the Tufts Medical Center Cost-Effectiveness Analysis Registry and Embase. For each CUA, a number of variables were collected. The search identified 23 articles on the Tufts registry and 167 articles on Embase. The final analysis included 45 CUAs and 61 incremental cost-utility ratios (ICURs) for 19 orphan drugs. Of all ICURS, 16·3% were related to dominant drugs (i.e. more effective and less expensive than the comparator), 70·5% were related to drugs that are more effective, but at a higher cost, and 13·1% were related to dominated drugs (i.e. less effective and more expensive than the comparator). The median overall ICUR was €40 242 per quality-adjusted life year (QALY) with a minimum ICUR of €6311/QALY and a maximum ICUR of €974,917/QALY. This study demonstrates that orphan drugs can meet traditional reimbursement thresholds. Considering a threshold of £30,000/QALY, in this study, ten (52·6%) of a total of 19 orphan drugs for which data were available meet the threshold. As much as fifteen orphan drugs (78·9%) are eligible for reimbursement if a threshold of €80,000/QALY is considered. © 2015 John Wiley & Sons Ltd.

Community disruptions and business costs for distant tsunami evacuations using maximum versus scenario-based zones

Science.gov (United States)

Wood, Nathan J.; Wilson, Rick I.; Ratliff, Jamie L.; Peters, Jeff; MacMullan, Ed; Krebs, Tessa; Shoaf, Kimberley; Miller, Kevin

2017-01-01

Well-executed evacuations are key to minimizing loss of life from tsunamis, yet they also disrupt communities and business productivity in the process. Most coastal communities implement evacuations based on a previously delineated maximum-inundation zone that integrates zones from multiple tsunami sources. To support consistent evacuation planning that protects lives but attempts to minimize community disruptions, we explore the implications of scenario-based evacuation procedures and use the California (USA) coastline as our case study. We focus on the land in coastal communities that is in maximum-evacuation zones, but is not expected to be flooded by a tsunami generated by a Chilean earthquake scenario. Results suggest that a scenario-based evacuation could greatly reduce the number of residents and employees that would be advised to evacuate for 24–36 h (178,646 and 159,271 fewer individuals, respectively) and these reductions are concentrated primarily in three counties for this scenario. Private evacuation spending is estimated to be greater than public expenditures for operating shelters in the area of potential over-evacuations ($13 million compared to $1 million for a 1.5-day evacuation). Short-term disruption costs for businesses in the area of potential over-evacuation are approximately $122 million for a 1.5-day evacuation, with one-third of this cost associated with manufacturing, suggesting that some disruption costs may be recouped over time with increased short-term production. There are many businesses and organizations in this area that contain individuals with limited mobility or access and functional needs that may have substantial evacuation challenges. This study demonstrates and discusses the difficulties of tsunami-evacuation decision-making for relatively small to moderate events faced by emergency managers, not only in California but in coastal communities throughout the world.

A low cost, printed microwave based level sensor with integrated oscillator readout circuitry

KAUST Repository

Karimi, Muhammad Akram

2017-10-24

This paper presents an extremely low cost, tube conformable, printed T-resonator based microwave level sensor, whose resonance frequency shifts by changing the level of fluids inside the tube. Printed T-resonator forms the frequency selective element of the tunable oscillator. Unlike typical band-pass resonators, T-resonator has a band-notch characteristics because of which it has been integrated with an unstable amplifying unit having negative resistance in the desired frequency range. Magnitude and phase of input reflection coefficient of the transistor has been optimized over the desired frequency range. Phase flattening technique has been introduced to maximize the frequency shift of the oscillator. With the help of this technique, we were able to enhance the percentage tuning of the oscillator manifolds which resulted into a level sensor with higher sensitivity. The interface level of fluids (oil and water in our case) causes a relative change in oscillation frequency by more than 50% compared to maximum frequency shift of 8% reported earlier with dielectric tunable oscillators.

Cost effectiveness of radon mitigation in Canada

International Nuclear Information System (INIS)

Letourneau, E.G.; Krewski, D.; Zielinski, J.M.; McGregor, R.G.

1992-01-01

This paper examines the cost effectiveness of comprehensive strategies for reducing exposure to radon gas in indoor air in Canadian homes. The analysis is conducted within the context of a general framework for risk management programme evaluation which includes well-known evaluation techniques such as cost effectiveness and cost-benefit analyses as special cases. Based on this analysis, it is clear that any comprehensive programme to reduce exposure to environmental radon will be extremely expensive, and may not be justifiable in terms of health impact, particularly when considered in relation to other public health programmes. Testing of homes at the point of sale and installing sub-slab suction equipment to reduce exposure to indoor radon where necessary appears to be a relatively cost-effective radon mitigation strategy. In general, radon mitigation was found to be most cost effective in cities with relatively high levels of radon. (author)

A Meta Analysis on Farm-Level Costs and Benefits of GM Crops

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Nataliya Stupak

2011-05-01

Full Text Available This paper reviews the evidence on the socio-economic impacts of GM crops and analyzes whether there are patterns across space and time. To this end, we investigate the effect of GM crops on farm-level costs and benefits using global data from more than one decade of field trials and surveys. More specifically, we analyze the effects of GM-crops on crop yields, seed costs, pesticide costs, and management and labor costs and finally gross margins. Based on collected data from studies on Bt cotton and Bt maize, statistical analyses are conducted to estimate the effect of GM crop adoption on these parameters. Our results show that, compared to conventional crops, GM crops can lead to yield increases and can lead to reductions in the costs of pesticide application, whereas seed costs are usually substantially higher. Thus, the results presented here do support the contention that the adoption of GM crops leads on average to a higher economic performance, which is also underlined by the high adoption rates for GM crops in a number of countries. However, the kind and magnitude of benefits from GM crops are very heterogeneous between countries and regions, particularly due to differences in pest pressure and pest management practices. Countries with poor pest management practices benefited most from a reduction in yield losses, whereas other countries benefited from cost reductions. However, our study also reveals limitations for meta-analyses on farm-level costs and benefits of GM crops. In particular, published data are skewed towards some countries and the employed individual studies rely on different assumptions, purposes and methodologies (e.g., surveys and field trials. Furthermore, a summary of several (often short-term individual studies may not necessarily capture long-term effects of GM crop adoption.

User's manual for levelized power generation cost using a microcomputer

International Nuclear Information System (INIS)

Fuller, L.C.

1984-08-01

Microcomputer programs for the estimation of levelized electrical power generation costs are described. Procedures for light-water reactor plants and coal-fired plants include capital investment cost, operation and maintenance cost, fuel cycle cost, nuclear decommissioning cost, and levelized total generation cost. Programs are written in Pascal and are run on an Apple II Plus microcomputer

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

Science.gov (United States)

Chhagan, Meera K; Van den Broeck, Jan; Luabeya, Kany-Kany Angelique; Mpontshane, Nontobeko; Bennish, Michael L

2014-09-01

To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

Population-level effects of fitness costs associated with repressible female-lethal transgene insertions in two pest insects.

Science.gov (United States)

Harvey-Samuel, Tim; Ant, Thomas; Gong, Hongfei; Morrison, Neil I; Alphey, Luke

2014-05-01

Genetic control strategies offer great potential for the sustainable and effective control of insect pests. These strategies involve the field release of transgenic insects with the aim of introducing engineered alleles into wild populations, either permanently or transiently. Their efficacy can therefore be reduced if transgene-associated fitness costs reduce the relative performance of released insects. We describe a method of measuring the fitness costs associated with transgenes by analyzing their evolutionary trajectories when placed in competition with wild-type alleles in replicated cage populations. Using this method, we estimated lifetime fitness costs associated with two repressible female-lethal transgenes in the diamondback moth and olive fly as being acceptable for field suppression programs. Furthermore, using these estimates of genotype-level fitness costs, we were able to project longer-term evolutionary trajectories for the transgenes investigated. Results from these projections demonstrate that although transgene-associated fitness costs will ultimately cause these transgenes to become extinct, even when engineered lethality is repressed, they may persist for varying periods of time before doing so. This implies that tetracycline-mediated transgene field persistence in these strains is unlikely and suggests that realistic estimates of transgene-associated fitness costs may be useful in trialing 'uncoupled' gene drive system components in the field.

Effect of a High-intensity Interval Training method on maximum oxygen consumption in Chilean schoolchildren

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Sergio Galdames-Maliqueo

2017-12-01

Full Text Available Introduction: The low levels of maximum oxygen consumption (VO2max evaluated in Chilean schoolchildren suggest the startup of trainings that improve the aerobic capacity. Objective: To analyze the effect of a High-intensity Interval Training method on maximum oxygen consumption in Chilean schoolchildren. Materials and methods: Thirty-two high school students from the eighth grade, who were divided into two groups, were part of the study (experimental group = 16 students and control group = 16 students. The main analyzed variable was the maximum oxygen consumption through the Course Navette Test. A High-intensity Interval training method was applied based on the maximum aerobic speed obtained through the Test. A mixed ANOVA was used for statistical analysis. Results: The experimental group showed a significant increase in the Maximum Oxygen Consumption between the pretest and posttest when compared with the control group (p < 0.0001. Conclusion: The results of the study showed a positive effect of the High-intensity Interval Training on the maximum consumption of oxygen. At the end of the study, it is concluded that High-intensity Interval Training is a good stimulation methodology for Chilean schoolchildren.

Base-Stock Level yang Meminimasi Biaya pada Permasalahan Single Order

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Tanti Octavia

2011-01-01

Full Text Available The purpose of this research is to conduct an analysis on demand characteristic and inventory cost which might potentially influence the determination of base-stock level. Appropriate base-stock level will determine the maximum profit and also reduce the stockout cost for fashion products which has high demand uncertainty and single order problem. Case study is applied on a garment company with eight fashion product types that can be classified into short and long lifetime. The effect of coefficient variation, salvage price and stockout cost is analyzed towards profits and base stock level. It can be concluded that demand variability does not affect base stock level, while stockout cost and salvage price does.

The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis.

Science.gov (United States)

Chun, June Sang; Har, Alix; Lim, Hyun-Pil; Lim, Hoi-Jeong

2016-02-01

This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective. The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate. When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10(th) year after the treatment, and more cost-effective regardless of the WTP from 20(th) year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10(th) year after the prosthodontic treatment, more than 35,000 won at the 20(th) year after prosthodontic treatment. The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10(th) year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.

Cost-effectiveness on a local level: whether and when to adopt a new technology.

Science.gov (United States)

Woertman, Willem H; Van De Wetering, Gijs; Adang, Eddy M M

2014-04-01

Cost-effectiveness analysis has become a widely accepted tool for decision making in health care. The standard textbook cost-effectiveness analysis focuses on whether to make the switch from an old or common practice technology to an innovative technology, and in doing so, it takes a global perspective. In this article, we are interested in a local perspective, and we look at the questions of whether and when the switch from old to new should be made. A new approach to cost-effectiveness from a local (e.g., a hospital) perspective, by means of a mathematical model for cost-effectiveness that explicitly incorporates time, is proposed. A decision rule is derived for establishing whether a new technology should be adopted, as well as a general rule for establishing when it pays to postpone adoption by 1 more period, and a set of decision rules that can be used to determine the optimal timing of adoption. Finally, a simple example is presented to illustrate our model and how it leads to optimal decision making in a number of cases.

Methods for estimating costs of transporting spent fuel and defense high-level radioactive waste for the civilian radioactive waste management program

International Nuclear Information System (INIS)

Darrough, M.E.; Lilly, M.J.

1989-01-01

The US Department of Energy (DOE), through the Office of Civilian Radioactive Waste Management, is planning and developing a transportation program for the shipment of spent fuel and defense high-level waste from current storage locations to the site of the mined geologic repository. In addition to its responsibility for providing a safe transportation system, the DOE will assure that the transportation program will function with the other system components to create an integrated waste management system. In meeting these objectives, the DOE will use private industry to the maximum extent practicable and in a manner that is cost effective. This paper discusses various methodologies used for estimating costs for the national radioactive waste transportation system. Estimating these transportation costs is a complex effort, as the high-level radioactive waste transportation system, itself, will be complex. Spent fuel and high-level waste will be transported from more than 100 nuclear power plants and defense sites across the continental US, using multiple transport modes (truck, rail, and barge/rail) and varying sizes and types of casks. Advance notification to corridor states will be given and scheduling will need to be coordinated with utilities, carriers, state and local officials, and the DOE waste acceptance facilities. Additionally, the waste forms will vary in terms of reactor type, size, weight, age, radioactivity, and temperature

An Iterative Maximum a Posteriori Estimation of Proficiency Level to Detect Multiple Local Likelihood Maxima

Science.gov (United States)

Magis, David; Raiche, Gilles

2010-01-01

In this article the authors focus on the issue of the nonuniqueness of the maximum likelihood (ML) estimator of proficiency level in item response theory (with special attention to logistic models). The usual maximum a posteriori (MAP) method offers a good alternative within that framework; however, this article highlights some drawbacks of its…

Cost effectiveness of below-threshold waste disposal at DOE sites

International Nuclear Information System (INIS)

Smith, C.F.; Cohen, J.J.

1987-01-01

A minimal health and environmental risk, limitations on disposal capacity, and the relatively high costs of low level waste (LLW) disposal are basic driving forces that lead to consideration of less restrictive disposal of wastes with very low levels of radiological contamination. The term threshold limit describes radioactive wastes that have sufficiently low-levels of radiological content to be managed according to their nonradiological properties. Given the efforts described elsewhere to provide guidance on the definition of below threshold (BT) doses and concentration levels, the purpose of this study was to quantify the resultant quantities, costs and cost effectiveness of BT disposal. For purposes of consistency with the previous demonstrations of the application of the threshold concept, available data for waste streams at the Idaho National Engineering Laboratory (INEL) and the Savannah River Plant (SRP) sites were collected and analyzed with regard to volumes, radionuclide concentrations, and disposal costs. From this information, quantities of BT waste, potential cost savings and cost effectiveness values were estimated. 1 reference, 5 tables

Costs of mixed low-level waste stabilization options

International Nuclear Information System (INIS)

Schwinkendorf, W.E.; Cooley, C.R.

1998-01-01

Selection of final waste forms to be used for disposal of DOE's mixed low-level waste (MLLW) depends on the waste form characteristics and total life cycle cost. In this paper the various cost factors associated with production and disposal of the final waste form are discussed and combined to develop life-cycle costs associated with several waste stabilization options. Cost factors used in this paper are based on a series of treatment system studies in which cost and mass balance analyses were performed for several mixed low-level waste treatment systems and various waste stabilization methods including vitrification, grout, phosphate bonded ceramic and polymer. Major cost elements include waste form production, final waste form volume, unit disposal cost, and system availability. Production of grout costs less than the production of a vitrified waste form if each treatment process has equal operating time (availability) each year; however, because of the lower volume of a high temperature slag, certification and handling costs and disposal costs of the final waste form are less. Both the total treatment cost and life cycle costs are higher for a system producing grout than for a system producing high temperature slag, assuming equal system availability. The treatment costs decrease with increasing availability regardless of the waste form produced. If the availability of a system producing grout is sufficiently greater than a system producing slag, then the cost of treatment for the grout system will be less than the cost for the slag system, and the life cycle cost (including disposal) may be less depending on the unit disposal cost. Treatment and disposal costs will determine the return on investment in improved system availability

The cost-effectiveness of Antiretroviral Treatment in Khayelitsha, South Africa – a primary data analysis

Directory of Open Access Journals (Sweden)

Boulle Andrew M

2006-12-01

Full Text Available Abstract Background Given the size of the HIV epidemic in South Africa and other developing countries, scaling up antiretroviral treatment (ART represents one of the key public health challenges of the next decade. Appropriate priority setting and budgeting can be assisted by economic data on the costs and cost-effectiveness of ART. The objectives of this research were therefore to estimate HIV healthcare utilisation, the unit costs of HIV services and the cost per life year (LY and quality adjusted life year (QALY gained of HIV treatment interventions from a provider's perspective. Methods Data on service utilisation, outcomes and costs were collected in the Western Cape Province of South Africa. Utilisation of a full range of HIV healthcare services was estimated from 1,729 patients in the Khayelitsha cohort (1,146 No-ART patient-years, 2,229 ART patient-years using a before and after study design. Full economic costs of HIV-related services were calculated and were complemented by appropriate secondary data. ART effects (deaths, therapy discontinuation and switching to second-line were from the same 1,729 patients followed for a maximum of 4 years on ART. No-ART outcomes were estimated from a local natural history cohort. Health-related quality of life was assessed on a sub-sample of 95 patients. Markov modelling was used to calculate lifetime costs, LYs and QALYs and uncertainty was assessed through probabilistic sensitivity analysis on all utilisation and outcome variables. An alternative scenario was constructed to enhance generalizability. Results Discounted lifetime costs for No-ART and ART were US$2,743 and US$9,435 over 2 and 8 QALYs respectively. The incremental cost-effectiveness ratio through the use of ART versus No-ART was US$1,102 (95% CI 1,043-1,210 per QALY and US$984 (95% CI 913-1,078 per life year gained. In an alternative scenario where adjustments were made across cost, outcome and utilisation parameters, costs and outcomes

Multi-level restricted maximum likelihood covariance estimation and kriging for large non-gridded spatial datasets

KAUST Repository

Castrillon, Julio; Genton, Marc G.; Yokota, Rio

2015-01-01

We develop a multi-level restricted Gaussian maximum likelihood method for estimating the covariance function parameters and computing the best unbiased predictor. Our approach produces a new set of multi-level contrasts where the deterministic

Cost-effectiveness of minimally invasive sacroiliac joint fusion

Directory of Open Access Journals (Sweden)

Cher DJ

2015-12-01

Full Text Available Daniel J Cher,1 Melissa A Frasco,2 Renée JG Arnold,2,3 David W Polly4,5 1Clinical Affairs, SI-BONE, Inc., San Jose, CA, USA; 2Division of Health Economics and Outcomes Research, Quorum Consulting, Inc., San Francisco, CA, USA; 3Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA; 5Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA 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

User's manual for levelized power generation cost using an IBM PC

International Nuclear Information System (INIS)

Fuller, L.C.

1985-06-01

Programs for the estimation of levelized electric power generation costs using the BASIC interpreter on an IBM PC are described. Procedures for light-water reactor plants and coal-fired plants include capital investment cost, operation and maintenance cost, fuel cycle cost, nuclear decommissioning cost, and levelized total generation cost

Cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in Malaysia.

Science.gov (United States)

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Ng, Nora; Schottenfeld, Richard

2012-01-01

To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia. We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars. Muar, Malaysia. 126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005) receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence. Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores. Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine. Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Cost-effectiveness of buprenorphine and naltrexone treatments for heroin dependence in Malaysia.

Directory of Open Access Journals (Sweden)

Jennifer Prah Ruger

Full Text Available To aid public health policymaking, we studied the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.We estimated the cost-effectiveness ratios of three treatments for heroin dependence. We used a microcosting methodology to determine fixed, variable, and societal costs of each intervention. Cost data were collected from investigators, staff, and project records on the number and type of resources used and unit costs; societal costs for participants' time were estimated using Malaysia's minimum wage. Costs were estimated from a provider and societal perspective and reported in 2004 US dollars.Muar, Malaysia.126 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial in Malaysia (2003-2005 receiving counseling and buprenorphine, naltrexone, or placebo for treatment of heroin dependence.Primary outcome measures included days in treatment, maximum consecutive days of heroin abstinence, days to first heroin use, and days to heroin relapse. Secondary outcome measures included treatment retention, injection drug use, illicit opiate use, AIDS Risk Inventory total score, and drug risk and sex risk subscores.Buprenorphine was more effective and more costly than naltrexone for all primary and most secondary outcomes. Incremental cost-effectiveness ratios were below $50 for primary outcomes, mostly below $350 for secondary outcomes. Naltrexone was dominated by placebo for all secondary outcomes at almost all endpoints. Incremental treatment costs were driven mainly by medication costs, especially the price of buprenorphine.Buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.

Waste Management Facilities cost information for low-level waste

Energy Technology Data Exchange (ETDEWEB)

Shropshire, D.; Sherick, M.; Biadgi, C.

1995-06-01

This report contains preconceptual designs and planning level life-cycle cost estimates for managing low-level waste. The report`s information on treatment, storage, and disposal modules can be integrated to develop total life-cycle costs for various waste management options. A procedure to guide the US Department of Energy and its contractor personnel in the use of cost estimation data is also summarized in this report.

The concept of an ACEX(R) cost-effective first level surface detector trigger in the Pierre Auger Observatory

International Nuclear Information System (INIS)

Szadkowski, Z.

2005-01-01

The paper describes the new design of the first level trigger for the surface array in the Pierre Auger Observatory. The previous design was tested in a small test segment called Engineering Array (EA). It confirmed full functionality and reliability of the PLD approach. However, because of the high price of the chips available at that time, a new cost-effective design was developed. Altera ( R) offered cost-effective family, which allows reducing the total budget of the electronics without compromise in the functionality. The here described concept of a splitting of data processing into two sub-channels implemented into the parallel working chips, the chips synchronization and the automatization of internal processing management, together with the fully pipelined AHDL code became the framework for the further implementation in the environmental condition of the Argentinian pampa

Cost-optimal levels for energy performance requirements

DEFF Research Database (Denmark)

Thomsen, Kirsten Engelund; Aggerholm, Søren; Kluttig-Erhorn, Heike

2011-01-01

The CA conducted a study on experiences and challenges for setting cost optimal levels for energy performance requirements. The results were used as input by the EU Commission in their work of establishing the Regulation on a comparative methodology framework for calculating cost optimal levels...... of minimum energy performance requirements. In addition to the summary report released in August 2011, the full detailed report on this study is now also made available, just as the EC is about to publish its proposed Regulation for MS to apply in their process to update national building requirements....

Performance analysis and comparison of an Atkinson cycle coupled to variable temperature heat reservoirs under maximum power and maximum power density conditions

International Nuclear Information System (INIS)

Wang, P.-Y.; Hou, S.-S.

2005-01-01

In this paper, performance analysis and comparison based on the maximum power and maximum power density conditions have been conducted for an Atkinson cycle coupled to variable temperature heat reservoirs. The Atkinson cycle is internally reversible but externally irreversible, since there is external irreversibility of heat transfer during the processes of constant volume heat addition and constant pressure heat rejection. This study is based purely on classical thermodynamic analysis methodology. It should be especially emphasized that all the results and conclusions are based on classical thermodynamics. The power density, defined as the ratio of power output to maximum specific volume in the cycle, is taken as the optimization objective because it considers the effects of engine size as related to investment cost. The results show that an engine design based on maximum power density with constant effectiveness of the hot and cold side heat exchangers or constant inlet temperature ratio of the heat reservoirs will have smaller size but higher efficiency, compression ratio, expansion ratio and maximum temperature than one based on maximum power. From the view points of engine size and thermal efficiency, an engine design based on maximum power density is better than one based on maximum power conditions. However, due to the higher compression ratio and maximum temperature in the cycle, an engine design based on maximum power density conditions requires tougher materials for engine construction than one based on maximum power conditions

Cost effectiveness of methods for removing radium and thorium in uranium mining

International Nuclear Information System (INIS)

Rogers, V.C.; Nielson, K.K.

1981-01-01

The potential health impact from uranium milling operations is mainly associated with long-term releases of radioactive contaminants from the mill tailings. The major mechanisms for mitigating these potential releases focus on increasing the tailings containment with the addition of migration barriers such as thick earthern covers and clay liners. Some limited investigation has also focused on reducing the radionuclide source terms. This alternative approach has some desirable features, but stringent cost requirements are placed upon source removal methods in order for them to be economically favorable. A cost effectiveness evaluation is presented herein, in which costs for containment methods are used to establish maximum cost guidelines for the source removal methods

Corneal Collagen Cross-Linking in the Management of Keratoconus in Canada: A Cost-Effectiveness Analysis.

Science.gov (United States)

Leung, Victoria C; Pechlivanoglou, Petros; Chew, Hall F; Hatch, Wendy

2017-08-01

To use patient-level microsimulation models to evaluate the comparative cost-effectiveness of early corneal cross-linking (CXL) and conventional management with penetrating keratoplasty (PKP) when indicated in managing keratoconus in Canada. Cost-utility analysis using individual-based, state-transition microsimulation models. Simulated cohorts of 100 000 individuals with keratoconus who entered each treatment arm at 25 years of age. Fellow eyes were modeled separately. Simulated individuals lived up to a maximum of 110 years. We developed 2 state-transition microsimulation models to reflect the natural history of keratoconus progression and the impact of conventional management with PKP versus CXL. We collected data from the published literature to inform model parameters. We used realistic parameters that maximized the potential costs and complications of CXL, while minimizing those associated with PKP. In each treatment arm, we allowed simulated individuals to move through health states in monthly cycles from diagnosis until death. For each treatment strategy, we calculated the total cost and number of quality-adjusted life years (QALYs) gained. Costs were measured in Canadian dollars. Costs and QALYs were discounted at 5%, converting future costs and QALYs into present values. We used an incremental cost-effectiveness ratio (ICER = difference in lifetime costs/difference in lifetime health outcomes) to compare the cost-effectiveness of CXL versus conventional management with PKP. Lifetime costs and QALYs for CXL were estimated to be Can$5530 (Can$4512, discounted) and 50.12 QALYs (16.42 QALYs, discounted). Lifetime costs and QALYs for conventional management with PKP were Can$2675 (Can$1508, discounted) and 48.93 QALYs (16.09 QALYs, discounted). The discounted ICER comparing CXL to conventional management was Can$9090/QALY gained. Sensitivity analyses revealed that in general, parameter variations did not influence the cost-effectiveness of CXL. CXL is

Preimplantation genetic screening in older women: a cost-effectiveness analysis.

Science.gov (United States)

Mersereau, Jennifer E; Plunkett, Beth A; Cedars, Marcelle I

2008-09-01

To compare the strategy of traditional IVF with prenatal diagnosis versus IVF with preimplantation genetic screening (IVF/PGS) to prevent aneuploid births in women with advanced maternal age. A decision tree analytic model was created to compare IVF alone versus IVF/PGS to evaluate which strategy is the least costly per healthy (euploid) infant. Outpatient IVF practices. Infertile women, 38-40 and >40 years old. IVF or IVF/PGS. Cost per healthy infant. Using base-case estimates of costs and probabilities in women aged 38-40 years, after a maximum of two fresh IVF cycles and two frozen cycles, the chance of having a healthy infant was 37.8% with IVF alone versus 21.7% with IVF/PGS. The average cost for each strategy is $25,700, but the cost per healthy infant is substantially higher when IVF/PGS is applied as opposed to IVF alone ($118,713 vs. $68,026). To assess the robustness of the model, all probabilities were varied simultaneously in a Monte Carlo simulation, and in 96.2% of trials, IVF alone proved to be the most cost-effective option. Conversely, our data demonstrate that in women aged >40, IVF and IVF/PGS are essentially equal in terms of cost-effectiveness ($122,000 vs. $118,713). IVF alone is less costly per healthy infant than IVF/PGS in women ages 38-40.

A cost effective degradation-based maintenance strategy under imperfect repair

International Nuclear Information System (INIS)

Wu, Fan; Niknam, Seyed A.; Kobza, John E.

2015-01-01

An optimization model is developed to minimize the total cost of imperfect degradation-based maintenance by determining an optimal interval of condition monitoring and the degradation level after imperfect preventive repairs. The decision model is based on a novel cost model that considers functional relationship between the expected degradation reduction and the cost of preventive repairs. The decision model is applied to simulated vibration signals with a variety of specifications of cost values and degradation model parameters. This study has initiated a new area for the research of cost effective maintenance strategies. The results clearly indicate the significance of the proposed model and the decision variables under the objective of minimal cost. For instance, the results indicate direct relationship between the optimal length of monitoring interval and the monitoring cost. However, longer monitoring interval increases the risk of failure, and therefore, more degradation reduction is needed. By increasing the slope of cumulative degradation, the cost effective strategy advocates taking more frequent monitoring. The optimal degradation level after each preventive repair is not so sensitive to the change in the degradation slope due to the uncertainty associated with degradation patterns. - Highlights: • Discuss the relationship of degradation reduction and maintenance cost. • Determine the optimal interval of condition monitoring with minimal cost. • Identify the optimal degradation level after imperfect preventive repairs. • Discuss the effects of change in the slope of cumulative degradation.

Renewable portfolio standards and cost-effective energy-efficiency investment

International Nuclear Information System (INIS)

Mahone, A.; Woo, C.K.; Williams, J.; Horowitz, I.

2009-01-01

Renewable portfolio standards (RPSs) and mandates to invest in cost-effective energy efficiency (EE) are increasingly popular policy tools to combat climate change and dependence on fossil fuels. These supply-side and demand-side policies, however, are often uncoordinated. Using California as a case in point, this paper demonstrates that states could improve resource allocation if these two policies were coordinated by incorporating renewable-energy procurement cost into the cost-effectiveness determination for EE investment. In particular, if renewable energy is relatively expensive when compared to conventional energy, increasing the RPS target raises the cost-effective level of EE investment

Ratio methods for cost-effective field sampling of commercial radioactive low-level wastes

International Nuclear Information System (INIS)

Eberhardt, L.L.; Simmons, M.A.; Thomas, J.M.

1985-07-01

In many field studies to determine the quantities of radioactivity at commercial low-level radioactive waste sites, preliminary appraisals are made with field radiation detectors, or other relatively inaccurate devices. More accurate determinations are subsequently made with procedures requiring chemical separations or other expensive analyses. Costs of these laboratory determinations are often large, so that adequate sampling may not be achieved due to budget limitations. In this report, we propose double sampling as a way to combine the expensive and inexpensive aproaches to substantially reduce overall costs. The underlying theory was developed for human and agricultural surveys, and is partially based on assumptions that are not appropriate for commercial low-level waste sites. Consequently, extensive computer simulations were conducted to determine whether the results can be applied in circumstances of importance to the Nuclear Regulatory Commission. This report gives the simulation details, and concludes that the principal equations are appropriate for most studies at commercial low-level waste sites. A few points require further research, using actual commercial low-level radioactive waste site data. The final section of the report provides some guidance (via an example) for the field use of double sampling. Details of the simulation programs are available from the authors. Major findings are listed in the Executive Summary. 9 refs., 9 figs., 30 tabs

Effects of fasting on maximum thermogenesis in temperature-acclimated rats

Science.gov (United States)

Wang, L. C. H.

1981-09-01

To further investigate the limiting effect of substrates on maximum thermogenesis in acute cold exposure, the present study examined the prevalence of this effect at different thermogenic capabilities consequent to cold- or warm-acclimation. Male Sprague-Dawley rats (n=11) were acclimated to 6, 16 and 26‡C, in succession, their thermogenic capabilities after each acclimation temperature were measured under helium-oxygen (21% oxygen, balance helium) at -10‡C after overnight fasting or feeding. Regardless of feeding conditions, both maximum and total heat production were significantly greater in 6>16>26‡C-acclimated conditions. In the fed state, the total heat production was significantly greater than that in the fasted state at all acclimating temperatures but the maximum thermogenesis was significant greater only in the 6 and 16‡C-acclimated states. The results indicate that the limiting effect of substrates on maximum and total thermogenesis is independent of the magnitude of thermogenic capability, suggesting a substrate-dependent component in restricting the effective expression of existing aerobic metabolic capability even under severe stress.

A probabilistic approach to the computation of the levelized cost of electricity

International Nuclear Information System (INIS)

Geissmann, Thomas

2017-01-01

This paper sets forth a novel approach to calculate the levelized cost of electricity (LCOE) using a probabilistic model that accounts for endogenous input parameters. The approach is applied to the example of a nuclear and gas power project. Monte Carlo simulation results show that a correlation between input parameters has a significant effect on the model outcome. By controlling for endogeneity, a statistically significant difference in the mean LCOE estimate and a change in the order of input leverages is observed. Moreover, the paper discusses the role of discounting options and external costs in detail. In contrast to the gas power project, the economic viability of the nuclear project is considerably weaker. - Highlights: • First model of levelized cost of electricity accounting for uncertainty and endogeneities in input parameters. • Allowance for endogeneities significantly affects results. • Role of discounting options and external costs is discussed and modelled.

[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.

COST EFFICIENCY LEVEL OF RURAL BANKS IN EAST JAVA

Directory of Open Access Journals (Sweden)

Abdul Mongid

2017-03-01

Full Text Available Abstract: Rural Bank (BPR was an important part of financial service industry in Indonesia.Their pivotal role on lending to SMEs in the rural area made their existence very strategic torural development. However, due to its operational scale, rural bank charged higher interestrate than commercial bank. The study estimated the cost efficiency of rural banks usingparametric approach. The result found that rural bank efficiency was very high. The two yearcost efficiency estimated using frontier 4.1 was 95% and median was 100%. The lowest of costefficiency level was 32%. It meant cost inefficiency of the banks under investigated was around10%. The cost efficiency level in 2006 was on average 95% and the median was 100%. It meantthat 50% or more of the observation enjoyed 100% cost efficiency. The minimum was only67%. It meant they operated at very efficient level, leaving only 5% inefficiency. In 2007, adramatic change on efficiency level was going on. The average efficiency was dropped from11% to 89.9% due to increase on interest rate and price level.

Maximum potential preventive effect of hip protectors

NARCIS (Netherlands)

van Schoor, N.M.; Smit, J.H.; Bouter, L.M.; Veenings, B.; Asma, G.B.; Lips, P.T.A.M.

2007-01-01

OBJECTIVES: To estimate the maximum potential preventive effect of hip protectors in older persons living in the community or homes for the elderly. DESIGN: Observational cohort study. SETTING: Emergency departments in the Netherlands. PARTICIPANTS: Hip fracture patients aged 70 and older who

Cost-effectiveness of Human Papilloma Virus (HPV) vaccination in Nigeria: a decision analysis using pragmatic parameter estimates for cost and programme coverage.

Science.gov (United States)

Ekwunife, Obinna I; Lhachimi, Stefan K

2017-12-08

World Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context. A microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers' perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold. Combination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV. National HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.

Levelized cost-risk reduction prioritization of waste disposal options

International Nuclear Information System (INIS)

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

1992-01-01

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

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

Directory of Open Access Journals (Sweden)

Nick Wilson

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

Experimental Implementation of a Low-Cost Single Phase Five-Level Inverter for Autonomous PV System Applications Without Batteries

OpenAIRE

Nouaiti, Ayoub; Saad, Abdallah; Mesbahi, Abdelouahed; Khafallah, Mohamed

2018-01-01

This paper presents the design and the implementation of a low-cost single phase five-level inverter for photovoltaic applications. The proposed multilevel inverter is composed of a simple boost converter, a switched-capacitor converter, and an H-bridge converter. An efficient control method which associates a closed-loop regulation method with a simple maximum power point tracking (MPPT) method is applied in order to allow the proposed multilevel inverter to transfer power energy from solar ...

Methodology to estimate the cost of the severe accidents risk / maximum benefit; Metodologia para estimar el costo del riesgo de accidentes severos / beneficio maximo

Energy Technology Data Exchange (ETDEWEB)

Mendoza, G.; Flores, R. M.; Vega, E., E-mail: gozalo.mendoza@inin.gob.mx [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico)

2016-09-15

For programs and activities to manage aging effects, any changes to plant operations, inspections, maintenance activities, systems and administrative control procedures during the renewal period should be characterized, designed to manage the effects of aging as required by 10 Cfr Part 54 that could impact the environment. Environmental impacts significantly different from those described in the final environmental statement for the current operating license should be described in detail. When complying with the requirements of a license renewal application, the Severe Accident Mitigation Alternatives (SAMA) analysis is contained in a supplement to the environmental report of the plant that meets the requirements of 10 Cfr Part 51. In this paper, the methodology for estimating the cost of severe accidents risk is established and discussed, which is then used to identify and select the alternatives for severe accident mitigation, which are analyzed to estimate the maximum benefit that an alternative could achieve if this eliminate all risk. Using the regulatory analysis techniques of the US Nuclear Regulatory Commission (NRC) estimates the cost of severe accidents risk. The ultimate goal of implementing the methodology is to identify candidates for SAMA that have the potential to reduce the severe accidents risk and determine if the implementation of each candidate is cost-effective. (Author)

Integrating conservation costs into sea level rise adaptive conservation prioritization

Directory of Open Access Journals (Sweden)

Mingjian Zhu

2015-07-01

Full Text Available Biodiversity conservation requires strategic investment as resources for conservation are often limited. As sea level rises, it is important and necessary to consider both sea level rise and costs in conservation decision making. In this study, we consider costs of conservation in an integrated modeling process that incorporates a geomorphological model (SLAMM, species habitat models, and conservation prioritization (Zonation to identify conservation priorities in the face of landscape dynamics due to sea level rise in the Matanzas River basin of northeast Florida. Compared to conservation priorities that do not consider land costs in the analysis process, conservation priorities that consider costs in the planning process change significantly. The comparison demonstrates that some areas with high conservation values might be identified as lower priorities when integrating economic costs in the planning process and some areas with low conservation values might be identified as high priorities when considering costs in the planning process. This research could help coastal resources managers make informed decisions about where and how to allocate conservation resources more wisely to facilitate biodiversity adaptation to sea level rise.

[Cost at the first level of care].

Science.gov (United States)

Villarreal-Ríos, E; Montalvo-Almaguer, G; Salinas-Martínez, M; Guzmán-Padilla, J E; Tovar-Castillo, N H; Garza-Elizondo, M E

1996-01-01

To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level. The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing. A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office. Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.

Cost-benefit analysis for management of low-level radioactive waste

International Nuclear Information System (INIS)

Jacobs, D.G.

1979-01-01

There are several types of cost-benefit analyses that can be used in evaluating a technical activity such as waste management. A direct comparison can be made of the benefits to be gained versus the costs to be accrued. If the balance is favorable the activity is considered to be acceptable. In many cases, however, a number of alternatives may be available requiring a comparative cost-benefit analysis so that the most favorable option is chosen. After the basic option is chosen, a further analysis is required in which additional control technologies can be considered to further reduce specific types of impact; this represents a differential cost-benefit analysis or, perhaps more properly, a study of cost-effectiveness. Also, because of the wide variety of parameters that go into a cost-benefit analysis and the range of value judgements that may be applied by different interest groups, it is likely that each additional increment of technology will have a slightly different balance point. Factors and impacts that need to be considered in management of low-level wastes will be discussed and a simplified example will be used to demonstrate the difficulties that may be encountered

Cost-benefit analysis for management of low-level radioactive waste

International Nuclear Information System (INIS)

Jacobs, D.G.

1977-01-01

There are several types of cost-benefit analyses that can be used in evaluating a technical activity such as waste management. A direct comparison can be made of the benefits to be gained versus the costs to be accrued. If the balance is favorable, the activity is considered to be acceptable. In many cases, however, a number of alternatives may be available requiring a comparative cost-benefit analysis so that the most favorable option is chosen. After the basic option is chosen, a further analysis is required in which additional control technologies can be considered to further reduce specific types of impact; this represents a differential cost-benefit analysis or, perhaps more properly, a study of cost-effectiveness. Also, because of the wide variety of parameters that go into a cost-benefit analysis and the range of value judgements that may be applied by different interest groups, it is likely that each additional increment of technology will have a slightly different balance point. Factors and impacts that need to be considered in management of low-level wastes will be discussed and a simplified example will be used to demonstrate the difficulties that may be encountered

Ethical objections against including life-extension costs in cost-effectiveness analysis: a consistent approach.

Science.gov (United States)

Gandjour, Afschin; Müller, Dirk

2014-10-01

One of the major ethical concerns regarding cost-effectiveness analysis in health care has been the inclusion of life-extension costs ("it is cheaper to let people die"). For this reason, many analysts have opted to rule out life-extension costs from the analysis. However, surprisingly little has been written in the health economics literature regarding this ethical concern and the resulting practice. The purpose of this work was to present a framework and potential solution for ethical objections against life-extension costs. This work found three levels of ethical concern: (i) with respect to all life-extension costs (disease-related and -unrelated); (ii) with respect to disease-unrelated costs only; and (iii) regarding disease-unrelated costs plus disease-related costs not influenced by the intervention. Excluding all life-extension costs for ethical reasons would require-for reasons of consistency-a simultaneous exclusion of savings from reducing morbidity. At the other extreme, excluding only disease-unrelated life-extension costs for ethical reasons would require-again for reasons of consistency-the exclusion of health gains due to treatment of unrelated diseases. Therefore, addressing ethical concerns regarding the inclusion of life-extension costs necessitates fundamental changes in the calculation of cost effectiveness.

Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

Energy Technology Data Exchange (ETDEWEB)

Busch, Jonah [Center for Applied Biodiversity Science, Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Strassburg, Bernardo [Center for Social and Economic Research on the Global Environment, University of East Anglia, Norwich NR4 7TJ (United Kingdom); Cattaneo, Andrea [Woods Hole Research Center, 149 Woods Hole Road, Falmouth, MA 02540-1644 (United States); Lubowski, Ruben [Environmental Defense Fund, 1875 Connecticut Avenue NW, Washington, DC (United States); Bruner, Aaron; Rice, Richard; Boltz, Frederick [Conservation International, 2011 Crystal Drive, Suite 500, Arlington, VA (United States); Creed, Anna; Ashton, Ralph, E-mail: jbusch@conservation.or [Terrestrial Carbon Group, 900 17th Street NW, Suite 700, Washington, DC (United States)

2009-10-15

The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

Comparing climate and cost impacts of reference levels for reducing emissions from deforestation

International Nuclear Information System (INIS)

Busch, Jonah; Strassburg, Bernardo; Cattaneo, Andrea; Lubowski, Ruben; Bruner, Aaron; Rice, Richard; Boltz, Frederick; Creed, Anna; Ashton, Ralph

2009-01-01

The climate benefit and economic cost of an international mechanism for reducing emissions from deforestation and degradation (REDD) will depend on the design of reference levels for crediting emission reductions. We compare the impacts of six proposed reference level designs on emission reduction levels and on cost per emission reduction using a stylized partial equilibrium model (the open source impacts of REDD incentives spreadsheet; OSIRIS). The model explicitly incorporates national incentives to participate in an international REDD mechanism as well as international leakage of deforestation emissions. Our results show that a REDD mechanism can provide cost-efficient climate change mitigation benefits under a broad range of reference level designs. We find that the most effective reference level designs balance incentives to reduce historically high deforestation emissions with incentives to maintain historically low deforestation emissions. Estimates of emission reductions under REDD depend critically on the degree to which demand for tropical frontier agriculture generates leakage. This underscores the potential importance to REDD of complementary strategies to supply agricultural needs outside of the forest frontier.

How does cognitive dissonance influence the sunk cost effect?

Science.gov (United States)

Chung, Shao-Hsi; Cheng, Kuo-Chih

2018-01-01

The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals' willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management.

Maximum surface level and temperature histories for Hanford waste tanks

International Nuclear Information System (INIS)

Flanagan, B.D.; Ha, N.D.; Huisingh, J.S.

1994-01-01

Radioactive defense waste resulting from the chemical processing of spent nuclear fuel has been accumulating at the Hanford Site since 1944. This waste is stored in underground waste-storage tanks. The Hanford Site Tank Farm Facilities Interim Safety Basis (ISB) provides a ready reference to the safety envelope for applicable tank farm facilities and installations. During preparation of the ISB, tank structural integrity concerns were identified as a key element in defining the safety envelope. These concerns, along with several deficiencies in the technical bases associated with the structural integrity issues and the corresponding operational limits/controls specified for conduct of normal tank farm operations are documented in the ISB. Consequently, a plan was initiated to upgrade the safety envelope technical bases by conducting Accelerated Safety Analyses-Phase 1 (ASA-Phase 1) sensitivity studies and additional structural evaluations. The purpose of this report is to facilitate the ASA-Phase 1 studies and future analyses of the single-shell tanks (SSTs) and double-shell tanks (DSTs) by compiling a quantitative summary of some of the past operating conditions the tanks have experienced during their existence. This report documents the available summaries of recorded maximum surface levels and maximum waste temperatures and references other sources for more specific data

Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study.

Science.gov (United States)

Ruggeri, Matteo; Bellasi, Antonio; Cipriani, Filippo; Molony, Donald; Bell, Cynthia; Russo, Domenico; Di Iorio, Biagio

2015-10-01

The recent multicenter, randomized, open-label INDEPENDENT study demonstrated that sevelamer improves survival in new to hemodialysis (HD) patients compared with calcium carbonate. The objective of this study was to determine the cost-effectiveness of sevelamer versus calcium carbonate for patients new to HD, using patient-level data from the INDEPENDENT study. Cost-effectiveness analysis. Adult patients new to HD in Italy. A patient-level cost-effectiveness analysis was conducted from the perspective of the Servizio Sanitario Nazionale, Italy's national health service. The analysis was conducted for a 3-year time horizon. The cost of dialysis was excluded from the base case analysis. Sevelamer was compared to calcium carbonate. Total life years (LYs), total costs, and the incremental cost per LY gained were calculated. Bootstrapping was used to estimate confidence intervals around LYs, costs, and cost-effectiveness and to calculate the cost-effectiveness acceptability curve. Sevelamer was associated with a gain of 0.26 in LYs compared to calcium carbonate, over the 3-year time horizon. Total drug costs were €3,282 higher for sevelamer versus calcium carbonate, while total hospitalization costs were €2,020 lower for sevelamer versus calcium carbonate. The total incremental cost of sevelamer versus calcium carbonate was €1,262, resulting in a cost per LY gained of €4,897. The bootstrap analysis demonstrated that sevelamer was cost effective compared with calcium carbonate in 99.4 % of 10,000 bootstrap replicates, assuming a willingness-to-pay threshold of €20,000 per LY gained. Data on hospitalizations was taken from a post hoc retrospective chart review of the patients included in the INDEPENDENT study. Patient quality of life or health utility was not included in the analysis. Sevelamer is a cost-effective alternative to calcium carbonate for the first-line treatment of hyperphosphatemia in new to HD patients in Italy.

Costs and Cost-Effectiveness of Plasmodium vivax Control.

Science.gov (United States)

White, Michael T; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard

2016-12-28

The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum-specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. © The American Society of Tropical Medicine and Hygiene.

Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case.

Science.gov (United States)

Meyer-Rath, Gesine; van Rensburg, Craig; Larson, Bruce; Jamieson, Lise; Rosen, Sydney

2017-01-01

The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment Case produced an alternative cost-effectiveness threshold for HIV prevention and treatment interventions based on estimates of life years saved and the country's committed HIV budget. We analysed the optimal mix of HIV interventions over a baseline of the current HIV programme under the committed HIV budget for 2016-2018. We calculated the incremental cost-effectiveness ratio (ICER) as cost per life-year saved (LYS) of 16 HIV prevention and treatment interventions over 20 years (2016-2035). We iteratively evaluated the most cost effective option (defined by an intervention and its coverage) over a rolling baseline to which the more cost effective options had already been added, thereby allowing for diminishing marginal returns to interventions. We constrained the list of interventions to those whose combined cost was affordable under the current HIV budget. Costs are presented from the government perspective, unadjusted for inflation and undiscounted, in 2016 USD. The current HIV budget of about $1.6 billion per year was sufficient to pay for the expansion of condom availability, medical male circumcision, universal treatment, and infant testing at 6 weeks to maximum coverage levels, while also implementing a social and behavior change mass media campaign with a message geared at increasing testing uptake and reducing the number of sexual partners. The combined ICER of this package of services was $547/ LYS. The ICER of the next intervention that was above the affordability threshold was $872/LYS. The results of the South African HIV Investment Case point to an HIV cost-effectiveness threshold based on affordability under the current budget of $547-872 per life year saved, a small fraction of the country's GDP per capita of

Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case.

Directory of Open Access Journals (Sweden)

Gesine Meyer-Rath

Full Text Available The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment Case produced an alternative cost-effectiveness threshold for HIV prevention and treatment interventions based on estimates of life years saved and the country's committed HIV budget.We analysed the optimal mix of HIV interventions over a baseline of the current HIV programme under the committed HIV budget for 2016-2018. We calculated the incremental cost-effectiveness ratio (ICER as cost per life-year saved (LYS of 16 HIV prevention and treatment interventions over 20 years (2016-2035. We iteratively evaluated the most cost effective option (defined by an intervention and its coverage over a rolling baseline to which the more cost effective options had already been added, thereby allowing for diminishing marginal returns to interventions. We constrained the list of interventions to those whose combined cost was affordable under the current HIV budget. Costs are presented from the government perspective, unadjusted for inflation and undiscounted, in 2016 USD.The current HIV budget of about $1.6 billion per year was sufficient to pay for the expansion of condom availability, medical male circumcision, universal treatment, and infant testing at 6 weeks to maximum coverage levels, while also implementing a social and behavior change mass media campaign with a message geared at increasing testing uptake and reducing the number of sexual partners. The combined ICER of this package of services was $547/ LYS. The ICER of the next intervention that was above the affordability threshold was $872/LYS.The results of the South African HIV Investment Case point to an HIV cost-effectiveness threshold based on affordability under the current budget of $547-872 per life year saved, a small fraction of the country's GDP

Modelling the existing Irish energy-system to identify future energy costs and the maximum wind penetration feasible

DEFF Research Database (Denmark)

Connolly, D.; Lund, Henrik; Mathiesen, Brian Vad

2010-01-01

energy- system to future energy costs by considering future fuel prices, CO2 prices, and different interest rates. The final investigation identifies the maximum wind penetration feasible on the 2007 Irish energy- system from a technical and economic perspective, as wind is the most promising fluctuating...... for the existing Irish energy-system is approximately 30% from both a technical and economic perspective based on 2020 energy prices. Future studies will use the model developed in this study to show that higher wind penetrations can be achieved if the existing energy-system is modified correctly. Finally...... renewable resource available in Ireland. It is concluded that the reference model simulates the Irish energy-system accurately, the annual fuel costs for Ireland’s energy could increase by approximately 58% from 2007 to 2020 if a business-as-usual scenario is followed, and the optimum wind penetration...

The maximum economic depth of groundwater abstraction for irrigation

Science.gov (United States)

Bierkens, M. F.; Van Beek, L. P.; de Graaf, I. E. M.; Gleeson, T. P.

2017-12-01

Over recent decades, groundwater has become increasingly important for agriculture. Irrigation accounts for 40% of the global food production and its importance is expected to grow further in the near future. Already, about 70% of the globally abstracted water is used for irrigation, and nearly half of that is pumped groundwater. In many irrigated areas where groundwater is the primary source of irrigation water, groundwater abstraction is larger than recharge and we see massive groundwater head decline in these areas. An important question then is: to what maximum depth can groundwater be pumped for it to be still economically recoverable? The objective of this study is therefore to create a global map of the maximum depth of economically recoverable groundwater when used for irrigation. The maximum economic depth is the maximum depth at which revenues are still larger than pumping costs or the maximum depth at which initial investments become too large compared to yearly revenues. To this end we set up a simple economic model where costs of well drilling and the energy costs of pumping, which are a function of well depth and static head depth respectively, are compared with the revenues obtained for the irrigated crops. Parameters for the cost sub-model are obtained from several US-based studies and applied to other countries based on GDP/capita as an index of labour costs. The revenue sub-model is based on gross irrigation water demand calculated with a global hydrological and water resources model, areal coverage of crop types from MIRCA2000 and FAO-based statistics on crop yield and market price. We applied our method to irrigated areas in the world overlying productive aquifers. Estimated maximum economic depths range between 50 and 500 m. Most important factors explaining the maximum economic depth are the dominant crop type in the area and whether or not initial investments in well infrastructure are limiting. In subsequent research, our estimates of

Multiple drug cost containment policies in Michigan's Medicaid program saved money overall, although some increased costs.

Science.gov (United States)

Kibicho, Jennifer; Pinkerton, Steven D

2012-04-01

Michigan's Medicaid program implemented four cost containment policies--preferred drug lists, joint and multistate purchasing arrangements, and maximum allowable cost--during 2002-04. The goal was to control growth of drug spending for beneficiaries who were enrolled in both Medicaid and Medicare and taking antihypertensive or antihyperlipidemic prescription drugs. We analyzed the impact of each policy while holding the effect of all other policies constant. Preferred drug lists increased both preferred and generic drugs' market share and reduced daily cost--the cost per day for each prescription provided to a beneficiary. In contrast, the maximum allowable cost policy increased daily cost and was the only policy that did not generate cost savings. The joint and multistate arrangements did not affect daily cost. Despite these policy trade-offs, the cumulative effect was a 10 percent decrease in daily cost and a total cost savings of $46,195 per year. Our findings suggest that policy makers need to evaluate the impact of multiple policies aimed at restraining drug spending, and further evaluate the policy trade-offs, to ensure that scarce public dollars achieve the greatest return for money spent.

Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

Science.gov (United States)

Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

2013-10-01

To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

Cost-effectiveness analysis of paclitaxel + carboplatin vs. alternative combinations in the treatment of non-small cell lung cancer

Directory of Open Access Journals (Sweden)

Mario Eandi

2006-06-01

Full Text Available Non-small cell lung cancer (NSCLC is the most common type of lung cancer and its medical and economical burden represents a serious matter in Europe and Usa, due to its high mortality rates and drug costs. Lung cancer is responsible for about 30% of cancer death in men and women; in Europe only about 8 per cent of people with lung cancer survive for 5 years. At present combination chemotherapy based on cisplatin or carboplatin associated with paclitaxel, vinorelbine or gemcitabine is the state of the art for the treatment in patients with stage IIIb or IV NSCLC. Aim of this study was to compare the cost-effectiveness of paclitaxel/carboplatin (PCb, gemcitabine/cisplatin (GC and vinorelbine/cisplatin (VC in the perspective of the Italian National Health Service. Therefore we perfomed a semi-Markov decision model mainly based on clinical results from the Italian Lung Cancer Project. The model included differential direct medical costs registered for two years from starting chemotherapy, using tariffs valid for 2005. Benefits was measured by years of life saved (YOLs. The model also allowed to estimate only costs accrued over the period of time, performing a cost-minimisation analysis. According to cost-effectiveness analysis, VC is dominated because it’s more costly and less effective than GC. On the contrary, combination chemotherapy with GC is more inexpensive but less effective than paclitaxel/carboplatin (PCb: in this case we compared the incremental cost-effectiveness ratio (ICER with a maximum acceptable willingness-to-pay (WTP value. In the base scenario the ICER of PCb over GC treatment is 52,326 euro/ YOLs, which is definitely lower than the maximum acceptable WTP value. Sensitivity analyses confirmed the robustness of the results from cost-effectiveness analysis in the base scenario.

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2017-08-01

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

A threshold analysis of the cost-effectiveness of artemisinin-based combination therapies in sub-saharan Africa.

Science.gov (United States)

Coleman, Paul G; Morel, Chantal; Shillcutt, Sam; Goodman, Catherine; Mills, Anne J

2004-08-01

Artemisinin-based combination therapies (ACTs) are generally regarded as vital in addressing the growing problem posed by the development of antimalarial resistance across sub-Saharan Africa. However, the costs of the new ACTs are likely to be significantly higher than current therapies. Therefore, it is important to examine formally the cost-effectiveness of the more effective yet more expensive ACTs before advocating a switch in policy. Importantly, any such economic evaluation must consider the temporal dynamics of drug resistance, and not just focus on the static question of whether switching today would be cost-effective at current levels of resistance, particularly since the development of new antimalarials in the future is so uncertain. However, predicting the future changes in drug resistance is a major difficulty in accurately quantifying the relative costs and health outcomes associated with different drug therapies over time. Here, we use a simple decision tree model to estimate the incremental cost-effectiveness of using ACTs, compared with persisting with current therapies, over 5-, 10-, and 15-year periods. We describe the dynamics of drug resistance using a general logistic growth function, in which the starting frequency of resistance and maximum growth may be altered. However, rather than make assumptions about the absolute rate at which resistance to ACTs will progress, we allow the ratio of the growth rate of resistance to ACTs relative to that of current therapies to vary. Defining the growth rate of ACT resistance in this manner allows us to calculate the threshold ratio at which ACTs would no longer appear cost-effective, for any starting conditions of resistance to current therapies and ACTs, and over any time period. The influence of uncertainty in other decision tree parameters on the threshold ratio values is also quantified, using Monte Carlo simulation techniques. This analysis shows that ACTs are more than 95% likely to be cost-effective

A compact cost-effective beamline for a PET Cyclotron

International Nuclear Information System (INIS)

Dehnel, M.P.; Jackle, P.; Roeder, M.; Stewart, T.; Theroux, J.; Brasile, J.P.; Sirot, P.; Buckley, K.R.; Bedue, M.

2007-01-01

Most commercial PET Cyclotrons have targets mounted on or near the main cyclotron vacuum chamber. There is often little or no system capability for centering or focusing the extracted beam on target to achieve maximum production. This paper describes the ion-optics, design and development of a compact cost-effective beamline comprised of low activation and radiation resistant materials. The beamline, complete with suitable diagnostic devices, permits the extracted proton beam to be centered (X-Y steering magnet), and focused (quadrupole doublet) on target eliminating unnecessary beamspill and ensuring high production

An investigation of the maximum penetration level of a photovoltaic (PV) system into a traditional distribution grid

Science.gov (United States)

Chalise, Santosh

Although solar photovoltaic (PV) systems have remained the fastest growing renewable power generating technology, variability as well as uncertainty in the output of PV plants is a significant issue. This rapid increase in PV grid-connected generation presents not only progress in clean energy but also challenges in integration with traditional electric power grids which were designed for transmission and distribution of power from central stations. Unlike conventional electric generators, PV panels do not have rotating parts and thus have no inertia. This potentially causes a problem when the solar irradiance incident upon a PV plant changes suddenly, for example, when scattered clouds pass quickly overhead. The output power of the PV plant may fluctuate nearly as rapidly as the incident irradiance. These rapid power output fluctuations may then cause voltage fluctuations, frequency fluctuations, and power quality issues. These power quality issues are more severe with increasing PV plant power output. This limits the maximum power output allowed from interconnected PV plants. Voltage regulation of a distribution system, a focus of this research, is a prime limiting factor in PV penetration levels. The IEEE 13-node test feeder, modeled and tested in the MATLAB/Simulink environment, was used as an example distribution feeder to analyze the maximum acceptable penetration of a PV plant. The effect of the PV plant's location was investigated, along with the addition of a VAR compensating device (a D-STATCOM in this case). The results were used to develop simple guidelines for determining an initial estimate of the maximum PV penetration level on a distribution feeder. For example, when no compensating devices are added to the system, a higher level of PV penetration is generally achieved by installing the PV plant close to the substation. The opposite is true when a VAR compensator is installed with the PV plant. In these cases, PV penetration levels over 50% may be

How does cognitive dissonance influence the sunk cost effect?

Directory of Open Access Journals (Sweden)

Chung SH

2018-03-01

Full Text Available Shao-Hsi Chung,1 Kuo-Chih Cheng2 1Department of Business Administration, Meiho University, Pingtung, Taiwan; 2Department of Accounting, National Changhua University of Education, Changhua City, Taiwan Background: The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals’ willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. Methods: This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. Results: The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. Conclusion: This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management. Keywords: sunk costs, sunk cost effect, cognitive dissonance, behavior, unfavorable investment

An improved set of standards for finding cost for cost-effectiveness analysis.

Science.gov (United States)

Barnett, Paul G

2009-07-01

Guidelines have helped standardize methods of cost-effectiveness analysis, allowing different interventions to be compared and enhancing the generalizability of study findings. There is agreement that all relevant services be valued from the societal perspective using a long-term time horizon and that more exact methods be used to cost services most affected by the study intervention. Guidelines are not specific enough with respect to costing methods, however. The literature was reviewed to identify the problems associated with the 4 principal methods of cost determination. Microcosting requires direct measurement and is ordinarily reserved to cost novel interventions. Analysts should include nonwage labor cost, person-level and institutional overhead, and the cost of development, set-up activities, supplies, space, and screening. Activity-based cost systems have promise of finding accurate costs of all services provided, but are not widely adopted. Quality must be evaluated and the generalizability of cost estimates to other settings must be considered. Administrative cost estimates, chiefly cost-adjusted charges, are widely used, but the analyst must consider items excluded from the available system. Gross costing methods determine quantity of services used and employ a unit cost. If the intervention will affect the characteristics of a service, the method should not assume that the service is homogeneous. Questions are posed for future reviews of the quality of costing methods. The analyst must avoid inappropriate assumptions, especially those that bias the analysis by exclusion of costs that are affected by the intervention under study.

Effectiveness and costs of phototest in dementia and cognitive impairment screening

Directory of Open Access Journals (Sweden)

Saez-Zea Carmen

2011-07-01

Full Text Available Abstract Background To assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE, and Memory Impairment Screen (MIS to screen for dementia (DEM and cognitive impairment (CI. Methods A phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU. The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA] and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts. Results The study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI. The MIS could not be applied to 23 illiterate subjects (16.4%. For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43, DA = 0.60 (95%CI, 0.52-0.68], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78, DA = 0.83 (95%CI, 0.80-0.92]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83, DA = 0.87 (95%CI, 0.80-0.92] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros] than with Phototest (208.2 ± 196.8€ or MIS (201.3 ± 193.4€, whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74, DA = 0.79 (95%CI, 0.64-0.97] and Phototest [k = 0.58 (95%CI, 0.45-0.74, DA = 0.78 (95%CI, 0.64-0.95] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45, DA = 0.69 (95%CI, 0.56-0.84]. Costs were higher for MMSE (393.4 �

Effect of current on the maximum possible reward.

Science.gov (United States)

Gallistel, C R; Leon, M; Waraczynski, M; Hanau, M S

1991-12-01

Using a 2-lever choice paradigm with concurrent variable interval schedules of reward, it was found that when pulse frequency is increased, the preference-determining rewarding effect of 0.5-s trains of brief cathodal pulses delivered to the medial forebrain bundle of the rat saturates (stops increasing) at values ranging from 200 to 631 pulses/s (pps). Raising the current lowered the saturation frequency, which confirms earlier, more extensive findings showing that the rewarding effect of short trains saturates at pulse frequencies that vary from less than 100 pps to more than 800 pps, depending on the current. It was also found that the maximum possible reward--the magnitude of the reward at or beyond the saturation pulse frequency--increases with increasing current. Thus, increasing the current reduces the saturation frequency but increases the subjective magnitude of the maximum possible reward.

A level playing field-obtaining consistent cost estimates for advanced reactor designs

International Nuclear Information System (INIS)

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

1987-01-01

A level playing field in sports is necessary to avoid a situation in which a team has an unfair advantage over its competition. Similarly, rules and guidelines for developing cost estimates can be established which, in effect, provide a level playing field whereby cost estimates for advanced power plant concepts can be presented on a consistent and equitable basis. As an example, consider the capital costs shown in Table 1. Both sets of cost are for the exact same power plant; Estimate 1 is expressed in constant dollars while Estimate 2 is presented in nominal or as-spent dollars. As shown, the costs in Table 1 are not directly comparable. Similar problems can be introduced as a result of differing assumptions in any number of parameters including the scope of the cost estimate, inflation/escalation and interest rates, contingency costs, and site location. Of course, the motivation for having consistent cost estimates is to permit comparison among various concepts. As the U.S. Department of Energy sponsors research and development work on several advanced reactor concepts in which expected cost is a key evaluation parameter, the emphasis in this particular endeavor has been in promoting the comparability of advanced reactor cost estimates among themselves and to existing power plant types. To continue with the analogy, the idea is to lay out the playing field and the rules of the contest such that each team participates in the match on an equal basis with the final score being solely determined by the inherent strengths and abilities of the teams. A description of the playing field and some of the more important rules will now be provided

Understanding the Benefits and Limitations of Increasing Maximum Rotor Tip Speed for Utility-Scale Wind Turbines

International Nuclear Information System (INIS)

Ning, A; Dykes, K

2014-01-01

For utility-scale wind turbines, the maximum rotor rotation speed is generally constrained by noise considerations. Innovations in acoustics and/or siting in remote locations may enable future wind turbine designs to operate with higher tip speeds. Wind turbines designed to take advantage of higher tip speeds are expected to be able to capture more energy and utilize lighter drivetrains because of their decreased maximum torque loads. However, the magnitude of the potential cost savings is unclear, and the potential trade-offs with rotor and tower sizing are not well understood. A multidisciplinary, system-level framework was developed to facilitate wind turbine and wind plant analysis and optimization. The rotors, nacelles, and towers of wind turbines are optimized for minimum cost of energy subject to a large number of structural, manufacturing, and transportation constraints. These optimization studies suggest that allowing for higher maximum tip speeds could result in a decrease in the cost of energy of up to 5% for land-based sites and 2% for offshore sites when using current technology. Almost all of the cost savings are attributed to the decrease in gearbox mass as a consequence of the reduced maximum rotor torque. Although there is some increased energy capture, it is very minimal (less than 0.5%). Extreme increases in tip speed are unnecessary; benefits for maximum tip speeds greater than 100-110 m/s are small to nonexistent

Understanding the Benefits and Limitations of Increasing Maximum Rotor Tip Speed for Utility-Scale Wind Turbines

Science.gov (United States)

Ning, A.; Dykes, K.

2014-06-01

For utility-scale wind turbines, the maximum rotor rotation speed is generally constrained by noise considerations. Innovations in acoustics and/or siting in remote locations may enable future wind turbine designs to operate with higher tip speeds. Wind turbines designed to take advantage of higher tip speeds are expected to be able to capture more energy and utilize lighter drivetrains because of their decreased maximum torque loads. However, the magnitude of the potential cost savings is unclear, and the potential trade-offs with rotor and tower sizing are not well understood. A multidisciplinary, system-level framework was developed to facilitate wind turbine and wind plant analysis and optimization. The rotors, nacelles, and towers of wind turbines are optimized for minimum cost of energy subject to a large number of structural, manufacturing, and transportation constraints. These optimization studies suggest that allowing for higher maximum tip speeds could result in a decrease in the cost of energy of up to 5% for land-based sites and 2% for offshore sites when using current technology. Almost all of the cost savings are attributed to the decrease in gearbox mass as a consequence of the reduced maximum rotor torque. Although there is some increased energy capture, it is very minimal (less than 0.5%). Extreme increases in tip speed are unnecessary; benefits for maximum tip speeds greater than 100-110 m/s are small to nonexistent.

Cost-effectiveness of maternal GBS immunization in low-income sub-Saharan Africa.

Science.gov (United States)

Russell, Louise B; Kim, Sun-Young; Cosgriff, Ben; Pentakota, Sri Ram; Schrag, Stephanie J; Sobanjo-Ter Meulen, Ajoke; Verani, Jennifer R; Sinha, Anushua

2017-12-14

A maternal group B streptococcal (GBS) vaccine could prevent neonatal sepsis and meningitis. Its cost-effectiveness in low-income sub-Saharan Africa, a high burden region, is unknown. We used a decision tree model, with Markov nodes to project infants' lifetimes, to compare maternal immunization delivered through routine antenatal care with no immunization. 37 countries were clustered on the basis of economic and health resources and past public health performance. Vaccine efficacy for covered serotypes was ranged from 50% to 90%. The model projected EOGBS (early-onset) and LOGBS (late-onset) cases and deaths, disability-adjusted life years (DALYs), healthcare costs (2014 US$), and cost-effectiveness for a representative country in each of the four clusters: Guinea-Bissau, Uganda, Nigeria, and Ghana. Maximum vaccination costs/dose were estimated to meet two cost-effectiveness benchmarks, 0.5 GDP and GDP per capita/DALY, for ranges of disease incidence (reported and adjusted for under-reporting) and vaccine efficacy. At coverage equal to the proportion of pregnant women with≥4 antenatal visits (ANC4) and serotype-specific vaccine efficacy of 70%, maternal GBS immunization would prevent one-third of GBS cases and deaths in Uganda and Nigeria, where ANC4 is 50%, 42-43% in Guinea-Bissau (ANC4=65%), and 55-57% in Ghana (ANC4=87%). At a vaccination cost of $7/dose, maternal immunization would cost $320-$350/DALY averted in Guinea-Bissau, Nigeria, and Ghana, less than half these countries' GDP per capita. In Uganda, which has the lowest case fatality ratios, the cost would be $573/DALY. If the vaccine prevents a small proportion of stillbirths, it would be even more cost-effective. Vaccination cost/dose, disease incidence, and case fatality were key drivers of cost/DALY in sensitivity analyses. Maternal GBS immunization could be a cost-effective intervention in low-income sub-Saharan Africa, with cost-effectiveness ratios similar to other recently introduced vaccines

Spinal Surgeon Variation in Single-Level Cervical Fusion Procedures: A Cost and Hospital Resource Utilization Analysis.

Science.gov (United States)

Hijji, Fady Y; Massel, Dustin H; Mayo, Benjamin C; Narain, Ankur S; Long, William W; Modi, Krishna D; Burke, Rory M; Canar, Jeff; Singh, Kern

2017-07-01

Retrospective analysis. To compare perioperative costs and outcomes of patients undergoing single-level anterior cervical discectomy and fusions (ACDF) at both a service (orthopedic vs. neurosurgical) and individual surgeon level. Hospital systems are experiencing significant pressure to increase value of care by reducing costs while maintaining or improving patient-centered outcomes. Few studies have examined the cost-effectiveness cervical arthrodesis at a service level. A retrospective review of patients who underwent a primary 1-level ACDF by eight surgeons (four orthopedic and four neurosurgical) at a single academic institution between 2013 and 2015 was performed. Patients were identified by Diagnosis-Related Group and procedural codes. Patients with the ninth revision of the International Classification of Diseases coding for degenerative cervical pathology were included. Patients were excluded if they exhibited preoperative diagnoses or postoperative social work issues affecting their length of stay. Comparisons of preoperative demographics were performed using Student t tests and chi-squared analysis. Perioperative outcomes and costs for hospital services were compared using multivariate regression adjusted for preoperative characteristics. A total of 137 patients diagnosed with cervical degeneration underwent single-level ACDF; 44 and 93 were performed by orthopedic surgeons and neurosurgeons, respectively. There was no difference in patient demographics. ACDF procedures performed by orthopedic surgeons demonstrated shorter operative times (89.1 ± 25.5 vs. 96.0 ± 25.5 min; P = 0.002) and higher laboratory costs (Δ+$6.53 ± $5.52 USD; P = 0.041). There were significant differences in operative time (P = 0.014) and labor costs (P = 0.034) between individual surgeons. There was no difference in total costs between specialties or individual surgeons. Surgical subspecialty training does not significantly affect total costs of

The application of a Grey Markov Model to forecasting annual maximum water levels at hydrological stations

Science.gov (United States)

Dong, Sheng; Chi, Kun; Zhang, Qiyi; Zhang, Xiangdong

2012-03-01

Compared with traditional real-time forecasting, this paper proposes a Grey Markov Model (GMM) to forecast the maximum water levels at hydrological stations in the estuary area. The GMM combines the Grey System and Markov theory into a higher precision model. The GMM takes advantage of the Grey System to predict the trend values and uses the Markov theory to forecast fluctuation values, and thus gives forecast results involving two aspects of information. The procedure for forecasting annul maximum water levels with the GMM contains five main steps: 1) establish the GM (1, 1) model based on the data series; 2) estimate the trend values; 3) establish a Markov Model based on relative error series; 4) modify the relative errors caused in step 2, and then obtain the relative errors of the second order estimation; 5) compare the results with measured data and estimate the accuracy. The historical water level records (from 1960 to 1992) at Yuqiao Hydrological Station in the estuary area of the Haihe River near Tianjin, China are utilized to calibrate and verify the proposed model according to the above steps. Every 25 years' data are regarded as a hydro-sequence. Eight groups of simulated results show reasonable agreement between the predicted values and the measured data. The GMM is also applied to the 10 other hydrological stations in the same estuary. The forecast results for all of the hydrological stations are good or acceptable. The feasibility and effectiveness of this new forecasting model have been proved in this paper.

Limited applicability of cost-effectiveness and cost-benefit analyses for the optimization of radon remedial measures

International Nuclear Information System (INIS)

Jiránek, Martin; Rovenská, Kateřina

2010-01-01

Ways of using different decision-aiding techniques for optimizing and evaluating radon remedial measures have been studied on a large set of data obtained from the remediation of 32 houses that had an original indoor radon concentration level above 1,000 Bq/m 3 (around 0.2 % of all dwellings in the Czech Republic have a radon concentration higher than 1,000 Bq/ m 3 ). Detailed information about radon concentrations before and after remediation, type and extent of remedial measures and installation and operation costs were used as the input parameters for a comparison of costs and for determining the efficiencies, for a cost-benefit analysis and a cost-effectiveness analysis, in order to find out whether these criteria and techniques provide sufficient and relevant information for the improvement and optimization of remediation. The study has delivered quite new results. It is confirmed that the installation costs of remedial measures do not depend on the original level of indoor radon concentration, but on the technical state of the building. In addition, the study reveals that the efficiency of remediation does not depend on the installation costs. Each of the studied remedial measures will on an average save 0.3 lives and gain 4.3 years of life. On one hand, the general decision-aiding techniques - cost-benefit analysis and cost-effectiveness analysis - lead to the conclusion that the remedial measures reducing the indoor radon concentration from values above 1,000 Bq/m 3 to values below the action level of 400 Bq/m 3 are always acceptable and reasonable. On the other hand, these analytical techniques can neither help the designer to choose the proper remedial measure nor provide information resulting in improved remediation. (author)

Lake-level increasing under the climate cryoaridization conditions during the Last Glacial Maximum

Science.gov (United States)

Amosov, Mikhail; Strelkov, Ivan

2017-04-01

A lake genesis and lake-level increasing during the Last Glacial Maximum (LGM) are the paramount issues in paleoclimatology. Investigating these problems reveals the regularities of lake development and figures out an arid territory conditions at the LGM stage. Pluvial theory is the most prevalent conception of lake formation during the LGM. This theory is based on a fact that the water bodies emerged and their level increased due to torrential rainfalls. In this study, it is paid attention to an alternative assumption of lake genesis at the LGM stage, which is called climate cryoaridization. In accordance with this hypothesis, the endorheic water basins had their level enlarged because of a simultaneous climate aridity and temperature decrease. In this research, a lake-level increasing in endorheic regions of Central Asia and South American Altiplano of the Andes is described. The lake investigation is related to its conditions during the LGM. The study also includes a lake catalogue clearly presenting the basin conditions at the LGM stage and nowadays. The data compilation partly consists of information from an earlier work of Mikhail Amosov, Lake-levels, Vegetation And Climate In Central Asia During The Last Glacial Maximum (EGU2014-3015). According to the investigation, a lake catalogue on 27 lakes showed that most of the water bodies had higher level. This feature could be mentioned for the biggest lakes of the Aral Sea, Lake Balkhash, Issyk-Kul etc. and for the small ones located in the mountains, such as Pamir, Tian-Shan and Tibet. Yet some lakes that are situated in Central Asian periphery (Lake Qinghai and lakes in Inner Mongolia) used to be lower than nowadays. Also, the lake-level increasing of Altiplano turned to be a significant feature during the LGM in accordance with the data of 5 lakes, such as Titicaca, Coipasa-Uyuni, Lejia, Miscanti and Santa-Maria. Most of the current endorheic basins at the LGM stage were filled with water due to abundant

Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence

Directory of Open Access Journals (Sweden)

Williams Brian G

2005-12-01

Full Text Available Abstract Background The HIV epidemic has caused a dramatic increase in tuberculosis (TB in East and southern Africa. Several strategies have the potential to reduce the burden of TB in high HIV prevalence settings, and cost and cost-effectiveness analyses can help to prioritize them when budget constraints exist. However, published cost and cost-effectiveness studies are limited. Methods Our objective was to compare the cost, affordability and cost-effectiveness of seven strategies for reducing the burden of TB in countries with high HIV prevalence. A compartmental difference equation model of TB and HIV and recent cost data were used to assess the costs (year 2003 US$ prices and effects (TB cases averted, deaths averted, DALYs gained of these strategies in Kenya during the period 2004–2023. Results The three lowest cost and most cost-effective strategies were improving TB cure rates, improving TB case detection rates, and improving both together. The incremental cost of combined improvements to case detection and cure was below US$15 million per year (7.5% of year 2000 government health expenditure; the mean cost per DALY gained of these three strategies ranged from US$18 to US$34. Antiretroviral therapy (ART had the highest incremental costs, which by 2007 could be as large as total government health expenditures in year 2000. ART could also gain more DALYs than the other strategies, at a cost per DALY gained of around US$260 to US$530. Both the costs and effects of treatment for latent tuberculosis infection (TLTI for HIV+ individuals were low; the cost per DALY gained ranged from about US$85 to US$370. Averting one HIV infection for less than US$250 would be as cost-effective as improving TB case detection and cure rates to WHO target levels. Conclusion To reduce the burden of TB in high HIV prevalence settings, the immediate goal should be to increase TB case detection rates and, to the extent possible, improve TB cure rates, preferably

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

International Nuclear Information System (INIS)

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

1989-01-01

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

Higher cost of implementing Xpert(®) MTB/RIF in Ugandan peripheral settings: implications for cost-effectiveness.

Science.gov (United States)

Hsiang, E; Little, K M; Haguma, P; Hanrahan, C F; Katamba, A; Cattamanchi, A; Davis, J L; Vassall, A; Dowdy, D

2016-09-01

Initial cost-effectiveness evaluations of Xpert(®) MTB/RIF for tuberculosis (TB) diagnosis have not fully accounted for the realities of implementation in peripheral settings. To evaluate costs and diagnostic outcomes of Xpert testing implemented at various health care levels in Uganda. We collected empirical cost data from five health centers utilizing Xpert for TB diagnosis, using an ingredients approach. We reviewed laboratory and patient records to assess outcomes at these sites and10 sites without Xpert. We also estimated incremental cost-effectiveness of Xpert testing; our primary outcome was the incremental cost of Xpert testing per newly detected TB case. The mean unit cost of an Xpert test was US$21 based on a mean monthly volume of 54 tests per site, although unit cost varied widely (US$16-58) and was primarily determined by testing volume. Total diagnostic costs were 2.4-fold higher in Xpert clinics than in non-Xpert clinics; however, Xpert only increased diagnoses by 12%. The diagnostic costs of Xpert averaged US$119 per newly detected TB case, but were as high as US$885 at the center with the lowest volume of tests. Xpert testing can detect TB cases at reasonable cost, but may double diagnostic budgets for relatively small gains, with cost-effectiveness deteriorating with lower testing volumes.

Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010.

LENUS (Irish Health Repository)

Bennett, Kathleen

2009-01-01

OBJECTIVE: Coronary heart disease (CHD) is associated with a large burden of disease in Ireland and is responsible for more than 6000 deaths annually. This study examined the cost-effectiveness of specific CHD treatments in Ireland. METHODS: Irish epidemiological data on patient numbers and median survival in specific groups, plus the uptake, effectiveness, and costs of specific interventions, all stratified by age and sex, were incorporated into a previously validated CHD mortality model, the IMPACT model. This model calculates the number of life-years gained (LYGs) by specific cardiology interventions to generate incremental cost-effectiveness ratios (ICERs) per LYG for each intervention. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 1885 CHD deaths in patients aged 25 to 84 years, and thus generated approximately 14,505 extra life-years (minimum 7270, maximum 22,475). In general, all the cardiac interventions investigated were highly cost-effective in the Irish setting. Aspirin, beta-blockers, ACE inhibitors, spironolactone, and warfarin for specific conditions were the most cost-effective interventions (< euro 3000\\/LYG), followed by the statins for secondary prevention (< euro 6500\\/LYG). Revascularization for chronic angina and primary angioplasty for myocardial infarction, although still cost-effective, had the highest ICER (between euro 12,000 and euro 20,000\\/LYG). CONCLUSIONS: Using a comprehensive standardized methodology, cost-effectiveness ratios in this study clearly favored simple medical treatments for myocardial infarction, secondary prevention, angina, and heart failure.

MPBoot: fast phylogenetic maximum parsimony tree inference and bootstrap approximation.

Science.gov (United States)

Hoang, Diep Thi; Vinh, Le Sy; Flouri, Tomáš; Stamatakis, Alexandros; von Haeseler, Arndt; Minh, Bui Quang

2018-02-02

The nonparametric bootstrap is widely used to measure the branch support of phylogenetic trees. However, bootstrapping is computationally expensive and remains a bottleneck in phylogenetic analyses. Recently, an ultrafast bootstrap approximation (UFBoot) approach was proposed for maximum likelihood analyses. However, such an approach is still missing for maximum parsimony. To close this gap we present MPBoot, an adaptation and extension of UFBoot to compute branch supports under the maximum parsimony principle. MPBoot works for both uniform and non-uniform cost matrices. Our analyses on biological DNA and protein showed that under uniform cost matrices, MPBoot runs on average 4.7 (DNA) to 7 times (protein data) (range: 1.2-20.7) faster than the standard parsimony bootstrap implemented in PAUP*; but 1.6 (DNA) to 4.1 times (protein data) slower than the standard bootstrap with a fast search routine in TNT (fast-TNT). However, for non-uniform cost matrices MPBoot is 5 (DNA) to 13 times (protein data) (range:0.3-63.9) faster than fast-TNT. We note that MPBoot achieves better scores more frequently than PAUP* and fast-TNT. However, this effect is less pronounced if an intensive but slower search in TNT is invoked. Moreover, experiments on large-scale simulated data show that while both PAUP* and TNT bootstrap estimates are too conservative, MPBoot bootstrap estimates appear more unbiased. MPBoot provides an efficient alternative to the standard maximum parsimony bootstrap procedure. It shows favorable performance in terms of run time, the capability of finding a maximum parsimony tree, and high bootstrap accuracy on simulated as well as empirical data sets. MPBoot is easy-to-use, open-source and available at http://www.cibiv.at/software/mpboot .

Cost-Effectiveness of School-Based Prevention of Cannabis Use.

Science.gov (United States)

Deogan, Charlotte; Zarabi, Natalie; Stenström, Nils; Högberg, Pi; Skärstrand, Eva; Manrique-Garcia, Edison; Neovius, Kristian; Månsdotter, Anna

2015-10-01

Cannabis is the most frequently used illicit drug globally. Despite increasing evidence that cannabis use is associated with adverse health effects, the knowledge on preventative strategies is still limited. This study stemmed from a systematic review of effective prevention in which school-based programmes were identified as promising. The primary objective was to evaluate the cost effectiveness of Project ALERT (Adolescent, Learning, Experiences, Resistance, and Training), compared with ordinary ATOD (Alcohol, Tobacco, and Other Drug) education, among Swedish students in the eighth grade of compulsory school. The cost-effectiveness analysis was performed from the societal perspective with quality-adjusted life-years (QALYs) as an outcome (willingness-to-pay threshold €50,000) and follow-up periods from 1 year to a lifetime, considering a discounting rate of 3%, and with costs inflated to 2013 levels. A Markov model was constructed on the basis of the 'states' of single use, regular use, daily use and use of other illicit drugs, which were associated with 'complications' of psychosis, schizophrenia, traffic accidents, depression and amotivational syndrome. Health and cost consequences were linked to both states and complications. The programme was cost saving on the basis of evidence from the USA (ratio 1:1.1), and was cost effective (incremental cost-effectiveness ratio €22,384 per QALY) after reasonable adjustment for the Swedish context and with 20 years of follow-up. When the target group was restricted to boys who were neither studying nor working/doing work experience, the programme was cost effective after 9 years and cost saving (ratio 1:3.2) after 20 years. School-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas. In the light of the shifting landscape regarding legalization of cannabis, it seems rational to continue the health economic analysis of prevention initiated

Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats.

Science.gov (United States)

Swanson, Jeffrey; Weissert, William G

2017-08-01

Case management programs often designate a nurse or social worker to take responsibility for guiding care when patients are expected to be expensive or risk a major decline. We hypothesized that though an intuitively appealing idea, careful program design and faithful implementation are essential if case management programs are to succeed. We employed two theory perspectives, principal-agent framework and street-level bureaucratic theory to describe the relationship between program designers (principals) and case managers (agents/street-level bureaucrats) to review 65 case management studies. Most programs were successful in limited program-specific process and outcome goals. But there was much less success in cost-saving or cost-effectiveness-the original and overarching goal of case management. Cost results might be improved if additional ideas of agency and street-level theory were adopted, specifically, incentives, as well as "green tape," clear rules, guidelines, and algorithms relating to resource allocation among patients.

A Departmental Cost-Effectiveness Model.

Science.gov (United States)

Holleman, Thomas, Jr.

In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…

Cost-Effectiveness of a Clinical Childhood Obesity Intervention.

Science.gov (United States)

Sharifi, Mona; Franz, Calvin; Horan, Christine M; Giles, Catherine M; Long, Michael W; Ward, Zachary J; Resch, Stephen C; Marshall, Richard; Gortmaker, Steven L; Taveras, Elsie M

2017-11-01

To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence. Copyright © 2017 by the American Academy of Pediatrics.

When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions.

Science.gov (United States)

Anis, Aslam H; Guh, Daphne P; Lacaille, Diane; Marra, Carlo A; Rashidi, Amir A; Li, Xin; Esdaile, John M

2005-11-22

Previous research has shown that patient cost-sharing leads to a reduction in overall health resource utilization. However, in Canada, where health care is provided free of charge except for prescription drugs, the converse may be true. We investigated the effect of prescription drug cost-sharing on overall health care utilization among elderly patients with rheumatoid arthritis. Elderly patients (> or = 65 years) were selected from a population-based cohort with rheumatoid arthritis. Those who had paid the maximum amount of dispensing fees (200 dollars) for the calendar year (from 1997 to 2000) were included in the analysis for that year. We defined the period during which the annual maximum co-payment had not been reached as the "cost-sharing period" and the one beyond which the annual maximum co-payment had been reached as the "free period." We compared health services utilization patterns between these periods during the 4 study years, including the number of hospital admissions, the number of physician visits, the number of prescriptions filled and the number of prescriptions per physician visit. Overall, 2968 elderly patients reached the annual maximum cost-sharing amount at least once during the study periods. Across the 4 years, there were 0.38 more physician visits per month (p filled per month (p = 0.001) and 0.52 fewer prescriptions filled per physician visit (p health care system, the implementation of cost-containment policies such as prescription drug cost-sharing may have the unintended effect of increasing overall health utilization among elderly patients with rheumatoid arthritis.

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

Cost-risk optimization of nondestructive inspection level

International Nuclear Information System (INIS)

Johnson, D.P.

1978-01-01

This paper develops a quantitative methodology for determining the nondestructive inspection (NDI) level that will result in a minimum cost product considering both type one inspection errors, acceptance of defective material units, and type two inspection errors, rejection of sound material units. This methodology represents an advance over fracture mechanics - nondestructive inspection (FM-NDI) design systems that do not consider type two inspection errors or the pre-inspection material quality. The inputs required for the methodology developed in this paper are (1) the rejection probability as a function of inspection size and imperfection size, (2) the flaw frequency (FF), as a function of imperfection size, (3) the probability of failure given the material unit contains an imperfection of a given size as a function of that given size, (4) the manufacturing cost per material unit, (5) the inspection cost per material unit, and (6) the average cost per failure including indirect costs. Four methods are identified for determining the flaw-frequency and three methods are identified for determining the conditional failure probability (one of these methods is probabilistic fracture mechanics). Methods for determining the rejection probability are discussed elsewhere. The NDI-FF methodology can have significant impact where the cost of failures represents a significant fraction of the manufacturing costs, or when a significant fraction of the components are being rejected by the inspection. (Auth.)

Biosimilar medicines and cost-effectiveness

Directory of Open Access Journals (Sweden)

Steven Simoens

2011-02-01

Full Text Available Steven SimoensResearch Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, BelgiumAbstract: Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical, the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events and effectiveness of a biosimilar, the cost-effectiveness

Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial

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Stokes, E A; Wordsworth, S; Bargo, D; Pike, K; Rogers, C A; Brierley, R C M; Angelini, G D; Murphy, G J; Reeves, B C

2016-01-01

Objective To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery. Design A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK. Setting 17 specialist cardiac surgery centres in UK NHS hospitals. Participants 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of threshold during hospitalisation after surgery. Main outcome measures Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). Results The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is −£182, 95% CI −£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI −0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained. Conclusions We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery. Trial registration number ISRCTN70923932; Results. PMID:27481621

Cost-effectiveness assessment in outpatient sinonasal surgery.

Science.gov (United States)

Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

2018-02-01

To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Studi Banding Penyusunan Laporan Keuangan Dengan Metode Historical Cost Accounting Dan General Price Level Accounting Pada Masa Inflasi

OpenAIRE

Kodrat, David Sukardi

2006-01-01

Generally, Financial Statements are based on Historical Cost Accounting (HCA) that assumes that prices are stable. Actually, there are several methods on accounting for the effect of changing prices, such as Current Cost Accounting (Replacement Cost Accounting) and Constant Dollar Accounting or General Price Level Accounting (GPLA)). GPLA will do restatement the components of financial statement to be a rupiah on a similar level of purchasing power, but without changes in accounting principle...

STUDI BANDING PENYUSUNAN LAPORAN KEUANGAN DENGAN METODE HISTORICAL COST ACCOUNTING DAN GENERAL PRICE LEVEL ACCOUNTING PADA MASA INFLASI

OpenAIRE

David Sukardi Kodrat

2006-01-01

Generally, Financial Statements are based on Historical Cost Accounting (HCA) that assumes that prices are stable. Actually, there are several methods on accounting for the effect of changing prices, such as Current Cost Accounting (Replacement Cost Accounting) and Constant Dollar Accounting or General Price Level Accounting (GPLA)). GPLA will do restatement the components of financial statement to be a rupiah on a similar level of purchasing power, but without changes in accounting principle...

The effect of alternative cost and environmental impact minimisation strategies on radioactive waste disposal strategies

International Nuclear Information System (INIS)

Laundy, R.S.; James, A.R.; Groom, M.S.; Dalrymple, G.J.

1985-06-01

The study reported here investigates the effects of different cost and environmental impact minimisation strategies for a single waste disposal scenario. Four disposal options are considered. The study examines the environmental impacts from waste storage and transport and the disposal impacts in terms of collective dose, maximum individual dose and individual dose from intrusion. The total cost of disposing of waste takes account of storage, transport and disposal costs to each of the four facilities. Two minimum cost scenarios and seven minimum impact assessments were performed. The results showed clearly that a trade-off has to be made between the environmental impacts from transport and storage of waste. A low objective risk of transport is achieved by directing waste to the engineered trench, assumed to have a central location. This waste is stored until the facility is available in 1995 thus increasing the potential impact from storage. The results also show a trade-off has to be made between minimising the maximum individual dose from disposal and collective dose. The study shows that for relatively little cost large reductions in the impacts can be obtained particularly in short and long-term collective dose and the individual dose from intrusion. (author)

Cost-Effectiveness Analysis of Second-Line Chemotherapy Agents for Advanced Gastric Cancer.

Science.gov (United States)

Lam, Simon W; Wai, Maya; Lau, Jessica E; McNamara, Michael; Earl, Marc; Udeh, Belinda

2017-01-01

Gastric cancer is the fifth most common malignancy and second leading cause of cancer-related mortality. Chemotherapy options for patients who fail first-line treatment are limited. Thus the objective of this study was to assess the cost-effectiveness of second-line treatment options for patients with advanced or metastatic gastric cancer. Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care. The model was performed from a third-party payer's perspective to compare lifetime costs and health benefits associated with studied second-line therapies. Costs included only relevant direct medical costs. The model assumed chemotherapy cycle lengths of 30 days and a maximum number of 24 cycles. Systematic review of literature was performed to identify clinical data sources and utility and cost data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. The primary outcome measure for this analysis was the ICER between different therapies, where the incremental cost was divided by the number of QALYs saved. The ICER was compared with a willingness-to-pay (WTP) threshold that was set at $50,000/QALY gained, and an exploratory analysis using $160,000/QALY gained was also used. The model's robustness was tested by using 1-way sensitivity analyses and a 10,000 Monte Carlo simulation probabilistic sensitivity analysis (PSA). Irinotecan had the lowest lifetime cost and was associated with a QALY gain of 0.35 year. Docetaxel, ramucirumab alone, and palliative care were dominated strategies. Paclitaxel and the combination of paclitaxel plus ramucirumab led to higher QALYs gained, at an incremental cost of $86,815 and $1,056,125 per QALY gained, respectively. Based on our prespecified

Cost-effectiveness of pharmacotherapy to reduce obesity.

Directory of Open Access Journals (Sweden)

J Lennert Veerman

Full Text Available AIMS: Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. METHODS: We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs below A$50 000 per Disability Adjusted Life Year (DALY averted are considered good value for money. RESULTS: The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000 for sibutramine and A$230 000/DALY (170 000-340 000 for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. CONCLUSIONS: Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

Maximum power point tracking techniques for wind energy systems using three levels boost converter

Science.gov (United States)

Tran, Cuong Hung; Nollet, Frédéric; Essounbouli, Najib; Hamzaoui, Abdelaziz

2018-05-01

This paper presents modeling and simulation of three level Boost DC-DC converter in Wind Energy Conversion System (WECS). Three-level Boost converter has significant advantage compared to conventional Boost. A maximum power point tracking (MPPT) method for a variable speed wind turbine using permanent magnet synchronous generator (PMSG) is also presented. Simulation of three-level Boost converter topology with Perturb and Observe algorithm and Fuzzy Logic Control is implemented in MATLAB/SIMULINK. Results of this simulation show that the system with MPPT using fuzzy logic controller has better performance to the Perturb and Observe algorithm: fast response under changing conditions and small oscillation.

Herd-Level Mastitis-Associated Costs on Canadian Dairy Farms

Science.gov (United States)

Aghamohammadi, Mahjoob; Haine, Denis; Kelton, David F.; Barkema, Herman W.; Hogeveen, Henk; Keefe, Gregory P.; Dufour, Simon

2018-01-01

Mastitis imposes considerable and recurring economic losses on the dairy industry worldwide. The main objective of this study was to estimate herd-level costs incurred by expenditures and production losses associated with mastitis on Canadian dairy farms in 2015, based on producer reports. Previously, published mastitis economic frameworks were used to develop an economic model with the most important cost components. Components investigated were divided between clinical mastitis (CM), subclinical mastitis (SCM), and other costs components (i.e., preventive measures and product quality). A questionnaire was mailed to 374 dairy producers randomly selected from the (Canadian National Dairy Study 2015) to collect data on these costs components, and 145 dairy producers returned a completed questionnaire. For each herd, costs due to the different mastitis-related components were computed by applying the values reported by the dairy producer to the developed economic model. Then, for each herd, a proportion of the costs attributable to a specific component was computed by dividing absolute costs for this component by total herd mastitis-related costs. Median self-reported CM incidence was 19 cases/100 cow-year and mean self-reported bulk milk somatic cell count was 184,000 cells/mL. Most producers reported using post-milking teat disinfection (97%) and dry cow therapy (93%), and a substantial proportion of producers reported using pre-milking teat disinfection (79%) and wearing gloves during milking (77%). Mastitis costs were substantial (662 CAD per milking cow per year for a typical Canadian dairy farm), with a large portion of the costs (48%) being attributed to SCM, and 34 and 15% due to CM and implementation of preventive measures, respectively. For SCM, the two most important cost components were the subsequent milk yield reduction and culling (72 and 25% of SCM costs, respectively). For CM, first, second, and third most important cost components were culling (48

Herd-Level Mastitis-Associated Costs on Canadian Dairy Farms

Directory of Open Access Journals (Sweden)

Mahjoob Aghamohammadi

2018-05-01

Full Text Available Mastitis imposes considerable and recurring economic losses on the dairy industry worldwide. The main objective of this study was to estimate herd-level costs incurred by expenditures and production losses associated with mastitis on Canadian dairy farms in 2015, based on producer reports. Previously, published mastitis economic frameworks were used to develop an economic model with the most important cost components. Components investigated were divided between clinical mastitis (CM, subclinical mastitis (SCM, and other costs components (i.e., preventive measures and product quality. A questionnaire was mailed to 374 dairy producers randomly selected from the (Canadian National Dairy Study 2015 to collect data on these costs components, and 145 dairy producers returned a completed questionnaire. For each herd, costs due to the different mastitis-related components were computed by applying the values reported by the dairy producer to the developed economic model. Then, for each herd, a proportion of the costs attributable to a specific component was computed by dividing absolute costs for this component by total herd mastitis-related costs. Median self-reported CM incidence was 19 cases/100 cow-year and mean self-reported bulk milk somatic cell count was 184,000 cells/mL. Most producers reported using post-milking teat disinfection (97% and dry cow therapy (93%, and a substantial proportion of producers reported using pre-milking teat disinfection (79% and wearing gloves during milking (77%. Mastitis costs were substantial (662 CAD per milking cow per year for a typical Canadian dairy farm, with a large portion of the costs (48% being attributed to SCM, and 34 and 15% due to CM and implementation of preventive measures, respectively. For SCM, the two most important cost components were the subsequent milk yield reduction and culling (72 and 25% of SCM costs, respectively. For CM, first, second, and third most important cost components were

The cost-effectiveness of rotavirus vaccination in Armenia.

Science.gov (United States)

Jit, Mark; Yuzbashyan, Ruzanna; Sahakyan, Gayane; Avagyan, Tigran; Mosina, Liudmila

2011-11-08

The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cost of delivering secondary-level health care services through public sector district hospitals in India

Science.gov (United States)

Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

2017-01-01

Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was 844 (USD 15.5), i; 3481 (USD 64) and 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India. PMID:29355142

Cost of delivering secondary-level health care services through public sector district hospitals in India.

Science.gov (United States)

Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

2017-09-01

Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was ' 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was ' 844 (USD 15.5), ' 3481 (USD 64) and ' 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was ' 139 (USD 2.5). The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

Use of low density lipoprotein particle number levels as an aid in statin treatment decisions for intermediate risk patients: a cost-effectiveness analysis.

Science.gov (United States)

Shiffman, Dov; Arellano, Andre R; Caulfield, Michael P; Louie, Judy Z; Bare, Lance A; Devlin, James J; Melander, Olle

2016-12-07

The 2013 ACC/AHA guideline recommended either no statin therapy or moderate-intensity statin therapy (MST) for intermediate risk patients-those with 5-7.5% 10-year risk and without cardiovascular disease (CVD), hypercholesterolemia or diabetes. The guideline further suggested that the therapy choice be based on patient-clinician discussions of risks and benefits. Since low-density lipoprotein particle (LDL-P) levels were reported to be associated with CVD independently of traditional risk factors in intermediate and low risk patients, we investigated the cost-effectiveness of using LDL-P levels to identify intermediate risk patients likely to benefit from initiating or intensifying statin therapy. We evaluated 5 care strategies for intermediate risk patients. These included the strategies suggested by the guideline: no-statin therapy and MST. We compared each of these strategies to a related strategy that incorporated LDL-P testing. No-statin therapy was compared with the strategy of MST for those with high LDL-P levels and no statin therapy for all other patients (test-and-MST). MST was compared with the strategy of high-intensity statin therapy (HST) for those with high LDL-P levels and MST for all other patients (test-and-HST). We also evaluated the strategy of HST for all. Costs (payer perspective) and utilities were assessed over a 5-year time horizon in a Markov model of 100,000 hypothetical intermediate risk patients. HST dominated all other strategies, costing less and-despite causing 739 more cases of diabetes than did MST-resulting in more quality adjusted life-years (QALYs). For patient-clinician discussions that would otherwise lead to the MST strategy, we found the test-and-HST strategy reduced costs by $4.67 MM and resulted in 134 fewer CVD events and 115 additional QALYs. For patient-clinician discussions that would otherwise lead to no statin therapy, we found that the test-and-MST strategy reduced costs by $3.25 MM, resulted in 97 fewer CVD events

[Cost-effectiveness of addiction care].

Science.gov (United States)

Suijkerbuijk, A W M; van Gils, P F; Greeven, P G J; de Wit, G A

2015-01-01

A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.

The Empirical Definition of the Function of Advertising Costs in E-Commerce

Directory of Open Access Journals (Sweden)

Pursky Oleg I.

2017-06-01

Full Text Available In the publication, an empirical study of the advertising costs in the e-commerce market is carried out. In order to determine the type of functional dependency of advertising costs, dynamics of advertising costs in the e-commerce markets of the US, the world, and Ukraine were researched, followed by an approximation of the series of statistical data on the Internet advertising costs. There is a functional dependency on the Internet advertising costs in the form of a power function with two coefficients that relate to the level of consumer awareness of goods and services in the e-commerce market and the level of saturation of the e-commerce market for advertising investments. The use of the power function of advertising costs has allowed to theoretical definition and statistical confirmation of existence of the effect of saturation of the developed e-commerce markets with advertising, where the growth of investment volumes in the Internet advertising begin with an increase, then peak and start to decline. The optimal level of advertising costs is determined by the condition of the full consumer awareness and the maximum saturation of the e-commerce market with advertising.

The Interpersonal Sunk-Cost Effect.

Science.gov (United States)

Olivola, Christopher Y

2018-05-01

The sunk-cost fallacy-pursuing an inferior alternative merely because we have previously invested significant, but nonrecoverable, resources in it-represents a striking violation of rational decision making. Whereas theoretical accounts and empirical examinations of the sunk-cost effect have generally been based on the assumption that it is a purely intrapersonal phenomenon (i.e., solely driven by one's own past investments), the present research demonstrates that it is also an interpersonal effect (i.e., people will alter their choices in response to other people's past investments). Across eight experiments ( N = 6,076) covering diverse scenarios, I documented sunk-cost effects when the costs are borne by someone other than the decision maker. Moreover, the interpersonal sunk-cost effect is not moderated by social closeness or whether other people observe their sunk costs being "honored." These findings uncover a previously undocumented bias, reveal that the sunk-cost effect is a much broader phenomenon than previously thought, and pose interesting challenges for existing accounts of this fascinating human tendency.

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.

A cost-effectiveness threshold analysis of a multidisciplinary structured educational intervention in pediatric asthma.

Science.gov (United States)

Rodriguez-Martinez, Carlos E; Sossa-Briceño, Monica P; Castro-Rodriguez, Jose A

2018-05-01

Asthma educational interventions have been shown to improve several clinically and economically important outcomes. However, these interventions are costly in themselves and could lead to even higher disease costs. A cost-effectiveness threshold analysis would be helpful in determining the threshold value of the cost of educational interventions, leading to these interventions being cost-effective. The aim of the present study was to perform a cost-effectiveness threshold analysis to determine the level at which the cost of a pediatric asthma educational intervention would be cost-effective and cost-saving. A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a single uncontrolled before-and-after study performed with Colombian asthmatic children. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). A deterministic threshold sensitivity analysis showed that the asthma educational intervention will be cost-saving to the health system if its cost is under US$513.20. Additionally, the analysis showed that the cost of the intervention would have to be below US$967.40 in order to be cost-effective. This study identified the level at which the cost of a pediatric asthma educational intervention will be cost-effective and cost-saving for the health system in Colombia. Our findings could be a useful aid for decision makers in efficiently allocating limited resources when planning asthma educational interventions for pediatric patients.

42 CFR 457.1015 - Cost-effectiveness.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart... may demonstrate cost-effectiveness by comparing the cost of coverage for the family to the cost of...

Levelized Costs for Nuclear, Gas and Coal for Electricity, under the Mexican Scenario

Energy Technology Data Exchange (ETDEWEB)

Palacios, J.C.; Alonso, G.; Ramirez, R.; Gomez, A.; Ortiz, J.; Longoria, L.C.

2004-10-06

In the case of new nuclear power stations, it is necessary to pay special attention to the financial strategy that will be applied, time of construction, investment cost, and the discount and return rate. The levelized cost quantifies the unitary cost of the electricity (the kWh) generated during the lifetime of the nuclear power plant; and allows the immediate comparison with the cost of other alternative technologies. The present paper shows levelized cost for different nuclear technologies and it provides comparison among them as well as with gas and coal electricity plants. For the calculations we applied our own methodology to evaluate the levelized cost considering investment, fuel and operation and maintenance costs, making assumptions for the Mexican market, and taking into account the gas prices projections. The study also shows comparisons using different discount rates (5% and 10%), and some comparisons between our results and an OECD 1998 study. The results are i n good agreement and shows that nuclear option is cost competitive in Mexico on the basis of levelized costs.

Levelized Costs for Nuclear, Gas and Coal for Electricity, under the Mexican Scenario

International Nuclear Information System (INIS)

Palacios, J.C.; Alonso, G.; Ramirez, R.; Gomez, A.; Ortiz, J.; Longoria, L.C.

2004-01-01

In the case of new nuclear power stations, it is necessary to pay special attention to the financial strategy that will be applied, time of construction, investment cost, and the discount and return rate. The levelized cost quantifies the unitary cost of the electricity (the kWh) generated during the lifetime of the nuclear power plant; and allows the immediate comparison with the cost of other alternative technologies. The present paper shows levelized cost for different nuclear technologies and it provides comparison among them as well as with gas and coal electricity plants. For the calculations we applied our own methodology to evaluate the levelized cost considering investment, fuel and operation and maintenance costs, making assumptions for the Mexican market, and taking into account the gas prices projections. The study also shows comparisons using different discount rates (5% and 10%), and some comparisons between our results and an OECD 1998 study. The results are i n good agreement and shows that nuclear option is cost competitive in Mexico on the basis of levelized costs

Cost effectiveness analysis in radiopharmacy

International Nuclear Information System (INIS)

Carpentier, N.; Verbeke, S.; Ducloux, T.

1999-01-01

Objective: to evaluate the cost effectiveness of radiopharmaceuticals and their quality control. Materials and methods: this retrospective study was made in the Nuclear Medicine Department of the University Hospital of Limoges. Radiopharmaceutical costs were obtained with adding the price of the radiotracer, the materials, the equipments, the labour, the running expenses and the radioisotope. The costs of quality control were obtained with adding the price of labour, materials, equipments, running expenses and the cost of the quality control of 99m Tc eluate. Results: during 1998, 2106 radiopharmaceuticals were prepared in the Nuclear Medicine Department. The mean cost effectiveness of radiopharmaceutical was 1430 francs (846 to 4260). The mean cost effectiveness of quality control was 163 francs (84 to 343). The rise of the radiopharmaceutical cost induced by quality control was 11%. Conclusion: the technical methodology of quality control must be mastered to optimize the cost of this operation. (author)

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

Directory of Open Access Journals (Sweden)

A. D. Chukalla

2017-07-01

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

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

Science.gov (United States)

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

2017-07-01

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

CT colonography and cost-effectiveness

Energy Technology Data Exchange (ETDEWEB)

Mavranezouli, Ifigeneia [University College London, National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-department of Clinical Health Psychology, London (United Kingdom); East, James E. [St Marks Hospital, Imperial College London, Wolfson Unit for Endoscopy, London (United Kingdom); Taylor, Stuart A. [University College Hospital, Specialist X-Ray, London (United Kingdom); University College Hospital, Department of Imaging, London (United Kingdom)

2008-11-15

CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

CT colonography and cost-effectiveness

International Nuclear Information System (INIS)

Mavranezouli, Ifigeneia; East, James E.; Taylor, Stuart A.

2008-01-01

CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

Parametric optimization of thermoelectric elements footprint for maximum power generation

DEFF Research Database (Denmark)

Rezania, A.; Rosendahl, Lasse; Yin, Hao

2014-01-01

The development studies in thermoelectric generator (TEG) systems are mostly disconnected to parametric optimization of the module components. In this study, optimum footprint ratio of n- and p-type thermoelectric (TE) elements is explored to achieve maximum power generation, maximum cost......-performance, and variation of efficiency in the uni-couple over a wide range of the heat transfer coefficient on the cold junction. The three-dimensional (3D) governing equations of the thermoelectricity and the heat transfer are solved using the finite element method (FEM) for temperature dependent properties of TE...... materials. The results, which are in good agreement with the previous computational studies, show that the maximum power generation and the maximum cost-performance in the module occur at An/Ap

Cost--effectiveness analysis of salpingectomy prior to IVF, based on a randomized controlled trial.

Science.gov (United States)

Strandell, Annika; Lindhard, Anette; Eckerlund, Ingemar

2005-12-01

In patients with ultrasound-visible hydrosalpinges, salpingectomy prior to IVF increases the chance of a live birth. This study compared the cost-effectiveness of this strategy (intervention) with that of optional salpingectomy after a failed cycle (control). Data from a Scandinavian randomized controlled trial were used to calculate the individual number of treatments and their outcomes. Only patients with ultrasound-visible hydrosalpinges were considered in the main analysis, and a maximum of three fresh cycles were included. The costs for surgical procedures, IVF treatment, medication, complications, management of pregnancy and delivery as well as of early pregnancy losses were calculated from standardized hospital charges. Among the 51 patients in the intervention group, the live birth rate was 60.8% compared with 40.9% in 44 controls. The average cost per patient was 13,943 euro and 12,091 euro, respectively. Thus, the average cost per live birth was 22,823 euro in the intervention group and 29,517 euro in the control group. The incremental cost-effectiveness ratio for adopting the intervention strategy was estimated at 9306 euro. The incremental cost to achieve the higher birth rate of the intervention strategy seems reasonable.

Maximum-Entropy Inference with a Programmable Annealer

Science.gov (United States)

Chancellor, Nicholas; Szoke, Szilard; Vinci, Walter; Aeppli, Gabriel; Warburton, Paul A.

2016-03-01

Optimisation problems typically involve finding the ground state (i.e. the minimum energy configuration) of a cost function with respect to many variables. If the variables are corrupted by noise then this maximises the likelihood that the solution is correct. The maximum entropy solution on the other hand takes the form of a Boltzmann distribution over the ground and excited states of the cost function to correct for noise. Here we use a programmable annealer for the information decoding problem which we simulate as a random Ising model in a field. We show experimentally that finite temperature maximum entropy decoding can give slightly better bit-error-rates than the maximum likelihood approach, confirming that useful information can be extracted from the excited states of the annealer. Furthermore we introduce a bit-by-bit analytical method which is agnostic to the specific application and use it to show that the annealer samples from a highly Boltzmann-like distribution. Machines of this kind are therefore candidates for use in a variety of machine learning applications which exploit maximum entropy inference, including language processing and image recognition.

Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

Science.gov (United States)

Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K

2015-02-01

Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

An event- and network-level analysis of college students' maximum drinking day.

Science.gov (United States)

Meisel, Matthew K; DiBello, Angelo M; Balestrieri, Sara G; Ott, Miles Q; DiGuiseppi, Graham T; Clark, Melissa A; Barnett, Nancy P

2018-04-01

Heavy episodic drinking is common among college students and remains a serious public health issue. Previous event-level research among college students has examined behaviors and individual-level characteristics that drive consumption and related consequences but often ignores the social network of people with whom these heavy drinking episodes occur. The main aim of the current study was to investigate the network of social connections between drinkers on their heaviest drinking occasions. Sociocentric network methods were used to collect information from individuals in the first-year class (N=1342) at one university. Past-month drinkers (N=972) reported on the characteristics of their heaviest drinking occasion in the past month and indicated who else among their network connections was present during this occasion. Average max drinking day indegree, or the total number of times a participant was nominated as being present on another students' heaviest drinking occasion, was 2.50 (SD=2.05). Network autocorrelation models indicated that max drinking day indegree (e.g., popularity on heaviest drinking occassions) and peers' number of drinks on their own maximum drinking occasions were significantly associated with participant maximum number of drinks, after controlling for demographic variables, pregaming, and global network indegree (e.g., popularity in the entire first-year class). Being present at other peers' heaviest drinking occasions is associated with greater drinking quantities on one's own heaviest drinking occasion. These findings suggest the potential for interventions that target peer influences within close social networks of drinkers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of Training Frequency on Maximum Expiratory Pressure

Science.gov (United States)

Anand, Supraja; El-Bashiti, Nour; Sapienza, Christine

2012-01-01

Purpose: To determine the effects of expiratory muscle strength training (EMST) frequency on maximum expiratory pressure (MEP). Method: We assigned 12 healthy participants to 2 groups of training frequency (3 days per week and 5 days per week). They completed a 4-week training program on an EMST trainer (Aspire Products, LLC). MEP was the primary…

Analysis of the Effect of Employee Costs on Company Performance

Directory of Open Access Journals (Sweden)

Željko Požega

2010-07-01

Full Text Available The goal of every economic entity is to accomplish an optimal system of compensation management and to reach maximum returns through optimal employee investment, raising their motivation and knowledge as well as developing their abilities and skills. In order to reach this goal of maximizing company performance it is necessary to systematically approach the management of human resources within a certain economic entity and to create the fairest material and non-material reward and punishment system by using compensation management methods. This in turn will bring about a positive working atmosphere in the company, where employees will rapidly and easily adjust to changes, interact and co-operate with one another at a high level. This research, which studies the effect of employee costs on company performance, is divided into three chapters. The first chapter provides a brief theoretical overview of the importance of compensation management in human resources administration and reaching business efficiency, i.e. the different possibilities of creating a reward and punishment system in a company which aims to organise an optimal working atmosphere. The second chapter demonstrates the applied methodology and illustrates the information from different companies, which has been used in this research and analysis. The information comprises statistical data of employee costs, income, profits and losses from a sample of companies from the Republic of Croatia in 2008. The third part deals with the analysis and interpretation of the research results which show the effect of employee costs on the income and company performance, also expressed per employee. The goal of this research is to test the hypothesis that companies with higher employee cost, i.e. with higher investment in human resources, on average obtain a higher income and a higher profit per employee and are more efficient and more successful on the market. From the given hypothesis, one can

Preliminary estimates of cost savings for defense high level waste vitrification options

International Nuclear Information System (INIS)

Merrill, R.A.; Chapman, C.C.

1993-09-01

The potential for realizing cost savings in the disposal of defense high-level waste through process and design modificatins has been considered. Proposed modifications range from simple changes in the canister design to development of an advanced melter capable of processing glass with a higher waste loading. Preliminary calculations estimate the total disposal cost (not including capital or operating costs) for defense high-level waste to be about $7.9 billion dollars for the reference conditions described in this paper, while projected savings resulting from the proposed process and design changes could reduce the disposal cost of defense high-level waste by up to $5.2 billion

Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.

Directory of Open Access Journals (Sweden)

Joakim Ramsberg

Full Text Available OBJECTIVE: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression. DESIGN: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine. The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year. DATA SOURCES: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources. RESULTS: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine. CONCLUSION: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

Cost-effectiveness analysis in minimally invasive spine surgery.

Science.gov (United States)

Al-Khouja, Lutfi T; Baron, Eli M; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

2014-06-01

Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%-all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10-392.5 ml) than in an open approach (range 55-535.5 ml). There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of

Cost-effectiveness of the fenceline cow

Energy Technology Data Exchange (ETDEWEB)

Eichholz, G G; Lando, A V [Georgia Inst. of Tech., Atlanta (USA). School of Nuclear Engineering

1979-07-01

The grass-cow-milk pathway for /sup 131/I is one of the main contributers to estimated population dose from BWR's and PWR's. Such estimates assume a cow at the fenceline grazing for 12 months of the year. Reductions in the population dose would require a trade-off, based on cost-effectiveness criteria, between additions to the effluent treatment system, expanding the exclusion area, or raising the stack height. It is suggested that a more practical and more cost-effective means may be provided by redistribution of nearby dairy cattle (or goats), and that the plant operator buy these animals and/or contract with the land owner(s) to use the land for alternative crops. Even a subsidy to compensate the farmer for any financial losses entailed in these changes might be less expensive than alternative technical installations to lower iodine effluent levels. Figures are provided to illustrate these points.

Cost-effectiveness of interventions to promote physical activity: a modelling study.

Directory of Open Access Journals (Sweden)

Linda J Cobiac

2009-07-01

Full Text Available BACKGROUND: Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity. METHODS AND FINDINGS: From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant and mass media-based community campaigns (Dominant are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY, the GP physical activity prescription program (AUS$12,000/DALY, and the program to encourage more active transport (AUS$20,000/DALY, although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered

Cost effective tools for soil organic carbon monitoring

Science.gov (United States)

Shepherd, Keith; Aynekulu, Ermias

2013-04-01

There is increasing demand for data on soil properties at fine spatial resolution to support management and planning decisions. Measurement of soil organic carbon has attracted much interest because (i) soil organic carbon is widely cited as a useful indicator of soil condition and (ii) of the importance of soil carbon in the global carbon cycle and climate mitigation strategies. However in considering soil measurement designs there has been insufficient attention given to careful analysis of the specific decisions that the measurements are meant to support and on what measurements have high information value for decision-making. As a result, much measurement effort may be wasted or focused on the wrong variables. A cost-effective measurement is one that reduces risk in decisions and does not cost more than the societal returns to additional evidence. A key uncertainty in measuring soil carbon as a soil condition indicator is what constitutes a good or bad level of carbon on a given soil. A measure of soil organic carbon concentration may have limited value for informing management decisions without the additional information required to interpret it, and so expending further efforts on improving measurements to increase precision may then have no value to improving the decision. Measuring soil carbon stock changes for carbon trading purposes requires high levels of measurement precision but there is still large uncertainty on whether the costs of measurement exceed the benefits. Since the largest cost component in soil monitoring is often travel to the field and physically sampling soils, it is generally cost-effective to meet multiple objectives by analysing a number of properties on a soil sample. Diffuse reflectance infrared spectroscopy is playing a key role in allowing multiple soil properties to be determined rapidly and at low cost. The method provides estimation of multiple soil properties (e.g. soil carbon, texture and mineralogy) in one measurement

The cost and impact of scaling up pre-exposure prophylaxis for HIV prevention: a systematic review of cost-effectiveness modelling studies.

Directory of Open Access Journals (Sweden)

Gabriela B Gomez

Full Text Available Cost-effectiveness studies inform resource allocation, strategy, and policy development. However, due to their complexity, dependence on assumptions made, and inherent uncertainty, synthesising, and generalising the results can be difficult. We assess cost-effectiveness models evaluating expected health gains and costs of HIV pre-exposure prophylaxis (PrEP interventions.We conducted a systematic review comparing epidemiological and economic assumptions of cost-effectiveness studies using various modelling approaches. The following databases were searched (until January 2013: PubMed/Medline, ISI Web of Knowledge, Centre for Reviews and Dissemination databases, EconLIT, and region-specific databases. We included modelling studies reporting both cost and expected impact of a PrEP roll-out. We explored five issues: prioritisation strategies, adherence, behaviour change, toxicity, and resistance. Of 961 studies retrieved, 13 were included. Studies modelled populations (heterosexual couples, men who have sex with men, people who inject drugs in generalised and concentrated epidemics from Southern Africa (including South Africa, Ukraine, USA, and Peru. PrEP was found to have the potential to be a cost-effective addition to HIV prevention programmes in specific settings. The extent of the impact of PrEP depended upon assumptions made concerning cost, epidemic context, programme coverage, prioritisation strategies, and individual-level adherence. Delivery of PrEP to key populations at highest risk of HIV exposure appears the most cost-effective strategy. Limitations of this review include the partial geographical coverage, our inability to perform a meta-analysis, and the paucity of information available exploring trade-offs between early treatment and PrEP.Our review identifies the main considerations to address in assessing cost-effectiveness analyses of a PrEP intervention--cost, epidemic context, individual adherence level, PrEP programme coverage

Costs and cost-effectiveness of malaria control interventions - a systematic review

Directory of Open Access Journals (Sweden)

White Michael T

2011-11-01

Full Text Available Abstract Background The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs, indoor residual spraying (IRS, intermittent preventive treatment (IPT, diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. Methods A systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives. Results Fifty-five studies of the costs and forty three studies of the cost-effectiveness of malaria interventions were identified, 78% of which were undertaken in sub-Saharan Africa, 18% in Asia and 4% in South America. The median financial cost of protecting one person for one year was $2.20 (range $0.88-$9.54 for ITNs, $6.70 (range $2.22-$12.85 for IRS, $0.60 (range $0.48-$1.08 for IPT in infants, $4.03 (range $1.25-$11.80 for IPT in children, and $2.06 (range $0.47-$3.36 for IPT in pregnant women. The median financial cost of diagnosing a case of malaria was $4.32 (range $0.34-$9.34. The median financial cost of treating an episode of uncomplicated malaria was $5.84 (range $2.36-$23.65 and the median financial cost of treating an episode of severe malaria was $30.26 (range $15.64-$137.87. Economies of scale were observed in the implementation of ITNs, IRS and IPT, with lower unit costs reported in studies with larger numbers of beneficiaries. From a provider perspective, the median incremental cost effectiveness ratio per disability adjusted life year averted was $27 (range $8.15-$110 for ITNs, $143 (range $135

Cost benefit analysis cost effectiveness analysis

International Nuclear Information System (INIS)

Lombard, J.

1986-09-01

The comparison of various protection options in order to determine which is the best compromise between cost of protection and residual risk is the purpose of the ALARA procedure. The use of decision-aiding techniques is valuable as an aid to selection procedures. The purpose of this study is to introduce two rather simple and well known decision aiding techniques: the cost-effectiveness analysis and the cost-benefit analysis. These two techniques are relevant for the great part of ALARA decisions which need the use of a quantitative technique. The study is based on an hypothetical case of 10 protection options. Four methods are applied to the data

Cost-effectiveness of school support for orphan girls to prevent HIV infection in Zimbabwe.

Science.gov (United States)

Miller, Ted; Hallfors, Denise; Cho, Hyunsan; Luseno, Winnie; Waehrer, Geetha

2013-10-01

This cost-effectiveness study analyzes the cost per quality-adjusted life year (QALY) gained in a randomized controlled trial that tested school support as a structural intervention to prevent HIV risk factors among Zimbabwe orphan girl adolescents. The intervention significantly reduced early marriage, increased years of schooling completed, and increased health-related quality of life. By reducing early marriage, the literature suggests the intervention reduced HIV infection. The intervention yielded an estimated US$1,472 in societal benefits and an estimated gain of 0.36 QALYs per orphan supported. It cost an estimated US$6/QALY gained, about 1 % of annual per capita income in Zimbabwe. That is well below the maximum price that the World Health Organization (WHO) Commission on Macroeconomics and Health recommends paying for health gains in low and middle income countries. About half the girls in the intervention condition were boarded when they reached high school. For non-boarders, the intervention's financial benefits exceeded its costs, yielding an estimated net cost savings of $502 per pupil. Without boarding, the intervention would yield net savings even if it were 34 % less effective in replication. Boarding was not cost-effective. It cost an additional $1,234 per girl boarded (over the 3 years of the study, discounted to present value at a 3 % discount rate) but had no effect on any of the outcome measures relative to girls in the treatment group who did not board. For girls who did not board, the average cost of approximately 3 years of school support was US$973.

10 CFR 800.200 - Maximum loan; allowable costs.

Science.gov (United States)

2010-01-01

... Energy DEPARTMENT OF ENERGY LOANS FOR BID OR PROPOSAL PREPARATION BY MINORITY BUSINESS ENTERPRISES... cost principles of the Federal Procurement Regulation (41 CFR Ch. 1, 1-15.205-3) and DOE Procurement..., but are not limited to: (1) Bid bond premiums. (2) Financial, accounting, legal, engineering and other...

Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model.

Science.gov (United States)

Saunders, James E; Barrs, David M; Gong, Wenfeng; Wilson, Blake S; Mojica, Karen; Tucci, Debara L

2015-09-01

Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective. Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation

Directory of Open Access Journals (Sweden)

Connock Martin J

2009-10-01

Full Text Available Abstract Background Acromegaly, an orphan disease usually caused by a benign pituitary tumour, is characterised by hyper-secretion of growth hormone (GH and insulin-like growth factor I (IGF-1. It is associated with reduced life expectancy, cardiovascular problems, a variety of insidiously progressing detrimental symptoms and metabolic malfunction. Treatments include surgery, radiotherapy and pharmacotherapy. Pegvisomant (PEG is a genetically engineered GH analogue licensed as a third or fourth line option when other treatments have failed to normalise IGF-1 levels. Methods Evidence about effectiveness and cost-effectiveness of PEG was systematically reviewed. Data were extracted from published studies and used for a narrative synthesis of evidence. A decision analytical economic model was identified and modified to assess the cost-effectiveness of PEG. Results One RCT and 17 non-randomised studies were reviewed for effectiveness. PEG substantially reduced and rapidly normalised IGF-1 levels in the majority of patients, approximately doubled GH levels, and improved some of the signs and symptoms of the disease. Tumour size was unaffected at least in the short term. PEG had a generally safe adverse event profile but a few patients were withdrawn from treatment because of raised liver enzymes. An economic model was identified and adapted to estimate the lower limit for the cost-effectiveness of PEG treatment versus standard care. Over a 20 year time horizon the incremental cost-effectiveness ratio was £81,000/QALY and £212,000/LYG. To reduce this to £30K/QALY would require a reduction in drug cost by about one third. Conclusion PEG is highly effective for improving patients' IGF-1 level. Signs and symptoms of disease improve but evidence is lacking about long term effects on improved signs and symptoms of disease, quality of life, patient compliance and safety. Economic evaluation indicated that if current standards (UK for determining cost-effectiveness

Cost Considerations and Financing Mechanisms for the Disposal of Low and Intermediate Level Radioactive Waste

International Nuclear Information System (INIS)

2007-06-01

The overall objective of this publication is to provide Member States who are currently planning or preparing new near surface repositories for low and intermediate level radioactive waste (LILW), guidance on cost considerations and funding mechanisms for the repositories' entire life cycle. The report focuses on both technical and non-technical factors affecting repository costs. It considers the major cost elements that comprise a cost evaluation for a disposal facility for LILW and identifies those factors which may result in major uncertainties in an overall cost estimate. In particular, the report lists the basic disposal options and summarizes the legal basis and infrastructure requirements for establishing an effective financing system. It further includes the cost estimation methodology, considers the major cost categories and discusses factors to be considered when planning the financing mechanism, and describes relevant financing schemes

Waste Management Facilities cost information for mixed low-level waste. Revision 1

International Nuclear Information System (INIS)

Shropshire, D.; Sherick, M.; Biadgi, C.

1995-06-01

This report contains preconceptual designs and planning level life-cycle cost estimates for managing mixed low-level waste. The report's information on treatment, storage, and disposal modules can be integrated to develop total life-cycle costs for various waste management options. A procedure to guide the US Department of Energy and its contractor personnel in the use of cost estimation data is also summarized in this report

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

Science.gov (United States)

2014-01-01

Background Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Methods Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Results Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. Conclusions The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result

Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova.

Science.gov (United States)

Kempers, Jari; Ketting, Evert; Lesco, Galina

2014-07-21

Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH

Cost and cost-effectiveness of conventional and liquid-based ...

African Journals Online (AJOL)

Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data ...

Experimental verification of the imposing principle for maximum permissible levels of multicolor laser radiation

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Ivashin V.A.

2013-12-01

Full Text Available Aims. The study presents the results of experimental research to verify the principle overlay for maximum permissible levels (MPL of multicolor laser radiation single exposure on eyes. This principle of the independence of the effects of radiation with each wavelength (the imposing principle, was founded and generalized to a wide range of exposure conditions. Experimental verification of this approach in relation to the impact of laser radiation on tissue fundus of an eye, as shows the analysis of the literature was not carried out. Material and methods. Was used in the experimental laser generating radiation with wavelengths: Л1 =0,532 microns, A2=0,556to 0,562 microns and A3=0,619to 0,621 urn. Experiments were carried out on eyes of rabbits with evenly pigmented eye bottom. Results. At comparison of results of processing of the experimental data with the calculated data it is shown that these levels are close by their parameters. Conclusions. For the first time in the Russian Federation had been performed experimental studies on the validity of multi-colored laser radiation on the organ of vision. In view of the objective coincidence of the experimental data with the calculated data, we can conclude that the mathematical formulas work.

Cost calculation and financial measures for high-level waste disposal business

International Nuclear Information System (INIS)

Sekiguchi, Hiromasa.

1987-01-01

A study is made on the costs for disposal of high-level wastes, centering on financial problems involving cost calculation for disposal business and methods and systems for funding the business. The first half of the report is focused on calculation of costs for disposal business. Basic equations are shown to calculate the total costs required for a disposal plant and the costs for disposal of one unit of high-level wastes. A model is proposed to calculate the charges to be paid by electric power companies to the plant for disposal of their wastes. Another equation is derived to calculate the disposal charge per kWh of power generation in a power plant. The second half of the report is focused on financial measures concerning expenses for disposal. A financial basis should be established for the implementation of high-level waste disposal. It is insisted that a reasonable method for estimating the disposal costs should be set up and it should be decided who will pay the expenses. Discussions are made on some methods and systems for funding the disposal business. An additional charge should be included in the electricity bill to be paid by electric power users, or it should be included in tax. (Nogami, K.)

Comparison of costs of integrating working level devices

International Nuclear Information System (INIS)

Langner, G.H. Jr.

1977-01-01

For the purpose of deciding upon the method for making routine field measurements of radon and radon daughter products there are primarily two factors to be taken into consideration: how well the various methods measure the parameter of interest and how much they cost. For the purpose of measuring the annual average working level within a structure there are available basically two devices: the integrating air sampler and track etch film. The cost and manpower requirements for each of these two devices are discussed

Cost-effectiveness analysis of potentially curative and combination treatments for hepatocellular carcinoma with person-level data in a Canadian setting.

Science.gov (United States)

Thein, Hla-Hla; Isaranuwatchai, Wanrudee; Qiao, Yao; Wong, Kenny; Sapisochin, Gonzalo; Chan, Kelvin K W; Yoshida, Eric M; Earle, Craig C

2017-09-01

Patients with early-stage hepatocellular carcinoma (HCC) are potential candidates for curative treatments such as radiofrequency ablation (RFA), surgical resection (SR), or liver transplantation (LT), which have demonstrated a significant survival benefit. We aimed to estimate the cost-effectiveness of curative and combination treatment strategies among patients diagnosed with HCC during 2002-2010. This study used Ontario Cancer Registry-linked administrative data to estimate effectiveness and costs (2013 USD) of the treatment strategies from the healthcare payer's perspective. Multiple imputation by logistic regression was used to handle missing data. A net benefit regression approach of baseline important covariates and propensity score adjustment were used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 2,222 patients diagnosed with HCC, 10.5%, 14.1%, and 10.3% received RFA, SR, and LT monotherapy, respectively; 0.5-3.1% dual treatments; and 0.5% triple treatments. Compared with no treatment (53.2%), transarterial chemoembolization (TACE) + RFA (average $2,465, 95% CI: -$20,000-$36,600/quality-adjusted life years [QALY]) or RFA monotherapy ($15,553, 95% CI: $3,500-$28,500/QALY) appears to be the most cost-effective modality with lowest ICER value. The cost-effectiveness acceptability curve showed that if the relevant threshold was $50,000/QALY, RFA monotherapy and TACE+ RFA would have a cost-effectiveness probability of 100%. Strategies using LT delivered the most additional QALYs and became cost-effective at a threshold of $77,000/QALY. Our findings found that TACE+ RFA dual treatment or RFA monotherapy appears to be the most cost-effective curative treatment for patients with potential early stage of HCC in Ontario. These findings highlight the importance of identifying and measuring differential benefits, costs, and cost-effectiveness of alternative HCC curative treatments in

The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.

Directory of Open Access Journals (Sweden)

Delphine Hu

Full Text Available BACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS: We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE: Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency

Cost-effectiveness of an exercise intervention program in perimenopausal women : the Fitness League Against MENopause COst (FLAMENCO) randomized controlled trial

NARCIS (Netherlands)

Carbonell-Baeza, Ana; Soriano-Maldonado, Alberto; Gallo, Francisco Javier; López del Amo, María Puerto; Ruiz-Cabello, Pilar; Andrade, Ana; Borges-Cosic, Milkana; Peces-Rama, Antonio Rubén; Spacírová, Zuzana; Álvarez-Gallardo, Inmaculada C; García-Mochón, Leticia; Segura-Jiménez, Víctor; Estévez-López, Fernando; Camiletti-Moirón, Daniel; Martín-Martín, Jose Jesús; Aranda, Pilar; Delgado-Fernández, Manuel; Aparicio, Virginia A

2015-01-01

BACKGROUND: The high prevalence of women that do not reach the recommended level of physical activity is worrisome. A sedentary lifestyle has negative consequences on health status and increases health care costs. The main objective of this project is to assess the cost-effectiveness of a primary

Waste Management Facilities cost information for mixed low-level waste. Revision 1

Energy Technology Data Exchange (ETDEWEB)

Shropshire, D.; Sherick, M.; Biadgi, C.

1995-06-01

This report contains preconceptual designs and planning level life-cycle cost estimates for managing mixed low-level waste. The report`s information on treatment, storage, and disposal modules can be integrated to develop total life-cycle costs for various waste management options. A procedure to guide the US Department of Energy and its contractor personnel in the use of cost estimation data is also summarized in this report.

UMTRA Project-Level Cost Reduction/Productivity Improvement Program manual

International Nuclear Information System (INIS)

1995-06-01

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

The costs and cost-effectiveness of an integrated sepsis treatment protocol.

Science.gov (United States)

Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

2008-04-01

Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

Fuel channel in-service inspection programs program design for maximum cost effectiveness

International Nuclear Information System (INIS)

Van den Brekel, N.C.

1995-01-01

Inspection is an integral part of fuel channel life management strategy. Inspection data is used to assess the state of reactor core integrity and provide the information necessary to optimize long term maintenance programs. This paper will provide an overview of the structured approach to developing fuel channel inspection programs within OHN. The inspection programs are designed to balance the resources utilized (cost, outage time, and dose expenditure) with the benefits provided by the inspection data obtained (improved knowledge of component status, degradation mechanisms and rates, etc..). The CANDU community has yet to have a fuel channel operate for a full 30 year design life. Since research programs can not fully simulate reactor operating conditions, inspections become an essential feature of the life management strategy as the components age. Inspection programs often include activities designed to develop predictive capability for long term fuel channel behaviour and provide early warning of changes in behaviour. It should be noted that although this paper addresses the design of fuel channel inspection programs, the basic principles presented can be applied to the design of inspection programs for any major power plant component or system. (author)

Pyrimethanil degradation by photo-Fenton process: Influence of iron and irradiance level on treatment cost.

Science.gov (United States)

Cabrera Reina, A; Miralles-Cuevas, S; Casas López, J L; Sánchez Pérez, J A

2017-12-15

This study evaluates the combined effect of photo-catalyst concentration and irradiance level on photo-Fenton efficiency when this treatment is applied to industrial wastewater decontamination. Three levels of irradiance (18, 32 and 46W/m 2 ) and three iron concentrations (8, 20 and 32mg/L) were selected and their influence over the process studied using a raceway pond reactor placed inside a solar box. For 8mg/L, it was found that there was a lack of catalyst to make use of all the available photons. For 20mg/L, the treatment always improved with irradiance indicating that the process was photo-limited. For 32mg/L, the excess of iron caused an excess of radicals production which proved to be counter-productive for the overall process efficiency. The economic assessment showed that acquisition and maintenance costs represent the lowest relative values. The highest cost was found to be the cost of the reagents consumed. Both sulfuric acid and sodium hydroxide are negligible in terms of costs. Iron cost percentages were also very low and never higher than 10.5% while the highest cost was always that of hydrogen peroxide, representing at least 85% of the reagent costs. Thus, the total costs were between 0.76 and 1.39€/m 3 . Copyright © 2017 Elsevier B.V. All rights reserved.

Deflationary Expectations and Real Cost of Capital -Micro-Level Estimates of Investment Function in the1990s (in Japanese)

OpenAIRE

Satoshi Shimizutani; Terai Akira

2003-01-01

The Japanese economy in the 1990s experienced a substantial decrease in the nominal interest rate. The positive effect on the business investment, however, should have been canceled out, since deflationary expectations raised the real cost of capital. In this study, we address this unexplored issue by taking advantage of firm-level micro data. First, we calculate firm-level real cost of capital in the 1990s. Our estimates demonstrate that the speed of reduction in the real cost of capital was...

Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level.

Science.gov (United States)

García-Cornejo, Beatriz; Pérez-Méndez, José A

2018-04-01

Promoting the improvement of standardized cost systems (CS) is one of the measures available to health policy makers for the purpose of improving efficiency in hospitals over the long-term. Nevertheless, very few studies evaluate the relationship between alternative CS and the costs really incurred. We use data from 242 hospitals of the Spanish National Health Service (NHS) between 2010 and 2013 in order to explore the determinants of the cost per adjusted patient day, using a difference-in-differences approach where the treatment is the implementation of an advanced CS. We also investigate if the association between advanced CS and unit cost is different depending upon the technological level of the hospital. Results show that hospitals with more advanced CS contained their costs better. However, the latter effect of advanced CS is lower in hospitals with a greater endowment of high technology. Results suggest that health authorities should support the development of CS, particularly in high-tech hospitals, which are usually larger and more complex hospitals that tend to accumulate a greater portion of NHS hospital sector expenditure. Copyright © 2018 Elsevier B.V. All rights reserved.

Assessing the cost-effectiveness of electric vehicles in European countries using integrated modeling

International Nuclear Information System (INIS)

Seixas, J.; Simões, S.; Dias, L.; Kanudia, A.; Fortes, P.; Gargiulo, M.

2015-01-01

Electric vehicles (EVs) are considered alternatives to internal combustion engines due to their energy efficiency and contribution to CO 2 mitigation. The adoption of EVs depends on consumer preferences, including cost, social status and driving habits, although it is agreed that current and expected costs play a major role. We use a partial equilibrium model that minimizes total energy system costs to assess whether EVs can be a cost-effective option for the consumers of each EU27 member state up to 2050, focusing on the impact of different vehicle investment costs and CO 2 mitigation targets. We found that for an EU-wide greenhouse gas emission reduction cap of 40% and 70% by 2050 vis-à-vis 1990 emissions, battery electric vehicles (BEVs) are cost-effective in the EU only by 2030 and only if their costs are 30% lower than currently expected. At the EU level, vehicle costs and the capability to deliver both short- and long-distance mobility are the main drivers of BEV deployment. Other drivers include each state’s national mobility patterns and the cost-effectiveness of alternative mitigation options, both in the transport sector, such as plug-in hybrid electric vehicles (PHEVs) or biofuels, and in other sectors, such as renewable electricity. - Highlights: • Electric vehicles were assessed through the minimization of the total energy systems costs. • EU climate policy targets could act as a major driver for PHEV adoption. • Battery EV is an option before 2030 if costs will drop by 30% from expected costs. • EV deployment varies per country depending on each energy system configuration. • Incentives at the country level should consider specific cost-effectiveness factors

Costs and health effects of screening and delivery of hearing aids in Tamil Nadu, India: an observational study

Directory of Open Access Journals (Sweden)

Job Anand

2009-05-01

Full Text Available Abstract Background The burden of disease of hearing disorders among adults is high, but a significant part goes undetected. Screening programs in combination with the delivery of hearing aids can alleviate this situation, but the economic attractiveness of such programs is unknown. This study aims to evaluate the population-level costs, effects and cost-effectiveness of alternative delivering hearing aids models in Tamil Nadu, India Methods In an observational study design, we estimated total costs and effects of two active screening programs in the community in combination with the provision of hearing aids at secondary care level, and the costs and effects of the provision of hearing aids at tertiary care level. Screening and hearing aid delivery costs were estimated on the basis of program records and an empirical assessment of health personnel time input. Household costs for seeking and undergoing hearing health care were collected with a questionnaire (see Additional file 2. Health effects were estimated on the basis of compliance with the hearing aid, and associated changes in disability, and were expressed in disability-adjusted life years (DALYs averted. Results Active screening and provision of hearing aids at the secondary care level costs around Rs.7,000 (US$152 per patient, whereas provision of hearing aids at the tertiary care level costs Rs 5,693 (US$122 per patient. The cost per DALY averted was around RS 42,200 (US$900 at secondary care level and Rs 33,900 (US$720 at tertiary care level. The majority of people did consult other providers before being screened in the community. Costs of food and transport ranged between Rs. 2 (US$0,04 and Rs. 39 (US$0,83. Conclusion Active screening and provision of hearing aids at the secondary care level is slightly more costly than passive screening and fitting of hearing aids at the tertiary care level, but seems also able to reach a higher coverage of hearing aids services. Although crude

Cost-Effectiveness of Intensive versus Standard Blood-Pressure Control.

Science.gov (United States)

Bress, Adam P; Bellows, Brandon K; King, Jordan B; Hess, Rachel; Beddhu, Srinivasan; Zhang, Zugui; Berlowitz, Dan R; Conroy, Molly B; Fine, Larry; Oparil, Suzanne; Morisky, Donald E; Kazis, Lewis E; Ruiz-Negrón, Natalia; Powell, Jamie; Tamariz, Leonardo; Whittle, Jeff; Wright, Jackson T; Supiano, Mark A; Cheung, Alfred K; Weintraub, William S; Moran, Andrew E

2017-08-24

In the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, control (target, costs associated with intensive control versus standard control. We used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. We determined that the mean number of QALYs would be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51 to 79% below the willingness-to-pay threshold of $50,000 per QALY and 76 to 93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime. In this simulation study, intensive systolic blood-pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness-to-pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient's remaining lifetime. (Funded by the National Heart, Lung, and Blood Institute and others; SPRINT ClinicalTrials.gov number, NCT01206062 .).

Use of cost-effective construction technologies in India to mitigate climate change

Energy Technology Data Exchange (ETDEWEB)

Sengupta, N. [Forum of Scientists, Engineers and Technologists, Kolkata (India)

2008-01-10

Concentration of greenhouse gases plays a major role in raising the earth's temperature. Carbon dioxide, produced from burning of fossil fuels, is the principle greenhouse gas and efforts are being made at international level to reduce its emission through adoption of energy-efficient technologies. The UN Conference on Environment and Development, 1992 made a significant development in this field by initiating the discussion on sustainable development under the Agenda 21. Cost-effective construction technologies can bring down the embodied energy level associated with production of building materials by lowering use of energy-consuming materials. This embodied energy is a crucial factor for sustainable construction practices and effective reduction of the same would contribute in mitigating global warming. The cost-effective construction technologies would emerge as the most acceptable case of sustainable technologies in India both in terms of cost and environment.

Comparison of SUREPAK life cycle costs to other methods of low-level radioactive waste management

International Nuclear Information System (INIS)

Winston, S.J.; Little, C.C.

1985-01-01

Comparisons of costs of low-level radioactive waste management techniques invariably degenerate into parochial arguments over differences in commercial objectives. The purpose of this paper is to establish a common basis for comparing technologies and then to examine the result as a complete cycle instead of a snapshot view taken at an arbitrary point in the progression. One objective is to portray cost sensitivity in terms of the options available for waste management. A second, perhaps less obvious, point is the definition of cost factors hidden from the short-term view. The final objective is to show the cumulative effects of costs externally imposed without reference to the technology employed (e.g., legislated surcharges based on arbitrary parameters)

Cost-effectiveness of norovirus vaccination in children in Peru.

Science.gov (United States)

Mirelman, Andrew J; Ballard, Sarah Blythe; Saito, Mayuko; Kosek, Margaret N; Gilman, Robert H

2015-06-17

With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru's routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher. Published

Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive-behavioural therapy in out-patients with anorexia nervosa.

Science.gov (United States)

Egger, N; Wild, B; Zipfel, S; Junne, F; Konnopka, A; Schmidt, U; de Zwaan, M; Herpertz, S; Zeeck, A; Löwe, B; von Wietersheim, J; Tagay, S; Burgmer, M; Dinkel, A; Herzog, W; König, H-H

2016-12-01

Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.

Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study.

Science.gov (United States)

Turner, Katy; Adams, Elisabeth; Grant, Arabella; Macleod, John; Bell, Gill; Clarke, Jan; Horner, Paddy

2011-01-04

To compare the cost, cost effectiveness, and sex equity of different intervention strategies within the English National Chlamydia Screening Programme. To develop a tool for calculating cost effectiveness of chlamydia control programmes at a local, national, or international level. An economic and mathematical modelling study with cost effectiveness analysis. Costs were restricted to those of screening and partner notification from the perspective of the NHS and excluded patient costs, the costs of reinfection, and costs of complications arising from initial infection. England. Population Individuals eligible for the National Chlamydia Screening Programme. Cost effectiveness of National Chlamydia Screening Programme in 2008-9 (as cost per individual tested, cost per positive diagnosis, total cost of screening, number screened, number infected, sex ratio of those tested and treated). Comparison of baseline programme with two different interventions-(i) increased coverage of primary screening in men and (ii) increased efficacy of partner notification. In 2008-9 screening was estimated to cost about £46.3m in total and £506 per infection treated. Provision for partner notification within the screening programme cost between £9 and £27 per index case, excluding treatment and testing. The model results suggest that increasing male screening coverage from 8% (baseline value) to 24% (to match female coverage) would cost an extra £22.9m and increase the cost per infection treated to £528. In contrast, increasing partner notification efficacy from 0.4 (baseline value) to 0.8 partners per index case would cost an extra £3.3m and would reduce the cost per infection diagnosed to £449. Increasing screening coverage to 24% in men would cost over six times as much as increasing partner notification to 0.8 but only treat twice as many additional infections. In the English National Chlamydia Screening Programme increasing the effectiveness of partner notification is likely

Zipf's law, power laws and maximum entropy

International Nuclear Information System (INIS)

Visser, Matt

2013-01-01

Zipf's law, and power laws in general, have attracted and continue to attract considerable attention in a wide variety of disciplines—from astronomy to demographics to software structure to economics to linguistics to zoology, and even warfare. A recent model of random group formation (RGF) attempts a general explanation of such phenomena based on Jaynes' notion of maximum entropy applied to a particular choice of cost function. In the present paper I argue that the specific cost function used in the RGF model is in fact unnecessarily complicated, and that power laws can be obtained in a much simpler way by applying maximum entropy ideas directly to the Shannon entropy subject only to a single constraint: that the average of the logarithm of the observable quantity is specified. (paper)

The impact of current infection levels on the cost-benefit of vaccination

Directory of Open Access Journals (Sweden)

Matt J. Keeling

2017-12-01

Full Text Available When considering a new vaccine programme or modifying an existing one, economic cost-benefit analysis, underpinned by predictive epidemiological modelling, is a key component. This analysis is intimately linked to the willingness to pay for additional QALYs (quality-adjusted life-years gained; currently in England and Wales a health programme is economically viable if the cost per QALY gained is less than £ 20,000, and models are often used to assess if a vaccine programme is likely to fall below this threshold cost. Before a programme begins, infection levels are generally high and therefore vaccination may be expected to have substantial effects and therefore will often be economically viable. However, once a programme is established, and infection rates are lower, it might be expected that a re-evaluation of the programme (using current incidence information will show it to be less cost-effective. This is the scenario we examine here with analytical tools and simple ODE models. Surprisingly we show that in most cases the benefits from maintaining an existing vaccination programme are at least equal to those of starting the programme initially, and in the majority of scenarios the differences between the two are minimal. In practical terms, this is an extremely helpful finding, allowing us to assert that the action of immunising individuals does not de-value the vaccination programme.

Statin cost effectiveness in primary prevention: A systematic review of the recent cost-effectiveness literature in the United States

Directory of Open Access Journals (Sweden)

Mitchell Aaron P

2012-07-01

Full Text Available Abstract Background The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins. Findings We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive. Conclusions Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

Levelized cost of energy and sensitivity analysis for the hydrogen-bromine flow battery

Science.gov (United States)

Singh, Nirala; McFarland, Eric W.

2015-08-01

The technoeconomics of the hydrogen-bromine flow battery are investigated. Using existing performance data the operating conditions were optimized to minimize the levelized cost of electricity using individual component costs for the flow battery stack and other system units. Several different configurations were evaluated including use of a bromine complexing agent to reduce membrane requirements. Sensitivity analysis of cost is used to identify the system elements most strongly influencing the economics. The stack lifetime and round-trip efficiency of the cell are identified as major factors on the levelized cost of electricity, along with capital components related to hydrogen storage, the bipolar plate, and the membrane. Assuming that an electrocatalyst and membrane with a lifetime of 2000 cycles can be identified, the lowest cost market entry system capital is 220 kWh-1 for a 4 h discharge system and for a charging energy cost of 0.04 kWh-1 the levelized cost of the electricity delivered is 0.40 kWh-1. With systems manufactured at large scales these costs are expected to be lower.

Engineering and Fabrication Considerations for Cost-Effective Space Reactor Shield Development

International Nuclear Information System (INIS)

Berg, Thomas A.; Disney, Richard K.

2004-01-01

Investment in developing nuclear power for space missions cannot be made on the basis of a single mission. Current efforts in the design and fabrication of the reactor module, including the reactor shield, must be cost-effective and take into account scalability and fabricability for planned and future missions. Engineering considerations for the shield need to accommodate passive thermal management, varying radiation levels and effects, and structural/mechanical issues. Considering these challenges, design principles and cost drivers specific to the engineering and fabrication of the reactor shield are presented that contribute to lower recurring mission costs

Overview of low level waste disposal facility costs

International Nuclear Information System (INIS)

Saverot, P.M.

1995-01-01

Economics and uncertainty go hand-in-hand and it is too soon to have conclusive data on the life cycle costs of a disposal facility. While LLW volumes from are decreasing year after year, the effect of the projected LLW volumes from decommissioning may have a significant impact on the final unit costs. This overview recognizes that countries see LLW disposal costs differently depending on the scale of their programs and on the geographical, political and economic frameworks within which they operate. The reasons for the cost differences arise from a number of factors: differences in designs and in technologies (near surface engineered vault, enhanced shallow land burial, silo type caverns,...), disposal capacities, programmatic and regulatory requirements, organizational, managerial and institutional frameworks, contractual arrangements, etc. Comparison of actual project costs, if done incorrectly, can lead to invalid conclusions and little purpose would be served by so doing since cost variations reflect the reality faced by each country

Estimate of Cost-Effective Potential for Minimum Efficiency Performance Standards in 13 Major World Economies Energy Savings, Environmental and Financial Impacts

Energy Technology Data Exchange (ETDEWEB)

Letschert, Virginie E. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bojda, Nicholas [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Ke, Jing [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McNeil, Michael A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2012-07-01

This study analyzes the financial impacts on consumers of minimum efficiency performance standards (MEPS) for appliances that could be implemented in 13 major economies around the world. We use the Bottom-Up Energy Analysis System (BUENAS), developed at Lawrence Berkeley National Laboratory (LBNL), to analyze various appliance efficiency target levels to estimate the net present value (NPV) of policies designed to provide maximum energy savings while not penalizing consumers financially. These policies constitute what we call the “cost-effective potential” (CEP) scenario. The CEP scenario is designed to answer the question: How high can we raise the efficiency bar in mandatory programs while still saving consumers money?

10 CFR 436.18 - Measuring cost-effectiveness.

Science.gov (United States)

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this section, each Federal agency shall measure cost-effectiveness by combining cost data established under...

Comparison of costs for alternative mixed low-level waste treatment systems

International Nuclear Information System (INIS)

Schwinkendorf, W.E.; Harvego, L.; Cooley, C.R.; Biagi, C.

1996-01-01

Total life cycle costs (TLCCs), including disposal costs, of thermal, nonthermal and enhanced nonthermal systems were evaluated to guide future research and development programs for the treatment of mixed low-level waste (MLLW) consisting of RCRA hazardous and low-level radioactive wastes. In these studies, nonthermal systems are defined as those systems that process waste at temperatures less than 350 C. Preconceptual designs and costs were developed for thirty systems with a capacity (2,927 lbs/hr) to treat the DOE MLLW stored inventor y(approximately 236 million pounds) in 20 years in a single, centralized facility. A limited comparison of the studies' results is presented in this paper. Sensitivity of treatment costs with respect to treatment capacity, number of treatment facilities, and system availability were also determined. The major cost element is operations and maintenance (O and M), which is 50 to 60% of the TLCC for both thermal and nonthermal systems. Energy costs constitute a small fraction (< 1%) of the TLCCs. Equipment cost is only 3 to 5% of the treatment cost. Evaluation of subsystem costs demonstrate that receiving and preparation is the highest cost subsystem at about 25 to 30% of the TLCC for both thermal and nonthermal systems. These studies found no cost incentives to use nonthermal or hybrid (combined nonthermal treatment with stabilization by vitrification) systems in place of thermal systems. However, there may be other incentives including fewer air emissions and less local objection to a treatment facility. Building multiple treatment facilities to treat the same total mass of waste as a single facility would increase the total treatment cost significantly, and improved system availability decreases unit treatment costs by 17% to 30%

Multi-level restricted maximum likelihood covariance estimation and kriging for large non-gridded spatial datasets

KAUST Repository

Castrillon, Julio

2015-11-10

We develop a multi-level restricted Gaussian maximum likelihood method for estimating the covariance function parameters and computing the best unbiased predictor. Our approach produces a new set of multi-level contrasts where the deterministic parameters of the model are filtered out thus enabling the estimation of the covariance parameters to be decoupled from the deterministic component. Moreover, the multi-level covariance matrix of the contrasts exhibit fast decay that is dependent on the smoothness of the covariance function. Due to the fast decay of the multi-level covariance matrix coefficients only a small set is computed with a level dependent criterion. We demonstrate our approach on problems of up to 512,000 observations with a Matérn covariance function and highly irregular placements of the observations. In addition, these problems are numerically unstable and hard to solve with traditional methods.

Systems costs for disposal of Savannah River high-level waste sludge and salt

International Nuclear Information System (INIS)

McDonell, W.R.; Goodlett, C.B.

1984-01-01

A systems cost model has been developed to support disposal of defense high-level waste sludge and salt generated at the Savannah River Plant. Waste processing activities covered by the model include decontamination of the salt by a precipitation process in the waste storage tanks, incorporation of the sludge and radionuclides removed from the salt into glass in the Defense Waste Processing Facility (DWPF), and, after interim storage, final disposal of the DWPF glass waste canisters in a federal geologic repository. Total costs for processing of waste generated to the year 2000 are estimated to be about $2.9 billion (1984 dollars); incremental unit costs for DWPF and repository disposal activities range from $120,000 to $170,000 per canister depending on DWPF processing schedules. In a representative evaluation of process alternatives, the model is used to demonstrate cost effectiveness of adjustments in the frit content of the waste glass to reduce impacts of wastes generated by the salt decontamination operations. 13 references, 8 tables

Determination of leveled costs of electric generation for gas plants, coal and nuclear

International Nuclear Information System (INIS)

Alonso V, G.; Palacios H, J.C.; Ramirez S, J.R.; Gomez, A.

2005-01-01

The present work analyzes the leveled costs of electric generation for different types of nuclear reactors known as Generation III, these costs are compared with the leveled costs of electric generation of plants with the help of natural gas and coal. In the study several discount rates were used to determine their impact in the initial investment. The obtained results are comparable with similar studies and they show that it has more than enough the base of the leveled cost the nuclear option it is quite competitive in Mexico. Also in this study it is also thinks about the economic viability of a new nuclear power station in Mexico. (Author)

Solitary pulmonary nodules: impact of functional CT on the cost-effectiveness of FDG-PET

International Nuclear Information System (INIS)

Miles, K.A.; Keith, C.J.; Wong, D.C.; Griffiths, M.R.

2002-01-01

Full text: FDG-PET has been shown to be cost-effective for the evaluation of solitary pulmonary nodules (SPNs) in Australia. This study evaluates the impact on cost-effectiveness produced by incorporating a novel CT technique, functional CT, into diagnostic algorithms for characterisation of SPNs. Four diagnostic strategies were evaluated using decision tree sensitivity analysis. The first strategy comprised patients undergoing conventional CT alone (CT). The second comprised conventional CT followed by functional CT study (FCT), when the SPN was not benign on conventional CT. The third strategy comprised conventional CT, which if positive is followed by FDG-PET (PET) and a fourth strategy where patients with a positive conventional CT undergo functional CT, which if positive also undergo FDG-PET (FCT+PET). Values for disease prevalence and diagnostic accuracy of PET, CT and functional CT were obtained from a literature review, using Australia values where available. Procedure costs were derived from the Medicare Benefits Schedule and DRG Cost Weights for Australian public hospitals. The cost per patient, accuracy and Incremental Cost-Accuracy Ratio (ICAR) were determined for each strategy. Sensitivity analysis evaluated the effect of disease prevalence on cost-effectiveness. Results: At the prevalence of malignancy reported from Australian series (54%), the FCT strategy incurs the least cost ($5560/patient), followed by the FCT+PET ($5910/patient). The FCT+PET strategy is the most cost-effective strategy with an ICAR of $12059/patient, followed by the PET strategy with an ICAR of $12300/patient. At levels of disease prevalence below 54% the above relationship for cost-effectiveness remains the same. For high levels of disease prevalence, CT or FCT are found to be more cost-effective. At typical prevalence of malignancy the cost-effectiveness of PET is enhanced by the addition of functional CT, but at high prevalence functional CT alone is most cost-effective

Societal costs and effects of implementing population-based mammography screening in Greenland

DEFF Research Database (Denmark)

Christensen, Maria Klitgaard; Niclasen, Birgit; Moesgaard Iburg, Kim

2017-01-01

With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper ...... transportation and accommodation costs and loss of productivity, and none would be accepted as cost-effective per YLS/QALY gained within a conventional threshold level. The least expensive strategy was regional screening with hotel accommodation.......With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper...... is to evaluate the cost effectiveness and cost utility of different strategies for implementing population-based breast cancer screening in Greenland. Two strategies were evaluated: Centralised screening in the capital Nuuk and decentralised screening in the five municipal regions of Greenland. A cost...

Cost-Effectiveness of Alternative Blood-Screening Strategies for West Nile Virus in the United States.

Directory of Open Access Journals (Sweden)

2006-01-01

Full Text Available BACKGROUND: West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist. METHODS AND FINDINGS: We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding US$1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings. CONCLUSIONS: In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations

Cost-effectiveness of alternative blood-screening strategies for West Nile Virus in the United States.

Directory of Open Access Journals (Sweden)

Caroline T Korves

2006-02-01

Full Text Available West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist.We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding USD 1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings.In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients is cost

Water Level Loggers as a Low-Cost Tool for Monitoring of Stormwater Control Measures

Directory of Open Access Journals (Sweden)

Laura Toran

2016-08-01

Full Text Available Stormwater control measures (SCMs are a key component of watershed health in urbanized areas. SCMs are used to increase infiltration and reduce discharge to streams or storm sewer systems during rain events. Monitoring is important for the evaluation of design and causes of failure in SCMs. However, the expense of monitoring means it is not always included in stormwater control planning. This study shows how low-cost water level loggers can be used to answer certain questions about SCM performance. Five case studies are presented that use water level loggers to evaluate the overflow of basins, compare a traditional stormpipe trench with an infiltration trench, monitor timing of blue roof storage, show the effects of retrofitting a basin, and provide long term performance data. Water level loggers can be used to answer questions about the timing and location of stormwater overflows, which helps to evaluate the effectiveness of SCMs. More expensive monitoring and modeling can be used as a follow up if needed to more thoroughly assess a site. Nonetheless, low-cost monitoring can be a first step in identifying sites that need improvement or additional monitoring.

Cost-Effective Fuel Treatment Planning

Science.gov (United States)

Kreitler, J.; Thompson, M.; Vaillant, N.

2014-12-01

The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

Cost-effectiveness analysis of radon remediation in schools

International Nuclear Information System (INIS)

Kennedy, C.A.; Gray, A.M.

2000-01-01

Indoor radon is an important source of radiation dosage in the general population and has been recognised as a world-wide environmental and public health challenge. Governments in many Western and Eastern European and North American countries are undertaking active radon-risk reduction policies, including the remediation of existing residential and work place building stocks (1). These endeavours include a priority of remediating school buildings. Epidemiological and technical radon research has produced information which has enabled attention to be turned to specific effectiveness and optimisation questions regarding radon identification and remediation programmes in buildings, including schools. Decision making about policy implementation has been an integral part of these programmes and questions have been raised about the economic implications of the regulations and optimisation strategies for workplace action level policy (2,3). (the action level applied to schools is 400 Bq m -3 ). No previous study has estimated the cost-effectiveness of a radon remediation programme for schools using the methodological framework now considered appropriate in the economic evaluation of health interventions. It is imperative that this should be done, in order that the resources required to obtain health gain from radon remediation in schools can be systematically compared with equivalent data for other health interventions and radon remediation programmes. In this study a cost-effectiveness analysis of radon remediation in schools was undertaken, using the best available national data and information from Northamptonshire on the costs and effectiveness of radon identification and remediation in schools, and the costs and health impact of lung cancer cases. A model based on data from Northamptonshire is presented (where 6.3% of residential stock is over 200 Bq m -3 ). The resultant cost-effectiveness ratio was pound 7,550 per life year gained in pound 1997. Results from the

Marginal ambulatory teaching cost under varying levels of service utilization.

Science.gov (United States)

Panton, D M; Mushlin, A I; Gavett, J W

1980-06-01

The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

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

NARCIS (Netherlands)

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

2017-01-01

Reducing the water footprint (WF) of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs) that rank management packages according to their cost-effectiveness to reduce

Expanding ART for Treatment and Prevention of HIV in South Africa: Estimated Cost and Cost-Effectiveness 2011-2050

Science.gov (United States)

Granich, Reuben; Kahn, James G.; Bennett, Rod; Holmes, Charles B.; Garg, Navneet; Serenata, Celicia; Sabin, Miriam Lewis; Makhlouf-Obermeyer, Carla; De Filippo Mack, Christina; Williams, Phoebe; Jones, Louisa; Smyth, Caoimhe; Kutch, Kerry A.; Ying-Ru, Lo; Vitoria, Marco; Souteyrand, Yves; Crowley, Siobhan; Korenromp, Eline L.; Williams, Brian G.

2012-01-01

Background Antiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa. Methods We model a best case scenario of 90% annual HIV testing coverage in adults 15–49 years old and four ART eligibility scenarios: CD4 count ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses. Results Expanding ART to CD4 count ART and monitoring costs, all CD4 levels saves $0.6 billion versus current; other ART scenarios cost $9–194 per DALY averted. If ART reduces transmission by 99%, savings from all CD4 levels reach $17.5 billion. Sensitivity analyses suggest that poor retention and predominant acute phase transmission reduce DALYs averted by 26% and savings by 7%. Conclusion Increasing the provision of ART to ART uptake, retention, and adherence should be evaluated. PMID:22348000

An analysis of the cost effectiveness of replacing maize with wheat ...

African Journals Online (AJOL)

Increasing the level of inclusion of agro-industrial by-products in poultry diets formulation that will not adversely affect growth performance but enhancing feed cost reduction have been the major concern of researchers. In this study the cost effectiveness of using wheat offal to replace maize at 0, 5, 10, 15, 20 and 25 percent ...

Utilization of small-angle neutron scattering to decide the maximum loading of nuclear waste in cement matrix

International Nuclear Information System (INIS)

Das, Avik; Mazumder, S.; Sen, D.; Yalmali, V.; Shah, J.G.

2014-01-01

Nuclear power plants generate many kinds of hazardous nuclear waste which are needed to be disposed in an eco-friendly manner. Many different waste incarceration techniques have been adapted for managing the nuclear waste of different category of radioactivity. Immobilisation of low and intermediate level radioactive wastes in cement matrix is one of the widely used and cost-effective techniques in waste management. However, loading of nuclear waste in cement matrix can alter the mesoscopic structure of the hydrated cement and hence, it is very important to set the maximum limit of waste loading in cement for providing proper physical isolation to the nuclear waste

Design of cost-effective M 25 grade of self compacting concrete

International Nuclear Information System (INIS)

Guru Jawahar, J.; Sashidhar, C.; Ramana Reddy, I.V.; Annie Peter, J.

2013-01-01

Highlights: ► Design of cost-effective M 25 grade of self compacting concrete is done. ► Mechanical properties of SCC compared with M 25 grade of conventional concrete. ► Effect of class F fly ash is studied on the SCC mechanical properties. ► Cost analysis is done between M 25 grade of CC and SCC. ► Recommendation of M 25 grade of SCC for normal building constructions. - Abstract: This investigation is mainly focused on the development of cost-effective normal strength M 25 grade of self compacting concrete (SCC) for the use of normal building constructions. Keeping in view of the normal strength, cost, quality and durability of SCC and greenhouse gas emissions, a combination type of SCC was developed with 35% replacement of cement with class F fly ash. This study recommended a SCC mix with moderate fines to obtain a cost-effective normal strength SCC for the normal building constructions. Studies also revealed that further reduction in fines content in SCC with the same replacement level of fly ash decreased the SCC strength and its performance. Cost analysis has been done between M 25 grade of SCC and conventional concrete (CC). Results shown that the SCC material cost is slightly higher than that of CC of the same strength class, but the savings in labour cost and construction time and quality of SCC would offset the SCC material cost and reduce the total life cycle cost of SCC

Evaluation of Low-Cost, Centimeter-Level Accuracy OEM GNSS Receivers

Science.gov (United States)

2018-02-02

This report discusses the results of a study to quantify the performance of low-cost, centimeter-level accurate Global Navigation Satellite Systems (GNSS) receivers that have appeared on the market in the last few years. Centimeter-level accuracy is ...

Method of levelized discounted costs applied in economic evaluation of nuclear power plant project

International Nuclear Information System (INIS)

Tian Li; Wang Yongqing; Liu Jingquan; Guo Jilin; Liu Wei

2000-01-01

The main methods of economic evaluation of bid which are in common use are introduced. The characteristics of levelized discounted cost method and its application are presented. The method of levelized discounted cost is applied to the cost calculation of a 200 MW nuclear heating reactor economic evaluation. The results indicate that the method of levelized discounted costs is simple, feasible and which is considered most suitable for the economic evaluation of various case. The method is suggested which is used in the national economic evaluation

Sea-Level Change in the Russian Arctic Since the Last Glacial Maximum

Science.gov (United States)

Horton, B.; Baranskaya, A.; Khan, N.; Romanenko, F. A.

2017-12-01

Relative sea-level (RSL) databases that span the Last Glacial Maximum (LGM) to present have been used to infer changes in climate, regional ice sheet variations, the rate and geographic source of meltwater influx, and the rheological structure of the solid Earth. Here, we have produced a quality-controlled RSL database for the Russian Arctic since the LGM. The database contains 394 index points, which locate the position of RSL in time and space, and 244 limiting points, which constrain the minimum or maximum limit of former sea level. In the western part of the Russian Arctic (Barents and White seas,) RSL was driven by glacial isostatic adjustment (GIA) due to deglaciation of the Scandinavian ice sheet, which covered the Baltic crystalline shield at the LGM. RSL data from isolation basins show rapid RSL from 80-100 m at 11-12 ka BP to 15-25 m at 4-5 ka BP. In the Arctic Islands of Franz-Joseph Land and Novaya Zemlya, RSL data from dated driftwood in raised beaches show a gradual fall from 25-35 m at 9-10 ka BP to 5-10 m at 3 ka BP. In the Russian plain, situated at the margins of the formerly glaciated Baltic crystalline shield, RSL data from raised beaches and isolation basins show an early Holocene rise from less than -20 m at 9-11 ka BP before falling in the late Holocene, illustrating the complex interplay between ice-equivalent meltwater input and GIA. The Western Siberian Arctic (Yamal and Gydan Peninsulas, Beliy Island and islands of the Kara Sea) was not glaciated at the LGM. Sea-level data from marine and salt-marsh deposits show RSL rise at the beginning of the Holocene to a mid-Holocene highstand of 1-5 m at 5-1 ka BP. A similar, but more complex RSL pattern is shown for Eastern Siberia. RSL data from the Laptev Sea shelf show RSL at -40- -45 m and 11-14 ka BP. RSL data from the Lena Delta and Tiksi region have a highstand from 5 to 1 ka BP. The research is supported by RSF project 17-77-10130

Cost-effective treatment of low-risk carcinoma not invading bladder muscle.

Science.gov (United States)

Green, David A; Rink, Michael; Cha, Eugene K; Xylinas, Evanguelos; Chughtai, Bilal; Scherr, Douglas S; Shariat, Shahrokh F; Lee, Richard K

2013-03-01

Study Type - Therapy (cost effectiveness analysis) Level of Evidence 2a What's known on the subject? and What does the study add? Bladder cancer is one of the costliest malignancies to treat throughout the life of a patient. The most cost-effective management for low-risk non-muscle-invasive bladder cancer is not known. The current study shows that employing cystoscopic office fulguration for low-risk appearing bladder cancer recurrences can materially impact the cost-effectiveness of therapy. In a follow-up protocol where office fulguration is routinely employed for low-risk bladder cancers, peri-operative intravesical chemotherapy may not provide any additional cost-effectiveness benefit. To examine the cost-effectiveness of fulguration vs transurethral resection of bladder tumour (TURBT) with and without perioperative intravesical chemotherapy (PIC) for managing low-risk carcinoma not invading bladder muscle (NMIBC). Low-risk NMIBC carries a low progression rate, lending support to the use of office-based fulguration for small recurrences rather than traditional TURBT. A Markov state transition model was created to simulate treatment of NMIBC with vs without PIC, with recurrence treated by formal TURBT vs treatment with fulguration. Costing data were obtained from the Medicare Resource Based Relative Value Scale. Data regarding the success of PIC were obtained from the peer-reviewed literature, as were corresponding utilities for bladder cancer-related procedures. Sensitivity analyses were performed. At 5-year follow-up, a strategy of fulguration without PIC was the most cost-effective (mean cost-effectiveness = US $654.8/quality-adjusted life year), despite a lower recurrence rate with PIC. Both fulguration strategies dominated each TURBT strategy. Sensitivity analysis showed that fulguration without PIC dominated all other strategies when the recurrence rate after PIC was increased to ≥14.2% per year. Similarly, the cost-effectiveness of TURBT becomes more

Evaluation of starter dietary digestible lysine level on broilers raised under a sex-separated or straight-run housing regime, part 2: Economics of sex separation and digestible lysine level for maximum returns.

Science.gov (United States)

Da Costa, M J; Colson, G; Frost, T J; Halley, J; Pesti, G M

2017-09-01

The objective of this experiment was to determine the maximum net returns digestible lysine (dLys) levels (MNRL) when maintaining the ideal amino acid ratio for starter diets of broilers raised sex separate or comingled (straight-run). A total of 3,240 Ross 708 chicks was separated by sex and placed in 90 pens by 2 rearing types: sex separate (36 males or 36 females) or straight-run (18 males + 18 females). Each rearing type was fed 6 starter diets (25 d) formulated to have dLys levels between 1.05 and 1.80%. A common grower diet with 1.02% of dLys was fed from 25 to 32 days. Body weight gain (BWG) and feed intake were assessed at 25 and 32 d for performance evaluation. Additionally, at 26 and 33 d, 4 birds per pen were sampled for carcass yield evaluation. Data were modeled using response surface methodology in order to estimate feed intake and whole carcass weight at 1,600 g live BW. Returns over feed cost were estimated for a 1.8-million-broiler complex of each rearing system under 9 feed/meat price scenarios. Results indicated that females needed more feed to reach market weight, followed by straight-run birds, and then males. At medium meat and feed prices, female birds had MNRL at 1.07% dLys, whereas straight-run and males had MNRL at 1.05%. As feed and meat prices increased, females had MNRL increased up to 1.15% dLys. Sex separation resulted in increased revenue under certain feed and meat prices, and before sex separation cost was deducted. When the sexing cost was subtracted from the returns, sex separation was not shown to be economically viable when targeting birds for light market BW. © 2017 Poultry Science Association Inc.

The cost-effectiveness of IVF in the UK: a comparison of three gonadotrophin treatments.

Science.gov (United States)

Sykes, D; Out, H J; Palmer, S J; van Loon, J

2001-12-01

The objective of this study was to evaluate the cost-effectiveness of women undergoing IVF treatment with recombinant FSH (rFSH) in comparison with highly purified urinary FSH (uFSH-HP) and human menopausal gonadotrophins (HMG). A decision-analytic model was used to estimate cost-effectiveness ratios for 'the average cost per ongoing pregnancy' and 'incremental cost per additional pregnancy' for women entering into IVF treatment for a maximum of three cycles. The model was constructed based on a previously published large prospective randomized clinical trial comparing rFSH and uFSH-HP. Where necessary, these data were augmented with a combination of expert opinion, evidence from the literature and observational data relating to the management and cost of IVF treatment in the UK. The cost of rFSH, uFSH-HP and HMG were obtained from National Health Service list prices in the UK. The model predicted a cumulative pregnancy rate after three cycles of 57.1% for rFSH and 44.4% for both uFSH-HP and HMG. The cost of IVF treatment was 5135 pounds sterling for rFSH, 4806 pounds sterling for uFSH-HP and 4202 pounds sterling for HMG. When assessed in association with outcomes, the average cost per ongoing pregnancy was more favourable with rFSH (8992 pounds sterling) than with either uFSH-HP (10 834 pounds sterling) or HMG (9472 pounds sterling). The incremental cost per additional pregnancy was 2583 pounds sterling using rFSH instead of uFSH-HP and 7321 pounds sterling using rFSH instead of HMG. These results were robust to changes in the baseline assumptions of the model. rFSH is a cost-effective treatment strategy in ovulation induction prior to IVF.

Experimental Implementation of a Low-Cost Single Phase Five-Level Inverter for Autonomous PV System Applications Without Batteries

Directory of Open Access Journals (Sweden)

A. Nouaiti

2018-02-01

Full Text Available This paper presents the design and the implementation of a low-cost single phase five-level inverter for photovoltaic applications. The proposed multilevel inverter is composed of a simple boost converter, a switched-capacitor converter, and an H-bridge converter. An efficient control method which associates a closed-loop regulation method with a simple maximum power point tracking (MPPT method is applied in order to allow the proposed multilevel inverter to transfer power energy from solar panels to autonomous load with no storage batteries. An experimental prototype of this inverter is fabricated at the laboratory and tested with a digital control system. Obtained results confirm the simplicity and the performance of the proposed photovoltaic system.

How rebates, copayments, and administration costs affect the cost-effectiveness of osteoporosis therapies.

Science.gov (United States)

Ferko, Nicole C; Borisova, Natalie; Airia, Parisa; Grima, Daniel T; Thompson, Melissa F

2012-11-01

Because of rising drug expenditures, cost considerations have become essential, necessitating the requirement for cost-effectiveness analyses for managed care organizations (MCOs). The study objective is to examine the impact of various drug-cost components, in addition to wholesale acquisition cost (WAC), on the cost-effectiveness of osteoporosis therapies. A Markov model of osteoporosis was used to exemplify different drug cost scenarios. We examined the effect of varying rebates for oral bisphosphonates--risedronate and ibandronate--as well as considering the impact of varying copayments and administration costs for intravenous zoledronate. The population modeled was 1,000 American women, > or = 50 years with osteoporosis. Patients were followed for 1 year to reflect an annual budget review of formularies by MCOs. The cost of therapy was based on an adjusted WAC, and is referred to as net drug cost. The total annual cost incurred by an MCO for each drug regimen was calculated using the net drug cost and fracture cost. We estimated cost on a quality adjusted life year (QALY) basis. When considering different rebates, results for risedronate versus ibandronate vary from cost-savings (i.e., costs less and more effective) to approximately $70,000 per QALY. With no risedronate rebate, an ibandronate rebate of approximately 65% is required before cost per QALY surpasses $50,000. With rebates greater than 25% for risedronate, irrespective of ibandronate rebates, results become cost-saving. Results also showed the magnitude of cost savings to the MCO varied by as much as 65% when considering no administration cost and the highest coinsurance rate for zoledronate. Our study showed that cost-effectiveness varies considerably when factors in addition to the WAC are considered. This paper provides recommendations for pharmaceutical manufacturers and MCOs when developing and interpreting such analyses.

Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya

Directory of Open Access Journals (Sweden)

Jukes Matthew CH

2008-09-01

Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This

48 CFR 1552.211-73 - Level of effort-cost-reimbursement term contract.

Science.gov (United States)

2010-10-01

...-reimbursement term contract. 1552.211-73 Section 1552.211-73 Federal Acquisition Regulations System... Provisions and Clauses 1552.211-73 Level of effort—cost-reimbursement term contract. As prescribed in 1511.011-73, insert the following contract clause in cost-reimbursement term contracts including cost...

Tariffs and Firm-Level Heterogeneous Fixed Export Costs

DEFF Research Database (Denmark)

Schröder, Philipp J.H.; Jørgensen, Jan Guldager

2006-01-01

This paper presents a two country intra-industry trade model with bilateral ad valorem tariffs and fixed export costs that are heterogeneous across firms. In this model not all firms will choose to export. We examine the effects of reciprocal changes in the tariff and the fixed export barrier...... on the number of firms, firm profits, tariff revenue and consumer welfare. We show that both types of trade barriers reduce (increase) the number of exporting (pure domestic) firms. However, the sum of available home and foreign varieties may actually increase for small tariffs. Firm profits fall for both...... the tariff and the fixed export barrier. Tariff revenue falls for an increase in fixed exporting costs whereas we have a Laffer curve effect for the tariff. Finally, we establish that welfare falls with fixed export costs and large tariffs but increases for small tariffs, i.e. there exist a welfare...

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

International Nuclear Information System (INIS)

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

1992-01-01

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

Evaluation of Excess Heat Utilization in District Heating Systems by Implementing Levelized Cost of Excess Heat

Directory of Open Access Journals (Sweden)

Borna Doračić

2018-03-01

Full Text Available District heating plays a key role in achieving high primary energy savings and the reduction of the overall environmental impact of the energy sector. This was recently recognized by the European Commission, which emphasizes the importance of these systems, especially when integrated with renewable energy sources, like solar, biomass, geothermal, etc. On the other hand, high amounts of heat are currently being wasted in the industry sector, which causes low energy efficiency of these processes. This excess heat can be utilized and transported to the final customer by a distribution network. The main goal of this research was to calculate the potential for excess heat utilization in district heating systems by implementing the levelized cost of excess heat method. Additionally, this paper proves the economic and environmental benefits of switching from individual heating solutions to a district heating system. This was done by using the QGIS software. The variation of different relevant parameters was taken into account in the sensitivity analysis. Therefore, the final result was the determination of the maximum potential distance of the excess heat source from the demand, for different available heat supplies, costs of pipes, and excess heat prices.

Cost-effectiveness of reduction of off-site dose

International Nuclear Information System (INIS)

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

1988-03-01

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

Modelling the existing Irish energy-system to identify future energy costs and the maximum wind penetration feasible

International Nuclear Information System (INIS)

Connolly, D.; Leahy, M.; Lund, H.; Mathiesen, B.V.

2010-01-01

In this study a model of the Irish energy-system was developed using EnergyPLAN based on the year 2007, which was then used for three investigations. The first compares the model results with actual values from 2007 to validate its accuracy. The second illustrates the exposure of the existing Irish energy-system to future energy costs by considering future fuel prices, CO 2 prices, and different interest rates. The final investigation identifies the maximum wind penetration feasible on the 2007 Irish energy-system from a technical and economic perspective, as wind is the most promising fluctuating renewable resource available in Ireland. It is concluded that the reference model simulates the Irish energy-system accurately, the annual fuel costs for Ireland's energy could increase by approximately 58% from 2007 to 2020 if a business-as-usual scenario is followed, and the optimum wind penetration for the existing Irish energy-system is approximately 30% from both a technical and economic perspective based on 2020 energy prices. Future studies will use the model developed in this study to show that higher wind penetrations can be achieved if the existing energy-system is modified correctly. Finally, these results are not only applicable to Ireland, but also represent the issues facing many other countries. (author)

Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier

Science.gov (United States)

Berger, Ariel; Inglese, Gary; Skountrianos, George; Karlsmark, Tonny; Oguz, Mustafa

2018-01-01

the product of maximum willingness to pay for 1 QALD times additional QALDs with CIB less the incremental cost of CIB) of A$228 (US $174). Probabilistic sensitivity analysis was also completed; it revealed that 97% of model runs resulted in fewer expected PSCs with CIB; 92% of these runs resulted in lower expected costs with CIB. CONCLUSIONS: Findings suggest that the CIB is a cost-effective skin barrier for persons living with an ostomy. PMID:29438140

Cost-effectiveness Analysis for Technology Acquisition.

Science.gov (United States)

Chakravarty, A; Naware, S S

2008-01-01

In a developing country with limited resources, it is important to utilize the total cost visibility approach over the entire life-cycle of the technology and then analyse alternative options for acquiring technology. The present study analysed cost-effectiveness of an "In-house" magnetic resonance imaging (MRI) scan facility of a large service hospital against outsourcing possibilities. Cost per unit scan was calculated by operating costing method and break-even volume was calculated. Then life-cycle cost analysis was performed to enable total cost visibility of the MRI scan in both "In-house" and "outsourcing of facility" configuration. Finally, cost-effectiveness analysis was performed to identify the more acceptable decision option. Total cost for performing unit MRI scan was found to be Rs 3,875 for scans without contrast and Rs 4,129 with contrast. On life-cycle cost analysis, net present value (NPV) of the "In-house" configuration was found to be Rs-(4,09,06,265) while that of "outsourcing of facility" configuration was Rs-(5,70,23,315). Subsequently, cost-effectiveness analysis across eight Figures of Merit showed the "In-house" facility to be the more acceptable option for the system. Every decision for acquiring high-end technology must be subjected to life-cycle cost analysis.

The effects of low level chlorination and chlorine dioxide on biofouling control in a once-through service water system

International Nuclear Information System (INIS)

Garrett, W.E. Jr.; Laylor, M.M.

1995-01-01

Continuous chlorination has been successfully used for the control of Corbicula at a nuclear power plant located on the Chattahoochee River in southeastern Alabama, since 1986. The purpose of this study was to investigate further minimization of chlorine usage and determine if chlorine dioxide is a feasible alternative. Four continuous biocide treatments were evaluated for macro and microfouling control effectiveness, operational feasibility, and environmental acceptability. One semi-continuous chlorination treatment was also evaluated for macrofouling control effectiveness. Higher treatment residuals were possible with chlorine dioxide than with chlorination due to the river discharge limitations. At the levels tested, continuous chlorine dioxide was significantly more effective in providing both macro and microfouling control. Semi-continuous chlorination was just as effective as continuous chlorination for controlling macrofouling. The Corbicula treatment programs that were tested should all provide sufficient control for zebra mussels. Chlorine dioxide was not as cost effective as chlorination for providing macrofouling control. The semi-continuous treatment save 50% on chemical usage and will allow for the simultaneous treatment of two service water systems. Chlorite levels produced during the chlorine dioxide treatments were found to be environmentally acceptable. Levels of trihalomethanes in the chlorinated service water were less than the maximum levels allowed in drinking water

Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment.

Directory of Open Access Journals (Sweden)

Smita Nayak

Full Text Available Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA, and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs; and incremental cost-effectiveness ratios (ICERs in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days. When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost

Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China.

Directory of Open Access Journals (Sweden)

Mehlika Toy

Full Text Available Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15-25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs, incremental cost-effectiveness ratios (ICERs, and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293 per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10-19.02 for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32-75 (195-460 RMB per month, highly cost-effective at $62-110 (379-670 RMB per month and cost-effective at $63-120 (384-734 RMB per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.

Cost and effectiveness analysis on unmanned aerial vehicle (UAV) use at border security

Science.gov (United States)

Yilmaz, Bahadır.

2013-06-01

Drones and Remotely Piloted Vehicles are types of Unmanned Aerial Vehicles. UAVs began to be used with the war of Vietnam, they had a great interest when Israel used them in Bekaa Valley Operations of 1982. UAVs have been used by different countries with different aims with the help of emerging technology and investments. In this article, in the context of areas of UAV usage in national security, benefits and disadvantages of UAVs are put forward. Particularly, it has been evaluated on the basis of cost-effectiveness by focusing the use of UAV in the border security. UAVs have been studied by taking cost analysis, procurement and operational costs into consideration. Analysis of effectiveness has been done with illegal passages of people and drugs from flight times of UAVs. Although the procurement cost of the medium-level UAVs is low, its operational costs are high. For this reason, the idea of less costly alternative systems have been revealed for the border security. As the costs are reduced to acceptable level involving national security and border security in future with high-technology products in their structure, it will continue to be used in an increasing proportion.

Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda.

Science.gov (United States)

Nanyonjo, Agnes; Bagorogoza, Benson; Kasteng, Frida; Ayebale, Godfrey; Makumbi, Fredrick; Tomson, Göran; Källander, Karin

2015-08-28

Integrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers' willingness to pay (WTP) for referral. Caregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the 'bidding game' approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective. Reasons for referral included having fever with a negative malaria test (46.8%), danger signs (29.6%) and drug shortage (37.4%). Among the referred, less than half completed referral (45.8%). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7%, caregivers' and CHWs' opportunity costs contributed 29.2% and 5.1% respectively and health facility costs contributed 39.6%. The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing

Cost effectiveness of a protocol using palivizumab in preterm infants

Directory of Open Access Journals (Sweden)

Yolanda Hernández-Gago

2017-03-01

Full Text Available Objective: The main objective was to evaluate the cost-effectiveness of protocol use of palivizumab in premature established by consensus in our Hospital comparing it based on the recommendations of various Scientific Societies. As a secondary objective risk factors and severity of hospitalized patients attending the established protocol in our Hospital were analyzed. Methods: The study period was 4 seasons with the expanded protocol (retrospective data versus 2 with restricted or agreed protocol (prospective data. The perspective of the study was the Health System, including the costs of hospitalization and palivizumab our center. The calculation of the effectiveness was determined with the admission rate of premature patients stratified by weeks of gestational age <29, <32; and <35. For the analysis of risk factors and severity in patients admitted seasons with the new protocol are collected prospectively clinical data and environmental and social factors. Results: In the range of gestational age <29 years old and <32 greater effectiveness of the extended protocol was not demonstrated against the consensus. Only more effective for EG <35 in the accumulated data and comparing seasons 12/13 and 08/09 to 13/14 for individual data was observed. This range has an associated incremental cost effectiveness ratio of € 53 250,07 (range: € 14 793,39 to € 90 446,47 for singles data and € 50 525,53 (€ 28 688.22 to € 211 575,65 for accumulated. The establishment of this protocol in our center meant an average saving per season € 169 911,51. A cost- effectiveness of the extended protocol appropriate relationship is found if the cost of palivizumab per patient was less than € 1 206,67 (calculated for maximum use of the vial and a higher rate of hospitalization of 9.21%. Children entering the season with the new protocol (season 12/13 and 13/14 are 63.4% in children under 3 months and 90% are term infants who do not belong to any population at

Estimating pharmacy level prescription drug acquisition costs for third-party reimbursement.

Science.gov (United States)

Kreling, D H; Kirk, K W

1986-07-01

Accurate payment for the acquisition costs of drug products dispensed is an important consideration in a third-party prescription drug program. Two alternative methods of estimating these costs among pharmacies were derived and compared. First, pharmacists were surveyed to determine the purchase discounts offered to them by wholesalers. A 10.00% modal and 11.35% mean discount resulted for 73 responding pharmacists. Second, cost-plus percents derived from gross profit margins of wholesalers were calculated and applied to wholesaler product costs to estimate pharmacy level acquisition costs. Cost-plus percents derived from National Median and Southwestern Region wholesaler figures were 9.27% and 10.10%, respectively. A comparison showed the two methods of estimating acquisition costs would result in similar acquisition cost estimates. Adopting a cost-plus estimating approach is recommended because it avoids potential pricing manipulations by wholesalers and manufacturers that would negate improvements in drug product reimbursement accuracy.

Cost-effective framework for basic surgical skills training.

Science.gov (United States)

Jiang, Deng-Jin; Wen, Chan; Yang, Ai-Jun; Zhu, Zhi-Li; Lei, Yan; Lan, Yang-Jun; Huang, Qing-Yuan; Hou, Xiao-Yu

2013-06-01

The importance of basic surgical skills is entirely agreed among surgical educators. However, restricted by ethical issues, finance etc, the basic surgical skills training is increasingly challenged. Increasing cost gives an impetus to the development of cost-effective training models to meet the trainees' acquisition of basic surgical skills. In this situation, a cost-effective training framework was formed in our department and introduced here. Each five students were assigned to a 'training unit'. The training was implemented weekly for 18 weeks. The framework consisted of an early, a transitional, an integrative stage and a surgical skills competition. Corresponding training modules were selected and assembled scientifically at each stage. The modules comprised campus intranet databases, sponge benchtop, nonliving animal tissue, local dissection specimens and simulating reality operations. The training outcomes used direct observation of procedural skills as an assessment tool. The training data of 50 trainees who were randomly selected in each year from 2006 to 2011 year, were retrospectively analysed. An excellent and good rate of the surgical skills is from 82 to 88%, but there is no significant difference among 6 years (P > 0.05). The skills scores of the contestants are markedly higher than those of non-contestants (P < 0.05). The average training cost per trainee is about $21.85-34.08. The present training framework is reliable, feasible, repeatable and cost-effective. The skills competition can promote to improve the surgical skills level of trainees. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

The Cost-effectiveness of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency and Outpatient Medical Settings.

Science.gov (United States)

Barbosa, Carolina; Cowell, Alexander; Bray, Jeremy; Aldridge, Arnie

2015-06-01

This study analyzed the cost-effectiveness of delivering alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency departments (ED) when compared to outpatient medical settings. A probabilistic decision analytic tree categorized patients into health states. Utility weights and social costs were assigned to each health state. Health outcome measures were the proportion of patients not drinking above threshold levels at follow-up, the proportion of patients transitioning from above threshold levels at baseline to abstinent or below threshold levels at follow-up, and the quality-adjusted life years (QALYs) gained. Expected costs under a provider perspective were the marginal costs of SBIRT, and under a societal perspective were the sum of SBIRT cost per patient and the change in social costs. Incremental cost-effectiveness ratios were computed. When considering provider costs only, compared to outpatient, SBIRT in ED cost $8.63 less, generated 0.005 more QALYs per patient, and resulted in 13.8% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained. Alcohol SBIRT generates costs savings and improves health in both ED and outpatient settings. EDs provide better effectiveness at a lower cost and greater social cost reductions than outpatient. Copyright © 2015 Elsevier Inc. All rights reserved.

Cost-effectiveness and incidence of renewable energy promotion in Germany

Energy Technology Data Exchange (ETDEWEB)

Boehringer, Christoph [Oldenburg Univ. (Germany). Dept. of Economics; Landis, Florian [Eidgenoessische Technische Hochschule, Zurich (Switzerland); Tovar Reanos, Miguel Angel [Zentrum fuer Europaeische Wirtschaftsforschung GmbH (ZEW), Mannheim (Germany)

2017-08-01

Over the last decade Germany has boosted renewable energy in power production by means of massive subsidies. The flip side are very high electricity prices which raises concerns that the transition cost towards a renewable energy system will be mainly borne by poor households. In this paper, we combine computable general equilibrium and microsimulation analysis to investigate the cost-effectiveness and incidence of Germany's renewable energy promotion. We find that the regressive effects of renewable energy promotion could be ameliorated by alternative subsidy financing mechanisms which achieve the same level of electricity generation from renewable energy sources.

STUDI BANDING PENYUSUNAN LAPORAN KEUANGAN DENGAN METODE HISTORICAL COST ACCOUNTING DAN GENERAL PRICE LEVEL ACCOUNTING PADA MASA INFLASI

Directory of Open Access Journals (Sweden)

David Sukardi Kodrat

2006-01-01

Full Text Available Generally, Financial Statements are based on Historical Cost Accounting (HCA that assumes that prices are stable. Actually, there are several methods on accounting for the effect of changing prices, such as Current Cost Accounting (Replacement Cost Accounting and Constant Dollar Accounting or General Price Level Accounting (GPLA. GPLA will do restatement the components of financial statement to be a rupiah on a similar level of purchasing power, but without changes in accounting principles which using on conventional accounting. Financial statements made by GPLA are comparing to financial statements made by HCA. Both of financial statements are analysis with NOD (Number of Dollar attribute to know that financial statements are interpretative and analysis with COG (Command of Good attribute to know that financial statements are relevant. Abstract in Bahasa Indonesia : Laporan keuangan disusun berdasarkan metode Historical Cost Accounting (HCA yang menggunakan asumsi nilai tukar stabil. Beberapa metode akuntansi yang memperhitungkan perubahan nilai tukar seperti Current Cost Accounting (Replacement Cost Accounting dan Constant Dollar Accounting atau General Price Level Accounting (GPLA. GPLA menyajikan komponen laporan keuangan berdasarkan penyesuaian rupiah dengan daya beli tanpa mengubah prinsip-prinsip akuntasi konvensional. Laporan keuangan yang disusun dengan GPLA dapat diperbandingkan dengan laporan keuangan berdasarkan HCA. Dengan analisa NOD (Number of Dollar dan COG (Command Over Good attribute menunjukkan bahwa laporan keuangan berdasarkan GPLA lebih interpretatif dan lebih relevan. Kata Kunci: Laporan Keuangan, Historical Cost Accounting, General Price Level Accounting, NOD attribute, COG attribute.

Cost-effective degradation test plan for a nonlinear random-coefficients model

International Nuclear Information System (INIS)

Kim, Seong-Joon; Bae, Suk Joo

2013-01-01

The determination of requisite sample size and the inspection schedule considering both testing cost and accuracy has been an important issue in the degradation test. This paper proposes a cost-effective degradation test plan in the context of a nonlinear random-coefficients model, while meeting some precision constraints for failure-time distribution. We introduce a precision measure to quantify the information losses incurred by reducing testing resources. The precision measure is incorporated into time-varying cost functions to reflect real circumstances. We apply a hybrid genetic algorithm to general cost optimization problem with reasonable constraints on the level of testing precision in order to determine a cost-effective inspection scheme. The proposed method is applied to the degradation data of plasma display panels (PDPs) following a bi-exponential degradation model. Finally, sensitivity analysis via simulation is provided to evaluate the robustness of the proposed degradation test plan.

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

International Nuclear Information System (INIS)

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

2013-01-01

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

Individualized cost-effective conventional ovulation induction treatment in normogonadotrophic anovulatory infertility (WHO group 2).

Science.gov (United States)

Eijkemans, Marinus J C; Polinder, Suzanne; Mulders, Annemarie G M G J; Laven, Joop S E; Habbema, J Dik F; Fauser, Bart C J M

2005-10-01

Conventional treatment in normogonadotrophic anovulatory infertility (WHO 2) consists of clomiphene citrate (CC), followed by exogenous gonadotrophins (FSH) and IVF. Response to these treatments may be predicted on the basis of individual patient characteristics. We aimed to devise a patient-tailored, cost-effective treatment algorithm involving the above-mentioned treatment modalities, based on individual patient characteristics. Sixteen prognostic groups are defined, according to the presence or absence of: age >30 years, amenorrhea, elevated androgen levels and obesity. The chances of response with each of the three treatments were calculated using prediction models. Treatment costs were based on the data of 240 patients visiting a specialist academic fertility unit. Outcome was an ongoing pregnancy within 12 months after initiation of treatment. The costs per pregnancy of three different strategies were compared, with a threshold for cost-effectiveness of 10 000. The strategy CC + FSH + IVF compared with FSH + IVF generated more pregnancies against lower costs. Compared with CC + IVF, it also produced more pregnancies, but at higher costs. For costs per pregnancy were less than 10 000. For women >30 years old, costs per pregnancy were 25 000 and over 200 000, when presenting with normal or elevated androgen levels, respectively. The conventional treatment protocol is efficient for women aged 30 years old with elevated androgen levels, FSH may be skipped.

Comparison study on models for calculation of NPP’s levelized unit electricity cost

International Nuclear Information System (INIS)

Nuryanti; Mochamad Nasrullah; Suparman

2014-01-01

Economic analysis that is generally done through the calculation of Levelized Unit Electricity Cost (LUEC) is crucial to be done prior to any investment decision on the nuclear power plant (NPP) project. There are several models that can be used to calculate LUEC, which are: R&D PT. PLN (Persero) Model, Mini G4ECONS model and Levelized Cost model. This study aimed to perform a comparison between the three models. Comparison technique was done by tracking the similarity used for each model and then given a case of LUEC calculation for SMR NPP 2 x 100 MW using these models. The result showed that the R&D PT. PLN (Persero) Model have a common principle with Mini G4ECONS model, which use Capital Recovery Factor (CRF) to discount the investment cost which eventually become annuity value along the life of plant. LUEC on both models is calculated by dividing the sum of the annual investment cost and the cost for operating NPP with an annual electricity production.While Levelized Cost model based on the annual cash flow. Total of annual costs and annual electricity production were discounted to the first year of construction in order to obtain the total discounted annual cost and the total discounted energy generation. LUEC was obtained by dividing both of the discounted values. LUEC calculations on the three models produce LUEC value, which are: 14.5942 cents US$/kWh for R&D PT. PLN (Persero) Model, 15.056 cents US$/kWh for Mini G4ECONs model and 14.240 cents US$/kWh for Levelized Cost model. (author)

Effects of variability in probable maximum precipitation patterns on flood losses

Science.gov (United States)

Zischg, Andreas Paul; Felder, Guido; Weingartner, Rolf; Quinn, Niall; Coxon, Gemma; Neal, Jeffrey; Freer, Jim; Bates, Paul

2018-05-01

The assessment of the impacts of extreme floods is important for dealing with residual risk, particularly for critical infrastructure management and for insurance purposes. Thus, modelling of the probable maximum flood (PMF) from probable maximum precipitation (PMP) by coupling hydrological and hydraulic models has gained interest in recent years. Herein, we examine whether variability in precipitation patterns exceeds or is below selected uncertainty factors in flood loss estimation and if the flood losses within a river basin are related to the probable maximum discharge at the basin outlet. We developed a model experiment with an ensemble of probable maximum precipitation scenarios created by Monte Carlo simulations. For each rainfall pattern, we computed the flood losses with a model chain and benchmarked the effects of variability in rainfall distribution with other model uncertainties. The results show that flood losses vary considerably within the river basin and depend on the timing and superimposition of the flood peaks from the basin's sub-catchments. In addition to the flood hazard component, the other components of flood risk, exposure, and vulnerability contribute remarkably to the overall variability. This leads to the conclusion that the estimation of the probable maximum expectable flood losses in a river basin should not be based exclusively on the PMF. Consequently, the basin-specific sensitivities to different precipitation patterns and the spatial organization of the settlements within the river basin need to be considered in the analyses of probable maximum flood losses.

Contribution to the study of maximum levels for liquid radioactive waste disposal into continental and sea water. Treatment of some typical samples

International Nuclear Information System (INIS)

Bittel, R.; Mancel, J.

1968-10-01

The most important carriers of radioactive contamination of man are the whole of foodstuffs and not only ingested water or inhaled air. That is the reason why, in accordance with the spirit of the recent recommendations of the ICRP, it is proposed to substitute the idea of maximum levels of contamination of water to the MPC. In the case of aquatic food chains (aquatic organisms and irrigated foodstuffs), the knowledge of the ingested quantities and of the concentration factors food/water permit to determinate these maximum levels, or to find out a linear relation between the maximum levels in the case of two primary carriers of contamination (continental and sea waters). The notion of critical food-consumption, critical radioelements and formula of waste disposal are considered in the same way, taking care to attach the greatest possible importance to local situations. (authors) [fr

Quantile-based Bayesian maximum entropy approach for spatiotemporal modeling of ambient air quality levels.

Science.gov (United States)

Yu, Hwa-Lung; Wang, Chih-Hsin

2013-02-05

Understanding the daily changes in ambient air quality concentrations is important to the assessing human exposure and environmental health. However, the fine temporal scales (e.g., hourly) involved in this assessment often lead to high variability in air quality concentrations. This is because of the complex short-term physical and chemical mechanisms among the pollutants. Consequently, high heterogeneity is usually present in not only the averaged pollution levels, but also the intraday variance levels of the daily observations of ambient concentration across space and time. This characteristic decreases the estimation performance of common techniques. This study proposes a novel quantile-based Bayesian maximum entropy (QBME) method to account for the nonstationary and nonhomogeneous characteristics of ambient air pollution dynamics. The QBME method characterizes the spatiotemporal dependence among the ambient air quality levels based on their location-specific quantiles and accounts for spatiotemporal variations using a local weighted smoothing technique. The epistemic framework of the QBME method can allow researchers to further consider the uncertainty of space-time observations. This study presents the spatiotemporal modeling of daily CO and PM10 concentrations across Taiwan from 1998 to 2009 using the QBME method. Results show that the QBME method can effectively improve estimation accuracy in terms of lower mean absolute errors and standard deviations over space and time, especially for pollutants with strong nonhomogeneous variances across space. In addition, the epistemic framework can allow researchers to assimilate the site-specific secondary information where the observations are absent because of the common preferential sampling issues of environmental data. The proposed QBME method provides a practical and powerful framework for the spatiotemporal modeling of ambient pollutants.

Cost-effectiveness Analysis with Influence Diagrams.

Science.gov (United States)

Arias, M; Díez, F J

2015-01-01

Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision trees.

Research of the cost-benefit evaluation for reprocessing research and development and high-level radioactive waste disposal research and development. Establishing R and D scenarios and extracting their effects

International Nuclear Information System (INIS)

Sugihara, K; Miura, N; Arii, Y

2004-02-01

This report is intended to explain the outline of research in the FY 2003 on cost-benefit evaluation for Reprocessing R and D and High-Level Radioactive Waste Disposal R and D. We decided to apply the Method of Cost-Benefit Analysis, based on cost-benefit analysis for Fast Reactor cycle system R and D, to Reprocessing R and D and High-Level Radioactive Waste Disposal R and D, and to compare with the results of cost-benefit analysis for both the JNC R and D scenario and the other optional scenarios. In this year, we first thought out all R and D scenarios in the future for Reprocessing R and D and High-Level Radioactive Waste Disposal R and D, and rejected difficult scenarios technically and impossible scenarios socially. Finally, the reasonable R and D scenarios were established. Besides, we thought out the effects (merits) by carrying out the R and D, and separated out them from economical view, environmental view, view of nuclear non-proliferation and so on. (author)

Cost-effectiveness of silicone and alginate impressions for complete dentures.

Science.gov (United States)

Hulme, C; Yu, G; Browne, C; O'Dwyer, J; Craddock, H; Brown, S; Gray, J; Pavitt, S; Fernandez, C; Godfrey, M; Dukanovic, G; Brunton, P; Hyde, T P

2014-08-01

The aim of this study was to assess the cost effectiveness of silicone and alginate impressions for complete dentures. Cost effectiveness analyses were undertaken alongside a UK single centre, double blind, controlled, crossover clinical trial. Taking the perspective of the healthcare sector, effectiveness is measured using the EuroQol (EQ-5D-3L) which provides a single index value for health status that may be combined with time to produce quality adjusted life years (QALYs); and Oral Health Impact Profile (OHIP-EDENT). Incremental cost effectiveness ratios are presented representing the additional cost per one unit gained. Mean cost was higher in the silicone impression group (£388.57 vs. £363.18). Negligible between-group differences were observed in QALY gains; the silicone group had greater mean OHIP-EDENT gains. The additional cost using silicone was £3.41 per change of one point in the OHIP-EDENT. The silicone group was more costly, driven by the cost of materials. Changes in the EQ-5D and QALY gains over time and between arms were not statistically significant. Change in OHIP-EDENT score showed greater improvement in the silicone group and the difference between arms was statistically significant. Given negligible QALY gains and low level of resource use, results must be treated with caution. It is difficult to make robust claims about the comparative cost-effectiveness. Silicone impressions for complete dentures improve patients' quality of life (OHIP-EDENT score). The extra cost of silicone impressions is £30 per patient. Dentists, patients and health care funders need to consider the clinical and financial value of silicone impressions. Different patients, different dentists, different health funders will have individual perceptions and judgements. ISRCTN01528038. NIHR-RfPB grant PB-PG-0408-16300. This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental

Cost of delivering secondary-level health care services through public sector district hospitals in India

Directory of Open Access Journals (Sweden)

Shankar Prinja

2017-01-01

Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

The cost-effectiveness of remedial and preventative measures against radon in Norwegian dwellings

International Nuclear Information System (INIS)

Strand, T.; Aanestad, K.

2006-01-01

Full text of publication follows: The indoor radon concentrations in Norway are among the highest in Europe. This is partly explained by the geology due to the large occurrences of radium rich soil and bedrock (e.g. alum shale and uranium rich granites), large occurrences of highly permeable unconsolidated sediments (e.g. moraines and eskers), and the construction of buildings due to the cold climate. An additional factor is the extensive use of highly permeable light expanded clay aggregates in the foundation construction. Entry of radon from the building ground is the dominant source of indoor radon in Norway. Based on the results of nation-wide surveys it has been concluded that most homes with high levels of radon are located on highly permeable sediments, and some of the homes on are sometimes very difficult and expensive to mitigate. In order to limit the mitigation costs it is therefore important the cost -effectiveness of measures is optimised. In this paper, the results of a Norwegian analysis of the cost -effectiveness of remedial measures in existing dwellings and preventative measures in new buildings will be presented. The analysis on measures in existing dwellings is based on data from approximately 1100 buildings which were mitigated by grants from the Government during the National Action Plan against Cancer between 1999 and 2003. The results show that the mitigation costs are significantly higher than earlier estimates based on controlled experiments in research projects, and it seem as though the mitigation costs have been significantly underestimated in earlier cost-effect analysis. There are several factor that have contributed to an increase of the mitigation costs and some of these factors will be discusses in more detail in this paper. The upper level for new dwellings is 200 Bq/m 3 and it is generally recommended by the Norwegian authorities that preventative measures are implemented in all new dwellings. By this strategy the costs of

Effect of patient's life expectancy on the cost-effectiveness of treatment for ocular hypertension.

Science.gov (United States)

Kymes, Steven M; Plotzke, Michael R; Kass, Michael A; Boland, Michael V; Gordon, Mae O

2010-05-01

To assess the influence of expected life span on the cost-effectiveness of treating ocular hypertension to prevent primary open-angle glaucoma. We used a Markov simulation model to estimate the cost and benefit of ocular hypertension treatment over a person's remaining life. We examined the influence of age on the cost-effectiveness decision in 2 ways: (1) by evaluating specific age cohorts to assess the influence of age at the initiation of treatment; and (2) by evaluating the influence of a specific life span. At a willingness to pay $50,000/quality-adjusted life year to $100,000/quality-adjusted life year, treatment of people with a 2% or greater annual risk of developing glaucoma was cost-effective for people aged 45 years with a life expectancy of at least 18 remaining years. However, to be cost-effective, a person aged 55 years must have a life expectancy of 21 remaining years and someone aged 65 years must have a life expectancy of 23 remaining years. A person with ocular hypertension must have a life expectancy of at least 18 remaining years to justify treatment at a threshold of a 2% or greater annual risk of developing glaucoma. Persons at higher levels of risk require a life expectancy of 7 to 10 additional years to justify treatment.

Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England.

Science.gov (United States)

Cromer, Deborah; van Hoek, Albert Jan; Newall, Anthony T; Pollard, Andrew J; Jit, Mark

2017-08-01

Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5-10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers. We performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year. We estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9-12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89-0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208-232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168-219), £81 (76-86), and £54 (51-57), respectively. Nearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might

Cost-effective analysis of PET application in NSCLC

International Nuclear Information System (INIS)

Gu Aichun; Liu Jianjun; Sun Xiaoguang; Shi Yiping; Huang Gang

2006-01-01

Objective: To evaluate the cost-effectiveness of PET and CT application for diagnosis of non-small cell lung cancer (NSCLC) in China. Methods: Using decision analysis method the diagnostic efficiency of PET and CT for diagnosis of NSCLC in china was analysed. And also the value of cost for accurate diagnosis (CAD), cost for accurate staging (CAS) and cost for effective therapy (CAT) was calculated. Results: (1) For the accurate diagnosis, CT was much more cost-effective than PET. (2) For the accurate staging, CT was still more cost-effective than PET. (3) For the all over diagnostic and therapeutic cost, PET was more cost-effective than CT. (4) The priority of PET to CT was for the diagnosis of stage I NSCLC. Conclusion: For the management of NSCLC patient in China, CT is more cost-effective for screening, whereas PET for clinical staging and monitoring therapeutic effect. (authors)

Differing Levels of Forestry Best Management Practices at Stream Crossing Structures Affect Sediment Delivery and Installation Costs

Directory of Open Access Journals (Sweden)

Brian C. Morris

2016-03-01

Full Text Available Forestry best management practices (BMPs are used to reduce sedimentation from forest stream crossings. Three BMP treatments (BMP−, BMP-std, and BMP+ were applied to three forest road stream crossings (bridge, culvert, and ford. BMP− did not meet existing BMP guidelines, BMP-std met standard recommendations, and BMP+ treatments exceeded recommendations. Following BMP applications, three simulated rainfall intensities (low, medium, and high were applied in order to evaluate sediment delivery from crossing type and BMP level. During rainfall simulation, sediment concentrations (mg/L were collected with automated samplers and discharge (L/s was estimated to calculate total sediment loading. Costs of stream crossings and BMP levels were also quantified. Mean sediment associated with the three stream crossings were 3.38, 1.87, and 0.64 Mg for the BMP−, BMP-std, and BMP+ levels, respectively. Ford, culvert, and bridge crossings produced 13.04, 12.95, and 0.17 Mg of sediment during construction, respectively. BMP enhancement was more critical for sediment control at the culvert and ford crossings than at the bridge. Respective costs for BMP−, BMP-std, and BMP+ levels were $5,368, $5,658, and $5,858 for the bridge; $3,568, $4,166 and $4,595 for the culvert; and $180, $420 and $1,903 for the ford. Costs and sediment values suggest that current standard BMP levels effectively reduce stream sediment while minimizing costs.

Modelling and Optimal Control of Typhoid Fever Disease with Cost-Effective Strategies.

Science.gov (United States)

Tilahun, Getachew Teshome; Makinde, Oluwole Daniel; Malonza, David

2017-01-01

We propose and analyze a compartmental nonlinear deterministic mathematical model for the typhoid fever outbreak and optimal control strategies in a community with varying population. The model is studied qualitatively using stability theory of differential equations and the basic reproductive number that represents the epidemic indicator is obtained from the largest eigenvalue of the next-generation matrix. Both local and global asymptotic stability conditions for disease-free and endemic equilibria are determined. The model exhibits a forward transcritical bifurcation and the sensitivity analysis is performed. The optimal control problem is designed by applying Pontryagin maximum principle with three control strategies, namely, the prevention strategy through sanitation, proper hygiene, and vaccination; the treatment strategy through application of appropriate medicine; and the screening of the carriers. The cost functional accounts for the cost involved in prevention, screening, and treatment together with the total number of the infected persons averted. Numerical results for the typhoid outbreak dynamics and its optimal control revealed that a combination of prevention and treatment is the best cost-effective strategy to eradicate the disease.

The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes.

Science.gov (United States)

Stewart, Bruce A; Momaya, Amit M; Silverstein, Marc D; Lintner, David

2017-01-01

Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Economic and decision analysis; Level of evidence, 2. The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

Inaugural Maximum Values for Sodium in Processed Food Products in the Americas.

Science.gov (United States)

Campbell, Norm; Legowski, Barbara; Legetic, Branka; Nilson, Eduardo; L'Abbé, Mary

2015-08-01

Reducing dietary salt/sodium is one of the most cost-effective interventions to improve population health. There are five initiatives in the Americas that independently developed targets for reformulating foods to reduce salt/sodium content. Applying selection criteria, recommended by the Pan American Health Organization (PAHO)/World Health Organization (WHO) Technical Advisory Group on Dietary Salt/Sodium Reduction, a consortium of governments, civil society, and food companies (the Salt Smart Consortium) agreed to an inaugural set of regional maximum targets (upper limits) for salt/sodium levels for 11 food categories, to be achieved by December 2016. Ultimately, to substantively reduce dietary salt across whole populations, targets will be needed for the majority of processed and pre-prepared foods. Cardiovascular and hypertension organizations are encouraged to utilize the regional targets in advocacy and in monitoring and evaluation of progress by the food industry. © 2015 Wiley Periodicals, Inc.

The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan.

Science.gov (United States)

Trenouth, Lani; Colbourn, Timothy; Fenn, Bridget; Pietzsch, Silke; Myatt, Mark; Puett, Chloe

2018-07-01

Cash-based interventions (CBIs) increasingly are being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash transfers for preventing undernutrition in emergency contexts. The objectives of this study were to assess the costs, cost-efficiency and cost-effectiveness in achieving nutrition outcomes of three CBIs in southern Pakistan: a 'double cash' (DC) transfer, a 'standard cash' (SC) transfer and a 'fresh food voucher' (FFV) transfer. Cash and FFVs were provided to poor households with children aged 6-48 months for 6 months in 2015. The SC and FFV interventions provided $14 monthly and the DC provided $28 monthly. Cost data were collected via institutional accounting records, interviews, programme observation, document review and household survey. Cost-effectiveness was assessed as cost per case of wasting, stunting and disability-adjusted life year (DALY) averted. Beneficiary costs were higher for the cash groups than the voucher group. Net total cost transfer ratios (TCTRs) were estimated as 1.82 for DC, 2.82 for SC and 2.73 for FFV. Yet, despite the higher operational costs, the FFV TCTR was lower than the SC TCTR when incorporating the participation cost to households, demonstrating the relevance of including beneficiary costs in cost-efficiency estimations. The DC intervention achieved a reduction in wasting, at $4865 per case averted; neither the SC nor the FFV interventions reduced wasting. The cost per case of stunting averted was $1290 for DC, $882 for SC and $883 for FFV. The cost per DALY averted was $641 for DC, $434 for SC and $563 for FFV without discounting or age weighting. These interventions are highly cost-effective by international thresholds. While it is debatable whether these resource requirements represent a feasible or sustainable investment given low health expenditures in Pakistan, these findings may provide justification for continuing Pakistan's investment in national social safety

Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers' quitline.

Science.gov (United States)

Farrelly, Matthew C; Hussin, Altijani; Bauer, Ursula E

2007-12-01

This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline. Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed. There was a positive and statistically significant relation between call volume and expenditures for television (padvertisements and a marginally significant effect for expenditures on newspaper advertisements (peffect was for television advertising. However, because of differences in advertising costs, for every $1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively. Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures.

Effects of lag and maximum growth in contaminant transport and biodegradation modeling

International Nuclear Information System (INIS)

Wood, B.D.; Dawson, C.N.

1992-06-01

The effects of time lag and maximum microbial growth on biodegradation in contaminant transport are discussed. A mathematical model is formulated that accounts for these effects, and a numerical case study is presented that demonstrates how lag influences biodegradation

Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies.

Science.gov (United States)

Wood, Alison; Blackhurst, Michael; Hawkins, Troy; Xue, Xiaobo; Ashbolt, Nicholas; Garland, Jay

2015-03-01

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Cost-effectiveness and the socialization of health care.

Science.gov (United States)

Musgrove, P

1995-01-01

The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

Cost effectiveness of rural development programme instruments in Denmark

DEFF Research Database (Denmark)

Jensen, J Dejgaard; Jakobsen, L; Madsen, B

2011-01-01

The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... to support sustainable economic growth and income diversification in rural areas (and in particular in economically vulnerable areas). The study combines different datasets and simulation models at farm level (register data, Farm Accountancy Data, farm sector model, run-off models, etc.), municipality level...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

A quantitative analysis of the cost-effectiveness of project types in the CDM pipeline

Energy Technology Data Exchange (ETDEWEB)

Green, Gavin A.

2008-09-15

The flexibility of the CDM is intended to reduce the cost of compliance for Annex 1 countries and contribute to cost-effective reductions. This paper provides a framework for defining cost-effective payments for CDM carbon reductions. The projects in the CDM pipeline are categorised into project types. The data provided in the Project Design Documents is quantitatively assessed to calculate the median cost and range of costs for producing a CER from the project categories. These are measured against the range of prices in the market in order to estimate the level of cost-effectiveness. Global warming potential and size of the project were shown to be key factors in the cost of producing a CER. The results show that although prices for CERs are difficult to define in the primary CER market, many of the project categories generated CERs at a cost well below the lowest market price. The difference in these two values is defined as a loss in cost-effectiveness. The CDM is shown to be successful at developing the 'lowest hanging fruit' but the mechanism could be improved to fulfil the goal of cost-effectiveness by linking the price per CER to the cost of generating a CER. (au)

Cost-effective backhaul design using hybrid radio/free-space optical technology

KAUST Repository

Douik, Ahmed S.

2015-06-08

The deluge of date rate in today\\'s networks poses a cost burden on the backhaul network design. Developing cost efficient backhaul solutions becomes an interesting, yet challenging, problem. Traditional technologies for backhaul networks include either radio-frequency backhauls (RF) or optical fibres (OF). While RF is a cost-effective solution as compared to OF, it supports lower data rate requirements. Another promising backhaul solution that may combine both a high data rate and a relatively low cost is the free-space optics (FSO). FSO, however, is sensitive to nature conditions (e.g., rain, fog, line-ofsight, etc.). A more reliable alternative is, therefore, to combine RF and FSO solutions through a hybrid structure called hybrid RF/FSO. Consider a backhaul network, where the base-stations (BS) can be connected to each other either via OF or hybrid RF/FSO backhaul links. The paper addresses the problem of minimizing the cost of backhaul planning under connectivity and data rates constraints, so as to choose the appropriate costeffective backhaul type between BSs (i.e., either OF or hybrid RF/FSO). The paper solves the problem using graph theory techniques by introducing the corresponding planning graph. It shows that under a specified realistic assumption about the cost of OF and hybrid RF/FSO links, the problem is equivalent to a maximum weight clique problem, which can be solved with moderate complexity. Simulation results show that our proposed solution shows a close-to-optimal performance, especially for practical prices of the hybrid RF/FSO.

Cost-effective backhaul design using hybrid radio/free-space optical technology

KAUST Repository

Douik, Ahmed S.; Dahrouj, Hayssam; Al-Naffouri, Tareq Y.; Alouini, Mohamed-Slim

2015-01-01

The deluge of date rate in today's networks poses a cost burden on the backhaul network design. Developing cost efficient backhaul solutions becomes an interesting, yet challenging, problem. Traditional technologies for backhaul networks include either radio-frequency backhauls (RF) or optical fibres (OF). While RF is a cost-effective solution as compared to OF, it supports lower data rate requirements. Another promising backhaul solution that may combine both a high data rate and a relatively low cost is the free-space optics (FSO). FSO, however, is sensitive to nature conditions (e.g., rain, fog, line-ofsight, etc.). A more reliable alternative is, therefore, to combine RF and FSO solutions through a hybrid structure called hybrid RF/FSO. Consider a backhaul network, where the base-stations (BS) can be connected to each other either via OF or hybrid RF/FSO backhaul links. The paper addresses the problem of minimizing the cost of backhaul planning under connectivity and data rates constraints, so as to choose the appropriate costeffective backhaul type between BSs (i.e., either OF or hybrid RF/FSO). The paper solves the problem using graph theory techniques by introducing the corresponding planning graph. It shows that under a specified realistic assumption about the cost of OF and hybrid RF/FSO links, the problem is equivalent to a maximum weight clique problem, which can be solved with moderate complexity. Simulation results show that our proposed solution shows a close-to-optimal performance, especially for practical prices of the hybrid RF/FSO.

Determinants and Effects of Logistics Costs in Container Ports: The Transaction Cost Economics Perspective

Directory of Open Access Journals (Sweden)

Hyuk-soo Cho

2014-08-01

Full Text Available Many countries seek to become a global logistics center linking major trading ports. They are competitively constructing container ports. The aggressive competition creates overcapacity situation in the container port sector. Massive investments are required to construct container ports with terminals, docks, storage areas and hinterlands. Nevertheless, it is not easy for container ports to have sufficient container cargo volumes to justify the massive investments. Therefore, container ports of individual countries are required to develop effective strategies to have enough traffic volumes. Based on country-level analysis, this study is designed to investigate empirically internal capabilities and external environments of logistics costs and traffic volumes in individual container ports. A theoretical foundation, the transaction cost economics (TCE is applied to support and explain empirical findings.

Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

DEFF Research Database (Denmark)

Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B

2008-01-01

Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full......-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen...... with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion...

FIRM SIZE EFFECTS ON TRANSACTION COSTS

NARCIS (Netherlands)

NOOTEBOOM, B

1993-01-01

Associated with effects of scale, scope, experience and learning there are effects of firm size on transaction costs; in the stages of contact, contract and control. These effects are due to ''threshold costs'' in setting up contacts, contracts and governance schemes, and to differences with respect

Cost-effectiveness of rotavirus vaccination in Albania.

Science.gov (United States)

Ahmeti, Albana; Preza, Iria; Simaku, Artan; Nelaj, Erida; Clark, Andrew David; Felix Garcia, Ana Gabriela; Lara, Carlos; Hoestlandt, Céline; Blau, Julia; Bino, Silvia

2015-05-07

Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively. From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases

Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review.

Science.gov (United States)

Konnopka, Alexander; Leichsenring, Falk; Leibing, Eric; König, Hans-Helmut

2009-04-01

To review cost-of-illness studies (COI) and cost-effectiveness analyses (CEA) conducted for anxiety disorders. Based on a database search in Pubmed, PsychINFO and NHS EED, studies were classified according to various criteria. Cost data were inflated and converted to 2005 US-$ purchasing power parities (PPP). We finally identified 20 COI and 11 CEA of which most concentrated on panic disorder (PD) and generalized anxiety disorder (GAD). Differing inclusion of cost categories limited comparability of COI. PD and GAD tended to show higher direct costs per case, but lower direct cost per inhabitant than social and specific phobias. Different measures of effectiveness severely limited comparability of CEA. Overall CEA analysed 26 therapeutic or interventional strategies mostly compared to standard treatment, 8 of them resulting in lower better effectiveness and costs than the comparator. Anxiety disorders cause considerable costs. More research on phobias, more standardised inclusion of cost categories in COI and a wider use of comparable effectiveness measures (like QALYs) in CEA is needed.

Effects of balanced dietary protein levels on egg production and egg quality parameters of individual commercial layers.

Science.gov (United States)

Shim, M Y; Song, E; Billard, L; Aggrey, S E; Pesti, G M; Sodsee, P

2013-10-01

The effects of a series of balanced dietary protein levels on egg production and egg quality parameters of laying hens from 18 through 74 wk of age were investigated. One hundred forty-four pullets (Bovans) were randomly assigned to individual cages with separate feeders including 3 different protein level series of isocaloric diets. Diets were separated into 4 phases of 18-22, 23-32, 33-44, and 45-74 wk of age. The high protein (H) series contained 21.62, 19.05, 16.32, and 16.05% CP, respectively. Medium protein (M) and low protein (L) series were 2 and 4% lower in balanced dietary protein. The results clearly demonstrated that the balanced dietary protein level was a limiting factor for BW, ADFI, egg weight, hen day egg production (HDEP), and feed per kilogram of eggs. Feeding with the L series resulted in lower ADFI and HDEP (90.33% peak production) and more feed per kilogram of eggs compared with the H or M series (HDEP; 93.23 and 95.68% peak production, monthly basis). Egg weight responded in a linear manner to balanced dietary protein level (58.78, 55.94, and 52.73 g for H, M, and L, respectively). Feed intake of all hens, but especially those in the L series, increased considerably after wk 54 when the temperature of the house decreased due to winter conditions. Thus, hens fed the L series seemed particularly dependent on house temperature to maintain BW, ADFI, and HDEP. For egg quality parameters, percent yolk, Haugh units, and egg specific gravity were similar regardless of diets. Haugh units were found to be greatly affected by the variation of housing temperature (P = 0.025). Maximum performance cannot always be expected to lead to maximum profits. Contrary to the idea of a daily amino acid requirement for maximum performance, these results may be used to determine profit-maximizing levels of balanced dietary protein based on the cost of protein and returns from different possible protein levels that may be fed.

Cost-effectiveness of peer role play and standardized patients in undergraduate communication training.

Science.gov (United States)

Bosse, Hans Martin; Nickel, Martin; Huwendiek, Sören; Schultz, Jobst Hendrik; Nikendei, Christoph

2015-10-24

The few studies directly comparing the methodological approach of peer role play (RP) and standardized patients (SP) for the delivery of communication skills all suggest that both methods are effective. In this study we calculated the costs of both methods (given comparable outcomes) and are the first to generate a differential cost-effectiveness analysis of both methods. Medical students in their prefinal year were randomly assigned to one of two groups receiving communication training in Pediatrics either with RP (N = 34) or 19 individually trained SP (N = 35). In an OSCE with standardized patients using the Calgary-Cambridge Referenced Observation Guide both groups achieved comparable high scores (results published). In this study, corresponding costs were assessed as man-hours resulting from hours of work of SP and tutors. A cost-effectiveness analysis was performed. Cost-effectiveness analysis revealed a major advantage for RP as compared to SP (112 vs. 172 man hours; cost effectiveness ratio .74 vs. .45) at comparable performance levels after training with both methods. While both peer role play and training with standardized patients have their value in medical curricula, RP has a major advantage in terms of cost-effectiveness. This could be taken into account in future decisions.

Cost-effectiveness of monitoring free flaps.

Science.gov (United States)

Subramaniam, Shiva; Sharp, David; Jardim, Christopher; Batstone, Martin D

2016-06-01

Methods of free flap monitoring have become more sophisticated and expensive. This study aims to determine the cost of free flap monitoring and examine its cost effectiveness. We examined a group of patients who had had free flaps to the head and neck over a two-year period, and combined these results with costs obtained from business managers and staff. There were 132 free flaps with a success rate of 99%. The cost of monitoring was Aus $193/flap. Clinical monitoring during this time period cost Aus$25 476 and did not lead to the salvage of any free flaps. Cost equivalence is reached between monitoring and not monitoring only at a failure rate of 15.8%. This is to our knowledge the first study to calculate the cost of clinical monitoring of free flaps, and to examine its cost-effectiveness. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.

Interim report: Waste management facilities cost information for mixed low-level waste

International Nuclear Information System (INIS)

Feizollahi, F.; Shropshire, D.

1994-03-01

This report contains preconceptual designs and planning level life-cycle cost estimates for treating alpha and nonalpha mixed low-level radioactive waste. This report contains information on twenty-seven treatment, storage, and disposal modules that can be integrated to develop total life cycle costs for various waste management options. A procedure to guide the US Department of Energy and its contractor personnel in the use of estimating data is also summarized in this report

Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria

Science.gov (United States)

Ezenduka, Charles; Post, Erik; John, Steven; Suraj, Abdulkarim; Namadi, Abdulahi; Onwujekwe, Obinna

2012-01-01

Background Despite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy. Methods A cross-sectional study was carried out to evaluate the additional benefits of using several case detection methods in addition to routine practice in two north-eastern states of Nigeria. Primary and secondary data were collected from routine practice records and the Nigerian Tuberculosis and Leprosy Control Programme of 2009. The methods evaluated were Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healers incentive method (TH). Effectiveness was measured as number of new leprosy cases detected and cost-effectiveness was expressed as cost per case detected. Costs were measured from both providers' and patients' perspectives. Additional costs and effects of each method were estimated by comparing each method against routine practise and expressed as incremental cost-effectiveness ratio (ICER). All costs were converted to the U.S. dollar at the 2010 exchange rate. Univariate sensitivity analysis was used to evaluate uncertainties around the ICER. Results The ICER for HCE was $142 per additional case detected at all contact levels and it was the most cost-effective method. At ICER of $194 per additional case detected, THs method detected more cases at a lower cost than the RVS, which was not cost-effective at $313 per additional case detected. Sensitivity analysis showed that varying the proportion of shared costs and subsistent wage for valuing unpaid time did not significantly change the

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

Energy Technology Data Exchange (ETDEWEB)

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

2013-08-15

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

A Case Study of Preliminary Cost-Benefit Analysis of Building Levees to Mitigate the Joint Effects of Sea Level Rise and Storm Surge

Directory of Open Access Journals (Sweden)

Binbin Peng

2018-02-01

Full Text Available Sea-level rise (SLR will magnify the impacts of storm surge; the resulting severe flooding and inundation can cause huge damage to coastal communities. Community leaders are considering implementing adaptation strategies, typically hard engineering projects, to protect coastal assets and resources. It is important to understand the costs and benefits of the proposed project before any decision is made. To mitigate the flooding impact of joint effects of storm surge and SLR, building levee segments is chosen to be a corresponding adaptation strategy to protect the real estate assets in the study area—the City of Miami, FL, USA. This paper uses the classic Cost-Benefit Analysis (CBA to assess the cost efficiency and proposes corresponding improvements in the benefit estimation, by estimating the avoided damages of implementing levee projects. Results show that the city will benefit from implementing levee projects along the Miami River in both a one-time 10 year storm event with SLR and cumulative long-term damage scenarios. This study also suggests that conducting CBA is a critical process before making coastal adaptation planning investment. A more meaningful result of cost effectiveness is estimated by accounting for the appreciation and time value. In addition, a sensitivity analysis is conducted to verify how the choice of discount rate influences the result. Uncertain factors including the rate of SLR, storm intensification, land use changes, and real estate appreciation are further analyzed.

10 CFR 455.63 - Cost-effectiveness testing.

Science.gov (United States)

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy conservation...

Contagion effect of enabling or coercive use of costing model within the managerial couple in lean organizations

DEFF Research Database (Denmark)

Kristensen, Thomas; Israelsen, Poul

In the lean strategy is enabling formalization behaviour expected at the lower levels of management to be successful. We study the contagion effect between the superior, middle manager, of the lower level manager. This effect is proposed to be a dominant contingency variable for the use of costin...... models at the lower levels of management. Thus the use of costing models at the middle manager level is an important key to be successful with the lean package.......In the lean strategy is enabling formalization behaviour expected at the lower levels of management to be successful. We study the contagion effect between the superior, middle manager, of the lower level manager. This effect is proposed to be a dominant contingency variable for the use of costing...

System of Indicators of the Level of Costs of Financing an Economic Subject

Directory of Open Access Journals (Sweden)

Laktionova Aleksandra A.

2013-11-01

Full Text Available The article offers a system of indicators of the level of costs of financing economic subjects, in the basis of which there is a function of formation of recommendations or identification of directions and priorities in the part of selection of one or another source of financing, its urgency and specific features of attraction of resources, on the basis of information on the level of agent’s costs, information asymmetry costs, financial instability, transaction and market indicators of cost of financial resources. The article pays a special attention to a significant structure forming factor of the ownership structure, which identifies the volume and logic of interconnection of all costs of financing and determining incentives and risks in the system of management of financial activity of an economic subject from the point of view of all participants. It exerts especially big influence upon formation of such implicit costs of financing as agent’s costs and information asymmetry costs. The system of factors of stimulants and de-stimulants of costs of financing includes factors of external environment (macro-economic and market indicators of cost and institutional provision and internal environment (ownership structure, characteristic of investment activity and financing an economic subject, organisation of business and corporate management.

Cost-effectiveness of feeding strategies to reduce greenhouse gas emissions from dairy farming

NARCIS (Netherlands)

Middelaar, van C.E.; Dijkstra, J.; Berentsen, P.B.M.; Boer, de I.J.M.

2014-01-01

The objective of this paper was to evaluate the cost-effectiveness of 3 feeding strategies to reduce enteric CH4 production in dairy cows by calculating the effect on labor income at the farm level and on greenhouse gas (GHG) emissions at the chain level (i.e., from production of farm inputs to the

Cost-Efficient Wafer-Level Capping for MEMS and Imaging Sensors by Adhesive Wafer Bonding

Directory of Open Access Journals (Sweden)

Simon J. Bleiker

2016-10-01

Full Text Available Device encapsulation and packaging often constitutes a substantial part of the fabrication cost of micro electro-mechanical systems (MEMS transducers and imaging sensor devices. In this paper, we propose a simple and cost-effective wafer-level capping method that utilizes a limited number of highly standardized process steps as well as low-cost materials. The proposed capping process is based on low-temperature adhesive wafer bonding, which ensures full complementary metal-oxide-semiconductor (CMOS compatibility. All necessary fabrication steps for the wafer bonding, such as cavity formation and deposition of the adhesive, are performed on the capping substrate. The polymer adhesive is deposited by spray-coating on the capping wafer containing the cavities. Thus, no lithographic patterning of the polymer adhesive is needed, and material waste is minimized. Furthermore, this process does not require any additional fabrication steps on the device wafer, which lowers the process complexity and fabrication costs. We demonstrate the proposed capping method by packaging two different MEMS devices. The two MEMS devices include a vibration sensor and an acceleration switch, which employ two different electrical interconnection schemes. The experimental results show wafer-level capping with excellent bond quality due to the re-flow behavior of the polymer adhesive. No impediment to the functionality of the MEMS devices was observed, which indicates that the encapsulation does not introduce significant tensile nor compressive stresses. Thus, we present a highly versatile, robust, and cost-efficient capping method for components such as MEMS and imaging sensors.

Cost-effectiveness of tubal patency tests.

Science.gov (United States)

Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J

2013-04-01

Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013

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

Directory of Open Access Journals (Sweden)

Peter J Neumann

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

Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

Directory of Open Access Journals (Sweden)

Huang Li-Hui

2012-04-01

Full Text Available Abstract Background Neonatal hearing screening (NHS has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China. Methods A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs, average cost-effectiveness ratio (ACER, and incremental cost-effectiveness ratio (ICER for universal screening compared to targeted screening in eight provinces. Results and discussion A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This

Application of maximum entropy to statistical inference for inversion of data from a single track segment.

Science.gov (United States)

Stotts, Steven A; Koch, Robert A

2017-08-01

In this paper an approach is presented to estimate the constraint required to apply maximum entropy (ME) for statistical inference with underwater acoustic data from a single track segment. Previous algorithms for estimating the ME constraint require multiple source track segments to determine the constraint. The approach is relevant for addressing model mismatch effects, i.e., inaccuracies in parameter values determined from inversions because the propagation model does not account for all acoustic processes that contribute to the measured data. One effect of model mismatch is that the lowest cost inversion solution may be well outside a relatively well-known parameter value's uncertainty interval (prior), e.g., source speed from track reconstruction or towed source levels. The approach requires, for some particular parameter value, the ME constraint to produce an inferred uncertainty interval that encompasses the prior. Motivating this approach is the hypothesis that the proposed constraint determination procedure would produce a posterior probability density that accounts for the effect of model mismatch on inferred values of other inversion parameters for which the priors might be quite broad. Applications to both measured and simulated data are presented for model mismatch that produces minimum cost solutions either inside or outside some priors.

Carbon footprint and cost-effectiveness of cataract surgery.

Science.gov (United States)

Venkatesh, Rengaraj; van Landingham, Suzanne W; Khodifad, Ashish M; Haripriya, Aravind; Thiel, Cassandra L; Ramulu, Pradeep; Robin, Alan L

2016-01-01

This article raises awareness about the cost-effectiveness and carbon footprint of various cataract surgery techniques, comparing their relative carbon emissions and expenses: manual small-incision cataract surgery (MSICS), phacoemulsification, and femtosecond laser-assisted cataract surgery. As the most commonly performed surgical procedure worldwide, cataract surgery contributes significantly to global climate change. The carbon footprint of a single phacoemulsification cataract surgery is estimated to be comparable to that of a typical person's life for 1 week. Phacoemulsification has been estimated to be between 1.4 and 4.7 times more expensive than MSICS; however, given the lower degree of postoperative astigmatism and other potential complications, phacoemulsification may still be preferable to MSICS in relatively resource-rich settings requiring high levels of visual function. Limited data are currently available regarding the environmental and financial impact of femtosecond laser-assisted cataract surgery; however, in its current form, it appears to be the least cost-effective option. Cataract surgery has a high value to patients. The relative environmental impact and cost of different types of cataract surgery should be considered as this treatment becomes even more broadly available globally and as new technologies are developed and implemented.

Privacy Enforcement in a Cost-Effective Smart Grid

DEFF Research Database (Denmark)

Mikkelsen, Søren Aagaard

In this technical report we present the current state of the research conducted during the first part of the PhD period. The PhD thesis “Privacy Enforcement in a Cost-Effective Smart Grid” focuses on ensuring privacy when generating market for energy service providers that develop web services...... for the residential domain in the envisaged smart grid. The PhD project is funded and associated to the EU project “Energy Demand Aware Open Services for Smart Grid Intelligent Automation” (Smart HG) and therefore introduces the project on a system-level. Based on this, we present some of the integration, security...... and privacy challenges that emerge when designing a system architecture and infrastructure. The resulting architecture is a consumer-centric and agent-based design and uses open Internet-based communication protocols for enabling interoperability while being cost-effective. Finally, the PhD report present...

Examining the effectiveness of municipal solid waste management systems: An integrated cost-benefit analysis perspective with a financial cost modeling in Taiwan

International Nuclear Information System (INIS)

Weng, Yu-Chi; Fujiwara, Takeshi

2011-01-01

In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBA framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O and M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities.

Examining the effectiveness of municipal solid waste management systems: an integrated cost-benefit analysis perspective with a financial cost modeling in Taiwan.

Science.gov (United States)

Weng, Yu-Chi; Fujiwara, Takeshi

2011-06-01

In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBA framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O&M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Specialty-specific admission: a cost-effective intervention?

LENUS (Irish Health Repository)

Slattery, E

2012-02-01

INTRODUCTION: Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions. METHODS: All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs. RESULTS: Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to 17,342 noted. Specialty-specific admission was associated with shorter LOS for most GI admissions. CONCLUSION: Significant disparity exists for both LOS and PLC for most GI diagnoses. Specialty-specific admissions are associated with reduced LOS. Specialty-specific admission would appear to be cost-effective which may also lead to improved clinical outcomes.

Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones.

Directory of Open Access Journals (Sweden)

Stephen Morris

Full Text Available Patients with suspected common bile duct (CBD stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP, an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS or Magnetic Resonance CholangioPancreatography (MRCP first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs per patient from the perspective of the UK National Health Service (NHS over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively, with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively. Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

Greenhouse effect, sea level rise, and coastal drainage systems

Energy Technology Data Exchange (ETDEWEB)

Titus, J G; Kuo, C Y; Gibbs, M J; LaRoche, T B; Webb, M K; Waddell, J O

1987-01-01

Increasing concentrations of carbon dioxide and other gases are expected to warm the earth several degrees in the next century, which would raise sea level a few feet and alter precipitation patterns. Both of these changes would have major impacts on the operation of coastal drainage systems. However, because sea level rise and climate change resulting from the greenhouse effect are still uncertain, most planners and engineers are ignoring the potential implications. Case studies of the potential impact on watersheds in Charleston, South Carolina, and Fort Walton Beach, Florida, suggest that the cost of designing a new system to accommodate a rise in sea level will sometimes be small compared with the retrofit cost that may ultimately be necessary if new systems are not designed for a rise. Rather than ignore the greenhouse effect until its consequences are firmly established, engineers and planners should evaluate whether it would be worthwhile to insure that new systems are not vulnerable to the risks of climate change and sea level rise.