WorldWideScience

Sample records for net cost savings

  1. Chapter 17: Estimating Net Savings: Common Practices

    Energy Technology Data Exchange (ETDEWEB)

    Violette, D. M.; Rathbun, P.

    2014-09-01

    This chapter focuses on the methods used to estimate net energy savings in evaluation, measurement, and verification (EM&V) studies for energy efficiency (EE) programs. The chapter provides a definition of net savings, which remains an unsettled topic both within the EE evaluation community and across the broader public policy evaluation community, particularly in the context of attribution of savings to particular program. The chapter differs from the measure-specific Uniform Methods Project (UMP) chapters in both its approach and work product. Unlike other UMP resources that provide recommended protocols for determining gross energy savings, this chapter describes and compares the current industry practices for determining net energy savings, but does not prescribe particular methods.

  2. Saving Green on Energy Costs

    Science.gov (United States)

    Tacke, Diane L.

    2006-01-01

    In recent years, colleges and universities have begun efforts to reduce their energy costs, an initiative that can not only save an institution money, but also strengthen relationships across campus. Board leadership has been central to this endeavor in setting goals, prioritizing projects, and financing those projects. Using her experiences with…

  3. ICU early physical rehabilitation programs: financial modeling of cost savings.

    Science.gov (United States)

    Lord, Robert K; Mayhew, Christopher R; Korupolu, Radha; Mantheiy, Earl C; Friedman, Michael A; Palmer, Jeffrey B; Needham, Dale M

    2013-03-01

    To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program. U.S.-based adult ICUs. Financial modeling of the introduction of an ICU early rehabilitation program. Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200-2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions. A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

  4. FY 1995 cost savings report

    Energy Technology Data Exchange (ETDEWEB)

    Andrews-Smith, K.L., Westinghouse Hanford

    1996-06-21

    Fiscal Year (FY) 1995 challenged us to dramatically reduce costs at Hanford. We began the year with an 8 percent reduction in our Environmental Management budget but at the same time were tasked with accomplishing additional workscope. This resulted in a Productivity Challenge whereby we took on more work at the beginning of the year than we had funding to complete. During the year, the Productivity Challenge actually grew to 23 percent because of recissions, Congressional budget reductions, and DOE Headquarters actions. We successfully met our FY 1995 Productivity Challenge through an aggressive cost reduction program that identified and eliminated unnecessary workscope and found ways to be more efficient. We reduced the size of the workforce, cut overhead expenses, eliminated paperwork, cancelled construction of new facilities, and reengineered our processes. We are proving we can get the job done better and for less money at Hanford. DOE`s drive to do it ``better, faster, cheaper`` has led us to look for more and larger partnerships with the private sector. The biggest will be privatization of Hanford`s Tank Waste Remediation System, which will turn liquid tank waste into glass logs for eventual disposal. We will also save millions of dollars and avoid the cost of replacing aging steam plants by contracting Hanford`s energy needs to a private company. Other privatization successes include the Hanford Mail Service, a spinoff of advanced technical training, low level mixed waste thermal treatment, and transfer of the Hanford Museums of Science and history to a private non-profit organization. Despite the rough roads and uncertainty we faced in FY 1995, less than 3 percent of our work fell behind schedule, while the work that was performed was completed with an 8.6 percent cost under-run. We not only met the FY 1995 productivity challenge, we also met our FY 1995-1998 savings commitments and accelerated some critical cleanup milestones. The challenges continue

  5. USAID IT Reform Cost Savings/Avoidance

    Data.gov (United States)

    US Agency for International Development — The Office of the Chief Information Officer in the Management Bureau of USAID launched initiatives designed for IT cost savings and avoidance. This dataset includes...

  6. Potential Logistics Cost Savings from Engine Commonality

    National Research Council Canada - National Science Library

    Henderson, Robert L; Higer, Matthew W

    2007-01-01

    The purpose of this MBA Project is to determine potential logistics cost savings the USAF and DoD could have realized through the life of the F-16 fighter aircraft had they required engine commonality...

  7. The effect of net foreign assets on saving rate

    Directory of Open Access Journals (Sweden)

    Ben David Nissim

    2014-01-01

    Full Text Available Observing empirical data we find that many countries try to delay the decision of increasing saving rate in order to avoid a decrease of the living standards. However the delay leads a deterioration of countries financial stability. We present a simple theoretical model that connects between countries' saving rate and their net foreign assets. Using cross section data set of 135 countries in 2010 we estimated the econometric relation between saving rate in 2010 as dependent variable and two explanatory variables: the current account in 2010 and the aggregated current account during 1980-2010. Our findings show that industrial countries in a bad financial state tend to decrease their saving rate as external debt is larger causing to deterioration in external debt while countries with good financial state tend to increase their saving rate and the tendency increase as financial state becomes better. Only in countries with a very large external debt saving rate tends to grow. The results point that gross foreign debt will keep increasing and will worsen world financial state causing increased risk of getting into a world crisis.

  8. Paternity leave in Sweden: costs, savings and health gains.

    Science.gov (United States)

    Månsdotter, Anna; Lindholm, Lars; Winkvist, Anna

    2007-06-01

    The initial objective is to examine the relationship between paternity leave in 1978-1979 and male mortality during 1981-2001, and the second objective is to calculate the cost-effectiveness of the 1974 parental insurance reform in Sweden. Based on a population of all Swedish couples who had their first child together in 1978 (45,801 males), the risk of death for men who took paternity leave, compared with men who did not, was estimated by odds ratios. The cost-effectiveness analysis considered costs for information, administration and production losses, minus savings due to decreased sickness leave and inpatient care, compared to health gains in life-years and quality-adjusted life-years (QALYs). It is demonstrated that fathers who took paternity leave have a statistically significant decreased death risk of 16%. Costs minus savings (discounted values) stretch from a net cost of EUR 19 million to a net saving of EUR 11 million, and the base case cost-effectiveness is EUR 8000 per QALY. The study indicates that that the right to paternity leave is a desirable reform based on commonly stated public health, economic, and feminist goals. The critical issue in future research should be to examine impact from health-related selection.

  9. Accrued Cost Savings of a Free Clinic Using Quality-Adjusted Life Years Saved and Return on Investment.

    Science.gov (United States)

    Sanders, Jim; Lacey, Marcus; Guse, Clare E

    2017-01-01

    Savings garnered through the provision of preventive services is a form of profit for health systems. Free clinics have been using this logic to demonstrate their cost-savings. The Community-Based Chronic Disease Management (CCDM) clinic treats hypertension using nurse-led teams, clinical protocols, and community-based settings. We calculated CCDM's cost-effectiveness from 2007 to 2013 using 2 metrics: Quality-adjusted life years (QALYs) saved and return on investment (ROI). QALYs were calculated using the Clinical Preventive Burden (CPB) score for hypertension care. ROI was calculated by tallying the savings from prevented heart attacks, strokes, and emergency department visits against the total operating costs. Using conservative assumptions for cost estimates, hypertension care resulted in a value of QALYs saved of $711,000 to $2,133,000 and an ROI ratio range of 0.35 to 1.20. Our study shows that when using conservative assumptions to calculate cost-savings, our free clinic did not save money. Cost-savings did occur, but the amount was modest, was less than that of cost-inputs, and was not likely captured by any single health entity. Although free clinics remain a vital health care access point for many Americans, it has yet to be demonstrated that they generate a net savings. © Copyright 2017 by the American Board of Family Medicine.

  10. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill

    2005-03-01

    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  11. Net Zero Pilot Program Lights the Path to Big Savings in Guam

    Energy Technology Data Exchange (ETDEWEB)

    PNNL

    2016-11-03

    Case study describes how the Army Reserve 9th Mission Support Command (MSC) reduced lighting energy consumption by 62% for a total savings of 125,000 kWh and more than $50,000 per year by replacing over 400 fluorescent troffers with 36 W LED troffers. This project was part of the Army Reserve Net Zero Pilot Program, initiated in 2013, to reduce energy and water consumption, waste generation, and utility costs.

  12. Direct and indirect costs and potential cost savings of laparoscopic adjustable gastric banding among obese patients with diabetes.

    Science.gov (United States)

    Finkelstein, Eric A; Allaire, Benjamin T; DiBonaventura, Marco DaCosta; Burgess, Somali M

    2011-09-01

    To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account. Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature. Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from $26570 (±$9000) to $34160 (±$10 380) when indirect costs are included. This study presented a novel approach for incorporating indirect costs into cost-benefit analyses. Application to gastric banding revealed that inclusion of indirect costs improves the financial outlook for the procedure. (C)2011The American College of Occupational and Environmental Medicine

  13. Chapter 21: Estimating Net Savings - Common Practices. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

    Energy Technology Data Exchange (ETDEWEB)

    Kurnik, Charles W [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Violette, Daniel M. [Navigant, Boulder, CO (United States); Rathbun, Pamela [Tetra Tech, Madison, WI (United States)

    2017-11-02

    This chapter focuses on the methods used to estimate net energy savings in evaluation, measurement, and verification (EM and V) studies for energy efficiency (EE) programs. The chapter provides a definition of net savings, which remains an unsettled topic both within the EE evaluation community and across the broader public policy evaluation community, particularly in the context of attribution of savings to a program. The chapter differs from the measure-specific Uniform Methods Project (UMP) chapters in both its approach and work product. Unlike other UMP resources that provide recommended protocols for determining gross energy savings, this chapter describes and compares the current industry practices for determining net energy savings but does not prescribe methods.

  14. Calculating cost savings in utilization management.

    Science.gov (United States)

    MacMillan, Donna

    2014-01-01

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

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

    Science.gov (United States)

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

    1998-07-01

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

  16. Average Costs versus Net Present Value

    NARCIS (Netherlands)

    E.A. van der Laan (Erwin); R.H. Teunter (Ruud)

    2000-01-01

    textabstractWhile the net present value (NPV) approach is widely accepted as the right framework for studying production and inventory control systems, average cost (AC) models are more widely used. For the well known EOQ model it can be verified that (under certain conditions) the AC approach gives

  17. Cost savings from a telemedicine model of care in northern Queensland, Australia.

    Science.gov (United States)

    Thaker, Darshit A; Monypenny, Richard; Olver, Ian; Sabesan, Sabe

    2013-09-16

    To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services. Retrospective cost-savings analysis; and a one-way sensitivity analysis performed to test the robustness of findings in net savings. Records of all patients managed by means of teleoncology at the Townsville Cancer Centre (TCC) and its six rural satellite centres in northern Queensland, Australia between 1 March 2007 and 30 November 2011. Costs for set-up and staffing to manage the service, and savings from avoidance of travel expenses for specialist oncologists, patients and their escorts, and for aeromedical retrievals. There were 605 teleoncology consultations with 147 patients over 56 months, at a total cost of $442 276. The cost for project establishment was $36 000, equipment/maintenance was $143 271, and staff was $261 520. The estimated travel expense avoided was $762 394; this figure included the costs of travel for patients and escorts of $658 760, aeromedical retrievals of $52 400 and travel for specialists of $47 634, as well as an estimate of accommodation costs for a proportion of patients of $3600. This resulted in a net saving of $320 118. Costs would have to increase by 72% to negate the savings. The teleoncology model of care at the TCC resulted in net savings, mainly due to avoidance of travel costs. Such savings could be redirected to enhancing rural resources and service capabilities. This teleoncology model is applicable to geographically distant areas requiring lengthy travel.

  18. GSA IT Reform Cost Savings/Avoidance

    Data.gov (United States)

    General Services Administration — GSA IT provides data related to Agency IT initiatives that save or avoid expenditures. This data is provided as a requirement of OMB's Integrated Data Collection...

  19. Lifestyle intervention: from cost savings to value for money.

    Science.gov (United States)

    Rappange, David R; Brouwer, Werner B F; Rutten, Frans F H; van Baal, Pieter H M

    2010-09-01

    Prevention of unhealthy lifestyles has sometimes been promoted as simultaneously reducing costs and improving public health but this will unlikely prove to be true. Additional medical costs in life years gained due to treatment of unrelated diseases may offset possible savings in related diseases, but are often ignored both in health promotion policies and in economic evaluations of life-prolonging interventions. Many national guidelines explicitly recommend excluding these costs from economic evaluations or leave inclusion up to the discretion of the analyst. This may result in too favorable estimations of cost-effectiveness, feeding the unjustified optimism among policymakers regarding lifestyle interventions as a cost-saving option. However, prevention may still be a cost-effective way to improve public health, even when it does not result in cost savings, but this should be judged taking all future costs into account and be based on the true value for money provided by lifestyle interventions.

  20. Reactors Save Energy, Costs for Hydrogen Production

    Science.gov (United States)

    2014-01-01

    While examining fuel-reforming technology for fuel cells onboard aircraft, Glenn Research Center partnered with Garrettsville, Ohio-based Catacel Corporation through the Glenn Alliance Technology Exchange program and a Space Act Agreement. Catacel developed a stackable structural reactor that is now employed for commercial hydrogen production and results in energy savings of about 20 percent.

  1. Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.

    Science.gov (United States)

    Nundy, Shantanu; Dick, Jonathan J; Chou, Chia-Hung; Nocon, Robert S; Chin, Marshall H; Peek, Monica E

    2014-02-01

    Even with the best health care available, patients with chronic illnesses typically spend no more than a few hours a year in a health care setting, while their outcomes are largely determined by their activities during the remaining 5,000 waking hours of the year. As a widely available, low-cost technology, mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. We examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes who belonged to an academic medical center's employee health plan. In addition to pre-post improvements in glycemic control (p=0.01) and patients' satisfaction with overall care (p=0.04), we observed a net cost savings of 8.8 percent. Those early results suggest that mHealth programs can support health care organizations' pursuit of the triple aim of improving patients' experiences with care, improving population health, and reducing the per capita cost of health care

  2. DETERMINING ENERGY SAVINGS IN BUILDINGS USING THE REDUCING COSTS METHOD

    OpenAIRE

    STAN IVAN F.E.; MIRCEA I

    2015-01-01

    The paper is structured in four parts. The first part presents the importance of thermal insulation for buildings energy economy and some insulation properties. In the second part of the paper it is described the reducing cost method to determine the energy savings. The third part of the paper includes an analysis and a comparison for an exterior wall provided with different thicknesses of insulation layer in order to determine the average savings cost. The last par...

  3. Cost Savings Analysis Guidelines for Manufacturing Technology Projects.

    Science.gov (United States)

    1985-06-28

    14 3.2.1 ’CHANGED COSTO SAMPLE PROJECT .................. .. 16 3.2.1.1 COST SAVINGS NARRATIVE ..................... 17 3.2.1.2 RECURRING COSTS...an MT project, an abbreviated format called Worksheet A is used. In such cases, all capital , operating, and implementation costs are . reflected in...not necessary to factor in the capital investment in the crystal Puller and other such implementation costs to the contractor. All such costs are

  4. Theoretical, Methodological, and Empirical Approaches to Cost Savings: A Compendium

    Energy Technology Data Exchange (ETDEWEB)

    M Weimar

    1998-12-10

    This publication summarizes and contains the original documentation for understanding why the U.S. Department of Energy's (DOE's) privatization approach provides cost savings and the different approaches that could be used in calculating cost savings for the Tank Waste Remediation System (TWRS) Phase I contract. The initial section summarizes the approaches in the different papers. The appendices are the individual source papers which have been reviewed by individuals outside of the Pacific Northwest National Laboratory and the TWRS Program. Appendix A provides a theoretical basis for and estimate of the level of savings that can be" obtained from a fixed-priced contract with performance risk maintained by the contractor. Appendix B provides the methodology for determining cost savings when comparing a fixed-priced contractor with a Management and Operations (M&O) contractor (cost-plus contractor). Appendix C summarizes the economic model used to calculate cost savings and provides hypothetical output from preliminary calculations. Appendix D provides the summary of the approach for the DOE-Richland Operations Office (RL) estimate of the M&O contractor to perform the same work as BNFL Inc. Appendix E contains information on cost growth and per metric ton of glass costs for high-level waste at two other DOE sites, West Valley and Savannah River. Appendix F addresses a risk allocation analysis of the BNFL proposal that indicates,that the current approach is still better than the alternative.

  5. Potential Logistics Cost Savings from Engine Commonality

    Science.gov (United States)

    2007-12-01

    BASICS AND COST-ESTIMATING METHODOLOGY Several RAND studies detail cost methodology and spending assessments across the full range of support of both...Moore, Lorell, Mason, and Graser’s 2002 RAND Report Military Jet Engine Acquisition: Technology Basics and Cost- Estimating Methodology, pages 9 -14...9 2 2 ,016 .75$ F t W ayn e F W A 3 3 .6 7.9 3 2 0 .526 2 .326 1 .01 5 2 .8 9 2 92 .5 2 3 ,400 .00$ D ulu th D LH 4 0

  6. Cost savings from performance-based maintenance contracting

    OpenAIRE

    Straub, A

    2009-01-01

    New procurement approaches combined with performance-based building approaches should reduce costs, but empirical qualitative and quantitative studies are lacking. Performance-based maintenance contracts give maintenance suppliers incentives to improve their way of working. Innovative, cost-effective solutions that meet the performance criteria can be achieved, especially if the principle of whole-life costing is being adopted. Indirect cost savings are expected as well. It enables maintenanc...

  7. COST SAVING WITH ULTRASONOGRAPHY IN A DEVELOPING ...

    African Journals Online (AJOL)

    1999-05-05

    May 5, 1999 ... under the Progamme of Science, Research and Development. STD 111 (Science and Technology for Development nr. TS3. - CT 94 - 0330) and Glaxo, Wellcome, Hamburg, Germany. REFERENCES. Margulis, A.R. Radiologic imaging: Changing cost, greater benefits (Whitehouse Lecture). Amer. J. Radiol.

  8. The impact of changing dental needs on cost savings from fluoridation.

    Science.gov (United States)

    Campain, A C; Mariño, R J; Wright, F A C; Harrison, D; Bailey, D L; Morgan, M V

    2010-03-01

    Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia. Net costs were estimated as Costs((programme)) minus Costs((averted caries).) Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6-20, 21-45, 46-65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized. With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal. Community water fluoridation remains a cost-effective preventive measure in Australia.

  9. 21 Cost-Saving Measures For The Judiciary

    Directory of Open Access Journals (Sweden)

    Jessica Vapnek

    2013-02-01

    Full Text Available Courts around the world are increasingly facing budget cuts and funding shortfalls. Budget problems are particularly acute in developing countries, where courts need to increase efficiency and access to justice while also managing resource limitations. International development agencies and donors expect measurable progress to justify continued funding of judicial reform projects. Yet, as rule of law efforts in developing countries improve public perception of courts and streamline court administration, more cases may be filed. Greater use of the courts puts greater strain on court resources, triggering the need to implement cost-saving measures while maintaining effective court administration.This paper outlines 21 measures that courts can implement to reduce costs. Specific examples from developing countries are presented wherever possible, with additional examples drawn from the United States and Europe. Although this paper is intended mainly for audiences in developing countries, the issues facing those courts are similar to issues addressed through court reforms in the United States over the past 50 years. For this reason, examples of cost-saving measures from developed countries such as the United States may be directly applicable or could be used as starting points to spur further cost savings innovation in the developing world.Section I of this paper explains the context for the implementation of judicial cost-saving measures, and raises some issues for reflection. Section II sets out specific judicial cost-saving measures, dividing them into three categories: measures that address court operations; measures directed at staffing and salaries; and measures that relate to court and case management. Section III discusses ways that countries and judiciaries can generate ideas for new and innovative cost-saving mechanisms.

  10. Costs and savings associated with implementation of a police crisis intervention team.

    Science.gov (United States)

    El-Mallakh, Peggy L; Kiran, Kranti; El-Mallakh, Rif S

    2014-06-01

    Police crisis intervention teams (CIT) have demonstrated their effectiveness in reducing injury to law enforcement personnel and citizens and the criminalization of mental illness; however, their financial effect has not been fully investigated. The objective of the study was to determine the total costs or total savings associated with implementing a CIT program in a medium-size city. The costs and savings associated with the implementation of a CIT program were analyzed in a medium-size city, Louisville, Kentucky, 9 years after the program's initiation. Costs associated with officer training, increased emergency psychiatry visits, and hospital admissions resulting from CIT activity were compared with the savings associated with diverted hospitalizations and reduced legal bookings. Based on an average of 2400 CIT calls annually, the overall costs associated with CIT per year were $2,430,128 ($146,079 for officer training, $1,768,536 for hospitalizations of patients brought in by CIT officers, $508,690 for emergency psychiatry evaluations, and $6823 for arrests). The annual savings of the CIT were $3,455,025 ($1,148,400 in deferred hospitalizations, $2,296,800 in reduced inpatient referrals from jail, and $9825 in avoided bookings and jail time). The balance is $1,024,897 in annual cost savings. The net financial effect of a CIT program is of modest benefit; however, much of this analysis was based on estimates and average length of stay. Furthermore, the costs and savings associated with officer or citizen injuries were not included because there was inadequate information about their prevalence and costs. Finally, this analysis does not take into account the nonmonetary gains of a CIT program.

  11. Energy-saving wastewater treatment systems: formulation of cost functions.

    Science.gov (United States)

    Nogueira, R; Ferreira, I; Janknecht, P; Rodríguez, J J; Oliveira, P; Brito, A G

    2007-01-01

    Natural interactions between water, soil, atmosphere, plants and microorganisms include physical, chemical and biological processes with decontaminating capacities. Natural or energy-saving wastewater treatment systems utilize these processes and thereby enable a sustainable management in the field of wastewater treatment, offering low investment and operation costs, little or no energy consumption, little and low-skill labor requirements, good landscape integration and excellent feasibility for small settlements, especially when remote from centralized sewer systems. The objective of this work is the development of cost functions for investment and operation of energy-saving wastewater treatment technologies. Cost functions are essential for making cost estimations based on a very reduced number of variables. The latter are easily identified and quantified and have a direct bearing on the costs in question. The formulated investment and operation cost functions follow a power law, and the costs decrease with the increase of the population served. The different energy-saving wastewater treatment systems serving small population settlements, between 50 p.e. and 250 p.e., present associated investment costs varying from 400 Euro/p.e. to 200 Euro/p.e. and annual operation costs in the range of 70 Euro/p.e. to 20 Euro/p.e., respectively.

  12. Energy saving for OpenFlow switch on the NetFPGA platform based on queue engineering.

    Science.gov (United States)

    Vu, Tran Hoang; Luc, Vu Cong; Quan, Nguyen Trung; Thanh, Nguyen Huu; Nam, Pham Ngoc

    2015-01-01

    Data centers play an important role in our daily activities. The increasing demand on data centers in both scale and size has led to huge energy consumption that rises the cost of data centers. Besides, environmental impacts also increase considerably due to a large amount of carbon emissions. In this paper, we present a design aimed at green networking by reducing the power consumption for routers and switches. Firstly, we design the Balance Switch on the NetFPGA platform to save consumed energy based on Queue Engineering. Secondly, we design the test-bed system to precisely measure the consumed energy of our switches. Experimental results show that energy saving of our switches is about 30% - 35% of power consumption according to variation of input traffic compared with normal Openflow Switch. Finally, we describe performance evaluations.

  13. The Program Administrator Cost of Saved Energy for Utility Customer-Funded Energy Efficiency Programs

    Energy Technology Data Exchange (ETDEWEB)

    Billingsley, Megan A.; Hoffman, Ian M.; Stuart, Elizabeth; Schiller, Steven R.; Goldman, Charles A.; LaCommare, Kristina

    2014-03-19

    construction, commercial/industrial custom rebate programs). In this report, the focus is on gross energy savings and the costs borne by the program administrator—including administration, payments to implementation contractors, marketing, incentives to program participants (end users) and both midstream and upstream trade allies, and evaluation costs. We collected data on net savings and costs incurred by program participants. However, there were insufficient data on participant cost contributions, and uncertainty and variability in the ways in which net savings were reported and defined across states (and program administrators).

  14. DETERMINING ENERGY SAVINGS IN BUILDINGS USING THE REDUCING COSTS METHOD

    Directory of Open Access Journals (Sweden)

    STAN IVAN F.E.

    2015-03-01

    Full Text Available The paper is structured in four parts. The first part presents the importance of thermal insulation for buildings energy economy and some insulation properties. In the second part of the paper it is described the reducing cost method to determine the energy savings. The third part of the paper includes an analysis and a comparison for an exterior wall provided with different thicknesses of insulation layer in order to determine the average savings cost. The last part presents conclusions and discussion.

  15. Feasibility of Achieving a Zero-Net-Energy, Zero-Net-Cost Homes

    Energy Technology Data Exchange (ETDEWEB)

    Al-Beaini, S.; Borgeson, S.; Coffery, B.; Gregory, D.; Konis, K.; Scown, C.; Simjanovic, J.; Stanley, J.; Strogen, B.; Walker, I.

    2009-09-01

    A green building competition, to be known as the Energy Free Home Challenge (EFHC), is scheduled to be opened to teams around the world in 2010. This competition will encourage both design innovation and cost reduction, by requiring design entries to meet 'zero net energy' and 'zero net cost' criteria. For the purposes of this competition, a 'zero net energy' home produces at least as much energy as it purchases over the course of a year, regardless of the time and form of the energy (e.g., electricity, heat, or fuel) consumed or produced. A 'zero net cost' home is no more expensive than a traditional home of comparable size and comfort, when evaluated over the course of a 30-year mortgage. In other words, the 'green premium' must have a payback period less than 30 years, based on the value of energy saved. The overarching goal of the competition is to develop affordable, high-performance homes that can be mass-produced at a large scale, and are able to meet occupant needs in harsh climates (as can be found where the competition will be held in Illinois). This report outlines the goals of the competition, and gauges their feasibility using both modeling results and published data. To ensure that the established rules are challenging, yet reasonable, this report seeks to refine the competition goals after exploring their feasibility through case studies, cost projections, and energy modeling. The authors of this report conducted a survey of the most progressive home energy-efficiency practices expected to appear in competition design submittals. In Appendix A, a summary can be found of recent projects throughout the United States, Canada, Germany, Switzerland, Sweden and Japan, where some of the most progressive technologies have been implemented. As with past energy efficient home projects, EFHC competitors will incorporate a multitude of energy efficiency measures into their home designs. The authors believe that

  16. Energy-saving wastewater treatment systems : formulation of cost functions

    OpenAIRE

    Nogueira, R.; Ferreira, I.; Janknecht, P; Rodríguez, Juan José; de Oliveira, Pedro; A. G. Brito

    2007-01-01

    Natural interactions between water, soil, atmosphere, plants and microorganisms include physical, chemical and biological processes with decontaminating capacities. Natural or energy-saving wastewater treatment systems utilize these processes and thereby enable a sustainable management in the field of wastewater treatment, offering low investment and operation costs, little or no energy consumption, little and low-skill labor requirements, good landscape integration and excellent ...

  17. Potential cost savings from generic medicines – protecting the ...

    African Journals Online (AJOL)

    One way to do this would be to limit the costs of medicines provided for the management of chronic conditions listed in the PMBs. This study assessed the potential savings that would be achievable by substituting generics for brand name (originator) medicines listed in the chronic disease algorithms set out by the CMS.

  18. Potential Energy Cost Savings from Increased Commercial Energy Code Compliance

    Energy Technology Data Exchange (ETDEWEB)

    Rosenberg, Michael I.; Hart, Philip R.; Athalye, Rahul A.; Zhang, Jian; Cohan, David F.

    2016-08-22

    An important question for commercial energy code compliance is: “How much energy cost savings can better compliance achieve?” This question is in sharp contrast to prior efforts that used a checklist of code requirements, each of which was graded pass or fail. Percent compliance for any given building was simply the percent of individual requirements that passed. A field investigation method is being developed that goes beyond the binary approach to determine how much energy cost savings is not realized. Prototype building simulations were used to estimate the energy cost impact of varying levels of non-compliance for newly constructed office buildings in climate zone 4C. Field data collected from actual buildings on specific conditions relative to code requirements was then applied to the simulation results to find the potential lost energy savings for a single building or for a sample of buildings. This new methodology was tested on nine office buildings in climate zone 4C. The amount of additional energy cost savings they could have achieved had they complied fully with the 2012 International Energy Conservation Code is determined. This paper will present the results of the test, lessons learned, describe follow-on research that is needed to verify that the methodology is both accurate and practical, and discuss the benefits that might accrue if the method were widely adopted.

  19. Permanent magnets in accelerators can save energy, space and cost

    DEFF Research Database (Denmark)

    Bødker, F.; Baandrup, L.O.; Hauge, N.

    2013-01-01

    Green Magnet® technology with close to zero electrical power consumption without the need for cooling water saves costs, space and natural resources. A compact dipole based on permanent magnets has been developed at Danfysik in collaboration with Sintex and Aarhus University. Our first Green Magnet...

  20. Disease prevention: saving lives or reducing health care costs?

    Directory of Open Access Journals (Sweden)

    Inge Grootjans-van Kampen

    Full Text Available BACKGROUND: Disease prevention has been claimed to reduce health care costs. However, preventing lethal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing diseases that reduce longevity increases health care costs while preventing non-fatal diseases could lead to health care savings. The objective of this research is to investigate if disease prevention could result in both increased longevity and lower lifetime health care costs. METHODS: Mortality rates for Netherlands in 2009 were used to construct cause-deleted life tables. Data originating from the Dutch Costs of Illness study was incorporated in order to estimate lifetime health care costs in the absence of selected disease categories. We took into account that for most diseases health care expenditures are concentrated in the last year of life. RESULTS: Elimination of diseases that reduce life expectancy considerably increase lifetime health care costs. Exemplary are neoplasms that, when eliminated would increase both life expectancy and lifetime health care spending with roughly 5% for men and women. Costs savings are incurred when prevention has only a small effect on longevity such as in the case of mental and behavioural disorders. Diseases of the circulatory system stand out as their elimination would increase life expectancy while reducing health care spending. CONCLUSION: The stronger the negative impact of a disease on longevity, the higher health care costs would be after elimination. Successful treatment of fatal diseases leaves less room for longevity gains due to effective prevention but more room for health care savings.

  1. Impact of pharmacist interventions on rational prophylactic antibiotic use and cost saving in elective cesarean section.

    Science.gov (United States)

    Wang, Jingwen; Dong, Mohan; Lu, Yang; Zhao, Xian; Li, Xin; Wen, Aidong

    2015-08-01

    To assess the impact of pharmacist interventions on rational use of prophylactic antibiotics and cost saving in elective cesarean section and the economic outcomes of implementing pharmacist interventions. A pre-to-post intervention design was applied to the practices of prophylactic antibiotic use in the department of gynecology and obstetrics in a Chinese tertiary hospital. Patients admitted during a 3-month period from June to August 2012 and during that from October to December 2012 undergoing elective cesarean section were assigned to the pre-intervention and the post-intervention group, respectively. Pharmacist interventions were performed in the post-intervention group, including obstetrician education, realtime monitoring of clinical records and making recommendations to obstetricians on prophylactic antibiotic prescription based on the criteria set at the beginning of the study. Data from the two groups were then compared to evaluate the outcomes of pharmacist interventions. Cost-outcome analysis was performed to determine the economic effect of implementing pharmacist interventions in preoperative antibiotic prophylaxis. Pharmacist interventions led to significant reductions in antibiotic usage cost/patient-day (p antibiotic cost (p antibiotics (p antibiotic use to the cost of pharmacist time was 27.23 : 1 and the net cost benefit was $65,255.84. This study provides evidence that pharmacist interventions promoted rational use of prophylactic antibiotics and substantial cost saving in elective cesarean section.

  2. Assessing the cost saving potential of shared product architectures

    DEFF Research Database (Denmark)

    Mortensen, Niels Henrik; Hansen, Christian Lindschou; Løkkegaard, Martin

    2016-01-01

    company. Experiences from the case company show it is possible to reduce the number of architectures with 60% which leads to significant reduction in direct material and labor costs. This can be achieved without compromising the market offerings of products. Experiences from the case study indicate cost......This article presents a method for calculating cost savings of shared architectures in industrial companies called Architecture Mapping and Evaluation. The main contribution is an operational method to evaluate the cost potential and evaluate the number of product architectures in an industrial...... reductions between 0.5% and 2% of turnover. The main implication is that the method provides a quantitative basis for the discussion on whether or not to implement shared product architectures. This means a more fact-based approach is introduced....

  3. Uncertainties in the Value of Bill Savings from Behind-the-Meter, Residential Photovoltaic Systems: The Roles of Electricity Market Conditions, Retail Rate Design, and Net Metering

    Science.gov (United States)

    Darghouth, Naim Richard

    Net metering has become a widespread policy mechanism in the U.S. for supporting customer adoption of distributed photovoltaics (PV), allowing customers with PV systems to reduce their electric bills by offsetting their consumption with PV generation, independent of the timing of the generation relative to consumption. Although net metering is one of the principal drivers for the residential PV market in the U.S., the academic literature on this policy has been sparse and this dissertation contributes to this emerging body of literature. This dissertation explores the linkages between the availability of net metering, wholesale electricity market conditions, retail rates, and the residential bill savings from behind-the-meter PV systems. First, I examine the value of the bill savings that customers receive under net metering and alternatives to net metering, and the associated role of retail rate design, based on current rates and a sample of approximately two hundred residential customers of California's two largest electric utilities. I find that the bill savings per kWh of PV electricity generated varies greatly, largely attributable to the increasing block structure of the California utilities' residential retail rates. I also find that net metering provides significantly greater bill savings than alternative compensation mechanisms based on avoided costs. However, retail electricity rates may shift as wholesale electricity market conditions change. I then investigate a potential change in market conditions -- increased solar PV penetrations -- on wholesale prices in the short-term based on the merit-order effect. This demonstrates the potential price effects of changes in market conditions, but also points to a number of methodological shortcomings of this method, motivating my usage of a long-term capacity investment and economic dispatch model to examine wholesale price effects of various wholesale market scenarios in the subsequent analysis. By developing

  4. Autonomous hip exoskeleton saves metabolic cost of walking uphill.

    Science.gov (United States)

    Seo, Keehong; Lee, Jusuk; Park, Young Jin

    2017-07-01

    We have developed a hip joint exoskeleton to boost gait function in the elderly and rehabilitation of post-stroke patients. To quantitatively evaluate the impact of the power and mass of the exoskeleton, we measured the metabolic cost of walking on slopes of 0, 5, and 10% grade, once not wearing the exoskeleton and then wearing it. The exoskeleton reduced the metabolic cost by 13.5,15.5 and 9.8% (31.9, 51.6 and 45.6 W) at 0, 5, and 10% grade, respectively. The exoskeleton performance index was computed as 0.97, 1.24, and 1.24 at each grade, implicating that the hip exoskeleton was more effective on slopes than level ground in saving the metabolic cost.

  5. Dialyzer reuse: justified cost saving for south Asian region.

    Science.gov (United States)

    Dhrolia, Murtaza F; Nasir, Kiran; Imtiaz, Salman; Ahmad, Aasim

    2014-08-01

    In spite of controversies, dialyzer reuse has remained an integral part of hemodialysis because of lower cost, good overall safety record, and improved membrane biocompatibility. Reuse declined in developed countries from the beginning of this century because of mass production of hemodialyzers at favourable price with better biocompatible membrane. Abandoning dialyzer reuse became challenging in South Asian region, where more than 40% of the population live below the International Poverty Line of $1.25 per day, less than 10% of end stage renal disease patients receive renal replacement therapy, and upto 70% of those starting dialysis stop treatment due to cost within the first 3 months. Dialyzer reuse is an efficient cost-saving method that allows the use of more efficient and expensive biocompatible synthetic membranes, thereby providing high-quality dialysis to individuals living in countries with limited medical resources without compromising the safety or effectiveness of the treatment.

  6. Save water to save carbon and money: developing abatement costs for expanded greenhouse gas reduction portfolios.

    Science.gov (United States)

    Stokes, Jennifer R; Hendrickson, Thomas P; Horvath, Arpad

    2014-12-02

    The water-energy nexus is of growing interest for researchers and policy makers because the two critical resources are interdependent. Their provision and consumption contribute to climate change through the release of greenhouse gases (GHGs). This research considers the potential for conserving both energy and water resources by measuring the life-cycle economic efficiency of greenhouse gas reductions through the water loss control technologies of pressure management and leak management. These costs are compared to other GHG abatement technologies: lighting, building insulation, electricity generation, and passenger transportation. Each cost is calculated using a bottom-up approach where regional and temporal variations for three different California water utilities are applied to all alternatives. The costs and abatement potential for each technology are displayed on an environmental abatement cost curve. The results reveal that water loss control can reduce GHGs at lower cost than other technologies and well below California's expected carbon trading price floor. One utility with an energy-intensive water supply could abate 135,000 Mg of GHGs between 2014 and 2035 and save--rather than spend--more than $130/Mg using the water loss control strategies evaluated. Water loss control technologies therefore should be considered in GHG abatement portfolios for utilities and policy makers.

  7. Compressed air systems. A guidebook on energy and cost savings

    Energy Technology Data Exchange (ETDEWEB)

    1984-03-30

    This guidebook shows how energy can be saved in compressed air systems. It discusses basic compressed air systems which are typical of those found in industry and describes them and the engineering practices behind them. Energy conservation recommendations follow. These recommendations cover equipment selection, design, maintenance, and operation. Included is information which will help the reader to make economic evaluations of various engineering and equipment alternatives as they affect operations and costs. The appendices include some modern computer based approaches to predicting pressure drop for designing compressed air distribution systems. Also included is a bibliography providing leads for further and more detailed technical information on these and related subjects.

  8. Cost savings from a teledentistry model for school dental screening: an Australian health system perspective.

    Science.gov (United States)

    Estai, Mohamed; Bunt, Stuart; Kanagasingam, Yogesan; Tennant, Marc

    2017-06-05

    to improve oral health and save significant resources. The use of role substitution, such as using MLDPs to provide oral care has been well acknowledged worldwide because of their ability to provide safe and effective care. The teledentistry approach for dental screening offers a comparable diagnostic performance to the traditional visual approach.What does this paper add? The results of the present study suggest that teledentistry is a practical and economically viable approach for mass dental screening not only for isolated communities, but also for underserved urban communities. The costs of the teledentistry model were substantially lower than the costs associated with a conventional, face-to-face approach to dental screening in both remote and urban areas. The primary driver of net savings is the low salary of MLDPs and avoidance of travel and overnight accommodation by MLDPs.What are the implications for practitioners? The use of lower-cost MLDPs and a teledentistry model for dental screening has the potential to save significant economic and human resources that can be redirected to improve infrastructure and oral care services in underserved regions. In the absence of evidence of the economic usefulness of teledentistry, studies such as the present one can increase the acceptance of this technology among dental care providers and guide future decisions on whether or not to implement teledentistry services.

  9. Consistent cost curves for identification of optimal energy savings across industry and residential sectors

    DEFF Research Database (Denmark)

    Klinge Jacobsen, Henrik; Baldini, Mattia

    Energy savings are a key element in reaching ambitious climate targets and may contribute to increased productivity as well. For identification of the most attractive saving options cost curves for savings are constructed illustrating potentials of savings with associated costs. In optimisation...... modelling these cost options are then compared with the cost of producing energy and all savings with negative costs and cost below the cost of producing the energy including the associated externality costs are expected to be implemented. There are however several methodological issues associated...... with constructing and applying the cost curves in modelling: • Cost curves do not have the same cost interpretation across economic subsectors and end-use technologies (investment cost for equipment varies – including/excluding installation – adaptation costs – indirect production costs) • The time issue of when...

  10. The Impact of Rate Design and Net Metering on the Bill Savings from Distributed PV for Residential Customers in California

    Energy Technology Data Exchange (ETDEWEB)

    Energy and Resources Group, University of California, Berkeley; Darghouth, Naim R.; Barbose, Galen; Wiser, Ryan

    2011-06-01

    Net metering has become a widespread mechanism in the U.S. for supporting customer adoption of distributed photovoltaics (PV), but has faced challenges as PV installations grow to a larger share of generation in a number of states. This paper examines the value of the bill savings that customers receive under net metering, and the associated role of retail rate design, based on a sample of approximately two hundred residential customers of California's two largest electric utilities. We find that the bill savings per kWh of PV electricity generated varies by more than a factor of four across the customers in the sample, which is largely attributable to the inclining block structure of the utilities' residential retail rates. We also compare the bill savings under net metering to that received under three potential alternative compensation mechanisms, based on California's Market Price Referent (MPR). We find that net metering provides significantly greater bill savings than a full MPR-based feed-in tariff, but only modestly greater savings than alternative mechanisms under which hourly or monthly net excess generation is compensated at the MPR rate.

  11. The Net Physiological Cost of Dribbling a Soccer Ball.

    Science.gov (United States)

    Reilly, Thomas; Ball, David

    1984-01-01

    To establish the net energy cost of dribbling a soccer ball, eight males ran on a treadmill while dribbling a ball against a rebound box. Oxygen uptake, perceived exertion, and blood lactate levels were measured and compared with results from subjects running without dribbling. Results are discussed. (Author/DF)

  12. Spending to save

    DEFF Research Database (Denmark)

    Larsen, Anders

    2013-01-01

    framework and guidelines for the following EEO period, i.e. 2013-2020. This paper focuses on the net savings impact and describes the evaluation method used to determine this. Three complementary analyses are described: 1) An analysis of the additionality of the reported saving, 2) an analysis...... the energy distribution companies meet their overall saving obligation, the net savings impact are about a third of the savings reported by the obligated parties. Further it was found that while energy savings in the public and business sector have a high net impact, some subsidies given under the EEO...... are inappropriately high. The net impact in the residential sector, on the other hand, was found to be very low. The evaluation recommended that the new EEO design addresses the additionality issues in order to ensure that savings realised in the residential sector are more cost-effective from a socioeconomic...

  13. Reported Energy and Cost Savings from the DOE ESPC Program: FY 2014

    Energy Technology Data Exchange (ETDEWEB)

    Slattery, Bob S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-03-01

    The objective of this work was to determine the realization rate of energy and cost savings from the Department of Energy’s Energy Savings Performance Contract (ESPC) program based on information reported by the energy services companies (ESCOs) that are carrying out ESPC projects at federal sites. Information was extracted from 156 Measurement and Verification (M&V) reports to determine reported, estimated, and guaranteed cost savings and reported and estimated energy savings for the previous contract year. Because the quality of the reports varied, it was not possible to determine all of these parameters for each project. For all 156 projects, there was sufficient information to compare estimated, reported, and guaranteed cost savings. For this group, the total estimated cost savings for the reporting periods addressed were $210.6 million, total reported cost savings were $215.1 million, and total guaranteed cost savings were $204.5 million. This means that on average: ESPC contractors guaranteed 97% of the estimated cost savings; projects reported achieving 102% of the estimated cost savings; and projects reported achieving 105% of the guaranteed cost savings. For 155 of the projects examined, there was sufficient information to compare estimated and reported energy savings. On the basis of site energy, estimated savings for those projects for the previous year totaled 11.938 million MMBtu, and reported savings were 12.138 million MMBtu, 101.7% of the estimated energy savings. On the basis of source energy, total estimated energy savings for the 155 projects were 19.052 million MMBtu, and reported saving were 19.516 million MMBtu, 102.4% of the estimated energy savings.

  14. Energy cost saving strategies in distributed power networks

    Directory of Open Access Journals (Sweden)

    Tcheukam Alain

    2016-01-01

    Full Text Available In this paper we study energy cost saving strategies in power networks in presence of prosumers. Three tips are considered: (i distributed power network architecture, (ii peak energy shaving with the integration of prosumers’ contribution, (iii Electric vehicles self-charging by means of prosumers’ production. The proposed distributed power network architecture reduces significantly the transmission costs and can reduce significantly the global energy cost up to 42 percent. Different types of prosumer who use self-charging photovoltaic systems, are able to intelligently buy energy from, or sell it, to the power grid. Therein, prosumers interact in a distributed environment during the purchase or sale of electric power using a double auction with negotiation mechanism. Using a two-step combined learning and optimization scheme, each prosumer can learn its optimal bidding strategy and forecast its energy production, consumption and storage. Our simulation results, conducted for the region of Sicily in Italy, show that the integration of prosumers can reduce peak hour costs up to 19 percent and 6 percent for eligible prosumers with electric vehicles.

  15. Medication nonadherence in diabetes: longitudinal effects on costs and potential cost savings from improvement.

    Science.gov (United States)

    Egede, Leonard E; Gebregziabher, Mulugeta; Dismuke, Clara E; Lynch, Cheryl P; Axon, R Neal; Zhao, Yumin; Mauldin, Patrick D

    2012-12-01

    To examine the longitudinal effects of medication nonadherence (MNA) on key costs and estimate potential savings from increased adherence using a novel methodology that accounts for shared correlation among cost categories. Veterans with type 2 diabetes (740,195) were followed from January 2002 until death, loss to follow-up, or December 2006. A novel multivariate, generalized, linear, mixed modeling approach was used to assess the differential effect of MNA, defined as medication possession ratio (MPR) ≥0.8 on healthcare costs. A sensitivity analysis was performed to assess potential cost savings at different MNA levels using the Consumer Price Index to adjust estimates to 2012 dollar value. Mean MPR for the full sample over 5 years was 0.78, with a mean of 0.93 for the adherent group and 0.58 for the MNA group. In fully adjusted models, all annual cost categories increased ∼3% per year (P = 0.001) during the 5-year study time period. MNA was associated with a 37% lower pharmacy cost, 7% lower outpatient cost, and 41% higher inpatient cost. Based on sensitivity analyses, improving adherence in the MNA group would result in annual estimated cost savings ranging from ∼$661 million (MPR <0.6 vs. ≥0.6) to ∼$1.16 billion (MPR <1 vs. 1). Maximal incremental annual savings would occur by raising MPR from <0.8 to ≥0.8 ($204,530,778) among MNA subjects. Aggressive strategies and policies are needed to achieve optimal medication adherence in diabetes. Such approaches may further the so-called "triple aim" of achieving better health, better quality care, and lower cost.

  16. The Impact of Rate Design and Net Metering on the Bill Savings from Distributed PV for Residential Customers in California

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim; Barbose, Galen; Wiser, Ryan

    2010-03-30

    Net metering has become a widespread policy in the U.S. for supporting distributed photovoltaics (PV) adoption. Though specific design details vary, net metering allows customers with PV to reduce their electric bills by offsetting their consumption with PV generation, independent of the timing of the generation relative to consumption - in effect, compensating the PV generation at retail electricity rates (Rose et al. 2009). While net metering has played an important role in jump-starting the residential PV market in the U.S., challenges to net metering policies have emerged in a number of states and contexts, and alternative compensation methods are under consideration. Moreover, one inherent feature of net metering is that the value of the utility bill savings it provides to customers with PV depends heavily on the structure of the underlying retail electricity rate, as well as on the characteristics of the customer and PV system. Consequently, the value of net metering - and the impact of moving to alternative compensation mechanisms - can vary substantially from one customer to the next. For these reasons, it is important for policymakers and others that seek to support the development of distributed PV to understand both how the bill savings varies under net metering, and how the bill savings under net metering compares to other possible compensation mechanisms. To advance this understanding, we analyze the bill savings from PV for residential customers of California's two largest electric utilities, Pacific Gas and Electric (PG&E) and Southern California Edison (SCE). The analysis is based on hourly load data from a sample of 215 residential customers located in the service territories of the two utilities, matched with simulated hourly PV production for the same time period based on data from the nearest of 73 weather stations in the state.

  17. Evaluation of energy and cost savings in mobile Cloud RAN

    DEFF Research Database (Denmark)

    Checko, Aleksandra; Christiansen, Henrik Lehrmann; Berger, Michael Stübert

    2013-01-01

    The load in mobile networks is subject to variations during the day, due to user mobility and varying network average usage. Therefore, the traditional or Distributed Radio Access Network (D-RAN) architecture, where the BaseBand processing Units (BBUs) are assigned statically to a number of cells...... using OPNET Modeler. A real case scenario is built upon the mobile traffic forecast for year 2017, a number of recommendations on traffic models and a proposed C-RAN implementation. The results achieved show that the maximum statistical multiplexing gain for user plane traffic in C-RAN architecture is 4......, is sub optimal, comparing to a novel, cloud based architecture called Cloud Radio Access Network (C-RAN). In C-RAN a group of cells shares processing resources, and hence benefit from statistical multiplexing gain is expected. In this paper, the energy and cost savings in C-RAN are evaluated numerically...

  18. Low inflation, a high net savings surplus and institutional restrictions keep the Japanese long-term interest rate low

    NARCIS (Netherlands)

    Jansen, Pieter W.

    2006-01-01

    This paper explains that the interest rate on long-term Japanese government bonds is low in comparison with other industrialised countries for four main reasons: lower inflation, net savings surplus, institutional restrictions and home bias. Monetary policy and institutionalised purchases of

  19. Energy Consumption and Saving Analysis for Laser Engineered Net Shaping of Metal Powders

    Directory of Open Access Journals (Sweden)

    Zhichao Liu

    2016-09-01

    Full Text Available With the increasing awareness of environmental protection and sustainable manufacturing, the environmental impact of laser additive manufacturing (LAM technology has been attracting more and more attention. Aiming to quantitatively analyze the energy consumption and extract possible ways to save energy during the LAM process, this investigation studies the effects of input variables including laser power, scanning speed, and powder feed rate on the overall energy consumption during the laser deposition processes. Considering microhardness as a standard quality, the energy consumption of unit deposition volume (ECUDV, in J/mm3 is proposed as a measure for the average applied energy of the fabricated metal part. The potential energy-saving benefits of the ultrasonic vibration–assisted laser engineering net shaping (LENS process are also examined in this paper. The experimental results suggest that the theoretical and actual values of the energy consumption present different trends along with the same input variables. It is possible to reduce the energy consumption and, at the same time, maintain a good part quality and the optimal combination of the parameters referring to Inconel 718 as a material is laser power of 300 W, scanning speed of 8.47 mm/s and powder feed rate of 4 rpm. When the geometry shaping and microhardness are selected as evaluating criterions, American Iron and Steel Institute (AISI 4140 powder will cause the largest energy consumption per unit volume. The ultrasonic vibration–assisted LENS process cannot only improve the clad quality, but can also decrease the energy consumption to a considerable extent.

  20. Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.

    Science.gov (United States)

    Horwitz, Jill R; Kelly, Brenna D; DiNardo, John E

    2013-03-01

    The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.

  1. Energy efficiency improvement and cost saving opportunities forpetroleum refineries

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Galitsky, Christina

    2005-02-15

    The petroleum refining industry in the United States is the largest in the world, providing inputs to virtually any economic sector,including the transport sector and the chemical industry. The industry operates 146 refineries (as of January 2004) around the country,employing over 65,000 employees. The refining industry produces a mix of products with a total value exceeding $151 billion. Refineries spend typically 50 percent of cash operating costs (i.e., excluding capital costs and depreciation) on energy, making energy a major cost factor and also an important opportunity for cost reduction. Energy use is also a major source of emissions in the refinery industry making energy efficiency improvement an attractive opportunity to reduce emissions and operating costs. Voluntary government programs aim to assist industry to improve competitiveness through increased energy efficiency and reduced environmental impact. ENERGY STAR (R), a voluntary program managed by the U.S. Environmental Protection Agency, stresses the need for strong and strategic corporate energy management programs. ENERGY STAR provides energy management tools and strategies for successful corporate energy management programs. This Energy Guide describes research conducted to support ENERGY STAR and its work with the petroleum refining industry.This research provides information on potential energy efficiency opportunities for petroleum refineries. This Energy Guide introduces energy efficiency opportunities available for petroleum refineries. It begins with descriptions of the trends, structure, and production of the refining industry and the energy used in the refining and conversion processes. Specific energy savings for each energy efficiency measure based on case studies of plants and references to technical literature are provided. If available, typical payback periods are also listed. The Energy Guide draws upon the experiences with energy efficiency measures of petroleum refineries worldwide

  2. Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.

    Science.gov (United States)

    Frost, Jennifer J; Sonfield, Adam; Zolna, Mia R; Finer, Lawrence B

    2014-12-01

    Policy Points: The US publicly supported family planning effort serves millions of women and men each year, and this analysis provides new estimates of its positive impact on a wide range of health outcomes and its net savings to the government. The public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low birth weight births. This investment resulted in net government savings of $13.6 billion in 2010, or $7.09 for every public dollar spent. Each year the United States' publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99

  3. Cost-Savings and Economic Benefits due to the Assistive Robotic Manipulator (ARM)

    NARCIS (Netherlands)

    Römer, G.R.B.E.; Stuyt, Harry J.A.; Peters, Albér

    2005-01-01

    Besides the social and personal benefits of a rehabilitation robot, the direct cost-savings and other (indirect) economic benefits, or effectiveness, are of major importance to party who pays for (or reimburses) the rehabilitation robot. This paper gives an overview of these cost-savings and, on a

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

    Science.gov (United States)

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

    2017-11-07

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

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

    DEFF Research Database (Denmark)

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

    2005-01-01

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

  6. Lives saved from malaria prevention in Africa--evidence to sustain cost-effective gains

    Directory of Open Access Journals (Sweden)

    Korenromp Eline L

    2012-03-01

    Full Text Available Abstract Lives saved have become a standard metric to express health benefits across interventions and diseases. Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved tool (LiST, extrapolating effectiveness estimates from community-randomized trials of scale-up of insecticide-treated nets (ITNs in the 1990s, confirm the substantial impact and good cost-effectiveness that ITNs have achieved in high-endemic sub-Saharan Africa. An even higher cost-effectiveness would likely have been found if the modelling had included the additional indirect mortality impact of ITNs on preventing deaths from other common child illnesses, to which malaria contributes as a risk factor. As conventional ITNs are being replaced by long-lasting insecticidal nets and scale-up is expanded to target universal coverage for full, all-age populations at risk, enhanced transmission reduction may--above certain thresholds--enhance the mortality impact beyond that observed in the trials of the 1990s. On the other hand, lives saved by ITNs might fall if improved malaria case management with artemisinin-based combination therapy averts the deaths that ITNs would otherwise prevent. Validation and updating of LiST's simple assumption of a universal, fixed coverage-to-mortality-reduction ratio will require enhanced national programme and impact monitoring and evaluation. Key indicators for time trend analysis include malaria-related mortality from population-based surveys and vital registration, vector control and treatment coverage from surveys, and parasitologically-confirmed malaria cases and deaths recorded in health facilities. Indispensable is triangulation with dynamic transmission models, fitted to long-term trend data on vector, parasite and human populations over successive phases of malaria control and elimination. Sound, locally optimized budget allocation including on monitoring and evaluation priorities will benefit much if policy

  7. Lives saved from malaria prevention in Africa--evidence to sustain cost-effective gains.

    Science.gov (United States)

    Korenromp, Eline L

    2012-03-28

    Lives saved have become a standard metric to express health benefits across interventions and diseases. Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved tool (LiST), extrapolating effectiveness estimates from community-randomized trials of scale-up of insecticide-treated nets (ITNs) in the 1990s, confirm the substantial impact and good cost-effectiveness that ITNs have achieved in high-endemic sub-Saharan Africa. An even higher cost-effectiveness would likely have been found if the modelling had included the additional indirect mortality impact of ITNs on preventing deaths from other common child illnesses, to which malaria contributes as a risk factor. As conventional ITNs are being replaced by long-lasting insecticidal nets and scale-up is expanded to target universal coverage for full, all-age populations at risk, enhanced transmission reduction may--above certain thresholds--enhance the mortality impact beyond that observed in the trials of the 1990s. On the other hand, lives saved by ITNs might fall if improved malaria case management with artemisinin-based combination therapy averts the deaths that ITNs would otherwise prevent.Validation and updating of LiST's simple assumption of a universal, fixed coverage-to-mortality-reduction ratio will require enhanced national programme and impact monitoring and evaluation. Key indicators for time trend analysis include malaria-related mortality from population-based surveys and vital registration, vector control and treatment coverage from surveys, and parasitologically-confirmed malaria cases and deaths recorded in health facilities. Indispensable is triangulation with dynamic transmission models, fitted to long-term trend data on vector, parasite and human populations over successive phases of malaria control and elimination.Sound, locally optimized budget allocation including on monitoring and evaluation priorities will benefit much if policy makers and programme planners

  8. Costs and cost-effectiveness of vector control in Eritrea using insecticide-treated bed nets.

    Science.gov (United States)

    Yukich, Joshua O; Zerom, Mehari; Ghebremeskel, Tewolde; Tediosi, Fabrizio; Lengeler, Christian

    2009-03-30

    While insecticide-treated nets (ITNs) are a recognized effective method for preventing malaria, there has been an extensive debate in recent years about the best large-scale implementation strategy. Implementation costs and cost-effectiveness are important elements to consider when planning ITN programmes, but so far little information on these aspects is available from national programmes. This study uses a standardized methodology, as part of a larger comparative study, to collect cost data and cost-effectiveness estimates from a large programme providing ITNs at the community level and ante-natal care facilities in Eritrea. This is a unique model of ITN implementation fully integrated into the public health system. Base case analysis results indicated that the average annual cost of ITN delivery (2005 USD 3.98) was very attractive when compared with past ITN delivery studies at different scales. Financing was largely from donor sources though the Eritrean government and net users also contributed funding. The intervention's cost-effectiveness was in a highly attractive range for sub-Saharan Africa. The cost per DALY averted was USD 13 - 44. The cost per death averted was USD 438-1449. Distribution of nets coincided with significant increases in coverage and usage of nets nationwide, approaching or exceeding international targets in some areas. ITNs can be cost-effectively delivered at a large scale in sub-Saharan Africa through a distribution system that is highly integrated into the health system. Operating and sustaining such a system still requires strong donor funding and support as well as a functional and extensive system of health facilities and community health workers already in place.

  9. Implementation of a shared-savings program for surgical supplies decreases inventory cost.

    Science.gov (United States)

    Eiferman, Daniel; Bhakta, Ankur; Khan, Safdar

    2015-10-01

    Management of operating room inventory has substantial cost-saving opportunities if surgeons agree to standardize supplies used to perform procedures; however, there is no incentive for surgeons to participate in these decisions, because the cost-savings are realized only by the hospital, not the practitioner. In an attempt to engage surgeons with the management of the operating room supply chain, a shared-savings programs was instituted that returned 50% of money saved to the surgery divisions. Opportunities for savings in the use of biologic mesh, cranial plating systems, and neurostimulators was identified. Each item was assigned a physician champion responsible for ensuring that there was clinical equipoise between the products being used. Any cost-savings realized during the fiscal year were shared 50-50 between the hospital and the surgery divisions. The total cost-savings was $893,865 with $446,932 being shared across 15 surgery divisions. Standardization of cranial plating systems ($374,805) generated the greatest amounts of savings followed by neurostimulators ($278,404) and biologic mesh ($240,655). Aligning hospital and surgeon incentives led to dramatic cost-savings and standardization of the operative inventory used. Quality of care is not compromised by this approach, and no conflicts of interest are created. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Can Additional Homeopathic Treatment Save Costs? A Retrospective Cost-Analysis Based on 44500 Insured Persons.

    Directory of Open Access Journals (Sweden)

    Julia K Ostermann

    Full Text Available The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group with the costs for those receiving usual care (control group.Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache.Data from 44,550 patients (67.3% females were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29] than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001 with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37] and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]. Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.

  11. Reported Energy and Cost Savings from the DOE ESPC Program: FY 2015

    Energy Technology Data Exchange (ETDEWEB)

    Slattery, Bob S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2017-01-01

    The objective of this work was to determine the realization rate of energy and cost savings from the Department of Energy’s Energy Savings Performance Contract (ESPC) program based on information reported by the energy services companies (ESCOs) that are carrying out ESPC projects at federal sites. Information was extracted from 151 Measurement and Verification (M&V) reports to determine reported, estimated, and guaranteed cost savings and reported and estimated energy savings for the previous contract year. Because the quality of the reports varied, it was not possible to determine all of these parameters for each project.

  12. Potential for the Use of Energy Savings Performance Contracts to Reduce Energy Consumption and Provide Energy and Cost Savings in Non-Building Applications

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Charles; Green, Andrew S.; Dahle, Douglas; Barnett, John; Butler, Pat; Kerner, David

    2013-08-01

    The findings of this study indicate that potential exists in non-building applications to save energy and costs. This potential could save billions of federal dollars, reduce reliance on fossil fuels, increase energy independence and security, and reduce greenhouse gas emissions. The Federal Government has nearly twenty years of experience with achieving similar energy cost reductions, and letting the energy costs savings pay for themselves, by applying energy savings performance contracts (ESPC) inits buildings. Currently, the application of ESPCs is limited by statute to federal buildings. This study indicates that ESPCs can be a compatible and effective contracting tool for achieving savings in non-building applications.

  13. Relationship Between Timing of Multiple Retention Bonuses and the Quality of Officers Retained on the Cost Savings for the Navy

    Science.gov (United States)

    2016-12-01

    BETWEEN TIMING OF MULTIPLE RETENTION BONUSES AND THE QUALITY OF OFFICERS RETAINED ON THE COST SAVINGS FOR THE NAVY by Marley E. Cassels...RETENTION BONUSES AND THE QUALITY OF OFFICERS RETAINED ON THE COST SAVINGS FOR THE NAVY 5. FUNDING NUMBERS 6. AUTHOR(S) Marley E. Cassels 7...objectives and providing cost savings. We found that a quality auction system could provide cost savings as much as $1,850,000 or could increase costs by

  14. The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

    Science.gov (United States)

    Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace

    2017-12-15

    To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient

  15. The Energy Smart Guide to Campus Cost Savings.

    Science.gov (United States)

    Department of Energy, Washington, DC. Office of Energy Efficiency and Renewable Energy.

    Rebuild America is a program of the U.S. Department of Energy that focuses on energy-savings solutions as community solutions. It works with K-12 schools, colleges and universities, state and local governments, public and multifamily housing, and commercial buildings. This guide focuses on colleges and universities. Each chapter spells out options…

  16. Purging energy costs. [Energy savings in ammonia refrigeration system

    Energy Technology Data Exchange (ETDEWEB)

    Whitwell, Ian (Energy Technology Support Unit, Harwell (United Kingdom))

    1992-09-01

    Energy savings of over Pound 8,000 per year have been achieved by Exel Logistics, which has installed a five-point automatic purger to the evaporative condenser and receiver of the ammonia refrigeration system at its Glasgow service depot. The main features of the system are described in this article. (Author).

  17. Potential Cost Savings from Generic Medicines - Protecting the ...

    African Journals Online (AJOL)

    Background: South Africa has followed a pro-generic policy since the introduction of the National Drug Policy in 1996. ... This study assessed the potential savings that would be achievable by substituting generics for brand name (originator) medicines listed in the chronic disease algorithms set out by the Council for ...

  18. Incorrect storage of medicines and potential for cost savings

    DEFF Research Database (Denmark)

    Colberg, Lene; Schmidt-Petersen, Lone; Hansen, Merete Kock

    2017-01-01

    Objective Incorrect storage and handling of refrigerated medicines may result in destruction of medicines and financial loss for hospitals. At the Medicine Information Centre we receive and answer queries on drug-related issues. In this study we aimed to investigate and quantify savings made foll...

  19. Maximizing Residential Energy Savings: Net Zero Energy House (ZEH) Technology Pathways

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, R.; Roberts, D.

    2008-11-01

    To meet current U.S. Department of Energy zero-energy home performance goals, new technologies and solutions must increase whole-house efficiency savings by an additional 40% relative to those provided by best available components and systems.

  20. Heat savings and heat generation technologies: Modelling of residential investment behaviour with local health costs

    DEFF Research Database (Denmark)

    Zvingilaite, Erika; Klinge Jacobsen, Henrik

    2015-01-01

    The trade-off between investing in energy savings and investing in individual heating technologies with high investment and low variable costs in single family houses is modelled for a number of building and consumer categories in Denmark. For each group the private economic cost of providing...... heating comfort is minimised. The private solution may deviate from the socio-economical optimal solution and we suggest changes to policy to incentivise the individuals to make choices more in line with the socio-economic optimal mix of energy savings and technologies. The households can combine...... to a combination of low costs of primary fuel and low environmental performance of woodstoves today, included health costs lead to decreased use of secondary heating. Overall the interdependence of heat generation technology- and heat saving-choice is significant. The total optimal level of heat savings...

  1. Impact of a Novel Cost-Saving Pharmacy Program on Pregabalin Use and Health Care Costs.

    Science.gov (United States)

    Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia

    2016-02-01

    Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di

  2. The SmokingPaST Framework: illustrating the impact of quit attempts, quit methods, and new smokers on smoking prevalence, years of life saved, medical costs saved, programming costs, cost effectiveness, and return on investment.

    Science.gov (United States)

    O'Donnell, Michael P; Roizen, Michael F

    2011-01-01

    Describe the specifications of the Smoking Prevalence, Savings, and Treatment (SmokingPaST) Framework and show how it can illustrate the impact of quit attempts, quit method, number of new smokers, smoking rates of immigrants and emigrants, and death rates of smokers and nonsmokers on future smoking prevalence rates, program costs, years of life saved, medical costs saved, cost effectiveness of programs, and return on investment (ROI). FRAMEWORK SPECIFICATIONS: Mathematical relationships among factors in SmokingPaST are described. Input variables include baseline smoking rates among current adults, new adults, immigrants, and emigrants; population counts for these groups; annual quit attempts; and distribution of quit methods. Assumption variables include success rate by quit method, death rates of smokers and nonsmokers, annual medical costs of smoking, costs per person for four tobacco treatment methods, age distribution of quitters, and distribution of medical cost funding by source. Output variables include year-end adult smoking rates, successful quitters, years of life saved by quitting, medical costs saved by quitting and by not hiring smokers, total costs of smoking treatment programs, cost per quitter, cost per life-year saved, distribution of medical cost savings from quitting, and ROI of treatment costs. The Framework was applied at the employer, county, state, and national levels. The SmokingPaST Framework provides a conceptually simple framework that can be applied to any population. It illustrates that significant drops in smoking rates can be achieved and significant savings in medical costs can be captured by employers as well as state and federal governments through tobacco treatment and prevention programs. Savings are especially important for reducing state and federal government deficits and enhancing job competitiveness.

  3. Directions of organisational and low-cost energy saving of engineering enterprises

    Directory of Open Access Journals (Sweden)

    Dzhedzhula Viacheslav V.

    2014-01-01

    Full Text Available The article analyses directions of energy saving of industrial enterprises. Taking into account the tendency to continuous growth of cost of energy resources, introduction of measures that would allow reduction of energy consumption of enterprises is an urgent task. One of the most important obstacles in the process of introduction of energy efficient solutions are fund limits and low awareness of owners and managers of industrial enterprises. The article offers a new classification of energy saving measures: apart from traditional expense and organisation measures it introduces the low-cost measures notion. It offers to consider low-cost those measures that are realised by the enterprise by means of own funds, moreover, their repayment term is not more than one year. It offers analytical expression for identification of annual funds saving from introduction of low-cost measures. It considers the process of identification of saving of funds from introduction of some of the main low-cost measures in detail: replacement of lighting units, balancing of ventilation networks and elimination of water leakages from pipelines and water supply equipment. Based on the analysis of bibliography information the article provides a list of main measures on energy saving, which could be referred to the low-cost ones. The proposed approaches would allow paying more attention to practical aspects of realisation of the concept of energy saving in the industry.

  4. Variable speed drives principles and applications for energy cost savings

    CERN Document Server

    Spitzer, David William

    2014-01-01

    Simply put, a variable speed drive is a controller that allows a motor and its associated equipment to run at different speeds depending upon automated input from an industrial process. That in turn provides the ability to provide smoother operations, and most importantly, energy savings by slowing down machinery when a process does not have to run at full speed. Long a leading book on this technology, this new edition by industry authority David William Spitzer provides insights to improving the applications of variable speed drives. Whether you have basic knowledge or advanced knowledge, you will find this book to be an extremely useful introduction to how variable speed drivers work, how they are best applied, and what to do and what to avoid when employing them as part of an overall automated industrial enterprise, all with an eye on energy savings. Inside, you will find: A basic overview of electrical, hydraulic, and instrumentation principles of variable speed drives. Coverage of the role that variabl...

  5. Evaluation of the Super ESPC Program: Level 2 -- Recalculated Cost Savings

    Energy Technology Data Exchange (ETDEWEB)

    Shonder, John A [ORNL; Hughes, Patrick [ORNL

    2009-04-01

    This report presents the results of Level 2 of a three-tiered evaluation of the U.S. Department of Energy Federal Energy Management Program's Super Energy Savings Performance Contract (Super ESPC) Program. Level 1 of the analysis studied all of the Super ESPC projects for which at least one Annual Measurement & Verification (M&V) Report had been produced by April 2006. For those 102 projects in aggregate, we found that the value of cost savings reported by the energy service company (ESCO) in the Annual M&V Reports was 108% of the cost savings guaranteed in the contracts. We also compared estimated energy savings (which are not guaranteed, but are the basis for the guaranteed cost savings) to the energy savings reported by the ESCO in the Annual M&V Report. In aggregate, reported energy savings were 99.8% of estimated energy savings on the basis of site energy, or 102% of estimated energy savings based on source energy. Level 2 focused on a random sample of 27 projects taken from the 102 Super ESPC projects studied in Level 1. The objectives were, for each project in the sample, to: repeat the calculations of the annual energy and cost savings in the most recent Annual M&V Report to validate the ESCO's results or correct any errors, and recalculate the value of the reported energy, water, and operations and maintenance (O&M) savings using actual utility prices paid at the project site instead of the 'contract' energy prices - the prices that are established in the project contract as those to be used by the ESCO to calculate the annual cost savings, which determine whether the guarantee has been met. Level 3 analysis will be conducted on three to five projects from the Level 2 sample that meet validity criteria for whole-building or whole-facility data analysis. This effort will verify energy and cost savings using statistical analysis of actual utility use, cost, and weather data. This approach, which can only be used for projects meeting

  6. Saving on design doesn't save money, life-cycle costing studies show.

    Science.gov (United States)

    Sprague, J G

    1982-09-01

    Design and energy management decisions significantly affect both initial construction and ongoing operation costs. Because of their importance, they are examined in this article, which also provides some general background concerning construction project development and typical fees expected by architect/engineers and construction managers.

  7. Potential Medicaid Cost Savings from Maternity Care Based..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce...

  8. Disease Prevention : Saving Lives or Reducing Health Care Costs?

    NARCIS (Netherlands)

    Grootjans-van Kampen, I.; Engelfriet, P.M.; Van Baal, P.H.M.

    2014-01-01

    Background Disease prevention has been claimed to reduce health care costs. However, preventing lethal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing diseases that reduce longevity increases

  9. Cost savings from performance-based maintenance contracting

    NARCIS (Netherlands)

    Straub, A.

    2009-01-01

    New procurement approaches combined with performance-based building approaches should reduce costs, but empirical qualitative and quantitative studies are lacking. Performance-based maintenance contracts give maintenance suppliers incentives to improve their way of working. Innovative,

  10. THAAD radar: examination of a cost saving initiative

    OpenAIRE

    Lewis, John W.

    1999-01-01

    Approved for public release; distribution is unlimited This thesis analyzes two acquisition reform initiatives that made Theater High Altitude Area Defense (THAAD) Radar Product Office's Best of Breed Transmit/Receive Module study a success and examines the risk involved in the pursuit of this study. The initiatives are Cost As an Independent Variable (CAIV) and commercial items in the form of dual-use technology. Analysis of the radar subsystem of THAAD reveals a major cost driver to be t...

  11. 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?

  12. Solar thermal technology development: Estimated market size and energy cost savings. Volume 1: Executive summary

    Science.gov (United States)

    Gates, W. R.

    1983-02-01

    Estimated future energy cost savings associated with the development of cost-competitive solar thermal technologies (STT) are discussed. Analysis is restricted to STT in electric applications for 16 high-insolation/high-energy-price states. The fuel price scenarios and three 1990 STT system costs are considered, reflecting uncertainty over future fuel prices and STT cost projections. STT R&D is found to be unacceptably risky for private industry in the absence of federal support. Energy cost savings were projected to range from $0 to $10 billion (1990 values in 1981 dollars), dependng on the system cost and fuel price scenario. Normal R&D investment risks are accentuated because the Organization of Petroleum Exporting Countries (OPEC) cartel can artificially manipulate oil prices and undercut growth of alternative energy sources. Federal participation in STT R&D to help capture the potential benefits of developing cost-competitive STT was found to be in the national interest.

  13. Green Energy in New Construction: Maximize Energy Savings and Minimize Cost

    Science.gov (United States)

    Ventresca, Joseph

    2010-01-01

    People often use the term "green energy" to refer to alternative energy technologies. But green energy doesn't guarantee maximum energy savings at a minimum cost--a common misconception. For school business officials, green energy means getting the lowest energy bills for the lowest construction cost, which translates into maximizing green energy…

  14. On the assessment of marginal life saving costs for risk acceptance criteria

    DEFF Research Database (Denmark)

    Fischer, Katharina; Virguez, Edgar; Sánchez-Silva, Mauricio

    2013-01-01

    : The definition of the marginal life saving costs, the discount rate used for comparing costs and benefits that accrue at different points in time and the time horizon over which future consequences of the decision are taken into account. In the present paper these issues are discussed based on a clear...

  15. Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD: MaineCare (Medicaid Cost Savings

    Directory of Open Access Journals (Sweden)

    Michael P. Towey

    2012-06-01

    Full Text Available This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent MaineCare patients consecutively referred to Waldo County General Hospital (WCGH with suspected diagnosis of Vocal Cord Dysfunction (VCD were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice.  The study suggests that without access to speech therapy telepractice for patients with VCD, the ongoing medical costs to MaineCare will be ongoing and significant.

  16. Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD): MaineCare (Medicaid) Cost Savings.

    Science.gov (United States)

    Towey, Michael P

    2012-01-01

    This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid) directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent) MaineCare patients consecutively referred to Waldo County General Hospital (WCGH) with suspected diagnosis of Vocal Cord Dysfunction (VCD) were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice. The study suggests that without access to speech therapy telepractice for patients with VCD, the medical costs to MaineCare will be ongoing and significant.

  17. Potential cost savings from generic medicines – protecting the ...

    African Journals Online (AJOL)

    Results: Three of the algorithms (diabetes insipidus, haemophilia and hypothyroidism) list medicines for which no generic equivalent was available at the time of the study. The median cost differential between brand and generic equivalents for the remaining 22 chronic conditions ranged from 19.5%. (for type 1 diabetes ...

  18. Disease prevention: Saving lives or reducing health care costs?

    NARCIS (Netherlands)

    I.G.-V. Kampen (Inge Grootjans-Van); P.M. Engelfriet (Peter); P.H.M. Van Baal (Pieter)

    2014-01-01

    textabstractBackground: Disease prevention has been claimed to reduce health care costs. However, preventing lethal diseases increases life expectancy and, thereby, indirectly increases the demand for health care. Previous studies have argued that on balance preventing diseases that reduce longevity

  19. Rightsizing HVAC Systems to Reduce Capital Costs and Save Energy

    Science.gov (United States)

    Sebesta, James

    2010-01-01

    Nearly every institution is faced with the situation of having to reduce the cost of a construction project from time to time through a process generally referred to as "value engineering." Just the mention of those words, however, gives rise to all types of connotations, thoughts, and memories (usually negative) for those in the…

  20. Pressure sores in spinal cord injury: Active intervention saves costs ...

    African Journals Online (AJOL)

    Summary. Pressure sores are a predictable consequence of poorly managed spinal cord-injured patients. Not only do pressure sores contribute to the morbidity, but also add significantly to the medical/nursing management, cost and admission stay, limiting optimal bed utilisation. This intervention study assesses the impact ...

  1. Energy Costs of Energy Savings in Buildings: A Review

    Directory of Open Access Journals (Sweden)

    Daniel Rousse

    2012-08-01

    Full Text Available It is often claimed that the cheapest energy is the one you do not need to produce. Nevertheless, this claim could somehow be unsubstantiated. In this article, the authors try to shed some light on this issue by using the concept of energy return on investment (EROI as a yardstick. This choice brings semantic issues because in this paper the EROI is used in a different context than that of energy production. Indeed, while watts and negawatts share the same physical unit, they are not the same object, which brings some ambiguities in the interpretation of EROI. These are cleared by a refined definition of EROI and an adapted nomenclature. This review studies the research in the energy efficiency of building operation, which is one of the most investigated topics in energy efficiency. This study focuses on the impact of insulation and high efficiency windows as means to exemplify the concepts that are introduced. These results were normalized for climate, life time of the building, and construction material. In many cases, energy efficiency measures imply a very high EROI. Nevertheless, in some circumstances, this is not the case and it might be more profitable to produce the required energy than to try to save it.

  2. Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies.

    Science.gov (United States)

    Prada, Sergio I

    2017-12-01

    The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of

  3. Sun pipeline`s tensioned cover system saves storage costs

    Energy Technology Data Exchange (ETDEWEB)

    Blaisdell, J.R. [Sun Pipe Line Co., Detroit, MI (United States); Lydick, L. [National Seal Co., Aurora, IL (United States)

    1996-02-01

    Sun Pipe Line chose the Columbia tensioned floating cover (TFC) system from Columbia Geosystems for several reasons. First, capital costs for the TFC system are considerably lower than those for structural metal or concrete systems. Installation requires less time than fixed structures, and construction costs are about one-tenth as much. A second reason for the choice is its patented tower/tension cover design which easily accommodates fluctuating fluid levels in brine ponds, even in a rapid drawdown. When brine is pumped into the storage chambers, changes in brine ponds can be as great as ten feet. The tensioned design maintains folds of extra material on the outer perimeter of the cover above fluid level. As fluid levels fall, the curtain unfolds and adequate reservoir coverage is maintained.

  4. Strategy on energy saving reconstruction of distribution networks based on life cycle cost

    Science.gov (United States)

    Chen, Xiaofei; Qiu, Zejing; Xu, Zhaoyang; Xiao, Chupeng

    2017-08-01

    Because the actual distribution network reconstruction project funds are often limited, the cost-benefit model and the decision-making method are crucial for distribution network energy saving reconstruction project. From the perspective of life cycle cost (LCC), firstly the research life cycle is determined for the energy saving reconstruction of distribution networks with multi-devices. Then, a new life cycle cost-benefit model for energy-saving reconstruction of distribution network is developed, in which the modification schemes include distribution transformers replacement, lines replacement and reactive power compensation. In the operation loss cost and maintenance cost area, the operation cost model considering the influence of load season characteristics and the maintenance cost segmental model of transformers are proposed. Finally, aiming at the highest energy saving profit per LCC, a decision-making method is developed while considering financial and technical constraints as well. The model and method are applied to a real distribution network reconstruction, and the results prove that the model and method are effective.

  5. Near-Net Shape Fabrication Using Low-Cost Titanium Alloy Powders

    Energy Technology Data Exchange (ETDEWEB)

    Dr. David M. Bowden; Dr. William H. Peter

    2012-03-31

    The use of titanium in commercial aircraft production has risen steadily over the last half century. The aerospace industry currently accounts for 58% of the domestic titanium market. The Kroll process, which has been used for over 50 years to produce titanium metal from its mineral form, consumes large quantities of energy. And, methods used to convert the titanium sponge output of the Kroll process into useful mill products also require significant energy resources. These traditional approaches result in product forms that are very expensive, have long lead times of up to a year or more, and require costly operations to fabricate finished parts. Given the increasing role of titanium in commercial aircraft, new titanium technologies are needed to create a more sustainable manufacturing strategy that consumes less energy, requires less material, and significantly reduces material and fabrication costs. A number of emerging processes are under development which could lead to a breakthrough in extraction technology. Several of these processes produce titanium alloy powder as a product. The availability of low-cost titanium powders may in turn enable a more efficient approach to the manufacture of titanium components using powder metallurgical processing. The objective of this project was to define energy-efficient strategies for manufacturing large-scale titanium structures using these low-cost powders as the starting material. Strategies include approaches to powder consolidation to achieve fully dense mill products, and joining technologies such as friction and laser welding to combine those mill products into near net shape (NNS) preforms for machining. The near net shape approach reduces material and machining requirements providing for improved affordability of titanium structures. Energy and cost modeling was used to define those approaches that offer the largest energy savings together with the economic benefits needed to drive implementation. Technical

  6. Comparing the net cost of CSP-TES to PV deployed with battery storage

    Science.gov (United States)

    Jorgenson, Jennie; Mehos, Mark; Denholm, Paul

    2016-05-01

    Concentrated solar power with thermal energy storage (CSP-TES) is a unique source of renewable energy in that its energy can be shifted over time and it can provide the electricity system with dependable generation capacity. In this study, we provide a framework to determine if the benefits of CSP-TES (shiftable energy and the ability to provide firm capacity) exceed the benefits of PV and firm capacity sources such as long-duration battery storage or conventional natural gas combustion turbines (CTs). The results of this study using current capital cost estimates indicate that a combination of PV and conventional gas CTs provides a lower net cost compared to CSP-TES and PV with batteries. Some configurations of CSP-TES have a lower net cost than PV with batteries for even the lowest battery cost estimate. Using projected capital cost targets, however, some configurations of CSP-TES have a lower net cost than PV with either option for even the lowest battery cost estimate. The net cost of CSP-TES varies with configuration, and lower solar multiples coupled with less storage are more attractive at current cost levels, due to high component costs. However, higher solar multiples show a lower net cost using projected future costs for heliostats and thermal storage materials.

  7. Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis.

    LENUS (Irish Health Repository)

    Murphy, C L

    2015-01-01

    The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.

  8. Energy Efficiency Improvement and Cost Saving Oportunities for the Concrete Industry

    Energy Technology Data Exchange (ETDEWEB)

    Kermeli, Katerina; Worrell, Ernst; Masanet, Eric

    2011-12-01

    The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for more than 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials accounting for more than 50% of total concrete production costs - cement only accounts for nearly 24%. In 2009, energy costs of the U.S. concrete industry were over $610 million. Hence, energy efficiency improvements along with efficient use of materials without negatively affecting product quality and yield, especially in times of increased fuel and material costs, can significantly reduce production costs and increase competitiveness. The Energy Guide starts with an overview of the U.S. concrete industry’s structure and energy use, a description of the various manufacturing processes, and identification of the major energy consuming areas in the different industry segments. This is followed by a description of general and process related energy- and cost-efficiency measures applicable to the concrete industry. Specific energy and cost savings and a typical payback period are included based on literature and case studies, when available. The Energy Guide intends to provide information on cost reduction opportunities to energy and plant managers in the U.S. concrete industry. Every cost saving opportunity should be assessed carefully prior to implementation in individual plants, as the economics and the potential energy and material savings may differ.

  9. Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

    Science.gov (United States)

    Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A

    2018-02-07

    On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p period, hospice increased costs to Medicare. Medicare savings could continue with the 2016 payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.

  10. Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program

    Science.gov (United States)

    Rostovtseva, Daria P.; Brindis, Claire D.; Biggs, M. Antonia; Hulett, Denis; Darney, Philip D.

    2009-01-01

    Objectives. We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955 000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. Methods. We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. Results. More than half of the 178 000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. Conclusions. All contraceptive methods were cost-effective—they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. PMID:18703437

  11. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving.

    Science.gov (United States)

    Prusa, Andrea-Romana; Kasper, David C; Sawers, Larry; Walter, Evelyn; Hayde, Michael; Stillwaggon, Eileen

    2017-07-01

    Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario. We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric long-term follow-up until May 2013. We constructed a decision-analytic model to compare lifetime societal costs of prenatal screening with lifetime societal costs estimated in a No-Screening scenario. We included costs of treatment, lifetime care, accommodation of injuries, loss of life, and lost earnings that would have occurred in a No-Screening scenario and compared them with the actual costs of screening, treatment, lifetime care, accommodation, loss of life, and lost earnings. We replicated that analysis excluding loss of life and lost earnings to estimate the budgetary impact alone. Our model calculated total lifetime costs of €103 per birth under prenatal screening as carried out in Austria, saving €323 per birth compared with No-Screening. Without screening and treatment, lifetime societal costs for all affected children would have been €35 million per year; the implementation costs of the Austrian program are less than €2 million per year. Calculating only the budgetary impact, the national program was still cost-saving by more than €15 million per year and saved €258 million in 17 years. Cost savings under a national program of prenatal screening for toxoplasma infection and treatment are

  12. The health gains and cost savings of dietary salt reduction interventions, with equity and age distributional aspects

    Directory of Open Access Journals (Sweden)

    Nhung Nghiem

    2016-05-01

    Full Text Available Abstract Background A “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013. We therefore aimed to model health gains and costs (savings of salt reduction interventions related to salt substitution and maximum levels in bread, including by ethnicity and age. We also ranked these four interventions compared to eight other modelled interventions. Methods A Markov macro-simulation model was used to estimate QALYs gained and net health system costs for four dietary sodium reduction interventions, discounted at 3 % per annum. The setting was New Zealand (NZ (2.3 million adults, aged 35+ years which has detailed individual-level administrative cost data. Results The health gain was greatest for an intervention where most (59 % of the sodium in processed foods was replaced by potassium and magnesium salts. This intervention gained 294,000 QALYs over the remaining lifetime of the cohort (95 % UI: 238,000 to 359,000; 0.13 QALY per 35+ year old. Such salt substitution also produced the highest net cost-savings of NZ$ 1.5 billion (US$ 1.0 billion (95 % UI: NZ$ 1.1 to 2.0 billion. All interventions generated relatively larger per capita QALYs for men vs women and for the indigenous Māori population vs non-Māori (e.g., 0.16 vs 0.12 QALYs per adult for the 59 % salt substitution intervention. Of relevance to workforce productivity, in the first 10 years post-intervention, 22 % of the QALY gain was among those aged <65 years (and 37 % for those aged <70. Conclusions The benefits are consistent with the international literature, with large health gains and cost savings possible from some, but not all, sodium reduction interventions. Health gain appears likely to occur among working-age adults and all interventions contributed to reducing health inequalities.

  13. United States menhaden oil could save billions in U.S. health care costs and improve IQ in children.

    Science.gov (United States)

    Bibus, Douglas M

    2016-02-01

    The United States menhaden oil annual production is sufficient to supply all of the recommended long chain Omega-3s for Americans over 55 with coronary heart disease (CHD) and pregnant and lactating women. According to a recent study, the utilization of preventable intake levels could potentially save up to $1.7 billion annually in hospital costs alone. In addition, the remaining oil could be used to support a culture of enough Atlantic salmon to provide every pregnant and lactating woman in the U.S. with 8-12 ounces of fish per week, as recommended by the Food and Drug Administration (FDA), throughout the duration of pregnancy and lactation. Based on the FDA's quantitative assessment, this may result in a net increase of IQ by 5.5 points in children and improve their early age verbal development.

  14. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology.

    Science.gov (United States)

    Kolaczinski, Jan; Hanson, Kara

    2006-05-08

    Insecticide-treated nets (ITNs) are an effective and cost-effective means of malaria control. Scaling-up coverage of ITNs is challenging. It requires substantial resources and there are a number of strategies to choose from. Information on the cost of different strategies is still scarce. To guide the choice of a delivery strategy (or combination of strategies), reliable and standardized cost information for the different options is required. The electronic online database PubMed was used for a systematic search of the published English literature on costing and economic evaluations of ITN distribution programmes. The keywords used were: net, bednet, insecticide, treated, ITN, cost, effectiveness, economic and evaluation. Identified papers were analysed to determine and evaluate the costing methods used. Methods were judged against existing standards of cost analysis to arrive at proposed standards for undertaking and presenting cost analyses. Cost estimates were often not readily comparable or could not be adjusted to a different context. This resulted from the wide range of methods applied and measures of output chosen. Most common shortcomings were the omission of certain costs and failure to adjust financial costs to generate economic costs. Generalisability was hampered by authors not reporting quantities and prices of resources separately and not examining the sensitivity of their results to variations in underlying assumptions. The observed shortcomings have arisen despite the abundance of literature and guidelines on costing of health care interventions. This paper provides ITN specific recommendations in the hope that these will help to standardize future cost estimates.

  15. A Method for Estimating Potential Energy and Cost Savings for Cooling Existing Data Centers

    Energy Technology Data Exchange (ETDEWEB)

    Van Geet, Otto

    2017-04-24

    NREL has developed a methodology to prioritize which data center cooling systems could be upgraded for better efficiency based on estimated cost savings and economics. The best efficiency results are in cool or dry climates where 'free' economizer or evaporative cooling can provide most of the data center cooling. Locations with a high cost of energy and facilities with high power usage effectiveness (PUE) are also good candidates for data center cooling system upgrades. In one case study of a major cable provider's data centers, most of the sites studied had opportunities for cost-effective cooling system upgrades with payback period of 5 years or less. If the cable provider invested in all opportunities for upgrades with payback periods of less than 15 years, it could save 27% on annual energy costs.

  16. Exergy costing for energy saving in combined heating and cooling applications

    DEFF Research Database (Denmark)

    Nguyen, Chan; Veje, Christian T.; Willatzen, Morten

    2014-01-01

    exergy balance equations are used in conjunction with mass and energy balance equations. In both costing methods the thermodynamic analysis is followed by an economic analysis which includes investment and operating costs. For both methods the unit costs of heating and cooling are found and compared......The aim of this study is to provide a price model that motivates energy saving for a combined district heating and cooling system. A novel analysis using two thermoeconomic methods for apportioning the costs to heating and cooling provided simultaneously by an ammonia heat pump is demonstrated...

  17. Annual Energy Usage Reduction and Cost Savings of a School: End-Use Energy Analysis

    Science.gov (United States)

    Alghoul, M. A.; Bakhtyar, B.; Asim, Nilofar; Sopian, K.

    2014-01-01

    Buildings are among the largest consumers of energy. Part of the energy is wasted due to the habits of users and equipment conditions. A solution to this problem is efficient energy usage. To this end, an energy audit can be conducted to assess the energy efficiency. This study aims to analyze the energy usage of a primary school and identify the potential energy reductions and cost savings. A preliminary audit was conducted, and several energy conservation measures were proposed. The energy conservation measures, with reference to the MS1525:2007 standard, were modelled to identify the potential energy reduction and cost savings. It was found that the school's usage of electricity exceeded its need, incurring an excess expenditure of RM 2947.42. From the lighting system alone, it was found that there is a potential energy reduction of 5489.06 kWh, which gives a cost saving of RM 2282.52 via the improvement of lighting system design and its operating hours. Overall, it was found that there is a potential energy reduction and cost saving of 20.7% when the energy conservation measures are earnestly implemented. The previous energy intensity of the school was found to be 50.6 kWh/m2/year, but can theoretically be reduced to 40.19 kWh/mm2/year. PMID:25485294

  18. Costs, effects, and savings of screening for cystic fibrosis gene carriers

    NARCIS (Netherlands)

    Wildhagen, MF; Hilderink, HBM; Verzijl, JG; Verheij, JBGM; Kooij, L; Tijmstra, T; ten Kate, LP; Habbema, JDF

    Study objective-Evaluating the costs, effects, and savings of several strategies for cystic fibrosis (CF) gene carrier screening. Design-A general model for evaluating prenatal, preconceptional, school, and neonatal carrier screening was constructed. For prenatal and preconceptional screening, two

  19. Shortened first-line TB treatment in Brazil: potential cost savings for patients and health services

    NARCIS (Netherlands)

    Trajman, Anete; Bastos, Mayara Lisboa; Belo, Marcia; Calaça, Janaína; Gaspar, Júlia; Dos Santos, Alexandre Martins; Dos Santos, Camila Martins; Brito, Raquel Trindade; Wells, William A.; Cobelens, Frank G.; Vassall, Anna; Gomez, Gabriela B.

    2016-01-01

    Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs. We estimated potential savings from a societal perspective in Brazil following the introduction of a hypothetical four-month regimen for tuberculosis treatment. Data were gathered in

  20. Annual Energy Usage Reduction and Cost Savings of a School: End-Use Energy Analysis

    Directory of Open Access Journals (Sweden)

    Aiman Roslizar

    2014-01-01

    Full Text Available Buildings are among the largest consumers of energy. Part of the energy is wasted due to the habits of users and equipment conditions. A solution to this problem is efficient energy usage. To this end, an energy audit can be conducted to assess the energy efficiency. This study aims to analyze the energy usage of a primary school and identify the potential energy reductions and cost savings. A preliminary audit was conducted, and several energy conservation measures were proposed. The energy conservation measures, with reference to the MS1525:2007 standard, were modelled to identify the potential energy reduction and cost savings. It was found that the school’s usage of electricity exceeded its need, incurring an excess expenditure of RM 2947.42. From the lighting system alone, it was found that there is a potential energy reduction of 5489.06 kWh, which gives a cost saving of RM 2282.52 via the improvement of lighting system design and its operating hours. Overall, it was found that there is a potential energy reduction and cost saving of 20.7% when the energy conservation measures are earnestly implemented. The previous energy intensity of the school was found to be 50.6 kWh/m2/year, but can theoretically be reduced to 40.19 kWh/mm2/year.

  1. A Cost-Savings Analysis of a Statewide Parenting Education Program in Child Welfare

    Science.gov (United States)

    Maher, Erin J.; Corwin, Tyler W.; Hodnett, Rhenda; Faulk, Karen

    2012-01-01

    Objectives: This article presents a cost-savings analysis of the statewide implementation of an evidence-informed parenting education program. Methods: Between the years 2005 and 2008, the state of Louisiana used the Nurturing Parenting Program (NPP) to impart parenting skills to child welfare-involved families. Following these families' outcomes…

  2. Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

    Science.gov (United States)

    Abdullah, Mohammad M. H.; Marinangeli, Christopher P. F.; Jones, Peter J. H.; Carlberg, Jared G.

    2017-01-01

    Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D) and incidence of cardiovascular disease (CVD) following a low glycemic index (GI) or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1) estimate the proportions of individuals who are likely to consume pulses; (2) evaluate the reductions in established risk factors for T2D and CVD; (3) assess the percent reduction in incidences or complications of the diseases of interest; and (4) calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6–$9.9) to Can$62.4 (95% CI $26–$98.8) and Can$31.6 (95% CI $11.1–$52) to Can$315.5 (95% CI $110.6–$520.4) million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term. PMID:28737688

  3. Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis.

    Science.gov (United States)

    Abdullah, Mohammad M H; Marinangeli, Christopher P F; Jones, Peter J H; Carlberg, Jared G

    2017-07-22

    Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D) and incidence of cardiovascular disease (CVD) following a low glycemic index (GI) or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1) estimate the proportions of individuals who are likely to consume pulses; (2) evaluate the reductions in established risk factors for T2D and CVD; (3) assess the percent reduction in incidences or complications of the diseases of interest; and (4) calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6-$9.9) to Can$62.4 (95% CI $26-$98.8) and Can$31.6 (95% CI $11.1-$52) to Can$315.5 (95% CI $110.6-$520.4) million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term.

  4. Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

    Directory of Open Access Journals (Sweden)

    Mohammad M. H. Abdullah

    2017-07-01

    Full Text Available Consumption of dietary pulses, including beans, peas and lentils, is recommended by health authorities across jurisdictions for their nutritional value and effectiveness in helping to prevent and manage major diet-related illnesses of significant socioeconomic burden. The aim of this study was to estimate the potential annual healthcare and societal cost savings relevant to rates of reduction in complications from type 2 diabetes (T2D and incidence of cardiovascular disease (CVD following a low glycemic index (GI or high fiber diet that includes pulses, or 100 g/day pulse intake in Canada, respectively. A four-step cost-of-illness analysis was conducted to: (1 estimate the proportions of individuals who are likely to consume pulses; (2 evaluate the reductions in established risk factors for T2D and CVD; (3 assess the percent reduction in incidences or complications of the diseases of interest; and (4 calculate the potential annual savings in relevant healthcare and related costs. A low GI or high fiber diet that includes pulses and 100 g/day pulse intake were shown to potentially yield Can$6.2 (95% CI $2.6–$9.9 to Can$62.4 (95% CI $26–$98.8 and Can$31.6 (95% CI $11.1–$52 to Can$315.5 (95% CI $110.6–$520.4 million in savings on annual healthcare and related costs of T2D and CVD, respectively. Specific provincial/territorial analyses suggested annual T2D and CVD related cost savings that ranged from up to Can$0.2 million in some provinces to up to Can$135 million in others. In conclusion, with regular consumption of pulse crops, there is a potential opportunity to facilitate T2D and CVD related socioeconomic cost savings that could be applied to Canadian healthcare or re-assigned to other priority domains. Whether these potential cost savings will be offset by other healthcare costs associated with longevity and diseases of the elderly is to be investigated over the long term.

  5. Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

    Directory of Open Access Journals (Sweden)

    Sheena Xin Liu

    2016-01-01

    Full Text Available Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from $2832 to $5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in $2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

  6. Impact of five years of rotavirus vaccination in Finland - And the associated cost savings in secondary healthcare.

    Science.gov (United States)

    Leino, Tuija; Baum, Ulrike; Scott, Peter; Ollgren, Jukka; Salo, Heini

    2017-10-09

    This study aimed to estimate the impact of the national rotavirus (RV) vaccination programme, starting 2009, on the total hospital-treated acute gastroenteritis (AGE) and severe RV disease burden in Finland during the first five years of the programme. This study also evaluated the costs saved in secondary healthcare by the RV vaccination programme. The RV related outcome definitions were based on ICD10 diagnostic codes recorded in the Care Register for Health Care. Incidences of hospitalised and hospital outpatient cases of AGE (A00-A09, R11) and RVGE (A08.0) were compared prior (1999-2005) and after (2010-2014) the start of the programme among children less than five years of age. The reduction in disease burden in 2014, when all children under five years of age have been eligible for RV vaccination, was 92.9% (95%CI: 91.0%-94.5%) in hospitalised RVGE and 68.5% (66.6%-70.3%) in the total hospitalised AGE among children less than five years of age. For the corresponding hospital outpatient cases, there was a reduction of 91.4% (82.4%-96.6%) in the RVGE incidence, but an increase of 6.3% (2.7%-9.9%) in the AGE incidence. The RV vaccination programme prevented 2206 secondary healthcare AGE cases costing €4.5 million annually. As the RV immunisation costs were €2.3 million, the total net savings just in secondary healthcare costs were €2.2 million, i.e. €33 per vaccinated child. The RV vaccination programme clearly controlled the severe, hospital-treated forms of RVGE. The total disease burden is a more valuable end point than mere specifically diagnosed cases as laboratory confirmation practises usually change after vaccine introduction. The RV vaccination programme annually pays for itself at least two times over. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Implementing Suicide Prevention Programs: Costs and Potential Life Years Saved in Canada.

    Science.gov (United States)

    Vasiliadis, Helen-Maria; Lesage, Alain; Latimer, Eric; Seguin, Monique

    2015-09-01

    ,979 per life year saved. Suicide prevention programs such as the NAD trial are cost-effective and can result in important potential cost-savings due to averted suicide deaths and reduced life years lost. Implementation of suicide prevention programs at the population level in Canada is cost-effective. Community mental health programs aimed at increasing awareness and the treatment of depression and better follow-up of high risk individuals for suicide are associated with a minimal per capita investment. These programs can result in important potential cost-savings due to averted suicide deaths and decreased disability due to depression. Additional research should focus on whether the outcomes of multi-modal suicide programs are specific or synergistic and most effective for which population subgroups. This may help inform how best to invest resources for the highest return.

  8. Cost savings associated with using immunization information systems for Vaccines for Children administrative tasks.

    Science.gov (United States)

    Bartlett, Diana L; Washington, Michael L; Bryant, Amanda; Thurston, Norman; Perfili, Christine A

    2007-01-01

    Our objective was to investigate the potential cost savings of immunization information systems (IIS) in performing some administrative tasks associated with the federal Vaccines for Children (VFC) program at the state and practice levels. VFC is an entitlement program providing free vaccine to eligible children. We timed the staff of the Utah Department of Health (UDOH) and 72 private VFC practices for administrative VFC-related tasks from September 2003 through March 2004. Time measurements included time for practices to produce VFC reports and for UDOH staff to assess practice coverage levels and process VFC reports manually or via the Utah Statewide Immunization Information System (USIIS). Median cost savings to the state health department could be as much as $11 740 annually. Utah VFC practices could save up to a maximum of $446 annually per practice by using USIIS for VFC tasks. If applied to the 218 enrolled private practices statewide, this would result in a median total cost savings of $17,615 ($15,519 for reports and $2,096 for pulling medical charts).

  9. Cost savings deliverables and criteria for the OST technology decision process

    Energy Technology Data Exchange (ETDEWEB)

    McCown, A.

    1997-04-01

    This document has been prepared to assist focus area (FA) technical and management teams in understanding the cost savings deliverables associated with a technology system during its research and development (R and D) phases. It discusses the usefulness of cost analysis in the decision-making process, and asserts that the level of confidence and data quality of a cost analysis is proportional to the maturity of the technology system`s development life cycle. Suggestions of specific investment criteria or cost savings metrics that a FA might levy on individual research projects are made but the final form of these elements should be stipulated by the FA management based on their rationale for a successful technology development project. Also, cost savings deliverables for a single FA will be more detailed than those for management of the Office of Science and Technology (OST). For example, OST management may want an analysis of the overall return on investment for each FA, while the FA program manager may want this analysis and the return on investment metrics for each technology research activity the FA supports.

  10. Vegetable output and cost savings of community gardens in San Jose, California.

    Science.gov (United States)

    Algert, Susan J; Baameur, Aziz; Renvall, Marian J

    2014-07-01

    Urban dwellers across the United States increasingly access a variety of fresh vegetables through participation in neighborhood-level community gardens. Here we document vegetable output and cost savings of community gardens in the city of San Jose, CA, to better understand the capacity of community gardens to affect food affordability in an urban setting. A convenience sample of 83 community gardeners in San Jose completed a background survey during spring and summer 2012. On average, gardeners were aged 57 years and had a monthly income of $4,900; 25% had completed college. A representative subset of 10 gardeners was recruited to weigh vegetable output of their plots using portable electronic scales at three separate garden sites. Accuracy of each portable scale was verified by comparing the weight of a sample vegetable to weights obtained using a lab scale precise to 0.2 oz. Garden yields and cost savings were tabulated overall for each plot. Results indicate that community garden practices are more similar to biointensive high-production farming, producing 0.75 lb vegetables/sq ft, rather than conventional agricultural practices, producing 0.60 lb/sq ft. Gardens produced on average 2.55 lb/plant and saved $435 per plot for the season. Results indicate that cost savings are greatest if vertical high value crops such as tomatoes and peppers are grown in community gardens, although yields depend on growing conditions, gardener's skill, availability of water, and other factors. Future research is needed to document cost savings and yields for specific crops grown in community gardens. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  11. Cost savings of telemedicine utilization for child psychiatry in a rural Kansas community.

    Science.gov (United States)

    Spaulding, Ryan; Belz, Norbert; DeLurgio, Stephen; Williams, Arthur R

    2010-10-01

    The costs of pediatric telemedicine services remain underreported and understudied; however, there is evidence that telepediatric services can be cost competitive with traditional ones. For 15 years, the University of Kansas Center for Telemedicine and Telehealth has been providing telemental health outreach from the University of Kansas Medical Center (KUMC). One service site is located in Crawford County, Kansas, which provides telepsychiatry services to children and adolescents. The purpose of this study was to examine the costs of operating the Crawford County site relative to accessing services at KUMC, the likely alternative service location. The cost of travel time to parents who accompanied a dependent to either location also was estimated. Patients and parents were examined over a 6-month period in 2006. One hundred thirty-two patients received 257 telemedicine psychiatric consultations during this period. Cost estimates for using the pediatric telemedicine service were assessed for all patients; however, travel and related costs were collected from a sample of 26 patient-parent dyads. The estimated costs of services were obtained using standard cost-accounting procedures. An average cost per consultation in Crawford County was $168.61. The cost savings in travel time and other expenses to parents and patients were substantial between use of the county site and KUMC. Subtracting average savings in travel costs to patients and parents produced an average cost of a telepsychiatry consult in Crawford County of only $30.99. This study was conducted over 6 months with a small number of observations; it should be replicated over a longer study period, with more patients, and with more data that might capture marginal costs of services.

  12. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving

    Science.gov (United States)

    Prusa, Andrea-Romana; Kasper, David C.; Sawers, Larry; Walter, Evelyn; Hayde, Michael

    2017-01-01

    Background Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario. Methodology/Principal findings We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric long-term follow-up until May 2013. We constructed a decision-analytic model to compare lifetime societal costs of prenatal screening with lifetime societal costs estimated in a No-Screening scenario. We included costs of treatment, lifetime care, accommodation of injuries, loss of life, and lost earnings that would have occurred in a No-Screening scenario and compared them with the actual costs of screening, treatment, lifetime care, accommodation, loss of life, and lost earnings. We replicated that analysis excluding loss of life and lost earnings to estimate the budgetary impact alone. Our model calculated total lifetime costs of €103 per birth under prenatal screening as carried out in Austria, saving €323 per birth compared with No-Screening. Without screening and treatment, lifetime societal costs for all affected children would have been €35 million per year; the implementation costs of the Austrian program are less than €2 million per year. Calculating only the budgetary impact, the national program was still cost-saving by more than €15 million per year and saved €258 million in 17 years. Conclusions/Significance Cost savings under a national program of

  13. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving.

    Directory of Open Access Journals (Sweden)

    Andrea-Romana Prusa

    2017-07-01

    Full Text Available Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario.We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric long-term follow-up until May 2013. We constructed a decision-analytic model to compare lifetime societal costs of prenatal screening with lifetime societal costs estimated in a No-Screening scenario. We included costs of treatment, lifetime care, accommodation of injuries, loss of life, and lost earnings that would have occurred in a No-Screening scenario and compared them with the actual costs of screening, treatment, lifetime care, accommodation, loss of life, and lost earnings. We replicated that analysis excluding loss of life and lost earnings to estimate the budgetary impact alone. Our model calculated total lifetime costs of €103 per birth under prenatal screening as carried out in Austria, saving €323 per birth compared with No-Screening. Without screening and treatment, lifetime societal costs for all affected children would have been €35 million per year; the implementation costs of the Austrian program are less than €2 million per year. Calculating only the budgetary impact, the national program was still cost-saving by more than €15 million per year and saved €258 million in 17 years.Cost savings under a national program of prenatal screening for toxoplasma infection and

  14. Energy Savings and Breakeven Cost for Residential Heat Pump Water Heaters in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Maguire, J.; Burch, J.; Merrigan, T.; Ong, S.

    2013-07-01

    Heat pump water heaters (HPWHs) have recently reemerged in the U.S. residential water heating market and have the potential to provide homeowners with significant energy savings. However, there are questions as to the actual performance and energy savings potential of these units, in particular in regards to the heat pump's performance in unconditioned space and the impact of the heat pump on space heating and cooling loads when it is located in conditioned space. To help answer these questions, simulations were performed of a HPWH in both conditioned and unconditioned space at over 900 locations across the continental United States and Hawaii. Simulations included a Building America benchmark home so that any interaction between the HPWH and the home's HVAC equipment could be captured. Comparisons were performed to typical gas and electric water heaters to determine the energy savings potential and cost effectiveness of a HPWH relative to these technologies. HPWHs were found to have a significant source energy savings potential when replacing typical electric water heaters, but only saved source energy relative to gas water heater in the most favorable installation locations in the southern US. When replacing an electric water heater, the HPWH is likely to break even in California, the southern US, and parts of the northeast in most situations. However, the HPWH will only break even when replacing a gas water heater in a few southern states.

  15. Energy Savings and Breakeven Costs for Residential Heat Pump Water Heaters in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Maguire, Jeff [National Renewable Energy Lab. (NREL), Golden, CO (United States); Burch, Jay [National Renewable Energy Lab. (NREL), Golden, CO (United States); Merrigan, Tim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ong, Sean [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-07-01

    Heat pump water heaters (HPWHs) have recently re-emerged in the U.S. residential water heating market and have the potential to provide homeowners with significant energy savings. However, there are questions as to the actual performance and energy savings potential of these units, in particular in regards to the heat pump's performance in unconditioned space and the impact of the heat pump on space heating and cooling loads when it is located in conditioned space. To help answer these questions, NREL performed simulations of a HPWH in both conditioned and unconditioned space at over 900 locations across the continental United States and Hawaii. Simulations included a Building America benchmark home so that any interaction between the HPWH and the home's HVAC equipment could be captured. Comparisons were performed to typical gas and electric water heaters to determine the energy savings potential and cost effectiveness of a HPWH relative to these technologies. HPWHs were found to have a significant source energy savings potential when replacing typical electric water heaters, but only saved source energy relative to gas water heater in the most favorable installation locations in the southern United States. When replacing an electric water heater, the HPWH is likely to break even in California, the southern United States, and parts of the northeast in most situations. However, the HPWH will only break even when replacing a gas water heater in a few southern states.

  16. The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi

    Directory of Open Access Journals (Sweden)

    Ortiz Juan

    2005-05-01

    Full Text Available Abstract Background Insecticide-treated nets (ITNs are a proven intervention to reduce the burden of malaria, yet there remains a debate as to the best method of ensuring they are universally utilized. This study is a cost-effectiveness analysis of an intervention in Malawi that started in 1998, in Blantyre district, before expanding nationwide. Over the 5-year period, 1.5 million ITNs were sold. Methods The costs were calculated retrospectively through analysis of expenditure data. Costs and effects were measured as cost per treated-net year (cost/TNY and cost per net distributed. Results The mean cost/TNY was calculated at $4.41, and the mean cost/ITN distributed at $2.63. It also shows evidence of economies of scale, with the cost/TNY falling from $7.69 in year one (72,196 ITN to $3.44 in year five (720,577 ITN. Cost/ITN distributed dropped from $5.04 to $1.92. Conclusion Combining targeting and social marketing has the potential of being both cost-effective and capable of achieving high levels of coverage, and it is possible that increasing returns to scale can be achieved.

  17. Costing the distribution of insecticide-treated nets: a review of cost and cost-effectiveness studies to provide guidance on standardization of costing methodology

    Directory of Open Access Journals (Sweden)

    Hanson Kara

    2006-05-01

    Full Text Available Abstract Background Insecticide-treated nets (ITNs are an effective and cost-effective means of malaria control. Scaling-up coverage of ITNs is challenging. It requires substantial resources and there are a number of strategies to choose from. Information on the cost of different strategies is still scarce. To guide the choice of a delivery strategy (or combination of strategies, reliable and standardized cost information for the different options is required. Methods The electronic online database PubMed was used for a systematic search of the published English literature on costing and economic evaluations of ITN distribution programmes. The keywords used were: net, bednet, insecticide, treated, ITN, cost, effectiveness, economic and evaluation. Identified papers were analysed to determine and evaluate the costing methods used. Methods were judged against existing standards of cost analysis to arrive at proposed standards for undertaking and presenting cost analyses. Results Cost estimates were often not readily comparable or could not be adjusted to a different context. This resulted from the wide range of methods applied and measures of output chosen. Most common shortcomings were the omission of certain costs and failure to adjust financial costs to generate economic costs. Generalisability was hampered by authors not reporting quantities and prices of resources separately and not examining the sensitivity of their results to variations in underlying assumptions. Conclusion The observed shortcomings have arisen despite the abundance of literature and guidelines on costing of health care interventions. This paper provides ITN specific recommendations in the hope that these will help to standardize future cost estimates.

  18. Modern methods of cost saving of the production activity in construction

    Science.gov (United States)

    Silka, Dmitriy

    2017-10-01

    Every time economy faces recession, cost saving questions acquire increased urgency. This article shows how companies of the construction industry have switched to the new kind of economic relations over recent years. It is specified that the dominant type of economic relations does not allow to quickly reorient on the necessary tools in accordance with new requirements of economic activity. Successful experience in the new environment becomes demanded. Cost saving methods, which were proven in other industries, are offered for achievement of efficiency and competitiveness of the companies. Analysis is performed on the example of the retail sphere, which, according to the authoritative analytical reviews, is extremely innovative on both local and world economic levels. At that, methods, based on the modern unprecedentedly high opportunities of communications and informational exchange took special place among offered methods.

  19. Guide to resource conservation and cost savings opportunities in the dairy processing sector

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-31

    This guide identifies and promotes opportunities for conserving energy and water, as well as reducing waste, in the dairy processing sector. The guide begins with an introduction and a profile of Ontario`s dairy processing sector, outlining the context for resource conservation and cost savings opportunities. It then outlines the rationale and the generic processes selected for careful examination of resource conservation and cost savings opportunities. Subsequent chapters describe the energy, water, and material resources commonly used in relation to the generic processes; the air, water, and solid waste residuals commonly derived from those processes; and new technologies with potential application in dairy processing. The generic processes covered in the guide are for fluid milk, cheese, ice cream and frozen products, cultured products such as yogurt, butter, and dried or evaporated products. The report ends with additional useful information for dairy processors.

  20. Assessing Potential Energy Cost Savings from Increased Energy Code Compliance in Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Rosenberg, Michael I.; Hart, Philip R.; Athalye, Rahul A.; Zhang, Jian; Wang, Weimin

    2016-02-15

    The US Department of Energy’s most recent commercial energy code compliance evaluation efforts focused on determining a percent compliance rating for states to help them meet requirements under the American Recovery and Reinvestment Act (ARRA) of 2009. That approach included a checklist of code requirements, each of which was graded pass or fail. Percent compliance for any given building was simply the percent of individual requirements that passed. With its binary approach to compliance determination, the previous methodology failed to answer some important questions. In particular, how much energy cost could be saved by better compliance with the commercial energy code and what are the relative priorities of code requirements from an energy cost savings perspective? This paper explores an analytical approach and pilot study using a single building type and climate zone to answer those questions.

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

    Science.gov (United States)

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

    2015-11-01

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

  2. Net Costs Due to Seasonal Influenza Vaccination--United States, 2005-2009.

    Directory of Open Access Journals (Sweden)

    Cristina Carias

    Full Text Available Seasonal influenza causes considerable morbidity and mortality across all age groups, and influenza vaccination was recommended in 2010 for all persons aged 6 months and above. We estimated the averted costs due to influenza vaccination, taking into account the seasonal economic burden of the disease.We used recently published values for averted outcomes due to influenza vaccination for influenza seasons 2005-06, 2006-07, 2007-08, and 2008-09, and age cohorts 6 months-4 years, 5-19 years, 20-64 years, and 65 years and above. Costs were calculated according to a payer and societal perspective (in 2009 US$, and took into account medical costs and productivity losses.When taking into account direct medical costs (payer perspective, influenza vaccination was cost saving only for the older age group (65≥ in seasons 2005-06 and 2007-08. Using the same perspective, influenza vaccination resulted in total costs of $US 1.7 billion (95%CI: $US 0.3-4.0 billion in 2006-07 and $US 1.8 billion (95%CI: $US 0.1-4.1 billion in 2008-09. When taking into account a societal perspective (and including the averted lost earnings due to premature death averted deaths in the older age group influenced the results, resulting in cost savings for all ages combined in season 07-08.Influenza vaccination was cost saving in the older age group (65≥ when taking into account productivity losses and, in some seasons, when taking into account medical costs only. Averted costs vary significantly per season; however, in seasons where the averted burden of deaths is high in the older age group, averted productivity losses due to premature death tilt overall seasonal results towards savings. Indirect vaccination effects and the possibility of diminished case severity due to influenza vaccination were not considered, thus the averted burden due to influenza vaccine may be even greater than reported.

  3. Net Costs Due to Seasonal Influenza Vaccination--United States, 2005-2009.

    Science.gov (United States)

    Carias, Cristina; Reed, Carrie; Kim, Inkyu K; Foppa, Ivo M; Biggerstaff, Matthew; Meltzer, Martin I; Finelli, Lyn; Swerdlow, David L

    2015-01-01

    Seasonal influenza causes considerable morbidity and mortality across all age groups, and influenza vaccination was recommended in 2010 for all persons aged 6 months and above. We estimated the averted costs due to influenza vaccination, taking into account the seasonal economic burden of the disease. We used recently published values for averted outcomes due to influenza vaccination for influenza seasons 2005-06, 2006-07, 2007-08, and 2008-09, and age cohorts 6 months-4 years, 5-19 years, 20-64 years, and 65 years and above. Costs were calculated according to a payer and societal perspective (in 2009 US$), and took into account medical costs and productivity losses. When taking into account direct medical costs (payer perspective), influenza vaccination was cost saving only for the older age group (65≥) in seasons 2005-06 and 2007-08. Using the same perspective, influenza vaccination resulted in total costs of $US 1.7 billion (95%CI: $US 0.3-4.0 billion) in 2006-07 and $US 1.8 billion (95%CI: $US 0.1-4.1 billion) in 2008-09. When taking into account a societal perspective (and including the averted lost earnings due to premature death) averted deaths in the older age group influenced the results, resulting in cost savings for all ages combined in season 07-08. Influenza vaccination was cost saving in the older age group (65≥) when taking into account productivity losses and, in some seasons, when taking into account medical costs only. Averted costs vary significantly per season; however, in seasons where the averted burden of deaths is high in the older age group, averted productivity losses due to premature death tilt overall seasonal results towards savings. Indirect vaccination effects and the possibility of diminished case severity due to influenza vaccination were not considered, thus the averted burden due to influenza vaccine may be even greater than reported.

  4. A cost-savings analysis of a candidate universal antiretroviral regimen.

    Science.gov (United States)

    Ripin, David; Prabhu, Vineet R

    2017-07-01

    Despite significant strides in tackling HIV/AIDS in low-income and middle-income countries (LMICs), many treatment shortcomings remain, with limited drug selection to patients emerging as a critical challenge. The potential cost-savings benefits of adopting newer drugs as near-universal first-line antiretroviral (ARV) regimens that also provide improved clinical outcomes are discussed. In the near term, a fixed-dose combination of dolutegravir (DTG or D) with tenofovir disoproxil fumarate (TDF), and either lamivudine or emtricitabine (XTC), that is, tenofovir disoproxil fumarate/XTC/DTG (TXD) (X = XTC), could represent a near-universal first-line antiretroviral regimen offering significant clinical benefit, commodity savings, and overall health system savings. In the longer term, tenofovir alafenamide fumarate (TAF) could further reduce the cost of the first-line treatment backbone, with possible clinical benefits. Relative to the current generic standard of care in first-line, currently priced at ∼USD 90 per patient per year (pppy), high-volume production of TXD could lead to price reductions of ∼USD 20 pppy, whereas high-volume production of tenofovir alafenamide fumarate/XTC/DTG (TAFXD) could offer a reduction of ∼USD 40 pppy. With TXD in the near term, and TAFXD in the longer term, patients can benefit from better tolerated and more durable treatment, and programs will benefit by simplifying patient care and reducing cost to cover more patients.

  5. The net effect of alternative allocation ratios on recruitment time and trial cost.

    Science.gov (United States)

    Vozdolska, Ralitza; Sano, Mary; Aisen, Paul; Edland, Steven D

    2009-04-01

    Increasing the proportion of subjects allocated to the experimental treatment in controlled clinical trials is often advocated as a method of increasing recruitment rates and improving the performance of trials. The presumption is that the higher likelihood of randomization to the experimental treatment will be perceived by potential study enrollees as an added benefit of participation and will increase recruitment rates and speed the completion of trials. However, studies with alternative allocation ratios require a larger sample size to maintain statistical power, which may result in a net increase in time required to complete recruitment and a net increase in total trial cost. To describe the potential net effect of alternative allocation ratios on recruitment time and trial cost. Models of recruitment time and trial cost were developed and used to compare trials with 1:1 allocation to trials with alternative allocation ratios under a range of per subject costs, per day costs, and enrollment rates. In regard to time required to complete recruitment, alternative allocation ratios are net beneficial if the recruitment rate improves by more than about 4% for trials with a 1.5:1 allocation ratio and 12% for trials with a 2:1 allocation ratio. More substantial improvements in recruitment rate, 13 and 47% respectively for scenarios we considered, are required for alternative allocation to be net beneficial in terms of tangible monetary cost. The cost models were developed expressly for trials comparing proportions or means across treatment groups. Using alternative allocation ratio designs to improve recruitment may or may not be time and cost-effective. Using alternative allocation for this purpose should only be considered for trial contexts where there is both clear evidence that the alternative design does improve recruitment rates and the attained time or cost efficiency justifies the added study subject burden implied by a larger sample size.

  6. Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania

    National Research Council Canada - National Science Library

    Hanson, Kara; Kikumbih, Nassor; Armstrong Schellenberg, Joanna; Mponda, Haji; Nathan, Rose; Lake, Sally; Mills, Anne; Tanner, Marcel; Lengeler, Christian

    2003-01-01

    To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use...

  7. Does remediation save lives? - on the cost of cleaning up arsenic-contaminated sites in Sweden.

    Science.gov (United States)

    Forslund, Johanna; Samakovlis, Eva; Johansson, Maria Vredin; Barregard, Lars

    2010-07-15

    Sweden has only just begun remediation of its many contaminated sites, a process that will cost an estimated SEK 60,000 million (USD 9100 million). Although the risk assessment method, carried out by the Swedish EPA, is driven by health effects, it does not consider actual exposure. Instead, the sites are assessed based on divergence from guideline values. This paper uses an environmental medicine approach that takes exposure into account to analyse how cancer risks on and near arsenic-contaminated sites are implicitly valued in the remediation process. The results show that the level of ambition is high. At 23 contaminated sites, the cost per life saved varies from SEK 287 million to SEK 1,835,000 million, despite conservative calculations that in fact probably underestimate the costs. It is concluded that if environmental health risks are to be reduced, there are probably other areas where economic resources can be used more cost-effectively.

  8. Cost and Benefit Tradeoffs in Using a Shade Tree for Residential Building Energy Saving

    Directory of Open Access Journals (Sweden)

    Sappinandana Akamphon

    2014-01-01

    Full Text Available Global warming and urban heat islands result in increased cooling energy consumption in buildings. Previous literature shows that planting trees to shade a building can reduce its cooling load. This work proposes a model to determine the cost effectiveness and profitability of planting a shade tree by considering both its potential to reduce cooling energy and its purchase and maintenance cost. A comparison between six selected tree species is used for illustration. Using growth rates, crown sizes, and shading coefficients, cooling energy savings from the tree shades are computed using an industrial-standard building energy simulation program, offset by costs of purchase, planting, and maintenance of these trees. The result shows that most worthwhile tree to plant should have high shading coefficient and moderate crown size to maximize shading while keeping the maintenance costs manageable.

  9. Achieving the 30% Goal: Energy and Cost Savings Analysis of ASHRAE Standard 90.1-2010

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, Brian A.; Rosenberg, Michael I.; Richman, Eric E.; Wang, Weimin; Xie, YuLong; Zhang, Jian; Cho, Heejin; Mendon, Vrushali V.; Athalye, Rahul A.; Liu, Bing

    2011-05-24

    This Technical Support Document presents the energy and cost savings analysis that PNNL conducted to measure the potential energy savings of 90.1-2010 relative to 90.1-2004. PNNL conducted this analysis with inputs from many other contributors and source of information. In particular, guidance and direction was provided by the Simulation Working Group under the auspices of the SSPC90.1. This report documents the approach and methodologies that PNNL developed to evaluate the energy saving achieved from use of ASHRAE/IES Standard 90.1-2010. Specifically, this report provides PNNL’s Progress Indicator process and methodology, EnergyPlus simulation framework, prototype model descriptions. This report covers the combined upgrades from 90.1-2004 to 90.1-2010, resulting in a total of 153 addenda. PNNL has reviewed and considered all 153 addenda for quantitative analysis in the Progress Indicator process. 53 of those are included in the quantitative analysis. This report provides information on the categorization of all of the addenda, a summary of the content, and deeper explanation of the impact and modeling of 53 identified addenda with quantitative savings.

  10. Graphic Warning Labels and the Cost Savings from Reduced Smoking among Pregnant Women.

    Science.gov (United States)

    Tauras, John A; Peck, Richard M; Cheng, Kai-Wen; Chaloupka, Frank J

    2017-02-08

    Introduction: The U.S. Food and Drug Administration (FDA) has estimated the economic impact of Graphic Warning Labels (GWLs). By omitting the impact on tobacco consumption by pregnant women, the FDA analysis underestimates the economic benefits that would occur from the proposed regulations. There is a strong link between the occurrence of low birth weight babies and smoking while pregnant. Low birth weight babies in turn generate much higher hospital costs than normal birth weight babies. This study aims to fill the gap by quantifying the national hospital cost savings from the reductions in prenatal smoking that will arise if GWLs are implemented in the U.S. Data and Methods: This study uses several data sources. It uses Natality Data from the National Vital Statistics System of the National Center for Health Statistics (NCHS) in 2013 to estimate the impact of prenatal smoking on the likelihood of having a low-birth-weight baby, controlling for socio-economic and demographic characteristics as well as medical and non-medical risk factors. Using these estimates, along with the estimates of Huang et al. (2014) regarding the effect of GWLs on smoking, we calculate the change in the number of LBW (low birth weight) babies resulting from decreased prenatal smoking due to GWLs. Using this estimated change and the estimates from Russell et al. (2007) and AHRQ (2013) on the excess hospital costs of LBW babies, we calculate cost saving that arises from reduced prenatal smoking in response of GWLs. Results and Conclusions: Our results indicated that GWLs for this population could lead to hospital cost savings of 1.2 billion to 2.0 billion dollars over a 30 year horizon.

  11. Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy.

    Science.gov (United States)

    Borrero, Sonya; Zite, Nikki; Potter, Joseph E; Trussell, James; Smith, Kenneth

    2013-12-01

    Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved. A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds. Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year. © 2013.

  12. Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

    Science.gov (United States)

    Hamid, Kamran S; Matson, Andrew P; Nwachukwu, Benedict U; Scott, Daniel J; Mather, Richard C; DeOrio, James K

    2017-01-01

    Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold of $863 was identified for PSI pricing at our institution below which PSI was less costly than SR. Similar internal cost accounting

  13. 10 CFR 436.21 - Savings-to-investment ratio.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Savings-to-investment ratio. 436.21 Section 436.21 Energy... Procedures for Life Cycle Cost Analyses § 436.21 Savings-to-investment ratio. The savings-to-investment ratio... conservation measure. The denominator of the ratio is the present value of the net increase in investment and...

  14. Mission science value-cost savings from the Advanced Imaging Communication System (AICS)

    Science.gov (United States)

    Rice, R. F.

    1984-01-01

    An Advanced Imaging Communication System (AICS) was proposed in the mid-1970s as an alternative to the Voyager data/communication system architecture. The AICS achieved virtually error free communication with little loss in the downlink data rate by concatenating a powerful Reed-Solomon block code with the Voyager convolutionally coded, Viterbi decoded downlink channel. The clean channel allowed AICS sophisticated adaptive data compression techniques. Both Voyager and the Galileo mission have implemented AICS components, and the concatenated channel itself is heading for international standardization. An analysis that assigns a dollar value/cost savings to AICS mission performance gains is presented. A conservative value or savings of $3 million for Voyager, $4.5 million for Galileo, and as much as $7 to 9.5 million per mission for future projects such as the proposed Mariner Mar 2 series is shown.

  15. Comparative net cost impact of the utilization of romiplostim and intravenous immunoglobulin for the treatment of patients with immune thrombocytopenia in Québec, Canada.

    Science.gov (United States)

    Pettigrew, Martine; Garces, Kirsten; Deuson, Robert; Kassis, Jeannine; Laroche, Vincent

    2013-01-01

    Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by platelet destruction, sub-optimal platelet production, and mild-to-severe bleeding. Nplate® (romiplostim), a thrombopoietin receptor agonist, and intravenous immunoglobulin (IVIg), an expensive and occasionally scarce blood product, are used in the treatment of ITP. The objective of this study was to compare the total cost of treating patients with romiplostim vs IVIg in Québec, Canada. A net cost impact model was developed to calculate the annual cost of romiplostim compared with IVIg based on actual practice observations in all patients (n = 95) treated for chronic ITP with IVIg from April 2010 to March 2011 in two participating hospitals. The model included costs of: drug acquisition, drug preparation and administration, patient monitoring, and indirect costs. Healthcare practitioners were consulted regarding romiplostim and IVIg treatment algorithms and the resources involved in patient monitoring. The average annual drug acquisition costs of romiplostim and IVIg were $48,024 and $98,868, respectively. Lower costs for drug preparation and administration ($309 vs $1245) and less time lost from work ($256 vs $2086) were attributed to romiplostim. The cost of follow-up monitoring was the same for both romiplostim and IVIg ($121). The total average annual per patient costs for romiplostim vs IVIg were, respectively, $48,710 and $102,320. The use of romiplostim was projected to save, on average, almost $54,000 per patient per year. The study was conducted in two hospitals in Québec. Romiplostim may show different cost savings in other hospitals and other provincial and national jurisdictions. Scarce blood products must be used wisely. Romiplostim can allow for improved healthcare resource allocation by reserving IVIg for use in other areas of greater need while also providing cost savings for the overall provincial healthcare budget.

  16. Selected bibliography: cost and energy savings of conservation and renewable energy technologies

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-05-01

    This bibliography is a compilation of reports on the cost and energy savings of conservation and renewable energy applications throughout the United States. It is part of an overall effort to inform utilities of technological developments in conservation and renewable energy technologies and so aid utilities in their planning process to determine the most effective and economic combination of capital investments to meet customer needs. Department of Energy assessments of the applications, current costs and cost goals for the various technologies included in this bibliography are presented. These assessments are based on analyses performed by or for the respective DOE Program Offices. The results are sensitive to a number of variables and assumptions; however, the estimates presented are considered representative. These assessments are presented, followed by some conclusions regarding the potential role of the conservation and renewable energy alternative. The approach used to classify the bibliographic citations and abstracts is outlined.

  17. A reformulation of the Cost Plus Net Value Change (C+NVC) model of wildfire economics

    Science.gov (United States)

    Geoffrey H. Donovan; Douglas B. Rideout

    2003-01-01

    The Cost plus Net Value Change (C+NVC) model provides the theoretical foundation for wildland fire economics and provides the basis for the National Fire Management Analysis System (NFMAS). The C+NVC model is based on the earlier least Cost plus Loss model (LC+L) expressed by Sparhawk (1925). Mathematical and graphical analysis of the LC+L model illustrates two errors...

  18. Cost savings associated with 10 years of road safety policies in Catalonia, Spain

    Science.gov (United States)

    Suelves, Josep M; Barbería, Eneko

    2013-01-01

    Abstract Objective To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society. Methods A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values. Findings A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care. Conclusion The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society. PMID:23397348

  19. Holistic impact assessment and cost savings of rainwater harvesting at the watershed scale

    Directory of Open Access Journals (Sweden)

    Santosh R. Ghimire

    2017-03-01

    Full Text Available We evaluated the impacts of domestic and agricultural rainwater harvesting (RWH systems in three watersheds within the Albemarle-Pamlico river basin (southeastern U.S. using life cycle assessment (LCA and life cycle cost assessment. Life cycle impact assessment (LCIA categories included energy demand, fossil fuel, metals, ozone depletion, global warming, acidification, smog, blue and green water use, ecotoxicity, eutrophication, and human health effects. Building upon previous LCAs of near-optimal domestic and agricultural RWH systems in the region, we scaled functional unit LCIA scores for adoption rates of 25%, 50%, 75%, and 100% and compared these to conventional municipal water and well water systems. In addition to investigating watershed-scale impacts of RWH adoption, which few studies have addressed, potential life cycle cost savings due to reduced cumulative energy demand were scaled in each watershed for a more comprehensive analysis. The importance of managing the holistic water balance, including blue water (surface/ground water, green water (rainwater use, and annual precipitation and their relationship to RWH are also addressed. RWH contributes to water resource sustainability by offsetting surface and ground water consumption and by reducing environmental and human health impacts compared to conventional sources. A watershed-wide RWH adoption rate of 25% has a number of ecological and human health benefits including blue water use reduction ranging from 2–39 Mm3, cumulative energy savings of 12–210 TJ, and reduced global warming potential of 600–10,100 Mg CO2 eq. Potential maximum lifetime energy cost savings were estimated at $5M and $24M corresponding to domestic RWH in Greens Mill and agricultural RWH in Back Creek watersheds.

  20. Cost savings and clinical acceptability of an intravascular line tip culture triage policy.

    Science.gov (United States)

    Colston, J; Batchelor, B; Bowler, I C J W

    2013-05-01

    Culture of intravascular line tips is useful for the diagnosis of intravascular line-related phlebitis and bacteraemia. However, the test lacks specificity, with a low predictive value for intravascular line bacteraemia. A recent randomised study showed that predictive value could be increased and costs reduced by refrigerating intravascular lines and retrieving them for culture only if there was a bacteraemia in the seven days before or after the intravascular line was received. We studied whether a similar triage policy could be introduced into our 1400-bed National Health Service (NHS) teaching hospital in the UK. We assessed cost reduction in the laboratory and clinical acceptability. Data regarding the number of intravascular lines received, stored and cultured and blood cultures received was retrieved from the microbiology computer, for five-month periods before and after the introduction of the new triage policy. Of the 134 intravascular line tips received in the five months after the policy had been introduced, 101 (75%) were stored without retrieval and 33 were cultured. Of these, 7/134 (5%) were culture positive and three matched a concurrent blood culture. Audit showed that compliance with the policy was >98%. The estimated annual cost reduction following the introduction of the policy was £3,166.96. The policy was acceptable to clinicians. The policy was both cost saving and clinically acceptable. If the policy were adopted throughout the NHS in the UK, the annual cost saving to the service might be in the order of £300,000. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  1. 2D net shape weaving for cost effective manufacture of textile reinforced composites

    Science.gov (United States)

    Vo, D. M. P.; Kern, M.; Hoffmann, G.; Cherif, C.

    2017-10-01

    Despite significant weight and performance advantages over metal parts, the today’s demand for fibre-reinforced polymer composites (FRPC) has been limited mainly by their large manufacturing cost. The combination of dry textile preforms and low-cost consolidation processes such as resin transfer molding (RTM) has been appointed as a promising approach to low-cost FRPC manufacture. At the current state of the art, tooling and impregnation technology is well understood whereas preform fabrication technology has not been developed effectively. This paper presents an advanced 2D net shape weaving technology developed with the aim to establish a more cost effective system for the manufacture of dry textile preforms for FRPC. 2D net shape weaving is developed based on open reed weave (ORW) technology and enables the manufacture of 2D contoured woven fabrics with firm edge, so that oversize cutting and hand trimming after molding are no longer required. The introduction of 2D net shape woven fabrics helps to reduce material waste, cycle time and preform manufacturing cost significantly. Furthermore, higher grade of automation in preform fabrication can be achieved.

  2. Net Costs Due to Seasonal Influenza Vaccination — United States, 2005–2009

    Science.gov (United States)

    Carias, Cristina; Reed, Carrie; Kim, Inkyu K.; Foppa, Ivo M.; Biggerstaff, Matthew; Meltzer, Martin I.; Finelli, Lyn; Swerdlow, David L.

    2015-01-01

    Background Seasonal influenza causes considerable morbidity and mortality across all age groups, and influenza vaccination was recommended in 2010 for all persons aged 6 months and above. We estimated the averted costs due to influenza vaccination, taking into account the seasonal economic burden of the disease. Methods We used recently published values for averted outcomes due to influenza vaccination for influenza seasons 2005-06, 2006-07, 2007-08, and 2008-09, and age cohorts 6 months-4 years, 5-19 years, 20-64 years, and 65 years and above. Costs were calculated according to a payer and societal perspective (in 2009 US$), and took into account medical costs and productivity losses. Results When taking into account direct medical costs (payer perspective), influenza vaccination was cost saving only for the older age group (65≥) in seasons 2005-06 and 2007-08. Using the same perspective, influenza vaccination resulted in total costs of $US 1.7 billion (95%CI: $US 0.3–4.0 billion) in 2006-07 and $US 1.8 billion (95%CI: $US 0.1–4.1 billion) in 2008-09. When taking into account a societal perspective (and including the averted lost earnings due to premature death) averted deaths in the older age group influenced the results, resulting in cost savings for all ages combined in season 07-08. Discussion Influenza vaccination was cost saving in the older age group (65≥) when taking into account productivity losses and, in some seasons, when taking into account medical costs only. Averted costs vary significantly per season; however, in seasons where the averted burden of deaths is high in the older age group, averted productivity losses due to premature death tilt overall seasonal results towards savings. Indirect vaccination effects and the possibility of diminished case severity due to influenza vaccination were not considered, thus the averted burden due to influenza vaccine may be even greater than reported. PMID:26230271

  3. Life Cycle Cost Analysis of a Multi-Storey Residential Net Zero Energy Building in Denmark

    DEFF Research Database (Denmark)

    Marszal, Anna Joanna; Heiselberg, Per

    2011-01-01

    renewable energy technologies? This analysis adopts the LCC methodology and uses a multi-family Net ZEB to find the answer to this question. Moreover, it looks at the issue from the building owner’s perspective, hence it should be seen as a private economy analysis. The study includes three levels of energy......It is well recognized that in the long run, the implementation of energy efficiency measures is a more cost-optimal solution in contrast to taking no action. However, the Net ZEB concept raises a new issue: how far should we go with energy efficiency measures and when should we start to apply...

  4. Web-based Tool Identifies and Quantifies Potential Cost Savings Measures at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Renevitz, Marisa J.; Peschong, Jon C.; Charboneau, Briant L.; Simpson, Brett C.

    2014-01-09

    The Technical Improvement system is an approachable web-based tool that is available to Hanford DOE staff, site contractors, and general support service contractors as part of the baseline optimization effort underway at the Hanford Site. Finding and implementing technical improvements are a large part of DOE’s cost savings efforts. The Technical Improvement dashboard is a key tool for brainstorming and monitoring the progress of submitted baseline optimization and potential cost/schedule efficiencies. The dashboard is accessible to users over the Hanford Local Area Network (HLAN) and provides a highly visual and straightforward status to management on the ideas provided, alleviating the need for resource intensive weekly and monthly reviews.

  5. Successful protocol for eliminating excessive urine microscopies: Quality improvement and cost savings with physician support.

    Science.gov (United States)

    Chen, Michael; Eintracht, Shaun; MacNamara, Elizabeth

    2017-01-01

    Clinical laboratories are under growing pressure to provide faster turn-around-time and maintain high quality while decreasing costs. In a setting of rising test volumes, implementation of evidence-based protocols with physician cooperation and feedback may provide frameworks and support for laboratory utilization optimization. The purpose of this study was to eliminate wasteful urine microscopy by targeting physician ordering behavior, and to ensure quality of care with physician satisfaction surveys. We evaluated how physicians use the laboratory for routine urine testing. Urinalysis requisition was redesigned with emphasis on clinical indications for testing. In collaboration with requesting physicians, restriction in reflex microscopy testing was applied with exceptions. Cost saving analysis was conducted based on test volume. After policy change, 2 physician satisfaction surveys were conducted 5year apart to address potential complaints. Over 47,000 urine microscopies have been eliminated annually, while the number of urine dipsticks and cultures remained stable. This translated into a 95% reduction in manual microscopy performed, and an estimated annual saving of $200,000. In both satisfaction surveys, 9 out of 10 physicians considered the change to have "no" or "a beneficial effect" on their clinical practice. Our laboratory did not receive any formal complaints in regards to the protocol change. By implementing changes to the way physicians order urinalysis, the number of tests can be substantially reduced. Satisfaction survey proved to be an effective tool for obtaining physician feedback, and support. The results of surveys indicated that new policy achieved significant savings without compromising on patient care. This experience has provided us with strategies on taking initiatives to further optimize utilization of laboratory tests. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  6. Safety and cost savings of reducing adult dengue hospitalization in a tertiary care hospital in Singapore.

    Science.gov (United States)

    Lee, Linda K; Earnest, Arul; Carrasco, Luis R; Thein, Tun L; Gan, Victor C; Lee, Vernon J; Lye, David C; Leo, Yee-Sin

    2013-01-01

    Previously, most dengue cases in Singapore were hospitalized despite low incidence of dengue hemorrhagic fever (DHF) or death. To minimize hospitalization, the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) in Singapore implemented new admission criteria which included clinical, laboratory, and DHF predictive parameters in 2007. All laboratory-confirmed dengue patients seen at TTSH during 2006-2008 were retrospectively reviewed for clinical data. Disease outcome and clinical parameters were compared over the 3 years. There was a 33.0% mean decrease in inpatients after the new criteria were implemented compared with the period before (p accumulation (15.5% vs 2.9% of outpatients), while most DHF outpatients had hypoproteinemia (92.7% vs 81.3% of inpatients). The eight intensive care unit admissions and five deaths during this time period all occurred among inpatients. The new criteria resulted in a median cost saving of US$1.4 million to patients in 2008. The new dengue admission criteria were effective in sustainably reducing length of hospitalization, yielding considerable cost savings. A minority of DHF patients with mild symptoms recovered uneventfully through outpatient management.

  7. Tele-Dysphagia management: an opportunity for prevention, cost-savings and advanced training.

    Science.gov (United States)

    Coyle, James

    2012-01-01

    Many patients survive severe stroke because of aggressive management in intensive care units. However, acquiring pneumonia during the post-onset phase significantly reduces both the quality and likelihood of survival. Aspiration pneumonia (AP), a relatively recent addition to the list of the pneumonias, is associated with dysphagia, a swallowing disorder that may cause aspiration of swallowed food or liquids mixed with bacterial pathogens common to saliva, or by aspiration of gastric contents due to emesis or gastroesophageal reflux. While it is within the purview of speech-language pathologists to provide evaluation, treatment, and management of dysphagia, the number of patients with dysphagia is growing faster than the number of qualified dysphagia clinicians. Because dysphagia consultations via telepractice are feasible and relatively accessible from a technological standpoint, they offer a promising strategy to bring the expertise of distant dysphagia experts to patients in underserved areas. Tele-dysphagia management has the potential to increase patients' survival, enhance the expertise of primary, local clinicians, and reduce healthcare costs. Even a modest reduction in either hospital admissions for aspiration pneumonia, or in the length of stay for AP, could save the US health care system hundreds of millions of dollars each year. Wide spread tele-dysphagia management offers significant opportunities for prevention, cost-savings and advanced training, and is therefore worthy of consideration by stakeholders in the health care system and university training programs.

  8. Energy savings estimates and cost benefit calculations for high performance relocatable classrooms

    Energy Technology Data Exchange (ETDEWEB)

    Rainer, Leo I.; Hoeschele, Marc A.; Apte, Michael G.; Shendell, Derek G.; Fisk, Wlliam J.

    2003-12-01

    This report addresses the results of detailed monitoring completed under Program Element 6 of Lawrence Berkeley National Laboratory's High Performance Commercial Building Systems (HPCBS) PIER program. The purpose of the Energy Simulations and Projected State-Wide Energy Savings project is to develop reasonable energy performance and cost models for high performance relocatable classrooms (RCs) across California climates. A key objective of the energy monitoring was to validate DOE2 simulations for comparison to initial DOE2 performance projections. The validated DOE2 model was then used to develop statewide savings projections by modeling base case and high performance RC operation in the 16 California climate zones. The primary objective of this phase of work was to utilize detailed field monitoring data to modify DOE2 inputs and generate performance projections based on a validated simulation model. Additional objectives include the following: (1) Obtain comparative performance data on base case and high performance HVAC systems to determine how they are operated, how they perform, and how the occupants respond to the advanced systems. This was accomplished by installing both HVAC systems side-by-side (i.e., one per module of a standard two module, 24 ft by 40 ft RC) on the study RCs and switching HVAC operating modes on a weekly basis. (2) Develop projected statewide energy and demand impacts based on the validated DOE2 model. (3) Develop cost effectiveness projections for the high performance HVAC system in the 16 California climate zones.

  9. Tele-Dysphagia Management: An Opportunity for Prevention, Cost-Savings and Advanced Training

    Directory of Open Access Journals (Sweden)

    James Coyle

    2012-06-01

    Full Text Available Many patients survive severe stroke because of aggressive management in intensive care units.  However, acquiring pneumonia during the post-onset phase significantly reduces both the quality and likelihood of survival. Aspiration pneumonia (AP, a relatively recent addition to the list of the pneumonias, is associated with dysphagia, a swallowing disorder that may cause aspiration of swallowed food or liquids mixed with bacterial pathogens common to saliva, or by aspiration of gastric contents due to emesis or gastroesophageal reflux. While it is within the purview of speech-language pathologists to provide evaluation, treatment, and management of dysphagia, the number of patients with dysphagia is growing faster than the number of qualified dysphagia clinicians.  Because dysphagia consultations via telepractice are feasible and relatively accessible from a technological standpoint, they offer a promising strategy to bring the expertise of distant dysphagia experts to patients in underserved areas.  Tele-dysphagia management has the potential to increase patients’ survival, enhance the expertise of primary, local clinicians, and reduce healthcare costs. Even a modest reduction in either hospital admissions for aspiration pneumonia, or in the length of stay for AP, could save the US health care system hundreds of millions of dollars each year.  Wide spread tele-dysphagia management offers significant opportunities for prevention, cost-savings and advanced training, and is therefore worthy of consideration by stakeholders in the health care system and university training programs.

  10. Energy conserved and costs saved by small and medium-size manufacturers, 1988--1989

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, F.W.

    1991-05-01

    Energy Analysis and Diagnostic Centers (EADCs) provided energy-conserving and cost saving assistance in 339 small and medium-size manufacturing plants nationwide during 1988-89. This report presents the results of what was recommended to those manufacturers, the record of what was implemented by them, and an analysis of the financial rewards gained by them. It also includes an accounting of the financial returns to the federal government, derived from taxes upon the cost savings, or incremental income, of the manufacturers who implement the EADCs` recommendations. EADCs collect implementation data within a year of the energy audit, and for these results that time period extended through 1990. The EADCs are located at accredited engineering departments of universities and staffed by faculty and students. At present there are 18 EADCs serving manufacturers in 37 states; of these, two were established as a result of the 1989 competition, and five more were chosen competitively in 1990. Most of the results in this report were generated by 11 EADCs (named in the Appendix); two others withdrew voluntarily after completing only 10 energy audits during 1988-89. Primary responsibility for selecting, training, evaluating, and managing the EADCs belongs to the Industrial Technology and Energy Management (ITEM) division of University City Science Center (UCSC). The Department of Energy`s Office of Industrial Technologies sponsors the EADC program through an agreement with UCSC.

  11. School nurses' role in asthma management, school absenteeism, and cost savings: a demonstration project.

    Science.gov (United States)

    Rodriguez, Eunice; Rivera, Diana Austria; Perlroth, Daniella; Becker, Edmund; Wang, Nancy Ewen; Landau, Melinda

    2013-12-01

    With increasing budget cuts to education and social services, rigorous evaluation needs to document school nurses' impact on student health, academic outcomes, and district funding. Utilizing a quasi-experimental design, we evaluated outcomes in 4 schools with added full-time nurses and 5 matched schools with part-time nurses in the San Jose Unified School District. Student data and logistic regression models were used to examine predictors of illness-related absenteeism for 2006-2007 and 2008-2009. We calculated average daily attendance (ADA) funding and parent wages associated with an improvement in illness-related absenteeism. Utilizing parent surveys, we also estimated the cost of services for asthma-related visits to the emergency room (ER; N = 2489). Children with asthma were more likely to be absent due to illness; however, mean absenteeism due to illness decreased when full-time nurses were added to demonstration schools but increased in comparison schools during 2008-2009, resulting in a potential savings of $48,518.62 in ADA funding (N = 6081). Parents in demonstration schools reported fewer ER visits, and the estimated savings in ER services and parent wages were significant. Full-time school nurses play an important role in improving asthma management among students in underserved schools, which can impact school absenteeism and attendance-related economic costs. © 2013, American School Health Association.

  12. Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings.

    Science.gov (United States)

    McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona; Giles, Margaret

    2016-11-01

    Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  13. Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets

    Directory of Open Access Journals (Sweden)

    Hanson Kara

    2008-02-01

    Full Text Available Abstract Background The cost-effectiveness of insecticide-treated nets (ITNs in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS, a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution. Methods Economic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered and treated nets years. Estimates were also made for the cost per malaria case and death averted. Results and Conclusion The total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups.

  14. Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants.

    Science.gov (United States)

    Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P

    2017-04-01

    The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. A business case evaluation of workplace engineering noise control: a net-cost model.

    Science.gov (United States)

    Lahiri, Supriya; Low, Colleen; Barry, Michael

    2011-03-01

    This article provides a convenient tool for companies to determine the costs and benefits of alternative interventions to prevent noise-induced hearing loss (NIHL). Contextualized for Singapore and in collaboration with Singapore's Ministry of Manpower, the Net-Cost model evaluates costs of intervention for equipment and labor, avoided costs of productivity losses and medical care, and productivity gains from the employer's economic perspective. To pilot this approach, four case studies are presented, with varying degrees of economic benefits to the employer, including one in which multifactor productivity is the main driver. Although compliance agencies may not require economic analysis of NIHL, given scarce resources in a market-driven economy, this tool enables stakeholders to understand and compare the costs and benefits of NIHL interventions comprehensively and helps in determining risk management strategies.

  16. Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement.

    Science.gov (United States)

    Gortmaker, Steven L; Wang, Y Claire; Long, Michael W; Giles, Catherine M; Ward, Zachary J; Barrett, Jessica L; Kenney, Erica L; Sonneville, Kendrin R; Afzal, Amna Sadaf; Resch, Stephen C; Cradock, Angie L

    2015-11-01

    Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity. Project HOPE—The People-to-People Health Foundation, Inc.

  17. Cost-saving potentials using demand side management in households and electric mobility

    Energy Technology Data Exchange (ETDEWEB)

    Schinz, S.; Najib, H.; Steiner, L. [Darmstadt Univ. of Technology (Germany). Inst. for Renewable Energies

    2010-07-01

    The increasing share of renewable energies in the electricity production has an influence on the grid and on the electricity markets, where higher price fluctuations are expected. One way of integrating renewable energies is using demand side management (DSM). In this case online energy markets enable private households to participate with their loads in these markets. Especially their household appliances participate on the basis of hourly electricity prices. Thus these markets can provide DSM-services for the grid by means of aggregating household loads. To estimate the cost-savings of DSM for the purpose of reducing electricity costs in private households different gadget-models are developed and minimal costs are calculated by formulating linear optimization models. In private households especially refrigerators, freezers, washing machines, tumble- dryers and dishwashers can be considered as shiftable loads for DSM purposes. This application of DSM is examined in this paper precisely. Future developments regarding DSM are analyzed with scenarios for 2010 and 2030. The gadget-models have average specifications of gadgets in Europe and Germany. Their operation is optimized for minimal electricity cost over one year on the basis of electricity prices from the European Energy Exchange EEX in Leipzig, Germany. Finally DSM in Micro Grids is analyzed and different control options are considered to solve the voltage stability problem. (orig.)

  18. COST OF PRODUCTION, GROSS RETURN AND NET PROFIT IN COMMERCIAL EGG PRODUCTION

    Directory of Open Access Journals (Sweden)

    M. Farooq, Zahoor-ul-Haq1, M.A. Mian, F.R. Durrani and M. Syed

    2003-01-01

    Full Text Available The present study was carried out in Chakwal, Pakistan by collecting data from randomly selected 109 flocks to investigate cost of production, gross return and net profit per layer. Majority of the buildings in the study area were rented therefore, rent per layer was added to the total cost of production instead of depreciation on building and equipments. Overall total cost of production, gross return and net profit per layer was Rs. 393.88 ± 5.36, 432.14 ± 8.01 and 38.26 ± 6.66, respectively. Rate of return over the invested capital was 27%. Mean feed cost per layer was Rs. 302.23 ± 5.01, including Rs. 10.27 ± 0.24, 29.19 ± 0.42 and 262.77 ± 5.08 for starter, grower and layer ration, respectively. Feed cost was the major component contributing 76.73% to the total cost of production. Average cost of labor, day-old chick, building rent, vaccination, therapy, miscellaneous item, electricity, bedding material and transportation was Rs. 19.90 ± 0.45, 19.75 ± 0.05, 16.25 ± 0.26, 12.80 ± 0.10, 10.90 ± 2.32, 4.35 ± 0.09, 3.15 ± 0.07, 2.65 ± 0.09 and 1.90 ± 0.08, respectively, contributing 5.05, 5.01, 4.13, 3.25, 2.77, 1.10, 0.80, 0.67 and 0.48 % to the total cost of production. Gross return from the sale of marketable eggs, culled eggs, spent/culled bird, empty bags and manure was Rs. 388.84 ± 7.91, 3.85 ± 0.01, 35.80 ± 0.23, 2.20 ± 0.04 and 1.45 ± 0.01, respectively, contributing 89.98, 0.89, 8.28, 0.51 and 0.34% to the total return. Determining the effect of different parameters on the cost of production and net profit, large flocks, Hisex strain, brood-grow and lay system of rearing, good hygienic conditions of the farm, normal stocking rate and cage system of housing wee found to give maximum gross return as well as net profit.

  19. Evaluation of a universal long-lasting insecticidal net (LLIN) distribution campaign in Ghana: cost effectiveness of distribution and hang-up activities.

    Science.gov (United States)

    Smith Paintain, Lucy; Awini, Elizabeth; Addei, Sheila; Kukula, Vida; Nikoi, Christian; Sarpong, Doris; Kwesi Manyei, Alfred; Yayemain, Daniel; Rusamira, Etienne; Agborson, Josephine; Baffoe-Wilmot, Aba; Bart-Plange, Constance; Chatterjee, Anirban; Gyapong, Margaret; Mangham-Jefferies, Lindsay

    2014-02-28

    Between May 2010 and October 2012, approximately 12.5 million long-lasting insecticidal nets (LLINs) were distributed through a national universal mass distribution campaign in Ghana. The campaign included pre-registration of persons and sleeping places, door-to-door distribution of LLINs with 'hang-up' activities by volunteers and post-distribution 'keep-up' behaviour change communication activities. Hang-up activities were included to encourage high and sustained use. The cost and cost-effectiveness of the LLIN Campaign were evaluated using a before-after design in three regions: Brong Ahafo, Central and Western. The incremental cost effectiveness of the 'hang-up' component was estimated using reported variation in the implementation of hang-up activities and LLIN use. Economic costs were estimated from a societal perspective assuming LLINs would be replaced after three years, and included the time of unpaid volunteers and household contributions given to volunteers. Across the three regions, 3.6 million campaign LLINs were distributed, and 45.5% of households reported the LLINs received were hung-up by a volunteer. The financial cost of the campaign was USD 6.51 per LLIN delivered. The average annual economic cost was USD 2.90 per LLIN delivered and USD 6,619 per additional child death averted by the campaign. The cost-effectiveness of the campaign was sensitive to the price, lifespan and protective efficacy of LLINs.Hang-up activities constituted 7% of the annual economic cost, though the additional financial cost was modest given the use of volunteers. LLIN use was greater in households in which one or more campaign LLINs were hung by a volunteer (OR=1.57; 95% CI=1.09, 2.27; p=0.02). The additional economic cost of the hang-up activities was USD 0.23 per LLIN delivered, and achieved a net saving per LLIN used and per death averted. In this campaign, hang-up activities were estimated to be net saving if hang-up increased LLIN use by 10% or more. This suggests

  20. Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study

    Directory of Open Access Journals (Sweden)

    Beecham Jennifer

    2011-10-01

    Full Text Available Abstract Background Conduct disorders are the most common psychiatric disorders in children and may persist into adulthood in about 50% of cases. The costs to society are high and impact many public sector agencies. Parenting programmes have been shown to positively affect child behaviour, but little is known about their potential long-term cost-effectiveness. We therefore estimate the costs of and longer-term savings from evidence-based parenting programmes for the prevention of persistent conduct disorder. Methods A decision-analytic Markov model compares two scenarios: 1 a 5-year old with clinical conduct disorder receives an evidence-based parenting programme; 2 the same 5-year old does not receive the programme. Cost-savings analysis is performed by comparing the probability that conduct disorder persists over time in each scenario, adopting both a public sector and a societal perspective. If the intervention is successful in reducing persistent conduct disorder, cost savings may arise from reduced use of health services, education support, social care, voluntary agencies and from crimes averted. Results Results strongly suggest that parenting programmes reduce the chance that conduct disorder persists into adulthood and are cost-saving to the public sector within 5-8 years under base case conditions. Total savings to society over 25 years are estimated at £16,435 per family, which compares with an intervention cost in the range of £952-£2,078 (2008/09 prices. Conclusions Effective implementation of evidence-based parenting programmes is likely to yield cost savings to the public sector and society. More research is needed to address evidence gaps regarding the current level of provision, longer-term effectiveness and questions of implementation, engagement and equity.

  1. Energy and Energy Cost Savings Analysis of the 2015 IECC for Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jian [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Xie, YuLong [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Athalye, Rahul A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhuge, Jing Wei [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rosenberg, Michael I. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hart, Philip R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Liu, Bing [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-06-01

    As required by statute (42 USC 6833), DOE recently issued a determination that ANSI/ASHRAE/IES Standard 90.1-2013 would achieve greater energy efficiency in buildings subject to the code compared to the 2010 edition of the standard. Pacific Northwest National Laboratory (PNNL) conducted an energy savings analysis for Standard 90.1-2013 in support of its determination . While Standard 90.1 is the model energy standard for commercial and multi-family residential buildings over three floors (42 USC 6833), many states have historically adopted the International Energy Conservation Code (IECC) for both residential and commercial buildings. This report provides an assessment as to whether buildings constructed to the commercial energy efficiency provisions of the 2015 IECC would save energy and energy costs as compared to the 2012 IECC. PNNL also compared the energy performance of the 2015 IECC with the corresponding Standard 90.1-2013. The goal of this analysis is to help states and local jurisdictions make informed decisions regarding model code adoption.

  2. Energy and Energy Cost Savings Analysis of the 2015 IECC for Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jian [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Xie, YuLong [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Athalye, Rahul A. [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Zhuge, Jing Wei [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Rosenberg, Michael I. [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Hart, Philip R. [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States); Liu, Bing [Pacific Northwest National Laboratory (PNNL), Richland, WA (United States)

    2015-09-01

    As required by statute (42 USC 6833), DOE recently issued a determination that ANSI/ASHRAE/IES Standard 90.1-2013 would achieve greater energy efficiency in buildings subject to the code compared to the 2010 edition of the standard. Pacific Northwest National Laboratory (PNNL) conducted an energy savings analysis for Standard 90.1-2013 in support of its determination . While Standard 90.1 is the model energy standard for commercial and multi-family residential buildings over three floors (42 USC 6833), many states have historically adopted the International Energy Conservation Code (IECC) for both residential and commercial buildings. This report provides an assessment as to whether buildings constructed to the commercial energy efficiency provisions of the 2015 IECC would save energy and energy costs as compared to the 2012 IECC. PNNL also compared the energy performance of the 2015 IECC with the corresponding Standard 90.1-2013. The goal of this analysis is to help states and local jurisdictions make informed decisions regarding model code adoption.

  3. [Cost control in anesthesiology--regulating net costs exemplified by anesthetics].

    Science.gov (United States)

    Bauer, M; Böttiger, B W; Martin, E; Bach, A

    2000-01-01

    German hospitals are beginning to feel more and more pressure due to rising costs in health care. These are due to continuous increase in health care expenditure and decrease in state insurance contributions. A change in the state insurance system (GKV) is well and truly overdue; the source of income needs to be increased by either raising the compulsory insurance wage base or making other forms of income liable for insurance contributions. Unfortunately, the government is still reluctant to take action. The ruling coalition feels that it is better to limit the increase in expenditure on hospital care by introducing a case-related payment system. Unfortunately, they do not recognize that the main reason for the increase in health care expenditure is the growing medical potential and the higher morbidity of an, on average, older population. These cuts in financial means demand an efficient allocation of the available funds. As far as hospital in-patient care is concerned, this means that hospitals need to reconsider their expenditure and that economic success is dependent on their potential to recognize ways of reducing overall costs. This article illustrates that before the "Diagnosis Related Groups" (DRG) become effective in 2003, one needs to establish the cost price of individual hospital cases. The economic principles of cost-benefit ratios and methods to prevent cost inflation are presented. The methods of making a cost-effectiveness analysis of anaesthetic costs are explained in detail. The aim of this paper is to give the clinician a better understanding of cost management and to motivate staff to initiate cost-control studies.

  4. Energy-Smart Building Choices: How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money

    Energy Technology Data Exchange (ETDEWEB)

    Energy Smart Schools Team

    2001-08-06

    Most K-12 schools could save 25% of their energy costs by being smart about energy. Nationwide, the savings potential is $6 billion. While improving energy use in buildings and busses, schools are likely to create better places for teaching and learning, with better lighting, temperature control, acoustics, and air quality. This brochure, targeted to school facilities managers and business officials, describes how schools can become more energy efficient.

  5. Cost-effectiveness of social marketing of insecticide-treated nets for malaria control in the United Republic of Tanzania.

    Science.gov (United States)

    Hanson, Kara; Kikumbih, Nassor; Armstrong Schellenberg, Joanna; Mponda, Haji; Nathan, Rose; Lake, Sally; Mills, Anne; Tanner, Marcel; Lengeler, Christian

    2003-01-01

    To assess the costs and consequences of a social marketing approach to malaria control in children by means of insecticide-treated nets in two rural districts of the United Republic of Tanzania, compared with no net use. Project cost data were collected prospectively from accounting records. Community effectiveness was estimated on the basis of a nested case-control study and a cross-sectional cluster sample survey. The social marketing approach to the distribution of insecticide-treated nets was estimated to cost 1560 US dollars per death averted and 57 US dollars per disability-adjusted life year averted. These figures fell to 1018 US dollars and 37 US dollars, respectively, when the costs and consequences of untreated nets were taken into account. The social marketing of insecticide-treated nets is an attractive intervention for preventing childhood deaths from malaria.

  6. Surgeon’s dilemma: should I save patient’s life at any cost?

    Directory of Open Access Journals (Sweden)

    Kamila Kocańda

    2017-12-01

    Full Text Available Every doctor practicing treatment in the field of medicine may be confronted with a serious question: should I save my patient’s life at any cost? If a doctor resigns from emergency procedures, he/she will risk the patient’s death. However, if he/she decides to proceed regardless of a Jehovah’s Witness patient’s statement of will, in which he or she refuses transfusion, he/she takes a risk of illegal medical intervention. There is neither an easy answer, nor a serious solution, thus the only way is to choose the lesser of two evils. Notwithstanding legal issues, there are still ethical problems, which result in an internal dilemma for a doctor.

  7. Can business impact analysis play a meaningful role in planning a cost-saving programme?

    Science.gov (United States)

    Wright, Trevor

    2011-02-01

    Business continuity as it exists today would appear to have reached something of a plateau. Considering the history of the discipline, and how it has developed from 'simple' disaster recovery to its present position, it is clear that the trend has been to move from a reactive discipline to a proactive process. Following on from this broadly-accepted point, it is perhaps time to consider how the discipline may develop and what wider and deeper contribution the business continuity profession may make to add further value for our clients. In the present climate, it seems appropriate to consider how (and if) business continuity practice can make a meaningful contribution to a cost saving exercise. The public and private sectors are considered and the differences are compared.

  8. Review of the Fuel Saving, Life Cycle GHG Emission, and Ownership Cost Impacts of Lightweighting Vehicles with Different Powertrains.

    Science.gov (United States)

    Luk, Jason M; Kim, Hyung Chul; De Kleine, Robert; Wallington, Timothy J; MacLean, Heather L

    2017-08-01

    The literature analyzing the fuel saving, life cycle greenhouse gas (GHG) emission, and ownership cost impacts of lightweighting vehicles with different powertrains is reviewed. Vehicles with lower powertrain efficiencies have higher fuel consumption. Thus, fuel savings from lightweighting internal combustion engine vehicles can be higher than those of hybrid electric and battery electric vehicles. However, the impact of fuel savings on life cycle costs and GHG emissions depends on fuel prices, fuel carbon intensities and fuel storage requirements. Battery electric vehicle fuel savings enable reduction of battery size without sacrificing driving range. This reduces the battery production cost and mass, the latter results in further fuel savings. The carbon intensity of electricity varies widely and is a major source of uncertainty when evaluating the benefits of fuel savings. Hybrid electric vehicles use gasoline more efficiently than internal combustion engine vehicles and do not require large plug-in batteries. Therefore, the benefits of lightweighting depend on the vehicle powertrain. We discuss the value proposition of the use of lightweight materials and alternative powertrains. Future assessments of the benefits of vehicle lightweighting should capture the unique characteristics of emerging vehicle powertrains.

  9. You say you want a revolution: casing drilling targets 30 per cent well-cost saving

    Energy Technology Data Exchange (ETDEWEB)

    Polczer, S.; Marsters, S.

    1999-10-01

    Casing drilling is a new method of drilling that eliminates drill strings by using standard casing to simultaneously drill and case wells. Tesco Corporation of Calgary acquired patent rights to casing drilling technology in 1995. The company now offers a conversion kit for existing drill rigs as well a new compact casing drilling rig for shallow markets. The single derrick will be rated at 1,500 meters, but initially it will be used to drill 700-800 meter gas wells in southeast Alberta. Some cost savings will be realized at these shallow depths, but the real cost saving advantages will be realized on deep holes. In the meantime, improvements are planned to the cutting structures of the under-rimming bit to increase safety and withstand higher torque loads. It will be also necessary to adapt techniques such as directional drilling and logging to the casing drilling conveyance mechanism which has been only partially successful thus far, especially in the retrieving mode. Another challenge already met, involved ensuring that casing could be run in high-compression loads without damage to connections. Despite these problems, the system attracted considerable attention with several international companies placing orders for immediate delivery. Another system, this one developed by Sperry-Sun Drilling Services and known as a 'casing while drilling' (CWD) system, is strictly a downhole assembly and is targeted for offshore use and deeper vertical holes. This system is currently being tested in two commercial operations in offshore Indonesia for Unocal Corporation. Despite numerous problems to fill casing with fluid during connections, penetration rates of 300-400 feet per hour were achieved.

  10. [Radiology in managed care environment: opportunities for cost savings in an HMO].

    Science.gov (United States)

    Schmidt, C; Mohr, A; Möller, J; Levin-Scherz, J; Heller, M

    2003-09-01

    A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these

  11. Supply chain collaboration and cost saving as a result of returns handling programmes in retail corporations in Poland

    Directory of Open Access Journals (Sweden)

    Anna Maria Jeszka

    2015-09-01

    Full Text Available Background: The objective is to define on the basis of the literature as well as to test empirically the main factors that affect the cost saving of many retail chains, resulting from deliberate and conscious policies as well as organized activities in the area of product returns management. Methods: Based on a survey developed for the study, standardized interviews were conducted with representatives of trade corporations in the apparel industry in Poland. The data collected were analysed statistically. Results:  The results of the statistical analysis showed that the analysed factors had a significant impact on cost saving. A company's ability to cooperate in the supply chain, limited  for the purposes of the study to the distributor - retailer relationship, is relevant to the cost savings resulting from the policies of retail corporations in the area of reverse logistics. The integration of IT systems with suppliers and customers also influences the level of cost saving, as does collaboration within a team. Conclusions: To date, studies in this field have not been conducted in Poland. A particularly important element seems to be the relationship between cooperation in the supply chain and the possible savings which this can generate. This study contributes to the growing trend of research into reverse logistics and emphasizes the role of retailers and cooperation in the supply chain.  

  12. Near net shape, low cost ceramic valves for advanced engine applications

    Energy Technology Data Exchange (ETDEWEB)

    Pidria, M.; Merlone, E.; Parussa, F. [Fiat Research Centre, Orbassano (Italy); Handelsman, J.; Gorodnev, A. [Ceracom Materials Ltd., Yavneh (Israel)

    2003-07-01

    Future gasoline and diesel engines with electro-hydraulic or electro-mechanical valve control systems require the development of lighter valves to achieve the best results in terms of increased performances, lower fuel consumption and overall efficiency. Ceramic materials can adequately satisfy the required mechanical and thermal properties, nevertheless they still lack as far as manufacturing costs are concerned. Objective of the work was the development of a low-cost forming and sintering process, to produce near-net shape ceramic valves thus requiring very low finishing operations and significantly minimizing material waste. Between available technical ceramic materials, silicon nitride has been chosen to replace conventional steels and Ni-based alloys for the exhaust valves application. The work was then devoted to (i) the selection of the best starting materials composition, taking into account the requirements of a cost effective and high volume production, (ii) the development of an innovative pressure-injection molding process to produce near-net shape parts via a thermosetting feedstock and (iii) the optimization of a proper pressure-less sintering route to obtain cost-competitive, real scale components with adequate final density and mechanical properties. (orig.)

  13. Vehicle Lightweighting: 40% and 45% Weight Savings Analysis: Technical Cost Modeling for Vehicle Lightweighting

    Energy Technology Data Exchange (ETDEWEB)

    Mascarin, Anthony [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hannibal, Ted [Idaho National Lab. (INL), Idaho Falls, ID (United States); Raghunathan, Anand [Idaho National Lab. (INL), Idaho Falls, ID (United States); Ivanic, Ziga [Idaho National Lab. (INL), Idaho Falls, ID (United States); Francfort, James [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-04-01

    The U.S. Department of Energy’s Vehicle Technologies Office, Materials area commissioned a study to model and assess manufacturing economics of alternative design and production strategies for a series of lightweight vehicle concepts. The strategic targets were a 40% and a 45% mass reduction relative to a standard North American midsize passenger sedan at an effective cost of $3.42 per pound (lb) saved. The baseline vehicle was an average of several available vehicles in this class. Mass and cost breakdowns from several sources were used, including original equipment manufacturers’ (OEMs’) input through U.S. Department of Energy’s Vehicle Technologies Office programs and public presentations, A2Mac1 LLC’s teardown information, Lotus Engineering Limited and FEV, Inc. breakdowns in their respective lightweighting studies, and IBIS Associates, Inc.’s decades of experience in automotive lightweighting and materials substitution analyses. Information on lightweighting strategies in this analysis came from these same sources and the ongoing U.S. Department of Energy-funded Vehma International of America, Inc. /Ford Motor Company Multi-Material Lightweight Prototype Vehicle Demonstration Project, the Aluminum Association Transportation Group, and many United States Council for Automotive Research’s/United States Automotive Materials Partnership LLC lightweight materials programs.

  14. Reusing dialyzer in low income countries: A good cost saving tactic with complex ethics.

    Science.gov (United States)

    Dhrolia, Murtaza Fakhruddin; Imtiaz, Salman; Qureshi, Ruqaya; Ahmed, Aasim

    2017-08-01

    Despite almost universal practice of dialyzer reuse from the earliest days of haemodialysis, reusing dialyzer always remains a controversial issue and several ethical concerns have been raised. Some of the important are safety of reuse over single use, informed consent of the patient, conflict of interest on the part of physician or manufacturer, fiscal responsibility and environmental stewardship. Indeed, at the beginning of this century, there was a drastic shift of practice in favour of single use in developed countries due to availability of biocompatible haemodialyzers, at favourable price. Despite this mega shift, dialyzer reuse is still widely practised in low-income countries. Considering cost inflation and limited medical resources in such countries, dialyzer reuse may be justified as a cost-saving strategy for this part of world. However, it poses the same ethical questions to us which were a matter of debate for the western world in the 1980s and 1990s. This review of literature was planned to revisit and highlight these concerns.

  15. Economic Utility: Combinatorial Pharmacogenomics and Medication Cost Savings for Mental Health Care in a Primary Care Setting.

    Science.gov (United States)

    Brown, Lisa C; Lorenz, Raymond A; Li, James; Dechairo, Bryan M

    2017-03-01

    This study was an analysis based on a previously completed prospective study investigating medication costs of patients with mental illness guided by using the GeneSight proprietary combinatorial pharmacogenomic (PGx) test. The primary objective of this study was to determine potential cost savings of combinatorial PGx testing over the course of 1 year in patients with mental illness treated by primary care providers (PCPs) and psychiatrists who had switched or added a new psychiatric medication after patients failed to respond to monotherapy. The current evaluation details cost savings of treatment decisions congruent and incongruent with the combinatorial PGx test recommendations specific to PCPs and psychiatrists. This study was a subanalysis of a 1-year, prospective trial comparing medication costs of 2168 patients undergoing GeneSight testing. Pharmacy claims were provided by a pharmacy benefits manager, comparing medication costs 6 months before combinatorial PGx testing and followed up for 1 year after the testing. This analysis compared congruence and cost savings per patient based on the type of health care provider administering care. Using data from a large pharmacy benefits manager, we found that PCPs treat the majority of mental health patients receiving psychotropic medication prescriptions, including treatment-resistant patients. PCPs congruent with combinatorial PGx testing provided the most medication cost savings for payers and patients at $3988 per member per year (P Health care providers treating patients with mental illness can significantly reduce medication costs by following the combinatorial PGx report recommendations. PCPs, who treat the majority of patients with mental illness, reported a significant reduction in medication costs for both central nervous system and non-central nervous system drugs. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  16. The cost-saving effect and prevention of medication errors by clinical pharmacist intervention in a nephrology unit.

    Science.gov (United States)

    Chen, Chia-Chi; Hsiao, Fei-Yuan; Shen, Li-Jiuan; Wu, Chien-Chih

    2017-08-01

    Medication errors may lead to adverse drug events (ADEs), which endangers patient safety and increases healthcare-related costs. The on-ward deployment of clinical pharmacists has been shown to reduce preventable ADEs, and save costs. The purpose of this study was to evaluate the ADEs prevention and cost-saving effects by clinical pharmacist deployment in a nephrology ward.This was a retrospective study, which compared the number of pharmacist interventions 1 year before and after a clinical pharmacist was deployed in a nephrology ward. The clinical pharmacist attended ward rounds, reviewed and revised all medication orders, and gave active recommendations of medication use. For intervention analysis, the numbers and types of the pharmacist's interventions in medication orders and the active recommendations were compared. For cost analysis, both estimated cost saving and avoidance were calculated and compared.The total numbers of pharmacist interventions in medication orders were 824 in 2012 (preintervention), and 1977 in 2013 (postintervention). The numbers of active recommendation were 40 in 2012, and 253 in 2013. The estimated cost savings in 2012 and 2013 were NT$52,072 and NT$144,138, respectively. The estimated cost avoidances of preventable ADEs in 2012 and 2013 were NT$3,383,700 and NT$7,342,200, respectively. The benefit/cost ratio increased from 4.29 to 9.36, and average admission days decreased by 2 days after the on-ward deployment of a clinical pharmacist.The number of pharmacist's interventions increased dramatically after her on-ward deployment. This service could reduce medication errors, preventable ADEs, and costs of both medications and potential ADEs.

  17. Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

    Science.gov (United States)

    May, Peter; Garrido, Melissa M; Cassel, J Brian; Kelley, Amy S; Meier, Diane E; Normand, Charles; Smith, Thomas J; Morrison, R Sean

    2017-04-01

    Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Prospective multi-site cohort study (2007-2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.

  18. Cost Control Best Practices for Net Zero Energy Building Projects: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Leach, M.; Pless, S.; Torcellini, P.

    2014-02-01

    For net zero energy (NZE) buildings to become the norm in commercial construction, it will be necessary to design and construct these buildings cost effectively. While industry leaders have developed workflows (for procurement, design, and construction) to achieve cost-effective NZE buildings for certain cases, the expertise embodied in those workflows has limited penetration within the commercial building sector. Documenting cost control best practices of industry leaders in NZE and packaging those strategies for adoption by the commercial building sector will help make the business case for NZE. Furthermore, it will promote market uptake of the innovative technologies and design approaches needed to achieve NZE. This paper summarizes successful cost control strategies for NZE procurement, design, and construction that key industry users (such as building owners, architects, and designers) can incorporate into their everyday workflows. It will also evaluate the current state of NZE economics and propose a path forward for greater market penetration of NZE buildings. By demonstrating how to combine NZE technologies and design approaches into an overall efficiency package that can be implemented at minimal (zero, in certain cases) incremental capital cost, the domain of NZE design and construction can be expanded from a niche market to the commercial construction mainstream.

  19. Process control, energy recovery and cost savings in acetic acid wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Vaiopoulou, E., E-mail: vaiop@env.duth.gr [Department of Environmental Engineering, Democritus University of Thrace, Vas. Sofias 12, 67 100 Xanthi (Greece); Melidis, P., E-mail: pmelidis@env.duth.gr [Department of Environmental Engineering, Democritus University of Thrace, Vas. Sofias 12, 67 100 Xanthi (Greece); Aivasidis, A., E-mail: aavazid@env.duth.gr [Department of Environmental Engineering, Democritus University of Thrace, Vas. Sofias 12, 67 100 Xanthi (Greece)

    2011-02-28

    An anaerobic fixed bed loop (AFBL) reactor was applied for treatment of acetic acid (HAc) wastewater. Two pH process control concepts were investigated; auxostatic and chemostatic control. In the auxostatic pH control, feed pump is interrupted when pH falls below a certain pH value in the bioreactor, which results in reactor operation at maximum load. Chemostatic control assures alkaline conditions by setting a certain pH value in the influent, preventing initial reactor acidification. The AFBL reactor treated HAc wastewater at low hydraulic residence time (HRT) (10-12 h), performed at high space time loads (40-45 kg COD/m{sup 3} d) and high space time yield (30-35 kg COD/m{sup 3} d) to achieve high COD (Chemical Oxygen Demand) removal (80%). Material and cost savings were accomplished by utilizing the microbial potential for wastewater neutralization during anaerobic treatment along with application of favourable pH-auxostatic control. NaOH requirement for neutralization was reduced by 75% and HRT was increased up to 20 h. Energy was recovered by applying costless CO{sub 2} contained in the biogas for neutralization of alkaline wastewater. Biogas was enriched in methane by 4 times. This actually brings in more energy profits, since biogas extra heating for CO{sub 2} content during biogas combustion is minimized and usage of other acidifying agents is omitted.

  20. netPICOMAG: a low-cost turn-key magnetometer for aurora detection

    Science.gov (United States)

    Schofield, I.; Connors, M.

    2008-12-01

    Previous work on development of a compact, low-cost, fluxgate magnetometer, dubbed PICOMAG, yielded a 1-nanotesla resolution, 1-second cadence instrument, suitable for research or teaching solar/terrestrial physics. With a low-cost magnetic instrument and the wider availability of Internet connectivity in the auroral zone (of Canada for example), the potential exists to fill gaps in spatial coverage that still plague auroral geomagnetic research. Thus, the ability to widely distribute accurate, low cost magnetometers was the motivating factor to develop PICOMAG. NetPICOMAG was developed in the effort to refine PICOMAG into a turn-key magnetometer data collection system that is self contained, simple to install and requires zero-maintenance. Once the unit is placed in the ground and connected to the Internet, it locks onto a GPS time signal and begins to transmit magnetic field measurements back to a central data repository, where it is archived, processed and plotted for public viewing via the World Wide Web. It is envisaged (among many other uses) that science teachers can use real scientific data provided by netPICOMAG in teaching the interactions between the sun and the Earth's magnetic field, manifesting itself in the phenomenon known as the northern lights. As such, netPICOMAG can be aptly described and is being promoted as an aurora detector. The netPICOMAG unit is based around three spatially oriented Speake and Company FGM-3/3h series magnetic field sensors that each emit a pulse stream whose frequency is related to the magnetic field along these three axes, and is nearly linearly related to magnetic field perturbations relevant to auroral studies. The individual pulse frequencies are measured by two PIC18F252 programmable microcontrollers. The measurements are combined with a GPS timestamp from a Garmin GPS 18 LVC GPS receiver, and transmitted as plain text as UDP datagrams by a Rabbit Semiconductor RCM4010 8-bit, networked microcontroller module. The self

  1. Savings in acute care costs if all older adults treated for fall-related injuries completed matter of balance.

    Science.gov (United States)

    Howland, Jonathan; Shankar, Kalpana Narayan; Peterson, Elizabeth W; Taylor, Alyssa A

    Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults, and recruitment usually occurs through direct marketing to the target population, rather than through referrals from healthcare providers. Matter of Balance, a program developed to reduce fear of falling and associated activity restriction in community-dwelling older adults, is currently being delivered in 38 of the 50 United States. In this study, we estimate the one-year medical care cost savings if older adults treated at Massachusetts hospitals for fall-related injuries were referred by healthcare providers to participate in Matter of Balance. Data from several sources were used for this study. We estimated annual cost savings in older adult falls recidivism for a hypothetical 100 patients presenting at an emergency department for a fall-related injury, assuming that all were referred to, and 50 % completed, Matter of Balance. This cost-saving estimate was subsequently expanded based on the actual number (43,931) of older adult patients presenting at, and discharged from Massachusetts emergency departments for all fall-related injuries in 2012. Cost savings were calculated for two additional participation rates: 25 % and 75 %. The return on investment (ROI), was calculated based on the percentage of return per each dollar invested. The calculated ROI for Matter of Balance was 144 %. Statewide savings ranged from $2.79 million assuming a 25 % participation rate to $8.37 million, assuming a 75 % participation rate. Referral to evidence-based falls prevention programs of older adult patients presenting at EDs with a fall-related injury could reduce subsequent falls and associated treatment costs.

  2. Rumble over jailhouse healthcare. As states broaden outsourcing to private vendors, critics question quality of care and cost savings.

    Science.gov (United States)

    Kutscher, Beth; Meyer, Harris

    2013-09-02

    The trend for states to outsource prison healthcare has met opposition from inmate advocates and legal aid groups. They fear quality of care will suffer, while others debate whether outsourcing care saves any money. Corizon, the largest U.S. private prison healthcare provider, says it definitely delivers savings. "We are the model because we've been doing capitated rates since we've been in business. Our cost per individual is significantly less than in the 'free world,' "says Corizon CEO Rich Hallworth.

  3. Lives saved from malaria prevention in Africa - Evidence to sustain cost-effective gains

    NARCIS (Netherlands)

    E.L. Korenromp (Eline)

    2012-01-01

    textabstractLives saved have become a standard metric to express health benefits across interventions and diseases. Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved tool (LiST), extrapolating effectiveness estimates from community-randomized trials of

  4. Do cost savings from reductions in nosocomial infections justify additional costs of single-bed rooms in intensive care units? A simulation case study.

    Science.gov (United States)

    Sadatsafavi, Hessam; Niknejad, Bahar; Zadeh, Rana; Sadatsafavi, Mohsen

    2016-02-01

    Evidence shows that single-patient rooms can play an important role in preventing cross-transmission and reducing nosocomial infections in intensive care units (ICUs). This case study investigated whether cost savings from reductions in nosocomial infections justify the additional construction and operation costs of single-bed rooms in ICUs. We conducted deterministic and probabilistic return-on-investment analyses of converting the space occupied by open-bay rooms to single-bed rooms in an exemplary ICU. We used the findings of a study of an actual ICU in which the association between the locations of patients in single-bed vs open-bay rooms with infection risk was evaluated. Despite uncertainty in the estimates of costs, infection risks, and length of stay, the cost savings from the reduction of nosocomial infections in single-bed rooms in this case substantially outweighed additional construction and operation expenses. The mean value of internal rate of return over a 5-year analysis period was 56.18% (95% credible interval, 55.34%-57.02%). This case study shows that although single-patient rooms are more costly to build and operate, they can result in substantial savings compared with open-bay rooms by avoiding costs associated with nosocomial infections. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model

    Science.gov (United States)

    2014-01-01

    Background Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. Methods Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose–response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. Results The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. Conclusions Increasing dietary fiber

  6. An economic evaluation of anticipated costs and savings of a behavior change intervention to enhance medication adherence

    Directory of Open Access Journals (Sweden)

    Wiegand PN

    2008-06-01

    Full Text Available Medication adherence across disease states is generally poor. Research has focused on various methods to improve medication adherence, but there is little conclusive evidence regarding specific methods efficacy. The Transtheoretical Model for Behavior Change has been used to modify existing addictive behaviors but not in medication adherence specifically. As a behavioral component is inherently related to medication adherence, it is thought that this model may be applicable. Objective: The purpose of this research is to evaluate the costs and savings of implementing a novel behavioral intervention against the cost of poor medication adherence to determine whether further development is realistic.Methods: The basic tools required to administer this intervention were determined through primary literature review and priced by vendors supplying such materials. Diabetes Mellitus Type 2 (DM2 was used as a vehicle to establish the cost of care for long-term complications of a chronic disease. The primary literature provided information regarding the cost of care for DM2 morbidity and outpatient annual drug therapy expenditure. The total cost of the behavioral intervention components and the cost of care for DM2 morbidity were applied to a theoretical cohort of 1000 patients. By dividing this cost across 1000 patients, a per-patient cost was yielded and multiplied over a 16-year timeframe. Results: It was found that the cost to implement the behavioral intervention and resultant medication costs is USD13,574 per-patient over 16 years. The cost to treat complications of diabetes mellitus is USD 36,528 per patient over the 16 years. The total amount of healthcare dollars potentially saved by utilizing this intervention is USD 22,954 per-patient. Conclusions: It appears that the cost to implement this behavioral intervention is reasonable and permits further evaluation in other chronic conditions with notoriously poor adherence levels.

  7. What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.

    Science.gov (United States)

    Hunter, Wynn G; Zhang, Cecilia Z; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-10-01

    More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression). Focus on 3 conditions with potentially high out-of-pocket costs. Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes. © The Author(s) 2016.

  8. What price commitment: what benefit? The cost of a saved life in a developing level I trauma center.

    Science.gov (United States)

    Rotondo, Michael F; Bard, Michael R; Sagraves, Scott G; Toschlog, Eric A; Schenarts, Paul J; Goettler, Claudia E; Newell, Mark A; Robertson, Matthew J

    2009-11-01

    In 1999, a Level I Trauma Center committed significant resources for development, recruitment of trauma surgeons, and call pay for subspecialists. Although this approach has sparked a national ethical debate, little has been published investigating efficacy. This study examines the price of commitment and outcomes at a Level I Trauma Center. Direct personnel costs including salary, call pay, and personnel expenses were analyzed against outcomes for two periods defined as PRE (1994-1999) and POST (2000-2005). Patient care costs and 1999 to 2000 transition data were excluded. Demographics, outcomes, and direct personnel costs were compared. Significant mortality reductions stratified by age and injury severity score (ISS) were used to calculate lives saved in relation to direct personnel costs. Student's t test and chi were used (significance *p gender (62.4% vs. 63.7% male), mechanism of injury (11.5% vs. 11.8% penetrating), and percent intensive care unit admissions (30.1 vs. 29.9). Significant differences were noted for ISS (10.5 +/- 9.7 vs. 11.6 +/- 10.1*), percent admissions with ISS >or=16 (18.5 vs. 27.3*), and revised trauma score (10.8 +/- 2.8 vs. 10.7 +/- 2.8*). Both the average length of stay (6.8 +/- 8.8 vs. 6.5 +/- 9.8*) and percent mortality for ISS >or=16 (23 vs. 17*) were reduced. When mortality was stratified by both age and ISS, significant reductions were noted and a total of 173 lives were saved as a result. However, direct personnel costs increased from $7.6 million to $22.7 million. When cost is allocated to lives saved; the cost of a saved life was more than $87,000. Resources for program development, including salary and call pay, significantly reduced mortality. Price of commitment: $3 million per year. The cost of a saved life: $87,000. The benefit: 173 surviving patients who would otherwise be dead.

  9. Cost and radiation savings of partial substitution of ultrasound for CT in appendicitis evaluation: a national projection.

    Science.gov (United States)

    Parker, Laurence; Nazarian, Levon N; Gingold, Eric L; Palit, Charles D; Hoey, Courtney L; Frangos, Andrea J

    2014-01-01

    The costs of an ultrasound-CT protocol and a CT-only protocol for an appendicitis evaluation are compared. For the ultrasound-CT protocol, patients with right lower quadrant abdominal pain undergo an ultrasound examination. If it is positive for appendicitis, they are sent directly to surgery, avoiding CT. A comparative effectiveness research study was conducted. The costs of imaging tests, excess surgeries, and excess surgical deaths for the ultrasound-CT protocol and the costs of imaging tests and excess cancer deaths in the CT-only protocol were estimated. Data sources were Centers for Medicare & Medicaid Services (CMS) datasets, national hospital discharge surveys, radiology information system cases, and U.S. Census Bureau life tables. A meta-analysis and sensitivity analyses were also conducted. The meta-analysis showed a positive predictive value of 92.5% for CT and 91.0% for ultrasound. Analysis of CMS files showed that utilization of CT was almost exactly 2.0 examinations (one abdominal and one pelvic) per patient and for ultrasound was almost nil. The cost of this imaging protocol was $547 per patient, whereas the cost of a limited ultrasound study would be $88 per patient. For the total U.S. population, the cost savings in imaging minus the cost of extra surgeries and extra surgical deaths is $24.9 million per year. Following model VII proposed by the Committee on the Biological Effects of Ionizing Radiation (BEIR), which is known as "BEIR VII," the avoidance of a 12.4-mSv exposure for 262,500 persons would prevent 180 excess cancer deaths. The value of the years of life lost would be $339.5 million. The sensitivity analyses indicate that the cost savings are robust. An ultrasound-CT protocol for appendicitis evaluation offers potentially large savings over the standard CT-only protocol. There are moderate savings from using a less expensive imaging technique despite extra surgeries and large savings from radiation exposure avoided.

  10. Location savings: assessing the international tax law concept through comparative law analysis

    OpenAIRE

    Falkenberg, Anton

    2015-01-01

    The subject of the master's thesis is location savings, which can be defined as the net cost savings realized by a multinational enterprise through operating in a low-cost jurisdiction instead of a high-cost jurisdiction. Location savings has emerged as one of the most interesting international tax law developments in the recent years as the tax administrations in countries such as China and India have begun to apply the concept in practice. The OECD Transfer Pricing Guidelines of 2010 define...

  11. Turbulence induces metabolically costly behaviors and inhibits food capture in oyster larvae, causing net energy loss.

    Science.gov (United States)

    Fuchs, Heidi L; Specht, Jaclyn A; Adams, Diane K; Christman, Adam J

    2017-10-01

    Planktotrophic invertebrate larvae require energy to develop, disperse and settle successfully, and it is unknown how their energetics are impacted by turbulence. Ciliated larvae gain metabolic energy from their phytoplankton food to offset the energetic costs of growth, development and ciliary activity for swimming and feeding. Turbulence may affect the energetic balance by inducing behaviors that alter the metabolic costs and efficiency of swimming, by raising the encounter rate with food particles and by inhibiting food capture. We used experiments and an empirical model to quantify the net rate of energy gain, swimming efficiency and food capture efficiency for eyed oyster larvae (Crassostrea virginica) in turbulence. At dissipation rates representative of coastal waters, larvae lost energy even when food concentrations were very high. Both feeding activity and turbulence-induced behaviors incurred high metabolic costs. Swimming efficiency was concave up versus dissipation rate, suggesting that ciliary activity for food handling became more costly while swimming became more efficient with turbulence intensity. Though counter-intuitive, swimming may have become more efficient in turbulence because vorticity-induced rotation caused larvae to swim more horizontally, which requires less effort than swimming vertically against the pull of gravity. Overall, however, larvae failed to offset high activity costs with food energy gains because turbulence reduced food capture efficiency more than it enhanced food encounter rates. Younger, smaller larvae may have some energetic advantages, but competent larvae would lose energy at turbulence intensities they experience frequently, suggesting that turbulence-induced starvation may account for much of oysters' high larval mortality. © 2017. Published by The Company of Biologists Ltd.

  12. Scope-of-practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics.

    Science.gov (United States)

    Spetz, Joanne; Parente, Stephen T; Town, Robert J; Bazarko, Dawn

    2013-11-01

    Retail clinics have the potential to reduce health spending by offering convenient, low-cost access to basic health care services. Retail clinics are often staffed by nurse practitioners (NPs), whose services are regulated by state scope-of-practice regulations. By limiting NPs' work scope, restrictive regulations could affect possible cost savings. Using multistate insurance claims data from 2004-07, a period in which many retail clinics opened, we analyzed whether the cost per episode associated with the use of retail clinics was lower in states where NPs are allowed to practice independently and to prescribe independently. We also examined whether retail clinic use and scope of practice were associated with emergency department visits and hospitalizations. We found that visits to retail clinics were associated with lower costs per episode, compared to episodes of care that did not begin with a retail clinic visit, and the costs were even lower when NPs practiced independently. Eliminating restrictions on NPs' scope of practice could have a large impact on the cost savings that can be achieved by retail clinics.

  13. The net national costs of illegal immigration into the United States.

    Science.gov (United States)

    Huddle, D L

    1995-04-01

    "This article examines the major economic pros and cons of illegal immigration and answers the question: what, if any, are the public and private costs of illegal immigration in the United States? In brief, the article finds that between four and 5.4 million illegal immigrants reside here.... The article also finds that illegal immigrants and their own citizen children cost taxpayers an additional $12 to $16.2 billion annually for education, public services, and incarceration after deducting all local, state, and federal taxes paid in by them. In the private sector, illegal aliens are found to save their employers and owners of capital about $1.5 billion more than U.S. workers lose due to wage depression. The article also considers what legal and enforcement reforms would be necessary to dramatically slow the current flow of 300,000 illegals yearly and concludes that, although improvements in the system are now being proposed, the actual reforms will be insufficient to more than stem the currently rising tide of illegals due to economic instability in Mexico and the Third World." excerpt

  14. United States menhaden oil could save billions in U.S. health care costs and improve IQ in children

    OpenAIRE

    Bibus, Douglas M

    2016-01-01

    The United States menhaden oil annual production is sufficient to supply all of the recommended long chain Omega?3s for Americans over 55 with coronary heart disease (CHD) and pregnant and lactating women. According to a recent study, the utilization of preventable intake levels could potentially save up to $1.7 billion annually in hospital costs alone. In addition, the remaining oil could be used to support a culture of enough Atlantic salmon to provide every pregnant and lactating woman in ...

  15. Potential cost savings from internal/external CO{sub 2} emissions trading in the Korean electric power industry

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myunghun, E-mail: leemh@inha.ac.kr [Department of International Trade, Inha University, 253 Yonghyun-dong, Nam-gu, Incheon 402-751 (Korea, Republic of)

    2011-10-15

    Korea plans to introduce an emissions trading scheme for the controlling greenhouse gas emissions in 2015. Using Shephard's (1970) output distance function, we first estimate the shadow price of CO{sub 2} for power generators in the Korean fossil-fueled electric generation industry. Then, by assuming that each power generator is required to reduce CO{sub 2} emissions by one ton, we compute the potential cost savings from internal trading among generators within the same plant and from external trading across plants at prevailing market prices. The results indicate that, on average, the generators paid $14.63 to abate one ton of CO{sub 2} emissions in 2007. Plants realized additional gains through external trading. In particular, cost savings from trades between different fuel-fired plants were substantial. - Highlights: > We estimated the shadow price of CO{sub 2} for the Korean steam power plants. > On average, the generators paid $14.63 to abate one ton of CO{sub 2} emissions in 2007. > We computed the potential cost savings from internal trading and external trading. > Plants realized additional gains through external trading.

  16. A comparative analysis of the epidemiological impact and disease cost-savings of HPV vaccines in France

    Science.gov (United States)

    Bresse, Xavier; Adam, Marjorie; Largeron, Nathalie; Roze, Stephane; Marty, Remi

    2013-01-01

    The aim was to compare the epidemiological and economic impact of 16/18 bivalent and 6/11/16/18 quadrivalent HPV vaccination in France, considering differences in licensed outcomes, protection against non-vaccine HPV types and prevention of HPV-6/11-related diseases. The differential impact of the two vaccines was evaluated using a published model adapted to the French setting. The target population was females aged 14–23 y and the time horizon was 100 y. A total of eight different scenarios compared vaccination impact in terms of reduction in HPV-16/18-associated carcinomas (cervical, vulvar, vaginal, anal, penile and head and neck), HPV-6/11-related genital warts and recurrent respiratory papillomatosis, and incremental reduction in cervical cancer due to potential cross-protection. Quadrivalent vaccine was associated with total discounted cost savings ranging from EUR 544–1,020 million vs. EUR 177–538 million with the bivalent vaccination (100-y time horizon). Genital wart prevention thanks to quadrivalent HPV vaccination accounted for EUR 306–380 million savings (37–56% of costs saved). In contrast, the maximal assumed cross-protection against cervical cancer resulted in EUR 13–33 million savings (4%). Prevention of vulvar, vaginal and anal cancers accounted for additional EUR 71–89 million savings (13%). In France, the quadrivalent HPV vaccination would result in significant incremental epidemiological and economic benefits vs. the bivalent vaccination, driven primarily by prevention of genital. The present analysis is the first in the French setting to consider the impact of HPV vaccination on all HPV diseases and non-vaccine types. PMID:23563511

  17. A comparative analysis of the epidemiological impact and disease cost-savings of HPV vaccines in France.

    Science.gov (United States)

    Bresse, Xavier; Adam, Marjorie; Largeron, Nathalie; Roze, Stephane; Marty, Rémi

    2013-04-01

    The aim was to compare the epidemiological and economic impact of 16/18 bivalent and 6/11/16/18 quadrivalent HPV vaccination in France, considering differences in licensed outcomes, protection against non-vaccine HPV types and prevention of HPV-6/11-related diseases. The differential impact of the two vaccines was evaluated using a published model adapted to the French setting. The target population was females aged 14-23 y and the time horizon was 100 y. A total of eight different scenarios compared vaccination impact in terms of reduction in HPV-16/18-associated carcinomas (cervical, vulvar, vaginal, anal, penile and head and neck), HPV-6/11-related genital warts and recurrent respiratory papillomatosis, and incremental reduction in cervical cancer due to potential cross-protection. Quadrivalent vaccine was associated with total discounted cost savings ranging from EUR 544-1,020 million vs. EUR 177-538 million with the bivalent vaccination (100-y time horizon). Genital wart prevention thanks to quadrivalent HPV vaccination accounted for EUR 306-380 million savings (37-56% of costs saved). In contrast, the maximal assumed cross-protection against cervical cancer resulted in EUR 13-33 million savings (4%). Prevention of vulvar, vaginal and anal cancers accounted for additional EUR 71-89 million savings (13%). In France, the quadrivalent HPV vaccination would result in significant incremental epidemiological and economic benefits vs. the bivalent vaccination, driven primarily by prevention of genital. The present analysis is the first in the French setting to consider the impact of HPV vaccination on all HPV diseases and non-vaccine types.

  18. 10 CFR 435.8 - Life-cycle costing.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Life-cycle costing. 435.8 Section 435.8 Energy DEPARTMENT...-cycle costing. Each Federal agency shall determine life-cycle cost-effectiveness by using the procedures..., including lower life-cycle costs, positive net savings, savings-to-investment ratio that is estimated to be...

  19. Standardization: Hardware and Software Standardization Can Reduce Costs and Save Time

    Science.gov (United States)

    Brooks-Young, Susan

    2005-01-01

    Sadly, technical support doesn't come cheap. One money-saving strategy that's gained popularity among school technicians is equipment and software standardization. When it works, standardization can be very effective. However, standardization has its drawbacks. This article discusses the advantages and disadvantages of standardization.

  20. Rotavirus diarrhea disease burden in Peru: the need for a rotavirus vaccine and its potential cost savings

    Directory of Open Access Journals (Sweden)

    Ehrenkranz Peter

    2001-01-01

    Full Text Available Objective. To assess the disease burden of rotavirus diarrhea in Peru as well the need for and the potential cost savings with a rotavirus vaccine in that country. Methods. To assess the burden of rotavirus diarrhea in Peru, we reviewed published and unpublished reports where rotavirus was sought as the etiologic agent of diarrhea in children. Rotavirus detection rates obtained from these studies were combined with diarrhea incidence rates from a number of national surveys in order to estimate both the burden of rotavirus diarrhea in the country and its associated medical costs. Results. Rotavirus is a significant cause of morbidity and mortality in Peruvian children. In their first 5 years of life, an estimated 1 in 1.6 children will experience an episode of rotavirus diarrhea, 1 in 9.4 will seek medical care, 1 in 19.7 will require hospitalization, and 1 in 375 will die of the disease. Per year, this represents approximately 384 000 cases, 64 000 clinic visits, 30 000 hospitalizations, and 1 600 deaths. The annual cost of medical care alone for these children is approximately US$ 2.6 million--and that does not take into account the indirect or societal costs of the illness and the deaths. Conclusions. Rotavirus immunization provides the prospect of decreasing the morbidity and mortality from diarrhea in Peru, but a vaccine regimen would have to be relatively inexpensive, a few dollars or less per child. Future cost-effectiveness analyses should explore the total costs (medical as well as indirect or societal associated with rotavirus diarrhea. Newly licensed vaccines should be tested according to both their ability to avert deaths and their efficacy with fewer than three doses. All three of these factors could increase the cost savings associated with a rotavirus vaccine.

  1. Rotavirus diarrhea disease burden in Peru: the need for a rotavirus vaccine and its potential cost savings

    Directory of Open Access Journals (Sweden)

    Peter Ehrenkranz

    2001-10-01

    Full Text Available Objective. To assess the disease burden of rotavirus diarrhea in Peru as well the need for and the potential cost savings with a rotavirus vaccine in that country. Methods. To assess the burden of rotavirus diarrhea in Peru, we reviewed published and unpublished reports where rotavirus was sought as the etiologic agent of diarrhea in children. Rotavirus detection rates obtained from these studies were combined with diarrhea incidence rates from a number of national surveys in order to estimate both the burden of rotavirus diarrhea in the country and its associated medical costs. Results. Rotavirus is a significant cause of morbidity and mortality in Peruvian children. In their first 5 years of life, an estimated 1 in 1.6 children will experience an episode of rotavirus diarrhea, 1 in 9.4 will seek medical care, 1 in 19.7 will require hospitalization, and 1 in 375 will die of the disease. Per year, this represents approximately 384 000 cases, 64 000 clinic visits, 30 000 hospitalizations, and 1 600 deaths. The annual cost of medical care alone for these children is approximately US$ 2.6 million--and that does not take into account the indirect or societal costs of the illness and the deaths. Conclusions. Rotavirus immunization provides the prospect of decreasing the morbidity and mortality from diarrhea in Peru, but a vaccine regimen would have to be relatively inexpensive, a few dollars or less per child. Future cost-effectiveness analyses should explore the total costs (medical as well as indirect or societal associated with rotavirus diarrhea. Newly licensed vaccines should be tested according to both their ability to avert deaths and their efficacy with fewer than three doses. All three of these factors could increase the cost savings associated with a rotavirus vaccine.

  2. The cost-effectiveness of permethrin-treated bed nets in an area of intense malaria transmission in western Kenya

    NARCIS (Netherlands)

    Wiseman, Virginia; Hawley, William A.; ter Kuile, Feiko O.; Phillips-Howard, Penelope A.; Vulule, John M.; Nahlen, Bernard L.; Mills, Anne J.

    2003-01-01

    This study compared the costs and effects of insecticide (permethrin)-treated bed net (ITN) use in children less than five years of age in an area of intense, perennial malaria transmission in western Kenya. The data were derived from a group-randomized controlled trial of ITNs conducted between

  3. Low-cost, highly transparent flexible low-e coating film to enable electrochromic windows with increased energy savings

    Energy Technology Data Exchange (ETDEWEB)

    Berland, Brian [ITN Energy Systems, Inc., Littleton, CO (United States); Hollingsworth, Russell [ITN Energy Systems, Inc., Littleton, CO (United States)

    2015-03-31

    Five Quads of energy are lost through windows annually in the U.S. Low-e coatings are increasingly employed to reduce the wasted energy. Most commonly, the low-e coating is an oxide material applied directly to the glass at high temperature. With over 100,000,000 existing homes, a retrofit product is crucial to achieve widespread energy savings. Low-e films, i.e. coatings on polymeric substrates, are now also available to meet this need. However, the traditional oxide materials and process is incompatible with low temperature plastics. Alternate high performing low-e films typically incorporate materials that limit visible transmission to 35% or less. Further, the cost is high. The objective of this award was to develop a retrofit, integrated low-e/electrochromic window film to dramatically reduce energy lost through windows. While field testing of state-of-the-art electrochromic (EC) windows show the energy savings are maximized if a low-e coating is used in conjunction with the EC, available low-e films have a low visible transmission (~70% or less) that limits the achievable clear state and therefore, appearance and energy savings potential. Comprehensive energy savings models were completed at Lawrence Berkeley National Lab (LBNL). A parametric approach was used to project energy usage for windows with a large range of low-e properties across all U.S. climate zones, without limiting the study to materials that had already been produced commercially or made in a lab. The model enables projection of energy savings for low-e films as well as integrated low-e/EC products. This project developed a novel low-e film, optimized for compatibility with EC windows, using low temperature, high deposition rate processes for the growth of low-e coatings on plastic films by microwave plasma enhanced chemical vapor deposition. Silica films with good density and optical properties were demonstrated at deposition rates as high as 130Å/sec. A simple bi-layer low-e stack of

  4. Developing Information on Energy Savings and Associated Costs and Benefits of Energy Efficient Emerging Technologies Applicable in California

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Tengfang; Slaa, Jan Willem; Sathaye, Jayant

    2010-12-15

    Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing carbon dioxide (CO2) emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing the costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world and in California. Successful implementation of applicable emerging technologies not only may help advance productivities, improve environmental impacts, or enhance industrial competitiveness, but also can play a significant role in climate-mitigation efforts by saving energy and reducing the associated GHG emissions. Developing new information on costs and savings benefits of energy efficient emerging technologies applicable in California market is important for policy makers as well as the industries. Therefore, provision of timely evaluation and estimation of the costs and energy savings potential of emerging technologies applicable to California is the focus of this report. The overall goal of the project is to identify and select a set of emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. Specifically, this report contains the results from performing Task 3 Technology Characterization for California Industries for the project titled Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies, sponsored by

  5. ResStock - Targeting Energy and Cost Savings for U.S. Homes

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, Eric J [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-29

    The ResStock analysis tool is helping states, municipalities, utilities, and manufacturers identify which home upgrades save the most energy and money. Across the country there's a vast diversity in the age, size, construction practices, installed equipment, appliances, and resident behavior of the housing stock, not to mention the range of climates. These variations have hindered the accuracy of predicting savings for existing homes. Researchers at the National Renewable Energy Laboratory (NREL) developed ResStock. It's a versatile tool that takes a new approach to large-scale residential energy analysis by combining: large public and private data sources, statistical sampling, detailed subhourly building simulations, high-performance computing. This combination achieves unprecedented granularity and most importantly - accuracy - in modeling the diversity of the single-family housing stock.

  6. Geothermal Heat Pumps as a Cost Saving and Capital Renewal Too!

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, P.J.

    1998-11-06

    An independent evaluation of the Fort Polk, Louisiana energy savings performance contract (ESPC) has verified the financial value of geothermal heat pump (GHP)-centered ESPCS to the federal government. The Department of Energy (DOE) Federal Energy Management Program (FEMP) has responded by issuing an RFP for the "National GHP-Technology-Specific Super ESPC Procurement." Federal agency sites anywhere in the nation will be able to implement GHP-centered ESPC projects as delivery orders against the awarded contracts.

  7. Evaluation of the cost saving potential of introducing Benepali® and Flixabi® on the European and Italian markets

    Directory of Open Access Journals (Sweden)

    Cristina Negrini

    2017-10-01

    CONCLUSIONS: The introduction of Benepali® and Flixabi® has a substantial cost saving potential for the Italian and European health systems, and the budget impact is sensitive to the uptake rates of the biosimilars market.

  8. Estimating health care cost savings from an educational intervention to prevent bleeding-related complications: the outcomes impact analysis model.

    Science.gov (United States)

    Ravyn, Dana; Ravyn, Vipa; Lowney, Rob; Ferraris, Victor

    2014-01-01

    Investments in continuing medical education (CME) exceed $2 billion annually, but few studies report the economic impact of CME activities. Analysis of patient-level economic outcomes data is often not feasible. Accordingly, we developed a model to illustrate estimation of the potential economic impact associated with CME activity outcomes. Outcomes impact analysis demonstrated how costs averted from a CME symposium that promoted prevention of bleeding-related complications (BRC) and reoperation for bleeding (RFB) in cardiac and thoracic operations could be estimated. Model parameter estimates were from published studies of costs associated with BRC and RFB. Operative volume estimates came from the Society of Thoracic Surgeons workforce data. The base case predicted 3 in 10 participants preventing one BRC or RFB in 2% or 1.5% of annual operations, respectively. Probabilistic sensitivity analysis (PSA) evaluated the effect of parameter uncertainty. 92% of participants (n = 133) self-reported commitment to change, a validated measure of behavior change. For BRC, estimates for costs averted were $1,502,769 (95% confidence interval [CI], $869,860-$2,359,068) for cardiac operations and $2,715,246 (95% CI, $1,590,308-$4,217,092) for thoracic operations. For RFB, the savings estimates were $2,233,988 (95% CI, $1,223,901-$3,648,719). Our economic model demonstrates that application of CME-related learning to prevent bleeding complications may yield substantial cost savings. Model prediction of averted costs associated with CME allows estimation of the economic impact on outcomes in the absence of patient-level outcomes data related to CME activities. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  9. Cost-Savings Achieved in Two Semesters through the Adoption of Open Educational Resources

    Science.gov (United States)

    Hilton, John Levi, III; Robinson, Jared; Wiley, David; Ackerman, J. Dale

    2014-01-01

    Textbooks represent a significant portion of the overall cost of higher education in the United States. The burden of these costs is typically shouldered by students, those who support them, and the taxpayers who fund the grants and student loans which pay for textbooks. Open educational resources (OER) provide students a way to receive…

  10. Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities

    Science.gov (United States)

    May, Peter; Garrido, Melissa M.; Cassel, J. Brian; Kelley, Amy S.; Meier, Diane E.; Normand, Charles; Stefanis, Lee; Smith, Thomas J.; Morrison, R. Sean

    2016-01-01

    Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially because of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2–3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending. PMID:26733700

  11. Energy Efficiency Improvement and Cost Saving Opportunities for Cement Making. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Worrell, Ernst; Galitsky, Christina

    2008-01-01

    The cost of energy as part of the total production costs in the cement industry is significant, warranting attention for energy efficiency to improve the bottom line. Historically, energy intensity has declined, although more recently energy intensity seems to have stabilized with the gains. Coal and coke are currently the primary fuels for the sector, supplanting the dominance of natural gas in the 1970s. Most recently, there is a slight increase in the use of waste fuels, including tires. Between 1970 and 1999, primary physical energy intensity for cement production dropped 1 percent/year from 7.3 MBtu/short ton to 5.3 MBtu/short ton. Carbon dioxide intensity due to fuel consumption and raw material calcination dropped 16 percent, from 609 lb. C/ton of cement (0.31 tC/tonne) to 510 lb. C/ton cement (0.26 tC/tonne). Despite the historic progress, there is ample room for energy efficiency improvement. The relatively high share of wet-process plants (25 percent of clinker production in 1999 in the U.S.) suggests the existence of a considerable potential, when compared to other industrialized countries. We examined over 40 energy efficient technologies and measures and estimated energy savings, carbon dioxide savings, investment costs, and operation and maintenance costs for each of the measures. The report describes the measures and experiences of cement plants around the wold with these practices and technologies. Substantial potential for energy efficiency improvement exists in the cement industry and in individual plants. A portion of this potential will be achieved as part of (natural) modernization and expansion of existing facilities, as well as construction of new plants in particular regions. Still, a relatively large potential for improved energy management practices exists.

  12. Energy Savings Lifetimes and Persistence

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, Ian M. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schiller, Steven R. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Todd, Annika [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Billingsley, Megan A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Goldman, Charles A. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa C. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-02-01

    This technical brief explains the concepts of energy savings lifetimes and savings persistence and discusses how program administrators use these factors to calculate savings for efficiency measures, programs and portfolios. Savings lifetime is the length of time that one or more energy efficiency measures or activities save energy, and savings persistence is the change in savings throughout the functional life of a given efficiency measure or activity. Savings lifetimes are essential for assessing the lifecycle benefits and cost effectiveness of efficiency activities and for forecasting loads in resource planning. The brief also provides estimates of savings lifetimes derived from a national collection of costs and savings for electric efficiency programs and portfolios.

  13. Development of a budget-impact model to quantify potential cost savings from prescription opioids designed to deter abuse or ease of extraction.

    Science.gov (United States)

    White, Alan G; Birnbaum, Howard G; Rothman, Dov B; Katz, Nathaniel

    2009-01-01

    Prescription opioid (RxO) abuse, dependence and misuse is a significant and growing problem in the US, and is associated with a substantial economic burden. Such abuse may be reduced by theoretical formulations that minimize the possibility of abuse, dependence and misuse of RxOs by injection, snorting, crushing or chewing. As well as public health and safety benefits, use of an abuse-deterrent/resistant RxO (ADO) that may deter abuse, dependence and misuse could also generate cost savings. To estimate potential annual cost savings to US third-party payers realized from introducing a theoretical ADO. A budget-impact model (BIM) was developed to assess potential cost savings from the introduction of an ADO to third-party payers. The BIM included information on ADO attributes, costs associated with RxO abuse-related episodes, prevalence of RxO abuse and potential market share capture of the new ADO. Numbers of abuse-related episodes were calculated using a database on admissions to substance abuse treatment centres and other national surveys. Direct (medical and pharmaceutical) costs associated with RxO abuse, dependence and misuse were calculated using de-identified employer claims data (n > 6 000 000) for costs of abuse-related episodes. All cost estimates are in $US, year 2006 values. The BIM was developed for a theoretical prescription drug with therapeutic properties similar to those of controlled-release oxycodone, in a formulation that is specifically designed to resist or deter common methods of abuse, including injection, crushing, snorting and chewing. Potential cost savings to third-party payers from introducing an ADO for the US (assuming a privately insured cost structure) could range from approximately $US0.6 billion to $US1.6 billion per year depending on different possible scenarios. While savings estimates from introduction of an ADO depend on a range of assumptions, cost savings would be substantial.

  14. Consortium Purchases: Case Study for a Cost-Benefit Analysis.

    Science.gov (United States)

    Scigliano, Marisa

    2002-01-01

    Discusses library cooperation and academic library consortia and presents a case study of a Canadian consortia that conducted a cost-benefit analysis for purchasing an electronic resource. Reports on member library subscription costs, external economic factors, value of patron time saved, costs and benefits for patrons, and net savings. (LRW)

  15. Designing Rainwater Harvesting Systems Cost-Effectively in a Urban Water-Energy Saving Scheme by Using a GIS-Simulation Based Design System

    Directory of Open Access Journals (Sweden)

    Yie-Ru Chiu

    2015-11-01

    Full Text Available Current centralized urban water supply depends largely on energy consumption, creating critical water-energy challenge especially for many rapid growing Asian cities. In this context, harvesting rooftop rainwater for non-potable use has enormous potential to ease the worsening water-energy issue. For this, we propose a geographic information system (GIS-simulation-based design system (GSBDS to explore how rainwater harvesting systems (RWHSs can be systematically and cost-effectively designed as an innovative water-energy conservation scheme on a city scale. This GSBDS integrated a rainfall data base, water balance model, spatial technologies, energy-saving investigation, and economic feasibility analysis based on a case study of eight communities in the Taipei metropolitan area, Taiwan. Addressing both the temporal and spatial variations in rainfall, the GSBDS enhanced the broad application of RWHS evaluations. The results indicate that the scheme is feasible based on the optimal design when both water and energy-savings are evaluated. RWHSs were observed to be cost-effective and facilitated 21.6% domestic water-use savings, and 138.6 (kWh/year-family energy-savings. Furthermore, the cost of per unit-energy-saving is lower than that from solar PV systems in 85% of the RWHS settings. Hence, RWHSs not only enable water-savings, but are also an alternative renewable energy-saving approach that can address the water-energy dilemma caused by rapid urbanization.

  16. Interactive internet-based clinical education: an efficient and cost-savings approach to point-of-care test training.

    Science.gov (United States)

    Knapp, Herschel; Chan, Kee; Anaya, Henry D; Goetz, Matthew B

    2011-06-01

    We successfully created and implemented an effective HIV rapid testing training and certification curriculum using traditional in-person training at multiple sites within the U.S. Department of Veterans Affairs (VA) Healthcare System. Considering the multitude of geographically remote facilities in the nationwide VA system, coupled with the expansion of HIV diagnostics, we developed an alternate training method that is affordable, efficient, and effective. Using materials initially developed for in-person HIV rapid test in-services, we used a distance learning model to offer this training via live audiovisual online technology to educate clinicians at a remote outpatient primary care VA facility. Participants' evaluation metrics showed that this form of remote education is equivalent to in-person training; additionally, HIV testing rates increased considerably in the months following this intervention. Although there is a one-time setup cost associated with this remote training protocol, there is potential cost savings associated with the point-of-care nurse manager's time productivity by using the Internet in-service learning module for teaching HIV rapid testing. If additional in-service training modules are developed into Internet-based format, there is the potential for additional cost savings. Our cost analysis demonstrates that the remote in-service method provides a more affordable and efficient alternative compared with in-person training. The online in-service provided training that was equivalent to in-person sessions based on first-hand supervisor observation, participant satisfaction surveys, and follow-up results. This method saves time and money, requires fewer personnel, and affords access to expert trainers regardless of geographic location. Further, it is generalizable to training beyond HIV rapid testing. Based on these consistent implementation successes, we plan to expand use of online training to include remote VA satellite facilities spanning

  17. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries.

    Science.gov (United States)

    Seidman, Gabriel; Atun, Rifat

    2017-04-13

    Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.

  18. Worker replacement and cost-benefit analysis of life-saving health care programs, a precautionary note.

    Science.gov (United States)

    Tessier, Philippe; Sultan-Taïeb, Hélène; Barnay, Thomas

    2014-04-01

    The assumption according to which ill individuals can be replaced at work that underpins the 'friction cost method' (FCM) to value productivity costs has been primarily discussed within the framework of cost-utility analysis. This paper investigates the consequences of this assumption for cost-benefit analysis (CBA). It makes three contributions. First, it provides the first analytical account of the overall consequences of ill worker replacement on social welfare and it analyzes the associated compensation effects within a CBA framework. Second, it highlights a double counting problem that arises when ill worker replacement is assumed in the CBA of life-saving health care programs. To the best of our knowledge, no satisfactory solution to this problem has yet been provided in the literature. Third, this paper suggests and discusses two original ways to address this double counting issue. One consists in adjusting value of a statistical life estimations for the well-being provided by future incomes. Another possibility lies in the estimation of marginal rates of substitution between health and wealth so as to directly monetize the value of life over and above consumption. We show that both solutions raise unresolved questions that should be addressed in future research to enable appropriate use of the FCM in CBA.

  19. Energy Efficiency Improvement and Cost Saving Opportunities for Breweries: An ENERGY STAR(R) Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Martin, Nathan; Worrell, Ernst; Lehman, Bryan

    2003-09-01

    Annually, breweries in the United States spend over $200 million on energy. Energy consumption is equal to 38 percent of the production costs of beer, making energy efficiency improvement an important way to reduce costs, especially in times of high energy price volatility. After a summary of the beer making process and energy use, we examine energy efficiency opportunities available for breweries. We provide specific primary energy savings for each energy efficiency measure based on case studies that have implemented the measures, as well as references to technical literature. If available, we have also listed typical payback periods. Our findings suggest that given available technology, there are still opportunities to reduce energy consumption cost-effectively in the brewing industry. Brewers value highly the quality, taste and drinkability of their beer. Brewing companies have and are expected to continue to spend capital on cost-effective energy conservation measures that meet these quality, taste and drinkability requirements. For individual plants, further research on the economics of the measures, as well as their applicability to different brewing practices, is needed to assess implementation of selected technologies.

  20. Energy Efficiency Improvement and Cost Saving Opportunities for the Pharmaceutical Industry. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Galitsky, Christina; Chang, Sheng-chieh; Worrell, Ernst; Masanet, Eric

    2008-03-01

    The U.S. pharmaceutical industry consumes almost $1 billion in energy annually. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants in the U.S. pharmaceutical industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy efficient technologies that can be implemented at the component, process, system, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the U.S. pharmaceutical industry is provided along with a description of the major process steps in the pharmaceutical manufacturing process. Expected savings in energy and energy-related costs are given for many energy efficiency measures, based on case study data from real-world applications in pharmaceutical and related facilities worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. The information in this Energy Guide is intended to help energy and plant managers reduce energy consumption in a cost-effective manner while meeting regulatory requirements and maintaining the quality of products manufactured. At individual plants, further research on the economics of the measures?as well as their applicability to different production practices?is needed to assess potential implementation of selected technologies.

  1. Evaluating C-RAN Fronthaul Functional Splits in Terms of Network Level Energy and Cost Savings

    DEFF Research Database (Denmark)

    Checko, Aleksandra; Popovska Avramova, Andrijana; Berger, Michael Stübert

    2016-01-01

    split in the baseband processing chain has been proposed to overcome these challenges. This paper evaluates, by mathematical and simulation methods, different splits with respect to network level energy and cost efficiency having in the mind the expected quality of service.The proposed mathematical......The placement of the complete baseband processing in a centralized pool results in high data rate requirement and inflexibility of the fronthaul network, which challenges the energy and cost effectiveness of the cloud radio access network (C-RAN). Recently, redesign of the C-RAN through functional...... model quantifies the multiplexing gains and the trade-offs between centralization and decentralization concerning the cost of the pool, fronthaul network capacity and resource utilization. The event-based simulation captures the influence of the traffic load dynamics and traffic type variation...

  2. Dry Kraft Pulping at Ambient Pressure for Cost Effective Energy Saving and Pollution Deduction

    Energy Technology Data Exchange (ETDEWEB)

    Yulin Deng; Art Ragauskas

    2012-08-28

    evaporated first under vacuum condition at low temperature. Then, the dry woodchips were baked at high temperature (120-130 C) at atmospheric pressure. The qualities of the pulp made with this method were improved compared to that made with method one. The pulp shows higher brightness and lower bulk than Kraft pulping. The tensile strength is significantly higher than the pulp made from the first method. Although the pulp is stronger than that of TMP pulp, it is still lower than conventional Kraft fiber. Method Three: The third dry method was done in a Kraft pulping digester at elevated pressure but without free liquid in the digester. With this method, pulp that has almost the same qualities as conventional Kraft pulp could be produced. The screen yield, Kappa number, fiber brightness, pulp strength and pulp bulk are almost identical to the conventional Kraft pulp. The key advantages of this dry pulping method include ca. 55 % of cooking energy saved during the pulping process, as high as 50 wt% of NaOH saving as well as 3 wt% of Na2S saving comparing to Kraft one. By analyzing fiber properties, yields, chemical and energy consumptions, we concluded that the dry pulping method based on Liquid Free Chemical Pulping, LFCP, could be very attractive for the pulp and paper industry. More fundamental studies and scale up trials are needed to fully commercialize the technology. We expect to conduct pilot trials between 12 to 24 months of period if the DOE or industry can provide continual research funding. Based on the technology we demonstrated in this report, several pilot trial facilities in the United States will be available after small modifications. For example, the Herty Foundation in Savannah, Georgia is one of these potential locations. DOE funding for continuous study and final lead to commercialization of the technique is important.

  3. Does the use of atypical antipsychotics as adjunctive therapy in depression result in cost savings? Comparing healthcare costs and utilization between second-line treatment options.

    Science.gov (United States)

    Hassan, Amany K; Farmer, Kevin C; Brahm, Nancy C; Keast, Shellie; Nesser, Nancy; Neas, Barbara R

    2016-12-01

    Several atypical antipsychotics (AAPs) are used as second-line agents for treatment resistant depression. AAPs can be expensive compared to other treatment options and can cause several side effects. To estimate healthcare costs and utilization of AAPs compared to other second-line agents. Observational study using Medicaid claims data (2006-2011). Subjects were depression-diagnosed adult members with at least two prescriptions of antidepressant medications followed by a second-line agent. Gamma generalized linear models (GLM) produced estimates of the difference in mean expenditures among treatment groups after adjusting for individual baseline characteristics using propensity scores. Negative binomial models produced estimates of the difference in number of hospitalizations and emergency department (ED) visits. A total of 3910 members received second-line treatment. Treatment groups were AAPs (n = 2211), augmentation agents other than AAPs (n = 1008), and antidepressant switching (n = 691). AAPs resulted in higher mean adjusted pharmacy costs and higher mean adjusted total mental health-related costs. Mean adjusted total healthcare costs and number of inpatient and ED visits were not different among treatments. The results show no evidence that AAPs used as second-line treatment for depression results in overall cost savings or lower inpatient and ED visits compared to other treatment strategies.

  4. Cost-benefit of energy saving in bioclimatic designs; Costo-beneficio del ahorro de energia en los disenos bioclimatios

    Energy Technology Data Exchange (ETDEWEB)

    Lopez P, J. Manuel A. [Doble dos soluciones de Negocios (Mexico); Morillon G, David; Rdriguez V, Luis [Universidad Autonoma de Mexico (Mexico)

    2001-06-01

    Tools and criteria for Cost-Benefit Analysis (ACB) of energy saving in bioclimatic designs (DB) are presented, for which a reference project is established. Based on the traditional design of air conditioning of a building and with the support of this one, the estimation of costs and benefits of the same building is made; but with passive systems. The tools used consider related resources such as time and money. Criteria are used such as: Present value (VP), Equivalent Annual Cost (EAC) and the Cost of the conserved Energy (CEC). The costs related to the construction, maintenance and operation of the design are taken into consideration. The differences between the design of reference and the Bioclimatic Design, established from the application of these criteria, allow evaluating the economic margin as far as operation and maintenance. Finally, the cost of the conserved energy of the bioclimatic measures is evaluated as an initiative for energy saving and calculates the present value from them in all of the period of useful life of the bioclimatic design. [Spanish] Se presentan herramientas y criterios para el analisis Costo-Beneficio (ACB) del ahorro de energia en los disenos bioclimaticos (DB), para lo cual se establece un proyecto de referencia. Basado en el diseno tradicional de la climatizacion de un edificio y con apoyo en este, se realiza la estimacion de costos y beneficios del mismo edificio; pero con sistema pasivos. Las herramientas usadas consideran recursos relacionados como son tiempo y dinero. Se usan criterios tales como: Valor Presente (VP), Costo Anual Equivalente (CAE) y el Costo de la Energia conservada (CEC). Se toman en consideracion los costos relacionados con la construccion, mantenimiento y operacion del diseno. Las diferencias entre el diseno de referencia y el Diseno Bioclimatico, establecidas a partir de la aplicacion de estos criterios, permiten evaluar el margen economico en cuanto a la operacion y el mantenimiento. Finalmente, se

  5. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda

    Directory of Open Access Journals (Sweden)

    Strachan Daniel

    2010-04-01

    Full Text Available Abstract Background In Uganda, long-lasting insecticidal nets (LLIN have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Methods Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY. These effects were calculated for the total number of LLINs delivered and for those retained and used. Results After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja and 99% (ANC Adjumani were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja. Economic cost for ANC distribution were considerably higher (USD 2.27 compared to campaign costs (USD 1.23 in Adjumani. Conclusions Targeted campaigns and routine ANC

  6. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.

    Science.gov (United States)

    Kolaczinski, Jan H; Kolaczinski, Kate; Kyabayinze, Daniel; Strachan, Daniel; Temperley, Matilda; Wijayanandana, Nayantara; Kilian, Albert

    2010-04-20

    In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used. After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani. Targeted campaigns and routine ANC services can both achieve high LLIN retention and use among

  7. [Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

    Science.gov (United States)

    Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

    2012-01-01

    DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

  8. Adding a dietitian to a Danish Liaison-team after discharge of geriatric patients at nutritional risk may save health care costs

    DEFF Research Database (Denmark)

    Pohju, Anne; Belqaid, Kerstin; Brandt, Christopher Flintenborg

    2016-01-01

    Background: A previous study investigated the value of adding a dietitian to a geriatric discharge Liaison-Team. The scope of this study was to explore the possible economic savings of this. Methods: Patients, 70+ and at nutritional risk, were randomized to receive discharge Liaison-Team either w......,416 compared to €1,150 (ONS only) in the CG. For hospitalizations, estimated cost was €92,020 in the IG and €220,025 in the CG. Cost savings added up to €3,048 per patient in the IG. Conclusion: Adding a dietitian to a Danish geriatric discharge Liaison-Team decreased health care costs...

  9. How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

    NARCIS (Netherlands)

    Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.

    2012-01-01

    Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic

  10. Modeling fuel treatment impacts on fire suppression cost savings: A review

    Science.gov (United States)

    Matthew P. Thompson; Nathaniel M. Anderson

    2015-01-01

    High up-front costs and uncertain return on investment make it difficult for land managers to economically justify large-scale fuel treatments, which remove trees and other vegetation to improve conditions for fire control, reduce the likelihood of ignition, or reduce potential damage from wildland fire if it occurs. In the short-term, revenue from harvested forest...

  11. Energy Efficiency Improvement and Cost Saving Opportunities for the Concrete Industry

    NARCIS (Netherlands)

    Kermeli, Katerina; Worrell, E.; Masanet, Eric

    2011-01-01

    The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for about 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials

  12. Energy Efficiency Improvement and Cost Saving Opportunities for the Glass Industry. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Worrell, Ernst; Galitsky, Christina; Masanet, Eric; Graus, Wina

    2008-03-01

    The U.S. glass industry is comprised of four primary industry segments--flat glass, container glass, specialty glass, and fiberglass--which together consume $1.6 billion in energy annually. On average, energy costs in the U.S. glass industry account for around 14 percent of total glass production costs. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There is a variety of opportunities available at individual plants in the U.S. glass industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy-efficient technologies that can be implemented at the component, process, system, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the U.S. glass industry is provided along with a description of the major process steps in glass manufacturing. Expected savings in energy and energy-related costs are given for many energy efficiency measures, based on case study data from real-world applications in glass production facilities and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. The information in this Energy Guide is intended to help energy and plant managers in the U.S. glass industry reduce energy consumption in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of the measures--as well on as their applicability to different production practices--is needed to assess potential implementation of selected technologies at individual plants.

  13. Temporal Dynamics of Sensorimotor Networks in Effort-Based Cost-Benefit Valuation: Early Emergence and Late Net Value Integration.

    Science.gov (United States)

    Harris, Alison; Lim, Seung-Lark

    2016-07-06

    Although physical effort can impose significant costs on decision-making, when and how effort cost information is incorporated into choice remains contested, reflecting a larger debate over the role of sensorimotor networks in specifying behavior. Serial information processing models, in which motor circuits simply implement the output of cognitive systems, hypothesize that effort cost factors into decisions relatively late, via integration with stimulus values into net (combined) value signals in dorsomedial frontal cortex (dmFC). In contrast, ethology-inspired approaches suggest a more active role for the dorsal sensorimotor stream, with effort cost signals emerging rapidly after stimulus onset. Here we investigated the time course of effort cost integration using event-related potentials in hungry human subjects while they made decisions about expending physical effort for appetitive foods. Consistent with the ethological perspective, we found that effort cost was represented from as early as 100-250 ms after stimulus onset, localized to dorsal sensorimotor regions including middle cingulate, somatosensory, and motor/premotor cortices. However, examining the same data time-locked to motor output revealed net value signals combining stimulus value and effort cost approximately -400 ms before response, originating from sensorimotor areas including dmFC, precuneus, and posterior parietal cortex. Granger causal connectivity analysis of the motor effector signal in the time leading to response showed interactions between these sensorimotor regions and ventrolateral prefrontal cortex, a structure associated with adjusting behavior-response mappings. These results suggest that rapid activation of sensorimotor regions interacts with cognitive valuation systems, producing a net value signal reflecting both physical effort and reward contingencies. Although physical effort imposes a cost on choice, when and how effort cost influences neural correlates of decision

  14. The costs and savings of a regional public palliative care program: the Catalan experience at 18 years.

    Science.gov (United States)

    Paz-Ruiz, Silvia; Gomez-Batiste, Xavier; Espinosa, Jose; Porta-Sales, Josep; Esperalba, Joaquim

    2009-07-01

    Conceived as a World Health Organization demonstration project for public health initiatives at the end of life, the palliative care program in Catalonia illustrates the impact that similar initiatives may have in terms of cost savings for a regional health system. In a publicly funded and freely accessible health system, decreasing the number of hospital admissions, shortening the lengths of hospital stay, diminishing the frequency of emergency room consultations, shifting the use of acute hospital beds to palliative care beds for treating advanced disease inpatients, and substantially improving the use of opioids in the community are major determinants of the palliative care program's success. These features add to the opportunity the discipline offers to improve the quality of health care at the end of life. In this article, the information gathered over an 18-year trajectory of the program is summarized. Key features of the existing financial models used while developing palliative care in Catalonia are described, and the mechanisms by which palliative care may have contributed to increase savings for the health care system in end-of-life care, from euro3,000,000 in 1995 to euro8,000,000 in 2005, are discussed.

  15. Reconciling uncertain costs and benefits in bayes nets for invasive species management

    Science.gov (United States)

    Burgman, M.A.; Wintle, B.A.; Thompson, C.A.; Moilanen, A.; Runge, M.C.; Ben-Haim, Y.

    2010-01-01

    Bayes nets are used increasingly to characterize environmental systems and formalize probabilistic reasoning to support decision making. These networks treat probabilities as exact quantities. Sensitivity analysis can be used to evaluate the importance of assumptions and parameter estimates. Here, we outline an application of info-gap theory to Bayes nets that evaluates the sensitivity of decisions to possibly large errors in the underlying probability estimates and utilities. We apply it to an example of management and eradication of Red Imported Fire Ants in Southern Queensland, Australia and show how changes in management decisions can be justified when uncertainty is considered. ?? 2009 Society for Risk Analysis.

  16. Costs for integrating wind into the future ERCOT system with related costs for savings in CO2 emissions.

    Science.gov (United States)

    Lu, Xi; McElroy, Michael B; Sluzas, Nora A

    2011-04-01

    Wind power can make an important contribution to the goal of reducing emissions of CO2. The major problem relates to the intrinsic variability of the source and the difficulty of reconciling the supply of electricity with demand particularly at high levels of wind penetration. This challenge is explored for the case of the ERCOT system in Texas. Demand for electricity in Texas is projected to increase by approximately 60% by 2030. Considering hourly load data reported for 2006, assuming that the pattern of demand in 2030 should be similar to 2006, and adopting as a business as usual (BAU) reference an assumption that the anticipated additional electricity should be supplied by a combination of coal and gas with prices, discounted to 2007 dollars of $2 and $6 per MMBTU respectively, we conclude that the bus-bar price for electricity would increase by about 1.1 ¢/kWh at a wind penetration level of 30%, by about 3.4 ¢/kWh at a penetration level of 80%. Corresponding costs for reductions in CO2 range from $20/ton to $60/ton. A number of possibilities are discussed that could contribute to a reduction in these costs including the impact of an expanded future fleet of electrically driven vehicles.

  17. Saving costs through the decontamination of the packaging of unused medical supplies using hydrogen peroxide vapor.

    Science.gov (United States)

    Otter, Jonathan A; Nowakowski, Elaine; Salkeld, James A G; Duclos, Mike; Passaretti, Catherine L; Yezli, Saber; Ross, Tracy; Carroll, Karen C; Perl, Trish M

    2013-05-01

    OBJECTIVE. Individually packaged sterile supply items may become contaminated and act as vectors for nosocomial transmission of multidrug-resistant organisms (MDROs). Thus, many hospitals have a policy to dispose of these unused, packaged supply items at patient discharge from the hospital, which has considerable cost implications. We evaluated the frequency of contamination of these items, the efficacy of hydrogen peroxide vapor (HPV) in disinfecting them, and costs associated with discarded supplies. DESIGN. Before-after study. METHODS. A pilot study was performed in the rooms of 20 patients known to be colonized or infected with vancomycin-resistant enterococci (VRE), and a follow-up study was performed in an additional 20 rooms of patients under precautions for various MDROs in 6 high-risk units. Five pairs of supply items were selected. One item of each pair was sampled without exposure to HPV, and the other was sampled after HPV exposure. The cost of discarded supplies was calculated by examining stock lists of supplies stored on the study units. RESULTS. Seven (7%) of 100 items were contaminated with VRE in the pilot study, and 9 (9%) of 100 items were contaminated with MDROs in the follow-up study. None of the items were contaminated after exposure to HPV (P supplies discarded at patient hospital discharge was $387,055. This figure does not include the cost of waste disposal and is therefore likely to be an underestimation of the financial burden. CONCLUSIONS. HPV effectively disinfected the packaging of supply items, which could generate considerable financial and environmental benefits.

  18. Planning long lasting insecticide treated net campaigns: should households' existing nets be taken into account?

    Science.gov (United States)

    Yukich, Joshua; Bennett, Adam; Keating, Joseph; Yukich, Rudy K; Lynch, Matt; Eisele, Thomas P; Kolaczinski, Kate

    2013-06-14

    Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net 'decay' parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered. Where pre-campaign coverage

  19. Planning long lasting insecticide treated net campaigns: should households’ existing nets be taken into account?

    Science.gov (United States)

    2013-01-01

    Background Mass distribution of long-lasting insecticide treated bed nets (LLINs) has led to large increases in LLIN coverage in many African countries. As LLIN ownership levels increase, planners of future mass distributions face the challenge of deciding whether to ignore the nets already owned by households or to take these into account and attempt to target individuals or households without nets. Taking existing nets into account would reduce commodity costs but require more sophisticated, and potentially more costly, distribution procedures. The decision may also have implications for the average age of nets in use and therefore on the maintenance of universal LLIN coverage over time. Methods A stochastic simulation model based on the NetCALC algorithm was used to determine the scenarios under which it would be cost saving to take existing nets into account, and the potential effects of doing so on the age profile of LLINs owned. The model accounted for variability in timing of distributions, concomitant use of continuous distribution systems, population growth, sampling error in pre-campaign coverage surveys, variable net ‘decay’ parameters and other factors including the feasibility and accuracy of identifying existing nets in the field. Results Results indicate that (i) where pre-campaign coverage is around 40% (of households owning at least 1 LLIN), accounting for existing nets in the campaign will have little effect on the mean age of the net population and (ii) even at pre-campaign coverage levels above 40%, an approach that reduces LLIN distribution requirements by taking existing nets into account may have only a small chance of being cost-saving overall, depending largely on the feasibility of identifying nets in the field. Based on existing literature the epidemiological implications of such a strategy is likely to vary by transmission setting, and the risks of leaving older nets in the field when accounting for existing nets must be considered

  20. Socio-economic impact of antiretroviral treatment in HIV patients. An economic review of cost savings after introduction of HAART.

    Science.gov (United States)

    Gonzalo, Teresa; García Goñi, Manuel; Muñoz-Fernández, María Angeles

    2009-01-01

    Star celebrities such as Rock Hudson, Freddie Mercury, Magic Johnson, and Isaac Asimov have unfortunately something in common: they were all victims of the HIV global pandemic. Since then HIV infection has become considered a pandemic disease, and it is regarded as a priority in healthcare worldwide. It is ranked as the first cause of death among young people in industrialized countries, and it is recognized as a public healthcare problem due to its human, social, mass media, and economic impact. Incorporation of new and highly active antiretroviral treatment, available since 1996 for HIV/AIDS treatment, has provoked a radical change in the disease pattern, as well as in the impact on patient survival and quality of life. The pharmaceutical industry's contribution, based on the research for more active new drugs, has been pivotal. Mortality rates have decreased significantly in 20 years by 50% and now AIDS is considered a chronic and controlled disease. In this review we have studied the impact of HAART treatment on infected patients, allowing them to maintain their status as active workers and the decreased absenteeism from work derived from this, contributing ultimately to overall social wealth and, thus, to economic growth. Furthermore, an analysis of the impact on healthcare costs, quality of life per year, life per year gained, cost economic savings and cost opportunity among other parameters has shown that society and governments are gaining major benefits from the inclusion of antiretroviral therapies in HIV/AIDS patients.

  1. Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands

    NARCIS (Netherlands)

    Moolenaar, L. M.; Connolly, M.; Huisman, B.; Postma, M. J.; Hompes, P. G. A.; van der Veen, F.; Mol, B. W. J.

    2014-01-01

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received

  2. Costs and benefits of individuals conceived after IVF : a net tax evaluation in The Netherlands

    NARCIS (Netherlands)

    Moolenaar, L. M.; Connolly, M.; Huisman, B.; Postma, M. J.; Hompes, P. G. A.; van der Veen, F.; Mol, B. W. J.

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received

  3. Ambulatory transradial percutaneous coronary intervention: a safe, effective, and cost-saving strategy.

    Science.gov (United States)

    Le Corvoisier, Philippe; Gellen, Barnabas; Lesault, Pierre-François; Cohen, Remy; Champagne, Stéphane; Duval, Anne-Marie; Montalescot, Gilles; Elhadad, Simon; Montagne, Olivier; Durand-Zaleski, Isabelle; Dubois-Randé, Jean-Luc; Teiger, Emmanuel

    2013-01-01

    The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. Major advances in PCI techniques have considerably reduced the incidence of post-procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high-volume angioplasty centers. On the basis of pre-specified clinical and PCI-linked criteria, 220 patients were selected for ambulatory PCI. The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4-6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non-cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non-procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10(-6)). Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization. Copyright © 2012 Wiley Periodicals, Inc.

  4. Designing Green Networks and Network Operations Saving Run-the-Engine Costs

    CERN Document Server

    Minoli, Daniel

    2011-01-01

    In recent years the confluence of socio-political trends toward environmental responsibility and the pressing need to reduce Run-the-Engine (RTE) costs has given birth to a nascent discipline of Green IT. A clear and concise introduction to green networks and green network operations, this book examines analytical measures and discusses virtualization, network computing, and web services as approaches for green data centers and networks. It identifies some strategies for green appliance and end devices and examines the methodical steps that can be taken over time to achieve a seamless migratio

  5. Program Potential: Estimates of Federal Energy Cost Savings from Energy Efficient Procurement

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Margaret [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Fujita, K. Sydny [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-09-17

    In 2011, energy used by federal buildings cost approximately $7 billion. Reducing federal energy use could help address several important national policy goals, including: (1) increased energy security; (2) lowered emissions of greenhouse gases and other air pollutants; (3) increased return on taxpayer dollars; and (4) increased private sector innovation in energy efficient technologies. This report estimates the impact of efficient product procurement on reducing the amount of wasted energy (and, therefore, wasted money) associated with federal buildings, as well as on reducing the needless greenhouse gas emissions associated with these buildings.

  6. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada

    OpenAIRE

    Abdullah, Mohammad M. H.; Gyles, Collin L.; Marinangeli, Christopher P F; Carlberg, Jared G.; Jones, Peter J.H.

    2015-01-01

    Background: Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with re...

  7. How much might a society spend on life-saving interventions at different ages while remaining cost-effective? A case study in a country with detailed data.

    Science.gov (United States)

    Kvizhinadze, Giorgi; Wilson, Nick; Nair, Nisha; McLeod, Melissa; Blakely, Tony

    2015-01-01

    We aimed to estimate the maximum intervention cost (EMIC) a society could invest in a life-saving intervention at different ages while remaining cost-effective according to a user-specified cost-effectiveness threshold. New Zealand (NZ) was used as a case study, and a health system perspective was taken. Data from NZ life tables and morbidity data from a burden of disease study were used to estimate health-adjusted life-years (HALYs) gained by a life-saving intervention. Health system costs were estimated from a national database of all publicly funded health events (hospitalizations, outpatient events, pharmaceuticals, etc.). For illustrative purposes we followed the WHO-CHOICE approach and used a cost-effectiveness threshold of the gross domestic product (GDP) per capita (NZ$45,000 or US$30,000 per HALY). We then calculated EMICs for an "ideal" life-saving intervention that fully returned survivors to the same average morbidity, mortality, and cost trajectories as the rest of their cohort. The EMIC of the "ideal" life-saving intervention varied markedly by age: NZ$1.3 million (US$880,000) for an intervention to save the life of a child, NZ$0.8 million (US$540,000) for a 50-year-old, and NZ$0.235 million (US$158,000) for an 80-year-old. These results were predictably very sensitive to the choice of discount rate and to the selected cost-effectiveness threshold. Using WHO data, we produced an online calculator to allow the performance of similar calculations for all other countries. We present an approach to estimating maximal cost-effective investment in life-saving health interventions, under various assumptions. Our online calculator allows this approach to be applied in other countries. Policymakers could use these estimates as a rapid screening tool to determine if more detailed cost-effectiveness analyses of potential life-saving interventions might be worthwhile or which proposed life-saving interventions are very unlikely to benefit from such additional

  8. Energy and Energy Cost Savings Analysis of the IECC for Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jian; Athalye, Rahul A.; Hart, Philip R.; Rosenberg, Michael I.; Xie, YuLong; Goel, Supriya; Mendon, Vrushali V.; Liu, Bing

    2013-08-30

    The purpose of this analysis is to assess the relative energy and energy cost performance of commercial buildings designed to meet the requirements found in the commercial energy efficiency provisions of the International Energy Conservation Code (IECC). Section 304(b) of the Energy Conservation and Production Act (ECPA), as amended, requires the Secretary of Energy to make a determination each time a revised version of ASHRAE Standard 90.1 is published with respect to whether the revised standard would improve energy efficiency in commercial buildings. As many states have historically adopted the IECC for both residential and commercial buildings, PNNL has evaluated the impacts of the commercial provisions of the 2006, 2009, and 2012 editions of the IECC. PNNL also compared energy performance with corresponding editions of ANSI/ASHRAE/IES Standard 90.1 to help states and local jurisdictions make informed decisions regarding model code adoption.

  9. Prime focus architectures for large space telescopes: reduce surfaces to save cost

    Science.gov (United States)

    Breckinridge, J. B.; Lillie, C. F.

    2016-07-01

    Conceptual architectures are now being developed to identify future directions for post JWST large space telescope systems to operate in the UV Optical and near IR regions of the spectrum. Here we show that the cost of optical surfaces within large aperture telescope/instrument systems can exceed $100M/reflection when expressed in terms of the aperture increase needed to over come internal absorption loss. We recommend a program in innovative optical design to minimize the number of surfaces by considering multiple functions for mirrors. An example is given using the Rowland circle imaging spectrometer systems for UV space science. With few exceptions, current space telescope architectures are based on systems optimized for ground-based astronomy. Both HST and JWST are classical "Cassegrain" telescopes derived from the ground-based tradition to co-locate the massive primary mirror and the instruments at the same end of the metrology structure. This requirement derives from the dual need to minimize observatory dome size and cost in the presence of the Earth's 1-g gravitational field. Space telescopes, however function in the zero gravity of space and the 1- g constraint is relieved to the advantage of astronomers. Here we suggest that a prime focus large aperture telescope system in space may have potentially have higher transmittance, better pointing, improved thermal and structural control, less internal polarization and broader wavelength coverage than Cassegrain telescopes. An example is given showing how UV astronomy telescopes use single optical elements for multiple functions and therefore have a minimum number of reflections.

  10. Metaldyne. Plant-Wide Assessment at Royal Oak Finds Opportunities to Improve Manufacturing Effciency, Reduce Energy Use, and Achieve Sigificant Cost Savings

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2005-05-01

    This case study prepared for the U.S. Department of Energy's Industrial Technologies Program describes a plant-wide energy assessment conducted at the Metaldyne, Inc., forging plant in Royal Oak, Michigan. The assessment focused on reducing the plant's operating costs, inventory, and energy use. If the company were to implement all the recommendations that came out of the assessment, its total annual energy savings for electricity would be about 11.5 million kWh and annual cost savings would be $12.6 million.

  11. Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings.

    Science.gov (United States)

    Napoles, Tessa M; Burke, Nancy J; Shim, Janet K; Davis, Elizabeth; Moskowitz, David; Yen, Irene H

    2017-12-01

    We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing

  12. Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization.

    Science.gov (United States)

    Ho, Jonhan; Ahlers, Stefan M; Stratman, Curtis; Aridor, Orly; Pantanowitz, Liron; Fine, Jeffrey L; Kuzmishin, John A; Montalto, Michael C; Parwani, Anil V

    2014-01-01

    Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology "slide less" clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload

  13. Can Digital Pathology Result In Cost Savings? A Financial Projection For Digital Pathology Implementation At A Large Integrated Health Care Organization

    Science.gov (United States)

    Ho, Jonhan; Ahlers, Stefan M.; Stratman, Curtis; Aridor, Orly; Pantanowitz, Liron; Fine, Jeffrey L.; Kuzmishin, John A.; Montalto, Michael C.; Parwani, Anil V.

    2014-01-01

    Background: Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology “slide less” clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. Aim: As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Methods: Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. Results: When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by

  14. CHARACTERIZING COSTS, SAVINGS AND BENEFITS OF A SELECTION OF ENERGY EFFICIENT EMERGING TECHNOLOGIES IN THE UNITED STATES

    Energy Technology Data Exchange (ETDEWEB)

    Xu, T.; Slaa, J.W.; Sathaye, J.

    2010-12-15

    Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing CO2 emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing the costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world. Successful implementation of emerging technologies not only can help advance productivities and competitiveness but also can play a significant role in mitigation efforts by saving energy. Providing evaluation and estimation of the costs and energy savings potential of emerging technologies is the focus of our work in this project. The overall goal of the project is to identify and select emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. This report contains the results from performing Task 2"Technology evaluation" for the project titled"Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies," which was sponsored by California Energy Commission and managed by CIEE. The project purpose is to analyze market status, market potential, and economic viability of selected technologies applicable to the U.S. In this report, LBNL first performed re-assessments of all of the 33 emerging energy-efficient industrial technologies, including re-evaluation of the 26 technologies that were previously identified by Martin et al. (2000) and

  15. Regulatory and cost barriers are likely to limit biosimilar development and expected savings in the near future.

    Science.gov (United States)

    Grabowski, Henry G; Guha, Rahul; Salgado, Maria

    2014-06-01

    In March 2010 Congress established an abbreviated Food and Drug Administration approval pathway for biosimilars-drugs that are very similar but not identical to a reference biological product and cost less. Because bringing biosimilars to the market currently requires large investments of money, fewer biosimilars are expected to enter the biologics market than has been the case with generic drugs entering the small-molecule drug market. Additionally, given the high regulatory hurdles to obtaining interchangeability-which would allow pharmacists to substitute a biosimilar for its reference product, subject to evolving state substitution laws-most biosimilars will likely compete as therapeutic alternatives instead of as therapeutic equivalents. In other words, biosimilars will need to compete with their reference product on the basis of quality; price; and manufacturer's reputation with physicians, insurers, and patient groups. Biosimilars also will face dynamic competition from new biologics in the same therapeutic class-including "biobetters," which offer incremental improvements on reference products, such as extended duration of action. The prospects for significant cost savings from the use of biosimilars appear to be limited for the next several years, but their use should increase over time because of both demand- and supply-side factors. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting.

    LENUS (Irish Health Repository)

    O’Brien, C

    2018-01-01

    Peripheral inserted central catheters (PICCs) have increasingly become the mainstay of patients requiring prolonged treatment with antibiotics, transfusions, oncologic IV therapy and total parental nutrition. They may also be used in delivering a number of other medications to patients. In recent years, bed occupancy rates have become hugely pressurized in many hospitals and any potential solutions to free up beds is welcome. Recent introductions of doctor or nurse led intravenous (IV) outpatient based treatment teams has been having a direct effect on early discharge of patients and in some cases avoiding admission completely. The ability to deliver outpatient intravenous treatment is facilitated by the placement of PICCs allowing safe and targeted treatment of patients over a prolonged period of time. We carried out a retrospective study of 2,404 patients referred for PICCs from 2009 to 2015 in a university teaching hospital. There was an exponential increase in the number of PICCs requested from 2011 to 2015 with a 64% increase from 2012 to 2013. The clear increase in demand for PICCs in our institution is directly linked to the advent of outpatient intravenous antibiotic services. In this paper, we assess the impact that the use of PICCs combined with intravenous outpatient treatment may have on cost and hospital bed demand. We advocate that a more widespread implementation of this service throughout Ireland may result in significant cost savings as well as decreasing the number of patients on hospital trollies.

  17. A stitch in time saves nine. The costs of postponing action in climate policy

    Energy Technology Data Exchange (ETDEWEB)

    Steinshamn, Stein Ivar; Kvamsdal, Sturla F.; Sandal, Leif K.

    2011-07-01

    The main purpose of this report is to investigate the effects of postponing implementation of a carbon tax assuming that externalities associated with climate change and global warming is real. Failing to internalize these externalities will only lead to a suboptimal situation. The model applied to investigate these externalities starts with the basic relationships, namely supply and demand for fossil fuel, and an added damage term that accounts for the externality. The objective is then to maximize the sum of consumers' and producers' surplus adjusted for the externality. This must be done subject to the dynamic constraint derived from emissions of carbon associated with extraction and consumption of fossil fuel and the natural assimilation of carbon in the atmosphere. The model is solved as a closed loop feedback policy. First the optimal emission path is calculated, and then the corresponding tax path is found. As the externality dealt with here is a pure stock externality it turns out that the optimal tax is equal to the shadow cost of the pollutant. The dynamic equation for assimilation, or natural decay, of carbon is specified using a fairly sophisticated method, namely the ensemble Kalman filter. Given the relative simplicity of the model with only one type of production and one type of pollutant, this method is supposed to give a best possible estimate of the parameters in the assimilation function.The main message in this report is that it may possibly be very expensive to postpone implementation of a carbon tax as the tax rate may have to increase by up to 30 per cent and more for each year implementation is postponed in order to recover optimality in the most pessimistic cases. In the more optimistic cases an increase of down to 0.5 per cent per year may be sufficient.(eb)

  18. When the strong punish: why net costs of punishment are often negligible.

    Science.gov (United States)

    von Rueden, Christopher R; Gurven, Michael

    2012-02-01

    In small-scale societies, punishment of adults is infrequent and employed when the anticipated cost-to-benefit ratio is low, such as when punishment is collectively justified and administered. In addition, benefits may exceed costs when punishers have relatively greater physical and social capital and gain more from cooperation. We provide examples from the Tsimane horticulturalists of Bolivia to support our claims.

  19. Reprocessing single-use cardiac catheters for interventional cardiology. A cost-minimization model for estimating potential saving at departmental scale and national level

    Directory of Open Access Journals (Sweden)

    Francesco Tessarolo

    2009-06-01

    Full Text Available

    Background: The utilization of single-use percutaneous catheters (SUDs is a common practice in interventional cardiology, but the increasing of cardiac interventions and the consequent economic load demand for assessing SUDs’ reuse. The study aimed at estimating the potential saving for Italian cardiology departments in the hypothesis that reprocessing and reuse of SUD is performed by guaranteeing safety and efficiency of the reconditioned device as high as the new marketed one.

    Methods: A cost-minimization model was applied from the perspective of the health national service. Input parameters for the model were settled by reviewing published data on technical, hygiene and functional properties of reprocessed electrophysiology (EP and percutaneous transluminal coronary angioplasty (PTCA catheters. Potential saving at department level was calculated as percentage of the actual expenditure for purchasing single-use devices. Two-ways sensitivity analysis was conducted on main cost drivers. Finally, saving at national level was estimated.

    Results: The revision of technical and safety data showed the feasibility of reprocessing and reuse of EP and PTCA catheters under determined constrains. Potential savings of 39%, and 12% were calculated at department level for EP and PTCA catheters, respectively. Sensitivity analysis showed saving was dependent primarily on departmental workload. Major variations in saving occurred in the range between one and 200 catheters per year. The cut-off between benefit and charges was also related to regeneration rate and maximum number of uses. The estimate of potential saving at national level ranged in the interval from €19.85M to €24.24M.

    Conclusions:When safety and efficiency is assured by certified reuse processing, substantial saving could be achieved both at departmental and national level contributing to optimize budget

  20. Design to Cost and Life Cycle Cost.

    Science.gov (United States)

    1980-07-01

    plant in Hookset, New Hampshire. It is anticipated that after full amor - tization of the Government investment, a net savings of approximately $15,000...prsividt: IT iLcabil ity’ and audiiting oif lis’ dessigin proci-ss. A cost effet’-ivei Prsoiicuet procss is css, filial it) tlic suiccess sif aI dcsigrr

  1. Energy and cost savings analysis of Wood Burning Boiler Plant, Fort Stewart, Georgia: Final report, Validation of ECIP Project No. 193: DOD, Energy Conservation Investment Program (ECIP)

    Energy Technology Data Exchange (ETDEWEB)

    Broders, M.A.; Miller, D.R.

    1987-08-01

    An Energy Conservation Investment Program (ECIP) project to install a 94,900 lb steam per hour wood burning boiler in the Fort Stewart Central Energy Plant was selected by the US Army for validation by the Oak Ridge National Laboratory. This ECIP project was justified on the basis of fuel cost savings and the use of a renewable energy source: wood waste, which is abundantly available at Fort Stewart, Georgia. This report documents the results of a 1-year postretrofit study designed to validate the energy and cost savings attributed to the installation of the new wood burning boiler. During the postretrofit validation study period (FY 1986), the new wood burning boiler produced approximately 90% of the steam required by the Central Energy Plant to meet the seasonal heating and cooling demands of Fort Stewart. In doing so, over 2,880,000 gal of No. 5 fuel oil (a nonrenewable energy source) was conserved. With full consideration given to the increase in electrical energy required to operate the new Wood Burning Boiler Plant addition, an annual nonrenewable energy savings of over 400,000 MBtu is projected. Based on the results of a life cycle cost analysis performed on this ECIP project, a first-year savings of over $1,200,000 is estimated. The resultant discounted savings ratio is 3.36, and the estimated simple payback period is 6.7 years. It was concluded that installation and operation of a wood burning boiler at a military installation such as Fort Stewart can result in significant cost and nonrenewable energy savings.

  2. Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis.

    Science.gov (United States)

    Fayet-Moore, Flavia; George, Alice; Cassettari, Tim; Yulin, Lev; Tuck, Kate; Pezzullo, Lynne

    2018-01-02

    An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.

  3. 25 CFR 900.134 - At the end of a self-determination construction contract, what happens to savings on a cost...

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false At the end of a self-determination construction contract... SERVICES CONTRACTS UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Construction § 900.134 At the end of a self-determination construction contract, what happens to savings on a cost...

  4. Exemplary.... Nine examples to save energy and cost by intelligent engineering; Zur Nachahmung empfohlen.... Neun Faelle, in denen mit intelligenter Technik Energie und Kosten gespart werden

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    Contents: Daylighting and energy management, light offices by daylight guidance, fresh air after demand by frequency converters, saving heating cost by intelligent control, optimized lighting systems in schools, fresh air from an external provider and compressed air monitoring in a mine. (GL)

  5. Energy Smart Guide to Campus Cost Savings: Today's Trends in Project Finance, Clean Fuel Fleets, Combined Heat& Power, Emissions Markets

    Energy Technology Data Exchange (ETDEWEB)

    2003-07-01

    The Energy Smart Guide to Campus Cost Savings covers today's trends in project finance, combined heat& power, clean fuel fleets and emissions trading. The guide is directed at campus facilities and business managers and contains general guidance, contact information and case studies from colleges and universities across the country.

  6. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fibre in Canada

    Directory of Open Access Journals (Sweden)

    Mohammad eAbdullah

    2015-08-01

    Full Text Available Background: Consumption of fibre-rich diets is associated with favourable impacts on type 2 diabetes (T2D and cardiovascular disease (CVD, two of the most costly ailments worldwide, however the economic value of altered fibre intakes remains poorly understood. Methods: A cost-of-illness analysis was conducted to identify the percentage of adults expected to consume fibre-rich diets in Canada, estimate fibre intakes in relation to T2D and CVD reductions, and assess the potential annual savings in healthcare costs with reductions in rates of these two epidemics. Results: Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8-$1,295.7 million in CVD costs were calculated under a scenario where cereal fibre was used to increase current intakes of dietary fibre to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fibre consumption resulted in annual CAD$2.6-$51.1 and $4.6-$92.1 million savings for T2D and CVD, respectively. Conclusions: Strategies to increase consumers’ knowledge of the recommended dietary fibre intakes, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of costs associated with T2D and CVD in Canada.

  7. Economic analysis of a new drug: potential savings in hospital operating costs from the use of a once-daily regimen of a parenteral cephalosporin.

    Science.gov (United States)

    Eisenberg, J M; Koffer, H; Finkler, S A

    1984-01-01

    The introduction of a new drug requires clear demonstration of its clinical efficacy and documentation of its adverse effects, but economic consequences of the new drug generally receive less attention. A new cephalosporin antibiotic, cefonicid, can be administered parenterally once daily, rather than three or four times daily, which is required for conventional cephalosporins. Methods of industrial engineering and cost accounting were used to determine the potential savings in hospital operating costs that would be available by reducing the frequency of intravenous administration of cephalosporin antibiotics. The variable cost of administering parenteral cephalosporin antibiotics averaged $2.24 per dose, $0.95 of which was attributable to labor costs and $1.28 to the costs of materials. Given present patterns of cephalosporin use, at four study hospitals the average potential savings per day for patients receiving intravenous cephalosporins ranged from $3.72 to $7.23, with a weighted mean of $5.42. Estimated national savings in hospital operating costs that would occur with use of an intravenous cephalosporin administered once daily range from $85.1 million to $115.4 million yearly.

  8. Discharge Disposition After Joint Replacement and the Potential for Cost Savings: Effect of Hospital Policies and Surgeons.

    Science.gov (United States)

    London, Daniel A; Vilensky, Seth; O'Rourke, Colin; Schill, Michelle; Woicehovich, Lynn; Froimson, Mark I

    2016-04-01

    Up to 55% of total joint arthroplasty costs come from post-acute care, with large variability dependent on a patient's discharge location. At our institution, we identified a group of surgeons using a preoperative discharge planning protocol emphasizing the merits of home discharge. We hypothesized that using the protocol would increase patients' odds for discharge home. Administrative data from 14,315 total hip and knee arthroplasties performed over a 3-year period were retrospectively analyzed to determine predictors of patient discharge location. Bayesian hierarchical logistic regression modeling was used to account for the complex multilevel structure within the data as we considered patient-, surgeon-, and hospital-level predictors. A simplified case-control data structure with logistic regression analysis was also used to better understand the impact of the preoperative discharge planning protocol. A variety of patient- and surgeon-level variables are predictive of patients being discharged home after total joint arthroplasty including a patient's length of stay, age, illness severity, and insurance, as well as surgeon's affiliation. In the case-control data, patients exposed to the rapid recovery protocol had 45% increased odds of being discharged home compared to patients not exposed to the protocol. Although patient factors are known to play a role in predicting postdischarge destination, this analysis describes additional surgeon- and hospital-level factors that predict discharge location. Exogenous factors based on how surgeons and hospital staff practice and interact with patients may impact the postdischarge decision-making process and provide a cost savings opportunity. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Cost-Effectiveness of a Savings-Led Economic Empowerment Intervention for AIDS-Affected Adolescents in Uganda: Implications for Scale-up in Low-Resource Communities.

    Science.gov (United States)

    Ssewamala, Fred M; Wang, Julia Shu-Huah; Neilands, Torsten B; Bermudez, Laura Gauer; Garfinkel, Irwin; Waldfogel, Jane; Brooks-Gunn, Jeanne; Kirkbride, Gwyneth

    2018-01-01

    Nearly 12 million children and adolescents in sub-Saharan Africa have lost one or both parents to AIDS. Within sub-Saharan Africa, Uganda has been greatly impacted, with an estimated 1.2 million orphaned children, nearly half of which have experienced parental loss due to the epidemic. Cost-effective and scalable interventions are needed to improve developmental outcomes for these children, most of whom are growing up in poverty. This article examines the direct impacts and cost-effectiveness of a savings-led family economic empowerment intervention, Bridges to the Future, that employed varying matched savings incentives to encourage investment in Ugandan children orphaned by AIDS. Using data from 48 primary schools in southwestern Uganda, we calculate per-person costs in each of the two treatment arms-Bridges (1:1 match savings) versus Bridges PLUS (1:2 match savings); estimate program effectiveness across outcomes of interest; and provide the ratios of per-person costs to their corresponding effectiveness. At the 24-month postintervention initiation, children in the two treatment arms showed better results in health, mental health, and education when compared to the usual care condition; however, no statistically significant differences were found between treatment arms with the exception of school attendance rates which were higher for those in Bridges PLUS. Owing to the minimal cost difference between the Bridges and Bridges PLUS arms, we did not find substantial cost-effectiveness differences across the two treatment arms. After 24 months, an economic intervention that incorporated matched savings yielded positive results on critical development outcomes for adolescents orphaned by AIDS in Uganda. The 1:1 and 1:2 match rates did not demonstrate variable levels of cost-effectiveness at 24-month follow-up, suggesting that governments intending to incorporate savings-led interventions within their social protection frameworks may not need to select a higher

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

    Science.gov (United States)

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

    2012-01-01

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

  11. EnviroNET: Space environment for Strategic Defense Initiative experiments

    Science.gov (United States)

    Lauriente, Michael

    1989-01-01

    EnviroNET is an operational system available to the Strategic Defense Initiative (SDI) experimenters who have access to a terminal or dial-up port. It is a tail node on Space Physics Analysis Network (SPAN) accessible directly or through the national networks via NPSS. Some of the benefits to using EnviroNET include: validated NASA environmental information and interactive space models; facilitating the payload integration process; easy access to expert assistance; and potential for time and cost savings.

  12. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?

    Science.gov (United States)

    2014-01-01

    Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. PMID:24564984

  13. VALUASI EKONOMI KEHILANGAN MANFAAT BERSIH AKIBAT BIAYA KESEHATAN PENGGUNAAN PESTISIDA KIMIA (Economic Valuation of Net Benefit Loss Due to Health Cost of Chemical Pesticides Use

    Directory of Open Access Journals (Sweden)

    Joko Mariyono

    2002-03-01

    Full Text Available ABSTRAK Mengingat pestisida merupakan bahan beracun, maka penggunaannya juga menimbulkan  risiko kesehatan. Penelitian ini bertujuan untuk mengestimasi bsarnya kehilangan manfaat bersih akibat adanya eksternalitas yang diakibatkan oleh penggunaan pestisda kimia. Manfaat yang hilang ditentukan menghitung selisih antara manfaat bersihmaksimum dihitung dengan menggunakan konsep yang mendalilkan bahwa manfaat bersih marjinal sama dengan biaya eksternal marjinal. Manfaat bersih marjinal diturunkan dari fungsi produksi, sedangkan biaya eksternal marjinal diperoleh dari fungsi biaya kesehatan yang telah diestimasi oleh peneliti sebelumnya. Studi ini menggunakan data nasional produksi padi mulai tahun 1974 sampai dengan 2000. Hasil studi menunjukkan bahwa kehilangan manfaat bersih akibat biaya kesehatan karena penggunaan pestisida sangat tinggi. Kehilangan manfaat bersih yang sangat tinggi ini terjadi karena elastisitas produksi dari pestisida terhadap padi sangat kecil.   ABSTRACT Since pesticide is a poisonous agent, its use also causes health risk. The objective of this study is to estimate the value of net benefit loss associated with chemical pestiside uses. The net benefit loss is determined by finding the difference between actual value of net benefit and maximum value of net benefit of pesticides use. The maximum value of net benefit can be obtained by employing the concept postulating that the net benefit is occurred when the marginal net benefit is aqual to marginal external cost. The marginal net benefit is derived from estimated production function of rice, whereas the marginal external cost is obtained by adopting health cost function of pesticides use that has been estimated by previous researchers. The study utilized the national data of rice production and agro-chemical input use during from 1974 to 2000. The results of the study show that there are extremely high net benefit losses associated with health costs of pesticides use. It is

  14. Effectiveness and costs of specialised physiotherapy given via ParkinsonNet: a retrospective analysis of medical claims data.

    Science.gov (United States)

    Ypinga, Jan H L; de Vries, Nienke M; Boonen, Lieke H H M; Koolman, Xander; Munneke, Marten; Zwinderman, Aeilko H; Bloem, Bastiaan R

    2018-02-01

    Parkinson's disease is a complex condition that is best managed by specialised professionals. Trials show that specialised allied health interventions are cost-effective, as compared with usual care. We aimed to study the long-term benefits of specialised physiotherapy using the ParkinsonNet approach in real-world practice. We did an observational study, retrospectively analysing a database of health insurance claims that included a representative population of Dutch patients with Parkinson's disease, who were followed for up to 3 years (Jan 1, 2013, to Dec 31, 2015). Eligibility criteria included having both a diagnosis of Parkinson's disease and having received physiotherapy for the disease. Allocation to specialised or usual care physiotherapy was based on the choices of patients and referring physicians. We used a mixed-effects model to compare health-care use and outcomes between patients treated by specialised or usual care physiotherapists. The primary outcome was the percentage of patients with a Parkinson's disease-related complication (ie, visit or admission to hospital because of fracture, other orthopaedic injuries, or pneumonia) adjusted for baseline variables. We compared physiotherapist caseload, the number of physiotherapy sessions, physiotherapy costs, and total health-care costs (including hospital care, but excluding community care, long-term care, and informal care) between the groups, and used a Cox's proportional hazard model for survival time to establish whether mortality was influenced by treatment by a specialised physiotherapist. We analysed 2129 patients (4649 observations) receiving specialised physiotherapy and 2252 patients (5353 observations) receiving usual care physiotherapy. Significantly fewer patients treated by a specialised physiotherapist had a Parkinson's disease-related complication (n=368 [17%]) than patients treated by a usual care physiotherapist (n=480 [21%]; odds ratio 0·67, 95% CI 0·56-0·81, plower for specialised

  15. The net return from animal activity in agro-ecosystems: trading off benefits from ecosystem services against costs from crop damage.

    Science.gov (United States)

    Luck, Gary W

    2013-01-01

    Animals provide benefits to agriculture through the provision of ecosystem services, but also inflict costs such as damaging crops. These benefits and costs are mostly examined independently, rather than comparing the trade-offs of animal activity in the same system and quantifying the net return from beneficial minus detrimental activities. Here, I examine the net return associated with the activity of seed-eating birds in almond orchards by quantifying the economic costs and benefits of bird consumption of almonds. Pre-harvest, the consumption of harvestable almonds by birds cost growers AUD$57.50 ha (-1) when averaged across the entire plantation. Post-harvest, the same bird species provide an ecosystem service by removing mummified nuts from trees that growers otherwise need to remove to reduce threats from fungal infection or insect pest infestations. The value of this ecosystem service ranged from AUD$82.50 ha (-1)-$332.50 ha (-1) based on the replacement costs of mechanical or manual removal of mummified nuts, respectively. Hence, bird consumption of almonds yielded a positive net return of AUD$25-$275 ha (-1) averaged across the entire plantation. However, bird activity varied spatially resulting in positive net returns occurring primarily at the edges of crops where activity was higher, compared to negative net returns in crop interiors. Moreover, partial mummy nut removal by birds meant that bird activity may only reduce costs to growers rather than replace these costs completely. Similar cost-benefit trade-offs exist across nature, and quantifying net returns can better inform land management decisions such as when to control pests or promote ecosystem service provision.

  16. Feature Selection as a Time and Cost-Saving Approach for Land Suitability Classification (Case Study of Shavur Plain, Iran

    Directory of Open Access Journals (Sweden)

    Saeid Hamzeh

    2016-10-01

    Full Text Available Land suitability classification is important in planning and managing sustainable land use. Most approaches to land suitability analysis combine a large number of land and soil parameters, and are time-consuming and costly. In this study, a potentially useful technique (combined feature selection and fuzzy-AHP method to increase the efficiency of land suitability analysis was presented. To this end, three different feature selection algorithms—random search, best search and genetic methods—were used to determine the most effective parameters for land suitability classification for the cultivation of barely in the Shavur Plain, southwest Iran. Next, land suitability classes were calculated for all methods by using the fuzzy-AHP approach. Salinity (electrical conductivity (EC, alkalinity (exchangeable sodium percentage (ESP, wetness and soil texture were selected using the random search method. Gypsum, EC, ESP, and soil texture were selected using both the best search and genetic methods. The result shows a strong agreement between the standard fuzzy-AHP methods and methods presented in this study. The values of Kappa coefficients were 0.82, 0.79 and 0.79 for the random search, best search and genetic methods, respectively, compared with the standard fuzzy-AHP method. Our results indicate that EC, ESP, soil texture and wetness are the most effective features for evaluating land suitability classification for the cultivation of barely in the study area, and uses of these parameters, together with their appropriate weights as obtained from fuzzy-AHP, can perform good results for land suitability classification. So, the combined feature selection presented and the fuzzy-AHP approach has the potential to save time and money for land suitability classification.

  17. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada

    Science.gov (United States)

    Abdullah, Mohammad M. H.; Gyles, Collin L.; Marinangeli, Christopher P. F.; Carlberg, Jared G.; Jones, Peter J. H.

    2015-01-01

    Background: Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with reductions in T2D and CVD rates, separately, following increased intakes of dietary fiber by adults. Methods: A three-step cost-of-illness analysis was conducted to identify the percentage of individuals expected to consume fiber-rich diets in Canada, estimate increased fiber intakes in relation to T2D and CVD reduction rates, and independently assess the potential annual savings in healthcare costs associated with the reductions in rates of these two epidemics. The economic model employed a sensitivity analysis of four scenarios (universal, optimistic, pessimistic, and very pessimistic) to cover a range of assumptions within each step. Results: Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8 million–$1.3 billion in CVD costs were calculated under a scenario where cereal fiber was used to increase current intakes of dietary fiber to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fiber consumption resulted in annual CAD$2.6 to $51.1 million savings for T2D and $4.6 to $92.1 million savings for CVD. Conclusion: Findings of this analysis shed light on the economic value of optimal dietary fiber intakes. Strategies to increase consumers’ general knowledge of the recommended intakes of dietary fiber, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of healthcare and related costs associated with T2D and CVD in Canada. PMID

  18. Cost-of-illness analysis reveals potential healthcare savings with reductions in type 2 diabetes and cardiovascular disease following recommended intakes of dietary fiber in Canada.

    Science.gov (United States)

    Abdullah, Mohammad M H; Gyles, Collin L; Marinangeli, Christopher P F; Carlberg, Jared G; Jones, Peter J H

    2015-01-01

    Type 2 diabetes (T2D) and cardiovascular disease (CVD) are leading causes of mortality and two of the most costly diet-related ailments worldwide. Consumption of fiber-rich diets has been repeatedly associated with favorable impacts on these co-epidemics, however, the healthcare cost-related economic value of altered dietary fiber intakes remains poorly understood. In this study, we estimated the annual cost savings accruing to the Canadian healthcare system in association with reductions in T2D and CVD rates, separately, following increased intakes of dietary fiber by adults. A three-step cost-of-illness analysis was conducted to identify the percentage of individuals expected to consume fiber-rich diets in Canada, estimate increased fiber intakes in relation to T2D and CVD reduction rates, and independently assess the potential annual savings in healthcare costs associated with the reductions in rates of these two epidemics. The economic model employed a sensitivity analysis of four scenarios (universal, optimistic, pessimistic, and very pessimistic) to cover a range of assumptions within each step. Non-trivial healthcare and related savings of CAD$35.9-$718.8 million in T2D costs and CAD$64.8 million-$1.3 billion in CVD costs were calculated under a scenario where cereal fiber was used to increase current intakes of dietary fiber to the recommended levels of 38 g per day for men and 25 g per day for women. Each 1 g per day increase in fiber consumption resulted in annual CAD$2.6 to $51.1 million savings for T2D and $4.6 to $92.1 million savings for CVD. Findings of this analysis shed light on the economic value of optimal dietary fiber intakes. Strategies to increase consumers' general knowledge of the recommended intakes of dietary fiber, as part of healthy diet, and to facilitate stakeholder synergy are warranted to enable better management of healthcare and related costs associated with T2D and CVD in Canada.

  19. Integrated control of emission reductions, energy-saving, and cost-benefit using a multi-objective optimization technique in the pulp and paper industry.

    Science.gov (United States)

    Wen, Zongguo; Xu, Chang; Zhang, Xueying

    2015-03-17

    Reduction of water pollutant emissions and energy consumption is regarded as a key environmental objective for the pulp and paper industry. The paper develops a bottom-up model called the Industrial Water Pollutant Control and Technology Policy (IWPCTP) based on an industrial technology simulation system and multiconstraint technological optimization. Five policy scenarios covering the business as usual (BAU) scenario, the structural adjustment (SA) scenario, the cleaner technology promotion (CT) scenario, the end-treatment of pollutants (EOP) scenario, and the coupling measures (CM) scenario have been set to describe future policy measures related to the development of the pulp and paper industry from 2010-2020. The outcome of this study indicates that the energy saving amount under the CT scenario is the largest, while that under the SA scenario is the smallest. Under the CT scenario, savings by 2020 include 70 kt/year of chemical oxygen demand (COD) emission reductions and savings of 7443 kt of standard coal, 539.7 ton/year of ammonia nitrogen (NH4-N) emission reductions, and savings of 7444 kt of standard coal. Taking emission reductions, energy savings, and cost-benefit into consideration, cleaner technologies like highly efficient pulp washing, dry and wet feedstock preparation, and horizontal continuous cooking, medium and high consistency pulping and wood dry feedstock preparation are recommended.

  20. Heat Saving Strategies in Sustainable Smart Energy Systems

    DEFF Research Database (Denmark)

    Lund, Henrik; Thellufsen, Jakob Zinck; Aggerholm, Søren

    2014-01-01

    This paper investigates to which extent heat should be saved rather than produced and to which extent district heating infrastructures, rather than individual heating solutions, should be used in future sustainable smart energy systems. Based on a concrete proposal to implement the Danish...... governmental 2050 fossil-free vision, this paper identifies marginal heat production costs and compares these to marginal heat savings costs for two different levels of district heating. A suitable least-cost heating strategy seems to be to invest in an approximately 50% decrease in net heat demands in new...... buildings and buildings that are being renovated anyway, while the implementation of heat savings in buildings that are not being renovated hardly pays. Moreover, the analysis points in the direction that a least-cost strategy will be to provide approximately 2/3 of the heat demand from district heating...

  1. Heat Saving Strategies in Sustainable Smart Energy Systems

    Directory of Open Access Journals (Sweden)

    Henrik Lund

    2014-06-01

    Full Text Available This paper investigates to which extent heat should be saved rather than produced and to which extent district heating infrastructures, rather than individual heating solutions, should be used in future sustainable smart energy systems. Based on a concrete proposal to implement the Danish governmental 2050 fossil-free vision, this paper identifies marginal heat production costs and compares these to marginal heat savings costs for two different levels of district heating. A suitable least-cost heating strategy seems to be to invest in an approximately 50% decrease in net heat demands in new buildings and buildings that are being renovated anyway, while the implementation of heat savings in buildings that are not being renovated hardly pays. Moreover, the analysis points in the direction that a least-cost strategy will be to provide approximately 2/3 of the heat demand from district heating and the rest from individual heat pumps.

  2. Genuine Savings Rates in Developing Countries

    National Research Council Canada - National Science Library

    Kirk Hamilton; Michael Clemens

    1999-01-01

    .... After developing the theory of genuine savings-traditional net savings less the value of resource depletion and environmental degradation plus the value of investment in human capital-this article...

  3. Applying the net-benefit framework for analyzing and presenting cost-effectiveness analysis of a maternal and newborn health intervention.

    Science.gov (United States)

    Hounton, Sennen; Newlands, David

    2012-01-01

    Coverage of maternal and newborn health (MNH) interventions is often influenced by important determinants and decision makers are often concerned with equity issues. The net-benefit framework developed and applied alongside clinical trials and in pharmacoeconomics offers the potential for exploring how cost-effectiveness of MNH interventions varies at the margin by important covariates as well as for handling uncertainties around the ICER estimate. We applied the net-benefit framework to analyze cost-effectiveness of the Skilled Care Initiative and assessed relative advantages over a standard computation of incremental cost effectiveness ratios. Household and facility surveys were carried out from January to July 2006 in Ouargaye district (where the Skilled Care Initiative was implemented) and Diapaga (comparison site) district in Burkina Faso. Pregnancy-related and perinatal mortality were retrospectively assessed and data were collected on place of delivery, education, asset ownership, place, and distance to health facilities, costs borne by households for institutional delivery, and cost of standard provision of maternal care. Descriptive and regression analyses were performed. There was a 30% increase in institutional births in the intervention district compared to 10% increase in comparison district, and a significant reduction of perinatal mortality rates (OR 0.75, CI 0.70-0.80) in intervention district. The incremental cost for achieving one additional institutional delivery in Ouargaye district compared to Diapaga district was estimated to be 170 international dollars and varied significantly by covariates. However, the joint probability distribution (net-benefit framework) of the effectiveness measure (institutional delivery), the cost data and covariates indicated distance to health facilities as the single most important determinant of the cost-effectiveness analysis with implications for policy making. The net-benefit framework, the application of which

  4. Chest pain unit using thrombolysis in myocardial infarction score risk stratification: an impact on the length of stay and cost savings.

    Science.gov (United States)

    Shah, Priyank P; Gupta, Nishant; Sharma, Anurag; Bhargava, Rishi K; Bajaj, Sharad; Mittal, Vipin; Johnson, Cynthia; Shamoon, Fayez; Bikkina, Mahesh

    2012-12-01

    Despite the fact that studies have demonstrated cost-effectiveness of chest pain observation units (CPOUs) in emergency departments, they have not been widely implemented. Thrombolysis in Myocardial Infarction (TIMI) score is an easy and reliable tool, but none of the prior studies have used it for risk stratification in CPOUs. We propose to study the impact of CPOU using TIMI risk stratification model on the length of stay (LOS) and cost savings. We studied 777 patients with chest pain admitted to our hospital from July 2010 to June 2011. The patients with a TIMI score of 0 to 2 were observed for 12 hours, those with a score of 3 to 4 were observed for 20 hours, and the ones with a score >4 were deemed appropriate for admission. We calculated the cost differences between the actual admissions and the CPOU. A total of 39.1% of patients had a TIMI score of 0, 31.1% had a TIMI score of 1, 18.1% had a TIMI score of 2, 9.2% and 2.5% had TIMI scores of 3 and 4, respectively. The expected LOS based on this model was 418.5 days versus the actual LOS of 1324 days. The cost of CPOU was estimated to be $1,979,977. However, the actual cost was $3,216,809. Hence, the annual cost savings were estimated to be $1,236,832. CPOU using TIMI score is an easy and reliable risk stratification tool for patients with chest pain in the emergency department and can significantly reduce the LOS, hence saving millions of dollars in this economic crisis.

  5. Estimation of potential cost savings associated with reduced rates of cardiovascular hospitalization among atrial fibrillation/flutter patients treated with dronedarone in the ATHENA trial.

    Science.gov (United States)

    Reynolds, Matthew R; Lin, Jay; Jhaveri, Mehul; Mozaffari, Essy; Plich, Adam

    2014-01-01

    The aim of this study was to estimate, from a US payer perspective, potential cost savings resulting from the reduction in cardiovascular (CV) hospitalizations obtained with dronedarone in the ATHENA (A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death from any Cause in PatiENts with Atrial Fibrillation/Atrial Flutter) trial. ATHENA randomized atrial fibrillation/flutter patients to dronedarone (n=2301) or placebo (n=2327) plus standard care. Dronedarone significantly reduced first CV hospitalization/all-cause mortality over 12-30 months of follow-up. CV hospitalization costs (2008 values) from a US cohort of ATHENA-like atrial fibrillation/flutter patients with Medicare supplemental insurance (n=10,200) and diagnosis-related group costs of adverse event-related hospitalizations were applied to hospitalizations occurring in ATHENA. The impact of cost variation was assessed using Monte Carlo simulation. In ATHENA, dronedarone reduced the overall CV hospitalization rate (vs. placebo) by 29% over the first 12 months (33.36 vs. 47.19 events per 100 patients) and by 25% over the full study (51.15 vs. 68.55 events per 100 patients). Adverse event-related hospitalization rates (dronedarone vs. placebo) were low (0.48 vs. 0.21 and 0.56 vs. 0.26 events per 100 patients over 12 months and the full study, respectively). Overall hospitalization cost savings were estimated at $1329 and $1763 per patient over 12 months and the full study, respectively. Cost savings were relatively stable [mean (95% confidence interval): $1330 ($994-$1676) for the first 12 months and $1763 ($1369-$2184) for the full study] over 10,000 cycles of random variation.

  6. Developing a student-led health and wellbeing clinic in an underserved community: collaborative learning, health outcomes and cost savings.

    Science.gov (United States)

    Stuhlmiller, Cynthia M; Tolchard, Barry

    2015-01-01

    The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable

  7. Potential cost saving of Epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects: a discrete-event simulation model.

    Directory of Open Access Journals (Sweden)

    Jörg Tomeczkowski

    Full Text Available OBJECTIVES: Transfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategyduring elective hip and knee replacement surgery. METHODS: Individual patients (N = 50,000 were simulated based on data from controlled trials, the German DRG institute (InEK and various publications and entered into a stochastic model (Monte-Carlo of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit, pneumonia treatment (€5,000, and length of stay (€300/day. Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes. RESULTS: At acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days. CONCLUSIONS: EPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.

  8. Economic Impact of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Emergency Department or Observation Setting: Cost Savings Associated with Avoidable Hospitalizations.

    Science.gov (United States)

    Lodise, Thomas P; Fan, Weihong; Sulham, Katherine A

    2016-01-01

    Data indicate that acute bacterial skin and skin structure infection (ABSSSI) patients without major comorbidities can be managed effectively in the outpatient setting. Because most patients with ABSSSIs present to the emergency department, it is essential that clinicians identify candidates for outpatient treatment given the substantially higher costs associated with inpatient care. We examined the potential cost avoidance associated with shifting care from inpatient treatment with vancomycin to outpatient treatment with oritavancin for ABSSSI patients without major complications or comorbidities. A decision analytic, cost-minimization model was developed to compare costs of inpatient vancomycin versus outpatient oritavancin treatment of ABSSSI patients with few or no comorbidities (Charlson Comorbidity Index score ≤1) and no life-threatening conditions presenting to emergency department. Hospital discharge data from the Premier Research Database was used to determine the costs associated with inpatient vancomycin treatment. Mean costs for inpatient treatment with vancomycin ranged from $5973 to $9885, depending on Charlson Comorbidity Index score and presence of systemic symptoms. Switching an individual patient from inpatient vancomycin treatment to outpatient oritavancin treatment was estimated to save $1752.46 to $6475.87 per patient, depending on Charlson Comorbidity Index score, presence of systemic symptoms, and use of observation status. Assuming some patients may be admitted to the hospital after treatment with oritavancin, it is estimated that up to 38.12% of patients could be admitted while maintaining budget neutrality. This cost-minimization model indicates that use of oritavancin in the emergency department or observation setting is associated with substantial cost savings compared with inpatient treatment with vancomycin. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

  9. 5 case studies : boiler system increases availability of hot water in CAP REIT apartment buildings while saving energy : electric-to-gas retrofit drives down energy costs and improves building performance : Novitherm heat reflector panels saves 28 per cent in heating costs for apartment building : Novitherm heat reflector panel installation with system adjustment saves 33.2 per cent in energy costs : natural gas conversion saves over $315,000 a year for condominium

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-07-01

    These 5 case studies presented the details of new systems and retrofits conducted by Enbridge Gas Distribution and its partners to improve the energy efficiency of various public and residential buildings. System retrofits included the installation of boiler system installed to address tenant demands on the domestic hot water systems of properties purchased purchased by the CAP REIT organization. The comprehensive program used to address the problems included replacement of the systems with high efficiency heating boilers designed to integrate space, hot water, ramp, and pool heat. A centralized controller included setback control, trend-following processors, and the isolation of heating equipment. The second case study described an electric-to-gas conversion of a make-up air unit and boiler system at an all-electric apartment building. The system was designed to address excessive air handling and water heating costs. The gas conversion included new heating and hot water boilers, as well as a number of efficiency upgrades. The third and fourth case study described the installation of Novitherm heat reflector panels at apartment buildings in Toronto. The fifth case study described a natural gas conversion project conducted at a luxury condominium. Energy savings for all 5 projects were presented. 9 figs.

  10. Partitioning net ecosystem carbon exchange into net assimilation and respiration using 13CO2 measurements: A cost-effective sampling strategy

    Science.gov (United States)

    OgéE, J.; Peylin, P.; Ciais, P.; Bariac, T.; Brunet, Y.; Berbigier, P.; Roche, C.; Richard, P.; Bardoux, G.; Bonnefond, J.-M.

    2003-06-01

    The current emphasis on global climate studies has led the scientific community to set up a number of sites for measuring the long-term biosphere-atmosphere net CO2 exchange (net ecosystem exchange, NEE). Partitioning this flux into its elementary components, net assimilation (FA), and respiration (FR), remains necessary in order to get a better understanding of biosphere functioning and design better surface exchange models. Noting that FR and FA have different isotopic signatures, we evaluate the potential of isotopic 13CO2 measurements in the air (combined with CO2 flux and concentration measurements) to partition NEE into FR and FA on a routine basis. The study is conducted at a temperate coniferous forest where intensive isotopic measurements in air, soil, and biomass were performed in summer 1997. The multilayer soil-vegetation-atmosphere transfer model MuSICA is adapted to compute 13CO2 flux and concentration profiles. Using MuSICA as a "perfect" simulator and taking advantage of the very dense spatiotemporal resolution of the isotopic data set (341 flasks over a 24-hour period) enable us to test each hypothesis and estimate the performance of the method. The partitioning works better in midafternoon when isotopic disequilibrium is strong. With only 15 flasks, i.e., two 13CO2 nighttime profiles (to estimate the isotopic signature of FR) and five daytime measurements (to perform the partitioning) we get mean daily estimates of FR and FA that agree with the model within 15-20%. However, knowledge of the mesophyll conductance seems crucial and may be a limitation to the method.

  11. Cost-Benefit of the energy saving in the bioclimatic designs; Costo-Beneficio del ahorro de energia en los disenos bioclimaticos

    Energy Technology Data Exchange (ETDEWEB)

    Lopez P, J. Manuel A. [Doble Dos Soluciones de Negocios, S.A. de C.V., Mexico, D.F. (Mexico); Morillon G, David; Rodriguez V, Luis [Instituto de Ingenieria de la UNAM, Mexico, D.F. (Mexico)

    1999-07-01

    Tools and criteria for the Cost-Benefit analysis from the energy saving in bioclimatic designs (BD) are presented, for which, a reference project is established and the costs and benefits of energy saving in BD with base in that project are evaluated. A case study is presented taking as reference the traditional design of the air conditioning of a building and with this base the estimation of cost-benefit of the same building is made, but with passive systems. The tools used are those that allow to consider related resources such as time and money; in that sense, are used criteria such as: Present value (PV), Equivalent Annual Cost (EAC) and the Cost of the Conserved Energy (CCE). The costs related to the construction, maintenance and operation of the design are taken into account. The differences between the reference design and the BD, established from the application of these criteria, allow to evaluate the economic margin of the BD as far as operation and maintenance is concerned. Finally the CCE of the bioclimatic measures is evaluated as an initiative of energy saving and the present value is calculated of the energy saving in the entire useful life of a bioclimatic design. [Spanish] Se presentan herramientas y criterios para el analisis Costo-Beneficio del ahorro de energia en disenos bioclimaticos (DB), para lo cual, se establece un proyecto de referencia y se evaluan los costos y beneficios del ahorro de energia en DB con base en ese proyecto. Se presenta el estudio de un caso tomando como referencia el dise tradicional de la climatizacion de un edificio y con base en este, se realiza la estimacion de costos y beneficios del mismo edificio, pero con sistemas pasivos. Las herramientas usadas, son aquellas que permiten considerar recursos relacionados como son tiempo y dinero; en ese sentido, se usan criterios como: Valor Presente (VP), Costo Anual Equivalente (CAE) y el Costo de la Energia Conservada (CEC). Se toman en consideracion los costos relacionados

  12. Adding a dietitian to a Danish Liaison-team after discharge of geriatric patients at nutritional risk may save health care costs

    DEFF Research Database (Denmark)

    Pohju, Anne; Belqaid, Kerstin; Brandt, Christopher Flintenborg

    2016-01-01

    Background: A previous study investigated the value of adding a dietitian to a geriatric discharge Liaison-Team. The scope of this study was to explore the possible economic savings of this. Methods: Patients, 70+ and at nutritional risk, were randomized to receive discharge Liaison-Team either......,416 compared to €1,150 (ONS only) in the CG. For hospitalizations, estimated cost was €92,020 in the IG and €220,025 in the CG. Cost savings added up to €3,048 per patient in the IG. Conclusion: Adding a dietitian to a Danish geriatric discharge Liaison-Team decreased health care costs......: Of the 71 included patients, 34 were in the IG, 30 patients received all three dietitian visits. Cumulated number of hospitalization days was 172 in the IG and 415 in the CG. Use of ONS was 48 % in the IG and 17% in the CG (P=0.001). Estimated cost for the dietitian and ONS combined in the IG was €9...

  13. Cost effectiveness and resource allocation of Plasmodium falciparum malaria control in Myanmar: a modelling analysis of bed nets and community health workers.

    Science.gov (United States)

    Drake, Tom L; Kyaw, Shwe Sin; Kyaw, Myat Phone; Smithuis, Frank M; Day, Nicholas P J; White, Lisa J; Lubell, Yoel

    2015-09-29

    Funding for malaria control and elimination in Myanmar has increased markedly in recent years. While there are various malaria control tools currently available, two interventions receive the majority of malaria control funding in Myanmar: (1) insecticide-treated bed nets and (2) early diagnosis and treatment through malaria community health workers. This study aims to provide practical recommendations on how to maximize impact from investment in these interventions. A simple decision tree is used to model intervention costs and effects in terms of years of life lost. The evaluation is from the perspective of the service provider and costs and effects are calculated in line with standard methodology. Sensitivity and scenario analysis are undertaken to identify key drivers of cost effectiveness. Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model. Community health workers have the potential for high impact on malaria, particularly where there are few alternatives to access malaria treatment, but are relatively costly. Insecticide-treated bed nets are comparatively inexpensive and modestly effective in Myanmar, representing a low risk but modest return intervention. Unlike some healthcare interventions, bed nets and community health workers are not mutually exclusive nor are they necessarily at their most efficient when universally applied. Modelled resource allocation scenarios highlight that in this case there is no "one size fits all" cost effectiveness result. Health gains will be maximized by effective targeting of both interventions.

  14. Effects of pyrethroid resistance on the cost effectiveness of a mass distribution of long-lasting insecticidal nets: a modelling study.

    Science.gov (United States)

    Briët, Olivier J T; Penny, Melissa A; Hardy, Diggory; Awolola, Taiwo S; Van Bortel, Wim; Corbel, Vincent; Dabiré, Roch K; Etang, Josiane; Koudou, Benjamin G; Tungu, Patrick K; Chitnis, Nakul

    2013-02-25

    The effectiveness of insecticide-treated nets in preventing malaria is threatened by developing resistance against pyrethroids. Little is known about how strongly this affects the effectiveness of vector control programmes. Data from experimental hut studies on the effects of long-lasting, insecticidal nets (LLINs) on nine anopheline mosquito populations, with varying levels of mortality in World Health Organization susceptibility tests, were used to parameterize malaria models. Both simple static models predicting population-level insecticidal effectiveness and protection against blood feeding, and complex dynamic epidemiological models, where LLINs decayed over time, were used. The epidemiological models, implemented in OpenMalaria, were employed to study the impact of a single mass distribution of LLINs on malaria, both in terms of episodes prevented during the effective lifetime of the batch of LLINs, and in terms of net health benefits (NHB) expressed in disability-adjusted life years (DALYs) averted during that period, depending on net type (standard pyrethroid-only LLIN or pyrethroid-piperonyl butoxide combination LLIN), resistance status, coverage and pre-intervention transmission level. There were strong positive correlations between insecticide susceptibility status and predicted population level insecticidal effectiveness of and protection against blood feeding by LLIN intervention programmes. With the most resistant mosquito population, the LLIN mass distribution averted up to about 40% fewer episodes and DALYs during the effective lifetime of the batch than with fully susceptible populations. However, cost effectiveness of LLINs was more sensitive to the pre-intervention transmission level and coverage than to susceptibility status. For four out of the six Anopheles gambiae sensu lato populations where direct comparisons between standard LLINs and combination LLINs were possible, combination nets were more cost effective, despite being more expensive

  15. Cost-effective sampling of ¹³⁷Cs-derived net soil redistribution: part 1--estimating the spatial mean across scales of variation.

    Science.gov (United States)

    Li, Y; Chappell, A; Nyamdavaa, B; Yu, H; Davaasuren, D; Zoljargal, K

    2015-03-01

    The (137)Cs technique for estimating net time-integrated soil redistribution is valuable for understanding the factors controlling soil redistribution by all processes. The literature on this technique is dominated by studies of individual fields and describes its typically time-consuming nature. We contend that the community making these studies has inappropriately assumed that many (137)Cs measurements are required and hence estimates of net soil redistribution can only be made at the field scale. Here, we support future studies of (137)Cs-derived net soil redistribution to apply their often limited resources across scales of variation (field, catchment, region etc.) without compromising the quality of the estimates at any scale. We describe a hybrid, design-based and model-based, stratified random sampling design with composites to estimate the sampling variance and a cost model for fieldwork and laboratory measurements. Geostatistical mapping of net (1954-2012) soil redistribution as a case study on the Chinese Loess Plateau is compared with estimates for several other sampling designs popular in the literature. We demonstrate the cost-effectiveness of the hybrid design for spatial estimation of net soil redistribution. To demonstrate the limitations of current sampling approaches to cut across scales of variation, we extrapolate our estimate of net soil redistribution across the region, show that for the same resources, estimates from many fields could have been provided and would elucidate the cause of differences within and between regional estimates. We recommend that future studies evaluate carefully the sampling design to consider the opportunity to investigate (137)Cs-derived net soil redistribution across scales of variation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care.

    LENUS (Irish Health Repository)

    Costelloe, L

    2012-02-01

    BACKGROUND: Despite understaffing of neurology services in Ireland, the demand for liaison neurologist input into the care of hospital inpatients is increasing. This aspect of the workload of the neurologist is often under recognised. AIMS\\/METHODS: We prospectively recorded data on referral and service delivery patterns to a liaison neurology service, the neurological conditions encountered, and the impact of neurology input on patient care. RESULTS: Over a 13-month period, 669 consults were audited. Of these, 79% of patients were seen within 48 h and 86% of patients were assessed by a consultant neurologist before discharge. Management was changed in 69% cases, and discharge from hospital expedited in 50%. If adequate resources for neurological assessment had been available, 28% could have been seen as outpatients, with projected savings of 857 bed days. CONCLUSIONS: Investment in neurology services would facilitate early accurate diagnosis, efficient patient and bed management, with substantial savings.

  17. Estimating Damage Cost of Net Primary Production due to Climate Change and Ozone(O3) Effect

    Science.gov (United States)

    Park, J. H.; Lee, D. K.; Park, C.; Sung, S.; Kim, H. G.; Mo, Y.; Kim, S.; Kil, S.

    2016-12-01

    productivity, net primary productivity (NPP), in Korea is about 622 gC/m2/yr in the results. And the result shows that NPP decreases about 2.3% by O3 negative effect. The NPP in the future also decreases about 1-2% and the negative effect of O3 is similar. Finally, damage cost by O3 in the future is bigger than damage by climate change.

  18. Energy Efficiency Improvement and Cost Saving Opportunities for Cement Making An ENERGY STAR® Guide for Energy and Plant Managers

    NARCIS (Netherlands)

    Worrell, E.|info:eu-repo/dai/nl/106856715; Kermeli, Katerina|info:eu-repo/dai/nl/411260553; Galitsky, Christina

    The cost of energy as part of the total production costs in the cement industry is significant, typically at 20 to 40% of operational costs, warranting attention for energy efficiency to improve the bottom line. Historically, energy intensity has declined, although more recently energy intensity

  19. Risk transfer via energy savings insurance

    Energy Technology Data Exchange (ETDEWEB)

    Mills, Evan

    2001-10-01

    Among the key barriers to investment in energy efficiency improvements are uncertainties about attaining projected energy savings and apprehension about potential disputes over these savings. The fields of energy management and risk management are thus intertwined. While many technical methods have emerged to manage performance risks (e.g. building commissioning), financial risk transfer techniques are less developed in the energy management arena than in other more mature segments of the economy. Energy Savings Insurance (ESI) - formal insurance of predicted energy savings - is one method of transferring financial risks away from the facility owner or energy services contractor. ESI offers a number of significant advantages over other forms of financial risk transfer, e.g. savings guarantees or performance bonds. ESI providers manage risk via pre-construction design review as well as post-construction commissioning and measurement and verification of savings. We found that the two mos t common criticisms of ESI - excessive pricing and onerous exclusions - are not born out in practice. In fact, if properly applied, ESI can potentially reduce the net cost of energy savings projects by reducing the interest rates charged by lenders, and by increasing the level of savings through quality control. Debt service can also be ensured by matching loan payments to projected energy savings while designing the insurance mechanism so that payments are made by the insurer in the event of a savings shortfall. We estimate the U.S. ESI market potential of $875 million/year in premium income. From an energy-policy perspective, ESI offers a number of potential benefits: ESI transfers performance risk from the balance sheet of the entity implementing the energy savings project, thereby freeing up capital otherwise needed to ''self-insure'' the savings. ESI reduces barriers to market entry of smaller energy services firms who do not have sufficiently strong balance

  20. Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis

    Directory of Open Access Journals (Sweden)

    Okumura LM

    2016-09-01

    Full Text Available Background: Computerized Provider Order Entry (CPOE and Clinical Decision Support System (CDSS help practitioners to choose evidence-based decisions, regarding patients’ needs. Despite its use in developed countries, in Brazil, the impact of a CPOE/CDSS to improve cefazolin use in surgical prophylaxis was not assessed yet. Objective: We aimed to evaluate the impact of a CDSS to improve the use of prophylactic cefazolin and to assess the cost savings associated to inappropriate prescribing. Methods: This is a cross-sectional study that compared two different scenarios: one prior CPOE/CDSS versus after software implementation. We conducted twelve years of data analysis (3 years prior and 9 years after CDSS implementation, where main outcomes from this study included: cefazolin Defined Daily Doses/100 bed-days (DDD, crude costs and product of costs-DDD (cost-DDD/100 bed-days. We applied a Spearman rho non-parametric test to assess the reduction of cefazolin consumption through the years. Results: In twelve years, 84,383 vials of cefazolin were dispensed and represented 38.89 DDD/100 bed-days or USD 44,722.99. Surgical wards were the largest drug prescribers and comprised >95% of our studied sample. While in 2002, there were 6.31 DDD/100 bed-days, 9 years later there was a reduction to 2.15 (p<0.05. In a scenario without CDSS, the hospital would have consumed 75.72 DDD/100 bed-days, which is equivalent to USD 116 998.07. It is estimated that CDSS provided USD 50,433.39 of cost savings. Conclusion: The implementation of a CPOE/CDSS helped to improve prophylactic cefazolin use by reducing its consumption and estimated direct costs.

  1. Energy, Pollutant Emissions and Other Negative Externality Savings from Curbing Individual Motorized Transportation (IMT: A Low Cost, Low Technology Scenario Analysis in Brazilian Urban Areas

    Directory of Open Access Journals (Sweden)

    Ursula Maruyama

    2012-03-01

    Full Text Available This article examines the inefficient use of resources in the Brazilian transportation system. The energy use growth and external cost generation in this essential economic sector are considerable, and the trend is towards an increasing problem in the coming years. The continued expansion of Brazilian cities and the increase in demand for mobility is a result of a substantial growth in the number of road transport users, as increased earnings enable lower income groups to acquire and use individual motorized means of transport. The aim of this paper is to estimate the potential gains from reducing individual motorized transport by the year 2020. This investigation concludes that in a conservationist scenario, by prioritizing low cost, low technology public policies—which include operation of Bus Rapid Transit systems, walking and cycling facilities and congestion charges, among others—it should be possible to save over USD 30 billion and USD 26 billion in external transportation and infrastructure costs, respectively, up to 2020. In addition, these public policies can save more than 35 million Tons of Oil Equivalents in energy consumption and avoid almost 4,000 thousand tons of local pollution emissions and 37,500 thousand tons of GHG emissions in the same period.

  2. Modelling the cost of community interventions to reduce child mortality in South Africa using the Lives Saved Tool (LiST).

    Science.gov (United States)

    Nkonki, Lungiswa Ll; Chola, Lumbwe L; Tugendhaft, Aviva A; Hofman, Karen K

    2017-08-28

    To estimate the costs and impact on reducing child mortality of scaling up interventions that can be delivered by community health workers at community level from a provider's perspective. In this study, we used the Lives Saved Tool (LiST), a module in the spectrum software. Within the spectrum software, LiST interacts with other modules, the AIDS Impact Module, Family Planning Module and Demography Projections Module (Dem Proj), to model the impact of more than 60 interventions that affect cause-specific mortality. DemProj Based on National South African Data. A total of nine interventions namely, breastfeeding promotion, complementary feeding, vitamin supplementation, hand washing with soap, hygienic disposal of children's stools, oral rehydration solution, oral antibiotics for the treatment of pneumonia, therapeutic feeding for wasting and treatment for moderate malnutrition. Reducing child mortality. A total of 9 interventions can prevent 8891 deaths by 2030. Hand washing with soap (21%) accounts for the highest number of deaths prevented, followed by therapeutic feeding (19%) and oral rehydration therapy (16%). The top 5 interventions account for 77% of all deaths prevented. At scale, an estimated cost of US$169.5 million (US$3 per capita) per year will be required in community health worker costs. The use of community health workers offers enormous opportunities for saving lives. These programmes require appropriate financial investments. Findings from this study show what can be achieved if concerted effort is channelled towards the identified set of life-saving interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. 48 CFR 970.5215-4 - Cost reduction.

    Science.gov (United States)

    2010-10-01

    ... develop and submit Cost Reduction Proposals (CRPs) to the Contracting Officer. If accepted, the Contractor may share in any shared net savings from accepted CRPs in accordance with paragraph (g) of this clause. (b) Definitions. Administrative cost is the Contractor cost of developing and administering the CRP...

  4. The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Walter Obiero

    Full Text Available Male circumcision (MC reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC method. The PrePex male circumcision (PMC method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method.Data were obtained from the Nyanza Reproductive Health Society (NRHS, an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars.Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively.The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.

  5. Medical cost savings for participants and nonparticipants in health risk assessments, lifestyle management, disease management, depression management, and nurseline in a large financial services corporation.

    Science.gov (United States)

    Serxner, Seth; Alberti, Angela; Weinberger, Sarah

    2012-01-01

    To compare changes in medical costs between participants and nonparticipants in five different health and productivity management (HPM) programs. Quasi-experimental pre/post intervention study. A large financial services corporation. A cohort population of employees enrolled in medical plans (n  =  49,723) [corrected]. A comprehensive HPM program, which addressed health risks, acute and chronic conditions, and psychosocial disorders from 2005 to 2007. Incentives were used to encourage health risk assessment participation in years 2 and 3. Program participation and medical claims data were collected for members at the end of each program year to assess the change in total costs from the baseline period. Analysis . Multivariate analyses for participation categories were conducted comparing baseline versus program year cost differences, controlling for demographics. All participation categories yielded a lower cost increase compared to nonparticipation and a positive return on investment (ROI) for years 2 and 3, resulting in a 2.45∶1 ROI for the combined program years. Medical cost savings exceeded program costs in a wide variety of health and productivity management programs by the second year.

  6. Energy Efficiency Improvement and Cost Saving Opportunities for the U.S. Iron and Steel Industry An ENERGY STAR(R) Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Blinde, Paul; Neelis, Maarten; Blomen, Eliane; Masanet, Eric

    2010-10-21

    Energy is an important cost factor in the U.S iron and steel industry. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants in the U.S. iron and steel industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy-efficient technologies that can be implemented at the component, process, facility, and organizational levels. A discussion of the structure, production trends, energy consumption, and greenhouse gas emissions of the iron and steel industry is provided along with a description of the major process technologies used within the industry. Next, a wide variety of energy efficiency measures are described. Many measure descriptions include expected savings in energy and energy-related costs, based on case study data from real-world applications in the steel and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. The information in this Energy Guide is intended to help energy and plant managers in the U.S. iron and steel industry reduce energy consumption and greenhouse gas emissions in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of all measures?and on their applicability to different production practices?is needed to assess their cost effectiveness at individual plants.

  7. Analysis of Base Services Structure and Development of Cost-Saving Strategies to Counterattack Decreasing Funding Levels

    Science.gov (United States)

    2005-12-01

    social , ethnic , religious, age, etc.), and the individual mix of interests and economic objectives can never be exactly the same between two...41 1. Cost Benefit Analysis .........................................................................41 2. Social Cost Benefit...us salivating for more. This quality cuisine was second only to Kathy’s always phenomenal culinary masterpieces. Thank you, cutie! xviii

  8. Network unites payers, physicians, hospitals. System participants work together to improve access to care and to design cost-saving incentives.

    Science.gov (United States)

    Cassidy, J

    1993-05-01

    Through Sacred Heart Health System (SHHS), Eugene, OR, physicians, payers, and hospitals are designing a network that will integrate care and improve access by reducing healthcare costs. Together, system members design cost-saving incentives and the products the system offers the community. They promote managed care as the most efficient means to coordinate care and reduce costs. All participants share in the risks of a capitated payment system. Since the system pulled together the payers, physician groups, and hospitals, many of these entities' management functions were consolidated at the system level to avoid duplication and reduce administrative costs. Bringing in physicians was the most difficult yet important aspect of forming a successful network. Working with two physician groups in the community, the system's sponsor-the Sisters of St. Joseph of Peace, Health and Hospital Services-developed the Physician Practice Board. The board, representing 300 physicians, meets weekly and makes recommendations on issues that affect physicians. SHHS also added innovative new functions such as an integrated medical cost management and continuous quality improvement program. Another key to success is a clinically oriented information system, which will allow the system to track patients once they leave the hospital. It also will provide a better understanding of what things have an impact on outcomes and will reduce paperwork. A portion of the system's revenue is designated for initiatives to improve access. And the system recently appointed a tack force on access to explore what they can do in cooperation with others in the community.

  9. Energy Efficiency Improvement and Cost Saving Opportunities for the Baking Industry: An ENERGY STAR® Guide for Plant and Energy Managers

    Energy Technology Data Exchange (ETDEWEB)

    Masanet, Eric [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Therkelsen, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Worrell, Ernst [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2012-12-28

    The U.S. baking industry—defined in this Energy Guide as facilities engaged in the manufacture of commercial bakery products such as breads, rolls, frozen cakes, pies, pastries, and cookies and crackers—consumes over $800 million worth of purchased fuels and electricity per year. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy-efficient technologies that can be implemented at the component, process, facility, and organizational levels. Many measure descriptions include expected savings in energy and energy-related costs, based on case study data from real-world applications in food processing facilities and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. A summary of basic, proven measures for improving plant-level water efficiency is also provided. The information in this Energy Guide is intended to help energy and plant managers in the U.S. baking industry reduce energy and water consumption in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of all measures—as well as on their applicability to different production practices—is needed to assess their cost effectiveness at individual plants.

  10. Energy Saving Potential, Costs and Uncertainties in the Industry: A Case Study of the Chemical Industry in Germany

    DEFF Research Database (Denmark)

    Bühler, Fabian; Guminski, Andrej; Gruber, Anna

    2017-01-01

    ), which rank these measures according to specific implementation costs. Existing analyses, however, often do not take uncertainties in costs and potentials into account. The aim of this paper is to create a MCC of energy efficiency measures for the chemical industry in Germany, while quantifying...... to 1990. To achieve this ambitious goal, energy planners and industries alike require an overview of the existing energy efficiency measures, their technical potential as well as the costs for realizing this potential. Energy efficiency opportunities are commonly presented in marginal cost curves (MCCs......In Germany, 19.6 % of the industrial final energy consumption (FEC) can be allocated to the chemical industry. Energy efficiency measures with focus on the chemical industry could thus significantly contribute to reaching the German goal of reducing greenhouse gas emissions by 80 % in 2050 compared...

  11. New environment-friendly and cost-saving fertiliser recommendation system for supporting sustainable agriculture in Hungary and beyond

    Directory of Open Access Journals (Sweden)

    Nándor FODOR

    2011-07-01

    Full Text Available In the current economic situation the former, intensive fertiliser recommendation system is unfit to help Hungarian farmers in their fertilising practice. The aim of the new system has been to apply the lowest possible NPK rates required to achieve safe and high yields as well as allowing minimal agricultural NP losses to surface and subsurface waters. The new system was developed by using the correlations revealed by analyzing the results of long-term fertilisation experiments set up in Hungary between 1960 and 2000. Several field experiments as well as comparative analyses confirmed the correctness of the basic principles as well as of the methods of calculating fertiliser rates of the new system. An estimated amount of 3,200,000 € was saved for the Hungarian farmers in 2007 alone by giving recommendations for more than 160,000 ha arable land applying the new system.

  12. Guide to protect climate. Saving energy and cost, protecting climate; Der Klima-Knigge. Energie sparen, Kosten senken, Klima schuetzen

    Energy Technology Data Exchange (ETDEWEB)

    Griesshammer, Rainer

    2008-07-01

    As a climate protector you mustn't seat in the darkness. The author shows by much humour and esprit how simple it is to save energy. Who is willing to persue his every day tips, must not miss comfort and lowers even carbon dioxide emission. This is good for the environment and fills up the own purse. (orig./GL) [German] Als Klimaschuetzer braucht man nicht im Dunkeln zu sitzen. Mit viel Humor und Esprit zeigt Griesshammer, wie einfach Energie sparen sein kann. Wer seine Alltagstipps befolgt, muss auf keinen Komfort verzichten und mindert trotzdem den CO2-Ausstoss. Das nutzt der Umwelt und fuellt den eigenen Geldbeutel auf. (orig./GL)

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

    Science.gov (United States)

    Drake, Tom; Chalabi, Zaid; Coker, Richard

    2015-02-01

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

  14. Household Savings

    DEFF Research Database (Denmark)

    Browning, Martin; Lusardi, Annamaria

    In this survey, we review the recent theoretical and empirical literature on household saving and consumption. The discussion is structured around a list of motives for saving and how well the standard theory captures these motives. We show that almost all of the motives for saving that have been...... of standard optimization techniques and focuses instead on direct consideration on saving. We provide a section on facts: who save and how much. We then discuss informally the recent decline in the U.S. saving rate and whether the theory is of much use in understanding this and other changes in aggregate...... be rationalized within a simple life cycle model. We also review a great number of studies of the consumption Euler equations. Based on our analysis of the studies cited we conclude that there is still mixed evidence that consumption is excessively sensitive to income. We also examine in depth the recent...

  15. Potential cost savings in waste incineration in grate furnaces; Kosteneinsparpotentiale bei der Verbrennung von Abfaellen in Rostfeuerungsanlagen

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, C.; Beckmann, R. [Fraunhofer Inst. fuer Umwelt-, Sicherheits- und Energietechnik UMSICHT, Oberhausen (Germany). Abt. Abfall- und Kreislaufwirtschaft

    1998-09-01

    Shortage of public puts increased cost pressure on thermal treatment of waste. The specific operating cost of current projects is around 200 DM/t. The contribution outlines parameters that can help to reduce the operating and investment cost. This includes economic as well as technical parameters that directly influence plant operation. The analyses were carried out using the UMSICHT-owned calculation program GLOBUS which permits the conservative determination of the cost-determining plant cost as a function of sensitive influencing parameters. (orig./SR) [Deutsch] Nicht zuletzt aufgrund leerer oeffentlicher Kassen hat in den letzten Jahren ein Umdenken stattgefunden, das durch die Forderung nach umweltvertraeglichen Entsorgungsverfahren bei gleichzeitig moderaten Abfallgebuehren gepraegt ist. Somit hat fuer die thermische Abfallbehandlung der Kostendruck stark zugenommen. Fuer aktuelle Projekte werden spezifische Betriebskosten von etwa 200 DM/t erreicht. Der vorliegende Beitrag zeigt kostenwirksame Einflussgroessen auf, durch die eine Reduzierung der Betriebs- und Investitionskosten ermoeglicht wird. Dazu gehoeren sowohl abfallwirtschaftlicher Parameter als auch technische Groessen, die einen direkten Einfluss auf den Betrieb der Anlage besitzen. Die Analysen wurden mit dem UMSICHT-eigenen Kalkulationsprogramm GLOBUS durchgefuehrt, das die belastbare Ermittlung der fuer die Kostenseite bestimmenden Apparatekosten in Abhaengigkeit sensitiver Einflussgroessen erlaubt. (orig./SR)

  16. Simplification and Saving

    Science.gov (United States)

    Beshears, John; Choi, James J.; Laibson, David; Madrian, Brigitte C.

    2012-01-01

    The daunting complexity of important financial decisions can lead to procrastination. We evaluate a low-cost intervention that substantially simplifies the retirement savings plan participation decision. Individuals received an opportunity to enroll in a retirement savings plan at a pre-selected contribution rate and asset allocation, allowing them to collapse a multidimensional problem into a binary choice between the status quo and the pre-selected alternative. The intervention increases plan enrollment rates by 10 to 20 percentage points. We find that a similar intervention can be used to increase contribution rates among employees who are already participating in a savings plan. PMID:24443619

  17. Extract BIG savings from physician preference items. Use a data-driven, team-based approach to drive down costs.

    Science.gov (United States)

    Tyson, Patricia

    2010-05-01

    As baby boomers reach retirement age, the demand for cardiac, spine and orthopedic implants is expected to escalate rapidly. Containing spending on these physician preference items (PPI) will be crucial for hospitals, which are facing reduced revenue streams due to bundled payments and other factors. Materials managers will play a lead role in devising cost-reduction strategies. They'll need to establish benchmarking data to share with physicians to build consensus on how to best cut PPI costs without sacrificing the quality of care. Follow these steps to get started.

  18. Feature Selection as a Time and Cost-Saving Approach for Land Suitability Classification (Case Study of Shavur Plain, Iran)

    NARCIS (Netherlands)

    Hamzeh, Saeid; Mokarram, Marzieh; Haratian, Azadeh; Bartholomeus, Harm; Ligtenberg, Arend; Bregt, Arnold

    2016-01-01

    Land suitability classification is important in planning and managing sustainable land use. Most approaches to land suitability analysis combine a large number of land and soil parameters, and are time-consuming and costly. In this study, a potentially useful technique (combined feature selection

  19. Energy Efficiency Improvement and Cost Saving Opportunities for the Petrochemical Industry - An ENERGY STAR(R) Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Neelis, Maarten; Worrell, Ernst; Masanet, Eric

    2008-09-01

    Energy is the most important cost factor in the U.S petrochemical industry, defined in this guide as the chemical industry sectors producing large volume basic and intermediate organic chemicals as well as large volume plastics. The sector spent about $10 billion on fuels and electricity in 2004. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants in the U.S. petrochemical industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy efficient technologies that can be implemented at the component, process, facility, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the petrochemical industry is provided along with a description of the major process technologies used within the industry. Next, a wide variety of energy efficiency measures are described. Many measure descriptions include expected savings in energy and energy-related costs, based on case study data from real-world applications in the petrochemical and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. The information in this Energy Guide is intended to help energy and plant managers in the U.S. petrochemical industry reduce energy consumption in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of all measures--and on their applicability to different production practices--is needed to assess their cost effectiveness at individual plants.

  20. The payout behaviour of German savings banks

    OpenAIRE

    Köhler, Matthias

    2016-01-01

    Our analysis finds that despite the growing number, the majority of savings banks currently do not make any payouts. Furthermore, savings banks distribute only a small part of their net profit to the shareholders. This means that they can still build up capital even if they make payouts. Savings banks also hold significantly more capital than is called for by the regulatory framework. Finally, the regression analysis shows that savings banks that have less capital distribute profits to their ...

  1. Energy saving report; Energispareredegoerelse

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-05-01

    Making the energy consumption more efficient in Denmark by means of energy saving are connected to the Danish government's overall National Growth Strategy. A reduced consumption of energy as a result of economic attractive energy saving initiatives leads to reduced energy costs and consequently an improvement of Denmark's competitive power. Furthermore, reducing the energy consumption decreases the vulnerability towards rising energy prices, and the security of supplies is increased. Finally energy conservation serves as a means of reducing environmental impact from the energy sector. Energy consumption is not damaging to the environment in itself, however, to the extent that energy consumption causes negative impact on the environment, e.g. through discharge of environmentally damaging substances generated during energy production, a reduction of the energy consumption will benefit the environment. Energy saving in itself does not lead to a decrease in CO{sub 2} emission in Denmark unless it is accompanied by an adjustment of CO{sub 2} quotas on production of electricity. The Danish Government emphasizes that the energy saving efforts are cost-effective both for the society and for the consumers. The energy saving report contains an updated projection of the Danish energy consumption and an evaluation of the impacts of the energy saving efforts. The impacts of more effective end use of energy are described, and an account of the barriers preventing the realization of a number of potential economic attractive energy saving initiatives is made. Finally the energy saving report presents a number of proposals for new energy saving initiatives. (BA)

  2. Net-Immobilization of β-glucosidase on Nonwoven Fabrics to Lower the Cost of "Cellulosic Ethanol" and Increase Cellulose Conversions.

    Science.gov (United States)

    Zhu, Xing; He, Bin; Zhao, Changwen; Fan, Rong; Zhang, Lihua; Wang, Guan; Ma, Yuhong; Yang, Wantai

    2016-03-24

    The main limitation preventing the use of enzymatic cellulosic ethanol in industrial production is its higher cost which is mainly due to the elevated price of β-glucosidase (BG). Herein, we report on a simple strategy for the in-situ encapsulation of BG for repeated cellulosic ethanol production. In this strategy, BG was net-immobilized into a poly(ethylene glycol) (PEG) net-cloth layer on a PP nonwoven fabric by way of the visible light-induced surface controlled/living graft cross-linking polymerization. The visible light and mild reaction conditions could ensure the activity retention of BG during immobilization, while the non-swelling uniform net-mesh formed by living cross-linking polymerization could prevent the leakage of BG effectively (at the immobilization rate of more than 98.6% and the leakage rate of only 0.4%). When the BG-loaded fabric was used in combination with free cellulase (CEL), the results of the catalytic reaction demonstrated that these BG-loaded fabrics could not only give a 40% increase in cellulose conversions but also be reused for more than fifteen batches without losing the activity. These BG-loaded fabrics with characteristics including easy separation, excellent operation stability, a low cost of the polymeric matrix and a simple fabrication process are particularly interesting for a future bio-fuel production strategy.

  3. Net-Immobilization of β-glucosidase on Nonwoven Fabrics to Lower the Cost of “Cellulosic Ethanol” and Increase Cellulose Conversions

    Science.gov (United States)

    Zhu, Xing; He, Bin; Zhao, Changwen; Fan, Rong; Zhang, Lihua; Wang, Guan; Ma, Yuhong; Yang, Wantai

    2016-03-01

    The main limitation preventing the use of enzymatic cellulosic ethanol in industrial production is its higher cost which is mainly due to the elevated price of β-glucosidase (BG). Herein, we report on a simple strategy for the in-situ encapsulation of BG for repeated cellulosic ethanol production. In this strategy, BG was net-immobilized into a poly(ethylene glycol) (PEG) net-cloth layer on a PP nonwoven fabric by way of the visible light-induced surface controlled/living graft cross-linking polymerization. The visible light and mild reaction conditions could ensure the activity retention of BG during immobilization, while the non-swelling uniform net-mesh formed by living cross-linking polymerization could prevent the leakage of BG effectively (at the immobilization rate of more than 98.6% and the leakage rate of only 0.4%). When the BG-loaded fabric was used in combination with free cellulase (CEL), the results of the catalytic reaction demonstrated that these BG-loaded fabrics could not only give a 40% increase in cellulose conversions but also be reused for more than fifteen batches without losing the activity. These BG-loaded fabrics with characteristics including easy separation, excellent operation stability, a low cost of the polymeric matrix and a simple fabrication process are particularly interesting for a future bio-fuel production strategy.

  4. A cost- and time-saving strategy of spraying TiO2 self-cleaning coatings in tubular substrates by air cold plasma

    Science.gov (United States)

    Zhang, Lujie; Yu, Shuang; Wang, Kaile; Zhang, Jue; Fang, Jing

    2017-11-01

    In this study, using an atmospheric pressure air plasma jet generated by a dielectric barrier structure with hollow electrodes (HEDBS), we developed an ultrafast process for spraying TiO2 self-cleaning films inside tubular substrates. Importantly, SEM images showed that the TiO2 particles were dispersed evenly in the tubular substrates. Furthermore, Raman and XRD pattern indicated the anatase structure of the HEDBS-spayed TiO2 coating after heating at 270 °C. Further results of the self cleaning test suggested that the proposed cost- and time-saving HEDBS approach with air working gas could provide a feasible way for synthesizing thin TiO2 nanofilms.

  5. Energy efficiency improvement and cost saving opportunities for the Corn Wet Milling Industry: An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Worrell, Ernst; Ruth, Michael

    2003-07-01

    Corn wet milling is the most energy intensive industry within the food and kindred products group (SIC 20), using 15 percent of the energy in the entire food industry. After corn, energy is the second largest operating cost for corn wet millers in the United States. A typical corn wet milling plant in the United States spends approximately $20 to $30 million per year on energy, making energy efficiency improvement an important way to reduce costs and increase predictable earnings, especially in times of high energy-price volatility. This report shows energy efficiency opportunities available for wet corn millers. It begins with descriptions of the trends, structure and production of the corn wet milling industry and the energy used in the milling and refining process. Specific primary energy savings for each energy efficiency measure based on case studies of plants and references to technical literature are provided. If available, typical payback periods are also listed. The report draws upon the experiences of corn, wheat and other starch processing plants worldwide for energy efficiency measures. The findings suggest that given available resources and technology, there are opportunities to reduce energy consumption cost-effectively in the corn wet milling industry while maintaining the quality of the products manufactured. Further research on the economics of the measures, as well as the applicability of these to different wet milling practices, is needed to assess the feasibility of implementation of selected technologies at individual plants.

  6. Energy Efficiency Improvement and Cost Saving Opportunities for the Vehicle Assembly Industry: An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Galitsky, Christina; Galitsky, Christina; Worrell, Ernst

    2008-01-01

    The motor vehicle industry in the U.S. spends about $3.6 billion on energy annually. In this report, we focus on auto assembly plants. In the U.S., over 70 assembly plants currently produce 13 million cars and trucks each year. In assembly plants, energy expenditures is a relatively small cost factor in the total production process. Still, as manufacturers face an increasingly competitive environment, energy efficiency improvements can provide a means to reduce costs without negatively affecting the yield or the quality of the product. In addition, reducing energy costs reduces the unpredictability associated with variable energy prices in today?s marketplace, which could negatively affect predictable earnings, an important element for publicly-traded companies such as those in the motor vehicle industry. In this report, we first present a summary of the motor vehicle assembly process and energy use. This is followed by a discussion of energy efficiency opportunities available for assembly plants. Where available, we provide specific primary energy savings for each energy efficiency measure based on case studies, as well as references to technical literature. If available, we have listed costs and typical payback periods. We include experiences of assembly plants worldwide with energy efficiency measures reviewed in the report. Our findings suggest that although most motor vehicle companies in the U.S. have energy management teams or programs, there are still opportunities available at individual plants to reduce energy consumption cost effectively. Further research on the economics of the measures for individual assembly plants, as part of an energy management program, is needed to assess the potential impact of selected technologies at these plants.

  7. Energy Efficiency Improvement and Cost Saving Opportunities for the Dairy Processing Industry: An ENERGY STAR? Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Brush, Adrian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Masanet, Eric [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Worrell, Ernst [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2011-10-01

    The U.S. dairy processing industry—defined in this Energy Guide as facilities engaged in the conversion of raw milk to consumable dairy products—consumes around $1.5 billion worth of purchased fuels and electricity per year. Energy efficiency improvement is an important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants in the U.S. dairy processing industry to reduce energy consumption and greenhouse gas emissions in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy-efficient technologies that can be implemented at the component, process, facility, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the U.S. dairy processing industry is provided along with a description of the major process technologies used within the industry. Next, a wide variety of energy efficiency measures applicable to dairy processing plants are described. Many measure descriptions include expected savings in energy and energy-related costs, based on case study data from real-world applications in dairy processing facilities and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. Given the importance of water in dairy processing, a summary of basic, proven measures for improving water efficiency are also provided. The information in this Energy Guide is intended to help energy and plant managers in the U.S. dairy processing industry reduce energy and water consumption in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of all measures—as well as on their applicability to different production practices—is needed to assess their cost effectiveness at individual plants.

  8. Energy Efficiency Improvement and Cost Saving Opportunities for the Fruit and Vegetable Processing Industry. An ENERGY STAR Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Masanet, Eric; Masanet, Eric; Worrell, Ernst; Graus, Wina; Galitsky, Christina

    2008-01-01

    The U.S. fruit and vegetable processing industry--defined in this Energy Guide as facilities engaged in the canning, freezing, and drying or dehydrating of fruits and vegetables--consumes over $800 million worth of purchased fuels and electricity per year. Energy efficiency improvement isan important way to reduce these costs and to increase predictable earnings, especially in times of high energy price volatility. There are a variety of opportunities available at individual plants in the U.S. fruit and vegetable processing industry to reduce energy consumption in a cost-effective manner. This Energy Guide discusses energy efficiency practices and energy-efficient technologies that can be implemented at the component, process, facility, and organizational levels. A discussion of the trends, structure, and energy consumption characteristics of the U.S. fruit and vegetable processing industry is provided along with a description of the major process technologies used within the industry. Next, a wide variety of energy efficiency measures applicable to fruit and vegetable processing plants are described. Many measure descriptions include expected savings in energy and energy-related costs, based on case study data from real-world applications in fruit and vegetable processing facilities and related industries worldwide. Typical measure payback periods and references to further information in the technical literature are also provided, when available. Given the importance of water in fruit and vegetable processing, a summary of basic, proven measures for improving plant-level water efficiency are also provided. The information in this Energy Guide is intended to help energy and plant managers in the U.S. fruit and vegetable processing industry reduce energy and water consumption in a cost-effective manner while maintaining the quality of products manufactured. Further research on the economics of all measures--as well as on their applicability to different production

  9. "Dial-an-ROI?" changing basic variables impacts cost trends in single-population pre-post ("DMAA type") savings analysis.

    Science.gov (United States)

    Juster, Iver A; Rosenberg, Stephen N; Senapati, Deeptimayee; Shah, Mayur R

    2009-02-01

    Disease management (DM) programs claim to achieve cost savings by reducing clinical adverse events. While measuring changes in adverse events is straightforward, plausibly demonstrating savings has been contentious, especially absent an external comparison population. In this situation, a single-population methodology is often used, in which the cost trend for those with no program conditions ("non-chronics"--NC) forms the expected trend for those who have at least 1 program condition ("chronics"--C). The methodology's fundamental assumption is that--absent DM--C and NC trends would be identical (or bear a constant relationship over time). We assessed this assumption by altering the values of key variables used to identify C and NC, and to calculate trend. We compared C and NC baseline trends for a 23-condition telephonic DM multiemployer program representing nearly 300,000 members. Trends were calculated for 16 combinations of values for 4 key variables: identification look-back frame (12 vs. 24 months); identification threshold (high vs. lower specificity); claims runout (3 vs. 6 months); and minimum required insurance eligibility (any 6 months vs. 12 months continuous eligibility in the measurement year). Identification was performed by annual qualification. Changes in values for the 4 key variables markedly impacted baseline C and NC trends. C trends varied between 10.1% and 13.1%; NC trends between 5.2% and 12.8%. C-NC trend differences ranged between -1.9% and +7.0%. The combination of 24 months identification look-back, high identification threshold, 6 months runout, and any-6-months eligibility gave the most convergent C and NC trends (10.4% and 10.7%). Seemingly minor changes in key variables impact C and NC trends in single-population pre-post DM savings methodologies. When a suitable comparison population is not available, at least 1 year of baseline C and NC trends should be reported-as recommended by the DMAA--and values of key variables used should be

  10. Waste molasses alone displaces glucose-based medium for microalgal fermentation towards cost-saving biodiesel production.

    Science.gov (United States)

    Yan, Dong; Lu, Yue; Chen, Yi-Feng; Wu, Qingyu

    2011-06-01

    The by-product of sugar refinery-waste molasses was explored as alternative to glucose-based medium of Chlorella protothecoides in this study. Enzymatic hydrolysis is required for waste molasses suitable for algal growth. Waste molasses hydrolysate was confirmed as a sole source of full nutrients to totally replace glucose-based medium in support of rapid growth and high oil yield from algae. Under optimized conditions, the maximum algal cell density, oil content, and oil yield were respectively 70.9 g/L, 57.6%, and 40.8 g/L. The scalability of the waste molasses-fed algal system was confirmed from 0.5L flasks to 5L fermenters. The quality of biodiesel from waste molasses-fed algae was probably comparable to that from glucose-fed ones. Economic analysis indicated the cost of oil production from waste molasses-fed algae reduced by 50%. Significant cost reduction of algal biodiesel production through fermentation engineering based on the approach is expected. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Costs and financial feasibility of malaria elimination

    Science.gov (United States)

    Sabot, Oliver; Cohen, Justin M; Hsiang, Michelle S; Kahn, James G; Basu, Suprotik; Tang, Linhua; Zheng, Bin; Gao, Qi; Zou, Linda; Tatarsky, Allison; Aboobakar, Shahina; Usas, Jennifer; Barrett, Scott; Cohen, Jessica L; Jamison, Dean T; Feachem, Richard GA

    2010-01-01

    Summary The marginal costs and benefits of converting malaria programmes from a control to an elimination goal are central to strategic decisions, but empirical evidence is scarce. We present a conceptual framework to assess the economics of elimination and analyse a central component of that framework—potential short-term to medium-term financial savings. After a review that showed a dearth of existing evidence, the net present value of elimination in five sites was calculated and compared with effective control. The probability that elimination would be cost-saving over 50 years ranged from 0% to 42%, with only one site achieving cost-savings in the base case. These findings show that financial savings should not be a primary rationale for elimination, but that elimination might still be a worthy investment if total benefits are sufficient to outweigh marginal costs. Robust research into these elimination benefits is urgently needed. PMID:21035839

  12. The net cost of incorporating resistance testing into HIV/AIDS treatment in South Africa: a Markov model with primary data.

    Science.gov (United States)

    Rosen, Sydney; Long, Lawrence; Sanne, Ian; Stevens, Wendy S; Fox, Matthew P

    2011-05-15

    Current guidelines for providing antiretroviral therapy (ART) in South Africa's public sector programme call for switching patients from first-line to second-line treatment upon virologic failure as indicated by two consecutive viral loads above 5000 copies/ml, but without laboratory evidence of viral resistance. We modelled the net cost of adding resistance testing for patients with virological failure and retaining patients without resistance on first-line therapy, rather than switching all failures to second-line therapy. Costs were estimated for three scenarios: routine maintenance (standard care without resistance testing, switch all failures to second line); resistance testing (resistance test for patients with failure, switch those with resistance); and limited testing (resistance test for patients with failure in the first three years, switch those with resistance). A Markov model was used to estimate the cost of each arm over five years after first line initiation. Rates of treatment failure, viral resistance and treatment costs were estimated with primary data from a large HIV treatment cohort at a public facility in Johannesburg. Future costs were discounted at 3%. Virological failure rates over five years were 19.8% in routine maintenance and 20.2% in resistance testing and limited testing; 16.8% and 11.4% of failures in routine and limited testing, respectively, did not have any resistance mutations, resulting in 3.1% and 2.0% fewer patients switching to second-line ART by the end of five years. Treatment costs were estimated at US$526 and $1268 per patient per year on first-line and second-line therapy, respectively; a resistance test cost $242. The total average cost per patient over five years was $2780 in routine maintenance; $2775 in resistance testing; and $2763 in limited testing. Incorporating resistance testing into treatment guidelines in South Africa is potentially cost-neutral and can identify other reasons for failure, conserve treatment

  13. Consumer-directed health plans with health savings accounts: whose skin is in the game and how do costs affect care seeking?

    Science.gov (United States)

    Reed, Mary; Graetz, Ilana; Wang, Huihui; Fung, Vicki; Newhouse, Joseph P; Hsu, John

    2012-07-01

    Employers are increasingly offering high-deductible health insurance plans with associated health savings accounts (HSAs), but there is limited information on account contributions or effects on patient care seeking. We examined HSA contributions and their source, patient-reported effects of costs on care seeking, and reports of financial burden. We conducted telephone interviews with 488 adult members of small group of employer-sponsored HSA-eligible plans within an integrated delivery system. HSA contribution sources and amounts varied with 32% receiving an employer contribution and also making their own employee contribution, 35% only receiving an employer contribution (no employee contribution), 19% only making their own contribution (no employer contribution), and 14% with no HSA contribution from either source. After adjustment for respondent characteristics, those who made their own HSA contributions in addition to their employer's contribution were significantly more likely to report that costs affected their care-seeking behavior, compared with those with only employer contributions (39% vs. 31% for emergency department and 60% vs. 49% for office visits, all Ppaid out-of-pocket for care were significantly more likely to report financial burdens than those with only employer contributions (Pemployer contributions to their HSA, but few have fully funded accounts. Those with only an employer contribution reported fewer changes in their care-seeking behavior and were less likely to report experiencing financial burdens.

  14. Telecardiology application in jordan: its impact on diagnosis and disease management, patients' quality of life, and time- and cost-savings.

    Science.gov (United States)

    Khader, Yousef Saleh; Jarrah, Mohamad Ismail; Al-Shudifat, Abde-Ellah M; Shdaifat, Amjad; Aljanabi, Husham; Al-Fakeh, Shadwan Ismeil; Turk, Elias Emil; Zayed, Khaled Ali; Al Quran, Hanadi A; Ellauzi, Ziad Mohd; Al Tahan, Mohammad

    2014-01-01

    Objectives. To assess the impact of live interactive telecardiology on diagnosis and disease management, patients' quality of life, and time- and cost-savings. Methods. All consecutive patients who attended or were referred to the teleclinics for suspected cardiac problems in two hospitals in remote areas of Jordan during the study period were included in the study. Patients were interviewed for relevant information and their quality of life was assessed during the first visit and 8 weeks after the last visit. Results. A total of 76 patients were included in this study. Final diagnosis and treatment plan were established as part of the telecardiology consultations in 71.1% and 77.3% of patients, respectively. Patients' travel was avoided for 38 (50.0%) who were managed locally. The majority of patients perceived that the visit to the telecardiology clinic results in less travel time (96.1%), less waiting time (98.1%), and lower cost (100.0%). Telecardiology consultations resulted in an improvement in the quality of life after two months of the first visit. Conclusions. Telecardiology care in remote areas of Jordan would improve the access to health care, help to reach proper diagnosis and establish the treatment plan, and improve the quality of life.

  15. Program-specific cost-effectiveness analysis: breast cancer screening policies for a safety-net program.

    Science.gov (United States)

    Melnikow, Joy; Tancredi, Daniel J; Yang, Zhuo; Ritley, Dominique; Jiang, Yun; Slee, Christina; Popova, Svetlana; Rylett, Phillip; Knutson, Kirsten; Smalley, Sherie

    2013-01-01

    Every Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices. A microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year. Projected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was $106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6%. Under equal mammography reimbursement, biennial digital mammography beginning at age 50 years was projected to decrease 15-year breast cancer mortality by 8.6% at an incremental cost per additional life-year of $17,050. For the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices. Copyright © 2013, International Society for

  16. Comparative cost analysis of insecticide-treated net delivery strategies: sales supported by social marketing and free distribution through antenatal care.

    Science.gov (United States)

    De Allegri, Manuela; Marschall, Paul; Flessa, Steffen; Tiendrebéogo, Justin; Kouyaté, Bocar; Jahn, Albrecht; Müller, Olaf

    2010-01-01

    Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge by developing such a comparative cost analysis, looking at the cost per ITN distributed for two alternative interventions: subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care (ANC). The study was conducted in rural Burkina Faso, where the two interventions were carried out alongside one another in 2006/07. Cost information was collected prospectively to derive both a financial analysis adopting a provider's perspective and an economic analysis adopting a societal perspective. The average financial cost per ITN distributed was US$8.08 and US$7.21 for sales supported by social marketing and free distribution through ANC, respectively. The average economic cost per ITN distributed was US$4.81 for both interventions. Contrary to common belief, costs did not differ substantially between the two interventions. Due to the district's ability to rely fully on the use of existing resources, financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign. This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities. Given restricted budgets, however, free distribution programmes are unlikely to be feasible.

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

    Science.gov (United States)

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

    2013-04-01

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

  18. Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures.

    Science.gov (United States)

    Rhee, Peter C; Fischer, Michelle M; Rhee, Laura S; McMillan, Ha; Johnson, Anthony E

    2017-03-01

    Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience. For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure. A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS. Economic/Decision Analysis IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Green liquor impregnation and Kraft pulping of South African Pinus Patula – “A practical approach to provide cost savings in a Kraft mill’s pulping operation”

    CSIR Research Space (South Africa)

    Johakimu, Jonas K

    2011-02-01

    Full Text Available benefits of GLP technology to the Kraft pulping industry are; providing cost savings, increased digester productivity, and mitigation of some of environmental impacts. Depending on the process economics of the pulping process of a Kraft pulp mill, GLP can...

  20. Reliability-Based and Cost-Oriented Product Optimization Integrating Fuzzy Reasoning Petri Nets, Interval Expert Evaluation and Cultural-Based DMOPSO Using Crowding Distance Sorting

    Directory of Open Access Journals (Sweden)

    Zhaoxi Hong

    2017-08-01

    Full Text Available In reliability-based and cost-oriented product optimization, the target product reliability is apportioned to subsystems or components to achieve the maximum reliability and minimum cost. Main challenges to conducting such optimization design lie in how to simultaneously consider subsystem division, uncertain evaluation provided by experts for essential factors, and dynamic propagation of product failure. To overcome these problems, a reliability-based and cost-oriented product optimization method integrating fuzzy reasoning Petri net (FRPN, interval expert evaluation and cultural-based dynamic multi-objective particle swarm optimization (DMOPSO using crowding distance sorting is proposed in this paper. Subsystem division is performed based on failure decoupling, and then subsystem weights are calculated with FRPN reflecting dynamic and uncertain failure propagation, as well as interval expert evaluation considering six essential factors. A mathematical model of reliability-based and cost-oriented product optimization is established, and the cultural-based DMOPSO with crowding distance sorting is utilized to obtain the optimized design scheme. The efficiency and effectiveness of the proposed method are demonstrated by the numerical example of the optimization design for a computer numerically controlled (CNC machine tool.

  1. A Cost Analysis of Hospitalizations for Infections Related to Injection Drug Use at a County Safety-Net Hospital in Miami, Florida.

    Directory of Open Access Journals (Sweden)

    Hansel Tookes

    Full Text Available Infections related to injection drug use are common. Harm reduction strategies such as syringe exchange programs and skin care clinics aim to prevent these infections in injection drug users (IDUs. Syringe exchange programs are currently prohibited by law in Florida. The goal of this study was to estimate the mortality and cost of injection drug use-related bacterial infections over a 12-month period to the county safety-net hospital in Miami, Florida. Additionally, the prevalence of HIV and hepatitis C virus among this cohort of hospitalized IDUs was estimated.IDUs discharged from Jackson Memorial Hospital were identified using the International Classification of Diseases, Ninth Revision, codes for illicit drug abuse and endocarditis, bacteremia or sepsis, osteomyelitis and skin and soft tissue infections (SSTIs. 349 IDUs were identified for chart abstraction and 92% were either uninsured or had publicly funded insurance. SSTIs, the most common infection, were reported in 64% of IDUs. HIV seroprevalence was 17%. Seventeen patients (4.9% died during their hospitalization. The total cost for treatment for injection drug use-related infections to Jackson Memorial Hospital over the 12-month period was $11.4 million.Injection drug use-related bacterial infections represent a significant morbidity for IDUs in Miami-Dade County and a substantial financial cost to the county hospital. Strategies aimed at reducing risk of infections associated with injection drug use could decrease morbidity and the cost associated with these common, yet preventable infections.

  2. Measuring the Social Recreation Per-Day Net Benefit of the Wildlife Amenities of a National Park: A Count-Data Travel-Cost Approach

    Science.gov (United States)

    Mendes, Isabel; Proença, Isabel

    2011-11-01

    In this article, we apply count-data travel-cost methods to a truncated sample of visitors to estimate the Peneda-Gerês National Park (PGNP) average consumer surplus (CS) for each day of visit. The measurement of recreation demand is highly specific because it is calculated by number of days of stay per visit. We therefore propose the application of altered truncated count-data models or truncated count-data models on grouped data to estimate a single, on-site individual recreation demand function, with the price (cost) of each recreation day per trip equal to out-of-pocket and time travel plus out-of-pocket and on-site time costs. We further check the sensitivity of coefficient estimations to alternative models and analyse the welfare measure precision by using the delta and simulation methods by Creel and Loomis. With simulated limits, CS is estimated to be €194 (range €116 to €448). This information is of use in the quest to improve government policy and PNPG management and conservation as well as promote nature-based tourism. To our knowledge, this is the first attempt to measure the average recreation net benefits of each day of stay generated by a national park by using truncated altered and truncated grouped count-data travel-cost models based on observing the individual number of days of stay.

  3. Measuring the social recreation per-day net benefit of the wildlife amenities of a national park: a count-data travel-cost approach.

    Science.gov (United States)

    Mendes, Isabel; Proença, Isabel

    2011-11-01

    In this article, we apply count-data travel-cost methods to a truncated sample of visitors to estimate the Peneda-Gerês National Park (PGNP) average consumer surplus (CS) for each day of visit. The measurement of recreation demand is highly specific because it is calculated by number of days of stay per visit. We therefore propose the application of altered truncated count-data models or truncated count-data models on grouped data to estimate a single, on-site individual recreation demand function, with the price (cost) of each recreation day per trip equal to out-of-pocket and time travel plus out-of-pocket and on-site time costs. We further check the sensitivity of coefficient estimations to alternative models and analyse the welfare measure precision by using the delta and simulation methods by Creel and Loomis. With simulated limits, CS is estimated to be 194 (range 116 to 448). This information is of use in the quest to improve government policy and PNPG management and conservation as well as promote nature-based tourism. To our knowledge, this is the first attempt to measure the average recreation net benefits of each day of stay generated by a national park by using truncated altered and truncated grouped count-data travel-cost models based on observing the individual number of days of stay.

  4. "It is about how the net looks": a qualitative study of perceptions and practices related to mosquito net care and repair in two districts in eastern Uganda.

    Science.gov (United States)

    Scandurra, Leah; Acosta, Angela; Koenker, Hannah; Kibuuka, Daniel Musoke; Harvey, Steven

    2014-12-17

    Prolonging net durability has important implications for reducing both malaria transmission and the frequency of net replacement. Protective behaviour, such as net care and repair, offers promise for improving net integrity and durability. Given the potential cost-savings and public health benefit associated with extending the useful life of long-lasting insecticidal nets (LLINs), prevention and mitigation of damage will become ever more critical to ensuring adequate net coverage at the population level. A qualitative assessment was conducted in two districts in central eastern Uganda in September 2013. Data on household net care and repair behaviour, attitudes and practices were collected from 30 respondents through in-depth interviews (IDIs), observations, photos, and video to gather an in-depth understanding of these behaviours. Net damage was common and the most cited causes were children and rodents. Responses revealed strong social norms about net cleanliness and aesthetics, and strong expectations that others should care for and repair their own nets. Respondents were receptive and able to repair nets, though longer-term repair methods, such as sewing and patching, were not as commonly reported or observed. Self-reported behaviour was not always consistent with observed or demonstrated behaviour, revealing potential misconceptions and the need for clear and consistent net care and repair messaging. Respondents considered both aesthetics and malaria protection important when deciding whether, when, and how to care for and repair nets. BCC should continue to emphasize the importance of maintaining net integrity for malaria prevention purposes as well as for maintaining aesthetic appeal. Additional research is needed, particularly surrounding washing, drying, daily storage routines, and gender roles in care and repair, in order to understand the complexity of these behaviours, and refine existing or develop new behaviour change communication (BCC) messages for

  5. Secure savings

    Energy Technology Data Exchange (ETDEWEB)

    Dawn, Tom

    1996-09-01

    When it was installed, Dartmoor Prison`s environmental management system promised enough savings in labour and energy to pay for itself in well under five years. The system`s benefits are appreciated by staff and are thoroughly practical. (author)

  6. 77 FR 20123 - Fee Change for Paying Agents Redeeming Definitive Savings Bonds and Savings Notes

    Science.gov (United States)

    2012-04-03

    ... Fiscal Service Fee Change for Paying Agents Redeeming Definitive Savings Bonds and Savings Notes AGENCY..., the Department of the Treasury will no longer pay fees to paying agents for redeeming definitive savings bonds and savings notes. The purpose of this change is to reduce Treasury's program costs. DATES...

  7. Energy Savings Measure Packages. Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Casey, Sean [National Renewable Energy Lab. (NREL), Golden, CO (United States); Booten, Chuck [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2011-11-01

    This document presents the most cost effective Energy Savings Measure Packages (ESMP) for existing mixed-fuel and all electric homes to achieve 15% and 30% savings for each BetterBuildings grantee location across the United States. These packages are optimized for minimum cost to homeowners for source energy savings given the local climate and prevalent building characteristics (i.e. foundation types). Maximum cost savings are typically found between 30% and 50% energy savings over the reference home; this typically amounts to $300 - $700/year.

  8. Effects of changing mosquito host searching behaviour on the cost effectiveness of a mass distribution of long-lasting, insecticidal nets: a modelling study.

    Science.gov (United States)

    Briët, Olivier J T; Chitnis, Nakul

    2013-06-26

    The effectiveness of long-lasting, insecticidal nets (LLINs) in preventing malaria is threatened by the changing biting behaviour of mosquitoes, from nocturnal and endophagic to crepuscular and exophagic, and by their increasing resistance to insecticides. Using epidemiological stochastic simulation models, we studied the impact of a mass LLIN distribution on Plasmodium falciparum malaria. Specifically, we looked at impact in terms of episodes prevented during the effective life of the batch and in terms of net health benefits (NHB) expressed in disability adjusted life years (DALYs) averted, depending on biting behaviour, resistance (as measured in experimental hut studies), and on pre-intervention transmission levels. Results were very sensitive to assumptions about the probabilistic nature of host searching behaviour. With a shift towards crepuscular biting, under the assumption that individual mosquitoes repeat their behaviour each gonotrophic cycle, LLIN effectiveness was far less than when individual mosquitoes were assumed to vary their behaviour between gonotrophic cycles. LLIN effectiveness was equally sensitive to variations in host-searching behaviour (if repeated) and to variations in resistance. LLIN effectiveness was most sensitive to pre-intervention transmission level, with LLINs being least effective at both very low and very high transmission levels, and most effective at around four infectious bites per adult per year. A single LLIN distribution round remained cost effective, except in transmission settings with a pre-intervention inoculation rate of over 128 bites per year and with resistant mosquitoes that displayed a high proportion (over 40%) of determined crepuscular host searching, where some model variants showed negative NHB. Shifts towards crepuscular host searching behaviour can be as important in reducing LLIN effectiveness and cost effectiveness as resistance to pyrethroids. As resistance to insecticides is likely to slow down the

  9. The net return from animal activity in agro-ecosystems: trading off benefits from ecosystem services against costs from crop damage [v2; ref status: indexed, http://f1000r.es/3c4

    Directory of Open Access Journals (Sweden)

    Gary W Luck

    2014-04-01

    Full Text Available Animals provide benefits to agriculture through the provision of ecosystem services, but also inflict costs such as damaging crops. These benefits and costs are mostly examined independently, rather than comparing the trade-offs of animal activity in the same system and quantifying the net return from beneficial minus detrimental activities. Here, I examine the net return associated with the activity of seed-eating birds in almond orchards by quantifying the economic costs and benefits of bird consumption of almonds. Pre-harvest, the consumption of harvestable almonds by birds cost growers AUD$57.50 ha-1 when averaged across the entire plantation. Post-harvest, the same bird species provide an ecosystem service by removing mummified nuts from trees that growers otherwise need to remove to reduce threats from fungal infection or insect pest infestations. The value of this ecosystem service ranged from AUD$82.50 ha-1–$332.50 ha-1 based on the replacement costs of mechanical or manual removal of mummified nuts, respectively. Hence, bird consumption of almonds yielded a positive net return of AUD$25–$275 ha-1 averaged across the entire plantation. However, bird activity varied spatially resulting in positive net returns occurring primarily at the edges of crops where activity was higher, compared to negative net returns in crop interiors. Moreover, partial mummy nut removal by birds meant that bird activity may only reduce costs to growers rather than replace these costs completely. Similar cost-benefit trade-offs exist across nature, and quantifying net returns can better inform land management decisions such as when to control pests or promote ecosystem service provision.

  10. Effectiveness and Cost of Insecticide-Treated Bed Nets and Indoor Residual Spraying for the Control of Cutaneous Leishmaniasis: A Cluster-Randomized Control Trial in Morocco.

    Science.gov (United States)

    Faraj, Chafika; Yukich, Joshua; Adlaoui, El Bachir; Wahabi, Rachid; Mnzava, Abraham Peter; Kaddaf, Mustapha; El Idrissi, Abderrahmane Laamrani; Ameur, Btissam; Kleinschmidt, Immo

    2016-03-01

    Cutaneous leishmaniasis (CL) remains an important public health problem in Morocco. A cluster-randomized trial was conducted with the following three study arms: 1) long-lasting insecticide-treated nets (LLINs) plus standard of care environmental management (SoC-EM), 2) indoor residual spraying (IRS) with α-cypermethrin plus SoC-EM, and 3) SoC-EM alone. Incidence of new CL cases by passive and active case detection, sandfly abundance, and cost and cost-effectiveness was compared between study arms over 5 years. Incidence of CL and sandfly abundance were significantly lower in the IRS arm compared with SoC-EM (CL incidence rate ratio = 0.32, 95% confidence interval [CI] = 0.15-0.69, P = 0.005 and sandfly abundance ratio = 0.39, 95% CI = 0.18-0.85, P = 0.022). Reductions in the LLIN arm of the study were not significant, possibly due to poor compliance. IRS was effective and more cost-effective for the prevention of CL in Morocco. © The American Society of Tropical Medicine and Hygiene.

  11. Tax incidence and net benefits in the market for employment-related health insurance: sensitivity of estimates to the incidence of employer costs.

    Science.gov (United States)

    Selden, Thomas M; Bernard, Didem M

    2004-06-01

    The market for employment-related coverage contains public transfers through the tax system and private transfers across workers with predictably different risks. We examine both transfers across a wide range of employee characteristics, including age, race, ethnicity, family size, poverty level, and health risk. To resolve longstanding questions regarding the incidence of employer contributions, we simulate a range of alternative incidence scenarios in which (i) all employees offered coverage in a firm share equally in the employer's costs, (ii) burdens are narrowly targeted according to employee-specific health risks, and (iii) intermediate cases with burdens targeted by job characteristics, age, sex, race, ethnicity, and family size. Our results provide evidence regarding the distribution of tax subsidies and net benefits under a range of scenarios that we believe bound the true incidence of employer premium contributions.

  12. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

    LENUS (Irish Health Repository)

    Pope, George

    2012-01-31

    OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.

  13. Evaluation of energy saving tasks performed by the energy transmission and distribution companies; Denmark; Evaluering af energiselskabernes energibespareaktiviteter

    Energy Technology Data Exchange (ETDEWEB)

    Togeby, M. (Ea Energianalyse A/S, Copenhagen (Denmark))

    2012-05-15

    The evaluation is described in the Agreement of 20 November 2009 between the Danish Climate and Energy Minister and the distribution companies for electricity, natural gas, district heating and oil about the companies' future energy conservation efforts. The evaluation was conducted to provide recommendations for adjusting the system. The results of the evaluation show that energy companies and utilities meet the overall savings obligation. In 2011, 2,098 GWh savings are recorded, which is more than the obligation. The evaluation shows that the net effect is about 760 GWh (36%). When looking at types of energy companies, then the oil companies' activities generally have a low net effect and additionally is assessed to be low in relation to the district heating companies' renovation of the district heating network. The greatest additionally exists among large savings in the industry. The means that energy companies use to achieve savings obligations are significantly different today than a few years ago. Today there are grants for more than 85% of registered savings. Before 2006 primarily information and advice was used. Thus an estimated 400 million DKK annually is used for grants. Socio-economics is positive for the part of the effort that is aimed at businesses. The socio-economic value of the savings is calculated to be twice as large as the total cost when you only look at the industry. The system can thus be readily seen as a useful instrument to promote energy conservation in industry. For households, it is estimated that the net effect is 20% of the reported savings, while for industry the net effect is estimated to be 45%. Also, for renovations of the heat distribution networks the net effect is estimated to be low. (LN)

  14. Spectacle wearing in children randomised to ready-made or custom spectacles, and potential cost savings to programmes: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Morjaria, Priya; Murali, Kaushik; Evans, Jennifer; Gilbert, Clare

    2016-01-19

    Uncorrected refractive errors are the commonest cause of visual impairment in children, with myopia being the most frequent type. Myopia usually starts around 9 years of age and progresses throughout adolescence. Hyperopia usually affects younger children, and astigmatism affects all age groups. Many children have a combination of myopia and astigmatism. To correct refractive errors, the type and degree of refractive error are measured and appropriate corrective lenses prescribed and dispensed in the spectacle frame of choice. Custom spectacles (that is, with the correction specifically required for that individual) are required if astigmatism is present, and/or the refractive error differs between eyes. Spectacles without astigmatic correction and where the refractive error is the same in both eyes are straightforward to dispense. These are known as 'ready-made' spectacles. High-quality spectacles of this type can be produced in high volume at an extremely low cost. Although spectacle correction improves visual function, a high proportion of children do not wear their spectacles for a variety of reasons. The aim of this study is to compare spectacle wear at 3-4 months amongst school children aged 11 to 15 years who have significant, simple uncorrected refractive error randomised to ready-made or custom spectacles of equivalent quality, and to evaluate cost savings to programmes. The study will take place in urban and semi-urban government schools in Bangalore, India. The hypothesis is that similar proportions of children randomised to ready-made or custom spectacles will be wearing their spectacles at 3-4 months. The trial is a randomised, non-inferiority, double masked clinical trial of children with simple uncorrected refractive errors. After screening, children will be randomised to ready-made or custom spectacles. Children will choose their preferred frame design. After 3-4 months the children will be followed up to assess spectacle wear. Ready

  15. Penggunaan Light Emitting Diode Pada Lampu Celup Bagan (the Use of Light Emitting Diode on Sunked Lamps of Lift Net)

    OpenAIRE

    Thenu, Imanuel M; Puspito, Gondo; Martasuganda, Sulaeman

    2013-01-01

    Lift net fishermen usually use fluorescent lamp as attractor to lure fish. As price of fuel rise, fishermen are forced to find another option to change their attractor into some much lower cost and more energy-save lamp, or in other words, to change into LED lamp. This research are providing evidence that sunked LED lamps can be utilized as a helper tools, and also determined the best time for catching fish in the lift net. Two lift net used in this research, one of them used sunked LED lamps...

  16. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... Download Instructions Explorer: Right-click on the link, choose "Save target as…", save file in desired location. Firefox/Chrome: Right-click on the link, choose "Save link as…", save file in desired location. ...

  17. Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries.

    Science.gov (United States)

    Seidman, Gabriel; Atun, Rifat

    2017-01-01

    Improving health systems performance, especially in low-resource settings facing complex disease burdens, can improve population health. Specifically, the efficiency and effectiveness of supply chains and procurement processes for pharmaceuticals, vaccines and other health products has important implications for health system performance. Pharmaceuticals, vaccines and other health products make up a large share of total health expenditure in low-income and middle-income countries (LMICs), and they are critical for delivering health services. Therefore, programmes which achieve cost savings on these expenditures may help improve a health system's efficiency, whereas programmes that increase availability of health products may improve a health system's effectiveness. This systematic review investigates whether changes to supply chains and procurement processes can achieve cost savings and/or improve the availability of drugs in LMICs. Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL and the Health Economic Evaluation Database to identify. We identified 1264 articles, of which 38 were included in our study. We found evidence that centralised procurement and tendering can achieve direct cost savings, while supply chain management programmes can reduce drug stock outs and increase drug availability for populations. This research identifies a broad set of programmes which can improve the ways that health systems purchase and delivery health products. On the basis of this evidence, policymakers and programme managers should examine the root causes of inefficiencies in pharmaceutical supply chain and procurement processes in order to determine how best to improve health systems performance in their specific contexts.

  18. Net Locality

    DEFF Research Database (Denmark)

    de Souza e Silva, Adriana Araujo; Gordon, Eric

    Provides an introduction to the new theory of Net Locality and the profound effect on individuals and societies when everything is located or locatable. Describes net locality as an emerging form of location awareness central to all aspects of digital media, from mobile phones, to Google Maps...... of emerging technologies, from GeoCities to GPS, Wi-Fi, Wiki Me, and Google Android....

  19. Net Neutrality

    DEFF Research Database (Denmark)

    Savin, Andrej

    2017-01-01

    Repealing “net neutrality” in the US will have no bearing on Internet freedom or security there or anywhere else.......Repealing “net neutrality” in the US will have no bearing on Internet freedom or security there or anywhere else....

  20. Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya?a study protocol

    OpenAIRE

    Gama, Elvis; Were, Vincent; Ouma, Peter; Desai, Meghna; Niessen, Louis; Ann M Buff; Kariuki, Simon

    2016-01-01

    Introduction \\ud Historically, Kenya has used various distribution models for long-lasting insecticide-treated bed nets (LLINs) with variable results in population coverage. The models presently vary widely in scale, target population and strategy. There is limited information to determine the best combination of distribution models, which will lead to sustained high coverage and are operationally efficient and cost-effective. Standardised cost information is needed in combination with progra...

  1. Energy-Saving Melting and Revert Reduction Technology (E-SMARRT): Use of Laser Engineered Net Shaping for Rapid Manufacturing of Dies with Protective Coatings and Improved Thermal Management

    Energy Technology Data Exchange (ETDEWEB)

    Brevick, Jerald R. [Ohio State University

    2014-06-13

    In the high pressure die casting process, molten metal is introduced into a die cavity at high pressure and velocity, enabling castings of thin wall section and complex geometry to be obtained. Traditional die materials have been hot work die steels, commonly H13. Manufacture of the dies involves machining the desired geometry from monolithic blocks of annealed tool steel, heat treating to desired hardness and toughness, and final machining, grinding and polishing. The die is fabricated with internal water cooling passages created by drilling. These materials and fabrication methods have been used for many years, however, there are limitations. Tool steels have relatively low thermal conductivity, and as a result, it takes time to remove the heat from the tool steel via the drilled internal water cooling passages. Furthermore, the low thermal conductivity generates large thermal gradients at the die cavity surfaces, which ultimately leads to thermal fatigue cracking on the surfaces of the die steel. The high die surface temperatures also promote the metallurgical bonding of the aluminum casting alloy to the surface of the die steel (soldering). In terms of process efficiency, these tooling limitations reduce the number of die castings that can be made per unit time by increasing cycle time required for cooling, and increasing downtime and cost to replace tooling which has failed either by soldering or by thermal fatigue cracking (heat checking). The objective of this research was to evaluate the feasibility of designing, fabricating, and testing high pressure die casting tooling having properties equivalent to H13 on the surface in contact with molten casting alloy - for high temperature and high velocity molten metal erosion resistance – but with the ability to conduct heat rapidly to interior water cooling passages. A layered bimetallic tool design was selected, and the design evaluated for thermal and mechanical performance via finite element analysis. H13 was

  2. Reducing injuries among Native Americans: five cost-outcome analyses.

    Science.gov (United States)

    Zaloshnja, Eduard; Miller, Ted R; Galbraith, Maury S; Lawrence, Bruce A; DeBruyn, Lemyra M; Bill, Nancy; Hicks, Kenny R; Keiffer, Michael; Perkins, Ronald

    2003-09-01

    This paper presents cost-outcome analyses of five injury prevention efforts in Native American jurisdictions: a safety-belt program, a streetlight project, a livestock control project, a drowning prevention program, and a suicide prevention and intervention program. Pre- and post-intervention data were analyzed to estimate projects' impact on injury reduction. Projects' costs were amortized over the time period covered by the evaluation or over the useful life of physical capital invested. Projects' savings were calculated based on estimated reduction in medical and public program expenses, on estimated decrease in lost productivity, and on estimated quality adjusted life years saved.All projects yielded positive benefit-cost ratios. The net cost per quality adjusted life years was less than zero (i.e. the monetary savings exceeded project costs) for all but one of the projects.

  3. Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of "community acquired" syncope

    Directory of Open Access Journals (Sweden)

    Rockx Marie

    2006-06-01

    Full Text Available Abstract Background Cost-effectiveness acceptability curves (CEACs describe the probability that a new treatment or intervention is cost-effective. The net benefit regression framework (NBRF allows cost-effectiveness analysis to be done in a simple regression framework. The objective of the paper is to illustrate how net benefit regression can be used to construct a CEAC. Methods One hundred patients referred for ambulatory monitoring with syncope or presyncope were randomized to a one-month external loop recorder (n = 49 or 48-hour Holter monitor (n = 51. The primary endpoint was symptom-rhythm correlation during monitoring. Direct costs were calculated based on the 2003 Ontario Health Insurance Plan (OHIP fee schedule combined with hospital case costing of labour, materials, service and overhead costs for diagnostic testing and related equipment. Results In the loop recorder group, 63.27% of patients (31/49 had symptom recurrence and successful activation, compared to 23.53% in the Holter group (12/51. The cost in US dollars for loop recording was $648.50 and $212.92 for Holter monitoring. The incremental cost-effectiveness ratio (ICER of the loop recorder was $1,096 per extra successful diagnosis. The probability that the loop recorder was cost-effective compared to the Holter monitor was estimated using net benefit regression and plotted on a CEAC. In a sensitivity analysis, bootstrapping was used to examine the effect of distributional assumptions. Conclusion The NBRF is straightforward to use and interpret. The resulting uncertainty surrounding the regression coefficient relates to the CEAC. When the link from the regression's p-value to the probability of cost-effectiveness is tentative, bootstrapping may be used.

  4. Reducing hospital expenditures with the COPE (Creating Opportunities for Parent Empowerment) program for parents and premature infants: an analysis of direct healthcare neonatal intensive care unit costs and savings.

    Science.gov (United States)

    Melnyk, Bernadette Mazurek; Feinstein, Nancy Fischbeck

    2009-01-01

    More than 500,000 premature infants are born in the United States every year. Preterm birth results in a multitude of negative adverse outcomes for children, including extended stays in the neonatal intensive care unit (NICU), developmental delays, physical and mental health/behavioral problems, increased medical utilization, and poor academic performance. In addition, parents of preterms experience a higher incidence of depression and anxiety disorders along with altered parent-infant interactions and overprotective parenting, which negatively impact their children. The costs associated with preterm birth are exorbitant. In 2005, it is estimated that preterm birth cost the United States $26.2 billion. The purpose of this study was to perform a cost analysis of the Creating Opportunities for Parent Empowerment (COPE) program for parents of premature infants, a manualized educational-behavioral intervention program comprising audiotaped information and an activity workbook that is administered to parents in 4 phases, the first phase commencing 2 to 4 days after admission to the NICU. Findings indicated that the COPE program resulted in cost savings of at least $4864 per infant. In addition to improving parent and child outcomes, routine implementation of COPE in NICUs across the United States could save the healthcare system more than $2 billion per year.

  5. Long-lasting insecticidal net (LLIN) ownership, use and cost of implementation after a mass distribution campaign in Kasaï Occidental Province, Democratic Republic of Congo.

    Science.gov (United States)

    Ntuku, Henry Maggi; Ruckstuhl, Laura; Julo-Réminiac, Jean-Emmanuel; Umesumbu, Solange E; Bokota, Alain; Tshefu, Antoinette Kitoto; Lengeler, Christian

    2017-01-09

    Long-lasting insecticidal nets (LLIN) are a highly effective means for preventing malaria infection and reducing associated morbidity and mortality. Mass free distribution campaigns have been shown to rapidly increase LLIN ownership and use. Around 3.5 million LLINs were distributed free of charge in the Kasaï Occidental Province in the Democratic Republic of Congo (DRC) in September-October 2014, using two different approaches, a fixed delivery strategy and a door-to-door strategy including hang-up activities. Repeated community-based cross-sectional surveys were conducted 2 months before and six months after the mass distribution. Descriptive statistics were used to measure changes in key malaria household indicators. LLIN ownership and use were compared between delivery strategies. Univariate and multivariate logistic regression analyses were used to identify factors associated with LLIN use before and after the mass distribution. A comparative financial cost analysis between the fixed delivery and door-to-door distribution strategies was carried out from the provider's perspective. Household ownership of at least one LLIN increased from 39.4% pre-campaign to 91.4% post-campaign and LLIN universal coverage, measured as the proportion of households with at least one LLIN for every two people increased from 4.1 to 41.1%. Population access to LLIN within the household increased from 22.2 to 80.7%, while overall LLIN use increased from 18.0 to 68.3%. Higher LLIN ownership was achieved with the fixed delivery strategy compared with the door-to-door (92.5% [95% CI 90.2-94.4%] versus 85.2% [95% CI 78.5-90.0%]), while distribution strategy did not have a significant impact on LLIN use (69.6% [95% CI 63.1-75.5%] versus 65.7% [95% CI 52.7-76.7%]). Malaria prevalence among children aged 6-59 months was 44.8% post-campaign. Living in a household with sufficient numbers of LLIN to cover all members was the strongest determinant of LLIN use. The total financial cost per

  6. Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients.

    Science.gov (United States)

    Rathod, K S; Antoniou, S; Avari, P; Ding, N; Wright, P; Knight, C; Jain, A K; Mathur, A; Smith, E J; Weerackody, R; Wragg, A; Jones, D A

    2017-01-01

    Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups. In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan-Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201). Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73-1.39), which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79-1.56) including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71-1.44). Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000). This observational data suggest that eptifibatide is associated with similar outcomes and significant cost savings compared to abciximab when

  7. Net-Immobilization of [beta]-glucosidase on Nonwoven Fabrics to Lower the Cost of "Cellulosic Ethanol" and Increase Cellulose Conversions

    National Research Council Canada - National Science Library

    Xing Zhu; Bin He; Changwen Zhao; Rong Fan; Lihua Zhang; Guan Wang; Yuhong Ma; Wantai Yang

    2016-01-01

    .... In this strategy, BG was net-immobilized into a poly(ethylene glycol) (PEG) net-cloth layer on a PP nonwoven fabric by way of the visible light-induced surface controlled/living graft cross-linking polymerization...

  8. Cost effectiveness of the 1993 Model Energy Code in Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, R.G.

    1995-06-01

    This report documents an analysis of the cost effectiveness of the Council of American Building Officials` 1993 Model Energy Code (MEC) building thermal-envelope requirements for single-family homes in Colorado. The goal of this analysis was to compare the cost effectiveness of the 1993 MEC to current construction practice in Colorado based on an objective methodology that determined the total life-cycle cost associated with complying with the 1993 MEC. This analysis was performed for the range of Colorado climates. The costs and benefits of complying with the 1993 NIEC were estimated from the consumer`s perspective. The time when the homeowner realizes net cash savings (net positive cash flow) for homes built in accordance with the 1993 MEC was estimated to vary from 0.9 year in Steamboat Springs to 2.4 years in Denver. Compliance with the 1993 MEC was estimated to increase first costs by $1190 to $2274, resulting in an incremental down payment increase of $119 to $227 (at 10% down). The net present value of all costs and benefits to the home buyer, accounting for the mortgage and taxes, varied from a savings of $1772 in Springfield to a savings of $6614 in Steamboat Springs. The ratio of benefits to costs ranged from 2.3 in Denver to 3.8 in Steamboat Springs.

  9. Performing impact evaluations in industrial retrofit: The Energy Savings Plan Program

    Energy Technology Data Exchange (ETDEWEB)

    Riewer, S. [USDOE Bonneville Power Administration, Portland, OR (United States); Spanner, G.E. [Pacific Northwest Lab., Richland, WA (United States)

    1991-08-01

    The Energy Savings Plan (ESP) is Bonneville Power Administration`s retrofit program for the industrial sector. The program pays incentives for energy conservation measures involving electrical energy efficiency improvements in manufacturing, processing, and refining industries. This paper will describe the ESP program, recount the techniques selected to evaluate the retrofits, and report the findings from five ESP project impact evaluations completed to date. The impact evaluations provide a framework for assessing the energy saving achieved by the provides implemented under the ESP. In addition to energy savings, the evaluations assess process changes, net utility impacts, levelized costs, and ``free ridership.`` The five ESP projects evaluated include: a waste heat recovery system for a food processing blancher, an energy management control system used to upgrade refrigeration, a variable speed drive for a fan motor in a lumber mill, a sludge screw press for waste water treatment, and replacement of rod anodes with blades anodes in mercury cells in an electrochemical plant.

  10. RESULTS FROM THE U.S. DOE 2006 SAVE ENERGY NOW ASSESSMENT INITIATIVE: DOE's Partnership with U.S. Industry to Reduce Energy Consumption, Energy Costs, and Carbon Dioxide Emissions

    Energy Technology Data Exchange (ETDEWEB)

    Wright, Anthony L [ORNL; Martin, Michaela A [ORNL; Gemmer, Bob [U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy; Scheihing, Paul [U.S. Department of Energy, Industrial Technologies Program; Quinn, James [U.S. Department of Energy

    2007-09-01

    In the wake of Hurricane Katrina and other severe storms in 2005, natural gas supplies were restricted, prices rose, and industry sought ways to reduce its natural gas use and costs. In October 2005, U.S. Department of Energy (DOE) Energy Secretary Bodman launched his Easy Ways to Save Energy campaign with a promise to provide energy assessments to 200 of the largest U.S. manufacturing plants. A major thrust of the campaign was to ensure that the nation's natural gas supplies would be adequate for all Americans, especially during home heating seasons. In a presentation to the National Press Club on October 3, 2005, Secretary Bodman said: 'America's businesses, factories, and manufacturing facilities use massive amounts of energy. To help them during this period of tightening supply and rising costs, our Department is sending teams of qualified efficiency experts to 200 of the nation's most energy-intensive factories. Our Energy Saving Teams will work with on-site managers on ways to conserve energy and use it more efficiently.' DOE's Industrial Technologies Program (ITP) responded to the Secretary's campaign with its Save Energy Now initiative, featuring a new and highly cost-effective form of energy assessments. The approach for these assessments drew heavily on the existing resources of ITP's Technology Delivery component. Over the years, ITP-Technology Delivery had worked with industry partners to assemble a suite of respected software decision tools, proven assessment protocols, training curricula, certified experts, and strong partnerships for deployment. Because of the program's earlier activities and the resources that had been developed, ITP was prepared to respond swiftly and effectively to the sudden need to promote improved industrial energy efficiency. Because of anticipated supply issues in the natural gas sector, the Save Energy Now initiative strategically focused on natural gas savings and targeted the

  11. Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries

    Science.gov (United States)

    Atun, Rifat

    2017-01-01

    Introduction Improving health systems performance, especially in low-resource settings facing complex disease burdens, can improve population health. Specifically, the efficiency and effectiveness of supply chains and procurement processes for pharmaceuticals, vaccines and other health products has important implications for health system performance. Pharmaceuticals, vaccines and other health products make up a large share of total health expenditure in low-income and middle-income countries (LMICs), and they are critical for delivering health services. Therefore, programmes which achieve cost savings on these expenditures may help improve a health system's efficiency, whereas programmes that increase availability of health products may improve a health system's effectiveness. This systematic review investigates whether changes to supply chains and procurement processes can achieve cost savings and/or improve the availability of drugs in LMICs. Methods Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL and the Health Economic Evaluation Database to identify. Results We identified 1264 articles, of which 38 were included in our study. We found evidence that centralised procurement and tendering can achieve direct cost savings, while supply chain management programmes can reduce drug stock outs and increase drug availability for populations. Conclusions This research identifies a broad set of programmes which can improve the ways that health systems purchase and delivery health products. On the basis of this evidence, policymakers and programme managers should examine the root causes of inefficiencies in pharmaceutical supply chain and procurement processes in order to determine how best to improve health systems performance in their specific contexts. PMID:28589028

  12. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... TV Contact and Feedback Form Download Instructions Explorer: Right-click on the link, choose "Save target as…", save file in desired location. Firefox/Chrome: Right-click on the link, choose "Save link as…", ...

  13. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... and public health professionals. More > Hand Hygiene Saves Lives (5:10) Recommend on Facebook Tweet Share Compartir Hand Hygiene Saves Lives Hand Hygiene Saves Lives Transcript [28 KB, 2 pages] High resolution [22. ...

  14. Hand Hygiene Saves Lives

    Science.gov (United States)

    ... and public health professionals. More > Hand Hygiene Saves Lives (5:10) Recommend on Facebook Tweet Share Compartir Hand Hygiene Saves Lives Hand Hygiene Saves Lives Transcript [28 KB, 2 pages] High resolution [22. ...

  15. RESTful NET

    CERN Document Server

    Flanders, Jon

    2008-01-01

    RESTful .NET is the first book that teaches Windows developers to build RESTful web services using the latest Microsoft tools. Written by Windows Communication Foundation (WFC) expert Jon Flanders, this hands-on tutorial demonstrates how you can use WCF and other components of the .NET 3.5 Framework to build, deploy and use REST-based web services in a variety of application scenarios. RESTful architecture offers a simpler approach to building web services than SOAP, SOA, and the cumbersome WS- stack. And WCF has proven to be a flexible technology for building distributed systems not necessa

  16. Petri Nets

    Indian Academy of Sciences (India)

    Associate Professor of. Computer Science and. Automation at the Indian. Institute of Science,. Bangalore. His research interests are broadly in the areas of stochastic modeling and scheduling methodologies for future factories; and object oriented modeling. GENERAL I ARTICLE. Petri Nets. 1. Overview and Foundations.

  17. Petri Nets

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 4; Issue 8. Petri Nets - Overview and Foundations. Y Narahari. General Article Volume 4 Issue 8 August 1999 pp ... Author Affiliations. Y Narahari1. Department ot Computer Science and Automation, Indian Institute of Science, Bangalore 560 012, India.

  18. Demonstration of the Energy Component of the Installation Master Plan Using the Net Zero Energy Planner Tool: Cost and Performance Report

    Science.gov (United States)

    2015-12-11

    fossil fuel based energy to achieve a net zero fossil fuel energy status. Energy goals are achieved through synergy among energy use reduction in... fossil fuel based energy to achieve a net zero fossil fuel energy status. Energy goals will be achieved through synergy among energy use reduction in... fossil fuel use in new and renovated facilities by 2030 and to reduce overall facility energy usage by 30% by 2015 (EISA 2007).

  19. Crushing leads to waste disposal savings for FUSRAP

    Energy Technology Data Exchange (ETDEWEB)

    Darby, J. [Department of Energy, Oak Ridge, TN (United States)

    1997-02-01

    In this article the author discusses the application of a rock crusher as a means of implementing cost savings in the remediation of FUSRAP sites. Transportation and offsite disposal costs are at present the biggest cost items in the remediation of FUSRAP sites. If these debris disposal problems can be handled in different manners, then remediation savings are available. Crushing can result in the ability to handle some wastes as soil disposal problems, which have different disposal regulations, thereby permitting cost savings.

  20. Can peer support be cost saving? An economic evaluation of RAPSID: a randomized controlled trial of peer support in diabetes compared to usual care alone in East of England communities.

    Science.gov (United States)

    Wingate, La'Marcus; Graffy, Jonathan; Holman, Daniel; Simmons, David

    2017-01-01

    Diabetes peer support, where one person with diabetes helps others, may improve diabetes management. The objective of this study was to perform a cost analysis of peer support strategies used in RAndomized controlled trial of Peer Support in type 2 Diabetes. We performed a 2×2 factorial randomized cluster controlled trial in England. People with type 2 diabetes were invited to participate as either 'peer' or 'peer support facilitator' (PSF) through postal invitation predominantly from general practice. Clusters, based on local communities, were each randomly assigned to one arm of group, 1:1, both group and 1:1 or control interventions. The intervention was delivered over 8-12 months by trained PSFs, supported by monthly meetings with a diabetes nurse. Out-of-pocket expenses/service utilization were self-reported at baseline, midpoint and on trial completion. Intervention costs were collated. Non-hospital costs used National Health Service (NHS) reference costs. Hospital payments were obtained from one local commissioning group and mean payments calculated. The analysis employed a societal perspective. Costs were evaluated at the conclusion of the trial. Participants (n=1299) were recruited across 130 clusters. The four arms were well balanced and matched (60% male, mean diabetes duration 9.5 years, mean glycated haemoglobin (HbA1c) 7.4+/-1.3%, 17% insulin treated). Implementation costs at 2013 rates were £13.84/participant/annum, participant out-of-pocket expenses for any intervention were £11.41/participant/annum and the NHS-incurred costs were reduced by £138.38/participant/annum. Savings for the 1:1, group and any intervention were £233.65, £90.52 and £113.13/participant/annum, respectively. We conclude that both 1:1 and group diabetes peer support over 8-12 months are cost saving in this setting, although much of the benefit is largely derived by differences in self-reported healthcare utilization. Long-term benefits should be investigated. ISRCTN

  1. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... Save link as…", save file in desired location. Safari: Right-click or command-click on the link, ... Save link as…", save file in desired location. Safari: Right-click or command-click on the link, ...

  2. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... target as…", save file in desired location. Firefox/Chrome: Right-click on the link, choose "Save link ... target as…", save file in desired location. Firefox/Chrome: Right-click on the link, choose "Save link ...

  3. Technical Support Document: Strategies for 50% Energy Savings in Large Office Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Leach, M.; Lobato, C.; Hirsch, A.; Pless, S.; Torcellini, P.

    2010-09-01

    This Technical Support Document (TSD) documents technical analysis that informs design guidance for designing and constructing large office buildings that achieve 50% net site energy savings over baseline buildings defined by minimal compliance with respect to ANSI/ASHRAE/IESNA Standard 90.1-2004. This report also represents a step toward developing a methodology for using energy modeling in the design process to achieve aggressive energy savings targets. This report documents the modeling and analysis methods used to identify design recommendations for six climate zones that capture the range of U.S. climate variability; demonstrates how energy savings change between ASHRAE Standard 90.1-2007 and Standard 90.1-2004 to determine baseline energy use; uses a four-story 'low-rise' prototype to analyze the effect of building aspect ratio on energy use intensity; explores comparisons between baseline and low-energy building energy use for alternate energy metrics (net source energy, energy emissions, and energy cost); and examines the extent to which glass curtain construction limits achieve energy savings by using a 12-story 'high-rise' prototype.

  4. Savings Growth and the Path of Utility

    NARCIS (Netherlands)

    Hamilton, K.; Withagen, C.A.A.M.

    2007-01-01

    We derive an expression relating the change in instantaneous utility to the growth of net (genuine) saving in an economy with multiple stocks and externalities that maximizes welfare in the utilitarian sense. This result is then shown to hold for decentralized competitive efficient economies as

  5. Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries

    National Research Council Canada - National Science Library

    Siapka, Mariana; Remme, Michelle; Obure, Carol Dayo; Maier, Claudia B; Dehne, Karl L; Vassall, Anna

    2014-01-01

    To synthesize the data available--on costs, efficiency and economies of scale and scope--for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale...

  6. The Sequential Self-Selection Auction Mechanism for Selective Reenlistment Bonuses: Potential Cost Savings to the U.S. Marine Corps

    National Research Council Canada - National Science Library

    Bock, Paul B

    2007-01-01

    ...). The S3AM greatly reduces the payment of economic rent. The payment of economic rent is limited because the Marine Corps would only pay Marines a monetary sum that more closely corresponds to their active duty opportunity cost...

  7. Final Technical Report - Autothermal Styrene Manufacturing Process with Net Export of Energy

    Energy Technology Data Exchange (ETDEWEB)

    Trubac, Robert , E.; Lin, Feng; Ghosh, Ruma: Greene, Marvin

    2011-11-29

    The overall objectives of the project were to: (a) develop an economically competitive processing technology for styrene monomer (SM) that would reduce process energy requirements by a minimum 25% relative to those of conventional technology while achieving a minimum 10% ROI; and (b) advance the technology towards commercial readiness. This technology is referred to as OMT (Oxymethylation of Toluene). The unique energy savings feature of the OMT technology would be replacement of the conventional benzene and ethylene feedstocks with toluene, methane in natural gas and air or oxygen, the latter of which have much lower specific energy of production values. As an oxidative technology, OMT is a net energy exporter rather than a net energy consumer like the conventional ethylbenzene/styrene (EB/SM) process. OMT plants would ultimately reduce the cost of styrene monomer which in turn will decrease the costs of polystyrene making it perhaps more cost competitive with competing polymers such as polypropylene.

  8. Household Saving in Australia

    OpenAIRE

    Richard Finlay; Fiona Price

    2014-01-01

    This paper investigates household saving behaviour in Australia, as well as the drivers behind the recent rise in the aggregate household saving ratio. Our results explaining differences in saving behaviour across households are consistent with theory and previous findings. As might be expected, households' saving ratios tend to increase with income, but decrease with wealth and gearing. Financially constrained and migrant households tend to save more than other households, all else equal. Wh...

  9. Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients

    Directory of Open Access Journals (Sweden)

    KS Rathod

    2017-10-01

    Full Text Available Introduction Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Methods This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups. Results In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan–Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201. Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73–1.39, which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79–1.56 including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71–1.44. Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000. Conclusion This observational data suggest that eptifibatide is associated with similar

  10. Type C distal radial fractures treated with conventional AO plates: an easy and cost-saving solution in a locking plate era.

    Science.gov (United States)

    Twigt, Bas; Bemelman, Michael; Lansink, Koen; Leenen, Loek

    2013-03-01

    C-type distal radial fractures remain challenging fractures. Currently locking plates are very popular because of their length preserving, stability. A considerable drawback is the high cost. Since 2003 we have been using mini AO plates (2.7 mm) as an alternative. We analysed our results and performed a cost analysis. Retrospective analysis was performed of all patients operated upon between 2003 and 2008 for C type distal radius fractures. Reduction was achieved with mini AO plates, applied in a buttress fashion, with ligamentotaxis. Rehabilitation consisted of immediate mobilisation. Pre- and postoperative X-rays, operative results and patient charts were reviewed. Furthermore, we prospectively evaluated the functional results using VAS, DASH and Mayo wrist scores. Lastly, we assessed the implant costs and compared them to locking plates. Thirty-four patients were treated with a mean age of 49 years. Mean radial shortening improved 2 mm; dorsal and radial angulation improved 23 and 4°, respectively. At consolidation (eight weeks) the average radial shortening was 0.75 mm, a volar angulation of 3°, and 21° of radial angulation. Functional results were excellent, demonstrated by a mean VAS score less than 1, a DASH score of 12 and a Mayo wrist score of 87. Compared to locking plates, there was an overall reduction in material costs of 15,300 Euro. Our technique has excellent biomechanical stability, enabling immediate functional rehabilitation, good anatomical and functional outcome with significantly lower costs.

  11. Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries.

    Science.gov (United States)

    Siapka, Mariana; Remme, Michelle; Obure, Carol Dayo; Maier, Claudia B; Dehne, Karl L; Vassall, Anna

    2014-07-01

    To synthesize the data available--on costs, efficiency and economies of scale and scope--for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries. The relevant peer-reviewed and "grey" literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence. HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery--which is, potentially, more efficient than the implementation of stand-alone services--should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost-effectiveness of each service-delivery model.

  12. Irbesartan is projected to be cost and life saving in a Spanish setting for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria

    NARCIS (Netherlands)

    Palmer, AJ; Annemans, L; Roze, S; Lapuerta, P; Chen, R; Gabriel, S; Carita, P; Rodby, RA; de Zeeuw, D; Parving, HH; De Alvaro, F

    Objectives. The purpose of this study was to project the cumulative incidence of end-stage renal disease (ESRD), life expectancy, and costs in a Spanish setting of treating patients with diabetes, hypertension, and microalbuminuria with either standard hypertension treatment alone or standard

  13. Cost management and potential savings in composting. 56th information discussion, Magdeburg, November 1997; Kostenmanagement und Einsparpotentiale bei der Kompostierung. 56. Informationsgespraech in Magdeburg im November 1997

    Energy Technology Data Exchange (ETDEWEB)

    Hangen, H.O. [comp.

    1997-12-31

    This workshop focussed on economic aspects of composting and danaerobic digestion of biological waste. Cost optimisation, methods, and ecological aspects are discussed for several facilities in the Federal Republic of Germany. (SR) [Deutsch] Thema dieses Workshops waren Wirtschaftlichkeitsbetrachtungen auf dem Sektor der Kompostierung und Vergaerung von Bioabfall. Hierbei werden die Kostenoptimierung, verschiedene Verfahren und oekologische Gesichtpunkte am Beispiel verschiedener Anlagen in der Bundesrepublik Deutschland betrachtet. (SR)

  14. Energy Savings from GSA's National Deep Retrofit Program

    Energy Technology Data Exchange (ETDEWEB)

    Shonder, John A [ORNL

    2014-09-01

    Under its National Deep Energy Retrofit (NDER) program, the U.S. General Services Administration (GSA) awarded 10 ESPC projects with the objectives of using innovative technologies and renewable energy technologies, and moving buildings toward net zero energy consumption. This report analyzes data on energy savings from the 10 NDER projects, and compares them with the savings of a sample of other recently awarded Federal ESPC projects. It is shown that by emphasizing the need for deeper energy savings, and by the establishment of a central Project Management Office (PMO) to provide authoritative contracting, technical and pricing assistance, the NDER projects achieved an average level of savings more than twice that of the other Federal ESPC projects. The level of savings achieved in each project seems to be dependent more on the availability of ECMs at the site than on energy price, energy cost per square foot, pre-retrofit EUI or the length of the contract term. This suggests that GSA can achieve similar results in a wide variety of building

  15. The conservation nexus: valuing interdependent water and energy savings in Arizona.

    Science.gov (United States)

    Bartos, Matthew D; Chester, Mikhail V

    2014-02-18

    Water and energy resources are intrinsically linked, yet they are managed separately--even in the water-scarce American southwest. This study develops a spatially explicit model of water-energy interdependencies in Arizona and assesses the potential for cobeneficial conservation programs. The interdependent benefits of investments in eight conservation strategies are assessed within the context of legislated renewable energy portfolio and energy efficiency standards. The cobenefits of conservation are found to be significant. Water conservation policies have the potential to reduce statewide electricity demand by 0.82-3.1%, satisfying 4.1-16% of the state's mandated energy-efficiency standard. Adoption of energy-efficiency measures and renewable generation portfolios can reduce nonagricultural water demand by 1.9-15%. These conservation cobenefits are typically not included in conservation plans or benefit-cost analyses. Many cobenefits offer negative costs of saved water and energy, indicating that these measures provide water and energy savings at no net cost. Because ranges of costs and savings for water-energy conservation measures are somewhat uncertain, future studies should investigate the cobenefits of individual conservation strategies in detail. Although this study focuses on Arizona, the analysis can be extended elsewhere as renewable portfolio and energy efficiency standards become more common nationally and internationally.

  16. ARC Code TI: Save

    Data.gov (United States)

    National Aeronautics and Space Administration — Save is a framework for implementing highly available network-accessible services. Save consists of a command-line utility and a small set of extensions for the...

  17. 'Nurture the sprouting bud; do not uproot it'. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda.

    Science.gov (United States)

    Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Muhumuza Kananura, Rornald; Mutebi, Aloysius; Jane, Pacuto; Tumuhairwe, Juliet; Tetui, Moses; Kiwanuka, Suzanne N

    2017-08-01

    Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members' access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members' views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like 'a sprouting bud that needs to be nurtured rather than uprooted', as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.

  18. ‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

    Science.gov (United States)

    Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Muhumuza Kananura, Rornald; Mutebi, Aloysius; Jane, Pacuto; Tumuhairwe, Juliet; Tetui, Moses; Kiwanuka, Suzanne N

    2017-01-01

    ABSTRACT Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with

  19. Effects of changing mosquito host searching behaviour on the cost effectiveness of a mass distribution of long-lasting, insecticidal nets : a modelling study

    OpenAIRE

    Briët, Olivier JT; Chitnis, Nakul

    2013-01-01

    Background The effectiveness of long-lasting, insecticidal nets (LLINs) in preventing malaria is threatened by the changing biting behaviour of mosquitoes, from nocturnal and endophagic to crepuscular and exophagic, and by their increasing resistance to insecticides. Methods Using epidemiological stochastic simulation models, we studied the impact of a mass LLIN distribution on Plasmodium falciparum malaria. Specifically, we looked at impact in terms of episodes prevented during the effective...

  20. Fatalism and Savings

    OpenAIRE

    Stephen, Wu; Joel, Shapiro

    2010-01-01

    We examine the impact of fatalism, the belief that one has little or no control over future events, on the decision of whether or not to save. We develop a model that predicts that fatalism decreases savings for moderately risk averse individuals, increases savings for highly risk averse individuals, and otherwise has no impact. Furthermore, fatalism decreases effort in learning about savings and investment options. We use data from National Longitudinal Survey of Youth (NLSY) and find genera...

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

    Directory of Open Access Journals (Sweden)

    Urmas Kaarlep

    2017-05-01

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

  2. Energy savings in Polish buildings

    Energy Technology Data Exchange (ETDEWEB)

    Markel, L.C.; Gula, A.; Reeves, G.

    1995-12-31

    A demonstration of low-cost insulation and weatherization techniques was a part of phase 1 of the Krakow Clean Fossil Fuels and Energy Efficient Project. The objectives were to identify a cost-effective set of measures to reduce energy used for space heating, determine how much energy could be saved, and foster widespread implementation of those measures. The demonstration project focused on 4 11-story buildings in a Krakow housing cooperative. Energy savings of over 20% were obtained. Most important, the procedures and materials implemented in the demonstration project have been adapted to Polish conditions and applied to other housing cooperatives, schools, and hospitals. Additional projects are being planned, in Krakow and other cities, under the direction of FEWE-Krakow, the Polish Energie Cities Network, and Biuro Rozwoju Krakowa.

  3. Energy and Cost Saving of a Photovoltaic-Phase Change Materials (PV-PCM System through Temperature Regulation and Performance Enhancement of Photovoltaics

    Directory of Open Access Journals (Sweden)

    Ahmad Hasan

    2014-03-01

    Full Text Available The current research seeks to maintain high photovoltaic (PV efficiency and increased operating PV life by maintaining them at a lower temperature. Solid-liquid phase change materials (PCM are integrated into PV panels to absorb excess heat by latent heat absorption mechanism and regulate PV temperature. Electrical and thermal energy efficiency analysis of PV-PCM systems is conducted to evaluate their effectiveness in two different climates. Finally costs incurred due to inclusion of PCM into PV system and the resulting benefits are discussed in this paper. The results show that such systems are financially viable in higher temperature and higher solar radiation environment.

  4. Utilization of agricultural residues of pineapple peels and sugarcane bagasse as cost-saving raw materials in Scenedesmus acutus for lipid accumulation and biodiesel production.

    Science.gov (United States)

    Rattanapoltee, Panida; Kaewkannetra, Pakawadee

    2014-07-01

    The aim of this study is to optimize the lipid accumulation in microalgae by using two agricultural residues of pineapple peels and sugarcane bagasse as low-cost organic carbon sources. Green microalgae Scenedesmus acutus was isolated and selected for cultivation. Effects of three initial sugar concentrations and the stage for adding sugar during cultivation on biomass and lipid production were investigated. The results clearly showed that two-stage cultivation is more suitable than one-stage. The maximum biomass concentration and productivity were obtained at 3.85 g/L and 160.42 mg/L/day when sugarcane bagasse was used. The highest lipid content and lipid yield was reached at 28.05 % and 0.93 g/L when pineapple peels were used, while in the case of sugarcane bagasse, 40.89 % and 1.24 g/L lipid content and yield were obtained. Lipid content was found in normal condition (autotrophic) at 17.71 % which was approximately 2.13-fold lower than when sugarcane bagasse was used (40.89 %). Biodiesel production via in situ transesterification was also investigated; the main fatty acids of palmitic acid and oleic acid were found. This work indicates that using agricultural residues as organic carbon sources could be able to increase lipid content and reduce the cost of biofuel production.

  5. Shared Savings Financing for College and University Energy Efficiency Investments.

    Science.gov (United States)

    Business Officer, 1984

    1984-01-01

    Shared savings arrangements for campus energy efficient investments are discussed. Shared savings is a term for an agreement in which a private company offers to implement an energy efficiency program, including capital improvements, in exchange for a portion of the energy cost savings. Attention is directed to: types of shared savings…

  6. The Importance of Powertrain Downsizing in a Benefit-Cost Analysis of Vehicle Lightweighting

    Science.gov (United States)

    Ward, J.; Gohlke, D.; Nealer, R.

    2017-04-01

    Reducing vehicle weight is an important avenue to improve energy efficiency and decrease greenhouse gas emissions from our cars and trucks. Conventionally, models have estimated acceptable increased manufacturing cost as proportional to the lifetime fuel savings associated with reduced vehicle weight. Vehicle lightweighting also enables a decrease in powertrain size and significant reductions in powertrain cost. Accordingly, we propose and apply a method for calculating the maximum net benefits and breakeven cost of vehicle lightweighting that considers both efficiency and powertrain downsizing for a conventional internal combustion engine vehicle, a battery electric vehicle with a range of 300 miles (BEV300), and a fuel cell electric vehicle (FCEV). We find that excluding powertrain downsizing cost savings undervalues the potential total net benefits of vehicle lightweighting, especially for the BEV300 and FCEV.

  7. On savings ratio.

    OpenAIRE

    Xiaochuan, Z.

    2011-01-01

    This paper explores the factors that affect saving and consumption behaviours, in a context where some believe that the high savings ratio of the East Asia and oil-producing countries is one major cause for the global imbalances and the crisis. The paper elaborates on the factors behind the high savings ratios in East Asia and oil producing countries and low savings ratios in the United States. It argues that the high savings in East Asia can mainly be explained by cultural and structural fac...

  8. The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model

    Science.gov (United States)

    Kahn, James G.; Jiwani, Aliya; Gomez, Gabriela B.; Hawkes, Sarah J.; Chesson, Harrell W.; Broutet, Nathalie; Kamb, Mary L.; Newman, Lori M.

    2014-01-01

    Background Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million disability-adjusted life years (DALYs) and $309 million in medical costs. Syphilis screening and treatment is simple, effective, and affordable, yet, worldwide, most pregnant women do not receive these services. We assessed cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in various programmatic, epidemiologic, and economic contexts. Methods and Findings We modeled the cost, health impact, and cost-effectiveness of expanded syphilis screening and treatment in ANC, compared to current services, for 1,000,000 pregnancies per year over four years. We defined eight generic country scenarios by systematically varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare. We calculated program and net costs, DALYs averted, and net costs per DALY averted over four years in each scenario. Program costs are estimated at $4,142,287 – $8,235,796 per million pregnant women (2010 USD). Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program averts an estimated 5,754 – 93,484 DALYs, yielding net savings in four scenarios, and a cost per DALY averted of $24 – $111 in the four scenarios with net costs. Results were robust in sensitivity analyses. Conclusions Eliminating MTCT of syphilis through expanded screening and treatment in ANC is likely to be highly cost-effective by WHO-defined thresholds in a wide range of settings. Countries with high prevalence, low current service coverage, and high healthcare cost would benefit most. Future analyses can be

  9. Retirement plans, personal saving, and saving adequacy.

    Science.gov (United States)

    Yakoboski, P

    2000-03-01

    This Issue Brief addresses three questions raised by recent trends in personal saving: How are national savings measured and what is the meaning of the trends in measured personal saving rates, given what is included and what is not included in those measures? What is the effect of retirement saving programs--in particular, 401(k) plans and individual retirement accounts (IRAs)--on personal saving levels? What are the implications of existing saving behavior for the retirement income security of today's workers? The National Income and Product Accounts (NIPA), the most commonly referenced gauge of personal saving, is a widely misunderstood measure. One could argue that a complete measure of saving would include increases in wealth through capital gains, but NIPA does not factor accrued and realized capital gains on stocks and other assets into the saving rate. By one measure, accounting for capital gains results in an aggregate personal saving rate of 33 percent--more than double the rate of four decades ago. A major policy question is the impact of tax-qualified retirement saving plans (i.e., IRAs and 401(k) plans) on personal saving rates. Empirical analysis of this issue is extremely challenging and findings have been contradictory. These programs now represent an enormous store of retirement-earmarked wealth in tax-deferred vehicles: Combined, such tax-deferred retirement accounts currently have assets of about $4 trillion. Ninety percent of IRA contributions are now the result of "rollovers" as employees leave employer plans, like 401(k) plans. While leakage from the system remains a challenge, the majority of the assets in the system can be expected to be available to fund workers' retirements. One could argue that, from a retirement income security perspective, workers in general are better off because IRA and 401(k) programs exist. Surely, many of the dollars in these programs would have been saved even without the programs; but they would not necessarily

  10. Negative predictive value and potential cost savings of acute nuclear myocardial perfusion imaging in low risk patients with suspected acute coronary syndrome: A prospective single blinded study

    Directory of Open Access Journals (Sweden)

    Björk Jonas

    2009-06-01

    Full Text Available Abstract Background Previous studies from the USA have shown that acute nuclear myocardial perfusion imaging (MPI in low risk emergency department (ED patients with suspected acute coronary syndrome (ACS can be of clinical value. The aim of this study was to evaluate the utility and hospital economics of acute MPI in Swedish ED patients with suspected ACS. Methods We included 40 patients (mean age 55 ± 2 years, 50% women who were admitted from the ED at Lund University Hospital for chest pain suspicious of ACS, and who had a normal or non-ischemic ECG and no previous myocardial infarction. All patients underwent MPI from the ED, and the results were analyzed only after patient discharge. The current diagnostic practice of admitting the included patients for observation and further evaluation was compared to a theoretical "MPI strategy", where patients with a normal MPI test would have been discharged home from the ED. Results Twenty-seven patients had normal MPI results, and none of them had ACS. MPI thus had a negative predictive value for ACS of 100%. With the MPI strategy, 2/3 of the patients would thus have been discharged from the ED, resulting in a reduction of total hospital cost by some 270 EUR and of bed occupancy by 0.8 days per investigated patient. Conclusion Our findings in a Swedish ED support the results of larger American trials that acute MPI has the potential to safely reduce the number of admissions and decrease overall costs for low-risk ED patients with suspected ACS.

  11. COST IMPACT OF ROD CONSOLIDATION ON THE VIABILITY ASSESSMENT DESIGN

    Energy Technology Data Exchange (ETDEWEB)

    D. Lancaster

    1999-03-29

    The cost impact to the Civilian Radioactive Waste Management System of using rod consolidation is evaluated. Previous work has demonstrated that the fuel rods of two assemblies can be packed into a canister that can fit into the same size space as that used to store a single assembly. The remaining fuel assembly hardware can be compacted into the same size canisters with a ratio of 1 hardware canister per each 6 to 12 assemblies. Transportation casks of the same size as currently available can load twice the number of assemblies by placing the compacted assemblies in the slots currently designed for a single assembly. Waste packages similarly could contain twice the number of assemblies; however, thermal constraints would require considering either a low burnup or cooling. The analysis evaluates the impact of rod consolidation on CRWMS costs for consolidation at prior to transportation and for consolidation at the Monitored Geological Repository surface facility. For this study, no design changes were made to either the transport casks or waste packages. Waste package designs used for the Viability Assessment design were employed but derated to make the thermal limits. A logistics analysis of the waste was performed to determine the number of each waste package with each loading. A review of past rod consolidation experience found cost estimates which range from $10/kgU to $32/kgU. $30/kgU was assumed for rod consolidation costs prior to transportation. Transportation cost savings are about $17/kgU and waste package cost savings are about $21/kgU. The net saving to the system is approximately $500 million if the consolidation is performed prior to transportation. If consolidation were performed at the repository surface facilities, it would cost approximately $15/kgU. No transportation savings would be realized. The net savings for consolidation at the repository site would be about $400 million dollars.

  12. Comparative Cost-Benefit Analysis of Renewable Energy Resource Trade Offs for Military Installations

    Science.gov (United States)

    2012-12-01

    issue is the current methodologies used through engineering analysis to calculate the energy cost savings. They do not show the unobserved costs or...individual buildings that are capable of producing net- zero capacity. In other words, designing and constructing buildings that are each capable of...to transport while attached, so they are normally transported separately. The nacelle is where the internal high dollar valuable components are

  13. Building America Residential System Research Results: Achieving 30% Whole House Energy Savings Level in Cold Climates

    Energy Technology Data Exchange (ETDEWEB)

    Building Industry Research Alliance (BIRA); Building Science Consortium (BSC); Consortium for Advanced Residential Buildings (CARB); Florida Solar Energy Center (FSEC); IBACOS; National Renewable Energy Laboratory (NREL)

    2006-08-01

    The Building America program conducts the system research required to reduce risks associated with the design and construction of homes that use an average of 30% to 90% less total energy for all residential energy uses than the Building America Research Benchmark, including research on homes that will use zero net energy on annual basis. To measure the program's progress, annual research milestones have been established for five major climate regions in the United States. The system research activities required to reach each milestone take from 3 to 5 years to complete and include research in individual test houses, studies in pre-production prototypes, and research studies with lead builders that provide early examples that the specified energy savings level can be successfully achieved on a production basis. This report summarizes research results for the 30% energy savings level and demonstrates that lead builders can successfully provide 30% homes in Cold Climates on a cost-neutral basis.

  14. 'Pre-endoscopy point of care test (Simtomax- IgA/IgG-Deamidated Gliadin Peptide) for coeliac disease in iron deficiency anaemia: diagnostic accuracy and a cost saving economic model'.

    Science.gov (United States)

    Lau, Michelle Shui Yee; Mooney, Peter; White, William; Appleby, Victoria; Moreea, Sulleman; Haythem, Ismail; Elias, Joshua; Bundhoo, Kiran; Corbett, Gareth; Wong, Liam; Tsai, Her Hsin; Cross, Simon; Hebden, John; Hoque, Sami; Sanders, David

    2016-09-15

    International guidelines recommend coeliac serology in iron deficiency anaemia, and duodenal biopsy for those tested positive to detect coeliac disease. However, pre-endoscopy serology is often unavailable, thus committing endoscopists to take routine duodenal biopsies. Some endoscopists consider duodenal biopsy mandatory in anaemia to exclude other pathologies. We hypothesise that using a point of care test at endoscopy could fill this gap, by providing rapid results to target anaemic patients who require biopsies, and save costs by biopsy avoidance. We therefore assessed three key aspects to this hypothesis: 1) the availability of pre-endoscopy serology in anaemia; 2) the sensitivities and cost effectiveness of pre-endoscopy coeliac screening with Simtomax in anaemia; 3) whether other anaemia-related pathologies could be missed by this targeted-biopsy approach. Group 1: pre-endoscopy serology availability was retrospectively analysed in a multicentre cohort of 934 anaemic patients at 4 UK hospitals. Group 2: the sensitivities of Simtomax, endomysial and tissue-transglutaminase antibodies were compared in 133 prospectively recruited patients with iron deficiency anaemia attending for a gastroscopy. The sensitivities were measured against duodenal histology as the reference standard in all patients. The cost effectiveness of Simtomax was calculated based on the number of biopsies that could have been avoided compared to an all-biopsy approach. Group 3: the duodenal histology of 153 patients presenting to a separate iron deficiency anaemia clinic were retrospectively reviewed. In group 1, serology was available in 361 (33.8 %) patients. In group 2, the sensitivity and negative predictive value (NPV) were 100 % and 100 % for Simtomax, 96.2 % and 98.9 % for IgA-TTG, and 84.6 % and 96.4 % for EMA respectively. In group 3, the duodenal histology found no causes for anaemia other than coeliac disease. Simtomax had excellent diagnostic accuracy in iron deficiency

  15. The Economic Value of PV and Net Metering to Residential Customers in California

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim; Barbose, Galen; Wiser, Ryan

    2010-05-17

    In this paper, we analyze the bill savings from PV for residential customers of the California's two largest electric utilities, under existing net metering tariffs as well as under several alternative compensation mechanisms. We find that economic value of PV to the customer is dependent on the structure of the underlying retail electricity rate and can vary quite significantly from one customer to another. In addition, we find that the value of the bill savings from PV generally declines with PV penetration level, as increased PV generation tends to offset lower-priced usage. Customers in our sample from both utilities are significantly better off with net metering than with a feed-in tariff where all PV generation is compensated at long-run avoided generation supply costs. Other compensation schemeswhich allow customers to displace their consumption with PV generation within each hour or each month, and are also based on the avoided costs, yield similar value to the customer as net metering.

  16. The health of safety net hospitals following Massachusetts health care reform: changes in volume, revenue, costs, and operating margins from 2006 to 2009.

    Science.gov (United States)

    Mohan, Arun; Grant, Jennifer; Batalden, Maren; McCormick, Danny

    2013-01-01

    Massachusetts health care reform, designed to expand coverage and access to care for vulnerable populations, serves as the model for national health reform in the United States that will be implemented in 2014. Yet, little is known about how the reform may have affected the demand for and the financial performance of safety net hospitals (SNH), the primary source of care for such populations before the reform. Using a quasi-experimental design that included all acute care hospitals in the state, we calculated changes in mean inpatient and outpatient volumes, revenue, and operating margins at SNH from the pre-reform (Fiscal Year 2006) to the post-reform (Fiscal Year 2009) period. We contrasted these changes with contemporaneous changes occurring among non-safety net hospitals (NSNH) using a difference-in-differences approach. We found that SNH in Massachusetts continue to play a disproportionately large role in caring for disadvantaged patients after reform, but that their financial performance has declined considerably compared with NSNH. Ongoing reform efforts in the United States should account for continued SNH demand among the most vulnerable patients and should be designed so as not to undermine the financial stability of SNH that meet this demand.

  17. Defining The Energy Saving Potential of Architectural Design

    DEFF Research Database (Denmark)

    Naboni, Emanuele; Malcangi, Antonio; Zhang, Yi

    2015-01-01

    behaviour. The research shows the best solution for each of the climates and compares them with Olgyay´s findings. Finally, for each climate the energy saving potential is defined and then compared to Lechner's conclusions. Defining The Energy Saving Potential of Architectural Design (PDF Download Available......Designers, in response to codes or voluntary " green building " programs, are increasingly concerned with building energy demand reduction, but they are not fully aware of the energy saving potential of architectural design. According to literature, building form, construction and material choices......). Available from: https://www.researchgate.net/publication/279885641_Defining_The_Energy_Saving_Potential_of_Architectural_Design [accessed Jan 21, 2016]....

  18. Insomnia - treatment pathways, costs and quality of life

    Directory of Open Access Journals (Sweden)

    O'Keeffe Karyn M

    2011-06-01

    Full Text Available Abstract Background Insomnia is perhaps the most common sleep disorder in the general population, and is characterised by a range of complaints around difficulties in initiating and maintaining sleep, together with impaired waking function. There is little quantitative information on treatment pathways, costs and outcomes. The aims of this New Zealand study were to determine from which healthcare practitioners patients with insomnia sought treatment, treatment pathways followed, the net costs of treatment and the quality of life improvements obtained. Methods The study was retrospective and prevalence based, and was both cost effectiveness (CEA and a cost utility (CUA analysis. Micro costing techniques were used and a societal analytic perspective was adopted. A deterministic decision tree model was used to estimate base case values, and a stochastic version, with Monte Carlo simulation, was used to perform sensitivity analysis. A probability and cost were attached to each event which enabled the costs for the treatment pathways and average treatment cost to be calculated. The inputs to the model were prevalence, event probabilities, resource utilisations, and unit costs. Direct costs and QALYs gained were evaluated. Results The total net benefit of treating a person with insomnia was $482 (the total base case cost of $145 less health costs avoided of $628. When these results were applied to the total at-risk population in New Zealand additional treatment costs incurred were $6.6 million, costs avoided $28.4 million and net benefits were $21.8 million. The incremental net benefit when insomnia was "successfully" treated was $3,072 per QALY gained. Conclusions The study has brought to light a number of problems relating to the treatment of insomnia in New Zealand. There is both inadequate access to publicly funded treatment and insufficient publicly available information from which a consumer is able to make an informed decision on the treatment

  19. Using EasyMatch® to anticipate the identification of an HLA identical unrelated donor: A validated efficient time and cost saving method.

    Science.gov (United States)

    Dubois, Valérie; Detrait, Marie; Sobh, Mohamad; Morisset, Stéphane; Labussière, Hélène; Giannoli, Catherine; Nicolini, Franck; Moskovtchenko, Philippe; Mialou, Valérie; Ducastelle, Sophie; Rey, Sylvie; Thomas, Xavier; Barraco, Fiorenza; Tedone, Nathalie; Marry, Evelyne; Garnier, Federico; Bertrand, Yves; Michallet, Mauricette

    2016-11-01

    In the absence of an HLA matched familial donor, a search for an unrelated donor or cord blood unit is initiated through worldwide registries. Although a first look-up on available HLA information of donors in the "book" at BMDW (Bone Marrow Donor Worldwide) can provide a good estimation of the number of compatible donors, the variety of resolution typing levels requires confirmatory typing (CT) which are expensive and time consuming. In order to help recipient centers in their work. The French donor registry (France Greffe de Moelle/Agence de la Biomedecine) has recently developed a software program called "EasyMatch®" that uses haplotype frequencies to compute the likelihood of phenotypic match in donors according to various typing resolution levels. The goal of our study is to report a single monocentric user-experience with EasyMatch®, demonstrating that its routine use reduced the cost and the delay of the donor search in our center, allowing the definition of a new strategy to search compatible unrelated donors. The strategy was first established on a retrospective cohort of 217 recipients (185 adults and 32 children=before score) and then validated on a prospective cohort of 171 recipients (160 adults and 11 children=after score). For all patients, we calculated the delay between the registration day and the donor identification day, and the number of CT requested to the donor centre. Considering both groups, we could observe a significant decrease of the number of CT from 8 to 2 (p<0,001), and a significant decrease of the median delay to identify a suitable donor from 43 to 31days (p<0.0001). EasyMatch® estimates the number of potentially identical donors, but doesn't foresee availability of the donors. It provides us an easy tracking of mismatches, an estimation of the number of potential donors, the selection of population following ethnic origin of patients and a high prediction when probability is high or low. It affords a new approach of donor

  20. An integrated tiered service delivery model (ITSDM based on local CD4 testing demands can improve turn-around times and save costs whilst ensuring accessible and scalable CD4 services across a national programme.

    Directory of Open Access Journals (Sweden)

    Deborah K Glencross

    Full Text Available The South African National Health Laboratory Service (NHLS responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART, has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT, to extend national coverage, improve local turn-around/(TAT and contain programmatic costs.NHLS Corporate Data Warehouse CD4 data, from 60-70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009-2012.An integrated tiered service delivery model (ITSDM is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (350-1500 tests/day, serving ≥ 200 health-clinics. Tier-6 provides national support for standardisation, harmonization and quality across the organization.The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service can facilitate sustainable 'full service coverage' across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers.

  1. Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya-a study protocol.

    Science.gov (United States)

    Gama, Elvis; Were, Vincent; Ouma, Peter; Desai, Meghna; Niessen, Louis; Buff, Ann M; Kariuki, Simon

    2016-11-21

    Historically, Kenya has used various distribution models for long-lasting insecticide-treated bed nets (LLINs) with variable results in population coverage. The models presently vary widely in scale, target population and strategy. There is limited information to determine the best combination of distribution models, which will lead to sustained high coverage and are operationally efficient and cost-effective. Standardised cost information is needed in combination with programme effectiveness estimates to judge the efficiency of LLIN distribution models and options for improvement in implementing malaria control programmes. The study aims to address the information gap, estimating distribution cost and the effectiveness of different LLIN distribution models, and comparing them in an economic evaluation. Evaluation of cost and coverage will be determined for 5 different distribution models in Busia County, an area of perennial malaria transmission in western Kenya. Cost data will be collected retrospectively from health facilities, the Ministry of Health, donors and distributors. Programme-effectiveness data, defined as the number of people with access to an LLIN per 1000 population, will be collected through triangulation of data from a nationally representative, cross-sectional malaria survey, a cross-sectional survey administered to a subsample of beneficiaries in Busia County and LLIN distributors' records. Descriptive statistics and regression analysis will be used for the evaluation. A cost-effectiveness analysis will be performed from a health-systems perspective, and cost-effectiveness ratios will be calculated using bootstrapping techniques. The study has been evaluated and approved by Kenya Medical Research Institute, Scientific and Ethical Review Unit (SERU number 2997). All participants will provide written informed consent. The findings of this economic evaluation will be disseminated through peer-reviewed publications. Published by the BMJ Publishing

  2. SAVED LEAVE BONUS

    CERN Multimedia

    Division des ressources humaines

    2000-01-01

    Staff members participating in the RSL programme are entitled to one additional day of saved leave for each full period of 20 days remaining in their saved leave account on 31 December 1999.Allowing some time for all concerned to make sure that their periods of leave taken in 1999 are properly registered, HR division will proceed with the crediting of the appropriate number of days in the saved leave accounts from 25 January 2000.Human Resources DivisionTel.73359

  3. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... Center (EOC) 101 Emergency Operations Center CDC Laboratory Science: Mission Critical Saving Lives, Protecting People Environmental Health CDC Tracking Network Health Begins at Home Smoke- ...

  4. Cost-effectiveness of a ROPS social marketing campaign.

    Science.gov (United States)

    Sorensen, J A; Jenkins, P; Bayes, B; Clark, S; May, J J

    2010-01-01

    Tractor rollovers are the most frequent cause of death in the farm community. Rollover protection structures (ROPS) can prevent the injuries and fatalities associated with these events; however, almost half of U.S. farms lack these essential devices. One promising strategy for increasing ROPS use is social marketing. The purpose of this study was to assess the costs associated with the New York ROPS Social Marketing Campaign in relation to the cost of fatalities and injuries averted as a result of the campaign to determine whether cost savings could be demonstrated in the initial years of program implementation. A total of 524 farmers who had retrofitted a tractor through the program were mailed a survey to assess the number of rollovers or close calls that occurred since ROPS installation. Responses were obtained from 382 farmers, two of whom indicated that they had a potential fatality/injury scenario since retrofitting their tractor through the program. The cost savings associated with the intervention was estimated using a decision-tree analysis adapted from Myers and Pana-Cryan with appropriate consumer price index adjustments. The data were compared to the cost of the New York ROPS Social Marketing Campaign to arrive at an associated cost-savings estimate relative to the intervention. This study indicates that a net savings will likely be demonstrated within the third year of the New York ROPS Social Marketing initiative. These data may provide evidence for researchers hoping to generate support from state and private agencies for similar initiatives.

  5. How to Save Money by Saving Energy.

    Science.gov (United States)

    Department of Energy, Washington, DC.

    This pamphlet presents energy conservation tips to help consumers save money. Conservation measures suggested here cover topics such as: (1) insulation; (2) space heating and cooling; (3) hot water heating; (4) cooking; (5) laundry; (6) lighting; (7) electrical appliances; (8) buying or building a home; and (9) buying, maintaining and driving a…

  6. Cost-threshold analyses of the National AIDS Demonstration Research HIV prevention interventions.

    Science.gov (United States)

    Pinkerton, S D; Holtgrave, D R; DiFranceisco, W; Semaan, S; Coyle, S L; Johnson-Masotti, A P

    2000-06-16

    The goal of the multisite National AIDS Demonstration Research (NADR) program was to reduce the sexual and drug injection-related HIV risks of out-of-treatment injection drug users and their sex partners. Previous analyses have established that the NADR interventions were effective at changing participants' risky behaviors. This study was to determine whether the NADR program also was cost-effective. Data from eight NADR study sites were included in the analysis. A mathematical model was used to translate reported sexual and injection-related behavior changes into an estimate of the number of infections prevented by the NADR interventions and then to calculate the corresponding savings in averted HIV/AIDS medical care costs and quality-adjusted years of life, assuming United States values for these parameters. Because cost data were not collected in the original NADR evaluation, the savings in averted medical care costs were compared with the cost of implementing a similar intervention program for injection drug users. The eight NADR interventions prevented approximately 129 infections among 6629 participants and their partners. Overall, the NADR program would be cost saving (i.e. provide net economic savings) if it cost less than US$2107 per person and would be cost-effective if it cost less than US$10,264 per person. Both of these estimates are considerably larger than the US$273 per person cost of the comparison intervention. There was substantial cross-site variability. The results of this analysis strongly suggest that the NADR interventions were cost-saving overall and were, at the very least, cost-effective at all eight sites. In the United States and other developed counties, investments in HIV-prevention interventions such as these have the potential to save substantial economic resources by averting HIV-related medical care expenses among injection drug users.

  7. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... As…", save file in desired location. About CDC-TV CDC-TV videos cover a variety of health, ... As…", save file in desired location. About CDC-TV CDC-TV videos cover a variety of health, ...

  8. Polish households’ saving strategies

    Directory of Open Access Journals (Sweden)

    Paulina Anioła

    2013-03-01

    Full Text Available The article presents the results of households’ saving strategies types classification. A cluster analysis method, based on households’ saving portfolio, was used for classification. Six types of strategies were distinguished: low risk, conservative, very passive, very conservative, diversification and aggressive.

  9. Potential energy savings

    DEFF Research Database (Denmark)

    Schultz, Jørgen Munthe

    1996-01-01

    This chapter describes the chosen methods for estimating the potential energy savings if ordinary window glazing is exchanged with aerogel glazing as well as commercial low-energy glazings.......This chapter describes the chosen methods for estimating the potential energy savings if ordinary window glazing is exchanged with aerogel glazing as well as commercial low-energy glazings....

  10. Plugging into Energy Savings.

    Science.gov (United States)

    Harrigan, Merrilee

    1999-01-01

    The nonprofit Alliance to Save Energy has been helping schools reduce energy consumption through a combination of retrofits, classroom instruction, and behavior. Lists eight small steps to big energy savings, among them: involve the whole school, stop leaks, turn off computers, and recycle. (MLF)

  11. Hand Hygiene Saves Lives

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    Full Text Available ... Download Linked File As…", save file in desired location. About CDC-TV CDC-TV videos cover a variety of health, safety and preparedness ... Download Linked File As…", save file in desired location. About CDC-TV CDC-TV videos cover a variety of health, safety and preparedness ...

  12. Cost effectiveness of the 1993 model energy code in New Jersey

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, R.G.

    1995-09-01

    This is an analysis of cost effectiveness the Council of American Building Officials` 1993 Model Energy Code (MEC) building thermal-envelope requirements for single-family houses and multifamily housing units in New Jersey. Goal was to compare the cost effectiveness of the 1993 MEC to the alternate allowed in the 1993 Building Officials & Code Administrators (BOCA) National Energy Conservation Code -- American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) Standard 90A-1980 -- based on a comparison of the costs and benefits associated with complying with each. This comparison was performed for Camden, New Brunswick; Somerville, and Sparta. The analysis was done for two different scenarios: a ``move-up`` home buyer purchasing a single-family house and a ``first-time`` financially limited home buyer purchasing a multifamily unit. For the single-family home buyer, compliance with the 1993 MEC was estimated to increase first costs by $1028 to $1564, resulting in an incremental down payment increase of $206 to $313 (at 20% down). The time when the homeowner realizes net cash savings (net positive cash flow) for houses built in accordance with the 1993 MEC was from 1 to 5 years. The home buyer who paid 20% down had recovered increases in down payments and mortgage payments in energy cost savings by the end of the fifth year or sooner and thereafter will save more money each year. For the multifamily unit home buyer first costs were estimated to increase by $121 to $223, resulting in an incremental down payment increase of $12 to $22 (at 10% down). The time when the homeowner realizes net cash savings (net positive cash flow) for houses built in accordance with the 1993 MEC was 1 to 3 years.

  13. Savings account for health care costs

    Science.gov (United States)

    ... who are self-employed and employees of small businesses (less than 50 employees), and their spouses. The ... J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of ...

  14. Realized Cost Savings and Avoidance Decisions

    Data.gov (United States)

    National Aeronautics and Space Administration — The OMB Office of the Chief Information Officer (OFCIO) has a long-standing practice of making information about Federal IT available to the public through various...

  15. Novel surface measurement system reading cost savings

    Energy Technology Data Exchange (ETDEWEB)

    Sword, M.

    1996-05-01

    A new state-of-the-art data acquisition system for the oil and natural gas industries is being marketed by OPSCO`92 Industries Ltd. The unit is portable, it measures surface data which is calibrated to bottom-hole conditions and designed to measure temperature and pressure information without the necessity of sending testing equipment downhole. The Surface Data System (SDS) uses silicon-crystal technology, is mounted in a suitcase size carrying case, and runs off a 12-volt battery enclosure which can be backed up by a small solar panel. The first generation system can handle 16 different channels of information input on a laptop computer. Pressure, pressure differential, temperature, frequency and pulse signals for flow meter measurements are handled by standard sensors. Areas of application include build-up and fall-off tests, pipeline evaluation, pre-frac tests, underbalanced drilling and gas well evaluation. 1 fig., 1 photo.

  16. EFFECTIVE SAVINGS IN PRODUCTION TIMES AND COST

    African Journals Online (AJOL)

    ES OBE

    e-mail:mcedeson@yahoo.com) ... into consideration their workshop temperatures for particular work-piece based, of course, on the .... the lamination in polyester resin of two car body components: (1) two sides of a car fender and (2) the floor ...

  17. EFFECTIVE SAVINGS IN PRODUCTION TIMES AND COST

    African Journals Online (AJOL)

    ES OBE

    time periods. 2.EXPERIMENTAL PROCEDURE. Materials. The following experiments were conducted in polyester resin matrix. (containing. 65% styrene) using hydroquinone as inhibitor; dimethyl aniline as accelerator and benzoyle peroxide as catalyst (see tables 1-6). Test Method. Six different tests were conducted each ...

  18. COST SAVING WITH ULTRASONOGRAPHY IN A DEVELOPING ...

    African Journals Online (AJOL)

    1999-05-05

    ) to the University of Gezira and this was placed in the Radiology Department in October 1986. Details of the ultrasound service in operation since then have been published previously(6). Eight hundred and sixty three ...

  19. EFFECTIVE SAVINGS IN PRODUCTION TIMES AND COST

    African Journals Online (AJOL)

    ES OBE

    controlling arm in production [4]. A minute error in the accelerator-to-resin percentage quantity required to achieve this purpose can ... tremendous wastes by way of down-time periods during handlay-up processes where applications of a second coat of resin would have to wait for the already applied coat to cure, And, in ...

  20. Tankering Fuel: A Cost Saving Initiative

    Science.gov (United States)

    2011-05-01

    Dakota US ANG NORTHCOM Hill AFB KHIF AF Utah US AFMC NORTHCOM Holloman AFB KHMN AF New Mexico US ACC NORTHCOM Holy Corp DESC Idaho US NULL NORTHCOM...NEWPORT NEWS WILLIAMSBURG INTL KPHF VA 3.587035 NIAGARA FALLS INTL KIAG NY 3.4684 NIAGARA FALLS INTL KIAG NY 3.4684 NINOY AQUINO INTL (COL JESUS A...3.653219 ST PETERSBURG CLEARWATER INTL KPIE FL 3.723219 ST. CROIX/HENRY E. ROHLSEN APT TISX OS 4.2308 ST. THOMAS /CYRIL E. KING APT TIST OS 3.9667

  1. Net neutrality and inflation of traffic

    NARCIS (Netherlands)

    Peitz, M.; Schütt, Florian

    Under strict net neutrality Internet service providers (ISPs) are required to carry data without any differentiation and at no cost to the content provider. We provide a simple framework with a monopoly ISP to evaluate the short-run effects of different net neutrality rules. Content differs in its

  2. Net Neutrality and Inflation of Traffic

    NARCIS (Netherlands)

    Peitz, M.; Schütt, F.

    2015-01-01

    Under strict net neutrality Internet service providers (ISPs) are required to carry data without any differentiation and at no cost to the content provider. We provide a simple framework with a monopoly ISP to evaluate different net neutrality rules. Content differs in its sensitivity to delay.

  3. Proton pump inhibitors: potential cost reductions by applying prescribing guidelines

    Directory of Open Access Journals (Sweden)

    Cahir Caitriona

    2012-11-01

    Full Text Available Abstract Background There are concerns that proton pump inhibitors (PPI are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing. Methods Retrospective population-based cohort study in the Republic of Ireland using the Health Services Executive (HSE Primary Care Reimbursement Services (PCRS pharmacy claims database. The HSE-PCRS scheme is means tested and provides free health care including medications to approximately 30% of the Irish population. Prescription items are WHO ATC coded and details of every drug dispensed and claimants’ demographic data are available. Potential cost savings (net ingredient cost were estimated according to UK NICE clinical guidelines for all HSE-PCRS claimants on PPI therapy for ≥3 consecutive months starting in 2007 with a one year follow up (n=167,747. Five scenarios were evaluated; (i change to PPI initiation (cheapest brand; and after 3 months (ii therapeutic switching (cheaper brand/generic equivalent; (iii dose reduction (maintenance therapy; (iv therapeutic switching and dose reduction and (v therapeutic substitution (H2 antagonist. Results Total net ingredient cost was €88,153,174 for claimants on PPI therapy during 2007. The estimated costing savings for each of the five scenarios in a one year period were: (i €36,943,348 (42% reduction; (ii €29,568,475 (34%; (iii €21,289,322 (24%; (iv €40,505,013 (46%; (v €34,991,569 (40%. Conclusion There are opportunities for substantial cost savings in relation to PPI prescribing if implementation of clinical guidelines in terms of generic substitution and step-down therapy is implemented on a national basis.

  4. Design and evaluation of modified screen net house for off-season vegetable raising in composite climate

    Energy Technology Data Exchange (ETDEWEB)

    Sethi, V.P. [Dept. of Mechanical Engineering, Punjab Agricultural Univ., Ludhiana 141004 (India); Dubey, R.K. [Dept. of Floriculture and Landscaping, Punjab Agricultural Univ., Ludhiana 141004 (India); Dhath, A.S. [Dept. of Vegetable Crops, Punjab Agricultural Univ., Ludhiana 141004 (India)

    2009-12-15

    Currently the use of conventional screen net houses for off-season vegetable raising in north India composite climate is not so effective and has many constructional and operational limitations like poor structural design, higher constructional cost, no greenhouse effect in winter and higher plant temperatures in summer. Similarly, the use of polyethylene sheet covered greenhouses also has problems like much higher constructional and operational costs and higher inside air temperatures in summers. In this study, modified designs of 500 m{sup 2} (one kanal) and 250 m{sup 2} (half kanal) screen net house have been presented particularly suitable for composite climate (where both winters as well as summers are harsh) as a replacement for conventional net house and polyethylene sheet covered greenhouse design. To make these designs low cost and more effective, low tunnels (covered with low density polyethylene sheet) have been designed and used in winter over the plant rows to generate localized greenhouse effect for faster plant growth. By doing so, average daily air temperature under the tunnels was raised about 9-10 C above the open field air temperature. In this way, huge cost of covering the net house or greenhouse during winter with costly polyethylene sheet could be saved. Similarly, in extreme summer when the ambient air temperature exceeded 40 C (during the fruiting stage of the crop) a 50% shade net was used inside the modified net house at 2.5 m height (instead of using active cooling system) resulting in 4-6 C drop in the plant temperature. Experimental evaluation of the modified net house was conducted during winter and summer months of year 2007-08 (December to June) by growing brinjal crop and compared with conventional net house, polyethylene sheet greenhouse and in open field condition. It was observed that due to the combined effect of low tunnels (in winter) and shade net (in summer), the micro-climatic parameters like air temperature, plant

  5. Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.

    Science.gov (United States)

    Stone, Alexander B; Grant, Michael C; Pio Roda, Claro; Hobson, Deborah; Pawlik, Timothy; Wu, Christopher L; Wick, Elizabeth C

    2016-03-01

    Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program. Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital. Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections. Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Energy savings in Danish residential building stock

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Svendsen, Svend

    2006-01-01

    A large potential for energy savings exists in the Danish residential building stock due to the fact that 75% of the buildings were constructed before 1979 when the first important demands for energy performance of building were introduced. It is also a fact that many buildings in Denmark face...... comprehensive renovations in the coming years and in connection with this renovation process energy saving measures can be implemented relatively inexpensive and cost effective. This opportunity should be used to insure the buildings in the future as far as energy consumption is concerned. This paper gives...... buildings representing the residential building stock and based on these calculations an assessment of the energy-saving potential is performed. A profitable savings potential of energy used for space heating of about 80% is identified over 45 years (until 2050) within the residential building stock...

  7. Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005–2010

    Directory of Open Access Journals (Sweden)

    Ni Mingjian J

    2012-07-01

    Full Text Available Abstract Background To quantify the contribution of locally implemented prevention programmes in contributing to reductions in treatment and care costs by averting HIV infections among those who inject drugs this study calculates net financial benefit of providing harm reduction programmes using information from services being implemented in Urumqi, Xinjiang Uighur Autonomous Region of China ( between 2005 and 2010. Methods Information was collected to assess cost of providing methadone treatment (MMT and needle and syringe programmes (NSP. HIV incidence was estimated among people who inject drugs (PWID. HIV infections averted were calculated. Net benefit was assessed by estimating costs of providing prevention programmes and comparing these to the costs of providing care. Results An estimated 5678 (range 3982–7599 HIV infections were averted between 2005 and 2010 and the net financial benefit of providing harm reduction programmes compared to treatment and care costs for HIV infections averted was USD 4.383 million during the same time period. Conclusion These results demonstrate the net and accumulating benefit of investing in harm reduction programmes for PWID in Urumqi. The return on investment progressively increased during the time period studied and it is clear that these cost savings will continue to accrue with the continued implementation of HIV prevention interventions in the community that include harm reduction programmes targeted at PWID.

  8. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants.

    Science.gov (United States)

    Ganapathy, Vaidyanathan; Hay, Joel W; Kim, Jae H

    2012-02-01

    This study evaluated the cost-effectiveness of a 100% human milk-based diet composed of mother's milk fortified with a donor human milk-based human milk fortifier (HMF) versus mother's milk fortified with bovine milk-based HMF to initiate enteral nutrition among extremely premature infants in the neonatal intensive care unit (NICU). A net expected costs calculator was developed to compare the total NICU costs among extremely premature infants who were fed either a bovine milk-based HMF-fortified diet or a 100% human milk-based diet, based on the previously observed risks of overall necrotizing enterocolitis (NEC) and surgical NEC in a randomized controlled study that compared outcomes of these two feeding strategies among 207 very low birth weight infants. The average NICU costs for an extremely premature infant without NEC and the incremental costs due to medical and surgical NEC were derived from a separate analysis of hospital discharges in the state of California in 2007. The sensitivity of cost-effectiveness results to the risks and costs of NEC and to prices of milk supplements was studied. The adjusted incremental costs of medical NEC and surgical NEC over and above the average costs incurred for extremely premature infants without NEC, in 2011 US$, were $74,004 (95% confidence interval, $47,051-$100,957) and $198,040 (95% confidence interval, $159,261-$236,819) per infant, respectively. Extremely premature infants fed with 100% human-milk based products had lower expected NICU length of stay and total expected costs of hospitalization, resulting in net direct savings of 3.9 NICU days and $8,167.17 (95% confidence interval, $4,405-$11,930) per extremely premature infant (p milk fortified with bovine milk-based supplements, a 100% human milk-based diet that includes mother's milk fortified with donor human milk-based HMF may result in potential net savings on medical care resources by preventing NEC.

  9. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... prepared for different audiences including, children, parents, and public health professionals. More > Hand Hygiene Saves Lives (5:10) ... prepared for different audiences including, children, parents, and public health professionals. More > File Formats Help: How do I ...

  10. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... is not supported by your browser. For this reason, some items on this page will be unavailable. ... CDC Laboratory Science: Mission Critical Saving Lives, Protecting People Environmental Health CDC Tracking Network Health Begins at ...

  11. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... 101 Emergency Operations Center CDC Laboratory Science: Mission Critical Saving Lives, Protecting People Environmental Health CDC Tracking ... Cultures Are Our Source of Health (:30) Systems Thinking The Value of Systems Thinking (10:09) Systems ...

  12. Hand Hygiene Saves Lives

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    Full Text Available ... public health professionals. More > Hand Hygiene Saves Lives (5:10) Recommend on Facebook Tweet Share Compartir Hand ... High resolution [22.9 MB] Open Captioned [14.5 MB] Request a higher resolution file Copy the ...

  13. Hand Hygiene Saves Lives

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    Full Text Available ... Center (EOC) 101 Emergency Operations Center CDC Laboratory Science: Mission Critical Saving Lives, Protecting People Environmental Health ... Break the Silence: Stop the Violence Injury Prevention Research In the Swim of Things Safe Teen Drivers ...

  14. Hand Hygiene Saves Lives

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    Full Text Available ... Critical Saving Lives, Protecting People Environmental Health CDC Tracking Network Health Begins at Home Smoke-free Multiunit ... The Story of Folic Acid Fortification Through the Eyes of the Eagle Wes Studi: Don’t Get ...

  15. Hand Hygiene Saves Lives

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    Full Text Available ... Obesity Epidemic Outbreaks CDC: Protecting Americans through Global Health Ebola and Contact Tracing Global Disease Detectives in ... Science: Mission Critical Saving Lives, Protecting People Environmental Health CDC Tracking Network Health Begins at Home Smoke- ...

  16. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... hospital while being treated for something else. The best way to help prevent infection is to practice proper hand hygiene. Hand Hygiene Saves Lives shows how patients can play an active role in reminding healthcare ...

  17. Hand Hygiene Saves Lives

    Medline Plus

    Full Text Available ... Please Parents Want To Do What′s Best The Obesity Epidemic Outbreaks CDC: Protecting Americans through Global Health ... best way to help prevent infection is to practice proper hand hygiene. Hand Hygiene Saves Lives shows ...

  18. The cost-effectiveness of three interventions for providing preventive services to low-income children.

    Science.gov (United States)

    Johnson, Ben; Serban, Nicoleta; Griffin, Paul M; Tomar, Scott L

    2017-12-01

    We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia. We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes. Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by Loan repa