Systematic Review of the Cost and Cost-Effectiveness of Rapid Endovascular Therapy for Acute Ischemic Stroke.

Science.gov (United States)

Sevick, Laura K; Ghali, Sarah; Hill, Michael D; Danthurebandara, Vishva; Lorenzetti, Diane L; Noseworthy, Tom; Spackman, Eldon; Clement, Fiona

2017-09-01

Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of EVT for ischemic stroke patients and to synthesize all the publicly available economic literature. A systematic review of the published literature was conducted to identify economic evaluations and cost analyses of EVT for acute ischemic stroke patients. Systematic review best practices were followed, and study quality was assessed. Four-hundred sixty-three articles were identified from electronic databases. After deduplication, abstract review, and full-text review, 17 studies were included. Seven of the studies were cost analyses, and 10 were cost-effectiveness studies. Generally, the cost analyses reported on the cost of the approach/procedure or the hospitalization costs associated with EVT. All of the cost-effectiveness studies reported a cost per quality-adjusted life year as the primary outcomes. Studies varied in regards to the costs considered, the perspective adopted, and the time horizon used. All the studies reported a cost per quality-adjusted life year of cost and cost-effectiveness of EVT. The cost analyses suggested that although EVT was associated with higher costs, it also resulted in improved patient outcomes. From the cost-effectiveness studies, EVT seems to be good value for money when a threshold of $50 000 per quality-adjusted life year gained is adopted. © 2017 American Heart Association, Inc.

Application of low-cost adsorbents for dye removal--a review.

Science.gov (United States)

Gupta, V K; Suhas

2009-06-01

Dyes are an important class of pollutants, and can even be identified by the human eye. Disposal of dyes in precious water resources must be avoided, however, and for that various treatment technologies are in use. Among various methods adsorption occupies a prominent place in dye removal. The growing demand for efficient and low-cost treatment methods and the importance of adsorption has given rise to low-cost alternative adsorbents (LCAs). This review highlights and provides an overview of these LCAs comprising natural, industrial as well as synthetic materials/wastes and their application for dyes removal. In addition, various other methods used for dye removal from water and wastewater are also complied in brief. From a comprehensive literature review, it was found that some LCAs, in addition to having wide availability, have fast kinetics and appreciable adsorption capacities too. Advantages and disadvantages of adsorbents, favourable conditions for particular adsorbate-adsorbent systems, and adsorption capacities of various low-cost adsorbents and commercial activated carbons as available in the literature are presented. Conclusions have been drawn from the literature reviewed, and suggestions for future research are proposed.

The Real Cost of "Cosmetic Tourism" Cost Analysis Study of "Cosmetic Tourism" Complications Presenting to a Public Hospital.

Science.gov (United States)

Livingston, Ryan; Berlund, Paul; Eccles-Smith, Jade; Sawhney, Raja

2015-01-01

"Cosmetic Tourism," the process of traveling overseas for cosmetic procedures, is an expanding global phenomenon. The model of care by which these services are delivered can limit perioperative assessment and postoperative follow-up. Our aim was to establish the number and type of complications being treated by a secondary referral hospital resulting from "cosmetic tourism" and the cost that has been incurred by the hospital in a 1-year period. Retrospective cost analysis and chart review of patients admitted to the hospital between the financial year of 2012 and 2013 were performed. Twelve "cosmetic tourism" patients presented to the hospital, requiring admission during the study period. Breast augmentation was the most common procedure and infected prosthesis was the most common complication (n = 4). Complications ranged from infection, pulmonary embolism to penile necrosis. The average cost of treating these patients was $AUD 12 597.71. The overall financial burden of the complication to the hospital was AUD$151 172.52. The "cosmetic tourism" model of care appears to be, in some cases, suboptimal for patients and their regional hospitals. In the cases presented in this study, it appears that care falls on the patient local hospital and home country to deal with the complications from their surgery abroad. This incurs a financial cost to that hospital in addition to redirecting medical resources that would otherwise be utilized for treating noncosmetic complications, without any remuneration to the local provider.

Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews.

Science.gov (United States)

Azar, Farbod Ebadifard; Azami-Aghdash, Saber; Pournaghi-Azar, Fatemeh; Mazdaki, Alireza; Rezapour, Aziz; Ebrahimi, Parvin; Yousefzadeh, Negar

2017-06-19

Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods. In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11. Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of

A review and analysis of the investment in, and cost structure of, intermodal rail terminals

NARCIS (Netherlands)

Wiegmans, Bart; Behdani, Behzad

2018-01-01

The results presented in this article identify the role of costs in the scientific and grey freight terminal handling literature and analyses the handling costs of different terminal sizes. The literature review shows that handling costs only play a marginal role in the scientific research in

Cost of falls in old age: a systematic review.

Science.gov (United States)

Heinrich, S; Rapp, K; Rissmann, U; Becker, C; König, H-H

2010-06-01

The purpose of this study was to review the evidence of the economic burden of falls in old age. This review showed that falls are a relevant economic burden. Efforts should be directed to fall-prevention programmes. Falls are a common mechanism of injury and a leading cause of costs of injury in the elderly. The purpose of this study was to review for the first time the evidence of the economic burden caused by falls in old age. A systematic review was conducted in the databases of PubMed, of the Centre for Reviews and Dissemination and in the Cochrane Database of Systematic Reviews until June 2009. Studies were assessed for inclusion, classified and synthesised. Costs per inhabitant, the share of fall-related costs in total health care expenditures and in gross domestic products (GDP) were calculated. If appropriate, cost data were inflated to the year 2006 and converted to US Dollar (USD PPP). A total of 32 studies were included. National fall-related costs of prevalence-based studies were between 0.85% and 1.5% of the total health care expenditures, 0.07% to 0.20% of the GDP and ranged from 113 to 547 USD PPP per inhabitant. Direct costs occurred especially in higher age groups, in females, in hospitals and long-term care facilities and for fractures. Mean costs per fall victim, per fall and per fall-related hospitalisation ranged from 2,044 to 25,955; 1,059 to 10,913 and 5,654 to 42,840 USD PPP and depended on fall severity. A more detailed comparison is restricted by the limited number of studies. Falls are a relevant economic burden to society. Efforts should be directed to economic evaluations of fall-prevention programmes aiming at reducing fall-related fractures, which contribute substantially to fall-related costs.

Systematic review of drug administration costs and implications for biopharmaceutical manufacturing.

Science.gov (United States)

Tetteh, Ebenezer; Morris, Stephen

2013-10-01

The acquisition costs of biologic drugs are often considered to be relatively high compared with those of nonbiologics. However, the total costs of delivering these drugs also depend on the cost of administration. Ignoring drug administration costs may distort resource allocation decisions because these affect cost effectiveness. The objectives of this systematic review were to develop a framework of drug administration costs that considers both the costs of physical administration and the associated proximal costs; and, as a case example, to use this framework to evaluate administration costs for biologics within the UK National Health Service (NHS). We reviewed literature that reported estimates of administration costs for biologics within the UK NHS to identify how these costs were quantified and to examine how differences in dosage forms and regimens influenced administration costs. The literature reviewed were identified by searching the Centre for Review and Dissemination Databases (DARE, NHS EED and HTA); EMBASE (The Excerpta Medica Database); MEDLINE (using the OVID interface); Econlit (EBSCO); Tufts Medical Center Cost Effectiveness Analysis (CEA) Registry; and Google Scholar. We identified 4,344 potentially relevant studies, of which 43 studies were selected for this systematic review. We extracted estimates of the administration costs of biologics from these studies. We found evidence of variation in the way that administration costs were measured, and that this affected the magnitude of costs reported, which could then influence cost effectiveness. Our findings suggested that manufacturers of biologic medicines should pay attention to formulation issues and their impact on administration costs, because these affect the total costs of healthcare delivery and cost effectiveness.

Hydrogen Production Cost Estimate Using Biomass Gasification: Independent Review

Energy Technology Data Exchange (ETDEWEB)

Ruth, M.

2011-10-01

This independent review is the conclusion arrived at from data collection, document reviews, interviews and deliberation from December 2010 through April 2011 and the technical potential of Hydrogen Production Cost Estimate Using Biomass Gasification. The Panel reviewed the current H2A case (Version 2.12, Case 01D) for hydrogen production via biomass gasification and identified four principal components of hydrogen levelized cost: CapEx; feedstock costs; project financing structure; efficiency/hydrogen yield. The panel reexamined the assumptions around these components and arrived at new estimates and approaches that better reflect the current technology and business environments.

ITER final design report, cost review and safety analysis (FDR) and relevant documents

International Nuclear Information System (INIS)

1999-01-01

This volume contains the fourth major milestone report and documents associated with its acceptance, review and approval. This ITER Final Design Report, Cost Review and Safety Analysis was presented to the ITER Council at its 13th meeting in February 1998 and was approved at its extraordinary meeting on 25 June 1998. The contents include an outline of the ITER objectives, the ITER parameters and design overview as well as operating scenarios and plasma performance. Furthermore, design features, safety and environmental characteristics and schedule and cost estimates are given

Cost of epilepsy: a systematic review.

Science.gov (United States)

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

2008-01-01

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

Cost allocation review : staff discussion paper

International Nuclear Information System (INIS)

2005-09-01

This report addressed the need for updated cost allocation studies filed by local electricity distribution companies because they ensure that distribution rates for each customer class remain just and reasonable. According to the 2001 Electricity Distribution Rate Handbook, the Ontario Energy Board requires new cost allocation studies before implementing any future incentive regulation plans. A review of cost allocations allows the Board to consider the need for adjustments to the current share of distribution costs paid by different classes of ratepayers. This report included 14 sections to facilitate consultations with stakeholders on financial information requirements for cost allocation; directly assignable costs; functionalization; categorization; allocation methods; allocation of other costs; load data requirements; cost allocation implementation issues; addition of new rate class and rate design for scattered unmetered loads; addition of new rate class for larger users; rates to charge embedded distributors; treatment of the rate sub-classification identified as time-of-use; and, rate design implementation issues. 1 fig., 7 appendices

Average Costs versus Net Present Value

NARCIS (Netherlands)

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

2000-01-01

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

Assessing the cost of electronic health records: a review of cost indicators.

Science.gov (United States)

Gallego, Ana Isabel; Gagnon, Marie-Pierre; Desmartis, Marie

2010-11-01

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

Is individualized medicine more cost-effective? A systematic review.

Science.gov (United States)

Hatz, Maximilian H M; Schremser, Katharina; Rogowski, Wolf H

2014-05-01

Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was

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

Directory of Open Access Journals (Sweden)

Femke Jansen

2016-01-01

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

Screening for gastric cancer and surveillance of premalignant lesions: a systematic review of cost-effectiveness studies.

Science.gov (United States)

Areia, Miguel; Carvalho, Rita; Cadime, Ana Teresa; Rocha Gonçalves, Francisco; Dinis-Ribeiro, Mário

2013-10-01

Cost-effectiveness studies are highly dependent on the models, settings, and variables used and should be based on systematic reviews. We systematically reviewed cost-effectiveness studies that address screening for gastric cancer and/or surveillance of precancerous conditions and lesions. A systematic review of cost-effectiveness studies was performed by conducting a sensitive search in seven databases (PubMed, Scopus, Web of Science, Current Contents Connect, Centre for Reviews and Dissemination, Academic Search Complete, and CINAHL Plus), independently evaluated by two investigators. Articles were evaluated for type of study, perspective, model, intervention, incremental cost-effectiveness ratio, clinical or cost variables, and quality, according to published guidelines. From 2395 abstracts, 23 articles were included: 19 concerning population screening and 4 on following up premalignant lesions. Studies on Helicobacter pylori screening concluded that serology was cost-effective, depending on cancer incidence and endoscopy cost (incremental cost-effectiveness ratio: 6264-25,881), and eradication after endoscopic resection was also cost-effective (dominant) based on one study. Studies on imaging screening concluded that endoscopy was more cost-effective than no screening (incremental cost-effectiveness ratio: 3376-26,836). Articles on follow-up of premalignant lesions reported conflicting results (incremental cost-effectiveness ratio: 1868-72,519 for intestinal metaplasia; 18,600-39,800 for dysplasia). Quality assessment revealed a unanimous lack of a detailed systematic review and fulfillment of a median number of 23 items (20-26) of 35 possible ones. The available evidence shows that Helicobacter pylori serology or endoscopic population screening is cost-effective, while endoscopic surveillance of premalignant gastric lesions presents conflicting results. Better implementation of published guidelines and accomplishment of systematic detailed reviews are needed

Review of the cost of venous thromboembolism

Science.gov (United States)

Fernandez, Maria M; Hogue, Susan; Preblick, Ronald; Kwong, Winghan Jacqueline

2015-01-01

Background Venous thromboembolism (VTE) is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion Costs for VTE treatment are considerable and increasing faster than general inflation for medical care services, with hospitalization costs being the primary cost driver. Readmissions for VTE are generally more costly than the initial VTE admission. Further studies evaluating the economic impact of new

Socio-economic costs of osteoarthritis: a systematic review of cost-of-illness studies.

Science.gov (United States)

Puig-Junoy, Jaume; Ruiz Zamora, Alba

2015-04-01

The burden of illness that can be attributed to osteoarthritis is considerable and ever increasing. The aim of this systematic review is to analyze currently available data derived from cost-of-illness studies on the healthcare and non-healthcare costs of osteoarthritis. PubMed, Index Medicus Español (IME), and the Spanish Database of Health Sciences [Índice Bibliográfico Español en Ciencias de la Salud (IBECS)] were searched up to the end of April 2013. This study adhered to the PRISMA guidelines. Articles were reviewed and the study quality assessed by two independent investigators with consensus resolution of discrepancies. We identified 39 studies that investigated the socio-economic cost of osteoarthritis. Only nine studies took a social perspective. Rather than estimating the incremental cost of osteoarthritis, nine studies estimated the total cost of treating patients with osteoarthritis without a control for comorbidity. The other 30 studies determined the incremental cost with or without a control group. Only nine studies assessed a comprehensive list of healthcare resources. The annual incremental healthcare costs of generalized osteoarthritis ranged from €705 to €19,715. The annual incremental non-healthcare-related costs of generalized osteoarthritis ranged from €432 to €11,956. The study concludes that the social cost of osteoarthritis could be between 0.25% and 0.50% of a country׳s GDP. This should be considered in order to foster studies that take into account both healthcare and non-healthcare costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Physician awareness of drug cost: a systematic review.

Science.gov (United States)

Allan, G Michael; Lexchin, Joel; Wiebe, Natasha

2007-09-01

Pharmaceutical costs are the fastest-growing health-care expense in most developed countries. Higher drug costs have been shown to negatively impact patient outcomes. Studies suggest that doctors have a poor understanding of pharmaceutical costs, but the data are variable and there is no consistent pattern in awareness. We designed this systematic review to investigate doctors' knowledge of the relative and absolute costs of medications and to determine the factors that influence awareness. Our search strategy included The Cochrane Library, EconoLit, EMBASE, and MEDLINE as well as reference lists and contact with authors who had published two or more articles on the topic or who had published within 10 y of the commencement of our review. Studies were included if: either doctors, trainees (interns or residents), or medical students were surveyed; there were more than ten survey respondents; cost of pharmaceuticals was estimated; results were expressed quantitatively; there was a clear description of how authors defined "accurate estimates"; and there was a description of how the true cost was determined. Two authors reviewed each article for eligibility and extracted data independently. Cost accuracy outcomes were summarized, but data were not combined in meta-analysis because of extensive heterogeneity. Qualitative data related to physicians and drug costs were also extracted. The final analysis included 24 articles. Cost accuracy was low; 31% of estimates were within 20% or 25% of the true cost, and fewer than 50% were accurate by any definition of cost accuracy. Methodological weaknesses were common, and studies of low methodological quality showed better cost awareness. The most important factor influencing the pattern and accuracy of estimation was the true cost of therapy. High-cost drugs were estimated more accurately than inexpensive ones (74% versus 31%, Chi-square p price of expensive drugs and overestimate the price of inexpensive ones, demonstrate a

Review of the cost of venous thromboembolism

Directory of Open Access Journals (Sweden)

Fernandez MM

2015-08-01

Full Text Available Maria M Fernandez,1 Susan Hogue,1 Ronald Preblick,2 Winghan Jacqueline Kwong2 1RTI-Health Solutions, Market Access and Outcomes Strategy, Research Triangle Park, NC, 2Daiichi Sankyo, Inc., Health Economics & Outcomes Research, Parsippany, NJ, USA Background: Venous thromboembolism (VTE is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods: Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results: Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion: Costs for VTE treatment are

Economic analysis of the costs associated with prematurity from a literature review.

Science.gov (United States)

Soilly, A L; Lejeune, C; Quantin, C; Bejean, S; Gouyon, J B

2014-01-01

To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth. A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to 'prematurity' and 'costs' were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (prematurity (extreme, early, moderate and late). Results showed that whatever the follow-up period, costs correlated inversely with GA. They also showed considerable variability in costs within the same GA group. Differences between studies could be explained by the choices made, concerning i/the study populations, ii/contextual information, iii/and various economic criteria. Despite these variations, a global trend of costs was estimated in the short-term period using mean costs from four American studies that presented similar methodologies. Costs stand at over US$ 100,000 for extreme prematurity, between US$ 40,000 and US$ 100,000 for early prematurity, between US$ 10,000 and US$ 30,000 for moderate prematurity and below US$ 4500 for late prematurity. This review underlined not only the clear inverse relationship between costs and GA at birth, but also the difficulty to transfer the results to the French context. It suggests that studies specific to the French health system need to be carried out. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Operations and Maintenance Cost for Stratified Buildings: A Critical Review

Directory of Open Access Journals (Sweden)

Che-Ghani Nor Zaimah

2016-01-01

Full Text Available Building maintenance is essential in preserving buildings’ appearance and performance. It needs to upkeep the building performance to prolong its value and building life cycle. Malaysia is still lacking in managing cost for building operation and maintenance. It has been found that the cost for housing maintenance is high due to poor maintenance practices. In order to get better understanding on how to manage the cost, this study reviews the contributing factors that affecting operation and maintenance cost of stratified buildings in Malaysia. The research first identified the factors through extensive literature review and scrutinize on factors that affecting and can minimize operation and maintenance cost. This literature review offers insight into building maintenance scenario in Malaysia focusing on the issues and challenges. The study also finds that operation and maintenance cost for housing in Malaysia is still in poor state. Interestingly, this paper revealed that operation and maintenance cost is also influenced by three significant factors like expectation of tenants, building characteristics and building defects. Measures to reduce the housing operation and maintenance cost are also highlighted so that this study can be a stepping stone towards proposing efficient and effective facilities management strategies for affordable housing in future.

Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

Science.gov (United States)

Saulle, Rosella; Semyonov, Leda; La Torre, Giuseppe

2013-01-01

The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs. PMID:24253053

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

Science.gov (United States)

Kawalec, Paweł; Malinowski, Krzysztof Piotr

2015-04-01

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

A systematic review of the cost and cost-effectiveness of electronic discharge communications.

Science.gov (United States)

Sevick, Laura K; Esmail, Rosmin; Tang, Karen; Lorenzetti, Diane L; Ronksley, Paul; James, Matthew; Santana, Maria; Ghali, William A; Clement, Fiona

2017-07-02

The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered. To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider. We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis. One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes. Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed

24 CFR 1000.22 - Are the costs of the environmental review an eligible cost?

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Are the costs of the environmental review an eligible cost? 1000.22 Section 1000.22 Housing and Urban Development Regulations Relating to..., DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT NATIVE AMERICAN HOUSING ACTIVITIES General § 1000.22 Are the...

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

Science.gov (United States)

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

2014-01-01

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

Systematic review of studies on cost-effectiveness of cystic fibrosis carrier testing

Directory of Open Access Journals (Sweden)

Ernesto Andrade-Cerquera

2016-10-01

Full Text Available Introduction: Cystic fibrosis is considered the most common autosomal disease with multisystem complications in non-Hispanic white population. Objective: To review the available evidence on cost-effectiveness of the cystic fibrosis carrier testing compared to no intervention. Materials and methods: The databases of MEDLINE, Embase, NHS, EBM Reviews - Cochrane Database of Systematic Reviews, LILACS, Health Technology Assessment, Genetests.org, Genetsickkids.org and Web of Science were used to conduct a systematic review of the cost-effectiveness of performing the genetic test in cystic fibrosis patients. Cost-effectiveness studies were included without language or date of publication restrictions. Results: Only 13 studies were relevant for full review. Prenatal, preconception and mixed screening strategies were found. Health perspective was the most used; the discount rate applied was heterogeneous between 3.5% and 5%; the main analysis unit was the cost per detected carrier couple, followed by cost per averted birth with cystic fibrosis. It was evident that the most cost-effective strategy was preconception screening associated with prenatal test. Conclusions: A marked heterogeneity in the methodology was found, which led to incomparable results and to conclude that there are different approaches to this genetic test.

Activity-Based Costing & Warm Fuzzies - Costing, Presentation & Framing Influences on Decision-Making ~ A Business Optimization Simulation ~

OpenAIRE

Harrison, David Shelby

1998-01-01

Activity-Based Costing is presented in accounting text books as a costing system that can be used to make valuable managerial decisions. Accounting journals regularly report the successful implementations and benefits of activity-based costing systems for particular businesses. Little experimental or empirical evidence exists, however, that has demonstrated the benefits of activity-based costing under controlled conditions. Similarly, although case studies report conditions that may or may...

Internalizing environmental costs: A survey of progress in estimating the external environmental costs of electricity production and a review of market-based policies to incorporate them

International Nuclear Information System (INIS)

Eto, J.H.; Helcke, G.

1991-01-01

The production of electricity creates environmental insults whose costs are not fully reflected in the prices paid by consumers for electricity services. Failure to incorporate these external costs leads to economically inefficient production and consumption decisions. The present work reviews two related efforts to address this market distortion. The first concerns progress in estimating the uninternalized environmental costs of electricity production. The second concerns market-based approaches to internalizing these costs in electricity production and consumption decisions. 10 tabs.; 41 refs

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

Science.gov (United States)

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

2010-01-21

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

Cost-effectiveness of external cephalic version for term breech presentation

Directory of Open Access Journals (Sweden)

Carvalho Brendan

2010-01-01

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

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

Science.gov (United States)

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

2009-04-01

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

What determines the effects and costs of breast cancer screening? A protocol of a systematic review of reviews.

Science.gov (United States)

Mandrik, O; Ekwunife, O I; Zielonke, N; Meheus, F; Severens, J L; Lhachimi, S K; Murillo, R

2017-06-28

Multiple reviews demonstrated high variability in effectiveness and cost-effectiveness outcomes among studies on breast cancer screening (BCS) programmes. No study to our knowledge has summarized the current evidence on determinants of effectiveness and cost-effectiveness of the most used BCS approaches or tried to explain differences in conclusions of systematic reviews on this topic. Based on published reviews, this systematic review aims to assess the degree of variability of determinants for (a) effectiveness and (b) cost-effectiveness of BCS programmes using mammography, clinical breast examination, breast self-examination, ultrasonography, or their combinations among the general population. We will perform a comprehensive systematic literature search in Cochrane, Scopus, Embase, and Medline (via Pubmed). The search will be supplemented with hand searching of references of the included reviews, with hand searching in the specialized journals, and by contacting prominent experts in the field. Additional search for grey literature will be conducted on the websites of international cancer associations and networks. Two trained research assistants will screen titles and abstracts of publications independently, with at least random 10% of all abstracts being also screened by the principal researcher. The full texts of the systematic reviews will then be screened independently by two authors, and disagreements will be solved by consensus. The included reviews will be grouped by publication year, outcomes, designs of original studies, and quality. Additionally, for reviews published since 2011, transparency in reporting will be assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for the review on determinants of effectiveness and a modified PRISMA checklist for the review on determinants for cost-effectiveness. The study will apply the Assessing the Methodological Quality of Systematic Reviews checklist to assess

Limitations of acceptability curves for presenting uncertainty in cost-effectiveness analysis

NARCIS (Netherlands)

Groot Koerkamp, Bas; Hunink, M. G. Myriam; Stijnen, Theo; Hammitt, James K.; Kuntz, Karen M.; Weinstein, Milton C.

2007-01-01

Clinical journals increasingly illustrate uncertainty about the cost and effect of health care interventions using cost-effectiveness acceptability curves (CEACs). CEACs present the probability that each competing alternative is optimal for a range of values of the cost-effectiveness threshold. The

Reducing healthcare costs facilitated by surgical auditing: a systematic review.

Science.gov (United States)

Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria

2015-07-01

Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

The impact of changes in intensive care organization on patient outcome and cost-effectiveness-a narrative review

NARCIS (Netherlands)

van der Sluijs, Alexander F.; van Slobbe-Bijlsma, Eline R.; Chick, Stephen E.; Vroom, Margreeth B.; Dongelmans, Dave A.; Vlaar, Alexander P. J.

2017-01-01

The mortality rate of critically ill patients is high and the cost of the intensive (ICU) department is among the highest within the health-care industry. The cost will continue to increase because of the aging population in the western world. In the present review, we will discuss the impact of

The neglected topic: presentation of cost information in patient decision AIDS.

Science.gov (United States)

Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

2015-05-01

Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. © The Author(s) 2015.

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

Science.gov (United States)

Malinowski, Krzysztof Piotr; Kawalec, Paweł

2015-04-01

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

The costs of critical care telemedicine programs: a systematic review and analysis.

Science.gov (United States)

Kumar, Gaurav; Falk, Derik M; Bonello, Robert S; Kahn, Jeremy M; Perencevich, Eli; Cram, Peter

2013-01-01

Implementation of telemedicine programs in ICUs (tele-ICUs) may improve patient outcomes, but the costs of these programs are unknown. We performed a systematic literature review to summarize existing data on the costs of tele-ICUs and collected detailed data on the costs of implementing a tele-ICU in a network of Veterans Health Administration (VHA) hospitals. We conducted a systematic review of studies published between January 1, 1990, and July 1, 2011, reporting costs of tele-ICUs. Studies were summarized, and key cost data were abstracted. We then obtained the costs of implementing a tele-ICU in a network of seven VHA hospitals and report these costs in light of the existing literature. Our systematic review identified eight studies reporting tele-ICU costs. These studies suggested combined implementation and first year of operation costs for a tele-ICU of $50,000 to $100,000 per monitored ICU-bed. Changes in patient care costs after tele-ICU implementation ranged from a $3,000 reduction to a $5,600 increase in hospital cost per patient. VHA data suggested a cost for implementation and first year of operation of $70,000 to $87,000 per ICU-bed, depending on the depreciation methods applied. The cost of tele-ICU implementation is substantial, and the impact of these programs on hospital costs or profits is unclear. Until additional data become available, clinicians and administrators should carefully weigh the clinical and economic aspects of tele-ICUs when considering investing in this technology.

A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis.

Science.gov (United States)

Fitzpatrick, Christopher; Floyd, Katherine

2012-01-01

Around 0.4 million cases of multidrug-resistant tuberculosis (MDR-TB) occur each year. Only a small fraction of these cases are treated according to international guidelines. Evidence relevant to decisions about whether to scale-up treatment for MDR-TB includes cost and cost-effectiveness data. Up to 2010, no systematic review of this evidence has been available. Our objective was to conduct a systematic review of the cost and cost effectiveness of treatment for MDR-TB and synthesize the available data. We searched for papers published or prepared for publication in peer-review journals and grey literature using search terms in five languages: English, French, Portuguese, Russian and Spanish. From an initial set of 420 studies, four were included, from Peru, the Philippines, Estonia and Tomsk Oblast in the Russian Federation. Results on costs, effectiveness and cost effectiveness were extracted. Assessment of the quality of each economic evaluation was guided by two existing checklists around which there is broad consensus. Costs were adjusted to a common year of value (2005) to remove distortions caused by inflation, and calculated in two common currencies: $US and international dollars (I$), to standardize for purchasing power parity. Data from the four identified studies were then synthesized using probabilistic sensitivity analysis, to appraise the likely cost and cost effectiveness of MDR-TB treatment in other settings, relative to WHO benchmarks for assessing whether or not an intervention is cost effective. Best estimates are provided as means, with 5th and 95th percentiles of the distributions. The cost per patient for MDR-TB treatment in Estonia, Peru, the Philippines and Tomsk was $US10 880, $US2423, $US3613 and $US14 657, respectively. Best estimates of the cost per disability-adjusted life-year (DALY) averted were $US598 (I$960), $US163 (I$291), $US143 (I$255) and $US745 (I$1059), respectively. The main influences on costs were (i) the model of care

The Economic Costs of Type 2 Diabetes: A Global Systematic Review.

Science.gov (United States)

Seuring, Till; Archangelidi, Olga; Suhrcke, Marc

2015-08-01

There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis

A Systematic Review of the Cost-Effectiveness of Biologics for Ulcerative Colitis.

Science.gov (United States)

Stawowczyk, Ewa; Kawalec, Paweł

2018-04-01

Ulcerative colitis (UC) is a chronic autoimmune inflammation of the colon. The condition significantly decreases quality of life and generates a substantial economic burden for healthcare payers, patients and the society in which they live. Some patients require chronic pharmacotherapy, and access to novel biologic drugs might be crucial for long-term remission. The analyses of cost-effectiveness for biologic drugs are necessary to assess their efficiency and provide the best available drugs to patients. Our aim was to collect and assess the quality of economic analyses carried out for biologic agents used in the treatment of UC, as well as to summarize evidence on the drivers of cost-effectiveness and evaluate the transferability and generalizability of conclusions. A systematic database review was conducted using MEDLINE (via PubMed), EMBASE, Cost-Effectiveness Analysis Registry and CRD0. Both authors independently reviewed the identified articles to determine their eligibility for final review. Hand searching of references in collected papers was also performed to find any relevant articles. The reporting quality of economic analyses included was evaluated by two reviewers using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement checklist. We reviewed the sensitivity analyses in cost-effectiveness analyses to identify the variables that may have changed the conclusions of the study. Key drivers of cost-effectiveness were selected by identifying uncertain parameters that caused the highest change of the results of the analyses compared with base-case results. Of the 576 identified records, 87 were excluded as duplicates and 16 studies were included in the final review; evaluations for Canada, the UK and Poland were mostly performed. The majority of the evaluations revealed were performed for infliximab (approximately 75% of total volume); however, some

Uranium milling costs

International Nuclear Information System (INIS)

Coleman, R.B.

1980-01-01

Basic process flowsheets are reviewed for conventional milling of US ores. Capital costs are presented for various mill capacities for one of the basic processes. Operating costs are shown for various mill capacities for all of the basic process flowsheets. The number of mills using, or planning to use, a particular process is reviewed. A summary of the estimated average milling costs for all operating US mills is shown

7 CFR 61.9 - Cost of review.

Science.gov (United States)

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Cost of review. 61.9 Section 61.9 Agriculture... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COTTONSEED SOLD OR OFFERED FOR SALE FOR CRUSHING PURPOSES (INSPECTION, SAMPLING AND CERTIFICATION) Regulations Administrative and...

Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review.

Science.gov (United States)

Le, Phuc; Nghiem, Van T; Mullen, Patricia Dolan; Deshpande, Abhishek

2018-04-01

BACKGROUND Clostridium difficile infection (CDI) presents a substantial economic burden and is associated with significant morbidity. While multiple treatment strategies have been evaluated, a cost-effective management strategy remains unclear. OBJECTIVE We conducted a systematic review to assess cost-effectiveness analyses of CDI treatment and to summarize key issues for clinicians and policy makers to consider. METHODS We searched PubMed and 5 other databases from inception to August 2016. These searches were not limited by study design or language of publication. Two reviewers independently screened the literature, abstracted data, and assessed methodological quality using the Drummond and Jefferson checklist. We extracted data on study characteristics, type of CDI, treatment characteristics, and model structure and inputs. RESULTS We included 14 studies, and 13 of these were from high-income countries. More than 90% of these studies were deemed moderate-to-high or high quality. Overall, 6 studies used a decision-tree model and 7 studies used a Markov model. Cost of therapy, time horizon, treatment cure rates, and recurrence rates were common influential factors in the study results. For initial CDI, fidaxomicin was a more cost-effective therapy than metronidazole or vancomycin in 2 of 3 studies. For severe initial CDI, 2 of 3 studies found fidaxomicin to be the most cost-effective therapy. For recurrent CDI, fidaxomicin was cost-effective in 3 of 5 studies, while fecal microbiota transplantation (FMT) by colonoscopy was consistently cost-effective in 4 of 4 studies. CONCLUSIONS The cost-effectiveness of fidaxomicin compared with other pharmacologic therapies was not definitive for either initial or recurrent CDI. Despite its high cost, FMT by colonoscopy may be a cost-effective therapy for recurrent CDI. A consensus on model design and assumptions are necessary for future comparison of CDI treatment. Infect Control Hosp Epidemiol 2018;39:412-424.

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

Directory of Open Access Journals (Sweden)

White Michael T

2011-11-01

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

Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses.

Science.gov (United States)

Elbert, Niels J; van Os-Medendorp, Harmieke; van Renselaar, Wilco; Ekeland, Anne G; Hakkaart-van Roijen, Leona; Raat, Hein; Nijsten, Tamar E C; Pasmans, Suzanne G M A

2014-04-16

eHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking. We conducted a systematic review of systematic reviews and meta-analyses on the effectiveness/cost-effectiveness of eHealth interventions in patients with somatic diseases to analyze whether, and to what possible extent, the outcome of recent research supports or differs from previous conclusions. Literature searches were performed in PubMed, EMBASE, The Cochrane Library, and Scopus for systematic reviews and meta-analyses on eHealth interventions published between August 2009 and December 2012. Articles were screened for relevance based on preset inclusion and exclusion criteria. Citations of residual articles were screened for additional literature. Included papers were critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement before data were extracted. Based on conclusions drawn by the authors of the included articles, reviews and meta-analyses were divided into 1 of 3 groups: suitable, promising, or limited evidence on effectiveness/cost-effectiveness. Cases of uncertainty were resolved by consensus discussion. Effect sizes were extracted from papers that included a meta-analysis. To compare our results with previous findings, a trend analysis was performed. Our literature searches yielded 31 eligible reviews, of which 20 (65%) reported on costs. Seven papers (23%) concluded that eHealth is effective/cost-effective, 13 (42%) underlined that evidence is promising, and others found limited or inconsistent proof. Methodological quality of the included reviews and meta-analyses was generally considered high. Trend analysis showed a considerable accumulation of literature on eHealth. However, a similar percentage of papers concluded that eHealth is effective/cost-effective or

Specific Space Transportation Costs to GEO - Past, Present and Future

Science.gov (United States)

Koelle, Dietrich E.

2002-01-01

The largest share of space missions is going to the Geosynchronous Orbit (GEO); they have the highest commercial importance. The paper first shows the historic trend of specific transportation costs to GEO from 1963 to 2002. It started out with more than 500 000 /kg(2002-value) and has come down to 36 000 /kg. This reduction looks impressive, however, the reason is NOT improved technology or new techniques but solely the growth of GEO payloads`unit mass. The first GEO satellite in 1963 did have a mass of 36 kg mass (BoL) . This has grown to a weight of 1600 kg (average of all GEO satellites) in the year 2000. Mass in GEO after injection is used here instead of GTO mass since the GTO mass depends on the launch site latitude. The specific cost reduction is only due to the "law-of-scale", valid in the whole transportation business: the larger the payload, the lower the specific transportation cost. The paper shows the actual prices of launch services to GTO by the major launch vehicles. Finally the potential GEO transportation costs of future launch systems are evaluated. What is the potential reduction of specific transportation costs if reusable elements are introduced in future systems ? Examples show that cost reductions up to 75 % seem achievable - compared to actual costs - but only with launch systems optimized according to modern principles of cost engineering. 1. 53rd International Astronautical Congress, World Space Congress Houston 2. First Submission 3. Specific Space Transportation Costs to GEO - Past, Present and Future 4. KOELLE, D.E. 5. IAA.1.1 Launch Vehicles' Cost Engineering and Economic Competitiveness 6. D.E. Koelle; A.E. Goldstein 7. One overhead projector and screen 8. Word file attached 9. KOELLE I have approval to attend the Congress. I am not willing to present this paper at the IAC Public Outreach Program.

Cost-effectiveness of enhanced recovery in hip and knee replacement: a systematic review protocol.

Science.gov (United States)

Murphy, Jacqueline; Pritchard, Mark G; Cheng, Lok Yin; Janarthanan, Roshni; Leal, José

2018-03-14

Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways. A systematic review will be conducted using MEDLINE, EMBASE, Econlit and the National Health Service Economic Evaluations Database. Separate search strategies were developed for each database including terms relating to hip and knee replacement/arthroplasty, economic evaluations, decision modelling and quality of life measures.We will extract peer-reviewed studies published between 2000 and 2017 reporting economic evaluations of preoperative, perioperative or postoperative enhanced recovery interventions within hip or knee replacement. Economic evaluations alongside cohort studies or based on decision models will be included. Only studies with patients undergoing elective replacement surgery of the hip or knee will be included. Data will be extracted using a predefined pro forma following best practice guidelines for economic evaluation, decision modelling and model validation.Our primary outcome will be the cost-effectiveness of enhanced recovery (entire pathway and individual components) in terms of incremental cost per quality-adjusted life year. A narrative synthesis of all studies will be presented, focussing on cost-effectiveness results, study design, quality and validation status. This systematic review is exempted from ethics approval because the work is carried out on published documents. The results of the review will be

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy.

Science.gov (United States)

Schroeck, Florian Rudolf; Jacobs, Bruce L; Bhayani, Sam B; Nguyen, Paul L; Penson, David; Hu, Jim

2017-11-01

Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer's perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective. We review the cost and cost effectiveness of robot-assisted radical prostatectomy, intensity-modulated radiotherapy, and proton beam therapy in prostate cancer treatment. These technologies are costlier than their traditional counterparts. It remains unclear whether their use is associated

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

Kawalec, Paweł

2016-04-01

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

Health Outcomes and Costs of Social Work Services: A Systematic Review.

Science.gov (United States)

Steketee, Gail; Ross, Abigail M; Wachman, Madeline K

2017-12-01

Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession's person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using "social work" AND "cost" and "health" for trials published from 1990 to 2017. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team

Cost-Optimal Analysis for Nearly Zero Energy Buildings Design and Optimization: A Critical Review

Directory of Open Access Journals (Sweden)

Maria Ferrara

2018-06-01

Full Text Available Since the introduction of the recast of the EPBD European Directive 2010/31/EU, many studies on the cost-effective feasibility of nearly zero-energy buildings (NZEBs were carried out either by academic research bodies and by national bodies. In particular, the introduction of the cost-optimal methodology has given a strong impulse to research in this field. This paper presents a comprehensive and significant review on scientific works based on the application of cost-optimal analysis applications in Europe since the EPBD recast entered into force, pointing out the differences in the analyzed studies and comparing their outcomes before the new recast of EPBD enters into force in 2018. The analysis is conducted with special regard to the methods used for the energy performance assessment, the global cost calculation, and for the selection of the energy efficiency measures leading to design optimization. A critical discussion about the assumptions on which the studies are based and the resulting gaps between the resulting cost-optimal performance and the zero energy target is provided together with a summary of the resulting cost-optimal set of technologies to be used for cost-optimal NZEB design in different contexts. It is shown that the cost-optimal approach results as an effective method for delineating the future of NZEB design throughout Europe while emerging criticalities and open research issues are presented.

48 CFR 15.407-4 - Should-cost review.

Science.gov (United States)

2010-10-01

... the contract work task, elements such as manufacturing, pricing and accounting, management and...) Corporate reorganizations, mergers, acquisitions, or takeovers. (vii) Other conditions (e.g., changes in accounting systems, management, or business activity). (3) The objective of the overhead should-cost review...

Costs associated with rheumatoid arthritis in Italy: past, present, and future

Directory of Open Access Journals (Sweden)

Benucci M

2016-02-01

Full Text Available Maurizio Benucci,1 Veronica Rogai,2 Fabiola Atzeni,3 Volker Hammen,4 Piercarlo Sarzti-Puttini,3 Alberto Migliore5 1Rheumatology Unit, S.Giovanni di Dio Hospital, Florence, Italy; 2Eli Lilly Italia SpA, Sesto Fiorentino, Italy; 3Rheumatology Unit, L Sacco Hospital, Milan, Italy; 4Lilly Deutschland GmbH, Bad Homburg, Germany; 5Villa San Pietro Fatebenefratelli Hospital, Rome, Italy Abstract: This literature review examines available evidence on the current and past costs associated with rheumatoid arthritis (RA in Italy, together with the future health-economic prospects for the disease. Studies have been conducted to date on the prevalence, or the associated costs, of RA in Italy. Although future changes in the incidence of RA are a matter of debate, the impact of RA on health care costs is expected to grow in coming decades in line with projected increases in life expectancy and in the proportion of elderly people in Italy. It has been estimated that the indirect (productivity loss and informal care and intangible (deterioration in health-related quality of life costs of the disease will contribute to an increase in national health service expenditure, which will correspond to 1% of the total health care costs of the nation in the near future. The introduction of biological agents for the treatment of rheumatic diseases has resulted in an increase in the direct costs of RA; however, economic analyses that exclude indirect costs will underestimate the full economic impact of RA. The effectiveness of innovative therapies in preventing disease progression and functional impairment may, over time, attenuate the cost impact of RA in terms of hospitalizations and work absenteeism. Further research is needed to develop estimates of the economic impact of different therapeutic approaches in patients with RA in Italy, in order to provide tools that can drive the choice of the most cost-effective therapeutic option while maintaining high-quality care

Post-operative telephone review is cost-effective and acceptable to patients.

LENUS (Irish Health Repository)

Gray, R T

2012-02-01

INTRODUCTION: Patients undergoing selective minor emergency and elective procedures are followed up by a nurse-led structured telephone review six weeks post-operatively in our hospital. Our study objectives were to review patients\\' satisfaction, assess cost-effectiveness and compare our practice with other surgical units in Northern Ireland (NI). PATIENTS AND METHODS: Completed telephone follow-up forms were reviewed retrospectively for a three-year period and cost savings calculated. Fifty patients were contacted prospectively by telephone using a questionnaire to assess satisfaction of this follow-up. A postal questionnaire was sent to 68 general and vascular surgeons in NI, assessing individual preferences for patient follow-up. RESULTS: A total of 1378 patients received a telephone review from September 2005 to September 2008. One thousand one hundred and seventy-seven (85.4%) were successfully contacted, while 201 (14.6%) did not respond despite multiple attempts. One hundred and forty-seven respondents (10.7%) required further outpatient follow-up, thereby saving 1231 outpatient reviews, equivalent to pound41,509 per annum. Thirty-nine (78%) patients expected post-operative follow-up, with 29 (58%) expecting this in the outpatient department. However, all patients were satisfied with the nurse-led telephone review. Fifty-three (78%) consultants responded. Those who always, or occasionally, review patients post-operatively varies according to the operation performed, ranging from 2.2% appendicectomy patients to 40.0% for varicose vein surgery. CONCLUSION: Current practice in NI varies, but a significant proportion of patients are not routinely reviewed. This study confirmed that patients expect post-operative follow-up. A nurse-led telephone review service is acceptable to patients, cost-effective and reduces the number of unnecessary outpatient reviews.

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

Science.gov (United States)

Goettler, Andrea; Grosse, Anna; Sonntag, Diana

2017-10-05

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

The economic cost of hospital malnutrition in Europe; a narrative review.

Science.gov (United States)

Khalatbari-Soltani, Saman; Marques-Vidal, Pedro

2015-06-01

Malnutrition among hospitalized patients increases length of stay (LOS) and carries extra hospitalization costs. To review the impact of malnutrition on hospital LOS and costs in Europe. PubMed and Google Scholar search. All articles from January 2004 until November 2014 were identified. Reference lists of relevant articles were also manually searched. Ten studies on LOS and nine studies on costs were reviewed. The methods used to assess malnutrition and to calculate costs differed considerably between studies. Malnutrition led to an increased LOS ranging from 2.4 to 7.2 days. Among hospitalized patients, malnutrition led to an additional individual cost ranging between 1640 € and 5829 €. At the national level, the costs of malnutrition ranged between 32.8 million € and 1.2 billion €. Expressed as percentage of national health expenditures, the values ranged between 2.1% and 10%. In Europe, malnutrition leads to an increase in LOS and in hospital costs, both at the individual and the national level. Standardization of methods and results reported is needed to adequately compare results between countries. Copyright © 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Rehabilitation costs

Energy Technology Data Exchange (ETDEWEB)

Kubo, Arthur S [BDM Corp., VA (United States); [Bikini Atoll Rehabilitation Committee, Berkeley, CA (United States)

1986-07-01

The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates.

Rehabilitation costs

International Nuclear Information System (INIS)

Kubo, Arthur S.

1986-01-01

The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates

Cost assessment of robotics in gynecologic surgery: a systematic review.

Science.gov (United States)

Iavazzo, Christos; Papadopoulou, Eleni K; Gkegkes, Ioannis D

2014-11-01

The application of robotics is an innovation in the field of gynecologic surgery. Our objective was to evaluate the currently available literature on the cost assessment of robotic surgery of various operations in the field of gynecologic surgery. PubMed and Scopus databases were systematically searched in order to retrieve the included studies in our review. We retrieved 23 studies on a variety of gynecologic operations. The mean cost for robotic, open and laparoscopic surgery ranged from 1731 to 48,769, 894 to 20,277 and 411 to 41,836 Euros, respectively. Operative charges, in hysterectomy, for robotic, open and laparoscopic technique ranged from 936 to 33,920, 684 to 25,616 and 858 to 25,578 Euros, respectively. In sacrocolpopexy, these costs ranged from 2067 to 7275, 2904 to 69,792 and 1482 to 2000 Euros, respectively. Non-operative charges ranged from 467 to 39,121 Euros. The mean total costs for myomectomy ranged from 27,342 to 42,497 and 13,709 to 20,277 Euros, respectively, for the robotic and open methods, while the mean total cost of the laparoscopic technique was 26,181 Euros. Conversions to laparotomy were present in 79/36,185 (0.2%) cases of laparoscopic surgery and in 21/3345 (0.62%) cases of robotic technique. Duration of robotic, open and laparoscopic surgery ranged from 50 to 445, 83.7 to 701 and 74 to 330 min, respectively. Robotic surgery has the potential to become cost-effective in centers with many patients while industry competition could reduce the cost of the robotic instrumentation, making robotic technology more affordable and cost-effective. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Instructional Cost Analysis: History and Present Inadequacies.

Science.gov (United States)

Humphrey, David A.

The cost analysis of instruction is conducted according to principles of teaching and learning that have often become historically dated. Using today's costing systems prevents determination of whether cost effectiveness actually exists. The patterns of instruction in higher education and the systems employed for instructional cost analysis are…

Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

Science.gov (United States)

Jack, Helen; Wagner, Ryan G.; Petersen, Inge; Thom, Rita; Newton, Charles R.; Stein, Alan; Kahn, Kathleen; Tollman, Stephen; Hofman, Karen J.

2014-01-01

Background Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions. Design Narrative overview methodology. Results and conclusions Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context. PMID:24848654

Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

Directory of Open Access Journals (Sweden)

Helen Jack

2013-05-01

Full Text Available Background: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS disorders and the cost-effectiveness of treatment interventions. Design: Narrative overview methodology. Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1 accurate and thorough assessment of the health burdens of MNS disorders, 2 design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3 information on the use and costs of traditional medicines, and 4 cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

78 FR 31550 - Federal Acquisition Regulation; Submission for OMB Review; Travel Costs

Science.gov (United States)

2013-05-24

...; Submission for OMB Review; Travel Costs AGENCIES: Department of Defense (DOD), General Services... collection requirement concerning Travel Costs. A notice was published in the Federal Register at 77 FR 67366..., 2013. ADDRESSES: Submit comments identified by Information Collection 9000- 0088, Travel Costs by any...

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

Directory of Open Access Journals (Sweden)

Gabriela B Gomez

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

Health Outcomes and Costs of Social Work Services: A Systematic Review

Science.gov (United States)

Ross, Abigail M.; Wachman, Madeline K.

2017-01-01

Background. Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession’s person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. Objectives. To systematically review international studies of the effect of social work–involved health services on health and economic outcomes. Search Methods. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017. Selection Criteria. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Data Collection and Analysis. Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Main Results. Average study quality was fair. Studies of 7 social work–led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Conclusions. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to

A worldwide review of the cost of nuclear power

International Nuclear Information System (INIS)

Lecomte, M.; Mario, N.; Vignon, D.

2014-01-01

The 'true cost' of nuclear energy is a subject of great controversy, especially when considering capital costs of recent projects which opponents to this technology claim to be out of control. In order to provide an objective assessment of nuclear competitiveness, a systematic review of nuclear costs as estimated by stakeholders on a worldwide basis (parliamentary commissions, general accounting offices, academics from universities, non-governmental organizations [either promoting nuclear, or nonnuclear energy], utilities and vendors) was done. Based on these data, levelised costs of electricity (LCOE) were calculated, for different technologies and different regional areas. A breakdown between the key factors (pre-construction and owner costs, Capex, Opex, spent fuel management, dismantling and decommissioning) was provided. The study generally concludes that nuclear energy remains competitive, although costs of advanced technologies soared compared to Gen II. It also demonstrates the benefit of steady and ongoing nuclear programs compared to construction of single projects from time to time. (authors)

Assessing value in breast reconstruction: A systematic review of cost-effectiveness studies.

Science.gov (United States)

Sheckter, Clifford C; Matros, Evan; Momeni, Arash

2018-03-01

Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high-value care models. A systematic review of PubMed, Web of Science, and the Cost-Effectiveness Analysis Registry was conducted. Two reviewers independently evaluated all publications up until August 17, 2017. After removal of duplicates, 1996 records were screened, from which 53 studies underwent full text review. All the 13 studies included for final analysis mention an incremental cost-effectiveness ratio. Five studies evaluated the cost-effectiveness of technologies including acellular dermal matrix (ADM) in staged prosthetic reconstruction, ADM in direct-to-implant (DTI) reconstruction, preoperative computed tomography angiography in autologous reconstruction, indocyanine green dye angiography in evaluating anastomotic patency, and abdominal mesh reinforcement in abdominal tissue transfer. The remaining eight studies evaluated the cost-effectiveness of different reconstruction methods. Cost-effective strategies included free vs. pedicled abdominal tissue transfer, DTI vs. staged prosthetic reconstruction, and fascia-sparing variants of free abdominal tissue transfer. Current evidence demonstrates multiple cost-effective technologies and methods in accomplishing successful breast reconstruction. Plastic surgeons should be well informed of such economic models when engaging payers and policymakers in discussions regarding high-value breast reconstruction. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Cost and Cost-Effectiveness of Donor Human Milk to Prevent Necrotizing Enterocolitis: Systematic Review.

Science.gov (United States)

Buckle, Abigail; Taylor, Celia

2017-11-01

Necrotizing enterocolitis (NEC) is a costly gastrointestinal disorder that mainly affects preterm and low-birth-weight infants and can lead to considerable morbidity and mortality. Mother's own milk is protective against NEC but is not always available. In such cases, donor human milk has also been shown to be protective (although to a lesser extent) compared with formula milk, but it is more expensive. This systematic review aimed at evaluating the cost of donor milk, the cost of treating NEC, and the cost-effectiveness of exclusive donor milk versus formula milk feeding to reduce the short-term health and treatment costs of NEC. We systematically searched five relevant databases to find studies with verifiable costs or charges of donor milk and/or treatment of NEC and any economic evaluations comparing exclusive donor milk with exclusive formula milk feeding. All search results were double screened. Seven studies with verifiable donor milk costs and 17 with verifiable NEC treatment costs were included. The types of cost or charge included varied considerably across studies, so quantitative synthesis was not attempted. Estimates of the incremental length of stay associated with NEC were ∼18 days for medical NEC and 50 days for surgical NEC. Two studies claimed to report economic evaluations but did not do so in practice. It is likely that donor milk provides short-term cost savings by reducing the incidence of NEC. Future studies should provide more details on cost components included and a full economic evaluation, including long-term outcomes, should be undertaken.

A Review of Last Mile Logistics Innovations in an Externalities Cost Reduction Vision

Directory of Open Access Journals (Sweden)

Luigi Ranieri

2018-03-01

Full Text Available In this paper, a review of the recent scientific literature contributions on innovative strategies for last mile logistics, focusing on externalities cost reduction, is presented. Transport is causing problems in urban areas, in particular in freight transport: modern cities need solutions to reduce externalities costs such as congestion, pollution and others, which have increased in the last few years, especially due to the growth of goods delivery. Online sales and globalization lead to new trends in freight transport, and moreover, a larger quantity of goods is expected to be delivered in the next future. In this context, most of the delivered goods end up in the city centers. Last mile logistics is the least efficient stage of the supply chain and comprises up to 28% of the total delivery cost. Therefore, the improvement of last mile logistics and a significant externalities reduction are very important challenges for researchers. New technologies and transport means, innovative techniques and organizational strategies allow handling in a more effective way the last mile delivery in urban areas. Based on the Systematic Literature Review (SLR method, recent papers that significantly contributed, with original proposals, to the reduction of externalities in urban logistics are identified and analyzed in this work. Furthermore, a classification of the papers dealing with the externality reduction problem is presented. It is consistent with a general formulation proposed to evaluate external costs in urban area. The innovative contributions are classified into five main categories: innovative vehicles, proximity stations or points, collaborative and cooperative urban logistics, optimization of transport management and routing, innovations in public policies and infrastructures. The new paradigm of smart logistics is based on the combination of these concepts and on the proposed innovations.

THE ROLE OF ETHICS FOR COST ACCOUNTING PROFESSSIONALS

OpenAIRE

Petru Stefea; Nita Cornel Gabriel

2014-01-01

The purpose of this paper is to improve the understood importance of ethics for cost accounting professionals as a tool for successful cost accounting system. Also, present study is outpointing the implications of ethical conduct over the cost accounting system and, also, a review of ethical standards and principles for cost accounting professionals. The value contribution of this paper comes from a critical review of the ethics of cost accounting professionals presented by the most important...

Animal board invited review: Dairy cow lameness expenditures, losses and total cost.

Science.gov (United States)

Dolecheck, K; Bewley, J

2018-03-20

Lameness is one of the most costly dairy cow diseases, yet adoption of lameness prevention strategies remains low. Low lameness prevention adoption might be attributable to a lack of understanding regarding total lameness costs. In this review, we evaluated the contribution of different expenditures and losses to total lameness costs. Evaluated expenditures included labor for treatment, therapeutic supplies, lameness detection and lameness control and prevention. Evaluated losses included non-saleable milk, reduced milk production, reduced reproductive performance, increased animal death, increased animal culling, disease interrelationships, lameness recurrence and reduced animal welfare. The previous literature on total lameness cost estimates was also summarized. The reviewed studies indicated that previous estimates of total lameness costs are variable and inconsistent in the expenditures and losses they include. Many of the identified expenditure and loss categories require further research to accurately include in total lameness cost estimates. Future research should focus on identifying costs associated with specific lameness conditions, differing lameness severity levels, and differing stages of lactation at onset of lameness to provide better total lameness cost estimates that can be useful for decision making at both the herd and individual cow level.

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

Science.gov (United States)

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

2014-11-01

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

Cost of dengue outbreaks: literature review and country case studies.

Science.gov (United States)

Stahl, Hans-Christian; Butenschoen, Vicki Marie; Tran, Hien Tinh; Gozzer, Ernesto; Skewes, Ronald; Mahendradhata, Yodi; Runge-Ranzinger, Silvia; Kroeger, Axel; Farlow, Andrew

2013-11-06

Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save--through early response activities--resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems.The country case studies--conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control

A Review of Recent RTO Benefit-Cost Studies: Toward MoreComprehensive Assessments of FERC Electricity RestructuringPolicies

Energy Technology Data Exchange (ETDEWEB)

Eto, Joseph H.; Lesieutre, Bernard C.

2005-12-01

During the past three years, government and private organizations have issued more than a dozen studies of the benefits and costs of Regional Transmission Organizations (RTOs). Most of these studies have focused on benefits that can be readily estimated using traditional production-cost simulation techniques, which compare the cost of centralized dispatch under an RTO to dispatch in the absence of an RTO, and on costs associated with RTO start-up and operation. Taken as a whole, it is difficult to draw definitive conclusions from these studies because they have not examined potentially much larger benefits (and costs) resulting from the impacts of RTOs on reliability management, generation and transmission investment and operation, and wholesale electricity market operation. This report: (1) Describes the history of benefit-cost analysis of FERC electricity restructuring policies; (2)Reviews current practice by analyzing 11 RTO benefit-cost studies that were published between 2002 and 2004 and makes recommendations to improve the documentation of data and methods and the presentation of findings in future studies that focus primarily on estimating short-run economic impacts; and (3) Reviews important impacts of FERC policies that have been overlooked or incompletely treated by recent RTO benefit-cost studies and the challenges to crafting more comprehensive assessments of these impacts based on actual performance, including impacts on reliability management, generation and transmission investment and operation, and wholesale electricity market operation.

PHENIX WBS notes. Cost and schedule review copy

Energy Technology Data Exchange (ETDEWEB)

1994-02-01

The Work Breakdown Structure (WBS) Book begins with this Overview section, which contains the high-level summary cost estimate, the cost profile, and the global construction schedule. The summary cost estimate shows the total US cost and the cost in terms of PHENIX construction funds for building the PHENIX detector. All costs in the WBS book are shown in FY 1993 dollars. Also shown are the institutional and foreign contributions, the level of pre-operations funding, and the cost of deferred items. Pie charts are presented at PHENIX WBS level 1 and 2 that show this information. The PHENIX construction funds are shown broken down to PHENIX WBS level 3 items per fiscal year, and the resulting profile is compared to the RHIC target profile. An accumulated difference of the two profiles is also shown. The PHENIX global construction schedule is presented at the end of the Overview section. Following the Overview are sections for each subsystem. Each subsystem section begins with a summary cost estimate, cost profile, and critical path. The total level 3 cost is broken down into fixed costs (M&S), engineering costs (EDIA) and labor costs. Costs are further broken down in terms of PHENIX construction funds, institutional and foreign contributions, pre-operations funding, and deferred items. Also shown is the contingency at level 3 and the level 4 breakdown of the total cost. The cost profile in fiscal years is shown at level 3. The subsystem summaries are followed by the full cost estimate and schedule sheets for that subsystem. These detailed sheets are typically carried down to level 7 or 8. The cost estimate Total, M&S, EDIA, and Labor breakdowns, as well as contingency, for each WBS entry.

Economic evaluation and cost of interventions for cerebral palsy: a systematic review.

Science.gov (United States)

Shih, Sophy T F; Tonmukayakul, Utsana; Imms, Christine; Reddihough, Dinah; Graham, H Kerr; Cox, Liz; Carter, Rob

2018-06-01

Economic appraisal can help guide policy-making for purchasing decisions, and treatment and management algorithms for health interventions. We conducted a systematic review of economic studies in cerebral palsy (CP) to inform future research. Economic studies published since 1970 were identified from seven databases. Two reviewers independently screened abstracts and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Any discrepancies were resolved by discussion. Of 980 identified references, 115 were included for full-text assessment. Thirteen articles met standard criteria for a full economic evaluation, two as partial economic evaluations, and 18 as cost studies. Six were full economic evaluations alongside clinical studies or randomized controlled trials, whereas seven involved modelling simulations. The economic case for administration of magnesium sulfate for imminent preterm birth is compelling, achieving both health gain and cost savings. Current literature suggests intrathecal baclofen therapy and botulinum toxin injection are cost-effective, but stronger evidence for long-term effects is needed. Lifestyle and web-based interventions are inexpensive, but broader measurement of outcomes is required. Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost-effective, although stronger evidence of clinical effectiveness is needed. What this paper adds Cost-effectiveness evidence shows prevention is the most significant strategy. Some treatments are cost-effective, but stronger evidence for long-term effectiveness is required. Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications. © 2018 Mac Keith Press.

Cost-effectiveness of national health insurance programs in high-income countries: A systematic review.

Directory of Open Access Journals (Sweden)

Son Nghiem

Full Text Available National health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries.A literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library, was conducted from April to October 2015.Two reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts.Studies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another.Data on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs.Four studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY. Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions

A review of costing methodologies in critical care studies.

Science.gov (United States)

Pines, Jesse M; Fager, Samuel S; Milzman, David P

2002-09-01

Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.

Can Economic Model Transparency Improve Provider Interpretation of Cost-effectiveness Analysis? Evaluating Tradeoffs Presented by the Second Panel on Cost-effectiveness in Health and Medicine.

Science.gov (United States)

Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

2017-11-01

The Second Panel on Cost-Effectiveness in Health and Medicine convened on December 7, 2016 at the National Academy of Medicine to disseminate their recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses (CEAs). Following its summary, panel proceedings included lengthy discussions including the field's struggle to disseminate findings efficiently through peer-reviewed literature to target audiences. With editors of several medical and outcomes research journals in attendance, there was consensus that findings of cost-effectiveness analyses do not effectively reach other researchers or health care providers. The audience members suggested several solutions including providing additional training to clinicians in cost-effectiveness research and requiring that cost-effectiveness models are made publicly available. However, there remains the questions of whether making economic modelers' work open-access through journals is fair under the defense that these models remain one's own intellectual property, or whether journals can properly manage the peer-review process specifically for cost-effectiveness analyses. In this article, we elaborate on these issues and provide some suggested solutions that may increase the dissemination and application of cost-effectiveness literature to reach its intended audiences and ultimately benefit the patient. Ultimately, it is our combined view as economic modelers and clinicians that cost-effectiveness results need to reach the clinician to improve the efficiency of medical practice, but that open-access models do not improve clinician access or interpretation of the economics of medicine.

Review of Least Cost Analysis of Social Landscapes. Archaeological Case Studies [Book

Directory of Open Access Journals (Sweden)

Irmela Herzog

2013-07-01

Full Text Available The application of least cost analysis by archaeologists in Northern America and Europe has increased considerably during the last decade, and the readily available tools for this purpose have led to a much wider interest in the application of this set of techniques for research. The volume under review mainly presents the papers held at the symposium "Tracing trails and modeling movement: Understanding past cultural landscapes and social networks through least cost analysis". This symposium was organised by the editors of the volume at the 74th Annual Meeting of the Society for American Archaeologists in Atlanta in April 2009. As the book, which contains 14 chapters by 18 - all US-based - contributors, took three years to appear, inevitably some references to more recent publications on the subject of least cost analysis (LCA were not included. The volume starts with an introduction and fairly basic applications of LCA, i.e. a methodology to reconstruct patterns of human movement in space; this is followed by two parts, each consisting of three papers with new ideas for LCA applications or more advanced methods for calculating LCA. The final part presents three papers discussing different aspects of LCA raised in the first parts of the volume and general issues of methodology. In the introductory chapter the editors describe the intention of the book. It is designed "to be a guidebook for archaeologists interested in using LCA to answer behavioral questions". They explain that LCA is based on the assumption that humans tend to economise many aspects of their behaviour. They emphasise that LCA is not an end in itself but a tool which should be used properly. This ambitious goal is however not necessarily matched by the contributions to the volume, in this reviewer's eyes. Some examples are presented here to show that LCA requires a clear understanding of its methodology and that outcomes need to be validated.

Cost-effectiveness of tobacco control policies and programmes targeting adolescents: a systematic review.

Science.gov (United States)

Leão, Teresa; Kunst, Anton E; Perelman, Julian

2018-02-01

Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association.

The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England.

Science.gov (United States)

Mahon, James; Lifschitz, Carlos; Ludwig, Thomas; Thapar, Nikhil; Glanville, Julie; Miqdady, Mohamad; Saps, Miguel; Quak, Seng Hock; Lenoir Wijnkoop, Irene; Edwards, Mary; Wood, Hannah; Szajewska, Hania

2017-11-14

To estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents. To estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a 'de novo' analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated. Our calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies. The total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Oral Cholera Vaccination Delivery Cost in Low- and Middle-Income Countries: An Analysis Based on Systematic Review.

Science.gov (United States)

Mogasale, Vittal; Ramani, Enusa; Wee, Hyeseung; Kim, Jerome H

2016-12-01

Use of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers. To review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization that can help in collation, analysis, and comparison of delivery costs across countries. Peer reviewed publications listed in PubMed database, Google Scholar and World Health Organization (WHO) websites and unpublished data from organizations involved in oral cholera vaccination. The publications and reports containing oral cholera vaccination delivery costs, conducted in low- and middle-income countries based on World Bank Classification. Limits are humans and publication date before December 31st, 2014. No participants are involved, only costs are collected. Oral cholera vaccination and cost estimation. A systematic review was conducted using pre-defined inclusion and exclusion criteria. Cost items were categorized into four main cost groups: vaccination program preparation, vaccine administration, adverse events following immunization and vaccine procurement; the first three groups constituting the vaccine delivery costs. The costs were re-estimated in 2014 US dollars (US$) and in international dollar (I$). Ten studies were identified and included in the analysis. The vaccine delivery costs ranged from US$0.36 to US$ 6.32 (in US$2014) which was equivalent to I$ 0.99 to I$ 16.81 (in I$2014). The vaccine procurement costs ranged from US$ 0.29 to US$ 29.70 (in US$2014), which was equivalent to I$ 0.72 to I$ 78.96 (in I$2014). The delivery costs in routine immunization systems were lowest from US$ 0.36 (in US$2014) equivalent to I$ 0.99 (in I$2014). The reported cost categories

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

Science.gov (United States)

2013-05-01

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

Cost of dengue outbreaks: literature review and country case studies

Science.gov (United States)

2013-01-01

Background Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Methods Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Results Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems. The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the

Value for Money in H1N1 Influenza: A Systematic Review of the Cost-Effectiveness of Pandemic Interventions.

Science.gov (United States)

Pasquini-Descomps, Hélène; Brender, Nathalie; Maradan, David

2017-06-01

The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research? The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective. We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality. The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises. This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

2014-01-01

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

Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: A systematic review of systematic reviews and meta-analyses

NARCIS (Netherlands)

N.J. Elbert (Niels); H. van Os-Medendorp (Harmieke); W. van Renselaar (Wilco); A.G. Ekeland (Anne G); L. van Hakkaart-van Roijen (Leona); H. Raat (Hein); T.E.C. Nijsten (Tamar); S.G.M.A. Pasmans (Suzanne)

2014-01-01

textabstractEHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking. Objective: We conducted a systematic review of

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations

Science.gov (United States)

Meuldijk, Denise; McCarthy, Alexandra; Bourke, Marianne E.; Grenyer, Brin F. S.

2017-01-01

Aim Borderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update. Methods Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities. Results We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found. Discussion Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations.

Directory of Open Access Journals (Sweden)

Denise Meuldijk

Full Text Available Borderline Personality Disorder (BPD is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update.Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $ using purchasing power parities.We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392 was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found.Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread reductions in

Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review.

Science.gov (United States)

Gabriel, L; Beriot-Mathiot, A

2014-09-01

In most healthcare systems, third-party payers fund the costs for patients admitted to hospital for Clostridium difficile infection (CDI) whereas, for CDI cases arising as complications of hospitalization, not all related costs are refundable to the hospital. We therefore aimed to critically review and categorize hospital costs and length of hospital stay (LOS) attributable to Clostridium difficile infection and to investigate the economic burden associated with it. A comprehensive literature review selected papers describing the costs and LOS for hospitalized patients as outcomes of CDI, following the use of statistics to identify costs and LOS solely attributable to CDI. Twenty-four studies were selected. Estimated attributable costs, all ranges expressed in US dollars, were $6,774-$10,212 for CDI requiring admission, $2,992-$29,000 for hospital-acquired CDI, and $2,454-$12,850 where no categorization was made. The ranges for LOS values were 5-13.6, 2.7-21.3, and 2.8-17.9 days, respectively. The categorization of CDI attributable costs allows budget holders to anticipate the cost per CDI case, a perspective that should enrich the design of appropriate incentives for the various budget holders to invest in prevention so that CDI prevention is optimized globally. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Patient-level costs of major cardiovascular conditions: a review of the international literature.

Science.gov (United States)

Nicholson, Gina; Gandra, Shravanthi R; Halbert, Ronald J; Richhariya, Akshara; Nordyke, Robert J

2016-01-01

Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events. MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values. Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union. This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.

The sunk cost effect across species: A review of persistence in a course of action due to prior investment.

Science.gov (United States)

Magalhães, Paula; Geoffrey White, K

2016-05-01

The sunk cost effect is the bias or tendency to persist in a course of action due to prior investments of effort, money or time. At the time of the only review on the sunk cost effect across species (Arkes & Ayton, 1999), research with nonhuman animals had been ecological in its nature, and the findings about the effect of past investments on current choice were inconclusive. However, in the last decade a new line of experimental laboratory-based research has emerged with the promise of revolutionizing the way we approach the study of the sunk cost effect in nonhumans. In the present review we challenge Arkes and Ayton's conclusion that the sunk cost effect is exclusive to humans, and describe evidence for the sunk cost effect in nonhuman animals. By doing so, we also challenge the current explanations for the sunk cost effect in humans, as they are not applicable to nonhumans. We argue that a unified theory is called for, because different independent variables, in particular, investment amount, have the same influence on the sunk cost effect across species. Finally, we suggest possible psychological mechanisms shared across different species, contrast and depreciation, that could explain the sunk cost effect. © 2016 Society for the Experimental Analysis of Behavior.

Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

Directory of Open Access Journals (Sweden)

Kennedy-Martin T

2017-06-01

Full Text Available Tessa Kennedy-Martin,1 Kristina S Boye,2 Xiaomei Peng2 1Kennedy-Martin Health Outcomes Ltd, Brighton, UK; 2Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA Purpose: To explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM.Methods: Primary research studies published between January 2006 and December 2015 on compliance, adherence, or persistence and treatment in patients with T2DM that document a link with health care costs were identified through literature searches in bibliographic databases and 2015 abstract books for relevant DM congresses. Results were assessed for relevance by two reviewers. The review was part of a larger overview evaluating the impact of adherence and persistence on a range of clinical and economic outcomes; only findings from the cost element are reported herein.Results: A total of 4,662 de-duplicated abstracts were identified and 110 studies included in the wider review. Of these, 19 reported an association between adherence (n=13, persistence (n=5, or adherence and persistence (n=1, and health care costs. All studies were retrospective, with sample sizes ranging from 301 to 740,195. Medication possession ratio was the most commonly employed adherence measure (n=11. The majority of adherence studies (n=9 reported that medication adherence was associated with lower total health care costs. Pharmacy costs were often increased in adherent patients but this was offset by beneficial effects on other costs. Findings were more variable in persistence studies; three reported that higher pharmacy costs in persistent patients were not sufficiently offset by savings in other areas to result in a reduction in total health care costs.Conclusions: Few studies have evaluated the relationship between adherence, persistence, and health care costs in T2DM. However, it has been consistently shown that medication

Systematic review of the cost-effectiveness of transcatheter interventions for valvular heart disease.

Science.gov (United States)

Gialama, Fotini; Prezerakos, Panagiotis; Apostolopoulos, Vasilis; Maniadakis, Nikolaos

2018-04-01

Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) are increasingly used for managing patients with valvular heart disease to whom surgery presents a high-risk. As these are costly procedures, a systematic review of studies concerned with their economic assessment was undertaken. The search was performed in PubMed and the Cochrane Library and followed recommended methodological steps. Studies were screened and their data were retrieved and were synthesized using a narrative approach. Twenty-four, good to high quality, evaluations were identified, representing different viewpoints, modelling techniques and willingness-to-pay thresholds. Studies show that in high-risk patients with symptomatic aortic stenosis, TAVI may be cost-effective compared with medical management (MM) across many health care settings. In contrast, studies of TAVI compared with surgical aortic valve replacement (SAVR) yield conflicting and inconclusive results. The limited data available show that TMVR may also be cost-effective relative to MM in mitral valve disease. Existing evidence indicates that transcatheter techniques may be cost-effective options, relative to MM, in high-risk patients with valvular disease. Nonetheless, more research is needed to establish their economic value further, to investigate the drives of cost-effectiveness, and to evaluate surgical with transcatheter techniques in aortic valvular disease.

Oral Cholera Vaccination Delivery Cost in Low- and Middle-Income Countries: An Analysis Based on Systematic Review

Science.gov (United States)

Ramani, Enusa; Wee, Hyeseung; Kim, Jerome H.

2016-01-01

Background Use of the oral cholera vaccine (OCV) is a vital short-term strategy to control cholera in endemic areas with poor water and sanitation infrastructure. Identifying, estimating, and categorizing the delivery costs of OCV campaigns are useful in analyzing cost-effectiveness, understanding vaccine affordability, and in planning and decision making by program managers and policy makers. Objectives To review and re-estimate oral cholera vaccination program costs and propose a new standardized categorization that can help in collation, analysis, and comparison of delivery costs across countries. Data sources Peer reviewed publications listed in PubMed database, Google Scholar and World Health Organization (WHO) websites and unpublished data from organizations involved in oral cholera vaccination. Study eligibility criteria The publications and reports containing oral cholera vaccination delivery costs, conducted in low- and middle-income countries based on World Bank Classification. Limits are humans and publication date before December 31st, 2014. Participants No participants are involved, only costs are collected. Intervention Oral cholera vaccination and cost estimation. Study appraisal and synthesis method A systematic review was conducted using pre-defined inclusion and exclusion criteria. Cost items were categorized into four main cost groups: vaccination program preparation, vaccine administration, adverse events following immunization and vaccine procurement; the first three groups constituting the vaccine delivery costs. The costs were re-estimated in 2014 US dollars (US$) and in international dollar (I$). Results Ten studies were identified and included in the analysis. The vaccine delivery costs ranged from US$0.36 to US$ 6.32 (in US$2014) which was equivalent to I$ 0.99 to I$ 16.81 (in I$2014). The vaccine procurement costs ranged from US$ 0.29 to US$ 29.70 (in US$2014), which was equivalent to I$ 0.72 to I$ 78.96 (in I$2014). The delivery costs in

78 FR 13675 - Federal Acquisition Regulation; Submission for OMB Review; Cost Accounting Standards Administration

Science.gov (United States)

2013-02-28

...; Submission for OMB Review; Cost Accounting Standards Administration AGENCY: Department of Defense (DOD... collection requirement concerning cost accounting standards administration. A notice was published in the...- 0129, Cost Accounting Standards Administration by any of the following methods: Regulations.gov : http...

A REVIEW OF ESTIMATION OF SOFTWARE PRODUCTS DEVELOPMENT COSTS

Directory of Open Access Journals (Sweden)

Edin Osmanbegović

2017-01-01

Full Text Available In the modern business and management of business processes, the standardization of procedures allows the creation of added value, increasing competitiveness and success in the business of an organization. Evaluation of the budget for software development is crucial to the success of an IT project, because the inability to make a realistic assessment leads to inadequate project plans, customer dissatisfaction, poor quality of software products, and reduced profits. In order to minimize such situations, making accurate and reliable software cost estimation should be carried out at all stages of the project life cycle. Although hundreds of research articles focusing on the application of different methods of budget estimates of the software product have been published so far, there is no comprehensive review of the current situation or review of research trends in the budget estimates of the software product. This paper aims to create a framework for estimation of costs of development of software products by providing an overview of the most influential researchers, the most influential articles published in the WoS database, the most used keywords for searching the articles, as well as a review of the estimation techniques used in budget estimates of the software product.

Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.

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Murray, A; Lourenco, T; de Verteuil, R; Hernandez, R; Fraser, C; McKinley, A; Krukowski, Z; Vale, L; Grant, A

2006-11-01

The aim of this study was to determine the clinical effectiveness and cost-effectiveness of laparoscopic, laparoscopically assisted (hereafter together described as laparoscopic surgery) and hand-assisted laparoscopic surgery (HALS) in comparison with open surgery for the treatment of colorectal cancer. Electronic databases were searched from 2000 to May 2005. A review of economic evaluations was undertaken by the National Institute for Health and Clinical Excellence in 2001. This review was updated from 2000 until July 2005. Data from selected studies were extracted and assessed. Dichotomous outcome data from individual trials were combined using the relative risk method and continuous outcomes were combined using the Mantel-Haenszel weighted mean difference method. Summaries of the results from individual patient data (IPD) meta-analyses were also presented. An economic evaluation was also carried out using a Markov model incorporating the data from the systematic review. The results were first presented as a balance sheet for comparison of the surgical techniques. It was then used to estimate cost-effectiveness measured in terms of incremental cost per life-year gained and incremental cost per quality-adjusted life-year (QALY) for a time horizon up to 25 years. Forty-six reports on 20 studies [19 randomised controlled trials (RCTs) and one IPD meta-analysis] were included in the review of clinical effectiveness. The RCTs were of generally moderate quality with the number of participants varying between 16 and 1082, with 10 having less than 100 participants. The total numbers of trial participants who underwent laparoscopic or open surgery were 2429 and 2139, respectively. A systematic review of four papers suggested that laparoscopic surgery is more costly than open surgery. However, the data they provided on effectiveness was poorer than the evidence from the review of effectiveness. The estimates from the systematic review of clinical effectiveness were

Review of the cost components of introducing industrially fortified rice.

Science.gov (United States)

Roks, Eveline

2014-09-01

Micronutrient deficiencies affect over two billion people worldwide, particularly in developing countries. Fortification of staple foods with multiple micronutrients is a cost-effective strategy to increase vitamin and mineral intake. The objective of this paper is to review the cost elements of industrially fortified rice by identifying the costs related to the implementation of rice fortification programs, using the experience of the United Nations World Food Programme in its pilot countries. The actual total costs of rice fortification are not easily captured. Core cost elements include the production of fortified rice kernels, transportation to the point of blending, blending of fortified with unfortified rice, costs related to sales or distribution, quality control and assurance, and additional planning. In the introduction phase, organizations or coalitions seeking to advance rice fortification will face additional costs related to the initiation of rice fortification. In the scale-up phase, greater efficiency in the supply chain and economies of scale can be expected. Different cost elements are normally borne by different stakeholders. This makes the implementation of rice fortification programs a feasible option to reach vulnerable populations with inadequate access to affordable nutrition solutions. © 2014 New York Academy of Sciences.

PHENIX Work Breakdown Structure. Cost and schedule review copy

Energy Technology Data Exchange (ETDEWEB)

1994-02-01

The Work Breakdown Structure (WBS) Book begins with this Overview section, which contains the high-level summary cost estimate, the cost profile, and the global construction schedule. The summary cost estimate shows the total US cost and the cost in terms of PHENIX construction funds for building the PHENIX detector. All costs in the WBS book are shown in FY 1993 dollars. Also shown are the institutional and foreign contributions, the level of pre-operations funding, and the cost of deferred items. Pie charts are presented at PHENIX WBS level 1 and 2 that show this information. The PHENIX construction funds are shown broken down to PHENIX WBS level 3 items per fiscal year, and the resulting profile is compared to the RHIC target profile. An accumulated difference of the two profiles is also shown. The PHENIX global construction schedule is presented at the end of the Overview section. Following the Overview are sections for each subsystem. Each subsystem section begins with a summary cost estimate, cost profile, and critical path. The total level 3 cost is broken down into fixed costs (M&S), engineering costs (EDIA) and labor costs. Costs are further broken down in terms of PHENIX construction funds, institutional and foreign contributions, pre-operations funding, and deferred items. Also shown is the contingency at level 3 and the level 4 breakdown of the total cost. The cost profile in fiscal years is shown at level 3. The subsystem summaries are followed by the full cost estimate and schedule sheets for that subsystem. These detailed sheets are typically carried down to level 7 or 8. The cost estimate shows Total, M&S, EDIA, and Labor breakdowns, as well as contingency, for each WBS entry.

Cost: the missing outcome in simulation-based medical education research: a systematic review.

Science.gov (United States)

Zendejas, Benjamin; Wang, Amy T; Brydges, Ryan; Hamstra, Stanley J; Cook, David A

2013-02-01

The costs involved with technology-enhanced simulation remain unknown. Appraising the value of simulation-based medical education (SBME) requires complete accounting and reporting of cost. We sought to summarize the quantity and quality of studies that contain an economic analysis of SBME for the training of health professions learners. We performed a systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Articles reporting original research in any language evaluating the cost of simulation, in comparison with nonstimulation instruction or another simulation intervention, for training practicing and student physicians, nurses, and other health professionals were selected. Reviewers working in duplicate evaluated study quality and abstracted information on learners, instructional design, cost elements, and outcomes. From a pool of 10,903 articles we identified 967 comparative studies. Of these, 59 studies (6.1%) reported any cost elements and 15 (1.6%) provided information on cost compared with another instructional approach. We identified 11 cost components reported, most often the cost of the simulator (n = 42 studies; 71%) and training materials (n = 21; 36%). Ten potential cost components were never reported. The median number of cost components reported per study was 2 (range, 1-9). Only 12 studies (20%) reported cost in the Results section; most reported it in the Discussion (n = 34; 58%). Cost reporting in SBME research is infrequent and incomplete. We propose a comprehensive model for accounting and reporting costs in SBME. Copyright © 2013 Mosby, Inc. All rights reserved.

Cost-effectiveness of health research study participant recruitment strategies: a systematic review.

Science.gov (United States)

Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A

2014-10-01

A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of

A review of the present status of food irradiation

International Nuclear Information System (INIS)

Beddoes, J.M.

1982-06-01

Investigations into the potential of food irradiation as a major food processing technology have been underway for over twenty years. Considerable progress has been made in the areas of its science and technology, its governmental and international regulation, its acceptance by consumers, and its economic impact on the cost of food. The paper reviews some of the major steps taken in food irradiation and predicts that it will become a new world wide application of technology in the 1980's

Cost Effectiveness of Monoclonal Antibody Therapy for Rare Diseases: A Systematic Review.

Science.gov (United States)

Park, Taehwan; Griggs, Scott K; Suh, Dong-Churl

2015-08-01

Monoclonal antibody (mAb)-based orphan drugs have led to advances in the treatment of diseases by selectively targeting molecule functions. However, their high treatment costs impose a substantial cost burden on patients and society. The study aimed to systematically review cost-effectiveness evidence of mAb orphan drugs. Ovid MEDLINE(®), EMBASE(®), and PsycINFO(®) were searched in June 2014 and articles were selected if they conducted economic evaluations of the mAb orphan drugs that had received marketing approval in the USA. The quality of the selected studies was assessed using the Quality of Health Economic Studies (QHES) instrument. We reviewed 16 articles that included 24 economic evaluations of nine mAb orphan drugs. Six of these nine drugs were included in cost-utility analysis studies, whereas three drugs were included in cost-effectiveness analysis studies. Previous cost-utility analysis studies revealed that four mAb orphan drugs (cetuximab, ipilimumab, rituximab, and trastuzumab) were found to be cost effective; one drug (bevacizumab) was not cost effective; and one drug (infliximab) was not consistent across the studies. Prior cost-effectiveness analysis studies which included three mAb orphan drugs (adalimumab, alemtuzumab, and basiliximab) showed that the incremental cost per effectiveness gained for these drugs ranged from $US4669 to $Can52,536 Canadian dollars. The quality of the included studies was good or fair with the exception of one study. Some mAb orphan drugs were reported as cost effective under the current decision-making processes. Use of these expensive drugs, however, can raise an equity issue which concerns fairness in access to treatment. The issue of equal access to drugs needs to be considered alongside other societal values in making the final health policy decisions.

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

Science.gov (United States)

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

2012-11-14

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

The Economic Cost of Implementing Maternal and Neonatal Death Review in a District of Bangladesh.

Science.gov (United States)

Biswas, Animesh; Halim, Abdul; Rahman, Fazlur; Eriksson, Charli; Dalal, Koustuv

2016-12-09

Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31 st Dec 2012. Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the first year (2010). In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011) and 6,622,166 BDT (270,735 $INT, during 2012). The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT). Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system.

The economic cost of implementing maternal and neonatal death review in a district of Bangladesh

Directory of Open Access Journals (Sweden)

Animesh Biswas

2016-12-01

Full Text Available Introduction: Maternal and neonatal death review (MNDR introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals. This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. Materials and methods: MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31st Dec 2012. Results: Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT in the first year (2010. In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011 and 6,622,166 BDT (270,735 $INT, during 2012. The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT.Conclusions: Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system.

Cost-of-illness studies for bipolar disorder: systematic review of international studies.

Science.gov (United States)

Jin, Huajie; McCrone, Paul

2015-04-01

Bipolar disorder (BD) may result in a greater burden than all forms of cancer, Alzheimer's disease and epilepsy. Cost-of-illness (COI) studies provide useful information on the economic burden that BD imposes on a society. Furthermore, COI studies are pivotal sources of evidence used in economic evaluations. This study aims to give a general overview of COI studies for BD and to discuss methodological issues that might potentially influence results. This study also aims to provide recommendations to improve practice in this area, based on the review. A search was performed to identify COI studies of BD. The following electronic databases were searched: MEDLINE, EMBASE, PsycInfo, Cochrane Database of Systematic Reviews, HMIC and openSIGLE. The primary outcome of this review was the annual cost per BD patient. A narrative assessment of key methodological issues was also included. Based on these findings, recommendations for good practice were drafted. Fifty-four studies were included in this review. Because of the widespread methodological heterogeneity among included studies, no attempt has been made to pool results of different studies. Potential areas for methodological improvement were identified. These were: description of the disease and population, the approach to deal with comorbidities, reporting the rationale and impact for choosing different cost perspectives, and ways in which uncertainty is addressed. This review showed that numerous COI studies have been conducted for BD since 1995. However, these studies employed varying methods, which limit the comparability of findings. The recommendations provided by this review can be used by those conducting COI studies and those critiquing them, to increase the credibility and reporting of study results.

Review of PV Inverter Technology Cost and Performance Projections

Energy Technology Data Exchange (ETDEWEB)

Navigant Consulting Inc.

2006-01-01

The National Renewable Energy Laboratory (NREL) has a major responsibility in the implementation of the U.S. Department of Energy's (DOE's) Solar Energy Technologies Program. Sandia National Laboratories (SNL) has a major role in supporting inverter development, characterization, standards, certifications, and verifications. The Solar Energy Technologies Program recently published a Multiyear Technical Plan, which establishes a goal of reducing the Levelized Energy Cost (LEC) for photovoltaic (PV) systems to $0.06/kWh by 2020. The Multiyear Technical Plan estimates that, in order to meet the PV system goal, PV inverter prices will need to decline to $0.25-0.30 Wp by 2020. DOE determined the need to conduct a rigorous review of the PV Program's technical and economic targets, including the target set for PV inverters. NREL requested that Navigant Consulting Inc.(NCI) conduct a review of historical and projected cost and performance improvements for PV inverters, including identification of critical barriers identified and the approaches government might use to address them.

What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses.

Science.gov (United States)

Doble, Brett; Wordsworth, Sarah; Rogers, Chris A; Welbourn, Richard; Byrne, James; Blazeby, Jane M

2017-08-01

This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven 'important' cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended 'important' cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis.

Science.gov (United States)

Welton, Nicky J; McAleenan, Alexandra; Thom, Howard Hz; Davies, Philippa; Hollingworth, Will; Higgins, Julian Pt; Okoli, George; Sterne, Jonathan Ac; Feder, Gene; Eaton, Diane; Hingorani, Aroon; Fawsitt, Christopher; Lobban, Trudie; Bryden, Peter; Richards, Alison; Sofat, Reecha

2017-05-01

Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources. To conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model. Systematic review, meta-analysis and cost-effectiveness analysis. Primary care. Adults. Screening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}. Sensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening. Two reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies. Diagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost

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.

A literature review of the cost-effectiveness of nuclear medicine

International Nuclear Information System (INIS)

Carter, J.

1995-01-01

Nuclear medicine is a medical speciality that uses tiny quantities of radioactivity to produce diagnostic images. It also has a role in therapy for some thyroid diseases and certain tumours. Surveys have shown that nuclear medicine procedures are used significantly less in the UK than in many other countries in Europe. One reason may be that there is inadequate information about the clinical utility of these techniques, particularly their cost-effectiveness in clinical management. To establish what evidence was currently available about the cost-effectiveness of nuclear medicine, the British Nuclear Medicine Society commissioned a worldwide literature review in diseases of the heart, kidney, lung, bone, brain, bowel and thyroid. This volume summarises the findings of the independent study and gives details of the background, clinical utility and limitations of the different nuclear medicine procedures used in the diagnosis and treatment of each disease reviewed. (author)

Cost escalation in nuclear power

International Nuclear Information System (INIS)

Montomery, W.D.; Quirk, J.P.

1978-01-01

This report is concerned with the escalation of capital costs of nuclear central station power plants between the early 1960s and the present. The report presents an historical overview of the development of the nuclear power industry and cost escalation in the industry, using existing data on orders and capital costs. New data are presented on regulatory delays in the licensing process, derived from a concurrent study being carried on in the Social Science group at Caltech. The conclusions of the study are that nuclear capital costs have escalated more rapidly than the GNP deflator or the construction industry price index. Prior to 1970, cost increases are related to bottleneck problems in the nuclear construction and supplying industries and the regulatory process; intervenors play only a minor role in cost escalation. After 1970, generic changes introduced into the licensing process by intervenors (including environmental impact reviews, antitrust reviews, more stringent safety standards) dominate the cost escalation picture, with bottlenecks of secondary importance. Recent increases in the time from application for a construction permit to commercial operation are related not only to intervenor actions, but also to suspensions, cancellations or postponements of construction by utilities due to unfavorable demand or financing conditions

Patient-level costs of major cardiovascular conditions: a review of the international literature

Directory of Open Access Journals (Sweden)

Nicholson G

2016-09-01

Full Text Available Gina Nicholson,1 Shravanthi R Gandra,2 Ronald J Halbert,1 Akshara Richhariya,2 Robert J Nordyke1 1ICON, El Segundo, 2Amgen Inc., Thousand Oaks, CA, USA Objective: Robust cost estimates of cardiovascular (CV events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events.Methods: MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest – unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values.Results: Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union.Conclusion: This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed. Keywords: cardiovascular diseases, health care costs, hospitalization economics, follow-up studies

Electricity transmission congestion costs: A review of recent reports

Energy Technology Data Exchange (ETDEWEB)

Lesieutre, Bernard C.; Eto, Joseph H.

2003-10-01

Recently, independent system operators (ISOs) and others have published reports on the costs of transmission congestion. The magnitude of congestion costs cited in these reports has contributed to the national discussion on the current state of U.S. electricity transmission system and whether it provides an adequate platform for competition in wholesale electricity markets. This report reviews reports of congestion costs and begins to assess their implications for the current national discussion on the importance of the U.S. electricity transmission system for enabling competitive wholesale electricity markets. As a guiding principle, we posit that a more robust electricity system could reduce congestion costs; and thereby, (1) facilitate more vibrant and fair competition in wholesale electricity markets, and (2) enable consumers to seek out the lowest prices for electricity. Yet, examining the details suggests that, sometimes, there will be trade-offs between these goals. Therefore, it is essential to understand who pays, how much, and how do they benefit in evaluating options (both transmission and non-transmission alternatives) to address transmission congestion. To describe the differences among published estimates of congestion costs, we develop and motivate three ways by which transmission congestion costs are calculated in restructured markets. The assessment demonstrates that published transmission congestion costs are not directly comparable because they have been developed to serve different purposes. More importantly, critical information needed to make them more comparable, for example in order to evaluate the impacts of options to relieve congestion, is sometimes not available.

Taking the Evolutionary Road to Developing an In-House Cost Estimate

Science.gov (United States)

Jacintho, David; Esker, Lind; Herman, Frank; Lavaque, Rodolfo; Regardie, Myma

2011-01-01

This slide presentation reviews the process and some of the problems and challenges of developing an In-House Cost Estimate (IHCE). Using as an example the Space Network Ground Segment Sustainment (SGSS) project, the presentation reviews the phases for developing a Cost estimate within the project to estimate government and contractor project costs to support a budget request.

The cost of prevention and treatment of pressure ulcers: A systematic review.

Science.gov (United States)

Demarré, Liesbet; Van Lancker, Aurélie; Van Hecke, Ann; Verhaeghe, Sofie; Grypdonck, Maria; Lemey, Juul; Annemans, Lieven; Beeckman, Dimitri

2015-11-01

Pressure ulcers impose a substantial financial burden. The need for high-quality health care while expenditures are constrained entails the interest to calculate the cost of preventing and treating pressure ulcers and their impact on patients, healthcare, and society. The aim of this paper is to provide insight into the cost of pressure ulcer prevention and treatment in an adult population. A systematic literature review was performed to conform the Cochrane Collaboration guidelines for systematic reviews. The search strategy contained index terms and key words related to pressure ulcers and cost. The search was performed in Medline, CINAHL, Web of Science, The Cochrane Library, Embase, and EconLit covering articles up to September 2013. Reference lists and conference abstracts were screened. Articles were eligible if they reported on direct medical cost of pressure ulcer prevention or treatment, and provided national cost estimates, cost per patient, or cost per patient per day. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies. In total, 2542 records were retrieved. After assessing eligibility, 17 articles were included. Five articles reported on both the cost of prevention and treatment, three articles reported on cost of prevention, and nine articles reported on the cost of pressure ulcer treatment. All articles were published between 2001 and 2013. Cost of pressure ulcer prevention per patient per day varied between 2.65 € to 87.57 € across all settings. Cost of pressure ulcer treatment per patient per day ranged from 1.71 € to 470.49 € across different settings. The methodological heterogeneity among studies was considerable, and encompassed differences regarding type of health economic design, perspective, cost components, and health outcomes. Cost of pressure ulcer prevention and treatment differed considerable between studies. Although the cost to provide pressure ulcer prevention

77 FR 58103 - Federal Acquisition Regulation; Submission for OMB Review; Corporate Aircraft Costs

Science.gov (United States)

2012-09-19

... is determined that an upward adjustment is not required at this time. The historical estimates remain...; Submission for OMB Review; Corporate Aircraft Costs AGENCY: Department of Defense (DOD), General Services... requirement concerning corporate aircraft costs. A notice was published in the Federal Register at 77 FR 20012...

The cost effectiveness of long-acting/extended-release antipsychotics for the treatment of schizophrenia: a systematic review of economic evaluations.

Science.gov (United States)

Achilla, Evanthia; McCrone, Paul

2013-04-01

Antipsychotic medication is the mainstay of treatment in schizophrenia. Long-acting medication has potential advantages over daily medication in improving compliance and thus reducing hospitalization and relapse rates. The high acquisition and administration costs of such formulations raise the need for pharmacoeconomic evaluation. The aim of this article is to provide a comprehensive review of the available evidence on the cost effectiveness of long-acting/extended-release antipsychotic medication and critically appraise the strength of evidence reported in the studies from a methodological viewpoint. Relevant studies were identified by searching five electronic databases: PsycINFO, MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database (HTA). Search terms included, but were not limited to, 'long-acting injection', 'economic evaluation', 'cost-effectiveness' and 'cost-utility'. No limits were applied for publication dates and language. Full economic evaluations on long-acting/extended-release antipsychotics were eligible for inclusion. Observational studies and clinical trials were also checked for cost-effectiveness information. Conference abstracts and poster presentations on the cost effectiveness of long-acting antipsychotics were excluded. Thirty-two percent of identified studies met the selection criteria. Pertinent abstracts were reviewed independently by two reviewers. Relevant studies underwent data extraction by one reviewer and were checked by a second, with any discrepancies being clarified during consensus meetings. Eligible studies were assessed for methodological quality using the quality checklist for economic studies recommended by the NICE guideline on interventions in the treatment and management of schizophrenia. After applying the selection criteria, the final sample consisted of 28 studies. The majority of studies demonstrated that risperidone long-acting injection, relative to oral or other long

Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

Science.gov (United States)

Herbert, T. T.

1971-01-01

Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

The quality of reporting methods and results of cost-effectiveness analyses in Spain: a methodological systematic review.

Science.gov (United States)

Catalá-López, Ferrán; Ridao, Manuel; Alonso-Arroyo, Adolfo; García-Altés, Anna; Cameron, Chris; González-Bermejo, Diana; Aleixandre-Benavent, Rafael; Bernal-Delgado, Enrique; Peiró, Salvador; Tabarés-Seisdedos, Rafael; Hutton, Brian

2016-01-07

Cost-effectiveness analysis has been recognized as an important tool to determine the efficiency of healthcare interventions and services. There is a need for evaluating the reporting of methods and results of cost-effectiveness analyses and establishing their validity. We describe and examine reporting characteristics of methods and results of cost-effectiveness analyses conducted in Spain during more than two decades. A methodological systematic review was conducted with the information obtained through an updated literature review in PubMed and complementary databases (e.g. Scopus, ISI Web of Science, National Health Service Economic Evaluation Database (NHS EED) and Health Technology Assessment (HTA) databases from Centre for Reviews and Dissemination (CRD), Índice Médico Español (IME) Índice Bibliográfico Español en Ciencias de la Salud (IBECS)). We identified cost-effectiveness analyses conducted in Spain that used quality-adjusted life years (QALYs) as outcome measures (period 1989-December 2014). Two reviewers independently extracted the data from each paper. The data were analysed descriptively. In total, 223 studies were included. Very few studies (10; 4.5 %) reported working from a protocol. Most studies (200; 89.7 %) were simulation models and included a median of 1000 patients. Only 105 (47.1 %) studies presented an adequate description of the characteristics of the target population. Most study interventions were categorized as therapeutic (189; 84.8 %) and nearly half (111; 49.8 %) considered an active alternative as the comparator. Effectiveness of data was derived from a single study in 87 (39.0 %) reports, and only few (40; 17.9 %) used evidence synthesis-based estimates. Few studies (42; 18.8 %) reported a full description of methods for QALY calculation. The majority of the studies (147; 65.9 %) reported that the study intervention produced "more costs and more QALYs" than the comparator. Most studies (200; 89.7 %) reported favourable

Cost of diabetic foot in France, Spain, Italy, Germany and United Kingdom: A systematic review.

Science.gov (United States)

Tchero, Huidi; Kangambega, Pauline; Lin, Lucien; Mukisi-Mukaza, Martin; Brunet-Houdard, Solenne; Briatte, Christine; Retali, Gerald Reparate; Rusch, Emmanuel

2018-04-01

Cost estimates for diabetic foot are available for developed countries based on cost data for different years. This study aimed to provide a comparison of the cost of diabetic foot in E5 (France, Spain, Italy, Germany, and the United Kingdom) and its characteristics across different conditions. PubMed, Central and Embase databases were searched in February 2017 for English language publications. Bibliographies of relevant papers were also searched manually. Reviews and research papers from E5 regions reporting on cost of diabetic foot were included. Reported cost was converted to equivalent 2016 $ for comparison purposes. All the costs presented are mean cost per patient per year in 2016 $. Nine studies were included in the analysis. The total cost of amputation ranged from $ 15,046 in 2001 to $ 38,621 in 2005. The direct cost of amputation ranged from $ 13,842 in 2001 to $ 83,728 during 2005-2009. Indirect cost of amputation was more uniform, ranging from between $ 1,043 to $ 1,442. The direct cost of gangrene ranged from $ 3,352 in 2003 to $ 8,818 in Germany. Although, for the same year, 2003, the cost for Spain was almost double that for Germany. The total cost of an uninfected ulcer was $ 6,174 in 2002, but increased to $ 14,441 in 2005; for an infected ulcer the cost increased from $ 2,637 to $ 2,957. The different countries showed variations in the components used to calculate the cost of diabetic foot. The E5 incurs a heavy cost from diabetic foot and its complications. There is an unmet need for the identification of cost-cutting strategies, as diabetic foot costs more than major cardiac diseases. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

2014 Water Power Program Peer Review: Hydropower Technologies, Compiled Presentations (Presentation)

Energy Technology Data Exchange (ETDEWEB)

2014-02-01

This document represents a collection of all presentations given during the EERE Wind and Water Power Program's 2014 Hydropower Peer Review. The purpose of the meeting was to evaluate DOE-funded hydropower and marine and hydrokinetic R&D projects for their contribution to the mission and goals of the Water Power Program and to assess progress made against stated objectives.

Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment – a review

Directory of Open Access Journals (Sweden)

Hasford Joerg

2009-03-01

Full Text Available Abstract Background Blood pressure lowering drugs are usually evaluated in short term trials determining the absolute blood pressure reduction during trough and the duration of the antihypertensive effect after single or multiple dosing. A lack of persistence with treatment has however been shown to be linked to a worse cardiovascular prognosis. This review explores the blood pressure reduction and persistence with treatment of antihypertensive drugs and the cost consequences of poor persistence with pharmaceutical interventions in arterial hypertension. Methods We have searched the literature for data on blood pressure lowering effects of different antihypertensive drug classes and agents, on persistence with treatment, and on related costs. Persistence was measured as patients' medication possession rate. Results are presented in the form of a systematic review. Results Angiotensin II receptor blocker (ARBs have a competitive blood pressure lowering efficacy compared with ACE-inhibitors (ACEi and calcium channel blockers (CCBs, beta-blockers (BBs and diuretics. 8 studies describing the persistence with treatment were identified. Patients were more persistent on ARBs than on ACEi and CCBs, BBs and diuretics. Thus the product of blood pressure lowering and persistence was higher on ARBs than on any other drug class. Although the price per tablet of more recently developed drugs (ACEi, ARBs is higher than that of older ones (diuretics and BBs, the newer drugs result in a more favourable cost to effect ratio when direct drug costs and indirect costs are also considered. Conclusion To evaluate drugs for the treatment of hypertension several key variables including the blood pressure lowering effect, side effects, compliance/persistence with treatment, as well as drug costs and direct and indirect costs of medical care have to be considered. ARBs, while nominally more expensive when drug costs are considered only, provide substantial cost savings

Cost-volume-profit and net present value analysis of health information systems.

Science.gov (United States)

McLean, R A

1998-08-01

The adoption of any information system should be justified by an economic analysis demonstrating that its projected benefits outweigh its projected costs. Analysis differ, however, on which methods to employ for such a justification. Accountants prefer cost-volume-profit analysis, and economists prefer net present value analysis. The article explains the strengths and weaknesses of each method and shows how they can be used together so that well-informed investments in information systems can be made.

Air pollution in Australia: review of costs, sources and potential solutions.

Science.gov (United States)

Robinson, Dorothy L

2005-12-01

Estimated health costs and principal sources of air pollution are reviewed, together with estimated costs of reducing pollution from major sources in Australia. Emissions data from the Australian National Pollutant Inventory were compared with published estimates of pollution costs and converted to the cost per kilogram of emissions. Costs per kg of emissions (and, for the two main sources of pollution, diesel vehicles and wood heaters, costs per heater and per vehicle) are relatively easy to understand, making it easier to compare health costs with costs of pollution-control strategies. Estimated annual costs of morbidity/mortality exceed $1,100 per diesel vehicle and $2,000 per wood heater. Costs of avoiding emissions (about $2.1/kg PM2.5 for phasing out wood heaters and upwards of $70/kg for reducing diesel emissions) are considerably less than the estimated health costs ($166/kg) of those emissions. In other countries, smokeless zones (for domestic heating), heavy vehicle low-emission zones, and lower registration charges for low-emission vehicles reduce pollution and improve health. Similar 'polluter-pays' taxes in Australia to encourage retrofitting of existing diesels and incentives to choose new ones with lowest emissions would provide substantial benefits. Adopting Christchurch's policy of phasing out wood heaters and 'polluter-pays' levies to discourage their use would be extremely cost-effective.

A Systematic Review of the Cost-Effectiveness of Biologics for the Treatment of Inflammatory Bowel Diseases.

Directory of Open Access Journals (Sweden)

Saara Huoponen

Full Text Available Biologics are used for the treatment of inflammatory bowel diseases, Crohn´s disease and ulcerative colitis refractory to conventional treatment. In order to allocate healthcare spending efficiently, costly biologics for inflammatory bowel diseases are an important target for cost-effectiveness analyses. The aim of this study was to systemically review all published literature on the cost-effectiveness of biologics for inflammatory bowel diseases and to evaluate the methodological quality of cost-effectiveness analyses.A literature search was performed using Medline (Ovid, Cochrane Library, and SCOPUS. All cost-utility analyses comparing biologics with conventional medical treatment, another biologic treatment, placebo, or surgery for the treatment of inflammatory bowel diseases in adults were included in this review. All costs were converted to the 2014 euro. The methodological quality of the included studies was assessed by Drummond's, Philips', and the Consolidated Health Economic Evaluation Reporting Standards checklist.Altogether, 25 studies were included in the review. Among the patients refractory to conventional medical treatment, the incremental cost-effectiveness ratio ranged from dominance to 549,335 €/Quality-Adjusted Life Year compared to the incremental cost-effectiveness ratio associated with conventional medical treatment. When comparing biologics with another biologic treatment, the incremental cost-effectiveness ratio ranged from dominance to 24,012,483 €/Quality-Adjusted Life Year. A study including both direct and indirect costs produced more favorable incremental cost-effectiveness ratios than those produced by studies including only direct costs.With a threshold of 35,000 €/Quality-Adjusted Life Year, biologics seem to be cost-effective for the induction treatment of active and severe inflammatory bowel disease. Between biologics, the cost-effectiveness remains unclear.

Social costs of energy. Present status and future trends. Proceedings

International Nuclear Information System (INIS)

Hohmeyer, O.; Ottinger, R.L.

1994-01-01

The social or external costs of energy have received a high degree of internatinal attention since the publication of the first empirical results in 1988. Possible global climate change and the call for a sustainable future of mankind have put the question of social costs onto the agenda of many national and international converences like the 'Earth Summit' in Rio 1992. A scientific discussion has been sparked off, searching for the best methodoligical approaches and reliable empirical data. An overview of this discussion was given by the report on the 1st international workshop published in 1991. This book reports on the 2nd international workshop on the subject and gives a broad overview of the discussion in the 25 papers presented. It is the most comprehensive picture of this subject matter avvailable. (orig.)

U.S. and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review.

Science.gov (United States)

Harvey, Michael J; Gaies, Michael G; Prosser, Lisa A

2015-08-01

The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established. To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types. Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms 'ECMO' AND 'health expenditures' or 'resource use' or 'costs' or 'cost analysis' or 'cost(-)effectiveness' or 'cost(-)benefit' or 'cost(-)utility' or 'economic(-)evaluation' or 'economic' or 'QALY' or 'cost per quality-adjusted life year'. Only full scientific research articles were included. The exclusion criteria included papers that focused on pumpless ECMO, simulation training or decision support systems; papers that did not include human subjects or were not written in English; papers that did not mention ECMO, costs, economics or resource utilization; and papers that included only outside-hospital, infrastructure capital or device capital costs. Data extraction was completed by one author, using predefined criteria. From the database searches, 1371 results were returned, 226 records underwent a full review and 18 studies were included in the final review. Three papers studied adult populations, two studied adult and paediatric populations, five studied only paediatric populations, one studied a paediatric and neonatal population, and the remaining seven exclusively examined ECMO in neonatal populations. The sample sizes ranged from 8 to 8753 patients. ECMO for respiratory conditions was the most common diagnosis category, followed by congenital diaphragmatic hernia (CDH) and then cardiac conditions. Most papers (n = 14) used retrospective cost collection. Only eight papers stated the perspective of the cost analysis. The results show a large variation in the cost of ECMO over multiple cost categories (e.g., range of total in-hospital costs of treatment: USD 42,554-537,554 [in 2013 values]). In the U.S.A., the

Nuclear energy: the real costs; and reply

International Nuclear Information System (INIS)

Jeffery, J.W.; Jones, P.M.S.

1982-01-01

Comments are made on a review by Jones (Atom. 306 April 1982) of 'Nuclear Energy: the Real Costs' - a special report by the Committee for the Study of the Economics of Nuclear Electricity, and criticisms contained in the review of the analysis of nuclear costs presented in the report are discussed. Dr Jones replies. (U.K.)

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

Science.gov (United States)

2012-01-01

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

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

Directory of Open Access Journals (Sweden)

Barter Devra M

2012-11-01

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

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

Directory of Open Access Journals (Sweden)

Mitchell Aaron P

2012-07-01

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

Treatments for Metastatic Prostate Cancer (mPC): A Review of Costing Evidence.

Science.gov (United States)

Norum, Jan; Nieder, Carsten

2017-12-01

Prostate cancer (PC) is the most common cancer in Western countries. More than one third of PC patients develop metastatic disease, and the 5-year expected survival in distant disease is about 35%. During the last few years, new treatments have been launched for metastatic castrate-resistant prostate cancer (mCRPC). We aimed to review the current literature on health economic analysis on the treatment of metastatic prostate cancer (mPC), compare the studies, summarize the findings and make the results available to administrators and decision makers. A systematic literature search was done for economic evaluations (cost-minimization, cost-effectiveness, cost-utility, cost-of-illness, cost-of-drug, and cost-benefit analyses). We employed the PubMed ® search engine and searched for publications published between 2012 and 2016. The terms used were "prostate cancer", "metastatic" and "cost". An initial screening of all headlines was performed, selected abstracts were analysed, and finally the full papers investigated. Study characteristics, treatment and comparator, country, type of evaluation, perspective, year of value, time horizon, efficacy data, discount rate, total costs and sensitivity analysis were analysed. The quality was assessed using the Quality of Health Economic Studies (QHES) instrument. A total of 227 publications were detected and screened, 58 selected for full-text assessment and 31 included in the final analyses. Despite the significant international literature on the treatment of mCRPC, there were only 15 studies focusing on cost-effectiveness analysis (CEA). Medical treatment constituted two thirds of the selected studies. Significant costs in the treatment of mCRPC were disclosed. In the pre-docetaxel setting, both abiraterone acetate (AA) and enzalutamide were concluded beyond accepted cost/quality-adjusted life year limits. In the docetaxel refractory setting, most studies concluded that enzalutamide was cost-effective and superior to AA. In

The economic cost of adverse health effects from wildfire-smoke exposure: A review

Science.gov (United States)

Ikuho Kochi; Geoffrey H. Donovan; Patricia A. Champ; John B. Loomis

2010-01-01

The economic costs of adverse health effects associated with exposure to wildfire smoke should be given serious consideration in determining the optimal wildfire management policy. Unfortunately, the literature in this research area is thin. In an effort to better understand the nature of these economic costs, we review and synthesise the relevant literature in three...

The Cost of Enforcing Building Energy Codes: Phase 1

Energy Technology Data Exchange (ETDEWEB)

Williams, Alison [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Vine, Ed [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Price, Sarah [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sturges, Andrew [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Rosenquist, Greg [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2013-04-01

The purpose of this literature review is to summarize key findings regarding the costs associated with enforcing building energy code compliance—primarily focusing on costs borne by local government. The review takes into consideration over 150 documents that discuss, to some extent, code enforcement. This review emphasizes those documents that specifically focus on costs associated with energy code enforcement. Given the low rates of building energy code compliance that have been reported in existing studies, as well as the many barriers to both energy code compliance and enforcement, this study seeks to identify the costs of initiatives to improve compliance and enforcement. Costs are reported primarily as presented in the original source. Some costs are given on a per home or per building basis, and others are provided for jurisdictions of a certain size. This literature review gives an overview of state-based compliance rates, barriers to code enforcement, and U.S. Department of Energy (DOE) and key stakeholder involvement in improving compliance with building energy codes. In addition, the processes and costs associated with compliance and enforcement of building energy codes are presented. The second phase of this study, which will be presented in a different report, will consist of surveying 34 experts in the building industry at the national and state or local levels in order to obtain additional cost information, building on the findings from the first phase, as well as recommendations for where to most effectively spend money on compliance and enforcement.

The costs, effects and cost-effectiveness of strategies to increase coverage of routine immunizations in low- and middle-income countries: systematic review of the grey literature.

Science.gov (United States)

Batt, Katherine; Fox-Rushby, J A; Castillo-Riquelme, Marianela

2004-09-01

Evidence-based reviews of published literature can be subject to several biases. Grey literature, however, can be of poor quality and expensive to access. Effective search strategies also vary by topic and are rarely known in advance. This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries. The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature. After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses. Interventions in the grey literature are more up to date and cover a different geographical spread. Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions. We recommend that in future researchers consider using non-English keywords in their searches.

Time-driven activity-based costing in health care: A systematic review of the literature.

Science.gov (United States)

Keel, George; Savage, Carl; Rafiq, Muhammad; Mazzocato, Pamela

2017-07-01

Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim of this study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses. TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods The method's ability to inform bundled payment reimbursement systems and to coordinate delivery across the care continuum remains to be demonstrated in the published literature, and the role of TDABC in this cost-accounting landscape is still developing. TDABC should be gradually incorporated into functional systems, while following and building upon the recommendations outlined in this review. In this way, TDABC will be better positioned to accurately capture the cost of care delivery for conditions and to control cost in the effort to create value in health care. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

The Cost-Effectiveness of Conventional Discectomy Compared to Other Surgical Techniques for Lumbar Disk Herniation. A Systematic Review

DEFF Research Database (Denmark)

Thorsen, May Tone; Ødegaard-Olsen, Øystein; Leboeuf-Yde, Charlotte

2018-01-01

Background: The current study reviews the literature on the cost-effectiveness of conventional diskectomy compared to other surgical techniques, by assessing studies with economical evaluation and studies using proxy measures of cost-effectiveness. Methods: In April 2016, a comprehensive search w...... studies. The available evidence, however, suggests that any cost-effectiveness difference between conventional diskectomy and the alternatives is unlikely to be great.......Background: The current study reviews the literature on the cost-effectiveness of conventional diskectomy compared to other surgical techniques, by assessing studies with economical evaluation and studies using proxy measures of cost-effectiveness. Methods: In April 2016, a comprehensive search......-four articles were included in the review, 9 retrieved from the original search, and an additional 15 from reference lists. Four studies included an economical evaluation and 20 reported proxy measures of cost-effectiveness. The quality of studies varied considerably and results were ambiguous; the four...

Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

Directory of Open Access Journals (Sweden)

Luca Masotti

2008-06-01

Full Text Available Luca Masotti1,8, Patrick Ray2, Marc Righini3, Gregoire Le Gal4, Fabio Antonelli5, Giancarlo Landini1, Roberto Cappelli6, Domenico Prisco7, Paola Rottoli81Internal Medicine, Cecina Hospital, Cecina, Italy; 2Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France; 3Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 4Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France; 5Clinical Chemistry, Cecina Hospital, Cecina, Italy; 6Department of Internal, Cardiovascular and Geriatric Medicine, University of Siena, Siena, Italy; 7Department of Critical Care Medicine, Thrombosis Centre, Careggi Hospital, Florence, Italy; 8Departiment of Clinical Medicine and Immunological Sciences, Division of Respiratory Diseases, University of Siena, Siena, ItalyObjective: Diagnosis of pulmonary embolism (PE remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more.Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE in the title, abstract or text, were reviewed.Results: Dyspnea (range 59%–91.5%, tachypnea (46%–74%, tachycardia (29%–76%, and chest pain (26%–57% represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%–67%; deep vein

The cost of proactive interference is constant across presentation conditions.

Science.gov (United States)

Endress, Ansgar D; Siddique, Aneela

2016-10-01

Proactive interference (PI) severely constrains how many items people can remember. For example, Endress and Potter (2014a) presented participants with sequences of everyday objects at 250ms/picture, followed by a yes/no recognition test. They manipulated PI by either using new images on every trial in the unique condition (thus minimizing PI among items), or by re-using images from a limited pool for all trials in the repeated condition (thus maximizing PI among items). In the low-PI unique condition, the probability of remembering an item was essentially independent of the number of memory items, showing no clear memory limitations; more traditional working memory-like memory limitations appeared only in the high-PI repeated condition. Here, we ask whether the effects of PI are modulated by the availability of long-term memory (LTM) and verbal resources. Participants viewed sequences of 21 images, followed by a yes/no recognition test. Items were presented either quickly (250ms/image) or sufficiently slowly (1500ms/image) to produce LTM representations, either with or without verbal suppression. Across conditions, participants performed better in the unique than in the repeated condition, and better for slow than for fast presentations. In contrast, verbal suppression impaired performance only with slow presentations. The relative cost of PI was remarkably constant across conditions: relative to the unique condition, performance in the repeated condition was about 15% lower in all conditions. The cost of PI thus seems to be a function of the relative strength or recency of target items and interfering items, but relatively insensitive to other experimental manipulations. Copyright © 2016 Elsevier B.V. All rights reserved.

Social costs of illegal drugs, alcohol and tobacco in the European Union: A systematic review.

Science.gov (United States)

Barrio, Pablo; Reynolds, Jillian; García-Altés, Anna; Gual, Antoni; Anderson, Peter

2017-09-01

Drug use accounts for one of the main disease groups in Europe, with relevant consequences to society. There is an increasing need to evaluate the economic consequences of drug use in order to develop appropriate policies. Here, we review the social costs of illegal drugs, alcohol and tobacco in the European Union. A systematic search of relevant databases was conducted. Grey literature and previous systematic reviews were also searched. Studies reporting on social costs of illegal drugs, alcohol and tobacco were included. Methodology, cost components as well as costs were assessed from individual studies. To compare across studies, final costs were transformed to 2014 Euros. Forty-five studies reported in 43 papers met the inclusion criteria (11 for illegal drugs, 26 for alcohol and 8 for tobacco). While there was a constant inclusion of direct costs related to treatment of substance use and comorbidities, there was a high variability for the rest of cost components. Total costs showed also a great variability. Price per capita for the year 2014 ranged from €0.38 to €78 for illegal drugs, from €26 to €1500 for alcohol and from €10.55 to €391 for tobacco. Drug use imposes a heavy economic burden to Europe. However, given the high existing heterogeneity in methodologies, and in order to better assess the burden and thus to develop adequate policies, standardised methodological guidance is needed. [Barrio P, Reynolds J, García-Altés A, Gual A, Anderson P. Social costs of illegal drugs, alcohol and tobacco in the European Union: A systematic review. Drug Alcohol Rev 2017;00:000-000]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Management of frozen shoulder: a systematic review and cost-effectiveness analysis.

Science.gov (United States)

Maund, E; Craig, D; Suekarran, S; Neilson, Ar; Wright, K; Brealey, S; Dennis, L; Goodchild, L; Hanchard, N; Rangan, A; Richardson, G; Robertson, J; McDaid, C

2012-01-01

Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. To evaluate the clinical effectiveness and cost-effectiveness of treatments for primary frozen shoulder, identify the most appropriate intervention by stage of condition and highlight any gaps in the evidence. A systematic review was conducted. Nineteen databases and other sources including the Cumulative Index to Nursing and Allied Health (CINAHL), Science Citation Index, BIOSIS Previews and Database of Abstracts of Reviews of Effects (DARE) were searched up to March 2010 and EMBASE and MEDLINE up to January 2011, without language restrictions. MEDLINE, CINAHL and PsycINFO were searched in June 2010 for studies of patients' views about treatment. Randomised controlled trials (RCTs) evaluating physical therapies, arthrographic distension, steroid injection, sodium hyaluronate injection, manipulation under anaesthesia, capsular release or watchful waiting, alone or in combination were eligible for inclusion. Patients with primary frozen shoulder (with or without diabetes) were included. Quasi-experimental studies were included in the absence of RCTs and case series for manipulation under anaesthesia (MUA) and capsular release only. Full economic evaluations meeting the intervention and population inclusion criteria of the clinical review were included. Two researchers independently screened studies for relevance based on the inclusion criteria. One reviewer extracted data and assessed study quality; this was checked by a second reviewer. The main outcomes of interest were pain, range of movement, function and disability, quality of life and adverse events. The analysis comprised a narrative synthesis and pair-wise meta

Simulation modeling for stratified breast cancer screening - a systematic review of cost and quality of life assumptions.

Science.gov (United States)

Arnold, Matthias

2017-12-02

The economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care. A literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters. Eighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias. This systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters.

A review on future trends of LWR fuel cycle costs

International Nuclear Information System (INIS)

Tamiya, S.; Otomo, T.; Meguro, T.

1977-01-01

In the cost estimations in the past, the main components of fuel cycle were mining and milling, uranium enrichment and fuel fabrication, and reprocessing charge deemed to be recovered by plutonium credit. Since the oil crisis, every component of fuel cycle cost has gone up in recent years as well as the construction cost of a power station. Recent analysis shows that the costs in the back end of fuel cycle are much higher than those anticipated several years ago, although their contribution to the electricity generating cost by nuclear would be small. The situation of the back end of the fuel cycle has been quite changed in recent years, and there are still many uncertainties in this field, that is, regulatory requirements for reprocessing plant such as safety, safeguards, environmental protection and high level waste management. So, it makes it more difficult to estimate the investment in this sector of fuel cycle, therefore, to estimate the cost of this sector. The institutional problems must be cleared in relation to the ultimate disposal of high level waste, too. Co-location of some parts of fuel cycle facilities may also affect on the fuel cycle costs. In this paper a review is made of the future trend of nuclear fuel cycle cost of LWR based on the recent analysis. Those factors which affect the fuel cycle costs are also discussed. In order to reduce the uncertainties of the cost estimations as soon as possible, the necessity is emphasized to discuss internationally such items as the treatment and disposal of high level radioactive wastes, siting issues of a reprocessing plant, physical protection of plutonium and the effects of plutonium on the environment

What determines the effects and costs of breast cancer screening? : A protocol of a systematic review of reviews

NARCIS (Netherlands)

E.A. Mandrik (Olena); O.I. Ekwunife (Obinna); N. Zielonke (Nadine); F. Meheus (Filip); J.L. Severens (Hans); S.K. Lhachimi (Stefan); R. Murillo (Raul)

2017-01-01

markdownabstract__Background:__ Multiple reviews demonstrated high variability in effectiveness and cost-effectiveness outcomes among studies on breast cancer screening (BCS) programmes. No study to our knowledge has summarized the current evidence on determinants of effectiveness and

DOE financial assurance presentation

International Nuclear Information System (INIS)

Huck, R.

1990-01-01

The presentation topic is California's approach to license application review in meeting financial assurances for the proposed Ward Valley site. The purpose of the presentation is to provide information on specific financial assurance provisions contained in 10 CFR Part 61 and how California intends to satisfy those requirements. Also, as rate setter, California intends to demonstrate how it will assure allowable costs to the rate base though a financial prudency review. The key provisions of financial assurance are: 10 CFR Section 61.61 - This provision requires an applicant to demonstrate its ability to finance licensed activities; 10 CFR Section 61.62 - This provision requires an applicant to provide assurance that sufficient funds will be available for site closure and stabilization; and 10 CFR Section 61.63 - This provision requires an applicant to provide 'a copy of a binding arrangement, such as a lease, between the applicant and the disposal site owner, so that sufficient funds will be available to cover the costs of the institutional control period.' To assist California in its determination of financial assurance compliance to be demonstrated by the applicant for Part 61 requirements, is NUREG guidance document 1199 'Standard Format and Content of a License Application for a Low-Level Radioactive Waste (LLRW) Disposal Facility.' The detailed financial assurance provisions of NUREG 1199 are then embodied in NUREG 1200, 'Standard Review Plant for the Review of a License Application for a LLRW Disposal Facility.'

Photovoltaics: Reviewing the European Feed-in-Tariffs and Changing PV Efficiencies and Costs

Directory of Open Access Journals (Sweden)

H. L. Zhang

2014-01-01

Full Text Available Feed-in-Tariff (FiT mechanisms have been important in boosting renewable energy, by providing a long-term guaranteed subsidy of the kWh-price, thus mitigating investment risks and enhancing the contribution of sustainable electricity. By ongoing PV development, the contribution of solar power increases exponentially. Within this significant potential, it is important for investors, operators, and scientists alike to provide answers to different questions related to subsidies, PV efficiencies and costs. The present paper therefore (i briefly reviews the mechanisms, advantages, and evolution of FiT; (ii describes the developments of PV, (iii applies a comprehensive literature-based model for the solar irradiation to predict the PV solar energy potential in some target European countries, whilst comparing output predictions with the monthly measured electricity generation of a 57 m² photovoltaic system (Belgium; and finally (iv predicts the levelized cost of energy (LCOE in terms of investment and efficiency, providing LCOE values between 0.149 and 0.313 €/kWh, as function of the overall process efficiency and cost. The findings clearly demonstrate the potential of PV energy in Europe, where FiT can be considerably reduced or even be eliminated in the near future.

Life cycle costing of food waste: A review of methodological approaches.

Science.gov (United States)

De Menna, Fabio; Dietershagen, Jana; Loubiere, Marion; Vittuari, Matteo

2018-03-01

Food waste (FW) is a global problem that is receiving increasing attention due to its environmental and economic impacts. Appropriate FW prevention, valorization, and management routes could mitigate or avoid these effects. Life cycle thinking and approaches, such as life cycle costing (LCC), may represent suitable tools to assess the sustainability of these routes. This study analyzes different LCC methodological aspects and approaches to evaluate FW management and valorization routes. A systematic literature review was carried out with a focus on different LCC approaches, their application to food, FW, and waste systems, as well as on specific methodological aspects. The review consisted of three phases: a collection phase, an iterative phase with experts' consultation, and a final literature classification. Journal papers and reports were retrieved from selected databases and search engines. The standardization of LCC methodologies is still in its infancy due to a lack of consensus over definitions and approaches. Research on the life cycle cost of FW is limited and generally focused on FW management, rather than prevention or valorization of specific flows. FW prevention, valorization, and management require a consistent integration of LCC and Life Cycle Assessment (LCA) to avoid tradeoffs between environmental and economic impacts. This entails a proper investigation of methodological differences between attributional and consequential modelling in LCC, especially with regard to functional unit, system boundaries, multi-functionality, included cost, and assessed impacts. Further efforts could also aim at finding the most effective and transparent categorization of costs, in particular when dealing with multiple stakeholders sustaining costs of FW. Interpretation of results from LCC of FW should take into account the effect on larger economic systems. Additional key performance indicators and analytical tools could be included in consequential approaches

Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States.

Science.gov (United States)

Sun, Shawn X; Liu, Gordon G; Christensen, Dale B; Fu, Alex Z

2007-10-01

To review the literature addressing the economic outcomes of nonadherence in the treatment of schizophrenia, and to utilize the review results to provide an update on the economic impact of hospitalizations among schizophrenia patients related to antipsychotic nonadherence. A structured search of EMBASE, Ovid MEDLINE, PubMed and PsycINFO for years 1995-2007 was conducted to identify published English-language articles addressing the economic impact of antipsychotic nonadherence in schizophrenia. The following key words were used in the search: compliance, noncompliance, adherence, nonadherence, relapse, economic, cost, and schizophrenia. A bibliographic search of retrieved articles was performed to identify additional studies. For a study to be included, the date of publication had to be from 1/1/1995 to 6/1/2007, and the impact of nonadherence had to be measured in terms of direct healthcare costs or inpatient days. Subsequently, an estimate of incremental hospitalization costs related to antipsychotic non adherence was extrapolated at the US national level based on the reviewed studies (nonadherence rate and hospitalization rate) and the National Inpatient Sample of Healthcare Cost and Utilization Project (average daily hospitalization costs). Seven studies were identified and reviewed based on the study design, measurement of medication nonadherence, study setting, and cost outcome results. Despite the varied adherence measures across studies, all articles reviewed showed that antipsychotic nonadherence was related to an increase in hospitalization rate, hospital days or hospital costs. We also estimated that the national rehospitalization costs related to antipsychotic nonadherence was $1479 million, ranging from $1392 million to $1826 million in the US in 2005. The estimate of rehospitalization costs was restricted to schizophrenia patients from the Medicaid program. Additionally, the studies we reviewed did not capture the newer antipsychotic drugs

International comparison of cost of falls in older adults living in the community: a systematic review.

Science.gov (United States)

Davis, J C; Robertson, M C; Ashe, M C; Liu-Ambrose, T; Khan, K M; Marra, C A

2010-08-01

Our objective was to determine international estimates of the economic burden of falls in older people living in the community. Our systematic review emphasized the need for a consensus on methodology for cost of falls studies to enable more accurate comparisons and subgroup-specific estimates among different countries. The purpose of this study was to determine international estimates of the economic burden of falls in older people living in the community. This is a systematic review of peer-reviewed journal articles reporting estimates for the cost of falls in people aged > or =60 years living in the community. We searched for papers published between 1945 and December 2008 in MEDLINE, PUBMED, EMBASE, CINAHL, Cochrane Collaboration, and NHS EED databases that identified cost of falls in older adults. We extracted the cost of falls in the reported currency and converted them to US dollars at 2008 prices, cost items measured, perspective, time horizon, and sensitivity analysis. We assessed the quality of the studies using a selection of questions from Drummond's checklist. Seventeen studies met our inclusion criteria. Studies varied with respect to viewpoint of the analysis, definition of falls, identification of important and relevant cost items, and time horizon. Only two studies reported a sensitivity analysis and only four studies identified the viewpoint of their economic analysis. In the USA, non-fatal and fatal falls cost US $23.3 billion (2008 prices) annually and US $1.6 billion in the UK. The economic cost of falls is likely greater than policy makers appreciate. The mean cost of falls was dependent on the denominator used and ranged from US $3,476 per faller to US $10,749 per injurious fall and US $26,483 per fall requiring hospitalization. A consensus on methodology for cost of falls studies would enable more accurate comparisons and subgroup-specific estimates among different countries.

Cost effectiveness of medication adherence-enhancing interventions: a systematic review of trial-based economic evaluations

NARCIS (Netherlands)

Oberje, E.J.M.; Kinderen, de R.J.A.; Evers, S.M.A.A.; Woerkum, van C.M.J.; Bruin, de M.

2013-01-01

Background In light of the pressure to reduce unnecessary healthcare expenditure in the current economic climate, a systematic review that assesses evidence of cost effectiveness of adherence-enhancing interventions would be timely. Objective Our objective was to examine the cost effectiveness of

Costing systems design for sustainability

Directory of Open Access Journals (Sweden)

Mihaela TURTUREA

2013-10-01

Full Text Available The aim of this article is to present an overall image of the way Accounting responds to nowadays user’s needs in relation to the quantification of the impact companies have towards the environment. Regarding this, there have been analyzed concepts like sustainable development, environmental accounting, environmental costs and there have been presented the main progress towards environmental cost identification and measurement from the perspective of Activity Based Costing system. To provide an overall image of this concepts, there have been used as research methodology methods the documentation from literature review, analysis, synthesis and comparison.

Costs of informal nursing care for patients with neurologic disorders: A systematic review.

Science.gov (United States)

Diederich, Freya; König, Hans-Helmut; Mietzner, Claudia; Brettschneider, Christian

2018-01-02

To systematically review the economic burden of informal nursing care (INC), often called informal care, caused by multiple sclerosis (MS), Parkinson disease (PD), and epilepsy, with special attention to disease severity. We systematically searched MEDLINE, PsycINFO, and NHS Economic Evaluation Database for articles on the cost of illness of the diseases specified. Title, abstract, and full-text review were conducted in duplicate by 2 researchers. The distribution of hours and costs of INC were extracted and used to compare the relevance of INC across included diseases and disease severity. Seventy-one studies were included (44 on MS, 17 on PD, and 10 on epilepsy). Studies on epilepsy reported an average of 2.3-54.5 monthly hours of INC per patient. For PD, average values of 42.9-145.9 hours and for MS average values of 9.2-249 hours per patient per month were found. In line with utilized hours, costs of INC were lowest for epilepsy (interquartile range [IQR] 229-1,466 purchasing power parity US dollars [PPP-USD]) and similar for MS (IQR 4,454-11,222 PPP-USD) and PD (IQR 1,440-7,117 PPP-USD). In addition, costs of INC increased with disease severity and accounted for 38% of total health care costs in severe MS stages on average. The course of diseases and disease severity matter for the amount of INC used by patients. For each of the neurologic disorders, an increase in the costs of INC, due to increasing disease severity, considerably contributes to the rise in total health care costs. Copyright © 2017 American Academy of Neurology.

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

Science.gov (United States)

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

2016-12-01

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

Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

Directory of Open Access Journals (Sweden)

Thomas Grochtdreis

Full Text Available For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care.To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care.A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP.In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562.Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

The Cost of Psoriasis and Psoriatic Arthritis in 5 European Countries: A Systematic Review.

Science.gov (United States)

Burgos-Pol, R; Martínez-Sesmero, J M; Ventura-Cerdá, J M; Elías, I; Caloto, M T; Casado, M Á

2016-09-01

While the introduction of biologics has improved the quality of life of patients with psoriasis and psoriatic arthritis, it may have increased the economic burden of these diseases. To perform a systematic review of studies on the costs associated with managing and treating psoriasis and psoriatic arthritis in 5 European countries: Germany, Spain, France, Italy, and the United Kingdom. We undertook a systematic review of the literature (up to May 2015) using the MEDLINE and EMBASE databases. The methodological quality of the studies identified was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. We considered both direct costs (medical and nonmedical) and indirect costs, adjusted for country-specific inflation and converted to international dollars using purchasing power parity exchange rates for 2015 ($US PPP). The search retrieved 775 studies; 68.3% analyzed psoriasis and 31.7% analyzed psoriatic arthritis. The total annual cost per patient ranged from US $2,077 to US $13,132 PPP for psoriasis and from US $10,924 to US $17,050 PPP for psoriatic arthritis. Direct costs were the largest component of total expenditure in both diseases. The severity of these diseases was associated with higher costs. The introduction of biologics led to a 3-fold to 5-fold increase in direct costs, and consequently to an increase in total costs. We have analyzed the economic burden of psoriasis and psoriatic arthritis and shown that costs increase with the treatment and management of more severe disease and the use of biologics. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Systematic mapping review about costs and economic evaluations of skin conditions and diseases in the aged.

Science.gov (United States)

Lichterfeld-Kottner, Andrea; Hahnel, Elisabeth; Blume-Peytavi, Ulrike; Kottner, Jan

2017-02-01

Skin conditions and dermatological diseases associated with advanced age (e.g. fungal infection, dry skin and itch) receive increasingly attention in clinical practice and research. Cost and economic evaluations are important sources to inform priority setting and ressource allocation decisions in healthcare. The economics of skin conditions in aged populations has not been systematically reviewed so far. The aim of this mapping review was to summarize the economic evidence of selected skin conditions in the aged (65 + years). A mapping literature review and evidence summary was conducted. Searches were conducted in data bases Medline and Embase via OVID. Cinahl was searched using EBSCO. References lists of potential eligible studies, reviews, guidelines or other sources were screened for additional literature. For evaluation of methodological quality of full economic analyses the Consensus on Health Economic Criteria (CHEC) checklist was used. Database searches resulted in 1388 records. A total of 270 articles were read in full-text. Thirty-five publications were finally included in the data analysis reporting 38 economic analyses. Ten cost of illness analyses and 26 cost-effectiveness analyses reporting about pressure ulcers, skin tears, pressure ulcers, incontinence associated dermatitis and intertrigo/contact dermatitis/candidiasis treatment and prevention and onychomycosis testing were identified. Limited evidence indicated that low air loss beds were more cost effective than standard beds for prevention of pressure ulcers. Standardized skin care regimens seem to lower the incidence of pressure ulcers, skin tears and IAD but a cost saving effect was not always observed. Findings of this mapping review indicate that there is a paucity of high quality evidence regarding the economic impact of age-associated skin conditions and diseases. Substantial heterogeneity in terms of study design, evaluation perspective, time period, and way of cost estimation was

Brief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.

Science.gov (United States)

Carvalho, Brendan; Tan, Jonathan M; Macario, Alex; El-Sayed, Yasser Y; Sultan, Pervez

2013-07-01

In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. Using a computer cost model, which considers possible outcomes and probability uncertainties at the same time, we estimated total expected delivery costs for breech presentation managed by a trial of ECV with and without neuraxial anesthesia. From published studies, the average probability of successful ECV with neuraxial anesthesia was 60% (with individual studies ranging from 44% to 87%) compared with 38% (with individual studies ranging from 31% to 58%) without neuraxial anesthesia. The mean expected total delivery costs, including the cost of attempting/performing ECV with anesthesia, equaled $8931 (2.5th-97.5th percentile prediction interval $8541-$9252). The cost was $9207 (2.5th-97.5th percentile prediction interval $8896-$9419) if ECV was attempted/performed without anesthesia. The expected mean incremental difference between the total cost of delivery that includes ECV with anesthesia and ECV without anesthesia was $-276 (2.5th-97.5th percentile prediction interval $-720 to $112). The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.

Evaluation of pavement life cycle cost analysis: Review and analysis

Directory of Open Access Journals (Sweden)

Peyman Babashamsi

2016-07-01

Full Text Available The cost of road construction consists of design expenses, material extraction, construction equipment, maintenance and rehabilitation strategies, and operations over the entire service life. An economic analysis process known as Life-Cycle Cost Analysis (LCCA is used to evaluate the cost-efficiency of alternatives based on the Net Present Value (NPV concept. It is essential to evaluate the above-mentioned cost aspects in order to obtain optimum pavement life-cycle costs. However, pavement managers are often unable to consider each important element that may be required for performing future maintenance tasks. Over the last few decades, several approaches have been developed by agencies and institutions for pavement Life-Cycle Cost Analysis (LCCA. While the transportation community has increasingly been utilising LCCA as an essential practice, several organisations have even designed computer programs for their LCCA approaches in order to assist with the analysis. Current LCCA methods are analysed and LCCA software is introduced in this article. Subsequently, a list of economic indicators is provided along with their substantial components. Collecting previous literature will help highlight and study the weakest aspects so as to mitigate the shortcomings of existing LCCA methods and processes. LCCA research will become more robust if improvements are made, facilitating private industries and government agencies to accomplish their economic aims. Keywords: Life-Cycle Cost Analysis (LCCA, Pavement management, LCCA software, Net Present Value (NPV

A Review of the Decommissioning Costs of the Ranstad Site

Energy Technology Data Exchange (ETDEWEB)

Varley, Geoff (NAC International, Norcross, GA (United States))

2009-08-15

The main objective of this study has been to review the future cost to decommission and dismantling the industrial area at the site of the old uranium mine at Ranstad in Sweden. Analyses of some detailed comparative empirical information have been used in the context of preliminary 'bench-marking' studies. The estimated costs for decommissioning of the old uranium mine in Ranstad have been compared with actual costs from other relevant decommissioning projects. In this way it has been possible to give a preliminary qualitative statement about the accuracy of the Ranstad cost estimate. The study gives the following lessons learned: 1. The available information suggests that the overall estimated cost may be reasonable, but there are still some points of weakness that need to be elaborated more in detail before a full statement about the adequacy of the forecast cost will be possible. 2. Especially the costs associated with declassification activities warrant further analysis in order to determine there level of accuracy. 3. There exists the possibility that the estimate might be low concerning decontamination, dismantling and planning and institutional work. 4. Further work and analysis is needed in order to develop a more transparent cost estimate in which the stakeholders can have the highest confidence. 5. A new bidding procedure for the conventional demolition may result in lower estimated costs. Hence, it would be beneficial to obtain an updated estimate based on at least more than one quotation. 6. The method of addressing uncertainty and risk should be more connected to the logistics of specific decommissioning activities, in order to be more transparent and clearer in details. There is a need for further study to develop a better estimate. In the short run follow-up work needs to be undertaken to provide a better understanding of what are the major contributors to risk and cost drivers in the planned decommissioning process at the Ranstad

A Review of the Decommissioning Costs of the Ranstad Site

International Nuclear Information System (INIS)

Varley, Geoff

2009-08-01

The main objective of this study has been to review the future cost to decommission and dismantling the industrial area at the site of the old uranium mine at Ranstad in Sweden. Analyses of some detailed comparative empirical information have been used in the context of preliminary 'bench-marking' studies. The estimated costs for decommissioning of the old uranium mine in Ranstad have been compared with actual costs from other relevant decommissioning projects. In this way it has been possible to give a preliminary qualitative statement about the accuracy of the Ranstad cost estimate. The study gives the following lessons learned: 1. The available information suggests that the overall estimated cost may be reasonable, but there are still some points of weakness that need to be elaborated more in detail before a full statement about the adequacy of the forecast cost will be possible. 2. Especially the costs associated with declassification activities warrant further analysis in order to determine there level of accuracy. 3. There exists the possibility that the estimate might be low concerning decontamination, dismantling and planning and institutional work. 4. Further work and analysis is needed in order to develop a more transparent cost estimate in which the stakeholders can have the highest confidence. 5. A new bidding procedure for the conventional demolition may result in lower estimated costs. Hence, it would be beneficial to obtain an updated estimate based on at least more than one quotation. 6. The method of addressing uncertainty and risk should be more connected to the logistics of specific decommissioning activities, in order to be more transparent and clearer in details. There is a need for further study to develop a better estimate. In the short run follow-up work needs to be undertaken to provide a better understanding of what are the major contributors to risk and cost drivers in the planned decommissioning process at the Ranstad industrial area

Cost-Effectiveness of Fecal Microbiota Transplantation in the Treatment of Recurrent Clostridium Difficile Infection: A Literature Review.

Science.gov (United States)

Arbel, Leor T; Hsu, Edmund; McNally, Keegan

2017-08-23

Clostridium difficile ( C. difficile ) is a common cause of antibiotic--associated diarrhea (AAD), being responsible for 15--25% of all AAD cases. The purpose of this literature review is to determine the cost-effectiveness of fecal microbiota transplantation (FMT) and how it compares in this regard to the standard treatments of choice for recurrent C. difficile infection (CDI). The review of the literature along with the evaluation of three comparative cost effective analyses yielded findings consistent with the view that FMT is the most cost-effective option in treating recurrent CDI. There are some (but considerably less) data indicating that FMT may be a cost effective strategy in treating initial CDI, as well. The superior cost-effectiveness of FMT as compared to the preferred standards of treatment for recurrent CDI suggest FMT use should become more integrated in routine clinical practice. Increased utilization of FMTs would allow for better control of this increasingly problematic disease as well as lower costs associated with its management.

Construction delays causing risks on time and cost - a critical review

Directory of Open Access Journals (Sweden)

Chidambaram Ramanathan

2012-02-01

Full Text Available There is an increase in the number of construction projects experiencing extensive delays leading to exceeding initial time and cost budget.  This paper reviews 41 studies around the world which surveyed the delay factors and classified them into Groups.  The main purpose of this paper is to review literature, each of which have categorized the causes that are responsible for time delays and cost overrun in projects. The collected list has 113 causes for delays categorized in to 18 different groups.  Most of the researches have analysed the responses from the Questionnaire survey.    The collected data are used to rank the problem.  The data are further used to investigate and analyse Important Index, Frequency Index, Severity Index, Relative Important Index, Relative Importance Weight, Weighted Average, Mean, Standard Deviation and Variance.  The collective comparison has revealed that the ranking given by all the researchers is not the same.  Further each and every study has different rank ratings for the different group of the delays.  This review paper attempts to provide an updated compilation of the earlier studies on ranking of the delay causers, which are never similar and constant for universal projects.  It is concluded that a separate study is required for identifying the factors causing delay for projects operated in Sabah, East Malaysia.

Ecological validity of cost-effectiveness models of universal HPV vaccination: A systematic literature review.

Science.gov (United States)

Favato, Giampiero; Easton, Tania; Vecchiato, Riccardo; Noikokyris, Emmanouil

2017-05-09

The protective (herd) effect of the selective vaccination of pubertal girls against human papillomavirus (HPV) implies a high probability that one of the two partners involved in intercourse is immunised, hence preventing the other from this sexually transmitted infection. The dynamic transmission models used to inform immunisation policy should include consideration of sexual behaviours and population mixing in order to demonstrate an ecological validity, whereby the scenarios modelled remain faithful to the real-life social and cultural context. The primary aim of this review is to test the ecological validity of the universal HPV vaccination cost-effectiveness modelling available in the published literature. The research protocol related to this systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016034145). Eight published economic evaluations were reviewed. None of the studies showed due consideration of the complexities of human sexual behaviour and the impact this may have on the transmission of HPV. Our findings indicate that all the included models might be affected by a different degree of ecological bias, which implies an inability to reflect the natural demographic and behavioural trends in their outcomes and, consequently, to accurately inform public healthcare policy. In particular, ecological bias have the effect to over-estimate the preference-based outcomes of selective immunisation. A relatively small (15-20%) over-estimation of quality-adjusted life years (QALYs) gained with selective immunisation programmes could induce a significant error in the estimate of cost-effectiveness of universal immunisation, by inflating its incremental cost effectiveness ratio (ICER) beyond the acceptability threshold. The results modelled here demonstrate the limitations of the cost-effectiveness studies for HPV vaccination, and highlight the concern that public healthcare policy might have been

Literature Review of Data on the Incremental Costs to Design and Build Low-Energy Buildings

Energy Technology Data Exchange (ETDEWEB)

Hunt, W. D.

2008-05-14

This document summarizes findings from a literature review into the incremental costs associated with low-energy buildings. The goal of this work is to help establish as firm an analytical foundation as possible for the Building Technology Program's cost-effective net-zero energy goal in the year 2025.

Approaches to capturing the financial cost of family care-giving within a palliative care context: a systematic review.

Science.gov (United States)

Gardiner, Clare; Brereton, Louise; Frey, Rosemary; Wilkinson-Meyers, Laura; Gott, Merryn

2016-09-01

The economic burden faced by family caregivers of people at the end of life is well recognised. Financial burden has a significant impact on the provision of family care-giving in the community setting, but has seen limited research attention. A systematic review with realist review synthesis and thematic analysis was undertaken to identify literature relating to the financial costs and impact of family care-giving at the end of life. This paper reports findings relating to previously developed approaches which capture the financial costs and implications of caring for family members receiving palliative/end-of-life care. Seven electronic databases were searched from inception to April 2012, for original research studies relating to the financial impact of care-giving at the end of life. Studies were independently screened to identify those which met the study inclusion criteria, and the methodological quality of included studies was appraised using realist review criteria of relevance and rigour. A descriptive thematic approach was used to synthesise data. Twelve articles met the inclusion criteria for the review. Various approaches to capturing data on the financial costs of care-giving at the end of life were noted; however, no single tool was identified with the sole purpose of exploring these costs. The majority of approaches used structured questionnaires and were administered by personal interview, with most studies using longitudinal designs. Calculation of costs was most often based on recall by patients and family caregivers, in some studies combined with objective measures of resource use. While the studies in this review provide useful data on approaches to capturing costs of care-giving, more work is needed to develop methods which accurately and sensitively capture the financial costs of caring at the end of life. Methodological considerations include study design and method of administration, contextual and cultural relevance, and accuracy of cost

Specific net present value: an improved method for assessing modularisation costs in water services with growing demand.

Science.gov (United States)

Maurer, M

2009-05-01

A specific net present value (SNPV) approach is introduced as a criterion in economic engineering decisions. The SNPV expresses average costs, including the growth rate and plant utilisation over the planning horizon, factors that are excluded from a standard net present value approach. The use of SNPV favours alternatives that are cheaper per service unit and are therefore closer to the costs that a user has to cover. It also shows that demand growth has a similar influence on average costs as an economy of scale. In a high growth scenario, solutions providing less idle capacity can have higher present value costs and still be economically favourable. The SNPV approach is applied in two examples to calculate acceptable additional costs for modularisation and comparable costs for on-site treatment (OST) as an extreme form of modularisation. The calculations show that: (i) the SNPV approach is suitable for quantifying the comparable costs of an OST system in a different scenario; (ii) small systems with projected high demand growth rates and high real interest rates are the most probable entry market for OST water treatment systems; (iii) operating expenses are currently the main economic weakness of membrane-based wastewater OST systems; and (iv) when high growth in demand is expected, up to 100% can be additionally invested in modularisation and staging the expansion of a treatment plant.

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

Science.gov (United States)

Seidman, Gabriel; Atun, Rifat

2017-04-13

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

Medical Care Costs Associated with Rheumatoid Arthritis in the US: A Systematic Literature Review and Meta-analysis.

Science.gov (United States)

Hresko, Andrew; Lin, Jay; Solomon, Daniel H

2018-01-05

Rheumatoid arthritis (RA) is a morbid, mortal and costly condition without a cure. Treatments for RA have expanded over the last two decades and direct medical costs may differ by types of treatments. There has not been a systematic literature review since the introduction of new RA treatments, including biologic disease modifying anti-rheumatic drugs (bDMARDs). We conducted a systematic literature review with meta-analysis of direct medical costs associated with RA cared for in the US since the marketing of the first bDMARD. Standard search strategies and sources were used and data were extracted independently by two reviewers. The methods and quality of included studies were assessed. Total direct medical costs as well as RA-specific costs were calculated using random effects meta-analysis. Subgroups of interest included Medicare patients and those using bDMARDs. We found 541 potentially relevant studies and 12 papers met the selection criteria. The quality of studies varied: 1/3 were poor, 1/3 were fair, and 1/3 were good. Total direct medical costs were estimated at $12,509 (95% CI $7,451-21,001) for all RA patients using any treatment regimen and $36,053 (95% CI $32,138-40,445) for bDMARD users. RA-specific costs were $3,723 (95% CI $2,408-5,762) for all RA patients using any treatment regimen and $20,262 (95% CI $17,480-23,487) for bDMARD users. The total and disease-specific direct medical costs of patients with RA is substantial. Among bDMARD users, cost of RA care is over half of all direct medical costs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Removal of heavy metals from emerging cellulosic low-cost adsorbents: a review

Science.gov (United States)

Malik, D. S.; Jain, C. K.; Yadav, Anuj K.

2017-09-01

Heavy metal pollution is a major problems in the environment. The impact of toxic metal ions can be minimized by different technologies, viz., chemical precipitation, membrane filtration, oxidation, reverse osmosis, flotation and adsorption. But among them, adsorption was found to be very efficient and common due to the low concentration of metal uptake and economically feasible properties. Cellulosic materials are of low cost and widely used, and very promising for the future. These are available in abundant quantity, are cheap and have low or little economic value. Different forms of cellulosic materials are used as adsorbents such as fibers, leaves, roots, shells, barks, husks, stems and seed as well as other parts also. Natural and modified types of cellulosic materials are used in different metal detoxifications in water and wastewater. In this review paper, the most common and recent materials are reviewed as cellulosic low-cost adsorbents. The elemental properties of cellulosic materials are also discussed along with their cellulose, hemicelluloses and lignin contents.

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.

Cost-effectiveness of surgical interventions for the management of osteoarthritis: a systematic review of the literature.

Science.gov (United States)

Kamaruzaman, Hanin; Kinghorn, Philip; Oppong, Raymond

2017-05-10

The primary purpose of this study is to assess the existing evidence on the cost-effectiveness of surgical interventions for the management of knee and hip osteoarthritis by systematically reviewing published economic evaluation studies. A systematic review was conducted for the period 2004 to 2016. Electronic databases were searched to identify both trial and model based economic evaluation studies that evaluated surgical interventions for knee and hip osteoarthritis. A total of 23 studies met the inclusion criteria and an assessment of these studies showed that total knee arthroplasty (TKA), and total hip arthroplasty (THA) showed evidence of cost-effectiveness and improvement in quality of life of the patients when compared to non-operative and non-surgical procedures. On the other hand, even though delaying TKA and THA may lead to some cost savings in the short-run, the results from the study showed that this was not a cost-effective option. TKA and THA are cost-effective and should be recommended for the management of patients with end stage/severe knee and hip OA. However, there needs to be additional studies to assess the cost-effectiveness of other surgical interventions in order for definite conclusions to be reached.

A periodic review integrated inventory model with controllable setup cost, imperfect items, and inspection errors under service level constraint

Science.gov (United States)

Saga, R. S.; Jauhari, W. A.; Laksono, P. W.

2017-11-01

This paper presents an integrated inventory model which consists of single vendor and buyer. The buyer managed its inventory periodically and orders products from the vendor to satisfy the end customer’s demand, where the annual demand and the ordering cost were in the fuzzy environment. The buyer used a service level constraint instead of the stock-out cost term, so that the stock-out level per cycle was bounded. Then, the vendor produced and delivered products to the buyer. The vendor had a choice to commit an investment to reduce the setup cost. However, the vendor’s production process was imperfect, thus the lot delivered contained some defective products. Moreover, the buyer’s inspection process was not error-free since the inspector could be mistaken in categorizing the product’s quality. The objective was to find the optimum value for the review period, the setup cost, and the number of deliveries in one production cycle which might minimize the joint total cost. Furthermore, the algorithm and numerical example were provided to illustrate the application of the model.

GEM, Fuel Cycle Cost and Economics for Thermal Reactor, Present Worth Analysis

International Nuclear Information System (INIS)

Hughes, J.A.; Hang, D.F.

1974-01-01

1- Description of problem or function: GEM is used to predict fuel cycle costs for any type nuclear system (i.e., BWR, HTGR, PWR, LMFBR, GCFR,... ). The current version is limited to thermal reactors. GEM is designed for production use by large utilities which have several reactor types on their system. GEM has been written so as to accommodate all major fuel management activities undertaken by a utility - (1) fuel bid analysis, (2) evaluation of actual day to day operation, and (3) system simulation and optimization studies. 2 - Method of solution: Costs are calculated using present-worth techniques and continuous compounding. The equations are based on an investor-owned utility capitalization structure which easily covers the range of industrial, private, and public (government) owned utilities. Three distinct types of analysis (cash flow, allocated costs, yearly cash flow) are performed, each yielding identical results. Using these as a basis many other analyses are undertaken. 3 - Restrictions on the complexity of the problem: Dimensions of all arrays are carried as variables throughout the analysis. The maximum size of each array is set by the user in program MAIN. Current values are set so that maxima are: 50 batches per case study, 20 year batch life, 30 year case study, 120 batch burn time-steps, 20 individual payments (sales) associated with each cost component

2014 Water Power Program Peer Review: Marine and Hydrokinetic Technologies, Compiled Presentations (Presentation)

Energy Technology Data Exchange (ETDEWEB)

2014-02-01

This document represents a collection of all presentations given during the EERE Wind and Water Power Program's 2014 Marine and Hydrokinetic Peer Review. The purpose of the meeting was to evaluate DOE-funded hydropower and marine and hydrokinetic R&D projects for their contribution to the mission and goals of the Water Power Program and to assess progress made against stated objectives.

Review of selected cost drivers for decisions on continued operation of older nuclear reactors. Safety upgrades, lifetime extension, decommissioning

International Nuclear Information System (INIS)

1999-05-01

Lately, the approach to the operation of relatively old NPPs has become an important issue for the nuclear industry for several reasons. First, a large part of operating NPPs will reach the planned end of their lives relatively soon. Replacing these capacities can involve significant investment for the concerned countries and utilities. Second, many operating NPPs while about 30 years old are still in very good condition. Their continued safe operation appears possible and may bring about essential economic gains. Finally, with the costs of new NPPs being rather high at present, continued operation of existing plants and eventually their lifetime extension are viable options for supporting the nuclear share in power generation. This is becoming especially important in view of the growing attention to the issue of global warming and the role of nuclear energy in greenhouse gas mitigation. This report is a review of information related to three cost categories that are part of such cost-benefit analysis: costs of safety upgrades for continued operation of a nuclear unit, costs of lifetime extension and costs of decommissioning. It can serve as a useful reference source for experts and decision makers involved in the economics of operating NPPs

Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review.

Science.gov (United States)

Jit, Mark; Mibei, Walter

2015-07-31

Discounting future costs and health benefits usually has a large effect on results of cost-effectiveness evaluations of vaccination because of delays between the initial expenditure in the programme and the health benefits from averting disease. Most guidelines currently recommend discounting both costs and health effects at a positive, constant, common rate back to a common point in time. A review of 84 published economic evaluations of vaccines found that most of them apply these recommendations. However, both technical and normative arguments have been presented for discounting health at a different rate to consumption (differential discounting), discounting at a rate that changes over time (non-constant discounting), discounting intra-generational and inter-generational effects at a different rate (two-stage discounting), and discounting the health gains from an intervention to a different discount year from the time of intervention (delayed discounting). These considerations are particularly acute for vaccines, because their effects can occur in a different generation from the one paying for them, and because the time of vaccination, of infection aversion, and of disease aversion usually differ. Using differential, two-stage or delayed discounting in model-based cost-effectiveness evaluations of vaccination raises technical challenges, but mechanisms have been proposed to overcome them. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Cost of Transmission for Wind Energy: A Review of Transmission Planning Studies

Energy Technology Data Exchange (ETDEWEB)

Mills, Andrew D.; Wiser, Ryan; Porter, Kevin

2009-02-02

The rapid development of wind power that the United States has experienced over the last several years has been coupled with a growing concern that wind development will require substantial additions to the nation's transmission infrastructure. Transmission is particularly important for wind power due to the locational dependence of wind resources, the relatively low capacity factor of wind plants, and the mismatch between the short lead time to build a new wind project and the longer lead time often needed to plan, permit, and construct transmission. It is clear that institutional issues related to transmission planning, siting, and cost allocation will pose major obstacles to accelerated wind power deployment, but also of concern is the potential cost of this infrastructure build out. Simply put, how much extra cost will society bear to deliver wind power to load centers? Without an answer to this question, there can be no consensus on whether or not the cost of developing transmission for wind will be a major barrier to further wind deployment, or whether the institutional barriers to transmission expansion are likely to be of more immediate concern. In this report, we review a sample of 40 detailed transmission studies that have included wind power. These studies cover a broad geographic area, and were completed from 2001-2008. Our primary goal in reviewing these studies is to develop a better understanding of the transmission costs needed to access growing quantities of wind generation. A secondary goal is to gain a better appreciation of the differences in transmission planning approaches in order to identify those methodologies that seem most able to estimate the incremental transmission costs associated with wind development. Finally, we hope that the resulting dataset and discussion might be used to inform the assumptions, methods, and results of higher-level assessment models that are sometimes used to estimate the cost of wind deployment (e.g. NEMS

Cost-Effectiveness of Fecal Microbiota Transplantation in the Treatment of Recurrent Clostridium Difficile Infection: A Literature Review

Science.gov (United States)

Arbel, Leor T; McNally, Keegan

2017-01-01

Clostridium difficile (C. difficile) is a common cause of antibiotic-­associated diarrhea (AAD), being responsible for 15­-25% of all AAD cases. The purpose of this literature review is to determine the cost-effectiveness of fecal microbiota transplantation (FMT) and how it compares in this regard to the standard treatments of choice for recurrent C. difficile infection (CDI). The review of the literature along with the evaluation of three comparative cost effective analyses yielded findings consistent with the view that FMT is the most cost-effective option in treating recurrent CDI. There are some (but considerably less) data indicating that FMT may be a cost effective strategy in treating initial CDI, as well. The superior cost-effectiveness of FMT as compared to the preferred standards of treatment for recurrent CDI suggest FMT use should become more integrated in routine clinical practice. Increased utilization of FMTs would allow for better control of this increasingly problematic disease as well as lower costs associated with its management. PMID:29067223

Costs and financial benefits of video communication compared to usual care at home: a systematic review.

NARCIS (Netherlands)

Peeters, J.M.; Mistiaen, P.; Francke, A.L.

2011-01-01

We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home

A systematic review of cost-effectiveness studies comparing conventional, biological and surgical interventions for inflammatory bowel disease.

Science.gov (United States)

Pillai, Nadia; Dusheiko, Mark; Burnand, Bernard; Pittet, Valérie

2017-01-01

Inflammatory bowel disease (IBD) is a chronic disease placing a large health and economic burden on health systems worldwide. The treatment landscape is complex with multiple strategies to induce and maintain remission while avoiding long-term complications. The extent to which rising treatment costs, due to expensive biologic agents, are offset by improved outcomes and fewer hospitalisations and surgeries needs to be evaluated. This systematic review aimed to assess the cost-effectiveness of treatment strategies for IBD. A systematic literature search was performed in March 2017 to identify economic evaluations of pharmacological and surgical interventions, for adults diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). Costs and incremental cost-effectiveness ratios (ICERs) were adjusted to reflect 2015 purchasing power parity (PPP). Risk of bias assessments and a narrative synthesis of individual study findings are presented. Forty-nine articles were included; 24 on CD and 25 on UC. Infliximab and adalimumab induction and maintenance treatments were cost-effective compared to standard care in patients with moderate or severe CD; however, in patients with conventional-drug refractory CD, fistulising CD and for maintenance of surgically-induced remission ICERs were above acceptable cost-effectiveness thresholds. In mild UC, induction of remission using high dose mesalazine was dominant compared to standard dose. In UC refractory to conventional treatments, infliximab and adalimumab induction and maintenance treatment were not cost-effective compared to standard care; however, ICERs for treatment with vedolizumab and surgery were favourable. We found that, in general, while biologic agents helped improve outcomes, they incurred high costs and therefore were not cost-effective, particularly for use as maintenance therapy. The cost-effectiveness of biologic agents may improve as market prices fall and with the introduction of biosimilars. Future research

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research.

Science.gov (United States)

Wali, Arvin R; Brandel, Michael G; Santiago-Dieppa, David R; Rennert, Robert C; Steinberg, Jeffrey A; Hirshman, Brian R; Murphy, James D; Khalessi, Alexander A

2018-05-01

OBJECTIVE Markov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research. METHODS The PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs. RESULTS A total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided. CONCLUSIONS As neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.

A systematic review of cost-effectiveness studies of prevention and treatment for eating disorders.

Science.gov (United States)

Le, Long Khanh-Dao; Hay, Phillipa; Mihalopoulos, Cathrine

2018-04-01

Eating disorders are serious mental disorders and are associated with substantial economic and social burden. The aim of this study is to undertake a systematic review of the cost-effectiveness studies of both preventive and treatment interventions for eating disorder. Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsycINFO, Academic Search Complete, Global Health, CINAHL complete, Health Business Elite, Econlit, Health Policy Reference Center and ERIC) were searched for published cost-effectiveness studies of eating disorder prevention and treatment including papers published up to January 2017. The quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. In all, 13 studies met the review inclusion criteria as full cost-effectiveness studies and 8 were published since 2011. The studies included three modelled and one trial-based study focused on prevention, two trial-based and one modelled study for anorexia nervosa treatment and three trial-based studies for bulimia nervosa treatment. The remaining studies targeted binge-eating disorder or non-specific eating disorder treatment. The average percent of CHEERS checklist items reported was 71% (standard deviation 21%). Eating disorder interventions were mainly cost-saving or more effective and more costly compared to comparators; however, some results did not reach statistical significance. In the two studies that achieved 100% CHEERS checklist, one study reported that a cognitive dissonance intervention might be cost-effective for prevention of anorexia nervosa and bulimia nervosa with a 90% participation rate and the second study supported lisdexamfetamine to be cost-effective in the treatment of binge-eating disorder. Insufficient evidence for long-term cost-effectiveness (e.g. over 2 years) was found. Cost-effectiveness studies in eating disorder appear to be increasing in number over the last 6 years. Findings

The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review.

Directory of Open Access Journals (Sweden)

Jaana T Joensuu

Full Text Available Economic evaluations provide information to aid the optimal utilization of limited healthcare resources. Costs of biologics for Rheumatoid arthritis (RA are remarkably high, which makes these agents an important target for economic evaluations. This systematic review aims to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically.A literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses (CUAs of one or more available biological drugs for the treatment of RA in adults were included. Two independent investigators systematically collected information and assessed the quality of the studies. To enable the comparison of the results, all costs were converted to 2013 euro.Of the 4890 references found in the literature search, 41 CUAs were included in the current systematic review. While considering only direct costs, the incremental cost-effectiveness ratio (ICER of the tumor necrosis factor inhibitors (TNFi ranged from 39,000 to 1,273,000 €/quality adjusted life year (QALY gained in comparison to conventional disease-modifying antirheumatic drugs (cDMARDs in cDMARD naïve patients. Among patients with an insufficient response to cDMARDs, biologics were associated with ICERs ranging from 12,000 to 708,000 €/QALY. Rituximab was found to be the most cost-effective alternative compared to other biologics among the patients with an insufficient response to TNFi.When 35,000 €/QALY is considered as a threshold for the ICER, TNFis do not seem to be cost-effective among cDMARD naïve patients and patients with an insufficient response to cDMARDs. With thresholds of 50,000 to 100,000 €/QALY biologics might be cost-effective among patients with an inadequate response to cDMARDs. Standardization of multiattribute utility instruments and a validated standard conversion method

Cost Effectiveness of HPV Vaccination: A Systematic Review of Modelling Approaches.

Science.gov (United States)

Pink, Joshua; Parker, Ben; Petrou, Stavros

2016-09-01

A large number of economic evaluations have been published that assess alternative possible human papillomavirus (HPV) vaccination strategies. Understanding differences in the modelling methodologies used in these studies is important to assess the accuracy, comparability and generalisability of their results. The aim of this review was to identify published economic models of HPV vaccination programmes and understand how characteristics of these studies vary by geographical area, date of publication and the policy question being addressed. We performed literature searches in MEDLINE, Embase, Econlit, The Health Economic Evaluations Database (HEED) and The National Health Service Economic Evaluation Database (NHS EED). From the 1189 unique studies retrieved, 65 studies were included for data extraction based on a priori eligibility criteria. Two authors independently reviewed these articles to determine eligibility for the final review. Data were extracted from the selected studies, focussing on six key structural or methodological themes covering different aspects of the model(s) used that may influence cost-effectiveness results. More recently published studies tend to model a larger number of HPV strains, and include a larger number of HPV-associated diseases. Studies published in Europe and North America also tend to include a larger number of diseases and are more likely to incorporate the impact of herd immunity and to use more realistic assumptions around vaccine efficacy and coverage. Studies based on previous models often do not include sufficiently robust justifications as to the applicability of the adapted model to the new context. The considerable between-study heterogeneity in economic evaluations of HPV vaccination programmes makes comparisons between studies difficult, as observed differences in cost effectiveness may be driven by differences in methodology as well as by variations in funding and delivery models and estimates of model parameters

Protecting Astronaut Medical Privacy: Review of Presentations and Publications for Attributability

Science.gov (United States)

Wear, M. L.; Charvat, J. M.; Lee, L. R.; Babiak-Vazquez, A.; Mason, S. S.; Van Baalen, M.

2018-01-01

Retrospective research and medical data collected on astronauts can be a valuable resource for researchers. This data can be requested from two separate NASA Archives. The Lifetime Surveillance of Astronaut Health (LSAH) holds astronaut medical data, and the Life Sciences Data Archive (LSDA) holds research data. One condition of use of astronaut research and medical data is the requirement that all abstracts, publications and presentations using this data must be reviewed for attributability. All final versions of abstracts, presentations, posters, and manuscripts must be reviewed by LSDA/LSAH prior to submission to a conference, journal, or other entities outside the Principal Investigator (PI) laboratory [including the NASA Export Control Document Availability Authorization (DAA) system]. If material undergoes multiple revisions (e.g., journal editor comments), the new versions must also be reviewed by LSDA/LSAH prior to re-submission to the journal. The purpose of this review is to ensure that no personally identifiable information (PII) is included in materials that are presented in a public venue or posted to the public domain. The procedures for submitting materials for review will be outlined. The process that LSAH/LSDA follows for assessing attributability will be presented. Characteristics and parameter combinations that often prompt attributability concerns will be identified. A published case report for a National Football League (NFL) player will be used to demonstrate how, in a population of public interest, a combination of information can result in inadvertent release of private or sensitive information.

A Systematic Review of the Energy Cost and Metabolic Intensity of Yoga.

Science.gov (United States)

Larson-Meyer, D Enette

2016-08-01

With the increasing popularity of Hatha yoga, it is important to understand the energy cost and METs of yoga practice within the context of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) physical activity guidelines. This systematic review evaluated the energy cost and metabolic intensity of yoga practice including yoga asanas (poses/postures) and pranayamas (breath exercises) measured by indirect calorimetry. The English-speaking literature was surveyed via PubMed using the general terms "yoga" and "energy expenditure" with no date limitations. Thirteen manuscripts were initially identified with an additional four located from review of manuscript references. Of the 17 studies, 10 evaluated the energy cost and METs of full yoga sessions or flow through Surya Namaskar (sun salutations), eight of individual asanas, and five of pranayamas. METs for yoga practice averaged 3.3 ± 1.6 (range = 1.83-7.4 METs) and 2.9 ± 0.8 METs when one outlier (i.e., 7.4 METs for Surya Namaskar) was omitted. METs for individual asanas averaged 2.2 ± 0.7 (range = 1.4-4.0 METs), whereas that of pranayamas was 1.3 ± 0.3. On the basis of ACSM/AHA classification, the intensity of most asanas and full yoga sessions ranged from light (less than 3 METs) to moderate aerobic intensity (3-6 METs), with the majority classified as light intensity. This review suggests that yoga is typically classified as a light-intensity physical activity. However, a few sequences/poses, including Surya Namaskar, meet the criteria for moderate- to vigorous-intensity activity. In accordance with the ACSM/AHA guidelines, the practice of asana sequences with MET intensities higher than three (i.e., >10 min) can be accumulated throughout the day and count toward daily recommendations for moderate- or vigorous-intensity physical activity.

The Costs and Benefits of Compliance with Renewable Portfolio Standards: Reviewing Experience to Date

Energy Technology Data Exchange (ETDEWEB)

Heeter, Jenny; Barbose, Galen; Bird, Lori; Weaver, Samantha; Flores, Francisco; Kuskova-Burns, Ksenia; Wiser, Ryan

2014-03-12

More than half of U.S. states have renewable portfolio standards (RPS) in place and have collectively deployed approximately 46,000 MW of new renewable energy capacity through year-end 2012. Most of these policies have five or more years of implementation experience, enabling an assessment of their costs and benefits. Understanding RPS benefits and costs is essential for policymakers evaluating existing RPS policies, assessing the need for modifications, and considering new policies. A key aspect of this study is the comprehensive review of existing RPS cost and benefit estimates, in addition to an examination of the variety of methods used to calculate such estimates. Based on available data and estimates reported by utilities and regulators, this study summarizes RPS costs to date. The study considers how those costs may evolve going forward, given scheduled increases in RPS targets and cost containment mechanisms incorporated into existing policies. The report also summarizes RPS benefits estimates, based on published studies for individual states, and discusses key methodological considerations.

2013 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Mone, C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Smith, A. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Maples, B. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hand, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2015-02-01

This report uses representative project types to estimate the levelized cost of wind energy (LCOE) in the United States for 2013. Scheduled to be published on an annual basis, it relies on both market and modeled data to maintain a current understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed from this analysis are used to inform wind technology cost projections, goals, and improvement opportunities.

A systematic review of the cost of data collection for performance monitoring in hospitals.

Science.gov (United States)

Jones, Cheryl; Gannon, Brenda; Wakai, Abel; O'Sullivan, Ronan

2015-04-01

Key performance indicators (KPIs) are used to identify where organisational performance is meeting desired standards and where performance requires improvement. Valid and reliable KPIs depend on the availability of high-quality data, specifically the relevant minimum data set ((MDS) the core data identified as the minimum required to measure performance for a KPI) elements. However, the feasibility of collecting the relevant MDS elements is always a limitation of performance monitoring using KPIs. Preferably, data should be integrated into service delivery, and, where additional data are required that are not currently collected as part of routine service delivery, there should be an economic evaluation to determine the cost of data collection. The aim of this systematic review was to synthesise the evidence base concerning the costs of data collection in hospitals for performance monitoring using KPI, and to identify hospital data collection systems that have proven to be cost minimising. We searched MEDLINE (1946 to May week 4 2014), Embase (1974 to May week 2 2014), and CINAHL (1937 to date). The database searches were supplemented by searching for grey literature through the OpenGrey database. Data was extracted, tabulated, and summarised as part of a narrative synthesis. The searches yielded a total of 1,135 publications. After assessing each identified study against specific inclusion exclusion criteria only eight studies were deemed as relevant for this review. The studies attempt to evaluate different types of data collection interventions including the installation of information communication technology (ICT), improvements to current ICT systems, and how different analysis techniques may be used to monitor performance. The evaluation methods used to measure the costs and benefits of data collection interventions are inconsistent across the identified literature. Overall, the results weakly indicate that collection of hospital data and improvements in data

Limiting the costs of renewable portfolio standards: A review and critique of current methods

International Nuclear Information System (INIS)

Stockmayer, Gabriella; Finch, Vanessa; Komor, Paul; Mignogna, Rich

2012-01-01

Over half of U.S. states have renewable portfolio standards (RPSs) mandating that a minimum percentage of electricity sold derives from renewable sources. State RPSs vary widely in how they attempt to control or limit the costs of these RPSs. Approaches utilized include alternative compliance payments, direct rate caps, and cost caps on resource acquisitions, while some states employ no specific limitation at all. This paper describes how states attempt to control RPS costs and discusses the strengths and weaknesses of these various cost controls. There is no one best method; however the experience to date suggests that the most important factors in implementing an effective mechanism to curtail costs are clarity of the rule, consistency in application, and transparency for customers. - Highlights: ▶ We review states' RPS statutes and regulations for mechanisms that attempt to control overall compliance costs. ▶ We categorize the major cost curtailment mechanisms. ▶ For each mechanism, we describe policy designs that are or could be implemented by states. ▶ We identify strengths and weaknesses of the various designs for consideration by policymakers.

Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs.

Science.gov (United States)

Maru, Shoko; Byrnes, Joshua; Whitty, Jennifer A; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

2015-02-01

The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs. © The European Society of Cardiology 2014.

The impact of clinical trial monitoring approaches on data integrity and cost--a review of current literature.

Science.gov (United States)

Olsen, Rasmus; Bihlet, Asger Reinstrup; Kalakou, Faidra; Andersen, Jeppe Ragnar

2016-04-01

Monitoring is a costly requirement when conducting clinical trials. New regulatory guidance encourages the industry to consider alternative monitoring methods to the traditional 100 % source data verification (SDV) approach. The purpose of this literature review is to provide an overview of publications on different monitoring methods and their impact on subject safety data, data integrity, and monitoring cost. The literature search was performed by keyword searches in MEDLINE and hand search of key journals. All publications were reviewed for details on how a monitoring approach impacted subject safety data, data integrity, or monitoring costs. Twenty-two publications were identified. Three publications showed that SDV has some value for detection of not initially reported adverse events and centralized statistical monitoring (CSM) captures atypical trends. Fourteen publications showed little objective evidence of improved data integrity with traditional monitoring such as 100 % SDV and sponsor queries as compared to reduced SDV, CSM, and remote monitoring. Eight publications proposed a potential for significant cost reductions of monitoring by reducing SDV without compromising the validity of the trial results. One hundred percent SDV is not a rational method of ensuring data integrity and subject safety based on the high cost, and this literature review indicates that reduced SDV is a viable monitoring method. Alternative methods of monitoring such as centralized monitoring utilizing statistical tests are promising alternatives but have limitations as stand-alone tools. Reduced SDV combined with a centralized, risk-based approach may be the ideal solution to reduce monitoring costs while improving essential data quality.

Supplemental report on cost estimates'

International Nuclear Information System (INIS)

1992-01-01

The Office of Management and Budget (OMB) and the U.S. Army Corps of Engineers have completed an analysis of the Department of Energy's (DOE) Fiscal Year (FY) 1993 budget request for its Environmental Restoration and Waste Management (ERWM) program. The results were presented to an interagency review group (IAG) of senior-Administration officials for their consideration in the budget process. This analysis included evaluations of the underlying legal requirements and cost estimates on which the ERWM budget request was based. The major conclusions are contained in a separate report entitled, ''Interagency Review of the Department of Energy Environmental Restoration and Waste Management Program.'' This Corps supplemental report provides greater detail on the cost analysis

Environmental performance review and cost analysis of MSW landfilling by baling-wrapping technology versus conventional system

International Nuclear Information System (INIS)

Baldasano, J.M.; Gasso, S.; Perez, C.

2003-01-01

This paper first reviews the chemical, physical and biological processes, and the environmental performance of MSW compacted and plastic-wrapped into air-tight bales with low-density polyethylene (LDPE). The baling-wrapping process halts the short and half-term biological activity and consequently the emission of gases and leachates. It also facilitates the handling of the refuse, and considerably reduces the main environmental impacts of a landfill. The main technologies available for baling-wrapping MSW are also presented. Furthermore, a cost analysis comparing a conventional landfill (CL) without baling system versus two landfills using different baling-wrapping technologies (rectangular and cylindrical bales) is carried out. The results are presented comparatively under the conditions of construction, operation and maintenance and postclosure, as required by European Directive 1999/31. A landfill using rectangular plastic-wrapped bales (LRPB) represents an economically competitive option compared to a CL. The increased capacity of the waste disposal zone when using rectangular bales due to the high density of the bales compensates for the increased operating and maintenance (O and M) costs of the method. Landfills using cylindrical plastic-wrapped bales (LCPB's) do not fare so well, mainly because the density within the bales is lower, the cylindrical geometry of the bales does not allow such an efficient use of the space within the landfill, and the processing capacity of the machinery is lower. From the cost model, the resulting unit costs per tonne in a LRPB, a LCPB and a CL for 100,000 t/year of waste, an operation time of 15 years and a landfill depth (H) of 20 m, are 31.52, 43.36 and 31.83 Euro/t, respectively

Preliminary Multi-Variable Cost Model for Space Telescopes

Science.gov (United States)

Stahl, H. Philip; Hendrichs, Todd

2010-01-01

Parametric cost models are routinely used to plan missions, compare concepts and justify technology investments. This paper reviews the methodology used to develop space telescope cost models; summarizes recently published single variable models; and presents preliminary results for two and three variable cost models. Some of the findings are that increasing mass reduces cost; it costs less per square meter of collecting aperture to build a large telescope than a small telescope; and technology development as a function of time reduces cost at the rate of 50% per 17 years.

COST-EFFECTIVENESS OF PERIOPERATIVE IMMUNONUTRITION IN GASTROINTESTINAL ONCOLOGIC SURGERY: A SYSTEMATIC REVIEW.

Science.gov (United States)

Reis, Audrey Machado Dos; Kabke, Geórgia Brum; Fruchtenicht, Ana Valéria Gonçalves; Barreiro, Taiane Dias; Moreira, Luis Fernando

2016-01-01

Costs, length of hospital staying and morbidity are frequently and significantly increased as a result of infections and other complications following surgical procedure for gastrointestinal tract cancer. Recently, improving host defence mechanisms have become a target of interest. Immunonutrition aims at improving immunity, most likely providing key nutrients to maintain T-lymphocyte and other host defence. To evaluate the immunonutrition in cancer patients who are operated by digestive diseases and assess the cost-effectiveness of this supplementation. This study consisted of a systematic review of the literature based on reference analyses retrieved from current databases such as PubMed, Lilacs and SciELO. The search strategy was defined by terms related to immunonutrition [immunonutrition, arginine, omega-3 and nucleotides] in combination with [costs, cost-effective and cost-effectiveness] as well as [gastrointestinal cancer surgery, oesophageal, gastric or pancreatic surgery] in English, Portuguese or Spanish language. For cost analyses, currencies used in the manuscripts were all converted to American dollars (US$) in order to uniform and facilitate comparison. Six prospective randomized studies were included in this review. The cost-effectiveness was positive in most of studies, demonstrating that this diet can significantly reduce hospital costs in the North hemisphere. However, similar studies needed to be carried to determine such results among us. Custos, tempo de hospitalização e morbidade estão frequentemente aumentados na presença de infecções e outras complicações decorrentes de procedimentos cirúrgicos para o câncer gastrointestinal. Recentemente, a melhora de mecanismos de defesa do hospedeiro tem se tornado um alvo de interesse. Nutrição adequada está fortemente relacionada com competência imune e redução de infeções. Imunonutrição objetiva a melhora da imunidade, principalmente para manutenção de linfócitos-T e outras

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

Science.gov (United States)

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

2017-01-01

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

Present status of titanium removable dentures--a review of the literature.

Science.gov (United States)

Ohkubo, C; Hanatani, S; Hosoi, T

2008-09-01

Although porcelain and zirconium oxide might be used for fixed partial dental prostheses instead of conventional dental metals in the near future, removable partial denture (RPD) frameworks will probably continue to be cast with biocompatible metals. Commercially pure (CP) titanium has appropriate mechanical properties, it is lightweight (low density) compared with conventional dental alloys, and has outstanding biocompatibility that prevents metal allergic reactions. This literature review describes the laboratory conditions needed for fabricating titanium frameworks and the present status of titanium removable prostheses. The use of titanium for the production of cast RPD frameworks has gradually increased. There are no reports about metallic allergy apparently caused by CP titanium dentures. The laboratory drawbacks still remain, such as the lengthy burn-out, inferior castability and machinability, reaction layer formed on the cast surface, difficulty of polishing, and high initial costs. However, the clinical problems, such as discoloration of the titanium surfaces, unpleasant metal taste, decrease of clasp retention, tendency for plaque to adhere to the surface, detachment of the denture base resin, and severe wear of titanium teeth, have gradually been resolved. Titanium RPD frameworks have never been reported to fail catastrophically. Thus, titanium is recommended as protection against metal allergy, particularly for large-sized prostheses such as RPDs or complete dentures.

The effectiveness of health care cost management strategies: a review of the evidence.

Science.gov (United States)

Fronstin, P

1994-10-01

This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care

Preliminary Cost Model for Space Telescopes

Science.gov (United States)

Stahl, H. Philip; Prince, F. Andrew; Smart, Christian; Stephens, Kyle; Henrichs, Todd

2009-01-01

Parametric cost models are routinely used to plan missions, compare concepts and justify technology investments. However, great care is required. Some space telescope cost models, such as those based only on mass, lack sufficient detail to support such analysis and may lead to inaccurate conclusions. Similarly, using ground based telescope models which include the dome cost will also lead to inaccurate conclusions. This paper reviews current and historical models. Then, based on data from 22 different NASA space telescopes, this paper tests those models and presents preliminary analysis of single and multi-variable space telescope cost models.

Estimating the cost of blood: past, present, and future directions.

Science.gov (United States)

Shander, Aryeh; Hofmann, Axel; Gombotz, Hans; Theusinger, Oliver M; Spahn, Donat R

2007-06-01

Understanding the costs associated with blood products requires sophisticated knowledge about transfusion medicine and is attracting the attention of clinical and administrative healthcare sectors worldwide. To improve outcomes, blood usage must be optimized and expenditures controlled so that resources may be channeled toward other diagnostic, therapeutic, and technological initiatives. Estimating blood costs, however, is a complex undertaking, surpassing simple supply versus demand economics. Shrinking donor availability and application of a precautionary principle to minimize transfusion risks are factors that continue to drive the cost of blood products upward. Recognizing that historical accounting attempts to determine blood costs have varied in scope, perspective, and methodology, new approaches have been initiated to identify all potential cost elements related to blood and blood product administration. Activities are also under way to tie these elements together in a comprehensive and practical model that will be applicable to all single-donor blood products without regard to practice type (e.g., academic, private, multi- or single-center clinic). These initiatives, their rationale, importance, and future directions are described.

Solar PV Manufacturing Cost Model Group: Installed Solar PV System Prices (Presentation)

Energy Technology Data Exchange (ETDEWEB)

Goodrich, A. C.; Woodhouse, M.; James, T.

2011-02-01

EERE's Solar Energy Technologies Program is charged with leading the Secretary's SunShot Initiative to reduce the cost of electricity from solar by 75% to be cost competitive with conventional energy sources without subsidy by the end of the decade. As part of this Initiative, the program has funded the National Renewable Energy Laboratory (NREL) to develop module manufacturing and solar PV system installation cost models to ensure that the program's cost reduction targets are carefully aligned with current and near term industry costs. The NREL cost analysis team has leveraged the laboratories' extensive experience in the areas of project finance and deployment, as well as industry partnerships, to develop cost models that mirror the project cost analysis tools used by project managers at leading U.S. installers. The cost models are constructed through a "bottoms-up" assessment of each major cost element, beginning with the system's bill of materials, labor requirements (type and hours) by component, site-specific charges, and soft costs. In addition to the relevant engineering, procurement, and construction costs, the models also consider all relevant costs to an installer, including labor burdens and overhead rates, supply chain costs, and overhead and materials inventory costs, and assume market-specific profits.

Managing the present and future costs of decommissioning

International Nuclear Information System (INIS)

Azorsky, T.L.; Fenster, H.L.

1987-01-01

The lack of state and federal standards for decommissioning and decontamination (D and D) of nuclear facilities may result in additional costs years after the D and D is complete. Increased costs may result from the application of certain environmental statutes to the facility or from personal injury and property damage, i.e., tort, litigation. Companies that operated facilities that provided a service or product for the government have certain financial protections and certain immunities from suit. Companies operating commercial facilities, however, have little or no protection from future liabilities. Accordingly, this country needs federal standards for D and D, standards that would govern the level of decontamination required and protect companies completing the D and D effort from future liability

A Second Opinion is Worth the Cost - 12479

Energy Technology Data Exchange (ETDEWEB)

Madsen, Drew [Project Time and Cost Inc. (United States)

2012-07-01

This paper, 'A Second Opinion is Worth the Cost', shows how a second opinion for a Department of Energy (DOE) Project helped prepare and pass a DOE Order 413.3A 'Program and Project Management for the acquisition of Capital Assets' Office of Engineering and Construction Management (OECM) required External Independent Review (EIR) in support of the approved baseline for Critical Decision (CD) 2. The DOE project personnel were informed that the project's Total Project Cost (TPC) was going to increase from $815 million to $1.1 billion due to unforeseen problems and unexplained reasons. The DOE Project Team determined that a second opinion was needed to review and validate the TPC. Project Time and Cost, Inc. (PT and C) was requested to evaluate the cost estimate, schedule, basis of estimate (BOE), and risk management plan of the Project and to give an independent assessment of the TPC that was presented to DOE. This paper will demonstrate how breaking down a project to the work breakdown structure (WBS) level allows a project to be analyzed for potential cost increases and/or decreases, thus providing a more accurate TPC. The review Team's cost analyses of Projects identified eight primary drivers resulting in cost increases. They included: - Overstatement of the effort required to develop drawings and specifications. - Cost allocation to 'Miscellaneous' without sufficient detail or documentation. - Cost for duplicated efforts. - Vendor estimates or quotations without sufficient detail. - The practice of using the highest price quoted then adding an additional 10% mark-up. - Application of Nuclear Quality Assurance (NQA) highest level quality requirements when not required. - Allocation of operational costs to the Project Costs instead of to the Operating Expenses (OPEX). OPEX costs come from a different funding source. - DOE had not approved the activities. By using a Team approach with professionals from cost, civil

Assessing the effectiveness and cost effectiveness of adaptive e-Learning to improve dietary behaviour: protocol for a systematic review.

Science.gov (United States)

Edwards, Phil; Felix, Lambert; Harris, Jody; Ferguson, Elaine; Free, Caroline; Landon, Jane; Lock, Karen; Michie, Susan; Miners, Alec; Murray, Elizabeth

2010-04-21

intervention, and outcomes. Statistical analyses appropriate to the data extracted, and an economic evaluation using a cost-utility analysis, will be undertaken if sufficient data exist, and effective components of successful interventions will be investigated. This review aims to provide comprehensive evidence of the effectiveness and cost-effectiveness of adaptive e-Learning interventions for dietary behaviour change, and explore potential psychological mechanisms of action and the effective components of effective interventions. This can inform policy makers and healthcare commissioners in deciding whether e-Learning should be part of a comprehensive response to the improvement of dietary behaviour for health, and if so which components should be present for interventions to be effective.

Stranded costs and exit fees

International Nuclear Information System (INIS)

2002-01-01

The New Brunswick Market Design Committee has been directed to examine the issue of stranded costs since it is a major component of restructuring within the electricity sector. When regulated monopolies are faced with competition, they could find that some of their embedded costs cannot be recovered. These costs are referred to as stranded costs. Common sources include large capital investments in uneconomic plants or expensive power purchase contracts or fuel supply contracts. In general, stranded costs do not include gains or losses associated with normal business risks experienced by regulated utilities. This report presents recommendations for mitigation of stranded costs, valuation methodologies and cost-recovery mechanisms. It also presents a summary of experience with stranded costs in other jurisdictions such as California, Rhode Island, Pennsylvania and Ontario. Stranded costs are often recovered through an obligatory charge on all customers, particularly in jurisdictions where retail competition exists. In the New Brunswick market, however, the only customers who can create stranded costs are those eligible to choose their own suppliers. It is argued that since most customers will not have a choice of electricity suppliers, they cannot generate stranded costs and therefore, should not have to pay costs stranded by others. A method to quantify stranded costs is presented, along with a review of transmission-related stranded costs in New Brunswick. Expansion of self-generation in New Brunswick could strand transmission assets. Currently, self-generators only contribute a small amount to fixed charges of the transmission system. However, under new recommended tariffs, the amount could increase. It is likely that the net amount of stranded transmission costs will not be large. 2 refs., 1 fig

[Hospital costs estimation by micro and gross-costing approaches].

Science.gov (United States)

Guerre, P; Hayes, N; Bertaux, A-C

2018-03-01

Cost analysis has become increasingly commonplace in healthcare facilities in recent years. Regardless of the aim, the first consideration for a hospital costing process is to determine the point of view, or perspective, to adopt. Should the cost figures reflect the healthcare facility's point of view or enlighten perspectives for the public health insurance system? Another consideration is in regard to the method to adopt, as there are several. The two most widely used methods to determine the costs of hospital treatments in France are the micro-costing method and the gross-costing method. The aims of this work are: (1) to describe each of these methods (e.g. data collection, assignment of monetary value to resource consumption) with their advantages and shortcomings as they relate to the difficulties encountered with their implementation in hospitals; (2) to present a review of the literature comparing the two methods and their possible combination; and (3) to propose ways to address the questions that need to be asked before compiling resource consumption data and assigning monetary value to hospital costs. A final diagram summarizes methodologies to be preferred according to the evaluation strategy and the impact on patient care. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Cost estimates for Operation Desert Shield/Desert Storm: a budgetary analysis

OpenAIRE

Johnson, J. Andrew.

1991-01-01

Operation Desert Shield/Desert Storm (DS/DS) presented unique challenges for estimating the cost of that conflict. This analysis reviews the cost estimates and methodologies developed for that purpose by DoD, CBO and GAO. It considers the budget climate and the role of foreign cash and in-kind contributions. Finally, it reviews the budgeting innovations used to provide and monitor DS/DS defense spending. At the outset of the crisis, costs were estimated to determine the defense funding requir...

A Review of Research on Sport Education: 2004 to the Present

Science.gov (United States)

Hastie, Peter A.; de Ojeda, Diego Martinez; Luquin, Antonio Calderon

2011-01-01

Background: In 2005, Wallhead and O'Sullivan presented a review of research on the Sport Education model. In that review, the authors identified certain strengths of the model (particularly persistent team membership) in facilitating student engagement within student-centered learning tasks. Other areas (such as student leadership skills) were…

The influence of size of plant upon reprocessing costs

International Nuclear Information System (INIS)

1978-10-01

This paper reviews recent published estimates for capital and operating costs of reprocessing plants in an attempt to establish a relative variation of unit reprocessing costs with plant design capacity and load factor. It is concluded that capital costs follow the well established ''rule of thumb'' for chemical plants in being proportional to (design capacity)sup(2/3). Operating costs vary significantly with variation in labour costs. Unit reprocessing costs are presented as a function of plant design capacity, load factor and method of financing

Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer.

Science.gov (United States)

Leung, Henry W C; Chan, Agnes L F; Leung, Matthew S H; Lu, Chin-Li

2013-04-01

To systematically review and assess the quality of cost-effectiveness analyses (CEAs) of pharmaceutical therapies for metastatic colorectal cancer (mCRC). The MEDLINE, EMBASE, Cochrane, and EconLit databases were searched for the Medical Subject Headings or text key words quality-adjusted, QALY, life-year gained (LYG), and cost-effectiveness (January 1, 1999-December 31, 2009). Original CEAs of mCRC pharmacotherapy published in English were included. CEAs that measured health effects in units other than quality-adjusted life years or LYG and letters to the editor, case reports, posters, and editorials were excluded. Each article was independently assessed by 2 trained reviewers according to a quality checklist created by the Panel on Cost-Effectiveness in Health and Medicine. Twenty-four CEA studies pertaining to pharmaceutical therapies for mCRC were identified. All studies showed a wide variation in methodologic approaches, which resulted in a different range of incremental cost-effectiveness ratios reported for each regimen. We found common methodologic flaws in a significant number of CEA studies, including lack of clear description for critique of data quality; lack of method for adjusting costs for inflation and methods for obtaining expert judgment; no results of model validation; wide differences in the types of perspective, time horizon, study design, cost categories, and effect outcomes; and no quality assessment of data (cost and effectiveness) for the interventions evaluation. This study has shown a wide variation in the methodology and quality of cost-effectiveness analysis for mCRC. Improving quality and harmonization of CEA for cancer treatment is needed. Further study is suggested to assess the quality of CEA methodology outside the mCRC disease state.

Cost-effectiveness of food, supplement and environmental interventions to address malnutrition in residential aged care: a systematic review.

Science.gov (United States)

Hugo, Cherie; Isenring, Elisabeth; Miller, Michelle; Marshall, Skye

2018-05-01

observational studies have shown that nutritional strategies to manage malnutrition may be cost-effective in aged care; but more robust economic data is needed to support and encourage translation to practice. Therefore, the aim of this systematic review is to compare the cost-effectiveness of implementing nutrition interventions targeting malnutrition in aged care homes versus usual care. residential aged care homes. systematic literature review of studies published between January 2000 and August 2017 across 10 electronic databases. Cochrane Risk of Bias tool and GRADE were used to evaluate the quality of the studies. eight included studies (3,098 studies initially screened) reported on 11 intervention groups, evaluating the effect of modifications to dining environment (n = 1), supplements (n = 5) and food-based interventions (n = 5). Interventions had a low cost of implementation (<£2.30/resident/day) and provided clinical improvement for a range of outcomes including weight, nutritional status and dietary intake. Supplements and food-based interventions further demonstrated a low cost per quality adjusted life year or unit of physical function improvement. GRADE assessment revealed the quality of the body of evidence that introducing malnutrition interventions, whether they be environmental, supplements or food-based, are cost-effective in aged care homes was low. this review suggests supplements and food-based nutrition interventions in the aged care setting are clinically effective, have a low cost of implementation and may be cost-effective at improving clinical outcomes associated with malnutrition. More studies using well-defined frameworks for economic analysis, stronger study designs with improved quality, along with validated malnutrition measures are needed to confirm and increase confidence with these findings.

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV infection: a general trend

Directory of Open Access Journals (Sweden)

Frédéric Gervais

2017-03-01

Full Text Available Abstract Background Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1 collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2 explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination. Methods A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies. Results A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness. Conclusions This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

A Mapping Review of Poster Presentation Publications Across Time and Academic Disciplines

Directory of Open Access Journals (Sweden)

Ruby Muriel Lavallee Warren

2018-03-01

Full Text Available A Review of: Rowe, N. (2017. Tracing the 'grey literature' of poster presentations: A mapping review. Health Information & Libraries Journal, 34(2, 106-124. Abstract Objective – To map the development and use of poster presentations in order to determine disciplines in which they are particularly prolific and how their popularity or presence may have changed over time. This will potentially assist health and interdisciplinary librarians asked to search for poster presentations in systematic reviews. Design – Informetric mapping review. Setting – An unnamed UK University Library search facility which processes 249 international databases and research publications. Databases and publications range across 37 research disciplines, including literature, medicine, and engineering. Subjects – Published literature connected to poster presentations – the authors state that this could be poster presentations themselves, abstracts, title listings in conference proceedings, or any variety of materials. They also state that over 99% of the results of this review were title citations or abstracts of conference poster presentations. Methods – An informetric mapping review was conducted via a UK University Library search facility by searching for the term “poster presentation” in 249 databases spanning 37 research areas. An index of databases used is provided as an appendix to the article. Results were not connected by the search facility to an individual database. Search results were categorized by discipline and decade of publication. Scholarly and peer-reviewed search limiters were used to obtain an idea of the themes and contributions to what could be considered core literature, and the search was also run in Google Scholar to provide a comparator. Duplications across databases were removed by the search service, although several results appeared both in aggregate (for example, conference proceedings encompassing all poster presentations and

The Costs and Benefits of Employing an Adult with Autism Spectrum Disorder: A Systematic Review.

Directory of Open Access Journals (Sweden)

Andrew Jacob

Full Text Available Despite an ambition from adults with Autism Spectrum Disorder (ASD to be employed, there are limited opportunities for competitive employment for this group. Employment is not only an entitlement enjoyed by others in society, but employing adults with ASD also has economic benefits by decreasing lost productivity and resource costs for this group. Few studies have explored the cost-benefit ratio for employing adults with ASD and even fewer have taken the viewpoint of the employer, particularly applying this situation to ASD. Until such study occurs, employers may continue to be reluctant to employ adults from this group.This review aimed to examine the costs, benefits and the cost-benefit ratio of employing adults with ASD, from a societal perspective and from the perspective of employers.Eight databases were searched for scientific studies within defined inclusion criteria. These databases included CINAHL Plus, Cochrane Library, Emerald, Ovid Medline, ProQuest, PsycINFO, Scopus and Web of Science.Enhancing the opportunities for adults with ASD to join the workforce is beneficial from a societal perspective, not only from an inclusiveness viewpoint, but also from a strict economic standpoint. Providing supported employment services for adults with ASD does not only cut the cost compared with providing standard care, it also results in better outcomes for adults with ASD. Despite the fact that ASD was the most expensive group to provide vocational rehabilitation services for, adults with ASD have a strong chance of becoming employed once appropriate measures are in place. Hence, rehabilitation services could be considered as a worthwhile investment. The current systematic review uncovered the fact that very few studies have examined the benefits, the costs and the cost-benefit ratio of employing an adult with ASD from the perspective of employers indicating a need for this topic to be further explored.

The lifetime costs of overweight and obesity in childhood and adolescence: a systematic review.

Science.gov (United States)

Hamilton, D; Dee, A; Perry, I J

2018-04-01

Research into lifetime costs of obesity in childhood is growing. This review synthesizes that knowledge. A computerized search of the international literature since 2000 was conducted. Mean total lifetime healthcare and productivity costs were estimated and inflated to 2014 Irish euros. This resulted in 13 published articles. The methodology used in these studies varied widely, and only one study estimated both healthcare and productivity costs. Cognizant of this heterogeneity, the mean total lifetime cost of a child or adolescent with obesity was €149,206 (range, €129,410 to €178,933) for a boy and €148,196 (range, €136,576 to €173,842) for a girl. This was divided into an average of €16,229 (range, €6,580 to €35,810) in healthcare costs and €132,977 (range, €122,830 to €143,123) in productivity losses for boys and €19,636 (range, €8,016 to €45,283) and €128,560, respectively, for girls. Income penalty accounted for the greater part of productivity costs, amounting to €97,118 (range, €86,971 to €107,264) per male adolescent with obesity and €126,108 per female adolescent. Healthcare costs and income penalty appear greater in girls while costs because of workdays lost seem greater in boys. There is proportionality between body mass index and costs. Productivity costs are greater than healthcare costs. © 2017 World Obesity Federation.

The impact of disease stage on direct medical costs of HIV management: a review of the international literature.

Science.gov (United States)

Levy, Adrian; Johnston, Karissa; Annemans, Lieven; Tramarin, Andrea; Montaner, Julio

2010-01-01

The global prevalence of HIV infection continues to grow, as a result of increasing incidence in some countries and improved survival where highly active antiretroviral therapy (HAART) is available. Growing healthcare expenditure and shifts in the types of medical resources used have created a greater need for accurate information on the costs of treatment. The objectives of this review were to compare published estimates of direct medical costs for treating HIV and to determine the impact of disease stage on such costs, based on CD4 cell count and plasma viral load. A literature review was conducted to identify studies meeting prespecified criteria for information content, including an original estimate of the direct medical costs of treating an HIV-infected individual, stratified based on markers of disease progression. Three unpublished cost-of-care studies were also included, which were applied in the economic analyses published in this supplement. A two-step procedure was used to convert costs into a common price year (2004) using country-specific health expenditure inflators and, to account for differences in currency, using health-specific purchasing power parities to express all cost estimates in US dollars. In all nine studies meeting the eligibility criteria, infected individuals were followed longitudinally and a 'bottom-up' approach was used to estimate costs. The same patterns were observed in all studies: the lowest CD4 categories had the highest cost; there was a sharp decrease in costs as CD4 cell counts rose towards 100 cells/mm³; and there was a more gradual decline in costs as CD4 cell counts rose above 100 cells/mm³. In the single study reporting cost according to viral load, it was shown that higher plasma viral load level (> 100,000 HIV-RNA copies/mL) was associated with higher costs of care. The results demonstrate that the cost of treating HIV disease increases with disease progression, particularly at CD4 cell counts below 100 cells

2015 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Mone, Christopher; Hand, Maureen; Bolinger, Mark; Rand, Joseph; Heimiller, Donna; Ho, Jonathan

2017-04-05

This report uses representative commercial projects to estimate the levelized cost of energy (LCOE) for both land-based and offshore wind plants in the United States for 2015. Scheduled to be published on an annual basis, the analysis relies on both market and modeled data to maintain an up-to-date understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed by the National Renewable Energy Laboratory (NREL) are used in this analysis to inform wind technology cost projections, goals, and improvement opportunities.

2014 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Mone, Christopher [National Renewable Energy Lab. (NREL), Golden, CO (United States); Stehly, Tyler [National Renewable Energy Lab. (NREL), Golden, CO (United States); Maples, Ben [National Renewable Energy Lab. (NREL), Golden, CO (United States); Settle, Edward [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2015-10-01

This report uses representative commercial projects to estimate the levelized cost of energy (LCOE) for both land-based and offshore wind plants in the United States for 2014. Scheduled to be published on an annual basis, the analysis relies on both market and modeled data to maintain an up-to-date understanding of wind generation cost trends and drivers. It is intended to provide insight into current component-level costs and a basis for understanding variability in the LCOE across the industry. Data and tools developed by the National Renewable Energy Laboratory (NREL) are used in this analysis to inform wind technology cost projections, goals, and improvement opportunities.

Cost-effectiveness of computed tomography colonography in colorectal cancer screening: a systematic review.

Science.gov (United States)

Hanly, Paul; Skally, Mairead; Fenlon, Helen; Sharp, Linda

2012-10-01

The European Code Against Cancer recommends individuals aged ≥ 50 should participate in colorectal cancer screening. CT-colonography (CTC) is one of several screening tests available. We systematically reviewed evidence on, and identified key factors influencing, cost-effectiveness of CTC screening. PubMed, Medline, and the Cochrane library were searched for cost-effectiveness or cost-utility analyses of CTC-based screening, published in English, January 1999 to July 2010. Data was abstracted on setting, model type and horizon, screening scenario(s), comparator(s), participants, uptake, CTC performance and cost, effectiveness, ICERs, and whether extra-colonic findings and medical complications were considered. Sixteen studies were identified from the United States (n = 11), Canada (n = 2), and France, Italy, and the United Kingdom (1 each). Markov state-transition (n = 14) or microsimulation (n = 2) models were used. Eleven considered direct medical costs only; five included indirect costs. Fourteen compared CTC with no screening; fourteen compared CTC with colonoscopy-based screening; fewer compared CTC with sigmoidoscopy (8) or fecal tests (4). Outcomes assessed were life-years gained/saved (13), QALYs (2), or both (1). Three considered extra-colonic findings; seven considered complications. CTC appeared cost-effective versus no screening and, in general, flexible sigmoidoscopy and fecal occult blood testing. Results were mixed comparing CTC to colonoscopy. Parameters most influencing cost-effectiveness included: CTC costs, screening uptake, threshold for polyp referral, and extra-colonic findings. Evidence on cost-effectiveness of CTC screening is heterogeneous, due largely to between-study differences in comparators and parameter values. Future studies should: compare CTC with currently favored tests, especially fecal immunochemical tests; consider extra-colonic findings; and conduct comprehensive sensitivity analyses.

Use of benefit-cost analysis in establishing Federal radiation protection standards: a review

Energy Technology Data Exchange (ETDEWEB)

Erickson, L.E.

1979-10-01

This paper complements other work which has evaluated the cost impacts of radiation standards on the nuclear industry. It focuses on the approaches to valuation of the health and safety benefits of radiation standards and the actual and appropriate processes of benefit-cost comparison. A brief historical review of the rationale(s) for the levels of radiation standards prior to 1970 is given. The Nuclear Regulatory Commission (NRC) established numerical design objectives for light water reactors (LWRs). The process of establishing these numerical design criteria below the radiation protection standards set in 10 CFR 20 is reviewed. EPA's 40 CFR 190 environmental standards for the uranium fuel cycle have lower values than NRC's radiation protection standards in 10 CFR 20. The task of allocating EPA's 40 CFR 190 standards to the various portions of the fuel cycle was left to the implementing agency, NRC. So whether or not EPA's standards for the uranium fuel cycle are more stringent for LWRs than NRC's numerical design objectives depends on how EPA's standards are implemented by NRC. In setting the numerical levels in Appendix I to 10 CFR 50 and 40 CFR 190 NRC and EPA, respectively, focused on the costs of compliance with various levels of radiation control. A major portion of the paper is devoted to a review and critique of the available methods for valuing health and safety benefits. All current approaches try to estimate a constant value of life and use this to vaue the expected number of lives saved. This paper argues that it is more appropriate to seek a value of a reduction in risks to health and life that varies with the extent of these risks. Additional research to do this is recommended. (DC)

Use of benefit-cost analysis in establishing Federal radiation protection standards: a review

International Nuclear Information System (INIS)

Erickson, L.E.

1979-10-01

This paper complements other work which has evaluated the cost impacts of radiation standards on the nuclear industry. It focuses on the approaches to valuation of the health and safety benefits of radiation standards and the actual and appropriate processes of benefit-cost comparison. A brief historical review of the rationale(s) for the levels of radiation standards prior to 1970 is given. The Nuclear Regulatory Commission (NRC) established numerical design objectives for light water reactors (LWRs). The process of establishing these numerical design criteria below the radiation protection standards set in 10 CFR 20 is reviewed. EPA's 40 CFR 190 environmental standards for the uranium fuel cycle have lower values than NRC's radiation protection standards in 10 CFR 20. The task of allocating EPA's 40 CFR 190 standards to the various portions of the fuel cycle was left to the implementing agency, NRC. So whether or not EPA's standards for the uranium fuel cycle are more stringent for LWRs than NRC's numerical design objectives depends on how EPA's standards are implemented by NRC. In setting the numerical levels in Appendix I to 10 CFR 50 and 40 CFR 190 NRC and EPA, respectively, focused on the costs of compliance with various levels of radiation control. A major portion of the paper is devoted to a review and critique of the available methods for valuing health and safety benefits. All current approaches try to estimate a constant value of life and use this to vaue the expected number of lives saved. This paper argues that it is more appropriate to seek a value of a reduction in risks to health and life that varies with the extent of these risks. Additional research to do this is recommended

Methods for cost management during product development: A review and comparison of different literatures

NARCIS (Netherlands)

Wouters, M.; Morales, S.; Grollmuss, S.; Scheer, M.

2016-01-01

Purpose The paper provides an overview of research published in the innovation and operations management (IOM) literature on 15 methods for cost management in new product development, and it provides a comparison to an earlier review of the management accounting (MA) literature (Wouters & Morales,

Laser fusion - an introductory review of the present position

International Nuclear Information System (INIS)

Bonnedal, M.

1973-01-01

The present state of research into the production of the thermonuclear reaction 2 D + 3 T→n+ 4 He by means of a laser beam is reviewed with special emphasis on the Lawson criterion and the effective absorption of the laser energy by the plasma. (H.E.G.)

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.

Cost-Cutting in Higher Education: Lessons Learned from Collaboration, Technology, and Outsourcing Initiatives. Draft.

Science.gov (United States)

Kaganoff, Tessa

This document presents a review of cost-containment initiatives relevant to higher education institutions. Originally commissioned to examine cost containment initiatives carried out by institutions affiliated with the Foundation for Independent Higher Education (FIHE), the paper was expanded to include a sector-wide review of three types of…

Direct medical cost of overweight and obesity in the United States: a quantitative systematic review

Science.gov (United States)

Tsai, Adam Gilden; Williamson, David F.; Glick, Henry A.

2010-01-01

Objectives To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. Methods PubMed (1968–2009), EconLit (1969–2009), and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. Results A total of 33 U.S. studies met review criteria. Among the 4 highest quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimate included: use of national samples versus more selected populations; age groups examined; inclusion of all medical costs versus obesity-related costs only; and BMI cutoffs for defining overweight and obesity. Conclusions Depending on the source of total national health care expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of U.S. health care spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs, and use standard BMI cutoffs. PMID:20059703

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review.

Science.gov (United States)

Cameron, David; Ubels, Jasper; Norström, Fredrik

2018-01-01

The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system. The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data. A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations. Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made. Most national C/E thresholds identified in our review fall within the WHO's recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they

Reducing contaminated soil rehabilitation costs - review of portable XRF performance on Australian soils

International Nuclear Information System (INIS)

Bowden-Smith, J.

2001-01-01

Mine owners and managers are often shocked by the financial costs involved in remediating metal contaminated soils, especially those associated with the closure of base metal mines. Lack of due consideration during planning, inappropriate operational controls for water and dust emissions, little monitoring data and new contaminated land legislation coupled with traditional owners seeking mining leases to be remediated to low (even background) levels are reasons for multi-million dollar cost blow-outs. At some base metal operations, emissions have travelled outside the mine lease impacting on neighbouring pastoral land and in some cases contaminating near-by communities. Traditional sampling and laboratory analysis costs have restricted the collection of data to adequately define the problem resulting in poor management of metal-contaminated soil. A portable analytical tool that provides on-site geochemistry could assist in identifying issues early, allowing for improved management practices and lower overall clean-up costs. This paper reviews independent evaluation studies for soil contaminated by heavy metal with XRF, using a new portable technology developed in the USA by the NITON Corporation

Cost analysis for the implementation of a medication review with follow-up service in Spain.

Science.gov (United States)

Noain, Aranzazu; Garcia-Cardenas, Victoria; Gastelurrutia, Miguel Angel; Malet-Larrea, Amaia; Martinez-Martinez, Fernando; Sabater-Hernandez, Daniel; Benrimoj, Shalom I

2017-08-01

Background Medication review with follow-up (MRF) is a professional pharmacy service proven to be cost-effective. Its broader implementation is limited, mainly due to the lack of evidence-based implementation programs that include economic and financial analysis. Objective To analyse the costs and estimate the price of providing and implementing MRF. Setting Community pharmacy in Spain. Method Elderly patients using poly-pharmacy received a community pharmacist-led MRF for 6 months. The cost analysis was based on the time-driven activity based costing model and included the provider costs, initial investment costs and maintenance expenses. The service price was estimated using the labour costs, costs associated with service provision, potential number of patients receiving the service and mark-up. Main outcome measures Costs and potential price of MRF. Results A mean time of 404.4 (SD 232.2) was spent on service provision and was extrapolated to annual costs. Service provider cost per patient ranged from €196 (SD 90.5) to €310 (SD 164.4). The mean initial investment per pharmacy was €4594 and the mean annual maintenance costs €3,068. Largest items contributing to cost were initial staff training, continuing education and renting of the patient counselling area. The potential service price ranged from €237 to €628 per patient a year. Conclusion Time spent by the service provider accounted for 75-95% of the final cost, followed by initial investment costs and maintenance costs. Remuneration for professional pharmacy services provision must cover service costs and appropriate profit, allowing for their long-term sustainability.

Cost-effectiveness analysis of vaccinations and decision makings on vaccination programmes in Hong Kong: A systematic review.

Science.gov (United States)

Wong, Carlos K H; Liao, Qiuyan; Guo, Vivian Y W; Xin, Yiqiao; Lam, Cindy L K

2017-05-31

To describe and systematically review the modelling and reporting of cost-effectiveness analysis of vaccination in Hong Kong, and to identify areas for quality enhancement in future cost-effectiveness analyses. We conducted a comprehensive and systematic review of cost-effectiveness studies related to vaccination and government immunisation programmes in Hong Kong published from 1990 to 2015, through database search of Pubmed, Web of Science, Embase, and OVID Medline. Methodological quality of selected studies was assessed using Consolidated Health Economic Evaluation Reporting Standards checklist (CHEERS). Decision making of vaccination was obtained from Scientific Committee on Vaccine Preventable Diseases (SCVPD) and Department of Health in Hong Kong. Nine eligible studies reporting twelve comparative cost-effectiveness comparisons of vaccination programme for influenza (n=2), pneumococcal disease (n=3), influenza plus pneumococcal disease (n=1), chickenpox (n=2), Haemophilus influenzae b (n=1), hepatitis A (n=1), cervical cancer (n=1) and rotavirus (n=1) were identified. Ten comparisons (83.3%) calculated the incremental cost-effectiveness ratio (ICER) of a vaccination strategy versus status quo as outcomes in terms of cost in USD per life-years, cost per quality-adjusted life-years, or cost per disability-adjusted life-years. Among those 10 comparisons in base-case scenario, 4 evaluated interventions were cost-saving relative to status quo while the ICER estimates in 3 of the 6 remaining comparisons were far below commonly accepted threshold and WHO willingness-to-pay threshold, suggestive of very cost-effective. Seven studies were of good quality based on the CHEERS checklist; one was of moderate quality; and one was of excellent quality. The common methodological problems were characterisation of heterogeneity and reporting of study parameters. There was a paucity of cost-effectiveness models evaluating vaccination targeted to the Hong Kong population. All

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment.

Science.gov (United States)

Shih, Ya-Chen Tina; Chien, Chun-Ru

2017-05-15

The American Society of Clinical Oncology released its first guidance statement on the cost of cancer care in August 2009, affirming that patient-physician cost communication is a critical component of high-quality care. This forward-thinking recommendation has grown increasingly important in oncology practice today as the high costs of cancer care impose tremendous financial burden to patients, their families, and the health care system. For the current review, a literature search was conducted using the PubMed and Web of Science databases to identify articles that covered 3 topics related to patient-physician cost communication: patient attitude, physician acceptance, and the associated outcomes; and 15 articles from 12 distinct studies were identified. Although most articles that addressed patient attitude suggested that cost communication is desired by >50% of patients in the respective study cohorts, only communication. When asked about whether cost communication actually took place in their practice, percentages reported by physicians varied widely from 60%. The data suggested that cost communication was associated with improved patient satisfaction, lower out-of-pocket expenses, and a higher likelihood of medication nonadherence; none of the studies established causality. Both patients and physicians expressed a strong need for accurate, accessible, and transparent information about the cost of cancer care. Cancer 2017;123:928-39. © 2016 American Cancer Society. © 2016 American Cancer Society.

Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review.

Science.gov (United States)

Jacob, Verughese; Thota, Anilkrishna B; Chattopadhyay, Sajal K; Njie, Gibril J; Proia, Krista K; Hopkins, David P; Ross, Murray N; Pronk, Nicolaas P; Clymer, John M

2017-05-01

This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSSs) to prevent cardiovascular disease (CVD). Methods developed for the Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSSs to prevent CVD from the available studies ( n  = 12) due to considerable heterogeneity. Several studies ( n  = 11) indicated that health care costs were averted by using CDSSs but many were partial assessments that did not consider all components of health care. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSSs based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. Intervention costs were not negligible, but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted health care cost could not be determined with confidence because many studies did not fully account for all components of health care. We were unable to conclude whether CDSSs for CVD prevention is either cost-beneficial or cost-effective. Several evidence gaps are identified, most prominently a lack of information about major drivers of cost and benefit, a lack of standard metrics for the cost of CDSSs, and not allowing for useful life of a CDSS that generally extends beyond one accounting period. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the US.

Review of present groundwater monitoring programs at the Nevada Test Site

International Nuclear Information System (INIS)

Hershey, R.L.; Gillespie, D.

1993-09-01

Groundwater monitoring at the Nevada Test Site (NTS) is conducted to detect the presence of radionuclides produced by underground nuclear testing and to verify the quality and safety of groundwater supplies as required by the State of Nevada and federal regulations, and by U.S. Department of Energy (DOE) Orders. Groundwater is monitored at water-supply wells and at other boreholes and wells not specifically designed or located for traditional groundwater monitoring objectives. Different groundwater monitoring programs at the NTS are conducted by several DOE Nevada Operations Office (DOE/NV) contractors. Presently, these individual groundwater monitoring programs have not been assessed or administered under a comprehensive planning approach. Redundancy exists among the programs in both the sampling locations and the constituents analyzed. Also, sampling for certain radionuclides is conducted more frequently than required. The purpose of this report is to review the existing NTS groundwater monitoring programs and make recommendations for modifying the programs so a coordinated, streamlined, and comprehensive monitoring effort may be achieved by DOE/NV. This review will be accomplished in several steps. These include: summarizing the present knowledge of the hydrogeology of the NTS and the potential radionuclide source areas for groundwater contamination; reviewing the existing groundwater monitoring programs at the NTS; examining the rationale for monitoring and the constituents analyzed; reviewing the analytical methods used to quantify tritium activity; discussing monitoring network design criteria; and synthesizing the information presented and making recommendations based on the synthesis. This scope of work was requested by the DOE/NV Hydrologic Resources Management Program (HRMP) and satisfies the 1993 (fiscal year) HRMP Groundwater Monitoring Program Review task

The epidemiology and cost analysis of patients presented to Emergency Department following traffic accidents.

Science.gov (United States)

Akgül Karadana, Gökçe; Metin Aksu, Nalan; Akkaş, Meltem; Akman, Canan; Üzümcügil, Akın; Özmen, M Mahir

2013-12-09

Traffic accidents are ranked first as the cause of personal injury throughout the world. The high number of traffic accidents yielding injuries and fatalities makes them of great importance to Emergency Departments. Patients admitted to Hacettepe University Faculty of Medicine Adult Emergency Department due to traffic accidents were investigated epidemiologically. Differences between groups were evaluated by Kruskall-Wallis, Mann-Whitney, and Wilcoxon tests. A value of paccidents were the most common. In 2004 the rate of traffic accidents (15.3%) was higher than the other years, the most common month was May (10.8%), and the most common time period was 6 pm to 12 am (midnight). About half of the patients (51.5%) were admitted in the first 30 minutes. Life-threatening condition was present in 9.6% of the patients. Head trauma was the most common type of trauma, with the rate of 18.3%. Mortality rate was 81.8%. The average length of hospital stay was 403 minutes (6.7 hours) and the average cost per patient was 983 ± 4364 TL. Further studies are needed to compare the cost found in this study with the mean cost for Turkey. However, the most important step to reduce the direct and indirect costs due to traffic accidents is the prevention of these accidents.

Review of the cost estimate and schedule for the 2240-MWt high-temperature gas-cooled reactor steam-cycle/cogeneration lead plant

International Nuclear Information System (INIS)

1983-09-01

This report documents Bechtel's review of the cost estimate and schedule for the 2240 MWt High Temperature Gas-Cooled Reactor Steam Cycle/Cogeneration (HTGR-SC/C) Lead Plant. The overall objective of the review is to verify that the 1982 update of the cost estimate and schedule for the Lead Plant are reasonable and consistent with current power plant experience

The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

Directory of Open Access Journals (Sweden)

Johri Mira

2011-02-01

Full Text Available Abstract Background Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT of HIV in low- and middle-income countries (LMICs. This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research. Methods Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French, date (January 1st, 1994 to January 17th, 2011 and article type (original research. Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form. Results We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health. Conclusions and Recommendations Interventions to prevent HIV MTCT are compelling on economic

Preliminary Multi-Variable Parametric Cost Model for Space Telescopes

Science.gov (United States)

Stahl, H. Philip; Hendrichs, Todd

2010-01-01

This slide presentation reviews creating a preliminary multi-variable cost model for the contract costs of making a space telescope. There is discussion of the methodology for collecting the data, definition of the statistical analysis methodology, single variable model results, testing of historical models and an introduction of the multi variable models.

Cost accounting models used for price-setting of health services: an international review.

Science.gov (United States)

Raulinajtys-Grzybek, Monika

2014-12-01

The aim of the article was to present and compare cost accounting models which are used in the area of healthcare for pricing purposes in different countries. Cost information generated by hospitals is further used by regulatory bodies for setting or updating prices of public health services. The article presents a set of examples from different countries of the European Union, Australia and the United States and concentrates on DRG-based payment systems as they primarily use cost information for pricing. Differences between countries concern the methodology used, as well as the data collection process and the scope of the regulations on cost accounting. The article indicates that the accuracy of the calculation is only one of the factors that determine the choice of the cost accounting methodology. Important aspects are also the selection of the reference hospitals, precise and detailed regulations and the existence of complex healthcare information systems in hospitals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Assessing the effectiveness and cost effectiveness of adaptive e-Learning to improve dietary behaviour: protocol for a systematic review

Directory of Open Access Journals (Sweden)

Michie Susan

2010-04-01

studies will describe study design, participants, the intervention, and outcomes. Statistical analyses appropriate to the data extracted, and an economic evaluation using a cost-utility analysis, will be undertaken if sufficient data exist, and effective components of successful interventions will be investigated. Discussion This review aims to provide comprehensive evidence of the effectiveness and cost-effectiveness of adaptive e-Learning interventions for dietary behaviour change, and explore potential psychological mechanisms of action and the effective components of effective interventions. This can inform policy makers and healthcare commissioners in deciding whether e-Learning should be part of a comprehensive response to the improvement of dietary behaviour for health, and if so which components should be present for interventions to be effective.

2010 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Tegen, S. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hand, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Maples, B. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Lantz, E. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Schwabe, P. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Smith, A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2012-04-01

This document provides a detailed description of NREL's levelized cost of wind energy equation, assumptions, and results in 2010, including historical cost trends and future projections for land-based and offshore utility-scale wind.

2010 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Tegen, S.; Hand, M.; Maples, B.; Lantz, E.; Schwabe, P.; Smith, A.

2012-04-01

This document provides a detailed description of NREL's levelized cost of wind energy equation, assumptions and results in 2010, including historical cost trends and future projections for land-based and offshore utility-scale wind.

Quinoxaline derivatives: a patent review (2006--present).

Science.gov (United States)

González, Mercedes; Cerecetto, Hugo

2012-11-01

Quinoxaline scaffold is included in a large number of therapeutic agents because of its physicochemical properties that make the difference between them and the carbono analogue, naphthalene. This review of patented products presents the quinoxaline heterocycle as part of the structural patent claims from a medicinal chemistry perspective. We centred our discussion in the various drug patent applications of the quinoxaline and its derivatives. The applications are based firstly in the specific enzyme target with very low development in the disease treatment. Only for cancer and antimicrobial agents they were specifically determined but little is mentioned in order to insight in the last development activities.

Jatropha tissue culture: A critical review on present scenario and future prospects

KAUST Repository

Kumar, Nitish

2012-10-26

Ever increasing fuel prices and depletion of fossil reserves have ignited worldwide search for alternative renewable energy sources. Development of biofuels as an alternative and renewable source of energy has become critical in the national efforts towards maximum self-reliance, the corner stone of our energy security strategy. Ever since it was established that Jatropha methyl esters yields biodiesel of an exceptional quality and easy adaptation to semi-arid marginal lands, there has been a surge of interest in biodiesel miracle tree. Large scale cultivation remains the single most important factor that will ultimately determine the success of Jatropha curcas as a source of biofuel. Non-availability of superior clones/varieties, shortage of cuttings, low multiplication rate, gaps in knowledge of clonal technology, higher cost of clonal plantation, etc. are the major factors that limit large-scale cultivation. Recent advances in DNA technology and genetic transformation offer a credible approach for the genetic improvement of the species. The last decade witnessed a blooming interest in the development of micropropagation and transformation techniques for this energy crop. In this review, the achievements made during the last three decades in J. curcas micropropagation are presented. © Springer Science+Business Media New York 2013. All rights are reserved.

An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review.

Science.gov (United States)

Casey, Mary; O'Connor, Laserina; Cashin, Andrew; Smith, Rita; O'Brien, Denise; Nicholson, Emma; O'Leary, Denise; Fealy, Gerard; McNamara, Martin; Glasgow, Mary Ellen; Stokes, Diarmuid; Egan, Claire

2017-09-01

This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services. A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles. A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015. The study also included primary data collection on the perceived impact of specialist and advanced practice nursing and midwifery roles and enablers and barriers to these roles using semi-structured interviews. These are not included in this paper. To facilitate a systematic approach to searching the literature, the PICO framework, was adapted. The database search yielded 437 articles relevant to the analysis of specialist and advanced practice in relation to quality care, cost and access to services with additional articles added in a manual review of reference lists. In the final review a total of 86 articles were included as they fulfilled the eligibility criteria. The evidence presented in the 86 articles indicates that nursing and midwifery practitioners continue to be under-utilised despite the evidence that greater reliance on advanced nurse practitioners could improve accessibility of primary care services while also saving on cost. Results point to continued difficulties associated with accurate measurement of the impact of these roles on patient outcomes. This review demonstrates that there is a need for robust measurement of the impact of these roles on patient outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estimating the cost of accidents and ill-health at work : a review of methodologies

NARCIS (Netherlands)

Weerd, M. de; Tierney, R.; Duuren-Stuurman, B. van; Bertranou, E.

2014-01-01

What is the real price to pay for not investing in occupational safety and health? Many studies have previously tackled this question by evaluating the costs of poor or non-existent safety and health at work. This report reviews a selection of these studies and analyses the estimating methods used

Message from the Director General Final costs to completion of LHC

CERN Multimedia

Luciano Maiani

2001-01-01

In March this year a review of the costs for the LHC machine was started, which was completed by the end of August. This was a bottom-up review with each group concerned making a projection of the cost to completion of the project. Figures presented were worryingly high. In conjunction, the responses from industries to the calls for tender for essential machine components, especially the superconducting magnet assembly, were also higher than originally anticipated. A summary of this situation was presented to the Finance Committee last week and then to the Committee of Council. After the meetings a summary was prepared by the chairman of Committee of Council which I reprint below. CHAIRMAN'S SUMMARY In the 248th Meeting of the Committee of Council, the Director-General presented a preliminary estimate of the cost to completion of the LHC Project, approved in 1994 and scheduled for commissioning and operation in 2006. Repeating that the project is well advanced and technically sound, the figures presented, s...

A review on past and present development on the interlocking loadbearing hollow block (ILHB) system

Science.gov (United States)

Bosro, M. Z. M.; Samad, A. A. A.; Mohamad, N.; Goh, W. I.; Tambichik, M. A.; Iman, M. A.

2018-04-01

Massive migration and increasing population in Malaysia has contributed to the increasing demand of quality and affordable housing. Over the past 50 years, the Malaysian housing industry has seen the growth of using conventional construction system such as reinforced concrete frame structures and bricks. The conventional system, as agreed by many researchers, causes delays and other disadvantages in some of the construction projects. Thus, the utilization of interlocking loadbearing hollow block (ILHB) system is needed to address these issues. This system has been identified as an alternative and sustainable building system for the construction industry in Malaysia which the PUTRA block system is the latest example of the ILHB developed. The system offers various advantages in terms of speed and cost in construction, strength, environmentally friendly and aesthetic qualities. Despite these advantages, this system has not been practically applied and develop in Malaysia. Therefore, this paper aims to review the past and present development of the interlocking loadbearing hollow block (ILHB) system that available locally and globally.

Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis.

Science.gov (United States)

Chen, Y-F; Madan, J; Welton, N; Yahaya, I; Aveyard, P; Bauld, L; Wang, D; Fry-Smith, A; Munafò, M R

2012-01-01

non-electronic behavioural support, but there is substantial uncertainty with regard to what the most effective (thus most cost-effective) type of electronic intervention is, which warrants further research. EVPI calculations suggested the upper limit for the benefit of this research is around £ 2000-3000 per person. The review focuses on smoking cessation programmes in the adult population, but does not cover smoking cessation in adolescents. Most available evidence relates to interventions with a single tailored component, while evidence for different modes of delivery (e.g. e-mail, text messaging) is limited. Therefore, the findings of lack of sufficient evidence for proving or refuting effectiveness should not be regarded as evidence of ineffectiveness. We have examined only a small number of factors that could potentially influence the effectiveness of the interventions. A comprehensive evaluation of potential effect modifiers at study level in a systematic review of complex interventions remains challenging. Information presented in published papers is often insufficient to allow accurate coding of each intervention or comparator. A limitation of the cost-effectiveness analysis, shared with several previous cost-effectiveness analyses of smoking cessation interventions, is that intervention benefit is restricted to the first quit attempt. Exploring the impact of interventions on subsequent attempts requires more detailed information on patient event histories than is available from current evidence. Our effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. The effectiveness does not appear to vary with respect to mode of delivery and concurrent non-electronic co-interventions. Our cost-effectiveness review suggests that making some form of electronic support available to smokers actively seeking to quit is highly likely to

Development of geological disposal system; localization of element cost data and cost evaluation on the HLW repository

Energy Technology Data Exchange (ETDEWEB)

Lee, Byung Sik; Kim, Kil Jung; Yang, Young Jin; Kim, Sung Chun [KOPEC, Taejeon (Korea)

2002-03-01

To estimate Total Life Cycle Cost (TSLCC) for Korea HLW Repository through localization of element cost data, we review and re-organize each basic element cost data for reference repository system, localize various element cost and finally estimate TSLCC considering economic parameters. As results of the study, TSLCC is estimated as 17,167,689 million won, which includes costs for site preparation, surface facilities, underground facilities and management/integration. Since HLW repository Project is an early stage of pre-conceptual design at present, the information of design and project information are not enough to perform cost estimate and cost localization for the Project. However, project cost structure is re-organized based on the local condition and Total System Life Cycle Cost is estimated using the previous cost data gathered from construction experience of the local nuclear power plant. Project results can be used as basic reference data to assume total construction cost for the local HLW repository and should be revised to more reliable cost data with incorporating detail project design information into the cost estimate in a future. 20 refs. (Author)

A Low-Cost Wireless Multi-Presentation on Single Screen in Classroom Using Raspberry Pi

Science.gov (United States)

Yulianto, Budi; Layona, Rita; Dewi, Lusiana Citra

2017-01-01

Smartphone has become a daily necessity in supporting the mobility of users, including teachers and students. The need of users to make multi-presentation via a smartphone wirelessly does not fit with the cost and multiplatform support. This study aims to produce a solution by using Raspberry Pi as a wireless digital media player that will be…

2015 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Moné, Christopher [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hand, Maureen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Rand, Joseph [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Heimiller, Donna [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ho, Jonathan [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2017-06-27

This report uses representative utility-scale projects to estimate the levelized cost of energy (LCOE) for land-based and offshore wind plants in the United States. Data and results detailed here are derived from 2015 commissioned plants. More specifically, analysis detailed here relies on recent market data and state-of-the-art modeling capabilities to maintain an up-to-date understanding of wind energy cost trends and drivers. It is intended to provide insight into current component-level costs as well as a basis for understanding variability in LCOE across the industry. This publication reflects the fifth installment of this annual report.

Systematic review of international evidence on the effectiveness and costs of paediatric home care for children and young people who are ill.

Science.gov (United States)

Parker, G; Spiers, G; Gridley, K; Atkin, K; Birks, Y; Lowson, K; Light, K

2013-01-01

Promoting 'care closer to home' for ill children is a policy and practice objective internationally. Progress towards this goal is hampered by a perceived lack of evidence on effectiveness and costs. The aim of the work reported here was to establish the strength of current international evidence on the effectiveness and costs of paediatric home care by updating and extending an earlier systematic review. A systematic review following Centre for Reviews and Dissemination guidelines involved updating electronic searches, and extending them to cover paediatric home care for short-term acute conditions. Twenty-one databases were searched from 1990 to April 2007. Hand searching was also carried out. Pairs of team members, guided by an algorithm, selected randomized controlled trials (RCTs), other comparative studies and studies including health economics data. A third reviewer resolved any disagreements. The quality of RCTs was assessed, but a 'best-evidence' approach was taken overall. Data were extracted into specifically designed spreadsheets and a second team member checked all data. Narrative synthesis was used throughout. This paper reports findings from RCTs and studies with health economics data. In total, 16 570 publications were identified after de-duplication. Eleven new RCTs (reported in 17 papers) and 20 papers with health economics data were included and reviewed. Evidence on costs and effectiveness of paediatric home care has not grown substantially since the previous review, but this updated review adds weight to the conclusion that it can deliver equivalent clinical outcomes for children and not impose a greater burden on families. Indeed, in some cases, there is evidence of reduced burden and costs for families compared with hospital care. There is also growing evidence, albeit based on weaker evidence, that paediatric home care may reduce costs for health services, particularly for children with complex and long-term needs. © 2012 Blackwell

The great environmental restoration cost estimating shootout: A blind test of three DOE cost estimating groups

International Nuclear Information System (INIS)

Klemen, Paul

1992-01-01

The cost of the Department of Energy's (DOE) Environmental Restoration (ER) Program has increased steadily over the last three years and, in the process, has drawn increasing scrutiny from Congress, the public, and government agencies such as the Office of Management and Budget and the General Accounting Office. Programmatic costs have been reviewed by many groups from within the DOE as well as from outside agencies. While cost may appear to be a universally applicable barometer of project conditions, it is actually a single dimensional manifestation of a complex set of conditions. As such, variations in cost estimates can be caused by a variety of underlying factors such as changes in scope, schedule, performing organization, economic conditions, or regulatory environment. This paper will examine the subject of cost estimates by evaluating three different cost estimates prepared for a single project including two estimates prepared by project proponents and another estimate prepared by a review team. The paper identifies the reasons for cost growth as measured by the different estimates and evaluates the ability of review estimates to measure the validity of costs. The comparative technique used to test the three cost estimates will identify the reasons for changes in the estimated cost, over time, and evaluate the ability of an independent review to correctly identify the reasons for cost growth and evaluate the reasonableness of the cost proposed by the project proponents. Recommendations are made for improved cost estimates and improved cost estimate reviews. Conclusions are reached regarding the differences in estimate results that can be attributed to differences in estimating techniques, the implications of these differences for decision makers, and circumstances that are unique to environmental cost estimating. (author)

Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.

Science.gov (United States)

Tsertsvadze, Alexander; Clar, Christine; Court, Rachel; Clarke, Aileen; Mistry, Hema; Sutcliffe, Paul

2014-01-01

The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions. A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases. Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (e.g., osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain. Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients. Copyright © 2014 National University

Cost analysis, cost recovery, marketing and fee-based services a guide for the health sciences librarian

CERN Document Server

Wood, M Sandra

2013-01-01

This outstanding volume won the 1986 Ida and George Eliot Prize--awarded by the Medical Library Association for the work judged most effective in furthering medical librarianship. Library professionals review the controversy behind fee-for-service programs and provide a rationale for incorporating them into contemporary library philosophies of service. Some fee-based services are necessary for survival in a society that treats information as a marketable commodity; this comprehensive book gives practical advice on cost analysis, cost recovery and marketing of reference services, and presents i

Tracing the 'grey literature' of poster presentations: a mapping review.

Science.gov (United States)

Rowe, Nicholas

2017-04-06

Posters are a popular way of presenting information at conferences. However, little research has been conducted into their development, and the patterns and extent of their use are unclear. A mapping review was performed to chart the development and utilisation of the poster medium, and to highlight the main literature themes and contributions. A search for the term 'poster presentation' was conducted simultaneously in 249 databases. Results were categorised by discipline and analysed by decade. The results were used to form an informetric-based mapping review. (i) Medicine and health care disciplines are the predominant poster users and since 1990 have accounted for 68-75% of the overall published data. (ii) Over 99% of the returns led only to abstract or title citations for conference posters. (iii) Poster presentations offer much potentially useful information, but remain difficult to access. If the aim of poster presentation is to share and discuss information with others, then the limitations of poster abstracts and questions raised in the retrieved literature suggest that further efforts are required to make this more effective. Library and information specialists of all disciplines are likely to play a key role in such developments, and especially those from the medicine and health care disciplines which feature so prominently. © 2017 Health Libraries Group.

Review of economics and cost-effectiveness analyses of anticoagulant therapy for stroke prevention in atrial fibrillation in the US.

Science.gov (United States)

von Schéele, Birgitta; Fernandez, Maria; Hogue, Susan Lynn; Kwong, Winghan Jacqueline

2013-05-01

To summarize the available evidence on the issues in health economics related to oral anticoagulation for stroke prevention in atrial fibrillation (AF) in the US. A literature review was performed using PubMed, EMBASE, Cochrane Library, and International Pharmaceutical Abstracts, as well as the websites of professional organizations. The search was conducted according to a prespecified protocol, limiting articles to those published in English from 2001 to October 2012 and focused on the economics associated with AF and AF-related stroke in the US. Data from 27 studies were extracted and included in the review. Strokes in patients with AF are more debilitating and have higher recurrence rates and mortality compared with strokes unrelated to AF. However, data describing the long-term cost of AF-related stroke and stroke subtypes remain limited. The costs of major gastrointestinal (GI) bleeding and intracranial bleeding related to warfarin are significant, whereas the costs of the more frequent minor GI bleeding are relatively low. Overall, the cost-effectiveness of warfarin versus aspirin or no treatment in patients with at least 1 risk factor for stroke is well established. Economic evaluations based on results from randomized controlled clinical trials generally found that new anticoagulants were a cost-effective alternative to warfarin for stroke prevention in AF. However, these cost-effectiveness results are highly sensitive to how well optimal international normalized ratio control is maintained (within target of 2.0-3.0) for warfarin and the time horizon used for analysis. Time in therapeutic range for warfarin in routine clinical practice was lower than in clinical trials, as shown by previous studies. This review identified several areas of uncertainty regarding the economic benefit of anticoagulants. The generalizability of cost-effectiveness results of anticoagulant therapy in AF based on clinical trial data must be confirmed by comparative effectiveness

GasFair/PowerFair/EnergyUser '98 : Presentations

International Nuclear Information System (INIS)

1998-01-01

Papers presented at three conferences, reviewing recent activities in the natural gas and electric power industries and matters of concern to energy consumers in North America are contained on this single CD-ROM. Seven presentations relate to the natural gas industry, nine to electric power generation and transmission, and ten to a wide range of topics dealing with various concerns relating to the environment, financial and cost management aspects of energy utilization. Speakers at the GasFair sessions discussed recent developments in natural gas supply, marketing, purchasing, risk management and the impact of energy convergence on natural gas. Presentations at the PowerFair segment dealt with issues in electricity deregulation, supply and financing, purchasing and marketing. Issues discussed at the EnergyUser sessions included presentations dealing with ways to save costs with energy technology and integrated services, environmental performance contracting and engineering and energy cost control. The CD-ROM also contains the summary of a round table discussion and five individual presentations made at the Natural Gas Pipeline Forum. This pre-conference institute dealt with the likely effects of new pipelines and pipeline extensions on North American natural gas consumers. . tabs., figs

Using fuzzy logic to improve the project time and cost estimation based on Project Evaluation and Review Technique (PERT

Directory of Open Access Journals (Sweden)

Farhad Habibi

2018-09-01

Full Text Available Among different factors, correct scheduling is one of the vital elements for project management success. There are several ways to schedule projects including the Critical Path Method (CPM and Program Evaluation and Review Technique (PERT. Due to problems in estimating dura-tions of activities, these methods cannot accurately and completely model actual projects. The use of fuzzy theory is a basic way to improve scheduling and deal with such problems. Fuzzy theory approximates project scheduling models to reality by taking into account uncertainties in decision parameters and expert experience and mental models. This paper provides a step-by-step approach for accurate estimation of time and cost of projects using the Project Evaluation and Review Technique (PERT and expert views as fuzzy numbers. The proposed method included several steps. In the first step, the necessary information for project time and cost is estimated using the Critical Path Method (CPM and the Project Evaluation and Review Technique (PERT. The second step considers the duration and cost of the project activities as the trapezoidal fuzzy numbers, and then, the time and cost of the project are recalculated. The duration and cost of activities are estimated using the questionnaires as well as weighing the expert opinions, averaging and defuzzification based on a step-by-step algorithm. The calculating procedures for evaluating these methods are applied in a real project; and the obtained results are explained.

Renewal processes with costs and rewards

NARCIS (Netherlands)

Vlasiou, M.; Cochran, J.J.; Cox, L.A.; Keskinocak, P.; Kharoufeh, J.P.; Smith, J.C.

2011-01-01

We review the theory of renewal reward processes, which describes renewal processes that have some cost or reward associated with each cycle. We present a new simplified proof of the renewal reward theorem that mimics the proof of the Elementary Renewal Theorem and avoids the technicalities in the

Interventions to Promote Cancer Awareness and Early Presentation: Systematic Review

OpenAIRE

J Austoker; C Bankhead; Lindsay J. L. Forbes; L Atkins; F Martin; K Robb; J Wardle; A J. Ramirez

2009-01-01

Background: Low cancer awareness contributes to delay in presentation for cancer symptoms and may lead to delay in cancer diagnosis. The aim of this study was to review the evidence for the effectiveness of interventions to raise cancer awareness and promote early presentation in cancer to inform policy and future research. Methods: We searched bibliographic databases and reference lists for randomised controlled trials of interventions delivered to individuals, and controlled or uncontrolled...

Cost-benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review.

Science.gov (United States)

Farbman, L; Avni, T; Rubinovitch, B; Leibovici, L; Paul, M

2013-12-01

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37-16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025-19 170) US$ per month; median savings were 38 751 (IQR 14 206-75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with 6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

2016 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Stehly, Tyler J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Heimiller, Donna M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Scott, George N. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2017-12-29

This report uses representative utility-scale projects to estimate the levelized cost of energy (LCOE) for land-based and offshore wind power plants in the United States. Data and results detailed here are derived from 2016 commissioned plants. More specifically, analysis detailed here relies on recent market data and state-of-the-art modeling capabilities to maintain an up-to-date understanding of wind energy cost trends and drivers. This report is intended to provide insight into current component-level costs as well as a basis for understanding variability in LCOE across the country. This publication represents the sixth installment of this annual report.

A review of planetary and space science projects presented at iCubeSat, the Interplanetary CubeSat Workshop

Science.gov (United States)

Johnson, Michael

2015-04-01

iCubeSat, the Interplanetary CubeSat Workshop, is an annual technical workshop for researchers working on an exciting new standardised platform and opportunity for planetary and space scientists. The first workshop was held in 2012 at MIT, 2013 at Cornell, 2014 at Caltech with the 2015 workshop scheduled to take place on the 26-27th May 2015 at Imperial College London. Mission concepts and flight projects presented since 2012 have included orbiters and landers targeting asteroids, the moon, Mars, Venus, Saturn and their satellites to perform science traditionally reserved for flagship missions at a fraction of their cost. Some of the first missions proposed are currently being readied for flight in Europe, taking advantage of multiple ride share launch opportunities and technology providers. A review of these and other interplanetary CubeSat projects will be presented, covering details of their science objectives, instrument capabilities, technology, team composition, budget, funding sources, and the other programattic elements required to implement this potentially revolutionary new class of mission.

Wearable Photoplethysmographic Sensors—Past and Present

OpenAIRE

Toshiyo Tamura; Yuka Maeda; Masaki Sekine; Masaki Yoshida

2014-01-01

Photoplethysmography (PPG) technology has been used to develop small, wearable, pulse rate sensors. These devices, consisting of infrared light-emitting diodes (LEDs) and photodetectors, offer a simple, reliable, low-cost means of monitoring the pulse rate noninvasively. Recent advances in optical technology have facilitated the use of high-intensity green LEDs for PPG, increasing the adoption of this measurement technique. In this review, we briefly present the history of PPG and recent deve...

Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation.

Science.gov (United States)

Hartwell, D; Colquitt, J; Loveman, E; Clegg, A J; Brodin, H; Waugh, N; Royle, P; Davidson, P; Vale, L; MacKenzie, L

2005-05-01

To review the clinical evidence comparing immediate angioplasty with thrombolysis, and to consider whether it would be cost-effective. Electronic databases. Experts in the field. For clinical effectiveness, a comprehensive review of randomised control trials (RCTs) was used for efficacy, and a selection of observational studies such as case series or audit data used for effectiveness in routine practice. RCTs of thrombolysis were used to assess the relative value of prehospital and hospital thrombolysis. Observational studies were used to assess the representativeness of patients in the RCTs, and to determine whether different groups have different capacity to benefit. Clinical effectiveness was synthesised through a narrative review with full tabulation of results of all included studies and a meta-analysis to provide a precise estimate of absolute clinical benefit. Consideration was given to the effect of the growing use of stents. The economic modelling adopted an NHS perspective to develop a decision-analytical model of cost-effectiveness focusing on opportunity costs over the short term (6 months). The results were consistent in showing an advantage of immediate angioplasty over hospital thrombolysis. The updated meta-analysis showed that mortality is reduced by about one-third, from 7.6% to 4.9% in the first 6 months, and by about the same in studies of up to 24 months. Reinfarction is reduced by over half, from 7.6% to 3.1%. Stroke is reduced by about two-thirds, from 2.3% with thrombolysis to 0.7% with percutaneous coronary intervention (PCI), with the difference being due to haemorrhagic stroke. The need for coronary artery bypass graft is reduced by about one-third, from 13.2% to 8.4%. Caution is needed in interpreting some of the older trials, as changes such as an increase in stenting and the use of the glycoprotein IIb/IIa inhibitors may improve the results of PCI. There is little evidence comparing prehospital thrombolysis with immediate PCI. Research

Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

Science.gov (United States)

Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto

2016-01-01

Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations

Directory of Open Access Journals (Sweden)

Lacy, Kyle

2015-01-01

Full Text Available Traumatic dislocations of the shoulder commonly present to emergency departments (EDs. Immediate closed reduction of both anterior and posterior glenohumeral dislocations is recommended and is frequently performed in the ED. Recurrence of dislocation is common, as anteroinferior labral tears (Bankart lesions are present in many anterior shoulder dislocations.14,15,18,23 Immobilization of the shoulder following closed reduction is therefore recommended; previous studies support the use of immobilization with the shoulder in a position of external rotation, for both anterior and posterior shoulder dislocations.7-11,19 In this study, we present a technique for assembling a low-cost external rotation shoulder brace using materials found in most hospitals: cotton roll, stockinette, and shoulder immobilizers. This brace is particularly suited for the uninsured patient, who lacks the financial resources to pay for a pre-fabricated brace out of pocket. We also performed a cost analysis for our low-cost external rotation shoulder brace, and a cost comparison with pre-fabricated brand name braces. At our institution, the total materials cost for our brace was $19.15. The cost of a pre-fabricated shoulder brace at our institution is $150 with markup, which is reimbursed on average at $50.40 according to our hospital billing data. The low-cost external rotation shoulder brace is therefore a more affordable option for the uninsured patient presenting with acute shoulder dislocation. [West J Emerg Med. 2015;16(1:114–120.

Costs, quality of life and treatment compliance associated with antibiotic therapies in patients with cystic fibrosis: a review of the literature.

Science.gov (United States)

Weiner, Jennifer R; Toy, Edmond L; Sacco, Patricia; Duh, Mei Sheng

2008-04-01

Cystic fibrosis is the most common incurable hereditary disease in the US. Persistent respiratory infection is the leading cause of morbidity and mortality in cystic fibrosis patients. This study aimed to review the literature on economic and quality of life outcomes and treatment compliance associated with antibiotic therapies for cystic fibrosis patients. A systematic literature review was conducted using keyword searches of the MEDLINE database and selected conference abstracts. The review covered studies published between January 1990 and May 2007. Evidence suggests that inhaled tobramycin, a key chronic suppressive therapy, can reduce other healthcare costs. The main determinants of the cost of care include disease severity and respiratory infection. Costs vary widely by country. There is evidence that inhaled tobramycin and oral azithromycin improve quality of life and that treatment setting and patient convenience may also impact on quality of life. Antibiotic treatment compliance varied significantly and depended on the method of measurement, with more subjective measures tending to be higher. This review concludes by offering directions for future research.

Is vaccination good value for money? A review of cost-utility analyses of vaccination strategies in eight European countries

OpenAIRE

Barbieri, Marco; Capri, Stefano

2016-01-01

Objective: The objective of this study is to review published cost-utility analyses of vaccination strategies in eight European countries and to assess whether there are differences in cost-effectiveness terms among countries and vaccinations. Methods: A systematic search of the literature was conducted using the National Health Service Economic Evaluation Database and the PubMed database. Cost-utility analyses of any type of vaccination that used quality-adjusted life years (QALYs) as me...

Presentation of Depression in Autism and Asperger Syndrome: A Review

Science.gov (United States)

Stewart, Mary E.; Barnard, Louise; Pearson, Joanne; Hasan, Reem; O'Brien, Gregory

2006-01-01

Depression is common in autism and Asperger syndrome, but despite this, there has been little research into this issue. This review considers the current literature on the prevalence, presentation, treatment and assessment of depression in autism and Asperger syndrome. There are diagnostic difficulties when considering depression in autism and…

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

Science.gov (United States)

Prada, Sergio I

2017-12-01

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

Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review.

Science.gov (United States)

Fesenfeld, Michaela; Hutubessy, Raymond; Jit, Mark

2013-08-20

The World Health Organization recommends establishing that human papillomavirus vaccination is cost-effective before vaccine introduction. We searched Pubmed, Embase and the Cochrane Library to 1 April 2012 for economic evaluations of human papillomavirus vaccination in low and middle income countries. We found 25 articles, but almost all low income countries and many middle income countries lacked country-specific studies. Methods, assumptions and consequently results varied widely, even for studies conducted for the same country. Despite the heterogeneity, most studies conclude that vaccination is likely to be cost-effective and possibly even cost saving, particularly in settings without organized cervical screening programmes. However, study uncertainty could be reduced by clarity about vaccine prices and vaccine delivery costs. The review supports extending vaccination to low income settings where vaccine prices are competitive, donor funding is available, cervical cancer burden is high and screening options are limited. Copyright © 2013 Elsevier Ltd. All rights reserved.

Review of hardware cost estimation methods, models and tools applied to early phases of space mission planning

Science.gov (United States)

Trivailo, O.; Sippel, M.; Şekercioğlu, Y. A.

2012-08-01

The primary purpose of this paper is to review currently existing cost estimation methods, models, tools and resources applicable to the space sector. While key space sector methods are outlined, a specific focus is placed on hardware cost estimation on a system level, particularly for early mission phases during which specifications and requirements are not yet crystallised, and information is limited. For the space industry, cost engineering within the systems engineering framework is an integral discipline. The cost of any space program now constitutes a stringent design criterion, which must be considered and carefully controlled during the entire program life cycle. A first step to any program budget is a representative cost estimate which usually hinges on a particular estimation approach, or methodology. Therefore appropriate selection of specific cost models, methods and tools is paramount, a difficult task given the highly variable nature, scope as well as scientific and technical requirements applicable to each program. Numerous methods, models and tools exist. However new ways are needed to address very early, pre-Phase 0 cost estimation during the initial program research and establishment phase when system specifications are limited, but the available research budget needs to be established and defined. Due to their specificity, for vehicles such as reusable launchers with a manned capability, a lack of historical data implies that using either the classic heuristic approach such as parametric cost estimation based on underlying CERs, or the analogy approach, is therefore, by definition, limited. This review identifies prominent cost estimation models applied to the space sector, and their underlying cost driving parameters and factors. Strengths, weaknesses, and suitability to specific mission types and classes are also highlighted. Current approaches which strategically amalgamate various cost estimation strategies both for formulation and validation

Admission rates and costs associated with emergency presentation of urolithiasis: analysis of the Nationwide Emergency Department Sample 2006-2009.

Science.gov (United States)

Eaton, Samuel H; Cashy, John; Pearl, Jeffrey A; Stein, Daniel M; Perry, Kent; Nadler, Robert B

2013-12-01

We sought to examine a large nationwide (United States) sample of emergency department (ED) visits to determine data related to utilization and costs of care for urolithiasis in this setting. Nationwide Emergency Department Sample was analyzed from 2006 to 2009. All patients presenting to the ED with a diagnosis of upper tract urolithiasis were analyzed. Admission rates and total cost were compared by region, hospital type, and payer type. Numbers are weighted estimates that are designed to approximate the total national rate. An average of 1.2 million patients per year were identified with the diagnosis of urolithiasis out of 120 million visits to the ED annually. Overall average rate of admission was 19.21%. Admission rates were highest in the Northeast (24.88%), among teaching hospitals (22.27%), and among Medicare patients (42.04%). The lowest admission rates were noted for self-pay patients (9.76%) and nonmetropolitan hospitals (13.49%). The smallest increases in costs over time were noted in the Northeast. Total costs were least in nonmetropolitan hospitals; however, more patients were transferred to other hospitals. When assessing hospital ownership status, private for-profit hospitals had similar admission rates compared with private not-for-profit hospitals (16.6% vs 15.9%); however, costs were 64% and 48% higher for ED and inpatient admission costs, respectively. Presentation of urolithiasis to the ED is common, and is associated with significant costs to the medical system, which are increasing over time. Costs and rates of admission differ by region, payer type, and hospital type, which may allow us to identify the causes for cost discrepancies and areas to improve efficiency of care delivery.

Comparing costs of power and heat production by prospective and present sources

International Nuclear Information System (INIS)

Novak, S.

1979-01-01

Capital and running costs are compared of power and heat production from different sources. The lowest capital costs were found for coal-fired power plants followed by light water reactor power plants. The capital costs of other types of power plants, such as wind, geothermal, solar, thermonuclear power plants are significantly higher. The estimated specific cost for electric power production in 1985 for a nuclear power plant is lower than for a fossil-fuel power plant. It is estimated that in 1985 coal will be the cheapest heat source. (Ha)

Provider costs for prevention and treatment of cardiovascular and related conditions in low- and middle-income countries: a systematic review.

Science.gov (United States)

Brouwer, Elizabeth D; Watkins, David; Olson, Zachary; Goett, Jane; Nugent, Rachel; Levin, Carol

2015-11-26

The burden of cardiovascular disease (CVD) and CVD risk conditions is rapidly increasing in low- and middle-income countries, where health systems are generally ill-equipped to manage chronic disease. Policy makers need an understanding of the magnitude and drivers of the costs of cardiovascular disease related conditions to make decisions on how to allocate limited health resources. We undertook a systematic review of the published literature on provider-incurred costs of treatment for cardiovascular diseases and risk conditions in low- and middle-income countries. Total costs of treatment were inflated to 2012 US dollars for comparability across geographic settings and time periods. This systematic review identified 60 articles and 143 unit costs for the following conditions: ischemic heart disease, non-ischemic heart diseases, stroke, heart failure, hypertension, diabetes, and chronic kidney disease. Cost data were most readily available in middle-income countries, especially China, India, Brazil, and South Africa. The most common conditions with cost studies were acute ischemic heart disease, type 2 diabetes mellitus, stroke, and hypertension. Emerging economies are currently providing a base of cost evidence for NCD treatment that may prove useful to policy-makers in low-income countries. Initial steps to publicly finance disease interventions should take account of costs. The gaps and limitations in the current literature include a lack of standardized reporting as well as sparse evidence from low-income countries.

Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

LENUS (Irish Health Repository)

Pope, George

2012-01-31

OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.

Environmental policy without costs? A review of the Porter hypothesis

Energy Technology Data Exchange (ETDEWEB)

Braennlund, Runar; Lundgren, Tommy. e-mail: runar.brannlund@econ.umu.se

2009-03-15

This paper reviews the theoretical and empirical literature connected to the so called Porter Hypothesis. That is, to review the literature connected to the discussion about the relation between environmental policy and competitiveness. According to the conventional wisdom environmental policy, aiming for improving the environment through for example emission reductions, do imply costs since scarce resources must be diverted from somewhere else. However, this conventional wisdom has been challenged and questioned recently through what has been denoted the 'Porter hypothesis'. Those in the forefront of the Porter hypothesis challenge the conventional wisdom basically on the ground that resources are used inefficiently in the absence of the right kind of environmental regulations, and that the conventional neo-classical view is too static to take inefficiencies into account. The conclusions that can be made from this review is (1) that the theoretical literature can identify the circumstances and mechanisms that must exist for a Porter effect to occur, (2) that these circumstances are rather non-general, hence rejecting the Porter hypothesis in general, (3) that the empirical literature give no general support for the Porter hypothesis. Furthermore, a closer look at the 'Swedish case' reveals no support for the Porter hypothesis in spite of the fact that Swedish environmental policy the last 15-20 years seems to be in line the prerequisites stated by the Porter hypothesis concerning environmental policy

Heavy metals in toys and low-cost jewelry: critical review of U.S. and Canadian legislations and recommendations for testing.

Science.gov (United States)

Guney, Mert; Zagury, Gerald J

2012-04-17

High metal contamination in toys and low-cost jewelry is a widespread problem, and metals can become bioavailable, especially via oral pathway due to common child-specific behaviors of mouthing and pica. In this review, the U.S., Canadian, and European Union (EU) legislations on metals in toys and jewelry are evaluated. A literature review on content, bioavailability, children's exposure, and testing of metals in toys and low-cost jewelry is provided. A list of priority metals is presented, and research needs and legislative recommendations are addressed. While the U.S. and Canadian legislations put emphasis on lead exposure prevention, other toxic elements like arsenic and cadmium in toy materials are not regulated except in paint and coatings. The EU legislation is more comprehensive in terms of contaminants and scientific approach. Current toy testing procedures do not fully consider metal bioavailability. In vitro bioaccessibility tests developed and validated for toys and corresponding metal bioaccessibility data in different toy matrices are lacking. The U.S. and Canadian legislations should put more emphasis on metal bioavailability and on other metals in addition to lead. A two-step management approach with mandatory testing of toys for total metal concentrations followed by voluntary bioaccessibility testing could be implemented.

The Efficacy of Written Information Intervention in Reduction of Hospital Re-admission Cost in Patients With Heart Failure; A Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Zarea Gavgani Vahideh

2015-03-01

Full Text Available Objective: To assess the efficacy of written information versus non written information intervention in reducing hospital readmission cost, if prescribed or presented to the patients with HF. Methods: The study was a systematic review and meta-analysis. We searched Medline (Ovidand Cochrane library during the past 20 years from 1993 to 2013. We also conducted a manual search through Google Scholar and a direct search in the group of related journals in Black Welland Science Direct trough their websites. Two reviewers appraised the identified studies, and meta-analysis was done to estimate the mean saving cost of patient readmission. All the included studies must have been done by randomization to be eligible for study. Result: We assessed the full-texts 3 out of 65 studies with 754 patients and average age of 74.33.The mean of estimated saving readmission cost in intervention group versus control group was US $2751 (95% CI: 2708 – 2794 and the mean of total saving cost in intervention group versus control group was US $2047 (base year 2010 with (95% CI: 2004 – 2089. No publication bias was found by testing the heterogeneity of studies. Conclusion: One of the effective factors in minimizing the healthcare cost and preventing from hospital re-admission is providing the patients with information prescription in a written format.It is suggested that hospital management, Medicare organizations, policy makers and individual physicians consider the prescription of appropriate medical information as the indispensable part of patient’s care process.

An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: is the tide changing due to adherence?

Science.gov (United States)

Kriza, Christine; Emmert, Martin; Wahlster, Philip; Niederländer, Charlotte; Kolominsky-Rabas, Peter

2013-11-01

The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research. A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012. Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study. CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: Is the tide changing due to adherence?

Energy Technology Data Exchange (ETDEWEB)

Kriza, Christine, E-mail: Christine.kriza@uk-erlangen.de [Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence, “Medical Technologies - Medical Valley EMN”, Schwabachanlage 6, 91054 Erlangen (Germany); Emmert, Martin, E-mail: Martin.Emmert@fau.de [School of Business and Economics, Institute of Management, University of Erlangen-Nuremberg, Lange Gasse 20, 90403 Nuremberg (Germany); Wahlster, Philip, E-mail: Philip.wahlster@uk-erlangen.de [Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence, “Medical Technologies - Medical Valley EMN”, Schwabachanlage 6, 91054 Erlangen (Germany); Niederländer, Charlotte, E-mail: Charlotte.niederlaender@uk-erlangen.de [Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence, “Medical Technologies - Medical Valley EMN”, Schwabachanlage 6, 91054 Erlangen (Germany); Kolominsky-Rabas, Peter, E-mail: Peter.kolominsky@uk-erlangen.de [Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence, “Medical Technologies - Medical Valley EMN”, Schwabachanlage 6, 91054 Erlangen (Germany)

2013-11-01

Objectives: The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research. Methods: A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012. Results: Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study. Conclusions: CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening.

An international review of the main cost-effectiveness drivers of virtual colonography versus conventional colonoscopy for colorectal cancer screening: Is the tide changing due to adherence?

International Nuclear Information System (INIS)

Kriza, Christine; Emmert, Martin; Wahlster, Philip; Niederländer, Charlotte; Kolominsky-Rabas, Peter

2013-01-01

Objectives: The majority of recent cost-effectiveness reviews concluded that computerised tomographic colonography (CTC) is not a cost-effective colorectal cancer (CRC) screening strategy yet. The objective of this review is to examine cost-effectiveness of CTC versus optical colonoscopy (COL) for CRC screening and identify the main drivers influencing cost-effectiveness due to the emergence of new research. Methods: A systematic review was conducted for cost-effectiveness studies comparing CTC and COL as a screening tool and providing outcomes in life-years saved, published between January 2006 and November 2012. Results: Nine studies were included in the review. There was considerable heterogeneity in modelling complexity and methodology. Different model assumptions and inputs had large effects on resulting cost-effectiveness of CTC and COL. CTC was found to be dominant or cost-effective in three studies, assuming the most favourable scenario. COL was found to be not cost effective in one study. Conclusions: CTC has the potential to be a cost-effective CRC screening strategy when compared to COL. The most important assumptions that influenced the cost-effectiveness of CTC and COL were related to CTC threshold-based reporting of polyps, CTC cost, CTC sensitivity for large polyps, natural history of adenoma transition to cancer, AAA parameters and importantly, adherence. There is a strong need for a differential consideration of patient adherence and compliance to CTC and COL. Recent research shows that laxative-free CTC screening has the potential to become a good alternative screening method for CRC as it can improve patient uptake of screening

Total Cost of Ownership and Cost-to-Serve

DEFF Research Database (Denmark)

Zachariassen, Frederik

2007-01-01

Artiklen reviewer den eksisterende litteratur vedrørende økonomistyringsværktøjerne Total Cost of Ownership (TCO) og Cost-to-Serve (CtS). Herefter kortlægges det, hvordan TCO og CtS bidrager til en identificering af direkte omkostninger såvel som indirekte omkostninger henholdsvis up-stream og down...

A systematic review of the unit costs of allied health and community services used by older people in Australia

Directory of Open Access Journals (Sweden)

Farag Inez

2013-02-01

Full Text Available Abstract Background An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. Method A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. Results The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. Conclusions Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.

Social costs of innovative electricity generation technologies in the present and in 2030

Energy Technology Data Exchange (ETDEWEB)

Preiss, Philipp; Friedrich, Rainer; Blesl, Markus; Wissel, Steffen; Mayer-Spohn, Oliver; Klotz, Volker [Stuttgart Univ. (DE). Inst. fuer Energiewirtschaft und Rationelle Energieanwendung (IER)

2008-07-01

Social costs (costs seen from the perspective of the society) differ from private costs and thus influence the ranking of electricity generating technologies. The resulting social costs data provide a basis for the recommendation to use the potential of nuclear, wind and hydropower as far as possible, however the potential of these technologies is limited. The analysis shows, that the remaining electricity demand in the future still should be met by using lignite and coal. Depending on the stringency of the climate change aims these plants would be equipped with CCS (carbon capture and storage) or not. Only with ambitious climate change aims and if CCS turns out to be less economically or technically feasible, than the import of electricity generated by a solar through systems in Mediterranean countries would become an option. The environmental advantages of PV are too small to compensate the very high investment costs in Germany. The detailed analysis of different contributions to the social costs per kWh shows that the costs of natural gas technologies are dominated by private costs of fuel supply. If we assume 50% higher prices than in the basic assumption this increases social costs up to 30%. (orig.)

Good research practices for measuring drug costs in cost-effectiveness analyses: a societal perspective: the ISPOR Drug Cost Task Force report--Part II.

Science.gov (United States)

Garrison, Louis P; Mansley, Edward C; Abbott, Thomas A; Bresnahan, Brian W; Hay, Joel W; Smeeding, James

2010-01-01

Major guidelines regarding the application of cost-effectiveness analysis (CEA) have recommended the common and widespread use of the "societal perspective" for purposes of consistency and comparability. The objective of this Task Force subgroup report (one of six reports from the International Society for Pharmacoeconomics and Outcomes Research [ISPOR] Task Force on Good Research Practices-Use of Drug Costs for Cost Effectiveness Analysis [Drug Cost Task Force (DCTF)]) was to review the definition of this perspective, assess its specific application in measuring drug costs, identify any limitations in theory or practice, and make recommendations regarding potential improvements. Key articles, books, and reports in the methodological literature were reviewed, summarized, and integrated into a draft review and report. This draft report was posted for review and comment by ISPOR membership. Numerous comments and suggestions were received, and the report was revised in response to them. The societal perspective can be defined by three conditions: 1) the inclusion of time costs, 2) the use of opportunity costs, and 3) the use of community preferences. In practice, very few, if any, published CEAs have met all of these conditions, though many claim to have taken a societal perspective. Branded drug costs have typically used actual acquisition cost rather than the much lower social opportunity costs that would reflect only short-run manufacturing and distribution costs. This practice is understandable, pragmatic, and useful to current decision-makers. Nevertheless, this use of CEA focuses on static rather than dynamic efficacy and overlooks the related incentives for innovation. Our key recommendation is that current CEA practice acknowledge and embrace this limitation by adopting a new standard for the reference case as one of a "limited societal" or "health systems" perspective, using acquisition drug prices while including indirect costs and community preferences. The

Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: a systematic review.

Science.gov (United States)

Shroufi, Amir; Chowdhury, Rajiv; Anchala, Raghupathy; Stevens, Sarah; Blanco, Patricia; Han, Tha; Niessen, Louis; Franco, Oscar H

2013-03-28

While there is good evidence to show that behavioural and lifestyle interventions can reduce cardiovascular disease risk factors in affluent settings, less evidence exists in lower income settings.This study systematically assesses the evidence on cost-effectiveness for preventive cardiovascular interventions in low and middle-income settings. Systematic review of economic evaluations on interventions for prevention of cardiovascular disease. PubMed, Web of Knowledge, Scopus and Embase, Opensigle, the Cochrane database, Business Source Complete, the NHS Economic Evaluations Database, reference lists and email contact with experts. we included economic evaluations conducted in adults, reporting the effect of interventions to prevent cardiovascular disease in low and middle income countries as defined by the World Bank. The primary outcome was a change in cardiovascular disease occurrence including coronary heart disease, heart failure and stroke. After selection of the studies, data were extracted by two independent investigators using a previously constructed tool and quality was evaluated using Drummond's quality assessment score. From 9731 search results we found 16 studies, which presented economic outcomes for interventions to prevent cardiovascular disease in low and middle income settings, with most of these reporting positive cost effectiveness results.When the same interventions were evaluated across settings, within and between papers, the likelihood of an intervention being judged cost effective was generally lower in regions with lowest gross national income. While population based interventions were in most cases more cost effective, cost effectiveness estimates for individual pharmacological interventions were overall based upon a stronger evidence base. While more studies of cardiovascular preventive interventions are needed in low and mid income settings, the available high-level of evidence supports a wide range of interventions for the prevention

Trauma in sub-Saharan Africa: review of cost, estimation methods, and interventions.

Science.gov (United States)

Smigelsky, Melissa A; Aten, Jamie D; Gerberich, Stacy; Sanders, Mark; Post, Rachael; Hook, Kimberly; Ku, Angie; Boan, David M; Monroe, Phil

2014-01-01

Trauma is a widely acknowledged problem facing individuals and communities in developing countries. In sub-Saharan Africa-a region that is home to some of the world's worst human rights violations, ethnic and civil conflicts, disease epidemics, and conditions of poverty-trauma is an all-too-common experience in citizens' daily lives. In order to address these conditions effectively, the impact of trauma must be understood. The authors reviewed recent literature on the cost and consequences of psychological trauma in sub-Saharan Africa to provide a substantive perspective on how trauma affects individuals, communities, and organizations and to inform the effort to determine a method for measuring the impact of trauma in sub-Saharan Africa and the efficacy of trauma interventions in the region. Several recommendations are offered to help broaden and deepen the current approaches to conceptualizing trauma, evaluating its cost, and intervening on behalf of those impacted by trauma in sub-Saharan Africa.

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

Science.gov (United States)

Drewnowski, Adam

2015-01-01

Context: It is well established in the literature that healthier diets cost more than unhealthy diets. Objective: The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. Data Sources: A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. Study Selection: Publications linking food prices, dietary quality, and socioeconomic status were selected. Data Extraction: Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. Data Synthesis: Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. Conclusions: Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health. PMID:26307238

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis.

Science.gov (United States)

Darmon, Nicole; Drewnowski, Adam

2015-10-01

It is well established in the literature that healthier diets cost more than unhealthy diets. The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality. A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed. Publications linking food prices, dietary quality, and socioeconomic status were selected. Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices. Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets. Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute.

Phenotypic plasticity, costs of phenotypes, and costs of plasticity

DEFF Research Database (Denmark)

Callahan, Hilary S; Maughan, Heather; Steiner, Uli

2008-01-01

Why are some traits constitutive and others inducible? The term costs often appears in work addressing this issue but may be ambiguously defined. This review distinguishes two conceptually distinct types of costs: phenotypic costs and plasticity costs. Phenotypic costs are assessed from patterns...... of covariation, typically between a focal trait and a separate trait relevant to fitness. Plasticity costs, separable from phenotypic costs, are gauged by comparing the fitness of genotypes with equivalent phenotypes within two environments but differing in plasticity and fitness. Subtleties associated with both...... types of costs are illustrated by a body of work addressing predator-induced plasticity. Such subtleties, and potential interplay between the two types of costs, have also been addressed, often in studies involving genetic model organisms. In some instances, investigators have pinpointed the mechanistic...

Reviewing nuclear power

International Nuclear Information System (INIS)

Robinson, Colin

1990-01-01

The UK government has proposed a review of the prospects for nuclear power as the Sizewell B pressurized water reactor project nears completion in 1994. However, a delay in the completion of Sizewell B or a change of government could put off the review for some years beyond the mid 1990s. Anticipating, though, that such a review will eventually take place, issues which it should consider are addressed. Three broad categories of possible benefit claimed for nuclear power are examined. These are that nuclear power contributes to the security of energy supply, that it provides protection against long run fossil fuel price increases and that it is a means of mitigating the greenhouse effect. Arguments are presented which cost doubt over the reality of these benefits. Even if these benefits could be demonstrated, they would have to be set against the financial, health and accident costs attendant on nuclear power. It is concluded that the case may be made that nuclear power imposes net costs on society that are not justified by the net benefits conferred. Some comments are made on how a government review, if and when it takes place, should be conducted. (UK)

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

Science.gov (United States)

Barnett, Paul G

2009-07-01

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

Estimating the Costs of Preventive Interventions

Science.gov (United States)

Foster, E. Michael; Porter, Michele M.; Ayers, Tim S.; Kaplan, Debra L.; Sandler, Irwin

2007-01-01

The goal of this article is to improve the practice and reporting of cost estimates of prevention programs. It reviews the steps in estimating the costs of an intervention and the principles that should guide estimation. The authors then review prior efforts to estimate intervention costs using a sample of well-known but diverse studies. Finally,…

Life cycle assessment of renewables: present issues, future outlook and implications for the calculation of external costs

International Nuclear Information System (INIS)

Frankl, P.

2002-01-01

In principle, Life Cycle Assessment (LCA) is certainly appropriate for estimating external costs of renewables, since major environmental impacts of the latter are generated in phases of the life cycle other than use. In practice however, several issues still remain. They are related to the availability and quality of Life Cycle Inventory (LCI) data, to the frit technological development of renewable energy technologies (RET), to the existence of many different applications of the latter and to a strong dependency on local conditions. Moreover, a 'static' picture of present technologies is not enough for policy indications. Therefore some kind of dynamic LCA is needed. These LCA issues are reflected in the calculation of external costs. First, the paper discusses these issues on the examples of two main technologies, namely photovoltaic (PV) and wind. Second, it discusses the results of ExternE for these two specific technologies and gives an outlook for the future. Future needs for a better use of LCA as a support tool for the calcination of external costs are identified. Finally, a new research project funded by the European Commission focused on LCI of renewables is briefly introduced and presented. (author)

Costs of Malnutrition in Institutionalized and Community-Dwelling Older Adults: A Systematic Review.

Science.gov (United States)

Abizanda, Pedro; Sinclair, Alan; Barcons, Núria; Lizán, Luis; Rodríguez-Mañas, Leocadio

2016-01-01

The aim of this study was to assess health economics evidence published to date on malnutrition costs in institutionalized or community-dwelling older adults. A systematic search of the literature published until December 2013 was performed using standard literature, international and national electronic databases, including MedLine/PubMed, Cochrane Library, ISI WOK, SCOPUS, MEDES, IBECS, and Google Scholar. Publications identified referred to the economic burden and use of medical resources associated with malnutrition (or risk of malnutrition) in institutionalized or community-dwelling older adults, written in either English or Spanish. Costs were updated to 2014 (€). A total of 9 studies of 46 initially retrieved met the preestablished criteria and were submitted to thorough scrutiny. All publications reviewed involved studies conducted in Europe, and the results regarding the contents of all the studies showed that total costs associated with malnutrition in institutionalized and community-dwelling older adults were considerably higher than those of well-nourished ones, mainly due to a higher use of health care resources (GP consultations, hospitalizations, health care monitoring, and treatments). Interventions to reduce the prevalence of malnutrition, such as the use of oral nutritional supplements, showed an important decrease in-hospital admissions and medical visits. Malnutrition is associated with higher health care costs in institutionalized or community-dwelling older adults. The adoption of nutritional interventions, such as oral nutritional supplements, may have an important impact in reducing annual health care costs per patient. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

APPLICATION, PERFORMANCE, AND COSTS OF ...

Science.gov (United States)

A critical review of biological treatment processes for remediation of contaminated soils is presented. The focus of the review is on documented cost and performance of biological treatment technologies demonstrated at full- or field-scale. Some of the data were generated by the U.S. Environmental Protection Agency's (EPA's) Bioremediation in the Field Program, jointly supported by EPA's Office of Research and Development, EPA's Office of Solid Waste and Emergency Waste, and the EPA Regions through the Superfund Innovative Technology Evaluation Program (SITE) Program. Military sites proved to be another fertile data source. Technologies reviewed in this report include both ex-situ processes, (land treatment, biopile/biocell treatment, composting, and bioslurry reactor treatment) and in-situ alternatives (conventional bioventing, enhanced or cometabolic bioventing, anaerobic bioventing, bioslurping, phytoremediation, and natural attenuation). Targeted soil contaminants at the documented sites were primarily organic chemicals, including BTEX, petroleum hydrocarbons, polycyclic aromatic hydrocarbons (PAHs), chlorinated aliphatic hydrocarbons (CAHs), organic solvents, polychlorinated biphenyls (PCBs), pesticides, dioxin, and energetics. The advantages, limitations, and major cost drivers for each technology are discussed. Box and whisker plots are used to summarize before and after concentrations of important contaminant groups for those technologies consider

The (cost-)effectiveness of preventive, integrated care for community-dwelling frail older people: A systematic review.

Science.gov (United States)

Looman, Wilhelmina Mijntje; Huijsman, Robbert; Fabbricotti, Isabelle Natalina

2018-04-17

Integrated care is increasingly promoted as an effective and cost-effective way to organise care for community-dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost-effectiveness of preventive, integrated care for community-dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost-effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk-of-bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom-reported outcomes such as well-being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost-effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost-effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected. © 2018 The Authors. Health and Social Care in the Community

Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: a systematic review.

Directory of Open Access Journals (Sweden)

Bikaramjit S Mann

Full Text Available BACKGROUND: Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear. OBJECTIVE: To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease. METHODS: Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs. MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies. FINDINGS: Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death, quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment

The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people.

Science.gov (United States)

Williams, Mark E; Pulliam, Charles C; Hunter, Rebecca; Johnson, Ted M; Owens, Justine E; Kincaid, Jean; Porter, Carol; Koch, Gary

2004-01-01

To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning. A randomized-controlled trial. Health center ambulatory clinic. Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks. A medication-change intervention group of 57 elders was compared with a control group of 76 elder adults. The primary intervention was a comprehensive review and recommended modification of a patient's medication regimen. Changes were endorsed by each patient's primary physician and discussed with each patient. Measures were the Timed Manual Performance Test, Physical Performance Test, Functional Reach Assessment, subtests from the Wechsler Adult Intelligence Scale, a modified Randt Memory Test, the Center for Epidemiological Studies-Depression Scale, the Self-Rating Anxiety Scale, and the Rand 36-item Health Survey 1.0. Comorbidity was determined using the International Classification of Diseases, Ninth Revision, Clinical Modification. Medication usage was determined using brown bag review. Intervention subjects decreased their medications by an average of 1.5 drugs. No differences in functioning were observed between groups. Intervention subjects saved an average $26.92 per month in wholesale medication costs; control subjects saved $6.75 per month (P<.006). Although the intervention significantly reduced the medications taken and monthly cost, most patients were resistant to reducing medications to the recommended level. Further study is needed to understand patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health. Greater focus on prescriber behavior is recommended.

Cost-effectiveness of greenhouse gas mitigation in transport: A review of methodological approaches and their impact

International Nuclear Information System (INIS)

Kok, Robert; Annema, Jan Anne; Wee, Bert van

2011-01-01

A review is given of methodological practices for ex ante cost-effectiveness analysis (CEA) of transport greenhouse gas (GHG) mitigation measures, e.g. fuel economy and CO 2 standards for road vehicles in the US and EU. Besides the fundamental differences between different types of policies and abatement options which inherently result in different CEA outcomes, differences in methodological choices and assumptions are another important source of variation in CEA outcomes. Fourteen methodological issues clustered into six groups are identified on which thirty-three selected studies are systematically reviewed. The potential variation between lower and upper cost-effectiveness estimates for GHG mitigation measures in transport, resulting from different methodological choices and assumptions, lies in the order of $400 per tonne CO 2 -eq. The practise of using CEA for policy-making could improve considerably by clearly indicating the specific purpose of the CEA and its strengths and limitations for policy decisions. Another improvement is related to the dominant approach in transport GHG mitigation studies: the bottom-up financial technical approach which assesses isolated effects, implying considerable limitations for policy-making. A shift to welfare-economic approaches using a hybrid model has the potential to establish an improved assessment of transport GHG mitigation measures based on realistic market responses and behavioural change. - Highlights: ► We identify fourteen important methodological issues clustered into six groups. ► We systematically review thirty-three selected transport GHG mitigation studies. ► Methodological choices can lead to a difference by up to $400 per tonne CO 2 -eq. ► The dominant bottom-up approach has limitations for policy-making. ► Welfare-economic approaches could improve cost-effectiveness analysis.

The messages presented in online electronic cigarette promotions and discussions: a scoping review protocol.

Science.gov (United States)

McCausland, Kahlia; Maycock, Bruce; Jancey, Jonine

2017-11-08

Electronic cigarettes have become increasingly popular over the last 10 years. These devices represent a new paradigm for tobacco control offering smokers an opportunity to inhale nicotine without inhaling tobacco smoke. To date there are no definite conclusions regarding the safety and long-term health effects of electronic cigarettes; however, there is evidence that they are being marketed online as a healthier alternative to traditional cigarettes. This scoping review aims to identify and describe the breadth of messages (eg, health, smoking-cessation and price related claims) presented in online electronic cigarette promotions and discussions. A scoping review will be undertaken adhering to the methodology outlined in The Joanna Briggs Institute Manual for Scoping Reviews. Six key electronic databases will be searched to identify eligible studies. Studies must be published in English between 2007 and 2017, examine and/or analyse content captured from online electronic cigarette promotions or discussions and report results for electronic cigarettes separately to other forms of tobacco delivery. Studies will be screened initially by title and abstract, followed by full-text review. Results of the search strategy will be reported in a PRISMA flow diagram and presented in tabular form with accompanying narrative summary. The methodology consists of reviewing and collecting data from publicly available studies, and therefore does not require ethics approval. Results will be published in a peer reviewed journal and be presented at national/international conferences. Additionally, findings will be disseminated via social media and online platforms. Advocacy will be key to informing policy makers of regulatory and health issues that need to be addressed. The review was registered prospectively with The Joanna Briggs Institute Systematic Reviews database. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

PV O&M Cost Model and Cost Reduction

Energy Technology Data Exchange (ETDEWEB)

Walker, Andy

2017-03-15

This is a presentation on PV O&M cost model and cost reduction for the annual Photovoltaic Reliability Workshop (2017), covering estimating PV O&M costs, polynomial expansion, and implementation of Net Present Value (NPV) and reserve account in cost models.

Costs of Decommissioning Nuclear Power Plants

International Nuclear Information System (INIS)

Neri, Emilio; French, Amanda; Urso, Maria Elena; Deffrennes, Marc; Rothwell, Geoffrey; ); Rehak, Ivan; Weber, Inge; ); Carroll, Simon; Daniska, Vladislav

2016-01-01

While refurbishments for the long-term operation of nuclear power plants and for the lifetime extension of such plants have been widely pursued in recent years, the number of plants to be decommissioned is nonetheless expected to increase in future, particularly in the United States and Europe. It is thus important to understand the costs of decommissioning so as to develop coherent and cost-effective strategies, realistic cost estimates based on decommissioning plans from the outset of operations and mechanisms to ensure that future decommissioning expenses can be adequately covered. This study presents the results of an NEA review of the costs of decommissioning nuclear power plants and of overall funding practices adopted across NEA member countries. The study is based on the results of this NEA questionnaire, on actual decommissioning costs or estimates, and on plans for the establishment and management of decommissioning funds. Case studies are included to provide insight into decommissioning practices in a number of countries. (authors)

Safety cost management in construction companies: A proposal classification.

Science.gov (United States)

López-Alonso, M; Ibarrondo-Dávila, M P; Rubio, M C

2016-06-16

Estimating health and safety costs in the construction industry presents various difficulties, including the complexity of cost allocation, the inadequacy of data available to managers and the absence of an accounting model designed specifically for safety cost management. Very often, the costs arising from accidents in the workplace are not fully identifiable due to the hidden costs involved. This paper reviews some studies of occupational health and safety cost management and proposes a means of classifying these costs. We conducted an empirical study in which the health and safety costs of 40 construction worksites are estimated. A new classification of the health and safety cost and its categories is proposed: Safety and non-safety costs. The costs of the company's health and safety policy should be included in the information provided by the accounting system, as a starting point for analysis and control. From this perspective, a classification of health and safety costs and its categories is put forward.

Some economic aspects of natural uranium graphite gas reactor types. Present status and trends of costs in France

International Nuclear Information System (INIS)

Gaussens, J.; Tanguy, P.

1964-01-01

The first part of this report defines the economic advantages of natural uranium fuels, which are as follows: the restricted number and relatively simple fabrication processes of the fuel elements, the low cost per kWh of the finished product and the reasonable capital investments involved in this type of fuel cycle as compared to that of enriched uranium. All these factors combine to reduce the arbitrary nature of cost estimates, which is particularly marked in the case of enriched uranium due to the complexity of its cycle and the uncertainties of plutonium prices). Finally, the wide availability of yellowcake, as opposed to the present day virtual monopoly of isotope separation, and the low cost of natural uranium stockpiling, offer appreciable guarantees in the way of security of supply and economic and political independence as compared with the use of enriched uranium. As far as overall capital investments are concerned, it is shown that, although graphite-gas reactor costs are higher than those of light water reactors in certain capacity ranges, the situation becomes far less clear when we start taking into account, in the interest of national independence, the cost of nuclear fuel production equipment in the case of each of these types of reactor. Finally, the marginal cost of the power capacity of a graphite-gas reactor is low and its technological limitations have receded (owing particularly to the use of prestressed concrete). It is a well known fact that the trend is now towards larger power station units, which means that the rentability of natural uranium graphite reactors as compared to other types of reactors will become more and more pronounced. The second section aims at presenting a realistic short and medium term view of the fuel, running, and investment costs of French natural uranium graphite gas, reactors. Finally, the economic goals which this type of reactor can reach in the very near future are given. It is thus shown that considerable

Cost-benefit

International Nuclear Information System (INIS)

1975-01-01

A critical review of the cost benefit analysis is given for the LMFBR-type reactor development program given in an environmental impact statement of AEC. Several methodological shortcomings are signalled. As compared with a HTGR-type/LWR-type mix of reactors the LMFBR-type reactor will not be competitive until the U 3 O 8 prices reach a level of $ 50/lb which is not likely to happen before the year 2020. It is recommended to review the draft of the ZEC document and include timing as one of the issues. Deferal of the LMFBR-type reactor development program if necessary will not be intolerably costly

Power plant economy of scale and cost trends: further analyses and review of empirical studies

International Nuclear Information System (INIS)

Fisher, C.F. Jr.; Paik, S.; Schriver, W.R.

1986-07-01

Multiple regression analyses were performed on capital cost data for nuclear and coal-fired power plants in an extension of an earlier study which indicated that nuclear units completed prior to the accident at Three-Mile Island (TMI) have no economy of scale, and that units completed after that event have a weak economy of scale (scaling exponent of about 0.81). The earlier study also indicated that the scaling exponent for coal-fired units is about 0.92, compared with conceptual models which project scaling exponents in a range from about 0.5 to 0.9. Other empirical studies have indicated poor economy of scale, but a large range of cost-size scaling exponents has been reported. In the present study, the results for nuclear units indicate a scaling exponent of about 0.94 but with no economy of scale for large units, that a first unit costs 17% more than a second unit, that a unit in the South costs 20% less than others, that a unit completed after TMI costs 33% more than one completed before TMI, and that costs are increasing at 9.3% per year. In the present study, the results for coal-fired units indicate a scaling exponent of 0.93 but with better scaling economy in the larger units, that a first unit costs 38.5% more, a unit in the South costs 10% less, flue-gas desulfurization units cost 23% more, and that costs are increasing at 4% per year

The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review.

Science.gov (United States)

Rice, Helena; Say, Richard; Betihavas, Vasiliki

2018-03-01

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community. A systematic review of randomised control trials was undertaken. Using the search terms nurse, education, heart failure, hospitalisation, readmission, rehospitalisation, economic burden, cost, expenditure and quality of life in PubMed, CINAHL and Google Scholar databases were searched. Papers pertaining to nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were reviewed. The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions, reduction in hospitalisation and a cost benefit. Additionally, higher functioning and improved QoL were also identified. These results suggest that nurse-led patient education for adults with HF improves QoL and reduces hospital admissions and readmissions. Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis.

Science.gov (United States)

Harris, J; Felix, L; Miners, A; Murray, E; Michie, S; Ferguson, E; Free, C; Lock, K; Landon, J; Edwards, P

2011-10-01

UK public health policy strongly advocates dietary change for the improvement of population health and emphasises the importance of individual empowerment to improve health. A new and evolving area in the promotion of dietary behavioural change is 'e-learning', the use of interactive electronic media to facilitate teaching and learning on a range of issues including health. The high level of accessibility, combined with emerging advances in computer processing power, data transmission and data storage, makes interactive e-learning a potentially powerful and cost-effective medium for improving dietary behaviour. This review aims to assess the effectiveness and cost-effectiveness of adaptive e-learning interventions for dietary behaviour change, and also to explore potential psychological mechanisms of action and components of effective interventions. Electronic bibliographic databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Dissertation Abstracts, EMBASE, Education Resources Information Center, Global Health, Health Economic Evaluations Database, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science) were searched for the period January 1990 to November 2009. Reference lists of included studies and previous reviews were also screened; authors were contacted and trial registers were searched. Studies were included if they were randomised controlled trials, involving participants aged ≥ 13 years, which evaluated the effectiveness of interactive software programs for improving dietary behaviour. Primary outcomes were measures of dietary behaviours, including estimated intakes or changes in intake of energy, nutrients, dietary fibre, foods or food groups. Secondary outcome measures were clinical outcomes such as anthropometry or blood biochemistry. Psychological mediators of dietary behaviour change were also investigated. Two review authors independently screened results and extracted data from

Systematic Review of Methods to Determine the Cost-Effectiveness of Monitoring Plans for Chemical and Biological Hazards in the Life Sciences

NARCIS (Netherlands)

Focker, M.; Fels-Klerx, van der H.J.; Oude Lansink, A.G.J.M.

2018-01-01

This study reviews the methods used to determine the cost-effectiveness of monitoring plans for hazards in animals (diseases), plants (pests), soil, water, food, and animal feed, and assesses their applicability to food safety hazards. The review describes the strengths and weaknesses of each

Understanding cost growth during operations of planetary missions: An explanation of changes

Science.gov (United States)

McNeill, J. F.; Chapman, E. L.; Sklar, M. E.

picture is constructed of why cost grew during the operations phase, even to the level of specific events in the life of the missions. As a next step, the Phase E EoC results were gleaned and synthesized to produce leading indicators, i.e., what may be identifiable signs of cost and staffing growth that may be present as early as PDR or CDR. Both a qualitative and quantitative approach was used to determine leading indicators. These leading indicators will be reviewed and a practical method for their use will be discussed.

2011 Cost of Wind Energy Review

Energy Technology Data Exchange (ETDEWEB)

Tegen, S.; Lantz, E.; Hand, M.; Maples, B.; Smith, A.; Schwabe, P.

2013-03-01

This report describes the levelized cost of energy (LCOE) for a typical land-based wind turbine installed in the United States in 2011, as well as the modeled LCOE for a fixed-bottom offshore wind turbine installed in the United States in 2011. Each of the four major components of the LCOE equation are explained in detail, such as installed capital cost, annual energy production, annual operating expenses, and financing, and including sensitivity ranges that show how each component can affect LCOE. These LCOE calculations are used for planning and other purposes by the U.S. Department of Energy's Wind Program.

Review on Dog Rabies Vaccination Coverage in Africa: A Question of Dog Accessibility or Cost Recovery?

NARCIS (Netherlands)

Jibat, T.; Hogeveen, H.; Mourits, Monique C.M.

2015-01-01

Rabies is one of the most fatal diseases in both humans and animals. A bite by a rabid dog is the main cause of human rabies in Africa. Parenteral mass dog vaccination is the most cost-effective tool to prevent rabies in humans. Our main objective was to review research articles on the parenteral

Cost accounting for the radiologist.

Science.gov (United States)

Gentili, Amilcare

2014-05-01

Cost accounting is the branch of managerial accounting that deals with the analysis of the costs of a product or service. This article reviews methods of classifying and allocating costs and relationships among costs, volume, and revenues. Radiology practices need to know the cost of a procedure or service to determine the selling price of a product, bid on contracts, analyze profitability, and facilitate cost control and cost reduction.

Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model.

Science.gov (United States)

Davies, L; Brown, T J; Haynes, S; Payne, K; Elliott, R A; McCollum, C

2006-11-01

To compare patient outcomes, resource use and costs to the NHS and NHS Blood Transfusion Authority (BTA) associated with cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion. Electronic databases covering the period 1996-2004 for systematic reviews and 1994-2004 for economic evidence. Existing systematic reviews were updated with data from selected randomised controlled trials (RCTs) that involved adults scheduled for elective non-urgent surgery. Any resource use or cost data were extracted for potential use in populating an economic model. Relative risks or weighted mean difference of each outcome for each intervention were assessed, taking into account the number of RCTs included in each outcome and intervention and the presence of any heterogeneity. This allowed indirect comparison of the relative effectiveness of each intervention when the intervention is compared with allogeneic blood transfusion. A decision analytic model synthesised clinical and economic data from several sources, to estimate the relative cost-effectiveness of cell salvage for people undergoing elective surgery with moderate to major expected blood loss. The perspective of the NHS and patients and a time horizon of 1 month were used. The economic model was developed from reviews of effectiveness and cost-effectiveness and clinical experts. Secondary analysis explored the robustness of the results to changes in the timing and costs of cell salvage equipment, surgical procedure, use of transfusion protocols and time horizon of analysis. Overall, 668 studies were identified electronically for the update of the two systematic reviews. This included five RCTs, of which two were cell salvage and three preoperative autologous donation (PAD). Five published systematic reviews were identified for antifibrinolytics, fibrin sealants and restrictive transfusion triggers, PAD plus erythropoietin, erythropoietin alone and acute normovolaemic haemodilution (ANH

Economics of human performance and systems total ownership cost.

Science.gov (United States)

Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z

2012-01-01

Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.

Wearable Photoplethysmographic Sensors—Past and Present

Directory of Open Access Journals (Sweden)

Toshiyo Tamura

2014-04-01

Full Text Available Photoplethysmography (PPG technology has been used to develop small, wearable, pulse rate sensors. These devices, consisting of infrared light-emitting diodes (LEDs and photodetectors, offer a simple, reliable, low-cost means of monitoring the pulse rate noninvasively. Recent advances in optical technology have facilitated the use of high-intensity green LEDs for PPG, increasing the adoption of this measurement technique. In this review, we briefly present the history of PPG and recent developments in wearable pulse rate sensors with green LEDs. The application of wearable pulse rate monitors is discussed.

COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

Directory of Open Access Journals (Sweden)

Moisello Anna Maria

2012-07-01

Full Text Available Firms are coping with a competitive scenario characterized by quick changes produced by internationalization, concentration, restructuring, technological innovation processes and financial market crisis. On the one hand market enlargement have increased the number and the segmentation of customers and have raised the number of competitors, on the other hand technological innovation has reduced product life cycle. So firms have to adjust their management models to this scenario, pursuing customer satisfaction and respecting cost constraints. In a context where price is a variable fixed by the market, firms have to switch from the cost measurement logic to the cost management one, adopting target costing methodology. The target costing process is a price driven, customer oriented profit planning and cost management system. It works, in a cross functional way, from the design stage throughout all the product life cycle and it involves the entire value chain. The process implementation needs a costing methodology consistent with the cost management logic. The aim of the paper is to focus on Activity Based Costing (ABC application to target costing process. So: -it analyzes target costing logic and phases, basing on a literary review, in order to highlight the costing needs related to this process; -it shows, through a numerical example, how to structure a flexible ABC model – characterized by the separation between variable, fixed in the short and fixed costs - that effectively supports target costing process in the cost measurement phase (drifting cost determination and in the target cost alignment; -it points out the effectiveness of the Activity Based Costing as a model of cost measurement applicable to the supplier choice and as a support for supply cost management which have an important role in target costing process. The activity based information allows a firm to optimize the supplier choice by following the method of minimizing the

Assessing the Implementation and Cost of High Quality Early Care and Education: A Review of the Literature. OPRE Report 2016-31

Science.gov (United States)

Caronongan, Pia; Kirby, Gretchen; Boller, Kimberly; Modlin, Emily; Lyskawa, Julia

2016-01-01

This report summarizes the findings of a literature review conducted as part of the Assessing the Implementation and Cost of High-Quality Early Care and Education (ECE-ICHQ) project. The project's goal is to create a technically sound and feasible instrument that will provide consistent, systematic measures of the implementation and costs of…

Thyroid leiomyosarcoma: presentation of two cases and review of the literature

Directory of Open Access Journals (Sweden)

Mehmet İlhan Şahin

Full Text Available Abstract Introduction: Leiomyosarcoma is a tumor which is rarely seen in the thyroid gland. The diagnosis may be difficult and the treatment is controversial. Objective: The objective of the study is to review the literature about a rare malignant disease of the thyroid gland which has high mortality. Methods: Two cases of thyroid leiomyosarcoma are presented and the previous 23 cases in the current literature are reviewed. Results: A total of 25 cases of thyroid leiomyosarcoma are reviewed; the most common complaint was rapidly growing anterior neck mass, and ten of the 25 patients had distant metastasis at the initial admission. Fifteen of the 25 patients died with the disease in the first 12 months after the diagnosis. Conclusion: The differential diagnosis of thyroid leiomyosarcoma is important and should be performed with other malignancies of the gland, especially with anaplastic carcinoma. The prognosis is poor and there is no consensus regarding the treatment.

Is There Evidence of Cost Benefits of Electronic Medical Records, Standards, or Interoperability in Hospital Information Systems? Overview of Systematic Reviews.

Science.gov (United States)

Reis, Zilma Silveira Nogueira; Maia, Thais Abreu; Marcolino, Milena Soriano; Becerra-Posada, Francisco; Novillo-Ortiz, David; Ribeiro, Antonio Luiz Pinho

2017-08-29

Electronic health (eHealth) interventions may improve the quality of care by providing timely, accessible information about one patient or an entire population. Electronic patient care information forms the nucleus of computerized health information systems. However, interoperability among systems depends on the adoption of information standards. Additionally, investing in technology systems requires cost-effectiveness studies to ensure the sustainability of processes for stakeholders. The objective of this study was to assess cost-effectiveness of the use of electronically available inpatient data systems, health information exchange, or standards to support interoperability among systems. An overview of systematic reviews was conducted, assessing the MEDLINE, Cochrane Library, LILACS, and IEEE Library databases to identify relevant studies published through February 2016. The search was supplemented by citations from the selected papers. The primary outcome sought the cost-effectiveness, and the secondary outcome was the impact on quality of care. Independent reviewers selected studies, and disagreement was resolved by consensus. The quality of the included studies was evaluated using a measurement tool to assess systematic reviews (AMSTAR). The primary search identified 286 papers, and two papers were manually included. A total of 211 were systematic reviews. From the 20 studies that were selected after screening the title and abstract, 14 were deemed ineligible, and six met the inclusion criteria. The interventions did not show a measurable effect on cost-effectiveness. Despite the limited number of studies, the heterogeneity of electronic systems reported, and the types of intervention in hospital routines, it was possible to identify some preliminary benefits in quality of care. Hospital information systems, along with information sharing, had the potential to improve clinical practice by reducing staff errors or incidents, improving automated harm detection

Costs and benefits of embedded generation

International Nuclear Information System (INIS)

1999-11-01

This project sought to evaluate the costs and benefits of embedded generation in the light of the UK government's consultation paper on the future of green generation, the government's aim to increase the levels of generation from renewable energy sources and cogeneration, the current Review of the Electricity Trading Arrangements, and the form of the Distribution Price Control. Definitions are given for embedded, centrally dispatched, and pooled generation, and licensed suppliers, and commercial and economic values. The commercial and economic value of embedded generation is examined in terms of generation prices, costs to electrical suppliers, losses (electrical, transmission, distribution), and effects on the national grid and distribution network. Diagrams showing the cost elements of trading through the Pool and the elements that are avoided by non-Pool embedded generator trading are presented

Decommissioning and disposal costs in Switzerland

International Nuclear Information System (INIS)

Zurkinden, Auguste

2003-01-01

Introduction Goal: Secure sufficient financial resources. Question: How much money is needed? Mean: Concrete plans for decommissioning and waste disposal. - It is the task of the operators to elaborate these plans and to evaluate the corresponding costs - Plans and costs are to be reviewed by the authorities Decommissioning Plans and Costs - Comprise decommissioning, dismantling and management (including disposal) of the waste. - New studies 2001 for each Swiss nuclear power plant (KKB 2 x 380 MWe, KKM 370 MWe, KKG 1020 MWe, KKL 1180 MWe). - Studies performed by NIS (D). - Last developments taken into account (Niederaichbach, Gundremmingen, Kahl). Decommissioning: Results and Review Results: Total cost estimates decreasing (billion CHF) 1994 1998 2001 13.7 13.1 11.8 Lower costs for spent fuel conditioning and BE/HAA/LMA repository (Opalinus Clay) Split in 2025: 5.6 bil. CHF paid by NPP 6.2 billion CHF in Fund Review: Concentrates on disposal, ongoing

Laryngeal Schwannoma: A Case Presentation and Review of the Mayo Clinic Experience.

Science.gov (United States)

Romak, Jonathan J; Neel, H Bryan; Ekbom, Dale C

2017-01-01

The aim of this study was to clarify the nature of laryngeal schwannomas through review of the experience of a single institution during a 104-year period. This is a retrospective case series. The Mayo Clinic, Rochester, Minnesota clinical and surgical pathology database was reviewed for the years 1985-2011. Four cases of laryngeal schwannoma were identified. These cases were pooled with a previously published series of laryngeal schwannomas treated at our institution between 1907 and 1986. The characteristics of all 11 cases were studied, and relevant literature was reviewed. A total of 11 cases of schwannoma of the larynx were identified. The mean age at presentation was 48 years (range 12-73 years). The most common presenting symptoms were dysphonia and dysphagia. The most frequently involved primary site was the false vocal fold (six patients), followed by the aryepiglottic fold (three), epiglottis (two), subglottis (two), ventricle (one), true vocal fold (one) and postcricoid region (one). The mean maximal tumor diameter was 2.5 cm. In all but one case, surgical excision was curative with no recurrence during recorded follow up ranging from 1 to 17 years. Laryngeal schwannomas, although rare, should be considered in the differential diagnosis of laryngeal tumors. They occur most frequently in the false vocal fold and present most commonly with dysphonia and/or dysphagia. Surgical excision is the treatment of choice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of interventions to control cardiovascular diseases and diabetes mellitus in South Asia: a systematic review

Science.gov (United States)

Singh, Kavita; Chandrasekaran, Ambalam M; Bhaumik, Soumyadeep; Chattopadhyay, Kaushik; Gamage, Anuji Upekshika; Silva, Padmal De; Roy, Ambuj; Prabhakaran, Dorairaj; Tandon, Nikhil

2018-01-01

Objectives More than 80% of cardiovascular diseases (CVD) and diabetes mellitus (DM) burden now lies in low and middle-income countries. Hence, there is an urgent need to identify and implement the most cost-effective interventions, particularly in the resource-constraint South Asian settings. Thus, we aimed to systematically review the cost-effectiveness of individual-level, group-level and population-level interventions to control CVD and DM in South Asia. Methods We searched 14 electronic databases up to August 2016. The search strategy consisted of terms related to ‘economic evaluation’, ‘CVD’, ‘DM’ and ‘South Asia’. Per protocol two reviewers assessed the eligibility and methodological quality of studies using standard checklists, and extracted incremental cost-effectiveness ratios of interventions. Results Of the 2949 identified studies, 42 met full inclusion criteria. Critical appraisal of studies revealed 15 excellent, 18 good and 9 poor quality studies. Most studies were from India (n=37), followed by Bangladesh (n=3), Pakistan (n=2) and Bhutan (n=1). The economic evaluations were based on observational studies (n=9), randomised trials (n=12) and decision models (n=21). Together, these studies evaluated 301 policy or clinical interventions or combination of both. We found a large number of interventions were cost-effective aimed at primordial prevention (tobacco taxation, salt reduction legislation, food labelling and food advertising regulation), and primary and secondary prevention (multidrug therapy for CVD in high-risk group, lifestyle modification and metformin treatment for diabetes prevention, and screening for diabetes complications every 2–5 years). Significant heterogeneity in analytical framework and outcome measures used in these studies restricted meta-analysis and direct ranking of the interventions by their degree of cost-effectiveness. Conclusions The cost-effectiveness evidence for CVD and DM interventions in South Asia

Review on studies for external cost of nuclear power generation

Energy Technology Data Exchange (ETDEWEB)

Park, Byung Heung [Korea National University of Transportation, Chungju (Korea, Republic of); Ko, Won Il [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2015-12-15

External cost is cost imposed on a third party when producing or consuming a good or service. Since the 1990s, the external costs of nuclear powered electricity production have been studied. Costs are a very important factor in policy decision and the external cost is considered for cost comparison on electricity production. As for nuclear fuel cycle, a chosen technology will determine the external cost. However, there has been little research on this issue. For this study, methods for external cost on nuclear power production have been surveyed and analyzed to develop an approach for evaluating external cost on nuclear fuel cycles. Before the Fukushima accident, external cost research had focused on damage costs during normal operation of a fuel cycle. However, accident cost becomes a major concern after the accident. Various considerations for external cost including accident cost have been used to different studies, and different methods have been applied corresponding to the considerations. In this study, the results of the evaluation were compared and analyzed to identify methodological applicability to the external cost estimation with nuclear fuel cycles.