WorldWideScience

Sample records for rising utility costs

  1. Consumerism and wellness: rising tide, falling cost.

    Science.gov (United States)

    Domaszewicz, Alexander

    2008-01-01

    Annual employer-sponsored health plan cost increases have been slowing incrementally due to slowing health care utilization--a phenomenon very likely tied to the proliferation of health management activities, wellness programs and other consumerism strategies. This article describes the sharp rise in recent years of consumer-directed health plans (CDHPs) and explains what developments must happen for genuine consumer-directed health care to realize its full potential. These developments include gathering transparent health care information, increasing consumer demand for that information and creating truly intuitive data solutions that allow consumers to easily access information in order to make better health care decisions.

  2. Nuclear costs: why do they keep rising?

    International Nuclear Information System (INIS)

    MacKerron, Gordon

    1992-01-01

    Nuclear power has performed badly in recent years as a new investment everywhere except Japan and Korea. This has mainly been for orthodox financial and economic reasons. Among the factors contributing to this loss of competitiveness, persistently rising real capital costs have been particularly important. While the nuclear industry has believed it could control and reduce capital costs, increasing regulatory stringency has made designs more complex and correspondingly more costly. These cost increasing factors have far outweighed traditional cost reducing factors (like learning). The only lasting way to meet increasing stringency in safety at acceptably low cost is likely to be the development of new and simpler reactor designs. (author)

  3. High and rising health care costs.

    Science.gov (United States)

    Ginsburg, Paul B

    2008-10-01

    The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

  4. Rising utilization of inpatient pediatric asthma pathways.

    Science.gov (United States)

    Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D

    2018-02-01

    Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

  5. Nuclear operating costs are rising exponentially - official

    International Nuclear Information System (INIS)

    Thomas, S.

    1988-01-01

    The Energy Information Agency of the United States Department of Energy has collected data on the operations of nuclear power plants in the United States. A statistical regression analysis was made of this data base. This shows that the escalation in annual, real non-fuel operating costs is such that the operating cost savings made by closing down an old nuclear plant would be sufficient to pay the capital and operating costs of replacing it with a brand new coal-fired plant. The main reason for the increasing operating and maintenance costs is the cost of replacement power i.e. the higher the economic penalty of plant breakdown the more the utility has to spend on maintenance. Another reason is time -not the age of the plant - but the year the data was collected. The economic case for nuclear power is seriously challenged. (U.K.)

  6. Calculating utility prudency issue costs

    International Nuclear Information System (INIS)

    Nielsen, K.R.

    1985-01-01

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

  7. Laboratory cost and utilization containment.

    Science.gov (United States)

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

    1991-01-01

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

  8. Integrating conservation costs into sea level rise adaptive conservation prioritization

    Directory of Open Access Journals (Sweden)

    Mingjian Zhu

    2015-07-01

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

  9. An analysis of electric utility embedded power supply costs

    International Nuclear Information System (INIS)

    Kahal, M.; Brown, D.

    1998-01-01

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

  10. Population Aging in Iran and Rising Health Care Costs

    Directory of Open Access Journals (Sweden)

    Mohammad Mirzaie

    2017-09-01

    Conclusion Based on the results of this research, it can be said that people throughout their life cycle always allocate a percentage of their total spending to health care costs, but the percentage of this allocation is different at different ages. In a way the demand for healthcare costs increases with aging, it rises significantly in the old age. At the macro level, due to an increase in the percentage of elderly in the population over the next decade, there will also be an increase in the share of health care costs.

  11. Nuclear utilities must cut costs: ANS meeting

    International Nuclear Information System (INIS)

    Taylor, G.M.

    1993-01-01

    This article looks at cost factors in the nuclear industry, and concludes that the nuclear industry must be very careful with its operations and maintenance (O ampersand M) costs in particular to stay competitive in the energy marketplace. These costs have been rising at 5% per year lately, and are becoming a major cost for the nuclear industry. Analysts feel that a major reason for these increases is the responsibility of management. The article highlights the need to tighten the cost factors or face the loss of market share

  12. South Africa’s rising logistics costs: An uncertain future

    Directory of Open Access Journals (Sweden)

    Jan H. Havenga

    2014-12-01

    Full Text Available A country’s competitiveness can be severely hampered by an uncompetitive freight logistics system. During the first decade of the 21st century, two in-depth models were developed for South Africa which provide a framework for measuring and improving the country’s freight logistics system – the cost of logistics survey and the freight demand model. These models also allow for the development of scenarios for key identified risks. The objectives of this study were to provide an overview of South Africa’s surface freight transport industry,identify key risks to national competitiveness and suggest ways in which these risks could be mitigated. Freight flows were modelled by disaggregating the national input–output model into 372 origin–destination pairs and 71 commodity groups, followed by distance decay gravity-modelling. Logistics costs were calculated by relating commodity-level freight flows to the costs of fulfilling associated logistical functions. South Africa’s economy is highly transport intensive. Excessive dependence on road freight transport exacerbates this situation. Furthermore, the road freight transport’s key cost driver is fuel, driven in turn by the oil price. Scenario analysis indicated the risk posed by this rising and volatile input and should provide impetus for policy instruments to reduce transport intensity. As such, this study concluded that a reduction in freight transport intensity is required to reduce exposure to volatile international oil prices.

  13. The Effects of Rising Interest Rates on Electric Utility Stock Prices: Regulatory Considerations and Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Kihm, Steve [Seventhwave, Madison, WI (United States); Satchwell, Andrew [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Cappers, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-07-26

    This technical brief identifies conditions under which utility regulators should consider implementing policy approaches that seek to mitigate negative outcomes due to an increase in interest rates. Interest rates are a key factor in determining a utility’s cost of equity and investors find value when returns exceed the cost of equity. Through historical observations of periods of rising and falling interest rates and application of a pro forma financial tool, we identify the key drivers of utility stock valuations and estimate the degree to which those valuations might be affected by increasing interest rates.3 We also analyze the efficacy of responses by utility regulators to mitigate potential negative financial impacts. We find that regulators have several possible approaches to mitigate a decline in value in an environment of increasing interest rates, though regulators must weigh the tradeoffs of improving investor value with potential increases in customer costs. Furthermore, the range of approaches reflects today’s many different electric utility regulatory models and regulatory responses to a decline in investor value will fit within state-specific models.

  14. The effects of rising energy costs and transportation mode mix on forest fuel procurement costs

    International Nuclear Information System (INIS)

    Rauch, Peter; Gronalt, Manfred

    2011-01-01

    Since fossil fuels have been broadly recognized as a non-renewable energy source that threatens the climate, sustainable and CO 2 neutral energy sources - such as forest fuels - are being promoted in Europe, instead. With the expeditiously growing forest fuel demand, the strategic problem of how to design a cost-efficient distribution network has evolved. This paper presents an MILP model, comprising decisions on modes of transportation and spatial arrangement of terminals, in order to design a forest fuel supply network for Austria. The MILP model is used to evaluate the impacts of rising energy costs on procurement sources, transport mix and procurement costs on a national scale, based on the example of Austria. A 20% increase of energy costs results in a procurement cost increase of 7%, and another 20% increase of energy costs would have similar results. While domestic waterways become more important as a result of the first energy cost increase, rail only does so after the second. One way to decrease procurement costs would be to reduce the share of empty trips with truck and trailer. Reducing this share by 10% decreases the average procurement costs by up to 20%. Routing influences the modal split considerably, and the truck transport share increases from 86% to 97%, accordingly. Increasing forest fuel imports by large CHPs lowers domestic competition and also enables smaller plants to cut their procurement costs. Rising forest fuel imports via ship will not significantly decrease domestic market shares, but they will reduce procurement costs considerably. (author)

  15. Healthcare Cost and Utilization Project (HCUP)

    Science.gov (United States)

    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  16. Calculating cost savings in utilization management.

    Science.gov (United States)

    MacMillan, Donna

    2014-01-01

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

  17. Cost Conscious: Incentive and Discount Programs Help Students Meet the Rising Cost of a Community College Education

    Science.gov (United States)

    Ullman, Ellen

    2013-01-01

    Aware that rising costs could force some community colleges to compromise their long-standing open-door policies, administrators have put in place programs and incentives to offset the higher price of the average community college education. This article features ideas and programs to help struggling community colleges cope with rising costs such…

  18. Opinion Leaders See Rising College Costs as Major Concern.

    Science.gov (United States)

    Chronicle of Higher Education, 1988

    1988-01-01

    A recent survey of federal government officials, corporate leaders in charge of personnel and research, and journalists found dramatically different views in some areas, but agreement in concern about college costs, financing, and lack of government spending for research. Most felt college is a fair value for the cost. (MSE)

  19. Increased costs to US pavement infrastructure from future temperature rise

    Science.gov (United States)

    Underwood, B. Shane; Guido, Zack; Gudipudi, Padmini; Feinberg, Yarden

    2017-10-01

    Roadway design aims to maximize functionality, safety, and longevity. The materials used for construction, however, are often selected on the assumption of a stationary climate. Anthropogenic climate change may therefore result in rapid infrastructure failure and, consequently, increased maintenance costs, particularly for paved roads where temperature is a key determinant for material selection. Here, we examine the economic costs of projected temperature changes on asphalt roads across the contiguous United States using an ensemble of 19 global climate models forced with RCP 4.5 and 8.5 scenarios. Over the past 20 years, stationary assumptions have resulted in incorrect material selection for 35% of 799 observed locations. With warming temperatures, maintaining the standard practice for material selection is estimated to add approximately US$13.6, US$19.0 and US$21.8 billion to pavement costs by 2010, 2040 and 2070 under RCP4.5, respectively, increasing to US$14.5, US$26.3 and US$35.8 for RCP8.5. These costs will disproportionately affect local municipalities that have fewer resources to mitigate impacts. Failing to update engineering standards of practice in light of climate change therefore significantly threatens pavement infrastructure in the United States.

  20. Improvement of the cost-benefit analysis algorithm for high-rise construction projects

    Directory of Open Access Journals (Sweden)

    Gafurov Andrey

    2018-01-01

    Full Text Available The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the “Project analysis scenario” flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

  1. Improvement of the cost-benefit analysis algorithm for high-rise construction projects

    Science.gov (United States)

    Gafurov, Andrey; Skotarenko, Oksana; Plotnikov, Vladimir

    2018-03-01

    The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the "Project analysis scenario" flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

  2. Rising costs call for new European refining strategies

    International Nuclear Information System (INIS)

    Sweeney, B.N.C.

    1993-01-01

    The outlook for the global refining industry is for increased spending and reduced margins, largely because of efforts to improve the environment. A look at these trends through the end of the decade is thus in order. Three major industry thrusts are proposed to see refiners through this uncertain period. Three main thrusts are necessary: fixed costs must be reduced by re-engineering business processes and reexamining noncore business units against total and marginal costs. In this respect the best refiners are well ahead of the good ones. New cooperative ways of meeting regulations must be sought, to avoid wasteful over capacity. Joint ventures and alliances with competitors will be needed. The cooperative principle upstream must be extended and new strategies must be sought to meet product demand changes and reduce feedstock costs. The picture that is presented is tough, largely because of the wish to improve the environment. The question that must be continually reviewed is ''Have governments got the right balance in these regulations between the environment and the downstream industry?''

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

    Science.gov (United States)

    Okolelova, Ella; Shibaeva, Marina; Trukhina, Natalya

    2018-03-01

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

  4. Wage and Benefit Changes in Response to Rising Health Insurance Costs

    OpenAIRE

    Dana Goldman; Neeraj Sood; Arleen Leibowitz

    2005-01-01

    Many companies have defined-contribution benefit plans requiring employees to pay the full cost (before taxes) of more generous health insurance choices. Research has shown that employee decisions are quite responsive to these arrangements. What is less clear is how the total compensation package changes when health insurance premiums rise. This paper examines employee compensation decisions during a three-year period when health insurance premiums were rising rapidly. The data come from a si...

  5. The High Rise Low Cost Housing : Sustainable Neighbourhood Elements (Green Elements) in Malaysia

    Science.gov (United States)

    Wahi, Noraziah; Mohamad, Ismail; Mohamad Zin, Rosli; Munikanan, Vikneswaran; Junaini, Syahrizan

    2018-03-01

    The sustainable development is a vital measure to alleviate the greenhouse gas effect, global warming and any other environment issues. The sustainable neighbourhood concept is not new in Malaysia, However, the concept still needs attention and awareness from the stakeholders. This paper discusses on the sustainable neighbourhood elements specifically green elements application on the high rise low cost housing in Malaysia. Malaysia should have focused sustainable neighbourhood planning and design especially on the high rise low cost housing therefore the future generation can be benefited from this type development.

  6. Cost-effectiveness, feed utilization and body composition of african ...

    African Journals Online (AJOL)

    Cost-effectiveness, feed utilization and body composition of african sharptooth catfish ( Clarias gariepinus , Burchell 1822) fingerlings fed locally formulated and commercial pelleted diets in tarpaulin tanks.

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

    International Nuclear Information System (INIS)

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

    1995-01-01

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

  8. Cost analysis of energy storage systems for electric utility applications

    Energy Technology Data Exchange (ETDEWEB)

    Akhil, A. [Sandia National Lab., Albuquerque, NM (United States); Swaminathan, S.; Sen, R.K. [R.K. Sen & Associates, Inc., Bethesda, MD (United States)

    1997-02-01

    Under the sponsorship of the Department of Energy, Office of Utility Technologies, the Energy Storage System Analysis and Development Department at Sandia National Laboratories (SNL) conducted a cost analysis of energy storage systems for electric utility applications. The scope of the study included the analysis of costs for existing and planned battery, SMES, and flywheel energy storage systems. The analysis also identified the potential for cost reduction of key components.

  9. Electric utility power plant construction costs, 1st Edition

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    New UDI report combines historical construction costs for more than 1,000 coal, oil, gas, nuclear and geothermal units that have entered commercial operation since 1966 and projected power plant construction costs for about 400 utility-owned generating units scheduled to enter commercial operation during the next 20 years. Key design characteristics and equipment suppliers, A/E, constructor and original installed cost data. Direct construction costs without AFUDC are provided where known. Historical construction cost data are also provided for about 130 utility-owned hydroelectric, gas turbine, combined-cycle and diesel units (these data are generally for units entering service after 1980)

  10. Health services utilization and costs of the insured and uninsured ...

    African Journals Online (AJOL)

    Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods ...

  11. Cost effective shift schedules enhance utility operations

    International Nuclear Information System (INIS)

    Coleman, R.M.

    1995-01-01

    This article describes how new shift scheduling concepts can save utility operations millions of dollars every year and yet maintain safety and improve employee morale. The key to scheduling is to define and match the work load. This includes discretionary as well as daily, weekly, and yearly core work loads. In most power plants the overall work load (including maintenance, operations, materials handling, etc.) on day shift is greater than on other shifts, hence an unbalanced schedule would be appropriate

  12. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

    Directory of Open Access Journals (Sweden)

    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  13. Calculating the marginal costs of a district-heating utility

    International Nuclear Information System (INIS)

    Sjoedin, Joergen; Henning, Dag

    2004-01-01

    District heating plays an important role in the Swedish heat-market. At the same time, the price of district heating varies considerably among different district-heating utilities. A case study is performed here in which a Swedish utility is analysed using three different methods for calculating the marginal costs of heat supply: a manual spreadsheet method, an optimising linear-programming model, and a least-cost dispatch simulation model. Calculated marginal-costs, obtained with the three methods, turn out to be similar. The calculated marginal-costs are also compared to the actual heat tariff in use by the utility. Using prices based on marginal costs should be able to bring about an efficient resource-allocation. It is found that the fixed rate the utility uses today should be replaced by a time-of-use rate, which would give a more accurate signal for customers to change their heat consumptions. (Author)

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Rose, K.

    1996-07-01

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

  16. Global cost analysis on adaptation to sea level rise based on RCP/SSP scenarios

    Science.gov (United States)

    Kumano, N.; Tamura, M.; Yotsukuri, M.; Kuwahara, Y.; Yokoki, H.

    2017-12-01

    Low-lying areas are the most vulnerable to sea level rise (SLR) due to climate change in the future. In order to adapt to SLR, it is necessary to decide whether to retreat from vulnerable areas or to install dykes to protect them from inundation. Therefore, cost- analysis of adaptation using coastal dykes is one of the most essential issues in the context of climate change and its countermeasures. However, few studies have globally evaluated the future costs of adaptation in coastal areas. This study tries to globally analyze the cost of adaptation in coastal areas. First, global distributions of projected inundation impacts induced by SLR including astronomical high tide were assessed. Economic damage was estimated on the basis of the econometric relationship between past hydrological disasters, affected population, and per capita GDP using CRED's EM-DAT database. Second, the cost of adaptation was also determined using the cost database and future scenarios. The authors have built a cost database for installed coastal dykes worldwide and applied it to estimating the future cost of adaptation. The unit costs of dyke construction will increase with socio-economic scenario (SSP) such as per capita GDP. Length of vulnerable coastline is calculated by identifying inundation areas using ETOPO1. Future cost was obtained by multiplying the length of vulnerable coastline and the unit cost of dyke construction. Third, the effectiveness of dyke construction was estimated by comparing cases with and without adaptation.As a result, it was found that incremental adaptation cost is lower than economic damage in the cases of SSP1 and SSP3 under RCP scenario, while the cost of adaptation depends on the durability of the coastal dykes.

  17. Prevalence and cost of imaging in inpatient falls: the rising cost of falling

    Directory of Open Access Journals (Sweden)

    Fields J

    2015-06-01

    Full Text Available Jessica Fields,1 Tahani Alturkistani,2 Neal Kumar,3 Arjun Kanuri,3 Deeb N Salem,1 Samson Munn,2 Deborah Blazey-Martin1 1Department of Medicine, Tufts Medical Center, Boston, MA, USA; 2Department of Radiology, Tufts Medical Center, Boston, MA, USA; 3Tufts University School of Medicine, Boston, MA, USA Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. Design: Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. Setting: Four hundred and fifteen bed urban academic hospital over 3 years (2008–2010. Patients: All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. Measurements and main results: Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20–98. More than half of falls were men (55% and patients considered at risk of falls (56%. Falls were evenly distributed across morning (33%, evening (34%, and night (33% shifts. Of 530 falls, 178 (34% patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700 from head computed tomography (CT. Conclusion: Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward

  18. Mobile Offshore Base Operational Utility and Cost Study

    National Research Council Canada - National Science Library

    Greer, William

    2001-01-01

    .... This study responds to the portion of the National Defense Authorization Act for Fiscal Year 2001 that directs the Secretary of Defense to provide an analysis of the operational utility and life cycle costs of the MOB...

  19. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 forward. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  20. Reducing Operating Costs and Energy Consumption at Water Utilities

    Science.gov (United States)

    Due to their unique combination of high energy usage and potential for significant savings, utilities are turning to energy-efficient technologies to help save money. Learn about cost and energy saving technologies from this brochure.

  1. The Impact of Medicaid Peer Support Utilization on Cost

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in The Impact of Medicaid Peer Support Utilization on Cost, published in Volume 4, Issue 1 of the Medicare and Medicaid Research...

  2. Construction Costs Assessment of Structural Systems for Low-Rise and Social Welfare Housing

    Directory of Open Access Journals (Sweden)

    Carrillo Julián

    2015-09-01

    Full Text Available A comparative analysis of the costs related to the construction of low-rise, low-cost and social welfare housing was carried out. The study included three of the most commonly used structural systems for low-rise housing in Latin America, such as the traditional system of confined masonry walls, concrete walls conventionally reinforced with welded-wire meshes and concrete walls reinforced with steel fiber. The cost comparison was carried out by budgets analysis, which were performed based on construction quantities, unit prices and particular items for each structural system. It was found in the study that, from an economic point of view, the systems of concrete walls reinforced with welded-wire meshes or steel fibers are more advantageous than confined masonry systems. In addition, the integral comparison of the three structural systems demonstrates that the industrialized system of steel fiber reinforced concrete walls allows obtaining greater advantages of cleaning and sustainability, faster construction, lower cost and a more attractive scenario for builders investing in such projects.

  3. Preventable Complications Driving Rising Costs in Management of Patients with Critical Limb Ischemia.

    Science.gov (United States)

    Dua, Anahita; Desai, Sapan S; Patel, Bhavin; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian; Rossi, Peter J; Malinowski, Michael; Lee, Cheong J

    2016-05-01

    This study aimed to identify factors that drive increasing health-care costs associated with the management of critical limb ischemia in elective inpatients. Patients with a primary diagnosis code of critical limb ischemia (CLI) were identified from the 2001-2011 Nationwide Inpatient Sample. Demographics, CLI management, comorbidities, complications (bleeding, surgical site infection [SSI]), length of stay, and median in-hospital costs were reviewed. Statistical analysis was completed using Students' t-test and Mann-Kendall trend analysis. Costs are reported in 2011 US dollars corrected using the consumer price index. From 2001 to 2011, there were a total of 451,823 patients who underwent open elective revascularization as inpatients for CLI. Costs to treat CLI increased by 63% ($12,560 in 2001 to $20,517 in 2011, P cost of care. From 2001 to 2011, the number of patient comorbidities (7.56-12.40) and percentage of endovascular cases (13.4% to 27.4%) increased, accounting for a 6% annual increase in total cost despite decreased median length of stay (6 to 5 days). Patients who developed SSI had total costs 83% greater than patients without SSIs ($30,949 vs. $16,939; P costs 41% greater than nonbleeding patients ($23,779 vs. $16,821, P cost of CLI treatment is increasing and driven by rising endovascular use, SSI, and bleeding in the in-patient population. Further efforts to reduce complications in this patient population may contribute to a reduction in health care-associated costs of treating CLI. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. The utilization of activity-based cost accounting in hospitals.

    Science.gov (United States)

    Emmett, Dennis; Forget, Robert

    2005-01-01

    Healthcare costs are being examined on all fronts. Healthcare accounts for 11% of the gross national product and will continue to rise as the "babyboomers" reach retirement age. While ascertaining costs is important, most research shows that costing methods have not been implemented in hospitals. This study is concerned with the use of costing methods; particularly activity-based cost accounting. A mail survey of CFOs was undertaken to determine the type of cost accounting method they use. In addition, they were asked whether they were aware of activity-based cost accounting and whether they had implemented it or were planning to implement it. Only 71.8% were aware of it and only 4.7% had implemented it. In addition, only 52% of all hospitals report using any cost accounting systems. Education needs to ensure that all healthcare executives are cognizant of activity-based accounting and its importance in determining costs. Only by determining costs can hospitals strive to contain them.

  5. Concepts for reducing nuclear utility inventory carrying costs

    International Nuclear Information System (INIS)

    Graybill, R.E.; DiCola, F.E.; Solanas, C.H.

    1985-01-01

    Nuclear utilities are under pressure to reduce their operating and maintenance expenses such that the total cost of generating electricity through nuclear power remains an economically attractive option. One area in which expenses may be reduced is total inventory carrying cost. The total inventory carrying cost consists of financing an inventory, managing the inventory, assuring quality, engineering of acceptable parts specifications, and procuring initial and replenishment stock. Concepts and methodology must be developed to reduce the remaining expenses of a utility's total inventory carrying cost. Currently, two concepts exist: pooled inventory management system (PIMS), originally established by General Electric Company and a group of boiling water reactor owners, and Nuclear Parts Associates' (NUPA) shared inventory management program (SIMP). Both concepts share or pool parts and components among utilities. The SIMP program objectives and technical activities are summarized

  6. Our winters of discontent : addressing the problem of rising home heating costs

    International Nuclear Information System (INIS)

    Hughes, L.; Wysocki, A.

    2006-03-01

    The cost of space heating may soon increase due to rising fuel prices in international energy markets and the absence of federal and provincial energy security policies. This report examined the benefits and disadvantages of 2 approaches to assist those with limited incomes to meet heating requirements: (1) offering Low Income Fuel Assistance (LIFA) as a one-time payment during the heating season; and (2) the elimination of taxes for home heating fuels. The cost of home heating fuels and their impacts on consumers and governments were considered. A review of the Nova Scotia government's Keep the Heat program noted that the program was not responsive to increases in the price of home heating fuel, particularly if increases in a year exceeded the level of assistance. It was suggested that the removal of heating sales taxes could provide unnecessary windfalls to households with large homes, as well as windfall profits for landlords if savings were not passed on to tenants. Using Nova Scotia as a case study, an alternative support system was considered that guaranteed a set price for heating fuel for those in need. It was suggested that this approach could cost less than a lump-sum payment or the elimination of taxes on home-heating fuel. In addition, the approach would provide low-income consumers with predictable and affordable prices. It was concluded that as space heating energy costs continue to rise, all government fuel assistance programs run the risk of becoming larger and more costly. Other solutions included reducing Canada's dependence on fossil fuels through the use of solar energy; the reduction of residential energy demand; and the promotion of district heating. 26 refs., 9 tabs., 3 figs

  7. Controlling Campylobacter in the chicken meat chain - Cost-effectiveness and cost-utility analysis

    NARCIS (Netherlands)

    Mangen MJJ; Havelaar AH; Nauta MJ; Koeijer AA de; Wit GA de; LEI; Animal Sciences Group; PZO; MGB

    2005-01-01

    The aim of this study was the estimation of cost-effectiveness and cost-utility of various interventions to control Campylobacter contamination of broiler meat. The relative risk, the intervention costs, the disease burden (expressed in Disability Adjusted Live Years (DALYs)) and the

  8. The emergence of rural transport strategies in response to rising fuel costs

    International Nuclear Information System (INIS)

    Shapiro, Dana; Pearlmutter, David; Schwartz, Moshe

    2012-01-01

    Rising and sometimes volatile fuel prices pose a challenge for rural organizations reliant on long distance transport. To understand the coping mechanisms used by such organizations, we survey rural business strategies in Israel, where fuel prices are high and urban development is concentrated in the country's geographic center. The businesses surveyed are operated by kibbutzim, historically collective communities that are now in various stages of privatization. Analysis of the ‘transport strategies’ employed by nearly 100 organizations in three regions of varying remoteness and isolation shows that firms rely on distinct strategies such as localization and high value density. Localization was found to be prevalent in all regions, as it requires little capital investment. Strategies exploiting high value density, including information-based services, were prevalent in remote and isolated regions where sensitivity to transport costs is acute. Non-remote firms were less inclined toward strategic adaptation, preferring non-disruptive changes such as cheaper shipping modes. The development implications of these transport strategies are consistent with rural economic trends observed throughout the developed world. If transport costs continue to rise, rural firms may shrink the radius of their sales and labor pools, or search for more lucrative products to reduce their relative transport costs. - Highlights: ► We survey transport strategies used by rural businesses in Israeli kibbutzim. ► The seven distinct strategies identified include localization and value density. ► Localization is used in all regions and value density in remote and isolated regions. ► Development implications are consistent with economic trends in other rural regions. ► Rural firms will likely respond to high fuel costs by strategic transport adaptation.

  9. 20 CFR 404.272 - Indexes we use to measure the rise in the cost-of-living.

    Science.gov (United States)

    2010-04-01

    ... cost-of-living. 404.272 Section 404.272 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.272 Indexes we use to measure the rise in the cost-of-living. (a) The bases. To measure...

  10. Economic justification of costs at inspection of industrial safety of high-rise marine structures

    Science.gov (United States)

    Garibin, Pavel; Ol'khovik, Evgeniy; Rastorguev, Igor

    2018-03-01

    The task of technical and economic regulation within mutual international recognition of testing laboratories are considered. Codes and procedures within requirements of international ISO/IEC standards of a series 17000 for elimination of non-tariff barriers and interlaboratory exchange of experts in the field of high-rise marine construction are considered. In paper, the methods of assessment of formation of economically justified cost of works at inspection and monitoring of technical condition of high-rise marine wharf engineering port structure based on settlement and actual labor input were applied. For the countries of EU, data on the average cost of works of testing laboratory within a week have been taken as a basis. Such approach will be objective as considers only expenses on obligatory actions in the course of inspection of technical condition of port engineering constructions. The analysis of public results of financial activities of the accredited organizations allowed to calculate the main indicators of the size of necessary profit and overheads at observance of all requirements imposed to test laboratories including taking into account their future technical development. The offered practice corresponds to the general direction by mutual international recognition of independent testing laboratories and can be use in the future.

  11. Rising food costs & global food security: Key issues & relevance for India

    Science.gov (United States)

    Gustafson, Daniel J.

    2013-01-01

    Rising food costs can have major impact on vulnerable households, pushing those least able to cope further into poverty and hunger. On the other hand, provided appropriate policies and infrastructure are in place, higher agricultural prices can also raise farmers’ incomes and rural wages, improve rural economies and stimulate investment for longer-term economic growth. High food prices since 2007 have had both short-term impacts and long-term consequences, both good and bad. This article reviews the evidence of how rising costs have affected global food security since the food price crisis of 2007-2008, and their impact on different categories of households and countries. In light of recent studies, we know more about how households, and countries, cope or not with food price shocks but a number of contentious issues remain. These include the adequacy of current estimates and the interpretation of national and household food and nutrition security indicators. India is a particularly important country in this regard, given the high number of food insecure, the relative weight of India in global estimates of food and nutrition insecurity, and the puzzles that remain concerning the country's reported declining per capita calorie consumption. Competing explanations for what is behind it are not in agreement, but these all point to the importance of policy and programme innovation and greater investment necessary to reach the achievable goal of food and nutrition security for all. PMID:24135190

  12. Rising food costs & global food security: Key issues & relevance for India

    Directory of Open Access Journals (Sweden)

    Daniel J Gustafson

    2013-01-01

    Full Text Available Rising food costs can have major impact on vulnerable households, pushing those least able to cope further into poverty and hunger. On the other hand, provided appropriate policies and infrastructure are in place, higher agricultural prices can also raise farmers′ incomes and rural wages, improve rural economies and stimulate investment for longer-term economic growth. High food prices since 2007 have had both short-term impacts and long-term consequences, both good and bad. This article reviews the evidence of how rising costs have affected global food security since the food price crisis of 2007-2008, and their impact on different categories of households and countries. In light of recent studies, we know more about how households, and countries, cope or not with food price shocks but a number of contentious issues remain. These include the adequacy of current estimates and the interpretation of national and household food and nutrition security indicators. India is a particularly important country in this regard, given the high number of food insecure, the relative weight of India in global estimates of food and nutrition insecurity, and the puzzles that remain concerning the country′s reported declining per capita calorie consumption. Competing explanations for what is behind it are not in agreement, but these all point to the importance of policy and programme innovation and greater investment necessary to reach the achievable goal of food and nutrition security for all.

  13. Rising food costs & global food security: key issues & relevance for India.

    Science.gov (United States)

    Gustafson, Daniel J

    2013-09-01

    Rising food costs can have major impact on vulnerable households, pushing those least able to cope further into poverty and hunger. On the other hand, provided appropriate policies and infrastructure are in place, higher agricultural prices can also raise farmers' incomes and rural wages, improve rural economies and stimulate investment for longer-term economic growth. High food prices since 2007 have had both short-term impacts and long-term consequences, both good and bad. This article reviews the evidence of how rising costs have affected global food security since the food price crisis of 2007-2008, and their impact on different categories of households and countries. In light of recent studies, we know more about how households, and countries, cope or not with food price shocks but a number of contentious issues remain. These include the adequacy of current estimates and the interpretation of national and household food and nutrition security indicators. India is a particularly important country in this regard, given the high number of food insecure, the relative weight of India in global estimates of food and nutrition insecurity, and the puzzles that remain concerning the country's reported declining per capita calorie consumption. Competing explanations for what is behind it are not in agreement, but these all point to the importance of policy and programme innovation and greater investment necessary to reach the achievable goal of food and nutrition security for all.

  14. Benefit/cost comparisons for utility SMES applications

    International Nuclear Information System (INIS)

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

    1991-01-01

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

  15. Benefit/cost comparison for utility SMES applications

    Science.gov (United States)

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

    1991-08-01

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

  16. Efficiency and cost effectiveness of retrofitting ventilation in low-rise housing

    International Nuclear Information System (INIS)

    Bowser, D.; Fugler, D.

    2000-01-01

    Effective and inexpensive ventilation systems that can be retrofitted to existing low-rise housing to improve indoor air quality in existing housing stock is discussed. In a project by CMHC ten retrofit ventilation systems in single family residential buildings were tested in an effort to identify homes with specific indoor air quality concerns and to evaluate the performance of these retrofit systems by monitoring air quality before and after installation. Measurements were taken over a two-to-three day period with normal occupancy. In one case radon contamination was also measured directly before and after the retrofit. Cost estimates were based on capital, operating and maintenance expenses. This paper describes the results of three sample case studies. One of these involved a home with high concentration of radon gas. The recommended solution was fan-assisted removal of soil gases as the only way to ensure substantial reductions in concentration. Cost of the system was $2,450, plus $79 annual operating expenses. The second case involved a basement apartment with odour and moisture build-up. To solve the problem, an exhaust-only ventilation system with multiple pick-up points was installed at a cost of $750. Annual operating costs are estimated at $171. The third case study described a dwelling with windows and exhaust ducts showing condensation and mold on the bathroom ceiling. Balanced mechanical ventilation via an HRV was installed to exhaust the moist air from the house and to supply fresh dry air. In this case cost of the system was $1,345 installed, plus annual operating costs of $117. It was stressed that different houses have different requirements. Therefore it is important to be fully aware of the amount of natural ventilation a house has, prior to determining whether the solution demands additional ventilation requirements or simply redistribution. 1 ref., 3 figs

  17. Rising labor costs, earnings management, and financial performance of health care providers around the world.

    Science.gov (United States)

    Dong, Gang Nathan

    2015-01-01

    Amid increasing interest in how government regulation and market competition affect the cost and financial sustainability in health care sector, it remains unclear whether health care providers behave similarly to their counterparts in other industries. The goal of this chapter is to study the degree to which health care providers manipulate accruals in periods of financial difficulties caused, in part, by the rising costs of labor. We collected the financial information of health care provider in 43 countries from 1984 to 2013 and conducted a pooled cross-sectional study with country and year fixed-effects. The empirical evidence shows that health care providers with higher wage costs are more likely to smooth their earnings in order to maintain financial sustainability. The finding of this study not only informs regulators that earnings management is pervasive in health care organizations around the world, but also contributes to the studies of financial booktax reporting alignment, given the existing empirical evidence linking earnings management to corporate tax avoidance in this very sector.

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-07-14

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

  19. The Quality of Cost-Utility Analyses in Orthopedic Trauma.

    Science.gov (United States)

    Nwachukwu, Benedict U; Schairer, William W; O'Dea, Evan; McCormick, Frank; Lane, Joseph M

    2015-08-01

    As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma. Copyright 2015, SLACK Incorporated.

  20. Marginal ambulatory teaching cost under varying levels of service utilization.

    Science.gov (United States)

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

    1980-06-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-06-14

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

  2. Incentive-Based Primary Care: Cost and Utilization Analysis.

    Science.gov (United States)

    Hollander, Marcus J; Kadlec, Helena

    2015-01-01

    In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

  3. $35 billion habit: will nuclear cost overruns bankrupt the utilities

    International Nuclear Information System (INIS)

    Morgan, R.E.

    1980-01-01

    The Nuclear Regulatory Commission (NRC) has proposed some 150 modifications in the design and operation of nuclear power plants as a result of the accident at Three Mile Island. The Atomic Industrial Forum estimates the total cost of the NRC's proposed rule changes at $35.5 billion ($3.5 billion in capital costs for the entire industry, and $32 billion in outage and construction-delay costs to the utilities) for existing facilities and for those with construction well underway. The changes range from improved training for reactor workers to a major overhaul of the reactor-containment design. The nuclear industry is asking the NRC to modify the proposals citing excessive costs (like the $100 million changes needed for a plant that cost $17 million to build) and safety (some of the complex regulations may interfere with safety). Financing the changes has become a major problem for the utilities. If the regulators allow all the costs to be passed along to the consumer, the author feels electricity will be too expensive for the consumer

  4. Distributed utility technology cost, performance, and environmental characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Y; Adelman, S

    1995-06-01

    Distributed Utility (DU) is an emerging concept in which modular generation and storage technologies sited near customer loads in distribution systems and specifically targeted demand-side management programs are used to supplement conventional central station generation plants to meet customer energy service needs. Research has shown that implementation of the DU concept could provide substantial benefits to utilities. This report summarizes the cost, performance, and environmental and siting characteristics of existing and emerging modular generation and storage technologies that are applicable under the DU concept. It is intended to be a practical reference guide for utility planners and engineers seeking information on DU technology options. This work was funded by the Office of Utility Technologies of the US Department of Energy.

  5. Formation of costs of high-rise objects of housing and civil purpose based on enlarged norms

    Science.gov (United States)

    Vorotyntseva, Anna; Ovsiannikov, Andrei; Bolgov, Vladimir

    2018-03-01

    When determining the cost of capital construction objects, for purposes of pre-design workings out and purposes of initial maximum initial price determination on tenders, construction price norms are used (CPNs). Modern CPNs are not designed to determine the value of high-rise buildings. It is necessary to adapt modern CPNs to get opportunity for the possibility to take into account special cost factors in determining the cost of high-rise buildings. The main ways can be: selection of new representative objects or application of additional correction factors.

  6. Utility loss and indirect costs after stroke in Sweden.

    Science.gov (United States)

    Lindgren, Peter; Glader, Eva-Lotta; Jönsson, Bengt

    2008-04-01

    Currently little data exist on the development of quality of life over time in patients suffering from stroke, in particular using instruments that can be adapted in economic studies. The purpose of the study was to assess the utility loss and indirect costs following a stroke in Sweden. A cross-sectional mail survey. In collaboration with the National Stroke registry (RIKS-STROKE), a questionnaire consisting of the EuroQol-5D and questions regarding the present working status and the status prior to the stroke was mailed to patients below 76 years of age at six participating centres. The questionnaire was mailed to 393 patients in total, divided into groups with 3, 6, 9 or 12 months having passed since the stroke. The EuroQol-5D scores were converted to utility scores using the UK social tariff. Indirect costs were valued according to the average salary+employer contributions. A total of 275 questionnaires (70%) were returned. Utility scores were similar over time: 0.65, 0.75, 0.63, and 0.67 at 3, 6, 9 and 12 months, respectively. Regression analyses revealed a tendency for lower utility scores among women, but no significant differences overall. Among patients in the working ages, a stroke caused 18.5 work weeks lost, corresponding to an indirect cost of 120,000 Swedish Kronor (SEK) (13,200euro, 95% confidence interval 82,541-160,050 SEK, 9080-17 605euro). Stroke causes a significant reduction in utility and causes high indirect costs. A substantial improvement was not noted over time, which is important to consider in economic models.

  7. The rise of low-cost sensing for managing air pollution in cities.

    Science.gov (United States)

    Kumar, Prashant; Morawska, Lidia; Martani, Claudio; Biskos, George; Neophytou, Marina; Di Sabatino, Silvana; Bell, Margaret; Norford, Leslie; Britter, Rex

    2015-02-01

    Ever growing populations in cities are associated with a major increase in road vehicles and air pollution. The overall high levels of urban air pollution have been shown to be of a significant risk to city dwellers. However, the impacts of very high but temporally and spatially restricted pollution, and thus exposure, are still poorly understood. Conventional approaches to air quality monitoring are based on networks of static and sparse measurement stations. However, these are prohibitively expensive to capture tempo-spatial heterogeneity and identify pollution hotspots, which is required for the development of robust real-time strategies for exposure control. Current progress in developing low-cost micro-scale sensing technology is radically changing the conventional approach to allow real-time information in a capillary form. But the question remains whether there is value in the less accurate data they generate. This article illustrates the drivers behind current rises in the use of low-cost sensors for air pollution management in cities, while addressing the major challenges for their effective implementation. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Angevine, Peter D; Berven, Sigurd

    2014-10-15

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

  9. Cost-Utility Analysis of a Cardiac Telerehabilitation Program

    DEFF Research Database (Denmark)

    Kidholm, Kristian; Rasmussen, Maja Kjær; Andreasen, Jan Jesper

    2016-01-01

    Background: Cardiac rehabilitation can reduce mortality of patients with cardiovascular disease, but a frequently low participation rate in rehabilitation programs has been found globally. The objective of the Teledialog study was to assess the cost-utility (CU) of a cardiac telerehabilitation (CTR...... was higher in the intervention group, but the difference was not statistically significant. The incremental CU ratio was more than (sic)400,000 per QALY gained. Conclusions: Even though the rehabilitation activities increased, the program does not appear to be cost-effective. The intervention itself...

  10. Cost and quality of fuels for electric utility plants 1991

    International Nuclear Information System (INIS)

    1992-01-01

    Data for 1991 and 1990 receipts and costs for fossil fuels discussed in the Executive Summary are displayed in Tables ES1 through ES7. These data are for electric generating plants with a total steam-electric and combined-cycle nameplate capacity of 50 or more megawatts. Data presented in the Executive Summary on generation, consumption, and stocks of fossil fuels at electric utilities are based on data collected on the Energy Information Administration, Form EIA-759, ''Monthly Power Plant Report.'' These data cover all electric generating plants. The average delivered cost of coal, petroleum, and gas each decreased in 1991 from 1990 levels. Overall, the average annual cost of fossil fuels delivered to electric utilities in 1991 was $1.60 per million Btu, a decrease of $0.09 per million Btu from 1990. This was the lowest average annual cost since 1978 and was the result of the abundant supply of coal, petroleum, and gas available to electric utilities. US net generation of electricity by all electric utilities in 1991 increased by less than I percent--the smallest increase since the decline that occurred in 1982.3 Coal and gas-fired steam net generation, each, decreased by less than I percent and petroleum-fired steam net generation by nearly 5 percent. Nuclear-powered net generation, however, increased by 6 percent. Fossil fuels accounted for 68 percent of all generation; nuclear, 22 percent; and hydroelectric, 10 percent. Sales of electricity to ultimate consumers in 1991 were 2 percent higher than during 1990

  11. A municipal guide to least cost utility planning

    International Nuclear Information System (INIS)

    1992-03-01

    The recent track record of ''traditional'' electricity planning, which entails selection of supply side resources to meet forecasted demand, has not been good. There are numerous examples of utilities incorrectly forecasting demand and over-building generating capacity while others underestimated growth and have had to cut demand and find alternate power sources to avoid outages. A potential solution to this problem is the continuing development of Least Cost Utility Plannning (LCUP). Regulatory commissions, consumer advocates and utilities are increasingly relying an LCUP as the most responsible way to avoid construction of new capacity and alleviate anticipated shortages caused by cancellation of construction projects, load growth, or natural replacement of aging capacity. The purpose of this report is to provide municipalities a starting point for evaluating their servicing utilities or states' least cost plan. This was accomplished by: Identifying key issues in LCUP; reviewing examples of the collaborative and classic approaches to LCUP in Illinois, California, New York State and Michigan; cataloging municipal authorities and strategies which can influence or support LCUP activities. Results of the project indicate that through a basic understanding of LCUP processes and issues, municipalities will be in a better position to influence plans or, if necessary, intervene in regulatory proceedings where plans are adopted. Constraints to municipal involvement in LCUP include statutory limitations, resource constraints, and a lack of knowledge of indirect authorities that support the LCUP process

  12. A municipal guide to least cost utility planning

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    The recent track record of ``traditional`` electricity planning, which entails selection of supply side resources to meet forecasted demand, has not been good. There are numerous examples of utilities incorrectly forecasting demand and over-building generating capacity while others underestimated growth and have had to cut demand and find alternate power sources to avoid outages. A potential solution to this problem is the continuing development of Least Cost Utility Plannning (LCUP). Regulatory commissions, consumer advocates and utilities are increasingly relying an LCUP as the most responsible way to avoid construction of new capacity and alleviate anticipated shortages caused by cancellation of construction projects, load growth, or natural replacement of aging capacity. The purpose of this report is to provide municipalities a starting point for evaluating their servicing utilities or states` least cost plan. This was accomplished by: Identifying key issues in LCUP; reviewing examples of the collaborative and classic approaches to LCUP in Illinois, California, New York State and Michigan; cataloging municipal authorities and strategies which can influence or support LCUP activities. Results of the project indicate that through a basic understanding of LCUP processes and issues, municipalities will be in a better position to influence plans or, if necessary, intervene in regulatory proceedings where plans are adopted. Constraints to municipal involvement in LCUP include statutory limitations, resource constraints, and a lack of knowledge of indirect authorities that support the LCUP process.

  13. A municipal guide to least cost utility planning

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    The recent track record of traditional'' electricity planning, which entails selection of supply side resources to meet forecasted demand, has not been good. There are numerous examples of utilities incorrectly forecasting demand and over-building generating capacity while others underestimated growth and have had to cut demand and find alternate power sources to avoid outages. A potential solution to this problem is the continuing development of Least Cost Utility Plannning (LCUP). Regulatory commissions, consumer advocates and utilities are increasingly relying an LCUP as the most responsible way to avoid construction of new capacity and alleviate anticipated shortages caused by cancellation of construction projects, load growth, or natural replacement of aging capacity. The purpose of this report is to provide municipalities a starting point for evaluating their servicing utilities or states' least cost plan. This was accomplished by: Identifying key issues in LCUP; reviewing examples of the collaborative and classic approaches to LCUP in Illinois, California, New York State and Michigan; cataloging municipal authorities and strategies which can influence or support LCUP activities. Results of the project indicate that through a basic understanding of LCUP processes and issues, municipalities will be in a better position to influence plans or, if necessary, intervene in regulatory proceedings where plans are adopted. Constraints to municipal involvement in LCUP include statutory limitations, resource constraints, and a lack of knowledge of indirect authorities that support the LCUP process.

  14. 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.

  15. Investigation on the Factors Influencing Construction Time and Cost Overrun for High-Rise Building Projects In Penang

    Science.gov (United States)

    Nor Haslinda, A.; Xian, T. Wei; Norfarahayu, K.; Muhamad Hanafi, R.; Fikri, H. Muhammad

    2018-04-01

    Time and cost overruns have become one prominent issue for most construction projects around the world. Project costing and timeframe extension had been causing a lot of wastage and loss of opportunity for many parties involved. Therefore, this research was carried out to investigate the factors influencing time and cost overruns for high-rise construction projects in Penang, Malaysia. A set of questionnaires survey was distributed to the project managers who had been or currently involved in the high-rise building projects in Penang to get their input and perceptions for each factor identified as well as its frequency of occurrence. In order to rank all the factors gathered, the mean index of the most distinguishing factors and its frequency of occurrence were multiplied to get the severity index. The results revealed that for time overrun, the most predominant causes were due to design changes, inadequate planning and scheduling and poor labor productivity. Meanwhile, the predominant causes of cost overrun were poor pre-construction budget and material cost planning, inaccurate quantity take-off and materials cost increased by inflation. The significance of establishing the issues related to time and cost overruns for the high-rise building construction project is to provide a greater insight and understanding on the causes of delays, particularly among the main project players: contractors, client, and consultants.

  16. Links between social environment and health care utilization and costs.

    Science.gov (United States)

    Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A

    2018-01-01

    The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

  17. Tweedie distributions for fitting semicontinuous health care utilization cost data

    Directory of Open Access Journals (Sweden)

    Christoph F. Kurz

    2017-12-01

    Full Text Available Abstract Background The statistical analysis of health care cost data is often problematic because these data are usually non-negative, right-skewed and have excess zeros for non-users. This prevents the use of linear models based on the Gaussian or Gamma distribution. A common way to counter this is the use of Two-part or Tobit models, which makes interpretation of the results more difficult. In this study, I explore a statistical distribution from the Tweedie family of distributions that can simultaneously model the probability of zero outcome, i.e. of being a non-user of health care utilization and continuous costs for users. Methods I assess the usefulness of the Tweedie model in a Monte Carlo simulation study that addresses two common situations of low and high correlation of the users and the non-users of health care utilization. Furthermore, I compare the Tweedie model with several other models using a real data set from the RAND health insurance experiment. Results I show that the Tweedie distribution fits cost data very well and provides better fit, especially when the number of non-users is low and the correlation between users and non-users is high. Conclusion The Tweedie distribution provides an interesting solution to many statistical problems in health economic analyses.

  18. Health care utilization, costs, and readmission rates associated with hyponatremia.

    Science.gov (United States)

    Deitelzweig, Steven; Amin, Alpesh; Christian, Rudell; Friend, Keith; Lin, Jay; Lowe, Timothy J

    2013-02-01

    Hyponatremia is associated with higher morbidity and mortality rates among hospitalized patients. Our study evaluated health care utilization and associated costs of patients hospitalized with a primary diagnosis of hyponatremia. Hospitalized patients with a primary discharge diagnosis of hyponatremia (aged ≥ 18 years) were identified from the Premier Perspective™ database (January 1, 2007-March 31, 2010) and matched to non-hyponatremic (non-HN) patients using a combination of exact patient characteristic matching and propensity score matching. Univariate and multivariate statistics were used to compare hospital resource usage, costs, and 30-day readmission rates between cohorts. Hospital length of stay (LOS) (± standard deviation) (3.78 ± 3.19 vs 3.54 ± 3.26 days; P ratio, 1.89, confidence limits, 1.72, 2.07; P ratio, 4.76; confidence limits, 4.31, 5.26; P profitability due to the increased likelihood of 30-day readmission.

  19. Cost utility analysis of diagnostic method of syphilis

    Directory of Open Access Journals (Sweden)

    Viroj Wiwanitkit

    2008-04-01

    Full Text Available Presently, the diagnosis of syphilis is dependent mainly on serological tests. The most widely used screening tests for syphilis are the VDRL and the rapid plasma reagin (RPR and for confirmation, the fluorescent treponemal antibody (FTA and the treponema pallidum hemagglutination (TPHA tests. The four alternative modes for diagnosis of syphilis can be a VDRL + FTA, b VDRL + TPHA, c RPR + FTA and d RPR + TPHA. Here the author reports an evaluation of cost utility of these tests in medical practice. It is shown that the cost per accurate diagnosis with VDRL + TPH is the least expensive choice. Therefore, this alternative is the best method for serological diagnosis for syphilis, based on medical laboratory economics principles

  20. Value-based insurance design: benefits beyond cost and utilization.

    Science.gov (United States)

    Gibson, Teresa B; Maclean, Ross J; Chernew, Michael E; Fendrick, A Mark; Baigel, Colin

    2015-01-01

    As value-based insurance design (VBID) programs proliferate, evidence is emerging on the impact of VBID. To date, studies have largely measured VBID impact on utilization, and a few studies have assessed its impact on quality, outcomes, and cost. In this commentary we discuss these domains, summarize evidence, and propose the extension of measurement of VBID impact into areas including workplace productivity and quality of life, employee and patient engagement, and talent attraction and retention. We contend that VBID evaluations should consider a broad variety of programmatic dividends on both humanistic and health-related outcomes.

  1. Healthcare utilization and costs for patients initiating Dabigatran or Warfarin.

    Science.gov (United States)

    Reynolds, Shannon L; Ghate, Sameer R; Sheer, Richard; Gandhi, Pranav K; Moretz, Chad; Wang, Cheng; Sander, Stephen; Costantino, Mary E; Annavarapu, Srinivas; Andrews, George

    2017-06-21

    Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population. A retrospective matched-cohort study was conducted using data from administrative health care claims during the study period 01/01/2010-12/31/2012. Cox regression analyses were used to compare all-cause risk of first hospitalizations and emergency room (ER) visits. Medical, pharmacy, and total costs per-patient-per-month (PPPM) were compared between dabigatran and warfarin users. A total of 1110 patients initiated on dabigatran were propensity score-matched with corresponding patients initiated on warfarin. The mean number of hospitalizations (0.92 vs. 1.13, P = 0.012), ER visits (1.32 vs. 1.56, P warfarin users. Patients initiated on dabigatran had significantly lower risk of first all-cause ER visits [hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.73-0.98] compared to those initiated on warfarin. Adjusted mean pharmacy costs PPPM were significantly greater for dabigatran users ($510 vs. $250, P warfarin users. Dabigatran users had significantly lower HCRU compared to warfarin users. In addition, dabigatran users had lower risk of all-cause ER visits. Despite higher pharmacy costs, the two cohorts did not differ significantly in medical or total all-cause costs.

  2. Retail clinic utilization associated with lower total cost of care.

    Science.gov (United States)

    Sussman, Andrew; Dunham, Lisette; Snower, Kristen; Hu, Min; Matlin, Olga S; Shrank, William H; Choudhry, Niteesh K; Brennan, Troyen

    2013-04-01

    To better understand the impact of retail clinic use on a patient's annual total cost of care. A propensity score matched-pair, cohort design was used to analyze healthcare spending patterns among CVS Caremark employees in the year following a visit to a MinuteClinic, the retail clinics inside CVS pharmacies. De-identified medical and pharmacy claims for CVS Caremark employees and their dependents who received care at a retail clinic between June 1, 2009, and May 31, 2010, were matched to those of subjects who received care elsewhere. High-dimensional propensity score and greedy matching techniques were used to create a 1-to-1 matched cohort that was analyzed using generalized linear regression models. Individuals using a retail clinic had a lower total cost of care (-$262; 95% confidence interval, -$510 to -$31; P = .025) in the year following their clinic visit than individuals who received care in other settings. This savings was primarily due to lower medical expenses at physicians' offices ($77 savings, P = .008) and hospital inpatient care ($121 savings, P = .049). The 6022 retail clinic users also had 142 (12%) fewer emergency department visits (P = .01), though this was not related to significant cost savings. This study found that retail clinic use was associated with lower overall total cost of care compared with that at alternative sites. Savings may extend beyond the retail clinic visit itself to other types of medical utilization.

  3. The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

    NARCIS (Netherlands)

    Mazairac, A.H.; Blankestijn, P.J.; Grooteman, M.P.C.; Penne, E.L.; Weerd, N.C. van der; Hoedt, C.H. den; Buskens, E.; Dorpel, M.A. van den; Wee, P.M. ter; Nube, M.J.; Bots, M.L.; Wit, G.A. de; Hamersvelt, H.W. van; et al.,

    2013-01-01

    BACKGROUND: Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). METHODS: A cost-utility analysis was performed using a

  4. The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

    NARCIS (Netherlands)

    Mazairac, Albert H. A.; Blankestijn, Peter J.; Grooteman, Muriel P. C.; Penne, E. Lars; van der Weerd, Neelke C.; den Hoedt, Claire H.; Buskens, Erik; van den Dorpel, Marinus A.; ter Wee, Piet M.; Nube, Menso J.; Bots, Michiel L.; de Wit, G. Ardine

    Background. Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). Methods. A cost-utility analysis was performed using a

  5. Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

    Science.gov (United States)

    Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

    2015-07-15

    replacement is preferred over ankle fusion; total ankle replacement is cost-saving when indirect costs are considered and demonstrates increasing cost-effectiveness in younger patients. As indications for and utilization of total ankle replacement increase, continued research is needed to define appropriate subgroups of patients who would likely derive the greatest clinical benefit from that procedure. Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  6. Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

    Directory of Open Access Journals (Sweden)

    Julide Oner

    Full Text Available The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

  7. Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

    Science.gov (United States)

    Oner, Julide; Sengoz, Burak

    2015-01-01

    The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing) at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

  8. Cost effectiveness of drug eluting coronary artery stenting in a UK setting: cost-utility study.

    Science.gov (United States)

    Bagust, A; Grayson, A D; Palmer, N D; Perry, R A; Walley, T

    2006-01-01

    To assess the cost effectiveness of drug eluting stents (DES) compared with conventional stents for treatment of symptomatic coronary artery disease in the UK. Cost-utility analysis of audit based patient subgroups by means of a simple economic model. Tertiary care. 12 month audit data for 2884 patients receiving percutaneous coronary intervention with stenting at the Cardiothoracic Centre Liverpool between January 2000 and December 2002. Risk of repeat revascularisation within 12 months of index procedure and reduction in risk from use of DES. Economic modelling was used to estimate the cost-utility ratio and threshold price premium. Four factors were identified for patients undergoing elective surgery (n = 1951) and two for non-elective surgery (n = 933) to predict risk of repeat revascularisation within 12 months. Most patients fell within the subgroup with lowest risk (57% of the elective surgery group with 5.6% risk and 91% of the non-elective surgery group with 9.9% risk). Modelled cost-utility ratios were acceptable for only one group of high risk patients undergoing non-elective surgery (only one patient in audit data). Restricting the number of DES for each patient improved results marginally: 4% of stents could then be drug eluting on economic grounds. The threshold price premium justifying 90% substitution of conventional stents was estimated to be 112 pound sterling (212 USD, 162 pound sterling) (sirolimus stents) or 89 pound sterling (167 USD, 130 pound sterling) (paclitaxel stents). At current UK prices, DES are not cost effective compared with conventional stents except for a small minority of patients. Although the technology is clearly effective, general substitution is not justified unless the price premium falls substantially.

  9. Health Care Utilization and Costs Associated with Pediatric Chronic Pain.

    Science.gov (United States)

    Tumin, Dmitry; Drees, David; Miller, Rebecca; Wrona, Sharon; Hayes, Don; Tobias, Joseph D; Bhalla, Tarun

    2018-03-30

    The population prevalence of pediatric chronic pain is not well characterized, in part due to lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0-17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. On multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (OR=2.01, 95% CI: 1.62, 2.47; pcomplementary and alternative medicine (OR=2.32, 95% CI: 1.79, 3.03; pchronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. Copyright © 2018. Published by Elsevier Inc.

  10. The Rise and Fall in Out-of-Pocket Costs in Australia: An Analysis of the Strengthening Medicare Reforms.

    Science.gov (United States)

    Wong, Chun Yee; Greene, Jessica; Dolja-Gore, Xenia; van Gool, Kees

    2017-08-01

    After a period of steady decline, out-of-pocket (OOP) costs for general practitioner (GP) consultations in Australia began increasing in the mid-1990s. Following the rising community concerns about the increasing costs, the Australian Government introduced the Strengthening Medicare reforms in 2004 and 2005, which included a targeted incentive for GPs to charge zero OOP costs for consultations provided to children and concession cardholders (older adults and the poor), as well as an increase in the reimbursement for all GP visits. This paper examines the impact of those reforms using longitudinal survey and administrative data from a large national sample of women. The findings suggest that the reforms were effective in reducing OOP costs by an average of $A0.40 per visit. Decreases in OOP costs, however, were not evenly distributed. Those with higher pre-reform OOP costs had the biggest reductions in OOP costs, as did those with concession cards. However, results also reveal increases in OOP costs for most people without a concession card. The analysis suggests that there has been considerable heterogeneity in GP responses to the reforms, which has led to substantial changes in the fees charged by doctors and, as a result, the OOP costs incurred by different population groups. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  11. An Enterprise Model of Rising Ship Costs: Loss of Learning Due to Time between Ships and Labor Force Instability

    OpenAIRE

    Summerville, Jessica R.; Cullis, Bethia L.; Druker, Eric R.; Rutledge, Gabriel B.; Braxton, Peter J.; Coleman, Richard L.

    2007-01-01

    Proceedings Paper (for Acquisition Research Program) Since the end of the Cold War, the perceived need for Navy ships has dropped, and so the shipbuilding budget has dropped. Seemingly coincidental with this budgetary pressure, and perversely aggravating the problem, ship costs began to rise steeply. We will set aside that ships have grown in weight by about three percent per year since World War II and that ever-more weapon systems are being put into them, and confine ourselves to discu...

  12. Nisin Production Utilizing Skimmed Milk Aiming to Reduce Process Cost

    Science.gov (United States)

    Jozala, Angela Faustino; de Andrade, Maura Sayuri; de Arauz, Luciana Juncioni; Pessoa, Adalberto; Penna, Thereza Christina Vessoni

    Nisin is a natural additive for conservation of food, pharmaceutical, and dental products and can be used as a therapeutic agent. Nisin inhibits the outgrowth of spores, the growth of a variety of Gram-positive and Gram-negative bacteria. This study was performed to optimize large-scale nisin production in skimmed milk and subproducts aiming at low-costs process and stimulating its utilization. Lactococcus lactis American Type Culture Collection (ATCC) 11454 was developed in a rotary shaker (30°C/36 h/100 rpm) in diluted skimmed milk and nisin activity, growth parameters, and media components were also studied. Nisin activity in growth media was expressed in arbitrary units (AU/mL) and converted to standard nisin concentration (Nisaplin®, 25 mg of pure nisin is 1.0×106 AU/mL). Nisin activity in skimmed milk 2.27 gtotal solids was up to threefold higher than transfers in skimmed milk 4.54 gtotal solids and was up to 85-fold higher than transfers in skimmed milk 1.14 gtotal solids. L. lactis was assayed in a New Brunswick fermentor with 1.5 L of diluted skimmed milk (2.27 gtotal solids) and airflow of 1.5 mL/min (30°C/36/200 rpm), without pH control. In this condition nisin activity was observed after 4 h (45.07 AU/mL) and in the end of 36 h process (3312.07 AU/mL). This work shows the utilization of a low-cost growth medium (diluted skimmed milk) to nisin production with wide applications. Furthermore, milk subproducts (milk whey) can be exploited in nisin production, because in Brazil 50% of milk whey is disposed with no treatment in rivers and because of high organic matter concentrations it is considered an important pollutant. In this particular case an optimized production of an antimicrobial would be lined up with industrial disposal recycling.

  13. Let the bleeding begin: rising costs are starting to crush oilpatch profits

    International Nuclear Information System (INIS)

    Koch, G.

    1997-01-01

    Reasons for the increase in the cost and decrease in profits in the oil industry were investigated. The most likely cause for the cost increase and hence the diminishing profit margin, was identified as a simple supply and demand increase in the cost of exploration and drilling: seismic crews, drilling rigs, well servicing and labour have all increased by an average of some 10 per cent as a result of the heavy demand for these services to support the growth that companies seek. Concentrated ownership in the drilling sector is partially to blame. A severe shortage of skilled labour, and an increase in land prices are some of the other possible causes. While some industry observers expect the worst, others are confident that gradually falling profits will prompt a market correction. The tightening of investment capital will slow down rates of drilling and land acquisition, gradually easing prices downward. Volume contracting ahead of time, booking seismic crews and rigs for an entire season at a fixed cost, and technological improvements also offer hope of forcing costs down. Heavy investment by industry majors in new oilsands and heavy oil developments is yet another promise of maintaining profit margins in the oil patch while reducing the industry''s reliance on conventional light crude

  14. Cost-effectiveness and cost utility of community screening for glaucoma in urban India.

    Science.gov (United States)

    John, Denny; Parikh, Rajul

    2017-07-01

    Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding

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

    Science.gov (United States)

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

    2018-04-12

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

  16. Colleges Struggle to Dispose of Hazardous Wastes in Face of Rising Costs and Increased Regulation.

    Science.gov (United States)

    Magner, Denise K.

    1989-01-01

    After years of being ignored by federal regulators because of the low volume of hazardous waste in question, colleges and universities are facing increased enforcement of environmental laws concerning waste disposal and storage, at great cost in money, facilities, and personnel. (MSE)

  17. The cost-utility of sodium oxybate as narcolepsy treatment

    DEFF Research Database (Denmark)

    Bolin, K; Berling, P; Wasling, P

    2017-01-01

    cost per additional QALY for the sodium oxybate treatment alternative compared with standard treatment was estimated above the informal Swedish willingness-to-pay threshold (SEK 500,000). The estimated cost per additional QALY obtained here is likely to overestimate the true cost-effectiveness ratio......AIMS AND OBJECTIVES: Based on class-I studies, sodium oxybate is regarded as a first-line treatment for both EDS and cataplexy. The cost-effectiveness of sodium oxybate is largely unknown, though. In this study, we estimate the cost-effectiveness of sodium oxybate as treatment for patients...... with narcolepsy as compared to standard treatment, by calculating incremental cost-effectiveness ratios (cost per quality-adjusted life year, QALY) for patients in a Swedish setting. MATERIALS AND METHODS: Calculations were performed using a Markov model with a 10-year time horizon. The study population consisted...

  18. Identifying critical success factors (CSFs) of Facilities Management (FM) in non-low cost high-rise residential buildings

    Science.gov (United States)

    Dahlan, F. M.; Zainuddin, A.

    2018-02-01

    Critical success factors (CSFs) are important key areas of activity that must be performed well in any Facilities Management (FM) organisation to achieve its missions, objectives or goals. Before implementing CSFs, an FM organisation must identify the key areas where things must be done properly to enable the business to flourish. Although many performance measurements in FM organisation have been discussed in previous research, not much research has been done on CSFs from the perspective of FM business in non-low cost high-rise residential buildings. The purpose of this study is to develop a methodology in developing the CSFs group and CSFs for FM organisation in non-low cost residential buildings. This research will involve three (3) phases of research strategy to achieve the objective of this research.

  19. 5 CFR 591.220 - How does OPM calculate energy utility cost indexes?

    Science.gov (United States)

    2010-01-01

    ... cost indexes? 591.220 Section 591.220 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS Cost-of-Living Allowance and Post Differential-Nonforeign Areas Cost-Of-Living Allowances § 591.220 How does OPM calculate energy utility cost indexes? (a) OPM...

  20. 18 CFR 141.100 - Original cost statement of utility property.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Original cost statement... POLICIES ACT OF 1978 STATEMENTS AND REPORTS (SCHEDULES) § 141.100 Original cost statement of utility... predecessors of an electric operating unit or system, the original cost, estimated, if not known, the cost of...

  1. Methods of determining incremental energy costs for economic dispatch and inter-utility interchange in Canadian utilities

    International Nuclear Information System (INIS)

    El-Hawary, M.E.; El-Hawary, F.; Mbamalu, G.A.N.

    1991-01-01

    A questionnaire was mailed to ten Canadian utilities to determine the methods the utilities use in determining the incremental cost of delivering energy at any time. The questionnaire was divided into three parts: generation, transmission and general. The generation section dealt with heat rates, fuel, operation and maintenance, startup and shutdown, and method of prioritizing and economic evaluation of interchange transactions. Transmission dealt with inclusion of transmission system incremental maintenance costs, and transmission losses determination. The general section dealt with incremental costs aspects, and various other economic considerations. A summary is presented of responses to the questionnaire

  2. A framework and review of customer outage costs: Integration and analysis of electric utility outage cost surveys

    Energy Technology Data Exchange (ETDEWEB)

    Lawton, Leora; Sullivan, Michael; Van Liere, Kent; Katz, Aaron; Eto, Joseph

    2003-11-01

    A clear understanding of the monetary value that customers place on reliability and the factors that give rise to higher and lower values is an essential tool in determining investment in the grid. The recent National Transmission Grid Study recognizes the need for this information as one of growing importance for both public and private decision makers. In response, the U.S. Department of Energy has undertaken this study, as a first step toward addressing the current absence of consistent data needed to support better estimates of the economic value of electricity reliability. Twenty-four studies, conducted by eight electric utilities between 1989 and 2002 representing residential and commercial/industrial (small, medium and large) customer groups, were chosen for analysis. The studies cover virtually all of the Southeast, most of the western United States, including California, rural Washington and Oregon, and the Midwest south and east of Chicago. All variables were standardized to a consistent metric and dollar amounts were adjusted to the 2002 CPI. The data were then incorporated into a meta-database in which each outage scenario (e.g., the lost of electric service for one hour on a weekday summer afternoon) is treated as an independent case or record both to permit comparisons between outage characteristics and to increase the statistical power of analysis results. Unadjusted average outage costs and Tobit models that estimate customer damage functions are presented. The customer damage functions express customer outage costs for a given outage scenario and customer class as a function of location, time of day, consumption, and business type. One can use the damage functions to calculate outage costs for specific customer types. For example, using the customer damage functions, the cost experienced by an ''average'' customer resulting from a 1 hour summer afternoon outage is estimated to be approximately $3 for a residential customer, $1

  3. The Cost and Utility of Renal Transplantation in Malaysia.

    Science.gov (United States)

    Bavanandan, Sunita; Yap, Yok-Chin; Ahmad, Ghazali; Wong, Hin-Seng; Azmi, Soraya; Goh, Adrian

    2015-11-01

    Kidney transplantation is the optimal therapy for the majority of patients with end-stage renal disease. However, the cost and health outcomes of transplantation have not been assessed in a middle-income nation with a low volume of transplantation, such as Malaysia. This study used microcosting methods to determine the cost and health outcomes of living and deceased donor kidney transplantation in adult and pediatric recipients. The perspective used was from the Ministry of Health Malaysia. Cost-effectiveness measures were cost per life year (LY) and cost per quality-adjusted LYs. The time horizon was the lifetime of the transplant recipient from transplant to death. Records of 206 KT recipients (118 adults and 88 children) were obtained for microcosting. In adults, discounted cost per LY was US $8609(Malaysian Ringgit [RM]29 482) and US $13 209(RM45 234) for living-donor kidney transplant (LKT) and deceased donor kidney transplant (DKT), respectively, whereas in children, it was US $10 485(RM35 905) and US $14 985(RM51 317), respectively. Cost per quality-adjusted LY in adults was US $8826 (RM30 224) for LKT and US $13 592(RM46 546) for DKT. Total lifetime discounted costs of adult transplants were US $119 702 (RM409 921) for LKT, US $147 152 (RM503 922) for DKT. Total costs for pediatric transplants were US $154 841(RM530 252) and US $159 313(RM545 566) for the 2 categories respectively. Both LKT and DKT are economically favorable for Malaysian adult and pediatric patients with ESRD and result in improvement in quality of life.

  4. Health services utilization and costs of the insured and uninsured ...

    African Journals Online (AJOL)

    2013-07-05

    Jul 5, 2013 ... Background: Health insurance is a social security system that aims to ... civil servants have no appreciable advantage in terms of access to and cost of health .... self‑medication, pharmaceutical shops, traditional healers,.

  5. REDUCING POWER PRODUCTION COSTS BY UTILIZING PETROLEUM COKE

    Energy Technology Data Exchange (ETDEWEB)

    Kevin C. Galbreath; Donald L. Toman; Christopher J. Zygarlicke

    1999-09-01

    Petroleum coke, a byproduct of the petroleum-refining process, is an attractive primary or supplemental fuel for power production primarily because of a progressive and predictable increase in the production volumes of petroleum coke (1, 2). Petroleum coke is most commonly blended with coal in proportions suitable to meet sulfur emission compliance. Petroleum coke is generally less reactive than coal; therefore, the cofiring of petroleum coke with coal typically improves ignition, flame stability, and carbon loss relative to the combustion of petroleum coke alone. Although petroleum coke is a desirable fuel for producing relatively inexpensive electrical power, concerns about the effects of petroleum coke blending on combustion and pollution control processes exist in the coal-fired utility industry (3). The Energy & Environmental Research Center (EERC) completed a 2-year technical assessment of petroleum coke as a supplemental fuel. A survey questionnaire was sent to seven electric utility companies that are currently cofiring coal and petroleum coke in an effort to solicit specific suggestions on research needs and fuel selections. An example of the letter and survey questionnaire is presented in Appendix A. Interest was expressed by most utilities in evaluating the effects of petroleum coke blending on grindability, combustion reactivity, fouling, slagging, and fly ash emissions control. Unexpectedly, concern over corrosion was not expressed by the utilities contacted. Although all seven utilities responded to the question, only two utilities, Northern States Power Company (NSP) and Ameren, sent fuels to the EERC for evaluation. Both utilities sent subbituminous coals from the Power River Basin and petroleum shot coke samples. Petroleum shot coke is produced unintentionally during operational upsets in the petroleum refining process. This report evaluates the effects of petroleum shot coke blending on grindability, fuel reactivity, fouling/slagging, and

  6. Impact of power purchases from nonutilities on the utility cost of capital

    International Nuclear Information System (INIS)

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

    1994-03-01

    This report studies the debt-equivalence debate empirically. The topics of the study include a review of the literature on the cost of equity capital for regulated utilities, a formulation of the debate on NUGs and the utility's cost of capital, a review of variable definitions and data sources, and a discussion of statistical issues and results

  7. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    Science.gov (United States)

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  8. Towards a tipping point in responding to change: rising costs, fewer options for Arctic and global societies.

    Science.gov (United States)

    Huntington, Henry P; Goodstein, Eban; Euskirchen, Eugénie

    2012-02-01

    Climate change incurs costs, but government adaptation budgets are limited. Beyond a certain point, individuals must bear the costs or adapt to new circumstances, creating political-economic tipping points that we explore in three examples. First, many Alaska Native villages are threatened by erosion, but relocation is expensive. To date, critically threatened villages have not yet been relocated, suggesting that we may already have reached a political-economic tipping point. Second, forest fires shape landscape and ecological characteristics in interior Alaska. Climate-driven changes in fire regime require increased fire-fighting resources to maintain current patterns of vegetation and land use, but these resources appear to be less and less available, indicating an approaching tipping point. Third, rapid sea level rise, for example from accelerated melting of the Greenland ice sheet, will create a choice between protection and abandonment for coastal regions throughout the world, a potential global tipping point comparable to those now faced by Arctic communities. The examples illustrate the basic idea that if costs of response increase more quickly than available resources, then society has fewer and fewer options as time passes.

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

    International Nuclear Information System (INIS)

    Ottinger, R.L.

    1990-01-01

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

  10. Fluoxetine and imipramine: are there differences in cost-utility for depression in primary care?

    Science.gov (United States)

    Serrano-Blanco, Antoni; Suárez, David; Pinto-Meza, Alejandra; Peñarrubia, Maria T; Haro, Josep Maria

    2009-02-01

    Depressive disorders generate severe personal burden and high economic costs. Cost-utility analyses of the different therapeutical options are crucial to policy-makers and clinicians. Previous cost-utility studies, comparing selective serotonin reuptake inhibitors and tricyclic antidepressants, have used modelling techniques or have not included indirect costs in the economic analyses. To determine the cost-utility of fluoxetine compared with imipramine for treating depressive disorders in primary care. A 6-month randomized prospective naturalistic study comparing fluoxetine with imipramine was conducted in three primary care centres in Spain. One hundred and three patients requiring antidepressant treatment for a DSM-IV depressive disorder were included in the study. Patients were randomized either to fluoxetine (53 patients) or to imipramine (50 patients) treatment. Patients were treated with antidepressants according to their general practitioner's usual clinical practice. Outcome measures were the quality of life tariff of the European Quality of Life Questionnaire: EuroQoL-5D (five domains), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and after 1, 3 and 6 months. Incremental cost-utility ratios (ICUR) were obtained. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out. Taking into account adjusted total costs and incremental quality of life gained, imipramine dominated fluoxetine with 81.5% of the bootstrap replications in the dominance quadrant. Imipramine seems to be a better cost-utility antidepressant option for treating depressive disorders in primary care.

  11. Comparative utilization and cost benefit of feeding three novel ...

    African Journals Online (AJOL)

    This study was conducted to determine the effect of feeding three differently processed discarded vegetable-bovine blood-rumen content mixture on nutrient digestibility and cost benefits of broiler chickens. A total of 1,080 day-old Marshal broiler chickens were fed diet containing discarded vegetablefresh bovine ...

  12. Utilization and cost of log production from animal loging operations

    Science.gov (United States)

    Suraj P. Shrestha; Bobby L. Lanford; Robert B. Rummer; Mark Dubois

    2006-01-01

    Forest harvesting with animals is a labor-intensive operation. It is expensive to use machines on smaller woodlots, which require frequent moves if mechanically logged. So, small logging systems using animals may be more cost effective. In this study, work sampling was used for five animal logging operations in Alabama to measure productive and non-productive time...

  13. 18 CFR 260.200 - Original cost statement of utility property.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Original cost statement...) § 260.200 Original cost statement of utility property. Any natural gas company becoming subject to the... of its predecessors: (1) The original cost (estimated only if not determinable from existing records...

  14. Ratio Utility and Cost Analysis for Privacy Preserving Subspace Projection

    OpenAIRE

    Al, Mert; Wan, Shibiao; Kung, Sun-Yuan

    2017-01-01

    With a rapidly increasing number of devices connected to the internet, big data has been applied to various domains of human life. Nevertheless, it has also opened new venues for breaching users' privacy. Hence it is highly required to develop techniques that enable data owners to privatize their data while keeping it useful for intended applications. Existing methods, however, do not offer enough flexibility for controlling the utility-privacy trade-off and may incur unfavorable results when...

  15. Cost-Utility of Evaluation for Posterior Vitreous Detachment and Prophylaxis of Retinal Detachment.

    Science.gov (United States)

    Yannuzzi, Nicolas A; Chang, Jonathan S; Brown, Gary C; Smiddy, William E

    2018-01-01

    To evaluate the costs and cost-utility of examination for posterior vitreous detachment (PVD) and treatment of associated pathology, and of managing various other peripheral retinal disorders to prevent retinal detachment (RD). A decision analysis model of cost-utility. There were no participants. Published retrospective data on the natural course of PVD, retinal tears, and lattice degeneration were used to quantitate the visual benefits of examination and treatment. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility/ambulatory surgical center (ASC)-based setting. Published standards of utility for a given level of visual acuity were used to derive costs and quality-adjusted life years (QALYs). Cost of evaluation and treatment, utility of defined health states, QALY, and cost per QALY. The modeled cost of evaluation of a patient with PVD and treatment of associated pathology in the facility/hospital (nonfacility/ASC)-based setting was $65 to $190 ($25-$71) depending on whether a single or 2-examination protocol was used. The cost per QALY saved was $255 to $638/QALY ($100-$239/QALY). Treatment of a symptomatic horseshoe tear resulted in a net cost savings of $1749 ($1314) and improved utility, whereas treatment of an asymptomatic horseshoe tear resulted in $2981/QALY ($1436/QALY). Treatment of asymptomatic lattice degeneration in an eye in which the fellow eye had a history of RD resulted in $4414/QALY ($2187/QALY). Evaluation and management of incident acute PVD (and symptomatic horseshoe tears) offer a low cost and a favorable cost-utility (low $/QALY) as a result of the minimization of the cost and morbidity associated with the development of RD, thus justifying current practice standards. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-10-01

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

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

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  18. Hedonic travel cost and random utility models of recreation

    Energy Technology Data Exchange (ETDEWEB)

    Pendleton, L. [Univ. of Southern California, Los Angeles, CA (United States); Mendelsohn, R.; Davis, E.W. [Yale Univ., New Haven, CT (United States). School of Forestry and Environmental Studies

    1998-07-09

    Micro-economic theory began as an attempt to describe, predict and value the demand and supply of consumption goods. Quality was largely ignored at first, but economists have started to address quality within the theory of demand and specifically the question of site quality, which is an important component of land management. This paper demonstrates that hedonic and random utility models emanate from the same utility theoretical foundation, although they make different estimation assumptions. Using a theoretically consistent comparison, both approaches are applied to examine the quality of wilderness areas in the Southeastern US. Data were collected on 4778 visits to 46 trails in 20 different forest areas near the Smoky Mountains. Visitor data came from permits and an independent survey. The authors limited the data set to visitors from within 300 miles of the North Carolina and Tennessee border in order to focus the analysis on single purpose trips. When consistently applied, both models lead to results with similar signs but different magnitudes. Because the two models are equally valid, recreation studies should continue to use both models to value site quality. Further, practitioners should be careful not to make simplifying a priori assumptions which limit the effectiveness of both techniques.

  19. Trends in transmission, distribution, and administration costs for U.S. investor-owned electric utilities

    International Nuclear Information System (INIS)

    Fares, Robert L.; King, Carey W.

    2017-01-01

    This paper analyzes the cost of transmission, distribution, and administration for U.S. investor-owned electric utilities. We analyze data reported to the Federal Energy Regulatory Commission (FERC) from 1994 to 2014 using linear regression to understand how the number of customers in a utility's territory, annual peak demand, and annual energy sales affect annual TD&A spending. Then, we use Edison Electric Institute data for 1960 to 1992 to show trends in TD&A spending between 1960 and 2014. We find that the number of customers in a utility's territory is the single best predictor for annual TD&A costs. Between 1994 and 2014, the average cost per customer was $119/Customer-Year for transmission, $291/Customer-Year for distribution, and $333/Customer-Year for utility administration. Total TD&A costs per customer have been approximately $700–$800/Customer-Year since 1960, but the cost per kWh of energy sold was significantly higher in the 1960s because the average customer used less than half as much energy annually versus 2014. Thus, TD&A costs per kWh are likely to increase if kWh energy sales decline in the future unless cost recovery is transitioned to a mechanism not based solely on kWh sales. - Highlights: • U.S. investor-owned electric utility delivery costs from 1960? 2014 are investigated. • Transmission, distribution, and utility administrative costs are analyzed separately. • The number of utility customers is the best predictor for annual delivery costs. • Delivery costs per kWh are likely to increase if kWh sales decrease in the future.

  20. Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions.

    Science.gov (United States)

    Khandelwal, Nikhil; Duncan, Ian; Rubinstein, Elan; Ahmed, Tamim; Pegus, Cheryl

    2012-04-01

    Pharmacy benefit management (PBM) companies promote mail order programs that typically dispense 90-day quantities of maintenance medications, marketing this feature as a key cost containment strategy to address plan sponsors' rising prescription drug expenditures. In recent years, community pharmacies have introduced 90-day programs that provide similar cost advantages, while allowing these prescriptions to be dispensed at the same pharmacies that patients frequent for 30-day quantities. To compare utilization rates and corresponding costs associated with obtaining 90-day prescriptions at community and mail order pharmacies for payers that offer equivalent benefits in different 90-day dispensing channels. We performed a retrospective, cross-sectional investigation using pharmacy claims and eligibility data from employer group clients of a large PBM between January 2008 and September 2010. We excluded the following client types: government, third-party administrators, schools, hospitals, 340B (federal drug pricing), employers in Puerto Rico, and miscellaneous clients for which the PBM provided billing services (e.g., the pharmacy's loyalty card program members). All employer groups in the sample offered 90-day community pharmacy and mail order dispensing and received benefits management services, such as formulary management and mail order pharmacy, from the PBM. We further limited the sample to employer groups that offered equivalent benefits for community pharmacy and mail order, defined as groups in which the mean and median copayments per claim for community and mail order pharmacy, by tier, differed by no more than 5%. Enrollees in the sample were required to have a minimum of 6 months of eligibility in each calendar year but were not required to have filled a prescription in any year. We evaluated pharmacy costs and utilization for a market basket of 14 frequently dispensed therapeutic classes of maintenance medications. The proportional share of claims for

  1. Impact of an Advanced Imaging Utilization Review Program on Downstream Health Care Utilization and Costs for Low Back Pain.

    Science.gov (United States)

    Graves, Janessa M; Fulton-Kehoe, Deborah; Jarvik, Jeffrey G; Franklin, Gary M

    2018-06-01

    Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP. Interrupted time series. In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014. Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month. After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization. The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.

  2. Utilizing big data to provide better health at lower cost.

    Science.gov (United States)

    Jones, Laney K; Pulk, Rebecca; Gionfriddo, Michael R; Evans, Michael A; Parry, Dean

    2018-04-01

    The efficient use of big data in order to provide better health at a lower cost is described. As data become more usable and accessible in healthcare, organizations need to be prepared to use this information to positively impact patient care. In order to be successful, organizations need teams with expertise in informatics and data management that can build new infrastructure and restructure existing infrastructure to support quality and process improvements in real time, such as creating discrete data fields that can be easily retrieved and used to analyze and monitor care delivery. Organizations should use data to monitor performance (e.g., process metrics) as well as the health of their populations (e.g., clinical parameters and health outcomes). Data can be used to prevent hospitalizations, combat opioid abuse and misuse, improve antimicrobial stewardship, and reduce pharmaceutical spending. These examples also serve to highlight lessons learned to better use data to improve health. For example, data can inform and create efficiencies in care and engage and communicate with stakeholders early and often, and collaboration is necessary to have complete data. To truly transform care so that it is delivered in a way that is sustainable, responsible, and patient-centered, health systems need to act on these opportunities, invest in big data, and routinely use big data in the delivery of care. Using data efficiently has the potential to improve the care of our patients and lower cost. Despite early successes, barriers to implementation remain including data acquisition, integration, and usability. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    1991-04-01

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

  4. Utility-adjusted analysis of the cost of palliative radiotherapy for bone metastases

    International Nuclear Information System (INIS)

    Barton, M.B.; Jacob, S.A.

    2003-01-01

    Palliative radiotherapy is effective in the treatment of bone metastases but is under-utilized, possibly because it is perceived to be expensive. We performed a cost-utility analysis of palliative radiotherapy for bone metastases, evaluating both the actual cost of radiotherapy as well as its impact on quality of life by adjusting for the variation in response to treatment. Hospital records between July 1991 and July 1996 were reviewed to ascertain the number of patients treated with palliative radiotherapy for bone metastases, the average number of fields of radiation delivered to each patient and the average duration of survival. Partial and complete response rates to palliative radiotherapy were obtained from a review of all published randomized controlled trials of radiation treatment of bone metastases. Utility values were assigned to the response rates, and an overall adjusted response rate to radiotherapy was derived. The cost of delivering a field of radiation was calculated. The total cost was divided by the total number of response months to give a utility-adjusted cost per month of palliative radiotherapy. The utility-adjusted cost per month of palliative radiotherapy of bone metastases was found to be AUS$ 100 per month or AUS$ 1200 per utility-adjusted life-year. This study demonstrates that, contrary to popular perception, palliative radiotherapy is a cost-effective treatment modality for bone metastases. Copyright (2003) Blackwell Science Pty Ltd

  5. The effects of utility DSM programs on electricity costs and prices

    Energy Technology Data Exchange (ETDEWEB)

    Hirst, E.

    1991-11-01

    More and more US utilities are running more and larger demand-side management (DSM) programs. Assessing the cost-effectiveness of these programs raises difficult questions for utilities and their regulators. Should these programs aim to minimize the total cost of providing electric-energy services or should they minimize the price of electricity? This study offers quantitative estimates on the tradeoffs between total costs and electricity prices. This study uses a dynamic model to assess the effects of energy-efficiency programs on utility revenues, total resource costs, electricity prices, and electricity consumption for the period 1990 to 2010. These DSM programs are assessed under alternative scenarios. In these cases, fossil-fuel prices, load growth, the amount of excess capacity the utility has in 1990, planned retirements of power plants, the financial treatment of DSM programs, and the costs of energy- efficient programs vary. These analyses are conducted for three utilities: a ``base`` that is typical of US utilities; a ``surplus`` utility that has excess capacity, few planned retirements, and slow growth in fossil-fuel prices and incomes; and a ``deficit`` utility that has little excess capacity, many planned retirements, and rapid growth in fossil-fuel prices and incomes. 28 refs.

  6. The effects of utility DSM programs on electricity costs and prices

    Energy Technology Data Exchange (ETDEWEB)

    Hirst, E.

    1991-11-01

    More and more US utilities are running more and larger demand-side management (DSM) programs. Assessing the cost-effectiveness of these programs raises difficult questions for utilities and their regulators. Should these programs aim to minimize the total cost of providing electric-energy services or should they minimize the price of electricity This study offers quantitative estimates on the tradeoffs between total costs and electricity prices. This study uses a dynamic model to assess the effects of energy-efficiency programs on utility revenues, total resource costs, electricity prices, and electricity consumption for the period 1990 to 2010. These DSM programs are assessed under alternative scenarios. In these cases, fossil-fuel prices, load growth, the amount of excess capacity the utility has in 1990, planned retirements of power plants, the financial treatment of DSM programs, and the costs of energy- efficient programs vary. These analyses are conducted for three utilities: a base'' that is typical of US utilities; a surplus'' utility that has excess capacity, few planned retirements, and slow growth in fossil-fuel prices and incomes; and a deficit'' utility that has little excess capacity, many planned retirements, and rapid growth in fossil-fuel prices and incomes. 28 refs.

  7. Quantity Surveying Undergraduates’ Awareness on Cost Significant of High-Rise Condominium Projects in Malaysia: The Case of a Private University in Malaysia

    OpenAIRE

    Peng Lee Wah; Seng Ng See; Choon Toh Tien; Sim Lim Cheng; Khian Yong Ching; Chen Goh Kai

    2016-01-01

    Recent developments in quantity surveying (QS) emphasised the importance of identifying cost significant elements (CSE). The knowledge on CSE of high-rise condominium projects (HRCP) is essential as high-rise residential multi-unit projects are the next option in building construction due to limited land areas in urban areas. This study aims to determine the levels of awareness among QS undergraduates of a private university in Malaysia on CSE of HRCP in Malaysia. The respondents’ knowledge o...

  8. 41 CFR 102-33.440 - Who must report CAS cost and utilization data?

    Science.gov (United States)

    2010-07-01

    ...-MANAGEMENT OF GOVERNMENT AIRCRAFT Reporting Information on Government Aircraft Commercial Aviation Services... agencies, except the Armed Forces and U.S. intelligence agencies, must report CAS cost and utilization data...

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

    Science.gov (United States)

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

    2017-11-01

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

  10. How often do sensitivity analyses for economic parameters change cost-utility analysis conclusions?

    Science.gov (United States)

    Schackman, Bruce R; Gold, Heather Taffet; Stone, Patricia W; Neumann, Peter J

    2004-01-01

    There is limited evidence about the extent to which sensitivity analysis has been used in the cost-effectiveness literature. Sensitivity analyses for health-related QOL (HR-QOL), cost and discount rate economic parameters are of particular interest because they measure the effects of methodological and estimation uncertainties. To investigate the use of sensitivity analyses in the pharmaceutical cost-utility literature in order to test whether a change in economic parameters could result in a different conclusion regarding the cost effectiveness of the intervention analysed. Cost-utility analyses of pharmaceuticals identified in a prior comprehensive audit (70 articles) were reviewed and further audited. For each base case for which sensitivity analyses were reported (n = 122), up to two sensitivity analyses for HR-QOL (n = 133), cost (n = 99), and discount rate (n = 128) were examined. Article mentions of thresholds for acceptable cost-utility ratios were recorded (total 36). Cost-utility ratios were denominated in US dollars for the year reported in each of the original articles in order to determine whether a different conclusion would have been indicated at the time the article was published. Quality ratings from the original audit for articles where sensitivity analysis results crossed the cost-utility ratio threshold above the base-case result were compared with those that did not. The most frequently mentioned cost-utility thresholds were $US20,000/QALY, $US50,000/QALY, and $US100,000/QALY. The proportions of sensitivity analyses reporting quantitative results that crossed the threshold above the base-case results (or where the sensitivity analysis result was dominated) were 31% for HR-QOL sensitivity analyses, 20% for cost-sensitivity analyses, and 15% for discount-rate sensitivity analyses. Almost half of the discount-rate sensitivity analyses did not report quantitative results. Articles that reported sensitivity analyses where results crossed the cost-utility

  11. A Canadian case study : the value of real time electricity monitoring : a real-time cost utility management solution

    International Nuclear Information System (INIS)

    Rouse, S.; Dittburner, D.

    2006-01-01

    Energy prices can vary significantly over the course of a single day in response to changing levels in energy demand and availability of supply. The impacts of varying energy prices on business and industry means that hourly electricity costs can fluctuate widely over the course of a day even though energy use remains stable. This presentation gave details of an energy efficiency initiative at Unilever's Rexdale site which has resulted in $4 million saved through reductions in energy consumption and equipment retrofits. The Rexdale plant won an energy efficiency award in 2005, and the success of the initiative was attributed to the use of Utility 3 + , an energy management software tool. A turn key system with integrated software and hardware, Utility 3 + is capable of measuring how much energy is being used and can provide details of costs using a combination of historical and forecast prices. The tool is equipped with alarms with pre-set thresholds to match real-time rises in energy prices. Real-time prices are relayed from the Internet along with a 2 way data communication system. It was concluded that use of the tool has resulted in improved cash flow management and greater control of energy costs. A system description of the tool was provided, as well as details of various equipment retrofits. refs.., tabs., figs

  12. A Canadian case study : the value of real time electricity monitoring : a real-time cost utility management solution

    Energy Technology Data Exchange (ETDEWEB)

    Rouse, S. [Energy at Work, Toronto, ON (Canada); Dittburner, D. [Unilever Canada, Toronto, ON (Canada)

    2006-07-01

    Energy prices can vary significantly over the course of a single day in response to changing levels in energy demand and availability of supply. The impacts of varying energy prices on business and industry means that hourly electricity costs can fluctuate widely over the course of a day even though energy use remains stable. This presentation gave details of an energy efficiency initiative at Unilever's Rexdale site which has resulted in $4 million saved through reductions in energy consumption and equipment retrofits. The Rexdale plant won an energy efficiency award in 2005, and the success of the initiative was attributed to the use of Utility 3{sup +}, an energy management software tool. A turn key system with integrated software and hardware, Utility 3{sup +} is capable of measuring how much energy is being used and can provide details of costs using a combination of historical and forecast prices. The tool is equipped with alarms with pre-set thresholds to match real-time rises in energy prices. Real-time prices are relayed from the Internet along with a 2 way data communication system. It was concluded that use of the tool has resulted in improved cash flow management and greater control of energy costs. A system description of the tool was provided, as well as details of various equipment retrofits. refs.., tabs., figs.

  13. A comparison of cost-based pricing rules for natural gas distribution utilities

    International Nuclear Information System (INIS)

    Klein, C.C.

    1993-01-01

    Partial-equilibrium social welfare deadweight losses under uniform Ramsey pricing, a cost allocation pricing method, and the actual average revenues by customer class for two natural gas distribution utilities are calculated and compared. Marginal cost estimates are derived from a multiple-output translog variable cost function and used, along with three sets of demand elasticities, to generate the Ramsey prices and welfare losses. The actual and cost-allocation prices are taken directly from rate case files. The largest social welfare losses are associated with the cost-allocation rule, as high as 10-25% of revenue, despite suggestions in the literature to the contrary. (Author)

  14. A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases

    International Nuclear Information System (INIS)

    Mehta, Minesh; Noyes, William; Craig, Bruce; Lamond, John; Auchter, Richard; French, Molly; Johnson, Mark; Levin, Allan; Badie, Behnam; Robbins, Ian; Kinsella, Timothy

    1997-01-01

    Purpose: The median survival of well-selected patients with single-brain metastases treated with whole-brain irradiation and resection or radiosurgery is comparable, although a randomized trial of these two modalities has not been performed. In this era of cost containment, it is imperative that health-care professionals make fiscally prudent decisions. The present environment necessitates a critical appraisal of apparently equi-efficacious therapeutic modalities, and it is within this context that we present a comparison of the actual costs of resection and radiosurgery for brain metastases. Methods and Materials: Survival and quality of life outcome data for radiation alone or with surgery were obtained from two randomized trials, and radiosurgical results were obtained from a multiinstitutional analysis that specifically evaluated patients meeting surgical criteria. Only linear accelerator radiosurgery data were considered. Cost analysis was performed from a societal view point, and the following parameters were evaluated: actual cost, cost ratios, cost effectiveness, incremental cost effectiveness, cost utility, incremental cost utility, and national cost burden. The computerized billing records for all patients undergoing resection or radiosurgery for single-brain metastases from January 1989 to July 1994 were reviewed. A total of 46 resections and 135 radiosurgery procedures were performed. During the same time period, 454 patients underwent whole-brain radiation alone. An analysis of the entire bill was performed for each procedure, and each itemized cost was assigned a proportionate figure. The relative cost ratios of resection and radiosurgery were compared using the Wilcoxon rank sum test. Cost effectiveness of each modality, defined as the cost per year of median survival, was evaluated. Incremental cost effectiveness, defined as the additional cost per year of incremental gain in median survival, compared to the next least expensive modality, was also

  15. Energy technologies for distributed utility applications: Cost and performance trends, and implications for photovoltaics

    International Nuclear Information System (INIS)

    Eyer, J.M.

    1994-01-01

    Utilities are evaluating several electric generation and storage (G ampersand S) technologies for distributed utility (DU) applications. Attributes of leading DU technologies and implications for photovoltaics (PV) are described. Included is a survey of present and projected cost and performance for: (1) small, advanced combustion turbines (CTs); (2) advanced, natural gas-fired, diesel engines (diesel engines); and (3) advanced lead-acid battery systems (batteries). Technology drivers and relative qualitative benefits are described. A levelized energy cost-based cost target for PV for DU applications is provided. The analysis addresses only relative cost, for PV and for three selected alternative DU technologies. Comparable size, utility, and benefits are assumed, although relative value is application-specific and often technology- and site-specific

  16. Quantification and Classification of E. coli Proteome Utilization and Unused Protein Costs across Environments

    DEFF Research Database (Denmark)

    O'Brien, Edward J.; Utrilla, Jose; Palsson, Bernhard

    2016-01-01

    The costs and benefits of protein expression are balanced through evolution. Expression of un-utilized protein (that have no benefits in the current environment) incurs a quantifiable fitness costs on cellular growth rates; however, the magnitude and variability of un-utilized protein expression...... in varying environments. Thus, unused protein expression is the source of large and pervasive fitness costs that may provide the benefit of hedging against environmental change....... in natural settings is unknown, largely due to the challenge in determining environment-specific proteome utilization. We address this challenge using absolute and global proteomics data combined with a recently developed genome-scale model of Escherichia coli that computes the environment-specific cost...

  17. Homeless Veterans' Use of Peer Mentors and Effects on Costs and Utilization in VA Clinics.

    Science.gov (United States)

    Yoon, Jean; Lo, Jeanie; Gehlert, Elizabeth; Johnson, Erin E; O'Toole, Thomas P

    2017-06-01

    The study compared health care utilization and costs among homeless veterans randomly assigned to peer mentors or usual care and described contacts with peer mentors. Homeless patients at four Department of Veterans Affairs clinics were randomly assigned to a peer mentor (N=195) or to usual care (N=180). Administrative data on utilization and costs over a six-month follow-up were combined with peer mentors' reports of patient contacts. Most patients (87%) in the peer mentor group had at least one peer contact. Patients in this group spent the largest proportions of time discussing housing and health issues with peer mentors and had more outpatient encounters than those in usual care, although differences were not significant. No other between-group differences were found in utilization or costs. Although significant impacts of peer mentors on health care patterns or costs were not detected, some patients had frequent contact with peer mentors.

  18. Evaluation of actual costs of power sources and effects on balance sheets of electric utilities

    International Nuclear Information System (INIS)

    Matsuo, Yuji; Yamaguchi, Yuji; Murakami, Tomoko

    2013-01-01

    After the Fukushima nuclear accident, almost all nuclear power stations continued to stop operation and sharp increase of purchase costs of fossil fuels forced some electric utilities to suffer a deficit. This article presented quantitative analysis of effects of present state on power costs and balance sheets of electric utilities. Levelized costs of electricity increased from 8.6 ¥/kWh (2010) to 11.6 ¥/kWh (2011) and 12.6 ¥/kWh (2012). Total power costs increased from 7.5 Trillion¥(2010) to 9.5 Trillion¥(2011). Due to increase of cost of fossil fuel compensated for nuclear power, electric utilities suffered a net loss of 0.8 Trillion¥ and decreased surplus to 2.5 Trillion¥ in 2011. Net loss of 1.3 Trillion¥ and surplus of 1.2 Trillion¥ was estimated for 2012. This state was beyond the limit of utilities' efforts to reduce costs and uncertain share of power sources became a great risk. Future share of power sources should be judged appropriately from various standpoints (costs, stable supply, energy security and national economic growth) and early public dissemination of new philosophy on share of power sources was highly required. (T. Tanaka)

  19. Capacity utilization and the cost of primary care visits: Implications for the costs of scaling up health interventions

    Directory of Open Access Journals (Sweden)

    Johns Benjamin

    2008-11-01

    Full Text Available Abstract Objective A great deal of international attention has been focussed recently on how much additional funding is required to scale up health interventions to meet global targets such as the Millennium Development Goals (MDGs. Most of the cost estimates that have been made in response have assumed that unit costs of delivering services will not change as coverage increases or as more and more interventions are delivered together. This is most unlikely. The main objective of this paper is to measure the impact of patient load on the cost per visit at primary health care facilities and the extent to which this would influence estimates of the costs and financial requirements to scale up interventions. Methods Multivariate regression analysis was used to explore the determinants of variability in unit costs using data for 44 countries with a total of 984 observations. Findings Controlling for other possible determinants, we find that the cost of an outpatient visit is very sensitive to the number of patients seen by providers each day at primary care facilities. Each 1% increase in patient through-put results, on average, in a 27% reduction in the cost per visit (p Conclusion Variability in capacity utilization, therefore, need to be taken into account in cost estimates, and the paper develops a method by which this can be done.

  20. Identifying Cost-Effective Residential Energy Efficiency Opportunities for the Kauai Island Utility Cooperative

    Energy Technology Data Exchange (ETDEWEB)

    Busche, S.; Hockett, S.

    2010-06-01

    This analysis is an update to the 2005 Energy Efficiency Potential Study completed by KEMA for the Kauai Island Utility Cooperative (KIUC) and identifies potential energy efficiency opportunities in the residential sector on Kauai (KEMA 2005). The Total Resource Cost (TRC) test is used to determine which of the energy efficiency measures analyzed in the KEMA report are cost effective for KIUC to include in a residential energy efficiency program. This report finds that there remains potential energy efficiency savings that could be cost-effectively incentivized through a utility residential demand-side management program on Kauai if implemented in such a way that the program costs per measure are consistent with the current residential program costs.

  1. VALUE-BASED MEDICINE AND OPHTHALMOLOGY: AN APPRAISAL OF COST-UTILITY ANALYSES

    Science.gov (United States)

    Brown, Gary C; Brown, Melissa M; Sharma, Sanjay; Brown, Heidi; Smithen, Lindsay; Leeser, David B; Beauchamp, George

    2004-01-01

    ABSTRACT Purpose To ascertain the extent to which ophthalmologic interventions have been evaluated in value-based medicine format. Methods Retrospective literature review. Papers in the healthcare literature utilizing cost-utility analysis were reviewed by researchers at the Center for Value-Based Medicine, Flourtown, Pennsylvania. A literature review of papers addressing the cost-utility analysis of ophthalmologic procedures in the United States over a 12-year period from 1992 to 2003 was undertaken using the National Library of Medicine and EMBASE databases. The cost-utility of ophthalmologic interventions in inflation-adjusted (real) year 2003 US dollars expended per quality-adjusted life-year ($/QALY) was ascertained in all instances. Results A total of 19 papers were found, including a total of 25 interventions. The median cost-utility of ophthalmologic interventions was $5,219/QALY, with a range from $746/QALY to $6.5 million/QALY. Conclusions The majority of ophthalmologic interventions are especially cost-effective by conventional standards. This is because of the substantial value that ophthalmologic interventions confer to patients with eye diseases for the resources expended. PMID:15747756

  2. The rise of smart customers. How consumer power will change the global power and utilities business. What the sector thinks

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-09-15

    This report is the second in a two-part study, geared to helping power and utilities companies adapt their business strategies and customer handling in a new smart world. It explores the views of power and utilities leaders across 12 countries on how smart might change consumers' needs and behaviors, what new services they plan to offer and where they see the strongest new opportunities and competitors. We also compare these results with those of the first study, which examined the views of consumers and their appetite for new smart services.

  3. Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

    Science.gov (United States)

    Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

    2013-02-01

    Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology

  4. Analysis on the cost performance and its impact to Japanese electric utilities and vision of the power portfolio

    International Nuclear Information System (INIS)

    Yamaguchi, Yuji; Matsuo, Yuji; Murakami, Tomoko

    2013-01-01

    Most of the nuclear power plants in Japan have been shut down since the Fukushima accident in March 2011, without being permitted to restart after periodical inspections. Accordingly, thermal power generation significantly increased in FY 2011. In this paper the authors made a quantitative analysis on the unit costs of power generation and on the financial performance based on the financial reports of electric utilities. The average unit cost in FY 2011 rose to 11.6 JPY/kWh, 3 JPY/kWh higher than that in FY 2010, and will rise further to 12.6 JPY/kWh in FY 2012. The total retained profit of 8 utilities decreased by some 1 trillion JPY from FY 2010 to FY 2011 and will decrease further to 1 trillion JPY by the end of FY 2012, which is the lowest level in history. Clear decisions on energy policies and future power portfolio, as well as the restructuring of the electricity system in line with the rapid change in the power portfolio will be highly required for policy planners in Japan. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-12-31

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

  6. Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs and effectiveness

    Directory of Open Access Journals (Sweden)

    Elisabetta Costantini

    2014-06-01

    Full Text Available Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81 were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS; Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

  7. The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2017-07-01

    Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes3 1IGES Institut, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, School of Accounting, Economics and Finance, University of KwaZulu Natal, KwaZulu Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany Objective: To evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand. Methods: A cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS versus oral rehydration solution (ORS alone for acute diarrhea in children <5 years old. The decision tree Excel model evaluates the costs and effects (quality-adjusted life years over a 6-day time horizon from a public health care payer’s perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken. Results: According to the cost utility model, the intervention (R+ORS is less costly and more effective than the comparator (ORS for the base case with a dominant incremental cost-effectiveness ratio of −2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years, the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is −0.0027%, resulting in potential net cost savings of −35,632,482฿ over 5 years. Conclusion: Subject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system. Keywords: economic evaluation, cost utility, decision analysis, health technology assessment

  8. Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings.

    Science.gov (United States)

    Adrion, Emily R; Kocher, Keith E; Nallamothu, Brahmajee K; Ryan, Andrew M

    2017-12-01

    Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes. Despite the potential for changed policies to indirectly affect non-Medicare patients, little is known about the use of, and spending associated with, observation care among commercially insured populations. Using multipayer commercial claims for the period 2009-13, we evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In our study period, the use of observation care increased relative to that of short-stay hospitalizations. Total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly-and at rates much higher than spending in the inpatient setting-over the study period. Despite this growth, spending on observation care is unlikely to exceed spending for short-stay hospitalizations. As observation care attracts greater attention, policy makers should be aware that Medicare policies that disincentivize observation may have unintended financial impacts on non-Medicare populations, where observation care may be cost saving.

  9. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...... heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training...

  10. Quantity Surveying Undergraduates’ Awareness on Cost Significant of High-Rise Condominium Projects in Malaysia: The Case of a Private University in Malaysia

    Directory of Open Access Journals (Sweden)

    Peng Lee Wah

    2016-01-01

    Full Text Available Recent developments in quantity surveying (QS emphasised the importance of identifying cost significant elements (CSE. The knowledge on CSE of high-rise condominium projects (HRCP is essential as high-rise residential multi-unit projects are the next option in building construction due to limited land areas in urban areas. This study aims to determine the levels of awareness among QS undergraduates of a private university in Malaysia on CSE of HRCP in Malaysia. The respondents’ knowledge on CSE has not achieved a satisfactory level. Both male and female respondents have the same levels of awareness on CSE. Remedial strategies to improve this situation are recommended.

  11. The impact of cost recovery on electric utilities' Clean Air Act compliance strategies

    International Nuclear Information System (INIS)

    Bensinger, D.L.

    1993-01-01

    By 1995, over 200 electric power plant units in twenty one states must comply with Phase I of the acid rain requirements in Title IV of the 1990 Clean Air Act Amendments (CAAA). By the year 2000, an additional 2200 units must comply with the Title IV. Compliance costs are expected to necessitate significant electricity rate increases. In order to recover their compliance costs, utilities must file rate increase requests with state public utility commissions (PUC's), and undergo a rate proceeding involving public heatings. Because of the magnitude of cost and the complexity of compliance options, including interaction with Titles I and III of the CAAA, extensive PUC reviews of compliance strategies are likely. These reviews could become as adversarial as the nuclear prudence reviews of the 1980's. A lack of understanding of air pollution and the CAA by much of the general public and the flexibility of compliance options creates an environment conducive to adverse public reaction to the cost of complying with the Clean Air Act. Public attitudes toward pollution control technologies will be greatly affected by these hearings, and the early plant hearings will shape the utility rate making process under the Clean Air Act. Inadequate cost recovery due to constrained compliance strategies or adverse hearings could significantly inhibit industry willingness to invest in certain control technologies or advanced combustion technologies. There are already signs that Clean Air Act compliance will be the prudence issue of the 1990's for utilities, even where state statutes mandate particular compliance approaches. Specific actions should be undertaken now by the utility industry to improve the probability of sound cost recovery decisions, preserve compliance options, including multimedia strategies, and avoid the social- and cost-acceptance problems of nuclear power

  12. Health Care Costs, Utilization and Patterns of Care following Lyme Disease

    Science.gov (United States)

    Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.

    2015-01-01

    Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, pLyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, pLyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization. PMID:25650808

  13. The rise of smart customers. How consumer power will change the global power and utilities business. What consumers think

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-08-15

    Smart technology puts unprecedented power in the hands of consumers to manage and control their energy use. In time, this will fundamentally shift the balance of customer relations. It seems the era of a one-way relationship - where a utility delivers energy to domestic consumers, end of story - is over. Most power and utility businesses are currently treating the smart transition as an infrastructure upgrade, focusing chiefly on the technology and on fulfilling regulatory obligations. So far, the customer perspective and need for consumer education have not figured prominently in smart implementation programs. But following customer resistance to implementations in the US and Australia, the sector has been alerted to further challenges. Consumers' newfound power to say 'no' is one that the industry is not used to dealing with. Power and utility businesses must learn from the mistakes made so far. They need customer buy-in before they can exploit the host of new business opportunities that smart technology could provide. To explore the sector's readiness to respond to the present cycle of change, we asked domestic energy consumers how they viewed their relationship with energy providers. We wanted to know if they understood the benefits of smart metering, as well as their appetite for smart energy services.

  14. Social cost considerations and legal constraints in implementing modular integrated utility systems

    Science.gov (United States)

    Lede, N. W.; Dixon, H. W.; King, O.; Hill, D. K.

    1974-01-01

    Social costs associated with the design, demonstration, and implementation of the Modular Integrated Utility System are considered including the social climate of communities, leadership patterns, conflicts and cleavages, specific developmental values, MIUS utility goal assessment, and the suitability of certian alternative options for use in a program of implementation. General considerations are discussed in the field of socio-technological planning. These include guidelines for understanding the conflict and diversity; some relevant goal choices and ideas useful to planners of the MIUS facility.

  15. Quantification and Classification of E. coli Proteome Utilization and Unused Protein Costs across Environments.

    Directory of Open Access Journals (Sweden)

    Edward J O'Brien

    2016-06-01

    Full Text Available The costs and benefits of protein expression are balanced through evolution. Expression of un-utilized protein (that have no benefits in the current environment incurs a quantifiable fitness costs on cellular growth rates; however, the magnitude and variability of un-utilized protein expression in natural settings is unknown, largely due to the challenge in determining environment-specific proteome utilization. We address this challenge using absolute and global proteomics data combined with a recently developed genome-scale model of Escherichia coli that computes the environment-specific cost and utility of the proteome on a per gene basis. We show that nearly half of the proteome mass is unused in certain environments and accounting for the cost of this unused protein expression explains >95% of the variance in growth rates of Escherichia coli across 16 distinct environments. Furthermore, reduction in unused protein expression is shown to be a common mechanism to increase cellular growth rates in adaptive evolution experiments. Classification of the unused protein reveals that the unused protein encodes several nutrient- and stress- preparedness functions, which may convey fitness benefits in varying environments. Thus, unused protein expression is the source of large and pervasive fitness costs that may provide the benefit of hedging against environmental change.

  16. Cost utility analysis of endoscopic biliary stent in unresectable hilar cholangiocarcinoma: decision analytic modeling approach.

    Science.gov (United States)

    Sangchan, Apichat; Chaiyakunapruk, Nathorn; Supakankunti, Siripen; Pugkhem, Ake; Mairiang, Pisaln

    2014-01-01

    Endoscopic biliary drainage using metal and plastic stent in unresectable hilar cholangiocarcinoma (HCA) is widely used but little is known about their cost-effectiveness. This study evaluated the cost-utility of endoscopic metal and plastic stent drainage in unresectable complex, Bismuth type II-IV, HCA patients. Decision analytic model, Markov model, was used to evaluate cost and quality-adjusted life year (QALY) of endoscopic biliary drainage in unresectable HCA. Costs of treatment and utilities of each Markov state were retrieved from hospital charges and unresectable HCA patients from tertiary care hospital in Thailand, respectively. Transition probabilities were derived from international literature. Base case analyses and sensitivity analyses were performed. Under the base-case analysis, metal stent is more effective but more expensive than plastic stent. An incremental cost per additional QALY gained is 192,650 baht (US$ 6,318). From probabilistic sensitivity analysis, at the willingness to pay threshold of one and three times GDP per capita or 158,000 baht (US$ 5,182) and 474,000 baht (US$ 15,546), the probability of metal stent being cost-effective is 26.4% and 99.8%, respectively. Based on the WHO recommendation regarding the cost-effectiveness threshold criteria, endoscopic metal stent drainage is cost-effective compared to plastic stent in unresectable complex HCA.

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

    Science.gov (United States)

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

    2009-05-01

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

  18. Associations of recent weight loss with health care costs and utilization among older women.

    Directory of Open Access Journals (Sweden)

    John T Schousboe

    Full Text Available The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI, weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars, a 15% increase in outpatient costs ($329 [95% C.I. -1 to 660], and odds ratios of 1.42 (95% CI, 1.14 to 1.76 for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03 for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

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

    Science.gov (United States)

    Picavet, E; Cassiman, D; Simoens, S

    2015-06-01

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

  2. Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D; Hirsch, Joshua A

    2017-01-01

    Background: Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design: Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives: To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results: The results showed direct

  3. Financial costs due to excess health risks among active employees of a utility company.

    Science.gov (United States)

    Yen, Louis; Schultz, Alyssa; Schnueringer, Elaine; Edington, Dee W

    2006-09-01

    The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks. A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees. There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status. Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.

  4. Can cost utility evaluations inform decision making about interventions for low back pain?

    Science.gov (United States)

    Dagenais, Simon; Roffey, Darren M; Wai, Eugene K; Haldeman, Scott; Caro, Jaime

    2009-11-01

    Low back pain (LBP) is associated with high health-care utilization and lost productivity. Numerous interventions are routinely used, although few are supported by strong evidence. Cost utility analyses (CUAs) may be helpful to inform decision makers. To conduct a systematic review of CUAs of interventions for LBP. Systematic review. A search strategy combining medical subject headings and free text related to LBP and health economic evaluations was executed in MEDLINE. Cost utility analyses combined with randomized controlled trials for LBP were included. Studies that were published before 1998, non-English, decision analyses, and duplicate reports were excluded. Search results were evaluated by two reviewers, who extracted data independently related to clinical study design, economic study design, direct cost components, utility results, cost results, and CUA results. The search produced 319 citations, and of these 15 met eligibility criteria. Most were from the United Kingdom (n=8), published in the past 3 years (n=12), studied chronic LBP or radiculopathy (n=13), and had a follow-up >12 months (n=13). Combined, there were 33 study groups who received a mean 2.1 interventions, most commonly education (n=17), exercise therapy (n=13), spinal manipulation therapy (n=7), surgery (n=7), and usual care from a general practitioner (n=7). Mean baseline utility was 0.57, improving to 0.67 at follow-up; the mean difference in utility improvement between study groups was 0.04. Based on available data and converted to US dollars, the cost per quality-adjusted life year ranged from $304 to 579,527 dollars, with a median of 13,015 dollars. Few CUAs were identified for LBP, and there was heterogeneity in the interventions compared, direct cost components measured, indirect costs, other methods, and results. Reporting quality was mixed. Currently published CUAs do not provide sufficient information to assist decision makers. Future CUAs should attempt to measure all known

  5. Superconducting magnetic energy storage for electric utility load leveling: A study of cost vs. stored energy

    International Nuclear Information System (INIS)

    Luongo, C.A.; Loyd, R.J.

    1987-01-01

    Superconducting Magnetic Energy Storage (SMES) is a promising technology for electric utility load leveling. This paper presents the results of a study to establish the capital cost of SMES as a function of stored energy. Energy-related coil cost and total installed plant cost are given for construction in nominal soil and in competent rock. Economic comparisons are made between SMES and other storage technologies and peaking gas turbines. SMES is projected to be competitive at stored energies as low as 1000 MWh

  6. Business administration of PET facilities. A cost analysis of three facilities utilizing delivery FDG

    International Nuclear Information System (INIS)

    Mitsutake, Naohiro; Oku, Shinya; Fujii, Ryo; Furui, Yuji; Yasunaga, Hideo

    2008-01-01

    PET (positron emission tomography) has been proved to be a powerful imaging tool in clinical oncology. The number of PET facilities in Japan has remarkably increased over the last decade. Furthermore, the approval of delivery fluorodeoxyglucose (FDG) in 2005 resulted in a tremendous expansion of the PET institutions without a cyclotron facility. The aim of this study was to conduct a cost analysis of PET institutions that utilized delivery FDG. Three PET facilities using delivery FDG were investigated about the costs for PET service. Fixed costs included depreciation costs for construction and medical equipments such as positron camera. Variable costs consisted of costs for medical materials including delivery FDG. The break-even point was analyzed in each of three institutions. In the three hospitals (A, B and C), the annual number of PET scan was 1,591, 1,637 and 914, while cost per scan was accounted as 110,262 yen, 111,091 yen, and 134,192 yen, respectively. The break-even point was calculated to be 2,583, 2,679 and 2,081, respectively. PET facilities utilizing delivery FDG seemed to have difficulty in business administration. Such a situation suggests the possibility that the current supply of PET facilities might exceed actual demand for the service. The efficiency of resource allocation should be taken into consideration in the future health service researches on PET. (author)

  7. Impact of cost sharing on utilization of primary health care Services ...

    African Journals Online (AJOL)

    impact of cost sharing on health-care utilization as viewed from both the providers and beneficiary ... Policy reform for user fees in public health care in poor countries was derived ..... 10,000 (equivalent to US$ 6.25) annually. In return, one gets.

  8. Uncertainty analysis in raw material and utility cost of biorefinery synthesis and design

    DEFF Research Database (Denmark)

    Cheali, Peam; Quaglia, Alberto; Gernaey, Krist

    2014-01-01

    are characterized by considerable uncertainty. These uncertainties might have significant impact on the results of the design problem, and therefore need to be carefully evaluated and managed, in order to generate candidates for robust design. In this contribution, we study the effect of data uncertainty (raw...... material price and utility cost) on the design of a biorefinery process network....

  9. Health Utilization and Cost Impact of Childhood Constipation in the United States

    NARCIS (Netherlands)

    Liem, Olivia; Harman, Jeffrey; Benninga, Marc; Kelleher, Kelly; Mousa, Hayat; Di Lorenzo, Carlo

    2009-01-01

    Objective To estimate the total health care utilization and costs for children with constipation in the United States. Study design We analyzed data from 2 consecutive years (2003 and 2004) of the Medical Expenditure Panel Survey (MEPS), a nationally representative household survey. We identified

  10. [Characteristics and healthcare utilization of patients with highest costs of care

    NARCIS (Netherlands)

    Wammes, J.J.G.; Tanke, M.A.C.; Jonkers, W.; Westert, G.P.; Wees, P.J. van der; Jeurissen, P.P.T.

    2017-01-01

    OBJECTIVE: To determine characteristics and healthcare utilization of high-cost patients in the Netherlands. DESIGN: Cross-sectional study, using claim data for 2013 from one Dutch health insurer. Analyses were limited to the curative health system (care that falls under the Health Insurance Act),

  11. Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment.

    Science.gov (United States)

    Chatterjee, Abhishek; Macarios, David; Griffin, Leah; Kosowski, Tomasz; Pyfer, Bryan J; Offodile, Anaeze C; Driscoll, Daniel; Maddali, Sirish; Attwood, John

    2015-11-01

    Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost-utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. In our cost-utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps.

  12. Cost-utility analysis of treating out of hospital cardiac arrests in Jerusalem.

    Science.gov (United States)

    Ginsberg, Gary M; Kark, Jeremy D; Einav, Sharon

    2015-01-01

    Out-of-hospital cardiac arrest (OHCA) initiates a chain of responses including emergency medical service mobilization and medical treatment, transfer and admission first to a hospital Emergency Department (ED) and then usually to an intensive care unit and ward. Costly pre- and in-hospital care may be followed by prolonged post discharge expenditure on treatment of patients with severe neurological sequelae. We assessed the cost-effectiveness of treatment of OHCA by calculating the cost per Disability Adjusted Life Year (DALY) averted. We studied 3355 consecutive non-traumatic OHCAs (2005-2010) in Jerusalem, Israel, supplemented by hospital utilization data extracted from patient files (n = 570) and post-discharge follow-up (n = 196). Demographic, utilization and economic data were incorporated into a spreadsheet model to calculate the cost-utility ratio. Advanced life support was administered to 2264 of the 3355 OHCAs (67.5%) and 1048 (45.6%) patients were transferred to the ED. Of 676 (20.1%) patients who survived the ED and were admitted, there were 206 (6.1%) survivors to discharge, among them only 113 (3.4%) neurologically intact. Total cost ($39,100,000) per DALY averted (1353) was $28,864. The current package of OHCA interventions in Jerusalem appears to be very cost-effective as the cost per averted DALY of $28,864 is less than the Gross Domestic Product per capita ($33,261). This paper provides a basis for studying the effects of potential interventions that can be evaluated in terms of their incremental costs per averted DALY for treatment of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-05-01

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

  14. State trends in premiums and deductibles, 2003-2009: how building on the Affordable Care Act will help stem the tide of rising costs and eroding benefits.

    Science.gov (United States)

    Schoen, Cathy; Stremikis, Kristof; How, Sabrina K H; Collins, Sara R

    2010-12-01

    Rapidly rising health insurance costs have strained U.S. families and employers in recent years. This issue brief examines data for all states on changes in private employer premiums and deductibles for 2003 and 2009. The analysis finds that premiums for businesses and their employees increased 41 percent across states from 2003 to 2009, while per-person deductibles jumped 77 percent in large as well as small firms. If these trends continue at the rate prior to enactment of the Affordable Care Act, the average premium for family coverage will rise 79 percent by 2020, to more than $23,000. The authors describe how health reform offers the potential to reduce insurance cost growth while improving value and protection. If reforms succeed in slowing premium growth by 1 percentage point annually in all states, by 2020 employers and families together will save $2,323 annually for family coverage, compared with projected trends.

  15. Construction cost impact analysis of the U.S. Department of Energy mandatory performance standards for new federal commercial and multi-family, high-rise residential buildings

    International Nuclear Information System (INIS)

    Di Massa, F.V.; Hadley, D.L.; Halverson, M.A.

    1993-12-01

    In accordance with federal legislation, the U.S. Department of Energy (DOE) has conducted a project to demonstrate use of its Energy Conservation Voluntary Performance Standards for Commercial and Multi-Family High-Rise Residential Buildings; Mandatory for New Federal Buildings; Interim Rule (referred to in this report as DOE-1993). A key requisite of the legislation requires DOE to develop commercial building energy standards that are cost effective. During the demonstration project, DOE specifically addressed this issue by assessing the impacts of the standards on (1) construction costs, (2) builders (and especially small builders) of multi-family, high-rise buildings, and (3) the ability of low-to moderate-income persons to purchase or rent units in such buildings. This document reports on this project

  16. Key data elements for use in cost-utility modeling of biological treatments for rheumatoid arthritis.

    Science.gov (United States)

    Ganz, Michael L; Hansen, Brian Bekker; Valencia, Xavier; Strandberg-Larsen, Martin

    2015-05-01

    Economic evaluation is becoming more common and important as new biologic therapies for rheumatoid arthritis (RA) are developed. While much has been published about how to design cost-utility models for RA to conduct these evaluations, less has been written about the sources of data populating those models. The goal is to review the literature and to provide recommendations for future data collection efforts. This study reviewed RA cost-utility models published between January 2006 and February 2014 focusing on five key sources of data (health-related quality-of-life and utility, clinical outcomes, disease progression, course of treatment, and healthcare resource use and costs). It provided recommendations for collecting the appropriate data during clinical and other studies to support modeling of biologic treatments for RA. Twenty-four publications met the selection criteria. Almost all used two steps to convert clinical outcomes data to utilities rather than more direct methods; most did not use clinical outcomes measures that captured absolute levels of disease activity and physical functioning; one-third of them, in contrast with clinical reality, assumed zero disease progression for biologic-treated patients; little more than half evaluated courses of treatment reflecting guideline-based or actual clinical care; and healthcare resource use and cost data were often incomplete. Based on these findings, it is recommended that future studies collect clinical outcomes and health-related quality-of-life data using appropriate instruments that can convert directly to utilities; collect data on actual disease progression; be designed to capture real-world courses of treatment; and collect detailed data on a wide range of healthcare resources and costs.

  17. Health plan utilization and costs of specialty drugs within 4 chronic conditions.

    Science.gov (United States)

    Gleason, Patrick P; Alexander, G Caleb; Starner, Catherine I; Ritter, Stephen T; Van Houten, Holly K; Gunderson, Brent W; Shah, Nilay D

    2013-09-01

    Drugs are most typically defined as specialty because they are expensive; however, other criteria used to define a drug as specialty include biologic drugs, the need to inject or infuse the drug, the requirement for special handling, or drug availability only via a limited distribution network. Specialty drugs play an increasingly important role in the treatment of chronic conditions such as multiple sclerosis (MS), rheumatoid arthritis (RA), psoriasis, and inflammatory bowel disease (IBD), yet little is known regarding the comprehensive medical and pharmacy benefit utilization and cost trends for these conditions. To describe MS, RA, psoriasis, and IBD trends for condition prevalence, treatment with specialty drugs, specialty costs, nonspecialty costs, and total direct costs of care within the medical and pharmacy benefits. This was a descriptive analysis of a commercially insured population made up of 1 million members, using integrated medical and pharmacy administrative claims data from 2008 to 2010. Analyses were limited to continuously enrolled commercially insured individuals less than 65 years of age. Condition-specific cohorts for MS, RA, psoriasis, and IBD were defined using standardized criteria. Trends in condition prevalence, specialty drug use for the conditions, and direct total cost of care were analyzed. The direct costs were subcategorized into the following: medical benefit specialty drug costs, medical benefit all other costs, pharmacy benefit specialty drug costs, and pharmacy benefit all other costs. Trends and compound annual growth rates were calculated for the total cost of care and subcategory costs from 2008 through 2010. Condition prevalence ranged from a low of 1,720 per million members for MS to a high of 4,489 per million members for RA. Psoriasis and MS condition prevalence rates were unchanged over the 3 years; however, IBD prevalence increased 7.0%, and RA prevalence increased 9.7%. The rate of specialty drug use was lowest for IBD

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

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Wiser, Ryan

    2005-08-10

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

  19. Utilization of day surgery services at Upper hill Medical Centre and the Karen hospital in Nairobi: the influence of medical providers, cost and patient awareness.

    Science.gov (United States)

    Odhiambo, Mildred Adhiambo; Njuguna, Susan; Waireri-Onyango, Rachel; Mulimba, Josephat; Ngugi, Peter Mungai

    2015-01-01

    Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors. The study design was cross sectional with self administered questionnaires used to collect data. Data analysis was done by using statistical package for social science (SPSS) and presented as frequencies, percentages and Spearman's correlation to establish relationship among variables. Medical providers included doctors, their employees and medical insurance providers. Most doctors were aware of day surgery services but their frequency of utilization was low. Furthermore, medical insurance providers approved only half of the requests for day surgery. Doctors' employees were aware of the services and most of them would recommend it to patients. Although, most patients were not aware of day surgery services those who were aware would prefer day surgery to in patient. Moreover, doctors and medical insurance providers considered day surgery to be cheaper than in patient. The study showed that medical providers and patient awareness had influence over day surgery utilization, though, cost alone did not influence day surgery utilization but as a combination with other factors.

  20. Measuring the costs of photovoltaics in an electric utility planning framework

    International Nuclear Information System (INIS)

    Awerbuch, Shimon

    1993-01-01

    Utility planning models evaluate alternative generating options using the revenue requirements method-an engineering-oriented, discounted cash-flow (DCF) methodology that has been widely used for over three decades. Discounted cash-flow techniques were conceived in the context of active expense-intensive technologies, such as conventional, fuel-intensive power generation. Photovoltaic (PV) technology, by contrast, is passive and capital intensive-attributes that are similar to those of other new process technologies, such as computer-integrated manufacturing. Discounted cash-flow techniques have a dismal record for correctly valuing new technologies with these attributes, in part because their benefits cannot be easily measured using traditional accounting concepts. This paper examines how these issues affect cost measurement in both conventional and PV-based electricity, and presents kWh-cost estimates for three technologies (coal, gas and PV) using risk-adjusted approaches, which suggest that PV costs are generally equivalent to the gas/combined cycle and about twice the cost of base-load coal (environmental externalities are ignored). Finally, the paper evaluates independent power purchases for a typical US utility and finds that in such a setting the cost of PV-based power is comparable to the firm's published avoided costs. (author)

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2018-03-30

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

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

    Science.gov (United States)

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

    2015-02-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  5. Restricted Albumin Utilization Is Safe and Cost Effective in a Cardiac Surgery Intensive Care Unit.

    Science.gov (United States)

    Rabin, Joseph; Meyenburg, Timothy; Lowery, Ashleigh V; Rouse, Michael; Gammie, James S; Herr, Daniel

    2017-07-01

    Volume expansion is often necessary after cardiac surgery, and albumin is often administered. Albumin's high cost motivated an attempt to reduce its utilization. This study analyzes the impact limiting albumin infusion in a cardiac surgery intensive care unit. This retrospective study analyzed albumin use between April 2014 and April 2015 in patients admitted to a cardiac surgery intensive care unit. During the first 9 months, there were no restrictions. In January 2015, institutional guidelines limited albumin use to patients requiring more than 3 L crystalloid in the early postoperative period, hypoalbuminemic patients, and to patients considered fluid overloaded. Albumin utilization was obtained from pharmacy records and compared with outcome quality metrics. In all, 1,401 patients were admitted over 13 months. Albumin use, mortality, ventilator days, patients receiving transfusions, and length of stay were compared for 961 patients before and 440 patients after guidelines were initiated. After restrictive guidelines were instituted, albumin utilization was reduced from a mean of 280 monthly doses to a mean of 101 monthly doses (p albumin doses, the cardiac surgery intensive care unit demonstrated more than $45,000 of wholesale savings per month after restrictions were implemented. Albumin restriction in the cardiac surgery intensive care unit was feasible and safe. Significant reductions in utilization and cost with no changes in morbidity or mortality were demonstrated. These findings may provide a strategy for reducing cost while maintaining quality of care. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Classifier utility modeling and analysis of hypersonic inlet start/unstart considering training data costs

    Science.gov (United States)

    Chang, Juntao; Hu, Qinghua; Yu, Daren; Bao, Wen

    2011-11-01

    Start/unstart detection is one of the most important issues of hypersonic inlets and is also the foundation of protection control of scramjet. The inlet start/unstart detection can be attributed to a standard pattern classification problem, and the training sample costs have to be considered for the classifier modeling as the CFD numerical simulations and wind tunnel experiments of hypersonic inlets both cost time and money. To solve this problem, the CFD simulation of inlet is studied at first step, and the simulation results could provide the training data for pattern classification of hypersonic inlet start/unstart. Then the classifier modeling technology and maximum classifier utility theories are introduced to analyze the effect of training data cost on classifier utility. In conclusion, it is useful to introduce support vector machine algorithms to acquire the classifier model of hypersonic inlet start/unstart, and the minimum total cost of hypersonic inlet start/unstart classifier can be obtained by the maximum classifier utility theories.

  7. Student Loan Programs. As Federal Costs of Loan Consolidation Rise, Other Options Should be Examined. Report to Congressional Requesters.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    In this report GAO recommends that the Secretary of Education assess the advantages of consolidation loans for borrowers and the government in light of program costs and identify options for reducing federal costs. Options could include targeting the program to borrowers at risk of default and extending existing consolidation alternatives to more…

  8. Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

    Science.gov (United States)

    Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

    2008-10-01

    Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

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

    Science.gov (United States)

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

    2014-09-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

  11. Analytic model comparing the cost utility of TVT versus duloxetine in women with urinary stress incontinence.

    Science.gov (United States)

    Jacklin, Paul; Duckett, Jonathan; Renganathan, Arasee

    2010-08-01

    The purpose of this study was to assess cost utility of duloxetine versus tension-free vaginal tape (TVT) as a second-line treatment for urinary stress incontinence. A Markov model was used to compare the cost utility based on a 2-year follow-up period. Quality-adjusted life year (QALY) estimation was performed by assuming a disutility rate of 0.05. Under base-case assumptions, although duloxetine was a cheaper option, TVT gave a considerably higher QALY gain. When a longer follow-up period was considered, TVT had an incremental cost-effectiveness ratio (ICER) of pound 7,710 ($12,651) at 10 years. If the QALY gain from cure was 0.09, then the ICER for duloxetine and TVT would both fall within the indicative National Institute for Health and Clinical Excellence willingness to pay threshold at 2 years, but TVT would be the cost-effective option having extended dominance over duloxetine. This model suggests that TVT is a cost-effective treatment for stress incontinence.

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

    Science.gov (United States)

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

    2017-11-01

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

  13. Concave utility, transaction costs, and risk in measuring discounting of delayed rewards.

    Science.gov (United States)

    Kirby, Kris N; Santiesteban, Mariana

    2003-01-01

    Research has consistently found that the decline in the present values of delayed rewards as delay increases is better fit by hyperbolic than by exponential delay-discounting functions. However, concave utility, transaction costs, and risk each could produce hyperbolic-looking data, even when the underlying discounting function is exponential. In Experiments 1 (N = 45) and 2 (N = 103), participants placed bids indicating their present values of real future monetary rewards in computer-based 2nd-price auctions. Both experiments suggest that utility is not sufficiently concave to account for the superior fit of hyperbolic functions. Experiment 2 provided no evidence that the effects of transaction costs and risk are large enough to account for the superior fit of hyperbolic functions.

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

    Energy Technology Data Exchange (ETDEWEB)

    Wiser, Ryan; Bolinger, Mark

    2005-09-01

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

  15. Is control through utilization a cost effective Prosopis juliflora management strategy?

    Science.gov (United States)

    Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

    2016-03-01

    The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control

  16. Impact of lung function on exacerbations, health care utilization, and costs among patients with COPD

    Directory of Open Access Journals (Sweden)

    Ke X

    2016-07-01

    Full Text Available Xuehua Ke,1 Jessica Marvel,2 Tzy-Chyi Yu,2 Debra Wertz,1 Caroline Geremakis,1 Liya Wang,1 Judith J Stephenson,1 David M Mannino3 1HealthCore Inc., Wilmington, DE, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, 3University of Kentucky, Lexington, KY, USA Objective: To evaluate the impact of lung function, measured as forced expiratory volume in 1 second (FEV1 % predicted, on health care resource utilization and costs among patients with COPD in a real-world US managed-care population.Methods: This observational retrospective cohort study utilized administrative claim data augmented with medical record data. The study population consisted of patients with one or more medical claims for pre- and postbronchodilator spirometry during the intake period (July 1, 2012 to June 30, 2013. The index date was the date of the earliest medical claim for pre- and postbronchodilator spirometry. Spirometry results were abstracted from patients’ medical records. Patients were divided into two groups (low FEV1% predicted [<50%] and high FEV1% predicted [≥50%] based on the 2014 Global Initiative for Chronic Obstructive Lung Disease report. Health care resource utilization and costs were based on the prevalence and number of discrete encounters during the 12-month postindex follow-up period. Costs were adjusted to 2014 US dollars.Results: A total of 754 patients were included (n=297 low FEV1% predicted group, n=457 high FEV1% predicted group. COPD exacerbations were more prevalent in the low FEV1% predicted group compared with the high group during the 12-month pre- (52.5% vs 39.6% and postindex periods (49.8% vs 36.8%. Mean (standard deviation follow-up all-cause and COPD-related costs were $27,380 ($38,199 and $15,873 ($29,609 for patients in the low FEV1% predicted group, and $22,075 ($28,108 and $10,174 ($18,521 for patients in the high group. In the multivariable analyses, patients in the low FEV1% predicted group were more likely to have COPD

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

    Science.gov (United States)

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

    2016-06-01

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

  18. Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

    Science.gov (United States)

    Goold, S D

    1996-01-01

    Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

  19. Reducing operating costs: A collaborative approach between industry and electric utilities

    International Nuclear Information System (INIS)

    Tyers, B.; Sibbald, L.

    1993-01-01

    The unit cost of electricity to industrial consumers is expected to increase at a rate of 5% annually in the 1990s. The partnership that has been created between Amoco Canada Petroleum Company and TransAlta Utilities to control the cost of electricity is described. To allow the company to receive lower rates for interruptible power, a number of measures have been taken. The Amoco Whitecourt plant has standby generators in reserve that can be used when utility power is not available. A Pembina compressor can be turned off for up to 12 hours, at 30 minutes notice, without affecting field pressure. At the East Crossfield plant sales gas can be compressed using electricity or a gas-driven engine. Spot market energy is used in a number of plants allowing electric drive alternatives to plant operators and offering short term energy markets. TransAlta invests in electrical equipment such as switchgear as well as transmission lines and transformers. New rate alternatives offered by TransAlta Utilities include review of the need for a demand ratchet, additional time of use rates, unbundling of rates allowing power purchase from alternative sources, rates that follow product costs, reduced rates for conversion of gas to electric drives certain circumstances, energy audits, and power factor credits. 5 figs

  20. Discontinuity of Medicaid Coverage: Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression.

    Science.gov (United States)

    Ji, Xu; Wilk, Adam S; Druss, Benjamin G; Lally, Cathy; Cummings, Janet R

    2017-08-01

    Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression. Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression. A total of 139,164 adults (18-64) with major depression was identified using the 2003-2004 Medicaid Analytic eXtract Files. We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification. Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs. Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-valuesMedicaid coverage may help prevent acute episodes requiring high-cost interventions.

  1. Cost-utility of a specific collaborative group intervention for patients with functional somatic syndromes.

    Science.gov (United States)

    Konnopka, Alexander; König, Hans-Helmut; Kaufmann, Claudia; Egger, Nina; Wild, Beate; Szecsenyi, Joachim; Herzog, Wolfgang; Schellberg, Dieter; Schaefert, Rainer

    2016-11-01

    Collaborative group intervention (CGI) in patients with functional somatic syndromes (FSS) has been shown to improve mental quality of life. To analyse incremental cost-utility of CGI compared to enhanced medical care in patients with FSS. An economic evaluation alongside a cluster-randomised controlled trial was performed. 35 general practitioners (GPs) recruited 300 FSS patients. Patients in the CGI arm were offered 10 group sessions within 3months and 2 booster sessions 6 and 12months after baseline. Costs were assessed via questionnaire. Quality adjusted life years (QALYs) were calculated using the SF-6D index, derived from the 36-item short-form health survey (SF-36). We calculated patients' net-monetary-benefit (NMB), estimated the treatment effect via regression, and generated cost-effectiveness acceptability curves. Using intention-to-treat analysis, total costs during the 12-month study period were 5777EUR in the intervention, and 6858EUR in the control group. Controlling for possible confounders, we found a small, but significant positive intervention effect on QALYs (+0.017; p=0.019) and an insignificant cost saving resulting from a cost-increase in the control group (-10.5%; p=0.278). NMB regression showed that the probability of CGI to be cost-effective was 69% for a willingness to pay (WTP) of 0EUR/QALY, increased to 92% for a WTP of 50,000EUR/QALY and reached the level of 95% at a WTP of 70,375EUR/QALY. Subgroup analyses yielded that CGI was only cost-effective in severe somatic symptom severity (PHQ-15≥15). CGI has a high probability to be a cost-effective treatment for FSS, in particular for patients with severe somatic symptom severity. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Testicular self-examination and testicular cancer: a cost-utility analysis.

    Science.gov (United States)

    Aberger, Michael; Wilson, Bradley; Holzbeierlein, Jeffrey M; Griebling, Tomas L; Nangia, Ajay K

    2014-12-01

    The United States Preventive Services Task Force (USPSTF) has recommended against testicular self-examinations (TSE) or clinical examination for testicular cancer screening. However, in this recommendation there was no consideration of the significant fiscal cost of treating advanced disease versus evaluation of benign disease. In this study, a cost-utility validation for TSE was performed. The cost of treatment for an advanced-stage testicular tumor (both seminomatous and nonseminomatous) was compared to the cost of six other scenarios involving the clinical assessment of a testicular mass felt during self-examination (four benign and two early-stage malignant). Medicare reimbursements were used as an estimate for a national cost standard. The total treatment cost for an advanced-stage seminoma ($48,877) or nonseminoma ($51,592) equaled the cost of 313-330 benign office visits ($156); 180-190 office visits with scrotal ultrasound ($272); 79-83 office visits with serial scrotal ultrasounds and labs ($621); 6-7 office visits resulting in radical inguinal orchiectomy for benign pathology ($7,686) or 2-3 office visits resulting in treatment and surveillance of an early-stage testicular cancer ($17,283: seminoma, $26,190: nonseminoma). A large number of clinical evaluations based on the TSE for benign disease can be made compared to the cost of one missed advanced-stage tumor. An average of 2.4 to 1 cost benefit ratio was demonstrated for early detected testicular cancer versus advanced-stage disease. © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  3. Costs and utilization of public sector family planning services in Pakistan.

    Science.gov (United States)

    Abbas, Khadija; Khan, Adnan Ahmad; Khan, Ayesha

    2013-04-01

    The public sector provides a third of family planning (FP) services in Pakistan. However, these services are viewed as being underutilized and expensive. We explored the utilization patterns and costs of FP services in the public sector. We used overall budgets and time allocation by health and population departments to estimate the total costs of FP by these departments, costs per woman served, and costs per couple-year of protection (CYP). The public sector is the predominant provider of FP to the poorest and is the main provider of female sterilization services. The overall costs of FP in the public sector are USD 55 per woman served, annually (USD 17 per CYP). Within the public sector, the population welfare departments provide services at USD 72 per woman served, annually (USD 17 per CYP) and the health departments at USD 39 per woman per year (USD 29 per CYP). While the public sector has a critical niche in serving the poor and providing female sterilization, its services are considerably more expensive compared to international and even some Pakistani non-government organization (NGO) costs. This reflects inefficiencies in services provided, client mistrust in the quality of services provided, and inadequate referrals, and will require specific actions for improving referrals and the quality of services.

  4. Cost utility analysis of co-prescribed heroin compared with methadone maintenance treatment in heroin addicts in two randomised trials

    NARCIS (Netherlands)

    Dijkgraaf, Marcel G. W.; van der Zanden, Bart P.; de Borgie, Corianne A. J. M.; Blanken, Peter; van Ree, Jan M.; van den Brink, Wim

    2005-01-01

    Objective To determine the cost utility of medical co-prescription of heroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. Design Cost utility analysis of two pooled open label randomised controlled trials. Setting Methadone maintenance programmes in

  5. Divorce Costs and Marital Dissolution in a One-to-One Matching Framework With Nontransferable Utilities

    Directory of Open Access Journals (Sweden)

    Ismail Saglam

    2013-03-01

    Full Text Available In this paper, we use a two-period one-to-one matching model with incomplete information to examine the effect of changes in divorce costs on marital dissolution. Each individual who has a nontransferable expected utility about the quality of each potential marriage decides whether to marry or to remain single at the beginning of the first period. Individuals married in the first period learn the qualities of their marriages at the beginning of the second period and then decide whether to stay married or to unilaterally divorce. We show that, for any society, there exist matching environments where the probability of the marital dissolution does not reduce divorce costs under gender-optimal matching rules. In such environments, an allocation effect of divorce costs with an ambiguous sign outweighs an incentive effect that is always negative. We also show that these results may also arise under stable matching rules that are not gender optimal.

  6. 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

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

    Science.gov (United States)

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

    2016-08-01

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

  8. Effect of improved glycemic control on health care costs and utilization.

    Science.gov (United States)

    Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C

    2001-01-10

    Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.

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

    Energy Technology Data Exchange (ETDEWEB)

    1976-06-01

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

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

    Science.gov (United States)

    Cecchini, Michele; Sassi, Franco

    2015-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-03-19

    End-use energy efficiency is increasingly being relied upon as a resource for meeting electricity and natural gas utility system needs within the United States. There is a direct connection between the maturation of energy efficiency as a resource and the need for consistent, high-quality data and reporting of efficiency program costs and impacts. To support this effort, LBNL initiated the Cost of Saved Energy Project (CSE Project) and created a Demand-Side Management (DSM) Program Impacts Database to provide a resource for policy makers, regulators, and the efficiency industry as a whole. This study is the first technical report of the LBNL CSE Project and provides an overview of the project scope, approach, and initial findings, including: • Providing a proof of concept that the program-level cost and savings data can be collected, organized, and analyzed in a systematic fashion; • Presenting initial program, sector, and portfolio level results for the program administrator CSE for a recent time period (2009-2011); and • Encouraging state and regional entities to establish common reporting definitions and formats that would make the collection and comparison of CSE data more reliable. The LBNL DSM Program Impacts Database includes the program results reported to state regulators by more than 100 program administrators in 31 states, primarily for the years 2009–2011. In total, we have compiled cost and energy savings data on more than 1,700 programs over one or more program-years for a total of more than 4,000 program-years’ worth of data, providing a rich dataset for analyses. We use the information to report costs-per-unit of electricity and natural gas savings for utility customer-funded, end-use energy efficiency programs. The program administrator CSE values are presented at national, state, and regional levels by market sector (e.g., commercial, industrial, residential) and by program type (e.g., residential whole home programs, commercial new

  12. 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...

  13. Price and utilization: why we must target both to curb health care costs.

    Science.gov (United States)

    Spiro, Topher; Lee, Emily Oshima; Emanuel, Ezekiel J

    2012-10-16

    The United States spends nearly $8000 per person on health care annually. Even for a wealthy country, this amount is substantially more than would be expected and 2.5 times the average spent by other Organization for Economic Cooperation and Development (OECD) countries. The growth rate of health care spending in the United States has also far outpaced that in all other high-income OECD countries since 1970, even accounting for population growth. This increase in health spending threatens to squeeze out critical investments in education and infrastructure. To successfully develop and implement policies that effectively address both the level and growth of U.S. health care costs, it is critical to first understand cost drivers. Many health policy and economics scholars have contributed to an ongoing debate on whether to blame high prices or high utilization of services for escalating health care spending in the United States. This paper argues that price and volume both contribute to high and increasing health care costs, along with high administrative costs, supply issues, and the fee-for-service payment system. Initial strategies to contain costs might include implementation and expansion of bundled payment systems and competitive bidding.

  14. Estimation of cost-effectiveness of the Finnish electricity distribution utilities

    Energy Technology Data Exchange (ETDEWEB)

    Kopsakangas-Savolainen, Maria; Svento, Rauli [Department of Economics, University of Oulu (Finland)

    2008-03-15

    This paper examines the cost-effectiveness of Finnish electricity distribution utilities. We estimate several panel data stochastic frontier specifications using both Cobb-Douglas and Translog model specifications. The conventional models are extended in order to model observed heterogeneity explicitly in the cost frontier models. The true fixed effects model has been used as a representative of the models which account for unobserved heterogeneity and extended conventional random effect models have been used in analysing the impact of observed heterogeneity. A comparison between the conventional random effects model and models where heterogeneity component is entered either into the mean or into the variance of the inefficiency term shows that relative efficiency scores diminish when heterogeneity is added to the analysis. The true fixed effects model on the other hand gives clearly smaller inefficiency scores than random effects models. In the paper we also show that the relative inefficiency scores and rankings are not sensitive to the cost function specification. Our analysis points out the importance of the efficient use of the existing distribution network. The economies of scale results suggest that firms could reduce their operating costs by using networks more efficiently. According to our results average size firms which have high load factors are the most efficient ones. All firms have unused capacities so that they can improve cost-effectiveness rather by increasing the average distributed volumes than by mergers. (author)

  15. Estimation of cost-effectiveness of the Finnish electricity distribution utilities

    International Nuclear Information System (INIS)

    Kopsakangas-Savolainen, Maria; Svento, Rauli

    2008-01-01

    This paper examines the cost-effectiveness of Finnish electricity distribution utilities. We estimate several panel data stochastic frontier specifications using both Cobb-Douglas and Translog model specifications. The conventional models are extended in order to model observed heterogeneity explicitly in the cost frontier models. The true fixed effects model has been used as a representative of the models which account for unobserved heterogeneity and extended conventional random effect models have been used in analysing the impact of observed heterogeneity. A comparison between the conventional random effects model and models where heterogeneity component is entered either into the mean or into the variance of the inefficiency term shows that relative efficiency scores diminish when heterogeneity is added to the analysis. The true fixed effects model on the other hand gives clearly smaller inefficiency scores than random effects models. In the paper we also show that the relative inefficiency scores and rankings are not sensitive to the cost function specification. Our analysis points out the importance of the efficient use of the existing distribution network. The economies of scale results suggest that firms could reduce their operating costs by using networks more efficiently. According to our results average size firms which have high load factors are the most efficient ones. All firms have unused capacities so that they can improve cost-effectiveness rather by increasing the average distributed volumes than by mergers

  16. U.S. Dental School Deans’ Perceptions of the Rising Cost of Dental Education and Borrowing Pressures on Dental Students: Report of Survey Results.

    Science.gov (United States)

    McAllister, Dora Elías; Garrison, Gwen E; Feldman, Cecile A; Anderson, Eugene L; Cook, Bryan J; Valachovic, Richard W

    2015-06-01

    This report presents findings from a survey of U.S. dental school deans designed to capture their perceptions regarding the rising cost of dental education and its impact on borrowing by dental students to finance their education. The survey included questions about factors influencing the cost of dental education, concerns about dental student borrowing, and financial awareness resources for students. The survey was distributed to the deans of all 63 U.S. dental schools in January 2013; 42 deans responded, for a 67% response rate. The results indicate that, according to the responding deans, new clinical technologies, technology costs, and central university taxes are the main factors that contribute to the increasing cost of dental education. Coupled with reduced state appropriations at public dental schools and declines in private giving at all dental schools, dental school deans face a perplexing set of financial management challenges. Tuition and fees are a primary source of revenue for all dental schools; however, many deans do not have total control over the cost of attending their schools since tuition and fees are often tied to mandates and policies from the parent university and the state legislature. The findings of this study indicate that U.S. dental school deans are aware of and concerned about the impact of increases in tuition and fees on dental student debt and that they are using a variety of strategies to address the growth in dental student borrowing.

  17. A bottom-up method to develop pollution abatement cost curves for coal-fired utility boilers

    Science.gov (United States)

    This paper illustrates a new method to create supply curves for pollution abatement using boiler-level data that explicitly accounts for technology costs and performance. The Coal Utility Environmental Cost (CUECost) model is used to estimate retrofit costs for five different NO...

  18. Cost-utility model of rasagiline in the treatment of advanced Parkinson's disease in Finland.

    Science.gov (United States)

    Hudry, Joumana; Rinne, Juha O; Keränen, Tapani; Eckert, Laurent; Cochran, John M

    2006-04-01

    The economic burden of Parkinson's disease (PD) is high, especially in patients experiencing motor fluctuations. Rasagiline has demonstrated efficacy against symptoms of PD in early and advanced stages of the disease. To assess the cost-utility of rasagiline and entacapone as adjunctive therapies to levodopa versus standard levodopa care in PD patients with motor fluctuations in Finland. A 2 year probabilistic Markov model with 3 health states: "25% or less off-time/day," "greater than 25% off-time/day," and "dead" was used. Off-time represents time awake with poor or absent motor function. Model inputs included transition probabilities from randomized clinical trials, utilities from a preference measurement study, and costs and resources from a Finnish cost-of-illness study. Effectiveness measures were quality-adjusted life years (QALYs) and number of months spent with 25% or less off-time/day. Uncertainty around parameters was taken into account by Monte Carlo simulations. Over 2 years from a societal perspective, rasagiline or entacapone as adjunctive therapies to levodopa showed greater effectiveness than levodopa alone at no additional costs. Benefits after 2 years were 0.13 (95% CI 0.08 to 0.17) additional QALYs and 5.2 (3.6 to 6.7) additional months for rasagiline and 0.12 (0.08 to 0.17) QALYs and 5.1 (3.5 to 6.6) months for entacapone, both in adjunct to levodopa compared with levodopa alone. The results of this study support the use of rasagiline and entacapone as adjunctive cost-effective alternatives to levodopa alone in PD patients with motor fluctuations in Finland. With a different mode of action, rasagiline is a valuable therapeutic alternative to entacapone at no additional charge to society.

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

    Science.gov (United States)

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

    2017-06-01

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

  20. A methodology to identify stranded generation facilities and estimate stranded costs for Louisiana's electric utility industry

    Science.gov (United States)

    Cope, Robert Frank, III

    1998-12-01

    The electric utility industry in the United States is currently experiencing a new and different type of growing pain. It is the pain of having to restructure itself into a competitive business. Many industry experts are trying to explain how the nation as a whole, as well as individual states, will implement restructuring and handle its numerous "transition problems." One significant transition problem for federal and state regulators rests with determining a utility's stranded costs. Stranded generation facilities are assets which would be uneconomic in a competitive environment or costs for assets whose regulated book value is greater than market value. At issue is the methodology which will be used to estimate stranded costs. The two primary methods are known as "Top-Down" and "Bottom-Up." The "Top-Down" approach simply determines the present value of the losses in revenue as the market price for electricity changes over a period of time into the future. The problem with this approach is that it does not take into account technical issues associated with the generation and wheeling of electricity. The "Bottom-Up" approach computes the present value of specific strandable generation facilities and compares the resulting valuations with their historical costs. It is regarded as a detailed and difficult, but more precise, approach to identifying stranded assets and their associated costs. This dissertation develops a "Bottom-Up" quantitative, optimization-based approach to electric power wheeling within the state of Louisiana. It optimally evaluates all production capabilities and coordinates the movement of bulk power through transmission interconnections of competing companies in and around the state. Sensitivity analysis to this approach is performed by varying seasonal consumer demand, electric power imports, and transmission inter-connection cost parameters. Generation facility economic dispatch and transmission interconnection bulk power transfers, specific

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

    Science.gov (United States)

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

    2017-05-01

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

  2. Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis.

    Science.gov (United States)

    Dawoud, Dalia; Fenu, Elisabetta; Higgins, Bernard; Wonderling, David; Amiel, Stephanie A

    2017-12-01

    To assess the cost-effectiveness of basal insulin regimens for adults with type 1 diabetes mellitus in England. A cost-utility analysis was conducted in accordance with the National Institute for Health and Care Excellence reference case. The UK National Health Service and personal and social services perspective was used and a 3.5% discount rate was applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis. The IMS CORE Diabetes Model was used, in which net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. A wide range of sensitivity analyses were conducted. Insulin detemir (twice daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared with the lowest cost strategy (insulin neutral protamine Hagedorn once daily), it had an incremental cost-effectiveness ratio of £7844/QALY gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMBs of £180,893 and £180,423, respectively. iDet (bid) remained the most cost-effective treatment in all the sensitivity analyses performed except when high doses were assumed (>30% increment compared with other regimens), where iGlarg (od) ranked first. iDet (bid) is the most cost-effective regimen, providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the iDet (bid) regimen is not acceptable or does not achieve required glycemic control. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. What is heartburn worth? A cost-utility analysis of management strategies.

    Science.gov (United States)

    Heudebert, G R; Centor, R M; Klapow, J C; Marks, R; Johnson, L; Wilcox, C M

    2000-03-01

    To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life.

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

    Science.gov (United States)

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

    2014-04-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  6. Cancer care coordinators in stage III colon cancer: a cost-utility analysis.

    Science.gov (United States)

    Blakely, Tony; Collinson, Lucie; Kvizhinadze, Giorgi; Nair, Nisha; Foster, Rachel; Dennett, Elizabeth; Sarfati, Diana

    2015-08-05

    There is momentum internationally to improve coordination of complex care pathways. Robust evaluations of such interventions are scarce. This paper evaluates the cost-utility of cancer care coordinators for stage III colon cancer patients, who generally require surgery followed by chemotherapy. We compared a hospital-based nurse cancer care coordinator (CCC) with 'business-as-usual' (no dedicated coordination service) in stage III colon cancer patients in New Zealand. A discrete event microsimulation model was constructed to estimate quality-adjusted life-years (QALYs) and costs from a health system perspective. We used New Zealand data on colon cancer incidence, survival, and mortality as baseline input parameters for the model. We specified intervention input parameters using available literature and expert estimates. For example, that a CCC would improve the coverage of chemotherapy by 33% (ranging from 9 to 65%), reduce the time to surgery by 20% (3 to 48%), reduce the time to chemotherapy by 20% (3 to 48%), and reduce patient anxiety (reduction in disability weight of 33%, ranging from 0 to 55%). Much of the direct cost of a nurse CCC was balanced by savings in business-as-usual care coordination. Much of the health gain was through increased coverage of chemotherapy with a CCC (especially older patients), and reduced time to chemotherapy. Compared to 'business-as-usual', the cost per QALY of the CCC programme was $NZ 18,900 (≈ $US 15,600; 95% UI: $NZ 13,400 to 24,600). By age, the CCC intervention was more cost-effective for colon cancer patients costs, meaning the cost-effectiveness was roughly comparable between ethnic groups. Such a nurse-led CCC intervention in New Zealand has acceptable cost-effectiveness for stage III colon cancer, meaning it probably merits funding. Each CCC programme will differ in its likely health gains and costs, making generalisation from this evaluation to other CCC interventions difficult. However, this evaluation suggests

  7. Assigning values to intermediate health states for cost-utility analysis: theory and practice.

    Science.gov (United States)

    Cohen, B J

    1996-01-01

    Cost-utility analysis (CUA) was developed to guide the allocation of health care resources under a budget constraint. As the generally stated goal of CUA is to maximize aggregate health benefits, the philosophical underpinning of this method is classic utilitarianism. Utilitarianism has been criticized as a basis for social choice because of its emphasis on the net sum of benefits without regard to the distribution of benefits. For example, it has been argued that absolute priority should be given to the worst off when making social choices affecting basic needs. Application of classic utilitarianism requires use of strength-of-preference utilities, assessed under conditions of certainty, to assign quality-adjustment factors to intermediate health states. The two methods commonly used to measure strength-of-preference utility, categorical scaling and time tradeoff, produce rankings that systematically give priority to those who are better off. Alternatively, von Neumann-Morgenstern utilities, assessed under conditions of uncertainty, could be used to assign values to intermediate health states. The theoretical basis for this would be Harsanyi's proposal that social choice be made under the hypothetical assumption that one had an equal chance of being anyone in society. If this proposal is accepted, as well as the expected-utility axioms applied to both individual choice and social choice, the preferred societal arrangement is that with the highest expected von Neumann-Morgenstern utility. In the presence of risk aversion, this will give some priority to the worst-off relative to classic utilitarianism. Another approach is to raise the values obtained by time-tradeoff assessments to a power a between 0 and 1. This would explicitly give priority to the worst off, with the degree of priority increasing as a decreases. Results could be presented over a range of a. The results of CUA would then provide useful information to those holding a range of philosophical points

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

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

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

  9. Factors associated with the utilization and costs of health and social services in frail elderly patients

    Directory of Open Access Journals (Sweden)

    Kehusmaa Sari

    2012-07-01

    Full Text Available Abstract Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in

  10. Using Stochastic Frontier Analysis to Analyze Adjustment Costs and Investment Utilization

    DEFF Research Database (Denmark)

    Olsen, Jakob Vesterlund; Henningsen, Arne

    of additional inputs and an initially incomplete investment utilization results in an output level that is temporarily not at its maximum. We estimate an output distance function as a stochastic "Efficiency Effects Frontier" model (Battese & Coelli 1995), where the estimated technical inefficiencies...... are explained with current and lagged investments, farm size, age of the farmer, and interaction terms between these variables. Furthermore, we derive the formula for calculating the marginal effects on technical efficiency for "Efficiency Effects Frontier" models so that we can calculate the (marginal) effect...... of current and past investments on technical efficiency, which we interpret as adjustment costs and temporary incomplete investment utilization. We apply this methodology to a large panel data set of Danish pig producers with 9,281 observations between 1996 and 2008. The results show that investments have...

  11. Prescription copay reduction program for diabetic employees: impact on medication compliance and healthcare costs and utilization.

    Science.gov (United States)

    Nair, Kavita V; Miller, Kerri; Saseen, Joseph; Wolfe, Pamela; Allen, Richard Read; Park, Jinhee

    2009-01-01

    To examine the impact of a value-based benefit design on utilization and expenditures. This benefit design involved all diabetes-related drugs and testing supplies placed on the lowest copay tier for 1 employer group. The sample of diabetic members were enrolled from a 9-month preperiod and for 2 years after the benefit design was implemented. Measured outcomes included prescription drug utilization for diabetes and medical utilization. Generalized measures were used to estimate differences between years 1 and 2 and the preperiod adjusting for age, gender, and comorbidity risk. Diabetes prescription drug use increased by 9.5% in year 1 and by 5.5% in year 2, and mean adherence increased by 7% to 8% in year 1 and fell slightly in year 2 compared with the preperiod. Pharmacy expenditures increased by 47% and 53% and expenditures for diabetes services increased by 16% and 32% in years 1 and 2, respectively. Increases in adherence and use of diabetes medications were observed. There were no compensatory cost-savings for the employer through lower utilization of medical expenditures in the first 2 years. Adherent patients had fewer emergency department visits than nonadherent patients after the implementation of this benefit design.

  12. When renewable energy met sustainable growth. Regulation, cost reduction, and the rise of renewable energy in the United States

    International Nuclear Information System (INIS)

    Stephens, Samantha

    2016-01-01

    Historically and famously fossil-fuel dependent, the U.S. energy and electricity mixes are evolving quickly as costs fall for renewables, regulations mandate their implementation, and fiscal policy incentivizes their installation. The investment and production tax credits (ITC and PTC) as well as power purchase agreements (PPAs) are well-known for their contributions to the development of solar and wind capacity, and the recent extensions of these credits has led to a positive outlook for continued growth in installations and generation. In addition, the green power market is experiencing record participation, as tracking the positive environmental externalities of renewable power has become important to meet renewable portfolio standards, which mandate implementation of renewable energy by state. Cost reduction is further taking place globally due to technological advances and economies of scale, which serves as another key driver for development. Of course, challenges are still present, particularly due to a plentiful and inexpensive domestic fossil fuel supply, uneven application of regulation and incentives state-by-state, and the uncertainty of continued political support. Even so, a progressive lowering of traditional barriers is leading to the potential for widespread deployment of renewables across the American landscape. (author)

  13. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  14. A Value-Based Medicine cost-utility analysis of genetic testing for neovascular macular degeneration.

    Science.gov (United States)

    Brown, Gary C; Brown, Melissa M; Lieske, Heidi B; Lieske, Philip A; Brown, Kathryn S

    2015-01-01

    There is a dearth of patient, preference-based cost-effectiveness analyses evaluating genetic testing for neovascular age-related macular degeneration (NVAMD). A Value-Based Medicine, 12-year, combined-eye model, cost-utility analysis evaluated genetic testing of Category 3 AMD patients at age 65 for progression to NVAMD. The benefit of genetic testing was predicated upon the fact that early-treatment ranibizumab therapy (baseline vision 20/40-20/80) for NVAMD confers greater patient value than late-treatment (baseline vision ≤20/160). Published genetic data and MARINA Study ranibizumab therapy data were utilized in the analysis. Patient value (quality-of-life gain) and financial value (2012 US real dollar) outcomes were discounted at 3 % annually. Genetic testing-enabled, early-treatment ranibizumab therapy per patient conferred mean 20/40 -1 vision, a 0.845 QALY gain and 14.1 % quality-of-life gain over sham therapy. Late-treatment ranibizumab therapy conferred mean 20/160 +2 vision, a 0.250 QALY gain and 4.2 % quality-of-life gain over sham therapy. The gain from early-treatment over late-treatment was 0.595 QALY (10.0 % quality-of-life gain). The per-patient cost for genetic testing/closer monitoring was $2205 per screened person, $2.082 billion for the 944,000 estimated new Category 3 AMD patients annually. Genetic testing/monitoring costs per early-treatment patient totaled $66,180. Costs per early-treatment patient included: genetic testing costs: $66,180 + direct non-ophthalmic medical costs: -$40,914 + caregiver costs: -$172,443 + employment costs: -$14,098 = a net societal cost saving of $160,582 per early treatment patient. When genetic screening facilitated an incremental 12,965 (8.0 %) of the 161,754, new annual NVAMD patients aged ≥65 in the US to undergo early-treatment ranibizumab therapy, each additional patient treated accrued an overall, net financial gain for society of $160,582. Genetic screening was cost-effective, using World

  15. POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia.

    Science.gov (United States)

    Miller, Heidi J; Neupane, Ruel; Fayezizadeh, Mojtaba; Majumder, Arnab; Marks, Jeffrey M

    2017-04-01

    Achalasia is a rare motility disorder of the esophagus. Treatment is palliative with the goal of symptom remission and slowing the progression of the disease. Treatment options include per oral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LM) and endoscopic treatments such as pneumatic dilation (PD) and botulinum toxin type A injections (BI). We evaluate the economics and cost-effectiveness of treating achalasia. We performed cost analysis for POEM, LM, PD and BI at our institution from 2011 to 2015. Cost of LM was set to 1, and other procedures are presented as percentage change. Cost-effectiveness was calculated based on cost, number of interventions required for optimal results for dilations and injections and efficacy reported in the current literature. Incremental cost-effectiveness ratio was calculated by a cost-utility analysis using quality-adjusted life year gained, defined as a symptom-free year in a patient with achalasia. Average number of interventions required was 2.3 dilations or two injections for efficacies of 80 and 61 %, respectively. POEM cost 1.058 times the cost of LM, and PD and BI cost 0.559 and 0.448 times the cost of LM. Annual cost per cure over a period of 4 years for POEM, and LM were consistently equivalent, trending the same as PD although this has a lower initial cost. The cost per cure of BI remains stable over 3 years and then doubles. The cost-effectiveness of POEM and LM is equivalent. Myotomy, either surgical or endoscopic, is more cost-effective than BI due to high failure rates of the economical intervention. When treatment is being considered BI should be utilized in patients with less than 2-year life expectancy. Pneumatic dilations are cost-effective and are an acceptable approach to treatment of achalasia, although myotomy has a lower relapse rate and is cost-effective compared to PD after 2 years.

  16. Estimating the demand for drop-off recycling sites: a random utility travel cost approach.

    Science.gov (United States)

    Sidique, Shaufique F; Lupi, Frank; Joshi, Satish V

    2013-09-30

    Drop-off recycling is one of the most widely adopted recycling programs in the United States. Despite its wide implementation, relatively little literature addresses the demand for drop-off recycling. This study examines the demand for drop-off recycling sites as a function of travel costs and various site characteristics using the random utility model (RUM). The findings of this study indicate that increased travel costs significantly reduce the frequency of visits to drop-off sites implying that the usage pattern of a site is influenced by its location relative to where people live. This study also demonstrates that site specific characteristics such as hours of operation, the number of recyclables accepted, acceptance of commingled recyclables, and acceptance of yard-waste affect the frequency of visits to drop-off sites. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. The comparative costs of nuclear and fossil fuelled power plants in an American electricity utility

    International Nuclear Information System (INIS)

    Corey, G.R.

    1984-01-01

    This chapter compares the current and historic operating performances of twelve large nuclear and coal-fired units now operated by Commonwealth Edison Company, and provides specific comparison of bus-bar costs of electricity generated by those units in recent years. It also provides cost comparisons for future nuclear and coal-fired units and attempts to deal realistically with the effect of future inflation upon these comparisons. The chapter attempts to deal responsibly with the problem of uncertainty - how present-day comparisons may be affected by future developments and how my own published comparisons have varied over the past four or five years. The conclusion is reached that, given the uncertain world in which we live, no electric power supplier can afford to put all its eggs in one basket. Utility managers have a strong incentive to diversify their sources of power generation, and society as a whole would do well to encourage such diversification. (author)

  18. Utilization of uranium cost/benefit study for nuclear powered merchant ships. Special study

    International Nuclear Information System (INIS)

    Smith, E.R.

    1977-05-01

    This study presents a cost/benefit analysis for the utilization of uranium in merchant ships versus the use of uranium for the generation of electricity in central power stations. The study concludes that an alternative naval fuel to oil must be developed for the merchant marine to reduce U.S. dependency upon foreign supplies of a critical fuel. The study further indicates that use of uranium for ship propulsion results in transport of large quantities of needed import/exports while the residual oil saved will generate the same quantity of electricity in a central power station as the uranium used for ship propulsion

  19. Cost-benefit assessment of energy storage for utility and customers: A case study in Malaysia

    International Nuclear Information System (INIS)

    Chua, Kein Huat; Lim, Yun Seng; Morris, Stella

    2015-01-01

    Highlights: • Energy storage can replace the peaking plants. • The cost of electricity for the plants with energy storage is as competitive as fossil fuel power plants. • Energy storage can reduce CO_2 emissions and defer the reinforcement of transmissions and distributions infrastructure. • Energy storage can reduce peak demand charge for customers. - Abstract: Under the existing commercial framework of electricity in Malaysia, commercial and industrial customers are required to pay for the peak power demand charge every month. Usually, the peak demand charge can contribute up to 30% to their electricity bills due to the use of open-cycle gas power plants that deliver expensive electricity to the customers. Therefore, alternative means are sought after in order to reduce the peak demand for the customers. Distributed small-scaled energy storage can offer a good option to reduce the peak. This paper aims to identify the financial benefits of the energy storage system for utility companies and customers. An energy dispatch model is developed in HOMER to determine the cost of electricity. The model considers the heat rates of power plants in calculating the costs of electricity under different regulatory frameworks of natural gas with various prices of battery components. Apart from that, the cost-benefit for the customers under various electric tariff structures is evaluated. Four battery storage technologies, namely lead acid, vanadium redox flow, zinc-bromine, and lithium-ion are considered. The simulation results show that the storage system with lead acid batteries is more cost-effective than other battery technologies. The customers can reduce their electricity bills with the payback period of 2.8 years. The generation cost for the power system with energy storage is lower than that without energy storage. Besides, the system with energy storage has lower greenhouse gas emissions than that without energy storage. The deferral of the reinforcement of

  20. Drug Utilization Patterns and Costs of Erythropoiesis-Stimulating Agents in an Outpatient Setting in Greece.

    Science.gov (United States)

    Papachristos, Apostolos; Kani, Chara; Litsa, Panagiota; Valsami, Georgia; Souliotis, Kyriakos; Saridi, Maria; Markantonis, Sophia

    2016-05-01

    Anemia in the elderly is often related to a higher prevalence of chronic diseases such as chronic kidney failure, arthritis, and malignancy. Erythropoiesis-stimulating agents (ESAs) have been used for years to effectively treat anemia and when used appropriately can substantially improve the health status and quality of life of older adults. Following the 2008 recession in Greece, the government introduced ESA price control restrictions, but no prescribing restrictions, in an effort to reduce drug expenditure. ESA prescribing patterns and treatment costs were analyzed to determine inappropriate or appropriate use of these agents and related health care resources in Greece. A retrospective register-based drug utilization study was carried out using data from prescriptions dispensed at the public pharmacy of the largest social insurance fund (IKA-ETAM), for patients receiving ESAs over a six-month period. For each patient, demographic data, ESA dosage regimen, treatment indication and cost, prescriber specialty, and prescription origin were recorded. A total of 14,387 prescriptions from 6,074 patients (median age 74 years) were reviewed. A substantial number of patients (13.5%) were treated for off-label indications, for which the average cost per patient per indication was higher. ESA dosage/frequency of administration varied but was in accordance with recommendations. The percentage of patients who received innovator and biosimilar erythropoietin (EPO) was 88% and 12%, respectively. For the optimization of ESA utilization and the reduction of treatment costs, strict ESA prescription monitoring, development of registries, and criteria for off-label indications and biosimilar use in naive patients under the umbrella of risk-sharing agreements should be proposed.

  1. Incremental health care utilization and costs for acute otitis media in children.

    Science.gov (United States)

    Ahmed, Sameer; Shapiro, Nina L; Bhattacharyya, Neil

    2014-01-01

    Determine the incremental health care costs associated with the diagnosis and treatment of acute otitis media (AOM) in children. Cross-sectional analysis of a national health-care cost database. Pediatric patients (age children with and without a diagnosis of AOM, adjusting for age, sex, region, race, ethnicity, insurance coverage, and Charlson comorbidity Index. A total of 8.7 ± 0.4 million children were diagnosed with AOM (10.7 ± 0.4% annually, mean age 5.3 years, 51.3% male) among 81.5 ± 2.3 million children sampled (mean age 8.9 years, 51.3% male). Children with AOM manifested an additional +2.0 office visits, +0.2 emergency department visits, and +1.6 prescription fills (all P <0.001) per year versus those without AOM, adjusting for demographics and medical comorbidities. Similarly, AOM was associated with an incremental increase in outpatient health care costs of $314 per child annually (P <0.001) and an increase of $17 in patient medication costs (P <0.001), but was not associated with an increase in total prescription expenses ($13, P = 0.766). The diagnosis of AOM confers a significant incremental health-care utilization burden on both patients and the health care system. With its high prevalence across the United States, pediatric AOM accounts for approximately $2.88 billion in added health care expense annually and is a significant health-care utilization concern. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Costs and utilization of hemophilia A and B patients with and without inhibitors.

    Science.gov (United States)

    Armstrong, Edward P; Malone, Daniel C; Krishnan, Sangeeta; Wessler, Maj Jacob

    2014-11-01

    To evaluate the health system costs among patients with hemophilia A and B with and without inhibitors over 5 years. This was a retrospective, observational study utilizing medical and pharmacy electronic medical records and administrative encounters/claims data tracking US patients between 2006-2011. Patients with diagnosis codes for hemophilia A and B were identified. Patients with inhibitors were characterized by utilization of bypassing agents activated prothrombin complex concentrate or factor VIIa on two or more distinct dates. Severity was classified as mild, moderate, or severe based on laboratory tests of clotting factor. There were 160 hemophilia A patients and 54 hemophilia B patients identified. From this group, seven were designated as patients with inhibitors (five with hemophilia A and two with hemophilia B). Hemophilia A patients without inhibitors reported 65 (41.9%) as being severe, 19 (12.3%) as moderate, and 71 (45.8%) as mild. Hemophilia B patients without inhibitors reported nine (17.3%) had severe, 13 (25.0%) had moderate, and 30 (57.7%) had mild hemophilia. All patients with inhibitors had been hospitalized in the previous 5 years compared to 64 (41.3%) with hemophilia A without inhibitors and 22 (42.3%) with hemophilia B without inhibitors. The median aggregate cost per year (including factor and health resource use) was $325,780 for patients with inhibitors compared to $98,334 for hemophilia A patients without inhibitors and $23,265 for hemophilia B patients without inhibitors. The results suggest that, while the frequency of inhibitors within the hemophilia cohort was low, there was a higher frequency of hospitalizations, and the associated median aggregate costs per year were 3-fold higher than those patients without inhibitors. In contrast, hemophilia B patients experience less severe disease and account for lower aggregate yearly costs compared to either patients with hemophilia A or patients with inhibitors.

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

    Science.gov (United States)

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

    2018-05-10

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

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

    Directory of Open Access Journals (Sweden)

    Binbin Peng

    2018-02-01

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

  5. Trends in Japan's power generation costs after the Fukushima Daiichi Nuclear Power Plant accident and their influence on finance of electric utilities

    International Nuclear Information System (INIS)

    Matsuo, Yuhji; Yamaguchi, Yuhji; Murakami, Tomoko

    2013-01-01

    Following the Fukushima Daiichi nuclear power plant accident, the nuclear reactors that were suspended for periodic inspections after the Fukushima accident were not permitted to resume operation, and nuclear power generation in Japan continued to decline. In this article, the authors quantitatively evaluated the effects on power generation costs of Japan's situation, using electric utilities financial reports up to FY 2011. We also analyzed the profitability of the Japanese electric industry, using the financial statements included in the reports, and quantitatively evaluated the effects of changes in power generation costs. The total cost of power generation has increased from 7.5 trillion yen in FY 2010 before the Fukushima accident to 9.6 trillion yen in FY 2011 and to 10.6 trillion yen in FY 2012. In particular, the fuel cost for thermal power generation rose sharply from 3.7 trillion yen in FY 2010 to 6.1 trillion yen in FY 2011 and 7.3 trillion yen in FY 2012, almost doubling in the two years from FY 2010 to 2012. The unit cost of power generation rose sharply from 8.6 yen/kWh in FY 2010 to 11.8 yen/kWh in FY 2011 and 13.5 yen/kWh in FY 2012. The unit cost is expected to rise even further in FY 2013 due to the weak yen. As the result not only Tokyo Electric Power Company, but also the other general electric utilities registered huge net losses. Their retained earnings (total of eight utilities) dropped by 2 trillion yen between FY 2010 and 2012. With increased thermal power generation, the risk of rising costs associated with changes in primary energy prices and exchange rates has increased drastically. For the stability of the electricity industry and the development of the Japanese economy, the government should clearly formulate a basic policy regarding the composition of power sources, and an effective plan both at home and abroad, and should develop a system that will be also to handle sudden changes in the composition of power sources. (author)

  6. Utilization and Costs of Compounded Medications for Commercially Insured Patients, 2012-2013.

    Science.gov (United States)

    McPherson, Timothy; Fontane, Patrick; Iyengar, Reethi; Henderson, Rochelle

    2016-02-01

    Although compounding has a long-standing tradition in clinical practice, insurers and pharmacy benefit managers have instituted policies to decrease claims for compounded medications, citing questions about their safety, efficacy, high costs, and lack of FDA approval. There are no reliable published data on the extent of compounding by community pharmacists nor on the fraction of patients who use compounded medications. Prior research suggests that compounded medications represent a relatively small proportion of prescription medications, but those surveys were limited by small sample sizes, subjective data collection methods, and low response rates. To determine the number of claims for compounded medications on a per user per year (PUPY) basis and the average ingredient cost of these claims among commercially insured patients in the United States for 2012 and 2013. This study used prescription claims data from a nationally representative sample of commercially insured members whose pharmacy benefits were managed by a large pharmacy benefit management company. A retrospective claims analysis was conducted from January 1, 2012, through December 31, 2013. Annualized prevalence, cost, and utilization estimates were drawn from the data. All prescription claims were adjusted to 30-day equivalents. Data-mining techniques (association rule mining) were employed in order to identify the most commonly combined ingredients in compounded medications. The prevalence of compound users was 1.1% (245,285) of eligible members in 2012 and 1.4% (323,501) in 2013, an increase of 27.3%. Approximately 66% of compound users were female, and the average age of a compound user was approximately 42 years throughout the study period. The geographic distribution of compound user prevalence was consistent across the United States. Compound users' prescription claims increased 36.6% from 2012 to 2013, from approximately 7.1 million to approximately 9.7 million prescriptions. The number of

  7. Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis.

    Science.gov (United States)

    Cooperberg, Matthew R; Ramakrishna, Naren R; Duff, Steven B; Hughes, Kathleen E; Sadownik, Sara; Smith, Joseph A; Tewari, Ashutosh K

    2013-03-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Multiple treatment alternatives exist for localised prostate cancer, with few high-quality studies directly comparing their comparative effectiveness and costs. The present study is the most comprehensive cost-effectiveness analysis to date for localised prostate cancer, conducted with a lifetime horizon and accounting for survival, health-related quality-of-life, and cost impact of secondary treatments and other downstream events, as well as primary treatment choices. The analysis found minor differences, generally slightly favouring surgical methods, in quality-adjusted life years across treatment options. However, radiation therapy (RT) was consistently more expensive than surgery, and some alternatives, e.g. intensity-modulated RT for low-risk disease, were dominated - that is, both more expensive and less effective than competing alternatives. To characterise the costs and outcomes associated with radical prostatectomy (open, laparoscopic, or robot-assisted) and radiation therapy (RT: dose-escalated three-dimensional conformal RT, intensity-modulated RT, brachytherapy, or combination), using a comprehensive, lifetime decision analytical model. A Markov model was constructed to follow hypothetical men with low-, intermediate-, and high-risk prostate cancer over their lifetimes after primary treatment; probabilities of outcomes were based on an exhaustive literature search yielding 232 unique publications. In each Markov cycle, patients could have remission, recurrence, salvage treatment, metastasis, death from prostate cancer, and death from other causes. Utilities for each health state were determined, and disutilities were applied for complications and toxicities of treatment. Costs were determined from the USA payer perspective, with incorporation of patient costs in a sensitivity analysis. Differences across treatments in quality-adjusted life years across methods were modest, ranging from 10.3 to

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

    Directory of Open Access Journals (Sweden)

    Borna Doračić

    2018-03-01

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

  9. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs.

    Science.gov (United States)

    Legorreta, Antonio P; Metz, R Douglas; Nelson, Craig F; Ray, Saurabh; Chernicoff, Helen Oster; Dinubile, Nicholas A

    2004-10-11

    Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations. This study ascertains the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system. A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit. Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year, P<.001). Having chiropractic coverage was associated with a 1.6% decrease (P = .001) in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs (17.5 vs 22.7, P<.001), low back surgery (3.3 vs 4.8, P<.001), hospitalizations (9.3 vs 15.6, P<.001), and magnetic resonance imaging (43.2 vs 68.9, P<.001). Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.

  10. Telemedicine-based diabetic retinopathy screening programs: an evaluation of utility and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Cuadros JA

    2015-06-01

    Full Text Available Jorge A Cuadros Optometry/Vision Science, University of California, Berkeley, CA, USA Abstract: Diabetes is the main cause of blindness among working age adults, although treatment is highly effective in preventing vision loss. Eye examinations are recommended on a yearly basis for most patients for timely detection of retinal disease. Telemedicine-based diabetic retinopathy screening (TMDRS programs have been developed to identify patients with sight-threatening diabetic eye disease because patients are often noncompliant with recommended live eye examinations. This article reviews the cost-effectiveness of the various forms of TMDRS. A review of relevant articles, mostly published since 2008, shows that societal benefits generally outweigh the costs of TMDRS. However, advances in technology to improve efficacy, lower costs, and broaden screening to other sight-threatening conditions, such as glaucoma and refractive error, are necessary to improve the sustainability of TMDRS within health care organizations. Patient satisfaction with these telemedicine programs is generally high. New models of shared care with primary care providers and staff are emerging to improve patient engagement and follow-up care when individuals are found to have sight-threatening eye disease. TMDRS programs are growing and provide valuable clinical benefit. The cost-utility is currently well proven in locations with limited access to regular eye care services, such as rural areas, poor communities, and prison systems; however, improvements over time are necessary for these programs to be cost-effective in mainstream medical settings in the future. Keywords: telemedicine, diabetes, retinopathy, retinal imaging

  11. Drug utilization and cost in a Medicaid population: A simulation study of community vs. mail order pharmacy

    Directory of Open Access Journals (Sweden)

    Seoane-Vazquez Enrique

    2007-07-01

    Full Text Available Abstract Background Outpatient drugs are dispensed through both community and mail order pharmacies. There is no empirical evidence that substitution of community pharmacy with mail order reduces overall drug expenditures. The need for evaluating the potential effects on utilization and costs of the possible extension of mail order services in Medicaid provides the rationale for conducting this study. This study compares drug utilization and drug product cost in community vs. mail order pharmacy dispensing services in a Medicaid population. Methods This study is a retrospective cohort study comparing utilization and cost patterns in community vs. mail order pharmacy. A simulation model was employed to assess drug utilization and cost in mail order pharmacy using community pharmacy claim data. The model assumed that courses of drug therapy (CDT in mail order pharmacy would have utilization patterns similar to those found in community pharmacy. A 95% confidence interval surrounding changes in average utilization and average cost were estimated using bootstrap analysis. A sensitivity analysis was performed by varying drug selection criteria and supply, fill point, and medication possession ratio (MPR. Sub-analyses were performed to address differences between mail order and community pharmacy related to therapeutic class and dual-eligible patients. Data for the study derived from pharmacy claims database of Ohio Medicaid State program for the period January 2000-September 2004. Drug claims were aggregated to obtain a set of CDTs representing unique patient IDs and unique drug products. Drug product cost estimates excluded dispensing fees and were used to estimate the cost reduction required in mail order to become cost neutral in comparison with community pharmacy. Results The baseline model revealed that the use of mail order vs. community pharmacy would result in a 5.5% increase in drug utilization and a 5.4% cost reduction required in mail order

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

    Science.gov (United States)

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

    2018-05-01

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

  13. [Current status of costs and utilizations of hospital based home health nursing care in Korea].

    Science.gov (United States)

    Ryu, Hosihn

    2006-12-01

    The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won ( approximately 48 $, 1 $=960 Won). The costs ranged from 74,523 Won ( approximately 78 $, loss of chronic kidney function, N18) to 32,270 Won ( approximately 34 $, other cerebrovascular diseases, I67). Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

  14. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    .001 in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 € was less than open surgery (17,260 €, (p=0.001. Conclusion: Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs. Keywords: laparoscopy, aortobifemoral bypass, cost-utility, quality-adjusted life years, QALYs, EQ-5D, health-related quality of life, HRQoL, cost-effectiveness

  15. The Potential to Forgo Social Welfare Gains through Over reliance on Cost Effectiveness/Cost Utility Analyses in the Evidence Base for Public Health

    International Nuclear Information System (INIS)

    Cohen, D.R.; Patel, N.

    2010-01-01

    Economic evaluations of clinical treatments most commonly take the form of cost effectiveness or cost utility analyses. This is appropriate since the main sometimes the only benefit of such interventions is increased health. The majority of economic evaluations in public health, however, have also been assessed using these techniques when arguably cost benefit analyses would in many cases have been more appropriate, given its ability to take account of non health benefits as well. An examination of the non health benefits from a sample of studies featured in a recent review of economic evaluations in public health illustrates how over focusing on cost effectiveness/cost utility analyses may lead to forgoing potential social welfare gains from programmes in public health. Prior to evaluation, programmes should be considered in terms of the potential importance of non health benefits and where these are considerable would be better evaluated by more inclusive economic evaluation techniques.

  16. Reliability and cost/worth evaluation of generating systems utilizing wind and solar energy

    Science.gov (United States)

    Bagen

    The utilization of renewable energy resources such as wind and solar energy for electric power supply has received considerable attention in recent years due to adverse environmental impacts and fuel cost escalation associated with conventional generation. At the present time, wind and/or solar energy sources are utilized to generate electric power in many applications. Wind and solar energy will become important sources for power generation in the future because of their environmental, social and economic benefits, together with public support and government incentives. The wind and sunlight are, however, unstable and variable energy sources, and behave far differently than conventional sources. Energy storage systems are, therefore, often required to smooth the fluctuating nature of the energy conversion system especially in small isolated applications. The research work presented in this thesis is focused on the development and application of reliability and economic benefits assessment associated with incorporating wind energy, solar energy and energy storage in power generating systems. A probabilistic approach using sequential Monte Carlo simulation was employed in this research and a number of analyses were conducted with regards to the adequacy and economic assessment of generation systems containing wind energy, solar energy and energy storage. The evaluation models and techniques incorporate risk index distributions and different operating strategies associated with diesel generation in small isolated systems. Deterministic and probabilistic techniques are combined in this thesis using a system well-being approach to provide useful adequacy indices for small isolated systems that include renewable energy and energy storage. The concepts presented and examples illustrated in this thesis will help power system planners and utility managers to assess the reliability and economic benefits of utilizing wind energy conversion systems, solar energy conversion

  17. Cost-Effectiveness and Cost-Utility Analysis of Ingenol Mebutate Versus Diclofenac 3% and Imiquimod 5% in the Treatment of Actinic Keratosis in Spain.

    Science.gov (United States)

    Elías, I; Ortega-Joaquín, N; de la Cueva, P; Del Pozo, L J; Moreno-Ramírez, D; Boada, A; Aguilar, M; Mirada, A; Mosquera, E; Gibbons, C; Oyagüez, I

    2016-01-01

    To perform a cost-effectiveness and cost-utility analysis of ingenol mebutate in the treatment of actinic keratosis in Spain. We used an adapted Markov model to simulate outcomes in a cohort of patients (mean age, 73 years) with actinic keratosis over a 5-year period. The comparators were diclofenac 3% and imiquimod 5%. The analysis was performed from the perspective of the Spanish National Health System based on direct costs (2015 retail price plus value added tax less the mandatory discount). A panel of experts estimated resources, taking unit costs from national databases. An annual discount rate of 3% was applied. Deterministic and probabilistic sensitivity analyses were performed. The effectiveness of ingenol mebutate-with 0.192 and 0.129 more clearances gained in treatments for face and scalp lesions and trunk and extremity lesions, respectively-was superior to diclofenac's. The total costs of treatment with ingenol mebutate were lower at € 551.50 (face and scalp) and € 622.27 (trunk and extremities) than the respective costs with diclofenac (€ 849.11 and € 844.93). The incremental cost-effectiveness and cost-utility ratios showed that ingenol mebutate was a dominant strategy vs diclofenac. Ingenol mebutate also proved to be more effective than imiquimod, based on 0.535 and 0.503 additional clearances, and total costs of € 551.50 and € 527.89 for the two drugs, respectively. The resulting incremental cost-effectiveness ratio was € 728.64 per clearance gained with ingenol mebutate vs imiquimod. Ingenol mebutate was a dominant treatment option vs diclofenac and was efficient vs imiquimod (i.e., more effective at a higher cost, achieving an incremental cost-utility ratio of<€30000/quality-adjusted life-years). Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

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

    2016-02-01

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

  19. Utilization and costs of lumbar and full spine radiography by Ontario chiropractors from 1994 to 2001.

    Science.gov (United States)

    Ammendolia, Carlo; Côté, Pierre; Hogg-Johnson, Sheilah; Bombardier, Claire

    2009-07-01

    In Ontario, chiropractors see one-third of patients who seek care for low back pain. Previous studies suggest that chiropractors have high utilization rates of lumbar and full spine radiography. There has been a proliferation of evidence-based guidelines recommending that plain film radiography be used only to assess high-risk patients with low back pain. Evidence for the use of full spine radiography, except for the evaluation of scoliosis is lacking. It is uncertain what impact the growing evidence against their use has had on radiography utilization by Ontario chiropractors. To describe the annual costs and use of lumbar and full spine plain film radiography among Ontario chiropractors between 1994 and 2001. Time-trend analysis of radiography utilization by Ontario chiropractors. Chiropractic claims data submitted to the Ontario Health Insurance Plan or the Workplace Safety & Insurance Board from 1994/1995 to 2000/2001. Change in the annual cost and proportion of claimants receiving lumbar and full spine radiography. Time-trend analysis of chiropractic claims submitted to the Ontario Health Insurance Plan (OHIP) or Workplace Safety & Insurance Board (WSIB) from 1994/1995 to 2000/2001 fiscal years. During the 7-year period, the proportion of OHIP claimants receiving lumbar spine radiography decreased from 4.54% to 3.25% and for full spine radiography from 3.87% to 3.04%. For WSIB claimants, lumbar spine radiography deceased from 6.49% to 3.30% of claimants and full spine radiography from 1.51% to 0.94%. OHIP payments for lumbar spine radiography decreased 12.7% to $562,944, whereas full spine radiography payments decreased 5.3% to $1,071,408. WSIB lumbar and full spine radiography payments decreased 44.2% and 34.3% to $31,202 and $11,713 respectively. Claims data from the two largest third-party payers of chiropractic services in Ontario, suggest that lumbar and full spine radiography, and their associated costs decreased steadily between 1994 and 2001.

  20. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.

  1. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Scott, Michael T. [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (United States); Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States)

    2016-10-01

    Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P<.0001). With a >16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation

  2. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.

    Science.gov (United States)

    Scott, Michael T; Todd, Kimberly E; Oakley, Heather; Bradley, Julie A; Rotondo, Ronny L; Morris, Christopher G; Klein, Stuart; Mendenhall, Nancy P; Indelicato, Daniel J

    2016-10-01

    To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of "$[(anesthesia cost to payer during radiation therapy course/6) - (CCLS expense to payer/N)]" per child (N) treated with radiation therapy, where N equals the number of children aged 3 to 12

  3. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

    International Nuclear Information System (INIS)

    Scott, Michael T.; Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P.; Indelicato, Daniel J.

    2016-01-01

    Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P 16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation therapy, where N

  4. Cost structure analysis of commercial nuclear power plants in Japan based on corporate financial statements of electric utility companies

    International Nuclear Information System (INIS)

    Kunitake, Norifumi; Nagano, Koji; Suzuki, Tatsujiro

    1998-01-01

    In this paper, we analyze past and current cost structure of commercial nuclear power plants in Japan based on annual corporate financial statements published by the Japanese electric utility companies, instead of employing the conventional methodology of evaluating the generation cost for a newly constructed model plant. The result of our study on existing commercial nuclear plants reveals the increasing significance of O and M and fuel cycle costs in total generation cost. Thus, it is suggested that electric power companies should take more efforts to reduce these costs in order to maintain the competitiveness of nuclear power in Japan. (author)

  5. Evaluation of strategies for utilizing rice husk based on life cycle cost analysis in relation to Greenhouse Gas emissions in An Giang province, Vietnam

    International Nuclear Information System (INIS)

    Mai Thao, Pham Thi; Kurisu, Kiyo H.; Hanaki, Keisuke

    2012-01-01

    To evaluate the cost effectiveness of rice husk utilization, a life cycle cost analysis was conducted for 18 scenarios developed in a previous study. The allocation of fuels other than rice husks was decided on the basis of current demand for and supply of rice husks. The production of rice husk briquettes is also discussed as a means of circumventing problems arising from the bulk of the material. In the power generation scenarios, differences between two generating capacities (5 and 30 MW) were analyzed. Costs savings are possible by using rice husk to replace fossil fuels for cooking. With regard to power generation, operation on a 30-MW scale by combustion of all available rice husk was identified as the most economically efficient scenario, followed by small-scale gasification scenarios (5 MW). The combustion of rice husk briquettes for power generation appeared to be less cost-efficient than direct combustion, whereas large-scale gasification scenarios and pyrolysis scenarios give rise to increases in cost compared with the baseline. When both GHG abatement and costs are taken into consideration, suitable scenarios that are practicable involve the use of rice husk for cooking, for large-scale combustion power generation, and for small-scale gasification. -- Highlights: ► Life cycle cost analysis was conducted to evaluate potentiality of rice husk use. ► The scenarios used rice husk for cooking showed a better cost effectiveness. ► While large-scale gasification and pyrolysis is less. ► In relation to GHG emission, the win–win scenarios are to use rice husk for cooking. ► Large-scale combustion and small-scale gasification also showed practical scenarios.

  6. Putting the ‘Q’ in QALY in cost-utility analyses

    DEFF Research Database (Denmark)

    Oddershede, Lars

    conditions. Secondly, it would make it possible to capture both effects and side effects of new technologies in a single outcome measure. Therefore, the present thesis explores how to procure optimal estimates of quality of life, i.e. utility, for QALY calculations in different situations, depending on which......Resources are scare and healthcare systems must, therefore, prioritize which new technologies should be funded, and which should be rejected. To aid decision makers in their choice, economic evaluations can be conducted to assess the cost-effectiveness of the new technologies. The present thesis...... in order to make the results of the economic evaluations submitted to the Danish Health and Medicines Authorities more comparable across conditions and interventions....

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

    Science.gov (United States)

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

    2017-06-01

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

  8. [Quality of life of patients with asthma on beclomethasone/formoterol. Cost-utility analysis].

    Science.gov (United States)

    García-Ruiz, A J; Quintano Jiménez, J A; García-Agua Soler, N; Ginel Mendoza, L; Hidalgo Requena, A; Del Moral, F

    2016-01-01

    To perform a cost-utility analysis on asthmatic patients on beclomethasone/formoterol fixed combination in Primary Health Care. Material and methods Non-probability sampling was used to select a group of asthmatic patients with moderate/severe persistent severity (GEMA 2009), treated with beclomethasone/formoterol fixed combination, over 18 years, had given their informed consent. The study observation period was 6 months. The variables studied were: age, sex, duration of disease, health resources used, analysis of health related quality of life by EQ-5D and SF-36, and the specific Asthma Quality of Life Questionnaire. For the qualitative variables, the frequency and percentages were calculated, and for the quantitative variables, the mean, SD and 95% CI. Chi-square, Student t-test and ANOVA were used for statistical inference. Comparisons were made with a statistical significance of 0.05. Of the 64 patients that completed the study, 59.4% were female. The mean age was 49 years, and mean disease duration was 93 months. For asthma control, 53% of patients had a prescription pattern of one/12h. All health related quality of life scales were modified with respect to the baseline and the differences were statistically significant. Our patients had a better health related quality of life than Spanish asthma cohort. The incremental cost utility beclomethasone/formoterol versus usual treatment option was € 6,256/QALY. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

    Science.gov (United States)

    Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

    2015-10-01

    Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose

  10. Impact of a new reimbursement program on hepatitis B antiviral medication cost and utilization in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Qian Qiu

    Full Text Available BACKGROUND: Hepatitis B virus (HBV infection is a significant clinical and financial burden for chronic hepatitis B (CHB patients. In Beijing, China, partial reimbursement on antiviral agents was first implemented for the treatment of CHB patients in July 1, 2011. AIMS: In this study, we describe the medical cost and utilization rates of antiviral therapy for CHB patients to explore the impact of the new partial reimbursement policy on the medical care cost, the composition, and antivirals utilization. METHODS: Clinical and claims data of a retrospective cohort of 92,776 outpatients and 2,774 inpatients with non-cirrhotic CHB were retrieved and analyzed from You'an Hospital, Beijing between February 14, 2008 and December 31, 2012. The propensity score matching was used to adjust factors associated with the annual total cost, including age, gender, medical insurance type and treatment indicator. RESULTS: Compared to patients who paid out-of-pocket, medical cost, especially antiviral costs increased greater among patients with medical insurance after July 1, 2011, the start date of reimbursement policy. Outpatients with medical insurance had 16% more antiviral utilization; usage increased 3% among those who paid out-of-pocket after the new partial reimbursement policy was implemented. CONCLUSIONS: Direct medical costs and antiviral utilization rates of CHB patients with medical insurance were higher than those from paid out-of-pocket payments, even after adjusting for inflation and other factors. Thus, a new partial reimbursement program may positively optimize the cost and standardization of antiviral treatment.

  11. A Low Cost Inflatable CubeSat Drag Brake Utilizing Sublimation

    Science.gov (United States)

    Horn, Adam Charles

    The United Nations Inter-Agency Debris Coordination Committee has adopted a 25-year post-mission lifetime requirement for any satellite orbiting below 2000 km in order to mitigate the growing orbital debris threat. Low-cost CubeSats have become important satellite platforms with startling capabilities, but this guideline restricts them to altitudes below 600 km because they remain in orbit too long. In order to enable CubeSat deployments at higher release altitudes, a low-cost, ultra-reliable deorbit device is needed. This thesis reports on efforts to develop a deployable and passively inflatable drag brake that can deorbit from higher orbital altitudes, thereby complying with the 25-year orbital lifetime guideline. On the basis of concepts first implemented during the NASA Echo Satellite Project, this study investigated the design of an inflatable CubeSat drag device that utilizes sublimating benzoic acid powder as the inflation propellant. Testing has focused on demonstrating the functionality of charging a Mylar drag brake bladder with appropriate quantities of benzoic acid powder, and the exposure to a controlled-temperature vacuum chamber causing the bladder to inflate. Although results show a measureable increase in internal pressure when introduced to anticipated orbital temperatures, a significant air-derived expansion prior to sublimation was encountered due to the undetectable volume of ambient residual air in the fabricated membrane bladders. These tests have demonstrated the feasibility of this approach, thereby demonstrating that this concept can create a potentially smaller and less expensive drag device, eliminating inflation gas tanks and valves. In that way, this system can provide a low-cost, miniaturized system that reduces a CubeSat's orbital lifetime to less than 25 years, when placed at higher orbital altitude.

  12. Equity, tariffing, regulation: analysis of the cost allocation policies of an electric utility industry

    International Nuclear Information System (INIS)

    Bezzina, J.

    1998-01-01

    In this work, an analysis in terms of equity of policies of tariffing regulation and cost allocation of a multi-products electric company (organized as a natural monopoly) is proposed. The goal is double. In a standard point of view, the first goal is to show that today's literature in the domains of public economy, industrial organization and regulation (traditionally based on efficiency considerations) is able to supply reading keys for the analysis of moral philosophy problems. In a positive point of view, the second goal is to demonstrate that the equity criterion is operational enough to judge tariffing management practices in a particular industrial environment and can be used as a regulatory instrument by an ethics-concerned authority. The document is organized in two parts. An ethical and economical analysis of the equity concepts between allocation efficiency, production efficiency and tariffing practices of companies is proposed first. A particular equity concept is considered which is ready to be implemented for the regulation of a public utility, and the ins and outs expected with an equity theory of tariffing practices are evoked. In a second part, an analysis of goal conflicts between the authority and the regulated company is made in a point of view of equity regulation and cost allocation. An improved equity criterion is defined first, from which a measure is built and becomes a tool for the regulatory authority. Then, its use by a regulatory authority fully informed or encountering information asymmetry problems are analyzed in order to show its stakes on the cost allocation and tariffing policies of the company. (J.S.)

  13. Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China.

    Science.gov (United States)

    Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

    2016-12-01

    Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m 2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m 3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m 3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

  14. A Cost-Utility Analysis of 5 Strategies for the Management of Acute Otitis Media in Children.

    Science.gov (United States)

    Shaikh, Nader; Dando, Emily E; Dunleavy, Mark L; Curran, Dorothy L; Martin, Judith M; Hoberman, Alejandro; Smith, Kenneth J

    2017-10-01

    To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective. We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic. The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained. In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Comparative study on medical utilization and costs of chronic obstructive pulmonary disease with good lung function

    Directory of Open Access Journals (Sweden)

    Lim JU

    2017-09-01

    costs were obtained from the Health Insurance Review and Assessment Service and were compared with the data of patients with COPD with FEV1 ≥60% from the Korean COPD Subtype Study (KOCOSS cohort.Results: Based on EuroQol 5-dimension questionnaire index scores of 0.9±0.14, we found that patients with COPD from the KNHANES group showed few symptoms compared to those from the KOCOSS cohort. In 2007, among the patients with COPD with an FEV1 value of ≥60%, only 3.6% from the KNHANES group and 30% from the KOCOSS cohort visited medical facilities. Total medical cost per person per year increased from 264.37±663.41 US Dollars (USD in 2007 to 797.00±2,724.21 USD in 2012 for the KNHANES group. In 2012, only 20.7% of the patients from KNHANES database received long-acting muscarinic agonists (LAMA, whereas 78.7% of the patients from KOCOSS database received LAMA.Conclusion: Medical resource utilization and medical costs per person for patients with early COPD in Korea increased. However, asymptomatic patients with COPD represented by the KNHANES group do not receive adequate long-term treatment compared to relatively symptomatic patients, and require more clinical attention from physicians. Keywords: early COPD, medical cost, medical utilization 

  16. Utility planning using least-cost principles and the role of externalities - staff report on a Keystone policy dialogue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    For over two years, The Keystone Center facilitated a two-phase dialogue on Utility Planning Using Least-Cost Principles and, in the second phase, on the role of Externalities. The intent of this report is to assist policy-makers faced with decisions about changes to traditional utility regulation and planning. This report is not a consensus document, rather it is staff written summary of two years of discussion on the issues. As a concept, least-cost planning has been discussed since the 1970`s and many states have implemented such programs since the mid-1980`s. Yet, the actual goals and objectives of least-cost planning remain a source of controversy between affected interest groups. Some industry observers believe that least-cost planning can help reconcile the often conflicting demands between increased capacity requirements and concerns about the external costs of power production. In traditional utility regulation practices, capital investments are rewarded and revenue is a direct function of sales. However, a number state public utility commissions have altered their practices to allow for returns on investments in more efficient end-use equipment (also known as ratebasing conservation) and adjusting revenues to account for sales lost due to utility conservation programs. Other states are planning these types of changes. Still others are observing the impacts of the changes before they commit.

  17. Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

    Science.gov (United States)

    Baltzer, H; Binhammer, P A

    2013-08-01

    In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

  18. Econometric estimation of investment utilization, adjustment costs, and technical efficiency in Danish pig farms using hyperbolic distance functions

    DEFF Research Database (Denmark)

    Henningsen, Arne; Fabricius, Ole; Olsen, Jakob Vesterlund

    2014-01-01

    Based on a theoretical microeconomic model, we econometrically estimate investment utilization, adjustment costs, and technical efficiency in Danish pig farms based on a large unbalanced panel dataset. As our theoretical model indicates that adjustment costs are caused both by increased inputs...... of investment activities by the maximum likelihood method so that we can estimate the adjustment costs that occur in the year of the investment and the three following years. Our results show that investments are associated with significant adjustment costs, especially in the year in which the investment...

  19. Estimating the cost of saving electricity through U.S. utility customer-funded energy efficiency programs

    International Nuclear Information System (INIS)

    Hoffman, Ian M.; Goldman, Charles A.; Rybka, Gregory; Leventis, Greg; Schwartz, Lisa; Sanstad, Alan H.; Schiller, Steven

    2017-01-01

    The program administrator and total cost of saved energy allow comparison of the cost of efficiency across utilities, states, and program types, and can identify potential performance improvements. Comparing program administrator cost with the total cost of saved energy can indicate the degree to which programs leverage investment by participants. Based on reported total costs and savings information for U.S. utility efficiency programs from 2009 to 2013, we estimate the savings-weighted average total cost of saved electricity across 20 states at $0.046 per kilowatt-hour (kW h), comparing favorably with energy supply costs and retail rates. Programs targeted on the residential market averaged $0.030 per kW h compared to $0.053 per kW h for non-residential programs. Lighting programs, with an average total cost of $0.018 per kW h, drove lower savings costs in the residential market. We provide estimates for the most common program types and find that program administrators and participants on average are splitting the costs of efficiency in half. More consistent, standardized and complete reporting on efficiency programs is needed. Differing definitions and quantification of costs, savings and savings lifetimes pose challenges for comparing program results. Reducing these uncertainties could increase confidence in efficiency as a resource among planners and policymakers. - Highlights: • The cost of saved energy allows comparisons among energy resource investments. • Findings from the most expansive collection yet of total energy efficiency program costs. • The weighted average total cost of saved electricity was $0.046 for 20 states in 2009–2013. • Averages in the residential and non-residential sectors were $0.030 and $0.053 per kW h, respectively. • Results strongly indicate need for more consistent, reliable and complete reporting on efficiency programs.

  20. The cost and performance of utility commercial lighting programs. A report from the Database on Energy Efficiency Programs (DEEP) project

    Energy Technology Data Exchange (ETDEWEB)

    Eto, J.; Vine, E.; Shown, L.; Sonnenblick, R.; Payne, C. [Lawrence Berkeley Lab., CA (United States). Energy and Environment Div.

    1994-05-01

    The objective of the Database on Energy Efficiency Programs (DEEP) is to document the measured cost and performance of utility-sponsored, energy-efficiency, demand-side management (DSM) programs. Consistent documentation of DSM programs is a challenging goal because of problems with data consistency, evaluation methodologies, and data reporting formats that continue to limit the usefulness and comparability of individual program results. This first DEEP report investigates the results of 20 recent commercial lighting DSM programs. The report, unlike previous reports of its kind, compares the DSM definitions and methodologies that each utility uses to compute costs and energy savings and then makes adjustments to standardize reported program results. All 20 programs were judged cost-effective when compared to avoided costs in their local areas. At an average cost of 3.9{cents}/kWh, however, utility-sponsored energy efficiency programs are not ``too cheap to meter.`` While it is generally agreed upon that utilities must take active measures to minimize the costs and rate impacts of DSM programs, the authors believe that these activities will be facilitated by industry adoption of standard definitions and reporting formats, so that the best program designs can be readily identified and adopted.

  1. Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

    Science.gov (United States)

    Ellis, Charles; Hardy, Rose Y; Lindrooth, Richard C

    2017-05-15

    To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Supporting ALARP decision-making by cost benefit analysis and multi-attribute utility theory

    International Nuclear Information System (INIS)

    French, Simon; Bedford, Tim; Atherton, Elizabeth

    2001-01-01

    Current regulation in the UK and elsewhere specify upper and target risk limits for the operation of nuclear plant in terms of frequencies of various kinds of accidents and accidental releases per annum. 'As low as reasonably practicable' (ALARP) arguments are used to justify the acceptance or rejection of policies that lead to risk changes between these limits. We assess the suitability of cost-benefit analysis (CBA) and multi-attribute utility theory (MAUT) for performing ALARP ('as low as reasonably possible') assessments, in particular within the nuclear industry. Four problems stand out in current CBA applications to ALARP, concerning the determination of prices of safety gains or detriments, the valuation of group and individual risk, calculations using 'disproportionality', and the use of discounting to trade off risks through time. This last point has received less attention in the past but is important because of the growing interest in risk-informed regulation in which policies extend over several timeframes and distribute the risk unevenly over these, or in policies that lead to a non-uniform risk within a single timeframe (such as maintenance policies). We discuss the problems associated with giving quantitative support to such decisions. We argue that multi-attribute utility methods (MAUT) provide an alternative methodology to CBA which enable the four problems described above to be addressed in a more satisfactory way. Through sensitivity analysis MAUT can address the perceptions of all stakeholder groups, facilitating constructive discussion and elucidating the key points of disagreement. We also argue that by being explicitly subjective it provides an open, auditable and clear analysis in contrast to the illusory objectivity of CBA. CBA seeks to justify a decision by using a common basis for weights (prices), while MAUT recognizes that different parties may want to give different valuations. It then allows the analyst to explore the ways in which

  3. Impact of depression on health care utilization and costs among multimorbid patients--from the MultiCare Cohort Study.

    Directory of Open Access Journals (Sweden)

    Jens-Oliver Bock

    Full Text Available OBJECTIVE: The objective of this study was to describe and analyze the effects of depression on health care utilization and costs in a sample of multimorbid elderly patients. METHOD: This cross-sectional analysis used data of a prospective cohort study, consisting of 1,050 randomly selected multimorbid primary care patients aged 65 to 85 years. Depression was defined as a score of six points or more on the Geriatric Depression Scale (GDS-15. Subjects passed a geriatric assessment, including a questionnaire for health care utilization. The impact of depression on health care costs was analyzed using multiple linear regression models. A societal perspective was adopted. RESULTS: Prevalence of depression was 10.7%. Mean total costs per six-month period were €8,144 (95% CI: €6,199-€10,090 in patients with depression as compared to €3,137 (95% CI: €2,735-€3,538; p<0.001 in patients without depression. The positive association between depression and total costs persisted after controlling for socio-economic variables, functional status and level of multimorbidity. In particular, multiple regression analyses showed a significant positive association between depression and pharmaceutical costs. CONCLUSION: Among multimorbid elderly patients, depression was associated with significantly higher health care utilization and costs. The effect of depression on costs was even greater than reported by previous studies conducted in less morbid patients.

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

    Science.gov (United States)

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

    2008-04-01

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

  5. Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United States.

    Science.gov (United States)

    Korbel, Lindsey; Spencer, John David

    2015-03-01

    The objective of this study is to evaluate the number of diabetics that seek medical treatment in emergency departments or require hospitalization for infection management in the United States. This study also assesses the socioeconomic impact of inpatient infection management among diabetics. We accessed the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample database and the Nationwide Inpatient Sample database to perform a retrospective analysis on diabetics presenting to the emergency department or hospitalized for infection management from 2006 to 2011. Emergency Department: Since 2006, nearly 10 million diabetics were annually evaluated in the emergency department. Infection was the primary reason for presentation in 10% of these visits. Among those visits, urinary tract infection was the most common infection, accounting for over 30% of emergency department encounters for infections. Other common infections included sepsis, skin and soft tissue infections, and pneumonia. Diabetics were more than twice as likely to be hospitalized for infection management than patients without diabetes. Hospitalization: Since 2006, nearly 6 million diabetics were annually hospitalized. 8-12% of these patients were hospitalized for infection management. In 2011, the inpatient care provided to patients with DM, and infection was responsible for over $48 billion dollars in aggregate hospital charges. Diabetics commonly present to the emergency department and require hospitalization for infection management. The care provided to diabetics for infection management has a large economic impact on the United States healthcare system. More efforts are needed to develop cost-effective strategies for the prevention of infection in patients with diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain.

    Science.gov (United States)

    Hidalgo-Vega, Alvaro; Ramos-Goñi, Juan Manuel; Villoro, Renata

    2014-12-01

    Ranolazine is an antianginal agent that was approved in the EU in 2008 as an add-on therapy for symptomatic chronic angina pectoris treatment in patients who are inadequately controlled by, or are intolerant to, first-line antianginal therapies. These patients' quality of life is significantly affected by more frequent angina events, which increase the risk of revascularization. To assess the cost-utility of ranolazine versus placebo as an add-on therapy for the symptomatic treatment of patients with chronic angina pectoris in Spain. A decision tree model with 1-year time horizon was designed. Transition probabilities and utility values for different angina frequencies were obtained from the literature. Costs were obtained from Spanish official DRGs for patients with chronic angina pectoris. We calculated the incremental cost-utility ratio of using ranolazine compared with a placebo. Sensitivity analyses, by means of Monte Carlo simulations, were performed. Acceptability curves and expected value of perfect information were calculated. The incremental cost-utility ratio was €8,455 per quality-adjusted life-year (QALY) per patient in Spain. Sensitivity analyses showed that if the decision makers' willingness to pay is €15,000 per QALY, the treatment with ranolazine will be cost effective at a 95 % level of confidence. The incremental cost-utility ratio is particularly sensitive to changes in utility values of those non-hospitalized patients with mild or moderate angina frequency. Ranolazine is a highly efficient add-on therapy for the symptomatic treatment of chronic angina pectoris in patients who are inadequately controlled by, or intolerant to, first-line antianginal therapies in Spain.

  7. Cost functions and the electric utility industry. A contribution to the debate on deregulation

    International Nuclear Information System (INIS)

    Ramos-Real, F.J.

    2005-01-01

    This study analyses the main articles that estimate cost functions in the electricity utility industry with a view to studying of the initial arguments for proposing competition and vertical disintegration. The works reviewed here, in general terms, confirm the initial arguments in favour of the deregulation process, mainly, the exhaustion of scale economies for moderate size firms in generation and the condition of natural monopoly for transmission and distribution. However, the savings obtained from undertaking different activities together should be kept in mind when restructuring the sector. On the other hand, the improvements in productivity deriving from the reforms have not translated into reductions in the price of electricity in many countries. These last two results suggest the need for appropriate market regulation for the deregulation process to translate into an improvement in how the sector works and into benefits for consumers. There is still insufficient empirical literature on these issues due to the fact that the process is still ongoing in many countries and more time will have to transpire before sufficient data is available

  8. Clean utilization of low-rank coals for low-cost power generation

    International Nuclear Information System (INIS)

    Sondreal, E.A.

    1992-01-01

    Despite the unique utilization problems of low-rank coals, the ten US steam electric plants having the lowest operating cost in 1990 were all fueled on either lignite or subbituminous coal. Ash deposition problems, which have been a major barrier to sustaining high load on US boilers burning high-sodium low-rank coals, have been substantially reduced by improvements in coal selection, boiler design, on-line cleaning, operating conditions, and additives. Advantages of low-rank coals in advanced systems are their noncaking behavior when heated, their high reactivity allowing more complete reaction at lower temperatures, and the low sulfur content of selected deposits. The principal barrier issues are the high-temperature behavior of ash and volatile alkali derived from the coal-bound sodium found in some low-rank coals. Successful upgrading of low-rank coals requires that the product be both stable and suitable for end use in conventional and advanced systems. Coal-water fuel produced by hydrothermal processing of high-moisture low-rank coal meets these criteria, whereas most dry products from drying or carbonizing in hot gas tend to create dust and spontaneous ignition problems unless coated, agglomerated, briquetted, or afforded special handling

  9. Logistics, Costs, and GHG Impacts of Utility Scale Cofiring with 20% Biomass

    Energy Technology Data Exchange (ETDEWEB)

    Boardman, Richard D.; Cafferty, Kara G.; Nichol, Corrie; Searcy, Erin M.; Westover, Tyler; Wood, Richard; Bearden, Mark D.; Cabe, James E.; Drennan, Corinne; Jones, Susanne B.; Male, Jonathan L.; Muntean, George G.; Snowden-Swan, Lesley J.; Widder, Sarah H.

    2014-07-22

    This report presents the results of an evaluation of utility-scale biomass cofiring in large pulverized coal power plants. The purpose of this evaluation is to assess the cost and greenhouse gas reduction benefits of substituting relatively high volumes of biomass in coal. Two scenarios for cofiring up to 20% biomass with coal (on a lower heating value basis) are presented; (1) woody biomass in central Alabama where Southern Pine is currently produced for the wood products and paper industries, and (2) purpose-grown switchgrass in the Ohio River Valley. These examples are representative of regions where renewable biomass growth rates are high in correspondence with major U.S. heartland power production. While these scenarios may provide a realistic reference for comparing the relative benefits of using a high volume of biomass for power production, this evaluation is not intended to be an analysis of policies concerning renewable portfolio standards or the optimal use of biomass for energy production in the U.S.

  10. The effects of utility cost reduction on residential energy consumption in Hungary – a decomposition analysis

    Directory of Open Access Journals (Sweden)

    Tekla Sebestyén Szép

    2017-01-01

    Full Text Available The residential energy consumption is influenced by a lot of factors. Understanding and calculating these factors is essential to making conscious energy policy decisions and feedbacks. Since 2013 the energy prices for households have been controlled by the government in Hungary and as a result of the utility cost reduction program a sharp decline can be observed in residential electricity, district heating and natural gas prices. This paper applies the LMDI (~Logarithmic Mean Division Index method to decompose the absolute change of the residential energy consumption during the period of 2010-2015. We calculate the price, the intensive structure (it means the change of energy expenditure share on energy sources, the extensive structure (it is in connection with the change of energy expenditure share in total expenditure, expenditure (it is the change of per capita total expenditure and population effect. All of that shows the impact of the specific factor on the residential energy consumption by income deciles. Our results have verified the preliminary expectations: the decreasing energy prices for households have a positive impact on energy use and it has been strengthened by the expenditure effect as well. However, the intensive structure, the extensive structure and the population effect have largely offset it.

  11. Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

    Science.gov (United States)

    Winkelman, Tyler N. A.; Heisler, Michele; Dalton, Vanessa K.

    2018-01-01

    Our objective was to measure obstetric outcomes and delivery-related health care utilization and costs among pregnant women with multiple chronic conditions. We used 2013–2014 data from the National Inpatient Sample to measure obstetric outcomes and delivery-related health care utilization and costs among women with no chronic conditions, 1 chronic condition, and multiple chronic conditions. Women with multiple chronic conditions were at significantly higher risk than women with 1 chronic condition or no chronic conditions across all outcomes measured. High-value strategies are needed to improve birth outcomes among vulnerable mothers and their infants. PMID:29420168

  12. A cost-utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme.

    LENUS (Irish Health Repository)

    Dee, Anne

    2010-04-01

    Cervical cancer is a leading cause of death worldwide, and in Ireland it is the ninth most commonly diagnosed cancer in women. Almost 100% of these cancers are caused by human papillomavirus (HPV) infection. Two newly developed vaccines against HPV infection have become available. This study is a cost-utility analysis of the HPV vaccine in Ireland, and it compares the cost-effectiveness profiles of the two vaccines.

  13. Rising equity

    International Nuclear Information System (INIS)

    Burr, M.T.

    1992-01-01

    This article reports on the results of a financial rankings survey of the independent energy industry indicating that lenders and investors provided more than five billion dollars in capital for new, private power projects during the first six months of 1992. The topics of the article include rising equity requirements, corporate finance, mergers and acquisitions, project finance investors, revenue bonds, project finance lenders for new projects, project finance lenders for restructurings, and project finance advisors

  14. Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

    Science.gov (United States)

    Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

    2016-01-01

    Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation

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

    Science.gov (United States)

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

    2013-06-01

    Standard procedure for cytomegalovirus disease (CMV) prophylaxis in kidney transplant patients was the administration of valganciclovir for up to 110 days after organ transplant. This prophylaxis has been extended up to 200 days in Poland since 2011. The decision was based on the results of clinical trials which showed significant clinical benefit in case of prolonged administration of the drug. The aim of the analysis was to provide the economic evaluation of extending the CMV prophylaxis with co-financed from public funds Valcyte (valganciclovirum; 60 tab. a 450 mg; Roche Polska Sp. z o.o.) from 110 to 200 days, in the high risk patients group after kidney transplant (seronegative recipient and infected donor, D+/R-). The analysis was performed from the Polish healthcare payer's perspective. All methods used in the following study were consistent with the Requirements of the Polish HTA Agency (AHTAPOL). The cost-effectiveness and the cost-utility analysis were performed on the basis of a randomised study which was identified as a result of the systematic search of the medical databases, comparing 200 days valgancyclovir administration with 100 days drug use as a prophylaxis of CMV disease in the patients group mentioned above. The Markov model was developed, simulating the disease evolution over time considering a high risk patient after kidney transplant treated with valgancicloviras the CMV disease prophylaxis. The disease period was divided into health states that are the most probable for this condition and the transitions probabilities between them were identified and assigned. Based on the clinical trial results, registry database of health conditions usability and experts' opinion, all health states (i.e. death, kidney transplant, CMV disease) were attributed with utilities and costs. The direct costs, important from the Polish healthcare payer's perspective, were included in the analysis. Extension of the proposed model in the series of one month time

  16. 76 FR 49841 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2011-08-11

    ... Commission-approved RTOs and ISOs. The Commission stated that it expected all non-public utility transmission... transmission planning processes that public utility transmission providers in regions outside of RTOs and ISOs...

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

    Science.gov (United States)

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

    2015-12-01

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

  18. Cost-effectiveness and cost-utility of cognitive therapy, rational emotive behavioral therapy, and fluoxetine (Prozac) in treating depression: a randomized clinical trial.

    Science.gov (United States)

    Sava, Florin A; Yates, Brian T; Lupu, Viorel; Szentagotai, Aurora; David, Daniel

    2009-01-01

    Cost-effectiveness and cost-utility of cognitive therapy (CT), rational emotive behavioral therapy (REBT), and fluoxetine (Prozac) for major depressive disorder (MDD) were compared in a randomized clinical trial with a Romanian sample of 170 clients. Each intervention was offered for 14 weeks, plus three booster sessions. Beck Depression Inventory (BDI) scores were obtained prior to intervention, 7 and 14 weeks following the start of intervention, and 6 months following completion of intervention. CT, REBT, and fluoxetine did not differ significantly in changes in the BDI, depression-free days (DFDs), or Quality-Adjusted Life Years (QALYs). Average BDI scores decreased from 31.1 before treatment to 9.7 six months following completion of treatment. Due to lower costs, both psychotherapies were more cost-effective, and had better cost-utility, than pharmacotherapy: median $26.44/DFD gained/month for CT and $23.77/DFD gained/month for REBT versus $34.93/DFD gained/month for pharmacotherapy, median $/QALYs=$1,638, $1,734, and $2,287 for CT, REBT, and fluoxetine (Prozac), respectively. (c) 2008 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    Mabasa, Vincent H; Ma, Johnny

    2006-06-01

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

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

    Science.gov (United States)

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

    2017-05-03

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

  1. Alternate bidding strategies for asphalt and concrete pavement projects utilizing life cycle cost analysis (LCCA).

    Science.gov (United States)

    2012-07-01

    Recent changes in pavement materials costs have impacted the competitive environment relative to the : determination of the most cost effective pavement structure for a specific highway project. In response, State : highway agencies have renewed thei...

  2. Comparing treatment persistence, healthcare resource utilization, and costs in adult patients with major depressive disorder treated with escitalopram or citalopram.

    Science.gov (United States)

    Wu, Eric Q; Greenberg, Paul E; Ben-Hamadi, Rym; Yu, Andrew P; Yang, Elaine H; Erder, M Haim

    2011-03-01

    Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (-$1174) and major depressive disorder-related costs (-$109; P escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare

  3. Methods for Analyzing the Benefits and Costs of Distributed Photovoltaic Generation to the U.S. Electric Utility System

    Energy Technology Data Exchange (ETDEWEB)

    Denholm, P.; Margolis, R.; Palmintier, B.; Barrows, C.; Ibanez, E.; Bird, L.; Zuboy, J.

    2014-09-01

    This report outlines the methods, data, and tools that could be used at different levels of sophistication and effort to estimate the benefits and costs of DGPV. In so doing, we identify the gaps in current benefit-cost-analysis methods, which we hope will inform the ongoing research agenda in this area. The focus of this report is primarily on benefits and costs from the utility or electricity generation system perspective. It is intended to provide useful background information to utility and regulatory decision makers and their staff, who are often being asked to use or evaluate estimates of the benefits and cost of DGPV in regulatory proceedings. Understanding the technical rigor of the range of methods and how they might need to evolve as DGPV becomes a more significant contributor of energy to the electricity system will help them be better consumers of this type of information. This report is also intended to provide information to utilities, policy makers, PV technology developers, and other stakeholders, which might help them maximize the benefits and minimize the costs of integrating DGPV into a changing electricity system.

  4. Costs of Medically Attended Acute Gastrointestinal Infections: The Polish Prospective Healthcare Utilization Survey.

    Science.gov (United States)

    Czech, Marcin; Rosinska, Magdalena; Rogalska, Justyna; Staszewska, Ewa; Stefanoff, Pawel

    The burden of acute gastrointestinal infections (AGIs) on the society has not been well studied in Central European countries, which prevents the implementation of effective, targeted public health interventions. We investigated patients of 11 randomly selected general practices and 8 hospital units. Each patient meeting the international AGI case definition criteria was interviewed on costs incurred related to the use of health care resources. Follow-up interview with consenting patients was conducted 2 to 4 weeks after the general practitioner (GP) visit or discharge from hospital, collecting information on self-medication costs and indirect costs. Costs were recalculated to US dollars by using the purchasing power parity exchange rate for Poland. Weighting the inpatient costs by age-specific probability of hospital referral by GPs, the societal cost of a medically attended AGI case was estimated to be US $168. The main cost drivers of direct medical costs were cost of hospital bed days (US $28), cost of outpatient pharmacotherapy (US $20), and cost of GP consultation (US $10). Patients covered only the cost of outpatient pharmacotherapy. Considering the AGI population GP consultation rate, the age-adjusted societal cost of medically attended AGI episodes was estimated at US $2222 million, of which 53% was attributable to indirect costs. Even though AGIs generate a low cost for individuals, they place a high burden on the society, attributed mostly to indirect costs. Higher resources could be allocated to the prevention and control of AGIs. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  5. User's guide to SERICPAC: A computer program for calculating electric-utility avoided costs rates

    Energy Technology Data Exchange (ETDEWEB)

    Wirtshafter, R.; Abrash, M.; Koved, M.; Feldman, S.

    1982-05-01

    SERICPAC is a computer program developed to calculate average avoided cost rates for decentralized power producers and cogenerators that sell electricity to electric utilities. SERICPAC works in tandem with SERICOST, a program to calculate avoided costs, and determines the appropriate rates for buying and selling of electricity from electric utilities to qualifying facilities (QF) as stipulated under Section 210 of PURA. SERICPAC contains simulation models for eight technologies including wind, hydro, biogas, and cogeneration. The simulations are converted in a diversified utility production which can be either gross production or net production, which accounts for an internal electricity usage by the QF. The program allows for adjustments to the production to be made for scheduled and forced outages. The final output of the model is a technology-specific average annual rate. The report contains a description of the technologies and the simulations as well as complete user's guide to SERICPAC.

  6. Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care - study protocol for a randomized clinical trial

    DEFF Research Database (Denmark)

    Eklund, Andreas; Axén, Iben; Kongsted, Alice

    2014-01-01

    is the number of days with bothersome pain over 12 months. Secondary measures are self-rated health (EQ-5D), function (the Roland Morris Disability Questionnaire), psychological profile (the Multidimensional Pain Inventory), pain intensity (the Numeric Rating Scale), and work absence.The primary utility measure...... of the study is quality-adjusted life years and will be calculated using the EQ-5D questionnaire. Direct medical costs as well as indirect costs will be considered.Subjects are randomly allocated into two treatment arms: 1) Symptom-guided treatment (patient controlled), receiving care when patients feel a need....... Strict inclusion criteria should ensure a suitable target group and the use of frequent data collection should provide an accurate outcome measurement. The study utilizes normal clinical procedures, which should aid the transferability of the results.Trial registration: Clinical trials.gov; NCT01539863...

  7. 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.

  8. A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions.

    Directory of Open Access Journals (Sweden)

    Andrea C Villanti

    Full Text Available A 2011 report from the National Lung Screening Trial indicates that three annual low-dose computed tomography (LDCT screenings for lung cancer reduced lung cancer mortality by 20% compared to chest X-ray among older individuals at high risk for lung cancer. Discussion has shifted from clinical proof to financial feasibility. The goal of this study was to determine whether LDCT screening for lung cancer in a commercially-insured population (aged 50-64 at high risk for lung cancer is cost-effective and to quantify the additional benefits of incorporating smoking cessation interventions in a lung cancer screening program.The current study builds upon a previous simulation model to estimate the cost-utility of annual, repeated LDCT screenings over 15 years in a high risk hypothetical cohort of 18 million adults between age 50 and 64 with 30+ pack-years of smoking history. In the base case, the lung cancer screening intervention cost $27.8 billion over 15 years and yielded 985,284 quality-adjusted life years (QALYs gained for a cost-utility ratio of $28,240 per QALY gained. Adding smoking cessation to these annual screenings resulted in increases in both the costs and QALYs saved, reflected in cost-utility ratios ranging from $16,198 per QALY gained to $23,185 per QALY gained. Annual LDCT lung cancer screening in this high risk population remained cost-effective across all sensitivity analyses.The findings of this study indicate that repeat annual lung cancer screening in a high risk cohort of adults aged 50-64 is highly cost-effective. Offering smoking cessation interventions with the annual screening program improved the cost-effectiveness of lung cancer screening between 20% and 45%. The cost-utility ratios estimated in this study were in line with other accepted cancer screening interventions and support inclusion of annual LDCT screening for lung cancer in a high risk population in clinical recommendations.

  9. A bottom-up method to develop pollution abatement cost curves for coal-fired utility boilers

    International Nuclear Information System (INIS)

    Vijay, Samudra; DeCarolis, Joseph F.; Srivastava, Ravi K.

    2010-01-01

    This paper illustrates a new method to create supply curves for pollution abatement using boiler-level data that explicitly accounts for technology cost and performance. The Coal Utility Environmental Cost (CUECost) model is used to estimate retrofit costs for five different NO x control configurations on a large subset of the existing coal-fired, utility-owned boilers in the US. The resultant data are used to create technology-specific marginal abatement cost curves (MACCs) and also serve as input to an integer linear program, which minimizes system-wide control costs by finding the optimal distribution of NO x controls across the modeled boilers under an emission constraint. The result is a single optimized MACC that accounts for detailed, boiler-specific information related to NO x retrofits. Because the resultant MACCs do not take into account regional differences in air-quality standards or pre-existing NO x controls, the results should not be interpreted as a policy prescription. The general method as well as NO x -specific results presented here should be of significant value to modelers and policy analysts who must estimate the costs of pollution reduction.

  10. Cost-utility analysis of adjuvant goserelin (Zoladex and adjuvant chemotherapy in premenopausal women with breast cancer

    Directory of Open Access Journals (Sweden)

    Cheng Tsui

    2012-01-01

    Full Text Available Abstract Background Increased health care costs have made it incumbent on health-care facilities and physicians to demonstrate both clinical and cost efficacy when recommending treatments. Though studies have examined the cost-effectiveness of adjuvant goserelin with radiotherapy for locally advanced prostate cancer, few have compared the cost-effectiveness of adjuvant goserelin to adjuvant chemotherapy alone in premenopausal breast cancer. Methods In this retrospective study at one hospital, the records of 152 patients with stage Ia to IIIa ER + breast cancer who received goserelin or chemotherapy were reviewed. Survival analysis was assessed by the Kaplan-Meier method. Patients were interviewed to evaluate their quality of life using the European Organization for Research and Treatment Quality of Life questionnaire (EORTC-QLQ-C30, version 4.0, and to obtain the utility value by the standard gamble (SG and visual scale (VS methods. Total medical cost was assessed from the (National Health Insurance NHI payer's perspective. Results Survival at 11 years was significantly better in the groserelin group (P Conclusions Goserelin therapy results in better survival and higher utility-weighted life-years, and is more cost-effective than TC or TEC chemotherapy.

  11. Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study.

    Science.gov (United States)

    Kourlaba, Georgia; Vlachopoulos, Charalambos; Parissis, John; Kanakakis, John; Gourzoulidis, George; Maniadakis, Nikos

    2015-12-18

    To conduct an economic evaluation comparing ranolazine as add-on therapy to standard-of-care (SoC) with SoC alone in patients with stable angina who did not respond adequately to first line therapy, in Greece. A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of ranolazine during a 6-month period. The analysis was conducted from a third-party payer perspective. The clinical inputs were extracted from the published literature. The cost inputs considered in the model reflect drug acquisition, hospitalizations, vascular interventions and monitoring of patients. The resource utilization data were obtained from 3 local experts. All costs refer to the year 2014. Cost-effectiveness was assessed by means of the incremental cost per quality adjusted life year (QALY) gained with the ranolazine as add-on therapy relative to SoC alone (ICER). Probabilistic sensitivity analysis (PSA) was performed. Ranolazine as add-on therapy was more costly compared to SoC alone, as the 6-month total cost per patient was €1170 and € 984, respectively. Patients received ranolazine plus SoC and SoC alone gained 0.3155 QALYs and 0.2752 QALYs, respectively. Ranolazine plus SoC resulted in an ICER equal to €4620 per QALY gained, well below the threshold of €34,000 per QALY gained. The PSA showed that the likelihood of ranolazine plus SoC being cost-effective at the threshold of €34,000 per QALY gained was 100 %. Τhe results suggest that ranolazine as add-on treatment may be a cost-effective alternative for the symptomatic treatment of patients with chronic stable angina in Greece.

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

    Science.gov (United States)

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

    2014-10-01

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

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

    International Nuclear Information System (INIS)

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

    2000-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Johnson BH

    2016-02-01

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

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

    Science.gov (United States)

    Ramohalli, Kumar

    1998-01-01

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

  16. Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-12-01

    Full Text Available Abstract Background Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH impacts patterns of healthcare utilization and costs. Methods Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8 who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment” and 6 months thereafter (“follow-up”; patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects. Results A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD age was 52 (10 years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p  Conclusions The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

  17. Nuclear power investment and generating costs from a utility point of view

    International Nuclear Information System (INIS)

    Roth, B.F.

    1975-01-01

    Nuclear power stations presently in operation in the Federal Republic of Germany have electricity generating costs between 3.5 Pf/kWh and 4.5 Pf/kWh. The higher electricity generating costs are due mainly to the increased expenditure required for the protection of plants against airplane crashes, earthquakes and sabotage, and to the higher costs of the entire fuel cycle. (orig./RW) [de

  18. Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

    Science.gov (United States)

    van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

    2017-09-01

    Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Marco Barbieri

    2016-12-01

    Full Text Available 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 measure of benefit and conducted in Belgium, France, Germany, Italy, Spain, Sweden, the Netherlands or the UK were included. Results: A total of 94 studies were identified. As a result of our search methodology, the vast majority of studies were conducted in the Netherlands or UK (33 and 30 studies, respectively. The most frequent vaccination types were against Human papillomavirus (HPV with 23 studies, followed by vaccination against pneumococcal infections (19 studies. The analysed vaccinations were generally cost-effective but with high variability. Considering an incremental cost effectiveness ratio (ICER of 40,000€/QALY, we noticed that the following vaccinations studies are below this threshold, i.e. all varicella and influenza (with one outlier studies, 90% of the studies for HPV and 75% of the studies for pneumococcal vaccinations. Rotavirus vaccination was considered as not cost-effective, with only 30% of studies below the threshold of 40,000€/QALY. There was no clear trend for vaccinations being more cost-effective in some countries. Conclusions: The published literature has shown that vaccination strategies are generally cost-effective in European countries. High heterogeneity in the results among studies and countries was found.

  20. Why does Existential Threat Promote Intergroup Violence? Examining the Role of Retributive Justice and Cost-Benefit Utility Motivations.

    Science.gov (United States)

    Hirschberger, Gilad; Pyszczynski, Tom; Ein-Dor, Tsachi

    2015-01-01

    The current research examined the role of retributive justice and cost-benefit utility motivations in the process through which mortality salience increases support for violent responses to intergroup conflict. Specifically, previous research has shown that mortality salience often encourages political violence, especially when perceptions of retributive justice are activated. The current research examined whether mortality salience directly activates a justice mindset over a cost-benefit utility mindset, and whether this justice mindset is associated with support for political violence. In Study 1 (N = 209), mortality salience was manipulated among Israeli participants who then read about a Hamas attack on Israel with either no casualties or many casualties, after which justice and utility motivations for retribution were assessed. Study 2 (N = 112), examined whether the link between death primes and support for an Israeli preemptive strike on Iran's nuclear facilities is mediated by justice or cost-benefit utility considerations. Results of both studies revealed that primes of death increased justice-related motivations, and these motives, rather than utility motives, were associated with support for violence. Findings suggest that existential concerns often fuel violent intergroup conflict because they increase desire for retributive justice, rather than increase belief that violence is an effective strategy. These findings expand our knowledge on the motivations for intergroup violence, and shed experimental light on real-life eruptions of violent conflict indicating that when existential concerns are salient, as they often are during violent conflict, the decision to engage in violence often disregards the utility of violence, and leads to the preference for violent solutions to political problems - even when these solutions make little practical sense.

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

    Science.gov (United States)

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

    2015-04-11

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

  2. Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

    Directory of Open Access Journals (Sweden)

    Walter Leutz

    2005-10-01

    care, respite care, and dentures. Rising costs per month per SHMO member reflected increasing HCB eligibility rather than costs per member with HCB care, which actually fell from $6,164 in 1989 to $4,328 in 2002. Care management accounted for about one-quarter of community care costs since 1992. Conclusions: The Kaiser Permanente Northwest SHMO served an increasingly aged and disabled membership by reducing costs per HCB member care plan and shifting utilization to a broad range of community care services. Supported by a disability-based Medicare payment formula and by SHMO beneficiaries willing to pay increasing premiums, KPNW has been able to offer comprehensive community care. The model could be replicated by other HMOs with the support of favorable federal policies.

  3. Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users.

    Science.gov (United States)

    Hardin, Lauran; Kilian, Adam; Muller, Leslie; Callison, Kevin; Olgren, Michael

    2017-02-01

    High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary's, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED) visits. All referred patients with three or more hospital visits (ED or inpatient [IP]) in the 12 months prior to initiation of a CCM© (n=339) were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR) to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. ED mean visits decreased 43% (pcost of care.

  4. The impact of team-based primary care on health care services utilization and costs: Quebec's family medicine groups.

    Science.gov (United States)

    Strumpf, Erin; Ammi, Mehdi; Diop, Mamadou; Fiset-Laniel, Julie; Tousignant, Pierre

    2017-09-01

    We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not. Participation in FMGs is voluntary and we address potential selection bias by matching on GP propensity scores, using inverse probability of treatment weights at the patient level, and then estimating difference-in-differences models. We also use appropriate modelling strategies to account for the distributions of health care cost and utilization data. We find that FMGs significantly decrease patients' health care services utilization and costs in outpatient settings relative to patients not in FMGs. The number of primary care visits decreased by 11% per patient per year among FMG enrolees and specialist visits declined by 6%. The declines in costs were of roughly equal magnitude. We found no evidence of an effect on hospitalizations, their associated costs, or the costs of ED visits. These results provide support for the idea that primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms. The extent to which the decline in GP visits represents substitution with other primary care providers warrants further investigation. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  5. A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment.

    Science.gov (United States)

    Ginsberg, Gary; Adunsky, Abraham; Rasooly, Iris

    2013-01-01

    The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

  6. PERFORMANCE AND COST OF MERCURY AND MULTIPOLLUTANT EMISSION CONTROL TECHNOLOGY APPLICATIONS ON ELECTRIC UTILITY BOILERS

    Science.gov (United States)

    The report presents estimates of the performance and cost of both powdered activated carbon (PAC) and multipollutant control technologies that may be useful in controlling mercury emissions. Based on currently available data, cost estimates for PAC injection range are 0.03-3.096 ...

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

    Science.gov (United States)

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

    2015-01-01

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

  8. Pertussis post-exposure prophylaxis among household contacts: a cost-utility analysis.

    Directory of Open Access Journals (Sweden)

    Nisha Thampi

    Full Text Available Recent pertussis outbreaks have prompted re-examination of post-exposure prophylaxis (PEP strategies, when immunization is not immediately protective. Chemoprophylaxis is recommended to household contacts; however there are concerns of clinical failure and significant adverse events, especially with erythromycin among infants who have the highest disease burden. Newer macrolides offer fewer side effects at higher drug costs. We sought to determine the cost-effectiveness of PEP strategies from the health care payer perspective.A Markov model was constructed to examine 4 mutually exclusive strategies: erythromycin, azithromycin, clarithromycin, or no intervention, stratified by age group of contacts ("infant", "child", and "adult". Transition probabilities, costs and quality-adjusted life years (QALYs were derived from the literature. Chronic neurologic sequelae were modeled over a lifetime, with costs and QALYs discounted at 5%. Associated health outcomes and costs were compared, and incremental cost-effectiveness ratios (ICER were calculated in 2012 Canadian dollars. Deterministic and probabilistic sensitivity analyses were performed to evaluate the degree of uncertainty in the results.Azithromycin offered the highest QALYs in all scenarios. While this was the dominant strategy among infants, it produced an ICER of $16,963 per QALY among children and $2,415 per QALY among adults. Total QALYs with azithromycin were 19.7 for a 5-kg infant, 19.4 for a 10-year-old child, and 18.8 for a 30-year-old adult. The costs of azithromycin PEP among infants, children and adults were $1,976, $132 and $90, respectively. While results were sensitive to changes in PEP effectiveness (11% to 87%, disease transmission (variable among age groups and hospitalization costs ($379 to $59,644, the choice of strategy remained unchanged.Pertussis PEP is a cost-effective strategy compared with no intervention and plays an important role in contact management, potentially in

  9. Determining the Cost of Capital for Turkish Electricity Distribution Utilities: Analysis and Recommendations

    OpenAIRE

    Gözen, Mustafa

    2012-01-01

    Turkey has been transforming her electricity market to a competitive one since the electricity market law was approved by the parliament in 2001. As part of the new regime, electricity distribution activities are subject to incentive-based regulation by the energy regulator - EMRA. At the beginning of each implementation period, initial revenue is allowed by EMRA for a distribution utility in which a rate of return for investments in the utility is added. Setting a fair rate is relatively eas...

  10. The cost-utility of Viagra® in The Netherlands

    NARCIS (Netherlands)

    E.A. Stolk (Elly); J.J. van Busschbach (Jan); M. Caffa; E.J.H. Meuleman; F.F.H. Rutten (Frans)

    1999-01-01

    textabstractOBJECTIVE: Clinical trials suggest that sildenafil is an effective treatment for erectile dysfunction. Nevertheless, reimbursement is controversial: sildenafil is expected to be more effective than conservative therapy (papaverine/ phentolamine injections), but also more costly to

  11. Hyaluronic Acid Injections for Treatment of Advanced Osteoarthritis of the Knee: Utilization and Cost in a National Population Sample.

    Science.gov (United States)

    Weick, Jack W; Bawa, Harpreet S; Dirschl, Douglas R

    2016-09-07

    The prevalence of knee osteoarthritis is increasing in the aging U.S. The efficacy and cost-effectiveness of the use of hyaluronic acid (HA) injections for the treatment of knee osteoarthritis are debated. In this study, we assessed the utilization and costs of HA injections in the 12 months preceding total knee arthroplasty (TKA) and evaluated the usage of HA injections in end-stage knee osteoarthritis management in relation to other treatments. MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases (Truven Health Analytics) were reviewed to identify patients who underwent TKA from 2005 to 2012. The utilization of patient-specific osteoarthritis-related health care (including medications, corticosteroid injections, HA injections, imaging, and office visits) and payment information were analyzed for the 12 months preceding TKA. A total of 244,059 patients met the inclusion criteria. Of those, 35,935 (14.7%) had ≥1 HA injection in the 12 months preceding TKA. HA injections were responsible for 16.4% of all knee osteoarthritis-related payments, trailing only imaging studies (18.2%), and HA injections accounted for 25.2% of treatment-specific payments, a rate that was higher than that of any other treatment. Patients receiving HA injections were significantly more likely to receive additional knee osteoarthritis-related treatments compared with patients who did not receive HA injections. Despite numerous studies questioning the efficacy and cost-effectiveness of HA injections for osteoarthritis of the knee, HA injections are still utilized for a substantial percentage of patients. Given the paucity of data supporting the effectiveness of HA injections and the current cost-conscious health-care climate, decreasing their use among patients with end-stage knee osteoarthritis may represent a substantial cost reduction that likely does not adversely impact the quality of care. Copyright © 2016 by The Journal of Bone

  12. Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.

    Science.gov (United States)

    Donovan, Peter J; McLeod, Donald S A; Little, Richard; Gordon, Louisa

    2016-12-01

    Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies. © 2016 European Society of Endocrinology.

  13. Cost-utility of enoxaparin compared with unfractionated heparin in unstable coronary artery disease

    Directory of Open Access Journals (Sweden)

    Milne Ruairidh

    2001-10-01

    Full Text Available Abstract Background Low molecular weight heparins hold several advantages over unfractionated heparin including convenience of administration. Enoxaparin is one such heparin licensed in the UK for use in unstable coronary artery disease (unstable stable angina and non-Q wave myocardial infarction. In these patients, two large randomised controlled trials and their meta-analysis showed small benefits for enoxaparin over unfractionated heparin at 30–43 days and potentially at one year. We found no relevant published full economic evaluations, only cost studies, one of which was conducted in the UK. The other studies, from the US, Canada and France, are difficult to interpret since their resource use and costs may not reflect UK practice. Methods We aimed to compare the benefits and costs of short-term treatment (two to eight days with enoxaparin and unfractionated heparin in unstable coronary artery disease. We used published data sources to estimate the incremental cost per quality adjusted life year (QALY, adopting a NHS perspective and using 1998 prices. Results The base case was a 0.013 QALY gain and net cost saving of £317 per person treated with enoxaparin instead of unfractionated heparin. All but one sensitivity analysis showed net savings and QALY gains, the exception (the worst case being a cost per QALY of £3,305. Best cases were a £495 saving and 0.013 QALY gain, or a £317 saving and 0.014 QALY gain per person. Conclusions Enoxaparin appears cost saving compared with unfractionated heparin in patients with unstable coronary artery disease. However, cost implications depend on local revascularisation practice.

  14. A utility/cost analysis of breast cancer risk prediction algorithms

    Science.gov (United States)

    Abbey, Craig K.; Wu, Yirong; Burnside, Elizabeth S.; Wunderlich, Adam; Samuelson, Frank W.; Boone, John M.

    2016-03-01

    Breast cancer risk prediction algorithms are used to identify subpopulations that are at increased risk for developing breast cancer. They can be based on many different sources of data such as demographics, relatives with cancer, gene expression, and various phenotypic features such as breast density. Women who are identified as high risk may undergo a more extensive (and expensive) screening process that includes MRI or ultrasound imaging in addition to the standard full-field digital mammography (FFDM) exam. Given that there are many ways that risk prediction may be accomplished, it is of interest to evaluate them in terms of expected cost, which includes the costs of diagnostic outcomes. In this work we perform an expected-cost analysis of risk prediction algorithms that is based on a published model that includes the costs associated with diagnostic outcomes (true-positive, false-positive, etc.). We assume the existence of a standard screening method and an enhanced screening method with higher scan cost, higher sensitivity, and lower specificity. We then assess expected cost of using a risk prediction algorithm to determine who gets the enhanced screening method under the strong assumption that risk and diagnostic performance are independent. We find that if risk prediction leads to a high enough positive predictive value, it will be cost-effective regardless of the size of the subpopulation. Furthermore, in terms of the hit-rate and false-alarm rate of the of the risk prediction algorithm, iso-cost contours are lines with slope determined by properties of the available diagnostic systems for screening.

  15. Cost-Utility Analysis of Depot Atypical Antipsychotics for Chronic Schizophrenia in Croatia.

    Science.gov (United States)

    Jukic, Vlado; Jakovljevic, Miro; Filipcic, Igor; Herceg, Miroslav; Silic, Ante; Tomljanovic, Tatjana; Zilbershtein, Roman; Jensen, Rasmus C D; Hemels, Michiel E H; Einarson, Thomas R

    As a nation with a developing economy, Croatia is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. We conducted a pharmacoeconomic analysis to determine the cost-effectiveness of atypical depots in Croatia. A 1-year decision-analytic framework modeled drug use. We determined the average direct cost to the Croatian Institute for Health Insurance of using depot formulations of paliperidone palmitate long-acting injectable (PP-LAI), risperidone LAI (RIS-LAI), or olanzapine LAI (OLZ-LAI). An expert panel plus literature-derived clinical rates populated the core model, along with costs adjusted to 2012 by using the Croatian consumer price index. Clinical outcomes included quality-adjusted life-years, hospitalization rates, emergency room treatment rates, and relapse days. Robustness of results was examined with one-way sensitivity analyses on important inputs; overall, all inputs were varied over 10,000 simulations in a Monte Carlo analysis. Costs (quality-adjusted life-years) per patient were €5061 (0.817) for PP-LAI, €5168 (0.807) for RIS-LAI, and €6410 (0.812) for OLZ-LAI. PP-LAI had the fewest relapse days, emergency room visits, and hospitalizations. Results were sensitive against RIS-LAI with respect to drug costs and adherence rates, but were generally robust overall, dominating OLZ-LAI in 77.3% and RIS-LAI in 56.8% of the simulations. PP-LAI dominated the other drugs because it had the lowest cost and best clinical outcomes. Compared with depots of olanzapine and risperidone and oral olanzapine, PP-LAI was the cost-effective atypical LAI for treating chronic schizophrenia in Croatia. Using depot paliperidone in place of either olanzapine or risperidone would reduce the overall costs of caring for these patients. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  16. Utilities Cost Comparison Analysis between a Public Work Center and the Non-DoD Sector

    Science.gov (United States)

    1992-12-01

    construction, consider innovative financing and 14 management arrangements (e.g. cost-sharing, public-private venture, leasing). Integrate...and services by financing all incurred costs. 27 Cash is put back into the working capital fund when customers pay cash from their O&M,N funds for the...firms, and other significantly sized business firms. The actual participants of the study may or may not be included in this listing. Disneyland was

  17. U.S. Photovoltaic Prices and Cost Breakdowns. Q1 2015 Benchmarks for Residential, Commercial, and Utility-Scale Systems

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Donald [National Renewable Energy Lab. (NREL), Golden, CO (United States); Davidson, Carolyn [National Renewable Energy Lab. (NREL), Golden, CO (United States); Fu, Ran [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ardani, Kristen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Margolis, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has continued to decline across all major market sectors. This report provides a Q1 2015 update regarding the prices of residential, commercial, and utility scale PV systems, based on an objective methodology that closely approximates the book value of a PV system. Several cases are benchmarked to represent common variations in business models, labor rates, and system architecture choice. We estimate a weighted-average cash purchase price of $3.09/W for residential scale rooftop systems, $2.15/W for commercial scale rooftop systems, $1.77/W for utility scale systems with fixed mounting structures, and $1.91/W for utility scale systems using single-axis trackers. All systems are modeled assuming standard-efficiency, polycrystalline-silicon PV modules, and further assume installation within the United States.

  18. Outcomes, utilization, and costs among thalassemia and sickle cell disease patients receiving deferoxamine therapy in the United States.

    Science.gov (United States)

    Delea, Thomas E; Hagiwara, May; Thomas, Simu K; Baladi, Jean-Francois; Phatak, Pradyumna D; Coates, Thomas D

    2008-04-01

    Deferoxamine mesylate (DFO) reduces morbidity and mortality associated with transfusional iron overload. Data on the utilization and costs of care among U.S. patients receiving DFO in typical clinical practice are limited however. This was a retrospective study using a large U.S. health insurance claims database spanning 1/97-12/04 and representing 40 million members in >70 health plans. Study subjects (n = 145 total, 106 sickle cell disease [SCD], 39 thalassemia) included members with a diagnosis of thalassemia or SCD, one or more transfusions (whole blood or red blood cells), and one or more claims for DFO. Mean transfusion episodes were 12 per year. Estimated mean DFO use was 307 g/year. Central venous access devices were required by 20% of patients. Cardiac disease was observed in 16% of patients. Mean total medical costs were $59,233 per year including $10,899 for DFO and $8,722 for administration of chelation therapy. In multivariate analyses, potential complications of iron overload were associated with significantly higher medical care costs. In typical clinical practice, use of DFO in patients with thalassemia and SCD receiving transfusions is low. Administration costs represent a large proportion of the cost of chelation therapy. Potential complications of iron overload are associated with increased costs. (c) 2007 Wiley-Liss, Inc.

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

    Science.gov (United States)

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

    2006-03-01

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

  20. More Useful, or Not so Bad? Evaluating the Effects of Interventions to Reduce Perceived Cost and Increase Utility Value with College Physics Students

    Science.gov (United States)

    Rosenzweig, Emily Quinn

    2017-01-01

    In the present study I developed and evaluated the effects of two interventions designed to target students' motivation to learn in an introductory college physics course. One intervention was designed to improve students' perceptions of utility value and the other was designed to reduce students' perceptions of cost. Utility value and cost both…

  1. Gestão de custos florestais: um estudo de caso utilizando o Activity-Based Costing Forest management costs: a case study utilizing Activity-Based Costing

    Directory of Open Access Journals (Sweden)

    Alcir Ribeiro Carneiro de Almeida

    1999-08-01

    Full Text Available No atual cenário de industrialização globalizada, tornou-se fundamental a eficácia no gerenciamento dos custos considerados inevitavelmente necessários. Programas convencionais de redução dos custos não consideram o grau de agregação de valor das atividades de rotina pela distorção dos sistemas contábeis atuais. No presente estudo, apresentam-se os principais motivos da falta de relevância das informações de custo, comenta-se sobre o problema da redução de desperdícios florestais e suas conseqüências. A partir de um estudo de caso em uma empresa do setor florestal, demonstra-se uma simulação do Activity Based Costing (ABC em uma determinada área da empresa, concluindo-se que a adoção de sistemas de custeio mais aprimorados, tal como o ABC, devem fazer parte de programas que busquem o aumento da competitividade do setor florestal.In the current view of globalized industrialization, it has become fundamental to manage essential costs effectively. Conventional programs for reducing costs, do no consider the value agregation grade of routine activities because of the distortion of current accounting systems. This study, presents the main reasons for the lack of relevance of the cost information, commenting on the problem of the reduction of forest waste and its consequences. Using a case study in a company from the forest sector, a simulation of Activity Based Costing (ABC is demonstrated in a determined area of the company it is concluded that the adoption of a more refined cost system, such as the ABC, should be included in programs, that seek to increase the competitiveness of the forest sector.

  2. Utility-Scale Solar 2015: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2016-08-17

    The utility-scale solar sector—defined here to include any ground-mounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar power (“CSP”) project that is larger than 5 MWAC in capacity—has led the overall U.S. solar market in terms of installed capacity since 2012. It is expected to maintain its market-leading position for at least another five years, driven in part by December 2015’s three-year extension of the 30% federal investment tax credit (“ITC”) through 2019 (coupled with a favorable switch to a “start construction” rather than a “placed in service” eligibility requirement, and a gradual phase down of the credit to 10% by 2022). In fact, in 2016 alone, the utility-scale sector is projected to install more than twice as much new capacity as it ever has previously in a single year. This unprecedented boom makes it difficult, yet more important than ever, to stay abreast of the latest utility-scale market developments and trends. This report—the fourth edition in an ongoing annual series—is intended to help meet this need, by providing in-depth, annually updated, data-driven analysis of the utility-scale solar project fleet in the United States. Drawing on empirical project-level data from a wide range of sources, this report analyzes not just installed project costs or prices—i.e., the traditional realm of most solar economic analyses—but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects throughout the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are also presented where appropriate.

  3. Utility-Scale Solar 2014. An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-09-01

    Other than the nine Solar Energy Generation Systems (“SEGS”) parabolic trough projects built in the 1980s, virtually no large-scale or “utility-scale” solar projects – defined here to include any groundmounted photovoltaic (“PV”), concentrating photovoltaic (“CPV”), or concentrating solar thermal power (“CSP”) project larger than 5 MWAC – existed in the United States prior to 2007. By 2012 – just five years later – utility-scale had become the largest sector of the overall PV market in the United States, a distinction that was repeated in both 2013 and 2014 and that is expected to continue for at least the next few years. Over this same short period, CSP also experienced a bit of a renaissance in the United States, with a number of large new parabolic trough and power tower systems – some including thermal storage – achieving commercial operation. With this critical mass of new utility-scale projects now online and in some cases having operated for a number of years (generating not only electricity, but also empirical data that can be mined), the rapidly growing utility-scale sector is ripe for analysis. This report, the third edition in an ongoing annual series, meets this need through in-depth, annually updated, data-driven analysis of not just installed project costs or prices – i.e., the traditional realm of solar economics analyses – but also operating costs, capacity factors, and power purchase agreement (“PPA”) prices from a large sample of utility-scale solar projects in the United States. Given its current dominance in the market, utility-scale PV also dominates much of this report, though data from CPV and CSP projects are presented where appropriate.

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

    Directory of Open Access Journals (Sweden)

    Schwab P

    2017-02-01

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

  5. Economic evaluation of a web-based tailored lifestyle intervention for adults: findings regarding cost-effectiveness and cost-utility from a randomized controlled trial.

    Science.gov (United States)

    Schulz, Daniela N; Smit, Eline S; Stanczyk, Nicola E; Kremers, Stef P J; de Vries, Hein; Evers, Silvia M A A

    2014-03-20

    Different studies have reported the effectiveness of Web-based computer-tailored lifestyle interventions, but economic evaluations of these interventions are scarce. The objective was to assess the cost-effectiveness and cost-utility of a sequential and a simultaneous Web-based computer-tailored lifestyle intervention for adults compared to a control group. The economic evaluation, conducted from a societal perspective, was part of a 2-year randomized controlled trial including 3 study groups. All groups received personalized health risk appraisals based on the guidelines for physical activity, fruit intake, vegetable intake, alcohol consumption, and smoking. Additionally, respondents in the sequential condition received personal advice about one lifestyle behavior in the first year and a second behavior in the second year; respondents in the simultaneous condition received personal advice about all unhealthy behaviors in both years. During a period of 24 months, health care use, medication use, absenteeism from work, and quality of life (EQ-5D-3L) were assessed every 3 months using Web-based questionnaires. Demographics were assessed at baseline, and lifestyle behaviors were assessed at both baseline and after 24 months. Cost-effectiveness and cost-utility analyses were performed based on the outcome measures lifestyle factor (the number of guidelines respondents adhered to) and quality of life, respectively. We accounted for uncertainty by using bootstrapping techniques and sensitivity analyses. A total of 1733 respondents were included in the analyses. From a willingness to pay of €4594 per additional guideline met, the sequential intervention (n=552) was likely to be the most cost-effective, whereas from a willingness to pay of €10,850, the simultaneous intervention (n=517) was likely to be most cost-effective. The control condition (n=664) appeared to be preferred with regard to quality of life. Both the sequential and the simultaneous lifestyle

  6. Transferability of results of cost utility analyses for biologicals in inflammatory conditions for Central and Eastern European countries.

    Science.gov (United States)

    Gulácsi, László; Rencz, Fanni; Péntek, Márta; Brodszky, Valentin; Lopert, Ruth; Hevér, Noémi V; Baji, Petra

    2014-05-01

    Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.

  7. The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

    Science.gov (United States)

    Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

    2014-10-01

    Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS

  8. Revisitando a literatura sobre custo-efetividade e utilidade em saúde Reviewing the literature of cost-effectiveness and cost-utility analysis in health

    Directory of Open Access Journals (Sweden)

    Leyla Gomes Sancho

    2008-12-01

    Full Text Available Este trabalho tem por finalidade contribuir com a disseminação do conteúdo teórico desta área do conhecimento, assim como oferecer subsídios para reflexões no que tange à consecução de estudos, os quais resultem em reais benefícios para a população e a gestão do sistema de saúde. Para tanto se realizou, sob uma perspectiva histórica e com base no ponto de vista de reconhecidos autores, ampla revisão da literatura que abrangeu desde sua fundamentação teórica até a formalização de guias metodológicos. O estudo ressalta, inclusive, as controvérsias metodológicas conseqüentes da diversidade das abordagens teóricas. E, como decorrência, recomenda a realização de pesquisas sobre a fundamentação teórica, particularmente a abordada pelos extrawelfaristas.This study aims to contribute to the dissemination of the theoretical foundations for cost-effectiveness and cost-utility analysis. It also provides backing for reflections on the implementation of studies leading to real benefits for both the population and health system management. Taking a historical perspective, and drawing on the work of renowned authors, the study provides an extensive literature review on cost-effectiveness and cost-utility analysis, from the theoretical formulation to the definition of methodological guidelines. The study also highlights the methodological controversies resulting from the diversity of theoretical approaches. As a result, it recommends conducting research on the theoretical foundations, and particularly the position of the extra-welfarists.

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

    Science.gov (United States)

    Welton, John M

    2015-10-01

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

  10. Cost/schedule performance measurement system utilized on the Fast Flux Test Facility project

    International Nuclear Information System (INIS)

    Brown, R.K.; Frost, R.A.; Zimmerman, F.M.

    1976-01-01

    An Earned Value-Integrated Cost/Schedule Performance Measurement System has been applied to a major nonmilitary nuclear design and construction project. This system is similar to the Department of Defense Cost/Schedule Performance Measurement System. The project is the Fast Flux Test Facility (a Fuels and Materials test reactor for the Liquid Metal Fast Breeder Reactor Program) being built at the Hanford Engineering Development Laboratory, Richland, Washington, by Westinghouse Hanford Company for the U. S. Energy Research and Development Administration. Because the project was well into the construction phase when the Earned Value System was being considered, it was decided that the principles of DOD's Cost/Schedule Control System Criteria would be applied to the extent possible but no major changes in accounting practices or management systems were imposed. Implementation of this system enabled the following questions to be answered: For work performed, how do actual costs compare with the budget for that work. What is the impact of cost and schedule variances at an overall project level composed of different kinds of activities. Without the Earned Value system, these questions could be answered in a qualitative, subjective manner at best

  11. A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand.

    Science.gov (United States)

    Leelahavarong, Pattara; Chaikledkaew, Usa; Hongeng, Suradej; Kasemsup, Vijj; Lubell, Yoel; Teerawattananon, Yot

    2010-07-16

    Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis. A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained. Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year. At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.

  12. Cost-Utility Analysis of Pedicle Screw Removal After Successful Posterior Instrumented Fusion in Thoracolumbar Burst Fractures.

    Science.gov (United States)

    Lee, Han-Dong; Jeon, Chang-Hoon; Chung, Nam-Su; Seo, Young-Wook

    2017-08-01

    A cost-utility analysis (CUA). The aim of this study was to determine the cost-effectiveness of pedicle screw removal after posterior fusion in thoracolumbar burst fractures. Pedicle screw instrumentation is a standard fixation method for unstable thoracolumbar burst fracture. However, removal of the pedicle screw after successful fusion remains controversial because the clinical benefits remain unclear. CUA can help clinicians make appropriate decisions about optimal health care for pedicle screw removal after successful fusion in thoracolumbar burst fractures. We conducted a single-center, retrospective, longitudinal matched-cohort study of prospectively collected outcomes. In total, 88 consecutive patients who had undergone pedicle screw instrumentation for thoracolumbar burst fracture with successful fusion confirmed by computed tomography (CT) were used in this study. In total, 45 patients wanted to undergo implant removal surgery (R group), and 43 decided not to remove the implant (NR group). A CUA was conducted from the health care perspective. The direct costs of health care were obtained from the medical bill of each patient. Changes in health-related quality of life (HRQoL) scores, validated by Short Form 6D, were used to calculate quality-adjusted life-years (QALYs). Total costs and gained QALY were calculated at 1 year (1 year) and 2 years (2 years) compared with baseline. Results are expressed as an incremental cost-effectiveness ratio (ICER). Different discount rates (0%, 3%, and 5%) were applied to both cost and QALY for sensitivity analysis. Baseline patient variables were similar between the two groups (all P > 0.05). The additional benefits of implant removal (0.201 QALY at 2 years) were achieved with additional costs ($2541 at 2 years), equating to an ICER of $12,641/QALY. On the basis of the different discount rates, the robustness of our study's results was also determined. Implant removal after successful fusion in a thoracolumbar burst

  13. Asbestos Utilization Costs on the Example of Functioning Landfill of Hazardous Waste

    Science.gov (United States)

    Polek, Daria

    2017-12-01

    Asbestos is a trademark of mineral fibres, which are the natural minerals found in nature. Products containing asbestos fibres, in accordance with the national and EU legislation, are covered by the production prohibition and forced to be removed. In Poland, the asbestos removal process started with the adaptation of the EU law by the Council of Ministers Treatment Program of the National Asbestos for the years 2009-2032. The purpose of the dissertation was to analyse the costs associated with the disposal of the costs of collection, transport and disposal of waste. Methodology consisted in obtaining information on the raw materials needed to produce asbestos sheets. The analysis allowed us to determine the asbestos removal cost and include state subsidies in the calculations.

  14. Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.

    Science.gov (United States)

    Lairson, David R; Parikh, Rohan C; Cormier, Janice N; Chan, Wenyaw; Du, Xianglin L

    2014-10-01

    Chemotherapy prolongs survival for stage III colon cancer patients but community-level evidence on the effectiveness and cost effectiveness of treatment for elderly patients is limited. Comparisons were between patients receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin). A retrospective cohort study was conducted using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked database. Patients (≥65 years) with American Joint Committee on Cancer stage III colon cancer at diagnosis in 2004-2009 were identified. The 3-way propensity score matched sample included 3,534 patients. Effectiveness was measured in life-years and quality-adjusted life-years (QALYs). Medicare costs (2010 US dollars) were estimated from diagnosis until death or end of study. FOLFOX patients experienced 6.06 median life-years and 4.73 QALYs. Patients on 5-FU had 5.75 median life-years and 4.50 median QALYs, compared to 3.42 and 2.51, respectively, for the no chemotherapy patients. Average total healthcare costs ranged from US$85,422 for no chemotherapy to US$168,628 for FOLFOX. Incremental cost-effectiveness ratios (ICER) for 5-FU versus no chemotherapy were US$17,131 per life-year gained and US$20,058 per QALY gained. ICERs for FOLFOX versus 5-FU were US$139,646 per life-year gained and US$188,218 per QALY gained. Results appear to be sensitive to age, suggesting that FOLFOX performs better for patients 65-69 and 80+ years old while 5-FU appears most effective and cost effective for the age groups 70-74 and 75-79 years. FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients. Results were sensitive to age, with ICERs exhibiting a U-shaped pattern.

  15. Cost-utility analysis of antihypertensive medications in Nigeria: a decision analysis

    Directory of Open Access Journals (Sweden)

    Ekwunife Obinna Ikechukwu

    2013-01-01

    Full Text Available Abstract Background Many drugs are available for control of hypertension and its sequels in Nigeria but some are not affordable for majority of the populace. This serious pharmacoeconomic question has to be answered by the nation’s health economists. The objective of this study was to evaluate the cost-effectiveness of drugs from 4 classes of antihypertensive medications commonly used in Nigeria in management of hypertension without compelling indication to use a particular antihypertensive drug. Methods The study employed decision analytic modeling. Interventions were obtained from a meta-analysis. The Markov process model calculated clinical outcomes and costs during a life cycle of 30 years of 1000 hypertensive patients stratified by 3 cardiovascular risk groups, under the alternative intervention scenarios. Quality adjusted life year (QALY was used to quantify clinical outcome. The average cost of treatment for the 1000 patient was tracked over the Markov cycle model of the alternative interventions and results were presented in 2010 US Dollars. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability frontiers. Expected value of perfect information (EVPI and expected value of parameter perfect information (EVPPI analyses were also conducted for the hypothetical population. Results Thiazide diuretic was the most cost-effective option across the 3 cardiovascular risk groups. Calcium channel blocker was the second best for Moderate risk and high risk with a willingness to pay of at least 2000$/QALY. The result was robust since it was insensitive to the parameters alteration. Conclusions The result of this study showed that thiazide diuretic followed by calcium channel blocker could be a feasible strategy in order to ensure that patients in Nigeria with hypertension are better controlled.

  16. Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

    Directory of Open Access Journals (Sweden)

    Lauran Hardin

    2017-02-01

    Full Text Available Introduction: High-need, high-cost (HNHC patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a crosscontinuum intervention process and a succinct tool called a Complex Care Map (CCM© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services. Methods: Using a pre-/post-test design in which each subject served as his/her own historical control, this quality improvement project focused on determining if the interdisciplinary intervention called CCM© had an impact on healthcare utilization and costs for HNHC patients. We conducted the analysis between November 2012 and December 2015 at Mercy Health Saint Mary’s, a Midwestern urban hospital with greater than 80,000 annual emergency department (ED visits. All referred patients with three or more hospital visits (ED or inpatient [IP] in the 12 months prior to initiation of a CCM© (n=339 were included in the study. Individualized CCMs© were created and made available in the electronic medical record (EMR to all healthcare providers. We compared utilization, cost, social, and healthcare access variables from the EMR and cost-accounting system for 12 months before and after CCMs© implementation. We used both descriptive and limited inferential statistics. Results: ED mean visits decreased 43% (p<0.001, inpatient mean admissions decreased 44% (p<0.001, outpatient mean visits decreased 17% (p<0.001, computed tomography mean scans decreased 62% (p<0.001, and OBS/IP length of stay mean days decreased 41% (p<0.001. Gross charges decreased 45% (p<0.001, direct expenses

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

    Science.gov (United States)

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

    2014-06-01

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

  18. A Cost-Utility Analysis of Lumbar Decompression With and Without Fusion for Degenerative Spine Disease in the Elderly.

    Science.gov (United States)

    Devin, Clinton J; Chotai, Silky; Parker, Scott L; Tetreault, Lindsay; Fehlings, Michael G; McGirt, Matthew J

    2015-10-01

    Value-based purchasing is rapidly being implemented to rein in the unsustainably rising costs of the US healthcare system. With a growing elderly population, it is vital to understand the value of spinal surgery in this group of individuals. To compare the cost-effectiveness of lumbar decompression with and without fusion for degenerative spine disease in elderly vs nonelderly patients. A total of 221 patients undergoing elective primary surgery for degenerative lumbar pathology who were enrolled in a prospective longitudinal registry were analyzed. Patient-reported outcomes of Oswestry Disability Index, numeric rating scale for back and leg pain, and quality-of-life scores (EuroQol-5D) were recorded. Two-year back-related medical resource use, missed work, and health-state values (quality-adjusted life-years [QALYs]) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by gross-of-tax wage rate (indirect cost). Patients were divided into age groups <70 and ≥70 years. Mean cumulative 2-year QALYs gained were statistically similar between younger and older patients for both decompression alone (0.67 ± 0.65 vs 0.56 ± 0.65; P = .47) and decompression with fusion (0.56 ± 0.55 vs 0.59 ± 0.55; P = .26). Mean 2-year cost per QALY gained between younger and older patients was similar for both decompression alone ($24,365 vs $31,750 per QALY; P = .11) and decompression with fusion ($64,228 vs $60,183 per QALY; P = .09). Surgical treatment provided significant improvements in pain, disability, and quality of life for elderly patients with degenerative lumbar disease. Observed costs per QALY gained for lumbar decompression with and without fusion were similar for younger and older patients, demonstrating that lumbar spine surgery in the elderly is an equally cost-effective and valuable intervention.

  19. Cost estimation of hydrogen and DME produced by nuclear heat utilization system II

    International Nuclear Information System (INIS)

    Shiina, Yasuaki; Nishihara, Tetsuo

    2004-09-01

    Utilization and production of hydrogen has been studied in order to spread utilization of the hydrogen energy in 2020 or 2030. It will take, however, many years for the hydrogen energy to be used very easily like gasoline, diesel oil and city gas in the world. During the periods, low CO 2 release liquid fuels would be used together with hydrogen. Recently, di-methyl-ether (DME). has been noticed as one of the substitute liquid fuels of petroleum. Such liquid fuels can be produced from the mixed gas such as hydrogen and carbon oxide which are produced from natural gas by steam reforming. Therefore, the system would become one of the candidates of future system of nuclear heat utilization. Following the study in 2002, we performed economic evaluation of the hydrogen and DME production by nuclear heat utilization plant where heat generated by HTGR is completely consumed for the production. The results show that hydrogen price produced by nuclear was about 17% cheaper than the commercial price by increase in recovery rate of high purity hydrogen with increased in PSA process. Price of DME in indirect method produced by nuclear heat was also about 17% cheaper than the commercial price by producing high purity hydrogen in the DME producing process. As for the DME, since price of DME produced near oil land in petroleum exporting countries is cheaper than production in Japan, production of DME by nuclear heat in Japan has disadvantage economically in this time. Trial study to estimate DME price produced by direct method was performed. From the present estimation, utilization of nuclear heat for the production of hydrogen would be more effective with coupled consideration of reduction effect of CO 2 release. (author)

  20. A register-based case-control study of health care utilization and costs in binge-eating disorder.

    Science.gov (United States)

    Watson, Hunna J; Jangmo, Andreas; Smith, Tosha; Thornton, Laura M; von Hausswolff-Juhlin, Yvonne; Madhoo, Manisha; Norring, Claes; Welch, Elisabeth; Wiklund, Camilla; Larsson, Henrik; Bulik, Cynthia M

    2018-05-01

    Capturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED. A case-control design and nationwide registers were used. All individuals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case). Cases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher. Individuals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden

  1. Energy balance and GHG-abatement cost of cassava utilization for fuel ethanol in Thailand

    International Nuclear Information System (INIS)

    Nguyen, Thu Lan Thi; Gheewala, Shabbir H.; Garivait, Savitri

    2007-01-01

    Since 2001, in order to enhance ethanol's cost competitiveness with gasoline, the Thai government has approved the exemption of excise tax imposed on ethanol, controlling the retail price of gasohol (a mixture of ethanol and gasoline at a ratio of 1:9) to be less than that of octane 95 gasoline, within a range not exceeding 1.5 baht a litre. The policy to promote ethanol for transport is being supported by its positive effects on energy security and climate change mitigation. An analysis of energy, greenhouse gas (GHG) balances and GHG abatement cost was done to evaluate fuel ethanol produced from cassava in Thailand. Positive energy balance of 22.4 MJ/L and net avoided GHG emission of 1.6 kg CO 2 eq./L found for cassava-based ethanol (CE) proved that it would be a good substitute for gasoline, effective in fossil energy saving and GHG reduction. With a GHG abatement cost of US$99 per tonne of CO 2 , CE is rather less cost effective than the many other climate strategies relevant to Thailand in the short term. Opportunities for improvements are discussed to make CE a reasonable option for national climate policy

  2. Does Medicaid managed care market penetration impact provider participation, costs, utilization, and access?

    Science.gov (United States)

    Minott, Jenny

    2010-09-01

    Key findings. (1) An increase in commercial plan penetration increased the liklihood [sic] that a physician would accept new Medicaid patients, but this did not significantly impact enrollee costs. (2) An increase in Medicaid-dominant HMO market penetration increased the probability that individuals reported using the ED as their primary source of care.

  3. Outcome Assessment for Cost-Utility Evaluations: SF-6D vs. EQ-5D

    DEFF Research Database (Denmark)

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

    2010-01-01

    What was formerly known as medicine has now become health care, an amalgam of several disciplines, including health economics. The role of health economics is fairly straightforward, namely to facilitate priority-setting under the objective of maximizing population health. For that purpose, cost...

  4. The Cost of Technical Trading Rules in the Forex Market: A Utility-based Evaluation

    NARCIS (Netherlands)

    H.D.R. Dewachter (Hans); M. Lyrio (Marco)

    2003-01-01

    textabstractWe compute the opportunity cost for rational risk averse agents of using technical trading rules in the foreign exchange rate market. Our purpose is to investigate whether these rules can be interpreted as near-rational investment strategies for rational investors. We analyze four

  5. Utilization of diabetes medication and cost of testing supplies in Saskatchewan, 2001.

    Science.gov (United States)

    Johnson, Jeffrey A; Pohar, Sheri L; Secnik, Kristina; Yurgin, Nicole; Hirji, Zeenat

    2006-12-12

    The purpose of this study was to describe the patterns of antidiabetic medication use and the cost of testing supplies in Canada using information collected by Saskatchewan's Drug Plan (DP) in 2001. The diabetes cohort (n = 41,630) included individuals who met the National Diabetes Surveillance System (NDSS) case definition. An algorithm was then used to identify subjects as having type 1 or type 2 diabetes. Among those identified as having type 2 diabetes (n = 37,625), 38% did not have records for antidiabetic medication in 2001. One-third of patients with type 2 diabetes received monotherapy. Metformin, alone or in combination with other medications, was the most commonly prescribed antidiabetic medication. Just over one-half of the all patients with diabetes had a DP records for diabetes testing supplies. For individuals (n = 4,005) with type 1 diabetes, 79% had a DP record for supplies, with an average annual cost of 472 +/- 560 dollars. For type 2 diabetes, 50% had records for testing supplies, with an average annual cost of 122 +/- 233 dollars. Those individuals with type 2 diabetes who used insulin had higher testing supply costs than those on oral antidiabetic medication alone (359 vs 131 dollars; p < 0.001).

  6. Logistics, Costs, and GHG Impacts of Utility-Scale Co-Firing with 20% Biomass

    Energy Technology Data Exchange (ETDEWEB)

    Nichol, Corrie Ian [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2013-06-01

    This study analyzes the possibility that biopower in the U.S. is a cost-competitive option to significantly reduce greenhouse gas emissions. In 2009, net greenhouse gas (GHG) emitted in the United States was equivalent to 5,618 million metric tons CO2, up 5.6% from 1990 (EPA 2011). Coal-fired power generation accounted for 1,748 million metric tons of this total. Intuitively, life-cycle CO2 emissions in the power sector could be reduced by substituting renewable biomass for coal. If just 20% of the coal combusted in 2009 had been replaced with biomass, CO2 emissions would have been reduced by 350 million metric tons, or about 6% of net annual GHG emission. This would have required approximately 225 million tons of dry biomass. Such an ambitious fuel substitution would require development of a biomass feedstock production and supply system tantamount to coal. This material would need to meet stringent specifications to ensure reliable conveyance to boiler burners, efficient combustion, and no adverse impact on heat transfer surfaces and flue gas cleanup operations. Therefore, this report addresses the potential cost/benefit tradeoffs of co-firing 20% specification-qualified biomass (on an energy content basis) in large U.S. coal-fired power plants. The dependence and sensitivity of feedstock cost on source of material, location, supply distance, and demand pressure was established. Subsequently, the dependence of levelized cost of electricity (LCOE) on feedstock costs, power plant feed system retrofit, and impact on boiler performance was determined. Overall life-cycle assessment (LCA) of greenhouse gas emissions saving were next evaluated and compared to wind and solar energy to benchmark the leading alternatives for meeting renewable portfolio standards (or RPS).

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

    Science.gov (United States)

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

    2013-02-01

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

  8. Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

    Science.gov (United States)

    Mihalopoulos, Cathrine; Magnus, Anne; Lal, Anita; Dell, Lisa; Forbes, David; Phelps, Andrea

    2015-04-01

    To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations

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

    Science.gov (United States)

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

    2018-06-01

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

  10. Risk aversion and uncertainty in cost-effectiveness analysis: the expected-utility, moment-generating function approach.

    Science.gov (United States)

    Elbasha, Elamin H

    2005-05-01

    The availability of patient-level data from clinical trials has spurred a lot of interest in developing methods for quantifying and presenting uncertainty in cost-effectiveness analysis (CEA). Although the majority has focused on developing methods for using sample data to estimate a confidence interval for an incremental cost-effectiveness ratio (ICER), a small strand of the literature has emphasized the importance of incorporating risk preferences and the trade-off between the mean and the variance of returns to investment in health and medicine (mean-variance analysis). This paper shows how the exponential utility-moment-generating function approach is a natural extension to this branch of the literature for modelling choices from healthcare interventions with uncertain costs and effects. The paper assumes an exponential utility function, which implies constant absolute risk aversion, and is based on the fact that the expected value of this function results in a convenient expression that depends only on the moment-generating function of the random variables. The mean-variance approach is shown to be a special case of this more general framework. The paper characterizes the solution to the resource allocation problem using standard optimization techniques and derives the summary measure researchers need to estimate for each programme, when the assumption of risk neutrality does not hold, and compares it to the standard incremental cost-effectiveness ratio. The importance of choosing the correct distribution of costs and effects and the issues related to estimation of the parameters of the distribution are also discussed. An empirical example to illustrate the methods and concepts is provided. Copyright 2004 John Wiley & Sons, Ltd

  11. Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types.

    Science.gov (United States)

    Van Bellinghen, Laure-Anne; Marijam, Alen; Tannus Branco de Araujo, Gabriela; Gomez, Jorge; Van Vlaenderen, Ilse

    Influenza burden in Brazil is considerable with 4.2-6.4 million cases in 2008 and influenza-like-illness responsible for 16.9% of hospitalizations. Cost-effectiveness of influenza vaccination may be assessed by different types of models, with limitations due to data availability, assumptions, and modelling approach. To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines in Brazil was estimated using three distinct models: a 1-year decision tree population model with three age groups (FLOU); a more detailed 1-year population model with five age groups (FLORA); and a more complex lifetime multi-cohort Markov model with nine age groups (FLORENCE). Analysis 1 (impact of model structure) compared each model using the same data inputs (i.e., best available data for FLOU). Analysis 2 (impact of increasing granularity) compared each model populated with the best available data for that model. Using the best data for each model, the discounted cost-utility ratio of quadrivalent versus trivalent influenza vaccine was R$20,428 with FLOU, R$22,768 with FLORA (versus R$20,428 in Analysis 1), and, R$19,257 with FLORENCE (versus R$22,490 in Analysis 1) using a lifetime horizon. Conceptual differences between FLORA and FLORENCE meant the same assumption regarding increased all-cause mortality in at-risk individuals had an opposite effect on the incremental cost-effectiveness ratio in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced this ratio in Analysis 2. FLOU provided adequate cost-effectiveness estimates with data in broad age groups. FLORA increased insights (e.g., in healthy versus at-risk, paediatric, respiratory/non-respiratory complications). FLORENCE provided greater insights and precision (e.g., in elderly, costs and complications, lifetime cost-effectiveness). All three models predicted a cost per quality-adjusted life year gained for quadrivalent versus

  12. Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Jabbarli, Ramazan; Shah, Mukesch; Hippchen, Beate; Velthoven, Vera van [University Hospital of Freiburg, Department of Neurosurgery, Freiburg/Breisgau (Germany); Taschner, Christian [University Hospital of Freiburg, Department of Neuroradiology, Freiburg (Germany); Kaier, Klaus [University Hospital of Freiburg, Institute for Medical Biometry and Medical Informatics, Freiburg (Germany)

    2014-10-15

    CT-angiography gains an increasing role in the initial diagnosis of patients with nontraumatic subarachnoid hemorrhage (SAH). However, the implementation of CT-angiography does not always exclude the necessity of conventional angiography. Our objective was to determine the practical utility and cost-effectiveness of CT-angiography. All patients with nontraumatic subarachnoid hemorrhage admitted to our university hospital after implementation of CT-angiography between June 1, 2011 and June 30, 2012 were retrospectively analyzed in regard to factors of treatment flow, radiation exposure, harms of contrast medium loading, and diagnostic costs. A control group of the same size was assembled from previously admitted SAH patients, who did not undergo pretreatment CT-angiography. Furthermore, cost-effectiveness analysis was performed. The final analysis consisted of 93 patients in each group. Of 93 patients with pretreatment CT-angiography, 74 had to undergo conventional angiography for diagnostic and/or therapeutic purposes. CT-angiography had significant impact on the reduction of collective effective radiation dose by 4.419 mSv per person (p = 0.0002) and was not associated with additional harms. Despite the significantly earlier detection of aneurysms with CT-angiography (p < 0.0001), there were no significant differences in the timing of aneurysm repair and duration of ICU and general hospital stay. There was an increase of diagnostic costs - the cost-effectiveness analysis showed, however, that benefits of CT-angiography in respect to radiation exposure and risk of conventional angiography-related complications justify the additional costs of CT-angiography. Although the implementation of CT-angiography in SAH diagnosis cannot completely replace conventional angiography, it can be approved in regard to radiation hygiene and cost-effectiveness. (orig.)

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

    Science.gov (United States)

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

    2018-06-07

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

  14. Including health economic analysis in pilot studies: lessons learned from a cost-utility analysis within the PROSPECTIV pilot study

    Directory of Open Access Journals (Sweden)

    Richéal M. Burns

    2017-07-01

    Full Text Available PurposeTo assess feasibility and health economic benefits and costs as part of a pilot study for a nurse-led, psychoeducational intervention (NPLI for prostate cancer in order to understand the potential for cost effectiveness as well as contribute to the design of a larger scale trial.MethodsMen with stable prostate cancer post-treatment were recruited from two cancer centres in the UK. Eighty-three men were randomised to the NLPI plus usual care or usual care alone (UCA (42 NLPI and 41 UCA; the NLPI plus usual care was delivered in the primary-care setting (the intervention and included an initial face-to-face consultation with a trained nurse, with follow-up tailored to individual needs. The study afforded the opportunity to undertake a short-term within pilot analysis. The primary outcome measure for the economic evaluation was quality of life, as measured by the EuroQol five dimensions questionnaire (EQ-5D (EQ-5D-5L instrument. Costs (£2014 assessed included health-service resource use, out-of-pocket expenses and losses from inability to undertake usual activities.ResultsTotal and incremental costs varied across the different scenarios assessed, with mean cost differences ranging from £173 to £346; incremental effect, as measured by the change in utility scores over the duration of follow-up, exhibited wide confidence intervals highlighting inconclusive effectiveness (95% CI: -0.0226; 0.0438. The cost per patient of delivery of the intervention would be reduced if rolled out to a larger patient cohort.ConclusionsThe NLPI is potentially cost saving depending on the scale of delivery; however, the results presented are not considered generalisable.

  15. Costs and Trends in Utilization of Low-value Services Among Older Adults With Commercial Insurance or Medicare Advantage.

    Science.gov (United States)

    Carter, Elizabeth A; Morin, Pamela E; Lind, Keith D

    2017-11-01

    Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States. To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older. A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse. Adults 50 and older enrolled in commercial plans and adults 65 and older enrolled in MA plans between 2009 and 2014. Costs and utilization of 16 low-value services in the following categories: cancer screening, imaging, and invasive procedures. The most commonly performed low-value service was imaging of the head for syncope, at rates of 33%-39% in commercial enrollees and 45% in MA enrollees. The least common service was peripheral artery stenting (value service utilization. Greater consistency would facilitate monitoring use of low-value services and changing clinical practice patterns over time.

  16. Cost benefit analysis of outsourcing initiatives/strategy at water utilities corporation (Botswana) / G Mogomotsi

    OpenAIRE

    Mogomotsi, G

    2016-01-01

    After the Water Utilities Corporation adopted outsourcing as a policy initiative and operational directive various non-core functions were outsourced. This raises obvious questions as to why the Corporation suddenly decided to do this. Does the Corporation indeed benefit in terms of value addition from outsourced functions? Some of the pertinent questions include: To what extent did policy guidelines and operational measures govern the said outsourcing initiatives? What are the...

  17. A cost-utility analysis of cervical cancer vaccination in preadolescent Canadian females

    Directory of Open Access Journals (Sweden)

    Merid Maraki

    2009-10-01

    Full Text Available Abstract Background Despite the fact that approximately 70% of Canadian women undergo cervical cancer screening at least once every 3 years, approximately 1,300 women were diagnosed with cervical cancer and approximately 380 died from it in 2008. This study estimates the effectiveness and cost-effectiveness of vaccinating 12-year old Canadian females with an AS04-adjuvanted cervical cancer vaccine. The indirect effect of vaccination, via herd immunity, is also estimated. Methods A 12-health-state 1-year-cycle Markov model was developed to estimate lifetime HPV related events for a cohort of 12-year old females. Annual transition probabilities between health-states were derived from published literature and Canadian population statistics. The model was calibrated using Canadian cancer statistics. From a healthcare perspective, the cost-effectiveness of introducing a vaccine with efficacy against HPV-16/18 and evidence of cross-protection against other oncogenic HPV types was evaluated in a population undergoing current screening practices. The base-case analysis included 70% screening coverage, 75% vaccination coverage, $135/dose for vaccine, and 3% discount rate on future costs and health effects. Conservative herd immunity effects were taken into account by estimated HPV incidence using a mathematical model parameterized by reported age-stratified sexual mixing data. Sensitivity analyses were performed to address parameter uncertainties. Results Vaccinating 12-year old females (n = 100,000 was estimated to prevent between 390-633 undiscounted cervical cancer cases (reduction of 47%-77% and 168-275 undiscounted deaths (48%-78% over their lifetime, depending on whether or not herd immunity and cross-protection against other oncogenic HPV types were included. Vaccination was estimated to cost $18,672-$31,687 per QALY-gained, the lower range representing inclusion of cross-protective efficacy and herd immunity. The cost per QALY-gained was most

  18. Cost estimation of hydrogen and DME produced by nuclear heat utilization system. Joint research

    International Nuclear Information System (INIS)

    Shiina, Yasuaki; Nishihara, Tetsuo

    2003-09-01

    Research of hydrogen energy has been performed in order to spread use of the hydrogen energy in 2020 or 2030. It will take, however, many years for the hydrogen energy to be used very easily like gasoline, diesel oil and city gas in all of countries. During the periods, low CO 2 release liquid fuels would be used together with hydrogen. Recently, di-methyl-either (DME) has been noticed as one of the substitute liquid fuels of petroleum. Such liquid fuels can be produced from the mixed gas such as hydrogen and carbon oxide which are produced by steam reforming hydrogen generation system by the use of nuclear heat. Therefore, the system would be one of the candidates of future system of nuclear heat utilization. In the present study, we focused on the production of hydrogen and DME. Economic evaluation was estimated for hydrogen and DME production in commercial and nuclear heat utilization plant. At first, heat and mass balance of each process in commercial plant of hydrogen production was estimated and commercial prices of each process were derived. Then, price was estimated when nuclear heat was used instead of required heat of commercial plant. Results showed that the production prices produced by nuclear heat were cheaper by 10% for hydrogen and 3% for DME. With the consideration of reduction effect of CO 2 release, utilization of nuclear heat would be more effective. (author)

  19. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    Directory of Open Access Journals (Sweden)

    Lau Breda HF

    2012-12-01

    Full Text Available Abstract Background Musculoskeletal disorders (MSDs affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC. The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. Methods This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group and a new model, the C-AKIC (i.e. experimental group. This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ. Results Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p Conclusions The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The

  20. Patient cost-sharing, socioeconomic status, and children’s health care utilization

    DEFF Research Database (Denmark)

    Paul, Alexander; Nilsson, Anton

    2018-01-01

    This paper estimates the effect of cost-sharing on the demand for children’s and adolescents’ use of medical care. We use a large population-wide registry dataset including detailed information on contacts with the health care system as well as family income. Two different estimation strategies...... caused by factors other than cost-sharing. We find that when care is free of charge, individuals increase their number of doctor visits by 5–10%. Effects are similar in middle childhood and adolescence, and are driven by those from low-income families. The differences across income groups cannot...... are used: regression discontinuity design exploiting age thresholds above which fees are charged, and difference- in-differences models exploiting policy changes. We also estimate combined regression discontinuity difference-in-differences models that take into account discontinuities around age thresholds...

  1. Cost Reductions for Wastewater Treatment Utilizing Water Management at Holston Army Ammunition Plant

    Science.gov (United States)

    1976-05-01

    says that the granular carbon used is made from bituminous coal. As the waste stream pass through a bed of carbon granules, com- pounds are adsorbed to...findings of laboratory-scale reactor studies conducted at Purdue University for * Clark, Dietz and Associates. The original recommendations and cost...Pretreatment Denitrification by Submerged Anaerbbic I ilters I ~ Trickling Filters S F ,2al Clarification "•’i Pump - ~ Sludge ,Treatment Dual Media Filh:ration

  2. Low-Cost High-Concentration Photovoltaic Systems for Utility Power Generation

    Energy Technology Data Exchange (ETDEWEB)

    McConnell, R.; Garboushian, V.; Gordon, R.; Dutra, D.; Kinsey, G.; Geer, S.; Gomez, H.; Cameron, C.

    2012-03-31

    Under DOE's Technology Pathway Partnership (TPP) program, Amonix, Inc. developed a new generation of high-concentration photovoltaic systems using multijunction technology and established the manufacturing capacity needed to supply multi-megawatt power plants buing using the new Amonix 7700-series solar energy systems. For this effort, Amonix Collaborated with a variety of suppliers and partners to complete project tasks. Subcontractors included: Evonik/Cyro; Hitek; the National Renewable Energy Laboratory (NREL); Raytech; Spectrolab; UL; University of Nevada, Las Vegas; and TUV Rheinland PTL. The Amonix TPP tasks included: Task 1: Multijunction Cell Optimization for Field Operation, Task 2: Fresnel Lens R&D, Task 3: Cell Package Design & Production, Task 4: Standards Compliance and Reliability Testing, Task 5: Receiver Plate Production, Task 6: MegaModule Performance, Task 7: MegaModule Cost Reduction, Task 8: Factory Setup and MegaModule Production, Task 9: Tracker and Tracking Controller, Task 10: Installation and Balance of System (BOS), Task 11: Field Testing, and Task 12: Solar Advisor Modeling and Market Analysis. Amonix's TPP addressed nearly the complete PV value chain from epitaxial layer design and wafer processing through system design, manufacturing, deployment and O&M. Amonix has made progress toward achieving these reduced costs through the development of its 28%+ efficient MegaModule, reduced manufacturing and installation cost through design for manufacturing and assembly, automated manufacturing processes, and reduced O&M costs. Program highlights include: (1) Optimized multijunction cell and cell package design to improve performance by > 10%; (2) Updated lens design provided 7% increased performance and higher concentration; (3) 28.7% DC STC MegaModule efficiency achieved in Phase II exceeded Phase III performance goal; (4) New 16' focal length MegaModule achieved target materials and manufacturing cost reduction; (5) Designed and

  3. Costly energy : why oil and gas prices are rising and what we can do about it : a collection of progressive analysis and policy alternatives

    International Nuclear Information System (INIS)

    Klein, S.

    2001-02-01

    A collection of essays were presented to address the issue of rising oil and gas prices. This issue has significant social and environmental implications and the public wants to know what is driving prices up and who is profiting. The myth that gas taxes are driving price increases was dispelled. It was argued that price hikes are mainly due to crude oil price increases and to refining and marketing price increases. The link between rising prices and free trade was also emphasized. The North American Free Trade Agreement (NAFTA) tied Canada into a North American energy market in which U.S. demand sets prices in Canada. It was suggested that trade rules regarding energy should be changed. Other short and longer-term progressive policy alternatives were also presented in the second part of this report. One possible short-term policy response would be to tax windfall oil and gas profits and direct the resulting revenues to rebates for low-income households and for energy conservation initiatives. It was noted that the environmental benefit of rising prices is that it encourages conservation and improved fuel efficiency. The final part of this report discussed the issue of protecting electricity from deregulation and sited lessons learned from the deregulation of natural gas. 2 tabs., 4 figs

  4. Clinical Characteristics, Health Care Utilization and Costs Among Men with Primary or Secondary Hypogonadism in a US Commercially Insured Population.

    Science.gov (United States)

    Grabner, Michael; Bodhani, Amit; Khandelwal, Nikhil; Palli, Swetha; Bonine, Nicole; Khera, Mohit

    2017-01-01

    Hypogonadism is broadly associated with increases in chronic comorbid conditions and health care costs. Little is known about the specific impact of primary and secondary hypogonadism on health care costs. To characterize the health care cost and utilization burden of primary and secondary hypogonadism in a population of US men with commercial insurance. Newly diagnosed patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with specific medical conditions known to have a high prevalence of testosterone deficiency (ie, relating to primary or secondary hypogonadism) or who had fills for testosterone replacement therapy from January 1, 2007 through April 30, 2013 were identified in administrative claims data from the HealthCore Integrated Research Database. A cohort of patients without hypogonadism was matched on demographics and comorbidities. The matched hypogonadism and non-hypogonadism cohorts (n = 5,777 in each cohort) were compared during a 12-month follow-up period. Direct health care expenditures and utilization were assessed for all causes and for hypogonadism-related claims. Costs included out-of-pocket patient expenditures and those paid by the insurer. Hypogonadism and matched non-hypogonadism cohorts were similar in demographics (mean age = 50 years) and diagnosed comorbid conditions in the 12 months preceding the index date. In the year after the index date, mean all-cause expenditures for patients with hypogonadism increased by 62% (from $5,425 to $8,813) compared with 25% for the matched controls (from $4,786 to $5,992; P groups). Approximately 16% of total mean costs ($1,377), primarily outpatient and pharmacy costs, were identifiable as related to hypogonadism. These data from a population of US men with commercial insurance coverage showed a greater resource use burden for patients with primary and secondary hypogonadism compared with similar patients without hypogonadism. Additional

  5. Recent advances in microbial production of mannitol: utilization of low-cost substrates, strain development and regulation strategies.

    Science.gov (United States)

    Zhang, Min; Gu, Lei; Cheng, Chao; Ma, Jiangfeng; Xin, Fengxue; Liu, Junli; Wu, Hao; Jiang, Min

    2018-02-26

    Mannitol has been widely used in fine chemicals, pharmaceutical industries, as well as functional foods due to its excellent characteristics, such as antioxidant protecting, regulation of osmotic pressure and non-metabolizable feature. Mannitol can be naturally produced by microorganisms. Compared with chemical manufacturing, microbial production of mannitol provides high yield and convenience in products separation; however the fermentative process has not been widely adopted yet. A major obstacle to microbial production of mannitol under industrial-scale lies in the low economical efficiency, owing to the high cost of fermentation medium, leakage of fructose, low mannitol productivity. In this review, recent advances in improving the economical efficiency of microbial production of mannitol were reviewed, including utilization of low-cost substrates, strain development for high mannitol yield and process regulation strategies for high productivity.

  6. Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study

    OpenAIRE

    Kourlaba, Georgia; Vlachopoulos, Charalambos; Parissis, John; Kanakakis, John; Gourzoulidis, George; Maniadakis, Nikos

    2015-01-01

    Background To conduct an economic evaluation comparing ranolazine as add-on therapy to standard-of-care (SoC) with SoC alone in patients with stable angina who did not respond adequately to first line therapy, in Greece. Methods A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of ranolazine during a 6-month period. The analysis was conducted from a third-party payer perspective. The clinical inputs were extracted from the published literature. The co...

  7. Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

    Science.gov (United States)

    Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

    2017-12-01

    Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2018-04-17

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

  10. Climate Adaptation and Sea Level Rise

    Science.gov (United States)

    EPA supports the development and maintenance of water utility infrastructure across the country. Included in this effort is helping the nation’s water utilities anticipate, plan for, and adapt to risks from flooding, sea level rise, and storm surge.

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

    Directory of Open Access Journals (Sweden)

    Evan S. Cole

    2016-09-01

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

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

    Science.gov (United States)

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

    1999-03-01

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

  13. Practice Innovation, Health Care Utilization and Costs in a Network of Federally Qualified Health Centers and Hospitals for Medicaid Enrollees.

    Science.gov (United States)

    Johnson, Tricia J; Jones, Art; Lulias, Cheryl; Perry, Anthony

    2018-06-01

    State Medicaid programs need cost-effective strategies to provide high-quality care that is accessible to individuals with low incomes and limited resources. Integrated delivery systems have been formed to provide care across the continuum, but creating a shared vision for improving community health can be challenging. Medical Home Network was created as a network of primary care providers and hospital systems providing care to Medicaid enrollees, guided by the principles of egalitarian governance, practice-level care coordination, real-time electronic alerts, and pay-for-performance incentives. This analysis of health care utilization and costs included 1,189,195 Medicaid enrollees. After implementation of Medical Home Network, a risk-adjusted increase of $9.07 or 4.3% per member per month was found over the 2 years of implementation compared with an increase of $17.25 or 9.3% per member per month, before accounting for the cost of care management fees and other financial incentives, for Medicaid enrollees within the same geographic area with a primary care provider outside of Medical Home Network. After accounting for care coordination fees paid to providers, the net risk-adjusted cost reduction was $11.0 million.

  14. Utilization of Paneer Whey Waste for Cost-Effective Production of Rhamnolipid Biosurfactant.

    Science.gov (United States)

    Patowary, Rupshikha; Patowary, Kaustuvmani; Kalita, Mohan Chandra; Deka, Suresh

    2016-10-01

    The present study aimed at isolating rhamnolipid biosurfactant-producing bacteria that could utilize paneer whey, an abundant waste source as sole medium for the production purpose. Pseudomonas aeruginosa strain, SR17, was isolated from hydrocarbon-contaminated soil that could efficiently utilize paneer whey for rhamnolipid production and reduce surface tension of the medium from 52 to 26.5 mN/m. The yield of biosurfactant obtained was 2.7 g/l, upgraded to 4.8 g/l when supplemented with 2 % glucose and mineral salts. Biochemical, FTIR, and LC-MS analysis revealed that extracted biosurfactant is a combination of both mono and di-rhamnolipid congeners. The critical micelle concentration (CMC) was measured to be 110 mg/l. Emulsification activity of the biosurfactant against n-hexadecane, olive oil, kerosene, diesel oil, engine oil, and crude oil were found to be 83, 88, 81, 92, 86, and 100 %, respectively. The rhamnolipid was detected to be non-toxic against mouse fibroblastic cell line L292.

  15. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

    Science.gov (United States)

    Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

    2014-10-01

    Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

  16. The Rise of the Low Cost Model in the Airline Industry : A Study of the Strategies of Southwest, RyanAir and Air Asia

    OpenAIRE

    Harsh, Saraogi

    2011-01-01

    The last decade has seen a major overhaul in the Airline Industry, with the emergence of a new breed of Airlines, the Low Cost Airlines. The trend that started from the United States, with Southwest being the pioneer, slowly and gradually replicated its way through Europe, Asia and the Rest of the World. Today, more than 1 flight in every five worldwide is now operated by a low cost carrier (LCC). The purpose of this paper is to explore the reasons for the growth of the Low Cost Carrier Mo...

  17. Upgrading security at nuclear power plants: effect on utility operations and costs

    International Nuclear Information System (INIS)

    Salvesen, R.S.

    1977-01-01

    The impact of the new security regulation on Salem Unit No. 1 is discussed. The upgrading of security requirements in 10CFR 73.55 did not alter the basic elements of a security plan established in ANSI 18.17, but rather upgraded the level of the threat to which a security plan must respond. Its basic thrust is first to require a hardening of physical barriers and/or increase the security organization response capability to better neutralize a threat from the outside. Secondly, to implement more extensive search requirements to reduce the threat from inside by preventing the entry of unauthorized material that might be used for sabotage. Thirdly, it requires a reevaluation of security organization responsibilities and preplanning for contingencies to assure effective coordination of all involved parties. The new regulations impact most significantly on two of the five elements of a basic security plan--Physical Barriers and the Security Force and to some extent on administrative controls. At this time, I cannot accurately estimate the cost increase but would guess it will be double or triple our initial costs. There will be reduced productivity to some extent in stores and material handling activities and some impediment to all employees who must pass access control points, however, its overall affect on operating a its overall affect on operating activities should not be significant

  18. A study on the clinical utilization of cranial computerized tomography: reasons and costs

    International Nuclear Information System (INIS)

    Oliveira, A.T.R. de

    1992-01-01

    It was reviewed a series of 2860 cerebral computed tomography (CCT) in order to compare the main reasons at referral to investigation with the CCT results and the costs with normal and abnormal CCT. It was also studied the age and sex of the patients. Data were collected from one out of three diagnostic centers in Salvador, Brasil, for a three years period. The 2860 CCT exclude all investigation carried out for the follow-up of a previously diagnosed abnormality. CCT abnormalities were detected in 1152 (40.3%). The following reasons showed the highest proportion of abnormal CCT, for males and females respectively: demential syndrome (91.7 and 83.3%); cerebrovascular accidents (85.1 and 73.6%); infectious and parasital diseases (76.5 and 78.6%); tumors (65.8 and 55.4%); and head injuries, 63.6% for males. In the female group, 65.0% of the CCT were normal, in a range of 65.0 to 80.0% for the age groups under 54 years old. In the male group, the highest proportion of normal CCT was found in the age groups: 25-34 (68.4%), <15 (62.9%) and 35-44 (62.7%). The most common reasons for normal CCT for males and females were: headache (81.3 and 87.5%); dizziness/vertigo (79.3 and 78.6%); seizures (67.3 and 70.0%); psycho motor deficiency (72.0 and 67.7%) and endocrine disorders, 75.0% for each sex. The highest proportion of normal CCT (65.3%) was requested by medical 'convenios'. The cost with normal CCT reached US$ 565,225 and with the abnormal ones, US$ 381,247. Cost with normal CCT were 2,2 higher for medical convenios as compared to those of the National Institute of Security requests and 2.8 more than those of private medicine. (author)

  19. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2012-04-01

    Full Text Available Tamlyn Anne Rautenberg1,2, Ute Zerwes1, Douglas Foerster3,4, Rick Aultman51Assessment in Medicine GmbH, Lörrach, Germany; 2Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; 3Abbott Products Operations AG, Allschwil, Switzerland; 4University of Bielefeld, School of Public Health, Bielefeld, Germany; 5Semalytics, Arizona, United States of AmericaBackground: The safety and efficacy of racecadotril to treat acute watery diarrhea (AWD in children is well established, however its cost effectiveness for infants and children in Europe has not yet been determined.Objective: To evaluate the cost utility of racecadotril adjuvant with oral rehydration solution (ORS compared to ORS alone for the treatment of AWD in children younger than 5 years old. The analysis is performed from a United Kingdom National Health Service (NHS perspective.Methods: A decision tree model has been developed in Microsoft® Excel. The model is populated with the best available evidence. Deterministic and probabilistic sensitivity analyses (PSA have been performed. Health effects are measured as quality-adjusted life years (QALYs and the model output is cost (2011 GBP per QALY. The uncertainty in the primary outcome is explored by probabilistic analysis using 1000 iterations of a Monte Carlo simulation.Results: Deterministic analysis results in a total incremental cost of –£379 in favor of racecadotril and a total incremental QALY gain in favor of racecadotril of +0.0008. The observed cost savings with racecadotril arise from the reduction in primary care reconsultation and secondary referral. The difference in QALYs is largely attributable to the timely resolution of symptoms in the racecadotril arm. Racecadotril remains dominant when base case parameters are varied. Monte Carlo simulation and PSA confirm that racecadotril is the dominant treatment strategy and is almost certainly cost effective, under the central assumptions of the model, at a

  20. Superphenix set to rise again

    International Nuclear Information System (INIS)

    Dorozynski, A.

    1993-01-01

    Superphenix, France's seemingly jinxed fast breeder reactor, which has not produced a single kilowatt of energy in more than 3 years, looks set to rise up next year like the mythical bird it is named after. The $5 billion reactor, the largest fast breeder in the world, has just been given the seal of approval by a public commission ordered by the government to look at the pros and cons of restarting. It still has hoops to jump through: a safety check and approval from the ministries of industries and environment. But the consortium of French, Italian, and German power utilities that run the plant are confident they can get it running by next summer. The Superphenix that rises out of the ashes will, however, be a different species of bird from the one planned 20 years ago. The consortium plans to turn the reactor into a debreeder, one that will incinerate more plutonium than it produces and so eat into Europe's plutonium stockpile. Calculations by Superphenix staff and the Atomic Energy Commission indicate that a plutonivorous fast breeder could incinerate 15 to 25 kilograms of plutonium while producing 1 billion kilowatt-hours of electricity-scarcely enough to make a dent in the tonnes of plutonium produced by Electricite de France's reactors each year. The Superphenix consortium is anxious to get the reactor back on line. The annual cost of upkeep and repair of the idle plant and salaries for its 700 staff may reach $140 million this year, 20% more than if the plant was running normally. If restarted, the existing core and a second one ready on the shelf will generate electricity worth $1.3 billion

  1. Cost-utility analysis of antiviral use under pandemic influenza using a novel approach - linking pharmacology, epidemiology and heath economics.

    Science.gov (United States)

    Wu, D B C; Chaiyakunapruk, N; Pratoomsoot, C; Lee, K K C; Chong, H Y; Nelson, R E; Smith, P F; Kirkpatrick, C M; Kamal, M A; Nieforth, K; Dall, G; Toovey, S; Kong, D C M; Kamauu, A; Rayner, C R

    2018-03-01

    Simulation models are used widely in pharmacology, epidemiology and health economics (HEs). However, there have been no attempts to incorporate models from these disciplines into a single integrated model. Accordingly, we explored this linkage to evaluate the epidemiological and economic impact of oseltamivir dose optimisation in supporting pandemic influenza planning in the USA. An HE decision analytic model was linked to a pharmacokinetic/pharmacodynamics (PK/PD) - dynamic transmission model simulating the impact of pandemic influenza with low virulence and low transmissibility and, high virulence and high transmissibility. The cost-utility analysis was from the payer and societal perspectives, comparing oseltamivir 75 and 150 mg twice daily (BID) to no treatment over a 1-year time horizon. Model parameters were derived from published studies. Outcomes were measured as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to examine the integrated model's robustness. Under both pandemic scenarios, compared to no treatment, the use of oseltamivir 75 or 150 mg BID led to a significant reduction of influenza episodes and influenza-related deaths, translating to substantial savings of QALYs. Overall drug costs were offset by the reduction of both direct and indirect costs, making these two interventions cost-saving from both perspectives. The results were sensitive to the proportion of inpatient presentation at the emergency visit and patients' quality of life. Integrating PK/PD-EPI/HE models is achievable. Whilst further refinement of this novel linkage model to more closely mimic the reality is needed, the current study has generated useful insights to support influenza pandemic planning.

  2. Optimization of temperature differences in a utilizer in relation to the lowest sum of capital and operating cost

    International Nuclear Information System (INIS)

    Kustrin, I.; Tuma, M.

    1992-01-01

    Our environment and nature are currently overburdened with the emission of noxious substances. Steam boilers fired with coal are therefore not very popular. Wherever possible, they are being replaced by devices which are less harmful for the environment because they use different fuel. This paper discusses replacing a steam boiler with a gas turbine and an utilizer. A mathematical model for performing the optimization of capital and operating costs is presented. The model optimizes the degree of preheating of the flue gases i.e. the temperature of the entering flue gases. The smallest temperature difference (pinch point) was not estimated by the pinch technology because the presented example is relatively simple and the pinch point temperature difference was chosen according to the values reported in various literature sources. The optimization is supplemented with an analysis of the thermal and exergetical efficiencies of the utilizer under different conditions (average temperature difference between the hot gases and water or steam, exit temperature of the hot gases), which condition the choice of the type of utilizer

  3. Evaluating the Cost-Benefits of Utilizing Host Nation Power for US Military Bases

    Science.gov (United States)

    2016-01-29

    treated.  In  fact, even the most unreliable host nation  grids  almost always have a higher availability then  solar   PV ,  which has at best a 30% capacity...heating value of the fuel. For diesel fuel, this is 40.737 kWh/gal.    I is the cost of adding a  connection  to the HN  power   grid  (including wires...Each base relies heavily on electrical  power  to accomplish their  mission.  In countries with poor electrical  system  reliability the  power  for these

  4. Costs associated with workdays lost and utilization of health care resources because of asthma in daily clinical practice in Spain.

    Science.gov (United States)

    Ojeda, P; Sanz de Burgoa, V

    2013-01-01

    Asthma is associated with high indirect costs due to lower work productivity and higher absenteeism and presenteeism. To study loss of productivity measured using the lost workday equivalent (LWDE) index and health care utilization in asthmatics depending on age, geographical location, time period, severity, and level of asthma control. In this cross-sectional, observational, epidemiological multicenter study, 120 allergists nationwide were asked to select asthmatic patients aged 18 to 65 years who were evenly distributed according to the 4 levels of asthma severity (Global Initiative on Asthma) during 3 different seasons. The participants collected sociodemographic data, spirometry values, Asthma Control Test (ACT) score, health care utilization data, perceived stress according to the Impact on Work Productivity Index (IMPALA, indice del Impacto de la Enfermedad en la Productividad Laboral), and score on the Sheehan disability scale. The LWDE index was used to measure the number of workdays lost and the number of workdays with asthma symptoms combined with the percentage for average performance at work. The study sample comprised 1098 patients (58.7% females; 48.5% aged 18-40 and 51.5% aged 41-65). According to the ACT score, disease was uncontrolled in 57.6% of patients, well controlled in 32.8%, and totally controlled in 9.6%. The mean cost due to workdays lost was Euro 285.81/patient/mo (95% CI, Euro 252.71-318.92). Indirect costs were significantly higher in older patients (41-65 years, Euro 405.08; 95% CI, 348.97-461.19), patients with more severe disease (Euro 698.95; 95% CI, 588.63-809.27), and patients with more poorly controlled asthma (Euro 466.86; 95% CI, Euro 414.39-519.33). The average cost of health care units per patient for each 3-month period was Euro1317.30 (95% CI, Euro 1151.34-Euro 1483.26). Indirect costs were significantly higher in older patients (Euro 2104.00 in patients aged 18-40 vs Euro 3301.55 in patients aged 41-65), in northern and

  5. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Directory of Open Access Journals (Sweden)

    Oded Vered

    Full Text Available Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU. Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470. Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410. HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391. Before diagnosis (baseline, the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05, however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001. Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001. Additional elevated costs were 3.6 times higher laboratory tests (P<0.001, 2.8 times higher emergency room visits (P<0.001, 1.8 times higher medication (P<0.001 and 1.3 times higher diagnostic procedures (P<0.001. We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  6. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Science.gov (United States)

    Vered, Oded; Simon-Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

    2015-01-01

    Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  7. About real cost calculations for biogas from vinasse biodigestion and its energy utilization

    Energy Technology Data Exchange (ETDEWEB)

    Salomon, K.R. [Universidade Federal de Alagoas (UFAL), Maceio, AL (Brazil)]. E-mail: kaka_salomon@yahoo.com.br; Lora , E.E.S.; Rocha, M.H. [Universidade Federal de Itajuba (UNIFEI), MG (Brazil). Thermal Systems Study Group]. E-mails: electo@unifei.edu.br; mateus.rocha@unifei.edu.br

    2008-07-01

    The sharp increase in ethanol production has drawn attention to the increase in the production of n residues, mainly stillage, a by-product from the ethanol agro-industry. As it is a highly polluting effluent that is generated in great volumes, its transport and disposal is not simple. Stillage Is a product that results from the distillation and fermentation of the sugarcane in the process of ethanol production. Today there are new environmental standards that restrict the disposal of the stillage in the soil. The anaerobic biodigestion comes as an alternative treatment for the stillage. One of the advantages of the biodigestion is that the stillage fertilization potential continues to be the same after the process and, this way, the effluent can be taken to the fields through fertirrigation. The main advantages are the conservation of the nutrients, mainly phosphor and nitrogen contents, and the increase in the pH for the application in the soil. This paper presents a methodology for the calculation of the biogas cost obtained from stillage biodigestion, considering the benefits of the fertirrigation with the effluent generated in the digester. Later an analysis of the economical feasibility of the use of the biogas obtained from the stillage anaerobic digestion in different scenarios is carried out, among them there are: electric power generation with alternative internal combustion, with gas turbines and micro-turbines, with the 'substituted' bagasse burned together with the biogas in the boilers, with the sales of the substituted bagasse (for electric power generation in another unit) and with the use of the biogas in spray dryers with the subsequent sales of dried yeasts. It is also considered an analysis under an environmental point of view of the use of the biogas that includes the possibility of selling the certificates of avoided emissions (carbon credits) due to the use of the biogas in substitution to fossil fuels. The most important results

  8. Pulp and paper markets peaking amid slow economy, rising input costs, and erosion of profits : markets for paper, paperboard and woodpulp, 2007-2008

    Science.gov (United States)

    Peter J. Ince; Eduard L. Akim; Bernard Lombard; Tomas Parik

    2008-01-01

    In mid-2008, pulp and paper prices were at or near historic peak levels, but global demand conditions were weakening. Industry profits were eroded in 2007 and 2008 as sharply higher energy costs led to higher prices for fuel, freight, pulpwood, recovered paper, chemicals, and other inputs. Expanding pulp and paper capacity in China is having a huge impact on paper and...

  9. COST Action TU1208 - Working Group 2 - GPR surveying of pavements, bridges, tunnels and buildings; underground utility and void sensing

    Science.gov (United States)

    Pajewski, Lara; Benedetto, Andrea; Derobert, Xavier; Fontul, Simona; Govedarica, Miro; Gregoire, Colette; Loizos, Andreas; Perez-Gracia, Vega; Plati, Christina; Ristic, Aleksandar; Tosti, Fabio; Van Geem, Carl

    2017-04-01

    This work aims at presenting the main results achieved by Working Group (WG) 2 "GPR surveying of pavements, bridges, tunnels and buildings; underground utility and void sensing" of the COST (European COoperation in Science and Technology) Action TU1208 "Civil Engineering Applications of Ground Penetrating Radar" (www.GPRadar.eu, www.cost.eu). The principal goal of the Action, started in April 2013 and ending in October 2017, is to exchange and increase scientific-technical knowledge and experience of Ground Penetrating Radar (GPR) techniques in civil engineering, whilst promoting throughout Europe the effective use of this safe non-destructive technique. The Action involves more than 300 Members from 28 COST Countries, a Cooperating State, 6 Near Neighbour Countries and 6 International Partner Countries. The most interesting achievements of WG2 include: 1. The state of the art on the use of GPR in civil engineering was composed and open issues were identified. The few existing international/national guidelines/protocols for GPR inspection in civil engineering were reviewed and discussed. Academic end-users, private companies and stakeholders presented their point of view and needs. 2. Guidelines for investigating flexible pavement by using GPR were prepared, with particular regard to layer-thickness assessment, moisture-content sensing, pavement-damage detection and classification, and other main GPR-based investigations in pavement engineering. 3. Guidelines for GPR sensing and mapping of underground utilities and voids were prepared, with a main focus on urban areas. 4. Guidelines for GPR assessment of concrete structures, with particular regard to inspections in bridges and tunnels, were prepared. 5. A report was composed, including a series of practical suggestions and very useful information to guide GPR users during building inspection. 6. WG2 Members carried out a plethora of case studies where GPR was used to survey roads, highways, airport runways, car

  10. Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial

    NARCIS (Netherlands)

    Polinder, Suzanne; Boyé, Nicole D. A.; Mattace-Raso, Francesco U. S.; van der Velde, Nathalie; Hartholt, Klaas A.; de Vries, Oscar J.; Lips, Paul; van der Cammen, Tischa J. M.; Patka, Peter; van Beeck, Ed F.; van Lieshout, Esther M. M.; van der Cammen, T. J. M.; Patka, P.; van Beeck, E. F.; van Lieshout, E. M. M.; Polinder, S.; Mattace-Raso, F. U. S.; Hartholt, K. A.; Boyé, N. D. A.; Looman, C. W. N.; Lips, P.; de Vries, O. J.; Kerver, A. J. H.; Bruijninckx, M. M. M.; de Vries, M. R.; Ziere, G.

    2016-01-01

    The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older

  11. Cost-utility of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial

    NARCIS (Netherlands)

    S. Polinder (Suzanne); N.D.A. Boyé (Nicole); F.U.S. Mattace Raso (Francesco); N. van der Velde (Nathalie); K.A. Hartholt (Klaas); O.J. de Vries (Oscar); P. Lips (Paul); T.J.M. van der Cammen (Tischa); P. Patka (Peter); E.F. van Beeck (Ed); E.M.M. van Lieshout (Esther)

    2016-01-01

    textabstractBackground: The use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus 'care as usual' on health-related quality of life (HRQoL), costs, and cost-utility in

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

    NARCIS (Netherlands)

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

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

  13. Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007

    Science.gov (United States)

    Smith, Monica; Davis, Matthew A.; Stano, Miron; Whedon, James M.

    2013-01-01

    Objectives The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services. Methods Using the MEPS 2-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71 838), we identified 12 104 respondents with back pain and further categorized 3842 as chronic cases and 8262 as nonchronic cases. Results Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007. Conclusion The prevalence of back pain, especially chronic back pain, is increasing. To the extent that the growth in chronic back pain is caused, in part, by an aging population, the growth will likely continue or accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for prioritizing health policy, clinical practice, and research efforts to improve care outcomes, costs, and cost-effectiveness and for health workforce planning. PMID:23380209

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

    Directory of Open Access Journals (Sweden)

    de Kort Nelleke

    2011-08-01

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

  15. Environmental effects of energy production and utilization in the U.S. Volume I. Sources, trends, and costs of control

    International Nuclear Information System (INIS)

    Newkirk, H.W.

    1976-01-01

    Volume I deals with sources (what the emissions are and where they come from), trends (quantities of emissions and their dispersion with time), and costs of control (what it takes in time, energy, and money to meet minimum standards). Volume II concerns itself with the public health effects of energy production and utilization. Volume III summarizes the various techniques for controlling emissions, technological as well as economic, social, and political. Each volume is divided into sections dealing with the atmosphere, water, land, and social activities--each division indicating a particular sphere of man's environment affected by energy production and use. The sources of information that were used in this study included textbooks, journal articles, technical reports, memoranda, letters, and personal communications. These are cited in the text at the end of each subsection and on the applicable tables and figures

  16. Environmental effects of energy production and utilization in the U. S. Volume I. Sources, trends, and costs of control

    Energy Technology Data Exchange (ETDEWEB)

    Newkirk, H.W. (comp.)

    1976-05-01

    Volume I deals with sources (what the emissions are and where they come from), trends (quantities of emissions and their dispersion with time), and costs of control (what it takes in time, energy, and money to meet minimum standards). Volume II concerns itself with the public health effects of energy production and utilization. Volume III summarizes the various techniques for controlling emissions, technological as well as economic, social, and political. (For abstracts of Vols. II and III, see ERDA Energy Research Abstracts, Vol. 2, Absts. 5764 and 5670, respectively) Each volume is divided into sections dealing with the atmosphere, water, land, and social activities--each division indicating a particular sphere of man's environment affected by energy production and use. The sources of information that were used in this study included textbooks, journal articles, technical reports, memoranda, letters, and personal communications. These are cited in the text at the end of each subsection and on the applicable tables and figures.

  17. Impact of minimally invasive surgery on healthcare utilization, cost, and workplace absenteeism in patients with Incisional/Ventral Hernia (IVH).

    Science.gov (United States)

    Mikami, Dean J; Melvin, W Scott; Murayama, Michael J; Murayama, Kenric M

    2017-11-01

    Incisional hernia repair is one of the most common general surgery operations being performed today. With the advancement of laparoscopy since the 1990s, we have seen vast improvements in faster return to normal activity, shorter hospital stays and less post-operative narcotic use, to name a few. The key aims of this review were to measure the impact of minimally invasive surgery versus open surgery on health care utilization, cost, and work place absenteeism in the patients undergoing inpatient incisional/ventral hernia (IVH) repair. We analyzed data from the Truven Health Analytics MarketScan ® Commercial Claims and Encounters Database. Total of 2557 patients were included in the analysis. Of the patient that underwent IVH surgery, 24.5% (n = 626) were done utilizing minimally invasive surgical (MIS) techniques and 75.5% (n = 1931) were done open. Ninety-day post-surgery outcomes were significantly lower in the MIS group compared to the open group for total payment ($19,288.97 vs. $21,708.12), inpatient length of stay (3.12 vs. 4.24 days), number of outpatient visit (5.48 vs. 7.35), and estimated days off (11.3 vs. 14.64), respectively. At 365 days post-surgery, the total payment ($27,497.96 vs. $30,157.29), inpatient length of stay (3.70 vs. 5.04 days), outpatient visits (19.75 vs. 23.42), and estimated days off (35.71 vs. 41.58) were significantly lower for MIS group versus the open group, respectively. When surgical repair of IVH is performed, there is a clear advantage in the MIS approach versus the open approach in regard to cost, length of stay, number of outpatient visits, and estimated days off.

  18. Utility-Scale Solar 2016: An Empirical Analysis of Project Cost, Performance, and Pricing Trends in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Bolinger, Mark; Seel, Joachim; LaCommare, Kristina Hamachi

    2017-09-19

    The utility-scale solar sector has led the overall U.S. solar market in terms of installed capacity since 2012. In 2016, the utility-scale sector installed more than 2.5 times as much new capacity as did the residential and commercial sectors combined, and is expected to maintain its dominant position for at least another five years. This report—the fifth edition in an ongoing annual series—provides data-driven analysis of the utility-scale solar project fleet in the United States. We analyze not just installed project prices, but also operating costs, capacity factors, and power purchase agreement ("PPA") prices from a large sample of utility-scale PV and CSP projects throughout the United States. Highlights from this year's edition include the following: Installation Trends: The use of solar tracking devices dominated 2016 installations, at nearly 80% of all new capacity. In a reflection of the ongoing geographic expansion of the market beyond California and the Southwest, the median long-term average insolation level at newly built project sites declined again in 2016. While new fixed-tilt projects are now seen predominantly in less-sunny regions, tracking projects are increasingly pushing into these same regions. The median inverter loading ratio has stabilized in 2016 at 1.3 for both tracking and fixed-tilt projects. Installed Prices: Median installed PV project prices within a sizable sample have fallen by two-thirds since the 2007-2009 period, to $2.2/WAC (or $1.7/WDC) for projects completed in 2016. The lowest 20th percentile of projects within our 2016 sample were priced at or below $2.0/WAC, with the lowest-priced projects around $1.5/WAC. Overall price dispersion across the entire sample and across geographic regions decreased significantly in 2016. Operation and Maintenance (“O&M”) Costs: What limited empirical O&M cost data are publicly available suggest that PV O&M costs were in the neighborhood of $18/kWAC-year, or $8/MWh, in 2016. These

  19. How energy can be more rationally used. Technical possibilities and facts of business management. Under the pressure of rising energy costs

    Energy Technology Data Exchange (ETDEWEB)

    Klein, H; Ziegler, A [Bundesministerium fuer Forschung und Technologie, Bonn (Germany, F.R.)

    1976-03-01

    The article deals with the technical possibilities and economical operating facts of rational energy consumption. Beginning with a short discussion of the available energy reserves it is shown that a rational way of dealing with energy can already be pre-programmed in the choice of the energy form for each particular consumption purpose. Economic growth, indeed, promotes the rational use of energy. The following main points are individually discussed: related subjects in economic pre-planning operation, energy economy in the heating of houses, questions of environmental protection. The article ends with a look at future aspects of rational energy utilization.

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

    Science.gov (United States)

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

    2016-03-01

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

  1. Cost-utility analysis of ledipasvir/sofosbuvir for the treatment of genotype 1 chronic hepatitis C in Japan.

    Science.gov (United States)

    Igarashi, Ataru; Tang, Wentao; Guerra, Ines; Marié, Lucile; Cure, Sandrine; Lopresti, Michael

    2017-01-01

    Hepatitis C is the result of a ribonucleic acid (RNA) virus (hepatitis C virus; HCV). The Japan Society of Hepatology (JSH) estimated that 1.5-2 million people in Japan carry HCV. Six major HCV genotypes (GT) and a large number of subtypes have been described in the literature. In Japan, around 70% to 80% of people are infected with HCV genotype 1b. The progress of the disease primarily affects the liver and may lead to liver cirrhosis, hepatocellular carcinoma (HCC) and death. Sofosbuvir (SOF) is a nucleotide analogue NS5B inhibitor and ledipasvir (LDV) is an inhibitor of the HCV NS5A protein. They are combined in a single tablet regimen for the treatment of GT1 patients and resulted in sustained virological response (SVR) above 94% in large phase III trials. This analysis assesses the cost-utility of LDV/SOF in GT1 patients in Japan. A cohort of 10,000 patients was followed through a Markov model until they reached 100 years of age. GT1 treatment-naïve and experienced, non-cirrhotic and cirrhotic patients were studied separately. LDV/SOF was compared to several treatment regimens containing pegylated interferon (PEGIFN), telaprevir (TVR), simeprevir (SMV), daclatasvir (DCV), asunaprevir (ASV) and ribavirin (RBV). Discount rates of 2% were applied to costs and outcomes according to the Japanese guidelines. LDV/SOF was cost-effective against most comparators with incremental cost-effectiveness ratios (ICERs) below JPY 5,000,000. By applying a societal perspective, LDV/SOF was the dominant treatment strategy in all cases. Moreover, LDV/SOF reduced the number of cases of advanced liver disease. These results were robust to sensitivity analyses. LDV/SOF was cost-effective compared to most of the currently recommended treatments. Furthermore, LDV/SOF extends treatments to HCV-infected patients who are ineligible for interferon and RBV-based regimens. LDV/SOF thus has the potential to help reduce the burden of HCV in Japan.

  2. Utilization of Supercapacitors in Adaptive Protection Applications for Resiliency against Communication Failures: A Size and Cost Optimization Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Habib, Hany F [Florida Intl Univ., Miami, FL (United States); El Hariri, Mohamad [Florida Intl Univ., Miami, FL (United States); Elsayed, Ahmed [Florida Intl Univ., Miami, FL (United States); Mohammed, Osama [Florida Intl Univ., Miami, FL (United States)

    2017-03-30

    Microgrids’ adaptive protection techniques rely on communication signals from the point of common coupling to ad- just the corresponding relays’ settings for either grid-connected or islanded modes of operation. However, during communication out- ages or in the event of a cyberattack, relays settings are not changed. Thus adaptive protection schemes are rendered unsuc- cessful. Due to their fast response, supercapacitors, which are pre- sent in the microgrid to feed pulse loads, could also be utilized to enhance the resiliency of adaptive protection schemes to communi- cation outages. Proper sizing of the supercapacitors is therefore im- portant in order to maintain a stable system operation and also reg- ulate the protection scheme’s cost. This paper presents a two-level optimization scheme for minimizing the supercapacitor size along with optimizing its controllers’ parameters. The latter will lead to a reduction of the supercapacitor fault current contribution and an increase in that of other AC resources in the microgrid in the ex- treme case of having a fault occurring simultaneously with a pulse load. It was also shown that the size of the supercapacitor can be reduced if the pulse load is temporary disconnected during the transient fault period. Simulations showed that the resulting super- capacitor size and the optimized controller parameters from the proposed two-level optimization scheme were feeding enough fault currents for different types of faults and minimizing the cost of the protection scheme.

  3. Cost-effectiveness performance analysis of organic Rankine cycle for low grade heat utilization coupling with operation condition

    International Nuclear Information System (INIS)

    Wang, Dongxiang; Ling, Xiang; Peng, Hao

    2013-01-01

    This paper analyzed the influence of working fluids selection and operation conditions on the cost-effectiveness performance and net power output of an ORC for low grade heat utilization. A net power output model has been proposed theoretically and compared with the theoretical data calculated from thermodynamic analysis, exhibiting excellent agreements with the theoretical data. The proposed net power output model theoretically indicates that Jacob number and the ratio of evaporating temperature and heat rejected temperature play essential roles in discriminating the net power output among various working fluids at the same operation condition. For a given condensing and evaporating temperature, it can be concluded theoretically that fluid with low Jacob number will show attractive performance in an ORC. The maximum net power output is determined by the heat source rather than working fluids with a low inlet temperature of heat source. Cost-effectiveness performance analysis reveals that the maximum net power output and the best CEP cannot be achieved at the same time and compromise must be made when choosing the most suitable organic working fluids in different ORC designs. -- Highlights: • A net power output model is proposed and compared with theoretical data. • For fixed operation condition, low Ja fluid shows attractive performance in ORC. • The heat source rather than working fluid determines ORC performance at low T hs,in • The peak W net and best CEP cannot be achieved at the same time, compromise must be made

  4. Least cost, utility scale abatement from Australia's NEM (National Electricity Market). Part 2: Scenarios and policy implications

    International Nuclear Information System (INIS)

    Brear, M.J.; Jeppesen, M.; Chattopadhyay, D.; Manzie, C.; Alpcan, T.; Dargaville, R.

    2016-01-01

    This paper is the second of a two part study that considers least cost, greenhouse gas abatement pathways for an electricity system. Part 1 of this study formulated a model for determining these abatement pathways, and applied this model to Australia's NEM (National Electricity Market) for a single reference scenario. Part 2 of this study applies this model to different scenarios and considers the policy implications. These include cases where nuclear power generation and CCS (carbon capture and storage) are implemented in Australia, which is presently not the case, as well as a more detailed examination of how an extended, RPS (renewable portfolio standard) might perform. The effect of future fuel costs and different discount rates are also examined. Several results from this study are thought to be significant. Most importantly, this study suggests that Australia already has utility scale technologies, renewable and non-renewable resources, an electricity market design and an abatement policy that permit continued progress towards deep greenhouse gas abatement in its electricity sector. In particular, a RPS (renewable portfolio standard) appears to be close to optimal as a greenhouse gas abatement policy for Australia's electricity sector for at least the next 10–15 years. - Highlights: • Considers scenarios and policy implications for Australia's NEM (National Electricity Market). • An extended form of RPS (renewable portfolio standard) appears near optimal until roughly 2030. • For up to 80% abatement, the inclusion of nuclear achieves only marginal benefit by 2050. • CCS (Carbon capture and storage) does not appear competitive with current cost estimates.

  5. Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis.

    Science.gov (United States)

    Leung, William; Kvizhinadze, Giorgi; Nair, Nisha; Blakely, Tony

    2016-08-01

    The anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab's high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone receptor (PR) status, which has previously been unexplored, to assist prioritisation. A cost-utility analysis was performed using a Markov macro-simulation model, with a lifetime horizon, comparing a 12-mo regimen of trastuzumab with chemotherapy alone using the latest (2014) effectiveness measures from landmark randomised trials. A New Zealand (NZ) health system perspective was adopted, employing high-quality national administrative data. Incremental quality-adjusted life-years for trastuzumab versus chemotherapy alone are two times higher (2.33 times for the age group 50-54 y; 95% CI 2.29-2.37) for the worst prognosis (ER-/PR-) subtype compared to the best prognosis (ER+/PR+) subtype, causing incremental cost-effectiveness ratios (ICERs) for the former to be less than half those of the latter for the age groups from 25-29 to 90-94 y (0.44 times for the age group 50-54 y; 95% CI 0.43-0.45). If we were to strictly apply an arbitrary cost-effectiveness threshold equal to the NZ gross domestic product per capita (2011 purchasing power parity [PPP]-adjusted: US$30,300; €23,700; £21,200), our study suggests that trastuzumab (2011 PPP-adjusted US$45,400/€35,900/£21,900 for 1 y at formulary prices) may not be cost-effective for ER+ (which are 61% of all) node-positive HER2+ early breast cancer patients but cost-effective for ER-/PR- subtypes (37% of all cases) to age 69 y. Market entry of trastuzumab biosimilars will likely reduce the ICER to below this threshold for premenopausal ER+/PR- cancer but not for ER+/PR+ cancer. Sensitivity analysis using the best-case effectiveness measure for ER+ cancer had the same result. A key limitation was a lack of treatment

  6. Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis.

    Directory of Open Access Journals (Sweden)

    William Leung

    2016-08-01

    Full Text Available The anti-human epidermal growth factor receptor 2 (HER2 monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab's high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER and progesterone receptor (PR status, which has previously been unexplored, to assist prioritisation.A cost-utility analysis was performed using a Markov macro-simulation model, with a lifetime horizon, comparing a 12-mo regimen of trastuzumab with chemotherapy alone using the latest (2014 effectiveness measures from landmark randomised trials. A New Zealand (NZ health system perspective was adopted, employing high-quality national administrative data. Incremental quality-adjusted life-years for trastuzumab versus chemotherapy alone are two times higher (2.33 times for the age group 50-54 y; 95% CI 2.29-2.37 for the worst prognosis (ER-/PR- subtype compared to the best prognosis (ER+/PR+ subtype, causing incremental cost-effectiveness ratios (ICERs for the former to be less than half those of the latter for the age groups from 25-29 to 90-94 y (0.44 times for the age group 50-54 y; 95% CI 0.43-0.45. If we were to strictly apply an arbitrary cost-effectiveness threshold equal to the NZ gross domestic product per capita (2011 purchasing power parity [PPP]-adjusted: US$30,300; €23,700; £21,200, our study suggests that trastuzumab (2011 PPP-adjusted US$45,400/€35,900/£21,900 for 1 y at formulary prices may not be cost-effective for ER+ (which are 61% of all node-positive HER2+ early breast cancer patients but cost-effective for ER-/PR- subtypes (37% of all cases to age 69 y. Market entry of trastuzumab biosimilars will likely reduce the ICER to below this threshold for premenopausal ER+/PR- cancer but not for ER+/PR+ cancer. Sensitivity analysis using the best-case effectiveness measure for ER+ cancer had the same result. A key limitation was a lack of

  7. Are decisions using cost-utility analyses robust to choice of SF-36/SF-12 preference-based algorithm?

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    Walton Surrey M

    2005-03-01

    Full Text Available Abstract Background Cost utility analysis (CUA using SF-36/SF-12 data has been facilitated by the development of several preference-based algorithms. The purpose of this study was to illustrate how decision-making could be affected by the choice of preference-based algorithms for the SF-36 and SF-12, and provide some guidance on selecting an appropriate algorithm. Methods Two sets of data were used: (1 a clinical trial of adult asthma patients; and (2 a longitudinal study of post-stroke patients. Incremental costs were assumed to be $2000 per year over standard treatment, and QALY gains realized over a 1-year period. Ten published algorithms were identified, denoted by first author: Brazier (SF-36, Brazier (SF-12, Shmueli, Fryback, Lundberg, Nichol, Franks (3 algorithms, and Lawrence. Incremental cost-utility ratios (ICURs for each algorithm, stated in dollars per quality-adjusted life year ($/QALY, were ranked and compared between datasets. Results In the asthma patients, estimated ICURs ranged from Lawrence's SF-12 algorithm at $30,769/QALY (95% CI: 26,316 to 36,697 to Brazier's SF-36 algorithm at $63,492/QALY (95% CI: 48,780 to 83,333. ICURs for the stroke cohort varied slightly more dramatically. The MEPS-based algorithm by Franks et al. provided the lowest ICUR at $27,972/QALY (95% CI: 20,942 to 41,667. The Fryback and Shmueli algorithms provided ICURs that were greater than $50,000/QALY and did not have confidence intervals that overlapped with most of the other algorithms. The ICUR-based ranking of algorithms was strongly correlated between the asthma and stroke datasets (r = 0.60. Conclusion SF-36/SF-12 preference-based algorithms produced a wide range of ICURs that could potentially lead to different reimbursement decisions. Brazier's SF-36 and SF-12 algorithms have a strong methodological and theoretical basis and tended to generate relatively higher ICUR estimates, considerations that support a preference for these algorithms over the

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

    Science.gov (United States)

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

    2017-11-01

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

  9. [Sexual hormone and traditional Chinese patent medicine for early postmenopausal women: effect on quality of life and cost-utility analysis].

    Science.gov (United States)

    Zhou, Ling-Ling; Xu, Liang-Zhi; Liu, Hong-Wei; Zhang, Jing; Liu, Ying; Liu, Xiao-Fang; Tang, Liu-Lin; Zhuang, Jing; Liu, Xiao-Xian; Qiao, Lin

    2009-11-01

    To evaluate the effect of Premarin and Kuntai capsule (a traditional Chinese patent medicine) on the quality of life (QOL) and their cost-utility in early postmenopausal women. Fifty-seven women with menopausal syndrome in the early postmenopausal stage were randomly allocated into Premarin group (0.3 mg/day and 0.6 mg/day alternately, n=29) and Kuntai group (4 g/day, n=28). The therapies lasted for one year and the patients were followed up every 3 months. The QOL of the patients was evaluated and the utility scores were obtained from rating scale to conduct a cost-utility analysis (CUA). At each follow-up examination, no significant difference was found in the QOL between the two groups (P>0.05). The QOL obviously increased after the 1-year-long therapy in both the groups, and Kuntai required longer treatment time than Premarin to take effect. The cost-utility ratio of Premarin and Kuntai were 13581.45 yuan/QALY (quality adjusted life year) and 25105.12 yuan/QALY, respectively. Both incremental cost analysis and sensitivity analysis showed that Kuntai was more costly than Premarin. The result of per-protocol analysis was consistent with that of intention-to-treat analysis. At early stage of menopause, the QOL of women with menopausal syndrome can be significantly improved by low-dose Premarin and Kuntai capsule, but the latter is more costly.

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

    Science.gov (United States)

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

    2015-06-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  12. Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography

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    Vlahiotis A

    2018-03-01

    Full Text Available Anna Vlahiotis,1 Brian Griffin,2 A Thomas Stavros,3 Jay Margolis1 1Value Based Care, Outcomes Research, Truven Health Analytics, an IBM Company, Bethesda, MD USA; 2Value Based Care, Outcomes Research, Truven Health Analytics, an IBM Company, Newark, NJ, USA; 3Seno Medical Instruments, Inc., San Antonio, TX, USA Background: Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam.Objectives: To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures.Materials and methods: Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event, with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes.Results: The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients, 6,987,399 breast ultrasounds (42.4% of patients, and 1,585,856 biopsies (10.3% of patients. Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD costs for diagnostic mammograms of US$349 ($493, ultrasounds US$132 ($134, and biopsies US$1,938 ($2,343 contributed

  13. Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil.

    Science.gov (United States)

    Campolina, Alessandro G; Rozman, Luciana M; Decimoni, Tassia C; Leandro, Roseli; Novaes, Hillegonda M D; De Soárez, Patrícia Coelho

    2017-04-01

    Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis. Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs. Many published Brazilian cost-utility studies

  14. Cost - utility analysis of parenteral antibiotics prescribed in medical wards in a tertiary care health facility in southern province of Sri Lanka

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    Lukshmy Menik Hettihewa

    2012-10-01

    Full Text Available Introduction: Parenteral antibiotic (PA prescription pattern in a hospital will directly influence the annual budget allocation, development of bacterial resistance and occurrence of unnecessary adverse drug reactions if it is done with poor adherence to the standard guidelines of prescription. As specialist in the field we understand the need of conducting economic studies in relation to the cost and utility of PA prescription pattern. It will be helpful to predict the drug procurement plan for the next year and also to prevent unnecessary complications mentioned above. Objective: Our main objective was to analyze the cost/utility relationship of PA drugs which were used in medical wards in this hospital according to the top ten of the cost (TTTC and the top ten of the consumption (TTCS. Materials and method : Aggregate data from the pharmacy record books were collected for year 2010 from indoor pharmacy. Unit prize was obtained from medical supplies division. Total quantity consumed by each medical ward was considered for analysis of the cost /utility relationship. Two top ten lists were prepared according to the cost and the consumption respectively for medical wards and the correlation was analyzed using non parametric testing with spearman test. Results: Regarding PA drugs used in this hospital, 7/10 PA drugs in TTTC are not included in the TTCS. Out of the total cost for TTTC, 82.6% of the cost had been spent for the PA drugs which are not in the TTCS and 17.5% of the cost of TTTC was used to purchase only three drugs from the TTCS. But these three drugs had contributed only 28% of top ten consumption. 72% of the PA drugs in TTCS were not costly drugs and highly consumed in medical wards. Correlation was significantly positive between cost and utility of PA drugs. ( r=-0.91,p<0.001 Conclusion: Majority of the consumed PA drugs are non-costly and it indicates the prescriptions had been done according to the rational guidelines including

  15. Cost utility analysis of reduced intensity hematopoietic stem cell transplantation in adolescence and young adult with severe thalassemia compared to hypertransfusion and iron chelation program.

    Science.gov (United States)

    Sruamsiri, Rosarin; Chaiyakunapruk, Nathorn; Pakakasama, Samart; Sirireung, Somtawin; Sripaiboonkij, Nintita; Bunworasate, Udomsak; Hongeng, Suradej

    2013-02-05

    Hematopoieticic stem cell transplantation is the only therapeutic option that can cure thalassemia disease. Reduced intensity hematopoietic stem cell transplantation (RI-HSCT) has demonstrated a high cure rate with minimal complications compared to other options. Because RI-HSCT is very costly, economic justification for its value is needed. This study aimed to estimate the cost-utility of RI-HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for adolescent and young adult with severe thalassemia in Thailand. A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes using a societal perspective. All future costs and outcomes were discounted at a rate of 3% per annum. The efficacy of RI-HSCT was based a clinical trial including a total of 18 thalassemia patients. Utility values were derived directly from all patients using EQ-5D and SF-6D. Primary outcomes of interest were lifetime costs, quality adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in US ($) per QALY gained. One-way and probabilistic sensitivity analyses (PSA) were conducted to investigate the effect of parameter uncertainty. In base case analysis, the RI-HSCT group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was US $3,236 per QALY. The acceptability curve showed that the probability of RI-HSCT being cost-effective was 71% at the willingness to pay of 1 time of Thai Gross domestic product per capita (GDP per capita), approximately US $4,210 per QALY gained. The most sensitive parameter was utility of severe thalassemia patients without cardiac complication patients. At a societal willingness to pay of 1 GDP per capita, RI-HSCT was a cost-effective treatment for adolescent and young adult with severe thalassemia in Thailand compared to BT-ICT.

  16. Cost utility analysis of reduced intensity hematopoietic stem cell transplantation in adolescence and young adult with severe thalassemia compared to hypertransfusion and iron chelation program

    Directory of Open Access Journals (Sweden)

    Sruamsiri Rosarin

    2013-02-01

    Full Text Available Abstract Background Hematopoieticic stem cell transplantation is the only therapeutic option that can cure thalassemia disease. Reduced intensity hematopoietic stem cell transplantation (RI-HSCT has demonstrated a high cure rate with minimal complications compared to other options. Because RI-HSCT is very costly, economic justification for its value is needed. This study aimed to estimate the cost-utility of RI-HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT for adolescent and young adult with severe thalassemia in Thailand. Methods A Markov model was used to estimate the relevant costs and health outcomes over the patients’ lifetimes using a societal perspective. All future costs and outcomes were discounted at a rate of 3% per annum. The efficacy of RI-HSCT was based a clinical trial including a total of 18 thalassemia patients. Utility values were derived directly from all patients using EQ-5D and SF-6D. Primary outcomes of interest were lifetime costs, quality adjusted life-years (QALYs gained, and the incremental cost-effectiveness ratio (ICER in US ($ per QALY gained. One-way and probabilistic sensitivity analyses (PSA were conducted to investigate the effect of parameter uncertainty. Results In base case analysis, the RI-HSCT group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was US $ 3,236 per QALY. The acceptability curve showed that the probability of RI-HSCT being cost-effective was 71% at the willingness to pay of 1 time of Thai Gross domestic product per capita (GDP per capita, approximately US $ 4,210 per QALY gained. The most sensitive parameter was utility of severe thalassemia patients without cardiac complication patients. Conclusion At a societal willingness to pay of 1 GDP per capita, RI-HSCT was a cost-effective treatment for adolescent and young adult with severe thalassemia in Thailand compared to BT-ICT.

  17. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention.

    Science.gov (United States)

    Klatt, Maryanna D; Sieck, Cynthia; Gascon, Gregg; Malarkey, William; Huerta, Timothy

    2016-08-01

    To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group. We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n=84) and the diet/exercise intervention (n=86) to a retrospectively matched control group (n=258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study. Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention. Significantly fewer primary care visits (porganization health cost savings that such programs can generate. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010.

    Science.gov (United States)

    Jeffery, Diana D; Bulathsinhala, Lakmini; Kroc, Michelle; Dorris, Joseph

    2014-09-01

    We compared prevalence, health care utilization, and costs over time for nonelderly adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) in relation to timing of federal approvals for FMS drugs. We used military health care claims from October 2006 to September 2010. Retrospective, multiple-year comparisons were conducted using trend analyses, and time series regression-based generalized linear models. Over 5 years, FMS prevalence rates increased from 0.307% to 0.522%, whereas IBS and CFS prevalence rates remained stable. The largest increase in FMS prevalence occurred between 2007 and 2008. Health care utilization was higher for FMS cases compared to IBS and CFS cases. Over 5 years, the total cost for FMS-related care increased $163.2 million, whereas IBS costs increased $14.9 million and CFS cost increased $3.7 million. Between 2006 and 2010, total pharmacy cost for FMS cases increased from $55 million ($3,641/person) to $96.3 million ($3,557/person). Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  19. Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

    Science.gov (United States)

    Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

    2011-08-01

    To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chunxiang Zhang

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

  2. Cost-Utility Analysis of Heberprot-P as an Add-on Therapy to Good Wound Care for Patients in Slovakia with Advanced Diabetic Foot Ulcer

    Directory of Open Access Journals (Sweden)

    Tomas Tesar

    2017-12-01

    Full Text Available Objectives: To explore whether Heberprot-P (an epidermal growth factor is a cost-effective option for the treatment of advanced diabetic foot ulcer as an add-on therapy to good wound care (GWC in Slovakia from the perspective of health care payers.Methods: A Markov model was constructed to compare the costs and effects of Heberprot-P plus GWC to those of GWC alone from the perspective of health care payers. The 52-week clinical trial period was extended to 5- and 10-year time horizons. Transition probabilities were calculated based on a previous clinical trial of Heberprot, utility values were derived from the scientific literature, and cost vectors were collected from the General Health Insurance Fund database in Slovakia. A one-way deterministic sensitivity analysis was employed to explore the influence of uncertainty for each input parameter on the incremental cost-effectiveness ratio (ICER.Results: Based on the ICER threshold of €30,030 per quality-adjusted life year (QALY recommended by the Slovak Ministry of Health, Heberprot-P therapy plus GWC is not a cost-effective alternative to GWC alone over a 10-year time horizon. The ICER increases if a longer time horizon is applied, as the incremental costs are similar, but the aggregated utility gain from avoided amputation is lower. Based on the sensitivity analysis, the utility multiplier for the health state “no ulcer after small amputation” had the most impact on the ICER; however, the model was robust to changes in all input parameters.Conclusions: Heberprot-P, as an add-on therapy to GWC in the treatment of advanced diabetic foot ulcer, is not a cost-effective alternative to GWC alone. However, if the unit cost of Heberprot-P we