WorldWideScience

Sample records for resource damage costs

  1. Natural resource damage assessment

    International Nuclear Information System (INIS)

    Seddelmeyer, J.

    1991-01-01

    The assessment and collection of natural resource damages from petroleum and chemical companies unfortunate enough to have injured publicly owned natural resources is perhaps the most rapidly expanding area of environmental liability. The idea of recovering for injury to publicly owned natural resources is an extension of traditional common law tort concepts under which a person who negligently injures another or his property is called upon to compensate the injured party. Normally, once liability has been established, it is a fairly straightforward matter to calculate the various elements of loss, such as the cost to repair or replace damaged property, or medical expenses, and lost income. More difficult questions, such as the amount to be awarded for pain and suffering or emotional distress, are left to the jury, although courts limit the circumstances in which the jury is permitted to award such damages

  2. Modeling of response, socioeconomic, and natural resource damage costs for hypothetical oil spill scenarios in San Francisco Bay

    International Nuclear Information System (INIS)

    Etkin, D.S.; French McCay, D.; Whittier, N.; Sankaranarayanan, S.; Jennings, J.

    2002-01-01

    A study was conducted to determine the influence of oil type, spill size, response strategy and location factors on oil spill response costs, with particular reference to the cost benefits of the use of dispersants. Modeling has been conducted for a hypothetical oil spill in San Francisco Bay to determine biological impacts, damages to natural resources and response costs. The SIMAP modeling software by the Applied Science Associates was used to model 3 spill sizes (20, 50 and 95 percentile by volume) and 4 types of oil (gasoline, diesel, heavy fuel oil, and crude oil). Response costs, natural resource damages and socioeconomic impact were determined based on spill trajectory and fate. Mechanical recovery-based operations carry higher response costs than dispersant-based operations. Response costs for diesel and gasoline spills make up 20 per cent of the total costs, compared to 43 per cent for crude and heavy fuel oil spills. Damages to natural resources are higher for spills of toxic lighter fuels such as gasoline and diesel because gasoline has a greater impact on the water column with less shoreline oiling, resulting in more damages to natural resources. Heavier oils have a greater impact on shorelines and higher response and socioeconomic costs. Although socioeconomic costs varied by location, they tend to be greater than response costs and natural resource damage costs. Proportions of the different costs were described with reference to various spill factors. Socioeconomic costs are 61, 76, 45 and 53 per cent respectively for gasoline, diesel, crude oil, and heavy fuel oil spills. 27 refs., 23 tabs., 5 figs

  3. Resources and Transaction Costs

    DEFF Research Database (Denmark)

    Foss, Kirsten; Foss, Nicolai Juul

    2004-01-01

    resources depends on the propertyrights that she holds to those resources and on the transaction costs of exchanging,defining and protecting the relevant property rights. While transaction costs aremajor sources of value dissipation, value may be created by reducing suchdissipation. Implications for the RBV...

  4. Natural resource damage assessments: The second generation

    International Nuclear Information System (INIS)

    Luthi, R.; Burlington, L.; Reinharz, E.; Shutler, S.

    1993-01-01

    The Damage Assessment Regulations Team (DART), Office of General Counsel, National Oceanic and Atmospheric Administration (NOAA), has focused on developing natural resource damage assessment regulations for oil pollution in navigable waters. These procedures may lower the transaction costs of assessments, encourage joint cooperative assessments, simplify most assessments and provide technical guidance for conducting assessments. DART is developing regulations for the assessment of damages due to injuries related to oil spills under the Oil pollution Act of 1990. These regulations will involve coordination, restoration and economic valuation. NOAA encourages federal, state, tribal and foreign trustees, to develop prespill plans. Coordination with response agencies assures protection of important natural resources. The regulations provide an open record, which becomes the basis for judicial review. Various methods being developed to assess damages for injuries to natural resources include: compensation formulas for spills under 50,000 gallons of oil, the Type A model, expedited damage assessment (EDA) procedures, and comprehensive damage assessment (CDA) procedures which can be used for spills of various sizes. These procedures provide trustees with a choice for assessing natural resource damages to each oil spill. NOAA is emphasizing the importance of restoration. Restoration plans will define project goals and objectives, establish procedures and methods for site restoration, and define the approach based on sound science. Finally, numerous economic methods are identified to calculate the lost or diminished use as passive use of the affected resources

  5. Resources and transaction costs

    DEFF Research Database (Denmark)

    Foss, Kirsten; Foss, Nicolai Juul

    2005-01-01

    from resources depends on the property rights that he or she holds and on the transaction costs of exchanging, defining, and protecting them. While transaction costs are a major source of value dissipation, reducing such dissipation may create value. Implications for the RBV analysis of sustained...

  6. The second generation of natural resource damage assessments: Lessons learned?

    International Nuclear Information System (INIS)

    Luthi, R.B.; Burlington, L.B.; Reinharz, E.; Shutler, S.K.

    1993-01-01

    The Damage Assessment Regulations Team (DART), under the Office of General Counsel of the National Oceanic and Atmospheric Administration (NOAA), has centered its efforts on developing natural resource damage assessment regulations for oil pollution in navigable waters. These procedures will likely lower the costs associated with damage assessments, encourage joint cooperative assessments and simplify most assessments. The DART team of NOAA is developing new regulations for the assessment of damages due to injuries related to oil spills under the Oil Pollution Act of 1990. These regulations will involve coordination, restoration, and economic valuation. Various methods are currently being developed to assess damages for injuries to natural resources. The proposed means include: compensation tables for spills under 50,000 gallons, Type A model, expedited damage assessment (EDA) procedures, and comprehensive procedures. They are being developed to provide trustees with a choice for assessing natural resource damages for each oil spill

  7. Use of simplified methods for predicting natural resource damages

    International Nuclear Information System (INIS)

    Loreti, C.P.; Boehm, P.D.; Gundlach, E.R.; Healy, E.A.; Rosenstein, A.B.; Tsomides, H.J.; Turton, D.J.; Webber, H.M.

    1995-01-01

    To reduce transaction costs and save time, the US Department of the Interior (DOI) and the National Oceanic and Atmospheric Administration (NOAA) have developed simplified methods for assessing natural resource damages from oil and chemical spills. DOI has proposed the use of two computer models, the Natural Resource Damage Assessment Model for Great Lakes Environments (NRDAM/GLE) and a revised Natural Resource Damage Assessment Model for Coastal and Marine Environments (NRDAM/CME) for predicting monetary damages for spills of oils and chemicals into the Great Lakes and coastal and marine environments. NOAA has used versions of these models to create Compensation Formulas, which it has proposed for calculating natural resource damages for oil spills of up to 50,000 gallons anywhere in the US. Based on a review of the documentation supporting the methods, the results of hundreds of sample runs of DOI's models, and the outputs of the thousands of model runs used to create NOAA's Compensation Formulas, this presentation discusses the ability of these simplified assessment procedures to make realistic damage estimates. The limitations of these procedures are described, and the need for validating the assumptions used in predicting natural resource injuries is discussed

  8. Natural resource damage assessment -- Trustee and defendant perspectives

    International Nuclear Information System (INIS)

    McHugh, M.; Trimmier, R. Jr.

    1995-01-01

    The goal of the NRD process is restoration: restoring injured resources and the services they provide to a level that will compensate the public for the losses associated with injuries. While restoration, the final step in the cleanup process, has only recently been pursued, experience dictates that it is more effective and efficient for cleanup agencies. Industry and natural resource trustees to address NRD by integrating it into the cleanup process in a cooperative and coordinated manner. Early integration reduces transaction costs and liability by: (1) enabling the collection of NRD information by field personnel already conducting RI work; (2) promoting the selection of remedial alternatives that are protective of resources; and (3) creating opportunities to build restoration directly into the remedy. The damage assessment regulations provide an objective template to guide this process. Integration thus facilitates timely restoration, thereby halting the accrual of further damages and reducing the potential for time consuming and costly litigation. Delays in settlement and restoration are more likely when trustees are not made part of the cleanup process. Particularly under CERCLA, reliance on unproven science for injury determination and unreliable economics for damage assessment results in inflated values, prolonged litigation, delayed or vacuous remedial action and high transaction costs. Under OPA, where oil spills require immediate and effective response action, cooperation between PRPs and Trustees is more likely, but even there, the post-response assessment of NRD is unlikely to be cooperative for the same reason CERCLA assessments tend not to be

  9. Estimation of Damage Costs Associated with Flood Events

    Science.gov (United States)

    Andrews, T. A.; Wauthier, C.; Zipp, K.

    2017-12-01

    This study investigates the possibility of creating a mathematical function that enables the estimation of flood-damage costs. We begin by examining the costs associated with past flood events in the United States. The data on these tropical storms and hurricanes are provided by the National Oceanic and Atmospheric Administration. With the location, extent of flooding, and damage reparation costs identified, we analyze variables such as: number of inches rained, land elevation, type of landscape, region development in regards to building density and infrastructure, and population concentration. We seek to identify the leading drivers of high flood-damage costs and understand which variables play a large role in the costliness of these weather events. Upon completion of our mathematical analysis, we turn out attention to the 2017 natural disaster of Texas. We divide the region, as we did above, by land elevation, type of landscape, region development in regards to building density and infrastructure, and population concentration. Then, we overlay the number of inches rained in those regions onto the divided landscape and apply our function. We hope to use these findings to estimate the potential flood-damage costs of Hurricane Harvey. This information is then transformed into a hazard map that could provide citizens and businesses of flood-stricken zones additional resources for their insurance selection process.

  10. Evaluation of compensation formulae to measure natural resource damages

    International Nuclear Information System (INIS)

    Robilliard, G.A.; Fischel, M.; Desvousges, W.H.; Dunford, R.W.; Mathews, K.

    1993-01-01

    Most of the oil spills in marine, estuarine, or freshwater environments of the United States are small (less than 1,000 gallons) and result in minimal injury to natural resources or little to no loss of services. However, federal, state, and Indian tribe trustees for natural resources are entitled under a variety of laws, including the Oil Pollution Act of 1990, to collect damages (money) from responsible parties to compensate for the foregone services and restoration of the services provided by the natural resources. Alaska, Washington, and Florida have developed a formula-based approach to calculating natural resource damages resulting from most spills; the federal National Oceanic and Atmospheric Administration and several other states are considering developing a compensation formula. The ideal compensation formula is a simplified assessment process that (a) can be applied rapidly, (b) requires relatively small transaction or assessment costs, (c) requires minimal site- and spill-specific data as inputs, (d) is based on generally accepted scientific and economic principles and methods, and (e) results in damage values acceptable to both the trustees and the responsible party. In theory, a compensation formula could be applied to most small oil spills in United States waters

  11. Construction Cost Management in Resource Based Economy

    OpenAIRE

    Elazzazy, Muhammad

    2017-01-01

    Resource Based Economy tested according to criteria formulated from the construction cost management best practices. A cost management plan modeled to demonstrate the possibility of construction management under a new socio-economic system, which counts the consumed natural resources by construction as the dry cost to the environment.

  12. 76 FR 20372 - Notice of Lodging of Consent Decree and Settlement Agreement Regarding Natural Resource Damage...

    Science.gov (United States)

    2011-04-12

    ..., Assistant Section Chief, Environmental Enforcement Section, Environment and Natural Resources Division. [FR... resolves claims for natural resource damages and assessment costs of the United States Department of the..., Environment and Natural Resources Division, and either e-mailed to [email protected] or mailed to...

  13. Freshwater Aquatic Nuisance Species Impacts and Management Costs and Benefits at Federal Water Resources Projects

    National Research Council Canada - National Science Library

    Cole, Richard A

    2006-01-01

    ...) when they significantly degrade services provided by water resources. Government agencies, utilities, and other water resource managers incur substantial costs controlling ANS and repairing damage to restore service performance to desired levels...

  14. Determinants of the property damage costs of tanker accidents

    International Nuclear Information System (INIS)

    Talley, W.K.

    1999-01-01

    This study investigates determinants of the vessel, oil cargo spillage, and other-property damage costs of tanker accidents. Tobit estimation of a three-equation recursive model suggests that, among types of tanker accidents, fire/explosion accidents incur the largest vessel damage costs, but the smallest oil cargo spillage costs. Alternatively, grounding accidents incur the smallest vessel damage costs, but the largest oil cargo spillage costs, reflecting the difficulty of controlling oil cargo spillage subsequent to such accidents. Also, oil cargo spillage costs are lower for US flag tanker accidents. A dollar of vessel damage cost increases other-property damage cost by 0.06 dollars, whereas a dollar of oil cargo spillage increases this cost by 1.55 dollars

  15. Adapting ecological risk valuation for natural resource damage assessment in water pollution.

    Science.gov (United States)

    Chen, Shuzhen; Wu, Desheng

    2018-07-01

    Ecological risk assessment can address requirements of natural resource damage assessment by quantifying the magnitude of possible damages to the ecosystem. This paper investigates an approach to assess water damages from pollution incident on the basis of concentrations of contaminants. The baseline of water pollution is determined with not-to-exceed concentration of contaminants required by water quality standards. The values of damage cost to water quality are estimated through sewage treatment cost. To get a reliable estimate of treatment cost, DEA is employed to classify samples of sewage plants based on their efficiency of sewage treatment. And exponential fitting is adopted to determine the relation between treatment cost and the decrease of COCs. The range of damage costs is determined through the fitting curves respectively based on efficient and inefficient samples. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Entrepreneurship, transaction costs, and resource attributes

    DEFF Research Database (Denmark)

    Foss, Kirsten; Foss, Nicolai Juul

    2006-01-01

    transaction costs shape the process of entrepreneurial discovery. We provide a sketch of the mechanisms that link entrepreneurship, property rights, and transaction costs in a resource-based setting, contributing further to the attempt to take the RBV in a more dynamic direction.......This paper responds to Kim and Mahoney's "How Property Rights Economics Furthers the Resource-Based View: Resources, Transaction Costs and Entrepreneurial Discovery" (a comment on Foss and Foss, 2005). While we agree with many of their arguments, we argue that they fail to recognise how exactly...

  17. Entrepreneurship, transaction costs, and resource attributes

    DEFF Research Database (Denmark)

    Foss, Kirsten; Foss, Nicolai Juul

    2006-01-01

    This paper responds to Kim and Mahoney's "How Property Rights Economics Furthers the Resource-Based View: Resources, Transaction Costs and Entrepreneurial Discovery" (a comment on Foss and Foss, 2005). While we agree with many of their arguments, we argue that they fail to recognise how exactly t...... transaction costs shape the process of entrepreneurial discovery. We provide a sketch of the mechanisms that link entrepreneurship, property rights, and transaction costs in a resource-based setting, contributing further to the attempt to take the RBV in a more dynamic direction....

  18. Entrepreneurship, Transaction Costs, and Resource Attributes

    DEFF Research Database (Denmark)

    Foss, Kirsten; Foss, Nicolai Juul

    transaction costs and property rights shape the process of entrepreneurial discovery. We provide a sketch of the mechanisms that link entrepreneurship, property rights, and transaction costs in a resource-based setting, contributing further to the attempt to take the RBV in a more dynamic direction....

  19. Assessing and Managing Natural Resource Damages: Continuing Challenges and Opportunities

    Science.gov (United States)

    Barnthouse, Lawrence W.; Stahl, Ralph G.

    2017-05-01

    In a 2002 paper, we discussed the technical challenges associated with quantifying natural resource injuries, service losses and damages, and suggested some actions that might help to overcome them. An important suggestion was to consider using some of the approaches in ecological risk assessment to help evaluate potential natural resource injuries, and ultimately in some cases to help translate those injuries into natural resource service loss. This was based on the observation that ecological risk assessment and natural resource damage assessments use much of the same types of data, but at that time the experience base with ecological risk assessment was greater than for natural resource damage assessments. We also discussed some of the issues in applying the then current Department of Interior natural resource damage assessments regulations. Since our 2002 publication the scientific literature, relevant regulations, the global context and more have changed. In the current paper we focus on the technical and regulatory changes in natural resource damage assessments practice since 2002, and use recent reports and publications to illustrate those changes and identify new directions in natural resource damage assessments.

  20. Integrated analysis considered mitigation cost, damage cost and adaptation cost in Northeast Asia

    Science.gov (United States)

    Park, J. H.; Lee, D. K.; Kim, H. G.; Sung, S.; Jung, T. Y.

    2015-12-01

    Various studies show that raising the temperature as well as storms, cold snap, raining and drought caused by climate change. And variety disasters have had a damage to mankind. The world risk report(2012, The Nature Conservancy) and UNU-EHS (the United Nations University Institute for Environment and Human Security) reported that more and more people are exposed to abnormal weather such as floods, drought, earthquakes, typhoons and hurricanes over the world. In particular, the case of Korea, we influenced by various pollutants which are occurred in Northeast Asian countries, China and Japan, due to geographical meteorological characteristics. These contaminants have had a significant impact on air quality with the pollutants generated in Korea. Recently, around the world continued their effort to reduce greenhouse gas and to improve air quality in conjunction with the national or regional development goals priority. China is also working on various efforts in accordance with the international flows to cope with climate change and air pollution. In the future, effect of climate change and air quality in Korea and Northeast Asia will be change greatly according to China's growth and mitigation policies. The purpose of this study is to minimize the damage caused by climate change on the Korean peninsula through an integrated approach taking into account the mitigation and adaptation plan. This study will suggest a climate change strategy at the national level by means of a comprehensive economic analysis of the impacts and mitigation of climate change. In order to quantify the impact and damage cost caused by climate change scenarios in a regional scale, it should be priority variables selected in accordance with impact assessment of climate change. The sectoral impact assessment was carried out on the basis of selected variables and through this, to derive the methodology how to estimate damage cost and adaptation cost. And then, the methodology was applied in Korea

  1. Legal acceptance of contingent valuation to determine natural resource damages

    International Nuclear Information System (INIS)

    Johnson, G.J.

    1993-01-01

    In enacting the Oil Pollution Act of 1990, Congress endorsed contingent valuation (CV) as an appropriate ''advanced technique'' to assess damages to natural resources resulting from oil and hazardous substance releases. Citing Ohio v. Department of Interior, 880 F.2d 432 (D.C.Cir. 1989), Congress stressed that ''forests are more than just board feed of lumbar,'' and rejected statutory language intended to prevent recovery of damages calculated using ''non-use'' or ''passive'' values of natural resources. Consequently, the key question is whether CV is a useful and rational means to determine non-use values when implementing statutory mandates to recover natural resource damages, not whether CV meets tests of statistical reliability. Because Congress intended that damages be calculated using non-use as well as use values, less precision in calculating non-use values is acceptable so the statutory right to full recovery is not rendered meaningless. While such damages might not be determined with the same precision as damages from a contract breach, a technique which yields results ''with as much or more certainty and accuracy as a jury determining damages for pain and suffering or mental anguish'' is adequate. No methodology except CV calculates non-use values. When designed and implemented conservatively, CV is sufficiently reliable to be used by natural resource trustees

  2. Damage cost of the Dan River coal ash spill

    International Nuclear Information System (INIS)

    Dennis Lemly, A.

    2015-01-01

    The recent coal ash spill on the Dan River in North Carolina, USA has caused several negative effects on the environment and the public. In this analysis, I report a monetized value for these effects after the first 6 months following the spill. The combined cost of ecological damage, recreational impacts, effects on human health and consumptive use, and esthetic value losses totals $295,485,000. Because the environmental impact and associated economic costs of riverine coal ash spills can be long-term, on the order of years or even decades, this 6-month assessment should be viewed as a short-term preview. The total cumulative damage cost from the Dan River coal ash spill could go much higher. - Highlights: • Six-month post-spill damage cost exceeded $295,000,000. • Components of cost include ecological, recreational, human health, property, and aesthetic values. • Attempts by the electric utility to “clean” the river left over 95% of coal ash behind. • Long-term impacts will likely drive the total damage cost much higher. - Damage costs of the Dan River coal ash spill are extensive and growing. The 6-month cost of that spill is valued at $295,485,000, and the long-term total cost is likely to rise substantially

  3. Natural resource damage assessments: Linking injury to restoration

    International Nuclear Information System (INIS)

    Newell, M.; Collinson-Kahl, C.

    1993-01-01

    Under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the Oil Pollution Act of 1990 (OPA 90), natural resource trustees have the authority to act on behalf of the public to file claims for damages against potentially responsible parties for injury to, destruction of, or loss of natural resources and related human services caused by releases of hazardous substances or discharges of oil. Damages recovered must be used to restore, replace, or acquire the equivalent of such resources. Therefore, to adequately restore an injured resource and the services it provides, a natural resource restoration proposal should address, as directly as possible, the injuries caused by a hazardous substance release. In other words, the resources restored and services generated by the restoration activities should be commensurate in type and amount with the reduction in services caused by the release. More specifically, the natural resource damage assessment regulations indicate that services should be used as the common currency for linking injury to restoration. The following conceptual steps may be followed to develop a primary restoration program that is linked to the injuries: Define the resources that were injured, and identify the services provided by those resources that were reduced by the injury. Define the baseline levels of the quantity of the resource, and the quantity of the services that would have been provided by the resource if the injury had not occurred. Quantify the interim lost value, which represents the reduction in services (compared to a baseline) from the time of the injury through the time of full recovery of the resources, assuming natural recovery. Evaluate the potential restoration projects for inclusion in the primary restoration program, which is designed to accelerate and enhance natural recovery of the resources and the flow of services from the resources

  4. Phosphate rock costs, prices and resources interaction.

    Science.gov (United States)

    Mew, M C

    2016-01-15

    This article gives the author's views and opinions as someone who has spent his working life analyzing the international phosphate sector as an independent consultant. His career spanned two price hike events in the mid-1970's and in 2008, both of which sparked considerable popular and academic interest concerning adequacy of phosphate rock resources, the impact of rising mining costs and the ability of mankind to feed future populations. An analysis of phosphate rock production costs derived from two major industry studies performed in 1983 and 2013 shows that in nominal terms, global average cash production costs increased by 27% to $38 per tonne fob mine in the 30 year period. In real terms, the global average cost of production has fallen. Despite the lack of upward pressure from increasing costs, phosphate rock market prices have shown two major spikes in the 30 years to 2013, with periods of less volatility in between. These price spike events can be seen to be related to the escalating investment cost required by new mine capacity, and as such can be expected to be repeated in future. As such, phosphate rock price volatility is likely to have more impact on food prices than rising phosphate rock production costs. However, as mining costs rise, recycling of P will also become increasingly driven by economics rather than legislation. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Resource allocation based on cost efficiency

    DEFF Research Database (Denmark)

    Dehnokhalaji, Akram; Ghiyasi, Mojtaba; Korhonen, Pekka

    2017-01-01

    -objective linear programming problem using two different strategies. First, we propose an RA model which keeps the cost efficiencies of units unchanged. This is done assuming fixed technical and allocative efficiencies. The approach is based on the assumption that the decision maker (DM) may not have big changes......In this paper, we consider a resource allocation (RA) problem and develop an approach based on cost (overall) efficiency. The aim is to allocate some inputs among decision making units (DMUs) in such way that their cost efficiencies improve or stay unchanged after RA. We formulate a multi...... in the structure of DMUs within a short term. The second strategy does not impose any restrictions on technical and allocative efficiencies. It guarantees that none of the cost efficiencies of DMUs get worse after RA, and the improvement for units is possible if it is feasible and beneficial. Two numerical...

  6. Aircraft ground damage and the use of predictive models to estimate costs

    Science.gov (United States)

    Kromphardt, Benjamin D.

    Aircraft are frequently involved in ground damage incidents, and repair costs are often accepted as part of doing business. The Flight Safety Foundation (FSF) estimates ground damage to cost operators $5-10 billion annually. Incident reports, documents from manufacturers or regulatory agencies, and other resources were examined to better understand the problem of ground damage in aviation. Major contributing factors were explained, and two versions of a computer-based model were developed to project costs and show what is possible. One objective was to determine if the models could match the FSF's estimate. Another objective was to better understand cost savings that could be realized by efforts to further mitigate the occurrence of ground incidents. Model effectiveness was limited by access to official data, and assumptions were used if data was not available. However, the models were determined to sufficiently estimate the costs of ground incidents.

  7. Washington's marine oil spill compensation schedule - simplified resource damage assessment

    International Nuclear Information System (INIS)

    Geselbracht, L.; Logan, R.

    1993-01-01

    The Washington State Preassessment Screening and Oil Spill Compensation Schedule Rule (Chapter 173-183 Washington Administrative Code), which simplifies natural resource damage assessment for many oil spill cases, became effective in May 1992. The approach described in the rule incorporates a number of preconstructed rankings that rate environmental sensitivity and the propensity of spilled oil to cause environmental harm. The rule also provides guidance regarding how damages calculated under the schedule should be reduced to take into account actions taken by the responsible party that reduce environmental injury. To apply the compensation schedule to marine estuarine spills, the resource trustees need only collect a limited amount of information such as type of product spilled, number of gallons spilled, compensation schedule subregions the spill entered, season of greatest spill impact, percent coverage of habitats affected by the spill, and actions taken by the responsible party. The result of adding a simplified tool to the existing assortment of damage assessment approaches is that resource trustees will now be able to assess damages for most oil spill cases and shift more effort than was possible in the past to resource restoration

  8. Consideration of environmental externality costs in electric utility resource selections and regulation

    International Nuclear Information System (INIS)

    Ottinger, R.L.

    1990-01-01

    A surprising number of state electric utility regulatory commissions (half) have started to require consideration of environmental externality costs in utility planning and resource selection. The principal rationale for doing so is that electric utility operations impose very real and large damages to human health and the environment which are not taken into account by traditional utility least cost planning, resource selection procedures, or by government pollution regulation. These failures effectively value the residual environmental costs to society of utility operations at zero. The likely future prospect for more stringent governmental pollution regulation renders imprudent the selection of resources without taking environmental externality costs into consideration. Most regulatory commissions requiring environmental externality consideration have left it to the utilities to compute the societal costs, although a few have either set those costs themselves or used a proxy adder to polluting resource costs (or bonus for non-polluting resources). These commissions have used control or pollution mitigation costs, rather than societal damage costs, in their regulatory computations. This paper recommends that damage costs be used where adequate studies exist to permit quantification, discusses the methodologies for their measurement, and describes the means that have been and might be used for their incorporation

  9. Implementation of the natural resource damage assessment rule

    International Nuclear Information System (INIS)

    1991-11-01

    Regulations have been promulgated by the Department of Interior (DOI) which provide an administrative process whereby natural resource trustees may establish the type and extent of injury and evaluate the damages to natural resources. These regulations provide an optional mechanism for Natural Resource Damage Assessments (NRDAs), with four major components. A workshop was held to develop recommendations for DOE-OR regarding implementation of the DOI NRDA regulations at the Oak Ridge Reservation (ORR). The attendants were divided into three working groups to consider (1) administrative/legal requirements, (2) ecological assessments, and (3) the NRDA/economic evaluation process. This report supplies an overview of the DOI NRDA regulations as well as summaries of the consensus of each of the three working groups

  10. The cost of the radiation damage by the ALARA conception

    International Nuclear Information System (INIS)

    Kononovich, A.L.; Nosov, A.V.; Ivanov, A.V.; Pechkurov, A.V.

    2000-01-01

    A basis for the determination of the cost of the radiation risk as a method for its optimization are given. The correlation between different components of the risk is considered. The aim for optimization as a requirement on decrease of the cumulative risk is formulated. The reliability in the use of mathematic modelling on the determination of the cost of the risk and damage is noted. The lines of approach to determination of the cost of the risk based on the direct analysis of financial expenses are proposed. The results of estimation of the cost of the risk are given. The use of suggested approach is demonstrated on a hypothetical example [ru

  11. Natural resource damage assessment models for Great Lakes, coastal, and marine environments

    International Nuclear Information System (INIS)

    French, D.P.; Reed, M.

    1993-01-01

    A computer model of the physical fates, biological effects, and economic damages resulting from releases of oil and other hazardous materials has been developed by Applied Science Associates to be used in Type A natural resource damage assessments under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Natural resource damage assessment models for great lakes environments and for coastal and marine environments will become available. A coupled geographical information system allows gridded representation of complex coastal boundaries, variable bathymetry, shoreline types, and multiple biological habitats. The physical and biological models are three dimensional. Direct mortality from toxic concentrations and oiling, impacts of habitat loss, and food web losses are included in the model. Estimation of natural resource damages is based both on the lost value of injured resources and on the costs of restoring or replacing those resources. The models are implemented on a personal computer, with a VGA graphical user interface. Following public review, the models will become a formal part of the US regulatory framework. The models are programmed in a modular and generic fashion, to facilitate transportability and application to new areas. The model has several major components. Physical fates and biological effects submodels estimate impacts or injury resulting from a spill. The hydrodynamic submodel calculates currents that transport contaminant(s) or organisms. The compensable value submodel values injuries to help assess damages. The restoration submodel determines what restoration actions will most cost-effectively reduce injuries as measured by compensable values. Injury and restoration costs are assessed for each of a series of habitats (environments) affected by the spill. Environmental, chemical, and biological databases supply required information to the model for computing fates and effects (injury)

  12. Environmental damage costs in Iran by the energy sector

    International Nuclear Information System (INIS)

    Shafie-Pour, Majid; Ardestani, Mojtaba

    2007-01-01

    On the basis of the energy supply and demand, this paper assesses the environmental damage from air pollution in Iran using the Extern-E study that has extended over 10 years and is still in progress in the European Union (EU) commission. Damage costs were transferred from Western European practice to the conditions of Iran by scaling according to GDP per capital measured in PPP terms. Using this approach, the total health damage from air pollution in 2001 is assessed at about $7 billion; equivalent to 8.4% of nominal GDP. In the absence of price reform and control policies, it is estimated that damage in Iran will grow to $9 billion by 2019, in the money of 2001. This is equivalent to 10.9% of nominal GDP, i.e. a larger percentage of a larger GDP. Of this total, $8.4 billion comes from the transport sector. The damage cost to the global environment from the flaring of natural gas, assessed on the basis of a carbon price of $10/ton CO 2 and found to be approximately $600 million per year. This is equal to a little less than 1% of current GDP. There are larger costs associated with recovery and use of such gas, but equally there are large potential benefits

  13. Externality costs by resource. E. Renewable generation resources

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    This chapter describes the environmental impacts associated with operation of renewable energy technologies. Renewable energy technologies currently supply 8% of US total energy usage and that figure is certain to grow. The rate of growth will depend heavily on the availability of research and development funds, and could reach 28% of US energy demands by 2030. Renewable generation resources include hydroelectric development, solar energy technologies, wind conversion facilities, and biomass fueled generation. A task force of personnel from five national laboratories recently concluded that renewable energy technologies generally have lower environmental impacts than do fossil fuel energy systems. The task force also stated that a comprehensive and comparative analysis of environmental impacts is needed and would strengthen the National Energy Strategy. This chapter summarizes some of the available literature on costing the environmental externalities associated with hydro, solar, wind, and biomass facilities. The less prevalent renewable energy technologies, including geothermal and ocean energy technologies, were not researched. The cost ranges identified are summarized in Table 1. The Table does not include a value for hydroelectric energy. The one study which attempted to value hydroelectric externalities was highly site-specific and has been criticized for having vastly overstated the value of the externalities

  14. Remedying CERCLA's natural resource damages provision: Incorporation of the public trust doctrine into natural resource damage actions

    International Nuclear Information System (INIS)

    Chase, A.R.

    1992-01-01

    When Congress enacted the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), it ushered in a sweeping approach to controlling the environmental effects of improper hazardous waste disposal. CERCLA's cleanup provisions, which focus on removal and remediation of hazardous substances from inactive hazardous waste sites, have progressed through more than a decade of litigation and a great deal of public debate. However, CERCLA's natural resource damage provisions have not shared this same degree of progress

  15. Natural Resource Damages Settlement Projects at the Fernald Preserve - 12316

    Energy Technology Data Exchange (ETDEWEB)

    Powell, Jane [Fernald Preserve Site Manager, DOE Office of Legacy Management, Harrison, Ohio (United States); Schneider, Tom [Fernald Project Manager, Ohio Environmental Protection Agency, Dayton, Ohio (United States); Hertel, Bill [Project Manager, S.M. Stoller Corporation, Harrison, Ohio (United States); Homer, John [Environmental Scientist, S.M. Stoller Corporation, Harrison, Ohio (United States)

    2012-07-01

    This paper describes the development and implementation of two ecological restoration projects at the Fernald Preserve that are funded through a CERCLA natural resource damage settlement. The Paddys Run Tributary Project involves creation of vernal pool wetland habitat with adjacent forest restoration. The Triangle Area Project is a mesic tall-grass prairie establishment, similar to other efforts at the Fernald Preserve. The goal of the Fernald Natural Resource Trustees is to establish habitat for Ambystomatid salamander species, as well as grassland birds. Planning and implementation of on-property ecological restoration projects is one component of compensation for natural resource injury. As with the rest of the Fernald Preserve, ecological restoration has helped turn a DOE liability into a community asset. (authors)

  16. As Bad as it Gets: How Climate Damage Functions Affect Growth and the Social Cost of Carbon

    OpenAIRE

    Bretschger, Lukas; Pattakou, Aimilia

    2017-01-01

    The paper analyzes the effects of varying climate impacts on the social cost of carbon and economic growth. We use polynomial damage functions in a model of an endogenously growing two-sector economy. The framework includes nonrenewable natural resources which cause greenhouse gas emissions; pollution stock harms capital and reduces economic growth. We find a big effect of the selected damage function on the social cost of carbon and a significant impact on the growth rate. In our calibration...

  17. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

    Full Text Available Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control, with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation

  18. Atmospheric and geological CO2 damage costs in energy scenarios

    International Nuclear Information System (INIS)

    Smekens, K.E.L.; Van der Zwaan, B.C.C.

    2006-05-01

    Geological carbon dioxide capture and storage (CCS) is currently seriously considered for addressing, in the near term, the problem of climate change. CCS technology is available today and is expected to become an increasingly affordable CO2 abatement alternative. Whereas the rapidly growing scientific literature on CCS as well as experimental and commercial practice demonstrate the technological and economic feasibility of implementing this clean fossil fuel option on a large scale, relatively little attention has been paid so far to the risks and environmental externalities of geological storage of CO2. This paper assesses the effects of including CCS damage costs in a long-term energy scenario analysis for Europe. An external cost sensitivity analysis is performed with a bottom-up energy technology model that accounts not only for CCS technologies but also for their external costs. Our main conclusion is that in a business-as-usual scenario (i.e. without climate change intervention or externality internalisation), CCS technologies are likely to be deployed at least to some extent, mainly in the power generation sector, given the economic benefits of opportunities such as enhanced coal bed methane, oil and gas recovery. Under a strict climate (CO2 emissions) constraint, CCS technologies are deployed massively. With the simultaneous introduction of both CO2 and CCS taxation in the power sector, designed to internalise the external atmospheric and geological effects of CO2 emissions and storage, respectively, we find that CCS will only be developed if the climate change damage costs are at least of the order of 100 euro/t CO2 or the CO2 storage damage costs not more than a few euro/t CO2. When the internalised climate change damage costs are as high as 67 euro/t CO2, the expensive application of CCS to biomass-fuelled power plants (with negative net CO2 emissions) proves the most effective CCS alternative to reduce CO2 emissions, rather than CCS applied to fossil

  19. A transportable system of models for natural resource damage assessment

    International Nuclear Information System (INIS)

    Reed, M.; French, D.

    1992-01-01

    A system of computer models has been developed for assessment of natural resource economic damages resulting from spills of oil and hazardous materials in marine and fresh water environments. Under USA federal legislation, the results of the model system are presumed correct in damage litigation proceedings. The model can address a wide range of spatial and temporal scales. The equations describing the motion of both pollutants and biota are solved in three dimensions. The model can simulate continuous releases of a contaminant, with representation of complex coastal boundaries, variable bathymetry, multiple shoreline types, and spatially variable ecosystem habitats. A graphic user interface provides easy control of the system in addition to the ability to display elements of the underlying geographical information system data base. The model is implemented on a personal computer and on a UNIX workstation. The structure of the system is such that transport to new geographic regions can be accomplished relatively easily, requiring only the development of the appropriate physical, toxicological, biological, and economic data sets. Applications are currently in progress for USA inland and coastal waters, the Adriatic Sea, the Strait of Sicily, the Gulf of Suez, and the Baltic Sea. 4 refs., 2 figs

  20. Health impact and damage cost assessment of pesticides in Europe.

    Science.gov (United States)

    Fantke, Peter; Friedrich, Rainer; Jolliet, Olivier

    2012-11-15

    Health impacts from pesticide use are of continuous concern in the European population, requiring a constant evaluation of European pesticide policy. However, health impacts have never been quantified accounting for specific crops contributing differently to overall human exposure as well as accounting for individual substances showing distinct environmental behavior and toxicity. We quantify health impacts and related damage costs from exposure to 133 pesticides applied in 24 European countries in 2003 adding up to almost 50% of the total pesticide mass applied in that year. Only 13 substances applied to 3 crop classes (grapes/vines, fruit trees, vegetables) contribute to 90% of the overall health impacts of about 2000 disability-adjusted life years in Europe per year corresponding to annual damage costs of 78 million Euro. Considering uncertainties along the full impact pathway mainly attributable to non-cancer dose-response relationships and residues in treated crops, we obtain an average burden of lifetime lost per person of 2.6 hours (95% confidence interval between 22 seconds and 45.3 days) or costs per person over lifetime of 12 Euro (95% confidence interval between 0.03 Euro and 5142 Euro), respectively. 33 of the 133 assessed substances accounting for 20% of health impacts in 2003 are now banned from the European market according to current legislation. The main limitation in assessing human health impacts from pesticides is related to the lack of systematic application data for all used substances. Since health impacts can be substantially influenced by the choice of pesticides, the need for more information about substance application becomes evident. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    1998-11-01

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

  2. Natural resource damage assessments for oil spills: Status of rules and application to recent oil spills

    International Nuclear Information System (INIS)

    Robilliard, G.A.; Winfield, T.P.; Lebednik, P.A.; Markarian, R.K.

    1992-01-01

    The natural resource damage assessment (NRDA) process is based on the concept that all natural resources managed by government agencies or Indian tribes (trustees) are available to the public for its use and enjoyment. These resources have an economic value that can be affected by a spill of oil or other chemicals. The spiller or potentially responsible party (PRP) is responsible to the public, through the trustees, for paying damages and for restoration of the resource. The NRDA process should also determine the appropriate means of restoration, provide a cost for doing so and for conducting the NRDA, and should implement the appropriate restoration activities. The legal and regulatory authority behind NRDA in the USA is explained and reasons why PRPs should be concerned about NRDAs in the context of oil spills are presented. US Department of the Interior regulations describe two procedures for implementing a NRDA. A simplified procedure intended for small spills uses a computer model to generate a damage value. A more thorough and complicated procedure involves a number of phases and steps within the phases, and may include field sampling, data collection and analysis, and detailed evaluation of restoration alternatives. The NRDA experience in oil spills to date is reviewed and the future of NRDA is assessed. Examples cited include the 1988 Shell Oil spill from the Martinez Refinery, the Exxon Bayway pipeline leak of 1990, the Mega Borg spill in the Texas offshore, and the Exxon Valdez spill. It is speculated that trustees will focus on the NRDA process as a cooperative one that includes the trustees and PRPs, with the ultimate goal being restoration of the foregone services provided by natural resources. 5 refs., 1 fig

  3. How much electricity really costs. Comparison of the state subsidisation and overall social costs of conventional and renewable energy resources

    International Nuclear Information System (INIS)

    Kuechler, Swantje; Meyer, Bettina

    2012-01-01

    This study explains how the costs of electricity are an aggregate of different components. The electricity price paid by the end consumer contains not only the actual costs of energy production, which make up only about a third of the actual price in an average household, but also different surcharges such as network charges, electricity tax, value added tax and the concession levy. It furthermore contains the allocation charge stipulated by the Renewable Energy Law (EEG reallocation charge) as a means of allocating the costs of the subsidisation of electricity from renewable resources to the consumers. On the other hand conventional energy resources such as nuclear energy, hard coal and brown coal have substantially benefited over many decades from state subsidies in the form of financial aids, tax rebates and other promotive measures. The main difference between this and the subsidisation of renewable energy is that the costs of conventional energy resources are largely charged to the state budget rather than being made transparent in the electricity price. Based on an evaluation of the literature, data, interviews and the authors' own methodological deliberations this study makes a systematic comparison of the direct as well as indirect state subsidisation of renewable and conventional energy resources during the period from 1970 until 2012. The annual totals obtained for each energy resources are then set in relation to the share of that resource in overall electricity production, yielding specific subsidisation rates in terms of cents per kWh for each resource. This does not yet take into account the high consequential costs in the form of environmental damage and climate-related damage caused by fossil and nuclear fuels as well as the risks associated with the latter (collectively referred to as ''external costs''), all of which are charged to the polluters only at a small fraction of the true amount. The two cost categories of state

  4. Equity weighting and the marginal damage costs of climate change

    Energy Technology Data Exchange (ETDEWEB)

    Anthoff, David [The Economic and Social Research Institute, Dublin (Ireland)]|[International Max Planck Research School on Earth System Modelling, Hamburg (Germany)]|[Research Unit Sustainability and Global Change, Hamburg University and Centre for Marine and Atmospheric Science, Hamburg (Germany); Hepburn, Cameron [Smith School of Enterprise and the Environment, and James Martin Institute, Said Business School, University of Oxford, and New College, Oxford (United Kingdom); Tol, Richard S.J. [The Economic and Social Research Institute, Dublin (Ireland)]|[Research Unit Sustainability and Global Change, Hamburg University and Centre for Marine and Atmospheric Science, Hamburg (Germany)]|[Institute for Environmental Studies, Vrije Universiteit, Amsterdam (Netherlands)]|[Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA (United States)

    2009-01-15

    Climate change will give rise to different impacts in different countries, and different countries have different levels of development. Equity-weighted estimates of the (marginal) impact of greenhouse gas emissions reflect these differences. This paper analyses the impact of equity weighting on the marginal damage cost of carbon dioxide emissions, and reaches four main conclusions. First, equity-weighted estimates are substantially higher than estimates without equity-weights; equity-weights may even change the sign of the social cost estimates. Second, estimates differ by two orders of magnitude depending on the region to which the equity weights are normalised. Third, equity-weighted estimates are sensitive to the resolution of the impact estimates. Depending on the assumed intra-regional income distribution, estimates may be more than twice as high if national rather than regional impacts are aggregated. Fourth, variations in the assumed inequality aversion have different impacts in different scenarios, not only because different scenarios have different emissions and hence warming, but also because different scenarios have different income differences, different growth rates, and different vulnerabilities. (author)

  5. Equity weighting and the marginal damage costs of climate change

    International Nuclear Information System (INIS)

    Anthoff, David; Hepburn, Cameron; Tol, Richard S.J.

    2009-01-01

    Climate change will give rise to different impacts in different countries, and different countries have different levels of development. Equity-weighted estimates of the (marginal) impact of greenhouse gas emissions reflect these differences. This paper analyses the impact of equity weighting on the marginal damage cost of carbon dioxide emissions, and reaches four main conclusions. First, equity-weighted estimates are substantially higher than estimates without equity-weights; equity-weights may even change the sign of the social cost estimates. Second, estimates differ by two orders of magnitude depending on the region to which the equity weights are normalised. Third, equity-weighted estimates are sensitive to the resolution of the impact estimates. Depending on the assumed intra-regional income distribution, estimates may be more than twice as high if national rather than regional impacts are aggregated. Fourth, variations in the assumed inequality aversion have different impacts in different scenarios, not only because different scenarios have different emissions and hence warming, but also because different scenarios have different income differences, different growth rates, and different vulnerabilities. (author)

  6. Low Cost Carbon Fiber From Renewable Resources

    International Nuclear Information System (INIS)

    Compere, A.L.

    2001-01-01

    The Department of Energy Partnership for a New Generation of Vehicles has shown that, by lowering overall weight, the use of carbon fiber composites could dramatically decrease domestic vehicle fuel consumption. For the automotive industry to benefit from carbon fiber technology, fiber production will need to be substantially increased and fiber price decreased to$7/kg. To achieve this cost objective, alternate precursors to pitch and polyacrylonitrile (PAN) are being investigated as possible carbon fiber feedstocks. Additionally, sufficient fiber to provide 10 to 100 kg for each of the 13 million cars and light trucks produced annually in the U.S. will require an increase of 5 to 50-fold in worldwide carbon fiber production. High-volume, renewable or recycled materials, including lignin, cellulosic fibers, routinely recycled petrochemical fibers, and blends of these components, appear attractive because the cost of these materials is inherently both low and insensitive to changes in petroleum price. Current studies have shown that a number of recycled and renewable polymers can be incorporated into melt-spun fibers attractive as carbon fiber feedstocks. Highly extrudable lignin blends have attractive yields and can be readily carbonized and graphitized. Examination of the physical structure and properties of carbonized and graphitized fibers indicates the feasibility of use in transportation composite applications

  7. Resource Requirements and Costs of Developing and Delivering MOOCs

    Directory of Open Access Journals (Sweden)

    Fiona M. Hollands

    2014-11-01

    Full Text Available Given the ongoing alarm regarding uncontrollable costs of higher education, it would be reasonable to expect not only concern about the impact of MOOCs on educational outcomes, but also systematic efforts to document the resources expended on their development and delivery. However, there is little publicly available information on MOOC costs that is based on rigorous analysis. In this article, we first address what institutional resources are required for the development and delivery of MOOCs, based on interviews conducted with 83 administrators, faculty members, researchers, and other actors in the MOOCspace. Subsequently, we use the ingredients method to present cost analyses of MOOC production and delivery at four institutions. We find costs ranging from $38,980 to $325,330 per MOOC, and costs per completer of $74-$272, substantially lower than costs per completer of regular online courses, by merit of scalability. Based on this metric, MOOCs appear more cost-effective than online courses, but we recommend judging MOOCs by impact on learning and caution that they may only be cost-effective for the most self-motivated learners. By demonstrating the methods of cost analysis as applied to MOOCs, we hope that future assessments of the value of MOOCs will combine both cost information and effectiveness data to yield cost-effectiveness ratios that can be compared with the cost-effectiveness of alternative modes of education delivery. Such information will help decision-makers in higher education make rational decisions regarding the most productive use of limited educational resources, to the benefit of both learners and taxpayers.

  8. Cognitive cost as dynamic allocation of energetic resources.

    Science.gov (United States)

    Christie, S Thomas; Schrater, Paul

    2015-01-01

    While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the "cost/benefit" and "limited resource" models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive look ahead, and model-free vs. model-based policy learning.

  9. BOOK REVIEW OPEN EDUCATIONAL RESOURCES: Policy, Costs and Transformation

    Directory of Open Access Journals (Sweden)

    Can GULER

    2016-10-01

    Full Text Available This book presents 15 case studies contributed by researchers and policy makers. The Open Educational Resources (OER implementations are expressed through different point of views. This book focused on three themes: policy, costs and transformation. Policy theme is related to the establishment of priorities for supporting the decisions made by an institution or organization. Costs theme explores the funding of OER, particularly in the sense of cost effectiveness. Transformation theme provides examples that demonstrate how OER can be used in ways that go beyond replication of current teaching and learning models. The editors in the Introduction elaborately describe these three themes.

  10. Passenger vehicles that minimize the costs of ownership and environmental damages in the Indian market

    International Nuclear Information System (INIS)

    Gilmore, Elisabeth A.; Patwardhan, Anand

    2016-01-01

    Highlights: • Full costs (private and social) are evaluated for Indian passenger cars. • Diesel has low ownership costs, but higher climate and health damages. • Compressed natural gas cars have lower costs and damages than petrol cars. • Electric cars have higher damages due to electricity generation emissions. • CNG and less carbon intensive electricity minimizes Indian cars’ full cost. - Abstract: Rapid expansion of population and income growth in developing countries, such as India, is increasing the demand for many goods and services, including four-wheeled passenger cars. Passenger cars provide personal mobility; however, they also have negative implications for human wellbeing from increased air pollutants and greenhouse gases (GHG). Here, we evaluate the range of passenger vehicles available in the Indian market to identify options that minimize costs, human health effects and climate damages. Our approach is to compare alternative fuel/powertrain vehicles with similar conventional gasoline fueled vehicles and assess the differences in full (private and societal) costs for each pair. Private costs are the combination of capital costs and the discounted expected future fuel costs over the vehicle lifetime. The costs to human health from air quality are calculated using intake fractions to estimate exposure and literature values for the damage costs adjusted by benefits transfer methods. We use the Social Cost of Carbon to estimate climate damages. We find that, on average, the net present value (NPV) of the full costs of compressed natural gas (CNG) vehicles are lower than comparable gasoline vehicles, while, diesel vehicles have higher costs. Presently, electric vehicles have higher private costs (due to high capital costs) and societal costs (due to electricity generation emissions). Either a less carbon intensive electricity grid or an increase in the CNG fleet would minimize total costs, human health effects and GHG emissions from the

  11. Cost of wind energy: comparing distant wind resources to local resources in the midwestern United States.

    Science.gov (United States)

    Hoppock, David C; Patiño-Echeverri, Dalia

    2010-11-15

    The best wind sites in the United States are often located far from electricity demand centers and lack transmission access. Local sites that have lower quality wind resources but do not require as much power transmission capacity are an alternative to distant wind resources. In this paper, we explore the trade-offs between developing new wind generation at local sites and installing wind farms at remote sites. We first examine the general relationship between the high capital costs required for local wind development and the relatively lower capital costs required to install a wind farm capable of generating the same electrical output at a remote site,with the results representing the maximum amount an investor should be willing to pay for transmission access. We suggest that this analysis can be used as a first step in comparing potential wind resources to meet a state renewable portfolio standard (RPS). To illustrate, we compare the cost of local wind (∼50 km from the load) to the cost of distant wind requiring new transmission (∼550-750 km from the load) to meet the Illinois RPS. We find that local, lower capacity factor wind sites are the lowest cost option for meeting the Illinois RPS if new long distance transmission is required to access distant, higher capacity factor wind resources. If higher capacity wind sites can be connected to the existing grid at minimal cost, in many cases they will have lower costs.

  12. Resource Footprints are Good Proxies of Environmental Damage

    NARCIS (Netherlands)

    Steinmann, Z.J.N.; Schipper, A.M.; Hauck, M.; Giljum, S.; Wernet, G.; Huijbregts, M.A.J.

    2017-01-01

    Environmental footprints are increasingly used to quantify and compare environmental impacts of for example products, technologies, households, or nations. This has resulted in a multitude of footprint indicators, ranging from relatively simple measures of resource use (water, energy, materials) to

  13. Cognitive cost as dynamic allocation of energetic resources

    Directory of Open Access Journals (Sweden)

    Scott Thomas Christie

    2015-08-01

    Full Text Available While it is widely recognized that thinking is somehow costly, involving cognitive effort and producing mental fatigue, these costs have alternatively been assumed to exist, treated as the brain's assessment of lost opportunities, or suggested to be metabolic but with implausible biological bases. We present a model of cognitive cost based on the novel idea that the brain senses and plans for longer-term allocation of metabolic resources by purposively conserving brain activity. We identify several distinct ways the brain might control its metabolic output, and show how a control-theoretic model that models decision-making with an energy budget can explain cognitive effort avoidance in terms of an optimal allocation of limited energetic resources. The model accounts for both for subject responsiveness to reward and the detrimental effects of hypoglycemia on cognitive function. A critical component of the model is using astrocytic glycogen as a plausible basis for limited energetic reserves. Glycogen acts as an energy buffer that can temporarily support high neural activity beyond the rate supported by blood glucose supply. The published dynamics of glycogen depletion and repletion are consonant with a broad array of phenomena associated with cognitive cost. Our model thus subsumes both the cost/benefit and limited resource models of cognitive cost while retaining valuable contributions of each. We discuss how the rational control of metabolic resources could underpin the control of attention, working memory, cognitive lookahead, model-free vs. model-based policy learning as well as the pattern of generalization of cognitive improvements due to video-game training experiments.

  14. Coordinating ecological risk assessment with natural resource damage assessment: A panel discussion.

    Science.gov (United States)

    Sanders, Brenda; Ammann, Mike; Hoff, Rebecca; Huston, Mark; Jenkins, Kenneth; Palagyi, Tony; Pelto, Karen; Rettig, Todd; Wagner, Anne

    2016-10-01

    Contaminated sites in the United States undergo remediation and restoration through regulatory programs that lead the 2 processes through independent but often parallel pathways with different objectives. The objective of remediation is to reduce risk to human health and the environment, whereas that of restoration is to restore injured resources and compensate the public for lost use of the services that natural resources provide. More complex sites, such as those associated with large river systems and urban waterways, have resulted in increasingly larger-scale ecological risk assessments (ERAs) and natural resource damage assessments (NRDAs) that take many years and involve diverse practitioners including scientists, economists, and engineers. Substantial levels of effort are now frequently required, creating a need for more efficient and cost-effective approaches to data collection, analyses, and assessments. Because there are commonalities in the data needs between ERAs and NRDAs, coordination of the design and implementation of site-specific studies that meet the needs of both programs could result in increased efficiency and lower costs. The Association for Environmental Health and Sciences Foundation convened a panel of environmental practitioners from industry, consulting, and regulatory bodies to examine the benefits and challenges associated with coordinating ERA and NRDA activities in the context of a broad range of regulatory programs. This brief communication presents the opinions and conclusions of the panelists on these issues and reports 2 case studies for which coordinated ERA and NRDA activities produced a positive outcome. Integr Environ Assess Manag 2016;12:616-621. © 2015 SETAC. © 2015 SETAC.

  15. Damage Cost of Drying of Aflaj in the Sultanate of Oman

    Directory of Open Access Journals (Sweden)

    Slim Zekri1

    2012-01-01

    Full Text Available Life style changes, population and economic growth, and lack of institutional innovations are causing noticeable damage to the rural communities living in and around Aflaj. The Ministry of Regional Municipalities and Water Resources (MRMWR reported more than 1,000 dried-up Aflaj out of 4,112 in 1996. This paper presents an estimation of the damage caused to the rural communities due to Aflaj dry-up. The production function method and the cost based method are used to estimate the direct losses incurred by farmers and the local communities. These are related to (1 losses in marketed agricultural products, (2 increase in domestic water expenditures per household and (3 capital losses related to changes in house and land values. The study considered 33 dried-up Aflaj among the 1029 monitored by the MRMWR. Our results show that on average each family in the dried-up Falaj has lost an income equivalent of O.R 320 per month. This highlights the importance of Aflaj as an income generator in the remote rural areas. Live Aflaj provide fresh vegetables and healthy food as well as drinking water to the rural population without the need for governmental intervention. The contribution of the supporting wells, whenever provided by the MRMWR, is estimated at O.R 1,478 per family per year. On average the annual financial loss per family due to dry-up is estimated at O.R 3,301 per year. The total damage cost of dried-up Aflaj, at the Sultanate level, is estimated at more than O.R 59 million per year.

  16. On measuring the natural and environmental resource value and damages

    Czech Academy of Sciences Publication Activity Database

    Seják, J.; Cudlín, Pavel

    2010-01-01

    Roč. 4, č. 2 (2010), s. 53-68 ISSN 1802-212X Institutional research plan: CEZ:AV0Z60870520 Keywords : monetary valuations of nature * biotopes * natural resource injuries * quantifications Subject RIV: EH - Ecology, Behaviour http://fzp.ujep.cz/Veda/Edice/StudiaOecologica/SO_2-2010_web.pdf

  17. 76 FR 65182 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-20

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

  18. 77 FR 25499 - Notice of Lodging of Proposed Natural Resource Damages Consent Decree Under the Comprehensive...

    Science.gov (United States)

    2012-04-30

    ... above. Ronald Gluck, Assistant Section Chief, Environmental Enforcement Section Environment and Natural... Department of the Interior's Natural Resource Damage Assessment and Restoration Fund, which can be used to.... Comments should be addressed to the Assistant Attorney General, Environment and Natural Resources Division...

  19. Alleviating inequality in climate policy costs: an integrated perspective on mitigation, damage and adaptation

    Science.gov (United States)

    De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, D. P.

    2016-07-01

    Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of including adaptation and residual damage in equity considerations by determining how the allocation of emission allowances would change to counteract regional differences in total climate costs, defined as the costs of mitigation, adaptation, and residual damage. We compare emission levels resulting from a global carbon tax with two allocations of emission allowances under a global cap-and-trade system: one equating mitigation costs and one equating total climate costs as share of GDP. To account for uncertainties in both mitigation and adaptation, we use a model-comparison approach employing two alternative modeling frameworks with different damage, adaptation cost, and mitigation cost estimates, and look at two different climate goals. Despite the identified model uncertainties, we derive unambiguous results on the change in emission allowance allocation that could lessen the unequal distribution of adaptation costs and residual damages through the financial transfers associated with emission trading.

  20. 75 FR 64717 - Convention on Supplementary Compensation for Nuclear Damage Contingent Cost Allocation

    Science.gov (United States)

    2010-10-20

    ... DEPARTMENT OF ENERGY Convention on Supplementary Compensation for Nuclear Damage Contingent Cost... Supplementary Compensation for Nuclear Damage (``CSC'') including its obligation to contribute to an international supplementary fund in the event of certain nuclear incidents. The NOI provided a September 27...

  1. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  2. Unit costs in international economic evaluations: resource costing of the Schizophrenia Outpatient Health Outcomes Study.

    Science.gov (United States)

    Urdahl, H; Knapp, M; Edgell, E T; Ghandi, G; Haro, J M

    2003-01-01

    We present unit costs corresponding to resource information collected in the Schizophrenia Outpatient Health Outcomes (SOHO) Study. The SOHO study is a 3-year, prospective, observational study of health outcomes associated with antipsychotic treatment in out-patients treated for schizophrenia. The study is being conducted across 10 European countries (Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Portugal, Spain and the UK) and includes over 10,800 patients and over 1000 investigators. To identify the best available unit costs of hospital admissions, day care and psychiatrist out-patient visits, a tariff-based approach was used. Unit costs were obtained for nine of the 10 countries and were adjusted to 2000 price levels by consumer price indices and converted to US dollars using purchasing power parity rates (and on to Euro). The paper illustrates the need to balance the search for sound unit costs with pragmatic solutions in the costing of international economic evaluations.

  3. MonitoringResources.org—Supporting coordinated and cost-effective natural resource monitoring across organizations

    Science.gov (United States)

    Bayer, Jennifer M.; Scully, Rebecca A.; Weltzin, Jake F.

    2018-05-21

    Natural resource managers who oversee the Nation’s resources require data to support informed decision-making at a variety of spatial and temporal scales that often cross typical jurisdictional boundaries such as states, agency regions, and watersheds. These data come from multiple agencies, programs, and sources, often with their own methods and standards for data collection and organization. Coordinating standards and methods is often prohibitively time-intensive and expensive. MonitoringResources.org offers a suite of tools and resources that support coordination of monitoring efforts, cost-effective planning, and sharing of knowledge among organizations. The website was developed by the Pacific Northwest Aquatic Monitoring Partnership—a collaboration of Federal, state, tribal, local, and private monitoring programs—and the U.S. Geological Survey (USGS), with funding from the Bonneville Power Administration and USGS. It is a key component of a coordinated monitoring and information network.

  4. Type A natural resource damage assessment models for Great Lakes environments (NRDAM/GLE) and coastal and marine environments (NRDAM/CME)

    International Nuclear Information System (INIS)

    French, D.P.; Reed, M.

    1993-01-01

    A computer model of the physical fates, biological effects, and economic damages resulting from releases of oil and other hazardous materials has been developed by ASA to be used in Type A natural resource damage assessments under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Natural Resource Damage Assessment Models for Great Lakes Environments (NRDAM/GLE) and for Coastal and Marine Environments (NRDAM/GLE) and for Coastal and Marine Environments (NRDAM/CME) will become available. These models will also support NOAA's damage assessment regulations under the Oil Pollution Act of 1990. The physical and biological models are three-dimensional. Direct mortality from toxic concentrations and oiling, impacts of habitat loss, and food web losses are included in the model. Estimation of natural resource damages is based both on the lost value of injured resources and on the costs for restoration or replacement of those resources. A coupled geographical information system (GIS) allows gridded representation of complex coastal boundaries, variable bathymetry, shoreline types, and multiple biological habitats. The models contain environmental, geographical, chemical, toxicological, biological, restoration and economic databases with the necessary information to estimate damages. Chemical and toxicological data are included for about 470 chemicals and oils. Biological data are unique to 77 coastal and marine plus 11 Great Lakes provinces, and to habitat type. Restoration and economic valuations are also regionally specific

  5. Alleviating inequality in climate policy costs : An integrated perspective on mitigation, damage and adaptation

    NARCIS (Netherlands)

    De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, Detlef

    2016-01-01

    Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of

  6. 76 FR 61089 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-03

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

  7. Damage and protection cost curves for coastal floods within the 600 largest European cities

    Science.gov (United States)

    Prahl, Boris F.; Boettle, Markus; Costa, Luís; Kropp, Jürgen P.; Rybski, Diego

    2018-01-01

    The economic assessment of the impacts of storm surges and sea-level rise in coastal cities requires high-level information on the damage and protection costs associated with varying flood heights. We provide a systematically and consistently calculated dataset of macroscale damage and protection cost curves for the 600 largest European coastal cities opening the perspective for a wide range of applications. Offering the first comprehensive dataset to include the costs of dike protection, we provide the underpinning information to run comparative assessments of costs and benefits of coastal adaptation. Aggregate cost curves for coastal flooding at the city-level are commonly regarded as by-products of impact assessments and are generally not published as a standalone dataset. Hence, our work also aims at initiating a more critical discussion on the availability and derivation of cost curves. PMID:29557944

  8. Damage and protection cost curves for coastal floods within the 600 largest European cities

    Science.gov (United States)

    Prahl, Boris F.; Boettle, Markus; Costa, Luís; Kropp, Jürgen P.; Rybski, Diego

    2018-03-01

    The economic assessment of the impacts of storm surges and sea-level rise in coastal cities requires high-level information on the damage and protection costs associated with varying flood heights. We provide a systematically and consistently calculated dataset of macroscale damage and protection cost curves for the 600 largest European coastal cities opening the perspective for a wide range of applications. Offering the first comprehensive dataset to include the costs of dike protection, we provide the underpinning information to run comparative assessments of costs and benefits of coastal adaptation. Aggregate cost curves for coastal flooding at the city-level are commonly regarded as by-products of impact assessments and are generally not published as a standalone dataset. Hence, our work also aims at initiating a more critical discussion on the availability and derivation of cost curves.

  9. Estimating the uncertainty of damage costs of pollution: A simple transparent method and typical results

    International Nuclear Information System (INIS)

    Spadaro, Joseph V.; Rabl, Ari

    2008-01-01

    Whereas the uncertainty of environmental impacts and damage costs is usually estimated by means of a Monte Carlo calculation, this paper shows that most (and in many cases all) of the uncertainty calculation involves products and/or sums of products and can be accomplished with an analytic solution which is simple and transparent. We present our own assessment of the component uncertainties and calculate the total uncertainty for the impacts and damage costs of the classical air pollutants; results for a Monte Carlo calculation for the dispersion part are also shown. The distribution of the damage costs is approximately lognormal and can be characterized in terms of geometric mean μ g and geometric standard deviation σ g , implying that the confidence interval is multiplicative. We find that for the classical air pollutants σ g is approximately 3 and the 68% confidence interval is [μ g / σ g , μ g σ g ]. Because the lognormal distribution is highly skewed for large σ g , the median is significantly smaller than the mean. We also consider the case where several lognormally distributed damage costs are added, for example to obtain the total damage cost due to all the air pollutants emitted by a power plant, and we find that the relative error of the sum can be significantly smaller than the relative errors of the summands. Even though the distribution for such sums is not exactly lognormal, we present a simple lognormal approximation that is quite adequate for most applications

  10. Cost-Benefit Analysis of Computer Resources for Machine Learning

    Science.gov (United States)

    Champion, Richard A.

    2007-01-01

    Machine learning describes pattern-recognition algorithms - in this case, probabilistic neural networks (PNNs). These can be computationally intensive, in part because of the nonlinear optimizer, a numerical process that calibrates the PNN by minimizing a sum of squared errors. This report suggests efficiencies that are expressed as cost and benefit. The cost is computer time needed to calibrate the PNN, and the benefit is goodness-of-fit, how well the PNN learns the pattern in the data. There may be a point of diminishing returns where a further expenditure of computer resources does not produce additional benefits. Sampling is suggested as a cost-reduction strategy. One consideration is how many points to select for calibration and another is the geometric distribution of the points. The data points may be nonuniformly distributed across space, so that sampling at some locations provides additional benefit while sampling at other locations does not. A stratified sampling strategy can be designed to select more points in regions where they reduce the calibration error and fewer points in regions where they do not. Goodness-of-fit tests ensure that the sampling does not introduce bias. This approach is illustrated by statistical experiments for computing correlations between measures of roadless area and population density for the San Francisco Bay Area. The alternative to training efficiencies is to rely on high-performance computer systems. These may require specialized programming and algorithms that are optimized for parallel performance.

  11. 15 CFR 990.20 - Relationship to the CERCLA natural resource damage assessment regulations.

    Science.gov (United States)

    2010-01-01

    ...., and the Federal Water Pollution Control Act (Clean Water Act), 33 U.S.C. 1321 et seq., are codified at... Relating to Commerce and Foreign Trade (Continued) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE OIL POLLUTION ACT REGULATIONS NATURAL RESOURCE DAMAGE ASSESSMENTS Authorities § 990.20...

  12. Economics of social trade-off: Balancing wastewater treatment cost and ecosystem damage.

    Science.gov (United States)

    Jiang, Yu; Dinar, Ariel; Hellegers, Petra

    2018-04-01

    We have developed a social optimization model that integrates the financial and ecological costs associated with wastewater treatment and ecosystem damage. The social optimal abatement level of water pollution is determined by finding the trade-off between the cost of pollution control and its resulting ecosystem damage. The model is applied to data from the Lake Taihu region in China to demonstrate this trade-off. A wastewater treatment cost function is estimated with a sizable sample from China, and an ecological damage cost function is estimated following an ecosystem service valuation framework. Results show that the wastewater treatment cost function has economies of scale in facility capacity, and diseconomies in pollutant removal efficiency. Results also show that a low value of the ecosystem service will lead to serious ecological damage. One important policy implication is that the assimilative capacity of the lake should be enhanced by forbidding over extraction of water from the lake. It is also suggested that more work should be done to improve the accuracy of the economic valuation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Cost of supplying energy from New Zealand resources

    Energy Technology Data Exchange (ETDEWEB)

    Norman, Robert G.

    1977-10-15

    The kinds of costs which face the community when a power project is promoted are broadly discussed. Sometimes, costs such as social, economic, and environmental impacts do not appear often in budgetary form. The growth of public participation is discussed. Components (investigation costs, development costs, distribution costs, social costs, environmental costs, etc.) which contribute to the cost of energy production and supply are examined in some detail.

  14. Stochastic renewal process models for estimation of damage cost over the life-cycle of a structure

    NARCIS (Netherlands)

    Pandey, Mahesh D.; van der Weide, J.A.M.

    2017-01-01

    In the life-cycle cost analysis of a structure, the total cost of damage caused by external hazards like earthquakes, wind storms and flood is an important but highly uncertain component. In the literature, the expected damage cost is typically analyzed under the assumption of either the

  15. Natural resources damage assessments at Department of Energy facilities - using the CERCLA process to minimize natural resources injuries

    International Nuclear Information System (INIS)

    Bascietto, J.J.; Martin, J.F.; Duke, C.S.; Gray, S.I.

    1991-01-01

    Fifty years of research, development and production in support of national defense have left the Department of Energy (DOE) with numerous radioactive, hazardous and mixed waste sites requiring environmental restoration and remediation. The responsibilities for DOE associated with releases of these wastes into the environment are driving major efforts to characterize contamination problems and identify and implement environmental restoration and remediation alternatives. The subject of this paper is the recently issued DOE guidance to minimize the basis for damage claims for injuries to natural resources on, over and under lands owned or controlled by DOE associated with the releases of hazardous substances from DOE facilities. Depending on the regulatory authority governing the facility, the preferred means of evaluating the possibility of injury to natural resources is the preparation of an ecological risk assessment or an environmental evaluation. As both the natural resource trustee and lead agency at facilities under its control, DOE receives dual responsibility requiring site remediation if necessary, and that any injured natural resources be restored, or that compensation for the injuries is made. Several executive and legislative sources of authority and responsibility with regard to lead agencies and trustees of natural resources will be detailed. Also, ongoing remedial investigation/feasibility study work at the DOE Fernald Environmental Management Project near Fernald, Ohio will be described as an example of how this guidance can be applied

  16. Harvest operations for density management: planning requirements, production, costs, stand damage, and recommendations

    Science.gov (United States)

    Loren D. Kellogg; Stephen J. Pilkerton

    2013-01-01

    Since the early 1990s, several studies have been undertaken to determine the planning requirements, productivity, costs, and residual stand damage of harvest operations in thinning treatments designed to promote development of complex forest structure in order to enhance ecological functioning and biological diversity. Th ese studies include the Oregon State...

  17. Potential damage costs of Diabrotica virgifera virgifera infestation in Europe - the 'no control' scenario

    NARCIS (Netherlands)

    Wesseler, J.H.H.; Fall, E.H.

    2010-01-01

    he Western Corn Rootworm (WCR or Dvv., Diabrotica virgifera virgifera Le Conte) was first detected in Europe in the early nineties in Serbia. Since then the beetle has spread to more than 15 European countries. We assess the potential damage costs of the invasive species Diabrotica virgifera

  18. Costs for insurance of civil responsibility for nuclear damage during transportation of nuclear materials

    International Nuclear Information System (INIS)

    Amelina, M.E.; Arsent'ev, S.V.; Molchanov, A.S.

    2009-01-01

    The article considers the method of calculation of rates for insurance of civil responsibility for nuclear damage during transportation of nuclear materials, which can minimize the insurer's costs for this type of insurance in situation when there is no statistics available and it is not possible to calculate the insurance rate by the traditional means using the probability theory

  19. Damage costs due to automotive air pollution and the influence of street canyons

    International Nuclear Information System (INIS)

    Spadaro, Joseph V.; Rabl, Ari

    2001-01-01

    Using the methodology of the ExternE Project of the European Commission, we have evaluated the damage costs of automotive air pollution by way of two case studies in France: a trip across Paris, and a trip from Paris to Lyon. This methodology involves an analysis of the impact pathways, starting with the emissions (e.g., g/km of particles form tailpipe), followed by local and regional dispersion (e.g., incremental μg/m 3 of particles), calculation of the physical impacts using exposure-response functions (e.g., cases of respiratory hospital admissions), and finally multiplication by unit costs factors (e.g., ε per hospital admission). Damages are aggregated over all affected receptors in Europe. In addition to the local and regional dispersion calculations carried out so far by ExternE, we also consider the increased microscale impacts due to the trapping of pollutants in street canyons, using numerical simulations with the FLUENT software. We have evaluated impacts to human health, agricultural crops and building materials, due to particles, NO x , CO, HC and CO 2 . Health impacts, especially reduced life expectancy, dominate in terms of cost. Damages for older cars (before 1997) range from 2 to 41Euro cents/km, whereas for newer cars (since 1997), the range 1-9 Euro cents/km, and there is continuing progress in reducing the emissions further. In large cities, the particulate emissions of diesel cars lead to the highest damages, exceeding those of gasoline cars by a factor of 7. For cars before 1997 the order of magnitude of the damage costs is comparable to the price of gasoline, and the loss of life expectancy is comparable to that from traffic accidents. (Author)

  20. The user cost of energy resource and its reasonable tax rate-A case of oil

    Science.gov (United States)

    Lifan, Liu

    2017-12-01

    The development and use of natural resources bring about the externality of resources depletion, especially for non-renewable resources. This paper takes oil as an example to analyze the user cost of energy resource with EI Serafy User cost method, and discusses the rationality of the resource tax. Meanwhile, this paper determines oil resource tax rate in consideration of resource sustainable development. The results show that, the user cost of oil isn’t compensated fully, it is too low to make compensation to the environment and the profit of future generation, and the resource tax is a little low. At last of the paper, some conclusions and policy suggestions on resource tax reform are given.

  1. Mathematical models for estimating earthquake casualties and damage cost through regression analysis using matrices

    International Nuclear Information System (INIS)

    Urrutia, J D; Bautista, L A; Baccay, E B

    2014-01-01

    The aim of this study was to develop mathematical models for estimating earthquake casualties such as death, number of injured persons, affected families and total cost of damage. To quantify the direct damages from earthquakes to human beings and properties given the magnitude, intensity, depth of focus, location of epicentre and time duration, the regression models were made. The researchers formulated models through regression analysis using matrices and used α = 0.01. The study considered thirty destructive earthquakes that hit the Philippines from the inclusive years 1968 to 2012. Relevant data about these said earthquakes were obtained from Philippine Institute of Volcanology and Seismology. Data on damages and casualties were gathered from the records of National Disaster Risk Reduction and Management Council. This study will be of great value in emergency planning, initiating and updating programs for earthquake hazard reduction in the Philippines, which is an earthquake-prone country.

  2. Benchmarking Discount Rate in Natural Resource Damage Assessment with Risk Aversion.

    Science.gov (United States)

    Wu, Desheng; Chen, Shuzhen

    2017-08-01

    Benchmarking a credible discount rate is of crucial importance in natural resource damage assessment (NRDA) and restoration evaluation. This article integrates a holistic framework of NRDA with prevailing low discount rate theory, and proposes a discount rate benchmarking decision support system based on service-specific risk aversion. The proposed approach has the flexibility of choosing appropriate discount rates for gauging long-term services, as opposed to decisions based simply on duration. It improves injury identification in NRDA since potential damages and side-effects to ecosystem services are revealed within the service-specific framework. A real embankment case study demonstrates valid implementation of the method. © 2017 Society for Risk Analysis.

  3. Transaction costs and community-based natural resource management in Nepal.

    Science.gov (United States)

    Adhikari, Bhim; Lovett, Jon C

    2006-01-01

    Transaction costs in community-based resource management are incurred by households attempting to enforce property right rules over common resources similar to those inherent in private property rights. Despite their importance, transaction costs of community-based management of common pool resources (CPRs) are often not incorporated into the economic analysis of participatory resource management. This paper examines the transaction costs incurred by forest users in community forestry (CF) based on a survey of 309 households belonging to eight different forest user groups (FUGs) in the mid hills of Nepal. The analysis reveals that the average 'poor' household incurred Nepalese rupees (NRS) 1265 in transaction costs annually, while wealthier 'rich' households incurred an average of NRS 2312 per year. Although richer households bear higher proportions of such costs, transaction costs for CF management as a percentage of resource appropriation costs are higher for poorer households (26%) than those of middle-wealth (24%) or rich households (14%). There are also village differences in the level of transaction costs. The results show that transaction costs are a major component of resource management costs and vary according to socio-economic status of resource users and characteristics of the community.

  4. A three-dimensional natural resource damage assessment and coupled geographical information system

    International Nuclear Information System (INIS)

    Reed, M.; French, D.; Feng, S.S.; Knauss, W.

    1991-01-01

    In this paper a numerical model for natural resource damage assessments is discussed. The model addresses a wide range of spatial and temporal scales. The transport equations for both pollutant and biota are solved with a three-dimensional Lagrangian particle methodology. The model can simulate continuous releases of a contaminant, with representation of complex coastal boundaries, variable bathymetry, multiple shoreline types, and spatially variable ecosystem habitats. A graphic interface gives the user complete and facile control of the dynamic transport and biological submodels, as ell as the ability to display elements of the underlying geographical information system (GIS) data base. The model is being implemented on a 386 PC

  5. Is reproduction costly? No increase of oxidative damage in breeding bank voles.

    Science.gov (United States)

    Ołdakowski, Łukasz; Piotrowska, Zaneta; Chrzaácik, Katarzyna M; Sadowska, Edyta T; Koteja, Paweł; Taylor, Jan R E

    2012-06-01

    According to life-history theory, investment in reproduction is associated with costs, which should appear as decreased survival to the next reproduction or lower future reproductive success. It has been suggested that oxidative stress may be the proximate mechanism of these trade-offs. Despite numerous studies of the defense against reactive oxygen species (ROS) during reproduction, very little is known about the damage caused by ROS to the tissues of wild breeding animals. We measured oxidative damage to lipids and proteins in breeding bank vole (Myodes glareolus) females after rearing one and two litters, and in non-breeding females. We used bank voles from lines selected for high maximum aerobic metabolic rates (which also had high resting metabolic rates and food intake) and non-selected control lines. The oxidative damage was determined in heart, kidneys and skeletal muscles by measuring the concentration of thiobarbituric acid-reactive substances, as markers of lipid peroxidation, and carbonyl groups in proteins, as markers of protein oxidation. Surprisingly, we found that the oxidative damage to lipids in kidneys and muscles was actually lower in breeding than in non-breeding voles, and it did not differ between animals from the selected and control lines. Thus, contrary to our predictions, females that bred suffered lower levels of oxidative stress than those that did not reproduce. Elevated production of antioxidant enzymes and the protective role of sex hormones may explain the results. The results of the present study do not support the hypothesis that oxidative damage to tissues is the proximate mechanism of reproduction costs.

  6. The external costs of low probability-high consequence events: Ex ante damages and lay risks

    International Nuclear Information System (INIS)

    Krupnick, A.J.; Markandya, A.; Nickell, E.

    1994-01-01

    This paper provides an analytical basis for characterizing key differences between two perspectives on how to estimate the expected damages of low probability - high consequence events. One perspective is the conventional method used in the U.S.-EC fuel cycle reports [e.g., ORNL/RFF (1994a,b]. This paper articulates another perspective, using economic theory. The paper makes a strong case for considering this, approach as an alternative, or at least as a complement, to the conventional approach. This alternative approach is an important area for future research. I Interest has been growing worldwide in embedding the external costs of productive activities, particularly the fuel cycles resulting in electricity generation, into prices. In any attempt to internalize these costs, one must take into account explicitly the remote but real possibilities of accidents and the wide gap between lay perceptions and expert assessments of such risks. In our fuel cycle analyses, we estimate damages and benefits' by simply monetizing expected consequences, based on pollution dispersion models, exposure-response functions, and valuation functions. For accidents, such as mining and transportation accidents, natural gas pipeline accidents, and oil barge accidents, we use historical data to estimate the rates of these accidents. For extremely severe accidents--such as severe nuclear reactor accidents and catastrophic oil tanker spills--events are extremely rare and they do not offer a sufficient sample size to estimate their probabilities based on past occurrences. In those cases the conventional approach is to rely on expert judgments about both the probability of the consequences and their magnitude. As an example of standard practice, which we term here an expert expected damage (EED) approach to estimating damages, consider how evacuation costs are estimated in the nuclear fuel cycle report

  7. The external costs of low probability-high consequence events: Ex ante damages and lay risks

    Energy Technology Data Exchange (ETDEWEB)

    Krupnick, A J; Markandya, A; Nickell, E

    1994-07-01

    This paper provides an analytical basis for characterizing key differences between two perspectives on how to estimate the expected damages of low probability - high consequence events. One perspective is the conventional method used in the U.S.-EC fuel cycle reports [e.g., ORNL/RFF (1994a,b]. This paper articulates another perspective, using economic theory. The paper makes a strong case for considering this, approach as an alternative, or at least as a complement, to the conventional approach. This alternative approach is an important area for future research. I Interest has been growing worldwide in embedding the external costs of productive activities, particularly the fuel cycles resulting in electricity generation, into prices. In any attempt to internalize these costs, one must take into account explicitly the remote but real possibilities of accidents and the wide gap between lay perceptions and expert assessments of such risks. In our fuel cycle analyses, we estimate damages and benefits' by simply monetizing expected consequences, based on pollution dispersion models, exposure-response functions, and valuation functions. For accidents, such as mining and transportation accidents, natural gas pipeline accidents, and oil barge accidents, we use historical data to estimate the rates of these accidents. For extremely severe accidents--such as severe nuclear reactor accidents and catastrophic oil tanker spills--events are extremely rare and they do not offer a sufficient sample size to estimate their probabilities based on past occurrences. In those cases the conventional approach is to rely on expert judgments about both the probability of the consequences and their magnitude. As an example of standard practice, which we term here an expert expected damage (EED) approach to estimating damages, consider how evacuation costs are estimated in the nuclear fuel cycle report.

  8. Evaluation of activity-based costing versus resource-based relative value costing.

    Science.gov (United States)

    Berlin, Mark F; Smith, Tommy H

    2004-01-01

    Activity-based costing (ABC) and relative value units costing (RVU) are two approaches that a practice manager can use to determine the cost of physician services. Each costing approach has features that provide distinction as well as differentiation in the cost estimates that are estimated. This paper will provide cost estimates under each approach along with cost estimates under a hybrid approach that merges features from each costing approach known as the ABC-RVU costing technique. A comparison of the results will be provided.

  9. Validation of the natural resource damage assessment model using historical observations on oil spills

    International Nuclear Information System (INIS)

    French, D.; Rines, H.

    1995-01-01

    The Natural Resource Damage Assessment Model for Coastal and Marine Environments (NRDAM/CME) was developed by Applied Science Associates to simulate the fate and effects of oil and chemical spills into estuarine and marine environments. The US Department of the Interior has proposed the NRDAM/CME for use in Natural Resource Damage Assessment (NRDA) regulations under CERCLA. As part of the evaluation of model performance, the NRDAM/CME has been validated with observational data from case histories of oil spills, including the Exxon Valdez, World Prodigy, Mega Borg, Apex Houston and a number of others. Primarily, the data available for validation were of oil slick trajectory and coverage (e.g., overflight maps), length of shoreline oiled, area of marshes oiled, and a number of oiled birds recovered. Model performance was dependent on the accuracy of available wind and current data (the primary forces affecting fate) and bird abundances. Where these data sources were good (relatively well quantified), model performance was excellent. Results of the model simulations also provide an interesting sensitivity analysis and indications of relative effects of oil under various spill scenarios and conditions

  10. Environmental management: Integrating ecological evaluation, remediation, restoration, natural resource damage assessment and long-term stewardship on contaminated lands

    International Nuclear Information System (INIS)

    Burger, Joanna

    2008-01-01

    Ecological evaluation is essential for remediation, restoration, and Natural Resource Damage Assessment (NRDA), and forms the basis for many management practices. These include determining status and trends of biological, physical, or chemical/radiological conditions, conducting environmental impact assessments, performing remedial actions should remediation fail, managing ecosystems and wildlife, and assessing the efficacy of remediation, restoration, and long-term stewardship. The objective of this paper is to explore the meanings of these assessments, examine the relationships among them, and suggest methods of integration that will move environmental management forward. While remediation, restoration, and NRDA, among others, are often conducted separately, it is important to integrate them for contaminated land where the risks to ecoreceptors (including humans) can be high, and the potential damage to functioning ecosystems great. Ecological evaluations can range from inventories of local plants and animals, determinations of reproductive success of particular species, levels of contaminants in organisms, kinds and levels of effects, and environmental impact assessments, to very formal ecological risk assessments for a chemical or other stressor. Such evaluations can range from the individual species to populations, communities, ecosystems or the landscape scale. Ecological evaluations serve as the basis for making decisions about the levels and kinds of remediation, the levels and kinds of restoration possible, and the degree and kinds of natural resource injuries that have occurred because of contamination. Many different disciplines are involved in ecological evaluation, including biologists, conservationists, foresters, restoration ecologists, ecological engineers, economists, hydrologist, and geologists. Since ecological evaluation forms the basis for so many different types of environmental management, it seems reasonable to integrate management options

  11. Estimating Resource Costs of Levy Campaigns in Five Ohio School Districts

    Science.gov (United States)

    Ingle, W. Kyle; Petroff, Ruth Ann; Johnson, Paul A.

    2011-01-01

    Using Levin and McEwan's (2001) "ingredients method," this study identified the major activities and associated costs of school levy campaigns in five districts. The ingredients were divided into one of five cost categories--human resources, facilities, fees, marketing, and supplies. As to overall costs of the campaigns, estimates ranged…

  12. Cost and Systems Analysis of Innovative Fuel Resources Concepts

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Erich [Univ. of Texas, Austin, TX (United States). Nuclear and Radiation Engineering Program; Byers, M. [Univ. of Texas, Austin, TX (United States). Nuclear and Radiation Engineering Program

    2017-05-04

    Economically recovered uranium from seawater can have a transformative effect on the way policy makers view the long-term viability of uranium based fuel cycles. Seawater uranium, even when estimated to cost more than terrestrially mined uranium, is integral in establishing an economic backstop, thus reducing uncertainty in future nuclear power costs. While a passive recovery scheme relying on a field of polymer adsorbents prepared via radiation induced grafting has long been considered the leading technology for full scale deployment, non-trivial cost and logistical barriers persist. Consequently, university partners of the nation-wide consortium for seawater uranium recovery have developed variants of this technology, each aiming to address a substantial weakness. The focus of this NEUP project is the economic impacts of the proposed variant technologies. The team at University of Alabama has pursued an adsorbent synthesis method that replaces the synthetic fiber backbone with a natural waste product. Chitin fibers suitable for ligand grafting have been prepared from shrimp shell waste. These environmental benefits could be realized at a comparable cost to the reference fiber so long as the uptake can be increased or the chemical consumption cost decreased.

  13. Investment in defense and cost of predator-induced defense along a resource gradient

    DEFF Research Database (Denmark)

    Steiner, Uli

    2007-01-01

    An organism's investment in different traits to reduce predation is determined by the fitness benefit of the defense relative to the fitness costs associated with the allocation of time and resources to the defense. Inherent tradeoffs in time and resource allocation should result in differential...... investment in defense along a resource gradient, but competing models predict different patterns of investment. There are currently insufficient empirical data on changes in investment in defensive traits or their costs along resource gradients to differentiate between the competing allocation models....... In this study, I exposed tadpoles to caged predators along a resource gradient in order to estimate investment in defense and costs of defense by assessing predator-induced plasticity. Induced defenses included increased tail depth, reduced feeding, and reduced swimming activity; costs associated...

  14. Regression Analysis: Instructional Resource for Cost/Managerial Accounting

    Science.gov (United States)

    Stout, David E.

    2015-01-01

    This paper describes a classroom-tested instructional resource, grounded in principles of active learning and a constructivism, that embraces two primary objectives: "demystify" for accounting students technical material from statistics regarding ordinary least-squares (OLS) regression analysis--material that students may find obscure or…

  15. Algae Production from Wastewater Resources: An Engineering and Cost Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Schoenung, Susan [Longitude 122 West, Inc.; Efroymson, Rebecca Ann [ORNL

    2018-03-01

    Co-locating algae cultivation ponds near municipal wastewater (MWW) facilities provides the opportunity to make use of the nitrogen and phosphorus compounds in the wastewater as nutrient sources for the algae. This use benefits MWW facilities, the algae biomass and biofuel or bioproduct industry, and the users of streams where treated or untreated waste would be discharged. Nutrient compounds can lead to eutrophication, hypoxia, and adverse effects to some organisms if released downstream. This analysis presents an estimate of the cost savings made possible to cultivation facilities by using the nutrients from wastewater for algae growth rather than purchase of the nutrients. The analysis takes into consideration the cost of pipe transport from the wastewater facility to the algae ponds, a cost factor that has not been publicly documented in the past. The results show that the savings in nutrient costs can support a wastewater transport distance up to 10 miles for a 1000-acre-pond facility, with potential adjustments for different operating assumptions.

  16. Cloud Computing and Information Technology Resource Cost Management for SMEs

    DEFF Research Database (Denmark)

    Kuada, Eric; Adanu, Kwame; Olesen, Henning

    2013-01-01

    This paper analyzes the decision-making problem confronting SMEs considering the adoption of cloud computing as an alternative to in-house computing services provision. The economics of choosing between in-house computing and a cloud alternative is analyzed by comparing the total economic costs...... in determining the relative value of cloud computing....

  17. Climate change adaptation, damages and fossil fuel dependence. An RETD position paper on the costs of inaction

    Energy Technology Data Exchange (ETDEWEB)

    Katofsky, Ryan; Stanberry, Matt; Hagenstad, Marca; Frantzis, Lisa

    2011-07-15

    The Renewable Energy Technology Deployment (RETD) agreement initiated this project to advance the understanding of the ''Costs of Inaction'', i.e. the costs of climate change adaptation, damages and fossil fuel dependence. A quantitative estimate was developed as well as a better understanding of the knowledge gaps and research needs. The project also included some conceptual work on how to better integrate the analyses of mitigation, adaptation, damages and fossil fuel dependence in energy scenario modelling.

  18. Overview of avian toxicity studies for the Deepwater Horizon Natural Resource Damage Assessment

    Science.gov (United States)

    Bursian, Steven J.; Alexander, C.R.; Cacela, Dave; Cunningham, Fred L.; Dean, Karen M.; Dorr, Brian S.; Ellis, Christine K.; Godard-Codding, Céline A.J.; Guglielmo, Christopher G.; Hanson-Dorr, Katie C.; Harr, Kendall E.; Healy, Katherine A.; Hooper, Michael J.; Horak, Katherine E.; Isanhart, John P.; Kennedy, Lisa V.; Link, Jane E.; Maggini, Ivan; Moye, John K.; Perez, Christina R.; Pritsos, Chris A.; Shriner, Susan A.; Trust, Kinberly A.; Tuttle, Peter L.

    2017-01-01

    The Oil Pollution Act of 1990 establishes liability for injuries to natural resources because of the release or threat of release of oil. Assessment of injury to natural resources resulting from an oil spill and development and implementation of a plan for the restoration, rehabilitation, replacement or acquisition of natural resources to compensate for those injuries is accomplished through the Natural Resource Damage Assessment (NRDA) process. The NRDA process began within a week of the Deepwater Horizon oil spill, which occurred on April 20, 2010. During the spill, more than 8500 dead and impaired birds representing at least 93 avian species were collected. In addition, there were more than 3500 birds observed to be visibly oiled. While information in the literature at the time helped to identify some of the effects of oil on birds, it was not sufficient to fully characterize the nature and extent of the injuries to the thousands of live oiled birds, or to quantify those injuries in terms of effects on bird viability. As a result, the US Fish and Wildlife Service proposed various assessment activities to inform NRDA injury determination and quantification analyses associated with the Deepwater Horizon oil spill, including avian toxicity studies. The goal of these studies was to evaluate the effects of oral exposure to 1–20 ml of artificially weathered Mississippi Canyon 252 oil kg bw-1 day-1 from one to 28 days or one to five applications of oil to 20% of the bird's surface area. It was thought that these exposure levels would not result in immediate or short-term mortality but might result in physiological effects that ultimately could affect avian survival, reproduction and health. These studies included oral dosing studies, an external dosing study, metabolic and flight performance studies and field-based flight studies. Results of these studies indicated changes in hematologic endpoints including formation of Heinz bodies and changes in cell counts

  19. Screening of plant resources with anti-ice nucleation activity for frost damage prevention.

    Science.gov (United States)

    Suzuki, Shingo; Fukuda, Satoshi; Fukushi, Yukiharu; Arakawa, Keita

    2017-11-01

    Previous studies have shown that some polyphenols have anti-ice nucleation activity (anti-INA) against ice-nucleating bacteria that contribute to frost damage. In the present study, leaf disk freezing assay, a test of in vitro application to plant leaves, was performed for the screening of anti-INA, which inhibits the ice nucleation activity of an ice-nucleating bacterium Erwinia ananas in water droplets on the leaf surfaces. The application of polyphenols with anti-INA, kaempferol 7-O-β-glucoside and (-)-epigallocatechin gallate, to the leaf disk freezing assay by cooling at -4--6 °C for 3 h, revealed that both the compounds showed anti-INAs against E. ananas in water droplets on the leaf surfaces. Further, this assay also revealed that the extracts of five plant leaves showed high anti-INA against E. ananas in water droplets on leaf surfaces, indicating that they are the candidate resources to protect crops from frost damage.

  20. Energy wood resources availability and delivery cost in Northwest Russia

    Energy Technology Data Exchange (ETDEWEB)

    Gerasimov, Yuri; Karjalainen, Timo [Finnish Forest Research Inst., Joensuu (Finland)], E-mail: yuri.gerasimov@metla.fi

    2013-10-01

    Availability of solid by-products from wood harvesting and mechanical wood processing was estimated as sources for energy production based on recent actual harvesting, sawmill, and plywood production in Northwest Russia at 30 million m{sup 3}. Nearly 70% of the energy wood, 20 million m{sup 3}, was from harvesting, consisting of non-industrial round wood, unused branches and tops, defective wood resulting from logging, and spruce stumps removed after final felling. Over 30%, 10 million m{sup 3}, of the available volume was from sawmills and plywood mills, i.e. wood chips, sawdust, and bark. Due to current low utilization of energy wood for bioenergy in Northwest Russia, delivery cost of energy wood to the potential border-crossing points in Finland was analyzed for three means of transport: railways, roadways, and waterways. Nearly 28 million m{sup 3} of the energy wood could be transported by railways and 2 million m{sup 3} by roadways and waterways. The costs were lowest by roadways from the nearby border areas (10-15 Euro/m{sup 3} for wood processing by-products and 16-22 Euro/m{sup 3} for forest chips). The costs by railways varied from 12 to 27 Euro/m{sup 3} on shorter distances to 47-58 Euro/m{sup 3} on longer distances. Waterway transportation was the most expensive, about 28-48 Euro/m{sup 3}. It should be emphasized that we have estimated availability and delivery costs of energy wood, not prices which are defined by the market based on supply and demand.

  1. Least-cost model predictive control of residential energy resources when applying ?mCHP

    NARCIS (Netherlands)

    Houwing, M.; Negenborn, R.R.; Heijnen, P.W.; De Schutter, B.; Hellendoorn, H.

    2007-01-01

    With an increasing use of distributed energy resources and intelligence in the electricity infrastructure, the possibilities for minimizing costs of household energy consumption increase. Technology is moving toward a situation in which households manage their own energy generation and consumption,

  2. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany

    Science.gov (United States)

    2012-01-01

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the “one hospital” approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the “one hospital” model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital’s cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level. PMID:22935314

  3. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany.

    Science.gov (United States)

    Vogl, Matthias

    2012-08-30

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the "one hospital" approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the "one hospital" model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital's cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level.

  4. Creating a new paradigm for the role of the responsible party in natural resource damage assessments

    International Nuclear Information System (INIS)

    Hansen, I.K.

    1993-01-01

    The Texas Natural Resource Trustees are conducting a negotiated rulemaking with representative from environmental groups and the oil industry. The philosophy guiding these rules, which will apply to oil spills that impact coastal waters, is that each spill is a unique circumstance. The particular spill's impact should be objectively assessed through a field investigation. Reliance solely on models or compensation tables is discouraged. The observable environmental impact is an important factor in determining the type of assessment utilized. The negotiated rules will utilize federal rules as guidance and will emphasize inclusion of the responsible party in the decision to conduct an expedited or a comprehensive assessment. The rules will establish time limits for trustee decision and completion of the assessments. The time limits, which can be waived by the Commissioner of the General Land Office, are intended to encourage rapid initiation of restoration, rehabilitation, replacement and acquisition activities. The imposition of time limits will require a new paradigm for the role of the responsible party in natural resource damage assessments. The paradigm will develop through the use of joint assessments, sharing of information, and participation of the responsible party in trustee decisions. The paper will describe a joint assessment used in a recent oil spill

  5. Freshwater Aquatic Nuisance Species Impacts and Management Costs and Benefits at Federal Water Resources Projects

    Science.gov (United States)

    2006-09-01

    ERDC/TN ANSRP-06-3 September 2006 Freshwater Aquatic Nuisance Species Impacts and Management Costs and Benefits at Federal Water Resources...Cole, R. A. (2006). “ Freshwater aquatic nuisance species impacts and management costs and benefits at Federal Water resources projects,” ANSRP...Projects1 by Richard A. Cole THE ISSUE: A small fraction of the species that inhabit the nation’s fresh waters become aquatic nuisance species (ANS

  6. The Social Cost of Trading: Measuring the Increased Damages from Sulfur Dioxide Trading in the United States

    Science.gov (United States)

    Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.

    2011-01-01

    The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…

  7. 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…

  8. Flood damage in Italy: towards an assessment model of reconstruction costs

    Science.gov (United States)

    Sterlacchini, Simone; Zazzeri, Marco; Genovese, Elisabetta; Modica, Marco; Zoboli, Roberto

    2016-04-01

    Recent decades in Italy have seen a very rapid expansion of urbanisation in terms of physical assets, while demographics have remained stable. Both the characteristics of Italian soil and anthropic development, along with repeated global climatic stress, have made the country vulnerable to floods, the intensity of which is increasingly alarming. The combination of these trends will contribute to large financial losses due to property damage in the absence of specific mitigation strategies. The present study focuses on the province of Sondrio in Northern Italy (area of about 3,200 km²), which is home to more than 180,000 inhabitants and the population is growing slightly. It is clearly a hot spot for flood exposure, as it is primarily a mountainous area where floods and flash floods hit frequently. The model we use for assessing potential flood damage determines risk scenarios by overlaying flood hazard maps and economic asset data. In Italy, hazard maps are provided by Regional Authorities through the Hydrogeological System Management Plan (PAI) based on EU Flood Directive guidelines. The PAI in the study area includes both the large plain and the secondary river system and considers three hazard scenarios of Low, Medium and High Frequency associated with return periods of 20, 200 and 500 years and related water levels. By an overlay of PAI maps and residential areas, visualized on a GIS, we determine which existing built-up areas are at risk for flood according to each scenario. Then we investigate the value of physical assets potentially affected by floods in terms of market values, using the database of the Italian Property Market Observatory (OMI), and in terms of reconstruction costs, by considering synthetic cost indexes of predominant building types (from census information) and PAI water height. This study illustrates a methodology to assess flood damage in urban settlements and aims to determine general guidelines that can be extended throughout Italy

  9. [Activity-based costing methodology to manage resources in intensive care units].

    Science.gov (United States)

    Alvear V, Sandra; Canteros G, Jorge; Jara M, Juan; Rodríguez C, Patricia

    2013-11-01

    An accurate estimation of resources use by individual patients is crucial in hospital management. To measure financial costs of health care actions in intensive care units of two public regional hospitals in Chile. Prospective follow up of 716 patients admitted to two intensive care units during 2011. The financial costs of health care activities was calculated using the Activity-Based Costing methodology. The main activities recorded were procedures and treatments, monitoring, response to patient needs, patient maintenance and coordination. Activity-Based Costs, including human resources and assorted indirect costs correspond to 81 to 88% of costs per disease in one hospital and 69 to 80% in the other. The costs associated to procedures and treatments are the most significant and are approximately $100,000 (Chilean pesos) per day of hospitalization. The second most significant cost corresponds to coordination activities, which fluctuates between $86,000 and 122,000 (Chilean pesos). There are significant differences in resources use between the two hospitals studied. Therefore cost estimation methodologies should be incorporated in the management of these clinical services.

  10. Cost-effectiveness Assessment of 5G Systems with Cooperative Radio Resource Sharing

    Directory of Open Access Journals (Sweden)

    V. Nikolikj

    2015-11-01

    Full Text Available By use of techno-economic analysis of heterogeneous hierarchical cell structures and spectral efficiencies of the forthcoming advanced radio access technologies, this paper proposes various cost-efficient capacity enlargement strategies evaluated through the level of the production cost per transferred data unit and achievable profit margins. For the purpose of maximizing the aggregate performance (capacity or profit, we also assess the cooperative manners of radio resource sharing between mobile network operators, especially in the cases of capacity over-provisioning, when we also determine the principles to provide guaranteed data rates to a particular number of users. The results show that, for heavily loaded office environments, the future 5G pico base stations could be a preferable deployment solution. Also, we confirm that the radio resource management method with dynamic resource allocation can significantly improve the capacity of two comparably loaded operators which share the resources and aim to increase their cost effectiveness.

  11. Tornadoes and related damage costs: statistical modelling with a semi-Markov approach

    Directory of Open Access Journals (Sweden)

    Guglielmo D’Amico

    2016-09-01

    Full Text Available We propose a statistical approach to modelling for predicting and simulating occurrences of tornadoes and accumulated cost distributions over a time interval. This is achieved by modelling the tornado intensity, measured with the Fujita scale, as a stochastic process. Since the Fujita scale divides tornado intensity into six states, it is possible to model the tornado intensity by using Markov and semi-Markov models. We demonstrate that the semi-Markov approach is able to reproduce the duration effect that is detected in tornado occurrence. The superiority of the semi-Markov model as compared to the Markov chain model is also affirmed by means of a statistical test of hypothesis. As an application, we compute the expected value and the variance of the costs generated by the tornadoes over a given time interval in a given area. The paper contributes to the literature by demonstrating that semi-Markov models represent an effective tool for physical analysis of tornadoes as well as for the estimation of the economic damages to human things.

  12. Environmental costs and resource planning consequences: New England electric's rating and weighting approach

    International Nuclear Information System (INIS)

    Destribats, A.F.; Hutchinson, M.A.; Stout, T.M.; White, D.S.

    1990-01-01

    In mid 1989, the New England Electric System (NEES or Company) began an effort to reflect the potential environmental externalities of new resources in its long range planning process. Having examined several methods for incorporating externalities, including cost of control, the Company adopted a rating and weighting approach. Not strictly quantitative nor qualitative, the rating and weighting approach provided a means to apply an environmental score to all new resources considered for the Company's long range resource plan, NEESPLAN 1990. A maximum environmental cost penalty of fifteen percent was applied to the resource considered for inclusion in the plan that posed the highest amount of potential environmental degradation. All other resources received a smaller penalty that was based on the ratio of their environmental score to the highest score. Application of this penalty tended to improve the cost-effectiveness of demand-side programs and worsen some supply-side options' cost-effectiveness. Both the rating and weighting approach employed by NEES and its application in the long range planning process have been the subject of several critical reviews. Having stated that the advantages of the rating and weighting approach include its easy reviewability and flexibility to be modified as better information becomes available, the Company has subsequently revised the approach to address the comments made by reviewers. The purpose of this paper is to describe the rating and weighting approach, its recent revisions, and the effect of the revised methodology on the Company's long range resource plan

  13. Resource-recovery facilities: Production and cost functions, and debt-financing issues

    International Nuclear Information System (INIS)

    Simonsen, W.S.

    1991-01-01

    Some of the fiscal questions relating to resource-recovery, or trash-burning, facilities are addressed. Production and cost functions for resource-recovery facilities are estimated using regression analysis. Whether or not there are returns to scale are addressed using the production and cost-function framework. Production functions are also estimated using data envelopment analysis (DEA), and results are compared to the regression results. DEA is a linear-program-based technique that can provide information about the production process. The data used to estimate the production and cost functions were collected from the Resource Recovery Yearbook. Once the decision is made to construct a resource-recovery facility, it needs to be financed. The high cost of these facilities usually prohibits financing construction out of regular operating revenues. Therefore, the issues a government faces when debt is used to finance a resource-recovery facility are analyzed. The most important public policy finding is that increasing economies of scale do not seem to be present for resource-recovery facilities

  14. The assessment of damages due to climate change in a situation of uncertainty: the contribution of adaptation cost modelling

    International Nuclear Information System (INIS)

    Dumas, P.

    2006-01-01

    The aim of this research is to introduce new elements for the assessment of damages due to climate changes within the frame of compact models aiding the decision. Two types of methodologies are used: sequential optimisation stochastic models and simulation stochastic models using optimal assessment methods. The author first defines the damages, characterizes their different categories, and reviews the existing assessments. Notably, he makes the distinction between damages due to climate change and damages due to its rate. Then, he presents the different models used in this study, the numerical solutions, and gives a rough estimate of the importance of the considered phenomena. By introducing a new category of capital in an optimal growth model, he tries to establish a framework allowing the representation of adaptation and of its costs. He introduces inertia in macro-economical evolutions, climatic variability, detection of climate change and damages due to climate hazards

  15. Assessing the Economic Cost of Landslide Damage in Low-Relief Regions: Case Study Evidence from the Flemish Ardennes (Belgium)

    Science.gov (United States)

    Vranken, L.; Van Turnhout, P.; Van Den Eeckhaut, M.; Vandekerckhove, L.; Vantilt, G.; Poesen, J.

    2012-04-01

    Several regions around the globe are at risk to incur damage from landslides. These landslides cause significant structural and functional damage to public and private buildings and infrastructure. Numerous studies investigated how natural factors and human activities control the (re-)activation of landslides. However, few studies have concentrated on a quantitative estimate of the overall damage caused by landslides at a regional scale. This study therefore starts with a quantitative economic assessment of the direct and indirect damage caused by landslides in the Flemish Ardennes (Belgium), a low-relief region (area=ca. 700 km2) susceptible to landslides. Based on focus interviews as well as on semi-structured interviews with homeowners, civil servants (e.g. from the technical services from the various towns), or with the owners and providers of lifelines such as electricity and sewage, we have quantitatively estimated the direct and indirect damage induced by landsliding and this for a 10 to 30 year period (depending on the type of infrastructure or buildings). Economic damage to public infrastructure and buildings was estimated for the entire region, while for private damage 10 cases with severe to small damage were quantified. For example, in the last 10 year, costs of road repair augmented to 814 560 €. Costs to repair damaged roads that have not yet been repaired, were estimated at 669 318 €. In the past 30 years, costs of measures to prevent road damage augmented to at least 14 872 380 €. More than 90% of this budget for preventive measures was spent 30 years ago, when an important freeway was damaged and had to be repaired. These preventive measures (building a grout wall and improving the drainage system) were effective as no further damage has been reported until present. To repair and prevent damage to waterworks and sewage systems, expenditures amounted to 551 044 € and this for the last 30 years. In the past 10 years, a new railway line

  16. Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau.

    Science.gov (United States)

    Tyrrell, Amanda K; Russo, Giuliano; Dussault, Gilles; Ferrinho, Paulo

    2010-06-25

    In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the

  17. Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau

    Directory of Open Access Journals (Sweden)

    Dussault Gilles

    2010-06-01

    Full Text Available Abstract Introduction In the context of the current human resources for health (HRH crisis, the need for comprehensive Human Resources Development Plans (HRDP is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools. Methods This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved. Results From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process. Conclusions The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may

  18. Cost of schizophrenia: direct costs and use of resources in the State of São Paulo

    Directory of Open Access Journals (Sweden)

    Leitão Raquel Jales

    2006-01-01

    Full Text Available OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US$191,781,327 (2.2% of the total health care expenditure in the state. Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

  19. Cost of schizophrenia: direct costs and use of resources in the State of São Paulo.

    Science.gov (United States)

    Leitão, Raquel Jales; Ferraz, Marcos Bosi; Chaves, Ana Cristina; Mari, Jair J

    2006-04-01

    To estimate the direct costs of schizophrenia for the public sector. A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US $191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

  20. How much electricity really costs. Comparison of the state subsidisation and overall social costs of conventional and renewable energy resources; Was Strom wirklich kostet. Vergleich der staatlichen Foerderungen und gesamtgesellschaftlichen Kosten konventioneller und erneuerbarer Energien

    Energy Technology Data Exchange (ETDEWEB)

    Kuechler, Swantje; Meyer, Bettina

    2012-07-01

    This study explains how the costs of electricity are an aggregate of different components. The electricity price paid by the end consumer contains not only the actual costs of energy production, which make up only about a third of the actual price in an average household, but also different surcharges such as network charges, electricity tax, value added tax and the concession levy. It furthermore contains the allocation charge stipulated by the Renewable Energy Law (EEG reallocation charge) as a means of allocating the costs of the subsidisation of electricity from renewable resources to the consumers. On the other hand conventional energy resources such as nuclear energy, hard coal and brown coal have substantially benefited over many decades from state subsidies in the form of financial aids, tax rebates and other promotive measures. The main difference between this and the subsidisation of renewable energy is that the costs of conventional energy resources are largely charged to the state budget rather than being made transparent in the electricity price. Based on an evaluation of the literature, data, interviews and the authors' own methodological deliberations this study makes a systematic comparison of the direct as well as indirect state subsidisation of renewable and conventional energy resources during the period from 1970 until 2012. The annual totals obtained for each energy resources are then set in relation to the share of that resource in overall electricity production, yielding specific subsidisation rates in terms of cents per kWh for each resource. This does not yet take into account the high consequential costs in the form of environmental damage and climate-related damage caused by fossil and nuclear fuels as well as the risks associated with the latter (collectively referred to as ''external costs''), all of which are charged to the polluters only at a small fraction of the true amount. The two cost categories of state

  1. Flexible resource management and its effect on project cost and duration

    Science.gov (United States)

    Pinha, Denis C.; Ahluwalia, Rashpal S.

    2018-06-01

    In practice, most projects result in cost overruns and schedule slippage due to poor resource management. This paper presents an approach that aims at reducing project duration and costs by empowering project managers to assess different scenarios. The proposed approach addresses combinatorial modes for tasks, multi-skilled resources, and multiple calendars for resources. A case study reported in the literature is presented to demonstrate the capabilities of this method. As for practical implications, this approach enhances the decision-making process which results in improved solutions in terms of total project duration and cost. From an academic viewpoint, this paper adds empirical evidence to enrich the existing literature, as it highlights relevant issues to model properly the complexity of real-life projects.

  2. Guide to resource conservation and cost savings opportunities in the soap, detergents and related products sector

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    The soaps, detergents and related products sector is an important component of the chemical industry within Ontario, as these products are used for cleaning purposes in industrial, institutional and domestic consumer applications. This guide was prepared to assist the sector with cost savings and resource conservation. The guide highlights opportunities for resource conservation through energy and water efficiency improvements, more efficient utilisation of raw materials, and reduction of environmental releases at source. 54 figs.

  3. Cost allocation model for distribution networks considering high penetration of distributed energy resources

    DEFF Research Database (Denmark)

    Soares, Tiago; Pereira, Fábio; Morais, Hugo

    2015-01-01

    The high penetration of distributed energy resources (DER) in distribution networks and the competitive environment of electricity markets impose the use of new approaches in several domains. The network cost allocation, traditionally used in transmission networks, should be adapted and used...... in the distribution networks considering the specifications of the connected resources. The main goal is to develop a fairer methodology trying to distribute the distribution network use costs to all players which are using the network in each period. In this paper, a model considering different type of costs (fixed......, losses, and congestion costs) is proposed comprising the use of a large set of DER, namely distributed generation (DG), demand response (DR) of direct load control type, energy storage systems (ESS), and electric vehicles with capability of discharging energy to the network, which is known as vehicle...

  4. Multimorbidity in chronic disease: impact on health care resources and costs

    Directory of Open Access Journals (Sweden)

    McPhail SM

    2016-07-01

    Full Text Available Steven M McPhail1,2 1Centre for Functioning and Health Research, Metro South Health, 2Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied. There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to

  5. Offshore Wind Resource, Cost, and Economic Potential in the State of Maine

    Energy Technology Data Exchange (ETDEWEB)

    Musial, Walter D. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2018-02-12

    This report provides information for decision-makers about floating offshore wind technologies in the state of Maine. It summarizes research efforts performed at the National Renewable Energy Laboratory between 2015 and 2017 to analyze the resource potential, cost of offshore wind, and economic potential of offshore wind from four primary reports: Musial et al. (2016); Beiter et al. (2016, 2017); and Mone et al. (unpublished). From Musial et al. (2016), Maine's technical offshore wind resource potential ranked seventh in the nation overall with more than 411 terawatt-hours/year of offshore resource generating potential. Although 90% of this wind resource is greater than 9.0-meters-per-second average velocity, most of the resource is over deep water, where floating wind technology is needed. Levelized cost of energy and levelized avoided cost of energy were computed to estimate the unsubsidized 'economic potential' for Maine in the year 2027 (Beiter et al. 2016, 2017). The studies found that Maine may have 65 gigawatts of economic potential by 2027, the highest of any U.S. state. Bottom-line costs for the Aqua Ventus project, which is part of the U.S. Department of Energy's Advanced Technology Demonstration project, were released from a proprietary report written by NREL in 2016 for the University of Maine (Mone et al. unpublished). The report findings were that economies of scale and new technology advancements lowered the cost from $300/megawatt-hour (MWh) for the two-turbine 12-megawatt (MW) Aqua Ventus 1 project, to $126/MWh for the commercial-scale, 498-MW Aqua Ventus-2 project. Further cost reductions to $77/MWh were found when new technology advancements were applied for the 1,000-MW Aqua Ventus-3 project in 2030. No new analysis was conducted for this report.

  6. A New Approach to Special Education Finance: The Resource Cost Model.

    Science.gov (United States)

    Geske, Terry G.; Johnston, Mary Jo

    1985-01-01

    Describes current practices in Illinois where a personnel reimbursement formula is used to finance special education. Summarizes the basic components of the Resource Cost Model (RCM), a complex school finance formula, and compares and contrasts RCM with Illinois' current method of financing special education. (MLF)

  7. Costs and trade-offs of grazer-induced defenses in Scenedesmus under deficient resource

    Science.gov (United States)

    Zhu, Xuexia; Wang, Jun; Chen, Qinwen; Chen, Ge; Huang, Yuan; Yang, Zhou

    2016-01-01

    The green alga Scenedesmus obliquus can form inducible defensive morphs under grazing threat. Costs and trade-offs of inducible defense are expected to accompany the benefits of defensive morphs, but are hard to detect under nutrient-sufficient experimental conditions. To test the existence of costs associated with inducible defense, we cultured S. obliquus along resource availability gradients in the presence or absence of infochemical cues from Daphnia, and measured the strength of defensive colony formation and fitness characters. Under the lowest phosphorous concentration, the expression of inducible defensive colony resulted in decreased growth rate, which provides direct evidence for physiological costs. Along the gradient reduction of phosphorous concentration or light intensity, inducible defense in S. obliquus showed a decreasing trend. However, the photosynthetic efficiency of S. obliquus was barely affected by its defense responses, suggesting that the negative correlations between resource availability and colony formation of this alga may be due to resource-based trade-offs in the allocation of limited resources. Thus, our results indicated that expression of inducible defense of S. obliquus was impaired under insufficient phosphorus or light. Furthermore, under severe phosphate deficiency, obvious physiological costs of inducible defense could be detected even though defensive colony formation also decreased significantly. PMID:26932369

  8. Survey cost of electric power generation from renewable resources in the state of Goias, Brazil

    International Nuclear Information System (INIS)

    Almeida, Ronaldo Pereira de; Bortoni, Edson da Costa; Haddad, Jamil

    2010-01-01

    The work presents a developed study to obtain the investment index costs for renewable based distributed generation in Goias state. A set of renewable resources was selected, along with their availability in each city of the state. Therefore, a rank of investments could be developed. (author)

  9. The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

    Science.gov (United States)

    Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

    2015-01-01

    Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  10. 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.

  11. Estimating resource costs of compliance with EU WFD ecological status requirements at the river basin scale

    DEFF Research Database (Denmark)

    Riegels, Niels; Jensen, Roar; Benasson, Lisa

    2011-01-01

    Resource costs of meeting EU WFD ecological status requirements at the river basin scale are estimated by comparing net benefits of water use given ecological status constraints to baseline water use values. Resource costs are interpreted as opportunity costs of water use arising from water...... scarcity. An optimization approach is used to identify economically efficient ways to meet WFD requirements. The approach is implemented using a river basin simulation model coupled to an economic post-processor; the simulation model and post-processor are run from a central controller that iterates until...... an allocation is found that maximizes net benefits given WFD requirements. Water use values are estimated for urban/domestic, agricultural, industrial, livestock, and tourism water users. Ecological status is estimated using metrics that relate average monthly river flow volumes to the natural hydrologic regime...

  12. Natural resource risk and cost management in environmental restoration: Demonstration project at the Savannah River Site

    International Nuclear Information System (INIS)

    Bascietto, J.J.; Sharples, F.E.

    1995-01-01

    The US Department of Energy (DOE) is both a trustee for the natural resources present on its properties and the lead response agency under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). As such, DOE is addressing the destruction or loss of those resources caused by releases of hazardous substances from its facilities (DOE 1991) and collecting data to be used in determining the extent of contamination at its facilities, estimating risks to human health and the environment, and selecting appropriate remedial actions. The remedial investigation/feasibility study (RI/FS) process is used to investigate sites and select remedial actions. A Natural Resource Damage Assessment (NRDA) process may be used to determine whether natural resources have also been injured by the released hazardous substances and to calculate compensatory monetary damages to be used to restore the natural resources. In FY 1994, the Savannah River Site (SRS) was chosen to serve as a demonstration site for testing the integrated NRDA framework and demonstrating how NRDA concerns might be integrated into the environmental restoration activities of an actual site that is characteristically large and complex. The demonstration project (1) provided a means to illustrate the use of complex analyses using real information on the specific natural resources of the SRS; (2) served as a vehicle for reinforcing and expanding the SRS staff's understanding of the links between the NRDA and RI/FS processes; (3) provided a forum for the discussion of strategic issues with SRS personnel; and (4) allowed the refining and elaboration of DOE guidance by benchmarking the theoretical process using real information and issues

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

    Science.gov (United States)

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

    2013-01-01

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

  14. Prospective memory function in late adulthood: affect at encoding and resource allocation costs.

    Directory of Open Access Journals (Sweden)

    Julie D Henry

    Full Text Available Some studies have found that prospective memory (PM cues which are emotionally valenced influence age effects in prospective remembering, but it remains unclear whether this effect reflects the operation of processes implemented at encoding or retrieval. In addition, none of the prior ageing studies of valence on PM function have examined potential costs of engaging in different valence conditions, or resource allocation trade-offs between the PM and the ongoing task. In the present study, younger, young-old and old-old adults completed a PM task in which the valence of the cues varied systematically (positive, negative or neutral at encoding, but was kept constant (neutral at retrieval. The results indicated that PM accuracy did not vary as a function of affect at encoding, and that this effect did not interact with age group. There was also no main or interaction effect of valence on PM reaction time in PM cue trials, indicating that valence costs across the three encoding conditions were equivalent. Old-old adults' PM accuracy was reduced relative to both young-old and younger adults. Prospective remembering incurred dual-task costs for all three groups. Analyses of reaction time data suggested that for both young-old and old-old, these costs were greater, implying differential resource allocation cost trade-offs. However, when reaction time data were expressed as a proportional change that adjusted for the general slowing of the older adults, costs did not differ as a function of group.

  15. 77 FR 516 - Notice of Lodging of Proposed Natural Resource Damages Consent Decree Under the Comprehensive...

    Science.gov (United States)

    2012-01-05

    ...-McMoRan Tyrone Inc., Freeport-McMoRan Tyrone Mining LLC, and Freeport-McMoRan Cobre Mining Company... Damage Assessment and Restoration Fund, which can be used to restore, rehabilitate, replace, or acquire...

  16. Pawtuxet River, Warwick, Rhode Island. Local Flood Damage Reduction Study. Detailed Project Report for Water Resources Development.

    Science.gov (United States)

    1982-06-01

    Warwich (Belmont Park) Rhode Island. Cover Title Reads: Flood Damage Reduction IS. KEY WORDS (Ce൘.. asm towvee aide of mogoseem aid 1~110j IV MeMAw...cost of the premium paid by policy holders. The actual premium is less than the actuarial rate by the amount of the subsidy which represents one facet...coverage limits, therefore it was not necessary to calculate additional coverage premiums based on actuarial rates. The annual average subsidized

  17. Cost Implications of Uncertainty in CO{sub 2} Storage Resource Estimates: A Review

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Steven T., E-mail: sanderson@usgs.gov [National Center, U.S. Geological Survey (United States)

    2017-04-15

    Carbon capture from stationary sources and geologic storage of carbon dioxide (CO{sub 2}) is an important option to include in strategies to mitigate greenhouse gas emissions. However, the potential costs of commercial-scale CO{sub 2} storage are not well constrained, stemming from the inherent uncertainty in storage resource estimates coupled with a lack of detailed estimates of the infrastructure needed to access those resources. Storage resource estimates are highly dependent on storage efficiency values or storage coefficients, which are calculated based on ranges of uncertain geological and physical reservoir parameters. If dynamic factors (such as variability in storage efficiencies, pressure interference, and acceptable injection rates over time), reservoir pressure limitations, boundaries on migration of CO{sub 2}, consideration of closed or semi-closed saline reservoir systems, and other possible constraints on the technically accessible CO{sub 2} storage resource (TASR) are accounted for, it is likely that only a fraction of the TASR could be available without incurring significant additional costs. Although storage resource estimates typically assume that any issues with pressure buildup due to CO{sub 2} injection will be mitigated by reservoir pressure management, estimates of the costs of CO{sub 2} storage generally do not include the costs of active pressure management. Production of saline waters (brines) could be essential to increasing the dynamic storage capacity of most reservoirs, but including the costs of this critical method of reservoir pressure management could increase current estimates of the costs of CO{sub 2} storage by two times, or more. Even without considering the implications for reservoir pressure management, geologic uncertainty can significantly impact CO{sub 2} storage capacities and costs, and contribute to uncertainty in carbon capture and storage (CCS) systems. Given the current state of available information and the

  18. Damages and resource of locomotive wheels used under the north operating conditions

    Directory of Open Access Journals (Sweden)

    A. V. Grigorev

    2014-01-01

    Full Text Available In operating railway equipment, in particular the elements, such as a wheel and a rail there is damage accumulation of any kind, causing a premature equipment failure. Thus, an analysis of the mechanisms and modeling of damage accumulation and fracture both on the surface and in the bulk material remain a challenge.Data on the defective wheel sets to be subjected to facing has been collected and analyzed to assess the locomotive wheel sets damage of the locomotive fleet company of AK «Yakutia Railways», city of Aldan, The Republic of Sakha (Yakutia. For this purpose, three main locomotives have been examined.The object of research carried out in this paper, is a locomotive wheels tire, which is subjected to cyclic impact (dynamic loads during operation. In this regard, the need arises to determine both the strength of material in response to such shock loads and the quantitative calculation of damage accumulated therein.The accumulated fatigue damage has been attributed to one radial cross section of the wheel coming into contact with the rail once per revolution of the wheel. Consequently, in one revolution a wheel is under one loading cycle. As stated, the average mileage of locomotives to have the unacceptable damages formed on the tread surface is 12 thousand km.Test results establish that along with the high-cycle loading the shock-contact action on rail joints significantly affects the accumulation of damage in the locomotive wheels tire. The number of cycles to failure due to the formation of unacceptable damage in the locomotive wheels tire is N = 2,4×106 and 6×105 cycles, respectively, for fatigue and shock-contact loading.In general, we can say that the problem of higher intensity to form the surface damage is directly related to the operation of the locomotive wheel tire under abnormally low climatic temperatures. With decreasing ambient temperature, this element material rapidly looses its plastic properties, thereby accelerating

  19. First estimates of the potential cost and cost saving of protecting childhood hearing from damage caused by congenital CMV infection.

    Science.gov (United States)

    Williams, Eleri J; Gray, Joanne; Luck, Suzanne; Atkinson, Claire; Embleton, Nicholas D; Kadambari, Seilesh; Davis, Adrian; Griffiths, Paul; Sharland, Mike; Berrington, Janet E; Clark, Julia E

    2015-11-01

    Congenital cytomegalovirus (cCMV) is an important cause of childhood deafness, which is modifiable if diagnosed within the first month of life. Targeted screening of infants who do not pass their newborn hearing screening tests in England is a feasible approach to identify and treat cases to improve hearing outcome. To conduct a cost analysis of targeted screening and subsequent treatment for cCMV-related sensorineural hearing loss (SNHL) in an, otherwise, asymptomatic infant, from the perspective of the UK National Health Service (NHS). Using data from the newborn hearing screening programme (NHSP) in England and a recent study of targeted screening for cCMV using salivary swabs within the NHSP, we estimate the cost (in UK pounds (£)) to the NHS. The cost of screening (time, swabs and PCR), assessing, treating and following up cases is calculated. The cost per case of preventing hearing deterioration secondary to cCMV with targeted screening is calculated. The cost of identifying, assessing and treating a case of cCMV-related SNHL through targeted cCMV screening is estimated to be £6683. The cost of improving hearing outcome for an infant with cCMV-related SNHL through targeted screening and treatment is estimated at £14 202. The costs of targeted screening for cCMV using salivary swabs integrated within NHSP resulted in an estimate of cost per case that compares favourably with other screening programmes. This could be used in future studies to estimate the full economic value in terms of incremental costs and incremental health benefits. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. 78 FR 53425 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2013-08-29

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

  1. Resource use and costs of exenatide bid or insulin in clinical practice

    DEFF Research Database (Denmark)

    Kiiskinen, Urpo; Matthaei, Stephan; Reaney, Matthew

    2013-01-01

    .9 in the exenatide bid cohort and €3265.5 in the insulin cohort (€1791.9 versus €2465.5 due to costs other than those of injectable therapy). When baseline direct cost and patients' and disease characteristics were controlled for, mean direct costs differed by country (P ...-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin) and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices....... RESULTS: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed...

  2. 41 CFR 301-10.451 - May I be reimbursed for the cost of collision damage waiver (CDW) or theft insurance?

    Science.gov (United States)

    2010-07-01

    ... the cost of collision damage waiver (CDW) or theft insurance? 301-10.451 Section 301-10.451 Public... I be reimbursed for the cost of collision damage waiver (CDW) or theft insurance? (a) General rule—no. You will not be reimbursed for CDW or theft insurance for travel within CONUS for the following...

  3. Wind resource assessment and wind energy system cost analysis: Fort Huachuca, Arizona

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, T.L. [Tim Olsen Consulting, Denver, CO (United States); McKenna, E. [National Renewable Energy Lab., Golden, CO (United States)

    1997-12-01

    The objective of this joint DOE and National Renewable Energy Laboratory (NREL) Strategic Environmental Research and Development Program (SERDP) project is to determine whether wind turbines can reduce costs by providing power to US military facilities in high wind areas. In support of this objective, one year of data on the wind resources at several Fort Huachuca sites was collected. The wind resource data were analyzed and used as input to an economic study for a wind energy installation at Fort Huachuca. The results of this wind energy feasibility study are presented in the report.

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

    Science.gov (United States)

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

    2014-09-01

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

  5. Residential heating costs: A comparison of geothermal solar and conventional resources

    Science.gov (United States)

    Bloomster, C. H.; Garrett-Price, B. A.; Fassbender, L. L.

    1980-08-01

    The costs of residential heating throughout the United States using conventional, solar, and geothermal energy were determined under current and projected conditions. These costs are very sensitive to location, being dependent on the local prices of conventional energy supplies, local solar insolation, climate, and the proximity and temperature of potential geothermal resources. The sharp price increases in imported fuels during 1979 and the planned decontrol of domestic oil and natural gas prices have set the stage for geothermal and solar market penetration in the 1980's.

  6. Urban seismic risk assessment: statistical repair cost data and probable structural losses based on damage scenario—correlation analysis

    Science.gov (United States)

    Eleftheriadou, Anastasia K.; Baltzopoulou, Aikaterini D.; Karabinis, Athanasios I.

    2016-06-01

    The current seismic risk assessment is based on two discrete approaches, actual and probable, validating afterwards the produced results. In the first part of this research, the seismic risk is evaluated from the available data regarding the mean statistical repair/strengthening or replacement cost for the total number of damaged structures (180,427 buildings) after the 7/9/1999 Parnitha (Athens) earthquake. The actual evaluated seismic risk is afterwards compared to the estimated probable structural losses, which is presented in the second part of the paper, based on a damage scenario in the referring earthquake. The applied damage scenario is based on recently developed damage probability matrices (DPMs) from Athens (Greece) damage database. The seismic risk estimation refers to 750,085 buildings situated in the extended urban region of Athens. The building exposure is categorized in five typical structural types and represents 18.80 % of the entire building stock in Greece. The last information is provided by the National Statistics Service of Greece (NSSG) according to the 2000-2001 census. The seismic input is characterized by the ratio, a g/ a o, where a g is the regional peak ground acceleration (PGA) which is evaluated from the earlier estimated research macroseismic intensities, and a o is the PGA according to the hazard map of the 2003 Greek Seismic Code. Finally, the collected investigated financial data derived from different National Services responsible for the post-earthquake crisis management concerning the repair/strengthening or replacement costs or other categories of costs for the rehabilitation of earthquake victims (construction and function of settlements for earthquake homeless, rent supports, demolitions, shorings) are used to determine the final total seismic risk factor.

  7. Prices and costs of irregularity in renewable resources in the liberalized electricity markets

    International Nuclear Information System (INIS)

    Menanteau, Ph.; Finon, D.

    2004-01-01

    The problems raised by incorporating irregular production are of a technical nature (risk of non-availability during peak demand, the requirements for additional reserves) but the electricity markets methods of operation impose economic penalties, which greatly exceed these additional technical costs. In this document, the authors examine the nature of the technical problems posed by irregularity of production and the additional costs resulting from this, and then analyse the origins of the economic penalties that the operation of liberalized electricity markets impose, taking in particular the example of the British market, the New Energy Trading Arrangement (NETA). It would appear that the markets' operating rules may conflict, in certain cases, with the targets for promoting electricity generation from renewable resources. Two types of solutions can therefore be envisaged: a set of rules to limit the impact on irregular production or collective handling of the adjustment to production from renewable resources as already exists in the Nordic electricity markets. (authors)

  8. Environmental cost-effectiveness analysis in intertemporal natural resource policy: evaluation of selective fishing gear.

    Science.gov (United States)

    Kronbak, Lone Grønbæk; Vestergaard, Niels

    2013-12-15

    In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. To make or buy patient safety solutions: a resource dependence and transaction cost economics perspective.

    Science.gov (United States)

    Fareed, Naleef; Mick, Stephen S

    2011-01-01

    For almost a decade, public and private organizations have pressured hospitals to improve their patient safety records. Since 2008, the Centers for Medicare & Medicaid Services has no longer been reimbursing hospitals for secondary diagnoses not reported during the point of admission. This ruling has motivated some hospitals to engage in safety-oriented programs to decrease adverse events. This study examined which hospitals may engage in patient safety solutions and whether they create these patient safety solutions within their structures or use suppliers in the market. We used a theoretical model that incorporates the key constructs of resource dependence theory and transaction cost economics theory to predict a hospital's reaction to Centers for Medicare & Medicaid Services "never event" regulations. We present propositions that speculate on how forces conceptualized from the resource dependence theory may affect adoption of patient safety innovations and, when they do, whether the adopting hospitals will do so internally or externally according to the transaction cost economics theory. On the basis of forces identified by the resource dependence theory, we predict that larger, teaching, safety net, horizontally integrated, highly interdependent, and public hospitals in concentrated, high public payer presence, competitive, and resource-rich environments will be more likely to engage in patient safety innovations. Following the logic of the transaction cost economics theory, we predict that of the hospitals that react positively to the never event regulation, most will internalize their innovations in patient safety solutions rather than approach the market, a choice that helps hospitals economize on transaction costs. This study helps hospital managers in their strategic thinking and planning in relation to current and future regulations related to patient safety. For researchers and policy analysts, our propositions provide the basis for empirical testing.

  10. The Cost of Nurse-Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting.

    Science.gov (United States)

    Altman, Molly R; Murphy, Sean M; Fitzgerald, Cynthia E; Andersen, H Frank; Daratha, Kenn B

    Obstetrical care often involves multiple expensive, and often elective, interventions that may increase costs to patients, payers, and the health care system with little effect on patient outcomes. The objectives of this study were to examine the following hospital related outcomes: 1) use of labor and birth interventions, 2) inpatient duration of stay, and 3) total direct health care costs for patients attended by a certified nurse-midwife (CNM) compared with those attended by an obstetrician-gynecologist (OB-GYN), within an environment of safe and high-quality care. Electronic health records for 1,441 medically low-risk women who gave birth at a hospital located in the U.S. Pacific Northwest between January and September 2013 were sampled. Multilevel regression and generalized linear models were used for analysis. Reduced use of selected labor and birth interventions (cesarean delivery, vacuum-assisted delivery, epidural anesthesia, labor induction, and cervical ripening), reduced maternal duration of stay, and reduced overall costs associated with CNM-led care relative to OB-GYN-led care were observed for medically low-risk women in a hospital setting. Maternal and neonatal outcomes were comparable across groups. This study supports consideration of increased use of CNMs as providers for the care of women at low risk for complications to decrease costs for the health care system. The use of CNMs to the fullest extent within state-regulated scopes of practice could result in more efficient use of hospital resources. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  11. Air pollution policies in Europe: efficiency gains from integrating climate effects with damage costs to health and crops

    International Nuclear Information System (INIS)

    Tollefsen, Petter; Rypdal, Kristin; Torvanger, Asbjorn; Rive, Nathan

    2009-01-01

    Emissions of air pollutants cause damage to health and crops, but several air pollutants also have an effect on climate through radiative forcing. We investigate efficiency gains achieved by integrating climate impacts of air pollutants into air quality strategies for the EU region. The pollutants included in this study are SO 2 , NH 3 , VOC, CO, NO x , black carbon, organic carbon, PM 2.5 , and CH 4 . We illustrate the relative importance of climate change effects compared to damage to health and crops, as well as monetary gains of including climate change contributions. The analysis considers marginal abatement costs and compares air quality and climate damage in Euros. We optimize abatement policies with respect to both climate and health impacts, which imply implementing all measures that yield a net benefit. The efficiency gains of the integrated policy are in the order of 2.5 billion Euros, compared to optimal abatement based on health and crop damage only, justifying increased abatement efforts of close to 50%. Climate effect of methane is the single most important factor. If climate change is considered on a 20- instead of a 100-year time-scale, the efficiency gain almost doubles. Our results indicate that air pollution policies should be supplemented with climate damage considerations.

  12. Comparative cost analyses: total flow vs other power conversion systems for the Salton Sea Geothermal Resource

    Energy Technology Data Exchange (ETDEWEB)

    Wright, G.W.

    1978-09-18

    Cost studies were done for Total Flow, double flash, and multistage flash binary systems for electric Energy production from the Salton Sea Geothermal Resource. The purpose was to provide the Department of energy's Division of Geothermal Energy with information by which to judge whether to continue development of the Total Flow system. Results indicate that the Total Flow and double flash systems have capital costs of $1,135 and $1,026 /kW with energy costs of 40.9 and 39.7 mills/kW h respectively. The Total Flow and double flash systems are not distinguishable on a cost basis alone; the multistage flash binary system, with capital cost of $1,343 /kW and energy cost of 46.9 mills/kW h, is significantly more expensive. If oil savings are considered in the total analysis, the Total Flow system could save 30% more oil than the double flash system, $3.5 billion at 1978 oil prices.

  13. Technology transfer by multinational firms: the resource cost of transferring technological know-how

    Energy Technology Data Exchange (ETDEWEB)

    Teece, D J

    1977-06-01

    The essence of modern economic growth is the increase in the stock of useful knowledge and the extension of its application. Since the origins of technical and social innovations have never been confined to the borders of any one nation, the economic growth of all countries depends to some degree on the successful application of a transnational stock of knowledge. Nevertheless, economists have been remarkably slow in addressing themselves to the economics of international technology transfer. This paper addresses itself to this need. The starting-point is Arrow's suggestion (Am. Econ. Review, 52: 29-35 (May 1969)) that the cost of communication, or information transfer, is a fundamental factor influencing the world-wide diffusion of technology. The purpose of the paper is to examine the level and determinants of the costs involved in transferring technology. The value of the resources that have to be utilized to accomplish the successful transfer of a given manufacturing technology is used as a measure of the cost of transfer. The resource cost concept is therefore designed to reflect the ease or difficulty of transferring technological know-how from manufacturing plants in one country to manufacturing plants in another. 32 references.

  14. Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma.

    Science.gov (United States)

    Ackland, Helen M; Wolfe, Rory; Cameron, Peter A; Cooper, D James; Malham, Gregory M; Varma, Dinesh K; Fitt, Gregory J; Rosenfeld, Jeffrey V; Liew, Susan M

    2012-11-01

    The costs associated with patients discharged with isolated clinician-elicited persistent midline tenderness and negative computed tomography (CT) findings have not been reported. Our aim was to determine the association of acute and post-acute patient and injury characteristics with health resource costs in such patients following road trauma. In a prospective cohort study, road trauma patients presenting with isolated persistent midline cervical tenderness and negative CT, who underwent additional acute imaging with MRI, were recruited. Patients were reviewed in the outpatient spine clinic following discharge, and were followed up at 6 and 12 months post-trauma. Multivariate linear regression was used to assess the association of injury mechanism, clinical assessment, socioeconomic factors and outcome findings with health resource costs generated in the acute hospital and post-acute periods. There were 64 patients recruited, of whom 24 (38%) had cervical spine injury detected on MRI. Of these, 2 patients were managed operatively, 6 were treated in cervical collars and 16 had the cervical spine cleared and were discharged. At 12 months, there were 25 patients (44%) with residual neck pain, and 22 (39%) with neck-related disability. The mean total cost was AUD $10,153 (SD=10,791) and the median was $4015 (IQR: 3044-6709). Transient neurologic deficit, which fully resolved early in the emergency department, was independently associated with higher marginal mean acute costs (represented in the analysis by the β coefficient) by $3521 (95% CI: 50-6880). Low education standard (β coefficient: $5988, 95% CI: 822-13,317), neck pain at 6 months (β coefficient: $4017, 95% CI: 426-9254) and history of transient neurologic deficit (β coefficient: $8471, 95% CI: 1766-18,334) were associated with increased post-acute costs. In a homogeneous group of road trauma patients with non fracture-related persistent midline cervical tenderness, health resource costs varied

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

    Directory of Open Access Journals (Sweden)

    Chandran A

    2013-04-01

    Full Text Available Tyler Knight,1 Caroline Schaefer,1 Arthi Chandran,2 Gergana Zlateva,2 Andreas Winkelmann,3 Serge Perrot4 1Health Economics and Outcomes Research, Covance Market Access Services, Gaithersburg, MD, USA; 2Primary Care Health Economics and Outcomes Research, Pfizer Global Health Economics, New York, NY, USA; 3Department of Physical Medicine and Rehabilitation, University Hospital Munich, Munich, Germany; 4Service de Médecine Interne et Thérapeutique, Université Paris Descartes, Paris, France Background: Fibromyalgia (FM is a chronic disorder characterized by widespread, persistent pain. Prospective and retrospective studies have demonstrated substantial health-care costs associated with FM in a number of countries. This study evaluated and compared health-resource use (HRU and associated costs related to FM in routine clinical practice across the US, France, and Germany. Methods: Two separate, cross-sectional, observational studies of subjects with FM were conducted: one in the US and one in France and Germany. HRU related to prescription medication, physician office visits, diagnostic tests, and hospitalizations was abstracted from chart review; patient out-of-pocket costs and lost productivity were collected via subject self-report. Costs were assigned to HRU based on standard algorithms. Direct and indirect costs were evaluated and compared by simple linear regression. Results: A total of 442 subjects (203 US, 70 France, 169 Germany with FM were analyzed. The mean (standard deviation age in the US, France, and Germany was 47.9 (10.9, 51.2 (9.5, and 49.2 (9.8, respectively (P = 0.085. Most subjects were female (95% US, 83% France, 80% Germany (P < 0.001. Adjusted annual direct costs per subject for FM were significantly higher in the US ($7087 than in France ($481, P < 0.001 or Germany ($2417, P < 0.001. Adjusted mean annual indirect costs per subject for FM were lower in the US ($6431 than in France ($8718 or Germany ($10,001, but represented

  16. Guide to resource conservation and cost savings opportunities in the food service sector

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    Opportunities for conserving energy and water, as well as reducing waste, within the 24,000 establishment-strong food service sector in Ontario are identified. Operators are encouraged to take advantage of these opportunities to lower their costs while conserving valuable resources at the same time. In preparing this guide, site visits were carried out at six food service facilities in Ontario. Information about how much money is generally spent on energy, water and waste management by food service operators is provided. The amount and type of waste generated by these facilities is also described. The volatility of the commercial food service market place was identified as one of the major impediments to energy conservation. It was found that most owners of the food service facilities make business decisions based on the lowest first costs, irrespective of longer-term energy efficiency and operating costs. 31 refs., 13 tabs., 9 figs., 4 appendices.

  17. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

    DEFF Research Database (Denmark)

    Prompers, L.; Huijberts, M.; Schaper, N.

    2008-01-01

    Aims/hypothesis The aim of the present study was to investigate resource utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in resource utilisation between individuals with or without peripheral arterial disease (PAD) and/or infection. Methods Data....... In view of the magnitude of the costs associated with in-hospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease Udgivelsesdato: 2008/10...

  18. A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

    Science.gov (United States)

    Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

    2015-04-27

    In resource-limited settings, efficiency is crucial to maximise resources available for patient care. Time driven activity-based costing (TDABC) estimates costs directly from clinical and administrative processes used in patient care, thereby providing valuable information for process improvements. TDABC is more accurate and simpler than traditional activity-based costing because it assigns resource costs to patients based on the amount of time clinical and staff resources are used in patient encounters. Other costing approaches use somewhat arbitrary allocations that provide little transparency into the actual clinical processes used to treat medical conditions. TDABC has been successfully applied in European and US health-care settings to facilitate process improvements and new reimbursement approaches, but it has not been used in resource-limited settings. We aimed to optimise TDABC for use in a resource-limited setting to provide accurate procedure and service costs, reliably predict financing needs, inform quality improvement initiatives, and maximise efficiency. A multidisciplinary team used TDABC to map clinical processes for obstetric care (vaginal and caesarean deliveries, from triage to post-partum discharge) and breast cancer care (diagnosis, chemotherapy, surgery, and support services, such as pharmacy, radiology, laboratory, and counselling) at Hôpital Universitaire de Mirebalais (HUM) in Haiti. The team estimated the direct costs of personnel, equipment, and facilities used in patient care based on the amount of time each of these resources was used. We calculated inpatient personnel costs by allocating provider costs per staffed bed, and assigned indirect costs (administration, facility maintenance and operations, education, procurement and warehouse, bloodbank, and morgue) to various subgroups of the patient population. This study was approved by the Partners in Health/Zanmi Lasante Research Committee. The direct cost of an uncomplicated vaginal

  19. Optimizing power plant cycling operations while reducing generating plant damage and costs

    Energy Technology Data Exchange (ETDEWEB)

    Lefton, S.A.; Besuner, P.H.; Grimsrud, P. [Aptech Engineering Services, Inc., Sunnyvale, CA (United States); Bissel, A. [Electric Supply Board, Dublin (Ireland)

    1998-12-31

    This presentation describes a method for analyzing, quantifying, and minimizing the total cost of fossil, combined cycle, and pumped hydro power plant cycling operation. The method has been developed, refined, and applied during engineering studies at some 160 units in the United States and 8 units at the Irish Electric Supply Board (ESB) generating system. The basic premise of these studies was that utilities are underestimating the cost of cycling operation. The studies showed that the cost of cycling conventional boiler/turbine fossil power plants can range from between $2,500 and $500,000 per start-stop cycle. It was found that utilities typically estimate these costs by factors of 3 to 30 below actual costs and, thus, often significantly underestimate their true cycling costs. Knowledge of the actual, or total, cost of cycling will reduce power production costs by enabling utilities to more accurately dispatch their units to manage unit life expectancies, maintenance strategies and reliability. Utility management responses to these costs are presented and utility cost savings have been demonstrated. (orig.) 7 refs.

  20. Optimizing power plant cycling operations while reducing generating plant damage and costs

    Energy Technology Data Exchange (ETDEWEB)

    Lefton, S A; Besuner, P H; Grimsrud, P [Aptech Engineering Services, Inc., Sunnyvale, CA (United States); Bissel, A [Electric Supply Board, Dublin (Ireland)

    1999-12-31

    This presentation describes a method for analyzing, quantifying, and minimizing the total cost of fossil, combined cycle, and pumped hydro power plant cycling operation. The method has been developed, refined, and applied during engineering studies at some 160 units in the United States and 8 units at the Irish Electric Supply Board (ESB) generating system. The basic premise of these studies was that utilities are underestimating the cost of cycling operation. The studies showed that the cost of cycling conventional boiler/turbine fossil power plants can range from between $2,500 and $500,000 per start-stop cycle. It was found that utilities typically estimate these costs by factors of 3 to 30 below actual costs and, thus, often significantly underestimate their true cycling costs. Knowledge of the actual, or total, cost of cycling will reduce power production costs by enabling utilities to more accurately dispatch their units to manage unit life expectancies, maintenance strategies and reliability. Utility management responses to these costs are presented and utility cost savings have been demonstrated. (orig.) 7 refs.

  1. Natural gas cost for evaluating energy resource opportunities at Fort Stewart

    Energy Technology Data Exchange (ETDEWEB)

    Stucky, D.J.; Shankle, S.A.

    1993-01-01

    Ft. Stewart, a United States Army Forces Command (FORSCOM) installation located near Hinesville, Georgia, is currently undergoing an evaluation of its energy usage, which is being performed by Pacific Northwest Laboratory. In order to examine the energy resource opportunities (EROs) at Ft. Stewart, marginal fuel costs must be calculated. The marginal, or avoided, cost of gas service is used in conjunction with the estimated energy savings of an ERO to calculate the dollar value of those savings. In the case of natural gas, the costing becomes more complicated due to the installation of a propane-air mixing station. The propane-air station is being built under a shared energy savings (SES) contract. The building of a propane-air station allows Ft. Stewart to purchase natural gas from their local utility at an interruptible rate, which is lower than the rate for contracting natural gas on a firm basis. The propane-air station will also provide Ft. Stewart with fuel in the event that the natural gas supply is curtailed. While the propane-air station does not affect the actual cost of natural gas, it does affect the cost of services provided by gas. Because the propane-air station and the SES contract affect the cost of gas service, they must be included in the analysis. Our analysis indicates a marginal cost of gas service of 30.0 cents per therm, assuming a total propane usage by the mixing station of 42,278 gallons (38,600 therms) annually. Because the amount of propane that may be required in the event of a curtailment is small relative to the total service requirement, variations in the actual amount should not significantly affect the cost per therm.

  2. Natural gas cost for evaluating energy resource opportunities at Fort Stewart

    International Nuclear Information System (INIS)

    Stucky, D.J.; Shankle, S.A.

    1993-01-01

    Ft. Stewart, a United States Army Forces Command (FORSCOM) installation located near Hinesville, Georgia, is currently undergoing an evaluation of its energy usage, which is being performed by Pacific Northwest Laboratory. In order to examine the energy resource opportunities (EROs) at Ft. Stewart, marginal fuel costs must be calculated. The marginal, or avoided, cost of gas service is used in conjunction with the estimated energy savings of an ERO to calculate the dollar value of those savings. In the case of natural gas, the costing becomes more complicated due to the installation of a propane-air mixing station. The propane-air station is being built under a shared energy savings (SES) contract. The building of a propane-air station allows Ft. Stewart to purchase natural gas from their local utility at an interruptible rate, which is lower than the rate for contracting natural gas on a firm basis. The propane-air station will also provide Ft. Stewart with fuel in the event that the natural gas supply is curtailed. While the propane-air station does not affect the actual cost of natural gas, it does affect the cost of services provided by gas. Because the propane-air station and the SES contract affect the cost of gas service, they must be included in the analysis. Our analysis indicates a marginal cost of gas service of 30.0 cents per therm, assuming a total propane usage by the mixing station of 42,278 gallons (38,600 therms) annually. Because the amount of propane that may be required in the event of a curtailment is small relative to the total service requirement, variations in the actual amount should not significantly affect the cost per therm

  3. Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

    Directory of Open Access Journals (Sweden)

    Zoë M. McLaren

    Full Text Available Background: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs. Methods: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results: Because the disability-adjusted life years (DALYs averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and

  4. Resource utilisation and costs in predementia and dementia: a systematic review protocol.

    Science.gov (United States)

    Landeiro, Filipa; Wace, Helena; Ghinai, Isaac; Nye, Elsbeth; Mughal, Seher; Walsh, Katie; Roberts, Nia; Lecomte, Pascal; Wittenberg, Raphael; Wolstenholme, Jane; Handels, Ron; Roncancio-Diaz, Emilse; Potashman, Michele H; Tockhorn-Heidenreich, Antje; Gray, Alastair M

    2018-01-23

    Dementia is the fastest growing major cause of disability globally with a mounting social and financial impact for patients and their families but also to health and social care systems. This review aims to systematically synthesise evidence on the utilisation of resources and costs incurred by patients and their caregivers and by health and social care services across the full spectrum of dementia, from its preceding preclinical stage to end of life. The main drivers of resources used and costs will also be identified. A systematic literature review was conducted in MEDLINE, EMBASE, CDSR, CENTRAL, DARE, EconLit, CEA Registry, TRIP, NHS EED, SCI, RePEc and OpenGrey between January 2000 and beginning of May 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. The reporting of costing methodology will be assessed using the British Medical Journal checklist. A narrative synthesis of all studies will be presented for resources used and costs incurred, by level of disease severity when available. If feasible, the data will be synthesised using appropriate statistical techniques. Included articles will be reviewed for an ethics statement. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer's disease spectrum for better care: multi-modal data access platform (ROADMAP). CRD42017071413. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Resource utilisation and costs in predementia and dementia: a systematic review protocol

    Science.gov (United States)

    Landeiro, Filipa; Wace, Helena; Ghinai, Isaac; Nye, Elsbeth; Mughal, Seher; Walsh, Katie; Roberts, Nia; Lecomte, Pascal; Wittenberg, Raphael; Wolstenholme, Jane; Handels, Ron; Roncancio-Diaz, Emilse; Potashman, Michele H; Tockhorn-Heidenreich, Antje; Gray, Alastair M

    2018-01-01

    Introduction Dementia is the fastest growing major cause of disability globally with a mounting social and financial impact for patients and their families but also to health and social care systems. This review aims to systematically synthesise evidence on the utilisation of resources and costs incurred by patients and their caregivers and by health and social care services across the full spectrum of dementia, from its preceding preclinical stage to end of life. The main drivers of resources used and costs will also be identified. Methods and analysis A systematic literature review was conducted in MEDLINE, EMBASE, CDSR, CENTRAL, DARE, EconLit, CEA Registry, TRIP, NHS EED, SCI, RePEc and OpenGrey between January 2000 and beginning of May 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. The reporting of costing methodology will be assessed using the British Medical Journal checklist. A narrative synthesis of all studies will be presented for resources used and costs incurred, by level of disease severity when available. If feasible, the data will be synthesised using appropriate statistical techniques. Ethics and dissemination Included articles will be reviewed for an ethics statement. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer’s disease spectrum for better care: multi-modal data access platform (ROADMAP). Trial registration number CRD42017071413. PMID:29362261

  6. Cognitive costs of decision-making strategies: A resource demand decomposition analysis with a cognitive architecture.

    Science.gov (United States)

    Fechner, Hanna B; Schooler, Lael J; Pachur, Thorsten

    2018-01-01

    Several theories of cognition distinguish between strategies that differ in the mental effort that their use requires. But how can the effort-or cognitive costs-associated with a strategy be conceptualized and measured? We propose an approach that decomposes the effort a strategy requires into the time costs associated with the demands for using specific cognitive resources. We refer to this approach as resource demand decomposition analysis (RDDA) and instantiate it in the cognitive architecture Adaptive Control of Thought-Rational (ACT-R). ACT-R provides the means to develop computer simulations of the strategies. These simulations take into account how strategies interact with quantitative implementations of cognitive resources and incorporate the possibility of parallel processing. Using this approach, we quantified, decomposed, and compared the time costs of two prominent strategies for decision making, take-the-best and tallying. Because take-the-best often ignores information and foregoes information integration, it has been considered simpler than strategies like tallying. However, in both ACT-R simulations and an empirical study we found that under increasing cognitive demands the response times (i.e., time costs) of take-the-best sometimes exceeded those of tallying. The RDDA suggested that this pattern is driven by greater requirements for working memory updates, memory retrievals, and the coordination of mental actions when using take-the-best compared to tallying. The results illustrate that assessing the relative simplicity of strategies requires consideration of the overall cognitive system in which the strategies are embedded. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Balancing Cost and Risk: The Treatment of Renewable Energy in Western Utility Resource Plans

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan

    2005-08-10

    Markets for renewable energy have historically been motivated primarily by policy efforts, but a less widely recognized driver is poised to also play a major role in the coming years: utility integrated resource planning (IRP). Resource planning has re-emerged in recent years as an important tool for utilities and regulators, particularly in regions where retail competition has failed to take root. In the western United States, the most recent resource plans contemplate a significant amount of renewable energy additions. These planned additions--primarily coming from wind power--are motivated by the improved economics of wind power, a growing acceptance of wind by electric utilities, and an increasing recognition of the inherent risks (e.g., natural gas price risk, environmental compliance risk) in fossil-based generation portfolios. This report examines how twelve western utilities treat renewable energy in their recent resource plans. In aggregate, these utilities supply approximately half of all electricity demand in the western United States. Our purpose is twofold: (1) to highlight the growing importance of utility IRP as a current and future driver of renewable energy, and (2) to identify methodological/modeling issues, and suggest possible improvements to methods used to evaluate renewable energy as a resource option. Here we summarize the key findings of the report, beginning with a discussion of the planned renewable energy additions called for by the twelve utilities, an overview of how these plans incorporated renewables into candidate portfolios, and a review of the specific technology cost and performance assumptions they made, primarily for wind power. We then turn to the utilities' analysis of natural gas price and environmental compliance risks, and examine how the utilities traded off portfolio cost and risk in selecting a preferred portfolio.

  8. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  9. Healthcare resource use and costs of multiple sclerosis patients in Germany before and during fampridine treatment.

    Science.gov (United States)

    Ziemssen, Tjalf; Prosser, Christine; Haas, Jennifer Scarlet; Lee, Andrew; Braun, Sebastian; Landsman-Blumberg, Pamela; Kempel, Angela; Gleißner, Erika; Patel, Sarita; Huang, Ming-Yi

    2017-03-27

    Multiple sclerosis (MS) patients often suffer from gait impairment and fampridine is indicated to medically improve walking ability in this population. Patient characteristics, healthcare resource use, and costs of MS patients on fampridine treatment for 12 months in Germany were analyzed. A retrospective claims database analysis was conducted including MS patients who initiated fampridine treatment (index date) between July 2011 and December 2013. Continuous insurance enrollment during 12 months pre- and post-index date was required, as was at least 1 additional fampridine prescription in the fourth quarter after the index date. Patient characteristics were evaluated and pre- vs post-index MS-related healthcare utilization and costs were compared. A total of 562 patients were included in this study. The mean (standard deviation [SD]) age was 50.5 (9.8) years and 63% were female. In the treatment period, almost every patient had at least 1 MS-related outpatient visit, 24% were hospitalized due to MS, and 79% utilized MS-specific physical therapy in addition to the fampridine treatment. Total MS-related healthcare costs were significantly higher in the fampridine treatment period than in the period prior to fampridine initiation (€17,392 vs €10,960, P treatment (€1,333 vs €1,565, P treatment. While healthcare costs were higher during fampridine treatment compared to the pre-treatment period, inpatient costs were lower. Further research is necessary to better understand the fampridine influence.

  10. On the global economic potentials and marginal costs of non-renewable resources and the price of energy commodities

    International Nuclear Information System (INIS)

    Mercure, Jean-François; Salas, Pablo

    2013-01-01

    A model is presented in this work for simulating endogenously the evolution of the marginal costs of production of energy carriers from non-renewable resources, their consumption, depletion pathways and timescales. Such marginal costs can be used to simulate the long term average price formation of energy commodities. Drawing on previous work where a global database of energy resource economic potentials was constructed, this work uses cost distributions of non-renewable resources in order to evaluate global flows of energy commodities. A mathematical framework is given to calculate endogenous flows of energy resources given an exogenous commodity price path. This framework can be used in reverse in order to calculate an endogenous marginal cost of production of energy carriers given an exogenous carrier demand. Using rigid price inelastic assumptions independent of the economy, these two approaches generate limiting scenarios that depict extreme use of natural resources. This is useful to characterise the current state and possible uses of remaining non-renewable resources such as fossil fuels and natural uranium. The theory is however designed for use within economic or technology models that allow technology substitutions. In this work, it is implemented in the global power sector model FTT:Power. Policy implications are given. - Highlights: • Theoretical model to forecast marginal costs of non-renewable resources. • Tracks the consumption and costs of non-renewable resources. • For use in economic or technology models

  11. Natural Resource Damage Assessment in highly impacted systems: A case study of the Anacostia River oil spill

    International Nuclear Information System (INIS)

    Pinkney, A.E.; Frithsen, J.B.; Burton, W.H.; Scott, L.C.; Siciliano, J.

    1993-01-01

    An approach and case study are presented to assessing natural resource damages due to additional perturbations in highly disturbed systems. The approach involves: (1) defining chemical characteristics unique to the additional perturbation, (2) identifying specific natural resources that may be sensitive to the additional perturbation and the most appropriate sampling period for each, and (3) using existing data to characterize previous conditions. This approach was used to assess the residual effects of a January 1992 spill of 3,400 gallons of number-sign 4 fuel oil in the Anacostia River, Washington, DC. Water quality is poor due to continuing inputs from urban runoff; one upstream tributary (Hickey Run) has a fifty year history of chronic oil spills and stormwater runoff of oil and grease. The challenge was to isolate possible spill impacts from those due to chronic pollutant inputs. GC/FID fingerprinting analyses were used to characterize spill material and hydrocarbons found in the spill area and two adjacent reference areas. Fish larvae (ichthyoplankton) and benthic invertebrates were identified as biological resources most likely to demonstrate residual effects. Results indicated that there were insignificant amounts of the hydrocarbons from the spill in the water, sediments, and biota of the river, and no residual impacts on biological resources could be identified

  12. Cost-effectiveness of environmental management for vector control in resource development projects.

    Science.gov (United States)

    Bos, R

    1991-01-01

    Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the

  13. Balancing Cost and Risk: The Treatment of Renewable Energy inWestern Utility Resource Plans

    Energy Technology Data Exchange (ETDEWEB)

    Wiser, Ryan; Bolinger, Mark

    2005-09-01

    Markets for renewable electricity have grown significantly in recent years, motivated in part by federal tax incentives and in part by state renewables portfolio standards and renewable energy funds. State renewables portfolio standards, for example, motivated approximately 45% of the 4,300 MW of wind power installed in the U.S. from 2001 through 2004, while renewable energy funds supported an additional 15% of these installations. Despite the importance of these state policies, a less widely recognized driver for renewable energy market growth is poised to also play an important role in the coming years: utility integrated resource planning (IRP). Formal resource planning processes have re-emerged in recent years as an important tool for utilities and regulators, particularly in regions where retail competition has failed to take root. In the western United States, recent resource plans contemplate a significant amount of renewable energy additions. These planned additions - primarily coming from wind power - are motivated by the improved economics of wind power, a growing acceptance of wind by electric utilities, and an increasing recognition of the inherent risks (e.g., natural gas price risk, environmental compliance risk) in fossil-based generation portfolios. The treatment of renewable energy in utility resource plans is not uniform, however. Assumptions about the direct and indirect costs of renewable resources, as well as resource availability, differ, as do approaches to incorporating such resources into the candidate portfolios that are analyzed in utility IRPs. The treatment of natural gas price risk, as well as the risk of future environmental regulations, also varies substantially. How utilities balance expected portfolio cost versus risk in selecting a preferred portfolio also differs. Each of these variables may have a substantial effect on the degree to which renewable energy contributes to the preferred portfolio of each utility IRP. This article

  14. Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype.

    Science.gov (United States)

    Goolsby Hunter, Alyssa; Rosenblatt, Lisa; Patel, Chad; Blauer-Peterson, Cori; Anduze-Faris, Beatrice

    2017-05-01

    In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored. In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics. Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity. The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs. Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients. These results suggest that liver disease progression varies by genotype and

  15. An Evaluation of the Consumer Costs and Benefits of Energy Efficiency Resource Standards

    Science.gov (United States)

    Lessans, Mark D.

    Of the modern-day policies designed to encourage energy efficiency, one with a significant potential for impact is that of Energy Efficiency Resource Standards (EERS). EERS policies place the responsibility for meeting an efficiency target on the electric and gas utilities, typically setting requirements for annual reductions in electricity generation or gas distribution to customers as a percentage of sales. To meet these requirements, utilities typically implement demand-side management (DSM) programs, which encourage energy efficiency at the customer level through incentives and educational initiatives. In Maryland, a statewide EERS has provided for programs which save a significant amount of energy, but is ultimately falling short in meeting the targets established by the policy. This study evaluates residential DSM programs offered by Pepco, a utility in Maryland, for cost-effectiveness. However, unlike most literature on the topic, analysis focuses on the costs-benefit from the perspective of the consumer, and not the utility. The results of this study are encouraging: the majority of programs analyzed show that the cost of electricity saved, or levelized cost of saved energy (LCSE), is less expensive than the current retail cost of electricity cost in Maryland. A key goal of this study is to establish a metric for evaluating the consumer cost-effectiveness of participation in energy efficiency programs made available by EERS. In doing so, the benefits of these programs can be effectively marketed to customers, with the hope that participation will increase. By increasing consumer awareness and buy-in, the original goals set out through EERS can be realized and the policies can continue to receive support.

  16. Covariates of depression and high utilizers of healthcare: Impact on resource use and costs.

    Science.gov (United States)

    Robinson, Rebecca L; Grabner, Michael; Palli, Swetha Rao; Faries, Douglas; Stephenson, Judith J

    2016-06-01

    To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; pcosts/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both pcosts in patients with depression. Copyright © 2016 Eli Lilly and Company. Published by Elsevier Inc. All rights reserved.

  17. NOx emissions from large point sources: variability in ozone production, resulting health damages and economic costs

    International Nuclear Information System (INIS)

    Mauzerall, D.L.; Namsoug Kim

    2005-01-01

    We present a proof-of-concept analysis of the measurement of the health damage of ozone (O 3 ) produced from nitrogen oxides (NO x =NO+NO 2 ) emitted by individual large point sources in the eastern United States. We use a regional atmospheric model of the eastern United States, the Comprehensive Air quality Model with Extensions (CAMx), to quantify the variable impact that a fixed quantity of NO x emitted from individual sources can have on the downwind concentration of surface O 3 , depending on temperature and local biogenic hydrocarbon emissions. We also examine the dependence of resulting O 3 -related health damages on the size of the exposed population. The investigation is relevant to the increasingly widely used 'cap and trade' approach to NO x regulation, which presumes that shifts of emission over time and space, holding the total fixed over the course of the summer O 3 season, will have minimal effect on the environmental outcome. By contrast, we show that a shift of a unit of NO x emissions from one place or time to another could result in large changes in resulting health effects due to O 3 formation and exposure. We indicate how the type of modeling carried out here might be used to attach externality-correcting prices to emissions. Charging emitters fees that are commensurate with the damage caused by their NO x emissions would create an incentive for emitters to reduce emissions at times and in locations where they cause the largest damage. (author)

  18. Resource use and costs of exenatide bid or insulin in clinical practice: the European CHOICE study

    Directory of Open Access Journals (Sweden)

    Kiiskinen U

    2013-07-01

    Full Text Available Urpo Kiiskinen,1 Stephan Matthaei,2 Matthew Reaney,3 Chantal Mathieu,4 Claes-Göran Östenson,5 Thure Krarup,6 Michael Theodorakis,7,* Jacek Kiljanski,8 Carole Salaun-Martin,9 Hélène Sapin,9 Bruno Guerci10 1Eli Lilly, Helsinki, Finland; 2Quakenbrück Diabetes Center, Quakenbrück, Germany; 3Eli Lilly, Windlesham, Surrey, UK; 4Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium; 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 6Department of Endocrinology, Bispebjerg Hospital, Copenhagen, Denmark; 7Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; 8Eli Lilly, Warsaw, Poland; 9Eli Lilly, Neuilly Cedex, France; 10Department of Diabetes, Metabolic Diseases, and Nutrition, Hôpital Brabois, Vandoeuvre-Lès-Nancy, France *Michael Theodorakis was affiliated with the institution shown above at the time of the study, but has since left this institution Purpose: CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy assessed patterns of exenatide bid and initial insulin therapy usage in clinical practice in six European countries and evaluated outcomes during the study. Methods: CHOICE was a 24-month, prospective, noninterventional observational study. Clinical and resource use data were collected at initiation of first injectable therapy (exenatide bid or insulin and at regular intervals for 24 months. Costs were evaluated from the national health care system perspective at 2009 prices. Results: A total of 2515 patients were recruited. At the 24-month analysis, significant treatment change had occurred during the study in 42.2% of 1114 eligible patients in the exenatide bid cohort and 36.0% of 1274 eligible patients in the insulin cohort. Improvements in glycemic control were observed over the course of the study in both cohorts (P < 0.001 for both, but mean weight was reduced in the exenatide bid cohort (P < 0

  19. Harnessing the best of Europe to understand and solve Keel Bone Damage: An ongoing EU-COST Action

    DEFF Research Database (Denmark)

    Riber, Anja Brinch; Sandilands, Victoria; Toscano, M.

    2017-01-01

    on a specific topic, i.e., the causes of KBD and solutions to reduce their severity and frequency. The Action brings various participants with a diverse mix of disciplines together to facilitate novel and trans-disciplinary discussions that will lead to definitive and quantifiable outputs. In addition......The KeelBoneDamage COST Action seeks to provide the European laying hen industry with the innovations in breeding, nutrition, and management necessary to resolve the problem of keel bone damage (KBD) in order to meet the high standards of welfare and productivity demanded by the European community...... to pursuing these research objectives, the Action also seeks to strengthen European research capacity by connecting relevant scientific communities and providing networking opportunities for young scientists. Activities are performed in concert with industrial partners whom are leaders in the field ensuring...

  20. Assessing damage cost estimation of urban pluvial flood risk as a mean of improving climate change adaptations investments

    DEFF Research Database (Denmark)

    Skovgård Olsen, Anders; Zhou, Qianqian; Linde, Jens Jørgen

    Estimating the expected annual damage (EAD) due to flooding in an urban area is of great interest for urban water managers and other stakeholders. It is a strong indicator for a given area showing how it will be affected by climate change and how much can be gained by implementing adaptation...... measures. This study investigates three different methods for estimating the EAD based on a loglinear relation between the damage costs and the return periods, one of which has been used in previous studies. The results show with the increased amount of data points there appears to be a shift in the log......-linear relation which could be contributed by the Danish design standards for drainage systems. Three different methods for estimating the EAD were tested and the choice of method is less important than accounting for the log-linear shift. This then also means that the statistical approximation of the EAD used...

  1. Digital resources and low cost of teaching materials for astronomical education

    Science.gov (United States)

    Paladino, L.; Voelzke, M. R.

    2017-12-01

    This work presents the results of the application of two questionnaires about Astronomical concepts in three classes in the first year High School of a public school in the periphery of São Paulo. In the first questionnaire was verified the prior knowledge of students. Then the intervention strategies were carried out: use of digital resources of the school, construction of mock-ups using low cost materials and the use of educational books, such as Couper & Henbest (1997), Horvath (2008). After four months, the second questionnaire was applied to verify the occurence of meaningful learning.

  2. Water resource taxation with full-cost water pricing: lessons from Europe

    DEFF Research Database (Denmark)

    Andersen, Mikael Skou; Pizzol, Massimo

    Green fiscal reform involves removal of environmentally harmful subsidies, introduction of taxes on pollution and resource depletion as well as full-cost pricing for environmental services. One sector which traditionally has been shielded against Green Fiscal Reform is the water sector, where...... social and distributional concerns have had priority over charging policies. This may seem a paradox, as the water sector is of major financial significance and traditionally accounts for 1-2 per cent of GDP in developed nations. Moreover, in the European Union the Water Framework Directive prescribes...

  3. The Psychiatric Patient as a Health Resource Consumer: Costs Associated with Electroconvulsive Therapy

    Science.gov (United States)

    Selva-Sevilla, Carmen; Gonzalez-Moral, Maria Luisa; Tolosa-Perez, Maria Teresa

    2016-01-01

    Background: Clinical practice protocols should consider both the psychological criteria related to a patient’s satisfaction as a consumer of health services and the economic criteria to allocate resources efficiently. An electroconvulsive therapy (ECT) program was implemented in our hospital to treat psychiatric patients. The main objective of this study was to determine the cost associated with the ECT sessions implemented in our hospital between 2008 and 2014. A secondary objective was to calculate the cost of sessions that were considered ineffective, defined as those sessions in which electrical convulsion did not reach the preset threshold duration, in order to identify possible ways of saving money and improving satisfaction among psychiatric patients receiving ECT. Methods: A descriptive analysis of the direct health costs related to ECT from the perspective of the public health system between 2008 and 2014 was performed using a retrospective chart review. All of the costs are in euros (2011) and were discounted at a rate of 3%. Based on the base case, a sensitivity analysis of the changes of those variables showing the greatest uncertainty was performed. Results: Seventy-six patients received 853 sessions of ECT. The cumulative cost of these sessions was €1409528.63, and 92.9% of this cost corresponded to the hospital stay. A total of €420732.57 (29.8%) was inefficiently spent on 269 ineffective sessions. A sensitivity analysis of the economic data showed stable results to changes in the variables of uncertainty. Conclusion: The efficiency of ECT in the context outlined here could be increased by discerning a way to shorten the associated hospital stay and by reducing the number of ineffective sessions performed. PMID:27303347

  4. Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer.

    Science.gov (United States)

    Rocque, Gabrielle B; Pisu, Maria; Jackson, Bradford E; Kvale, Elizabeth A; Demark-Wahnefried, Wendy; Martin, Michelle Y; Meneses, Karen; Li, Yufeng; Taylor, Richard A; Acemgil, Aras; Williams, Courtney P; Lisovicz, Nedra; Fouad, Mona; Kenzik, Kelly M; Partridge, Edward E

    2017-06-01

    Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214

  5. Efficient Phase Locking of Fiber Amplifiers Using a Low-Cost and High-Damage-Threshold Phase Control System

    International Nuclear Information System (INIS)

    Pu, Zhou; Yan-Xing, Ma; Xiao-Lin, Wang; Hao-Tong, Ma; Xiao-Jun, Xu; Ze-Jin, Liu

    2010-01-01

    We propose a low-cost and high-damage-threshold phase control system that employs a piezoelectric ceramic transducer modulator controlled by a stochastic parallel gradient descent algorithm. Efficient phase locking of two fiber amplifiers is demonstrated. Experimental results show that energy encircled in the target pinhole is increased by a factor of 1.76 and the visibility of the fringe pattern is as high as 90% when the system is in close-loop. The phase control system has potential in phase locking of large-number and high-power fiber laser endeavors. (fundamental areas of phenomenology (including applications))

  6. Pastures to Prairies to Pools: An Update on Natural Resource Damages Settlement Projects at the Fernald Preserve - 13198

    Energy Technology Data Exchange (ETDEWEB)

    Powell, Jane [Fernald Preserve Site Manager, DOE Office of Legacy Management, Harrison, Ohio (United States); Schneider, Tom [Fernald Project Manager, Ohio Environmental Protection Agency, Dayton, Ohio (United States); Hertel, Bill [Project Manager, S.M. Stoller Corporation, Harrison, Ohio (United States); Homer, John [Environmental Scientist, S.M. Stoller Corporation, Harrison, Ohio (United States)

    2013-07-01

    The DOE Office of Legacy Management oversees implementation and monitoring of two ecological restoration projects at the Fernald Preserve, Fernald, Ohio, that are funded through a CERCLA natural resource damage settlement. Planning and implementation of on-property ecological restoration projects is one component of compensation for natural resource injury. The Paddys Run Tributary Project involves creation of vernal pool wetland habitat with adjacent forest restoration. The Triangle Area Project is a mesic tall-grass prairie establishment, similar to other efforts at the Fernald Preserve. The goal of the Fernald Natural Resource Trustees is to establish habitat for Ambystomatid salamander species, as well as grassland birds. Field implementation of these projects was completed in May 2012. Herbaceous cover and woody vegetation survival was determined in August and September 2012. Results show successful establishment of native vegetation. Additional monitoring will be needed to determine whether project goals have been met. As with the rest of the Fernald Preserve, ecological restoration has helped turn a DOE liability into a community asset. (authors)

  7. Pastures to Prairies to Pools: An Update on Natural Resource Damages Settlement Projects at the Fernald Preserve - 13198

    International Nuclear Information System (INIS)

    Powell, Jane; Schneider, Tom; Hertel, Bill; Homer, John

    2013-01-01

    The DOE Office of Legacy Management oversees implementation and monitoring of two ecological restoration projects at the Fernald Preserve, Fernald, Ohio, that are funded through a CERCLA natural resource damage settlement. Planning and implementation of on-property ecological restoration projects is one component of compensation for natural resource injury. The Paddys Run Tributary Project involves creation of vernal pool wetland habitat with adjacent forest restoration. The Triangle Area Project is a mesic tall-grass prairie establishment, similar to other efforts at the Fernald Preserve. The goal of the Fernald Natural Resource Trustees is to establish habitat for Ambystomatid salamander species, as well as grassland birds. Field implementation of these projects was completed in May 2012. Herbaceous cover and woody vegetation survival was determined in August and September 2012. Results show successful establishment of native vegetation. Additional monitoring will be needed to determine whether project goals have been met. As with the rest of the Fernald Preserve, ecological restoration has helped turn a DOE liability into a community asset. (authors)

  8. Application of Bayesian and cost benefit risk analysis in water resources management

    Science.gov (United States)

    Varouchakis, E. A.; Palogos, I.; Karatzas, G. P.

    2016-03-01

    Decision making is a significant tool in water resources management applications. This technical note approaches a decision dilemma that has not yet been considered for the water resources management of a watershed. A common cost-benefit analysis approach, which is novel in the risk analysis of hydrologic/hydraulic applications, and a Bayesian decision analysis are applied to aid the decision making on whether or not to construct a water reservoir for irrigation purposes. The alternative option examined is a scaled parabolic fine variation in terms of over-pumping violations in contrast to common practices that usually consider short-term fines. The methodological steps are analytically presented associated with originally developed code. Such an application, and in such detail, represents new feedback. The results indicate that the probability uncertainty is the driving issue that determines the optimal decision with each methodology, and depending on the unknown probability handling, each methodology may lead to a different optimal decision. Thus, the proposed tool can help decision makers to examine and compare different scenarios using two different approaches before making a decision considering the cost of a hydrologic/hydraulic project and the varied economic charges that water table limit violations can cause inside an audit interval. In contrast to practices that assess the effect of each proposed action separately considering only current knowledge of the examined issue, this tool aids decision making by considering prior information and the sampling distribution of future successful audits.

  9. Prevention of postpartum haemorrhage: cost consequences analysis of misoprostol in low-resource settings.

    Science.gov (United States)

    Lang, Danielle L; Zhao, Fei-Li; Robertson, Jane

    2015-11-23

    While inferior to oxytocin injection in both efficacy and safety, orally administered misoprostol has been included in the World Health Organization Model List of Essential Medicines for use in the prevention of postpartum haemorrhage (PPH) in low-resource settings. This study evaluates the costs and health outcomes of use of oral misoprostol to prevent PPH in settings where injectable uterotonics are not available. A cost-consequences analysis was conducted from the international health system perspective, using data from a recent Cochrane systematic review and WHO's Mother-Baby Package Costing Spreadsheet in a hypothetical cohort of 1000 births in a mixed hospital (40% births)/community setting (60% births). Costs were estimated based on 2012 US dollars. Using oxytocin in the hospital setting and misoprostol in the community setting in a cohort of 1000 births, instead of oxytocin (hospital setting) and no treatment (community setting), 22 cases of PPH could be prevented. Six fewer women would require additional uterotonics and four fewer women a blood transfusion. An additional 130 women would experience shivering and an extra 42 women fever. Oxytocin/misoprostol was found to be cost saving (US$320) compared to oxytocin/no treatment. If misoprostol is used in both the hospital and community setting compared with no treatment (i.e. oxytocin not available in the hospital setting), 37 cases of PPH could be prevented; ten fewer women would require additional uterotonics; and six fewer women a blood transfusion. An additional 217 women would experience shivering and 70 fever. The cost savings would be US$533. Sensitivity analyses indicate that the results are sensitive to the incidence of PPH-related outcomes, drug costs and the proportion of hospital births. Our findings confirm that, even though misoprostol is not the optimum choice in the prevention of PPH, misoprostol could be an effective and cost-saving choice where oxytocin is not or cannot be used due to a

  10. Cost and benefit including value of life, health and environmental damage measured in time units

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager; Friis-Hansen, Peter

    2009-01-01

    Key elements of the authors' work on money equivalent time allocation to costs and benefits in risk analysis are put together as an entity. This includes the data supported dimensionless analysis of an equilibrium relation between total population work time and gross domestic product leading...... of this societal value over the actual costs, used by the owner for economically optimizing an activity, motivates a simple risk accept criterion suited to be imposed on the owner by the public. An illustration is given concerning allocation of economical means for mitigation of loss of life and health on a ferry...

  11. Performance costs when emotion tunes inappropriate cognitive abilities: implications for mental resources and behavior.

    Science.gov (United States)

    Storbeck, Justin

    2012-08-01

    Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency. In 2 experiments, either an approach-motivated positive state or a withdrawal-motivated negative state was induced, and then participants completed a verbal or a spatial working memory task creating conditions of emotion-cognition alignment (e.g., approach/verbal) or misalignment (e.g., approach/spatial). A control condition was also included. To examine behavioral costs due to depleted self-control resources, participants completed either a Stroop task (Stroop, 1935; Experiment 1) or a Black/White implicit association test (IAT; Greenwald, McGhee, & Schwartz, 1998; Experiment 2). Participants in the misalignment conditions performed worse on the Stroop task, and they were worse at controlling their implicit attitude biases on the IAT. Thus, when emotion tunes inappropriate cognitive tendencies for one's current environment, self-control resources become depleted, impairing behavioral control. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

  12. The Marginal Damage Costs of Different Greenhouse Gases: An Application of FUND

    NARCIS (Netherlands)

    Waldhoff, S.; Anthoff, D.; Rose, S.; Tol, R.S.J.

    2014-01-01

    The authors use FUND 3.9 to estimate the social cost of four greenhouse gases—carbon dioxide, methane, nitrous oxide, and sulphur hexafluoride—with sensitivity tests for carbon dioxide fertilization, terrestrial feedbacks, climate sensitivity, discounting, equity weighting, and socioeconomic and

  13. 77 FR 57074 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2012-09-17

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

  14. Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-06-01

    Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

  15. Initial investigation into lower-cost CT for resource limited regions of the world

    Science.gov (United States)

    Dobbins, James T., III; Wells, Jered R.; Segars, W. Paul; Li, Christina M.; Kigongo, Christopher J. N.

    2010-04-01

    This paper describes an initial investigation into means for producing lower-cost CT scanners for resource limited regions of the world. In regions such as sub-Saharan Africa, intermediate level medical facilities serving millions have no CT machines, and lack the imaging resources necessary to determine whether certain patients would benefit from being transferred to a hospital in a larger city for further diagnostic workup or treatment. Low-cost CT scanners would potentially be of immense help to the healthcare system in such regions. Such scanners would not produce state-of-theart image quality, but rather would be intended primarily for triaging purposes to determine the patients who would benefit from transfer to larger hospitals. The lower-cost scanner investigated here consists of a fixed digital radiography system and a rotating patient stage. This paper describes initial experiments to determine if such a configuration is feasible. Experiments were conducted using (1) x-ray image acquisition, a physical anthropomorphic chest phantom, and a flat-panel detector system, and (2) a computer-simulated XCAT chest phantom. Both the physical phantom and simulated phantom produced excellent image quality reconstructions when the phantom was perfectly aligned during acquisition, but artifacts were noted when the phantom was displaced to simulate patient motion. An algorithm was developed to correct for motion of the phantom and demonstrated success in correcting for 5-mm motion during 360-degree acquisition of images. These experiments demonstrated feasibility for this approach, but additional work is required to determine the exact limitations produced by patient motion.

  16. An analysis of factors affecting participation behavior of limited resource farmers in agricultural cost-share programs in Alabama

    Science.gov (United States)

    Okwudili Onianwa; Gerald Wheelock; Buddhi Gyawali; Jianbang Gan; Mark Dubois; John Schelhas

    2004-01-01

    This study examines factors that affect the participation behavior of limited resource farmers in agricultural cost-share programs in Alabama. The data were generated from a survey administered to a sample of limited resource farm operators. A binary logit model was employed to analyze the data. Results indicate that college education, age, gross sales, ratio of owned...

  17. Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020).

    Science.gov (United States)

    Kovacs, Kent; Václavík, Tomáš; Haight, Robert G; Pang, Arwin; Cunniffe, Nik J; Gilligan, Christopher A; Meentemeyer, Ross K

    2011-04-01

    Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and replacement on developed land in California communities using simulations of P. ramorum spread and infection risk over the next decade (2010-2020). An estimated 734 thousand oak trees occur on developed land in communities in the analysis area. The simulations predict an expanding sudden oak death (SOD) infestation that will likely encompass most of northwestern California and warrant treatment, removal, and replacement of more than 10 thousand oak trees with discounted cost of $7.5 million. In addition, we estimate the discounted property losses to single family homes of $135 million. Expanding the land base to include developed land outside as well as inside communities doubles the estimates of the number of oak trees killed and the associated costs and losses. The predicted costs and property value losses are substantial, but many of the damages in urban areas (e.g. potential losses from increased fire and safety risks of the dead trees and the loss of ecosystem service values) are not included. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. High resource utilization in liver transplantation-how strongly differ costs between the care sectors and what are the main cost drivers?: a retrospective study.

    Science.gov (United States)

    Harries, Lena; Schrem, Harald; Stahmeyer, Jona T; Krauth, Christian; Amelung, Volker E

    2017-06-01

    To control treatment pathways of transplant patients across healthcare sectors, a profound knowledge of the underlying cost structure is necessary. The aim of this study was to analyze the resource utilization of patients undergoing liver transplantation. Data on resource utilization for 182 liver-transplanted patients was investigated retrospectively. The observational period started with the entry on the waiting list and ended up to 3 years after transplantation. Median treatment cost was 144 424€. During waiting time, median costs amounted to 9466€; 72% of costs were attributed to inpatient care, 3% to outpatient care, and 26% to pharmaceuticals. During the first year after transplantation, median costs of 105 566€ were calculated; 83% were allocated for inpatient and 1% outpatient care, 14% for drugs, and 1% for rehabilitative care. During follow-up after the first year of transplantation, median costs amounted to 20 115€; 75% of these were caused by pharmaceuticals, 21% by inpatient, 4% by outpatient, and Costs incurred by inpatient care and pharmaceuticals are the dominating cost factors. These findings encourage a debate on challenges and improvements for cost-efficient clinical management between different healthcare sectors. © 2017 Steunstichting ESOT.

  19. Antiepileptic Drug Titration and Related Health Care Resource Use and Costs.

    Science.gov (United States)

    Fishman, Jesse; Kalilani, Linda; Song, Yan; Swallow, Elyse; Wild, Imane

    2018-02-27

    Unexpected breakthrough seizures resulting from suboptimal antiepileptic drug (AED) dosing during the titration period, as well as adverse events resulting from rapid AED titration, may influence the titration schedule and significantly increase health care resource use (HRU) and health care costs. To assess the relationship between AEDs, HRU, and costs during AED titration and maintenance. Practicing neurologists were recruited from a nationwide panel to provide up to 3 patient records each for this retrospective medical chart review. Patients with epilepsy who were aged ≥ 18 years and had initiated an AED between January 1, 2014, and January 1, 2016, were followed for 6 months from AED initiation. Titration duration was the time from AED initiation to the beginning of treatment maintenance as determined by the physician. Outcomes were epilepsy-specific HRU (hospitalizations, emergency department visits, outpatient visits, physician referral, laboratory testing/diagnostic imaging, and phone calls) and related costs that occurred during the titration or maintenance treatment periods. Of 811 patients, 156, 128, 125, 120, 114, 107, and 61 initiated the following AEDs: levetiracetam, lamotrigine, lacosamide, valproate, topiramate, carbamazepine, and phenytoin, respectively. Most patients (619/803 [77.1%] with complete AED data) received monotherapy. Baseline characteristics were similar across AEDs (mean [SD] age, 36.6 [14.4] years; 59.0% male). Kaplan-Meier estimates of titration duration ranged from 3.3 weeks (phenytoin) to 8.1 weeks (lamotrigine). From titration to maintenance, the overall incidence of HRU per person-month decreased 54.5%-89.3% for each HRU measure except outpatient visits (24.6% decrease). Total epilepsy-related costs decreased from $80.48 to $42.77 per person-month, or 46.9% from titration to maintenance. AED titration periods had higher HRU rates and costs than AED maintenance, suggesting that use of AEDs with shorter titration requirements

  20. The Cost of Crop Damage Caused by Ozone Air Pollution From Motor Vehicles

    OpenAIRE

    Delucchi, Mark A.; Murphy, James; Kim, Jin; McCubbin, Donald R.

    1996-01-01

    The detrimental effects of ambient ozone on crops, even at relatively low concentrations, are well-established (Thompson et al., 1976; Heck and Brandt, 1977; Heck et al., 1982; Environmental Protection Agency, 1984; California Air Resources Board, 1987; Olszyk et al., 1988a, 1988b; Heagle et al., 1986; McCool et al., 1986, Ashmore, 1991). Ozone enters plant leaves through the stomatal openings in the leaf surface and then produces byproducts that reduce the efficiency of photosynthesis (CARB...

  1. Tornadoes and related damage costs: statistical modeling with a semi-Markov approach

    OpenAIRE

    Corini, Chiara; D'Amico, Guglielmo; Petroni, Filippo; Prattico, Flavio; Manca, Raimondo

    2015-01-01

    We propose a statistical approach to tornadoes modeling for predicting and simulating occurrences of tornadoes and accumulated cost distributions over a time interval. This is achieved by modeling the tornadoes intensity, measured with the Fujita scale, as a stochastic process. Since the Fujita scale divides tornadoes intensity into six states, it is possible to model the tornadoes intensity by using Markov and semi-Markov models. We demonstrate that the semi-Markov approach is able to reprod...

  2. Assessment of the economic costs of damage caused by air pollution

    International Nuclear Information System (INIS)

    Holland, M.R.

    1995-01-01

    Cost-benefit analysis is one of the fundamental tools for the development of economic instruments for pollution control. The costs of various abatement measures are reasonably well characterised. However, assessment of the economic costs of pollutant impacts is less well developed. This paper reports on two studies carried out for DGXII of the European Commission, the ExternE-Project and the Green Accounting Research Project. Both studies have been performed by international, multi-disciplinary research teams. Analysis of the effects of emissions of PM 10 , SO 2 , NO x and VOCs (as ozone precursors) has included assessment of human health, materials, crops and other terrestrial ecosystems, and freshwater fisheries. The analysis follows the 'impact pathway' approach, linking dose-response functions, valuation data and other models. It differs significantly to earlier 'top-down' approaches that made only very limited use of the wealth of scientific data available. Most success has been achieved in analysis of impacts on human health, building materials and crops. Significant uncertainties exist for these receptors, though these have been identified and are now being addressed. Assessment of impacts on other receptors, perhaps most notably forests, is more limited. The methodology is particularly applicable for analysis of impacts on receptors for which the critical loads approach is not appropriate. 7 refs., 3 figs., 1 tab

  3. DIDEM - An integrated model for comparative health damage costs calculation of air pollution

    Science.gov (United States)

    Ravina, Marco; Panepinto, Deborah; Zanetti, Maria Chiara

    2018-01-01

    Air pollution represents a continuous hazard to human health. Administration, companies and population need efficient indicators of the possible effects given by a change in decision, strategy or habit. The monetary quantification of health effects of air pollution through the definition of external costs is increasingly recognized as a useful indicator to support decision and information at all levels. The development of modelling tools for the calculation of external costs can provide support to analysts in the development of consistent and comparable assessments. In this paper, the DIATI Dispersion and Externalities Model (DIDEM) is presented. The DIDEM model calculates the delta-external costs of air pollution comparing two alternative emission scenarios. This tool integrates CALPUFF's advanced dispersion modelling with the latest WHO recommendations on concentration-response functions. The model is based on the impact pathway method. It was designed to work with a fine spatial resolution and a local or national geographic scope. The modular structure allows users to input their own data sets. The DIDEM model was tested on a real case study, represented by a comparative analysis of the district heating system in Turin, Italy. Additional advantages and drawbacks of the tool are discussed in the paper. A comparison with other existing models worldwide is reported.

  4. Marginal Cost Pricing in a World without Perfect Competition: Implications for Electricity Markets with High Shares of Low Marginal Cost Resources

    Energy Technology Data Exchange (ETDEWEB)

    Frew, Bethany A. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Clark, Kara [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bloom, Aaron P. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Milligan, Michael [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2017-12-02

    A common approach to regulating electricity is through auction-based competitive wholesale markets. The goal of this approach is to provide a reliable supply of power at the lowest reasonable cost to the consumer. This necessitates market structures and operating rules that ensure revenue sufficiency for all generators needed for resource adequacy purposes. Wholesale electricity markets employ marginal-cost pricing to provide cost-effective dispatch such that resources are compensated for their operational costs. However, marginal-cost pricing alone cannot guarantee cost recovery outside of perfect competition, and electricity markets have at least six attributes that preclude them from functioning as perfectly competitive markets. These attributes include market power, externalities, public good attributes, lack of storage, wholesale price caps, and ineffective demand curve. Until (and unless) these failures are ameliorated, some form of corrective action(s) will be necessary to improve market efficiency so that prices can correctly reflect the needed level of system reliability. Many of these options necessarily involve some form of administrative or out-of-market actions, such as scarcity pricing, capacity payments, bilateral or other out-of-market contracts, or some hybrid combination. A key focus with these options is to create a connection between the electricity market and long-term reliability/loss-of-load expectation targets, which are inherently disconnected in the native markets because of the aforementioned market failures. The addition of variable generation resources can exacerbate revenue sufficiency and resource adequacy concerns caused by these underlying market failures. Because variable generation resources have near-zero marginal costs, they effectively suppress energy prices and reduce the capacity factors of conventional generators through the merit-order effect in the simplest case of a convex market; non-convexities can also suppress prices.

  5. Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings.

    Science.gov (United States)

    Bennett, Desmond J; Carroll, Ryan W; Kacmarek, Robert M

    2018-04-01

    Respiratory compromise is a leading contributor to global neonatal death. CPAP is a method of treatment that helps maintain lung volume during expiration, promotes comfortable breathing, and improves oxygenation. Bubble CPAP is an effective alternative to standard CPAP. We sought to determine the reliability and functionality of a low-cost bubble CPAP device designed for low-resource settings. The low-cost bubble CPAP device was compared to a commercially available bubble CPAP system. The devices were connected to a lung simulator that simulated neonates of 4 different weights with compromised respiratory mechanics (∼1, ∼3, ∼5, and ∼10 kg). The devices' abilities to establish and maintain pressure and flow under normal conditions as well as under conditions of leak were compared. Multiple combinations of pressure levels (5, 8, and 10 cm H 2 O) and flow levels (3, 6, and 10 L/min) were tested. The endurance of both devices was also tested by running the systems continuously for 8 h and measuring the changes in pressure and flow. Both devices performed equivalently during the no-leak and leak trials. While our testing revealed individual differences that were statistically significant and clinically important (>10% difference) within specific CPAP and flow-level settings, no overall comparisons of CPAP or flow were both statistically significant and clinically important. Each device delivered pressures similar to the desired pressures, although the flows delivered by both machines were lower than the set flows in most trials. During the endurance trials, the low-cost device was marginally better at maintaining pressure, while the commercially available device was better at maintaining flow. The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness. Copyright © 2018 by Daedalus Enterprises.

  6. The competitiveness of domestic rice production in East Africa: A domestic resource cost approach in Uganda

    Directory of Open Access Journals (Sweden)

    Masao Kikuchi

    2016-03-01

    Full Text Available The rapid increase of rice imports in sub-Saharan Africa under the unstable situation in the world rice market during the 2000s has made it an important policy target for the countries in the region to increase self-sufficiency in rice in order to enhance food security. Whether domestic rice production can be competitive with imported rice is a serious question in East African countries that lie close, just across the Arabian Sea, to major rice exporting countries in South Asia. This study investigates the international competitiveness of domestic rice production in Uganda in terms of the domestic resource cost ratio. The results show that rainfed rice cultivation, which accounts for 95% of domestic rice production, does not have a comparative advantage with respect to rice imported from Pakistan, the largest supplier of imported rice to Uganda. However, the degree of non-competitiveness is not serious, and a high possibility exists for Uganda’s rainfed rice cultivation to become internationally competitive by improving yield levels by applying more modern inputs and enhancing labour productivity. Irrigated rice cultivation, though very limited in area, is competitive even under the present input-output structure when the cost of irrigation infrastructure is treated as a sunk cost. If the cost of installing irrigation infrastructure and its operation and maintenance is taken into account, the types of irrigation development that are economically feasible are not large-scale irrigation projects, but are small- and microscale projects for lowland rice cultivation and rain-water harvesting for upland rice cultivation.

  7. Association of obesity with healthcare resource utilization and costs in a commercial population.

    Science.gov (United States)

    Kamble, Pravin S; Hayden, Jennifer; Collins, Jenna; Harvey, Raymond A; Suehs, Brandon; Renda, Andrew; Hammer, Mette; Huang, Joanna; Bouchard, Jonathan

    2018-05-10

    To examine the association of obesity with healthcare resource utilization (HRU) and costs among commercially insured individuals. This retrospective observational cohort study used administrative claims from 1 January 2007 to 1 December 2013. The ICD-9-CM status codes (V85 hierarchy) from 2008 to 2012 classified body mass index (BMI) into the World Health Organizations' BMI categories. The date of first observed BMI code was defined as the index date and continuous eligibility for one year pre- and post- index date was ensured. Post-index claims determined individuals' HRU and costs. Sampling weights developed using the entropy balance method and National Health and Nutrition Examination Survey data ensured representation of the US adult commercially insured population. Baseline characteristics were described across BMI classes and associations between BMI categories, and outcomes were examined using multivariable regression. The cohort included 9651 individuals with BMI V85 codes. After weighting, the BMI distribution was: normal (31.1%), overweight (33.4%), obese class I (22.0%), obese class II (8.1%) and obese class III (5.4%). Increasing BMI was associated with greater prevalence of cardiometabolic conditions, including hypertension, type 2 diabetes and metabolic syndrome. The use of antihypertensives, antihyperlipidemics, antidiabetics, analgesics and antidepressants rose with increasing BMI. Greater BMI level was associated with increased inpatient, emergency department and outpatient utilization, and higher total healthcare, medical and pharmacy costs. Increasing BMI was associated with higher prevalence of cardiometabolic conditions and higher HRU and costs. There is an urgent need to address the epidemic of obesity and its clinical and economic impacts.

  8. What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

    Science.gov (United States)

    Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

    2016-02-01

    U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician

  9. 26 CFR 301.7430-8 - Administrative costs incurred in damage actions for violations of section 362 or 524 of the...

    Science.gov (United States)

    2010-04-01

    ...) In general. The Internal Revenue Service may grant a taxpayer's request for recovery of reasonable... Revenue Service or recovery of damages from the Internal Revenue Service under § 301.7433-2(e). (d) Costs... administrative costs within six months after such request is filed, the Internal Revenue Service's failure to...

  10. Contribution of insurance data to cost assessment of coastal flood damage to residential buildings: insights gained from Johanna (2008 and Xynthia (2010 storm events

    Directory of Open Access Journals (Sweden)

    C. André

    2013-08-01

    Full Text Available There are a number of methodological issues involved in assessing damage caused by natural hazards. The first is the lack of data, due to the rarity of events and the widely different circumstances in which they occur. Thus, historical data, albeit scarce, should not be neglected when seeking to build ex-ante risk management models. This article analyses the input of insurance data for two recent severe coastal storm events, to examine what causal relationships may exist between hazard characteristics and the level of damage incurred by residential buildings. To do so, data was collected at two levels: from lists of about 4000 damage records, 358 loss adjustment reports were consulted, constituting a detailed damage database. The results show that for flooded residential buildings, over 75% of reconstruction costs are associated with interior elements, with damage to structural components remaining very localised and negligible. Further analysis revealed a high scatter between costs and water depth, suggesting that uncertainty remains high in drawing up damage functions with insurance data alone. Due to the paper format of the loss adjustment reports, and the lack of harmonisation between their contents, the collection stage called for a considerable amount of work. For future events, establishing a standardised process for archiving damage information could significantly contribute to the production of such empirical damage functions. Nevertheless, complementary sources of data on hazards and asset vulnerability parameters will definitely still be necessary for damage modelling; multivariate approaches, crossing insurance data with external material, should also be investigated more deeply.

  11. Contribution of insurance data to cost assessment of coastal flood damage to residential buildings: insights gained from Johanna (2008) and Xynthia (2010) storm events

    Science.gov (United States)

    André, C.; Monfort, D.; Bouzit, M.; Vinchon, C.

    2013-08-01

    There are a number of methodological issues involved in assessing damage caused by natural hazards. The first is the lack of data, due to the rarity of events and the widely different circumstances in which they occur. Thus, historical data, albeit scarce, should not be neglected when seeking to build ex-ante risk management models. This article analyses the input of insurance data for two recent severe coastal storm events, to examine what causal relationships may exist between hazard characteristics and the level of damage incurred by residential buildings. To do so, data was collected at two levels: from lists of about 4000 damage records, 358 loss adjustment reports were consulted, constituting a detailed damage database. The results show that for flooded residential buildings, over 75% of reconstruction costs are associated with interior elements, with damage to structural components remaining very localised and negligible. Further analysis revealed a high scatter between costs and water depth, suggesting that uncertainty remains high in drawing up damage functions with insurance data alone. Due to the paper format of the loss adjustment reports, and the lack of harmonisation between their contents, the collection stage called for a considerable amount of work. For future events, establishing a standardised process for archiving damage information could significantly contribute to the production of such empirical damage functions. Nevertheless, complementary sources of data on hazards and asset vulnerability parameters will definitely still be necessary for damage modelling; multivariate approaches, crossing insurance data with external material, should also be investigated more deeply.

  12. Comparison of cost determination of both resource consumption accounting and time-driven activity-based costing systems in a healthcare setting.

    Science.gov (United States)

    Özyapıcı, Hasan; Tanış, Veyis Naci

    2017-05-01

    Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting. Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA. Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA. Conclusion Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs. What is known about the topic? TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA. What does this paper add? There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting. What are the implications for practitioners? This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.

  13. A Transmission-Cost-Based Model to Estimate the Amount of Market-Integrable Wind Resources

    DEFF Research Database (Denmark)

    Morales González, Juan Miguel; Pinson, Pierre; Madsen, Henrik

    2012-01-01

    are made to share the expenses in transmission derived from their integration, they may see the doors of electricity markets closed for not being competitive enough. This paper presents a model to decide the amount of wind resources that are economically exploitable at a given location from a transmission......In the pursuit of the large-scale integration of wind power production, it is imperative to evaluate plausible frictions among the stochastic nature of wind generation, electricity markets, and the investments in transmission required to accommodate larger amounts of wind. If wind producers......-cost perspective. This model accounts for the uncertain character of wind by using a modeling framework based on stochastic optimization, simulates market barriers by means of a bi-level structure, and considers the financial risk of investments in transmission through the conditional value-at-risk. The major...

  14. The Comparative Effects of Transaction Cost Economics and Resource Based View: A Technological Alliance Motivational Perspective

    Directory of Open Access Journals (Sweden)

    Hwan Jin Kim

    2016-06-01

    Full Text Available This paper examines the impact of two main alliance motivation theories, transaction cost economics (TCE and resource based view (RBV, on alliance processes among Korean manufacturing high-tech ventures. Results show that TCE and RBV are complimentarily explaining the formation of inter-firm alliances. TCE variables are more related with alliance partner characteristics while RBV is more linked with partner capabilities. Both show positive effects on performance. No significant effect is found on determining an alliance governance structure. While selecting appropriate technological alliance partners show positive effects on performance, no significant effect is found between alliance governance structure and performance. Factors of both theories impacting each alliance stage and analytical explanations of such impacts are discussed.

  15. Desalination as Groundwater Conservation: The Cost of Protecting Cultural and Environmental Resources in Chile's Region II

    Science.gov (United States)

    Edwards, E. C.; Cristi, O.; Libecap, G. D.

    2012-12-01

    There is a substantial body of evidence that groundwater overdraft is occurring worldwide. Economists argue that the cause of this overdraft is the open-access nature of the resource, which results in a "tragedy of the commons." Sustainable water management requires that some institution control the resource to limit this overdraft by reducing water extraction. This reduction creates scarcity and requires a method of rationing. The economically efficient outcome occurs when the lowest value uses of water are eliminated. This allocation, though, may have undesirable social consequences, such as the loss of small-scale farming, and political ramifications that make such an allocation unpopular to implement. This paper explores the economic cost of leaving water in low-value uses. The policy we explore is a moratorium on voluntary water sales to mining firms to protect the groundwater resource in northern Chile. This policy has accelerated the use of expensive desalinated water, whose cost is primarily driven by its heavy use of carbon-based electricity. Chile has a strong system of water property rights that economists argue ration water in a way that leads to the efficient allocation through water markets. This paper first explores the potential inefficiency of a water market when groundwater and surface water are linked, as well as when different users vary in their intensity of use. This theoretical background provides a framework for determining the economically efficient allocation of water and the losses associated with the moratorium in northern Chile. The policy does protect some environmental and cultural public goods, which potentially offset some or all of this cost. We provide a perspective on the magnitude of these public goods but do not attempt to value them explicitly. Instead, we demonstrate what their value must be so that the moratorium policy has a cost-to-benefit ratio of one. While the estimate of lost income from inefficiency is the main focus

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

    Science.gov (United States)

    Virta, Lena; Joranger, Pål; Brox, Jens Ivar; Eriksson, Rikard

    2012-02-10

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

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

    Directory of Open Access Journals (Sweden)

    Virta Lena

    2012-02-01

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

  18. Low-cost teleoperator-controlled vehicle for damage assessment and radiation dose measurement

    International Nuclear Information System (INIS)

    Tyree, W.H.

    1991-01-01

    A low-cost, disposable, radio-controlled, remote-reading, ionizing radiation and surveillance teleoperator re-entry vehicle has been built. The vehicle carries equipment, measures radiation levels, and evaluates building conditions. The basic vehicle, radio control with amplifiers, telemetry, elevator, and video camera with monitor cost less than $2500. Velcro-mounted alpha, beta-gamma, and neutron sensing equipment is used in the present system. Many types of health physics radiation measuring equipment may be substituted on the vehicle. The system includes a black-and-white video camera to observe the environment surrounding the vehicle. The camera is mounted on a vertical elevator extendible to 11 feet above the floor. The present vehicle uses a video camera with an umbilical cord between the vehicle and the operators. Preferred operation would eliminate the umbilical. Video monitoring equipment is part of the operator control system. Power for the vehicle equipment is carried on board and supplied by sealed lead-acid batteries. Radios are powered by 9-V alkaline batteries. The radio control receiver, servo drivers, high-power amplifier and 49-MHz FM transceivers were irradiated at moderate rates with neutron and gamma doses to 3000 Rem and 300 Rem, respectively, to ensure system operation

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

    Science.gov (United States)

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

    2018-05-01

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

  20. Estimates of the Damage Costs of Climate Change. Part 2. Dynamic Estimates

    International Nuclear Information System (INIS)

    Tol, R.S.J.

    2002-01-01

    Monetised estimates of the impact of climate change are derived. Impacts are expressed as functions of climate change and 'vulnerability'. Vulnerability is measured by a series of indicators, such as per capita income, population above 65, and economic structure. Impacts are estimated for nine world regions, for the period 2000-2200, for agriculture, forestry, water resources, energy consumption, sea level rise, ecosystems, fatal vector-borne diseases, and fatal cardiovascular and respiratory disorders. Uncertainties are large, often including sign switches. In the short term, the estimated sensitivity of a sector to climate change is found to be the crucial parameter. In the longer term, the change in the vulnerability of the sector is often more important for the total impact. Impacts can be negative or positive, depending on the time, region, and sector one is looking at. Negative impacts tend to dominate in the later years and in the poorer regions

  1. Efficiency versus cost of alternative fuels from renewable resources: outlining decision parameters

    International Nuclear Information System (INIS)

    Kaul, Sanjay; Edinger, Raphael

    2004-01-01

    In the discussion of traditional versus renewable energies and alternatives to conventional crude oil-based fuels in the transportation sector, efficiency calculations are but one decision making parameter. Comparing the assets and liabilities of fossil-based and renewable fuels in the transportation sector, further aspects such as centralized versus decentralized technologies, cost evaluations, taxation, and ecological/social benefits have to be taken into account. This paper outlines the driving parameters for shifting toward alternative fuels based on fossil or renewable resources and their use in innovative vehicle technologies such as advanced internal combustion and fuel cell electric drive systems. For the decision in favor or against an alternative fuel to be introduced to the mass market, automotive technologies and the energy supply system have to be examined in an integrated way. From an economic and technological perspective, some fuels may be even incompatible with the trend toward using renewable resources that have advantages in decentralized systems. Beyond efficiency calculations, political and industrial interests arise and may be influential to reshaping our currently crude oil-based mobility sector

  2. Integrated Evaluation of Cost, Emissions, and Resource Potential for Algal Biofuels at the National Scale

    Energy Technology Data Exchange (ETDEWEB)

    Davis, Ryan; Fishman, Daniel; Frank, Edward D.; Johnson, Michael C.; Jones, Susanne B.; Kinchin, Christopher; Skaggs, Richard; Venteris, Erik R.; Wigmosta, Mark S.

    2014-04-21

    Costs, emissions, and resource availability were modeled for the production of 5 billion gallons yr-1 (5 BGY) of renewable diesel in the United States from Chlorella biomass by hydrothermal liquefaction (HTL). The HTL model utilized data from a continuous 1-L reactor including catalytic hydrothermal gasification of the aqueous phase, and catalytic hydrotreatment of the HTL oil. A biophysical algae growth model coupled with weather and pond simulations predicted biomass productivity from experimental growth parameters, allowing site-by-site and temporal prediction of biomass production. The 5 BGY scale required geographically and climatically distributed sites. Even though screening down to 5 BGY significantly reduced spatial and temporal variability, site-to-site, season-to-season, and inter-annual variations in productivity affected economic and environmental performance. Performance metrics based on annual average or peak productivity were inadequate; temporally and spatially explicit computations allowed more rigorous analysis of these dynamic systems. For example, 3-season operation with a winter shutdown was favored to avoid high greenhouse gas emissions, and economic performance was harmed by underutilized equipment during slow-growth periods. Thus, analysis of algal biofuel pathways must combine spatiotemporal resource assessment, economic analysis, and environmental analysis integrated over many sites when assessing national scale performance.

  3. Integrated evaluation of cost, emissions, and resource potential for algal biofuels at the national scale.

    Science.gov (United States)

    Davis, Ryan E; Fishman, Daniel B; Frank, Edward D; Johnson, Michael C; Jones, Susanne B; Kinchin, Christopher M; Skaggs, Richard L; Venteris, Erik R; Wigmosta, Mark S

    2014-05-20

    Costs, emissions, and resource availability were modeled for the production of 5 billion gallons yr(-1) (5 BGY) of renewable diesel in the United States from Chlorella biomass by hydrothermal liquefaction (HTL). The HTL model utilized data from a continuous 1-L reactor including catalytic hydrothermal gasification of the aqueous phase, and catalytic hydrotreatment of the HTL oil. A biophysical algae growth model coupled with weather and pond simulations predicted biomass productivity from experimental growth parameters, allowing site-by-site and temporal prediction of biomass production. The 5 BGY scale required geographically and climatically distributed sites. Even though screening down to 5 BGY significantly reduced spatial and temporal variability, site-to-site, season-to-season, and interannual variations in productivity affected economic and environmental performance. Performance metrics based on annual average or peak productivity were inadequate; temporally and spatially explicit computations allowed more rigorous analysis of these dynamic systems. For example, 3-season operation with a winter shutdown was favored to avoid high greenhouse gas emissions, but economic performance was harmed by underutilized equipment during slow-growth periods. Thus, analysis of algal biofuel pathways must combine spatiotemporal resource assessment, economic analysis, and environmental analysis integrated over many sites when assessing national scale performance.

  4. Two-Stage Coordinated Operational Strategy for Distributed Energy Resources Considering Wind Power Curtailment Penalty Cost

    Directory of Open Access Journals (Sweden)

    Jing Qiu

    2017-07-01

    Full Text Available The concept of virtual power plant (VPP has been proposed to facilitate the integration of distributed renewable energy. VPP behaves similar to a single entity that aggregates a collection of distributed energy resources (DERs such as distributed generators, storage devices, flexible loads, etc., so that the aggregated power outputs can be flexibly dispatched and traded in electricity markets. This paper presents an optimal scheduling model for VPP participating in day-ahead (DA and real-time (RT markets. In the DA market, VPP aims to maximize the expected profit and reduce the risk in relation to uncertainties. The risk is measured by a risk factor based on the mean-variance Markowitz theory. In the RT market, VPP aims to minimize the imbalance cost and wind power curtailment by adjusting the scheduling of DERs in its portfolio. In case studies, the benefits (e.g., surplus profit and reduced wind power curtailment of aggregated VPP operation are assessed. Moreover, we have investigated how these benefits are affected by different risk-aversion levels and uncertainty levels. According to the simulation results, the aggregated VPP scheduling approach can effectively help the integration of wind power, mitigate the impact of uncertainties, and reduce the cost of risk-aversion.

  5. Ablation - breakthrough technology to reduce uranium mining cost and increase resources

    International Nuclear Information System (INIS)

    Scriven, D.

    2014-01-01

    Ablation Technologies, LLC has developed and patented a revolutionary mining technology termed “ablation”. Ablation is a process using only mechanical forces to upgrade sandstone uranium ores. Uranium bearing sandstone orebodies are formed from a uranium enriched solution flowing through an aquifer until it reached some type of a “red/ox” zone forcing the uranium and other heavy metals to come out of solution. The precipitate forms a thin coating on the sand grains and fills the interstitial space between the sand grains but does no penetrate the sand grains. The ablation process knocks the precipitate off the sand grains using the forces of abrasion, elastic compression and rebounding, much like a mud coated tennis ball will sheds the mud when bounced off the ground, and to some extent, sonic waves. This produces a product which collectively is exactly the same as the ore going in but with all the individual components separated. This allows for disgressionary separation, the most important of which is screening. The uranium and heavy metals report to the finer fractions of the material, typically less than 250 mesh. The larger fractions contain less than five percent of the uranium but 90 to 95 percent of the mass. The advantages of making an enriched ore are numerous: • Reduce haulage costs from 90 to 95 percent. • Reduce milling costs by reducing material handling costs, acid consumption and tailings disposal costs. • In addition to reducing overall mining and milling costs, the overall recovery of the recourse is increased because the ablation process is so inexpensive, if the material has to be mined it will be ablated and screened. This basically means ore control is significantly reduced, cutoff grade goes to practically zero and overall resource recovery is significantly increased. • Environmentally, the two major advantages are reduced tailings requirements at the mill site and cleaner waste dumps at the mine site. This paper will show

  6. Cost Optimization of Water Resources in Pernambuco, Brazil: Valuing Future Infrastructure and Climate Forecasts

    Science.gov (United States)

    Kumar, Ipsita; Josset, Laureline; Lall, Upmanu; Cavalcanti e Silva, Erik; Cordeiro Possas, José Marcelo; Cauás Asfora, Marcelo

    2017-04-01

    Optimal management of water resources is paramount in semi-arid regions to limit strains on the society and economy due to limited water availability. This problem is likely to become even more recurrent as droughts are projected to intensify in the coming years, causing increasing stresses to the water supply in the concerned areas. The state of Pernambuco, in the Northeast Brazil is one such case, where one of the largest reservoir, Jucazinho, has been at approximately 1% capacity throughout 2016, making infrastructural challenges in the region very real. To ease some of the infrastructural stresses and reduce vulnerabilities of the water system, a new source of water from Rio São Francisco is currently under development. Till its development, water trucks have been regularly mandated to cover water deficits, but at a much higher cost, thus endangering the financial sustainability of the region. In this paper, we propose to evaluate the sustainability of the considered water system by formulating an optimization problem and determine the optimal operations to be conducted. We start with a comparative study of the current and future infrastructures capabilities to face various climate. We show that while the Rio Sao Francisco project mitigates the problems, both implementations do not prevent failure and require the reliance on water trucks during prolonged droughts. We also study the cost associated with the provision of water to the municipalities for several streamflow forecasts. In particular, we investigate the value of climate predictions to adapt operational decisions by comparing the results with a fixed policy derived from historical data. We show that the use of climate information permits the reduction of the water deficit and reduces overall operational costs. We conclude with a discussion on the potential of the approach to evaluate future infrastructure developments. This study is funded by the Inter-American Development Bank (IADB), and in

  7. A Rapid and Low-Cost PCR Thermal Cycler for Low Resource Settings.

    Directory of Open Access Journals (Sweden)

    Grace Wong

    Full Text Available Many modern molecular diagnostic assays targeting nucleic acids are typically confined to developed countries or to the national reference laboratories of developing-world countries. The ability to make technologies for the rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a revolutionary step forward in global health. Many molecular assays are also developed based on polymerase chain reactions (PCR, which require thermal cyclers that are relatively heavy (>20 pounds and need continuous electrical power. The temperature ramping speed of most economical thermal cyclers are relatively slow (2 to 3 °C/s so a polymerase chain reaction can take 1 to 2 hours. Most of all, these thermal cyclers are still too expensive ($2k to $4k for low-resource setting uses.In this article, we demonstrate the development of a low-cost and rapid water bath based thermal cycler that does not require active temperature control or continuous power supply during PCR. This unit costs $130 to build using commercial off-the-shelf items. The use of two or three vacuum-insulated stainless-steel Thermos food jars containing heated water (for denaturation and annealing/extension steps and a layer of oil on top of the water allow for significantly stabilized temperatures for PCR to take place. Using an Arduino-based microcontroller, we automate the "archaic" method of hand-transferring PCR tubes between water baths.We demonstrate that this innovative unit can deliver high speed PCR (17 s per PCR cycle with the potential to go beyond the 1,522 bp long amplicons tested in this study and can amplify from templates down to at least 20 copies per reaction. The unit also accepts regular PCR tubes and glass capillary tubes. The PCR efficiency of our thermal cycler is not different from other commercial thermal cyclers. When combined with a rapid nucleic acid detection approach, the thermos thermal cycler (TTC can enable on-site molecular

  8. Estimates of the Damage Costs of Climate Change. Part 1. Benchmark Estimates

    International Nuclear Information System (INIS)

    Tol, R.S.J.

    2002-01-01

    A selection of the potential impacts of climate change - on agriculture, forestry, unmanaged ecosystems, sea level rise, human mortality, energy consumption, and water resources - are estimated and valued in monetary terms. Estimates are derived from globally comprehensive, internally consistent studies using GCM based scenarios. An underestimate of the uncertainty is given. New impact studies can be included following the meta-analytical methods described here. A 1C increase in the global mean surface air temperature would have, on balance, a positive effect on the OECD, China, and the Middle East, and a negative effect on other countries. Confidence intervals of regionally aggregated impacts, however, include both positive and negative impacts for all regions. Global estimates depend on the aggregation rule. Using a simple sum, world impact of a 1C warming would be a positive 2% of GDP, with a standard deviation of 1%. Using globally averaged values, world impact would be a negative 3% (standard deviation: 1%). Using equity weighting, world impact would amount to 0% (standard deviation: 1%)

  9. The classification, cost categories and the system of accounting for uranium resources in the Russian Federation and CIS countries

    International Nuclear Information System (INIS)

    Naumov, S.S.; Shumilin, M.V.

    1998-01-01

    In 1992 the uranium resource classification systems of Kazakhstan, Russian Federation, Ukraine and Uzbekistan are the same as the system used in the former Soviet Union. The Soviet Union adopted this system as a state law in 1981. Under this system resources are reported as ''in situ'' with no allowance for mining or milling losses and resource depletion. The resources are subdivided according to the degree of exploration and economic value. The classification system divides resources into 7 categories. This includes 3 categories of explored resources (A, B, and C); one of preliminary assessment (C2); and 3 as prognosticated or speculative (P1, P2 and P3). Further analyses and classification is used to determine the readiness for production. This system is used to define the inventory of ''State Balance''. Examples are given for classifying vein-type and rollfront-type sandstone hosted deposits. A discussion of how resources are classified by cost category is given. It is stated, however, that any coincidence between the cost categories used in the former Soviet Union and the cost categories of the IAEA system are ''purely accidental''. (author)

  10. Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing.

    Science.gov (United States)

    McBain, Ryan K; Jerome, Gregory; Warsh, Jonathan; Browning, Micaela; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Rhatigan, Joseph; Leandre, Fernet; Kaplan, Robert

    2016-01-01

    Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world.

  11. With timing options and heterogeneous costs, the lognormal diffusion is hardly an equilibrium price process for exhaustible resources

    International Nuclear Information System (INIS)

    Lund, D.

    1992-01-01

    The report analyses the possibility that the lognormal diffusion process should be an equilibrium spot price process for an exhaustible resource. A partial equilibrium model is used under the assumption that the resource deposits have different extraction costs. Two separate problems have been pointed out. Under full certainty, when the process reduces to an exponentially growing price, the equilibrium places a very strong restriction on a relationship between the demand function and the cost density function. Under uncertainty there is an additional problem that during periods in which the price is lower than its previously recorded high, no new deposits will start extraction. 30 refs., 1 fig

  12. Optimal real time cost-benefit based demand response with intermittent resources

    International Nuclear Information System (INIS)

    Zareen, N.; Mustafa, M.W.; Sultana, U.; Nadia, R.; Khattak, M.A.

    2015-01-01

    Ever-increasing price of conventional energy resources and related environmental concern enforced to explore alternative energy sources. Inherent uncertainty of power generation and demand being strongly influenced by the electricity market has posed severe challenges for DRPs (Demand Response Programs). Definitely, the success of such uncertain energy systems under new market structures is critically decided by the advancement of innovative technical and financial tools. Recent exponential growth of DG (distributed generations) demanded both the grid reliability and financial cost–benefits analysis for deregulated electricity market stakeholders. Based on the SGT (signaling game theory), the paper presents a novel user-aware demand-management approach where the price are colligated with grid condition uncertainties to manage the peak residential loads. The degree of information disturbances are considered as a key factor for evaluating electricity bidding mechanisms in the presence of independent multi-generation resources and price-elastic demand. A correlation between the cost–benefit price and variable reliability of grid is established under uncertain generation and demand conditions. Impacts of the strategies on load shape, benefit of customers and the reduction of energy consumption are inspected and compared with Time-of-Used based DRPs. Simulation results show that the proposed DRP can significantly reduce or even eliminate peak-hour energy consumption, leading to a substantial raise of revenues with 18% increase in the load reduction and a considerable improvement in system reliability is evidenced. - Highlights: • Proposed an optimal real time cost-benefit based demand response model. • Used signaling game theory for the information disturbances in deregulated market. • Introduced a correlation between the cost–benefit price and variable grid reliability. • Derive robust bidding strategies for utility/customers successful participation.

  13. Potentials for Improvement of Resource Efficiency in Printed Circuit Board Manufacturing: A Case Study Based on Material Flow Cost Accounting

    Directory of Open Access Journals (Sweden)

    Yi-Xuan Wang

    2017-05-01

    Full Text Available The pursuit of sustainable resource use by manufacturing companies is driven by resource scarcity, environmental awareness, and cost savings potentials. To address these issues, Material Flow Cost Accounting (MFCA has been developed and applied as an effective environmental management tool. Within MFCA’s general allocation, the accounts of products and losses are overrated by weight or volume. However, such a method is incompatible with Printed Circuit Board (PCB manufacturing because of industry characteristics in which primary inputs and products are measured by area. Based on MFCA, this case study systematically established several linear cost calculation models along the production process for capturing the actual waste flows as well as performing cost-benefit analysis. The recognition of previously ignored losses offered the incentive to find appropriate indicators to conduct cost-benefit analysis on hotspots for losses. Loss identification and analysis indicated that machining and wiring are the necessities and priorities of process optimization for resource efficiency improvement measures. Therefore, this research could not only advance the achievement of a profitable and sustainable production while improving resource efficiency at the source but could also provide support for decision making in PCB manufacturing.

  14. Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada.

    Science.gov (United States)

    Cressman, Sonya; Lam, Stephen; Tammemagi, Martin C; Evans, William K; Leighl, Natasha B; Regier, Dean A; Bolbocean, Corneliu; Shepherd, Frances A; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R; Mayo, John R; McWilliams, Annette; Couture, Christian; English, John C; Goffin, John; Hwang, David M; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J; Goss, Glenwood D; Nicholas, Garth; Seely, Jean M; Sekhon, Harmanjatinder S; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J

    2014-10-01

    It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer's perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400-$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553-$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254-$52,200; p = 0.061). In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure.

  15. Dramatically Bringing down the Cost of Education with OER: How Open Education Resources Unlock the Door to Free Learning

    Science.gov (United States)

    Wiley, David; Green, Cable; Soares, Louis

    2012-01-01

    The nation is in the midst of a revolution in education. For the first time in human history, tools to enable everyone to attain all the education they desire are available. And best of all this education is available at almost no cost. The key to this sea of change in learning is open education resources, or OER. OER are educational materials…

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

    Science.gov (United States)

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

    1999-03-01

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

  17. A Cost-Effectiveness Evaluation Approach to Improving Resource Allocations for School Systems. Administering for Change Program. A Professional Paper.

    Science.gov (United States)

    Temkin, Sanford

    This dissertation begins with a description of some methods employed in making public-sector resource-allocation decisions, with conclusions on the appropriateness of each method for evaluating the ongoing programs of a school system. The second section has been rewritten and published as "A Comprehensive Theory of Cost-Effectiveness" (EA 002…

  18. Solution of resource allocation problem for identification of cost-effective measures to reduce nuclear proliferation risks

    International Nuclear Information System (INIS)

    Andrianov, A.; Kuptsov, I.

    2013-01-01

    This report presents a methodology of selection of cost-effective measures to reduce nuclear proliferation risks. The methodology relies on a graded security model used in practice in different applications. The method is based on the controlled finite Markov chain approach set in combination with discrete dynamic programming and MCDM (Multi Criteria Decision Making) techniques that enables the expert to select the cost-effective measures to reduce nuclear proliferation risks depending on availability of resources. The analysis performed with different number of possible measures confirms the conclusions that the implementation of extra-large costs may not produce the required effect, and the increase in resources above a certain level does not appear sensitive. Diversification in improving the effectiveness of other measures seems more rational and efficient for the whole system than the unlimited improvement of the effectiveness of only one measure

  19. Solution of resource allocation problem for identification of cost-effective measures to reduce nuclear proliferation risks

    Energy Technology Data Exchange (ETDEWEB)

    Andrianov, A.; Kuptsov, I. [Obninsk Institute for Nuclear Power Engineering, Studgorodok 1, Obninsk, Kaluga region 249030 (Russian Federation)

    2013-07-01

    This report presents a methodology of selection of cost-effective measures to reduce nuclear proliferation risks. The methodology relies on a graded security model used in practice in different applications. The method is based on the controlled finite Markov chain approach set in combination with discrete dynamic programming and MCDM (Multi Criteria Decision Making) techniques that enables the expert to select the cost-effective measures to reduce nuclear proliferation risks depending on availability of resources. The analysis performed with different number of possible measures confirms the conclusions that the implementation of extra-large costs may not produce the required effect, and the increase in resources above a certain level does not appear sensitive. Diversification in improving the effectiveness of other measures seems more rational and efficient for the whole system than the unlimited improvement of the effectiveness of only one measure.

  20. Assessment of resource use and costs associated with parathyroidectomy for secondary hyperparathyroidism in end stage renal disease in the UK.

    Science.gov (United States)

    Pockett, Rhys D; Cevro, Emir; Chamberlain, George; Scott-Coombes, David; Baboolal, Kesh

    2014-03-01

    Secondary hyperparathyroidism (SHPT) is a major complication of end stage renal disease (ESRD). For the National Health Service (NHS) to make appropriate choices between medical and surgical management, it needs to understand the cost implications of each. A recent pilot study suggested that the current NHS healthcare resource group tariff for parathyroidectomy (PTX) (£2071 and £1859 in patients with and without complications, respectively) is not representative of the true costs of surgery in patients with SHPT. This study aims to provide an estimate of healthcare resources used to manage patients and estimate the cost of PTX in a UK tertiary care centre. Resource use was identified by combining data from the Proton renal database and routine hospital data for adults undergoing PTX for SHPT at the University Hospital of Wales, Cardiff, from 2000-2008. Data were supplemented by a questionnaire, completed by clinicians in six centres across the UK. Costs were obtained from NHS reference costs, British National Formulary and published literature. Costs were applied for the pre-surgical, surgical, peri-surgical, and post-surgical periods so as to calculate the total cost associated with PTX. One hundred and twenty-four patients (mean age=51.0 years) were identified in the database and 79 from the questionnaires. The main costs identified in the database were the surgical stay (mean=£4066, SD=£,130), the first month post-discharge (£465, SD=£176), and 3 months prior to surgery (£399, SD=£188); the average total cost was £4932 (SD=£4129). From the questionnaires the total cost was £5459 (SD=£943). It is possible that the study was limited due to missing data within the database, as well as the possibility of recall bias associated with the clinicians completing the questionnaires. This analysis suggests that the costs associated with PTX in SHPT exceed the current NHS tariffs for PTX. The cost implications associated with PTX need to be considered in the

  1. Incremental healthcare resource utilization and costs in US patients with Cushing's disease compared with diabetes mellitus and population controls.

    Science.gov (United States)

    Broder, Michael S; Neary, Maureen P; Chang, Eunice; Ludlam, William H

    2015-12-01

    Resource utilization and costs in Cushing's disease (CD) patients have not been studied extensively. We compared CD patients with diabetes mellitus (DM) patients and population-based controls to characterize differences in utilization and costs. Using 2008-2012 MarketScan® database, we identified three patient groups: (1) CD patients; (2) DM patients; and (3) population-based control patients without CD. DM and control patients were matched to CD patients by age, gender, region, and review year in a 2:1 ratio. Outcomes included annual healthcare resource utilization and costs. There were 1852 CD patients, 3704 DM patients and 3704 controls. Mean age was 42.9 years; 78.2 % were female. CD patients were hospitalized more frequently (19.3 %) than DM patients (11.0 %, p < .001) or controls (5.6 %, p < .001). CD patients visited the ED more frequently (25.4 %) than DM patients (21.1 %, p < .001) or controls (14.3 %, p < .001). CD patients had more office visits than DM patients (19.1 vs. 10.7, p < .001) or controls (7.1, p < .001). CD patients on average filled more prescriptions than DM patients (51.7 vs. 42.7, p < .001) or controls (20.5, p < .001). Mean total healthcare costs for CD patients were $26,269 versus $12,282 for DM patients (p < .001) and $5869 for controls (p < .001). CD patients had significantly higher annual rates of healthcare resource utilization compared to matched DM patients and population controls without CD. CD patient costs were double DM costs and quadruple control costs. This study puts into context the additional burdens of CD over DM, a common, chronic endocrine condition affecting multiple organ systems, and population controls.

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

    International Nuclear Information System (INIS)

    Hanson, D.A.

    1992-01-01

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

  3. Use and Cost of Electronic Resources in Central Library of Ferdowsi University Based on E-metrics

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Davarpanah

    2012-07-01

    Full Text Available The purpose of this study was to investigate the usage of electronic journals in Ferdowsi University, Iran based on e-metrics. The paper also aimed to emphasize the analysis of cost-benefit and the correlation between the journal impact factors and the usage data. In this study experiences of Ferdowsi University library on licensing and usage of electronic resources was evaluated by providing a cost-benefit analysis based on the cost and usage statistics of electronic resources. Vendor-provided data were also compared with local usage data. The usage data were collected by tracking web-based access locally, and by collecting vender-provided usage data. The data sources were one-year of vendor-supplied e-resource usage data such as Ebsco, Elsevier, Proquest, Emerald, Oxford and Springer and local usage data collected from the Ferdowsi university web server. The study found that actual usage values differ for vendor-provided data and local usage data. Elsevier has got the highest usage degree in searches, sessions and downloads. Statistics also showed that a small number of journals satisfy significant amount of use while the majority of journals were used less frequent and some were never used at all. The users preferred the PDF rather than HTML format. The data in subject profile suggested that the provided e-resources were best suited to certain subjects. There was no correlation between IF and electronic journal use. Monitoring the usage of e-resources gained increasing importance for acquisition policy and budget decisions. The article provided information about local metrics for the six surveyed vendors/publishers, e.g. usage trends, requests per package, cost per use as related to the scientific specialty of the university.

  4. Costing of Paediatric Treatment alongside Clinical Trials under Low Resource Constraint Environments: Cotrimoxazole and Antiretroviral Medications in Children Living with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Bona M. Chitah

    2016-01-01

    Full Text Available Introduction. Costing evidence is essential for policy makers for priority setting and resource allocation. It is in this context that the clinical trials of ARVs and cotrimoxazole provided a costing component to provide evidence for budgeting and resource needs alongside the clinical efficacy studies. Methods. A micro based costing approach was adopted, using case record forms for maintaining patient records. Costs for fixed assets were allocated based on the paediatric space. Medication and other resource costs were costed using the WHO/MSH Drug Price Indicators as well as procurement data where these were available. Results. The costs for cotrimoxazole and ARVs are significantly different. The average costs for human resources were US$22 and US$71 for physician costs and $1.3 and $16 for nursing costs while in-patient costs were $257 and $15 for the cotrimoxazole and ARV cohorts, respectively. Mean or average costs were $870 for the cotrimoxazole cohort and $218 for the ARV. The causal factors for the significant cost differences are attributable to the higher human resource time, higher infections of opportunistic conditions, and longer and higher frequency of hospitalisations, among others.

  5. The costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs: A systematic review of international evidence.

    Science.gov (United States)

    Salamanca-Balen, Natalia; Seymour, Jane; Caswell, Glenys; Whynes, David; Tod, Angela

    2018-02-01

    Patients with palliative care needs do not access specialist palliative care services according to their needs. Clinical Nurse Specialists working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective. To present results from a systematic review of the international evidence on the costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilize. Systematic review following PRISMA methodology. Medline, Embase, CINAHL and Cochrane Library up to 2015. Studies focusing on the outcomes of Clinical Nurse Specialist interventions for patients with palliative care needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna Briggs Institute. A total of 79 papers were included: 37 randomized controlled trials, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly. Clinical Nurse Specialist interventions may be effective in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that Clinical Nurse Specialists' roles and activities are clearly described and evaluated.

  6. Development of a national system for prevention and mitigation of earthquake damages to people and properties, and the reduction of costs related to earthquakes for the Italian Government

    Science.gov (United States)

    Console, R.; Greco, M.; Colangelo, A.; Cioè, A.; Trivigno, L.; Chiappini, M.; Ponzo, F.

    2015-12-01

    Recognizing that the Italian territory is prone to disasters in connection with seismic and hydro-geological risk, it has become necessary to define novel regulations and viable solutions aimed at conveying the economical resources of the Italian Government, too often utilized for the management of post-event situations, towards prevention activities. The work synthetically presents the project developed by the CGIAM together with the INGV, and open to collaboration with other Italian and International partners. This project is aimed at the development of a National System for prevention and mitigation of the earthquakes damages, through the definition of a model that achieves the mitigation of the building collapsing risk and the consequent reduction of casualties. Such a model is based on two main issues a) a correct evaluation of risk, defined as a reliable assessment of the hazard expected at a given site and of the vulnerability of civil and industrial buildings, b) setting up of novel strategies for the safety of buildings. The hazard assessment is pursued through the application of innovative multidisciplinary geophysical methodologies and the application of a physically based earthquake simulator. The structural vulnerability of buildings is estimated by means of simplified techniques based on few representative parameters (such as different structural typologies, dynamic soil-structure interaction, etc.) and, for detailed studies, standard protocols for model updating techniques. We analyze, through numerical and experimental approaches, new solutions for the use of innovative materials, and new techniques for the reduction of seismic vulnerability of structural, non-structural and accessorial elements, including low cost type. The project activities are initially implemented on a study area in Southern Italy (Calabria) selected because of its tectonic complexity. The results are expected to be applicable for other hazardous seismic areas of Italy.

  7. New Technologies for Reliable, Low-Cost In Situ Resource Utilization

    Science.gov (United States)

    Ramohalli, Kumar

    1998-01-01

    New technologies can dramatically alter overall mission feasibility, architecture, window-of-opportunity, and science return. In the specific context of planetary exploration/development, several new technologies have been recently developed. It is significant that every one of these new technologies won a NASA NTR award in 1997-1998. In the area of low-cost space access and planetary transportation, hybrids are discussed. Whether we carry all of the fuel and oxidizer from Earth, or we make some or all of it in situ, mass advantages are shown through calculations. The hybrisol concept, where a solid fuel is cast over a state-of-the-art solid propellant, is introduced as a further advance in these ideas,. Thus, the motor operates as a controllable, high Isp rocket initially, and transitions to a high-thrust rocket after ascent, at which time the empty oxidizer tank is jettisoned. Again, calculations show significant advantages. In the area of efficient energy use for various mechanical actuations and robotic movements, muscle wires are introduced. Not only do we present detailed systems-level schemes, but we also present results from a hardware mechanism that has seen more than 18,000 cycles of operation. Recognizing that power is the real issue in planetary exploration/ development, the concept of LORPEX is introduced as a means of converting low-level energy accumulation into sudden bursts of power that can give factors of millions (in power magnification) in the process; this robot employs a low-power In Situ Resource Utilization (ISRU) unit to accumulate ISRU-generated fuel and oxidizer to be consumed at a rapid rate, chemically in an engine. Drilling, hopping, jumping, and ascent, or even return to Earth, are possible. Again, the hardware has been built and initial systems checkout demonstrated. Long-duration exploration and long-distance travel are made possible through aerobots, as is well known for planets with an atmosphere. However, power has again been a

  8. Validation of simple and cost-effective stains to assess acrosomal status, DNA damage and mitochondrial activity in rooster spermatozoa.

    Science.gov (United States)

    Rui, Bruno R; Angrimani, Daniel S R; Losano, João Diego A; Bicudo, Luana de Cássia; Nichi, Marcílio; Pereira, Ricardo J G

    2017-12-01

    Several methods have been developed to evaluate spermatozoa function in birds but many of these are sometimes complicated, costly and not applicable to field studies (i.e., performed within poultry breeding facilities). The objective was, therefore, to validate efficient, practical and inexpensive procedures to determine DNA fragmentation, acrosomal integrity, and mitochondrial activity in poultry spermatozoa. Initially, ejaculates were individually diluted and divided into control (4°C, 4h) and UV-irradiated aliquots (room temperature, 4h), and then samples containing different percentages of DNA-damaged spermatozoa (0%, 25%, 50%, 75% and 100%) were subjected to Toluidine Blue (TB) and Sperm Chromatin Dispersion assessments (SCD). Fast Green-Rose Bengal (FG-RB) and FITC-PSA staining protocols were subsequently used to assess acrosome status in aliquots comprising assorted amounts of acrosome-reacted spermatozoa. Furthermore, to validate 3,3'-diaminobenzidine (DAB) assay, ejaculates containing different gradients of spermatozoa with great amounts of mitochondrial activity were concurrently evaluated using DAB and JC-1 stains. The proportion of spermatozoa with abnormal DNA integrity when evaluated using the TB assessment correlated significantly with the expected percentages of UV-irradiated spermatozoa and with SCD results. A significant linear regression coefficient was also observed between expected amounts of acrosome-intact spermatozoa and FG-RB readings, and there was a significant correlation of the data when FG-RB and FITC-PSA were used. Likewise, the use of the DAB assay enabled for accurately ascertaining percentages of rooster spermatozoa with greater and lesser mitochondrial function, and results were highly correlated to results with staining with JC-1. Altogether, findings of the present study indicate acrosomal status, DNA integrity and mitochondrial activity in rooster spermatozoa can be easily and reliably determined using FG-RB, TB and DAB stains

  9. [A Method Research on Environmental Damage Assessment of a Truck Rollover Pollution Incident].

    Science.gov (United States)

    Cai, Feng; Zhao, Shi-ho; Chen, Gang-cai; Xian, Si-shu; Yang, Qing-ling; Zhou, Xian-jie; Yu, Hai

    2015-05-01

    With high occurrence of sudden water pollution incident, China faces an increasingly severe situation of water environment. In order to deter the acts of environmental pollution, ensure the damaged resources of environment can be restored and compensated, it is very critical to quantify the economic losses caused by the sudden water pollution incident. This paper took truck rollover pollution incidents in Chongqing for an example, established a set of evaluation method for quantifying the environmental damage, and then assessed the environmental damage by the method from four aspects, including the property damage, ecological environment and resources damages, the costs of administrative affairs in emergency disposal, and the costs of investigation and evaluation.

  10. MINIMIZING RESIDUAL STAND DAMAGE AND FELLING COST USING LOWEST POSSIBLE FELLING TECHNIQUE (A case study in one logging company in West Kalimantan

    Directory of Open Access Journals (Sweden)

    Sona Suhartana

    2005-03-01

    Full Text Available The implementation of felling technique in logging companies is not yet carried out efficiently and appropriately. Study on the lowest possible felling technique (LPFf is considered  to be important to  reduce residual  stand damage and felling cost. This study was carried out in a logging company in West Kalimantan in 2004. The aim of this study was to  determine the effect of LPFT on residual stand damage and felling cost. Data collected in this research include: residual stand damage, working time, timber  volume, productivity,  efficiency,  stump   height  and  felling cost.  Two categories  data were analyzed with  respect  to  their  possible  differences  using  T-test.    The  result  showed  that  the implementation   of  LPFT  was more advantage impact compared  to   that of  conventional felling technique, which is  indicated by the following factors:  (1  Trees damage decreased 2.96%;  (2 Poles damage decreased 4.75%;  (3 Felling productivity decreased 17.16%; (4 Felling efficiency  increased approximately  3.2%;  (5 Felling cost increased about Rp 327.07 /  m'; and (6 in average stump height was 40.60 cm lower.

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

    Directory of Open Access Journals (Sweden)

    Johnson BH

    2016-02-01

    Full Text Available Barbara H Johnson,1 Machaon M Bonafede,1 Crystal Watson2 1Outcomes Research, Truven Health Analytics, Cambridge, MA, USA; 2Health Economics and Outcomes Research, Biogen, Cambridge, MA, USA Objectives: The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS.Methods: This retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS were described in the year postindex.Results: The eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6% of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days and Medicare beneficiaries (4.0 vs 10.8 days

  12. Documentation of the Resource Allocation and Mine Costing (RAMC) model (Methodology description)

    International Nuclear Information System (INIS)

    1992-01-01

    The RAMC is used to develop coal supply curves for EIA's coal supply models. It can be used to analyze the impact of changes in coal supply or costs resulting from changes in taxes, production and preparation costs, productivity, coal reserves, and other supply-related factors

  13. The no-cost radwaste resource: Utilizing the system engineer to help achieve optimum radwaste system performance

    International Nuclear Information System (INIS)

    Green, R.; Michalski, M.

    1995-01-01

    All of us in the nuclear power business today know and often use words like - de-regulation, downsize, manpower reduction, cost savings, budget cuts, cost per kilowatt and probably 25 other terms, all relating to you doing a better job with less money and fewer resources. Maybe I have a suggestion that will help you find a resource that can help you - a no-cost resource that you may already have and may not be using. I don't know what you believe, but I believe that a nuclear power station can only be as good as the people who work there, and I believe that system performance and reliability can be improved on virtually any system by merely directing focus and attention to that system. In other words, systems are like children, if you neglect them, they go bad... And they go bad when you're not expecting it. This paper looks at what a system engineer can do for you toward a goal of optimum Radwaste system performance and reviews some of the tools we are using at Grand Gulf to reach our goals

  14. Resource Use and Costs of Dengue: Analysis of Data from Phase III Efficacy Studies of a Tetravalent Dengue Vaccine.

    Science.gov (United States)

    El Fezzazi, Hanna; Branchu, Marie; Carrasquilla, Gabriel; Pitisuttithum, Punnee; Perroud, Ana Paula; Frago, Carina; Coudeville, Laurent

    2017-12-01

    A tetravalent dengue vaccine (CYD-TDV) has recently been approved in 12 countries in southeast Asia and Latin America for individuals aged 9-45 years or 9-60 years (age indication approvals vary by country) living in endemic areas. Data on utilization of medical and nonmedical resources as well as time lost from school and work were collected during the active phase of two phase III efficacy studies performed in 10 countries in the Asia-Pacific region and Latin America (NCT01373281; NCT01374516). We compared dengue-related resource utilization and costs among vaccinated and nonvaccinated participants. Country-specific unit costs were derived from available literature. There were 901 virologically confirmed dengue episodes among participants aged ≥ 9 years ( N = 25,826): corresponding to 373 episodes in the CYD-TDV group ( N = 17,230) and 528 episodes in the control group ( N = 8,596). Fewer episodes in the CYD-TDV group resulted in hospitalization than in the control group (7.0% versus 13.3%; P = 0.002), but both had a similar average length of stay of 4 days. Overall, a two-thirds reduction in resource consumption and missed school/work days was observed in the CYD-TDV group relative to the control group. The estimated direct and indirect cost (2014 I$) associated with dengue episodes per participant in the CYD-TDV group was 73% lower than in the control group (I$6.72 versus I$25.08); representing a saving of I$I8.36 (95% confidence interval [CI]:17.05-19.78) per participant with vaccination. This is the first study providing information on dengue costs among vaccinated individuals and direct confirmation that vaccination has the potential to reduce dengue illness costs.

  15. Health care resource use and costs among patients with cushing disease.

    Science.gov (United States)

    Swearingen, Brooke; Wu, Ning; Chen, Shih-Yin; Pulgar, Sonia; Biller, Beverly M K

    2011-01-01

    To assess health care costs associated with Cushing disease and to determine changes in overall and comorbidity-related costs after surgical treatment. In this retrospective cohort study, patients with Cushing disease were identified from insurance claims databases by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for Cushing syndrome (255.0) and either benign pituitary adenomas (227.3) or hypophysectomy (07.6×) between 2004 and 2008. Each patient with Cushing disease was age- and sex-matched with 4 patients with nonfunctioning pituitary adenomas and 10 population control subjects. Comorbid conditions and annual direct health care costs were assessed within each calendar year. Postoperative changes in health care costs and comorbidity-related costs were compared between patients presumed to be in remission and those with presumed persistent disease. Of 877 identified patients with Cushing disease, 79% were female and the average age was 43.4 years. Hypertension, diabetes mellitus, and hyperlipidemia were more common among patients with Cushing disease than in patients with nonfunctioning pituitary adenomas or in control patients (PCushing disease had significantly higher total health care costs (2008: $26 440 [Cushing disease] vs $13 708 [nonfunctioning pituitary adenomas] vs $5954 [population control], Pdisease-related costs with remission. A significant increase in postoperative health care costs was observed in those patients not in remission. Patients with Cushing disease had more comorbidities than patients with nonfunctioning pituitary adenomas or control patients and incurred significantly higher annual health care costs; these costs decreased after successful surgery and increased after unsuccessful surgery.

  16. Material flow cost accounting as a tool for improved resource efficiency in the hotel sector: A case of emerging market

    Directory of Open Access Journals (Sweden)

    Celani John Nyide

    2016-12-01

    Full Text Available Material Flow Cost Accounting (MFCA is one of the Environmental Management Accounting (EMA tools that has been developed to enable environmentally and economically efficient material usage and thus improve resource efficiency. However, the use of this tool to improve resource efficiency in the South African hotel sector remains unknown. An exploratory study, qualitative in nature, was conducted using a single case study with embedded units approach. A Hotel Management Group that met the selection criteria formed part of this study. In-depth interviews were conducted with 10 participants and additional documents were analysed. The investigated hotels have developed technologies that provide an environmental account in both physical and monetary units which constitute the use of MFCA to improve resource efficiencies. However, the study established a number of factors that affect the implementation of MFCA by the hotel sector in a South African context

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

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

  18. Resource Utilisation and Costs of Depressive Patients in Germany: Results from the Primary Care Monitoring for Depressive Patients Trial

    Directory of Open Access Journals (Sweden)

    Christian Krauth

    2014-01-01

    Full Text Available Background. Depression is the most common type of mental disorder in Germany. It is associated with a high level of suffering for individuals and imposes a significant burden on society. The aim of this study was to estimate the depression related costs in Germany taking a societal perspective. Materials and Methods. Data were collected from the primary care monitoring for depressive patients trial (PRoMPT of patients with major depressive disorder who were treated in a primary care setting. Resource utilisation and days of sick leave were observed and analysed over a 1-year period. Results. Average depression related costs of €3813 were calculated. Significant differences in total costs due to sex were demonstrated. Male patients had considerable higher total costs than female patients, whereas single cost categories did not differ significantly. Further, differences in costs according to severity of disease and age were observed. The economic burden to society was estimated at €15.6 billion per year. Conclusion. The study results show that depression poses a significant economic burden to society. There is a high potential for prevention, treatment, and patient management innovations to identify and treat patients at an early stage.

  19. Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation.

    Science.gov (United States)

    Turner-Stokes, Lynne; Poppleton, Rob; Williams, Heather; Schoewenaars, Katie; Badwan, Derar

    2012-01-01

    A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a "real-life" application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.

  20. The difference between energy consumption and energy cost: Modelling energy tariff structures for water resource recovery facilities.

    Science.gov (United States)

    Aymerich, I; Rieger, L; Sobhani, R; Rosso, D; Corominas, Ll

    2015-09-15

    The objective of this paper is to demonstrate the importance of incorporating more realistic energy cost models (based on current energy tariff structures) into existing water resource recovery facilities (WRRFs) process models when evaluating technologies and cost-saving control strategies. In this paper, we first introduce a systematic framework to model energy usage at WRRFs and a generalized structure to describe energy tariffs including the most common billing terms. Secondly, this paper introduces a detailed energy cost model based on a Spanish energy tariff structure coupled with a WRRF process model to evaluate several control strategies and provide insights into the selection of the contracted power structure. The results for a 1-year evaluation on a 115,000 population-equivalent WRRF showed monthly cost differences ranging from 7 to 30% when comparing the detailed energy cost model to an average energy price. The evaluation of different aeration control strategies also showed that using average energy prices and neglecting energy tariff structures may lead to biased conclusions when selecting operating strategies or comparing technologies or equipment. The proposed framework demonstrated that for cost minimization, control strategies should be paired with a specific optimal contracted power. Hence, the design of operational and control strategies must take into account the local energy tariff. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Depletion of the non-renewable natural exergy resources as a measure of the ecological cost

    International Nuclear Information System (INIS)

    Szargut, Jan; Ziebik, Andrzej; Stanek, Wojciech

    2002-01-01

    The cumulative consumption of non-renewable exergy connected with the fabrication of particular products has been termed as their ecological cost. System of linear input-output equations determining the ecological costs have been formulated. The cogeneration processes have been considered using the principle of the avoided costs of fabrication of the products substituted by the by-products of the considered process. The ecological cost determined in a regional scope takes into account the ecological cost of the imported raw materials and semi-finished products. These quantities have been substituted by the economically equivalent export of own products. The deleterious effect of the rejection of waste products to the environment has been approximately determined by means of the monetary indices of harmfulness of waste products. It has been proved, that the ecological cost of human work cannot be introduced into the set of input-output equations. Exemplary calculations have been made for the products connected with the blast-furnace process. The influence of the injection of auxiliary fuels into the blast furnace on the ecological cost of pig iron has been analyzed too. (Author)

  2. Optimal distributed energy resources and the cost of reduced greenhouse gas emissions in a large retail shopping centre

    International Nuclear Information System (INIS)

    Braslavsky, Julio H.; Wall, Josh R.; Reedman, Luke J.

    2015-01-01

    Highlights: • Optimal options for distributed energy resources are analysed for a shopping centre. • A multiobjective optimisation model is formulated and solved using DER-CAM. • Cost and emission trade-offs are compared in four key optimal investment scenarios. • Moderate investment in DER technologies lowers emissions by 29.6% and costs by 8.5%. • Larger investment in DER technologies lowers emissions by 72% at 47% higher costs. - Abstract: This paper presents a case study on optimal options for distributed energy resource (DER) technologies to reduce greenhouse gas emissions in a large retail shopping centre located in Sydney, Australia. Large retail shopping centres take the largest share of energy consumed by all commercial buildings, and present a strong case for adoption of DER technologies to reduce energy costs and emissions. However, the complexity of optimally designing and operating DER systems has hindered their widespread adoption in practice. This paper examines and demonstrates the value of DER in reducing the carbon footprint of the shopping centre by formulating and solving a multiobjective optimisation problem using the Distributed Energy Resources Customer Adoption Model (DER-CAM) tool. An economic model of the shopping centre is developed in DER-CAM using on-site-specific demand, tariffs, and performance data for each DER technology option available. Four key optimal DER technology investment scenarios are then analysed by comparing: (1) solution trade-offs of costs and emissions, (2) the cost of reduced emissions attained in each investment scenario, and (3) investment benefits with respect to the business-as-usual scenario. The analysis shows that a moderate investment in combined cooling, heat and power (CCHP) technology alone can reduce annual energy costs by 8.5% and carbon dioxide-equivalent emissions by 29.6%. A larger investment in CCHP technology, in conjunction with on-site solar photovoltaic (PV) generation, can deliver

  3. Low-cost matched sibling bone marrow transplant for standard-risk thalassemia in a limited-resource setting

    Directory of Open Access Journals (Sweden)

    Stalin Ramprakash

    2017-12-01

    Full Text Available Thalassemias are the most common inherited genetic disorder in India and a major public health burden with bone marrow transplant (BMT considered the only established curative therapy. We describe outcomes for patients (n = 71 with standard-risk thalassemia (liver size 80 at the last follow up. 5 patients (7% died, mortality related to transplant. Enough data existed for 2 centers in India (36/71 transplants to analyze overall costs from admission up to one-year post-BMT which revealed a median cost of Rs 7,30,445 ($11519 [Range Rs 4,52,821–10,32,842 ($ 7079–16147]. In conclusion, children with thalassemia in resource limited settings can achieve good outcomes with BMT at a reasonable cost.

  4. Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Wu J

    2015-04-01

    Full Text Available Jing Wu,1 Xiaoning He,1 Li Liu,2 Wenyu Ye,2 William Montgomery,3 Haibo Xue,2 Jeffery S McCombs41School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China; 2Lilly Suzhou Pharmaceutical Company, Ltd, Shanghai, People’s Republic of China; 3Eli Lilly and Company, Sydney, Australia; 4Departments of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USAObjective: Information concerning the treatment costs of schizophrenia is scarce in People’s Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China.Methods: Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated.Results: A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median length of stay of 112.1 (71 days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median number of visits of 6.2 (4 and a mean cost of $42 per visit during the 12-month follow-up period. Non

  5. Cost Benefit Analysis of Enterprise Resource Planning System for the Naval Postgraduate School

    National Research Council Canada - National Science Library

    Rosa, Liza

    2002-01-01

    This thesis reviewed and evaluated the ERP Solution System currently in the Integration Testing Phase at NAVAIR and examined the benefits and cost that NPS could leverage by purchasing the system for approximately...

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

    Science.gov (United States)

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

    2017-10-01

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

  7. Structural Health and Prognostics Management for Offshore Wind Turbines: Sensitivity Analysis of Rotor Fault and Blade Damage with O&M Cost Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Myrent, Noah J. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Barrett, Natalie C. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Adams, Douglas E. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Griffith, Daniel Todd [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Wind Energy Technology Dept.

    2014-07-01

    Operations and maintenance costs for offshore wind plants are significantly higher than the current costs for land-based (onshore) wind plants. One way to reduce these costs would be to implement a structural health and prognostic management (SHPM) system as part of a condition based maintenance paradigm with smart load management and utilize a state-based cost model to assess the economics associated with use of the SHPM system. To facilitate the development of such a system a multi-scale modeling and simulation approach developed in prior work is used to identify how the underlying physics of the system are affected by the presence of damage and faults, and how these changes manifest themselves in the operational response of a full turbine. This methodology was used to investigate two case studies: (1) the effects of rotor imbalance due to pitch error (aerodynamic imbalance) and mass imbalance and (2) disbond of the shear web; both on a 5-MW offshore wind turbine in the present report. Sensitivity analyses were carried out for the detection strategies of rotor imbalance and shear web disbond developed in prior work by evaluating the robustness of key measurement parameters in the presence of varying wind speeds, horizontal shear, and turbulence. Detection strategies were refined for these fault mechanisms and probabilities of detection were calculated. For all three fault mechanisms, the probability of detection was 96% or higher for the optimized wind speed ranges of the laminar, 30% horizontal shear, and 60% horizontal shear wind profiles. The revised cost model provided insight into the estimated savings in operations and maintenance costs as they relate to the characteristics of the SHPM system. The integration of the health monitoring information and O&M cost versus damage/fault severity information provides the initial steps to identify processes to reduce operations and maintenance costs for an offshore wind farm while increasing turbine availability

  8. Low cost, low tech SNP genotyping tools for resource-limited areas: Plague in Madagascar as a model.

    Science.gov (United States)

    Mitchell, Cedar L; Andrianaivoarimanana, Voahangy; Colman, Rebecca E; Busch, Joseph; Hornstra-O'Neill, Heidie; Keim, Paul S; Wagner, David M; Rajerison, Minoarisoa; Birdsell, Dawn N

    2017-12-01

    Genetic analysis of pathogenic organisms is a useful tool for linking human cases together and/or to potential environmental sources. The resulting data can also provide information on evolutionary patterns within a targeted species and phenotypic traits. However, the instruments often used to generate genotyping data, such as single nucleotide polymorphisms (SNPs), can be expensive and sometimes require advanced technologies to implement. This places many genotyping tools out of reach for laboratories that do not specialize in genetic studies and/or lack the requisite financial and technological resources. To address this issue, we developed a low cost and low tech genotyping system, termed agarose-MAMA, which combines traditional PCR and agarose gel electrophoresis to target phylogenetically informative SNPs. To demonstrate the utility of this approach for generating genotype data in a resource-constrained area (Madagascar), we designed an agarose-MAMA system targeting previously characterized SNPs within Yersinia pestis, the causative agent of plague. We then used this system to genetically type pathogenic strains of Y. pestis in a Malagasy laboratory not specialized in genetic studies, the Institut Pasteur de Madagascar (IPM). We conducted rigorous assay performance validations to assess potential variation introduced by differing research facilities, reagents, and personnel and found no difference in SNP genotyping results. These agarose-MAMA PCR assays are currently employed as an investigative tool at IPM, providing Malagasy researchers a means to improve the value of their plague epidemiological investigations by linking outbreaks to potential sources through genetic characterization of isolates and to improve understanding of disease ecology that may contribute to a long-term control effort. The success of our study demonstrates that the SNP-based genotyping capacity of laboratories in developing countries can be expanded with manageable financial cost for

  9. Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

    Science.gov (United States)

    Welton, John M

    2015-10-01

    The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

  10. Health status, resource consumption, and costs of dysthymia. A multi-center two-year longitudinal study.

    Science.gov (United States)

    Barbui, Corrado; Motterlini, Nicola; Garattini, Livio

    2006-02-01

    In this study we estimated the health status, resource consumption and costs of a large cohort of patients with early and late-onset dysthymia. The DYSCO (DYSthymia COsts) project is a multi-center observational study which prospectively followed for two years a randomly chosen sample of patients with dysthymia in the Italian primary health care system. A total of 501 patients were followed for two years; 81% had early-onset dysthymic disorder. During the study, improvement was seen in most domains of the 36-Item Short Form Health Survey (SF-36) questionnaire. Comparison of the SF-36 scores for the two groups showed that only the physical health index significantly differed during the two years. The use of outpatient consultations, laboratory tests and diagnostic procedures was similar in the two groups, but patients with early-onset dysthymia were admitted significantly more than late-onset cases. Hospital admissions were almost entirely responsible for the higher total cost per patient per year of early-onset dysthymia. A first limitation of this study is that general practitioners were selected on the basis of their willingness to participate, not at random; secondly, no information was collected on concomitant psychiatric comorbidities. The present study provides the first prospective, long-term data on service use and costs in patients with dysthymia. Differently from patients with early-onset dysthymia, patients with late-onset dysthymia were admitted less and cost less.

  11. Renewable Diesel from Algal Lipids: An Integrated Baseline for Cost, Emissions, and Resource Potential from a Harmonized Model

    Energy Technology Data Exchange (ETDEWEB)

    Davis, R.; Fishman, D.; Frank, E. D.; Wigmosta, M. S.; Aden, A.; Coleman, A. M.; Pienkos, P. T.; Skaggs, R. J.; Venteris, E. R.; Wang, M. Q.

    2012-06-01

    The U.S. Department of Energy's Biomass Program has begun an initiative to obtain consistent quantitative metrics for algal biofuel production to establish an 'integrated baseline' by harmonizing and combining the Program's national resource assessment (RA), techno-economic analysis (TEA), and life-cycle analysis (LCA) models. The baseline attempts to represent a plausible near-term production scenario with freshwater microalgae growth, extraction of lipids, and conversion via hydroprocessing to produce a renewable diesel (RD) blendstock. Differences in the prior TEA and LCA models were reconciled (harmonized) and the RA model was used to prioritize and select the most favorable consortium of sites that supports production of 5 billion gallons per year of RD. Aligning the TEA and LCA models produced slightly higher costs and emissions compared to the pre-harmonized results. However, after then applying the productivities predicted by the RA model (13 g/m2/d on annual average vs. 25 g/m2/d in the original models), the integrated baseline resulted in markedly higher costs and emissions. The relationship between performance (cost and emissions) and either productivity or lipid fraction was found to be non-linear, and important implications on the TEA and LCA results were observed after introducing seasonal variability from the RA model. Increasing productivity and lipid fraction alone was insufficient to achieve cost and emission targets; however, combined with lower energy, less expensive alternative technology scenarios, emissions and costs were substantially reduced.

  12. Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery

    Directory of Open Access Journals (Sweden)

    Wittbrodt ET

    2018-05-01

    Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee

  13. Understanding alliance evolution and termination: Adjustment costs and the economics of resource value

    NARCIS (Netherlands)

    Madhok, A.; Keyhani, M; Bossink, B.A.G.

    2015-01-01

    Alliances have been studied extensively in the past and various arguments have been suggested to explain their evolution and eventual termination. We argue that one important explanation of alliance termination has remained overlooked, one where the mechanism revolves around resource value and is

  14. Heroes or Zeros? Portuguese-Canadian Youth and the Cost of Mobilising Different Sociolinguistic Resources

    Science.gov (United States)

    da Silva, Emanuel

    2012-01-01

    This critical sociolinguistic paper adopts a materialist view of how multiple languages and identities are negotiated in an effort to re-examine multilingualism and why people invest in certain sociolinguistic practices. The focus is on the social and linguistic resources and performances of Portuguese-Canadian youth in student cultural…

  15. Performance Costs when Emotion Tunes Inappropriate Cognitive Abilities: Implications for Mental Resources and Behavior

    Science.gov (United States)

    Storbeck, Justin

    2012-01-01

    Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency.…

  16. Risk Factors, Health Care Resource Utilization, and Costs Associated with Nonadherence to Antiretrovirals in Medicaid-Insured Patients with HIV.

    Science.gov (United States)

    Dunn, Keith; Lafeuille, Marie-Hélène; Jiao, Xiaolong; Romdhani, Hela; Emond, Bruno; Woodruff, Kimberly; Pesa, Jacqueline; Tandon, Neeta; Lefebvre, Patrick

    2018-06-07

    Adherence to antiretrovirals (ARVs) is critical to achieving durable virologic suppression. To investigate risk factors of poor adherence and the effect of suboptimal adherence on health care resource utilization (HCRU) and costs in Medicaid patients. A retrospective longitudinal study was conducted using Medicaid data. Adults (aged ≥ 18 years) with human immunodeficiency virus (HIV)-1 initiating selected ARVs (index date) were identified. Adherence was measured using medication possession ratio (MPR) and proportion of days covered (PDC) at 6 and 12 months post-index. Risk factors of poor adherence (PDC logistic regression. HCRU and costs were compared between suboptimal (80% ≤ PDC costs (mean monthly cost difference = $339; 95% CI = $153-$536; P costs (mean monthly cost difference = $259; 95% CI = $122-$418; P costs. Age, insurance type and coverage, previous ARV treatment, and HIV symptoms were predictors of adherence. Treatment options that enhance adherence and prevent developing virologic failure with drug resistance should be considered for HIV patients. This study was supported by Janssen Scientific Affairs, which was involved in the study design, data collection, data analysis, manuscript preparation, and publication decisions. Emond, Lafeuille, Romdhani, and Lefebvre are employees of Analysis Group, a consulting company that received research grants from Janssen Scientific Affairs to conduct this study. Dunn, Woodruff, Pesa, and Tandon are current employees and stockholders of Johnson & Johnson, owner of Janssen Scientific Affairs. Jiao was an employee of Janssen at the time of the study. Emond has received grants from Novartis, Regeneron, Aegerion, Lundbeck, Bristol-Myers Squibb, Bayer, Millennium, Allergan, AbbVie, and GlaxoSmithKline unrelated to this study. Part of the material in this study was presented at the Academy of Managed Care Pharmacy 2017 Annual Meeting, March 27-30, 2017, in Denver, Colorado, and at the 9th International AIDS Society

  17. Water supply facility damage and water resource operation at disaster base hospitals in miyagi prefecture in the wake of the Great East Japan Earthquake.

    Science.gov (United States)

    Matsumura, Takashi; Osaki, Shizuka; Kudo, Daisuke; Furukawa, Hajime; Nakagawa, Atsuhiro; Abe, Yoshiko; Yamanouchi, Satoshi; Egawa, Shinichi; Tominaga, Teiji; Kushimoto, Shigeki

    2015-04-01

    The aim of this study was to shed light on damage to water supply facilities and the state of water resource operation at disaster base hospitals in Miyagi Prefecture (Japan) in the wake of the Great East Japan Earthquake (2011), in order to identify issues concerning the operational continuity of hospitals in the event of a disaster. In addition to interview and written questionnaire surveys to 14 disaster base hospitals in Miyagi Prefecture, a number of key elements relating to the damage done to water supply facilities and the operation of water resources were identified from the chronological record of events following the Great East Japan Earthquake. Nine of the 14 hospitals experienced cuts to their water supplies, with a median value of three days (range=one to 20 days) for service recovery time. The hospitals that could utilize well water during the time that water supply was interrupted were able to obtain water in quantities similar to their normal volumes. Hospitals that could not use well water during the period of interruption, and hospitals whose water supply facilities were damaged, experienced significant disruption to dialysis, sterilization equipment, meal services, sanitation, and outpatient care services, though the extent of disruption varied considerably among hospitals. None of the hospitals had determined the amount of water used for different purposes during normal service or formulated a plan for allocation of limited water in the event of a disaster. The present survey showed that it is possible to minimize the disruption and reduction of hospital functions in the event of a disaster by proper maintenance of water supply facilities and by ensuring alternative water resources, such as well water. It is also clear that it is desirable to conclude water supply agreements and formulate strategic water allocation plans in preparation for the eventuality of a long-term interruption to water services.

  18. No Child Left Behind and Administrative Costs: A Resource Dependence Study of Local School Districts

    Science.gov (United States)

    Neely, Stephen R.

    2015-01-01

    This study considers the impact of federal funding on the administrative expenditures of local school districts since the passage of the No-Child-Left-Behind (NCLB) Act of 2001. Under NCLB, federal education funds were made contingent upon a variety of accountability and reporting standards, creating new administrative costs and challenges for…

  19. Cost-resources trade-off analysis for long-range efficient plutonium consumption

    International Nuclear Information System (INIS)

    Sato, Osamu; Nakano, Yasuyuki; Yasukawa, Shigeru

    1988-01-01

    JALTES-III, an analysis model using an optimization technique, is applied to the determination of major requirements for plutonium to serve as fuel for FRR on a paying basis and estimation of the possible reduction in natural uranium consumption. The analysis covers the period from 1970 to 2100. Optimization of the nuclear fuel cycle system is studied by using the following objective functions: overall system cost (COST), natural uranium consumption (NU) and trade-off function (COST + α·NU, where α is the premium related with the price of natural uranium). Assuming that there will be no escalation of the prices of system elements, competitive conditions for FBR are analyzed based on the effective price of natural uranium in relation with the above-mentioned premium: Po + (1 + D) t ·α, where Po is the basic price and D the discount rate. To minimize the term COST, FBR cannot be introduced and the natural uranium consumption will be 2,180,000 tons. To minimize NU, FBR should be introduced to the possible greatest degree, with the estimated natural uranium consumption being 900,000 tons. Analysis is also made of the relations of the introduction of FBRs with the effective price and total consumption of natural uranium. (Nogami, K.)

  20. Understanding the Uncertainty of an Effectiveness-Cost Ratio in Educational Resource Allocation: A Bayesian Approach

    Science.gov (United States)

    Pan, Yilin

    2016-01-01

    Given the necessity to bridge the gap between what happened and what is likely to happen, this paper aims to explore how to apply Bayesian inference to cost-effectiveness analysis so as to capture the uncertainty of a ratio-type efficiency measure. The first part of the paper summarizes the characteristics of the evaluation data that are commonly…

  1. Strategies for achieving a sustainable, clean and cost-effective biomass resource

    International Nuclear Information System (INIS)

    Turnbull, J.

    1993-01-01

    Biomass produced in an economically and environmentally sustainable manner, could realistically be used to supply 50,000 MW (5 Quads) of electric capacity by the year 2010 and probably twice that amount by the year 2030. During the past year, the Electric Power Research Institute (EPRI) and the U.S. Department of Energy (DOE) have each been independently evaluating the potential for biomass to become a major renewable energy resource over the next four decades, able to offset some of the U.S. dependency on imported fossil fuels while also offering important environmental and economic benefits. This paper presents EPRI's conclusions, which are more conservative than those of DOE, and outlines possible strategies by which EPRI can advance acceptance of biomass as a preferred renewable resource

  2. Survey of stranded gas and delivered costs to Europe of selected gas resources

    Science.gov (United States)

    Attanasi, E.D.; Freeman, P.A.

    2011-01-01

    Two important trends affecting the expected growth of global gas markets are (1) the shift by many industrialized countries from coal-fired electricity generation to the use of natural gas to generate electricity and (2) the industrialization of the heavily populated Asian countries of India and China. This paper surveys discovered gas in stranded conventional gas accumulations and presents estimates of the cost of developing and producing stranded gas in selected countries. Stranded gas is natural gas in discovered or identified fields that is not currently commercially producible for either physical or economic reasons. Published reserves of gas at the global level do not distinguish between volumes of gas in producing fields and volumes in nonproducing fields. Data on stranded gas reported here-that is the volumes, geographical distribution, and size distributions of stranded gas fields at the country and regional level-are based on the examination of individual-field data and represent a significant improvement in information available to industry and government decision makers. Globally, stranded gas is pervasive, but large volumes in large accumulations are concentrated in only a few areas. The cost component of the paper focuses on stranded conventional gas accumulations in Africa and South America that have the potential to augment supplies to Europe. The methods described for the computation of extraction and transport costs are innovative in that they use information on the sizes and geographical distribution of the identified stranded gas fields. The costs are based on industry data specific to the country and geologic basin where the stranded gas is located. Gas supplies to Europe can be increased significantly at competitive costs by the development of stranded gas. Net extraction costs of producing the identified gas depend critically on the natural-gas-liquids (NGLs) content, the prevailing prices of liquids, the size of the gas accumulation, and the

  3. Developing a cost effective environmental solution for produced water and creating a ''new'' water resource

    Energy Technology Data Exchange (ETDEWEB)

    Doran, Glenn; Leong, Lawrence Y.C.

    2000-05-01

    The project goal is to convert a currently usable by-product of oil production, produced water, into a valuable drinking water resource. The project was located at the Placate Oil Field in Santa Clarita, California, approximately 25 miles north of Los Angeles. The project included a literature review of treatment technologies; preliminary bench-scale studies to refine a planning level cost estimate; and a 10-100 gpm pilot study to develop the conceptual design and cost estimate for a 44,000 bpd treatment facility. A reverse osmosis system was constructed, pilot tested, and the data used to develop a conceptual design and operation of four operational scenarios, two industrial waters levels and two irrigation/potable water.

  4. IMPROVING ENERGY EFFICIENCY AND REDUCING COSTS IN THE DRINKING WATER SUPPLY INDUSTRY: An ENERGY STAR Resource Guide for Energy and Plant Managers

    Energy Technology Data Exchange (ETDEWEB)

    Melody, Moya; Dunham Whitehead, Camilla; Brown, Richard

    2010-09-30

    As American drinking water agencies face higher production costs, demand, and energy prices, they seek opportunities to reduce costs without negatively affecting the quality of the water they deliver. This guide describes resources for cost-effectively improving the energy efficiency of U.S. public drinking water facilities. The guide (1) describes areas of opportunity for improving energy efficiency in drinking water facilities; (2) provides detailed descriptions of resources to consult for each area of opportunity; (3) offers supplementary suggestions and information for the area; and (4) presents illustrative case studies, including analysis of cost-effectiveness.

  5. Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States.

    Science.gov (United States)

    Zhang, Dongmu; Prabhu, Vimalanand S; Marcella, Stephen W

    2018-04-17

    The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI). This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs). A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01-5.39) and 1.95 days (95% CI, 1.48-2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436-$25013) and $10580 (95% CI, $8849-$12446), respectively. The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI.

  6. Supply-cost curves for geographically distributed renewable-energy resources

    International Nuclear Information System (INIS)

    Izquierdo, Salvador; Dopazo, Cesar; Fueyo, Norberto

    2010-01-01

    The supply-cost curves of renewable-energy sources are an essential tool to synthesize and analyze large-scale energy-policy scenarios, both in the short and long terms. Here, we suggest and test a parametrization of such curves that allows their representation for modeling purposes with a minimal set of information. In essence, an economic potential is defined based on the mode of the marginal supply-cost curves; and, using this definition, a normalized log-normal distribution function is used to model these curves. The feasibility of this proposal is assessed with data from a GIS-based analysis of solar, wind and biomass technologies in Spain. The best agreement is achieved for solar energy.

  7. Methodology for reducing energy and resource costs in construction of trenchless crossover of pipelines

    Science.gov (United States)

    Toropov, V. S.

    2018-05-01

    The paper suggests a set of measures to select the equipment and its components in order to reduce energy costs in the process of pulling the pipeline into the well in the constructing the trenchless pipeline crossings of various materials using horizontal directional drilling technology. A methodology for reducing energy costs has been developed by regulating the operation modes of equipment during the process of pulling the working pipeline into a drilled and pre-expanded well. Since the power of the drilling rig is the most important criterion in the selection of equipment for the construction of a trenchless crossover, an algorithm is proposed for calculating the required capacity of the rig when operating in different modes in the process of pulling the pipeline into the well.

  8. Health care resource utilization and cost of care for haemophilia A and B patients in Iran.

    Science.gov (United States)

    Gharibnaseri, Zahra; Davari, Majid; Cheraghali, Abdolmajid; Eshghi, Peyman; Ravanbod, Roya; Espandar, Ramin; Hantooshzadeh, Razieh

    2016-02-01

    Despite the fact that the total therapeutic expenditure of haemophilia is paid by the national health system in Iran, a limited number of research has been performed to evaluate the economic burden of haemophilia. It is even more important when considering the fact that "prophylaxis" has never been used as the main treatment protocol in haemophiliacs in the country, causing high arthropathy rates. The aim of this study is to evaluate the cost drivers in the treatment of haemophilia A and B patients in Iran. The national registry database of Ministry of Health (MoH) was queried to identify total number of individuals characteristics diagnosed with Factor VIII and IX deficiency. The service package defined by the department for special diseases was used as the reference for the type and frequency of health care utilization in haemophiliacs in Iran. The direct medical costs including prescription, medical intervention, inpatient, outpatient and diagnostics services and arthroplasty were considered. The prices were extracted from Iranian medical tariff book 2014-15. Medication cost was obtained from the Iranian Food and Drug Organization. Among 8,337 patients registered with bleeding disorders, 3,948 and 848 were identified with haemophilia A and B respectively, of whom 856 (18%) patients had inhibitor at any time in the past. In the two groups, 2,328 (59%) and 452 (53%) patients suffered from severe, 686 (17%) and 186 (22%) from moderate and 902 (23%) and 185 (22%) from mild type of haemophilia. The average annual health care cost for every patient was USD 15,130, mostly allocated to medication USD 10,180 (67%), followed by therapeutic services USD 4,775 (32%) while diagnostic services stood third USD 177 (1%). There is an urgent need for developing clinical practice guidelines for treatment protocols, procedures and supportive care in haemophilia management in Iran. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. The methodological convention 2,0 for the estimation of environmental costs. An economic evaluation of environmental damages; Methodenkonvention 2.0 zur Schaetzung von Umweltkosten. Oekonomische Bewertung von Umweltschaeden

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-08-15

    The reliable estimation of environmental damage costs requires a high degree of transparency of the objectives, assumptions and methods of assessment in order to ensure a correct classification and comparability of the cost factors. The methods convention under consideration aims to develop uniform standards for the technical evaluation of environmental costs and to improve the transparency of the estimates.

  10. Incorporation of environmental costs in electric utility planning and resource selection

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Generation of electricity is pervasively regulated for economic, environmental and other governmental objectives at both the state and federal levels. A panoply of legislative and regulatory devices implicitly or explicitly influence the acquisition of generation and fuel resources seeking to achieve environmentally sound selections. Effective implementation or enforcement of these laws and policies may be impeded by the regional or global character of the environmental impacts; jurisdictional conflicts and limitations; and the division of regulatory authority between economic regulatory agencies and their environmental or energy policy counterparts. This chapter reviews the state and federal statutory and regulatory treatment of environmental externalities and discusses alternatives for their consideration

  11. Agricultural losses related to frost events: use of the 850 hPa level temperature as an explanatory variable of the damage cost

    Science.gov (United States)

    Papagiannaki, K.; Lagouvardos, K.; Kotroni, V.; Papagiannakis, G.

    2014-09-01

    The objective of this study is the analysis of damaging frost events in agriculture, by examining the relationship between the daily minimum temperature in the lower atmosphere (at an isobaric level of 850 hPa) and crop production losses. Furthermore, the study suggests a methodological approach for estimating agriculture risk due to frost events, with the aim of estimating the short-term probability and magnitude of frost-related financial losses for different levels of 850 hPa temperature. Compared with near-surface temperature forecasts, temperature forecasts at the level of 850 hPa are less influenced by varying weather conditions or by local topographical features; thus, they constitute a more consistent indicator of the forthcoming weather conditions. The analysis of the daily monetary compensations for insured crop losses caused by weather events in Greece shows that, during the period 1999-2011, frost caused more damage to crop production than any other meteorological phenomenon. Two regions of different geographical latitudes are examined further, to account for the differences in the temperature ranges developed within their ecological environment. Using a series of linear and logistic regressions, we found that minimum temperature (at an 850 hPa level), grouped into three categories according to its magnitude, and seasonality, are significant variables when trying to explain crop damage costs, as well as to predict and quantify the likelihood and magnitude of damaging frost events.

  12. Cost-effective resource allocation in C-RAN with mobile cloud

    OpenAIRE

    Wang, Kezhi; Yang, Kun; Wang, Xinhou; Magurawalage, Chathura Sarathchandra

    2016-01-01

    Taking full advantages of two cloud-based techniques, i.e., cloud radio access network (C-RAN) and mobile cloud computing (MCC), mobile operators will be able to provide the good service to the mobile user as well as increasing their revenue. This paper aims to minimize the mobile operator's cost while at the same time, meet the task time constraints of the mobile users. In particular, we assume that the mobile cloud first completes the tasks for the mobile user and then transmits the results...

  13. Modular Laboratories—Cost-Effective and Sustainable Infrastructure for Resource-Limited Settings

    Science.gov (United States)

    Bridges, Daniel J.; Colborn, James; Chan, Adeline S. T.; Winters, Anna M.; Dengala, Dereje; Fornadel, Christen M.; Kosloff, Barry

    2014-01-01

    High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. PMID:25223943

  14. Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population

    Directory of Open Access Journals (Sweden)

    Schwab P

    2017-02-01

    Full Text Available Phil Schwab,1 Amol D Dhamane,2 Sari D Hopson,1 Chad Moretz,1 Srinivas Annavarapu,1 Kate Burslem,2 Andrew Renda,3 Shuchita Kaila2 1Comprehensive Health Insights Inc., Louisville, KY, 2Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, 3Humana Inc., Louisville, KY, USA Background: Patients with chronic obstructive pulmonary disease (COPD often have multiple underlying comorbidities, which may lead to increased health care resource utilization (HCRU and costs.Objective: To describe the comorbidity profiles of COPD patients and examine the associations between the presence of comorbidities and HCRU or health care costs.Methods: A retrospective cohort study utilizing data from a large US national health plan with a predominantly Medicare population was conducted. COPD patients aged 40–89 years and continuously enrolled for 12 months prior to and 24 months after the first COPD diagnosis during the period of January 01, 2009, through December 31, 2010, were selected. Eleven comorbidities of interest were identified 12 months prior through 12 months after COPD diagnosis. All-cause and COPD-related hospitalizations and costs were assessed 24 months after diagnosis, and the associations with comorbidities were determined using multivariate statistical models.Results: Ninety-two percent of 52,643 COPD patients identified had at least one of the 11 comorbidities. Congestive heart failure (CHF, coronary artery disease, and cerebrovascular disease (CVA had the strongest associations with all-cause hospitalizations (mean ratio: 1.56, 1.32, and 1.30, respectively; P<0.0001; other comorbidities examined had moderate associations. CHF, anxiety, and sleep apnea had the strongest associations with COPD-related hospitalizations (mean ratio: 2.01, 1.32, and 1.21, respectively; P<0.0001; other comorbidities examined (except chronic kidney disease [CKD], obesity, and osteoarthritis had moderate associations. All

  15. The external costs of electricity generation. A comparison of environmental damage of silicon photovoltaic electricity, produced with different electricity mixes, vs natural gas and coal

    Energy Technology Data Exchange (ETDEWEB)

    Olson, C.L.; Veltkamp, A.C.; Sinke, W.C. [ECN Solar Energy, Petten (Netherlands)

    2012-09-15

    In this paper the environmental damages of crystalline silicon photovoltaics are calculated, using the most recent photovoltaics data, and compared with those of the prevalent conventional energy technologies. A life cycle assessment of selected environmental impacts of 1kWh of electricity generated by various technologies was performed using Simapro software (version 7.2.4) in conjunction with the Ecoinvent database (version 2.2). The environmental impacts were assessed using the ReCiPe methodology. Because of the important role of coal and natural gas in the global electricity generation portfolio, special attention is given to the comparison of PV with those technologies. The environmental consequences of manufacturing PV modules with renewable, UCTE or 100% coal electricity mixes are explored. A brief update of the estimated monetarization of damages due to coal and climate change is included. A rough estimate of the true cost of coal and PV electricity is made in 2011.

  16. An Empirical Study of the Assessment of Green Development in Beijing, China: Considering Resource Depletion, Environmental Damage and Ecological Benefits Simultaneously

    Directory of Open Access Journals (Sweden)

    Haohui Wu

    2018-03-01

    Full Text Available Urban green development (UGD is a highly topical issue. To assess the degree of UGD, in this paper, we use the driving forces, pressures, states, impacts, and responses (DPSIR model to evaluate UGD with a collection of 40 indicators based on the three aspects of resource depletion, environmental damage and ecological benefits. The established system of indicators is then applied to evaluate the UGD in Beijing from 2000 to 2014 as a case study. The results demonstrate that it is essential to analyze the trend in the change in resource depletion, which had a high weight of 0.556 because environmental damage and ecological benefits partly changed in response to this driving force and pressure. However, the UGD index value of environmental damage (positive index has decreased since 2010. By ranking the degree of correlation among indicators, it can be seen that UGD is highly related to the lifestyle, status quo, technology and education, industrialization, environmental quality, and ecological environment of a city. The health situation in Beijing has improved in the past 15 years; it was determined to be very unhealthy (75% at the very unhealthy level (V and 9% at the very healthy level (I in 2000 but very healthy (8% at the very unhealthy level (V and 60% at the very healthy level (I in 2014. However, there are internal problems due to imbalanced development in Beijing related to aspects such as the ecological environment, population and economy, social life, investment management, energy consumption and urban infrastructure. And government should adjust the energy structure, formulate detailed plans and policies on urban environment, and increase investment in education and business development.

  17. Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis.

    Science.gov (United States)

    Akiyama, Sayako; Tanaka, Erika; Cristeau, Olivier; Onishi, Yoshie; Osuga, Yutaka

    2018-06-01

    Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition. This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18-49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls. The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p < .0001) and 4.44-times higher in secondary HMB cases (p < .0001) vs healthy controls. Outpatient care was the main cost driver. The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database. A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.

  18. The Role of Cost Shared R&D in the Development of Geothermal Resources

    Energy Technology Data Exchange (ETDEWEB)

    None

    1995-03-16

    This U.S. Department of Energy Geothermal Program Review starts with two interesting pieces on industries outlook about market conditions. Dr. Allan Jelacics introductory talk includes the statistics on the impacts of the Industry Coupled Drilling Program (late-1970's) on geothermal power projects in Nevada and Utah (about 140 MWe of power stimulated). Most of the papers in these Proceedings are in a technical report format, with results. Sessions included: Exploration, The Geysers, Reservoir Engineering, Drilling, Energy Conversion (including demonstration of a BiPhase Turbine Separator), Energy Partnerships (including the Lake County effluent pipeline to The Geysers), and Technology Transfer (Biochemical processing of brines, modeling of chemistry, HDR, the OIT low-temperature assessment of collocation of resources with population, and geothermal heat pumps). There were no industry reviews at this meeting.

  19. The Holy Grail of Resource Assessment: Low Cost Ground-Based Measurements with Good Accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Marion, Bill; Smith, Benjamin

    2017-06-22

    Using performance data from some of the millions of installed photovoltaic (PV) modules with micro-inverters may afford the opportunity to provide ground-based solar resource data critical for developing PV projects. The method used back-solves for the direct normal irradiance (DNI) and the diffuse horizontal irradiance (DHI) from the micro-inverter ac production data. When the derived values of DNI and DHI were then used to model the performance of other PV systems, the annual mean bias deviations were within +/- 4%, and only 1% greater than when the PV performance was modeled using high quality irradiance measurements. An uncertainty analysis shows the method better suited for modeling PV performance than using satellite-based global horizontal irradiance.

  20. Low cost, low tech SNP genotyping tools for resource-limited areas: Plague in Madagascar as a model.

    Directory of Open Access Journals (Sweden)

    Cedar L Mitchell

    2017-12-01

    Full Text Available Genetic analysis of pathogenic organisms is a useful tool for linking human cases together and/or to potential environmental sources. The resulting data can also provide information on evolutionary patterns within a targeted species and phenotypic traits. However, the instruments often used to generate genotyping data, such as single nucleotide polymorphisms (SNPs, can be expensive and sometimes require advanced technologies to implement. This places many genotyping tools out of reach for laboratories that do not specialize in genetic studies and/or lack the requisite financial and technological resources. To address this issue, we developed a low cost and low tech genotyping system, termed agarose-MAMA, which combines traditional PCR and agarose gel electrophoresis to target phylogenetically informative SNPs.To demonstrate the utility of this approach for generating genotype data in a resource-constrained area (Madagascar, we designed an agarose-MAMA system targeting previously characterized SNPs within Yersinia pestis, the causative agent of plague. We then used this system to genetically type pathogenic strains of Y. pestis in a Malagasy laboratory not specialized in genetic studies, the Institut Pasteur de Madagascar (IPM. We conducted rigorous assay performance validations to assess potential variation introduced by differing research facilities, reagents, and personnel and found no difference in SNP genotyping results. These agarose-MAMA PCR assays are currently employed as an investigative tool at IPM, providing Malagasy researchers a means to improve the value of their plague epidemiological investigations by linking outbreaks to potential sources through genetic characterization of isolates and to improve understanding of disease ecology that may contribute to a long-term control effort.The success of our study demonstrates that the SNP-based genotyping capacity of laboratories in developing countries can be expanded with manageable

  1. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study.

    Science.gov (United States)

    de Andrés-Nogales, F; Vivancos Mora, J; Barriga Hernández, F J; Díaz Otero, F; Izquierdo Esteban, L; Ortega-Casarrubios, M Á; Castillo Moreno, L; Ximénez-Carrillo Rico, Á; Martín Torres, M P; Gómez-Escalonilla Escobar, C I; Torres González, C; de Salas-Cansado, M; Casado Gómez, M Á; Soto Álvarez, J; Gil-Núñez, A

    2015-01-01

    Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier Espa

  2. Promotion of renewable energy resources with a focus on cost-based feed-in tariffs

    International Nuclear Information System (INIS)

    Schweighofer, M.; Tretter, H.; Veigl, A.

    2006-01-01

    This final report published by the Swiss Federal Office of Energy (SFOE) presents a review of possible systems that could be used to promote power production in Switzerland using renewable energy sources. Promotional models on both the provider and consumer sides that use both price and quantity as control factors are examined. Three models are compared: the submission-to-tender model, the quota model with certificates and a model that uses cost-based feed-in tariffs. On the basis of a comparison with Austria, interaction between increasing the proportion of renewable forms of energy and the realisation of energy-efficiency goals is discussed. A further part of the report deals with various options for the use of biomass as a source of energy

  3. Modular laboratories--cost-effective and sustainable infrastructure for resource-limited settings.

    Science.gov (United States)

    Bridges, Daniel J; Colborn, James; Chan, Adeline S T; Winters, Anna M; Dengala, Dereje; Fornadel, Christen M; Kosloff, Barry

    2014-12-01

    High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. © The American Society of Tropical Medicine and Hygiene.

  4. Model of investment appraisal of high-rise construction with account of cost of land resources

    Science.gov (United States)

    Okolelova, Ella; Shibaeva, Marina; Trukhina, Natalya

    2018-03-01

    The article considers problems and potential of high-rise construction as a global urbanization. The results of theoretical and practical studies on the appraisal of investments in high-rise construction are provided. High-rise construction has a number of apparent upsides in modern terms of development of megapolises and primarily it is economically efficient. Amid serious lack of construction sites, skyscrapers successfully deal with the need of manufacturing, office and living premises. Nevertheless, there are plenty issues, which are related with high-rise construction, and only thorough scrutiny of them allow to estimate the real economic efficiency of this branch. The article focuses on the question of economic efficiency of high-rise construction. The suggested model allows adjusting the parameters of a facility under construction, setting the tone for market value as well as the coefficient for appreciation of the construction net cost, that depends on the number of storey's, in the form of function or discrete values.

  5. Acute pavement burns: a unique subset of burn injuries: a five-year review of resource use and cost impact.

    Science.gov (United States)

    Silver, Andrew G; Dunford, Gerrit M; Zamboni, William A; Baynosa, Richard C

    2015-01-01

    This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient's stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries.

  6. Using non-renewable resources to promote economic development: The case of stock-dependent extraction cost

    International Nuclear Information System (INIS)

    Jefferson, R.W.

    1991-01-01

    Various policies for using a newly discovered deposit of a non-renewable resource to promote local economic development are considered. A model of optimal extraction, in which cost depends on both current output and remaining stock levels is constructed. The model is simplified by the assumptions that prices are exogenous and that extraction cost is linear homogeneous in current output and remaining stock. Both pure depletion and combined extraction and exploration models are considered. The models are solved using the dynamic programming algorithm. The effects of taxes on profit and gross revenue are analyzed both algebraically and through numerical simulations. The conditions under which a tax on profit does not distort production are specified. The welfare costs of tax-induced distortions in extraction and exploration are discussed using simulation results. The effects on production of future prices being stochastic are discussed, and it is shown that a firm which re-optimizes each period on the basis of new information concerning that period's price will choose to restrict output below that which would have been optimal if the expected price could be forecast with certainty

  7. Current costing models: are they suitable for allocating health resources? The example of fall injury prevention in Australia.

    Science.gov (United States)

    Moller, Jerry

    2005-01-01

    The example of fall injury among older people is used to define and illustrate how current Australian systems for allocation of health resources perform for funding emerging public health issues. While the examples are Australian, the allocation and priority setting methods are common in the health sector in all developed western nations. With an ageing population the number of falls injuries in Australia and the cost of treatment will rise dramatically over the next 20-50 years. Current methods of allocating funds within the health system are not well suited to meeting this coming epidemic. The information requirements for cost-benefit and cost-effectiveness measures cannot be met. Marginal approaches to health funding are likely to continue to fund already well-funded treatment or politically driven prevention processes and to miss the opportunity for new prevention initiatives in areas that do not have a high political profile. Fall injury is one of many emerging areas that struggle to make claims for funding because the critical mass of intervention and evidence of its impact is not available. The beneficiaries of allocation failure may be those who treat the disease burden that could have been easily prevented. Changes to allocation mechanisms, data systems and new initiative funding practices are required to ensure that preventative strategies are able to compete on an equal footing with treatment approaches for mainstream health funding.

  8. Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

    Science.gov (United States)

    Rognoni, Carla; Tarricone, Rosanna

    2017-01-17

    This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Italian Healthcare Service perspective. Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent

  9. Resource utilisation and direct costs in patients with recently diagnosed fibromyalgia who are offered one of three different interventions in a randomised pragmatic trial.

    Science.gov (United States)

    van Eijk-Hustings, Yvonne; Kroese, Mariëlle; Creemers, An; Landewé, Robert; Boonen, Annelies

    2016-05-01

    The purpose of this study is to understand the course of costs over a 2-year period in a cohort of recently diagnosed fibromyalgia (FM) patients receiving different treatment strategies. Following the diagnosis, patients were randomly assigned to a multidisciplinary programme (MD), aerobic exercise (AE) or usual care (UC) without being aware of alternative interventions. Time between diagnosis and start of treatment varied between patients. Resource utilisation, health care costs and costs for patients and families were collected through cost diaries. Mixed linear model analyses (MLM) examined the course of costs over time. Linear regression was used to explore predictors of health care costs in the post-intervention period. Two hundred three participants, 90 % women, mean (SD) age 41.7 (9.8) years, were included in the cohort. Intervention costs per patient varied from €864 to 1392 for MD and were €121 for AE. Health care costs (excluding intervention costs) decreased after diagnosis, but before the intervention in each group, and increased again afterwards to the level close to the diagnostic phase. In contrast, patient and family costs slightly increased over time in all groups without initial decrease immediately after diagnosis. Annualised health care costs post-intervention varied between €1872 and 2310 per patient and were predicted by worse functioning and high health care costs at diagnosis. In patients with FM, health care costs decreased following the diagnosis by a rheumatologist. Offering patients a specific intervention after diagnosis incurred substantial costs while having only marginal effects on costs.

  10. Prodigiosin Production by Serratia marcescens UCP 1549 Using Renewable-Resources as a Low Cost Substrate

    Directory of Open Access Journals (Sweden)

    Galba M. Campos Takaki

    2010-10-01

    Full Text Available A new strain of Serratia marcescens UCP1459 isolated from a semi-arid soil produced the natural red pigment prodigiosin, characterized by an uncommon pyrrolylpyrromethane skeleton. Prodigiosin is a promising drug due to its reported antifungal, immunosuppressive and anti-proliferative activities. The objective of this work was to indentify a suitable medium to simultaneously enhance S. marcescens growth and pigment production using renewable resources obtained from industrial wastes. S. marcescens produced the highest level of prodigiosin (49.5 g/L at 48 h of cultivation using 6% “manipueira” (cassava wastewater supplemented with mannitol (2% at pH 7 and 28 °C. Carbohydrates in “manipueira” and mannitol play a role in the enhanced cell growth and prodigiosin production. The purified pigment extracted from the biomass was analyzed by mass spectrophotometry and showed the expected molecular weight of 324 Da corresponding to prodigiosin. In conclusion, we have successfully designed a new, economically feasible medium supporting enhanced S. marcescens growth and a high yield production of prodigiosin.

  11. Developing our resources doesn't have to cost us the Earth

    International Nuclear Information System (INIS)

    Century, J.R.; Wonfor, J.; Fuenning, P.; Hewitt, T. Jr.; Tenant, R.; Breiteneder, M.

    1991-01-01

    The Environmental Geology Division of the CSPG was organized in 1990 to promote the study, evaluation, and protection of the environment as it related to geology and the earth sciences. Since the problems range from local to global, a pragmatic approach to activities was adopted, matching professional strengths with our environmental concerns. The following standing committees were formed with specific priority projects underway: (1) scientific measurements of global change, (2) environmental protection solutions, (3) environmental effects of recent geological processes, (4) monitoring global changes by remote sensing, and (5) economic and environmental energy rationalization. Examples of the effects of man-made and naturally occurring events are best illustrated through remote sensing images. The Amoco Cadiz major oil spill of 1978 off the Brittany coast and a 1977 winter Chinook in the Calgary region are contrasts in change. Land reclamation of coal mines in the Grand Cache area of the Alberta Foothills illustrates a balanced approach to resource extraction and surface environmental values. A recent environmentally successful case history of a sour gas plant project will be presented also. The Hewitt Oil Golden Spike emission-free gas-processing plant was opened in 1987 after a small operating company and the affected public went from confrontation to cooperation. Illustrations from the geologic record of geosphere/biosphere green-house gas variations (CO 2 and CH 4 ) show current high rates of increase greater than any since 150,000 years B.P

  12. Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer’s disease: 18-month UK results from the GERAS observational study

    OpenAIRE

    Alan Lenox-Smith; Catherine Reed; Jeremie Lebrec; Mark Belger; Roy W. Jones

    2016-01-01

    Abstract Background Alzheimer’s disease (AD), the commonest cause of dementia, represents a significant cost to UK society. This analysis describes resource utilisation, costs and clinical outcomes in non-institutionalised patients with AD in the UK. Methods The GERAS prospective observational study assessed societal costs associated with AD for patients and caregivers over 18 months, stratified according to baseline disease severity (mild, moderate, or moderately severe/severe [MS/S]). All p...

  13. Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020)

    Science.gov (United States)

    Kent Kovacs; Tomas Václavík; Robert G. Haight; Arwin Pang; Nik J. Cunniffe; Christopher A. Gilligan; Ross K. Meentemeyer

    2011-01-01

    Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and...

  14. Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy

    DEFF Research Database (Denmark)

    Søndergaard, Jens; Christensen, Helene Nordahl; Ibsen, Rikke

    2017-01-01

    -based cohort study including patients ≥18 years of age initiating ≥4 weeks opioid therapy (1998–2012) in Denmark. A measure of OIC was constructed based on data from Danish national health registries, and defined as ≥1 diagnosis of constipation, diverticulitis, mega colon, ileus/subileus, abdominal pain....../acute abdomen or haemorrhoids and/or ≥2 subsequent prescription issues of laxatives. Total healthcare resource utilization and costs (including pharmacy dispense, inpatient-, outpatient-, emergency room- and primary care) were estimated according to OIC status, opioid treatment dosage and length, gender, age...... characteristics of non-cancer OIC patients showed a higher frequency of strong opioid treatment (69% versus 41%), long-term opioid treatment (1189 days versus 584 days), advanced age (73 years versus 61 years), and cardiovascular disease (31% versus 19%) compared to those without OIC (P 

  15. Transportation Energy Futures Series: Alternative Fuel Infrastructure Expansion: Costs, Resources, Production Capacity, and Retail Availability for Low-Carbon Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, W. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Heath, Garvin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sandor, Debra [National Renewable Energy Lab. (NREL), Golden, CO (United States); Steward, Darlene [National Renewable Energy Lab. (NREL), Golden, CO (United States); Vimmerstedt, Laura [National Renewable Energy Lab. (NREL), Golden, CO (United States); Warner, Ethan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Webster, Karen W. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-04-01

    The petroleum-based transportation fuel system is complex and highly developed, in contrast to the nascent low-petroleum, low-carbon alternative fuel system. This report examines how expansion of the low-carbon transportation fuel infrastructure could contribute to deep reductions in petroleum use and greenhouse gas (GHG) emissions across the U.S. transportation sector. Three low-carbon scenarios, each using a different combination of low-carbon fuels, were developed to explore infrastructure expansion trends consistent with a study goal of reducing transportation sector GHG emissions to 80% less than 2005 levels by 2050.These scenarios were compared to a business-as-usual (BAU) scenario and were evaluated with respect to four criteria: fuel cost estimates, resource availability, fuel production capacity expansion, and retail infrastructure expansion.

  16. Management features of the innovative development of the enterprise taking into account cost-effective use of resources

    Directory of Open Access Journals (Sweden)

    Babanova Yu.V.

    2017-01-01

    Full Text Available Modern business is developing in the conditions of innovation-driven economy in which science and technology are the basis of competitive ability and a productive force. Most of the managerial decisions are taken in the context of limited resources and high uncertainty, because they depend on many factors, the dynamics of which is not always possible to estimate with reasonable accuracy. In this article special method is presented, which allows you to formalize the process of management decision, in terms of innovative product development. This method includes matrix analysis and vector calculus. The purpose of this method and model is to develop a set of alternative options for the product development and the selection of the most cost effective projects based on the integration of consumer requirements, innovative product specifications and the manufacturing capability of the organization (initial conditions for the project realization.

  17. Market segmentation and industry overcapacity considering input resources and environmental costs through the lens of governmental intervention.

    Science.gov (United States)

    Jiang, Zhou; Jin, Peizhen; Mishra, Nishikant; Song, Malin

    2017-09-01

    The problems with China's regional industrial overcapacity are often influenced by local governments. This study constructs a framework that includes the resource and environmental costs to analyze overcapacity using the non-radial direction distance function and the price method to measure industrial capacity utilization and market segmentation in 29 provinces in China from 2002 to 2014. The empirical analysis of the spatial panel econometric model shows that (1) the industrial capacity utilization in China's provinces has a ladder-type distribution with a gradual decrease from east to west and there is a severe overcapacity in the traditional heavy industry areas; (2) local government intervention has serious negative effects on regional industry utilization and factor market segmentation more significantly inhibits the utilization rate of regional industry than commodity market segmentation; (3) economic openness improves the utilization rate of industrial capacity while the internet penetration rate and regional environmental management investment have no significant impact; and(4) a higher degree of openness and active private economic development have a positive spatial spillover effect, while there is a significant negative spatial spillover effect from local government intervention and industrial structure sophistication. This paper includes the impact of resources and the environment in overcapacity evaluations, which should guide sustainable development in emerging economies.

  18. The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

    Science.gov (United States)

    Mabry, C D

    2001-03-01

    Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement. Copyright 2001 by W.B. Saunders Company

  19. Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings

    Science.gov (United States)

    Lam, Christopher T.; Krieger, Marlee S.; Gallagher, Jennifer E.; Asma, Betsy; Muasher, Lisa C.; Schmitt, John W.; Ramanujam, Nimmi

    2015-01-01

    Introduction Current guidelines by WHO for cervical cancer screening in low- and middle-income countries involves visual inspection with acetic acid (VIA) of the cervix, followed by treatment during the same visit or a subsequent visit with cryotherapy if a suspicious lesion is found. Implementation of these guidelines is hampered by a lack of: trained health workers, reliable technology, and access to screening facilities. A low cost ultra-portable Point of Care Tampon based digital colposcope (POCkeT Colposcope) for use at the community level setting, which has the unique form factor of a tampon, can be inserted into the vagina to capture images of the cervix, which are on par with that of a state of the art colposcope, at a fraction of the cost. A repository of images to be compiled that can be used to empower front line workers to become more effective through virtual dynamic training. By task shifting to the community setting, this technology could potentially provide significantly greater cervical screening access to where the most vulnerable women live. The POCkeT Colposcope’s concentric LED ring provides comparable white and green field illumination at a fraction of the electrical power required in commercial colposcopes. Evaluation with standard optical imaging targets to assess the POCkeT Colposcope against the state of the art digital colposcope and other VIAM technologies. Results Our POCkeT Colposcope has comparable resolving power, color reproduction accuracy, minimal lens distortion, and illumination when compared to commercially available colposcopes. In vitro and pilot in vivo imaging results are promising with our POCkeT Colposcope capturing comparable quality images to commercial systems. Conclusion The POCkeT Colposcope is capable of capturing images suitable for cervical lesion analysis. Our portable low cost system could potentially increase access to cervical cancer screening in limited resource settings through task shifting to community

  20. Projections of costs, financing, and additional resource requirements for low- and lower middle-income country immunization programs over the decade, 2011-2020.

    Science.gov (United States)

    Gandhi, Gian; Lydon, Patrick; Cornejo, Santiago; Brenzel, Logan; Wrobel, Sandra; Chang, Hugh

    2013-04-18

    The Decade of Vaccines Global Vaccine Action Plan has outlined a set of ambitious goals to broaden the impact and reach of immunization across the globe. A projections exercise has been undertaken to assess the costs, financing availability, and additional resource requirements to achieve these goals through the delivery of vaccines against 19 diseases across 94 low- and middle-income countries for the period 2011-2020. The exercise draws upon data from existing published and unpublished global forecasts, country immunization plans, and costing studies. A combination of an ingredients-based approach and use of approximations based on past spending has been used to generate vaccine and non-vaccine delivery costs for routine programs, as well as supplementary immunization activities (SIAs). Financing projections focused primarily on support from governments and the GAVI Alliance. Cost and financing projections are presented in constant 2010 US dollars (US$). Cumulative total costs for the decade are projected to be US$57.5 billion, with 85% for routine programs and the remaining 15% for SIAs. Delivery costs account for 54% of total cumulative costs, and vaccine costs make up the remainder. A conservative estimate of total financing for immunization programs is projected to be $34.3 billion over the decade, with country governments financing 65%. These projections imply a cumulative funding gap of $23.2 billion. About 57% of the total resources required to close the funding gap are needed just to maintain existing programs and scale up other currently available vaccines (i.e., before adding in the additional costs of vaccines still in development). Efforts to mobilize additional resources, manage program costs, and establish mutual accountability between countries and development partners will all be necessary to ensure the goals of the Decade of Vaccines are achieved. Establishing or building on existing mechanisms to more comprehensively track resources and

  1. Healthcare resource utilization and cost among males with lower urinary tract symptoms with a predominant storage component in Spain: The epidemiological, cross-sectional MERCURY study.

    Science.gov (United States)

    Errando-Smet, Carlos; Müller-Arteaga, Carlos; Hernández, Marta; Lenero, Enrique; Roset, Montse

    2018-01-01

    To assess the relationship between storage-predominant LUTS and healthcare resource consumption and cost among males in Spain. In this non-interventional, cross-sectional study, urologists enrolled males with storage-predominant LUTS and recorded the consumption of healthcare resources (medical visits, diagnostic tests/monitoring, treatment, and hospitalizations) within the previous 6 months. The cost of healthcare resources was calculated from unit costs extracted from a Spanish eHealth database. Severity of LUTS was assessed by the Bladder Self-Assessment Questionnaire (BSAQ) and patients were stratified by symptom score (used more healthcare resources compared with patients with BSAQ symptom scores used as monotherapy (n = 229 [37.5%]) or in combination with antimuscarinics (n = 227 [37.2%]). The estimated median annual cost was €1070 per patient, consisting of diagnostic tests/monitoring (54.6%), medical visits (20.5%), and treatment (29.6%), and was higher in patients with BSAQ symptom score ≥6 (€1127) than in patients with BSAQ symptom score <6 (€920; P < 0.001). More severe LUTS are associated with higher healthcare consumption and cost. These findings highlight the importance of symptom management in LUTS patients to help minimize healthcare consumption and cost. © 2017 Wiley Periodicals, Inc.

  2. Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization

    Science.gov (United States)

    Brauer, David G; Hawkins, William G; Strasberg, Steven M; Brunt, L Michael; Jaques, David P; Mercurio, Nicholas R; Hall, Bruce L; Fields, Ryan C

    2015-01-01

    Background Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. Methods All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. Results From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Conclusions Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. PMID:26345351

  3. Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

    Science.gov (United States)

    Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E; White, Richard G; Vassall, Anna

    2016-11-01

    The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

  4. Effect of Apixaban Versus Warfarin Use on Health Care Resource Utilization and Costs Among Elderly Patients with Nonvalvular Atrial Fibrillation.

    Science.gov (United States)

    Deitelzweig, Steven; Luo, Xuemei; Gupta, Kiran; Trocio, Jeffrey; Mardekian, Jack; Curtice, Tammy; Lingohr-Smith, Melissa; Menges, Brandy; Lin, Jay

    2017-11-01

    The clinical trial ARISTOTLE showed that apixaban was superior to warfarin in reducing the risks of stroke and bleeding among patients with nonvalvular atrial fibrillation (NVAF). Further study of the effect of apixaban versus warfarin use on health care resource utilization (HCRU) and associated costs in the real-world setting is warranted, especially among elderly patients who are at higher risk of stroke and bleeding. To compare HCRU and costs among elderly NVAF patients treated with apixaban versus warfarin in the United States. Elderly patients (aged ≥ 65 years) with Medicare coverage who initiated apixaban or warfarin were identified from the Humana research database during January 1, 2013-September 30, 2015. Patients were required to have 12 months of continuous insurance coverage before drug initiation (baseline period) and an atrial fibrillation diagnosis during the baseline period or on the date of drug initiation. NVAF patients were grouped into cohorts depending on the drug initiated. Propensity score matching (PSM) was conducted to control for differences in demographics and clinical characteristics of study cohorts. Patients were followed after the index date for a variable length of follow-up. All-cause and disease-specific HCRU and costs during the follow-up were evaluated before and after PSM and reported as per patient per year. Of the overall (unmatched) population, 8,250 patients (mean age: 78.0 years) initiated apixaban and 14,051 patients (mean age: 78.2 years) initiated warfarin. Among NVAF patients who initiated apixaban versus those who initiated warfarin, mean Charlson Comorbidity Index (CCI) scores (3.0 vs. 3.4, P the baseline period for patients treated with apixaban versus warfarin ($17,077 vs. $20,236, P the baseline period. During the follow-up among matched cohorts, apixaban versus warfarin treatment was associated with higher annual pharmacy costs ($5,159 vs. $2,867, P the real-world setting apixaban versus warfarin use was

  5. Costs and Operating Dynamics of Integrating Distributed Energy Resources in Commercial and Industrial Buildings with Electric Vehicle Charging

    Science.gov (United States)

    Flores, Robert Joseph

    Growing concerns over greenhouse gas and pollutant emissions have increased the pressure to shift energy conversion paradigms from current forms to more sustainable methods, such as through the use of distributed energy resources (DER) at industrial and commercial buildings. This dissertation is concerned with the optimal design and dispatch of a DER system installed at an industrial or commercial building. An optimization model that accurately captures typical utility costs and the physical constraints of a combined cooling, heating, and power (CCHP) system is designed to size and operate a DER system at a building. The optimization model is then used with cooperative game theory to evaluate the financial performance of a CCHP investment. The CCHP model is then modified to include energy storage, solar powered generators, alternative fuel sources, carbon emission limits, and building interactions with public and fleet PEVs. Then, a separate plugin electric vehicle (PEV) refueling model is developed to determine the cost to operate a public Level 3 fast charging station. The CCHP design and dispatch results show the size of the building load and consistency of the thermal loads are critical to positive financial performance. While using the CCHP system to produce cooling can provide savings, heat production drives positive financial performance. When designing the DER system to reduce carbon emissions, the use of renewable fuels can allow for a gas turbine system with heat recovery to reduce carbon emissions for a large university by 67%. Further reductions require large photovoltaic installations coupled with energy storage or the ability to export electricity back to the grid if costs are to remain relatively low. When considering Level 3 fast charging equipment, demand charges at low PEV travel levels are sufficiently high to discourage adoption. Integration of the equipment can reduce demand charge costs only if the building maximum demand does not coincide

  6. Cost Reduction and Business Strategy Matters to Human Resource Outsourcing? A Validation by HR Experts from Government Link Companies (GLC’s.

    Directory of Open Access Journals (Sweden)

    Mansor Mohd Fitri

    2018-01-01

    Full Text Available The phenomenon of outsourcing has spawned a rich body scholarly reseach in sveral decades. However, the answer to one of the pertinent question has remained elusive: Does cost reduction and business strategy really matters to the human resource outsourcing impacts. Looking at this question it is important for the organization to embark on the practice of human resource outsourcing to save operating cost and remain competitive. Therefore, the objective of this study is to investigate the effects of cost reduction and business starategy towards human resource outsourcing impacts. Both quantitative and qualitative methods were employed and the top management in Malaysian Government Link Companies (GLC’ is the unit of analysis. The findings revelaved that, both variables are significant statistically and non statically i.e from the experts opinion. Finally, the study also provides useful directions for future research, HR Practitioners and policy maker particularly in managing and organizing human reseouce matters.

  7. Favorable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs and Resource Utilization: The 2012 Medical Expenditure Panel Survey.

    Science.gov (United States)

    Valero-Elizondo, Javier; Salami, Joseph A; Ogunmoroti, Oluseye; Osondu, Chukwuemeka U; Aneni, Ehimen C; Malik, Rehan; Spatz, Erica S; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

    2016-03-01

    The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD). The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD. Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD. © 2016 American Heart Association, Inc.

  8. JNK1 ablation in mice confers long-term metabolic protection from diet-induced obesity at the cost of moderate skin oxidative damage.

    Science.gov (United States)

    Becattini, Barbara; Zani, Fabio; Breasson, Ludovic; Sardi, Claudia; D'Agostino, Vito Giuseppe; Choo, Min-Kyung; Provenzani, Alessandro; Park, Jin Mo; Solinas, Giovanni

    2016-09-01

    Obesity and insulin resistance are associated with oxidative stress, which may be implicated in the progression of obesity-related diseases. The kinase JNK1 has emerged as a promising drug target for the treatment of obesity and type 2 diabetes. JNK1 is also a key mediator of the oxidative stress response, which can promote cell death or survival, depending on the magnitude and context of its activation. In this article, we describe a study in which the long-term effects of JNK1 inactivation on glucose homeostasis and oxidative stress in obese mice were investigated for the first time. Mice lacking JNK1 (JNK1(-/-)) were fed an obesogenic high-fat diet (HFD) for a long period. JNK1(-/-) mice fed an HFD for the long term had reduced expression of antioxidant genes in their skin, more skin oxidative damage, and increased epidermal thickness and inflammation compared with the effects in control wild-type mice. However, we also observed that the protection from obesity, adipose tissue inflammation, steatosis, and insulin resistance, conferred by JNK1 ablation, was sustained over a long period and was paralleled by decreased oxidative damage in fat and liver. We conclude that compounds targeting JNK1 activity in brain and adipose tissue, which do not accumulate in the skin, may be safer and most effective.-Becattini, B., Zani, F., Breasson, L., Sardi, C., D'Agostino, V. G., Choo, M.-K., Provenzani, A., Park, J. M., Solinas, G. JNK1 ablation in mice confers long-term metabolic protection from diet-induced obesity at the cost of moderate skin oxidative damage. © FASEB.

  9. Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.

    Science.gov (United States)

    Revill, Paul; Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J

    2018-01-01

    The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. The findings have

  10. Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

    Science.gov (United States)

    Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J.

    2018-01-01

    Background The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. Key issues for economic evaluation The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest

  11. Transportation Energy Futures Series: Alternative Fuel Infrastructure Expansion: Costs, Resources, Production Capacity, and Retail Availability for Low-Carbon Scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Melaina, M. W.; Heath, G.; Sandor, D.; Steward, D.; Vimmerstedt, L.; Warner, E.; Webster, K. W.

    2013-04-01

    Achieving the Department of Energy target of an 80% reduction in greenhouse gas emissions by 2050 depends on transportation-related strategies combining technology innovation, market adoption, and changes in consumer behavior. This study examines expanding low-carbon transportation fuel infrastructure to achieve deep GHG emissions reductions, with an emphasis on fuel production facilities and retail components serving light-duty vehicles. Three distinct low-carbon fuel supply scenarios are examined: Portfolio: Successful deployment of a range of advanced vehicle and fuel technologies; Combustion: Market dominance by hybridized internal combustion engine vehicles fueled by advanced biofuels and natural gas; Electrification: Market dominance by electric drive vehicles in the LDV sector, including battery electric, plug-in hybrid, and fuel cell vehicles, that are fueled by low-carbon electricity and hydrogen. A range of possible low-carbon fuel demand outcomes are explored in terms of the scale and scope of infrastructure expansion requirements and evaluated based on fuel costs, energy resource utilization, fuel production infrastructure expansion, and retail infrastructure expansion for LDVs. This is one of a series of reports produced as a result of the Transportation Energy Futures (TEF) project, a Department of Energy-sponsored multi-agency project initiated to pinpoint underexplored transportation-related strategies for abating GHGs and reducing petroleum dependence.

  12. Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models

    NARCIS (Netherlands)

    Menzies, Nicolas A.; Gomez, Gabriela B.; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V.; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S.; Bendavid, Eran; Chang, Stewart T.; Cohen, Ted; Denholm, Justin T.; Dowdy, David W.; Eckhoff, Philip A.; Goldhaber-Fiebert, Jeremy D.; Handel, Andreas; Huynh, Grace H.; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S.; Pandey, Surabhi; Salomon, Joshua A.; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M.; Wagner, Bradley G.; Whalen, Christopher C.; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K.; Charalambous, Salome; Chin, Daniel P.; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W.; Grant, Alison D.; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M. G. J.; Kimerling, Michael E.; White, Richard G.; Vassall, Anna

    2016-01-01

    The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios

  13. Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience.

    Science.gov (United States)

    Eze, Kenneth C; Irekpita, E; Salami, T A

    2016-01-01

    , and eventual closure of the ESWL procedure center in the hospital in 1998. ESWL at Okada was not cost-effective both to patients and the hospital management. Despite these, ESWL is desirable in poor-resource countries because of its noninvasiveness, low morbidity, and usability in patients who are unfit for open surgery. Purchasing high technological medical equipment as commodities by sub-Saharan Africans without considering the prevalence of diseases they are meant to cater for, their maintenance for steady function during useful lifespan, their cost-effectiveness and how to recoup the money spent on investments depletes the scarce foreign exchange reserve of the home countries and is eventually counterproductive as exemplified by this case.

  14. Healthcare Resource Utilization and Costs Associated with Ketosis Events in Pediatric and Adult Patients with Type 1 Diabetes Mellitus in the UK.

    Science.gov (United States)

    Thalange, Nandu; Aldhouse, Natalie Valerie Jane; Kitchen, Helen; Howard, Daniel; Tutkunkardas, Deniz; Håkan-Bloch, Jonas

    2017-10-01

    Ketosis is a metabolic state associated with insulin deficiency. Untreated, it develops into diabetic ketoacidosis, a significant contributor to mortality and morbidity in people with type 1 diabetes mellitus (T1DM). Little is understood about how patients utilize healthcare resources during ketosis events. This study aimed to identify and quantify healthcare resource utilization and provide estimates of associated costs of ketosis events in T1DM, treated unaided or with healthcare professional (HCP) assistance in the UK. Qualitative interviews with adult patients, pediatric carers, and HCPs identified resources used by patients/carers during ketosis events. An online quantitative survey was then used to quantify patients/carers resource use during their/their child's most recent ketosis event, and HCPs estimated patient resource uptake to corroborate the findings. Associated costs estimated from UK data sources were applied to the survey results to calculate the cost of ketosis events in adults and children. Quantitative survey responses from 93 adults, 76 carers, and 52 HCPs were analyzed. Patients and carers monitored ketosis during and following the event with ketone strips and additional glucose strips, and administered treatment comprising insulin and pump set changes where appropriate. Additionally, patients/carers accessed phone services and many received follow-up medical appointments. In total, 70% (n = 65) of adult and 66% (n = 50) of pediatric ketosis events were managed at home, for which resource use costs per event were £23.87 and £38.00 respectively. Remaining events were treated in NHS facilities costing £217.57 per adult and £352.92 per child. Weighted averages identified that ketosis events cost £81.98 per adult and £142.97 per child. Indirect costs from work productivity loss increase these figures to £225.11 per adult and £256.88 per child. Healthcare resource use for ketosis events is high in adults and children with T1DM and

  15. Assessment of healthcare measures, healthcare resource use, and cost of care among severe hemophilia A patients in Mumbai region of India.

    Science.gov (United States)

    Jadhav, U; Mukherjee, K

    2017-10-23

    In India, the low public health priority given to rare disorders such as hemophilia hinders their management and optimal care, leading to relatively poor health outcomes. This study aims to profile the multidimensional health status of patients with severe hemophilia A, and its association with the use of healthcare resources and the cost of care in Mumbai region of India. A cross-sectional, single-center study was conducted during January-May 2011, among 160 patients diagnosed with severe hemophilia A in Mumbai region of India. Their health status was documented using the Hemophilia Utilization Group Study's validated instrument of Functional Health Status Measure (FHS) and a single item of Self-care Measure. Of 160 patients, 55% (n = 88) scored on the lower side on the FHS, with an average score of 6.65 ± 2.85. The use of healthcare resources and cost of treatment were considerable for patients with a lower mean rank score on the FHS and a higher mean rank score on the self-care measure. The consumption of clotting factor concentrates (CFCs), number of visits to a health facility and incidence of inpatient episodes were significantly associated with a relatively low score on the FHS. Similarly, a higher cost of treatment, in terms of the cost of CFCs, direct cost, emergency room cost, and indirect cost, were significantly associated with a lower score on the FHS. The health status of patients with severe hemophilia A is compromised and has a significant impact on the use of healthcare resources and the cost of treatment.

  16. Healthcare resource use and costs associated with chronic kidney disease in US private insurance patients with multiple myeloma.

    Science.gov (United States)

    Bhowmik, Debajyoti; Song, Xue; Intorcia, Michele; Kent, Shia T; Shi, Nianwen

    2018-01-01

    Objectives Within a median 1.2 years after patients have an initial diagnosis with multiple myeloma, up to 61% were diagnosed with renal impairment and 50% were diagnosed with chronic kidney disease. This study estimated economic burden associated with chronic kidney disease in multiple myeloma patients in the US. Methods In this retrospective cohort study, patients ≥18 years old with ≥1 inpatient or ≥ 2 outpatient multiple myeloma diagnoses between 1 January 2008 and 31 March 2015 were identified from MarketScan® Commercial and Medicare Supplemental Databases. Chronic kidney disease patients had ≥1 diagnosis of chronic kidney disease Stages 1-5 (first chronic kidney disease diagnosis date = index date) on or after the first multiple myeloma diagnosis, and were propensity score matched 1:1 to multiple myeloma patients without chronic kidney disease, end-stage renal disease, dialysis, or other type of chronically impaired renal function. All patients had ≥six-month continuous enrollment prior to index date and were followed for ≥one month from index date until the earliest of inpatient death, end of continuous enrollment, or end of the study period (30 September 2015). The per-patient per-year healthcare resource utilization and costs were measured during follow-up. Costs were total reimbursed amount in 2016 US dollars. Results A total of 2541 multiple myeloma patients with chronic kidney disease stages 1-5 and 2541 matched controls met the study criteria and were respectively 69.3 and 69.6 years, 54.5% and 55.3% men, and had 572.2 and 533.4 mean days of follow up. Compared to controls, chronic kidney disease patients had significantly (all P chronic kidney disease, end-stage renal disease, or dialysis had $78,455 ( P chronic kidney disease in patients with multiple myeloma was estimated to be between $34,754 and $78,455 per-patient per-year. Given its substantial clinical and economic impact, preservation of renal function is important in

  17. Evaluation of resource allocation and supply-demand balance in clinical practice with high-cost technologies.

    Science.gov (United States)

    Otsubo, Tetsuya; Imanaka, Yuichi; Lee, Jason; Hayashida, Kenshi

    2011-12-01

    Japan has one of the highest numbers of high-cost medical devices installed relative to its population. While evaluations of the distribution of these devices traditionally involve simple population-based assessments, an indicator that includes the demand of these devices would more accurately reflect the situation. The purpose of this study was to develop an indicator of the supply-demand balance of such devices, using examples of magnetic resonance imaging scanners (MRI) and extracorporeal shockwave lithotripters (ESWL), and to investigate the relationship between this indicator, personnel distribution statuses and operating statuses at the prefectural level. Using data from nation-wide surveys and claims data from 16 hospitals, we developed an indicator based on the ratio of the supplied number of device units to the number of device units in demand for MRI and ESWL. The latter value was based on patient volume and utilization proportion. Correlation analyses were conducted between the supply-demand balances of these devices, personal distribution and operating statuses. Comparisons between our indicator and conventional population-based indicators revealed that 15% and 30% of prefectures were at risk of underestimating the availability of MRI and ESWL, respectively. The numbers of specialist personnel/device units showed significant, negative correlations with our indicators in both devices. Utilization-based analyses of health care resource placement and utilization status provide a more accurate indication than simple population-based assessments, and can assist decision makers in reviewing gaps between health policy and management. Such an indicator therefore has the potential to be a tool in helping to improve the efficiency of the allocation and placement of such devices. © 2010 Blackwell Publishing Ltd.

  18. Refinement of motion correction strategies for lower-cost CT for under-resourced regions of the world

    Science.gov (United States)

    Wells, Jered R.; Segars, W. Paul; Kigongo, Christopher J. N.; Dobbins, James T., III

    2011-03-01

    This paper describes a recently developed post-acquisition motion correction strategy for application to lower-cost computed tomography (LCCT) for under-resourced regions of the world. Increased awareness regarding global health and its challenges has encouraged the development of more affordable healthcare options for underserved people worldwide. In regions such as sub-Saharan Africa, intermediate level medical facilities may serve millions with inadequate or antiquated equipment due to financial limitations. In response, the authors have proposed a LCCT design which utilizes a standard chest x-ray examination room with a digital flat panel detector (FPD). The patient rotates on a motorized stage between the fixed cone-beam source and FPD, and images are reconstructed using a Feldkamp algorithm for cone-beam scanning. One of the most important proofs-of-concept in determining the feasibility of this system is the successful correction of undesirable motion. A 3D motion correction algorithm was developed in order to correct for potential patient motion, stage instabilities and detector misalignments which can all lead to motion artifacts in reconstructed images. Motion will be monitored by the radiographic position of fiducial markers to correct for rigid body motion in three dimensions. Based on simulation studies, projection images corrupted by motion were re-registered with average errors of 0.080 mm, 0.32 mm and 0.050 mm in the horizontal, vertical and depth dimensions, respectively. The overall absence of motion artifacts in motion-corrected reconstructions indicates that reasonable amounts of motion may be corrected using this novel technique without significant loss of image quality.

  19. Resource consumption and costs in Dutch patients with Type 2 diabetes mellitus. Results from 29 general practices

    NARCIS (Netherlands)

    Redekop, WK; Koopmanschap, MA; Rutten, GEHM; Wolffenbuttel, BHR; Stolk, RP; Niessen, LW

    Aims The aims of this study were to estimate the costs incurred by Dutch patients with Type 2 diabetes, examine which patient and/or treatment characteristics are associated with costs, and estimate the medical and non-medical costs of patients with Type 2 diabetes in The Netherlands. Methods

  20. A retrospective review comparing two-year patient-reported outcomes, costs, and healthcare resource utilization for TLIF vs. PLF for single-level degenerative spondylolisthesis.

    Science.gov (United States)

    Kim, Elliott; Chotai, Silky; Stonko, David; Wick, Joseph; Sielatycki, Alex; Devin, Clinton J

    2018-03-01

    The purpose of this study was to compare patient-reported outcomes (PROs), morbidity, and costs of TLIF vs PLF to determine whether one treatment was superior in the setting of single-level degenerative spondylolisthesis. Patients undergoing TLIF or PLF for single-level spondylolisthesis were included for retrospective analysis. EQ-5D, ODI, SF-12 MCS/PCS, NRS-BP/LP scores were collected at baseline and 24 months after surgery. 90-day post-operative complications, revision surgery rates, and satisfaction scores were also collected. Two-year resource use was multiplied by unit costs based on Medicare payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost was used to assess mean total 2-year cost per QALYs gained after surgery. 62 and 37 patients underwent TLIF and PLF, respectively. Patients in the PLF group were older (p differences were seen in baseline or 24-month PROs between the two groups. There was a significant improvement in all PROs from baseline to 24 months after surgery (p difference in 24-month direct, indirect, and total cost. Overall costs and health care utilization were similar in both the groups. Both TLIF and PLF for single-level degenerative spondylolisthesis provide improvement in disability, pain, quality of life, and general health.

  1. Health care resource use and costs associated with possible side effects of high oral corticosteroid use in asthma: a claims-based analysis.

    Science.gov (United States)

    Luskin, Allan T; Antonova, Evgeniya N; Broder, Michael S; Chang, Eunice Y; Omachi, Theodore A; Ledford, Dennis K

    2016-01-01

    The objective of this study was to estimate the prevalence of possible oral corticosteroid (OCS)-related side effects and health care resource use and costs in patients with asthma. This was a cross-sectional, matched-cohort, retrospective study using a commercial claims database. Adults with asthma diagnosis codes and evidence of asthma medication use were studied. Patients with high OCS use (≥30 days of OCS annually) were divided into those who did versus those who did not experience OCS-related possible side effects. Their health care resource use and costs were compared using linear regression or negative binomial regression models, adjusting for age, sex, geographic region, Charlson Comorbidity Index score, and chronic obstructive pulmonary disease status. After adjustment, high OCS users with possible side effects were more likely to have office visits (23.0 vs 19.6; P possible side effects. Emergency department visits were similar between the groups. High OCS users with possible side effects had higher adjusted total annual mean health care costs ($25,168) than those without such side effects ($21,882; P =0.009). Among high OCS users, patients with possible OCS-related side effects are more likely to use health care services than those without such side effects. Although OCS may help control asthma and manage exacerbations, OCS side effects may result in additional health care resource use and costs, highlighting the need for OCS-sparing asthma therapies.

  2. GIS-based approach for defining bioenergy facilities location: A case study in Northern Spain based on marginal delivery costs and resources competition between facilities

    Energy Technology Data Exchange (ETDEWEB)

    Panichelli, Luis; Gnansounou, Edgard [Laboratory of Energy Systems, Swiss Federal Institute of Technology, LASEN-ICARE-ENAC, Station 18, EPFL, CH-1015 Lausanne (Switzerland)

    2008-04-15

    This paper presents a GIS-based decision support system for selecting least-cost bioenergy locations when there is a significant variability in biomass farmgate price and when more than one bioenergy plant with a fixed capacity has to be placed in the region. The methodology tackles the resources competition problem between energy facilities through a location-allocation model based on least-cost biomass quantities. Whole system least delivery cost including intermediate bioenergy products is estimated. The methodology is based on a case study where forest wood residues (FWR) from final cuttings (FCs) are used to produce torrefied wood (TW) in two torrefaction plants (TUs) that supply a gasification unit (GU) in order to produce electricity. The provinces of Navarra, Bizkaia, Gipuzkoa, Alava, La Rioja, Cantabria and Burgos are assessed in order to find the best locations for settling down the TUs and the GU according to biomass availability, FWR and TW marginal delivery costs. (author)

  3. Cost and resource use of patients on antiretroviral therapy in the urban and semiurban public sectors of South Africa.

    Science.gov (United States)

    Meyer-Rath, Gesine; Miners, Alec; Santos, Andreia C; Variava, Ebrahim; Venter, Willem Daniel Francois

    2012-11-01

    South Africa has the world's largest number of patients on antiretroviral treatment (ART). As coverage expands beyond urban environments, the cost of care is becoming increasingly important. Health care cost data for the first year after initiation were analyzed for cohorts of patients in a semiurban and an urban public sector ART clinic in South Africa. We compared mean cost by CD4 cell count and time on ART between clinics. Patients in both clinics had comparable CD4 cell counts at initiation and under treatment. In the urban clinic, mean cost per patient-year on ART in 2011 USD was $1040 [95% confidence interval (CI): $800 to $1280], of which outpatient cost was $692 (67%) and inpatient cost was $348 (33%). Fourteen percent of urban patients required inpatient care at a mean length of stay of 9 days and mean cost per hospitalized patient of $1663 (95% CI: $1103 to $2041). In the semiurban clinic, mean cost per patient-year on ART was $1115 (95% CI: $776 to $1453), of which outpatient cost was $697 (63%) and inpatient cost $418 (37%). Seven percent of semiurban patients required inpatient care at a mean length of stay of 28 days and mean cost per hospitalized patient of $3824 (95% CI: $1143 to $6505). Outpatient ART provision in the semiurban setting cost the same as in the urban setting, but inpatient costs are higher in the semiurban clinic because of longer hospitalizations. Cost in both clinics was highest in the first 3 months on ART and at CD4 cell counts <50 cells/μL.

  4. Costing commodity and human resource needs for integrated community case management in thie differing community health strategies of Ethiopia, Kenya and Zambia.

    Science.gov (United States)

    Nefdt, Rory; Ribaira, Eric; Diallo, Khassoum

    2014-10-01

    To ensure correct and appropriate funding is available, there is a need to estimate resource needs for improved planning and implementation of integrated Community Case Management (iCCM). To compare and estimate costs for commodity and human resource needs for iCCM, based on treatment coverage rates, bottlenecks and national targets in Ethiopia, Kenya and Zambia from 2014 to 2016. Resource needs were estimated using Ministry of Health (MoH) targets fronm 2014 to 2016 for implementation of case management of pneumonia, diarrhea and malaria through iCCM based on epidemiological, demographic, economic, intervention coverage and other health system parameters. Bottleneck analysis adjusted cost estimates against system barriers. Ethiopia, Kenya and Zambia were chosen to compare differences in iCCM costs in different programmatic implementation landscapes. Coverage treatment rates through iCCM are lowest in Ethiopia, followed by Kenya and Zambia, but Ethiopia had the greatest increases between 2009 and 2012. Deployment of health extension workers (HEWs) in Ethiopia is more advanced compared to Kenya and Zambia, which have fewer equivalent cadres (called commu- nity health workers (CHWs)) covering a smaller proportion of the population. Between 2014 and 2016, the propor- tion of treatments through iCCM compared to health centres are set to increase from 30% to 81% in Ethiopia, 1% to 18% in Kenya and 3% to 22% in Zambia. The total estimated cost of iCCM for these three years are USD 75,531,376 for Ethiopia, USD 19,839,780 for Kenya and USD 33,667,742 for Zambia. Projected per capita expen- diture for 2016 is USD 0.28 for Ethiopia, USD 0.20 in Kenya and USD 0.98 in Zambia. Commodity costs for pneumonia and diarrhea were a small fraction of the total iCCM budget for all three countries (less than 3%), while around 80% of the costs related to human resources. Analysis of coverage, demography and epidemiology data improves estimates of fimding requirements for iCCM. Bottleneck

  5. Potential Impact of a Free Online HIV Treatment Response Prediction System for Reducing Virological Failures and Drug Costs after Antiretroviral Therapy Failure in a Resource-Limited Setting

    Directory of Open Access Journals (Sweden)

    Andrew D. Revell

    2013-01-01

    Full Text Available Objective. Antiretroviral drug selection in resource-limited settings is often dictated by strict protocols as part of a public health strategy. The objective of this retrospective study was to examine if the HIV-TRePS online treatment prediction tool could help reduce treatment failure and drug costs in such settings. Methods. The HIV-TRePS computational models were used to predict the probability of response to therapy for 206 cases of treatment change following failure in India. The models were used to identify alternative locally available 3-drug regimens, which were predicted to be effective. The costs of these regimens were compared to those actually used in the clinic. Results. The models predicted the responses to treatment of the cases with an accuracy of 0.64. The models identified alternative drug regimens that were predicted to result in improved virological response and lower costs than those used in the clinic in 85% of the cases. The average annual cost saving was $364 USD per year (41%. Conclusions. Computational models that do not require a genotype can predict and potentially avoid treatment failure and may reduce therapy costs. The use of such a system to guide therapeutic decision-making could confer health economic benefits in resource-limited settings.

  6. Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands

    International Nuclear Information System (INIS)

    Miquel-Cases, Anna; Steuten, Lotte M. G.; Rigter, Lisanne S.; Harten, Wim H. van

    2016-01-01

    Response-guided neoadjuvant chemotherapy (RG-NACT) with magnetic resonance imaging (MRI) is effective in treating oestrogen receptor positive/human epidermal growth factor receptor-2 negative (ER-positive/HER2-negative) breast cancer. We estimated the expected cost-effectiveness and resources required for its implementation compared to conventional-NACT. A Markov model compared costs, quality-adjusted-life-years (QALYs) and costs/QALY of RG-NACT vs. conventional-NACT, from a hospital perspective over a 5-year time horizon. Health services required for and health outcomes of implementation were estimated via resource modelling analysis, considering a current (4 %) and a full (100 %) implementation scenario. RG-NACT was expected to be more effective and less costly than conventional NACT in both implementation scenarios, with 94 % (current) and 95 % (full) certainty, at a willingness to pay threshold of €20.000/QALY. Fully implementing RG-NACT in the Dutch target population of 6306 patients requires additional 5335 MRI examinations and an (absolute) increase in the number of MRI technologists, by 3.6 fte (full-time equivalent), and of breast radiologists, by 0.4 fte. On the other hand, it prevents 9 additional relapses, 143 cancer deaths, 23 congestive heart failure events and 2 myelodysplastic syndrome/acute myeloid leukaemia events. Considering cost-effectiveness, RG-NACT is expected to dominate conventional-NACT. While personnel capacity is likely to be sufficient for a full implementation scenario, MRI utilization needs to be intensified

  7. Animal damage management handbook.

    Science.gov (United States)

    Hugh C. Black

    1994-01-01

    This handbook treats animal damage management (ADM) in the West in relation to forest, range, and recreation resources; predator management is not addressed. It provides a comprehensive reference of safe, effective, and practical methods for managing animal damage on National Forest System lands. Supporting information is included in references after each chapter and...

  8. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    Full Text Available Routine HIV screening in emergency department (ED settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor.We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1 no screening program; 2 an ED provider-based program; and 3 an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%. Undiagnosed HIV prevalence (0.4% and linkage to care rates (80% were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs.Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY and the Counselor strategy (compared to the Provider strategy had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs.The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in

  9. Resource utilization and cost-effectiveness of counselor- vs. provider-based rapid point-of-care HIV screening in the emergency department.

    Science.gov (United States)

    Walensky, Rochelle P; Morris, Bethany L; Reichmann, William M; Paltiel, A David; Arbelaez, Christian; Donnell-Fink, Laurel; Katz, Jeffrey N; Losina, Elena

    2011-01-01

    Routine HIV screening in emergency department (ED) settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor. We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1) no screening program; 2) an ED provider-based program; and 3) an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%). Undiagnosed HIV prevalence (0.4%) and linkage to care rates (80%) were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs. Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening) had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY) and the Counselor strategy (compared to the Provider strategy) had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs. The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in situations

  10. Cost, production and effectiveness of masticated fireline.

    Science.gov (United States)

    Elizabeth Dodson; Dana Mitchell

    2016-01-01

    Fire managers are continuously looking for improved methods to construct fireline with minimal resource damage. One option for fireline construction that has so far received limited attention is the use of mastication equipment. This study evaluated a masticating disk mounted on a self-leveling feller- buncher for the cost, speed, and adherence to fireline...

  11. The cost of treatment failure: resource use and costs incurred by hepatitis C virus genotype 1-infected patients who do or do not achieve sustained virological response to therapy.

    Science.gov (United States)

    Backx, M; Lewszuk, A; White, J R; Cole, J; Sreedharan, A; van Sanden, S; Diels, J; Lawson, A; Neal, K R; Wiselka, M J; Ito, T; Irving, W L

    2014-03-01

    Chronic hepatitis C virus (HCV) infection places a considerable economic burden on health services. Cost-effectiveness analyses of antiviral treatment for patients with chronic HCV infection are dependent on assumptions about cost reductions following sustained virological response (SVR) to therapy. This study quantified the medium-term difference in health resource usage and costs depending on treatment outcome. Retrospective chart review of patients with HCV genotype 1 infection who had received at least 2 months pegylated interferon and ribavirin therapy, with known treatment outcome was conducted. Disease status was categorized as chronic hepatitis, cirrhosis or decompensated liver disease. Health resource use was documented for each patient in each disease state. Unit costs were from the NHS 'Payment by Results' database and the British National Formulary. One hundred and ninety three patients (108 SVR, 85 non-SVR) with mean follow-up of 3.5 (SVR) and 4.9 (non-SVR) years were enrolled. No SVR patient progressed to a more severe liver disease state. Annual transition rates for non-SVR patients were 7.4% (chronic hepatitis to cirrhosis) and 4.9% (cirrhosis to decompensated liver disease). By extrapolation of modelled data over a 5-year post-treatment period, failure of patients with chronic hepatitis to achieve SVR was associated with a 13-fold increase (roughly £2300) in costs, whilst for patients who were retreated, the increase was 56-fold, equating to more than £10 000. Achievement of an SVR has significant effects on health service usage and costs. This work provides real-life data for future cost-effectiveness analyses related to the treatment for chronic HCV infection. © 2013 John Wiley & Sons Ltd.

  12. Patterns of resource utilization and cost for postmenopausal women with hormone-receptor–positive, human epidermal growth factor receptor-2–negative advanced breast cancer in Europe

    International Nuclear Information System (INIS)

    Jerusalem, Guy; Neven, Patrick; Marinsek, Nina; Zhang, Jie; Degun, Ravi; Benelli, Giancarlo; Saletan, Stephen; Ricci, Jean-François; Andre, Fabrice

    2015-01-01

    Healthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. However, lack of clarity in guidelines can result in varied interpretation and heterogeneous treatment management and costs. In Europe, the extent of this variability is unclear. Therefore, evaluation of chemotherapy use and costs versus hormone therapy across Europe is needed. This retrospective chart review (N = 355) examined primarily direct costs for chemotherapy versus hormone therapy in postmenopausal women with hormone-receptor–positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer across 5 European countries (France, Germany, The Netherlands, Belgium, and Sweden). Total direct costs across the first 3 treatment lines were approximately €10 000 to €14 000 lower for an additional line of hormone therapy-based treatment versus switching to chemotherapy-based treatment. Direct cost difference between chemotherapy-based and hormone therapy-based regimens was approximately €1900 to €2500 per month. Chemotherapy-based regimens were associated with increased resource utilization (managing side effects; concomitant targeted therapy use; and increased frequencies of hospitalizations, provider visits, and monitoring tests). The proportion of patients taking sick leave doubled after switching from hormone therapy to chemotherapy. These results suggest chemotherapy is associated with increased direct costs and potentially with increased indirect costs (lower productivity of working patients) versus hormone therapy in HR+, HER2– advanced breast cancer. The online version of this article (doi:10.1186/s12885-015-1762-3) contains supplementary material, which is available to authorized users

  13. Retrospective analysis of drug utilization, health care resource use, and costs associated with IFN therapy for adjuvant treatment of malignant melanoma

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-07-01

    Full Text Available ≥Ying Zhang,1 Trong Kim Le,1 James W Shaw,2 Srividya Kotapati31Center for Observational Research and Data Sciences, Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Hopewell, NJ, USA; 2Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Princeton, NJ, USA; 3Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Wallingford Center, CT, USABackground: This study examines real-world drug utilization patterns, health care resource use, and costs among patients receiving adjuvant treatment with IFN versus patients receiving no treatment ("observation" for malignant melanoma following surgery.Methods: A retrospective cohort study was conducted using administrative claims from Truven Health Analytics (MarketScan® to identify all adjuvant melanoma patients (aged ≥18 years diagnosed between June 2007 and June 2011 who had a lymph node dissection (ie, index surgery and were treated with IFN or subsequently observed. Health care resource use and costs of services were converted to 2012 US dollars and were evaluated and compared using multivariable regression.Results: Of 1,999 eligible subjects with melanoma surgery claims, 179 (9.0% were treated with IFN and 1,820 (91.0% were observed. The median duration (days and number of doses of IFN therapy were 73 and 36, respectively. Among IFN-treated patients, only 10.6% completed ≥80% of maintenance therapy. The total average cost for patients treated with IFN was US$60,755±$3,972 (n=179; significantly higher than for patients undergoing observation ($31,641±$2,471; P<0.0001. Similar trends were observed when evaluating total cost components, including melanoma-related and non-melanoma–related medical costs. Among the melanoma-related medical costs, outpatient services, including office visits and laboratory testing, represented between 33% and 53% of total costs and

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

    Science.gov (United States)

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

    2017-03-01

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

  15. Hospitalization resource use and costs before and after TIA and stroke: results from a population-based cohort study (OXVASC).

    Science.gov (United States)

    Luengo-Fernandez, Ramon; Silver, Louise E; Gutnikov, Sergei A; Gray, Alastair M; Rothwell, Peter M

    2013-01-01

    High hospitalization rates, prolonged length of stay, and increased risks of subsequent events mean a steep increase in health care usage after stroke. No study, however, has examined to what extent increased costs after transient ischemic attack (TIA) or stroke are due to hospitalizations for the initial event, recurrent events, and/or nonvascular hospitalizations, and how costs compare with the year prior to the event. We studied patients in a population-based cohort study (Oxford Vascular Study) in the United Kingdom from 2003 to 2007. Hospitalization and cost details were obtained from patients' individualized Hospital Episode Statistics records. A total of 295 incident TIA and 439 incident stroke patients were included. For patients with stroke, average costs increased from £1437 in the year pre-event to £6629 in the year post-event (PTIA, costs increased from £876 1 year before the event to £2410 in the year post-event (PTIA incurred nonsignificantly higher costs due to hospitalizations linked to subsequent vascular events (£774) than for hospitalizations linked to the index TIA (£720). Hospital costs increased after TIA or stroke, primarily because of increased initial cerebrovascular hospitalizations. The finding that costs due to nonvascular diagnoses also increased after TIA or stroke appears, in part, to be explained by the miscoding of TIA/stroke-related hospitalizations in electronic information systems. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  16. Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial

    NARCIS (Netherlands)

    van der Heijden, A.A.W.A.; de Bruijne, M.C.; Feenstra, T.L.; Dekker, J.M.; Baan, C.A.; Bosmans, J.E.; Bot, S.D.M.; Donker, G.A.; Nijpels, G.

    2014-01-01

    Background: The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care

  17. Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care : A controlled clinical trial

    NARCIS (Netherlands)

    van der Heiden, A.W.A.; de Bruijne, M.C.; Feenstra, T.L.; Dekker, J.M.; Baan, Caroline; Bosmans, J.E.; Bot, S.D.M.; Donker, G.A.; Nijpels, G.

    2014-01-01

    Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care

  18. Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial.

    NARCIS (Netherlands)

    Heijden, A.A.W.A. van der; Bruijne, M.C. de; Feenstra, T.L.; Dekker, J.M.; Baan, C.A.; Bosmans, J.E.; Bot, S.D.M.; Donker, G.A.; Nijpels, G.

    2014-01-01

    Background: The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care

  19. Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial.

    Science.gov (United States)

    van der Heijden, Amber A W A; de Bruijne, Martine C; Feenstra, Talitha L; Dekker, Jacqueline M; Baan, Caroline A; Bosmans, Judith E; Bot, Sandra D M; Donker, Gé A; Nijpels, Giel

    2014-06-25

    The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€ 758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Compared to usual care, managed

  20. Application and utility of a low-cost unmanned aerial system to manage and conserve aquatic resources in four Texas rivers

    Science.gov (United States)

    Birdsong, Timothy W.; Bean, Megan; Grabowski, Timothy B.; Hardy, Thomas B.; Heard, Thomas; Holdstock, Derrick; Kollaus, Kristy; Magnelia, Stephan J.; Tolman, Kristina

    2015-01-01

    Low-cost unmanned aerial systems (UAS) have recently gained increasing attention in natural resources management due to their versatility and demonstrated utility in collection of high-resolution, temporally-specific geospatial data. This study applied low-cost UAS to support the geospatial data needs of aquatic resources management projects in four Texas rivers. Specifically, a UAS was used to (1) map invasive salt cedar (multiple species in the genus Tamarix) that have degraded instream habitat conditions in the Pease River, (2) map instream meso-habitats and structural habitat features (e.g., boulders, woody debris) in the South Llano River as a baseline prior to watershed-scale habitat improvements, (3) map enduring pools in the Blanco River during drought conditions to guide smallmouth bass removal efforts, and (4) quantify river use by anglers in the Guadalupe River. These four case studies represent an initial step toward assessing the full range of UAS applications in aquatic resources management, including their ability to offer potential cost savings, time efficiencies, and higher quality data over traditional survey methods.

  1. Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice.

    Science.gov (United States)

    Sicras-Mainar, A; Rejas-Gutiérrez, J; Navarro-Artieda, R; Aguado-Jodar, A; Ruíz-Torrejón, A

    2014-10-01

    To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (P=.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, €1,775 (1550-2014) vs. solifenacin €2,062 (1911-2223) and tolterodine €2,149 (1,978-2,307), P=.042, as a result of lower utilization visits and concomitant medication. Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  2. Evaluating cost and resource use associated with pulse oximetry screening for critical congenital heart disease: Empiric estimates and sources of variation.

    Science.gov (United States)

    Reeder, Matthew R; Kim, Jaewhan; Nance, Amy; Krikov, Sergey; Feldkamp, Marcia L; Randall, Harper; Botto, Lorenzo D

    2015-11-01

    Newborn screening for critical congenital heart disease (CCHD) using pulse oximetry is being implemented in the United States and internationally; however, few data are available on the associated in-hospital costs and use of resources. Time and motion study in well-baby nurseries at two large urban hospitals in Utah using different approaches to pulse oximetry screening. Two observers recorded the time for each screening step together with provider and equipment characteristics. Structured questionnaire provided additional information on labor and equipment costs. Fifty-three CCHD screens were observed. At site A (n = 22), screening was mostly done by medical assistants (95%) using disposable probes (100%); at site B (n = 31), screening was mostly performed by certified nursing assistants (90%) using reusable probes (90%). Considering only first screens (n = 53), the median screen time was 8.6 min (range: 3.2-23.2), with no significant difference between sites. The overall cost ($ in 2014) of screening per baby was $24.52 at site A and $2.60 at site B. Nearly all the variation in cost (90%) was due to the cost of disposable probes; labor costs were similar between sites. CCHD screening by means of pulse oximetry is reasonably fast for most babies, leading to relative small labor costs with little variation by provider type. The main driver of costs is equipment: in a high throughput setting, reusable probes are currently associated with considerable cost saving compared with disposable probes. As programs expand to universal screening, improved and cheaper technologies could lead to considerable economies of scale. © 2015 Wiley Periodicals, Inc.

  3. International Programme for Resource Use in Critical Care (IPOC)--a methodology and initial results of cost and provision in four European countries.

    Science.gov (United States)

    Negrini, D; Sheppard, L; Mills, G H; Jacobs, P; Rapoport, J; Bourne, R S; Guidet, B; Csomos, A; Prien, T; Anderson, G; Edbrooke, D L

    2006-01-01

    A standardized top-down costing method is not currently available internationally. An internally validated method developed in the UK was modified for use in critical care in different countries. Costs could then be compared using the World Health Organization's Purchasing Power Parities (WHO PPPs). This was an observational, retrospective, cross-sectional, multicentre study set in four European countries: France, UK, Germany and Hungary. A total of 329 adult intensive care units (ICUs) participated in the study. The costs are reported in international dollars ($) derived from the WHO PPP programme. The results show significant differences in resource use and costs of ICUs over the four countries. On the basis of the sum of the means for the major components, the average cost per patient day in UK hospitals was $1512, in French hospitals $934, in German hospitals $726 and in Hungarian hospitals $280. The reasons for such differences are poorly understood but warrant further investigation. This information will allow us to better adjust our measures of international ICU costs.

  4. The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study.

    Science.gov (United States)

    Asensio, Angel; Di Bella, Stefano; Lo Vecchio, Andrea; Grau, Santiago; Hart, Warren M; Isidoro, Beatriz; Scotto, Ricardo; Petrosillo, Nicola; Watt, Maureen; Nazir, Jameel

    2015-07-01

    To assess the impact of Clostridium difficile infection (CDI) on hospital resources and costs in Spain and Italy. CDI data were collected from institutions in Spain and Italy. Each patient was matched with two randomly selected uninfected controls in the same institution. Patient outcomes were assessed for the first and second episodes of CDI and for patients aged ≤65 and >65 years. The impact of CDI on hospital length of stay (LOS) was used to calculate CDI-attributable costs. A multivariate analysis using duration of stay as the continuous outcome variable assessed the independent effect of CDI on hospital costs and LOS. LOS attributable to CDI ranged from 7.6-19.0 days in adults and was 5.0 days in children; the increases were greater in adults in Italy than in Spain. Attributable costs per adult patient ranged from €4396 in Madrid to €14 023 in Rome, with the majority of the cost being due to hospitalization. For children, the total attributable cost was €3545/patient. These data show that the burden of CDI is considerable in Spain and Italy. Treatments that can reduce LOS, disease severity, and recurrence rates, as well as effective infection control measures to prevent transmission, have the potential to reduce the burden of CDI. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Gupta S

    2015-11-01

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

  6. Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

    Directory of Open Access Journals (Sweden)

    Norheim Ole

    2004-01-01

    Full Text Available Abstract Introduction Several studies carried out to establish the relative preference of cost-effectiveness of interventions and severity of disease as criteria for priority setting in health have shown a strong preference for severity of disease. These preferences may differ in contexts of resource scarcity, as in developing countries, yet information is limited on such preferences in this context. Objective This study was carried out to identify the key players in priority setting in health and explore their relative preference regarding cost-effectiveness of interventions and severity of disease as criteria for setting priorities in Uganda. Design 610 self-administered questionnaires were sent to respondents at national, district, health sub-district and facility levels. Respondents included mainly health workers. We used three different simulations, assuming same patient characteristics and same treatment outcome but with varying either severity of disease or cost-effectiveness of treatment, to explore respondents' preferences regarding cost-effectiveness and severity. Results Actual main actors were identified to be health workers, development partners or donors and politicians. This was different from what respondents perceived as ideal. Above 90% of the respondents recognised the importance of both severity of disease and cost-effectiveness of intervention. In the three scenarios where they were made to choose between the two, a majority of the survey respondents assigned highest weight to treating the most severely ill patient with a less cost-effective intervention compared to the one with a more cost-effective intervention for a less severely ill patient. However, international development partners in in-depth interviews preferred the consideration of cost-effectiveness of intervention. Conclusions In a survey among health workers and other actors in priority setting in Uganda, we found that donors are considered to have more say than

  7. A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

    Science.gov (United States)

    Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

    2012-01-01

    BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

  8. Comparing treatment persistence, healthcare resource utilization, and costs in adult patients with major depressive disorder treated with escitalopram or citalopram.

    Science.gov (United States)

    Wu, Eric Q; Greenberg, Paul E; Ben-Hamadi, Rym; Yu, Andrew P; Yang, Elaine H; Erder, M Haim

    2011-03-01

    Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (-$1174) and major depressive disorder-related costs (-$109; P escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare

  9. Cost-benefit assessment of energy efficiency investments: Accounting for future resources, savings and risks in the Australian residential sector

    International Nuclear Information System (INIS)

    Morrissey, J.; Meyrick, B.; Sivaraman, D.; Horne, R.E.; Berry, M.

    2013-01-01

    This article focuses on the impact of the discount rate on cost-benefit assessment of investment options for residential building efficiency. An integrated thermal modeling, life cycle costing approach is applied to an extensive sample of dominant house designs for Australian conditions. The relative significance of predicted thermal performance and the applied discount rate on the Present Value of energy savings from alternative investment scenarios is investigated. Costs and benefits are also evaluated at the economy-wide scale, including carbon pricing considerations, and for a test-case household faced with alternative investment options at the point of construction. The influence of the applied discount rate on produced cost-benefit calculations is investigated, as is the interaction between critical cost-benefit input parameters. Findings support that the discounting framework is the primary driver of difference in estimates about costs and benefits of higher standards of efficiency in the residential sector. Results demonstrate that agreement on a low discount rate based on sustainability principals would prioritise those projects with significant environmental benefits. - Highlights: ► High thermal efficiency is a key strategy to limit energy use in buildings. ► Integrated thermal modeling—life-cycle costing methods are applied to dominant house designs. ► The discounting framework is the primary driver of difference in observed costs. ► The selection of optimal performance investment options depends on the discount rate. ► Application of a discount rate of 3.5% or lower favours energy saving projects

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

    Science.gov (United States)

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

    2006-03-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

  12. Healthcare resource use and costs of managing children and adults with lysosomal acid lipase deficiency at a tertiary referral centre in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Julian F Guest

    Full Text Available To estimate clinical progression and resource utilisation together with the associated costs of managing children and adults with LAL Deficiency, at a tertiary referral centre in the UK.A retrospective chart review was undertaken of patients in the UK with a confirmed diagnosis of LAL Deficiency who were managed at a LAL Deficiency tertiary referral treatment centre. Patients' pathways, treatment patterns, health outcomes and resource use were quantified over differing lengths of time for each patient enabling the NHS cost of patient management in tertiary care to be estimated.The study population comprised 19 patients of whom 58% were male. Mean age at the time of initial presentation was 15.5 years and the mean age at diagnosis was 18.0 years. 63%, 53% and 42% of patients had hepatomegaly, abnormal lipid storage and splenomegaly at a mean age of presentation of 17.8, 17.1 and 20.9 years, respectively. Over a period of 50 years there were a mean of 48.5 clinician visits and 3.4 hospital admissions per patient. The mean NHS cost of patient management at a LAL Deficiency tertiary referral treatment centre, spanning a period of over 50 years was £61,454 per patient.This study provides important insights into a number of aspects of the disease that are difficult to ascertain from published case reports. Additionally, it provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions pertaining to managing this ultra-orphan disease.

  13. Healthcare resource use and costs of managing children and adults with lysosomal acid lipase deficiency at a tertiary referral centre in the United Kingdom.

    Science.gov (United States)

    Guest, Julian F; Ingram, Andy; Ayoub, Nadia; Hendriksz, Christian J; Murphy, Elaine; Rahman, Yusof; McKiernan, Patrick; Mundy, Helen; Deegan, Patrick

    2018-01-01

    To estimate clinical progression and resource utilisation together with the associated costs of managing children and adults with LAL Deficiency, at a tertiary referral centre in the UK. A retrospective chart review was undertaken of patients in the UK with a confirmed diagnosis of LAL Deficiency who were managed at a LAL Deficiency tertiary referral treatment centre. Patients' pathways, treatment patterns, health outcomes and resource use were quantified over differing lengths of time for each patient enabling the NHS cost of patient management in tertiary care to be estimated. The study population comprised 19 patients of whom 58% were male. Mean age at the time of initial presentation was 15.5 years and the mean age at diagnosis was 18.0 years. 63%, 53% and 42% of patients had hepatomegaly, abnormal lipid storage and splenomegaly at a mean age of presentation of 17.8, 17.1 and 20.9 years, respectively. Over a period of 50 years there were a mean of 48.5 clinician visits and 3.4 hospital admissions per patient. The mean NHS cost of patient management at a LAL Deficiency tertiary referral treatment centre, spanning a period of over 50 years was £61,454 per patient. This study provides important insights into a number of aspects of the disease that are difficult to ascertain from published case reports. Additionally, it provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions pertaining to managing this ultra-orphan disease.

  14. Depression, quality of life, work productivity, resource use, and costs among women experiencing menopause and hot flashes: a cross-sectional study.

    Science.gov (United States)

    Dibonaventura, Marco Dacosta; Wagner, Jan-Samuel; Alvir, Jose; Whiteley, Jennifer

    2012-01-01

    To examine the effect of depression on health-related quality of life, work productivity, resource use, and costs among women experiencing menopausal symptoms, including hot flashes. The study included data from the 2005 US National Health and Wellness Survey (N = 41,184), a cross-sectional, Internet-based survey representative of the adult US population. Among women who reported experiencing menopausal symptoms, including hot flashes, women who reported experiencing depression in the last year (n = 1,165) were compared with women who did not report experiencing depression in the last year (n = 2,467), controlling for demographic and health characteristics. Outcome measures included health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey [SF-8]), work productivity within the past 7 days, self-reported health care resource use within the past 6 months, and indirect and direct costs. Women experiencing depression were significantly more likely to be white, to be unemployed, to be uninsured, to currently smoke, to not exercise, and to be obese (all P women experiencing depression reported significantly lower mental (39.66 vs 50.85, P work (5.31% vs 2.80%, P work (25.00% vs 14.32%, P women experiencing depression. The numbers of physician visits (2.47 vs 1.77, P women experiencing depression. Per woman per year indirect and direct costs were $3,066 and $1,075 higher, respectively, for women experiencing depression compared with those not experiencing depression. Approximately one-third of women experiencing menopausal symptoms, including hot flashes, also reported experiencing depression. These women reported significantly worse quality of life and significantly greater work productivity loss, health care resource use, and costs. Given the prevalence and burden, these findings suggest that proper assessment and management of depressive symptoms among women with menopause may have an important humanistic and economic benefit.

  15. Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma.

    Science.gov (United States)

    Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M

    2016-04-01

    The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P total health care costs and $2599 (95% CI, $1985-$3212; P total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

  16. Estimating the impact of enterprise resource planning project management decisions on post-implementation maintenance costs: a case study using simulation modelling

    Science.gov (United States)

    Fryling, Meg

    2010-11-01

    Organisations often make implementation decisions with little consideration for the maintenance phase of an enterprise resource planning (ERP) system, resulting in significant recurring maintenance costs. Poor cost estimations are likely related to the lack of an appropriate framework for enterprise-wide pre-packaged software maintenance, which requires an ongoing relationship with the software vendor (Markus, M.L., Tanis, C., and Fenema, P.C., 2000. Multisite ERP implementation. CACM, 43 (4), 42-46). The end result is that critical project decisions are made with little empirical data, resulting in substantial long-term cost impacts. The product of this research is a formal dynamic simulation model that enables theory testing, scenario exploration and policy analysis. The simulation model ERPMAINT1 was developed by combining and extending existing frameworks in several research domains, and by incorporating quantitative and qualitative case study data. The ERPMAINT1 model evaluates tradeoffs between different ERP project management decisions and their impact on post-implementation total cost of ownership (TCO). Through model simulations a variety of dynamic insights were revealed that could assist ERP project managers. Major findings from the simulation show that upfront investments in mentoring and system exposure translate to long-term cost savings. The findings also indicate that in addition to customisations, add-ons have a significant impact on TCO.

  17. Health care resource use and costs associated with possible side effects of high oral corticosteroid use in asthma: a claims-based analysis

    Directory of Open Access Journals (Sweden)

    Luskin AT

    2016-10-01

    Full Text Available Allan T Luskin,1 Evgeniya N Antonova,2 Michael S Broder,3 Eunice Y Chang,3 Theodore A Omachi,2 Dennis K Ledford4 1HealthyAirways, Madison, WI, 2Genentech, Inc., South San Francisco, 3Partnership for Health Analytic Research, LLC, Beverly Hills, CA, 4Division of Allergy and Immunology, Department of Medicine, James A. Haley Veterans’ Hospital, Morsani College of Medicine, University of South Florida, Tampa, FL, USA Background: The objective of this study was to estimate the prevalence of possible oral corticosteroid (OCS-related side effects and health care resource use and costs in patients with asthma.Methods: This was a cross-sectional, matched-cohort, retrospective study using a commercial claims database. Adults with asthma diagnosis codes and evidence of asthma medication use were studied. Patients with high OCS use (≥30 days of OCS annually were divided into those who did versus those who did not experience OCS-related possible side effects. Their health care resource use and costs were compared using linear regression or negative binomial regression models, adjusting for age, sex, geographic region, Charlson Comorbidity Index score, and chronic obstructive pulmonary disease status.Results: After adjustment, high OCS users with possible side effects were more likely to have office visits (23.0 vs 19.6; P<0.001 and hospitalizations (0.44 vs 0.22; P<0.001 than those without possible side effects. Emergency department visits were similar between the groups. High OCS users with possible side effects had higher adjusted total annual mean health care costs ($25,168 than those without such side effects ($21,882; P=0.009.Conclusion: Among high OCS users, patients with possible OCS-related side effects are more likely to use health care services than those without such side effects. Although OCS may help control asthma and manage exacerbations, OCS side effects may result in additional health care resource use and costs, highlighting the need

  18. Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: a systematic review.

    Science.gov (United States)

    Langton, Julia M; Blanch, Bianca; Drew, Anna K; Haas, Marion; Ingham, Jane M; Pearson, Sallie-Anne

    2014-12-01

    There has been an increase in observational studies using health administrative data to examine the nature, quality, and costs of care at life's end, particularly in cancer care. To synthesize retrospective observational studies on resource utilization and/or costs at the end of life in cancer patients. We also examine the methods and outcomes of studies assessing the quality of end-of-life care. A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) methodology. We searched MEDLINE, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Independent reviewers screened abstracts of 14,424 articles, and 835 full-text manuscripts were further reviewed. Inclusion criteria were English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life focus. We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 33 were published since 2008. We observed exponential increases in service use and costs as death approached; hospital services being the main cost driver. Palliative services were relatively underutilized and associated with lower expenditures than hospital-based care. The 15 studies using quality indicators demonstrated that up to 38% of patients receive chemotherapy or life-sustaining treatments in the last month of life and up to 66% do not receive hospice/palliative services. Observational studies using health administrative data have the potential to drive evidence-based palliative care practice and policy. Further development of quality care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations. © The Author(s) 2014.

  19. Costs and health resources utilization following switching to pregabalin in individuals with gabapentin-refractory neuropathic pain: a post hoc analysis.

    Science.gov (United States)

    Navarro, Ana; Saldaña, María T; Pérez, Concepción; Masramón, Xavier; Rejas, Javier

    2012-06-01

    To analyze the changes in pain severity and associated costs resulting from resource utilization and reduced productivity in patients with gabapentin-refractory peripheral neuropathic pain who switched to pregabalin therapy in primary care settings in Spain. This is a post hoc analysis of a 12-week, multicentre, noninterventional cost-of-illness study. Patients were included in the study if they were over 18 years of age and had a diagnosis of chronic, treatment-refractory peripheral neuropathic pain. The analysis included all pregabalin-naïve patients who had previously shown an inadequate response to gabapentin and switched to pregabalin. Severity of pain before and after treatment with pregabalin, alone or as an add-on therapy, was assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ) and its related visual analogue scale (VA). Healthcare resource utilization, productivity (including lost-workday equivalents [LWDE]), and related costs were assessed at baseline and after pregabalin treatment. A total of 174 patients switched to pregabalin had significant and clinically relevant reductions in pain severity (mean [SD] change on SF-MPQ VA scale, -31.9 [22.1]; P use [in pregabalin add-on group], ancillary tests, and unscheduled medical visits) were observed at the end of trial. Additionally, there were substantial improvements in productivity, including a reduction in the number of LWDE following pregabalin treatment (-18.9 [26.0]; P < 0.0001). These changes correlated with substantial reductions in both direct (-652.9 ± 1622.4 €; P < 0.0001) and indirect healthcare costs (-851.6 [1259.6] €; P < 0.0001). The cost of care in patients with gabapentin-refractory peripheral neuropathic pain appeared to be significantly reduced after switching to pregabalin treatment, alone or in combination with other analgesic drugs, in a real-life setting. © 2011 The Authors. Pain Practice © 2011 World Institute of Pain.

  20. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Science.gov (United States)

    Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

    2014-01-01

    Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

  1. Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

    Science.gov (United States)

    VanDeusen, Adam; Paintsil, Elijah; Agyarko-Poku, Thomas; Long, Elisa F

    2015-03-18

    Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.

  2. Impact of a preconception counseling program for teens with type 1 diabetes (READY-Girls) on patient-provider interaction, resource utilization, and cost.

    Science.gov (United States)

    Fischl, Andrea F Rodgers; Herman, William H; Sereika, Susan M; Hannan, Margaret; Becker, Dorothy; Mansfield, M Joan; Freytag, Linda L; Milaszewski, Kerry; Botscheller, Amanda N; Charron-Prochownik, Denise

    2010-04-01

    To evaluate the impact of a preconception counseling program tailored for teens with type 1 diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness. A total of 88 teens with type 1 diabetes from two sites were randomized into the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n = 43) or standard care (SC) (n = 45) groups. During three diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions, and behaviors regarding diabetes, pregnancy, sexuality, and preconception counseling. Assessments occurred at baseline, before and after viewing program materials, and at 9 months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis. Age range was 13.2-19.7 years (mean +/- SD 16.7 +/- 1.7 years); 6% (n = 5) were African American, and 24% (n = 21) were sexually active. Compared with baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of preconception counseling and reproductive health: increasing immediately after the first visit (P intention and initiation of preconception counseling and reproductive health discussions increased (P < 0.001). Costs of adverse reproductive outcomes are high. Direct medical costs of READY-Girls were low. READY-Girls was beneficial and effects were sustained for at least 9 months. This low-cost self-instructional program can potentially empower young women with type 1 diabetes to make well-informed reproductive health choices, adding little time burden or cost to their diabetes management.

  3. Carbon emission and mitigation cost comparisons between fossil fuel, nuclear and renewable energy resources for electricity generation

    International Nuclear Information System (INIS)

    Sims, R.E.H.; Rogner, H.-H.; Gregory, Ken

    2003-01-01

    A study was conducted to compare the electricity generation costs of a number of current commercial technologies with technologies expected to become commercially available within the coming decade or so. The amount of greenhouse gas emissions resulting per kWh of electricity generated were evaluated. A range of fossil fuel alternatives (with and without physical carbon sequestration), were compared with the baseline case of a pulverised coal, steam cycle power plant. Nuclear, hydro, wind, bioenergy and solar generating plants were also evaluated. The objectives were to assess the comparative costs of mitigation per tonne of carbon emissions avoided, and to estimate the total amount of carbon mitigation that could result from the global electricity sector by 2010 and 2020 as a result of fuel switching, carbon dioxide sequestration and the greater uptake of renewable energy. Most technologies showed potential to reduce both generating costs and carbon emission avoidance by 2020 with the exception of solar power and carbon dioxide sequestration. The global electricity industry has potential to reduce its carbon emissions by over 15% by 2020 together with cost saving benefits compared with existing generation

  4. Costs and resource utilization for diagnosis and treatment during the initial year in a European inflammatory bowel disease inception cohort

    DEFF Research Database (Denmark)

    Burisch, Johan; Vardi, Hillel; Pedersen, Natalia

    2015-01-01

    :: The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were...

  5. A randomised clinical trial of routine versus selective CT imaging in acute abdomen: Impact of patient age on treatment costs and hospital resource use

    Energy Technology Data Exchange (ETDEWEB)

    Lehtimäki, Tiina T., E-mail: tiina.lehtimaki@kuh.fi [Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210, Kuopio (Finland); Valtonen, Hannu, E-mail: hannu.valtonen@uef.fi [University of Eastern Finland, Department of Health and Social Management, Yliopistonranta 1, FI-70211 Kuopio (Finland); Miettinen, Pekka, E-mail: pekka.miettinen@satucon.fi [Department of Gastrointestinal Surgery, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210 Kuopio (Finland); Juvonen, Petri, E-mail: petri.juvonen@kuh.fi [Department of Gastrointestinal Surgery, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210 Kuopio (Finland); Paajanen, Hannu, E-mail: hannu.paajanen@kuh.fi [Department of Gastrointestinal Surgery, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210 Kuopio (Finland); University of Eastern Finland, Department of Clinical Medicine, Unit of Surgery, Yliopistonranta 1, FI-70211 Kuopio (Finland); Vanninen, Ritva, E-mail: ritva.vanninen@kuh.fi [Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, FI-70210, Kuopio (Finland); University of Eastern Finland, Department of Clinical Medicine, Unit of Radiology, Yliopistonranta 1, FI-70211 Kuopio (Finland)

    2017-02-15

    Objectives: To evaluate the impact of patient age on hospital resource use and treatment costs of acute abdominal pain (AAP). Materials and methods: A total of 300 adult patients with AAP were randomised to either computed tomography (CT, n = 150) or selective imaging practice (SIP, n = 150) groups. Final analysis included 254 patients, 143 (42 patients ≥65 years) in the CT and 111 (32 patients ≥65 years) in the SIP group. All CT group patients underwent abdominal CT whereas in the SIP group, imaging was based on the clinical assessment. For each patient, the hospital length of stay (LOS), the numbers and costs of diagnostic and treatment procedures arising from AAP were calculated and registered. The incremental cost-effectiveness ratio (ICER) and bootstrapped cost-effectiveness acceptability curve (CEAC) were estimated for routine CT. Results: Treatment costs, imaging costs and LOS increased in conjunction with aging in both study groups, and were generally higher in the CT group compared to the SIP group. In the SIP group, CT was undertaken in 34% (27/79) of the <65 year olds but in 59% (19/32) of the older patients (≥65 years) (p = 0.02). The proportion of patients with non-specific abdominal pain was significantly lower in patients ≥65 years than in their younger counterparts (p = 0.04). In the routine CT group, the ICER of obtaining a specific diagnosis was 1682 € for patients <65 years and 1055 € for patients ≥65 years. According to CEAC estimation, routine CT for every patient with AAP has a 95% probability of being cost-effective if society is willing to pay 14087 € for an additional specific diagnosis for patients <65 years but only 4204 € in those ≥65 years. Conclusion: Treatment costs of AAP increase in parallel with aging, and the costs are generally higher with routine CT compared to selective imaging. The probability of obtaining a specific diagnosis of AAP increases with aging. If obtaining a specific diagnosis is deemed crucial

  6. The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Emily P Hyle

    2014-09-01

    Full Text Available Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.We use a validated model of HIV testing, linkage, and treatment (CEPAC-International to examine two strategies of immunological staging in Mozambique: (1 laboratory-based CD4 testing (LAB-CD4 and (2 point-of-care CD4 testing (POC-CD4. Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs. Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%, probability of correctly detecting antiretroviral therapy (ART eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90% or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%, and test cost (LAB-CD4, US$10; POC-CD4, US$24. In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570 to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%, increasing to 65.0% (95% CI, 64.9%-65.1% with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y and US$2,440 (95% CI, US$2,440-US$2,450 and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y and US$2,800 (95% CI, US$2,790-US$2,800; the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS (95% CI, US$480-US$520/YLS. POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published

  7. Road crash costs.

    NARCIS (Netherlands)

    2010-01-01

    Road crashes result in all kinds of social costs, such as medical costs, production loss, human losses, property damage, settlement costs and costs due to congestion. Studies into road crash costs and their trends are carried out quite regularly. In 2009, the costs amounted to € 12.5 billion, or

  8. Update of the external cost for environmental damage (for Flanders) with regard to air pollution and climatic change; Actualisering van de externe milieuschadekosten (algemeen voor Vlaanderen) met betrekking tot luchtverontreiniging en klimaatverandering

    Energy Technology Data Exchange (ETDEWEB)

    De Nocker, L.; Michiels, H.; Deutsch, F.; Lefebvre, W.; Buekers, J.; Torfs, R. [Unit Ruimtelijke Milieuaspecten, VITO, Mol (Belgium)

    2010-12-15

    This report contains a set of indicators for calculating external costs of air-polluting substances and greenhouse gases. The external costs of environmental damage relate to the damage to human health, eco systems, buildings and economy as a result of an activity. This leads to loss of welfare for inhabitants in Flanders and abroad for the current and future generations. The magnitude and evolution of the external or environmental damage cost resulting from air pollution is one of the indicators for the MIRA report that translates the state of the environment into consequences for man and economy. [Dutch] Dit rapport bevat een set van kengetallen voor de berekening van de externe kosten van luchtverontreinigende stoffen en broeikasgassen. De externe kosten of milieuschadekosten hebben betrekking op de schade aan menselijke gezondheid, ecosystemen, gebouwen en economie als gevolg van een activiteit. Dit leidt tot een verlies aan welvaart voor inwoners in Vlaanderen en het buitenland, voor deze en toekomstige generaties. De omvang en evolutie van de externe of milieuschadekosten ten gevolge van luchtverontreiniging ia 1 van de indicatoren voor het MIRA rapport die de toestand van het milieu vertaalt naar gevolgen voor mens en economie.

  9. US/FRG joint report on the pebble bed high temperature reactor resource conservation potential and associated fuel cycle costs

    International Nuclear Information System (INIS)

    Teuchert, E.; Ruetten, H.J.; Worley, B.A.; Vondy, D.R.

    1979-11-01

    Independent analyses at ORNL and KFA have led to the general conclusion that the flexibility in design and operation of a high-temperature gas-cooled pebble-bed reactor (PBR) can result in favorable ore utilization and fuel costs in comparison with other reactor types, in particular, with light-water reactors (LWRs). Fuel reprocessign and recycle show considerable promise for reducing ore consumption, and even the PBR throwaway cycle is competitive with fuel recycle in an LWR. The best performance results from the use of highly enriched fuel. Proliferation-resistant measures can be taken using medium-enriched fuel at a modest ore penalty, while use of low-enriched fuel would incur further ore penalty. Breeding is possible but net generation of fuel at a significant rate would be expensive, becoming more feasible as ore costs increase substantially. The 233 U inventory for a breeder could be produced by prebreeders using 235 U fuel

  10. On cost-informed pricing and customer value: a resource-advantage perspective on industrial innovation pricing practices

    OpenAIRE

    Ingenbleek, Paul; Debruyne, Marion; Frambach, Ruud T.

    2001-01-01

    By empirically testing a framework of pricing strategies and their determinants in an industrial setting, Noble and Gruca (1999a) help to overcome the lack of empirical validation of pricing theory. In a commentary to the article, Cressman (1999) (1) expresses worries about the high percentage of firms that engages in cost-based pricing; (2) raises a definition question on value-based pricing; and (3) stresses that empirical pricing literature does not provide ideas on successful pricing prac...

  11. Costs associated with workdays lost and utilization of health care resources because of asthma in daily clinical practice in Spain.

    Science.gov (United States)

    Ojeda, P; Sanz de Burgoa, V

    2013-01-01

    Asthma is associated with high indirect costs due to lower work productivity and higher absenteeism and presenteeism. To study loss of productivity measured using the lost workday equivalent (LWDE) index and health care utilization in asthmatics depending on age, geographical location, time period, severity, and level of asthma control. In this cross-sectional, observational, epidemiological multicenter study, 120 allergists nationwide were asked to select asthmatic patients aged 18 to 65 years who were evenly distributed according to the 4 levels of asthma severity (Global Initiative on Asthma) during 3 different seasons. The participants collected sociodemographic data, spirometry values, Asthma Control Test (ACT) score, health care utilization data, perceived stress according to the Impact on Work Productivity Index (IMPALA, indice del Impacto de la Enfermedad en la Productividad Laboral), and score on the Sheehan disability scale. The LWDE index was used to measure the number of workdays lost and the number of workdays with asthma symptoms combined with the percentage for average performance at work. The study sample comprised 1098 patients (58.7% females; 48.5% aged 18-40 and 51.5% aged 41-65). According to the ACT score, disease was uncontrolled in 57.6% of patients, well controlled in 32.8%, and totally controlled in 9.6%. The mean cost due to workdays lost was Euro 285.81/patient/mo (95% CI, Euro 252.71-318.92). Indirect costs were significantly higher in older patients (41-65 years, Euro 405.08; 95% CI, 348.97-461.19), patients with more severe disease (Euro 698.95; 95% CI, 588.63-809.27), and patients with more poorly controlled asthma (Euro 466.86; 95% CI, Euro 414.39-519.33). The average cost of health care units per patient for each 3-month period was Euro1317.30 (95% CI, Euro 1151.34-Euro 1483.26). Indirect costs were significantly higher in older patients (Euro 2104.00 in patients aged 18-40 vs Euro 3301.55 in patients aged 41-65), in northern and

  12. A comparison of methods to handle skew distributed cost variables in the analysis of the resource consumption in schizophrenia treatment.

    Science.gov (United States)

    Kilian, Reinhold; Matschinger, Herbert; Löeffler, Walter; Roick, Christiane; Angermeyer, Matthias C

    2002-03-01

    Transformation of the dependent cost variable is often used to solve the problems of heteroscedasticity and skewness in linear ordinary least square regression of health service cost data. However, transformation may cause difficulties in the interpretation of regression coefficients and the retransformation of predicted values. The study compares the advantages and disadvantages of different methods to estimate regression based cost functions using data on the annual costs of schizophrenia treatment. Annual costs of psychiatric service use and clinical and socio-demographic characteristics of the patients were assessed for a sample of 254 patients with a diagnosis of schizophrenia (ICD-10 F 20.0) living in Leipzig. The clinical characteristics of the participants were assessed by means of the BPRS 4.0, the GAF, and the CAN for service needs. Quality of life was measured by WHOQOL-BREF. A linear OLS regression model with non-parametric standard errors, a log-transformed OLS model and a generalized linear model with a log-link and a gamma distribution were used to estimate service costs. For the estimation of robust non-parametric standard errors, the variance estimator by White and a bootstrap estimator based on 2000 replications were employed. Models were evaluated by the comparison of the R2 and the root mean squared error (RMSE). RMSE of the log-transformed OLS model was computed with three different methods of bias-correction. The 95% confidence intervals for the differences between the RMSE were computed by means of bootstrapping. A split-sample-cross-validation procedure was used to forecast the costs for the one half of the sample on the basis of a regression equation computed for the other half of the sample. All three methods showed significant positive influences of psychiatric symptoms and met psychiatric service needs on service costs. Only the log- transformed OLS model showed a significant negative impact of age, and only the GLM shows a significant

  13. A hand-powered, portable, low-cost centrifuge for diagnosing anemia in low-resource settings.

    Science.gov (United States)

    Brown, Jocelyn; Theis, Lauren; Kerr, Lila; Zakhidova, Nazima; O'Connor, Kelly; Uthman, Margaret; Oden, Z Maria; Richards-Kortum, Rebecca

    2011-08-01

    This report describes the development of a hand-powered centrifuge to determine hematocrit values in low-resource settings. A hand-powered centrifuge was constructed by using a salad spinner. Hematocrit values were measured by using the hand-powered device, and results were compared with those of a benchtop centrifuge. The packed cell volume (PCV) measured with the hand-powered device correlated linearly with results obtained with a benchtop centrifuge (r = 0.986, P centrifuge were consistently 1.14 times higher than those measured with the benchtop system. The 14% increase in PCV measured with the hand-powered centrifuge is caused by increased plasma trapped in the cell column. The reader card was adjusted to compensate for trapped plasma. A hand-powered centrifuge and calibrated reader card can be constructed for U.S. $35 and can accurately determine hematocrit values. It is suitable for use in low-resource settings because it is mechanically-powered, inexpensive, and accurate.

  14. Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

    Science.gov (United States)

    Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

    2017-12-01

    Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

  15. Melt-and-mold fabrication (MnM-Fab) of reconfigurable low-cost devices for use in resource-limited settings.

    Science.gov (United States)

    Li, Zhi; Tevis, Ian D; Oyola-Reynoso, Stephanie; Newcomb, Lucas B; Halbertsma-Black, Julian; Bloch, Jean-Francis; Thuo, Martin

    2015-12-01

    Interest in low-cost analytical devices (especially for diagnostics) has recently increased; however, concomitant translation to the field has been slow, in part due to personnel and supply-chain challenges in resource-limited settings. Overcoming some of these challenges require the development of a method that takes advantage of locally available resources and/or skills. We report a Melt-and-mold fabrication (MnM Fab) approach to low-cost and simple devices that has the potential to be adapted locally since it requires a single material that is recyclable and simple skills to access multiple devices. We demonstrated this potential by fabricating entry level bio-analytical devices using an affordable low-melting metal alloy, Field's metal, with molds produced from known materials such as plastic (acrylonitrile-butadiene-styrene (ABS)), glass, and paper. We fabricated optical gratings then 4×4 well plates using the same recycled piece of metal. We then reconfigured the well plates into rapid prototype microfluidic devices with which we demonstrated laminar flow, droplet generation, and bubble formation from T-shaped channels. We conclude that this MnM-Fab method is capable of addressing some challenges typically encountered with device translation, such as technical know-how or material supply, and that it can be applied to other devices, as needed in the field, using a single moldable material. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Uso de recursos y costos asociados a las fracturas en mujeres españolas Use of resources and costs associated to fractures in spanish women

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2012-09-01

    Full Text Available El objetivo del estudio fue determinar el uso de recursos y costos debidos a fracturas óseas en mujeres españolas mayores de 50 años en un ámbito poblacional. Se realizó un estudio observacional y retrospectivo, en seis centros de atención primaria y dos hospitales urbanos de España. Se registró datos sociodemográficos, de comorbilidad, uso de recursos (consultas médicas en atención primaria, pruebas complementarias, medicación, atención especializada, hospitalizaciones, visitas, urgencias, costos y pérdida de productividad. Se incluyeron los registros de 19 022 mujeres de los cuales el 7% presentó algún tipo de fractura entre el 2003 y 2007. Las fracturas se asociaron mayoritariamente con osteoporosis (OR: 3,2, fibromialgia (OR: 2,4 y alteraciones tiroideas (OR: 2,2. En el modelo corregido, el costo total para las pacientes que tuvieron fractura fue de USD 3727 mientras que en las que no la tuvieron fue USD 2705,5 (pThe objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies, costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2, fibromyalgia (OR: 2.4 and thyroid changes (OR: 2.2. In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p<0.001 for those who did not have it. Patients with a fracture generate a greater use of resources, sanitation costs and work productivity losses

  17. Domestic Resources Cost Analysis of Small-Scale Beef Cattle Farming at Upstream Area of Benain-Noelmina Watershed, West Timor, East Nusa Tenggara

    Directory of Open Access Journals (Sweden)

    Nalle Agus Arnold

    2017-02-01

    Full Text Available The study aims to evaluate the Domestic Resources Cost (DRC of beef cattle raised either on grazing, or a tethering system of small-scale beef cattle farming. The study was done using a survey method. A total of 120 respondents were selected purposively to consist of 60 farmers applying the grazing system and another 60 farmers applying the tethering system. The parameters measured were socio-economic characteristic, Domestic Resources Cost Ratio (DRCR and Private Cost Ratio (PCR. Data were analyzed by applying a method of Policy Analysis Matrix (PAM. The result of the study indicated that 87% of those farmers involved in the grazing system and 85% of those involved in tethered beef cattle production, were within the productive age range. In the grazing system, the cattle farmers upstream of Benain-Noelmina watershed area gain the private and social profit levels which is IDR 406,284,-/AU/year and IDR 688,388,-/AU/year, respectively. Further, in the tethering system, the average of private and social profit gain is IDR 855,222,-/AU/year and IDR 1,385,712,-/AU/year, respectively. The small-scale beef cattle farming upstream of Benain-Noelmina watershed has competitive and comparative advantages, indicated by the value of PCR and DRCR which are less than 1. The PCR value was 0.41 in the grazing system and 0.71 on the tethering system; hence, the DRCR of the grazing system was 0.29 and 0.60 of the tethering system.

  18. Impact of Paliperidone Palmitate Versus Oral Atypical Antipsychotics on Health Care Resource Use and Costs in Veterans With Schizophrenia and Comorbid Substance Abuse.

    Science.gov (United States)

    Lefebvre, Patrick; Muser, Erik; Joshi, Kruti; DerSarkissian, Maral; Bhak, Rachel H; Duh, Mei Sheng; Shiner, Brian; Young-Xu, Yinong

    2017-07-01

    Almost half of all patients diagnosed with schizophrenia have a history of substance abuse (SA). However, data on treatment of schizophrenia with paliperidone palmitate (PP) among patients with comorbid SA are limited. The objective of this study was to compare all-cause and SA-related health care resource utilization and costs in veterans with schizophrenia and co-occurring SA who were treated with PP versus oral atypical antipsychotics (OAAs). Veterans Health Administration electronic health record data were used to conduct a retrospective longitudinal study in veterans with schizophrenia who initiated PP or OAA between January 1, 2010 and June 30, 2016, had ≥12 months of enrollment before treatment initiation (baseline), were diagnosed with SA, and had ≥1 Global Assessment of Functioning score during baseline. Differences in baseline characteristics were adjusted for using inverse probability of treatment weighting. Adjusted cost differences and incidence rate ratios (IRR) for the association between PP versus OAA and all-cause and SA-related health care costs and health care resource utilization in the 12 months after treatment initiation were estimated with corresponding 95% CIs using weighted linear and Poisson regression models, respectively. Of 6872 veterans in the study, 1684 (25%) and 5188 (75%) were treated with PP and OAA, respectively. After adjustment, PP was associated with fewer all-cause inpatient (IRR = 0.88; 95% CI, 0.85 to 0.90), mental health-related inpatient (IRR = 0.88; 95% CI, 0.85 to 0.91), and long-term care stays (IRR = 0.53; 95% CI, 0.44 to 0.64), but more frequent mental health intensive case management visits (IRR = 1.51; 95% CI, 1.49 to 1.53) compared with OAA (all P schizophrenia and comorbid SA. Thus, PP appears to be a valuable treatment option for patients in this subpopulation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  19. The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings

    Directory of Open Access Journals (Sweden)

    Hernandez-Barrera Valentín

    2010-02-01

    Full Text Available Abstract Background To evaluate the influence of heart disease on clinical characteristics, quality of life, use of health resources, and costs of patients with COPD followed at primary care settings under common clinical practice conditions. Methods Epidemiologic, observational, and descriptive study (EPIDEPOC study. Patients ≥ 40 years of age with stable COPD attending primary care settings were included. Demographic, clinical characteristics, quality of life (SF-12, seriousness of the disease, and treatment data were collected. Results were compared between patients with or without associated heart disease. Results A total of 9,390 patients with COPD were examined of whom 1,770 (18.8% had heart disease and 78% were males. When comparing both patient groups, significant differences were found in the socio-demographic characteristics, health profile, comorbidities, and severity of the airway obstruction, which was greater in patients with heart disease. Differences were also found in both components of quality of life, physical and mental, with lower scores among those patients with heart disease. Higher frequency of primary care and pneumologist visits, emergency-room visits and number of hospital admissions were observed among patients with heart diseases. The annual total cost per patient was significantly higher in patients with heart disease; 2,937 ± 2,957 vs. 1,749 ± 2,120, p Conclusion Patients with COPD plus heart disease had greater disease severity and worse quality of life, used more healthcare resources and were associated with greater costs compared to COPD patients without known hearth disease.

  20. Health care resource utilization and medical costs of spinal cord injury with neuropathic pain in a commercially insured population in the United States.

    Science.gov (United States)

    Margolis, Jay M; Juneau, Paul; Sadosky, Alesia; Cappelleri, Joseph C; Bryce, Thomas N; Nieshoff, Edward C

    2014-12-01

    To evaluate health care resource use, costs, and cost drivers among patients with neuropathic pain (NeP) after spinal cord injury (SCI) in a commercially insured population. Retrospective longitudinal cohort study comparing SCI patients with and without NeP. Truven Health MarketScan commercial claims database from 2005 through 2012. Commercially insured SCI patients with NeP (n=3524) propensity score matched to SCI patients without NeP (n=3524). Not applicable. Health care resource utilization and expenditures for the 12 months after NeP onset (index event; identified through International Classification of Diseases, 9th Revision, Clinical Modification diagnosis 338.0x or use of NeP-specific antiepileptic drugs or NeP-specific antidepressants) in patients with SCI compared with matched patients without NeP. Utilization over 12 months postindex among patients with SCI-associated NeP was higher than among SCI-only patients for inpatient admissions (27.4% vs 22.1%), emergency department visits (36.7% vs 26.4%), and office visits per patient (mean ± SD: 13.0±9.5 vs 9.5±8.3); all P values were patient with SCI-associated NeP during the 12-month postindex period. Patients with evidence of NeP secondary to SCI have significantly higher health care utilization and total costs compared with SCI patients without evidence of NeP. Factors contributing to NeP in patients with SCI need to be clinically assessed to determine the optimal approach for treating these individuals. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Coal transportation road damage

    International Nuclear Information System (INIS)

    Burtraw, D.; Harrison, K.; Pawlowski, J.A.

    1994-01-01

    Heavy trucks are primarily responsible for pavement damage to the nation's highways. In this paper we evaluate the pavement damage caused by coal trucks. We analyze the chief source of pavement damage (vehicle weight per axle, not total vehicle weight) and the chief cost involved (the periodic overlay that is required when a road's surface becomes worn). This analysis is presented in two stages. In the first section we present a synopsis of current economic theory including simple versions of the formulas that can be: used to calculate costs of pavement wear. In the second section we apply this theory to a specific example proximate to the reference environment for the Fuel Cycle Study in New Mexico in order to provide a numerical measure of the magnitude of the costs

  2. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-02-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

  3. Use of healthcare resources and costs associated to the start of treatment with injectable drugs in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Morano, Raúl; Ruíz, Lucía

    2016-12-01

    The main objective was to assess resource use and costs of starting treatment with insulin or injectable GLP-1 receptor analogues (GLP-1 RAs) in a Spanish population of patients with type 2 diabetes mellitus. Treatment adherence and persistence were also determined for both treatment groups. A retrospective, non-interventional, observational study was conducted. Patients aged ≥20 years who started treatment with insulin or GLP-1 RAs in the 2010-2012 period were recruited. Use of healthcare resources was estimated to evaluate healthcare costs in these two groups of patients (medical visits, hospital stay, emergency visits, diagnostic or treatment requests, medication). Clinical information including body mass index (BMI, kg/m 2 ), metabolic control (HbA1c), adherence, persistence, and complications (hypoglycemia, and cardiovascular events (CVE) was collected. The follow-up period was 12 months. Only direct healthcare costs were considered. A total of 1301 patients with a mean age of 67.6 years (51.6% males) were recruited. Of these, 71.9% and 28.1% were on treatment with insulin and GLP-1 RA respectively. After one year of follow-up, patients treated with GLP-1 RAs were found less visits to primary care (8 vs. 11; P<.001) and specialized care (1.0 vs. 1.8; P<.001), hospital stays (0.3 vs. 0.7; P=.030) and less visits to the emergency room (0.8 vs. 1.6; P<.001). Patients treated with GLP-1 showed greater adherence (88.1% vs. 82.7%; P<.001) and persistence (62.0% vs. 55.9%; P=.046), and had less hypoglycemia episodes (13.4% vs. 18.7%; P=.022), with similar metabolic control (HbA1c: 7.2% vs. 7.4%; P=.049), BMI (29.1 vs. 30.9kg/m 2 ), and CVE rate (9.1% vs. 11.5%; P=.330) respectively. The mean corrected direct healthcare cost per patient was €1787 vs. €2005 (P=.046.) CONCLUSIONS: Patients treated with GLP-1 RAs caused lower direct healthcare costs for the National Health System than patients treated with insulin. The results may be explained by greater treatment

  4. Effect of water availability on tolerance of leaf damage in tall morning glory, Ipomoea purpurea

    Science.gov (United States)

    Atala, Cristian; Gianoli, Ernesto

    2009-03-01

    Resource availability may limit plant tolerance of herbivory. To predict the effect of differential resource availability on plant tolerance, the limiting resource model (LRM) considers which resource limits plant fitness and which resource is mostly affected by herbivore damage. We tested the effect of experimental drought on tolerance of leaf damage in Ipomoea purpurea, which is naturally exposed to both leaf damage and summer drought. To seek mechanistic explanations, we also measured several morphological, allocation and gas exchange traits. In this case, LRM predicts that tolerance would be the same in both water treatments. Plants were assigned to a combination of two water treatments (control and low water) and two damage treatments (50% defoliation and undamaged). Plants showed tolerance of leaf damage, i.e., a similar number of fruits were produced by damaged and undamaged plants, only in control water. Whereas experimental drought affected all plant traits, leaf damage caused plants to show a greater leaf trichome density and reduced shoot biomass, but only in low water. It is suggested that the reduced fitness (number of fruits) of damaged plants in low water was mediated by the differential reduction of shoot biomass, because the number of fruits per shoot biomass was similar in damaged and undamaged plants. Alternative but less likely explanations include the opposing direction of functional responses to drought and defoliation, and resource costs of the damage-induced leaf trichome density. Our results somewhat challenge the LRM predictions, but further research including field experiments is needed to validate some of the preliminary conclusions drawn.

  5. An application of cost-effectiveness analysis to restrict the damage caused by an accidental release of radioactive material to the environment

    International Nuclear Information System (INIS)

    Frittelli, L.; Tamburrano, A.

    1980-01-01

    When an accidental release of radioactive material occurs health effects in the exposed population can be mitigated by remedial actions applied to individuals or their environment. A cost-effectiveness analysis is performed by comparing the cost of remedial action with the monetary value of the collective dose avoided. (H.K.)

  6. Are wildfire management resources in the United States efficiently allocated to protect resources at risk? A case study from Montana

    Science.gov (United States)

    Derek T. O' Donnell; Tyron J. Venna; David E. Calkin

    2014-01-01

    Federal wildfire management agencies in the United States are under substantial pressure to reduce and economically justify their expenditures. To support economically efficient management of wildfires, managers need better estimates of the resource benefits and avoided damage costs associated with alternative wildfire management strategies. This paper reports findings...

  7. Evaluation of costs and benefits of mammography screening for breast cancer in the context of French resources

    International Nuclear Information System (INIS)

    Bouhnik, H.; Renaud-Salis, J.L.; Maccia, C.

    1987-01-01

    Breast cancer is one of the major causes of mortality among American and European adult women. In the last two decades the probability for a woman of developing breast cancer in one's lifetime has changed from 1 in 20 to 1 in 11. The overall ten years survival is no more than 50% and the death rate from breast cancer has been stationary for the last 40 years. According to the available data from some regional tumor registries the annual incidence of breast cancer in France is about 0.8%. Approximately 25,000 new cases of breast cancer are annually diagnosed among the 12 000 000 French women above 40 years old. About 9,000 of them will die of the disease. This represents about 20% of the deaths from cancers, and 4% of deaths from all causes among women. The overall five years survival rate is approximately 60% for white females. However, if breast cancer is diagnosed and treated while localized, the five years survival is greater than 85% for women without nodal involvement while it drops to 47% when nodes are involved. Moreover, while the standard treatment of breast tumors more than 3 cm involves at least a simple mastectomy, a more conservative approach is increasingly accepted as a safe solution for tumors less than 3 cm in size. The Rational behind Breast Cancer Screening (BSC) is that early detection provides the chance to treat patients at a time when the treatment is more likely to be effective in reducing morbidity, mortality or both. The only diagnostic test whose effectiveness for early detection of breast cancer has been proven is mammography. However, this radiologic test involves risks and costs that have led to considerable controversies concerning its overall efficacy and safety. We shall present in this paper the current evidences and assumptions about the effectiveness, the costs, and the benefits of mammography as a breast cancer screening test. We shall focus in the last section on the feasibility of such a program in France taking into account

  8. Resource cost results for one-way entanglement distillation and state merging of compound and arbitrarily varying quantum sources

    International Nuclear Information System (INIS)

    Boche, H.; Janßen, G.

    2014-01-01

    We consider one-way quantum state merging and entanglement distillation under compound and arbitrarily varying source models. Regarding quantum compound sources, where the source is memoryless, but the source state an unknown member of a certain set of density matrices, we continue investigations begun in the work of Bjelaković et al. [“Universal quantum state merging,” J. Math. Phys. 54, 032204 (2013)] and determine the classical as well as entanglement cost of state merging. We further investigate quantum state merging and entanglement distillation protocols for arbitrarily varying quantum sources (AVQS). In the AVQS model, the source state is assumed to vary in an arbitrary manner for each source output due to environmental fluctuations or adversarial manipulation. We determine the one-way entanglement distillation capacity for AVQS, where we invoke the famous robustification and elimination techniques introduced by Ahlswede. Regarding quantum state merging for AVQS we show by example that the robustification and elimination based approach generally leads to suboptimal entanglement as well as classical communication rates

  9. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Krasa, Holly; Oberdhan, Dorothee; Chapman, Arlene; Perrone, Ronald D

    2015-01-01

    Background Autosomal dominant polycystic kidney disease (ADPKD) results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD) leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU) and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13). ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years) and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860), dialysis (n=586), and post-transplant (n=615). Mean ages did not differ across CKD stages (range 43–56 years). Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant). The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons). Conclusion ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. PMID:25759590

  10. Resource use and costs for a glaucoma screening program in Austria: an 8-year review: a cost-consequence analysis based on the Salzburg-Moorfields Collaborative Glaucoma Study.

    Science.gov (United States)

    Hitzl, W; Ortner, C; Hornykewycz, K; Grabner, G; Reitsamer, H A

    2006-01-01

    The aim of this study is to report costs, detection rates, and resources needed for detection of primary open angle glaucoma and related diseases in a glaucoma screening program in Salzburg, Austria, over a period of 8 years. The Salzburg-Moorfields Collaborative Glaucoma Study performed a complete ophthalmologic examination on a total of 4864 subjects within a study period of approximately 8 years (98 months). The total numbers reported are total number of subjects screened at the initial examination and follow-up examinations; total working hours and estimated working hours per visit for one ophthalmologist and two medical assistants; direct costs per visit; detection rates for subjects; and corresponding costs per true positive case diagnosed with definite primary open angle glaucoma (POAG), early POAG, POAG suspect, ocular hypertension (OHT), and glaucoma artefact. Within the screening period of 98 months, a total of 9427 examinations and second verification checks were performed: 5466 at the initial examination, 404 at the 1-year follow-up, 815 at the 2-year follow-up, 339 at the 3-year follow-up, 225 at the 4-year follow-up, 1059 at the 5-year follow-up, 996 at the 6-year follow-up, 118 at the 7-year follow-up, and 5 at the 8-year follow-up. The total amount of time spent for screening was 23,814 working hours. We estimate the costs per visit at EUR 123 for each initial examination, EUR 28 for each second confirmation check, and EUR 95 per follow-up examination. The following detection rates were observed: definite POAG: 1.7% (95% CI: 1.3-2.2%), early POAG: 2.9% (95% CI: 2.3-3.5%), POAG suspect: 8.5% (95% CI: 7.6-9.4%), OHT: 2.2% (95% CI: 1.7-2.7%), glaucoma artefact or other causes: 5.8% (95% CI: 5.1-6.6%), normal cases: 79% (95% CI: 78-80%). Direct costs per visit were considerably higher than those reported in the Netherlands or the United Kingdom. If a health care provider decides to perform a glaucoma screening within this setting, the costs for the

  11. Severity of Acute Kidney Injury in the Post-Lung Transplant Patient Is Associated With Higher Healthcare Resources and Cost.

    Science.gov (United States)

    Nguyen, Albert P; Gabriel, Rodney A; Golts, Eugene; Kistler, Erik B; Schmidt, Ulrich

    2017-08-01

    Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated. Retrospective. University hospital. Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015. The incidences of AKI and ARF, as defined using the Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria, were measured. Perioperative events were analyzed to identify risk factors for renal compromise. A comparison of ventilator days, intensive care unit (ICU) and hospital lengths of stay (LOS), 1-year readmissions, and emergency department visits was performed among AKI, ARF, and uninjured patients. Ninety-seven patients underwent lung transplantation; 22 patients developed AKI and 35 patients developed ARF. Patients with ARF had significantly longer ICU LOS (12 days v 4 days, p < 0.001); ventilator days (4.5 days v 1 day, p < 0.001); and hospital LOS (22.5 days v 14 days, p < 0.001) compared with uninjured patients. Patients with AKI also had significantly longer ICU and hospital LOS. Patients with ARF had significantly more emergency department visits and hospital readmissions (2 v 1 readmissions, p = 0.002) compared with uninjured patients. A univariable analysis suggested that prolonged surgical time, intraoperative vasopressor use, and cardiopulmonary bypass use were associated with the highest increased risk for AKI. Intraoperative vasopressor use and cardiopulmonary bypass mean arterial pressure <60 mmHg were identified as independent risk factors by multivariable analysis for AKI. The severity of AKI was associated with an increase in the use of healthcare resources after surgery and discharge. Certain risk factors appeared modifiable and may reduce the incidence of AKI and ARF. Copyright © 2017. Published by Elsevier Inc.

  12. 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.

  13. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Directory of Open Access Journals (Sweden)

    Knight T

    2015-02-01

    Full Text Available Tyler Knight,1 Caroline Schaefer,1 Holly Krasa,2 Dorothee Oberdhan,2 Arlene Chapman,3 Ronald D Perrone4 1Covance Market Access Services Inc., Gaithersburg, MD, 2Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD, 3Emory University, Atlanta, GA, 4Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA Background: Autosomal dominant polycystic kidney disease (ADPKD results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods: This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13. ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results: The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860, dialysis (n=586, and post-transplant (n=615. Mean ages did not differ across CKD stages (range 43–56 years. Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant. The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons. Conclusion: ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system

  14. Valuation of ecological resources

    Energy Technology Data Exchange (ETDEWEB)

    Scott, M.J.; Bilyard, G.R.; Link, S.O.; Ricci, P.F.; Seely, H.E.; Ulibarri, C.A.; Westerdahl, H.E.

    1995-04-01

    Ecological resources are resources that have functional value to ecosystems. Frequently, these functions are overlooked in terms of the value they provide to humans. Environmental economics is in search of an appropriate analysis framework for such resources. In such a framework, it is essential to distinguish between two related subsets of information: (1) ecological processes that have intrinsic value to natural ecosystems; and (2) ecological functions that are values by humans. The present study addresses these concerns by identifying a habitat that is being displaced by development, and by measuring the human and ecological values associated with the ecological resources in that habitat. It is also essential to determine which functions are mutually exclusive and which are, in effect, complementary or products of joint production. The authors apply several resource valuation tools, including contingent valuation methodology (CVM), travel cost methodology (TCM), and hedonic damage-pricing (HDP). One way to derive upper-limit values for more difficult-to-value functions is through the use of human analogs, because human-engineered systems are relatively inefficient at supplying the desired services when compared with natural systems. Where data on the relative efficiencies of natural systems and human analogs exist, it is possible to adjust the costs of providing the human analog by the relative efficiency of the natural system to obtain a more realistic value of the function under consideration. The authors demonstrate this approach in an environmental economic case study of the environmental services rendered by shrub-steppe habitats of Benton County, Washington State.

  15. Contribution of insurance data to cost assessment of coastal flood damage to residential buildings: insights gained from Johanna (2008) and Xynthia (2010) storm events

    OpenAIRE

    C. André; D. Monfort; M. Bouzit; C. Vinchon

    2013-01-01

    There are a number of methodological issues involved in assessing damage caused by natural hazards. The first is the lack of data, due to the rarity of events and the widely different circumstances in which they occur. Thus, historical data, albeit scarce, should not be neglected when seeking to build ex-ante risk management models. This article analyses the input of insurance data for two recent severe coastal storm events, to examine what causal relationships may exist bet...

  16. Australian uranium resources

    International Nuclear Information System (INIS)

    Battey, G.C.; Miezitis, Y.; McKay, A.D.

    1987-01-01

    Australia's uranium resources amount to 29% of the WOCA countries (world outside centrally-planned-economies areas) low-cost Reasonably Assured Resources and 28% of the WOCA countries low-cost Estimated Additional Resources. As at 1 January 1986, the Bureau of Mineral Resources estimated Australia's uranium resources as: (1) Cost range to US$80/kg U -Reasonably Assured Resources, 465 000 t U; Estimated Additional Resources, 256 000 t U; (2) Cost range US$80-130/kg U -Reasonably Assured Resources, 56 000 t U; Estimated Additional Resources, 127 000 t U. Most resources are contained in Proterozoic unconformity-related deposits in the Alligator Rivers uranium field in the Northern Territory (Jabiluka, Ranger, Koongarra, Nabarlek deposits) and the Proterozoic stratabound deposit at Olympic Dam on the Stuart Shelf in South Australia

  17. Utility of the heteroduplex assay (HDA) as a simple and cost-effective tool for the identification of HIV type 1 dual infections in resource-limited settings.

    Science.gov (United States)

    Powell, Rebecca L R; Urbanski, Mateusz M; Burda, Sherri; Nanfack, Aubin; Kinge, Thompson; Nyambi, Phillipe N

    2008-01-01

    The predominance of unique recombinant forms (URFs) of HIV-1 in Cameroon suggests that dual infection, the concomitant or sequential infection with genetically distinct HIV-1 strains, occurs frequently in this region; yet, identifying dual infection among large HIV cohorts in local, resource-limited settings is uncommon, since this generally relies on labor-intensive and costly sequencing methods. Consequently, there is a need to develop an effective, cost-efficient method appropriate to the developing world to identify these infections. In the present study, the heteroduplex assay (HDA) was used to verify dual or single infection status, as shown by traditional sequence analysis, for 15 longitudinally sampled study subjects from Cameroon. Heteroduplex formation, indicative of a dual infection, was identified for all five study subjects shown by sequence analysis to be dually infected. Conversely, heteroduplex formation was not detectable for all 10 HDA reactions of the singly infected study subjects. These results suggest that the HDA is a simple yet powerful and inexpensive tool for the detection of both intersubtype and intrasubtype dual infections, and that the HDA harbors significant potential for reliable, high-throughput screening for dual infection. As these infections and the recombinants they generate facilitate leaps in HIV-1 evolution, and may present major challenges for treatment and vaccine design, this assay will be critical for monitoring the continuing pandemic in regions of the world where HIV-1 viral diversity is broad.

  18. Resources and Costs Associated with the Treatment of Advanced and Metastatic Gastric Cancer in the Mexican Public Sector: A Patient Chart Review.

    Science.gov (United States)

    Quintana, Miguel; Toriz, José A; Novick, Diego; Jones, Kyla; Botello, Brenda S; Silva, Juan Alejandro

    2017-07-31

    Little evidence is available on the management and cost of treating patients with advanced or metastatic gastric cancer (GC). This study evaluates patient characteristics, treatment patterns, and resource utilization for these patients in Mexico. Data were collected from three centers of investigation (tertiary level). Patients were ≥18 years of age, diagnosed between 1 January 2009 and 1 January 2015, had advanced or metastatic GC, received first-line fluoropyrimidine/platinum, and had ≥3 months follow-up after discontinuing first-line treatment. Data were summarized using descriptive statistics. The study sample totaled 180. Patients' mean age was 57.2 years (±12.4) and 57.0% were male; 151 (83.9%) patients received second-line chemotherapy. A total of 16 and 19 regimens were identified in first- and second-line therapy. Of the sample, 51 (28.3%) received third-line therapy, and <10% received more than three lines of active chemotherapy. Supportive care received in first- and second-line chemotherapy, included pain interventions (12.2 and 7.9%), nutritional support (3.3 and 1.3%), radiotherapy (6.1 and 16.6%), and transfusions (13.3 and 10.6%), respectively. Using Mexican Institute of Social Security (IMSS) tariffs, the average total cost per patient-month in first- and second-line therapy was US$1230 [95% confidence interval (CI) 1034-1425] and US$1192 (95% CI 913-1471), respectively. Administration and acquisition of chemotherapy comprised the majority of costs. This study shows considerable variation in first- and second-line chemotherapy regimens of patients with advanced or metastatic GC. Understanding GC treatment patterns in Mexico will help address unmet needs.

  19. A retrospective study on the impact of comorbid depression or anxiety on healthcare resource use and costs among diabetic neuropathy patients

    Directory of Open Access Journals (Sweden)

    Bao Yanjun

    2009-06-01

    Full Text Available Abstract Background Diabetic neuropathy (DN is a common complication of diabetes that has significant economic burden, especially for patients with comorbid depression or anxiety. This study examines and quantifies factors associated with healthcare costs among patients diagnosed with diabetic neuropathy (DN with or without a comorbid diagnosis of depression or anxiety (DA using retrospective administrative claims data. No study has examined the differences in economic outcomes depending on the presence of comorbid DA disorders. Methods Over-age-18 individuals with 1+ diagnosis of DN in 2005 were selected. The first observed DN claim was considered the "index date." All individuals had a 12-month pre-index and follow-up period. For both under-age-65 commercially insured and over-age-65 individuals with employer-sponsored Medicare supplemental insurance, we constructed 2 subgroups for individuals with DA (DN-DA or without (DN-only. Patients' clinical characteristics over pre-index period were compared. Multivariate regressions were performed to assess whether DN-DA patients had higher utilization of healthcare resources and costs than DN-only patients, controlling for demographic and clinical characteristics. Results We identified 16,831 DN-only and 1,699 DN-DA patients in the Medicare supplemental cohort, as well as 17,205 and 3,105 in the commercially insured. DN-DA patients had higher prevalence of diabetes-related comorbidities for cardiovascular disease, cerebrovascular/peripheral vascular disease, nephropathy, obesity, and hypoglycemic events than DN-only patients (all p Conclusion These findings indicate that the healthcare costs were significantly higher for DN patients with depression or anxiety relative to those without such comorbid disorders.

  20. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

  1. Comparison of health care resource utilization and costs among patients with GERD on once-daily or twice-daily proton pump inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Mody R

    2013-04-01

    Full Text Available Reema Mody,1 Debra Eisenberg,2 Likun Hou,2 Siddhesh Kamat,2 Joseph Singer,2 Lauren B Gerson3 1Takeda Pharmaceuticals International Inc, Deerfield, IL, 2HealthCore Inc, Wilmington, DE, 3Stanford University School of Medicine, Stanford, CA, USA Background: The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI therapy. Most patients with gastroesophageal reflux disease (GERD achieve symptom control on once-daily PPI therapy, but approximately 20%–30% require twice-daily dosing. Methods: Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRDSM during 2004–2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim. Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply, patients were classified as once-daily (dose ≤ 1.5 pills per day or twice-daily (≥1.5 PPI users. Results: The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05. More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001 than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%, outpatient visit (60% versus 49%, and office visit (48% versus 38% versus once-daily patients (P < 0.0001. Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001. Conclusion: Patients receiving twice-daily PPI therapy were likely to have more

  2. Reimbursement and costs of pediatric ambulatory diabetes care by using the resource-based relative value scale: is multidisciplinary care financially viable?

    Science.gov (United States)

    Melzer, Sanford M; Richards, Gail E; Covington, Maxine L

    2004-09-01

    The ambulatory care for children with diabetes mellitus (DM) within an endocrinology specialty practice typically includes services provided by a multidisciplinary team. The resource-based relative value scale (RBRVS) is increasingly used to determine payments for ambulatory services in pediatrics. It is not known to what extent resource-based practice expenses and physician work values as allocated through the RBRVS for physician and non-physician practice expenses cover the actual costs of multidisciplinary ambulatory care for children with DM. A pediatric endocrinology and diabetes clinic staffed by faculty physicians and hospital support staff in a children's hospital. Data from a faculty practice plan billing records and income and expense reports during the period from 1 July 2000 to 30 June 2001 were used to determine endocrinologist physician ambulatory productivity, revenue collection, and direct expenses (salary, benefits, billing, and professional liability (PLI)). Using the RBRVS, ambulatory care revenue was allocated between physician, PLI, and practice expenses. Applying the activity-based costing (ABC) method, activity logs were used to determine non-physician and facility practice expenses associated with endocrine (ENDO) or diabetes visits. Of the 4735 ambulatory endocrinology visits, 1420 (30%) were for DM care. Physicians generated $866,582 in gross charges. Cash collections of 52% of gross charges provided revenue of $96 per visit. Using the actual Current Procedural Terminology (CPT)-4 codes reported for these services and the RBRVS system, the revenue associated with the 13,007 total relative value units (TRVUs) produced was allocated, with 58% going to cover physician work expenses and 42% to cover non-physician practice salary, facility, and PLI costs. Allocated revenue of $40.60 per visit covered 16 and 31% of non-physician and facility practice expenses per DM and general ENDO visit, respectively. RBRVS payments ($35/RVU) covered 46% of

  3. The Nature of the Nuisance—Damage or Threat—Determines How Perceived Monetary Costs and Cultural Benefits Influence Farmer Tolerance of Wildlife

    Directory of Open Access Journals (Sweden)

    Kate Goodale

    2015-08-01

    Full Text Available Biodiversity-friendly farming is a growing area of discussion among farmers, as well as in government departments and non-government organizations interested in conservation on private land. Those seeking to encourage biodiversity on farms must understand the production challenges presented by wildlife. Such species destroy agricultural commodities or present threats to family, pets, or infrastructure. A survey of farmers in the Canadian Maritime provinces sought to understand the drivers of tolerance. Our results demonstrated that estimated monetary losses from a species were largely unrelated to the perceived acceptability of those losses. Rather, the type of nuisance—damage to crops/property or threat to the safety of people, pets, or livestock—determined whether a loss would be perceived as acceptable and if that acceptability would influence tolerance. For damaging species, the perception of cultural benefits seemed able to convert high estimated economic losses to acceptable ones, for overall tolerance. For threatening species, however, minor perceived financial losses seemed augmented by low perceived benefits and made unacceptable, leading to intolerance. Female, older, and part-time farmers were most likely to identify threatening species as a nuisance. The use of an elicitation-based survey design provided novel insight as a result of the lack of prompts, but also presented analytical challenges that weakened predictive power. Recommendations are given for further research and management.

  4. 32 CFR 229.14 - Determination of archaeological or commercial value and cost of restoration and repair.

    Science.gov (United States)

    2010-07-01

    ... shall be its fair market value. Where the violation has resulted in damage to the archaeological resource, the fair market value should be determined using the condition of the archaeological resource... value and cost of restoration and repair. 229.14 Section 229.14 National Defense Department of Defense...

  5. 36 CFR 296.14 - Determination of archaeological or commercial value and cost of restoration and repair.

    Science.gov (United States)

    2010-07-01

    ... shall be its fair market value. Where the violation has resulted in damage to the archaeological resource, the fair market value should be determined using the condition of the archaeological resource... archaeological or commercial value and cost of restoration and repair. 296.14 Section 296.14 Parks, Forests, and...

  6. 22 CFR 1104.13 - Determination of archaeological or commercial value and cost of restoration and repair.

    Science.gov (United States)

    2010-04-01

    ... part shall be its fair market value. Where the violation has resulted in damage to the archaeological resource, the fair market value should be determined using the condition of the archaeological resource... value and cost of restoration and repair. 1104.13 Section 1104.13 Foreign Relations INTERNATIONAL...

  7. Uranium resources

    International Nuclear Information System (INIS)

    Gangloff, A.

    1978-01-01

    It is first indicated how to evaluate the mining resources as a function of the cost of production and the degree of certainty in the knowledge of the deposit. A table is given of the world resources (at the beginning 1977) and resources and reserves are compared. There is a concordance between requirements and possible production until 1990. The case of France is examined: known reserves, present and future prospection, present production (In 1978 2200 T of U metal will be produced from 3 French processing plants), production coming from Cogema. A total production of 2000 T in 1980 and 10.000 in 1985 is expected [fr

  8. Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany.

    Science.gov (United States)

    Greven, Peter; Sikirica, Vanja; Chen, Yaozhu J; Curtice, Tammy G; Makin, Charles

    2017-09-01

    Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families. A retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6-17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy. Patients received at least one prescription for their index medication (ATX/LA-MPH) during 2006-2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index. No significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients. These real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.

  9. Network resilience against intelligent attacks constrained by the degree-dependent node removal cost

    International Nuclear Information System (INIS)

    Annibale, A; Coolen, A C C; Bianconi, G

    2010-01-01

    We study the resilience of complex networks against attacks in which nodes are targeted intelligently, but where disabling a node has a cost to the attacker which depends on its degree. Attackers have to meet these costs with limited resources, which constrains their actions. A network's integrity is quantified in terms of the efficacy of the process that it supports. We calculate how the optimal attack strategy and the most attack-resistant network degree statistics depend on the node removal cost function and the attack resources. The resilience of networks against intelligent attacks is found to depend strongly on the node removal cost function faced by the attacker. In particular, if node removal costs increase sufficiently fast with the node degree, power law networks are found to be more resilient than Poissonian ones, even against optimized intelligent attacks. For cost functions increasing quadratically in the node degrees, intelligent attackers cannot damage the network more than random damages would.

  10. Environmental damage costs from airborne pollution of industrial activities in the greater Athens, Greece area and the resulting benefits from the introduction of BAT

    International Nuclear Information System (INIS)

    Mirasgedis, S.; Hontou, V.; Georgopoulou, E.; Sarafidis, Y.; Gakis, N.; Lalas, D.P.; Loukatos, A.; Gargoulas, N.; Mentzis, A.; Economidis, D.; Triantafilopoulos, T.; Korizi, K.; Mavrotas, G.

    2008-01-01

    Attributing costs to the environmental impacts associated with industrial activities can greatly assist in protecting human health and the natural environment as monetary values are capable of directly influencing technological and policy decisions without changing the rules of the market. This paper attempts to estimate the external cost attributable to the atmospheric pollution from 'medium and high environmental burden' industrial activities located in the greater Athens area and the benefits from Best Available Techniques (BAT) introduction. To this end a number of typical installations were defined to be used in conjunction with the Impact Pathway Approach developed in the context of the ExternE project to model all industrial sectors/sub-sectors located in the area of interest. Total environmental externalities due to air pollutants emitted by these industrial activities were found to reach 211 M Euro per year, associated mainly with human mortality and morbidity due to PM 10 emissions, as well as with climate change impacts due to CO 2 emissions for which non-metallic minerals and oil processing industries are the main sources. The results obtained can be used as the basis for an integrated evaluation of potential BAT, taking into account not only private costs and benefits but also the environmental externalities, thus leading to policy decisions that maximize social welfare in each industrial sector/sub-sector

  11. Process-based costing.

    Science.gov (United States)

    Lee, Robert H; Bott, Marjorie J; Forbes, Sarah; Redford, Linda; Swagerty, Daniel L; Taunton, Roma Lee

    2003-01-01

    Understanding how quality improvement affects costs is important. Unfortunately, low-cost, reliable ways of measuring direct costs are scarce. This article builds on the principles of process improvement to develop a costing strategy that meets both criteria. Process-based costing has 4 steps: developing a flowchart, estimating resource use, valuing resources, and calculating direct costs. To illustrate the technique, this article uses it to cost the care planning process in 3 long-term care facilities. We conclude that process-based costing is easy to implement; generates reliable, valid data; and allows nursing managers to assess the costs of new or modified processes.

  12. The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy.

    Science.gov (United States)

    Brixner, D; Biltaji, E; Bress, A; Unni, S; Ye, X; Mamiya, T; Ashcraft, K; Biskupiak, J

    2016-01-01

    To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients. An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources. There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs. 16.1% in the untested group (RR = 0.61, 95% CI = 0.39-0.95, p = 0.027), ED visit rate was 4.4% in the tested group vs. 15.4% in the untested group (RR = 0.29, 95% CI = 0.15-0.55, p = 0.0002) and outpatient visit rate was 71.7% in the tested group vs. 36.5% in the untested group (RR = 1.97, 95% CI = 1.74-2.23, p provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations. Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.

  13. Monitoring of HIV viral load, CD4 cell count, and clinical assessment versus clinical monitoring alone for antiretroviral therapy in low-resource settings (Stratall ANRS 12110/ESTHER) : a cost-effectiveness analysis

    OpenAIRE

    Boyer, S.; March, L.; Kouanfack, C.; Laborde-Balen, G.; Marino, P.; Aghokeng Fobang, Avelin; Mpoudi-Ngole, E.; Koulla-Shiro, S.; Delaporte, Eric; Carrieri, M. P.; Spire, B.; Laurent, Christian; Moatti, Jean-Paul

    2013-01-01

    Background In low-income countries, the use of laboratory monitoring of patients taking antiretroviral therapy (ART) remains controversial in view of persistent resource constraints. The Stratall trial did not show that clinical monitoring alone was non-inferior to laboratory and clinical monitoring in terms of immunological recovery. We aimed to evaluate the costs and cost-effectiveness of the ART monitoring approaches assessed in the Stratall trial. Methods The randomised, controlled, non-i...

  14. Clinical outcomes, health resource use, and cost in patients with early versus late dual or triple anti-platelet treatment for acute coronary syndrome.

    Science.gov (United States)

    Friedman, Howard; Mollon, Patrick; Lian, Jean; Navaratnam, Prakash

    2013-08-01

    Acute coronary syndrome (ACS) guidelines recommend early dual anti-platelet therapy (thienopyridines + acetylsalicylic acid [aspirin]). However, triple therapy (thienopyridines + aspirin + glycoprotein IIb/IIIa receptor inhibitors [GRIs]) has shown benefit in clinical trials. This study assessed real-world ACS treatment patterns and outcomes in the acute care setting. A retrospective analysis of patients admitted to hospital with ACS (index event) from January 2007 to December 2009 was conducted (Thomson's MarketScan Hospital Drug Database). Eligible patients were ≥18 years of age, of either sex, and had primary admission and discharge diagnoses of ACS. Cohorts were defined by anti-platelet treatment and then by the timing of treatment initiation (early initiation: within ≤2 days of admission; late initiation: ≥2 days post-admission). Patient characteristics, clinical outcomes, resource utilization, and costs were assessed using descriptive statistics. A total of 249,907 eligible patients were placed into four treatment cohorts (aspirin assumed for all patients): aspirin only; clopidogrel only (dual therapy); GRI only (dual therapy); and clopidogrel + GRI (triple therapy). Patients in the 'clopidogrel-only' cohort were more likely to be older, female, and have more co-morbidities than those in other cohorts; stroke (6.2 %) and re-hospitalization (15.4 %) rates were higher than in the 'GRI-only' and 'triple therapy' cohorts. The GRI-only cohort had higher major bleeding rates (3.3 %), mortality (7.6 %), and costs ($US21,975 [year 2010 values]) than the clopidogrel-only and triple-therapy cohorts. Late initiation cohorts were more likely to be older, female, and have more co-morbidities than early initiation cohorts. Major bleeding was more likely with GRI-only patients (regardless of initiation timing) than with other cohorts. Late-treated clopidogrel-only patients had higher rates of stroke (6.9 %), ACS-related re-admissions (6.1 %), and all

  15. The valuation of external costs: An overview of issues and state actions

    International Nuclear Information System (INIS)

    Caverhill, E.J.

    1992-01-01

    The valuation of externalities helps determine the cost effectiveness of environmentally superior resources that would not be cost effective on a direct cost comparison to utility avoided costs. Explicitly monetizing externalities appears to be the best way to meet the criteria of consistency across resource options and pollutants and allowing selection of societally least-cost resources among a variety of resource types. Environmental costs should be defined so as not to exclude any potential external effects, including all environmental, social, and economic effects. For practical purposes, the definition could probably include only environmental externalities without materially affecting resource decisions in the foreseeable future for most North American utilities. More specifically, a comprehensive list of external costs should at least include emissions of pollutants such as SO 2 , CO, NO x , volatile organics, and greenhouse gases; thermal effluents; solid wastes; risk of catastrophic accidents; and for hydro projects, destruction of habitat and recreational areas, and mercury accumulation in reservoirs. Environmental effects should then be counted and valued, most commonly by damage costing or regulatory cost of control. Some utilities and other parties have proposed a market-based approach to valuing externalities, determining the marginal cost of controlling emissions by the market price of emissions allowances. Quantification of environmental costs, ensuring consistency among externality sources, and estimation of avoided externality costs are also discussed. Examples are presented of externality values selected in a number of areas of the USA. 11 refs., 5 figs

  16. Survey cost of electric power generation from renewable resources in the state of Goias, Brazil; Levantamento de custos da geracao de energia eletrica a partir de recursos renovaveis no estado de Goias

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Ronaldo Pereira de; Bortoni, Edson da Costa; Haddad, Jamil [Universidade Federal de Itajuba (UNIFEI), MG (Brazil)], emails: ronaldopa@gmail.com, bortoni@unifei.edu.br, jamil@unifei.edu.br

    2010-07-01

    The work presents a developed study to obtain the investment index costs for renewable based distributed generation in Goias state. A set of renewable resources was selected, along with their availability in each city of the state. Therefore, a rank of investments could be developed. (author)

  17. Health Care Resource Utilization and Costs in Patients with Chronic Myeloid Leukemia with Better Adherence to Tyrosine Kinase Inhibitors and Increased Molecular Monitoring Frequency.

    Science.gov (United States)

    Latremouille-Viau, Dominick; Guerin, Annie; Gagnon-Sanschagrin, Patrick; Dea, Katherine; Cohen, Benjamin G; Joseph, George J

    2017-02-01

    Frequent molecular monitoring (qPCR tests), as recommended by evidence-based monitoring guidelines, is associated with higher adherence to tyrosine kinase inhibitors (TKIs) in the management of chronic myeloid leukemia (CML); both factors have been associated with better clinical and economic outcomes. To (a) estimate the effect of more frequent qPCR tests on health care resource utilization (HRU) and associated costs, including direct (effect of qPCR test frequency on HRU) and indirect (through TKI adherence) effects, and (b) develop an economic model applicable to multiple clinical practice scenarios. Adult patients newly diagnosed with CML who started TKI firstline therapy were identified from U.S. administrative claims data (2010-2015). TKI adherence (medication possession ratio [MPR]), number of inpatient days, emergency room (ER) visits, outpatient service days, and mean costs per HRU event were measured during the first year of CML treatment. Direct and indirect effects of qPCR test frequency were estimated using multivariate regression models. Subsequently, an economic model was developed to assess the overall effect of varying qPCR test frequency on HRU and associated costs during the first year of CML treatment under different clinical practice scenarios; the scenario reported is the increase from 1 to 2 qPCR tests. Of the 1,431 patients included, 36% had no qPCR tests, the average qPCR test frequency was 1.6, and the average MPR was 0.86 during the first year of CML treatment. The direct effect of increasing qPCR test frequency by 1 was associated with 13.0% fewer inpatient days (adjusted incidence rate ratio [adjusted IRR] = 0.87; P = 0.010); 8.3% fewer ER visits (adjusted IRR = 0.92; P = 0.043); and 3.0% more outpatient service days (adjusted IRR = 1.03; P = 0.002). Each increase of 1 test was associated with an increase in TKI adherence by 2.2 percentage points (adjusted MPR difference = 0.022; P better adherence to TKIs were associated with lower HRU

  18. Radiation damage

    CERN Document Server

    Heijne, Erik H M; CERN. Geneva

    1998-01-01

    a) Radiation damage in organic materials. This series of lectures will give an overview of radiation effects on materials and components frequently used in accelerator engineering and experiments. Basic degradation phenomena will be presented for organic materials with comprehensive damage threshold doses for commonly used rubbers, thermoplastics, thermosets and composite materials. Some indications will be given for glass, scintillators and optical fibres. b) Radiation effects in semiconductor materials and devices. The major part of the time will be devoted to treat radiation effects in semiconductor sensors and the associated electronics, in particular displacement damage, interface and single event phenomena. Evaluation methods and practical aspects will be shown. Strategies will be developed for the survival of the materials under the expected environmental conditions of the LHC machine and detectors. I will describe profound revolution in our understanding of black holes and their relation to quantum me...

  19. High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting.

    Science.gov (United States)

    Zaidah, Abdul Rahman; Mohammad, Nurul Izzah; Suraiya, Siti; Harun, Azian

    2017-01-01

    Infections by multidrug-resistant gram-negative bacteria (MDR-GNB) have been continuously growing and pose challenge to health institution globally. Carbapenem-resistant Enterobacteriacea (CRE) was identified as one of the MDR-GNB which has limited treatment options and higher mortality compared to those of sensitive strains. We report an increased burden of CRE fecal carriage at a hospital in the North-eastern region of Malaysia. A retrospective descriptive study from August 2013 to December 2015 was conducted in the Medical Microbiology & Parasitology laboratory of Hospital Universiti Sains Malaysia, which is a tertiary teaching hospital with more than 700 beds. This hospital treats patients with various medical and surgical conditions. Suspected CRE from any clinical specimens received by the laboratory was identified and confirmed using standard protocols. Polymerase chain reaction (PCR) assay was performed to determine the genotype. Altogether, 8306 Enterobacteriaceae was isolated from various clinical specimens during the study period and 477/8306 (5.74%) were CRE. Majority of the isolated CRE were Klebsiella [408/477, (85.5%)], of which Klebsiella pneumoniae was the predominant species, 388/408 (95%). CRE were mainly isolated from rectal swab (screening), 235/477 (49.3%); urine, 76/477 (15.9%); blood, 46/477 (9.6%) and about 7.1% from tracheal aspirate. One hundred and thirty-six isolates were subjected to genotype determination and., 112/136 (82.4%) showed positive detection of New Delhi metallo-β-lactamase 1 (NDM-1) gene ( bla NDM1 ). The study noted a high numbers of CRE isolated especially from rectal swabs. Active screening results in significant cost pressures and therefore should be revisited and revised, especially in low resource settings.

  20. High burden of Carbapenem-resistant Enterobacteriaceae (CRE fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting

    Directory of Open Access Journals (Sweden)

    Abdul Rahman Zaidah

    2017-05-01

    Full Text Available Abstract Background Infections by multidrug-resistant gram-negative bacteria (MDR-GNB have been continuously growing and pose challenge to health institution globally. Carbapenem-resistant Enterobacteriacea (CRE was identified as one of the MDR-GNB which has limited treatment options and higher mortality compared to those of sensitive strains. We report an increased burden of CRE fecal carriage at a hospital in the North-eastern region of Malaysia. Methods A retrospective descriptive study from August 2013 to December 2015 was conducted in the Medical Microbiology & Parasitology laboratory of Hospital Universiti Sains Malaysia, which is a tertiary teaching hospital with more than 700 beds. This hospital treats patients with various medical and surgical conditions. Suspected CRE from any clinical specimens received by the laboratory was identified and confirmed using standard protocols. Polymerase chain reaction (PCR assay was performed to determine the genotype. Results Altogether, 8306 Enterobacteriaceae was isolated from various clinical specimens during the study period and 477/8306 (5.74% were CRE. Majority of the isolated CRE were Klebsiella [408/477, (85.5%], of which Klebsiella pneumoniae was the predominant species, 388/408 (95%. CRE were mainly isolated from rectal swab (screening, 235/477 (49.3%; urine, 76/477 (15.9%; blood, 46/477 (9.6% and about 7.1% from tracheal aspirate. One hundred and thirty-six isolates were subjected to genotype determination and., 112/136 (82.4% showed positive detection of New Delhi metallo-β-lactamase 1 (NDM-1 gene (bla NDM1. Conclusion The study noted a high numbers of CRE isolated especially from rectal swabs. Active screening results in significant cost pressures and therefore should be revisited and revised, especially in low resource settings.

  1. Patient Characteristics, Health Care Resource Utilization, and Costs Associated with Treatment-Regimen Failure with Biologics in the Treatment of Psoriasis.

    Science.gov (United States)

    Foster, Shonda A; Zhu, Baojin; Guo, Jiaying; Nikai, Enkeleida; Ojeh, Clement; Malatestinic, William; Goldblum, Orin; Kornberg, Lori J; Wu, Jashin J

    2016-04-01

    Psoriasis is a chronic, incurable, and immune-mediated skin disorder that is characterized by erythematous scaly papules and plaques. Understanding of psoriasis at the molecular level has led to the development of biologic agents that target disease-specific inflammatory mediators in psoriatic lesions. Biologic agents have become important components of the psoriasis armamentarium, but some patients become refractory to these agents over time or fail to respond to subsequent biologics. To (a) evaluate demographic and clinical characteristics of psoriasis patients who have treatment patterns suggestive of failure to a newly initiated biologic agent (treatment-regimen failures) compared with those who do not (non-treatment-regimen failures) and (b) to assess health care-related resource utilization and costs in non-treatment-regimen failures and treatment-regimen failures. In this retrospective observational cohort study, patients were selected from the MarketScan claims database of commercially insured individuals and individuals with Medicare supplemental insurance. The index event was a newly initiated biologic agent for the treatment of psoriasis (etanercept, adalimumab, ustekinumab, or infliximab) between January 2010 and December 2011. The analysis included psoriasis patients aged ≥ 18 years with ≥ 1 prescription claim for a biologic and continuous enrollment 12 months pre- and post-index date. Patients with claims for a biologic in the pre-index period were excluded. Patients were divided into treatment-regimen-failure and non-treatment-regimen-failure groups based on their treatment patterns post-index date. The treatment-regimen-failure group included patients who switched to another biologic, discontinued the biologic without restarting, increased the dose of the biologic, or augmented treatment with a nontopical psoriasis medication during the post-index period. Between-group patient characteristics and medication use were compared using analysis of

  2. Tort Damages

    NARCIS (Netherlands)

    L.T. Visscher (Louis)

    2008-01-01

    textabstractAbstract: In this Chapter, I provide an overview of Law and Economics literature regarding tort damages. Where necessary, attention is also spent to rules of tort liability. Both types of rules provide behavioral incentives to both injurers and victims, with respect to their level of

  3. Nuclear damage compensation and energy reform

    International Nuclear Information System (INIS)

    Yokemoto, Masafumi

    2013-01-01

    Nuclear damage compensation and energy reform were closely related. Nuclear damage compensation cost should be part of generation cost of nuclear power. Extend of nuclear damage compensation was limited by compensation standard of Tokyo Electric Power Co. (TEPCO) following guidelines of Dispute Reconciliation Committee for Nuclear Damage Compensation. TEPCO had already paid compensation of about two trillion yen until now, which was only a part of total damage compensation cost. TEPCO had been provided more than 3.4 trillion yen by Nuclear Damage Liability Facilitation Cooperation, which would be put back by nuclear operators including TEPCO. TEPCO could obtain present raising funds and try to reconstruct business with restart of nuclear power, which might disturb energy reform. Present nuclear damage compensation scheme had better be reformed with learning more from Minamata disease case in Japan. (T. Tanaka)

  4. Implicit environmental costs in hydroelectric development

    International Nuclear Information System (INIS)

    Carlsen, A.J.; Wenstoep, F.; Strand, J.

    1992-01-01

    The ranking of hydropower projects under the Norwegian Master Plan for Water Resources is used to derive implicit government preferences for a number of environmental attributes described by ordinal scores for each project. Higher negative scores are generally associated with greater implicit willingness to pay to avoid the environmental damage tied to the attribute, caused by hydropower development. The total (ordinary economic and implicit environmental) cost for each project are derived, and the environmental costs per capacity unit are found to be on the same order as the economic costs, lower for projects ranked for early exploitation, and higher for projects to be saved permanently. An implicit long-run marginal cost curve for Norwegian hydropower development is derived, which is generally upward sloping, but not uniformly so. This can be due to the model specification problems or ranking inconsistencies, both of which are likely to be present. 11 refs., 7 figs., 1 tab

  5. ACCOUNTING OF ENVIRONMENTAL DAMAGE IN THE DESIGN OF MINING OBJECTS

    Directory of Open Access Journals (Sweden)

    A. M. Maksimova

    2016-01-01

    Full Text Available The purpose of this article is to study the existing methods of calculation of environmental damage and identifying the most effective ones. To achieve this goal, the author has formulated and solved the following tasks: to investigate the mining sector, given its environmental safety; to define the stages of development of deposits of rare earth metals and to assess their level of environmental damage.The theoretical basis of the article is the domestic and foreign scholars on various aspects of the world energy market the hydrocarbon resources and the economy of industrial enterprises. As a methodological basis of applied methods: analysis, synthesis, analogy, comparison, induction and deduction, mathematical-statistical (factor.In the result of the study revealed that the greatest importance and practical significance is a methodology  based on the effectiveness of environmental protection measures as it may consider three types of environmental risks: environmental damage that was caused in the past; the present environmental pollution associated with the existing mining facility; future environmental costs.The study shows that the design of the mining facilities shall be based on the assessment of possible environmental impacts and effectiveness of environmental protection measures. In this regard, the economic assessment of environmental damage in the mining design of the object should represent a combination of costs of implementing environmental measures to compensate for residual environmental impacts and reclamation of disturbed natural complexes.

  6. The Human Resource Management Information Network (HRMIN): A Cost Comparison in Accordance with Office of Management and Budget (OMB) Circular No. A-76, of 5 April 1979.

    Science.gov (United States)

    1984-12-01

    documentation details to support this presentation can be obtained from NMPC and NPRDC RMS accounting records. Cost estimates and their underlying 62 S ...Economics, Application, Science Research Associates, 1974. Horngren , C.T., Cost Accounting : A Managerial Emphasis, Prentice-Hall, 1977. Krauss, L.I...that will be encountered in the course of this work. Techniques and terms used in Managerial and Cost Accounting , Economics, the Behavioral Sciences

  7. Inpatient resource use and costs associated with switching from oral antipsychotics to aripiprazole once-monthly for the treatment of schizophrenia

    Directory of Open Access Journals (Sweden)

    Michele Wilson

    2016-03-01

    Full Text Available Background: Schizophrenia is associated with high direct healthcare costs due to progression of disease and frequent occurrence of relapses. Aripiprazole once-monthly (AOM has been shown to reduce total psychiatric hospitalizations among patients who switched from oral standard of care (SOC therapy to AOM in a multicenter, open-label, mirror-image study of patients with schizophrenia. Because of the increasing need to improve patient outcomes while containing costs, it is important to understand the impact of AOM treatment initiation on medical costs associated with psychiatric hospitalizations and antipsychotic pharmacy costs. Methods: In the current study, an economic model was developed using data from the AOM mirror-image study to evaluate the psychiatric hospitalization-related medical costs and antipsychotic pharmacy costs during a 6-month period before (retrospective period and after (prospective period the AOM treatment initiation. The economic model evaluated cost-saving potential of AOM among all patients (n=433 as well as a subset of patients with ≥1 prior hospitalization (n=165 who switched from oral SOC to AOM. Unit cost data were obtained from publicly available sources. Results: Both hospitalizations and hospital days were reduced following a switch from oral SOC to AOM. As a result, psychiatric hospitalization-related costs were lower during the prospective period when compared with the retrospective period. Furthermore, the increase in antipsychotic pharmacy costs due to switching from oral SOC to AOM was offset by a reduction in psychiatric hospitalization-related medical costs. Per-patient costs were reduced by $1,046 (USD in the overall population and by $20,353 in a subset of patients who had at least 1 psychiatric hospitalization during the retrospective period. Results were most sensitive to changes in hospitalization costs. Conclusions: AOM is associated with reducing the risk of relapse among patients with

  8. Innovative repair of subsidence damage

    International Nuclear Information System (INIS)

    Marino, G.G.

    1992-01-01

    In order to improve handling of subsidence damages the Illinois Mine Subsidence Insurance Fund supported the development of novel cost-effective methods of repair. The research in developing the repairs was directed towards the most common and costly damages that had been observed. As a result repair techniques were designed for structurally cracked foundations in the tension zone; structurally cracked foundations in the compression zone; and damaged or undamaged tilted foundations. When appropriate the postulated methods would result in: 1. significant cost savings (over conventional procedures); 2. a structural capacity greater than when the foundation was uncracked; and 3. an aesthetic appeal. All the postulated repair methodologies were laboratory and/or field tested. This paper will summarize the essentials of each technique developed and the test results

  9. The role of natural gas in assessing environmental cost of fossil fuels

    International Nuclear Information System (INIS)

    Riva, A.; Trebeschi, C.

    1999-01-01

    The actual price of a resource is the results of its internal and external costs. Internal costs means the price paid by the users in order to utilise the resource. On the other hand, externals costs, which are associated with the resource, are not paid directly by the users, but they shall be paid for by the society of the future generations. The article presents methodologies and issues relevant to energy policy decisions, when it comes to evaluating and using environmental external costs of fossil fuel life, with particular consideration to the end-use phase. The results of published studies on environmental costs of energy sources and an analysis applied to the Italia case show that natural gas as a significantly higher environmental value than other fossil fuels. The range of values depends upon the technologies considered and on the assumptions adopted when assessment environmental damages [it

  10. The REVAMP trial to evaluate HIV resistance testing in sub-Saharan Africa: a case study in clinical trial design in resource limited settings to optimize effectiveness and cost effectiveness estimates.

    Science.gov (United States)

    Siedner, Mark J; Bwana, Mwebesa B; Moosa, Mahomed-Yunus S; Paul, Michelle; Pillay, Selvan; McCluskey, Suzanne; Aturinda, Isaac; Ard, Kevin; Muyindike, Winnie; Moodley, Pravikrishnen; Brijkumar, Jaysingh; Rautenberg, Tamlyn; George, Gavin; Johnson, Brent; Gandhi, Rajesh T; Sunpath, Henry; Marconi, Vincent C

    2017-07-01

    In sub-Saharan Africa, rates of sustained HIV virologic suppression remain below international goals. HIV resistance testing, while common in resource-rich settings, has not gained traction due to concerns about cost and sustainability. We designed a randomized clinical trial to determine the feasibility, effectiveness, and cost-effectiveness of routine HIV resistance testing in sub-Saharan Africa. We describe challenges common to intervention studies in resource-limited settings, and strategies used to address them, including: (1) optimizing generalizability and cost-effectiveness estimates to promote transition from study results to policy; (2) minimizing bias due to patient attrition; and (3) addressing ethical issues related to enrollment of pregnant women. The study randomizes people in Uganda and South Africa with virologic failure on first-line therapy to standard of care virologic monitoring or immediate resistance testing. To strengthen external validity, study procedures are conducted within publicly supported laboratory and clinical facilities using local staff. To optimize cost estimates, we collect primary data on quality of life and medical resource utilization. To minimize losses from observation, we collect locally relevant contact information, including Whatsapp account details, for field-based tracking of missing participants. Finally, pregnant women are followed with an adapted protocol which includes an increased visit frequency to minimize risk to them and their fetuses. REVAMP is a pragammatic randomized clinical trial designed to test the effectiveness and cost-effectiveness of HIV resistance testing versus standard of care in sub-Saharan Africa. We anticipate the results will directly inform HIV policy in sub-Saharan Africa to optimize care for HIV-infected patients.

  11. Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography. Pooled evidence from ROMICAT II and ACRIN-PA trials

    International Nuclear Information System (INIS)

    Bamberg, Fabian; Hoffmann, Udo; Mayrhofer, Thomas; Ferencik, Maros; Bittner, Daniel O.; Hallett, Travis R.; Janjua, Sumbal; Schlett, Christopher L.; Nagurney, John T.; Udelson, James E.; Truong, Quynh A.; Woodard, Pamela K.; Hollander, Judd E.; Litt, Harold

    2018-01-01

    To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860-5935 in men, p < 0.001). CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. (orig.)

  12. Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography. Pooled evidence from ROMICAT II and ACRIN-PA trials

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, Fabian; Hoffmann, Udo [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); University of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Mayrhofer, Thomas [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Stralsund University of Applied Science, School of Business Studies, Stralsund (Germany); Ferencik, Maros [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR (United States); Bittner, Daniel O. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Friedrich-Alexander University Erlangen-Nuernberg (FAU), University Hospital Erlangen, Department of Medicine 2 - Cardiology, Erlangen (Germany); Hallett, Travis R.; Janjua, Sumbal [Harvard Medica