Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction.

Directory of Open Access Journals (Sweden)

Shannon M Fast

Full Text Available Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence.The spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response.The model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy.

An Insight Into the Two Costing Technique: Absorption Costing and Marginal Costing

OpenAIRE

Mariam Nawaz

2013-01-01

This paper will investigate the controversy that is innate between the two costing techniques; Absorption Costing and Marginal Costing and would throw light on which costing technique better serves its purpose in helping management for decision making process and if Marginal Costing technique is concluded as better technique then why it should not be used for external reporting purpose. This paper will only crystallize and highlight the issues descriptively and will not resolve the issues tha...

Application of benefit/cost analysis to insect pest control using the sterile insect technique

International Nuclear Information System (INIS)

Mumford, J.D.

2005-01-01

Before embarking on area-wide integrated pest management (AW-IPM) programmes involving eradication, exclusion, or suppression of insect pests using the sterile insect technique (SIT), and/or other area-wide control measures, not only their technical but also their economic feasibility needs to be assessed. They may require significant initial capital investments to achieve long-term returns in subsequent periods, and may raise questions about the distribution of benefits or the justification of public or private pest control efforts. A consistent and transparent system is needed to analyse the benefits and costs of such programmes and to demonstrate their value, or in some cases to assess appropriate contributions to the costs by the various stakeholders who gain the benefits. Benefit/cost analysis (BCA) provides such a framework, and has been applied to many AW-IPM programmes that integrate the SIT, in which it has been used to demonstrate the expected value of area-wide eradication, exclusion or suppression. This chapter outlines the process of BCA in which itemized future costs and benefits are compared in terms of present values. It also provides a review and examples of the application of BCA to the SIT. A checklist of BCA inputs, and some examples of benefit/cost outputs, are also presented. (author)

Cost-Effectiveness Analysis of Breast Cancer Control Interventions in Peru

Science.gov (United States)

Zelle, Sten G.; Vidaurre, Tatiana; Abugattas, Julio E.; Manrique, Javier E.; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N.; Lauer, Jeremy A.; Sepulveda, Cecilia R.; Venegas, Diego; Baltussen, Rob

2013-01-01

Objectives In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this

A Cost-Effective Two-Part Experiment for Teaching Introductory Organic Chemistry Techniques

Science.gov (United States)

Sadek, Christopher M.; Brown, Brenna A.; Wan, Hayley

2011-01-01

This two-part laboratory experiment is designed to be a cost-effective method for teaching basic organic laboratory techniques (recrystallization, thin-layer chromatography, column chromatography, vacuum filtration, and melting point determination) to large classes of introductory organic chemistry students. Students are exposed to different…

Monitoring systems and their effectiveness for project cost control in construction

NARCIS (Netherlands)

Al-Jibouri, Saad H.S.

2003-01-01

This paper reports on a research to investigate the effectiveness of some commonly used monitoring systems, in detecting deviations from the planned cost and performance. The monitoring systems used in this work are: Leading parameter technique Variances method Activity based ratios technique The

Cost-effectiveness of a smokeless tobacco control mass media campaign in India.

Science.gov (United States)

Murukutla, Nandita; Yan, Hongjin; Wang, Shuo; Negi, Nalin Singh; Kotov, Alexey; Mullin, Sandra; Goodchild, Mark

2017-08-10

Tobacco control mass media campaigns are cost-effective in reducing tobacco consumption in high-income countries, but similar evidence from low-income countries is limited. An evaluation of a 2009 smokeless tobacco control mass media campaign in India provided an opportunity to test its cost-effectiveness. Campaign evaluation data from a nationally representative household survey of 2898 smokeless tobacco users were compared with campaign costs in a standard cost-effectiveness methodology. Costs and effects of the Surgeon campaign were compared with the status quo to calculate the cost per campaign-attributable benefit, including quit attempts, permanent quits and tobacco-related deaths averted. Sensitivity analyses at varied CIs and tobacco-related mortality risk were conducted. The Surgeon campaign was found to be highly cost-effective. It successfully generated 17 259 148 additional quit attempts, 431 479 permanent quits and 120 814 deaths averted. The cost per benefit was US$0.06 per quit attempt, US$2.6 per permanent quit and US$9.2 per death averted. The campaign continued to be cost-effective in sensitivity analyses. This study suggests that tobacco control mass media campaigns can be cost-effective and economically justified in low-income and middle-income countries. It holds significant policy implications, calling for sustained investment in evidence-based mass media campaigns as part of a comprehensive tobacco control strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

DEFF Research Database (Denmark)

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

2018-01-01

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

Cost benefit analysis cost effectiveness analysis

International Nuclear Information System (INIS)

Lombard, J.

1986-09-01

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

Cost effective material control and accountability training

International Nuclear Information System (INIS)

Robichaux, J.J.; Shull, L.M.; Salizzoni, L.M.

1995-01-01

DOE Order 5630.15, ''Safeguards and Security Training Program'' is being implemented at the Savannah River Site within the Westinghouse Savannah River Company's material control and accountability program. This paper reviews the development of a material control and accountability task analysis, the development of specific material control and accountability courses, and the cost effective and innovative strategies employed to implement the training program. The paper also discusses how the site material control and accountability policies and procedures are incorporated into the Westinghouse Savannah River Company training program to ensure that personnel receive the most current information

Emission Control Cost-Effectiveness of Alternative-Fuel Vehicles

OpenAIRE

Wang, Quanlu; Sperling, Daniel; Olmstead, Janis

1993-01-01

Although various legislation and regulations have been adopted to promote the use of alternative-fuel vehicles for curbing urban air pollution problems, there is a lack of systematic comparisons of emission control cost-effectiveness among various alternative-fuel vehicle types. In this paper, life-cycle emission reductions and life-cycle costs were estimated for passenger cars fueled with methanol, ethanol, liquified petroleum gas, compressed natural gas, and electricity. Vehicle emission es...

The Trojan Female Technique: A Novel, Effective and Humane Approach for Pest Population Control

Energy Technology Data Exchange (ETDEWEB)

Gemmell, Neil J. [Centre for Reproduction and Genomics and Allan Wilson Centre for Molecular Ecology and Evolution, Department of Anatomy, University of Otago, Dunedin (New Zealand); Jalilzadeh, Aidin [Department of Mathematics and Statistics, University of Otago, Dunedin (New Zealand); Didham, Raphael K. [School of Animal Biology, University of Western Australia (Australia); CSIRO Ecosystem Sciences, Perth, Western Australia (Australia); Soboleva, Tanya [Science and Risk Assessment Directorate, Ministry for Primary Industries, PO Box 2526, Wellington (New Zealand); Tompkins, Daniel M. [Landcare Research, Private Bag 1930, Dunedin (New Zealand); New Zealand Institute for Plant and Food Research Ltd., Christchurch (New Zealand)

2014-01-15

Full-text: Humankind's ongoing battle with pest species spans millennia. Pests cause or carry disease, damage or consume food crops and other resources, and drive global environmental change. Conventional approaches to pest management usually involve lethal control, but such approaches are costly, of varying efficiency and often have ethical issues. Thus, pest management via control of reproductive output is increasingly considered an optimal solution. One of the most successful such 'fertility control' strategies developed to date is the sterile male technique (SMT), in which large numbers of sterile males are released into a population each generation. However, this approach is time-consuming, labour- intensive and costly. We use mathematical models to test a new twist on the SMT, using maternally inherited mitochondrial (mtDNA) mutations that affect male, but not female reproductive fitness. 'Trojan females' carrying such mutations, and their female descendants, produce 'sterile-male'-equivalents under natural conditions over multiple generations. We find that the Trojan Female Technique (TFT) has the potential to be a novel humane approach for pest control. Single large releases and relatively few small repeat releases of Trojan females both provided effective and persistent control within relatively few generations. Although greatest efficacy was predicted for high-turnover species, the additive nature of multiple releases made the TFT applicable to the full range of life histories modelled. The extensive conservation of mtDNA among eukaryotes suggests this approach could have broad utility for pest control. (author)

The Trojan female technique: a novel, effective and humane approach for pest population control.

Science.gov (United States)

Gemmell, Neil J; Jalilzadeh, Aidin; Didham, Raphael K; Soboleva, Tanya; Tompkins, Daniel M

2013-12-22

Humankind's ongoing battle with pest species spans millennia. Pests cause or carry disease, damage or consume food crops and other resources, and drive global environmental change. Conventional approaches to pest management usually involve lethal control, but such approaches are costly, of varying efficiency and often have ethical issues. Thus, pest management via control of reproductive output is increasingly considered an optimal solution. One of the most successful such 'fertility control' strategies developed to date is the sterile male technique (SMT), in which large numbers of sterile males are released into a population each generation. However, this approach is time-consuming, labour-intensive and costly. We use mathematical models to test a new twist on the SMT, using maternally inherited mitochondrial (mtDNA) mutations that affect male, but not female reproductive fitness. 'Trojan females' carrying such mutations, and their female descendants, produce 'sterile-male'-equivalents under natural conditions over multiple generations. We find that the Trojan female technique (TFT) has the potential to be a novel humane approach for pest control. Single large releases and relatively few small repeat releases of Trojan females both provided effective and persistent control within relatively few generations. Although greatest efficacy was predicted for high-turnover species, the additive nature of multiple releases made the TFT applicable to the full range of life histories modelled. The extensive conservation of mtDNA among eukaryotes suggests this approach could have broad utility for pest control.

Low-Cost Servomotor Driver for PFM Control.

Science.gov (United States)

Aragon-Jurado, David; Morgado-Estevez, Arturo; Perez-Peña, Fernando

2017-12-31

Servomotors have already been around for some decades and they are extremely popular among roboticists due to their simple control technique, reliability and low-cost. They are usually controlled by using Pulse Width Modulation (PWM) and this paper aims to keep the idea of simplicity and low-cost, while introducing a new control technique: Pulse Frequency Modulation (PFM). The objective of this paper is to focus on our development of a low-cost servomotor controller which will allow the research community to use them with PFM. A low-cost commercial servomotor is used as the base system for the development: a small PCB that fits inside the case and allocates all the electronic components to control the motor has been designed to replace the original. The potentiometer is retained as the feedback sensor and a microcontroller is responsible for controlling the position of the motor. The paper compares the performance of a PWM and a PFM controlled servomotor. The comparison shows that the servomotor with our controller achieves a faster mechanism for switching targets and a lower latency. This controller can be used with neuromorphic systems to remove the conversion from events to PWM.

Techniques for Conducting Effective Concept Design and Design-to-Cost Trade Studies

Science.gov (United States)

Di Pietro, David A.

2015-01-01

Concept design plays a central role in project success as its product effectively locks the majority of system life cycle cost. Such extraordinary leverage presents a business case for conducting concept design in a credible fashion, particularly for first-of-a-kind systems that advance the state of the art and that have high design uncertainty. A key challenge, however, is to know when credible design convergence has been achieved in such systems. Using a space system example, this paper characterizes the level of convergence needed for concept design in the context of technical and programmatic resource margins available in preliminary design and highlights the importance of design and cost evaluation learning curves in determining credible convergence. It also provides techniques for selecting trade study cases that promote objective concept evaluation, help reveal unknowns, and expedite convergence within the trade space and conveys general practices for conducting effective concept design-to-cost studies.

Relevant Costs for Decision in an Effective Controlling System

Directory of Open Access Journals (Sweden)

Mihaela TULVINSCHI

2010-05-01

Full Text Available Controlling is considered a leading concept in the sense of coordination, planning, control and automation, in order to produce the synthesis necessary in decision making. The purpose of article is to highlight the link between a dynamic accounting system and an effective controlling system. The research method used is based on the idea that the cost analysis in an efficient controlling system involves obtaining accounting information from within the entity which management then uses in decision making. In conclusion, we emphasize that an effective controlling system must provide managers the tools to meet their informational needs.

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain: economic evaluation.

Science.gov (United States)

Hollinghurst, Sandra; Sharp, Debbie; Ballard, Kathleen; Barnett, Jane; Beattie, Angela; Evans, Maggie; Lewith, George; Middleton, Karen; Oxford, Frances; Webley, Fran; Little, Paul

2008-12-11

An economic evaluation of therapeutic massage, exercise, and lessons in the Alexander technique for treating persistent back pain. Cost consequences study and cost effectiveness analysis at 12 month follow-up of a factorial randomised controlled trial. 579 patients with chronic or recurrent low back pain recruited from primary care. Normal care (control), massage, and six or 24 lessons in the Alexander technique. Half of each group were randomised to a prescription for exercise from a doctor plus behavioural counselling from a nurse. Costs to the NHS and to participants. Comparison of costs with Roland-Morris disability score (number of activities impaired by pain), days in pain, and quality adjusted life years (QALYs). Comparison of NHS costs with QALY gain, using incremental cost effectiveness ratios and cost effectiveness acceptability curves. Intervention costs ranged from pound30 for exercise prescription to pound596 for 24 lessons in Alexander technique plus exercise. Cost of health services ranged from pound50 for 24 lessons in Alexander technique to pound124 for exercise. Incremental cost effectiveness analysis of single therapies showed that exercise offered best value ( pound61 per point on disability score, pound9 per additional pain-free day, pound2847 per QALY gain). For two-stage therapy, six lessons in Alexander technique combined with exercise was the best value (additional pound64 per point on disability score, pound43 per additional pain-free day, pound5332 per QALY gain). An exercise prescription and six lessons in Alexander technique alone were both more than 85% likely to be cost effective at values above pound20 000 per QALY, but the Alexander technique performed better than exercise on the full range of outcomes. A combination of six lessons in Alexander technique lessons followed by exercise was the most effective and cost effective option.

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

RodPilotR - The Innovative and Cost-Effective Digital Control Rod Drive Control System for PWRs

International Nuclear Information System (INIS)

Baron, Clemens

2008-01-01

With RodPilot, AREVA NP offers an innovative and cost-effective system for controlling control rods in Pressurized Water Reactors. RodPilot controls the three operating coils of the control rod drive mechanism (lift, moveable gripper and stationary gripper coil). The rods are inserted into or withdrawn from the core as required by the Reactor Control System. The system combines modern components, state-of-the-art logic and a proven electronic control rod drive control principle to provide enhanced reliability and lower maintenance costs. (author)

Efficacy and cost-effectiveness of environmental management for malaria control.

Science.gov (United States)

Utzinger, J; Tozan, Y; Singer, B H

2001-09-01

Roll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub-Saharan Africa, and it is proposed to implement efficacious and cost-effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3-5 years, malaria-related mortality, morbidity and incidence rates were reduced by 70-95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161,205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3-5 years start-up period, analogous to the short-duration of cost-effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524-591. However, the strategy has a track record of becoming cost-effective in the longer term, as maintenance costs were much lower: US$ 22-92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management--integrated with pharmacological, insecticidal and bednet interventions

Modeling of Control Costs, Emissions, and Control Retrofits for Cost Effectiveness and Feasibility Analyses

Science.gov (United States)

Learn about EPA’s use of the Integrated Planning Model (IPM) to develop estimates of SO2 and NOx emission control costs, projections of futureemissions, and projections of capacity of future control retrofits, assuming controls on EGUs.

Simple, Safe, and Cost-Effective Technique for Resected Stomach Extraction in Laparoscopic Sleeve Gastrectomy.

Science.gov (United States)

Derici, Serhan; Atila, Koray; Bora, Seymen; Yener, Serkan

2016-01-01

Background. Laparoscopic sleeve gastrectomy (LSG) has become a popular operation during the recent years. This procedure requires resection of 80-90% of the stomach. Extraction of gastric specimen is known to be a challenging and costly stage of the operation. In this paper, we report results of a simple and cost-effective specimen extraction technique which was applied to 137 consecutive LSG patients. Methods. Between October 2013 and October 2015, 137 laparoscopic sleeve gastrectomy surgeries were performed at Dokuz Eylul University General Surgery Department, Upper Gastrointestinal Surgery Unit. All specimens were extracted through a 15 mm trocar site without using any special device. Results. We noticed one superficial incisional surgical site infection and treated this patient with oral antibiotics. No cases of trocar site hernia were observed. Conclusion. Different techniques have been described for specimen extraction. This simple technique allows extraction of specimen safely in a short time and does not require any special device.

Engine control techniques to account for fuel effects

Science.gov (United States)

Kumar, Shankar; Frazier, Timothy R.; Stanton, Donald W.; Xu, Yi; Bunting, Bruce G.; Wolf, Leslie R.

2014-08-26

A technique for engine control to account for fuel effects including providing an internal combustion engine and a controller to regulate operation thereof, the engine being operable to combust a fuel to produce an exhaust gas; establishing a plurality of fuel property inputs; establishing a plurality of engine performance inputs; generating engine control information as a function of the fuel property inputs and the engine performance inputs; and accessing the engine control information with the controller to regulate at least one engine operating parameter.

Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction

OpenAIRE

Fast, Shannon M.; Markuzon, Natasha; Gonzalez, Marta C.

2015-01-01

Background Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence. Methodology The spread of disease and social resp...

Control Strategy Tool (CoST)

Data.gov (United States)

U.S. Environmental Protection Agency — The EPA Control Strategy Tool (CoST) is a software tool for projecting potential future control scenarios, their effects on emissions and estimated costs. This tool...

Cost-effectiveness of controlling Salmonella in the pork chain

NARCIS (Netherlands)

Gaag, van der M.A.; Saatkamp, H.W.; Backus, G.B.C.; Beek, van P.; Huirne, R.B.M.

2004-01-01

Pork is one of the sources of food-borne salmonellosis in humans. In this paper, the cost-effectiveness of different control scenarios against Salmonella in the stages finishing, transport, lairage and slaughtering is explored. A stochastic simulation model was used for the epidemiological analysis

[Cost-effectiveness and cost-benefit analysis on the integrated schistosomiasis control strategies with emphasis on infection source in Poyang Lake region].

Science.gov (United States)

Lin, Dan-Dan; Zeng, Xiao-Jun; Chen, Hong-Gen; Hong, Xian-Lin; Tao, Bo; Li, Yi-Feng; Xiong, Ji-Jie; Zhou, Xiao-Nong

2009-08-01

To evaluate the cost-effectiveness and cost-benefit on the integrated schistosomiasis control strategies with emphasis on infection source, and provide scientific basis for the improvement of schistosomiasis control strategy. Aiguo and Xinhe villages in Jinxian County were selected as intervention group where the new comprehensive strategy was implemented, while Ximiao and Zuxi villages in Xinzi County served as control where routine control program was implemented. New strategy of interventions included removing cattle from snail-infested grasslands and providing farmers with farm machinery, improving sanitation by supplying tap water and building lavatories and methane gas tanks, and implementing an intensive health education program. Routine interventions were carried out in the control villages including diagnosis and treatment for human and cattle, health education, and focal mollusciciding. Data were collected from retrospective investigation and field survey for the analysis and comparison of cost-effectiveness and cost-benefit between intervention and control groups. The control effect of the intervention group was better than that of the control. The cost for 1% decrease of infection rate per 100 people, 100 cattle, and 100 snails in intervention group was 480.01, 6 851.24, and 683.63 Yuan, respectively, which were about 2.70, 4.37 and 20.25 times as those in the control respectively. The total cost/benefit ratio (BCR) was lower than 1 (0.94 in intervention group and 0.08 in the control). But the total benefit of intervention group was higher than that of the control from 2005 to 2008. The forecasting analysis indicated that the total BCR in intervention group would be 1.13 at the 4th year and all cost could be recalled. Sensitivity analysis revealed that the BCR in intervention group changed in the range around 1.0 and that of the control ranged blow 0.5. The cost-benefit of intervention group was evidently higher than that of the control. The integrated

Reliable cost effective technique for in situ ground stress measurements in deep gold mines.

CSIR Research Space (South Africa)

Stacey, TR

1995-07-01

Full Text Available on these requirements, an in situ stress measurement technique which will be practically applicable in the deep gold mines, has been developed conceptually. Referring to the figure on the following page, this method involves: • a borehole-based system, using... level mines have not been developed. 2 This is some of the background to the present SIMRAC research project, the title ofwhich is “Reliable cost effective technique for in-situ ground stress measurements in deep gold mines”. A copy of the research...

Embolization of the Internal Iliac Artery: Cost-Effectiveness of Two Different Techniques

International Nuclear Information System (INIS)

Pellerin, Olivier; Caruba, Thibaud; Kandounakis, Yanis; Novelli, Luigi; Pineau, Judith; Prognon, Patrice; Sapoval, Marc

2008-01-01

The purpose of this study was to compare the cost-effectiveness of coils versus the Amplatzer Vascular Plug (AVP) for occlusion of the internal iliac artery (IAA). Between 2002 and January 2006, 13 patients (mean age 73 ± 13 years) were referred for stent-grafting of abdominal aortic aneurysm (n = 6); type I distal endoleak (n = 3), isolated iliac aneurysm (n = 3), or rupture of a common iliac aneurysm (n = 1). In all patients, extension of the stent-graft was needed because the distal neck was absent. Two different techniques were used to occlude the IIA: AVP in seven patients (group A) and coil embolization in six patients (group C). Immediate results and direct material costs were assessed retrospectively. Immediate success was achieved in all patients, and simultaneous stent-grafting was successfully performed in two of six patients in group C versus five of seven patients in group A. In all group A patients, a single AVP was sufficient to achieve occlusion of the IIA, accounting for a mean cost of 485 Euro , whereas in group C patients, an average of 7 ± 3 coils were used, accounting for a mean cost of 1,745 Euro . Mean average cost savings using the AVP was 1,239 Euro . When IIA occlusion is needed, the AVP allows a single-step procedure at significant cost savings.

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

Science.gov (United States)

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

2011-05-01

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

RodPilot{sup R} - The Innovative and Cost-Effective Digital Control Rod Drive Control System for PWRs

Energy Technology Data Exchange (ETDEWEB)

Baron, Clemens [AREVA NP GmbH, NLEE-G, Postfach 1199, 91001 Erlangen (Germany)

2008-07-01

With RodPilot, AREVA NP offers an innovative and cost-effective system for controlling control rods in Pressurized Water Reactors. RodPilot controls the three operating coils of the control rod drive mechanism (lift, moveable gripper and stationary gripper coil). The rods are inserted into or withdrawn from the core as required by the Reactor Control System. The system combines modern components, state-of-the-art logic and a proven electronic control rod drive control principle to provide enhanced reliability and lower maintenance costs. (author)

Effective tree hazard control on forested recreation sites...losses and protection costs evaluated

Science.gov (United States)

Lee A. Paine

1967-01-01

Effectiveness of hazard control was evaluated by analyzing data on tree failures, accidents, and control costs on California recreation sites. Results indicate that reduction of limb hazard in oaks and bole hazard in conifers is the most effective form of control. Least effective is limb hazard reduction in conifers. After hazard control goals or control budgets have...

Controlling air pollution from passenger ferries: cost-effectiveness of seven technological options.

Science.gov (United States)

Farrell, Alexander E; Corbett, James J; Winebrake, James J

2002-12-01

Continued interest in improving air quality in the United States along with renewed interest in the expansion of urban passenger ferry service has created concern about air pollution from ferry vessels. This paper presents a methodology for estimating the air pollution emissions from passenger ferries and the costs of emissions control strategies. The methodology is used to estimate the emissions and costs of retrofitting or re-powering ferries with seven technological options (combinations of propulsion and emission control systems) onto three vessels currently in service in San Francisco Bay. The technologies include improved engine design, cleaner fuels (including natural gas), and exhaust gas cleanup devices. The three vessels span a range of ages and technologies, from a 25-year-old monohull to a modern, high-speed catamaran built only four years ago. By looking at a range of technologies, vessel designs, and service conditions, a sense of the broader implications of controlling emissions from passenger ferries across a range of vessels and service profiles is provided. Tier 2-certified engines are the most cost-effective choice, but all options are cost-effective relative to other emission control strategies already in place in the transportation system.

Cost effectiveness analysis in radiopharmacy

International Nuclear Information System (INIS)

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

1999-01-01

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

Using counterfactuals to evaluate the cost-effectiveness of controlling biological invasions.

Science.gov (United States)

McConnachie, Matthew M; van Wilgen, Brian W; Ferraro, Paul J; Forsyth, Aurelia T; Richardson, David M; Gaertner, Mirijam; Cowling, Richard M

2016-03-01

Prioritizing limited conservation funds for controlling biological invasions requires accurate estimates of the effectiveness of interventions to remove invasive species and their cost-effectiveness (cost per unit area or individual). Despite billions of dollars spent controlling biological invasions worldwide, it is unclear whether those efforts are effective, and cost-effective. The paucity of evidence results from the difficulty in measuring the effect of invasive species removal: a researcher must estimate the difference in outcomes (e.g. invasive species cover) between where the removal program intervened and what might have been observed if the program had not intervened. In the program evaluation literature, this is called a counterfactual analysis, which formally compares what actually happened and what would have happened in the absence of an intervention. When program implementation is not randomized, estimating counterfactual outcomes is especially difficult. We show how a thorough understanding of program implementation, combined with a matching empirical design can improve the way counterfactual outcomes are estimated in nonexperimental contexts. As a practical demonstration, we estimated the cost-effectiveness of South Africa's Working for Water program, arguably the world's most ambitious invasive species control program, in removing invasive alien trees from different land use types, across a large area in the Cape Floristic Region. We estimated that the proportion of the treatment area covered by invasive trees would have been 49% higher (5.5% instead of 2.7% of the grid cells occupied) had the program not intervened. Our estimates of cost per hectare to remove invasive species, however, are three to five times higher than the predictions made when the program was initiated. Had there been no control (counter-factual), invasive trees would have spread on untransformed land, but not on land parcels containing plantations or land transformed by

A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control.

Directory of Open Access Journals (Sweden)

Jorge A Alfaro-Murillo

2016-05-01

Full Text Available As Zika virus continues to spread, decisions regarding resource allocations to control the outbreak underscore the need for a tool to weigh policies according to their cost and the health burden they could avert. For example, to combat the current Zika outbreak the US President requested the allocation of $1.8 billion from Congress in February 2016.Illustrated through an interactive tool, we evaluated how the number of Zika cases averted, the period during pregnancy in which Zika infection poses a risk of microcephaly, and probabilities of microcephaly and Guillain-Barré Syndrome (GBS impact the cost at which an intervention is cost-effective. From Northeast Brazilian microcephaly incidence data, we estimated the probability of microcephaly in infants born to Zika-infected women (0.49% to 2.10%. We also estimated the probability of GBS arising from Zika infections in Brazil (0.02% to 0.06% and Colombia (0.08%. We calculated that each microcephaly and GBS case incurs the loss of 29.95 DALYs and 1.25 DALYs per case, as well as direct medical costs for Latin America and the Caribbean of $91,102 and $28,818, respectively. We demonstrated the utility of our cost-effectiveness tool with examples evaluating funding commitments by Costa Rica and Brazil, the US presidential proposal, and the novel approach of genetically modified mosquitoes. Our analyses indicate that the commitments and the proposal are likely to be cost-effective, whereas the cost-effectiveness of genetically modified mosquitoes depends on the country of implementation.Current estimates from our tool suggest that the health burden from microcephaly and GBS warrants substantial expenditures focused on Zika virus control. Our results justify the funding committed in Costa Rica and Brazil and many aspects of the budget outlined in the US president's proposal. As data continue to be collected, new parameter estimates can be customized in real-time within our user-friendly tool to provide

Cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry meat food supply.

Science.gov (United States)

Lake, Robin J; Horn, Beverley J; Dunn, Alex H; Parris, Ruth; Green, F Terri; McNickle, Don C

2013-07-01

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

CO2 control technology effects on IGCC plant performance and cost

International Nuclear Information System (INIS)

Chen Chao; Rubin, Edward S.

2009-01-01

As part of the USDOE's Carbon Sequestration Program, an integrated modeling framework has been developed to evaluate the performance and cost of alternative carbon capture and storage (CCS) technologies for fossil-fueled power plants in the context of multi-pollutant control requirements. This paper uses the newly developed model of an integrated gasification combined cycle (IGCC) plant to analyze the effects of adding CCS to an IGCC system employing a GE quench gasifier with water gas shift reactors and a Selexol system for CO 2 capture. Parameters of interest include the effects on plant performance and cost of varying the CO 2 removal efficiency, the quality and cost of coal, and selected other factors affecting overall plant performance and cost. The stochastic simulation capability of the model is also used to illustrate the effect of uncertainties or variability in key process and cost parameters. The potential for advanced oxygen production and gas turbine technologies to reduce the cost and environmental impacts of IGCC with CCS is also analyzed

Cost analysis and estimating tools and techniques

CERN Document Server

Nussbaum, Daniel

1990-01-01

Changes in production processes reflect the technological advances permeat­ ing our products and services. U. S. industry is modernizing and automating. In parallel, direct labor is fading as the primary cost driver while engineering and technology related cost elements loom ever larger. Traditional, labor-based ap­ proaches to estimating costs are losing their relevance. Old methods require aug­ mentation with new estimating tools and techniques that capture the emerging environment. This volume represents one of many responses to this challenge by the cost analysis profession. The Institute of Cost Analysis (lCA) is dedicated to improving the effective­ ness of cost and price analysis and enhancing the professional competence of its members. We encourage and promote exchange of research findings and appli­ cations between the academic community and cost professionals in industry and government. The 1990 National Meeting in Los Angeles, jointly spo~sored by ICA and the National Estimating Society (NES),...

Estimating the costs of tsetse control options: an example for Uganda.

Science.gov (United States)

Shaw, A P M; Torr, S J; Waiswa, C; Cecchi, G; Wint, G R W; Mattioli, R C; Robinson, T P

2013-07-01

cattle per km(2)). Throughout the study, sensitivity analyses were conducted to explore the impact on cost estimates of different densities of ITC and traps, costs of baseline studies and discount rates. The present analysis highlights the cost differentials between the different intervention techniques, whilst attesting to the significant progress made over the years in reducing field costs. Results indicate that continuous control activities can be cost-effective in reducing tsetse populations, especially where the creation of fly-free zones is challenging and reinvasion pressure high. Copyright © 2013 Food and Agriculture Organization of the United Nations. Published by Elsevier B.V. All rights reserved.

Method for Controlling Space Transportation System Life Cycle Costs

Science.gov (United States)

McCleskey, Carey M.; Bartine, David E.

2006-01-01

A structured, disciplined methodology is required to control major cost-influencing metrics of space transportation systems during design and continuing through the test and operations phases. This paper proposes controlling key space system design metrics that specifically influence life cycle costs. These are inclusive of flight and ground operations, test, and manufacturing and infrastructure. The proposed technique builds on today's configuration and mass properties control techniques and takes on all the characteristics of a classical control system. While the paper does not lay out a complete math model, key elements of the proposed methodology are explored and explained with both historical and contemporary examples. Finally, the paper encourages modular design approaches and technology investments compatible with the proposed method.

In search of financial sufficiency in the Spanish public university: From financing to the cost control and cost management

Directory of Open Access Journals (Sweden)

Santiago Aguilà

2016-02-01

Full Text Available Purpose: The current socio-economic context characterized by restrictive budgetary policies in the countries of the European Union has led to a reduction in public funding in the Spanish public university raising the deficit in many universities. That is why, while they are completing the implementation of a cost accounting model (Modelo Canoa to quantify their real financial needs, are also increasing academic rates with the limits established in the Decree-Law 14/2012 of 20 April as practically the only resource. This fact may ultimately affect demand. It is urgent to find therefore new sources of private funding as well as implementing techniques to control and reduce costs justified by the extreme financial situations of some universities. Design/methodology: These new sources of private funding as well as the specific techniques of control and cost management that are used in public universities outside of Spain are described. It has also made a poll to the managers of the Spanish public universities considering the diversification of funding sources and the feasibility of adopting specific techniques of control and cost management to help the achievement of financial sufficiency. Findings: Especially in the US universities, financing is more diversified and not depend so much of the increase in public rates. Specific techniques of control and cost management are also used and they are applicable to the Spanish case according to the opinion of the managers. Research limitations/implications: 82% of managers have completed the proposed poll. Originality/value: Identifying sources of private funding and specific techniques of control and cost management applicable to the Spanish public universities.

The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study.

Directory of Open Access Journals (Sweden)

Dongfeng Gu

2015-08-01

Full Text Available Hypertension is China's leading cardiovascular disease risk factor. Improved hypertension control in China would result in result in enormous health gains in the world's largest population. A computer simulation model projected the cost-effectiveness of hypertension treatment in Chinese adults, assuming a range of essential medicines list drug costs.The Cardiovascular Disease Policy Model-China, a Markov-style computer simulation model, simulated hypertension screening, essential medicines program implementation, hypertension control program administration, drug treatment and monitoring costs, disease-related costs, and quality-adjusted life years (QALYs gained by preventing cardiovascular disease or lost because of drug side effects in untreated hypertensive adults aged 35-84 y over 2015-2025. Cost-effectiveness was assessed in cardiovascular disease patients (secondary prevention and for two blood pressure ranges in primary prevention (stage one, 140-159/90-99 mm Hg; stage two, ≥160/≥100 mm Hg. Treatment of isolated systolic hypertension and combined systolic and diastolic hypertension were modeled as a reduction in systolic blood pressure; treatment of isolated diastolic hypertension was modeled as a reduction in diastolic blood pressure. One-way and probabilistic sensitivity analyses explored ranges of antihypertensive drug effectiveness and costs, monitoring frequency, medication adherence, side effect severity, background hypertension prevalence, antihypertensive medication treatment, case fatality, incidence and prevalence, and cardiovascular disease treatment costs. Median antihypertensive costs from Shanghai and Yunnan province were entered into the model in order to estimate the effects of very low and high drug prices. Incremental cost-effectiveness ratios less than the per capita gross domestic product of China (11,900 international dollars [Int$] in 2015 were considered cost-effective. Treating hypertensive adults with prior

Cost-Effective Control Systems for Colleges and Universities: A New Paradigm.

Science.gov (United States)

Hubbell, Loren Loomis; Dougherty, Jennifer Dowling

This report addresses the issue of maintaining adequate controls within a streamlined or restructured financial affairs environment at an institution of higher education. It presents a new paradigm for control structures designed to more effectively meet administrators' needs--both in terms of cost and risk management. The first section: (1)…

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

Science.gov (United States)

Strandell, Annika; Lindhard, Anette; Eckerlund, Ingemar

2005-12-01

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

Simple and cost-effective fabrication of size-tunable zinc oxide architectures by multiple size reduction technique

Directory of Open Access Journals (Sweden)

Hyeong-Ho Park, Xin Zhang, Seon-Yong Hwang, Sang Hyun Jung, Semin Kang, Hyun-Beom Shin, Ho Kwan Kang, Hyung-Ho Park, Ross H Hill and Chul Ki Ko

2012-01-01

Full Text Available We present a simple size reduction technique for fabricating 400 nm zinc oxide (ZnO architectures using a silicon master containing only microscale architectures. In this approach, the overall fabrication, from the master to the molds and the final ZnO architectures, features cost-effective UV photolithography, instead of electron beam lithography or deep-UV photolithography. A photosensitive Zn-containing sol–gel precursor was used to imprint architectures by direct UV-assisted nanoimprint lithography (UV-NIL. The resulting Zn-containing architectures were then converted to ZnO architectures with reduced feature sizes by thermal annealing at 400 °C for 1 h. The imprinted and annealed ZnO architectures were also used as new masters for the size reduction technique. ZnO pillars of 400 nm diameter were obtained from a silicon master with pillars of 1000 nm diameter by simply repeating the size reduction technique. The photosensitivity and contrast of the Zn-containing precursor were measured as 6.5 J cm−2 and 16.5, respectively. Interesting complex ZnO patterns, with both microscale pillars and nanoscale holes, were demonstrated by the combination of dose-controlled UV exposure and a two-step UV-NIL.

Simple and cost-effective fabrication of size-tunable zinc oxide architectures by multiple size reduction technique

International Nuclear Information System (INIS)

Park, Hyeong-Ho; Hwang, Seon-Yong; Jung, Sang Hyun; Kang, Semin; Shin, Hyun-Beom; Kang, Ho Kwan; Ko, Chul Ki; Zhang Xin; Hill, Ross H; Park, Hyung-Ho

2012-01-01

We present a simple size reduction technique for fabricating 400 nm zinc oxide (ZnO) architectures using a silicon master containing only microscale architectures. In this approach, the overall fabrication, from the master to the molds and the final ZnO architectures, features cost-effective UV photolithography, instead of electron beam lithography or deep-UV photolithography. A photosensitive Zn-containing sol–gel precursor was used to imprint architectures by direct UV-assisted nanoimprint lithography (UV-NIL). The resulting Zn-containing architectures were then converted to ZnO architectures with reduced feature sizes by thermal annealing at 400 °C for 1 h. The imprinted and annealed ZnO architectures were also used as new masters for the size reduction technique. ZnO pillars of 400 nm diameter were obtained from a silicon master with pillars of 1000 nm diameter by simply repeating the size reduction technique. The photosensitivity and contrast of the Zn-containing precursor were measured as 6.5 J cm −2 and 16.5, respectively. Interesting complex ZnO patterns, with both microscale pillars and nanoscale holes, were demonstrated by the combination of dose-controlled UV exposure and a two-step UV-NIL.

Cost-effectiveness analysis of a state funded programme for control of severe asthma

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Loureiro Sebastião

2007-05-01

Full Text Available Abstract Background Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce. Methods 81 patients with severe asthma (12–75 years joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted. Results 64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387 per patient. Family annual income increased US$512, and family costs were reduced by US$733. Conclusion A programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families.

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Ruth F. Hunter

2016-07-01

Full Text Available Abstract Background Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions. Methods/design This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control. The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards, feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701 for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention “dose”, website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial.

Science.gov (United States)

Hunter, Ruth F; Brennan, Sarah F; Tang, Jianjun; Smith, Oliver J; Murray, Jennifer; Tully, Mark A; Patterson, Chris; Longo, Alberto; Hutchinson, George; Prior, Lindsay; French, David P; Adams, Jean; McIntosh, Emma; Kee, Frank

2016-07-22

Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions. This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability

Optimal Materials and Deposition Technique Lead to Cost-Effective Solar Cell with Best-Ever Conversion Efficiency (Fact Sheet)

Energy Technology Data Exchange (ETDEWEB)

2012-07-01

This fact sheet describes how the SJ3 solar cell was invented, explains how the technology works, and why it won an R&D 100 Award. Based on NREL and Solar Junction technology, the commercial SJ3 concentrator solar cell - with 43.5% conversion efficiency at 418 suns - uses a lattice-matched multijunction architecture that has near-term potential for cells with {approx}50% efficiency. Multijunction solar cells have higher conversion efficiencies than any other type of solar cell. But developers of utility-scale and space applications crave even better efficiencies at lower costs to be both cost-effective and able to meet the demand for power. The SJ3 multijunction cell, developed by Solar Junction with assistance from foundational technological advances by the National Renewable Energy Laboratory, has the highest efficiency to date - almost 2% absolute more than the current industry standard multijunction cell-yet at a comparable cost. So what did it take to create this cell having 43.5% efficiency at 418-sun concentration? A combination of materials with carefully designed properties, a manufacturing technique allowing precise control, and an optimized device design.

Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania.

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Frida Ngalesoni

Full Text Available Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost.We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD in Tanzania.A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters.Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively.Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government's ability to implement these interventions.

Use of nuclear techniques in biological control

International Nuclear Information System (INIS)

Greany, Patrick D.; Carpenter, James E.

2000-01-01

As pointed out by Benbrook (1996), pest management is at a crossroads, and there is a great need for new, biointensive pest management strategies. Among these approaches, biological control is a keystone. However, because of increasing concerns about the introduction of exotic natural enemies of insect pests and weeds (Howarth 1991, Delfosse 1997), the overall thrust of biological control has moved toward augmentative biological control, involving releases of established natural enemy species (Knipling 1992). This in turn has created a need to develop more cost-effective mass rearing technologies for beneficial insects. Nuclear techniques could play an especially important role in augmentative biological control, not only in facilitating mass rearing, but in several other ways, as indicated below. Recognising the potential value for use of nuclear techniques in biological control, the Insect and Pest Control Section of the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture, International Atomic Energy Agency, sponsored a Consultants' Group Meeting on this subject in April 1997. The Group produced a document entitled Use of Nuclear Techniques in Biological Control: Managing Pests, Facilitating Trade and Protecting the Environment. The consultants included the authors of this paper as well as Ernest Delfosse (at that time, with the USDA-APHIS National Biological Control Institute), Garry Hill (Intl. Institute for Biological Control), Sinthya Penn (Beneficial Insectary), and Felipe Jeronimo (USDA-APHIS PPQ, Guatemala). The remarks presented in this paper reflect the thoughts presented by these consultants and other participants at the IAEA-sponsored meeting. Several potential uses for nuclear techniques were identified by the Consultants' Group, including: 1) improvements in rearing media (either artificial diets or natural hosts/prey), 2) provision of sterilised natural prey to be used as food during shipment, to ameliorate concerns relating to the

Trade off between costs and environmental effects of weed control on pavements

NARCIS (Netherlands)

Kempenaar, C.; Lotz, L.A.P.; Horst, van der C.L.M.; Beltman, W.H.J.; Leemans, K.J.M.; Bannink, A.D.

2007-01-01

An actor-participative project on sustainable weed control on pavements was started in 2000 in the Netherlands. The aim of the project was to develop a new concept of weed management that provides cost-effective and environmentally sound weed control. Early in 2002, practical guidelines were drawn

Humans, 'things' and space: costing hospital infection control interventions.

Science.gov (United States)

Page, K; Graves, N; Halton, K; Barnett, A G

2013-07-01

Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts. To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues. Previous literature and techniques in both health economics and psychology are reviewed and synthesized. This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed. These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Gedanken Experiments in Educational Cost Effectiveness

Science.gov (United States)

Brudner, Harvey J.

1978-01-01

Discusses the effectiveness of cost determining techniques in education. The areas discussed are: education and management; cost-effectiveness models; figures of merit determination; and the implications as they relate to the areas of audio-visual and computer educational technology. (Author/GA)

A Cost-Effective Atomic Force Microscope for Undergraduate Control Laboratories

Science.gov (United States)

Jones, C. N.; Goncalves, J.

2010-01-01

This paper presents a simple, cost-effective and robust atomic force microscope (AFM), which has been purposely designed and built for use as a teaching aid in undergraduate controls labs. The guiding design principle is to have all components be open and visible to the students, so the inner functioning of the microscope has been made clear to…

Cost-effective ERT technique for oil-in-water measurement for offshore hydrocyclone installations

DEFF Research Database (Denmark)

Durdevic, Petar; Hansen, Leif; Mai, Christian

2015-01-01

The goal of this paper is to introduce and design a cost-effective Oil-in-Water (OiW) measuring instrument, which will be investigated for its value in increasing the efficiency of a deoiling hydrocyclone. The technique investigated is based on Electrical Resistivity Tomography (ERT), which basic...... principle is to measure the resistivity of substances from multiple electrodes and from these measurements create a 2-D image of the oil and gas component in the water. This technique requires the measured components to have different electrical resistances, such as seawater which has a lower electrical...... resistance than hydrocarbon oil and gas. This work involves construction of a pilot plant, for testing the feasibility of ERT for OiW measurements, and further exploring if this measured signal can be applied as a reliable feedback signal in optimization of the hydrocyclone's efficiency. Different algorithms...

Cost-Effective ERT Technique for Oil-in-Water Measurement for Offshore Hydrocyclone Installations

DEFF Research Database (Denmark)

Løhndorf, Petar Durdevic; Hansen, Leif; Mai, Christian

2015-01-01

The goal of this paper is to introduce and design a cost-effective Oil-in-Water (OiW) measuring instrument, which will be investigated for its value in increasing the efficiency of a deoiling hydrocyclone. The technique investigated is based on Electrical Resistivity Tomography (ERT), which basic...... principle is to measure the resistivity of substances from multiple electrodes and from these measurements create a 2-D image of the oil and gas component in the water. This technique requires the measured components to have different electrical resistances, such as seawater which has a lower electrical...... resistance than hydrocarbon oil and gas. This work involves construction of a pilot plant, for testing the feasibility of ERT for OiW measurements, and further exploring if this measured signal can be applied as a reliable feedback signal in optimization of the hydrocyclone's efficiency. Different algorithms...

Switching Fuzzy Guaranteed Cost Control for Nonlinear Networked Control Systems

Directory of Open Access Journals (Sweden)

Linqin Cai

2014-01-01

Full Text Available This paper deals with the problem of guaranteed cost control for a class of nonlinear networked control systems (NCSs with time-varying delay. A guaranteed cost controller design method is proposed to achieve the desired control performance based on the switched T-S fuzzy model. The switching mechanism is introduced to handle the uncertainties of NCSs. Based on Lyapunov functional approach, some sufficient conditions for the existence of state feedback robust guaranteed cost controller are presented. Simulation results show that the proposed method is effective to guarantee system’s global asymptotic stability and quality of service (QoS.

Cost-Effectiveness of Group and Internet Cognitive Behavioral Therapy for Insomnia in Adolescents: Results from a Randomized Controlled Trial.

Science.gov (United States)

De Bruin, Eduard J; van Steensel, Francisca J A; Meijer, Anne Marie

2016-08-01

To investigate cost-effectiveness of adolescent cognitive behavioral therapy for insomnia (CBTI) in group- and Internet-delivered formats, from a societal perspective with a time horizon of 1 y. Costs and effects data up to 1-y follow-up were obtained from a randomized controlled trial (RCT) comparing Internet CBTI to face-to-face group CBTI. The study was conducted at the laboratory of the Research Institute of Child Development and Education at the University of Amsterdam, and the academic youth mental health care center UvAMinds in Amsterdam. Sixty-two participants meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for insomnia were randomized to face-to-face group CBTI (GT; n = 31, age = 15.6 y ± 1.8, 71.0% girls) or individual Internet CBTI (IT; n = 31, age = 15.4 y ± 1.5, 83.9% girls). The intervention consisted of six weekly sessions and a 2-mo follow up booster-session of CBTI, consisting of psychoeducation, sleep hygiene, restriction of time in bed, stimulus control, cognitive therapy, and relaxation techniques. GT sessions were held in groups of six to eight adolescents guided by two trained sleep therapists. IT consisted of individual Internet therapy with preprogrammed content similar to GT, and guided by trained sleep therapists. Outcome measures were subjective sleep efficiency (SE) ≥ 85%, and quality-adjusted life-years (QALY). Analyses were conducted from a societal perspective. Incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling, and presented in cost-effectiveness planes. Primary analysis showed costs over 1 y were higher for GT but effects were similar for IT and GT. Bootstrapped ICERs demonstrated there is a high probability of IT being cost-effective compared to GT. Secondary analyses confirmed robustness of results. Internet CBTI is a cost-effective treatment compared to group CBTI for adolescents, although effects were largely similar for both formats

Developing methods of controlling quality costs

OpenAIRE

Gorbunova A. V.; Maximova O. N.; Ekova V. A.

2017-01-01

The article examines issues of managing quality costs, problems of applying economic methods of quality control, implementation of progressive methods of quality costs management in enterprises with the view of improving the efficiency of their evaluation and analysis. With the aim of increasing the effectiveness of the cost management mechanism, authors introduce controlling as a tool of deviation analysis from the standpoint of the process approach. A list of processes and corresponding eva...

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

Science.gov (United States)

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

2017-01-01

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

Spatially-Distributed Cost-Effectiveness Analysis Framework to Control Phosphorus from Agricultural Diffuse Pollution.

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Runzhe Geng

Full Text Available Best management practices (BMPs for agricultural diffuse pollution control are implemented at the field or small-watershed scale. However, the benefits of BMP implementation on receiving water quality at multiple spatial is an ongoing challenge. In this paper, we introduce an integrated approach that combines risk assessment (i.e., Phosphorus (P index, model simulation techniques (Hydrological Simulation Program-FORTRAN, and a BMP placement tool at various scales to identify the optimal location for implementing multiple BMPs and estimate BMP effectiveness after implementation. A statistically significant decrease in nutrient discharge from watersheds is proposed to evaluate the effectiveness of BMPs, strategically targeted within watersheds. Specifically, we estimate two types of cost-effectiveness curves (total pollution reduction and proportion of watersheds improved for four allocation approaches. Selection of a ''best approach" depends on the relative importance of the two types of effectiveness, which involves a value judgment based on the random/aggregated degree of BMP distribution among and within sub-watersheds. A statistical optimization framework is developed and evaluated in Chaohe River Watershed located in the northern mountain area of Beijing. Results show that BMP implementation significantly (p >0.001 decrease P loss from the watershed. Remedial strategies where BMPs were targeted to areas of high risk of P loss, deceased P loads compared with strategies where BMPs were randomly located across watersheds. Sensitivity analysis indicated that aggregated BMP placement in particular watershed is the most cost-effective scenario to decrease P loss. The optimization approach outlined in this paper is a spatially hierarchical method for targeting nonpoint source controls across a range of scales from field to farm, to watersheds, to regions. Further, model estimates showed targeting at multiple scales is necessary to optimize program

Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: Results of an economic evaluation alongside a randomised controlled trial

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Oostdam Nicolette

2012-07-01

Full Text Available Abstract Background The prevalence of gestational diabetes mellitus (GDM is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care. Methods A randomised controlled trial (RCT and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n = 62 or to standard care (n = 59. The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios. Results There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204. The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs. Conclusion The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of

Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: results of an economic evaluation alongside a randomised controlled trial.

Science.gov (United States)

Oostdam, Nicolette; Bosmans, Judith; Wouters, Maurice G A J; Eekhoff, Elisabeth M W; van Mechelen, Willem; van Poppel, Mireille N M

2012-07-04

The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM and the risks associated with GDM lead to increased health care costs and losses in productivity. The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to standard care. A randomised controlled trial (RCT) and simultaneous economic evaluation of the FitFor2 program were conducted. Pregnant women at risk for GDM were randomised to an exercise program to prevent high maternal blood glucose (n = 62) or to standard care (n = 59). The exercise program consisted of two sessions of aerobic and strengthening exercises per week. Clinical outcome measures were maternal fasting blood glucose levels, insulin sensitivity and infant birth weight. Quality of life was measured using the EuroQol 5-D and quality-adjusted life-years (QALYs) were calculated. Resource utilization and sick leave data were collected by questionnaires. Data were analysed according to the intention-to-treat principle. Missing data were imputed using multiple imputations. Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios. There were no statistically significant differences in any outcome measure. During pregnancy, total health care costs and costs of productivity losses were statistically non-significant (mean difference €1308; 95%CI €-229 - €3204). The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels, insulin sensitivity, infant birth weight or QALYs. The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to standard care. Based on these results, implementation of this exercise program for the prevention of GDM cannot be recommended. NTR1139.

In search of cost-effective, reliable software

International Nuclear Information System (INIS)

Naser, J.A.; Bhatt, S.C.

1992-01-01

Considerable effort is ongoing to utilize the strengths of digital technology to upgrade and add functionality to existing systems and to develop solutions to problems in the nuclear industry. Acceptance of digital solutions requires verification and validation activities to ensure the reliability and acceptance of these solutions. EPRI has an ongoing effort to develop a methodology for verification and validation of digital control systems. Also, a joint project between the NRC and EPRI is developing a methodology for expert system verification and validation. To obtain a wider acceptance of digital system solutions and hence the utilization of verification and validation techniques, cost effective methods for design, development and verification and validation are needed. EPRI is leading an effort to develop methods for cost effective verification and validation for all types of software

Costs and effects in lumbar spinal fusion

DEFF Research Database (Denmark)

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

2007-01-01

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

The costs and effectiveness of various decontamination procedures

International Nuclear Information System (INIS)

Robinson, C.A.; Haywood, S.M.; Brown, J.

1991-01-01

Knowledge of the cost and effectiveness of decontamination techniques is necessary to optimise the implementation of this countermeasure. These factors vary depending upon the nature of the land affected. There is a great deal of data available on the cost and efficacy of specific decontamination techniques on particular surfaces, but little information for combinations of techniques in real environments. This paper describes the preliminary stages of a project, in progress at the National Radiological Protection Board (NRPB), aimed at providing this information, for inner city, residential and rural areas. The efficacies of individual decontamination processes on specific surfaces were from the available literature. The NRPB EXPURT (EXPosure from Urban Radionuclide Transfer) compartmental model was used to determine the effectiveness of a number of representative decontamination programmes; each programme represents a combination of common decontamination techniques which may be applied to the various surfaces comprising an inner-city, residential or rural environment, ie, paving, walls, roofs and soil. The effectiveness of each programme was measured in terms of the reduction in dose, or dose rate, to an individual in that environment, taking account of the building characteristics, and the occupancy of the population in these buildings. The costs of each programme were derived, based on data available in current literature on the cost of the constituent decontamination techniques. Representative cost and effectiveness data are presented and their application is discussed

Developing methods of controlling quality costs

Directory of Open Access Journals (Sweden)

Gorbunova A. V.

2017-01-01

Full Text Available The article examines issues of managing quality costs, problems of applying economic methods of quality control, implementation of progressive methods of quality costs management in enterprises with the view of improving the efficiency of their evaluation and analysis. With the aim of increasing the effectiveness of the cost management mechanism, authors introduce controlling as a tool of deviation analysis from the standpoint of the process approach. A list of processes and corresponding evaluation criteria in the quality management system of enterprises is introduced. Authors also introduce the method of controlling quality costs and propose it for the practical application, which allows them to determine useful and unnecessary costs at the existing operating plant. Implementing the proposed recommendations in the system of cost management at an enterprise will allow to improve productivity of processes operating and reduce wasted expense on the quality of the process on the basis of determining values of useful and useless costs of quality according to criteria of processes functioning in the system of quality management.

The Use of Probability Theory as a Basis for Planning and Controlling Overhead Costs in Education and Industry. Final Report.

Science.gov (United States)

Vinson, R. B.

In this report, the author suggests changes in the treatment of overhead costs by hypothesizing that "the effectiveness of standard costing in planning and controlling overhead costs can be increased through the use of probability theory and associated statistical techniques." To test the hypothesis, the author (1) presents an overview of the…

Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.

Science.gov (United States)

Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A

2016-09-01

To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.

Low-Cost Quality Control and Nondestructive Evaluation Technologies for General Aviation Structures

Science.gov (United States)

Cramer, K. Elliott; Gavinsky, Bob; Semanskee, Grant

1998-01-01

NASA's Advanced General Aviation Transport Experiments (AGATE) Program has as a goal to reduce the overall cost of producing private aviation aircraft while maintaining the safety of these aircraft. In order to successfully meet this goal, it is necessary to develop nondestructive inspection techniques which will facilitate the production of the materials used in these aircraft and assure the quality necessary to maintain airworthiness. This paper will discuss a particular class of general aviation materials and several nondestructive inspection techniques that have proven effective for making these inspections. Additionally, this paper will discuss the investigation and application of other commercially available quality control techniques applicable to these structures.

Cost Engineering Techniques and Their Applicability for Cost Estimation of Organic Rankine Cycle Systems

Directory of Open Access Journals (Sweden)

Sanne Lemmens

2016-06-01

Full Text Available The potential of organic Rankine cycle (ORC systems is acknowledged by both considerable research and development efforts and an increasing number of applications. Most research aims at improving ORC systems through technical performance optimization of various cycle architectures and working fluids. The assessment and optimization of technical feasibility is at the core of ORC development. Nonetheless, economic feasibility is often decisive when it comes down to considering practical instalments, and therefore an increasing number of publications include an estimate of the costs of the designed ORC system. Various methods are used to estimate ORC costs but the resulting values are rarely discussed with respect to accuracy and validity. The aim of this paper is to provide insight into the methods used to estimate these costs and open the discussion about the interpretation of these results. A review of cost engineering practices shows there has been a long tradition of industrial cost estimation. Several techniques have been developed, but the expected accuracy range of the best techniques used in research varies between 10% and 30%. The quality of the estimates could be improved by establishing up-to-date correlations for the ORC industry in particular. Secondly, the rapidly growing ORC cost literature is briefly reviewed. A graph summarizing the estimated ORC investment costs displays a pattern of decreasing costs for increasing power output. Knowledge on the actual costs of real ORC modules and projects remains scarce. Finally, the investment costs of a known heat recovery ORC system are discussed and the methodologies and accuracies of several approaches are demonstrated using this case as benchmark. The best results are obtained with factorial estimation techniques such as the module costing technique, but the accuracies may diverge by up to +30%. Development of correlations and multiplication factors for ORC technology in particular is

Sensorless control of low-cost single-phase hybrid switched reluctance motor drive

DEFF Research Database (Denmark)

Jakobsen, Uffe; Lu, Kaiyuan; Rasmussen, Peter Omand

2013-01-01

This paper presents a sensorless-controlled, low-cost, low-power, variable-speed drive system suitable for fan and pump applications. The main advantages of this drive system are the low system cost, simple converter structure, and simple but robust sensorless control technique. The drive motor...... is a special Hybrid Switched Reluctance Motor (HSRM). The proposed sensorless control method utilizes beneficially the stator side permanent magnet field and its performance is motor parameter independent. The unique low-cost drive system solution, simple and robust sensorless control features of this drive...

Sensorless Control of Low-cost Single-phase Hybrid Switched Reluctance Motor Drive

DEFF Research Database (Denmark)

Jakobsen, Uffe; Lu, Kaiyuan; Rasmussen, Peter Omand

2015-01-01

This paper presents a sensorless-controlled, low-cost, low-power, and variable-speed drive system suitable for fan and pump applications. The main advantages of this drive system are the low system cost, simple converter structure, and simple but robust sensorless control technique. The drive motor...... is a special hybrid switched reluctance motor. The proposed sensorless control method beneficially utilizes the stator side PM field and its performance is motor parameter independent. The unique low-cost drive system solution, simple and robust sensorless control features of this drive system, is demonstrated...

Tradeable CO2 emission permits for cost-effective control of global warming

International Nuclear Information System (INIS)

Kosobud, R.F.; South, D.W.; Daly, T.A.; Quinn, K.G.

1991-01-01

Many current global warming mitigation policy proposals call for large, near-term reductions in CO 2 emissions, thereby entailing high initial carbon emission tax rates or permit prices. This paper claims that these high initial tax rates or permit prices are not cost-effective in achieving the desired degree of climate change control. A cost-effective permit system is proposed and described that, under certain assumptions, would allow markets to optimally lead permit prices along a gradually increasing trajectory over tie. This price path presents the Hotelling result and would ease the abrupt, inefficient, and costly adjustments imposed on the fossil fuel and other industries in current proposals. This finding is demonstrated using the Argonne Model, a linear programming energy- environmental-economic model that allows for intertemporal optimization of consumer energy well-being. 12 refs., 3 figs., 1 tab

Nonfragile Guaranteed Cost Control and Optimization for Interconnected Systems of Neutral Type

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Heli Hu

2013-01-01

Full Text Available The design and optimization problems of the nonfragile guaranteed cost control are investigated for a class of interconnected systems of neutral type. A novel scheme, viewing the interconnections with time-varying delays as effective information but not disturbances, is developed to decrease the conservatism. Many techniques on decomposing and magnifying the matrices are utilized to obtain the guaranteed cost of the considered system. Also, an algorithm is proposed to solve the nonlinear problem of the interconnected matrices. Based on this algorithm, the minimization of the guaranteed cost of the considered system is obtained by optimization. Further, the state feedback control is extended to the case in which the underlying system is dependent on uncertain parameters. Finally, two numerical examples are given to illustrate the proposed method, and some comparisons are made to show the advantages of the schemes of dealing with the interconnections.

Optimalization of logistic costs by the controlling approach

OpenAIRE

Katarína Teplická

2007-01-01

Article deals with logistic cost problems, their following, reporting and evaluation in the firm. It gives basic information about possible access of the effective decreasing of the logistic cost by the way of controlling access, or evaluation of Balance Score Card. It indicates short algorithm of logistic costs reporting by the way of controlling.

Optimalization of logistic costs by the controlling approach

Directory of Open Access Journals (Sweden)

Katarína Teplická

2007-10-01

Full Text Available Article deals with logistic cost problems, their following, reporting and evaluation in the firm. It gives basic information about possible access of the effective decreasing of the logistic cost by the way of controlling access, or evaluation of Balance Score Card. It indicates short algorithm of logistic costs reporting by the way of controlling.

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

Science.gov (United States)

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

2008-04-01

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

Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial.

Science.gov (United States)

McBain, Ryan K; Salhi, Carmel; Hann, Katrina; Salomon, Joshua A; Kim, Jane J; Betancourt, Theresa S

2016-05-01

One billion children live in war-affected regions of the world. We conducted the first cost-effectiveness analysis of an intervention for war-affected youth in sub-Saharan Africa, as well as a broader cost analysis. The Youth Readiness Intervention (YRI) is a behavioural treatment for reducing functional impairment associated with psychological distress among war-affected young persons. A randomized controlled trial was conducted in Freetown, Sierra Leone, from July 2012 to July 2013. Participants (n = 436, aged 15-24) were randomized to YRI (n = 222) or care as usual (n = 214). Functional impairment was indexed by the World Health Organization Disability Assessment Scale; scores were converted to quality-adjusted life years (QALYs). An 'ingredients approach' estimated financial and economic costs, assuming a societal perspective. Incremental cost-effectiveness ratios (ICERs) were also expressed in terms of gains across dimensions of mental health and schooling. Secondary analyses explored whether intervention effects were largest among those worst-off (upper quartile) at baseline. Retention at 6-month follow-up was 85% (n = 371). The estimated economic cost of the intervention was $104 per participant. Functional impairment was lower among YRI recipients, compared with controls, following the intervention but not at 6-month follow-up, and yielded an ICER of $7260 per QALY gained. At 8-month follow-up, teachers' interviews indicated that YRI recipients observed higher school enrolment [P cost of $431 per additional school year gained, as well as better school attendance (P = 0.007, OR 34.9) and performance (P = 0.03, effect size = -1.31). Secondary analyses indicated that the intervention was cost-effective among those worst-off at baseline, yielding an ICER of $3564 per QALY gained. The YRI is not cost-effective at a willingness-to-pay threshold of three times average gross domestic product per capita. However, results indicate that

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

Science.gov (United States)

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

2018-02-01

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

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

Science.gov (United States)

Bos, R

1991-01-01

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

Comparative study of abdominal cavity temporary closure techniques for damage control

Directory of Open Access Journals (Sweden)

MARCELO A. F. RIBEIRO JR

Full Text Available ABSTRACT The damage control surgery, with emphasis on laparostomy, usually results in shrinkage of the aponeurosis and loss of the ability to close the abdominal wall, leading to the formation of ventral incisional hernias. Currently, various techniques offer greater chances of closing the abdominal cavity with less tension. Thus, this study aims to evaluate three temporary closure techniques of the abdominal cavity: the Vacuum-Assisted Closure Therapy - VAC, the Bogotá Bag and the Vacuum-pack. We conducted a systematic review of the literature, selecting 28 articles published in the last 20 years. The techniques of the bag Bogotá and Vacuum-pack had the advantage of easy access to the material in most centers and low cost, contrary to VAC, which, besides presenting high cost, is not available in most hospitals. On the other hand, the VAC technique was more effective in reducing stress at the edges of lesions, removing stagnant fluids and waste, in addition to acting at the cellular level by increasing proliferation and cell division rates, and showed the highest rates of primary closure of the abdominal cavity.

A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability.

Science.gov (United States)

Cho, Byung-Ki; Kim, Yong-Min; Park, Kyoung-Jin; Park, Ji-Kang; Kim, Do-Kyoon

2015-02-01

There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level II, prospective comparative study. © The Author(s) 2014.

Cost-effectiveness of trachoma control in seven world regions.

NARCIS (Netherlands)

Baltussen, R.M.P.M.; Sylla, M.; Frick, K.D.; Mariotti, S.P.

2005-01-01

BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and

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

NARCIS (Netherlands)

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

2018-01-01

Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such

The Technique of Special-Effects Cinematography.

Science.gov (United States)

Fielding, Raymond

The author describes the many techniques used to produce cinematic effects that would be too costly, too difficult, too time-consuming, too dangerous, or simply impossible to achieve with conventional photographic techniques. He points out that these techniques are available not only for 35 millimeter work but also to the 16 mm. photographer who…

Modified natural cycle versus controlled ovarian hyperstimulation IVF: a cost-effectiveness evaluation of three simulated treatment scenarios

NARCIS (Netherlands)

Groen, Henk; Tonch, Nino; Simons, Arnold H. M.; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A.

2013-01-01

Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a cost-effective alternative for one

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

Directory of Open Access Journals (Sweden)

Williams Brian G

2005-12-01

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

Cost-effectiveness of family psychoeducation to prevent relapse in major depression: Results from a randomized controlled trial

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Shimodera Shinji

2012-05-01

Full Text Available Abstract Background Family psychoeducation is a relatively simple and straightforward intervention whose prophylactic effectiveness and cost-effectiveness is well-established for schizophrenia. We have recently demonstrated its effectiveness for unipolar depression, but its cost-effectiveness has never been examined. We hereby report a cost-effectiveness analysis alongside a randomized controlled trial in order to assess its cost-effectiveness for preventing relapse/recurrence in depression. Methods Fifty-seven patients diagnosed with major depression and undergoing its maintenance treatment, and their primary family members were randomized to treatment as usual (TAU only or to TAU plus family psychoeducation, which consisted of four 2-hour multiple-family sessions consisting of didactic lectures about depression (30 minutes and group discussion and problem solving (60–90 minutes. The economic analyses were undertaken from the perspective of the National Health Insurance (NHI, assuming the most reasonable price of US$50 per psychoeducation session per patient. The main outcome measures included relapse-free days and direct costs to the NHI. Results The intervention group enjoyed 272 (SD: 7.1 relapse-free days, while the control group spent 214 (SD: 90.8 relapse-free days (Cox proportional hazard ratio = 0.17, 95%CI: 0.04 to 0.75, p = 0.002. Cost-effectiveness acceptability curves suggested that the family psychoeducation has 90% or more chances of being cost-effective if the decision-maker is prepared to pay US$20 for one additional relapse-free day. This cost-effectiveness finding was robust when the price for family psychoeducation ranged between 50% to 150% of the baseline scenario in sensitivity analyses. If a relapse-free day is considered to be worth $30 or more, all the pricing scenarios have a close to 100% probability of being cost-effective. Conclusion Family psychoeducation is effective in the relapse prevention of

A novel eco-friendly technique for efficient control of lime water softening process.

Science.gov (United States)

Ostovar, Mohamad; Amiri, Mohamad

2013-12-01

Lime softening is an established type of water treatment used for water softening. The performance of this process is highly dependent on lime dosage. Currently, lime dosage is adjusted manually based on chemical tests, aimed at maintaining the phenolphthalein (P) and total (M) alkalinities within a certain range (2 P - M > or = 5). In this paper, a critical study of the softening process has been presented. It has been shown that the current method is frequently incorrect. Furthermore, electrical conductivity (EC) has been introduced as a novel indicator for effectively characterizing the lime softening process.This novel technique has several advantages over the current alkalinities method. Because no chemical reagents are needed for titration, which is a simple test, there is a considerable reduction in test costs. Additionally, there is a reduction in the treated water hardness and generated sludge during the lime softening process. Therefore, it is highly eco-friendly, and is a very cost effective alternative technique for efficient control of the lime softening process.

Mission management, planning, and cost: PULSE Attitude And Control Systems (AACS)

Science.gov (United States)

1990-01-01

The Pluto unmanned long-range scientific explorer (PULSE) is a probe that will do a flyby of Pluto. It is a low weight, relatively low costing vehicle which utilizes mostly off-the-shelf hardware, but not materials or techniques that will be available after 1999. A design, fabrication, and cost analysis is presented. PULSE will be launched within the first decade of the twenty-first century. The topics include: (1) scientific instrumentation; (2) mission management, planning, and costing; (3) power and propulsion systems; (4) structural subsystem; (5) command, control, and communication; and (6) attitude and articulation control.

Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana.

Science.gov (United States)

Pitt, Catherine; Tawiah, Theresa; Soremekun, Seyi; ten Asbroek, Augustinus H A; Manu, Alexander; Tawiah-Agyemang, Charlotte; Hill, Zelee; Owusu-Agyei, Seth; Kirkwood, Betty R; Hanson, Kara

2016-01-01

Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5-18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting. We prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI -12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20-60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates. In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to -7674) per newborn life saved, or $352 (95% CI 104 to -268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER

Effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients.

Science.gov (United States)

Mehrtak, Mohammad; Habibzadeh, Shahram; Farzaneh, Esmaeil; Rjaei-Khiavi, Abdollah

2017-10-01

Many of the cognitive behavioral models and therapeutic protocols developed so far for psychological disorders and chronic diseases have proved effective through clinical research. This study aimed to determine the effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients. This controlled clinical trial study was conducted in 2015 with 76 patients selected by census and treated with a hemodialysis machine in the dialysis department of Vali-Asr Hospital in the city of Meshkinshahr. A total of four patients were excluded because of their critical conditions while the rest, who were recruited, were randomly divided into two equal groups of 36 patients as the intervention and control groups. First, the locus of control was measured in both groups through a pretest, and cognitive-behavioral techniques were then taught to the intervention group during eight 45 to 90-minute sessions. The locus of control in patients of both groups was finally re-measured through a posttest. Data were collected using Rotter's Locus of Control Inventory. The Wilcoxon test and Mann-Whitney U test were respectively used in SPSS18 for data analysis. In the pretest and posttest stages respectively, 4.8% and 14.3% of samples in the control group as well as 14.3% and 33.3% of samples in the intervention group enjoyed internal locus of control. The difference between the pretest and posttest scores of internal locus of control in the intervention group was significant (p=0.004), which indicates the positive effect of cognitive-behavioral psychotherapeutic intervention on internalization of locus of control in this group. Given the external locus of control in most of the study patients and also the positive significant effect of cognitive-behavioral psychotherapy on internalization of locus of control in this group of patients, it appears necessary to have a psychology resident present in the hemodialysis department to teach the necessary cognitive

Biosimilar medicines and cost-effectiveness

Directory of Open Access Journals (Sweden)

Steven Simoens

2011-02-01

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

E-learning: controlling costs and increasing value.

Science.gov (United States)

Walsh, Kieran

2015-04-01

E-learning now accounts for a substantial proportion of medical education provision. This progress has required significant investment and this investment has in turn come under increasing scrutiny so that the costs of e-learning may be controlled and its returns maximised. There are multiple methods by which the costs of e-learning can be controlled and its returns maximised. This short paper reviews some of those methods that are likely to be most effective and that are likely to save costs without compromising quality. Methods might include accessing free or low-cost resources from elsewhere; create short learning resources that will work on multiple devices; using open source platforms to host content; using in-house faculty to create content; sharing resources between institutions; and promoting resources to ensure high usage. Whatever methods are used to control costs or increase value, it is most important to evaluate the impact of these methods.

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

Science.gov (United States)

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

2013-12-01

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

Low-Cost Intra-Articular Distraction Technique Using Kirschner Wires and a Toothed Lamina Spreader.

Science.gov (United States)

Shymon, Stephen Joseph; Harris, Thomas Gregory

We describe a low-cost (instrument cost) technique for joint distraction using 2 Kirschner wires and a toothed lamina spreader in lieu of a Hintermann distractor. The described technique allows for temporary intra-articular distraction and visualization and preservation of the articular surface with extra-articular instrumentation. The technique can also allow for closed reduction and percutaneous treatment in cases of soft tissue compromise. Additionally, the technique uses common orthopedic surgical instruments, leading to a minimal learning curve for novice surgeons. We have found this distraction technique to be most effective for intra-articular preparation of hindfoot and midfoot arthrodeses and for navicular fracture reduction. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Optimal treatment cost allocation methods in pollution control

International Nuclear Information System (INIS)

Chen Wenying; Fang Dong; Xue Dazhi

1999-01-01

Total emission control is an effective pollution control strategy. However, Chinese application of total emission control lacks reasonable and fair methods for optimal treatment cost allocation, a critical issue in total emission control. The author considers four approaches to allocate treatment costs. The first approach is to set up a multiple-objective planning model and to solve the model using the shortest distance ideal point method. The second approach is to define degree of satisfaction for cost allocation results for each polluter and to establish a method based on this concept. The third is to apply bargaining and arbitration theory to develop a model. The fourth is to establish a cooperative N-person game model which can be solved using the Shapley value method, the core method, the Cost Gap Allocation method or the Minimum Costs-Remaining Savings method. These approaches are compared using a practicable case study

FIRM SIZE EFFECTS ON TRANSACTION COSTS

NARCIS (Netherlands)

NOOTEBOOM, B

1993-01-01

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

Searching for the most cost-effective strategy for controlling epidemics spreading on regular and small-world networks.

Science.gov (United States)

Kleczkowski, Adam; Oleś, Katarzyna; Gudowska-Nowak, Ewa; Gilligan, Christopher A

2012-01-07

We present a combined epidemiological and economic model for control of diseases spreading on local and small-world networks. The disease is characterized by a pre-symptomatic infectious stage that makes detection and control of cases more difficult. The effectiveness of local (ring-vaccination or culling) and global control strategies is analysed by comparing the net present values of the combined cost of preventive treatment and illness. The optimal strategy is then selected by minimizing the total cost of the epidemic. We show that three main strategies emerge, with treating a large number of individuals (global strategy, GS), treating a small number of individuals in a well-defined neighbourhood of a detected case (local strategy) and allowing the disease to spread unchecked (null strategy, NS). The choice of the optimal strategy is governed mainly by a relative cost of palliative and preventive treatments. If the disease spreads within the well-defined neighbourhood, the local strategy is optimal unless the cost of a single vaccine is much higher than the cost associated with hospitalization. In the latter case, it is most cost-effective to refrain from prevention. Destruction of local correlations, either by long-range (small-world) links or by inclusion of many initial foci, expands the range of costs for which the NS is most cost-effective. The GS emerges for the case when the cost of prevention is much lower than the cost of treatment and there is a substantial non-local component in the disease spread. We also show that local treatment is only desirable if the disease spreads on a small-world network with sufficiently few long-range links; otherwise it is optimal to treat globally. In the mean-field case, there are only two optimal solutions, to treat all if the cost of the vaccine is low and to treat nobody if it is high. The basic reproduction ratio, R(0), does not depend on the rate of responsive treatment in this case and the disease always invades

Cost-effectiveness of budesonide/formoterol for maintenance and reliever asthma therapy in Denmark--cost-effectiveness analysis based on five randomised controlled trials

DEFF Research Database (Denmark)

Wickstrøm, Jannie; Dam, Nanna; Malmberg, Irena

2009-01-01

Budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) is an effective asthma-management regime where patients use budesonide/formoterol both as maintenance treatment and as additional doses as needed to improve overall asthma control by reducing symptoms and exacerbations....... The aim of this study was to determine the cost-effectiveness of the Symbicort SMART regime in Denmark vs higher dose inhaled corticosteroid (ICS) plus reliever medication, similar dose inhaled corticosteroid/long-acting beta(2)-agonist (ICS/LABA) combination therapy plus reliever medication or higher...

Early intervention in panic: randomized controlled trial and cost-effectiveness analysis

Directory of Open Access Journals (Sweden)

van Balkom Anton

2008-11-01

Full Text Available Abstract Background Panic disorder (PD is a common, severe and persistent mental disorder, associated with a high degree of distress and occupational and social disability. A substantial proportion of the population experiences subthreshold and mild PD and is at risk of developing a chronic PD. A promising intervention, aimed at preventing panic disorder onset and reducing panic symptoms, is the 'Don't Panic' course. It consists of eight sessions of two hours each. The purpose of this study is to evaluate the effectiveness of this early intervention – based on cognitive behavioural principles – on the reduction of panic disorder symptomatology. We predict that the experimental condition show superior clinical and economic outcomes relative to a waitlisted control group. Methods/design A pragmatic, pre-post, two-group, multi-site, randomized controlled trial of the intervention will be conducted with a naturalistic follow-up at six months in the intervention group. The participants are recruited from the general population and are randomized to the intervention or a waitlist control group. The intervention is offered by community mental health centres. Included are people over 18 years of age with subthreshold or mild panic disorder, defined as having symptoms of PD falling below the cut-off of 13 on the Panic Disorder Severity Scale-Self Report (PDSS-SR. Primary outcomes are panic disorder and panic symptoms. Secondary outcomes are symptoms of agoraphobia, anxiety, cognitive aspects of panic disorder, depressive symptoms, mastery, health-related quality of life, and cost-effectiveness. We will examine the following variables as potential mediators: cognitive aspects of panic disorder, symptoms of agoraphobia, anxiety and mastery. Potential moderating variables are: socio-demographic characteristics, panic disorder, agoraphobia, treatment credibility and mastery. Discussion This study was designed to evaluate the (cost effectiveness of an

Cost-effectiveness of peer-delivered interventions for cocaine and alcohol abuse among women: a randomized controlled trial.

Directory of Open Access Journals (Sweden)

Jennifer Prah Ruger

Full Text Available To determine whether the additional interventions to standard care are cost-effective in addressing cocaine and alcohol abuse at 4 months (4 M and 12 months (12 M from baseline.We conducted a cost-effectiveness analysis of a randomized controlled trial with three arms: (1 NIDA's Standard intervention (SI; (2 SI plus a Well Woman Exam (WWE; and, (3 SI, WWE, plus four Educational Sessions (4ES.To obtain an additional cocaine abstainer, WWE compared to SI cost $7,223 at 4 M and $3,611 at 12 M. Per additional alcohol abstainer, WWE compared to SI cost $3,611 and $7,223 at 4 M and 12 M, respectively. At 12 M, 4ES was dominated (more costly and less effective by WWE for abstinence outcomes.To our knowledge, this is the first cost-effectiveness analysis simultaneously examining cocaine and alcohol abuse in women. Depending on primary outcomes sought and priorities of policy makers, peer-delivered interventions can be a cost-effective way to address the needs of this growing, underserved population.ClinicalTrials.gov NCT01235091.

Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial

DEFF Research Database (Denmark)

Søgaard, Rikke; Fischer, Barbara Malene B; Mortensen, Jann

2011-01-01

PURPOSE: Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effective......PURPOSE: Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost......-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC. METHODS: The study was conducted alongside an RCT in which 189 patients were allocated to conventional staging (n = 91) or conventional staging + PET/CT (n = 98......) and followed for 1 year after which the numbers of futile thoracotomies in each group were monitored. A full health care sector perspective was adapted for costing resource use. The outcome parameter was defined as the number needed to treat (NNT)-here number of PET/CT scans needed-to avoid one futile...

Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention.

Science.gov (United States)

Yamagishi, Kazumasa; Sato, Shinichi; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Tanigawa, Takeshi; Ohira, Tetsuya; Imano, Hironori; Kondo, Masahide; Okubo, Ichiro; Ishikawa, Yoshinori; Shimamoto, Takashi; Iso, Hiroyasu

2012-09-01

The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

Cost-effectiveness Analysis with Influence Diagrams.

Science.gov (United States)

Arias, M; Díez, F J

2015-01-01

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

A cost-effectiveness analysis of online, radio and print tobacco control advertisements targeting 25-39 year-old males.

Science.gov (United States)

Clayforth, Cassandra; Pettigrew, Simone; Mooney, Katie; Lansdorp-Vogelaar, Iris; Rosenberg, Michael; Slevin, Terry

2014-06-01

To assess the relative cost-effectiveness of various non-television advertising media in encouraging 25-39 year-old male smokers to respond to a cessation-related call to action. Information about how new electronic media compare in effectiveness is important to inform the implementation of future tobacco control media campaigns. Two testimonial advertisements featuring members of the target group were developed for radio, press and online media. Multiple waves of media activity were scheduled over a period of seven weeks, including an initial integrated period that included all three media and subsequent single media phases that were interspersed with a week of no media activity. The resulting Quit website hits, Quitline telephone calls, and registrations to online and telephone counselling services were compared to advertising costs to determine the relative cost-effectiveness of each media in isolation and the integrated approach. The online-only campaign phase was substantially more cost-effective than the other phases, including the integrated approach. This finding is contrary to the current assumption that the use of a consistent message across multiple media simultaneously is the most cost-effective way of reaching and affecting target audiences. Online advertising may be a highly cost-effective channel for low-budget tobacco control media campaigns. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

Advanced instrumentation and control techniques for nuclear power plants

International Nuclear Information System (INIS)

Hayakawa, Hiroyasu; Makino, Maomi

1989-01-01

Toshiba has been promoting the development and improvement of control and instrumentation (C and I) systems employing the latest technologies, to fulfill the requirements of nuclear power plants for increased reliability, the upgrading of functions, improved maintainability, and reasonable cost. Such development has been systematically performed based on a schematic view of integrated digital control and instrumentation systems, actively adopting state-of-the-art techniques such as the latest man-machine interfaces, digital and optical multiplexing techniques, and artificial intelligence. In addition, comprehensive feedback has been obtained from the accumulation of operating experience. This paper describes the purpose, contents and status of applications of representative newly-developed systems. (author)

Cost effectiveness of novel oral anticoagulants for stroke prevention in atrial fibrillation depending on the quality of warfarin anticoagulation control.

Science.gov (United States)

Janzic, Andrej; Kos, Mitja

2015-04-01

Vitamin K antagonists, such as warfarin, are standard treatments for stroke prophylaxis in patients with atrial fibrillation. Patient outcomes depend on quality of warfarin management, which includes regular monitoring and dose adjustments. Recently, novel oral anticoagulants (NOACs) that do not require regular monitoring offer an alternative to warfarin. The aim of this study was to evaluate whether cost effectiveness of NOACs for stroke prevention in atrial fibrillation depends on the quality of warfarin control. We developed a Markov decision model to simulate warfarin treatment outcomes in relation to the quality of anticoagulation control, expressed as percentage of time in the therapeutic range (TTR). Standard treatment with adjusted-dose warfarin and improved anticoagulation control by genotype-guided dosing were compared with dabigatran, rivaroxaban, apixaban and edoxaban. The analysis was performed from the Slovenian healthcare payer perspective using 2014 costs. In the base case, the incremental cost-effectiveness ratio for apixaban, dabigatran and edoxaban was below the threshold of €25,000 per quality-adjusted life-years compared with adjusted-dose warfarin with a TTR of 60%. The probability that warfarin was a cost-effective option was around 1%. This percentage rises as the quality of anticoagulation control improves. At a TTR of 70%, warfarin was the preferred treatment in half the iterations. The cost effectiveness of NOACs for stroke prevention in patients with nonvalvular atrial fibrillation who are at increased risk for stroke is highly sensitive to warfarin anticoagulation control. NOACs are more likely to be cost-effective options in settings with poor warfarin management than in settings with better anticoagulation control, where they may not represent good value for money.

Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.

Science.gov (United States)

Epps, H; Ginnelly, L; Utley, M; Southwood, T; Gallivan, S; Sculpher, M; Woo, P

2005-10-01

To compare the effects of combined hydrotherapy and land-based physiotherapy (combined) with land-based physiotherapy only (land) on cost, health-related quality of life (HRQoL) and outcome of disease in children with juvenile idiopathic arthritis (JIA). Also to determine the cost-effectiveness of combined hydrotherapy and land-based physiotherapy in JIA. A multicentre randomised controlled, partially blinded trial was designed with 100 patients in a control arm receiving land-based physiotherapy only (land group) and 100 patients in an intervention arm receiving a combination of hydrotherapy and land-based physiotherapy (combined group). Three tertiary centres in the UK. Patients aged 4-19 years diagnosed more than 3 months with idiopathic arthritides, onset before their 16th birthday, stable on medication with at least one active joint. Patients in the combined and land groups received 16 1-hour treatment sessions over 2 weeks followed by local physiotherapy attendances for 2 months. Disease improvement defined as a decrease of > or =30% in any three of six core set variables without there being a 30% increase in more than one of the remaining three variables was used as the primary outcome measure and assessed at 2 months following completion of intervention. Health services resource use (in- and outpatient care, GP visits, drugs, interventions, and investigations) and productivity costs (parents' time away from paid work) were collected at 6 months follow-up. HRQoL was measured at baseline and 2 and 6 months following intervention using the EQ-5D, and quality-adjusted life-years (QALYs) were calculated. Secondary outcome measures at 2 and 6 months included cardiovascular fitness, pain, isometric muscle strength and patient satisfaction. Seventy-eight patients were recruited into the trial and received treatment. Two months after intervention 47% patients in the combined group and 61% patients in the land group had improved disease with 11 and 5% with worsened

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

The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs.

Science.gov (United States)

Wurzelbacher, Steven J; Bertke, Stephen J; Lampl, Michael P; Bushnell, P Timothy; Meyers, Alysha R; Robins, David C; Al-Tarawneh, Ibraheem S

2014-12-01

This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. © 2014 Wiley Periodicals, Inc.

Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial

Science.gov (United States)

2014-01-01

Background This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education ‘booster’ sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, −0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, −1,415 to −128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes. Trial registration Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007). PMID:24927851

Cost effectiveness of radon mitigation in Canada

International Nuclear Information System (INIS)

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

1992-01-01

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

The clinical impact and cost-effectiveness of essential oils and aromatherapy for the treatment of acne vulgaris: a protocol for a randomized controlled trial.

Science.gov (United States)

Agnew, Tamara; Leach, Matthew; Segal, Leonie

2014-05-01

Acne is a prevalent, chronic, and sometimes severe skin disorder affecting an estimated 85% of adolescents and 50% of adults older than age 20 years. The psychosocial implications of acne can be considerable, often continuing long after physical symptoms resolve. Although effective acne medications are available, most exhibit adverse-effect profiles that can leave the patient with few effective treatment options. Emerging evidence indicates that plant-derived essential oils may be a biologically plausible treatment for acne, although high-quality evidence of effectiveness and safety is lacking. To examine the clinical effectiveness and cost-effectiveness of essential oils and aromatherapy for the treatment of acne. This randomized, wait-list controlled trial will have three parallel groups; 192 participants with acne vulgaris, aged 16-45 years, will be recruited primarily through eight Technical and Further Education campuses across Adelaide, South Australia. Participants will be randomly assigned to standard essential oil blend, customized aromatherapy treatment, or wait-list control. Changes in the physical and psychosocial symptoms of acne will be assessed at baseline and 6 and 12 weeks by using the Leeds Acne Grading System, Assessment of Quality of Life-8 Dimension instrument, and Acne-Specific Quality of Life instrument. Costs of treatment will be measured on the basis of resource inputs and unit costs and will be limited to acne treatment. The clinical effectiveness and cost-effectiveness will be compared between each intervention and against usual care, using standard health economic techniques. The provision of high-quality evidence of the effectiveness of essential oils and aromatherapy in the treatment of acne may help consumers make better-informed choices about acne management. Insights gained from this research will also contribute to the academic field of complementary medicine, specifically aromatherapy, for which the evidence base is extremely

Characterization of controlled bone defects using 2D and 3D ultrasound imaging techniques

Energy Technology Data Exchange (ETDEWEB)

Parmar, Biren J; Longsine, Whitney; Han, Arum; Righetti, Raffaella [Department of Electrical and Computer Engineering, Dwight Look College of Engineering, Texas A and M University, College Station, TX (United States); Sabonghy, Eric P [OneOrtho Orthopedic Surgery Clinic, Houston, TX (United States); Tasciotti, Ennio; Ferrari, Mauro [Department of Nanomedicine and Biomedical Engineering, University of Texas Health Science Center at Houston, Houston, TX (United States); Weiner, Bradley K, E-mail: righetti@ece.tamu.ed [Division of Spinal Surgery, Department of Orthopaedic Surgery, Methodist Hospital, Houston, TX 77030 (United States)

2010-08-21

Ultrasound is emerging as an attractive alternative modality to standard x-ray and CT methods for bone assessment applications. As of today, however, there is a lack of systematic studies that investigate the performance of diagnostic ultrasound techniques in bone imaging applications. This study aims at understanding the performance limitations of new ultrasound techniques for imaging bones in controlled experiments in vitro. Experiments are performed on samples of mammalian and non-mammalian bones with controlled defects with size ranging from 400 {mu}m to 5 mm. Ultrasound findings are statistically compared with those obtained from the same samples using standard x-ray imaging modalities and optical microscopy. The results of this study demonstrate that it is feasible to use diagnostic ultrasound imaging techniques to assess sub-millimeter bone defects in real time and with high accuracy and precision. These results also demonstrate that ultrasound imaging techniques perform comparably better than x-ray imaging and optical imaging methods, in the assessment of a wide range of controlled defects both in mammalian and non-mammalian bones. In the future, ultrasound imaging techniques might provide a cost-effective, real-time, safe and portable diagnostic tool for bone imaging applications.

Exercise, Manual Therapy, and Booster Sessions in Knee Osteoarthritis: Cost-Effectiveness Analysis From a Multicenter Randomized Controlled Trial.

Science.gov (United States)

Bove, Allyn M; Smith, Kenneth J; Bise, Christopher G; Fritz, Julie M; Childs, John; Brennan, Gerard P; Abbott, J Haxby; Fitzgerald, G Kelley

2018-01-01

Limited information exists regarding the cost-effectiveness of rehabilitation strategies for individuals with knee osteoarthritis (OA). The study objective was to compare the cost-effectiveness of 4 different combinations of exercise, manual therapy, and booster sessions for individuals with knee OA. This economic evaluation involved a cost-effectiveness analysis performed alongside a multicenter randomized controlled trial. The study took place in Pittsburgh, Pennsylvania; Salt Lake City, Utah; and San Antonio, Texas. The study participants were 300 individuals taking part in a randomized controlled trial investigating various physical therapy strategies for knee OA. Participants were randomized into 4 treatment groups: exercise only (EX), exercise plus booster sessions (EX+B), exercise plus manual therapy (EX+MT), and exercise plus manual therapy and booster sessions (EX+MT+B). For the 2-year base case scenario, a Markov model was constructed using the United States societal perspective and a 3% discount rate for costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated to compare differences in cost per QALY gained among the 4 treatment strategies. In the 2-year analysis, booster strategies (EX+MT+B and EX+B) dominated no-booster strategies, with both lower health care costs and greater effectiveness. EX+MT+B had the lowest total health care costs. EX+B cost ${\\$}$1061 more and gained 0.082 more QALYs than EX+MT+B, for an incremental cost-effectiveness ratio of ${\\$}$12,900/QALY gained. The small number of total knee arthroplasty surgeries received by individuals in this study made the assessment of whether any particular strategy was more successful at delaying or preventing surgery in individuals with knee OA difficult. Spacing exercise-based physical therapy sessions over 12 months using periodic booster sessions was less costly and more effective over 2 years than strategies not containing booster sessions for

Regional disparity and cost-effective SO2 pollution control in China: A case study in 5 mega-cities

International Nuclear Information System (INIS)

Kanada, Momoe; Dong, Liang; Fujita, Tsuyoshi; Fujii, Minoru; Inoue, Tsuyoshi; Hirano, Yujiro; Togawa, Takuya; Geng, Yong

2013-01-01

With rapid development, increasing sulfur dioxide (SO 2 ) emission becomes a key environmental issue in China. To respond to this challenge, the Chinese government established a top-down scheme to reduce its SO 2 emissions. However, regional disparity and the associated cost differences brought uncertainties to the policy effectiveness and efficiency. Few studies focus on this field. Therefore, this study tries to fill such a gap by investigating the differences of SO 2 emissions, reduction potential, and cost-effectiveness through use of the GAINS-China model in five mega-cities in China, namely, Beijing, Shanghai, Tianjin, Chongqing, and Hong Kong. A scenario analysis approach is employed, focusing on two technologies named flue gas desulfurization (FGD) and limestone injection (LINJ). Results demonstrated that a large SO 2 reduction potential exists, as well as a great disparity, among the five mega-cities. Chongqing had the largest reduction potential with lowest unit cost, while Beijng and Hong Kong showed the lowest reduction potential with higher unit cost. In Beijing and Shanghai, FGD and LINJ in the power generation sector had the larger reduction potential with the highest cost-effectiveness. However, in Chongqing, the industry sectors also had large reduction potentials. Finally, appropriate SO 2 control strategies and policies are raised by considering the local realities. - Highlights: • The cost-effectiveness of SO 2 control policy was analyzed in five mega-cities in China. • Reduction potential and cost-effectiveness were closely linked to regional disparity. • Beijing and Hong Kong showed lower reduction potential and higher marginal reduction cost. • Chongqing showed the largest reduction potential and the lowest marginal reduction cost

Cost effectiveness methodology for evaluating Korean international communication system alternatives.

OpenAIRE

Hwang, Tae Kyun.

1987-01-01

Approved for public release; distribution in unlimited. Cost and Effectiveness models are developed by using of cost-effectiveness technique for fiber optic cable and satellite communication media. The models are applied to the Korean international communication problem. Alternative selection is required since the two medias different in cost and effectiveness. The major difficulties encountered were data gathering and measuring the effectiveness of the Korean international ...

Cost-Effectiveness of Nicotine Patches for Smoking Cessation in Pregnancy: A Placebo Randomized Controlled Trial (SNAP).

Science.gov (United States)

Essex, Holly N; Parrott, Steve; Wu, Qi; Li, Jinshuo; Cooper, Sue; Coleman, Tim

2015-06-01

Smoking during pregnancy is the most important, preventable cause of adverse pregnancy outcomes including miscarriage, premature birth, and low birth weight with huge financial costs to the National Health Service. However, there are very few published economic evaluations of smoking cessation interventions in pregnancy and previous studies are predominantly U.S.-based and do not present incremental cost-effectiveness ratios (ICER). A number of studies have demonstrated cost-effectiveness of nicotine replacement therapy (NRT) in the general population, but this has yet to be tested among pregnant smokers. A cost-effectiveness analysis was undertaken alongside the smoking, nicotine, and pregnancy trial to compare NRT patches plus behavioral support to behavioral support alone, for pregnant women who smoked. At delivery, biochemically verified quit rates were slightly higher at 9.4% in the NRT group compared to 7.6% in the control group (odds ratio = 1.26, 95% CI = 0.82-1.96), at an increased cost of around £90 per participant. Higher costs in the NRT group were mainly attributable to the cost of NRT patches (mean = £46.07). The incremental cost-effectiveness ratio associated with NRT was £4,926 per quitter and a sensitivity analysis including only singleton births yielded an ICER of £4,156 per quitter. However, wide confidence intervals indicated a high level of uncertainty. Without a specific willingness to pay threshold, and due to high levels of statistical uncertainty, it is hard to determine the cost-effectiveness of NRT in this population. Furthermore, future research should address compliance issues, as these may dilute any potential effects of NRT, thus reducing the cost-effectiveness. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Second-Order Harmonic Reduction Technique for Photovoltaic Power Conditioning Systems Using a Proportional-Resonant Controller

Directory of Open Access Journals (Sweden)

Hae-Gwang Jeong

2013-01-01

Full Text Available This paper proposes a second-order harmonic reduction technique using a proportional-resonant (PR controller for a photovoltaic (PV power conditioning system (PCS. In a grid-connected single-phase system, inverters create a second-order harmonic at twice the fundamental frequency. A ripple component unsettles the operating points of the PV array and deteriorates the operation of the maximum power point tracking (MPPT technique. The second-order harmonic component in PV PCS is analyzed using an equivalent circuit of the DC/DC converter and the DC/AC inverter. A new feed-forward compensation technique using a PR controller for ripple reduction is proposed. The proposed algorithm is advantageous in that additional devices are not required and complex calculations are unnecessary. Therefore, this method is cost-effective and simple to implement. The proposed feed-forward compensation technique is verified by simulation and experimental results.

In Situ Object Counting System (ISOCS) Technique: Cost-Effective Tool for NDA Verification in IAEA Safeguards

International Nuclear Information System (INIS)

Braverman, E.; Lebrun, A.; Nizhnik, V.; Rorif, F.

2010-01-01

Uranium materials measurements using the ISOCS technique play an increasing role in IAEA verification activities. This methodology provides high uranium/plutonium sensitivity and a low detection limit together with the capability to measure items with different shapes and sizes. In addition, the numerical absolute efficiency calibration of a germanium detector which is used by the technique does not require any calibration standards or reference materials. ISOCS modelling software allows performing absolute efficiency calibration for items of arbitrary container shape and wall material, matrix chemical composition, material fill-height, uranium or plutonium weight fraction inside the matrix and even nuclear material/matrix non-homogeneous distribution. Furthermore, in a number of cases, some key parameters such as matrix density and U/Pu weight fraction can be determined along with analysis of nuclear material mass and isotopic composition. These capabilities provide a verification solution suitable for a majority of cases where quantitative and isotopic analysis should be performed. Today, the basic tool for uranium and plutonium mass measurement used in Safeguards verification activities is the neutron counting technique which employs neutron coincidence and multiplicity counters. In respect to the neutron counting technique, ISOCS calibrated detectors have relatively low cost. Taking into account its advantages, this methodology becomes a cost-effective solution for nuclear material NDA verification. At present, the Agency uses ISOCS for quantitative analysis in a wide range of applications: - Uranium scrap materials; - Uranium contaminated solid wastes; - Uranium fuel elements; - Some specific verification cases like measurement of Pu-Be neutron sources, quantification of fission products in solid wastes etc. For uranium hold-up measurements, ISOCS the only available methodology for quantitative and isotopic composition analysis of nuclear materials deposited

Multiagent based Distributed Control for Operation Cost Minimization of Droop Controlled AC Microgrid Using Incremental Cost Consensus

DEFF Research Database (Denmark)

Li, Chendan; Firoozabadi, Mehdi Savaghebi; Quintero, Juan Carlos Vasquez

2015-01-01

sharing based on the power rating. With various types of distributed generator (DG) units in the system, factors that closely related to the operation cost, such as fuel cost and efficiencies of the generator should be taken into account in order to improve the efficiency of the whole system....... In this paper, a multiagent based distributed method is proposed to minimize operation cost of the AC microgrid. Each DG is acting as an agent which regulates the power individually using proposed frequency scheduling method. Optimal power command is obtained through carefully designed consensus algorithm...... with only light communication between neighboring agents. Case studies verified that the proposed control strategy can effectively reduce the operation cost....

Diazo processing of LANDSAT imagery: A low-cost instructional technique

Science.gov (United States)

Lusch, D. P.

1981-01-01

Diazo processing of LANDSAT imagery is a relatively simple and cost effective method of producing enhanced renditions of the visual LANDSAT products. This technique is capable of producing a variety of image enhancements which have value in a teaching laboratory environment. Additionally, with the appropriate equipment, applications research which relys on accurate and repeatable results is possible. Exposure and development equipment options, diazo materials, and enhancement routines are discussed.

Environmental control costs for oil shale processes

Energy Technology Data Exchange (ETDEWEB)

None

1979-10-01

The studies reported herein are intended to provide more certainty regarding estimates of the costs of controlling environmental residuals from oil shale technologies being readied for commercial application. The need for this study was evident from earlier work conducted by the Office of Environment for the Department of Energy Oil Shale Commercialization Planning, Environmental Readiness Assessment in mid-1978. At that time there was little reliable information on the costs for controlling residuals and for safe handling of wastes from oil shale processes. The uncertainties in estimating costs of complying with yet-to-be-defined environmental standards and regulations for oil shale facilities are a critical element that will affect the decision on proceeding with shale oil production. Until the regulatory requirements are fully clarified and processes and controls are investigated and tested in units of larger size, it will not be possible to provide definitive answers to the cost question. Thus, the objective of this work was to establish ranges of possible control costs per barrel of shale oil produced, reflecting various regulatory, technical, and financing assumptions. Two separate reports make up the bulk of this document. One report, prepared by the Denver Research Institute, is a relatively rigorous engineering treatment of the subject, based on regulatory assumptions and technical judgements as to best available control technologies and practices. The other report examines the incremental cost effect of more conservative technical and financing alternatives. An overview section is included that synthesizes the products of the separate studies and addresses two variations to the assumptions.

Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

NARCIS (Netherlands)

Tjon-Kon-Fat, R. I.; Bensdorp, A. J.; Bossuyt, P. M. M.; Koks, C.; Oosterhuis, G. J. E.; Hoek, A.; Hompes, P.; Broekmans, F. J.; Verhoeve, H. R.; de Bruin, J. P.; van Golde, R.; Repping, S.; Cohlen, B. J.; Lambers, M. D. A.; van Bommel, P. F.; Slappendel, E.; Perquin, D.; Smeenk, J.; Pelinck, M. J.; Gianotten, J.; Hoozemans, D. A.; Maas, J. W. M.; Groen, H.; Eijkemans, M. J. C.; van der Veen, F.; Mol, B. W. J.; van Wely, M.

2015-01-01

STUDY QUESTION: What is the cost-effectiveness of in vitro fertilization(IVF) with conventional ovarian stimulation, single embryotransfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation

Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

NARCIS (Netherlands)

Tjon-Kon-Fat, R. I.; Bensdorp, A. J.; Bossuyt, P. M M; Koks, C.; Oosterhuis, G. J E; Hoek, A.; Hompes, P.; Broekmans, F. J.; Verhoeve, H. R.; De Bruin, J. P.; Van Golde, R.; Repping, S.; Cohlen, B. J.; Lambers, M. D A; Van Bommel, P. F.; Slappendel, E.; Perquin, D.; Smeenk, J.; Pelinck, M. J.; Gianotten, J.; Hoozemans, D. A.; Maas, J. W M; Groen, H.; Eijkemans, M. J C; Van Der Veen, F.; Mol, B. W J; Van Wely, M.

2015-01-01

STUDY QUESTION What is the cost-effectiveness of in vitro fertilization (IVF) with conventional ovarian stimulation, single embryo transfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation

Cost-Effectiveness of a Model Infection Control Program for Preventing Multi-Drug-Resistant Organism Infections in Critically Ill Surgical Patients.

Science.gov (United States)

Jayaraman, Sudha P; Jiang, Yushan; Resch, Stephen; Askari, Reza; Klompas, Michael

2016-10-01

Interventions to contain two multi-drug-resistant Acinetobacter (MDRA) outbreaks reduced the incidence of multi-drug-resistant (MDR) organisms, specifically methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile in the general surgery intensive care unit (ICU) of our hospital. We therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of MDR organisms based on the practices used to control the MDRA outbreak. We created a model of a proactive infection control program based on the 2011 MDRA outbreak response. We built a decision analysis model and performed univariable and probabilistic sensitivity analyses to evaluate the cost-effectiveness of the proposed program compared with standard infection control practices to reduce transmission of these MDR organisms. The cost of a proactive infection control program would be $68,509 per year. The incremental cost-effectiveness ratio (ICER) was calculated to be $3,804 per aversion of transmission of MDR organisms in a one-year period compared with standard infection control. On the basis of probabilistic sensitivity analysis, a willingness-to-pay (WTP) threshold of $14,000 per transmission averted would have a 42% probability of being cost-effective, rising to 100% at $22,000 per transmission averted. This analysis gives an estimated ICER for implementing a proactive program to prevent transmission of MDR organisms in the general surgery ICU. To better understand the causal relations between the critical steps in the program and the rate reductions, a randomized study of a package of interventions to prevent healthcare-associated infections should be considered.

Rate-cost tradeoffs in control

KAUST Repository

Kostina, Victoria

2017-02-13

Consider a distributed control problem with a communication channel connecting the observer of a linear stochastic system to the controller. The goal of the controller is minimize a quadratic cost function. The most basic special case of that cost function is the mean-square deviation of the system state from the desired state. We study the fundamental tradeoff between the communication rate r bits/sec and the limsup of the expected cost b, and show a lower bound on the rate necessary to attain b. The bound applies as long as the system noise has a probability density function. If target cost b is not too large, that bound can be closely approached by a simple lattice quantization scheme that only quantizes the innovation, that is, the difference between the controller\\'s belief about the current state and the true state.

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus

Directory of Open Access Journals (Sweden)

Alireza Ahmadi

2014-01-01

Full Text Available BACKGROUND: Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA. Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. METHODS: In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. RESULTS: There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090. The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001. This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031. PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$ or with Nit-Occlud coils (PFM (912.73 ± 565.94 US$, P < 0.001 was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650 had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths

Techniques for cost-effective electric information sharing; Cost balance wo koryoshita denshi joho kyoyuka gijutsu

Energy Technology Data Exchange (ETDEWEB)

Shinohara, Y. [Central Research Institute of Electric Power Industry, Tokyo (Japan)

1997-04-01

The key technology that can effectively support the sharing of each information such as documents, data, and know-how was rearranged to clarify how to utilize it for constructing an electronic information sharing system. The key technology that supports the sharing of electronic information was rearranged from the viewpoint of information gathering, information rearrangement, and information utilization. The reduction in cost for information gathering and rearrangement is indispensable to the promotion of much information sharing. However, each automation method presently causes the deterioration in quality of the rearranged information and the increase in cost for information utilization. To realize a practical electronic information sharing system, it is important to combine the key technologies properly so that the total cost balance of information gathering and information utilization is improved. Therefore, the combination of character recognition by OCR and unpreciseness retrieval, and the complementary combination of automatic document sorting, based on multiple incomplete rearrangement systems, and multiple sorting menus were proposed. 23 refs., 5 figs., 2 tabs.

Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.

Science.gov (United States)

Cochrane, T; Davey, R C; Matthes Edwards, S M

2005-08-01

To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis (OA) in older patients. A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment, to check design assumptions and delivery processes. The main study was a randomised controlled trial of the effectiveness of water-based exercise (treatment) compared with usual care (control) in older patients with hip and/or knee OA. The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments. Water exercise was delivered in public swimming pools in the UK. Physical function assessments were carried out in established laboratory settings. 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA took part in the preliminary study. A similar, but larger, group of 312 patients (196 women, 116 men) took part in the main study, randomised into control (159) and water exercise (153) groups. Control group patients received usual care with quarterly semi-structured telephone interview follow-up only. The intervention in the main study lasted for 1 year, with a further follow-up period of 6 months. Pain score on the Western Ontario and McMaster Universities OA index (WOMAC). Additional outcome measures were included to evaluate effects on quality of life, cost-effectiveness and physical function measurements. Short-term efficacy of water exercise in the management of lower limb OA was confirmed, with effect sizes ranging from 0.44 [95% confidence interval (CI) 0.03 to 0.85] on WOMAC pain to 0.76 (95% CI 0.33 to 1.17) on WOMAC physical function. Of 153 patients randomised to treatment, 82 (53.5%) were estimated to have complied satisfactorily with their treatment at the 1-year point. This had declined to 28 (18%) by the end of the 6-month follow-up period, during which support for the intervention had been removed and those wishing to continue

Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

NARCIS (Netherlands)

Tjon-Kon-Fat, R. I.; Bensdorp, A. J.; Bossuyt, P. M. M.; Koks, C.; Oosterhuis, G. J. E.; Hoek, A.; Hompes, P.; Broekmans, F. J.; Verhoeve, H. R.; de Bruin, J. P.; van Golde, R.; Repping, S.; Cohlen, B. J.; Lambers, M. D. A.; van Bommel, P. F.; Slappendel, E.; Perquin, D.; Smeenk, J.; Pelinck, M. J.; Gianotten, J.; Hoozemans, D. A.; Maas, J. W. M.; Groen, H.; Eijkemans, M. J. C.; van der Veen, F.; Mol, B. W. J.; van Wely, M.

2015-01-01

What is the cost-effectiveness of in vitro fertilization (IVF) with conventional ovarian stimulation, single embryo transfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) as a

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

Directory of Open Access Journals (Sweden)

Joakim Ramsberg

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

The effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial.

Science.gov (United States)

Kuyken, Willem; Nuthall, Elizabeth; Byford, Sarah; Crane, Catherine; Dalgleish, Tim; Ford, Tamsin; Greenberg, Mark T; Ukoumunne, Obioha C; Viner, Russell M; Williams, J Mark G

2017-04-26

Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness or cost-effectiveness for young people. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of a mindfulness training (MT) programme to enhance mental health, wellbeing and social-emotional behavioural functioning in adolescence. To address this aim, the design will be a superiority, cluster randomised controlled, parallel-group trial in which schools offering social and emotional provision in line with good practice (Formby et al., Personal, Social, Health and Economic (PSHE) Education: A mapping study of the prevalent models of delivery and their effectiveness, 2010; OFSTED, Not Yet Good Enough: Personal, Social, Health and Economic Education in schools, 2013) will be randomised to either continue this provision (control) or include MT in this provision (intervention). The study will recruit and randomise 76 schools (clusters) and 5700 school students aged 12 to 14 years, followed up for 2 years. The study will contribute to establishing if MT is an effective and cost-effective approach to promoting mental health in adolescence. International Standard Randomised Controlled Trials, identifier: ISRCTN86619085 . Registered on 3 June 2016.

The cost-effectiveness analysis of JinQi Jiangtang tablets for the treatment on prediabetes: a randomized, double-blind, placebo-controlled, multicenter design.

Science.gov (United States)

Sun, Xiao; Guo, Liping; Shang, Hongcai; Ren, Ming; Wang, Yue; Huo, Da; Lei, Xiang; Wang, Hui; Zhai, Jingbo

2015-11-03

At present, diabetes is a chronic disease of great cost and heavy burdens. The International Diabetes Federation has repeatedly warned that by 2025, the global number of diabetics would rise to 333 million from 194 million in 2003. Although the occurrence of diabetes in developing countries is lower, China has a large population, so that the number of cases is increased. At the same time, more people have prediabetes, a growing health concern where a large percentage of the patients develop full type 2 diabetes. In addition, the patients of diabetes easily incur complications such as blindness, kidney failure, and cardiovascular diseases that can seriously affect the patients' quality of life and cause great economic burdens to family and society. Therefore, effective interventions for prediabetes are needed to prevent or delay the occurrence and development of diabetes. A randomized controlled trial that was assessed with pharmacoeconomic methods was undertaken in this study. The study term was 24 months (12 months for the intervention and 12 months for follow up). Four hundred participants, recruited from four cities in China: Beijing, Tianjin, Xian, and Naning, were randomized to the treatment group (JQJT tablets) and the control group (placebo). Participants included in this study had been diagnosed with prediabetes according to the criteria for western medicine and Traditional Chinese Medicine (TCM). The end-point effectiveness indexes included the incidence of diabetes and the reversion rate. The drug costs and lifestyle intervention costs were included in the total costs. The study used the cost-effectiveness analysis to discuss the economic advantage of the JQJT tablets. The outcomes of the study contained 2 sections,namely clinical outcomes and cost-effectiveness analysis outcomes. The clinical outcomes: the treatment group and control group had no significant statistical difference P> 0.05) on the baseline of situation; Jinqi Jiangtang tablet effectively

Cost Estimation and Control for Flight Systems

Science.gov (United States)

Hammond, Walter E.; Vanhook, Michael E. (Technical Monitor)

2002-01-01

Good program management practices, cost analysis, cost estimation, and cost control for aerospace flight systems are interrelated and depend upon each other. The best cost control process cannot overcome poor design or poor systems trades that lead to the wrong approach. The project needs robust Technical, Schedule, Cost, Risk, and Cost Risk practices before it can incorporate adequate Cost Control. Cost analysis both precedes and follows cost estimation -- the two are closely coupled with each other and with Risk analysis. Parametric cost estimating relationships and computerized models are most often used. NASA has learned some valuable lessons in controlling cost problems, and recommends use of a summary Project Manager's checklist as shown here.

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

Science.gov (United States)

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

2014-01-01

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

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

International Nuclear Information System (INIS)

Jiránek, Martin; Rovenská, Kateřina

2010-01-01

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

Variance analysis refines overhead cost control.

Science.gov (United States)

Cooper, J C; Suver, J D

1992-02-01

Many healthcare organizations may not fully realize the benefits of standard cost accounting techniques because they fail to routinely report volume variances in their internal reports. If overhead allocation is routinely reported on internal reports, managers can determine whether billing remains current or lost charges occur. Healthcare organizations' use of standard costing techniques can lead to more realistic performance measurements and information system improvements that alert management to losses from unrecovered overhead in time for corrective action.

Quality upgrading and cost reducing effects of using an operation control system for performance of maintenance tasks

International Nuclear Information System (INIS)

Ramler, K.

1996-01-01

According to available results, the use of an operation control system has come up to expections with respect to a quality enhancement of maintenance work. The tasks are performed more safely and there is more insight into the processes. so that, as indirect results, cost savings and rationalisation effects are to be expected. However, the cost savings achieved through the operation control system for maintenance tasks will remain modest. The truly cost-effective optimisation potentials in the maintenance area primarily consist in a reduction of preventive measures to the required scope, i.e reduction of the envisaged quantity of processes for maintenance and recurrent inspection. In order to extend savings to the organisational level, with respect to personnel expenditure, by DP supported maintenance planning, a suitable optimisation of the organisational structure and personnel employment is inevitable, because otherwise the rationalisation potentials will remain utopia. (orig.) [de

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus.

Science.gov (United States)

Ahmadi, Alireza; Sabri, Mohammadreza; Bigdelian, Hamid; Dehghan, Bahar; Gharipour, Mojgan

2014-01-01

Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including

Cost-Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines

Energy Technology Data Exchange (ETDEWEB)

Kirby S. Chapman; Sarah R. Nuss-Warren

2007-02-01

The objective of this project is to identify, develop, test, and commercialize emissions control and monitoring technologies that can be implemented by exploration and production (E&P) operators to significantly lower the cost of environmental compliance and expedite project permitting. The project team takes considerable advantage of the emissions control research and development efforts and practices that have been underway in the gas pipeline industry for the last 12 years. These efforts and practices are expected to closely interface with the E&P industry to develop cost-effective options that apply to widely-used field and gathering engines, and which can be readily commercialized. The project is separated into two phases. Phase 1 work establishes an E&P industry liaison group, develops a frequency distribution of installed E&P field engines, and identifies and assesses commercially available and emerging engine emissions control and monitoring technologies. Current and expected E&P engine emissions and monitoring requirements are reviewed, and priority technologies are identified for further development. The identified promising technologies are tested on a laboratory engine to confirm their generic viability. In addition, a full-scale field test of prototype emissions controls will be conducted on at least ten representative field engine models with challenging emissions profiles. Emissions monitoring systems that are integrated with existing controls packages will be developed. Technology transfer/commercialization is expected to be implemented through compressor fleet leasing operators, engine component suppliers, the industry liaison group, and the Petroleum Technology Transfer Council. This topical report discusses work completed during Phase 1 of the project Cost Effective Reciprocating Engine Emissions Control and Monitoring for E&P Field and Gathering Engines. In this report information, data, and results are compiled and summarized from quarterly

Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: a single-blind randomized controlled trial.

Science.gov (United States)

Basheti, Iman A; Obeidat, Nathir M; Reddel, Helen K

2017-02-09

Inhaler technique can be corrected with training, but skills drop off quickly without repeated training. The aim of our study was to explore the effect of novel inhaler technique labels on the retention of correct inhaler technique. In this single-blind randomized parallel-group active-controlled study, clinical pharmacists enrolled asthma patients using controller medication by Accuhaler [Diskus] or Turbuhaler. Inhaler technique was assessed using published checklists (score 0-9). Symptom control was assessed by asthma control test. Patients were randomized into active (ACCa; THa) and control (ACCc; THc) groups. All patients received a "Show-and-Tell" inhaler technique counseling service. Active patients also received inhaler labels highlighting their initial errors. Baseline data were available for 95 patients, 68% females, mean age 44.9 (SD 15.2) years. Mean inhaler scores were ACCa:5.3 ± 1.0; THa:4.7 ± 0.9, ACCc:5.5 ± 1.1; THc:4.2 ± 1.0. Asthma was poorly controlled (mean ACT scores ACCa:13.9 ± 4.3; THa:12.1 ± 3.9; ACCc:12.7 ± 3.3; THc:14.3 ± 3.7). After training, all patients had correct technique (score 9/9). After 3 months, there was significantly less decline in inhaler technique scores for active than control groups (mean difference: Accuhaler -1.04 (95% confidence interval -1.92, -0.16, P = 0.022); Turbuhaler -1.61 (-2.63, -0.59, P = 0.003). Symptom control improved significantly, with no significant difference between active and control patients, but active patients used less reliever medication (active 2.19 (SD 1.78) vs. control 3.42 (1.83) puffs/day, P = 0.002). After inhaler training, novel inhaler technique labels improve retention of correct inhaler technique skills with dry powder inhalers. Inhaler technique labels represent a simple, scalable intervention that has the potential to extend the benefit of inhaler training on asthma outcomes. REMINDER LABELS IMPROVE INHALER TECHNIQUE: Personalized

Cost of malaria control in Sri Lanka

DEFF Research Database (Denmark)

Konradsen, F; Steele, P; Perera, D

1999-01-01

The study provides estimates of the cost of various malaria control measures in an area of North-Central Province of Sri Lanka where the disease is endemic. We assumed that each measure was equally effective. In these terms, impregnating privately purchased bednets with insecticide was estimated...... to cost Rs 48 (US(40.87) per individual protected per year, less than half the cost of spraying houses with residual insecticides. Larviciding of vector breeding sites and especially the elimination of breeding habitats by flushing streams through seasonal release of water from upstream reservoirs...

Neutron radiography activity in the european program cost 524: Neutron imaging techniques

International Nuclear Information System (INIS)

Chirco, P.; Bach, P.; Lehmann, E.; Balasko, M.

2001-01-01

COST is a framework for scientific and technical cooperation, allowing the coordination of national research on a European level, including 32 member countries. Participation of institutes from non-COST countries is possible. From an initial 7 Actions in 1971, COST has grown to 200 Actions at the beginning of 2000. COST Action 524 is under materials domain, the title of which being 'Neutron Imaging Techniques for the Detection of Defects in Materials', under the Chairmanship of Dr. P. Chirco (I.N.F.N.). The following countries are represented in the Management Committee of Action 524: Italy, France, Austria, Germany, United Kingdom, Hungary, Switzerland, Spain, Czech Republic, Slovenia, and Russia. The six working groups of this Action are working respectively on standardization of neutron radiography techniques, on aerospace application, on civil engineering applications, on comparison and integration of neutron imaging techniques with other NDT, on neutron tomography, and on non radiographic techniques such as neutron scattering techniques. A specific effort is devoted to standardization issues, with respect to other non European standards. Results of work performed in the COST frame are published or will be published in the review INSIGHT, edited by the British Institute of Non Destructive Testing

Comparative cost assessment of the Kato-Katz and FLOTAC techniques for soil-transmitted helminth diagnosis in epidemiological surveys

Directory of Open Access Journals (Sweden)

Speich Benjamin

2010-08-01

Full Text Available Abstract Background The Kato-Katz technique is widely used for the diagnosis of soil-transmitted helminthiasis in epidemiological surveys and is believed to be an inexpensive method. The FLOTAC technique shows a higher sensitivity for the diagnosis of light-intensity soil-transmitted helminth infections but is reported to be more complex and expensive. We assessed the costs related to the collection, processing and microscopic examination of stool samples using the Kato-Katz and FLOTAC techniques in an epidemiological survey carried out in Zanzibar, Tanzania. Methods We measured the time for the collection of a single stool specimen in the field, transfer to a laboratory, preparation and microscopic examination using standard protocols for the Kato-Katz and FLOTAC techniques. Salaries of health workers, life expectancy and asset costs of materials, and infrastructure costs were determined. The average cost for a single or duplicate Kato-Katz thick smears and the FLOTAC dual or double technique were calculated. Results The average time needed to collect a stool specimen and perform a single or duplicate Kato-Katz thick smears or the FLOTAC dual or double technique was 20 min and 34 sec (20:34 min, 27:21 min, 28:14 min and 36:44 min, respectively. The total costs for a single and duplicate Kato-Katz thick smears were US$ 1.73 and US$ 2.06, respectively, and for the FLOTAC double and dual technique US$ 2.35 and US$ 2.83, respectively. Salaries impacted most on the total costs of either method. Conclusions The time and cost for soil-transmitted helminth diagnosis using either the Kato-Katz or FLOTAC method in epidemiological surveys are considerable. Our results can help to guide healthcare decision makers and scientists in budget planning and funding for epidemiological surveys, anthelminthic drug efficacy trials and monitoring of control interventions.

Integration of quality improvement and cost-efficiency through industrial improvement techniques

Directory of Open Access Journals (Sweden)

Vink JP

2016-06-01

Full Text Available Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

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.

Control and Effort Costs Influence the Motivational Consequences of Choice

Directory of Open Access Journals (Sweden)

Holly Sullivan-Toole

2017-05-01

Full Text Available The act of making a choice, apart from any outcomes the choice may yield, has, paradoxically, been linked to both the enhancement and the detriment of intrinsic motivation. Research has implicated two factors in potentially mediating these contradictory effects: the personal control conferred by a choice and the costs associated with a choice. Across four experiments, utilizing a physical effort task disguised as a simple video game, we systematically varied costs across two levels of physical effort requirements (Low-Requirement, High-Requirement and control over effort costs across three levels of choice (Free-Choice, Restricted-Choice, and No-Choice to disambiguate how these factors affect the motivational consequences of choosing within an effortful task. Together, our results indicated that, in the face of effort requirements, illusory control alone may not sufficiently enhance perceptions of personal control to boost intrinsic motivation; rather, the experience of actual control may be necessary to overcome effort costs and elevate performance. Additionally, we demonstrated that conditions of illusory control, while otherwise unmotivating, can through association with the experience of free-choice, be transformed to have a positive effect on motivation.

Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

Science.gov (United States)

Tjon-Kon-Fat, R I; Bensdorp, A J; Bossuyt, P M M; Koks, C; Oosterhuis, G J E; Hoek, A; Hompes, P; Broekmans, F J; Verhoeve, H R; de Bruin, J P; van Golde, R; Repping, S; Cohlen, B J; Lambers, M D A; van Bommel, P F; Slappendel, E; Perquin, D; Smeenk, J; Pelinck, M J; Gianotten, J; Hoozemans, D A; Maas, J W M; Groen, H; Eijkemans, M J C; van der Veen, F; Mol, B W J; van Wely, M

2015-10-01

What is the cost-effectiveness of in vitro fertilization (IVF) with conventional ovarian stimulation, single embryo transfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) as a first-line treatment in couples with unexplained subfertility and an unfavourable prognosis on natural conception?. Both IVF strategies are significantly more expensive when compared with IUI-COH, without being significantly more effective. In the comparison between IVF-MNC and IUI-COH, the latter is the dominant strategy. Whether IVF-SET is cost-effective depends on society's willingness to pay for an additional healthy child. IUI-COH and IVF, either after conventional ovarian stimulation or in a MNC, are used as first-line treatments for couples with unexplained or mild male subfertility. As IUI-COH is less invasive, this treatment is usually offered before proceeding to IVF. Yet, as conventional IVF with SET may lead to higher pregnancy rates in fewer cycles for a lower multiple pregnancy rate, some have argued to start with IVF instead of IUI-COH. In addition, IVF in the MNC is considered to be a more patient friendly and less costly form of IVF. We performed a cost-effectiveness analysis alongside a randomized noninferiority trial. Between January 2009 and February 2012, 602 couples with unexplained infertility and a poor prognosis on natural conception were allocated to three cycles of IVF-SET including frozen embryo transfers, six cycles of IVF-MNC or six cycles of IUI-COH. These couples were followed until 12 months after randomization. We collected data on resource use related to treatment, medication and pregnancy from the case report forms. We calculated unit costs from various sources. For each of the three strategies, we calculated the mean costs and effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated for IVF-SET compared with IUI-COH and

Cluster Randomized Controlled Trial: Clinical and Cost-Effectiveness of a System of Longer-Term Stroke Care.

Science.gov (United States)

Forster, Anne; Young, John; Chapman, Katie; Nixon, Jane; Patel, Anita; Holloway, Ivana; Mellish, Kirste; Anwar, Shamaila; Breen, Rachel; Knapp, Martin; Murray, Jenni; Farrin, Amanda

2015-08-01

We developed a new postdischarge system of care comprising a structured assessment covering longer-term problems experienced by patients with stroke and their carers, linked to evidence-based treatment algorithms and reference guides (the longer-term stroke care system of care) to address the poor longer-term recovery experienced by many patients with stroke. A pragmatic, multicentre, cluster randomized controlled trial of this system of care. Eligible patients referred to community-based Stroke Care Coordinators were randomized to receive the new system of care or usual practice. The primary outcome was improved patient psychological well-being (General Health Questionnaire-12) at 6 months; secondary outcomes included functional outcomes for patients, carer outcomes, and cost-effectiveness. Follow-up was through self-completed postal questionnaires at 6 and 12 months. Thirty-two stroke services were randomized (29 participated); 800 patients (399 control; 401 intervention) and 208 carers (100 control; 108 intervention) were recruited. In intention to treat analysis, the adjusted difference in patient General Health Questionnaire-12 mean scores at 6 months was -0.6 points (95% confidence interval, -1.8 to 0.7; P=0.394) indicating no evidence of statistically significant difference between the groups. Costs of Stroke Care Coordinator inputs, total health and social care costs, and quality-adjusted life year gains at 6 months, 12 months, and over the year were similar between the groups. This robust trial demonstrated no benefit in clinical or cost-effectiveness outcomes associated with the new system of care compared with usual Stroke Care Coordinator practice. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN 67932305. © 2015 Bradford Teaching Hospitals NHS Foundation Trust.

Reward Pays the Cost of Noise Reduction in Motor and Cognitive Control.

Science.gov (United States)

Manohar, Sanjay G; Chong, Trevor T-J; Apps, Matthew A J; Batla, Amit; Stamelou, Maria; Jarman, Paul R; Bhatia, Kailash P; Husain, Masud

2015-06-29

Speed-accuracy trade-off is an intensively studied law governing almost all behavioral tasks across species. Here we show that motivation by reward breaks this law, by simultaneously invigorating movement and improving response precision. We devised a model to explain this paradoxical effect of reward by considering a new factor: the cost of control. Exerting control to improve response precision might itself come at a cost--a cost to attenuate a proportion of intrinsic neural noise. Applying a noise-reduction cost to optimal motor control predicted that reward can increase both velocity and accuracy. Similarly, application to decision-making predicted that reward reduces reaction times and errors in cognitive control. We used a novel saccadic distraction task to quantify the speed and accuracy of both movements and decisions under varying reward. Both faster speeds and smaller errors were observed with higher incentives, with the results best fitted by a model including a precision cost. Recent theories consider dopamine to be a key neuromodulator in mediating motivational effects of reward. We therefore examined how Parkinson's disease (PD), a condition associated with dopamine depletion, alters the effects of reward. Individuals with PD showed reduced reward sensitivity in their speed and accuracy, consistent in our model with higher noise-control costs. Including a cost of control over noise explains how reward may allow apparent performance limits to be surpassed. On this view, the pattern of reduced reward sensitivity in PD patients can specifically be accounted for by a higher cost for controlling noise. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Computational Techniques for Model Predictive Control of Large-Scale Systems with Continuous-Valued and Discrete-Valued Inputs

Directory of Open Access Journals (Sweden)

Koichi Kobayashi

2013-01-01

Full Text Available We propose computational techniques for model predictive control of large-scale systems with both continuous-valued control inputs and discrete-valued control inputs, which are a class of hybrid systems. In the proposed method, we introduce the notion of virtual control inputs, which are obtained by relaxing discrete-valued control inputs to continuous variables. In online computation, first, we find continuous-valued control inputs and virtual control inputs minimizing a cost function. Next, using the obtained virtual control inputs, only discrete-valued control inputs at the current time are computed in each subsystem. In addition, we also discuss the effect of quantization errors. Finally, the effectiveness of the proposed method is shown by a numerical example. The proposed method enables us to reduce and decentralize the computation load.

Costs of disarmament - Rethinking the price tag: A methodological inquiry into the costs and benefits of arms control

International Nuclear Information System (INIS)

Willett, S.

2002-06-01

The growing number of arms control and disarmament treaties agreed on over the past decades as well as rising concerns about harmful environmental and public health effects of weapons disposal, have understandably led to an increase in the cost of implementing arms control agreements. As a result, the expenses associated with treaty compliance have emerged as a contentious issue within the realm of arms control and disarmament discussions. In particular, opponents of arms control and disarmament point to perceived rising costs of meeting current and proposed treaty obligations in an attempt to limit and undermine such activities. Yet determining just how much arms control and disarmament cost remains very much an ambiguous task. In Costs of Disarmament - Rethinking the Price Tag: A Methodological Inquiry into the Costs and Benefits of Arms Control, Susan Willett addresses the question of how the cost of arms control ought to be measured. Emphasizing the proper allocation of costs associated with arms control treaty implementation to the life cycle costs of weapon systems and their correct weighing against the benefits they procure in terms of averted arms races and increased international security, Willett argues for a revised methodology of costing arms control and disarmament that gives a more accurate - and significantly lower - estimate of the latter. Adopting such a revised methodology concludes the author, might dispel considerable misunderstanding and help point decisions over arms control and disarmament in the right direction

The Clinical Effectiveness and Cost-Effectiveness of Lamotrigine in Borderline Personality Disorder: A Randomized Placebo-Controlled Trial.

Science.gov (United States)

Crawford, Mike J; Sanatinia, Rahil; Barrett, Barbara; Cunningham, Gillian; Dale, Oliver; Ganguli, Poushali; Lawrence-Smith, Geoff; Leeson, Verity; Lemonsky, Fenella; Lykomitrou, Georgia; Montgomery, Alan A; Morriss, Richard; Munjiza, Jasna; Paton, Carol; Skorodzien, Iwona; Singh, Vineet; Tan, Wei; Tyrer, Peter; Reilly, Joseph G

2018-04-06

The authors examined whether lamotrigine is a clinically effective and cost-effective treatment for people with borderline personality disorder. This was a multicenter, double-blind, placebo-controlled randomized trial. Between July 2013 and November 2016, the authors recruited 276 people age 18 or over who met diagnostic criteria for borderline personality disorder. Individuals with coexisting bipolar affective disorder or psychosis, those already taking a mood stabilizer, and women at risk of pregnancy were excluded. A web-based randomization service was used to allocate participants randomly in a 1:1 ratio to receive either an inert placebo or up to 400 mg/day of lamotrigine. The primary outcome measure was score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. Secondary outcome measures included depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment, and adverse events. A total of 195 (70.6%) participants were followed up at 52 weeks, at which point 49 (36%) of those in the lamotrigine group and 58 (42%) of those in the placebo group were taking study medication. The mean ZAN-BPD score was 11.3 (SD=6.6) among those in the lamotrigine group and 11.5 (SD=7.7) among those in the placebo group (adjusted difference in means=0.1, 95% CI=-1.8, 2.0). There was no evidence of any differences in secondary outcomes. Costs of direct care were similar in the two groups. The results suggest that treating people with borderline personality disorder with lamotrigine is not a clinically effective or cost-effective use of resources.

Contamination Control Techniques

Energy Technology Data Exchange (ETDEWEB)

EBY, J.L.

2000-05-16

Welcome to a workshop on contamination Control techniques. This work shop is designed for about two hours. Attendee participation is encouraged during the workshop. We will address different topics within contamination control techniques; present processes, products and equipment used here at Hanford and then open the floor to you, the attendees for your input on the topics.

Contamination Control Techniques

International Nuclear Information System (INIS)

EBY, J.L.

2000-01-01

Welcome to a workshop on contamination Control techniques. This work shop is designed for about two hours. Attendee participation is encouraged during the workshop. We will address different topics within contamination control techniques; present processes, products and equipment used here at Hanford and then open the floor to you, the attendees for your input on the topics

Parameters of Dismantling Techniques Related to Costs for Decommissioning of Nuclear Facilities

International Nuclear Information System (INIS)

Jeong, Kwanseong; Moon, Jeikwon; Choi, Byungseon

2012-01-01

Reliable cost estimating is one of the most important elements of decommissioning operation. Reliable cost estimating is one of the most important elements of decommissioning planning. Alternative technologies may be evaluated and compared on their efficiency and effectiveness, and measured against a baseline cost as to the feasibility and benefit derived from the technology. This principle ensures that the cost consideration is economically sound and practical for funding. This paper provides a list with basic review of cutting and dismantling techniques, including some typical characteristics if available, as well as aspects of implementation, parameters of cutting and dismantling techniques in decommissioning costing. This paper gives an overview of the principles of the unit factor approach and its implementation in costing in relation to dismantling activities. In general, proper evaluation of decommissioning costs is important for following issues and relevant measures for achieving the listed aspects are: · Selection of a decommissioning strategy and activities: several decommissioning options should be evaluated: · Support to a cost-benefit analysis to ensure that the principle of optimization and reasonably practicable measures are applied: the extent of evaluated decommissioning options should cover all possible scenarios for dismantling activities; · Estimate of required financial resources for the selected strategy: the selected option should involve the dismantling activities in a structure and extent relevant to real procedure of dismantling activities; · Preparation of the project schedule, workforce requirements and phased funding needs: dismantling activities should be structured according to the tasks of the decommissioning schedule; · Definition of measures for proper management and maintenance of resources for safe and timely decommissioning: the time distribution and safety related parameters of dismantling activities should be known

Cost effectiveness of preventive home visits to the elderly: economic evaluation alongside randomized controlled study

DEFF Research Database (Denmark)

Kronborg, Christian; Vass, Mikkel; Lauridsen, Jørgen

2006-01-01

We evaluated the cost effectiveness of preventive home visits to elderly persons in Denmark alongside a 3-year randomized controlled study. The main outcome measure was incremental costs per active life-year gained. The number of active life-years was defined as those during which the person...... is able independently to transfer, walk indoors, go outdoors, walk outdoors in both pleasant and poor weather, and climb stairs. In 17 of 34 municipalities health visitors and general practitioners were offered geriatric training, which focused on early signs of disability, physical activity......,455 to 744) in 75-year-olds and 694 euro (-2,684 to 4,071) in 80-year-olds. The discounted difference in mean active life-years was 0.034 (-0.058 to 0.125) and 0.197 (0.013 to 0.380), respectively. The study did not provide conclusive evidence on the cost effectiveness of the programs under consideration....

Impact of robotic technique and surgical volume on the cost of radical prostatectomy.

Science.gov (United States)

Hyams, Elias S; Mullins, Jeffrey K; Pierorazio, Phillip M; Partin, Alan W; Allaf, Mohamad E; Matlaga, Brian R

2013-03-01

Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited. Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore, we performed a study to define the effect of robotic technology and surgical volume on the cost of RP. The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008 and 2011 (the period during which robot-assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High-volume hospitals were defined as >60 cases per year, and high-volume surgeons were defined as >40 cases per year. Multivariate regression analysis was performed to evaluate whether robotic technique and high surgical volume impacted the cost of RP. There were 1499 patients who underwent RALRP and 2565 who underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs 10,100; Probotic surgery has come to dominate the healthcare marketplace, strategies to increase the role of high-volume providers may be needed to improve the cost-effectiveness of prostate cancer surgical therapy.

Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs.

Science.gov (United States)

Rodgers, S; Avery, A J; Meechan, D; Briant, S; Geraghty, M; Doran, K; Whynes, D K

1999-09-01

It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. We report the results of a controlled trial of pharmacist intervention in United Kingdom general practice. To determine whether intervention practices made savings relative to controls. An evaluation of an initiative set up by Doncaster Health Authority. Eight practices agreed to take part and received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of 163,000 Pounds. Changes in prescribing patterns were investigated by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. Prescribing data (PACTLINE) were used to assess these changes. The measures used to take account of differences in the populations of the practices included the ASTRO-PU for overall prescribing and the STAR-PU for prescribing in specific therapeutic areas. Differences between intervention and control practices were subjected to Wilcoxon matched-pairs, signed-ranks tests. The median (minimum to maximum) rise in prescribing costs per ASTRO-PU was 0.85 Pound (-1.95 Pounds to 2.05 Pounds) in the intervention practices compared with 2.55 Pounds (1.74 Pounds to 4.65 Pounds) in controls (P = 0.025). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around 347,000 Pounds higher. This study suggests that the use of pharmacists did control prescribing expenditure sufficiently to offset their employment costs.

Traditional Vs. Contemporary Managerial/Cost Accounting Techniques Differences Between Opinions Of Educators And Practitioners

OpenAIRE

M. A. Ekbatani; M. A. Sangeladji

2011-01-01

From the mid 1980s, the start of new movements in the field of managerial/cost accounting, a gap has emerged between the opinions of academia and practitioners regarding the degree of usefulness of managerial/cost accounting techniques. It is believed that practitioners generally prefer managerial/cost accounting techniques which are simple, practical and economically applicable. On the other hand, many authors and academia believe that the traditional managerial/cost accounting techniques ar...

Minimalist fault-tolerance techniques for mitigating single-event effects in non-radiation-hardened microcontrollers

Science.gov (United States)

Caldwell, Douglas Wyche

Commercial microcontrollers--monolithic integrated circuits containing microprocessor, memory and various peripheral functions--such as are used in industrial, automotive and military applications, present spacecraft avionics system designers an appealing mix of higher performance and lower power together with faster system-development time and lower unit costs. However, these parts are not radiation-hardened for application in the space environment and Single-Event Effects (SEE) caused by high-energy, ionizing radiation present a significant challenge. Mitigating these effects with techniques which require minimal additional support logic, and thereby preserve the high functional density of these devices, can allow their benefits to be realized. This dissertation uses fault-tolerance to mitigate the transient errors and occasional latchups that non-hardened microcontrollers can experience in the space radiation environment. Space systems requirements and the historical use of fault-tolerant computers in spacecraft provide context. Space radiation and its effects in semiconductors define the fault environment. A reference architecture is presented which uses two or three microcontrollers with a combination of hardware and software voting techniques to mitigate SEE. A prototypical spacecraft function (an inertial measurement unit) is used to illustrate the techniques and to explore how real application requirements impact the fault-tolerance approach. Low-cost approaches which leverage features of existing commercial microcontrollers are analyzed. A high-speed serial bus is used for voting among redundant devices and a novel wire-OR output voting scheme exploits the bidirectional controls of I/O pins. A hardware testbed and prototype software were constructed to evaluate two- and three-processor configurations. Simulated Single-Event Upsets (SEUs) were injected at high rates and the response of the system monitored. The resulting statistics were used to evaluate

Costs and cost-effectiveness of periviable care.

Science.gov (United States)

Caughey, Aaron B; Burchfield, David J

2014-02-01

With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.

Optimal combinations of control strategies and cost-effective analysis for visceral leishmaniasis disease transmission.

Directory of Open Access Journals (Sweden)

Santanu Biswas

Full Text Available Visceral leishmaniasis (VL is a deadly neglected tropical disease that poses a serious problem in various countries all over the world. Implementation of various intervention strategies fail in controlling the spread of this disease due to issues of parasite drug resistance and resistance of sandfly vectors to insecticide sprays. Due to this, policy makers need to develop novel strategies or resort to a combination of multiple intervention strategies to control the spread of the disease. To address this issue, we propose an extensive SIR-type model for anthroponotic visceral leishmaniasis transmission with seasonal fluctuations modeled in the form of periodic sandfly biting rate. Fitting the model for real data reported in South Sudan, we estimate the model parameters and compare the model predictions with known VL cases. Using optimal control theory, we study the effects of popular control strategies namely, drug-based treatment of symptomatic and PKDL-infected individuals, insecticide treated bednets and spray of insecticides on the dynamics of infected human and vector populations. We propose that the strategies remain ineffective in curbing the disease individually, as opposed to the use of optimal combinations of the mentioned strategies. Testing the model for different optimal combinations while considering periodic seasonal fluctuations, we find that the optimal combination of treatment of individuals and insecticide sprays perform well in controlling the disease for the time period of intervention introduced. Performing a cost-effective analysis we identify that the same strategy also proves to be efficacious and cost-effective. Finally, we suggest that our model would be helpful for policy makers to predict the best intervention strategies for specific time periods and their appropriate implementation for elimination of visceral leishmaniasis.

Connection between optimal control theory and adiabatic-passage techniques in quantum systems

Science.gov (United States)

Assémat, E.; Sugny, D.

2012-08-01

This work explores the relationship between optimal control theory and adiabatic passage techniques in quantum systems. The study is based on a geometric analysis of the Hamiltonian dynamics constructed from Pontryagin's maximum principle. In a three-level quantum system, we show that the stimulated Raman adiabatic passage technique can be associated to a peculiar Hamiltonian singularity. One deduces that the adiabatic pulse is solution of the optimal control problem only for a specific cost functional. This analysis is extended to the case of a four-level quantum system.

Recruitment techniques for alcohol pharmacotherapy clinical trials: A cost-benefit analysis.

Science.gov (United States)

Tompkins, D Andrew; Sides, Jessica A; Harrison, Joseph A; Strain, Eric C

2015-12-01

Alcohol use disorders (AUDs) represent a large public health burden with relatively few efficacious pharmacotherapies. Randomized controlled trials (RCTs) for new AUD therapies can be hampered by ineffective recruitment, leading to increased trial costs. The current analyses examined the effectiveness of recruitment efforts during two consecutive outpatient RCTs of novel AUD pharmacotherapies conducted between 2009 and 2012. During an initial phone screen, participants identified an ad source for learning about the study. Qualified persons were then scheduled for in-person screens. The present analyses examined demographic differences amongst the eight ad sources utilized. Recruitment effectiveness was determined by dividing the number of persons meeting criteria for an in-person screen by the total number of callers from each ad source. Cost-effectiveness was determined by dividing total ad source cost by number of screens, participants randomized, and completers. 1,813 calls resulted in 1,005 completed phone screens. The most common ad source was TV (34%), followed by print (29%), word-of-mouth (11%), flyer (8%), internet (5%), radio (5%), bus ad (2%), and billboard (1%). Participants reporting bus ads (46%), billboard (44%), or print ads (34%) were significantly more likely than the other sources to meet criteria to be scheduled for in-person screens. The most cost-effective ad source was print ($2,506 per completer), while bus ad was the least cost-effective ($13,376 per completer). Recruitment in AUD RCTs can be successful using diverse advertising methods. The present analyses favored use of print ads as most cost-effective.

Improved process control, lowered costs and reduced risks through the use of non-destructive mobility and sheet carrier density measurements on GaAs and GaN wafers

Science.gov (United States)

Nguyen, D.; Hogan, K.; Blew, A.; Cordes, M.

2004-12-01

Improved process control, lowered costs and reduced risks can be realized through the use of non-destructive mobility and sheet charge density measurements during the fabrication of GaAs and GaN wafers. The results from this microwave-based technique are shown to agree with destructive van der Pauw Hall testing results to within ±5%. In addition, it has the ability to map wafer uniformity and provide separated 2DEG data for thick cap or multi-layered structures. As a result, this technique provides an efficient and cost-effective alternative to current process control metrology methods, while providing the user with important process control data.

Training techniques for industry

International Nuclear Information System (INIS)

Jones, D.W.

1978-01-01

The advantages and disadvantages of commonly used training techniques in relation to cost-effective, prevention-oriented Quality Assurance are examined. Important questions are whether training techniques teach cost effectiveness and whether the techniques are, themselves, cost effective. To answer these questions, criteria for evaluating teaching techniques for cost effectiveness were developd, and then commonly used techniques are evaluated in terms of specific training program objectives. Motivation of personnel is also considered important to the success of a training program, and methods are outlined by which recognition of the academic quality of industrial training can be used as a motivational technique

Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial

International Nuclear Information System (INIS)

Soegaard, Rikke; Fischer, Barbara Malene B.; Mortensen, Jann; Hoejgaard, Liselotte; Lassen, Ulrik

2011-01-01

Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC. The study was conducted alongside an RCT in which 189 patients were allocated to conventional staging (n = 91) or conventional staging + PET/CT (n = 98) and followed for 1 year after which the numbers of futile thoracotomies in each group were monitored. A full health care sector perspective was adapted for costing resource use. The outcome parameter was defined as the number needed to treat (NNT) - here number of PET/CT scans needed - to avoid one futile thoracotomy. All monetary estimates were inflated to 2010 EUR. The incremental cost of the PET/CT-based regimen was estimated at 3,927 EUR [95% confidence interval (CI) -3,331; 10,586] and the NNT at 4.92 (95% CI 3.00; 13.62). These resulted in an average incremental cost-effectiveness ratio of 19,314 EUR, which would be cost-effective at a probability of 0.90 given a willingness to pay of 50,000 EUR per avoided futile thoracotomy. When costs of comorbidity-related hospital services were excluded, the PET/CT regimen appeared dominant. Applying a full health care sector perspective, the cost-effectiveness of PET/CT for staging NSCLC seems to depend on the willingness to pay in order to avoid a futile thoracotomy. However, given that four outliers in terms of extreme comorbidity were all randomized to the PET/CT arm, there is uncertainty about the conclusion. When hospital costs of comorbidity were excluded, the PET/CT regimen was found to be both more accurate and cost saving. (orig.)

Reactive control processes contributing to residual switch cost and mixing cost across the adult lifespan.

Science.gov (United States)

Whitson, Lisa R; Karayanidis, Frini; Fulham, Ross; Provost, Alexander; Michie, Patricia T; Heathcote, Andrew; Hsieh, Shulan

2014-01-01

In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost) and when repeating a task alone rather than intermixed with another task (mixing cost). These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs). Moreover, residual reaction time mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these "mixed" repeat trials (Karayanidis et al., 2011). In this paper, we analyze stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. These findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba.

Directory of Open Access Journals (Sweden)

David A Watkins

Full Text Available Acute rheumatic fever (ARF and rheumatic heart disease (RHD persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986-1996. The present study analyzes the cost-effectiveness of this Cuban program.We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a "do nothing" approach. Our population of interest was the cohort of children aged 5-24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program's effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children and saved $7,848,590 (2010 USD despite a total program cost of $202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving.A 10-year

A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba.

Science.gov (United States)

Watkins, David A; Mvundura, Mercy; Nordet, Porfirio; Mayosi, Bongani M

2015-01-01

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986-1996. The present study analyzes the cost-effectiveness of this Cuban program. We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a "do nothing" approach. Our population of interest was the cohort of children aged 5-24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs) averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program's effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children) and saved $7,848,590 (2010 USD) despite a total program cost of $202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving. A 10-year program to

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

International Nuclear Information System (INIS)

Andrianov, A.; Kuptsov, I.

2013-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2013-07-01

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

Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

Science.gov (United States)

Hastrup, Lene Halling; Kronborg, Christian; Bertelsen, Mette; Jeppesen, Pia; Jorgensen, Per; Petersen, Lone; Thorup, Anne; Simonsen, Erik; Nordentoft, Merete

2013-01-01

Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%. The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.

Applied Research of Enterprise Cost Control Based on Linear Programming

Directory of Open Access Journals (Sweden)

Yu Shuo

2015-01-01

This paper researches the enterprise cost control through the linear programming model, and analyzes the restriction factors of the labor of enterprise production, raw materials, processing equipment, sales price, and other factors affecting the enterprise income, so as to obtain an enterprise cost control model based on the linear programming. This model can calculate rational production mode in the case of limited resources, and acquire optimal enterprise income. The production guiding program and scheduling arrangement of the enterprise can be obtained through calculation results, so as to provide scientific and effective guidance for the enterprise production. This paper adds the sensitivity analysis in the linear programming model, so as to learn about the stability of the enterprise cost control model based on linear programming through the sensitivity analysis, and verify the rationality of the model, and indicate the direction for the enterprise cost control. The calculation results of the model can provide a certain reference for the enterprise planning in the market economy environment, which have strong reference and practical significance in terms of the enterprise cost control.

Uranium solution mining cost estimating technique: means for rapid comparative analysis of deposits

International Nuclear Information System (INIS)

Anon.

1978-01-01

Twelve graphs provide a technique for determining relative cost ranges for uranium solution mining projects. The use of the technique can provide a consistent framework for rapid comparative analysis of various properties of mining situations. The technique is also useful to determine the sensitivities of cost figures to incremental changes in mining factors or deposit characteristics

Active vibration control by robust control techniques

International Nuclear Information System (INIS)

Lohar, F.A.

2001-01-01

This paper studies active vibration control of multi-degree-of-freedom system. The control techniques considered are LTR, H/sup 2/ and H/sup infinite/. The results show that LTR controls the vibration but its respective settling time is higher than that of the other techniques. The control performance of H/sup infinite/ control is similar to that of H/sup 2/ control in the case of it weighting functions. However, H/sup infinite/ control is superior to H/sup 2/ control with respect to robustness, steady state error and settling time. (author)

Can a Costly Intervention Be Cost-effective?

Science.gov (United States)

Foster, E. Michael; Jones, Damon

2009-01-01

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

Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment.

Science.gov (United States)

Kaper, Janneke; Wagena, Edwin J; van Schayck, Constant P; Severens, Johan L

2006-01-01

Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Reimbursement for SCT may

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

International Nuclear Information System (INIS)

Bokanowski, Olivier; Picarelli, Athena; Zidani, Hasnaa

2015-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2015-02-15

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

Laboratory cost control and financial management software.

Science.gov (United States)

Mayer, M

1998-02-09

Economical constraints within the health care system advocate the introduction of tighter control of costs in clinical laboratories. Detailed cost information forms the basis for cost control and financial management. Based on the cost information, proper decisions regarding priorities, procedure choices, personnel policies and investments can be made. This presentation outlines some principles of cost analysis, describes common limitations of cost analysis, and exemplifies use of software to achieve optimized cost control. One commercially available cost analysis software, LabCost, is described in some detail. In addition to provision of cost information, LabCost also serves as a general management tool for resource handling, accounting, inventory management and billing. The application of LabCost in the selection process of a new high throughput analyzer for a large clinical chemistry service is taken as an example for decisions that can be assisted by cost evaluation. It is concluded that laboratory management that wisely utilizes cost analysis to support the decision-making process will undoubtedly have a clear advantage over those laboratories that fail to employ cost considerations to guide their actions.

Active structural control with stable fuzzy PID techniques

CERN Document Server

Yu, Wen

2016-01-01

This book presents a detailed discussion of intelligent techniques to measure the displacement of buildings when they are subjected to vibration. It shows how these techniques are used to control active devices that can reduce vibration 60–80% more effectively than widely used passive anti-seismic systems. After introducing various structural control devices and building-modeling and active structural control methods, the authors propose offset cancellation and high-pass filtering techniques to solve some common problems of building-displacement measurement using accelerometers. The most popular control algorithms in industrial settings, PD/PID controllers, are then analyzed and then combined with fuzzy compensation. The stability of this combination is proven with standard weight-training algorithms. These conditions provide explicit methods for selecting PD/PID controllers. Finally, fuzzy-logic and sliding-mode control are applied to the control of wind-induced vibration. The methods described are support...

Cost-Effectiveness of Breast Cancer Control Strategies in Central America: The Cases of Costa Rica and Mexico

Science.gov (United States)

Niëns, Laurens M.; Zelle, Sten G.; Gutiérrez-Delgado, Cristina; Rivera Peña, Gustavo; Hidalgo Balarezo, Blanca Rosa; Rodriguez Steller, Erick; Rutten, Frans F. H.

2014-01-01

This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50–70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40–70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible

Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

Science.gov (United States)

Lam, Hwai-Tai Chen

In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

Two-year effects and cost-effectiveness of pelvic floor muscle training in mild pelvic organ prolapse : a randomised controlled trial in primary care

NARCIS (Netherlands)

Panman, Chantal M.C.R.; Wiegersma, M; Kollen, B J; Berger, M Y; Lisman-Van Leeuwen, Y; Vermeulen, K M; Dekker, J H

OBJECTIVE: To compare effects and cost-effectiveness of pelvic floor muscle training (PFMT) and watchful waiting in women with pelvic organ prolapse. DESIGN: Randomised controlled trial. SETTING: Dutch general practice. POPULATION: Women (≥55 years) with symptomatic mild prolapse, identified by

Reactive control processes contributing to residual switch cost and mixing cost in young and old adults

Directory of Open Access Journals (Sweden)

Lisa Rebecca Whitson

2014-04-01

Full Text Available In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost and when repeating a task alone rather than intermixed with another task (mixing cost. These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs. Moreover, residual RT mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these ‘mixed’ repeat trials (Karayanidis et al., 2011. In this study, we examine stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. We argue that, together with evidence of greater proactive control and more cautious responding for these trials, these findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

Cost-effectiveness of cognitive behavioral therapy for insomnia comorbid with depression: Analysis of a randomized controlled trial.

Science.gov (United States)

Watanabe, Norio; Furukawa, Toshiaki A; Shimodera, Shinji; Katsuki, Fujika; Fujita, Hirokazu; Sasaki, Megumi; Sado, Mitsuhiro; Perlis, Michael L

2015-06-01

Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual (TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years (QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY (P = 0.002) than the TAU-alone group with an incremental value of 0.019 (SD 0.006), and had non-significantly higher costs with an incremental value of 254 (SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: -5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial).

Science.gov (United States)

Mol, F; van Mello, N M; Strandell, A; Jurkovic, D; Ross, J A; Yalcinkaya, T M; Barnhart, K T; Verhoeve, H R; Graziosi, G C; Koks, C A; Mol, B W; Ankum, W M; van der Veen, F; Hajenius, P J; van Wely, M

2015-09-01

Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better ongoing pregnancy rate while risks of persistent trophoblast are higher. Women with a tubal pregnancy treated by salpingotomy or salpingectomy in the presence of a healthy contralateral tube have comparable ongoing pregnancy rates by natural conception. Salpingotomy bears the risk of persistent trophoblast necessitating additional medical or surgical treatment. Repeat ectopic pregnancy occurs slightly more often after salpingotomy compared with salpingectomy. Both consequences imply potentially higher costs after salpingotomy. We performed an economic evaluation of salpingotomy compared with salpingectomy in an international multicentre randomized controlled trial in women with a tubal pregnancy and a healthy contralateral tube. Between 24 September 2004 and 29 November 2011, women were allocated to salpingotomy (n = 215) or salpingectomy (n = 231). Fertility follow-up was done up to 36 months post-operatively. We performed a cost-effectiveness analysis from a hospital perspective. We compared the direct medical costs of salpingotomy and salpingectomy until an ongoing pregnancy occurred by natural conception within a time horizon of 36 months. Direct medical costs included the surgical treatment of the initial tubal pregnancy, readmissions including reinterventions, treatment for persistent trophoblast and interventions for repeat ectopic pregnancy. The analysis was performed according to the intention-to-treat principle. Mean direct medical costs per woman in the salpingotomy group and in the salpingectomy group were €3319 versus €2958, respectively, with a mean difference of €361 (95% confidence interval €217 to €515). Salpingotomy resulted in a marginally higher ongoing pregnancy rate by

Costs and benefits of controlling quarantine diseases : a bio-economic modeling approach

NARCIS (Netherlands)

Breukers, M.L.H.; Mourits, M.C.M.; Werf, van der W.; Oude Lansink, A.G.J.M.

2008-01-01

This article describes a bio-economic model to quantify the costs and benefits of controlling plant quarantine diseases. The model integrates the epidemiology and economic consequences of a quarantine disease. It allows for ex ante evaluation of control scenarios for their cost-effectiveness, taking

What is the perceived impact of Alexander technique lessons on health status, costs and pain management in the real life setting of an English hospital? The results of a mixed methods evaluation of an Alexander technique service for those with chronic back pain

OpenAIRE

McClean, Stuart; Brilleman, Sam; Wye, Lesley

2015-01-01

Background: Randomised controlled trial evidence indicates that Alexander Technique is clinically and cost effective for chronic back pain. The aim of this mixed methods evaluation was to explore the role and perceived impact of Alexander Technique lessons in the naturalistic setting of an acute hospital Pain Management Clinic in England.\\ud \\ud Methods: To capture changes in health status and resource use amongst service users, 43 service users were administered three widely used questionnai...

Evaluation of the cost effectiveness of exenatide versus insulin glargine in patients with sub-optimally controlled Type 2 diabetes in the United Kingdom

Directory of Open Access Journals (Sweden)

Tetlow Anthony P

2008-08-01

Full Text Available Abstract Objective Exenatide belongs to a new therapeutic class in the treatment of diabetes (incretin mimetics, allowing glucose-dependent glycaemic control in Type 2 diabetes. Randomised controlled trial data suggest that exenatide is as effective as insulin glargine at reducing HbA1c in combination therapy with metformin and sulphonylureas; with reduced weight but higher incidence of adverse gastrointestinal events. The objective of this study is to evaluate the cost effectiveness of exenatide versus insulin glargine using RCT data and a previously published model of Type 2 diabetes disease progression that is based on the United Kingdom Prospective Diabetes Study; the perspective of the health-payer of the United Kingdom National Health Service. Methods The study used a discrete event simulation model designed to forecast the costs and health outcome of a cohort of 1,000 subjects aged over 40 years with sub-optimally-controlled Type 2 diabetes, following initiation of either exenatide, or insulin glargine, in addition to oral hypoglycaemic agents. Sensitivity analysis for a higher treatment discontinuation rate in exenatide patients was applied to the cohort in three different scenarios; (1 either ignored or (2 exenatide-failures excluded or (3 exenatide-failures switched to insulin glargine. Analyses were undertaken to evaluate the price sensitivity of exenatide in terms of relative cost effectiveness. Baseline cohort profiles and effectiveness data were taken from a published randomised controlled trial. Results The relative cost-effectiveness of exenatide and insulin glargine was tested under a variety of conditions, in which insulin glargine was dominant in all cases. Using the most conservative of assumptions, the cost-effectiveness ratio of exenatide vs. insulin glargine at the current UK NHS price was -£29,149/QALY (insulin glargine dominant and thus exenatide is not cost-effective when compared with insulin glargine, at the current

Guaranteed Cost Finite-Time Control of Fractional-Order Positive Switched Systems

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Leipo Liu

2017-01-01

Full Text Available The problem of guaranteed cost finite-time control of fractional-order positive switched systems (FOPSS is considered in this paper. Firstly, a new cost function is defined. Then, by constructing linear copositive Lyapunov functions and using the average dwell time (ADT approach, a state feedback controller and a static output feedback controller are constructed, respectively, and sufficient conditions are derived to guarantee that the corresponding closed-loop systems are guaranteed cost finite-time stable (GCFTS. Such conditions can be easily solved by linear programming. Finally, two examples are given to illustrate the effectiveness of the proposed method.

An Empirical Study of Agricultural Product Logistics Cost Control Evaluation via Fuzzy Analytic Hierarchy Process

OpenAIRE

Qianxia Lu; Yazhou Xiong; Ling Wei

2015-01-01

It is one of the core agricultural logistics cost control to establish a reasonable and effective evaluation system of agricultural logistics cost control. In this study, based on the cost basis of the value chain, an agricultural logistics cost control evaluation system is established from three levels, including the logistics costs of agricultural pre-value chain, logistics costs of agricultural mid-value chain, logistics costs of agricultural late-value chain. AHP theory and expert investi...

Integrated Cost and Schedule Control Systems for Nuclear Power Plant Construction: Leveraging Strategic Advantages to Owners and EPC Firms

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Youngsoo Jung

2015-01-01

Full Text Available As the owners expect that the cost and time for nuclear power plant construction would decrease with new entrants into the market, there will be severer competition in the nuclear industry. In order to achieve performance improvement and to attain competitive advantages under the globalized competition, practitioners and researchers in the nuclear industry have recently exerted efforts to develop an advanced and efficient management methodology for the nuclear mega-projects. Among several candidates, integrated cost and schedule control system is of great concern because it can effectively manage the three most important project performances including cost, time, and quality. In this context, the purpose of this paper is to develop a project numbering system (PNS of integrated cost and schedule control system for nuclear power plant construction. Distinct attributes of nuclear power plant construction were investigated first in order to identify influencing variables that characterize real-world implementation of advanced cost and schedule controls. A scenario was then developed and analysed to simulate a case-project. By using this case-project, proposed management requirements, management methods, measurement techniques, data structure, and data collection methods for integrated cost and schedule PNS were illustrated. Finally, findings and implications are outlined, and recommendations for further research are presented.

Resilient guaranteed cost control of a power system.

Science.gov (United States)

Soliman, Hisham M; Soliman, Mostafa H; Hassan, Mohammad F

2014-05-01

With the development of power system interconnection, the low-frequency oscillation is becoming more and more prominent which may cause system separation and loss of energy to consumers. This paper presents an innovative robust control for power systems in which the operating conditions are changing continuously due to load changes. However, practical implementation of robust control can be fragile due to controller inaccuracies (tolerance of resistors used with operational amplifiers). A new design of resilient (non-fragile) robust control is given that takes into consideration both model and controller uncertainties by an iterative solution of a set of linear matrix inequalities (LMI). Both uncertainties are cast into a norm-bounded structure. A sufficient condition is derived to achieve the desired settling time for damping power system oscillations in face of plant and controller uncertainties. Furthermore, an improved controller design, resilient guaranteed cost controller, is derived to achieve oscillations damping in a guaranteed cost manner. The effectiveness of the algorithm is shown for a single machine infinite bus system, and then, it is extended to multi-area power system.

Inspections - a cost effective approach

International Nuclear Information System (INIS)

Joseph, C.

1981-01-01

This paper describes a cost effective approach for inspections of Computerized Nuclear Materials Control and Accounting Systems (CNMCAS). Highlighted is the capability to conduct an inspection program via portable telephone terminals from off-site locations. The program can be applied to various materials management functions including materials control, quality assurance, and materials accounting. The system is designed to facilitate inspections by both external and internal groups

District heating systems' control for cost effective and environmentally compatible operation

International Nuclear Information System (INIS)

Balati, J.

1999-01-01

District heating systems are being developed in accordance with the growing of large European cities. These systems are formed by enlarging networks of heat distribution from heat sources to heat consumers and, simultaneously, by gradually connecting newly built heat sources. District heating control consists in optimum control of the output of heat sources and in control of heat distribution and consumption. The aim of the paper is to inform about the works in the field of creating a mathematical-physical model of extensive hot water and steam supply circle network and heat sources for the purpose of creating unconventional control algorithms for the complex control of the technological sequence ''heat production distribution- consumption''. For the optimum control algorithms the artificial intelligence methods are also utilised. The aim of the complex access to the solution of new control algorithms will be to decrease the cost of the consumed heat unit and increase environmental protection. The function of the Extensive Heating System District Heating System (DHS) is to ensure permanently the economically justified requirements of heat supply for all consumers with minimum cost per heat supply unit and with enhanced level of environmental protection. The requirements of heat consumers have to be in harmony with the requirements of the maximum possible economy of the whole DHS when adhering to the required qualitative parameters of supplied energy. Therefore, it offers the application of optimised control methods as artificial intelligence methods for the control of the operational circle of DHS heat networks. It is obvious that a higher level of DHS control is required from the technological, economic and ecological point of view. (author)

The costs and cost-effectiveness of a school-based comprehensive intervention study on childhood obesity in China.

Directory of Open Access Journals (Sweden)

Liping Meng

Full Text Available The dramatic rise of overweight and obesity among Chinese children has greatly affected the social economic development. However, no information on the cost-effectiveness of interventions in China is available. The objective of this study is to evaluate the cost and the cost-effectiveness of a comprehensive intervention program for childhood obesity. We hypothesized the integrated intervention which combined nutrition education and physical activity (PA is more cost-effective than the same intensity of single intervention.And Findings: A multi-center randomized controlled trial conducted in six large cities during 2009-2010. A total of 8301 primary school students were categorized into five groups and followed one academic year. Nutrition intervention, PA intervention and their shared common control group were located in Beijing. The combined intervention and its' control group were located in other 5 cities. In nutrition education group, 'nutrition and health classes' were given 6 times for the students, 2 times for the parents and 4 times for the teachers and health workers. "Happy 10" was carried out twice per day in PA group. The comprehensive intervention was a combination of nutrition and PA interventions. BMI and BAZ increment was 0.65 kg/m(2 (SE 0.09 and 0.01 (SE 0.11 in the combined intervention, respectively, significantly lower than that in its' control group (0.82 ± 0.09 for BMI, 0.10 ± 0.11 for BAZ. No significant difference were found neither in BMI nor in BAZ change between the PA intervention and its' control, which is the same case in the nutrition intervention. The single intervention has a relative lower intervention costs compared with the combined intervention. Labor costs in Guangzhou, Shanghai and Jinan was higher compared to other cities. The cost-effectiveness ratio was $120.3 for BMI and $249.3 for BAZ in combined intervention, respectively.The school-based integrated obesity intervention program was cost-effectiveness

ORIGINAL ARTICLES Cost-effectiveness analysis for priority-setting ...

African Journals Online (AJOL)

health outcomes and wasted resources.4-5 It was found that the cost- effectiveness of South ... Priorities for Developing Countries Project was that emergency (and even some elective) ... to control air pollutants found that in South Africa the most cost- effective ..... outdoor air pollution in South Africa in 2000. S Afr Med J ...

Research review: Indoor air quality control techniques

International Nuclear Information System (INIS)

Fisk, W.J.

1986-10-01

Techniques for controlling the concentration of radon, formaldehyde, and combustion products in the indoor air are reviewed. The most effective techniques, which are generally based on limiting or reducing indoor pollutant source strengths, can decrease indoor pollutant concentrations by a factor of 3 to 10. Unless the initial ventilation rate is unusually low, it is difficult to reduce indoor pollutant concentrations more than approximately 50% by increasing the ventilation rate of an entire building. However, the efficiency of indoor pollutant control by ventilation can be enhanced through the use of local exhaust ventilation near concentrated sources of pollutants, by minimizing short circuiting of air from supply to exhaust when pollutant sources are dispersed and, in some situations, by promoting a displacement flow of air and pollutants toward the exhaust. Active air cleaning is also examined briefly. Filtration and electrostatic air cleaning for removal of particles from the indoor air are the most practical and effective currently available techniques of air cleaning. 49 refs., 7 figs

Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

Science.gov (United States)

Johnson, R K; Wright, C K; Gandhi, A; Charny, M C; Barr, L

2013-03-01

We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Statistical Techniques for Project Control

CERN Document Server

Badiru, Adedeji B

2012-01-01

A project can be simple or complex. In each case, proven project management processes must be followed. In all cases of project management implementation, control must be exercised in order to assure that project objectives are achieved. Statistical Techniques for Project Control seamlessly integrates qualitative and quantitative tools and techniques for project control. It fills the void that exists in the application of statistical techniques to project control. The book begins by defining the fundamentals of project management then explores how to temper quantitative analysis with qualitati

Influence of transaction costs on controlling activity of territorial taxation bodies

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Natalya A. Bondareva

2016-01-01

Full Text Available Objective to disclose and justify transaction costs of controlling activities of the territorial taxation bodies and their impact on tax control under the need for effective functioning and optimal decision making with a view of reducing the state expenditures on tax control. Methods general scientific synthesis deduction induction generalization testing interviewing observation forecasting scientific abstraction statistical analysis logic and methods of grouping and classification expert assessment. Results the analysis and grouping of transaction costs of controlling activities of the territorial taxation bodies have been carried out. It was found that the most time and resource consuming are onsite tax inspections. The factors that have a significant impact on the efficiency of tax control were revealed. It is proved that the release of material and time resources contributes to the transformation of the tax bodies. Scientific novelty the main problem of implementation of the onsite tax control is its costs. The existing studies do not give a systematic list of tax control costs of the territorial tax bodies in general and transaction costs of tax control in particular. The author shows that the reduction of transaction costs as factors of influence on the tax control will free up the working time of the inspectors and will bring economic benefits and also will allow to consolidate territorial tax bodies and change the status of a tax inspector. Practical significance reducing the cost of tax control is becoming increasingly important in terms of saving financial resources of the state.

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

Science.gov (United States)

Brown, Nadia J; David, Michael; Cuttle, Leila; Kimble, Roy M; Rodger, Sylvia; Higashi, Hideki

2015-07-01

To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care. Copyright © 2015. Published by Elsevier Inc.

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

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Jukes Matthew CH

2008-09-01

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

Pros, cons of techniques used to calculate oil, gas finding costs

International Nuclear Information System (INIS)

Gaddis, D.; Brock, H.; Boynton, C.

1992-01-01

A major problem facing the U.S. petroleum industry is the higher average finding costs that now exist within the U.S. compared with the average finding costs outside the U.S. It has been argued that federal lands and offshore areas need to be open for drilling in order to reduce average finding costs in the U.S. This article analyzes the strengths and weaknesses of conventional techniques for determining finding costs. Our goal is a finding costs measure that is a reliable indicator of future profitability

The Use of Management Control Systems and Operations Management Techniques

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Edelcio Koitiro Nisiyama

2016-01-01

Full Text Available It is well known that both management control systems (MCSs and operations management (OM are related to firm performance; however, an integrated st udy that involves MCS and OM within the context of firm performance is still lacking. This research aimed to examine the relationships among the use of MCSs and OM techniques and firm performance in the Brazilian auto parts industry. Simons’ levers of cont rol framework was used to characterise the uses of MCSs, and OM techniques, such as total quality management (TQM and continuous improvement programmes, were adopted. The results obtained through the structural equation modelling indicated that the diagno stic use of MCSs is positively associated with the goals of cost reduction. In addition, the interactive use of MCSs is positively associated with the objectives of introducing new products, which is consistent with previous research. Additionally, OM tech niques are positively related to cost reduction but have no direct relationship with the introduction of new products.

Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

Science.gov (United States)

Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

2017-10-01

Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.

Science.gov (United States)

Isetta, Valentina; Negrín, Miguel A; Monasterio, Carmen; Masa, Juan F; Feu, Nuria; Álvarez, Ainhoa; Campos-Rodriguez, Francisco; Ruiz, Concepción; Abad, Jorge; Vázquez-Polo, Francisco J; Farré, Ramon; Galdeano, Marina; Lloberes, Patricia; Embid, Cristina; de la Peña, Mónica; Puertas, Javier; Dalmases, Mireia; Salord, Neus; Corral, Jaime; Jurado, Bernabé; León, Carmen; Egea, Carlos; Muñoz, Aida; Parra, Olga; Cambrodi, Roser; Martel-Escobar, María; Arqué, Meritxell; Montserrat, Josep M

2015-11-01

Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). NCT01716676. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

DEFF Research Database (Denmark)

Sørensen, Sabrina Storgaard; Pedersen, Kjeld Møller; Weinreich, Ulla Møller

2015-01-01

Background: Case management interventions are recommended to improve quality of care and reduce costs in chronic care, but further evidence on effectiveness and cost-effectiveness is needed. The objective of this study is the reporting of the design and participant enrollment of a randomized...... controlled trial, conducted to evaluate the effectiveness and cost-effectiveness of a community-based case management model for patients suffering from chronic obstructive pulmonary disease (COPD). With a focus on support for self-care and care coordination, the intervention was hypothesized to result...... patients were randomized into two groups: the case-managed group and the usual-care group. Participant characteristics were obtained at baseline, and measures on effectiveness and costs were obtained through questionnaires and registries within a 12-month follow-up period. In the forthcoming analysis...

Balancing Training Techniques for Flight Controller Certification

Science.gov (United States)

Gosling, Christina

2011-01-01

Training of ground control teams has been a difficult task in space operations. There are several intangible skills that must be learned to become the steely eyed men and women of mission control who respond to spacecraft failures that can lead to loss of vehicle or crew if handled improperly. And as difficult as training is, it can also be costly. Every day, month or year an operator is in training, is a day that not only they are being trained without direct benefit to the organization, but potentially an instructor or mentor is also being paid for hours spent assisting them. Therefore, optimization of the training flow is highly desired. Recently the Expedition Division (DI) at Johnson Space Flight Center has recreated their training flows for the purpose of both moving to an operator/specialist/instructor hierarchy and to address past inefficiencies in the training flow. This paper will discuss the types of training DI is utilizing in their new flows, and the balance that has been struck between the ideal learning environments and realistic constraints. Specifically, the past training flow for the ISS Attitude Determination and Control Officer will be presented, including drawbacks that were encountered. Then the new training flow will be discussed and how a new approach utilizes more training methods and teaching techniques. We will look at how DI has integrated classes, workshops, checkouts, module reviews, scenarios, OJT, paper sims, Mini Sims, and finally Integrated Sims to balance the cost and timing of training a new flight controller.

Deregulation and Nuclear Training: Cost Effective Alternatives

International Nuclear Information System (INIS)

Richard P. Coe; Patricia A. Lake

2000-01-01

Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies

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

Science.gov (United States)

Savitz, Lucy A; Savitz, Samuel T

2016-01-01

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

An Assessment Of The Effectiveness Of Collaborative Cost ...

African Journals Online (AJOL)

This paper presents the effects of Collaborative Cost Reduction Model (CCRM) as a control Approach to reduce the high cost implication that causes the slow pace of migration process from IPV4 to IPV6 in Nigeria. This study reveals that CCRM can be applied to achieve Cost Reduction in collocation efforts in ...

Assessing the interaction effect of cost control systems and information technology integration on manufacturing plant financial performance

OpenAIRE

Maiga, Adam S; Nilsson, Anders; Jacobs, Fred

2014-01-01

The interface between management control and information technology is an under-developed research area with a knowledge gap concerning its implications for financial performance. This study contributes to bridging this gap by investigates the interaction effect of cost control systems and information technology integration on manufacturing plant financial performance. We surveyed a sample of 518 managers of U.S. manufacturing plants, approximately evenly distributed between those using activ...

Pursuing Photovoltaic Cost-Effectiveness

DEFF Research Database (Denmark)

Yang, Yongheng; Koutroulis, Eftichios; Sangwongwanich, Ariya

2017-01-01

loading of the power devices. However, its feasibility is challenged by the associated energy losses. An increase of the inverter lifetime and a reduction of the energy yield can alter the cost of energy, demanding an optimization of the power limitation. Therefore, aiming at minimizing the Levelized Cost...... be flexibly performed. As an advanced control strategy, the Absolute Active Power Control (AAPC) can effectively solve the overloading issues by limiting the maximum possible PV power to a certain level (i.e., the power limitation), and also benefit the inverter reliability due to the reduction in the thermal...... performance in terms of LCOE and energy production can be obtained by enabling the AAPC strategy, compared to the conventional PV inverter operating only in the maximum power point tracking mode. In the presented case study, the minimum of the LCOE is achieved for the PV system when the power limit...

Advanced Materials and Fabrication Techniques for the Orion Attitude Control Motor

Science.gov (United States)

Gorti, Sridhar; Holmes, Richard; O'Dell, John; McKechnie, Timothy; Shchetkovskiy, Anatoliy

2013-01-01

Rhenium, with its high melting temperature, excellent elevated temperature properties, and lack of a ductile-to-brittle transition temperature (DBTT), is ideally suited for the hot gas components of the ACM (Attitude Control Motor), and other high-temperature applications. However, the high cost of rhenium makes fabricating these components using conventional fabrication techniques prohibitive. Therefore, near-net-shape forming techniques were investigated for producing cost-effective rhenium and rhenium alloy components for the ACM and other propulsion applications. During this investigation, electrochemical forming (EL-Form ) techniques were evaluated for producing the hot gas components. The investigation focused on demonstrating that EL-Form processing techniques could be used to produce the ACM flow distributor. Once the EL-Form processing techniques were established, a representative rhenium flow distributor was fabricated, and samples were harvested for material properties testing at both room and elevated temperatures. As a lower cost and lighter weight alternative to an all-rhenium component, rhenium- coated graphite and carbon-carbon were also evaluated. The rhenium-coated components were thermal-cycle tested to verify that they could withstand the expected thermal loads during service. High-temperature electroforming is based on electrochemical deposition of compact layers of metals onto a mandrel of the desired shape. Mandrels used for electro-deposition of near-net shaped parts are generally fabricated from high-density graphite. The graphite mandrel is easily machined and does not react with the molten electrolyte. For near-net shape components, the inner surface of the electroformed part replicates the polished graphite mandrel. During processing, the mandrel itself becomes the cathode, and scrap or refined refractory metal is the anode. Refractory metal atoms from the anode material are ionized in the molten electrolytic solution, and are deposited

Cost of microbial larviciding for malaria control in rural Tanzania.

Science.gov (United States)

Rahman, Rifat; Lesser, Adriane; Mboera, Leonard; Kramer, Randall

2016-11-01

Microbial larviciding may be a potential supplement to conventional malaria vector control measures, but scant information on its relative implementation costs and effectiveness, especially in rural areas, is an impediment to expanding its uptake. We perform a costing analysis of a seasonal microbial larviciding programme in rural Tanzania. We evaluated the financial and economic costs from the perspective of the public provider of a 3-month, community-based larviciding intervention implemented in twelve villages in the Mvomero District of Tanzania in 2012-2013. Cost data were collected from financial reports and invoices and through discussion with programme administrators. Sensitivity analysis explored the robustness of our results to varying key parameters. Over the 2-year study period, approximately 6873 breeding sites were treated with larvicide. The average annual economic costs of the larviciding intervention in rural Tanzania are estimated at 2014 US$ 1.44 per person protected per year (pppy), US$ 6.18 per household and US$ 4481.88 per village, with the larvicide and staffing accounting for 14% and 58% of total costs, respectively. We found the costs pppy of implementing a seasonal larviciding programme in rural Tanzania to be comparable to the costs of other larviciding programmes in urban Tanzania and rural Kenya. Further research should evaluate the cost-effectiveness of larviciding relative to, and in combination with, other vector control strategies in rural settings. © 2016 John Wiley & Sons Ltd.

Modified natural cycle versus controlled ovarian hyperstimulation IVF : a cost-effectiveness evaluation of three simulated treatment scenarios

NARCIS (Netherlands)

Groen, Henk; Tonch, Nino; Simons, Arnold H. M.; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A.

2013-01-01

STUDY QUESTION: Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? SUMMARY ANSWER: The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

International Nuclear Information System (INIS)

Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

2015-01-01

Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

Science.gov (United States)

Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

2015-10-01

Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system

Cost of intensive routine control and incremental cost of insecticide-treated curtain deployment in a setting with low Aedes aegypti infestation

Directory of Open Access Journals (Sweden)

Alberto Baly

Full Text Available Abstract: INTRODUCTION Information regarding the cost of implementing insecticide-treated curtains (ITCs is scarce. Therefore, we evaluated the ITC implementation cost, in addition to the costs of intensive conventional routine activities of the Aedes control program in the city of Guantanamo, Cuba. METHODS A cost-analysis study was conducted from the perspective of the Aedes control program, nested in an ITC effectiveness trial, during 2009-2010. Data for this study were obtained from bookkeeping records and activity registers of the Provincial Aedes Control Programme Unit and the account records of the ITC trial. RESULTS The annual cost of the routine Aedes control program activities was US$16.80 per household (p.h. Among 3,015 households, 6,714 ITCs were distributed. The total average cost per ITC distributed was US$3.42, and 74.3% of this cost was attributed to the cost of purchasing the ITCs. The annualized costs p.h. of ITC implementation was US$3.80. The additional annualized cost for deploying ITCs represented 19% and 48.4% of the total cost of the routine Aedes control and adult-stage Aedes control programs, respectively. The trial did not lead to further reductions in the already relatively low Aedes infestation levels. CONCLUSIONS At current curtain prices, ITC deployment can hardly be considered an efficient option in Guantanamo and other comparable environments.

Cost of intensive routine control and incremental cost of insecticide-treated curtain deployment in a setting with low Aedes aegypti infestation.

Science.gov (United States)

Baly, Alberto; Toledo, Maria Eugenia; Lambert, Isora; Benítez, Elizabeth; Rodriguez, Karina; Rodriguez, Esther; Vanlerberghe, Veerle; Stuyft, Patrick Van der

2016-01-01

Information regarding the cost of implementing insecticide-treated curtains (ITCs) is scarce. Therefore, we evaluated the ITC implementation cost, in addition to the costs of intensive conventional routine activities of the Aedes control program in the city of Guantanamo, Cuba. A cost-analysis study was conducted from the perspective of the Aedes control program, nested in an ITC effectiveness trial, during 2009-2010. Data for this study were obtained from bookkeeping records and activity registers of the Provincial Aedes Control Programme Unit and the account records of the ITC trial. The annual cost of the routine Aedes control program activities was US$16.80 per household (p.h). Among 3,015 households, 6,714 ITCs were distributed. The total average cost per ITC distributed was US$3.42, and 74.3% of this cost was attributed to the cost of purchasing the ITCs. The annualized costs p.h. of ITC implementation was US$3.80. The additional annualized cost for deploying ITCs represented 19% and 48.4% of the total cost of the routine Aedes control and adult-stage Aedes control programs, respectively. The trial did not lead to further reductions in the already relatively low Aedes infestation levels. At current curtain prices, ITC deployment can hardly be considered an efficient option in Guantanamo and other comparable environments.

Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial

Directory of Open Access Journals (Sweden)

Stamuli Eugena

2012-02-01

Full Text Available Abstract Background Plantar warts (verrucae are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA 95% CI: 85.09-117.26 more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions Cryotherapy is more costly and no more effective than salicylic acid. Trial registration Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151.

Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)

Science.gov (United States)

2012-01-01

Abstract Background Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions Cryotherapy is more costly and no more effective than salicylic acid. Trial registration Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151. PMID:22369511

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

Science.gov (United States)

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

2018-04-01

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

The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement.

Science.gov (United States)

Thompson, Carl; Pulleyblank, Ryan; Parrott, Steve; Essex, Holly

2016-02-01

In resource constrained systems, decision makers should be concerned with the efficiency of implementing improvement techniques and technologies. Accordingly, they should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. An approach to doing this effectively is encapsulated in the 'policy cost-effectiveness' approach. This paper outlines some of the theoretical and practical challenges to assessing policy cost-effectiveness (the cost-effectiveness of implementation projects). A checklist and associated (freely available) online application are also presented to help services develop more cost-effective implementation strategies. © 2015 John Wiley & Sons, Ltd.

Cost-Effectiveness Research in Neurosurgery: We Can and We Must.

Science.gov (United States)

Stein, Sherman C

2018-01-05

Rapid advancement of medical and surgical therapies, coupled with the recent preoccupation with limiting healthcare costs, makes a collision of the 2 objectives imminent. This article explains the value of cost-effectiveness analysis (CEA) in reconciling the 2 competing goals, and provides a brief introduction to evidence-based CEA techniques. The historical role of CEA in determining whether new neurosurgical strategies provide value for cost is summarized briefly, as are the limitations of the technique. Finally, the unique ability of the neurosurgical community to provide input to the CEA process is emphasized, as are the potential risks of leaving these important decisions in the hands of others. Copyright © 2018 by the Congress of Neurological Surgeons.

Reducing Wildlife Damage with Cost-Effective Management Programmes.

Directory of Open Access Journals (Sweden)

Cheryl R Krull

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

Evaluation of syngas production unit cost of bio-gasification facility using regression analysis techniques

Energy Technology Data Exchange (ETDEWEB)

Deng, Yangyang; Parajuli, Prem B.

2011-08-10

Evaluation of economic feasibility of a bio-gasification facility needs understanding of its unit cost under different production capacities. The objective of this study was to evaluate the unit cost of syngas production at capacities from 60 through 1800Nm 3/h using an economic model with three regression analysis techniques (simple regression, reciprocal regression, and log-log regression). The preliminary result of this study showed that reciprocal regression analysis technique had the best fit curve between per unit cost and production capacity, with sum of error squares (SES) lower than 0.001 and coefficient of determination of (R 2) 0.996. The regression analysis techniques determined the minimum unit cost of syngas production for micro-scale bio-gasification facilities of $0.052/Nm 3, under the capacity of 2,880 Nm 3/h. The results of this study suggest that to reduce cost, facilities should run at a high production capacity. In addition, the contribution of this technique could be the new categorical criterion to evaluate micro-scale bio-gasification facility from the perspective of economic analysis.

Robust intelligent backstepping tracking control for uncertain non-linear chaotic systems using H∞ control technique

International Nuclear Information System (INIS)

Peng, Y.-F.

2009-01-01

The cerebellar model articulation controller (CMAC) is a non-linear adaptive system with built-in simple computation, good generalization capability and fast learning property. In this paper, a robust intelligent backstepping tracking control (RIBTC) system combined with adaptive CMAC and H ∞ control technique is proposed for a class of chaotic systems with unknown system dynamics and external disturbance. In the proposed control system, an adaptive backstepping cerebellar model articulation controller (ABCMAC) is used to mimic an ideal backstepping control (IBC), and a robust H ∞ controller is designed to attenuate the effect of the residual approximation errors and external disturbances with desired attenuation level. Moreover, the all adaptation laws of the RIBTC system are derived based on the Lyapunov stability analysis, the Taylor linearization technique and H ∞ control theory, so that the stability of the closed-loop system and H ∞ tracking performance can be guaranteed. Finally, three application examples, including a Duffing-Holmes chaotic system, a Genesio chaotic system and a Sprott circuit system, are used to demonstrate the effectiveness and performance of proposed robust control technique.

A cooperative reduction model for regional air pollution control in China that considers adverse health effects and pollutant reduction costs.

Science.gov (United States)

Xie, Yujing; Zhao, Laijun; Xue, Jian; Hu, Qingmi; Xu, Xiang; Wang, Hongbo

2016-12-15

How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO 2 ) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×10 6 compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases. Copyright �

Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial.

Science.gov (United States)

Orgeta, Vasiliki; Leung, Phuong; Yates, Lauren; Kang, Sujin; Hoare, Zoe; Henderson, Catherine; Whitaker, Chris; Burns, Alistair; Knapp, Martin; Leroi, Iracema; Moniz-Cook, Esme D; Pearson, Stephen; Simpson, Stephen; Spector, Aimee; Roberts, Steven; Russell, Ian T; de Waal, Hugo; Woods, Robert T; Orrell, Martin

2015-01-01

BACKGROUND Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based, carer-led cognitive stimulation interventions is limited. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers, compared with treatment as usual (TAU). DESIGN A multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point). SETTING Participants were recruited through Memory Clinics and Community Mental Health Teams for older people. PARTICIPANTS A total of 356 caregiving dyads were recruited and 273 completed the trial. INTERVENTION iCST consisted of structured cognitive stimulation sessions for people with dementia, completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home. MAIN OUTCOME MEASURES Primary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms, activities of daily living, depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions), mood symptoms, resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives. RESULTS There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference -0.55, 95% confidence interval (CI) -2.00 to 0.90; p-value = 0.45; self-reported quality of life: mean difference -0.02, 95% CI -1.22 to 0.82; p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental

Controlling HR Costs.

Science.gov (United States)

Ellig, Bruce R.

1990-01-01

Controlling human resources costs is critical for a competitive advantage. More money will have to be invested in education and training because of an inadequate, ill-prepared group of entry-level workers. Commitment to employees will have to be considered in relation to the increased investment in them. (JOW)

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

Science.gov (United States)

Mabry, C D

2001-03-01

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

Potential cost savings with terrestrial rabies control

Directory of Open Access Journals (Sweden)

Cherry Bryan

2007-04-01

Full Text Available Abstract Background The cost-benefit of raccoon rabies control strategies such as oral rabies vaccination (ORV are under evaluation. As an initial quantification of the potential cost savings for a control program, the collection of selected rabies cost data was pilot tested for five counties in New York State (NYS in a three-year period. Methods Rabies costs reported to NYS from the study counties were computerized and linked to a human rabies exposure database. Consolidated costs by county and year were averaged and compared. Results Reported rabies-associated costs for all rabies variants totalled $2.1 million, for human rabies postexposure prophylaxes (PEP (90.9%, animal specimen preparation/shipment to laboratory (4.7%, and pet vaccination clinics (4.4%. The proportion that may be attributed to raccoon rabies control was 37% ($784,529. Average costs associated with the raccoon variant varied across counties from $440 to $1,885 per PEP, $14 to $44 per specimen, and $0.33 to $15 per pet vaccinated. Conclusion Rabies costs vary widely by county in New York State, and were associated with human population size and methods used by counties to estimate costs. Rabies cost variability must be considered in developing estimates of possible ORV-related cost savings. Costs of PEPs and specimen preparation/shipments, as well as the costs of pet vaccination provided by this study may be valuable for development of more realistic scenarios in economic modelling of ORV costs versus benefits.

Using Length of Stay to Control for Unobserved Heterogeneity When Estimating Treatment Effect on Hospital Costs with Observational Data: Issues of Reliability, Robustness, and Usefulness.

Science.gov (United States)

May, Peter; Garrido, Melissa M; Cassel, J Brian; Morrison, R Sean; Normand, Charles

2016-10-01

To evaluate the sensitivity of treatment effect estimates when length of stay (LOS) is used to control for unobserved heterogeneity when estimating treatment effect on cost of hospital admission with observational data. We used data from a prospective cohort study on the impact of palliative care consultation teams (PCCTs) on direct cost of hospital care. Adult patients with an advanced cancer diagnosis admitted to five large medical and cancer centers in the United States between 2007 and 2011 were eligible for this study. Costs were modeled using generalized linear models with a gamma distribution and a log link. We compared variability in estimates of PCCT impact on hospitalization costs when LOS was used as a covariate, as a sample parameter, and as an outcome denominator. We used propensity scores to account for patient characteristics associated with both PCCT use and total direct hospitalization costs. We analyzed data from hospital cost databases, medical records, and questionnaires. Our propensity score weighted sample included 969 patients who were discharged alive. In analyses of hospitalization costs, treatment effect estimates are highly sensitive to methods that control for LOS, complicating interpretation. Both the magnitude and significance of results varied widely with the method of controlling for LOS. When we incorporated intervention timing into our analyses, results were robust to LOS-controls. Treatment effect estimates using LOS-controls are not only suboptimal in terms of reliability (given concerns over endogeneity and bias) and usefulness (given the need to validate the cost-effectiveness of an intervention using overall resource use for a sample defined at baseline) but also in terms of robustness (results depend on the approach taken, and there is little evidence to guide this choice). To derive results that minimize endogeneity concerns and maximize external validity, investigators should match and analyze treatment and comparison arms

Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial.

Science.gov (United States)

D'Amico, Francesco; Rehill, Amritpal; Knapp, Martin; Lowery, David; Cerga-Pashoja, Arlinda; Griffin, Mark; Iliffe, Steve; Warner, James

2016-06-01

Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. We aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia. Cost-effectiveness analysis within a two-arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored, for 20-30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses. Mean intervention cost was £284 per dyad. For the subsample of 52 dyads, the intervention group had significantly higher mean cost from a societal perspective (mean difference £2728.60, p = 0.05), but costs were not significantly different from a health and social care perspective. The exercise intervention was more cost-effective than treatment as usual from both societal and health and social care perspectives for the measure of behavioural and psychological symptoms (Neuropsychiatric Inventory). It does not appear cost-effective in terms of cost per quality-adjusted life year gain. The exercise intervention has the potential to be seen as cost-effective when considering behavioural and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains. Copyright © 2015 John Wiley & Sons, Ltd.

Accounting and cost control of a nuclear power station

International Nuclear Information System (INIS)

Dangelmaier, P.

1977-01-01

1) chart or classification of accounts, 2) all plant expenses, 3) cost control, 4) storage of spare parts and supplies, 5) control of applicable dose rate, 6) charges for insurance. The accuracy of accounting and cost control is a primary thing for the efficiency in a nuclear power station. The much more important factor is the availability. It is necessary to save costs by a more effective storage or a more detailed and automatic process of single jobs in the workshop. But a very definite experience made in Obrigheim is the fact that not only commercial people know which financial loss will occur if the plant is out of operation one hour. This knowledge is also important for the technical people and for the workers in the workshops. The technical responsibility and the security in operation of the plant and the commercial understanding for the risk of non-availability do not exclude each other. (HP) [de

The cost of routine Aedes aegypti control and of insecticide-treated curtain implementation.

Science.gov (United States)

Baly, Alberto; Flessa, Steffen; Cote, Marilys; Thiramanus, Thirapong; Vanlerberghe, Veerle; Villegas, Elci; Jirarojwatana, Somchai; Van der Stuyft, Patrick

2011-05-01

Insecticide-treated curtains (ITCs) are promoted for controlling the Dengue vector Aedes aegypti. We assessed the cost of the routine Aedes control program (RACP) and the cost of ITC implementation through the RACP and health committees in Venezuela and through health volunteers in Thailand. The yearly cost of the RACP per household amounted to US$2.14 and $1.89, respectively. The ITC implementation cost over three times more, depending on the channel used. In Venezuela the RACP was the most efficient implementation-channel. It spent US$1.90 (95% confidence interval [CI]: 1.83; 1.97) per curtain distributed, of which 76.9% for the curtain itself. Implementation by health committees cost significantly (P = 0.02) more: US$2.32 (95% CI: 1.93; 2.61) of which 63% for the curtain. For ITC implementation to be at least as cost-effective as the RACP, at equal effectiveness and actual ITC prices, the attained curtain coverage and the adulticiding effect should last for 3 years.

Effects of Active and Passive Control Techniques on Mach 1.5 Cavity Flow Dynamics

Directory of Open Access Journals (Sweden)

Selin Aradag

2017-01-01

Full Text Available Supersonic flow over cavities has been of interest since 1960s because cavities represent the bomb bays of aircraft. The flow is transient, turbulent, and complicated. Pressure fluctuations inside the cavity can impede successful weapon release. The objective of this study is to use active and passive control methods on supersonic cavity flow numerically to decrease or eliminate pressure oscillations. Jet blowing at several locations on the front and aft walls of the cavity configuration is used as an active control method. Several techniques are used for passive control including using a cover plate to separate the flow dynamics inside and outside of the cavity, trailing edge wall modifications, such as inclination of the trailing edge, and providing curvature to the trailing edge wall. The results of active and passive control techniques are compared with the baseline case in terms of pressure fluctuations, sound pressure levels at the leading edge, trailing edge walls, and cavity floor and in terms of formation of the flow structures and the results are presented. It is observed from the results that modification of the trailing edge wall is the most effective of the control methods tested leading to up to 40 dB reductions in cavity tones.

A simple technique to manipulate foraging costs in seed-eating birds

NARCIS (Netherlands)

Koetsier, Egbert; Verhulst, Simon

Food availability is a key factor in ecology and evolution, but available techniques to manipulate the effort to acquire food in vertebrates are technically challenging and/or labour intensive. We present a simple technique to increase foraging costs in seed-eating birds that can be applied with

Exploratory Cost-Effectiveness Analysis of Response-Guided Neoadjuvant Chemotherapy for Hormone Positive Breast Cancer Patients.

Directory of Open Access Journals (Sweden)

Anna Miquel-Cases

Full Text Available Guiding response to neoadjuvant chemotherapy (guided-NACT allows for an adaptative treatment approach likely to improve breast cancer survival. In this study, our primary aim is to explore the expected cost-effectiveness of guided-NACT using as a case study the first randomized controlled trial that demonstrated effectiveness (GeparTrio trial.As effectiveness was shown in hormone-receptor positive (HR+ early breast cancers (EBC, our decision model compared the health-economic outcomes of treating a cohort of such women with guided-NACT to conventional-NACT using clinical input data from the GeparTrio trial. The expected cost-effectiveness and the uncertainty around this estimate were estimated via probabilistic cost-effectiveness analysis (CEA, from a Dutch societal perspective over a 5-year time-horizon.Our exploratory CEA predicted that guided-NACT as proposed by the GeparTrio, costs additional €110, but results in 0.014 QALYs gained per patient. This scenario of guided-NACT was considered cost-effective at any willingness to pay per additional QALY. At the prevailing Dutch willingness to pay threshold (€80.000/QALY cost-effectiveness was expected with 78% certainty.This exploratory CEA indicated that guided-NACT (as proposed by the GeparTrio trial is likely cost-effective in treating HR+ EBC women. While prospective validation of the GeparTrio findings is advisable from a clinical perspective, early CEAs can be used to prioritize further research from a broader health economic perspective, by identifying which parameters contribute most to current decision uncertainty. Furthermore, their use can be extended to explore the expected cost-effectiveness of alternative guided-NACT scenarios that combine the use of promising imaging techniques together with personalized treatments.

Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls.

Science.gov (United States)

Stauffer, Brett D; Fullerton, Cliff; Fleming, Neil; Ogola, Gerald; Herrin, Jeph; Stafford, Pamala Martin; Ballard, David J

2011-07-25

Randomized controlled trials have demonstrated the efficacy of nurse-led transitional care programs to reduce readmission rates for patients with heart failure; the effectiveness of these programs in real-world health care systems is less well understood. We performed a prospective study with concurrent controls to test an advanced practice nurse-led transitional care program for patients with heart failure who were 65 years or older and were discharged from Baylor Medical Center Garland (BMCG) from August 24, 2009, through April 30, 2010. We compared the effect of the program on 30-day (from discharge) all-cause readmission rate, length of stay, and 60-day (from admission) direct cost for BMCG with that of other hospitals within the Baylor Health Care System. We also performed a budget impact analysis using costs and reimbursement experience from the intervention. The intervention significantly reduced adjusted 30-day readmission rates to BMCG by 48% during the postintervention period, which was better than the secular reductions seen at all other facilities in the system. The intervention had little effect on length of stay or total 60-day direct costs for BMCG. Under the current payment system, the intervention reduced the hospital financial contribution margin on average $227 for each Medicare patient with heart failure. Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure. This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals.

Effectiveness and cost effectiveness of counselling in primary care.

Science.gov (United States)

Bower, P; Rowland, N; Mellor, C l; Heywood, P; Godfrey, C; Hardy, R

2002-01-01

Counsellors are prevalent in primary care settings. However, there are concerns about the clinical and cost-effectiveness of the treatments they provide, compared with alternatives such as usual care from the general practitioner, medication or other psychological therapies. To assess the effectiveness and cost effectiveness of counselling in primary care by reviewing cost and outcome data in randomised controlled trials, controlled clinical trials and controlled patient preference trials of counselling interventions in primary care, for patients with psychological and psychosocial problems considered suitable for counselling. The original search strategy included electronic searching of databases (including the CCDAN Register of RCTs and CCTs) along with handsearching of a specialist journal. Published and unpublished sources (clinical trials, books, dissertations, agency reports etc.) were searched, and their reference lists scanned to uncover further controlled trials. Contact was made with subject experts and CCDAN members in order to uncover further trials. For the updated review, searches were restricted to those databases judged to be high yield in the first version of the review: MEDLINE, EMBASE, PSYCLIT and CINAHL, the Cochrane Controlled Trials register and the CCDAN trials register. All controlled trials comparing counselling in primary care with other treatments for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of June 2001 were included in the review. Data were extracted using a standardised data extraction sheet. The relevant data were entered into the Review Manager software. Trials were quality rated, using CCDAN criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95

Cost analysis and cost justification of automated data processing in the clinical laboratory.

Science.gov (United States)

Westlake, G E

1983-03-01

Prospective cost analysis of alternative data processing systems can be facilitated by proper selection of the costs to be analyzed and realistic appraisal of the effect on staffing. When comparing projects with dissimilar cash flows, techniques such as analysis of net present value can be helpful in identifying financial benefits. Confidence and accuracy in prospective analyses will increase as more retrospective studies are published. Several accounts now in the literature describe long-term experience with turnkey laboratory information systems. Acknowledging the difficulty in longitudinal studies, they all report favorable effects on labor costs and recovery of lost charges. Enthusiasm is also expressed for the many intangible benefits of the systems. Several trends suggest that cost justification and cost effectiveness will be more easily demonstrated in the future. These are the rapidly decreasing cost of hardware (with corresponding reduction in service costs) and the entry into the market of additional systems designed for medium to small hospitals. The effect of broadening the sales base may be lower software prices. Finally, operational and executive data management and reporting are destined to become the premier extensions of the LIS for cost justification. Aptly applied, these facilities can promote understanding of costs, control of costs, and greater efficiency in providing laboratory services.

A strategy of cost control for Mariner Venus/Mercury 1973

Science.gov (United States)

Biggs, John R.; Downhower, Walter J.

1994-01-01

The spacecraft launched by NASA on November 3, 1973 to explore Venus and Mercury proved a notable success as a development project both in space and on the ground. This article on the development points our management approaches and techniques that kept schedules and controlled costs, the intent being to stimulate thought about how to do the same with future spacecraft and payloads. The Mariner Venus/Mercury '73 (MVM '73) project kept within its originally established goals for schedule, performance, and cost. Underlying this development success was the availability of the Mariner technology. But meeting the goals demanded management determination, planning, and discipline to make optimum use of state-of-the-art technology--on the part of people at NASA, JPL, and The Boeing Co. (the contractor).

Cost-effectiveness of a central venous catheter care bundle.

Directory of Open Access Journals (Sweden)

Kate A Halton

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

Cost-effectiveness of early intervention in first-episode psychosis

DEFF Research Database (Denmark)

Hastrup, Lene Halling; Kronborg, C; Bertelsen, M

2013-01-01

Background Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. Aims To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community...... treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. Method An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. Results The mean...... treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective...

Multiagent-based Distributed Control for Operation Cost Minimization of Droop Controlled DC Microgrid Using Incremental Cost Consensus

DEFF Research Database (Denmark)

Li, Chendan; Quintero, Juan Carlos Vasquez; Guerrero, Josep M.

2015-01-01

In this paper, a multiagent based distributed control is proposed for DC microgrid to minimize the operation cost. The power of each distributed generator (DG) is dispatched in a distributed manner in a multiagent system by means of voltage scheduling. Every DG unit is taken as an agent......, and they share the load corresponding to the operation cost of all the units in the system with only communication with direct neighbors through incremental cost consensus. The power regulation according to the power reference generated by consensus is implemented through voltage scheduling in local primary...... controllers. Simulation verification shows that total operation cost of the DC microgrid is successfully reduced though the proposed method....

Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q.

Science.gov (United States)

Matros, Evan; Albornoz, Claudia R; Razdan, Shantanu N; Mehrara, Babak J; Macadam, Sheina A; Ro, Teresa; McCarthy, Colleen M; Disa, Joseph J; Cordeiro, Peter G; Pusic, Andrea L

2015-04-01

Reimbursement has been recognized as a physician barrier to autologous reconstruction. Autologous reconstructions are more expensive than prosthetic reconstructions, but provide greater health-related quality of life. The authors' hypothesis is that autologous tissue reconstructions are cost-effective compared with prosthetic techniques when considering health-related quality of life and patient satisfaction. A cost-effectiveness analysis from the payer perspective, including patient input, was performed for unilateral and bilateral reconstructions with deep inferior epigastric perforator (DIEP) flaps and implants. The effectiveness measure was derived using the BREAST-Q and interpreted as the cost for obtaining 1 year of perfect breast health-related quality-adjusted life-year. Costs were obtained from the 2010 Nationwide Inpatient Sample. The incremental cost-effectiveness ratio was generated. A sensitivity analysis for age and stage at diagnosis was performed. BREAST-Q scores from 309 patients with implants and 217 DIEP flap reconstructions were included. The additional cost for obtaining 1 year of perfect breast-related health for a unilateral DIEP flap compared with implant reconstruction was $11,941. For bilateral DIEP flaps compared with implant reconstructions, the cost for an additional breast health-related quality-adjusted life-year was $28,017. The sensitivity analysis demonstrated that the cost for an additional breast health-related quality-adjusted life-year for DIEP flaps compared with implants was less for younger patients and earlier stage breast cancer. DIEP flaps are cost-effective compared with implants, especially for unilateral reconstructions. Cost-effectiveness of autologous techniques is maximized in women with longer life expectancy. Patient-reported outcomes findings can be incorporated into cost-effectiveness analyses to demonstrate the relative value of reconstructive procedures.

Cost effectiveness of adopted quality requirements in hospital laboratories.

Science.gov (United States)

Hamza, Alneil; Ahmed-Abakur, Eltayib; Abugroun, Elsir; Bakhit, Siham; Holi, Mohamed

2013-01-01

The present study was designed in quasi-experiment to assess adoption of the essential clauses of particular clinical laboratory quality management requirements based on international organization for standardization (ISO 15189) in hospital laboratories and to evaluate the cost effectiveness of compliance to ISO 15189. The quality management intervention based on ISO 15189 was conceded through three phases; pre - intervention phase, Intervention phase and Post-intervention phase. In pre-intervention phase the compliance to ISO 15189 was 49% for study group vs. 47% for control group with P value 0.48, while the post intervention results displayed 54% vs. 79% for study group and control group respectively in compliance to ISO 15189 and statistically significant difference (P value 0.00) with effect size (Cohen's d) of (0.00) in pre-intervention phase and (0.99) in post - intervention phase. The annual average cost per-test for the study group and control group was 1.80 ± 0.25 vs. 1.97 ± 0.39, respectively with P value 0.39 whereas the post-intervention results showed that the annual average total costs per-test for study group and control group was 1.57 ± 0.23 vs 2.08 ± 0.38, P value 0.019 respectively, with cost-effectiveness ratio of (0.88) in pre -intervention phase and (0.52) in post-intervention phase. The planned adoption of quality management requirements (QMS) in clinical laboratories had great effect to increase the compliance percent with quality management system requirement, raise the average total cost effectiveness, and improve the analytical process capability of the testing procedure.

Operation Cost Minimization of Droop-Controlled AC Microgrids Using Multiagent-Based Distributed Control

Directory of Open Access Journals (Sweden)

Chendan Li

2016-09-01

Full Text Available Recently, microgrids are attracting increasing research interest as promising technologies to integrate renewable energy resources into the distribution system. Although many works have been done on droop control applied to microgrids, they mainly focus on achieving proportional power sharing based on the power rating of the power converters. With various primary source for the distributed generator (DG, factors that are closely related to the operation cost, such as fuel cost of the generators and losses should be taken into account in order to improve the efficiency of the whole system. In this paper, a multiagent-based distributed method is proposed to minimize the operation cost in AC microgrids. In the microgrid, each DG is acting as an agent which regulates the power individually using a novel power regulation method based on frequency scheduling. An optimal power command is obtained through carefully designed consensus algorithm by using sparse communication links only among neighbouring agents. Experimental results for different cases verified that the proposed control strategy can effectively reduce the operation cost.

Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial

Science.gov (United States)

2013-01-01

Background A recent HTA review concluded that there was a need for RCTs of exercise referral schemes (ERS) for people with a medical diagnosis who might benefit from exercise. Overall, there is still uncertainty as to the cost-effectiveness of ERS. Evaluation of public health interventions places challenges on conventional health economics approaches. This economic evaluation of a national public health intervention addresses this issue of where ERS may be most cost effective through subgroup analysis, particularly important at a time of financial constraint. Method This economic analysis included 798 individuals aged 16 and over (55% of the randomised controlled trial (RCT) sample) with coronary heart disease risk factors and/or mild to moderate anxiety, depression or stress. Individuals were referred by health professionals in a primary care setting to a 16 week national exercise referral scheme (NERS) delivered by qualified exercise professionals in local leisure centres in Wales, UK. Health-related quality of life, health care services use, costs per participant in NERS, and willingness to pay for NERS were measured at 6 and 12 months. Results The base case analysis assumed a participation cost of £385 per person per year, with a mean difference in QALYs between the two groups of 0.027. The incremental cost-effectiveness ratio was £12,111 per QALY gained. Probabilistic sensitivity analysis demonstrated an 89% probability of NERS being cost-effective at a payer threshold of £30,000 per QALY. When participant payments of £1 and £2 per session were considered, the cost per QALY fell from £12,111 (base case) to £10,926 and £9,741, respectively. Participants with a mental health risk factor alone or in combination with a risk of chronic heart disease generated a lower ICER (£10,276) compared to participants at risk of chronic heart disease only (£13,060). Conclusions Results of cost-effectiveness analyses suggest that NERS is cost saving in fully

Improving cost-effectiveness of hypertension management at a ...

African Journals Online (AJOL)

Objectives. To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

Utility and Cost-Effectiveness of Motivational Messaging to Increase Survey Response in Physicians: A Randomized Controlled Trial

Science.gov (United States)

Chan, Randolph C. H.; Mak, Winnie W. S.; Pang, Ingrid H. Y.; Wong, Samuel Y. S.; Tang, Wai Kwong; Lau, Joseph T. F.; Woo, Jean; Lee, Diana T. F.; Cheung, Fanny M.

2018-01-01

The present study examined whether, when, and how motivational messaging can boost the response rate of postal surveys for physicians based on Higgin's regulatory focus theory, accounting for its cost-effectiveness. A three-arm, blinded, randomized controlled design was used. A total of 3,270 doctors were randomly selected from the registration…

On the cost-effectiveness of Carbon ion radiation therapy for skull base chordoma

International Nuclear Information System (INIS)

Jaekel, Oliver; Land, Beate; Combs, Stephanie Elisabeth; Schulz-Ertner, Daniela; Debus, Juergen

2007-01-01

Aim: The cost-effectiveness of Carbon ion radiotherapy (RT) for patients with skull base chordoma is analyzed. Materials and Methods: Primary treatment costs and costs for recurrent tumors are estimated. The costs for treatment of recurrent tumors were estimated using a sample of 10 patients presenting with recurrent chordoma at the base of skull at DKFZ. Using various scenarios for the local control rate and reimbursements of Carbon ion therapy the cost-effectiveness of ion therapy for these tumors is analyzed. Results: If local control rate for skull base chordoma achieved with carbon ion therapy exceeds 70.3%, the overall treatment costs for carbon RT are lower than for conventional RTI. The cost-effectiveness ratio for carbon RT is 2539 Euro per 1% increase in survival, or 7692 Euro per additional life year. Conclusion: Current results support the thesis that Carbon ion RT, although more expensive, is at least as cost-effective as advanced photon therapies for these patients. Ion RT, however, offers substantial benefits for the patients such as improved control rates and less severe side effects

[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.

The effects of the Bowen technique on hamstring flexibility over time: a randomised controlled trial.

Science.gov (United States)

Marr, Michelle; Baker, Julian; Lambon, Nicky; Perry, Jo

2011-07-01

The hamstring muscles are regularly implicated in recurrent injuries, movement dysfunction and low back pain. Links between limited flexibility and development of neuromusculoskeletal symptoms are frequently reported. The Bowen Technique is used to treat many conditions including lack of flexibility. The study set out to investigate the effect of the Bowen Technique on hamstring flexibility over time. An assessor-blind, prospective, randomised controlled trial was performed on 120 asymptomatic volunteers. Participants were randomly allocated into a control group or Bowen group. Three flexibility measurements occurred over one week, using an active knee extension test. The intervention group received a single Bowen treatment. A repeated measures univariate analysis of variance, across both groups for the three time periods, revealed significant within-subject and between-subject differences for the Bowen group. Continuing increases in flexibility levels were observed over one week. No significant change over time was noted for the control group. Copyright © 2010 Elsevier Ltd. All rights reserved.

Project control integrating cost and schedule in construction

CERN Document Server

Del Pico, Wayne J

2013-01-01

The key to successful project control is the fusing of cost to schedule whereby the management of one helps to manage the other. Project Control: Integrating Cost and Schedule in Construction explores the reasons behind and the methodologies for proper planning, monitoring, and controlling both project costs and schedule. Filling a current void the topic of project control applied to the construction industry, it is essential reading for students and professionals alike.

Atmospheric Nitrogen Deposition Loadings to the Chesapeake Bay: An Initial Analysis of the Cost Effectiveness of Control Options (1996)

Science.gov (United States)

This report examines the cost effectiveness of control options which reduce nitrate deposition to the Chesapeake watershed and to the tidal Bay. The report analyzes current estimates of the reductions expected in the ozone transport region.

Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients

Directory of Open Access Journals (Sweden)

Wong Frances Kam Yuet

2012-12-01

Full Text Available Abstract Background Readmissions are costly and have implications for quality of care. Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes. However, there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs. This study is therefore launched to fill this knowledge gap. Methods Cost-effectiveness analysis was conducted alongside a randomized controlled trial that examined the effects of a Health-Social Transitional Care Management Program (HSTCMP for medical patients discharged from an acute regional hospital in Hong Kong. The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care. The total costs comprised the pre-program, program, and healthcare utilization costs. Quality of life was measured with SF-36 and transformed to utility values between 0 and 1. Results The readmission rates within 28 (control 10.2%, study 4.0% and 84 days (control 19.4%, study 8.1% were significantly higher in the control group. Utility values showed no difference between the control and study groups at baseline (p = 0.308. Utility values for the study group were significantly higher than in the control group at 28 (p  Conclusions Previous studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure. Studies examining the cost-effectiveness of the post-discharge support services are scanty. This study is the first to examine the cost-effectiveness of a transitional care program that used nurse-led services participated by volunteers. Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare resources.

Dutch elm disease control: performance and costs

Science.gov (United States)

William N., Jr. Cannon; David P. Worley

1980-01-01

Municipal programs to suppress Dutch elm disease have had highly variable results. Performance as measured by tree mortality was unrelated to control strategies. Costs for control programs were 37 to 76 percent less than costs without control programs in the 15-year time-span of the study. Only those municipalities that conducted a high-performance program could be...

Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial.

Science.gov (United States)

Brittenden, Julie; Cotton, Seonaidh C; Elders, Andrew; Tassie, Emma; Scotland, Graham; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Francis, Jill; Wileman, Samantha; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, Jonothan; Lees, Tim; Scott, Julian; Baker, Sara A; MacLennan, Graeme; Prior, Maria; Bolsover, Denise; Campbell, Marion K

2015-04-01

trial-based cost-effectiveness analysis showed that, at 6 months, foam had the highest probability of being considered cost-effective at a ceiling willingness-to-pay ratio of £20,000 per QALY. EVLA was found to cost £26,107 per QALY gained versus foam, and was less costly and generated slightly more QALYs than surgery. Markov modelling using trial costs and the limited recurrence data available suggested that, at 5 years, EVLA had the highest probability (≈ 79%) of being cost-effective at conventional thresholds, followed by foam (≈ 17%) and surgery (≈ 5%). With regard to secondary outcomes, health gains at 6 weeks (p < 0.005) were greater for EVLA than for foam (EQ-5D, p = 0.004). There were fewer procedural complications in the EVLA group (1%) than after foam (7%) and surgery (8%) (p < 0.001). Participants returned to a wide range of behaviours more quickly following foam or EVLA than following surgery (p < 0.05). There were no differences in VCSS between the three treatments. Truncal ablation rates were higher for surgery (p < 0.001) and EVLA (p < 0.001) than for foam, and were similar for surgery and EVLA. Considerations of both the 6-month clinical outcomes and the estimated 5-year cost-effectiveness suggest that EVLA should be considered as the treatment of choice for suitable patients. Five-year trial results are currently being evaluated to compare the cost-effectiveness of foam, surgery and EVLA, and to determine the recurrence rates following each treatment. This trial has highlighted the need for long-term outcome data from RCTs on QoL, recurrence rates and costs for foam sclerotherapy and other endovenous techniques compared against each other and against surgery. Current Controlled Trials ISRCTN51995477. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 27. See the NIHR Journals

Cost-effective FITL technologies for small business and residential customers

Science.gov (United States)

Andersen, Niels E.; Woolnough, Peter; Seidenberg, Juergen; Ferreira, Mario F. S.

1995-02-01

FIRST is a RACE project where 5 main European telecoms operators, 4 equipment manufacturers and one university have joined up to define and test in a field trial in Portugal a cost effective Optical Access Network. The main design target has been a system which gives cost effective provision of wideband services for small and medium business customers. The system however, incorporates provision of telephone, ISDN and analog and digital video for residential customers as well. Technologies have been chosen with the objective of providing a simple, robust and flexible system where initial deployment costs are low and closely related to the service take up. The paper describes the main technical features of the system and network applications which shows how the system may be introduced in network planning. The system is based on Passive Optical Network technology where video is distributed in the 1550 nm window and telecoms services transmitted at 1300 nm in full duplex mode. The telecoms system provides high capacity, flexibility in loop length and robustness towards outside plant performance. The Subcarrier Multiple Access (SCMA) method is used for upstream transmission of bi-directional telecoms services. SCMA has advantages compared to the Time Division Multiple Access technology used in other systems. Bandwidth/cost tradeoff is better and the lower requirements to the outside plant increases the overall cost benefit. Optical beat noise due to overlapping of laser spectra which may be a problem for this technology has been addressed with success through the use of a suitable modulation and control technique. This technology is further validated in the field trial. The video system provides cost effective long distance transmission on standard fiber with externally modulated lasers and cascaded amplifiers. Coexistence of analog and digital video on one fiber with different modulation schemes i.e. BPSK, QPSK and 64 QAM have been validated. Total life cycle cost

Flow control and routing techniques for integrated voice and data networks

Science.gov (United States)

Ibe, O. C.

1981-10-01

We consider a model of integrated voice and data networks. In this model the network flow problem is formulated as a convex optimization problem. The objective function comprises two types of cost functions: the congestion cost functions, which limit the average input traffic to values compatible with the network conditions; and the rate limitation cost functions, which ensure that all conversations are fairly treated. A joint flow control and routing algorithm is constructed which determines the routes for each conversation, and effects flow control by setting voice packet lengths and data input rates in a manner that achieves optimal tradeoff between each user's satisfaction and the cost of network congestion. An additional congestion control protocol is specified which could be used in conjunction with the algorithm to make the latter respond more dynamically to network congestion.

Elimination of maintenance outage and cost reduction by development of outage-free maintenance techniques

International Nuclear Information System (INIS)

Jakabe, Hideo; Maruyama, Yoshinaga

1996-01-01

The development program of KEPCO on outage-free maintenance techniques for distribution line work since 1984 is overviewed. It has succeeded in eliminating maintenance outages since 1989. The original aim was to improve customer satisfaction. However, in all, four benefits were realised through the development. These are cost reduction, securing of worker safety, improvement of customer service, and advancement of distribution techniques and morale in KEPCO. The introduction of robotic techniques for maintenance work and manipulator techniques for repair work is planned for further modernization. These new techniques are helping in both work safety and work efficiency improvement. Cost reduction and advancement of distribution line work techniques is also considered. (R.P.)

Applicability of statistical process control techniques

NARCIS (Netherlands)

Schippers, W.A.J.

1998-01-01

This paper concerns the application of Process Control Techniques (PCTs) for the improvement of the technical performance of discrete production processes. Successful applications of these techniques, such as Statistical Process Control Techniques (SPC), can be found in the literature. However, some

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

Science.gov (United States)

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

2018-01-01

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

Targeting the underlying causes of undernutrition. Cost-effectiveness of a multifactorial personalized intervention in community-dwelling older adults: A randomized controlled trial.

Science.gov (United States)

van der Pols-Vijlbrief, Rachel; Wijnhoven, Hanneke A H; Bosmans, Judith E; Twisk, Jos W R; Visser, Marjolein

2017-12-01

Undernutrition in old age is associated with increased morbidity, mortality and health care costs. Treatment by caloric supplementation results in weight gain, but compliance is poor in the long run. Few studies targeted underlying causes of undernutrition in community-dwelling older adults. This study aimed to evaluate the cost-effectiveness of a multifactorial personalized intervention focused on eliminating or managing the underlying causes of undernutrition to prevent and reduce undernutrition in comparison with usual care. A randomized controlled trial was performed among 155 community-dwelling older adults receiving home care with or at risk of undernutrition. The intervention included a personalized action plan and 6 months support. The control group received usual care. Body weight, and secondary outcomes were measured in both groups at baseline and 6 months follow-up. Multiple imputation, linear regression and generalized estimating equation analyses were used to analyze intervention effects. In the cost-effectiveness analyses regression models were bootstrapped to estimate statistical uncertainty. This intervention showed no statistically significant effects on body weight, mid-upper arm circumference, grip strength, gait speed and 12-Item Short-Form Health Survey physical component scale as compared to usual care, but there was an effect on the 12-Item Short-Form Health Survey mental component scale (0-100) (β = 8.940, p=0.001). Borderline significant intervention effects were found for both objective and subjective physical function measures, Short Physical Performance Battery (0-12) (β = 0.56, p=0.08) and ADL-Barthel score (0-20) (β = 0.69, p=0.09). Societal costs in the intervention group were statistically non-significantly lower than in the control group (mean difference -274; 95% CI -1111; 782). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 0.72 at a willingness-to-pay of 1000�

Assessing the effectiveness and cost-effectiveness of audit and feedback on physician’s prescribing indicators: study protocol of a randomized controlled trial with economic evaluation

Science.gov (United States)

2012-01-01

Background Physician prescribing is the most frequent medical intervention with a highest impact on healthcare costs and outcomes. Therefore improving and promoting rational drug use is a great interest. We aimed to assess the effectiveness and cost-effectiveness of two forms of conducting prescribing audit and feedback interventions and a printed educational material intervention in improving physician prescribing. Method/design A four-arm randomized trial with economic evaluation will be conducted in Tehran. Three interventions (routine feedback, revised feedback, and printed educational material) and a no intervention control arm will be compared. Physicians working in outpatient practices are randomly allocated to one of the four arms using stratified randomized sampling. The interventions are developed based on a review of literature, physician interviews, current experiences in Iran and with theoretical insights from the Theory of Planned Behavior. Effects of the interventions on improving antibiotics and corticosteroids prescribing will be assessed in regression analyses. Cost data will be assessed from a health care provider’s perspective and incremental cost-effectiveness ratios will be calculated. Discussion This study will determine the effectiveness and cost-effectiveness of three interventions and allow us to determine the most effective interventions in improving prescribing pattern. If the interventions are cost-effective, they will likely be applied nationwide. Trial registration Iranian Registry of Clinical Trials Registration Number: IRCT201106086740N1Pharmaceutical Sciences Research Center of TUMS Ethics Committee Registration Number: 90-02-27-07 PMID:23351564

Nuclear fuel cycle cost analysis using a probabilistic simulation technique

International Nuclear Information System (INIS)

Won, Il Ko; Jong, Won Choi; Chul, Hyung Kang; Jae, Sol Lee; Kun, Jai Lee

1998-01-01

A simple approach was described to incorporate the Monte Carlo simulation technique into a fuel cycle cost estimate. As a case study, the once-through and recycle fuel cycle options were tested with some alternatives (ie. the change of distribution type for input parameters), and the simulation results were compared with the values calculated by a deterministic method. A three-estimate approach was used for converting cost inputs into the statistical parameters of assumed probabilistic distributions. It was indicated that the Monte Carlo simulation by a Latin Hypercube Sampling technique and subsequent sensitivity analyses were useful for examining uncertainty propagation of fuel cycle costs, and could more efficiently provide information to decisions makers than a deterministic method. It was shown from the change of distribution types of input parameters that the values calculated by the deterministic method were set around a 40 th ∼ 50 th percentile of the output distribution function calculated by probabilistic simulation. Assuming lognormal distribution of inputs, however, the values calculated by the deterministic method were set around an 85 th percentile of the output distribution function calculated by probabilistic simulation. It was also indicated from the results of the sensitivity analysis that the front-end components were generally more sensitive than the back-end components, of which the uranium purchase cost was the most important factor of all. It showed, also, that the discount rate made many contributions to the fuel cycle cost, showing the rank of third or fifth of all components. The results of this study could be useful in applications to another options, such as the Dcp (Direct Use of PWR spent fuel In Candu reactors) cycle with high cost uncertainty

Using Technology to Control Costs

Science.gov (United States)

Ho, Simon; Schoenberg, Doug; Richards, Dan; Morath, Michael

2009-01-01

In this article, the authors examines the use of technology to control costs in the child care industry. One of these technology solutions is Software-as-a-Service (SaaS). SaaS solutions can help child care providers save money in many aspects of center management. In addition to cost savings, SaaS solutions are also particularly appealing to…

Quality of neurological care. Balancing cost control and ethics.

Science.gov (United States)

Bernat, J L

1997-11-01

As the quality of neurological care becomes a mutual objective of physicians, patients, and health planners, increased demands on cost savings will create conflicts that could threaten the ethical basis of medical practice. Physicians will see increasing ethical conflicts between their fiduciary duties to make treatment decisions in the best interest of their patients and their justice-based duties to conserve societal resources. These conflicts can be best mitigated if physicians maintain their orientation as patient advocates but practice cost-conscious clinical behaviors that consider the cost-effectiveness of tests and treatments and do not squander society's finite resources by ordering medical tests and treatments of zero or marginal utility. Health system planners should resolve their conflicting objectives of quality and cost control by rigorously defining and measuring quality through physician leadership and by implementing cost-control measures that enhance the quality of medical care. Managed care organizations voluntarily should forsake financially successful but blatantly unethical cost-saving schemes, such as gag clauses and end-of-year kickback payments to physicians, because these schemes diminish patients' trust in physicians and degrade the integrity of the patient-physician relationship. State and federal laws should prudently regulate these unethical cost-saving schemes to the same extent as they have for the harmful conflicts in fee-for-service medicine.

TRU-ART: A cost-effective prototypical neutron imaging technique for transuranic waste certification systems

International Nuclear Information System (INIS)

Horton, W.S.

1989-01-01

The certification of defense radioactive waste as either transuranic or low-level waste requires very sensitive and accurate assay instrumentation to determine the specific radioactivity within an individual waste package. An assay instrument that employs a new technique (TRU-ART), which can identify the location of the radioactive material within a waste package, was designed, fabricated, and tested to potentially enhance the certification of problem defense waste drums. In addition, the assay instrumentation has potential application in radioactive waste reprocessing and neutron tomography. The assay instrumentation uses optimized electronic signal responses from an array of boral- and cadmium-shielded polyethylene-moderated 3 H detector packages. Normally, thermal neutrons that are detected by 3 H detectors have very poor spatial dependency that may be used to determine the location of the radioactive material. However, these shielded-detector packages of the TRU-ART system maintain the spatial dependency of the radioactive material in that the point of fast neutron thermalization is immediately adjacent to the 3 H detector. The TRU-ART was used to determine the location of radioactive material within three mock-up drums (empty, peat moss, and concrete) and four actual waste drums. The TRU-ART technique is very analogous to emission tomography. The mock-up drum and actual waste drum data, which were collected by the TRU-ART, were directly input into a algebraic reconstruction code to produce three-dimensional isoplots. Finally, a comprehensive fabrication cost estimate of the fielded drum assay system and the TRU-ART system was determined, and, subsequently, these estimates were used in a cost-benefit analysis to compare the economic advantage of the respective systems

Material control in nuclear fuel fabrication facilities. Part II. Accountability, instrumentation and measurement techniques in fuel fabrication facilities

International Nuclear Information System (INIS)

Borgonovi, G.M.; McCartin, T.J.; McDaniel, T.; Miller, C.L.; Nguyen, T.

1978-01-01

This report describes the measurement techniques, the instrumentation, and the procedures used in accountability and control of nuclear materials, as they apply to fuel fabrication facilities. A general discussion is given of instrumentation and measurement techniques which are presently used being considered for fuel fabrication facilities. Those aspects which are most significant from the point of view of satisfying regulatory constraints have been emphasized. Sensors and measurement devices have been discussed, together with their interfacing into a computerized system designed to permit real-time data collection and analysis. Estimates of accuracy and precision of measurement techniques have been given, and, where applicable, estimates of associated costs have been presented. A general description of material control and accounting is also included. In this section, the general principles of nuclear material accounting have been reviewed first (closure of material balance). After a discussion of the most current techniques used to calculate the limit of error on inventory difference, a number of advanced statistical techniques are reviewed. The rest of the section deals with some regulatory aspects of data collection and analysis, for accountability purposes, and with the overall effectiveness of accountability in detecting diversion attempts in fuel fabrication facilities. A specific example of application of the accountability methods to a model fuel fabrication facility is given. The effect of random and systematic errors on the total material uncertainty has been discussed, together with the effect on uncertainty of the length of the accounting period

Material control in nuclear fuel fabrication facilities. Part II. Accountability, instrumentation and measurement techniques in fuel fabrication facilities

Energy Technology Data Exchange (ETDEWEB)

Borgonovi, G.M.; McCartin, T.J.; McDaniel, T.; Miller, C.L.; Nguyen, T.

1978-01-01

This report describes the measurement techniques, the instrumentation, and the procedures used in accountability and control of nuclear materials, as they apply to fuel fabrication facilities. A general discussion is given of instrumentation and measurement techniques which are presently used being considered for fuel fabrication facilities. Those aspects which are most significant from the point of view of satisfying regulatory constraints have been emphasized. Sensors and measurement devices have been discussed, together with their interfacing into a computerized system designed to permit real-time data collection and analysis. Estimates of accuracy and precision of measurement techniques have been given, and, where applicable, estimates of associated costs have been presented. A general description of material control and accounting is also included. In this section, the general principles of nuclear material accounting have been reviewed first (closure of material balance). After a discussion of the most current techniques used to calculate the limit of error on inventory difference, a number of advanced statistical techniques are reviewed. The rest of the section deals with some regulatory aspects of data collection and analysis, for accountability purposes, and with the overall effectiveness of accountability in detecting diversion attempts in fuel fabrication facilities. A specific example of application of the accountability methods to a model fuel fabrication facility is given. The effect of random and systematic errors on the total material uncertainty has been discussed, together with the effect on uncertainty of the length of the accounting period.

Long Term Cost Efficiency through Green Management Control Systems

OpenAIRE

Vukania Adda, Nancy; Qin, Xiaochen

2012-01-01

Title: Long term cost efficiency through green management control systems.Authors: Nancy Vukania &Xiaochen QinSupervisor: Åsa Karin-EngstrandBackground: The worldwide financial crisis of 2008 has reconfigured the economic turf leading to a more uncertain and turbulent playing field – a greater challenge for business strategy and the quest for optimization- The oil price hike of 2008 (Furlong 2010)1 caused its rippling effect to affect various cost categories including energy, labor and lo...

Modified natural cycle versus controlled ovarian hyperstimulation IVF: a cost-effectiveness evaluation of three simulated treatment scenarios.

Science.gov (United States)

Groen, Henk; Tonch, Nino; Simons, Arnold H M; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A

2013-12-01

Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a cost-effective alternative for one cycle of COH with strict application of single embryo transfer (SET). MNC is cheaper per cycle than COH but also less effective in terms of live birth rate (LBR). However, strict application of SET in COH cycles reduces effectiveness and up to three MNC cycles can be performed at the same costs as one COH cycle. The cost-effectiveness of MNC versus COH was evaluated in three simulated treatment scenarios: three cycles of MNC versus one cycle of COH with SET or double embryo transfer (DET) and subsequent transfer of cryopreserved embryos (Scenario 1); six cycles of MNC versus one cycle of COH with strictly SET and subsequent transfer of cryopreserved embryos (Scenario 2); six cycles of MNC with minimized medication (hCG ovulation trigger only) versus one cycle of COH with SET or DET and subsequent transfer of cryopreserved embryos (Scenario 3). We used baseline data obtained from two retrospective cohorts of consecutive patients (2005-2008) undergoing MNC in the University Medical Center Groningen (n = 499, maximum six cycles per patient) or their first COH cycle with subsequent transfer of cryopreserved embryos in the Academic Medical Center Amsterdam (n = 392). Data from 1994 MNC cycles (958 MNC-IVF and 1036 MNC-ICSI) and 392 fresh COH cycles (one per patient, 196 COH-IVF and 196 COH-ICSI) with subsequent transfer of cryopreserved embryos (n = 72 and n = 94 in MNC and COH cycles, respectively) in ovulatory, subfertile women cost-effectiveness ratio (ICER) was calculated, defined as the ratio of the difference in IVF costs up to 6 weeks postpartum to the difference in LBR. Live birth was the primary outcome measure and was defined as the birth of at least one living child

Arms control verification costs: the need for a comparative analysis

International Nuclear Information System (INIS)

MacLean, G.; Fergusson, J.

1998-01-01

The end of the Cold War era has presented practitioners and analysts of international non-proliferation, arms control and disarmament (NACD) the opportunity to focus more intently on the range and scope of NACD treaties and their verification. Aside from obvious favorable and well-publicized developments in the field of nuclear non-proliferation, progress also has been made in a wide variety of arenas, ranging from chemical and biological weapons, fissile material, conventional forces, ballistic missiles, to anti-personnel landmines. Indeed, breaking from the constraints imposed by the Cold War United States-Soviet adversarial zero-sum relationship that impeded the progress of arms control, particularly on a multilateral level, the post Cold War period has witnessed significant developments in NACD commitments, initiatives, and implementation. The goals of this project - in its final iteration - will be fourfold. First, it will lead to the creation of a costing analysis model adjustable for uses in several current and future arms control verification tasks. Second, the project will identify data accumulated in the cost categories outlined in Table 1 in each of the five cases. By comparing costs to overall effectiveness, the application of the model will demonstrate desirability in each of the cases (see Chart 1). Third, the project will identify and scrutinize 'political costs' as well as real expenditures and investment in the verification regimes (see Chart 2). And, finally, the project will offer some analysis on the relationship between national and multilateral forms of arms control verification, as well as the applicability of multilateralism as an effective tool in the verification of international non-proliferation, arms control, and disarmament agreements. (author)

Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics.

Science.gov (United States)

Blæhr, Emely Ek; Væggemose, Ulla; Søgaard, Rikke

2018-04-13

Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI -9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. ISRCTN

Impact of air pollution control costs on the cost and spatial arrangement of cellulosic biofuel production in the U.S.

Science.gov (United States)

Murphy, Colin W; Parker, Nathan C

2014-02-18

Air pollution emissions regulation can affect the location, size, and technology choice of potential biofuel production facilities. Difficulty in obtaining air pollutant emission permits and the cost of air pollution control devices have been cited by some fuel producers as barriers to development. This paper expands on the Geospatial Bioenergy Systems Model (GBSM) to evaluate the effect of air pollution control costs on the availability, cost, and distribution of U.S. biofuel production by subjecting potential facility locations within U.S. Clean Air Act nonattainment areas, which exceed thresholds for healthy air quality, to additional costs. This paper compares three scenarios: one with air quality costs included, one without air quality costs, and one in which conversion facilities were prohibited in Clean Air Act nonattainment areas. While air quality regulation may substantially affect local decisions regarding siting or technology choices, their effect on the system as a whole is small. Most biofuel facilities are expected to be sited near to feedstock supplies, which are seldom in nonattainment areas. The average cost per unit of produced energy is less than 1% higher in the scenarios with air quality compliance costs than in scenarios without such costs. When facility construction is prohibited in nonattainment areas, the costs increase by slightly over 1%, due to increases in the distance feedstock is transported to facilities in attainment areas.

Value Engineering. "A Working Tool for Cost Control in the Design of Educational Facilities."

Science.gov (United States)

Lawrence, Jerry

Value Engineering (VE) is a cost optimizing technique used to analyze design quality and cost-effectiveness. The application of VE procedures to the design and construction of school facilities has been adopted by the state of Washington. By using VE, the optimum value for every life cycle dollar spent on a facility is obtained by identifying not…

Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future Directions

Directory of Open Access Journals (Sweden)

A. Sarvazyan

2008-01-01

Full Text Available Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicine in developing countries is inadequate for the majority of the population. There is a tremendous worldwide need to detect breast cancer at its earliest stage. These needs must be balanced by the ability of countries to provide breast cancer screening technology to their populations. We reviewed the diagnostic accuracy, procedure cost and cost-effectiveness of currently available technique for breast screening and diagnosis including clinical breast examination, mammography, ultrasound, magnetic resonance imaging, biopsy and a new modality for cancer diagnostics termed elasticity imaging that has emerged in the last decade. Clinical results demonstrate that elasticity imaging even in its simplest and least sophisticated versions, like tactile imaging, has significant diagnostic potential comparable and exceeding that of conventional imaging techniques. In view of many countries with limited resources, effective yet less expensive modes of screening must be considered worldwide. The tactile imaging is one method that has the potential to provide cost-effective breast cancer screening and diagnostics.

The cost-effectiveness of single-row compared with double-row arthroscopic rotator cuff repair.

Science.gov (United States)

Genuario, James W; Donegan, Ryan P; Hamman, Daniel; Bell, John-Erik; Boublik, Martin; Schlegel, Theodore; Tosteson, Anna N A

2012-08-01

Interest in double-row techniques for arthroscopic rotator cuff repair has increased over the last several years, presumably because of a combination of literature demonstrating superior biomechanical characteristics and recent improvements in instrumentation and technique. As a result of the increasing focus on value-based health-care delivery, orthopaedic surgeons must understand the cost implications of this practice. The purpose of this study was to examine the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with traditional single-row repair. A decision-analytic model was constructed to assess the cost-effectiveness of double-row arthroscopic rotator cuff repair compared with single-row repair on the basis of the cost per quality-adjusted life year gained. Two cohorts of patients (one with a tear of row compared with single-row arthroscopic rotator cuff repair was $571,500 for rotator cuff tears of row repair was less than $287 for small or moderate tears and less than $352 for large or massive tears compared with the cost of single-row repair, then double-row repair would represent a cost-effective surgical alternative. On the basis of currently available data, double-row rotator cuff repair is not cost-effective for any size rotator cuff tears. However, variability in the values for costs and probability of retear can have a profound effect on the results of the model and may create an environment in which double-row repair becomes the more cost-effective surgical option. The identification of the threshold values in this study may help surgeons to determine the most cost-effective treatment.

Operation Cost Minimization of Droop-Controlled AC Microgrids Using Multiagent-Based Distributed Control

DEFF Research Database (Denmark)

Li, Chendan; Savaghebi, Mehdi; Guerrero, Josep M.

2016-01-01

on the power rating of the power converters. With various primary source for the distributed generator (DG), factors that are closely related to the operation cost, such as fuel cost of the generators and losses should be taken into account in order to improve the efficiency of the whole system. In this paper......, a multiagent-based distributed method is proposed to minimize the operation cost in AC microgrids. In the microgrid, each DG is acting as an agent which regulates the power individually using a novel power regulation method based on frequency scheduling. An optimal power command is obtained through carefully...... designed consensus algorithm by using sparse communication links only among neighbouring agents. Experimental results for different cases verified that the proposed control strategy can effectively reduce the operation cost....

Cost-effectiveness of open versus arthroscopic rotator cuff repair.

Science.gov (United States)

Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant

2010-03-01

Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Tools and techniques for schedule's controlling: tracking system and control of Urucu-Manaus gas-pipeline construction, stretch B1

Energy Technology Data Exchange (ETDEWEB)

Zuany, Valdenise Marques; Dias, Jose Luiz Gomes [CONCREMAT Engenharia e Tecnologia S/A, Rio de Janeiro, RJ (Brazil)

2009-07-01

The goal is to show the monitoring systems and deadline control, using the PMBOK{sup R} project management tools, in the Construction and Assembly of the Coari-Manaus Gas-pipeline, stretch B1, which includes the cities of Coari, Codajas, Anori and Anama, in the state of Amazon, in the Northern Undertaking Implementation (IENOR), an Engineering division of the PETROBRAS System. This report presents the practical effects of the usage of three schedule control tools of the project: Performance Measurement, using the technique of the Earned Value Management (EVM), which integrates cost, schedule and physical progress of the enterprise to determine the variations of schedule and performance; Project Management Software, MSProject, which allows schedule's elaboration and makes the tracking of the planned dates possible (baseline) in relation to real dates and forecasts the trend level, the effects of changes in the project's schedule, demonstrating its utility as a schedule control tool; and Schedule Variance Analysis, which adopts practical data to reach the pessimistic, most likely and optimistic expectations. The implantation of these tools was based in the Work Breakdown Structure of the enterprise. The application of these three tools in the tracking and control of the enterprise demonstrates that, the use of information and techniques deriving from the planning and control can be an important support for project management and decision taking, comparing the results gotten in the implantation of the plan with its actual realization, defining, thus, the necessary corrective actions, generating learned lessons to use in future projects. (author)

Training effectiveness vs. cost effectiveness: The next millennium challenge

International Nuclear Information System (INIS)

Coe, Richard P.

2003-01-01

With the advent of the new millennium and energy deregulation, organizations will be challenged to be cost competitive and profitable. Deregulation in the US energy industry will force utilities and, more specifically, commercial nuclear power production to unprecedented cost control measures. It will also renew the fires of debate about costs vs. safety. With personnel costs being the single largest expenditure for most organizations management will be faced with constant dilemmas of competition for scarce resources. Salaries, benefits and training costs will be under greater scrutiny. Training resources and programs will face increased pressure to be job related, based on conservative requirements and more cost effective than in the past. For nearly two decades the US National Academy for Nuclear Training (NANT) has developed and used industry-wide accreditation and evaluation standards based on the Systematic Approach to Training (SAT). This process assures that existing and emerging technical training is constantly reviewed and evaluated against standardized criteria to assure job relatedness and enhanced job performance. The process also requires management to approve, actively participate in and support the training of NPP personnel. Instructors must be highly skilled and well trained in the SAT process and various instructional strategies. The SAT process is grounded in five interlocking keystone steps; Analysis - Design - Development - Implementation - Evaluation (ADDIE). Evaluation of training is often said to be the most crucial and most difficult step. Here is where an organization determines if the training is effective and meeting the legitimate needs of all of the stakeholders. This QA/QC aspect of training must be an ongoing process involving management, instructors and the students. It is only through the discipline of an SAT based evaluation process that an organization can truly determine if the training is efficient, effective, cost effective and

Adaptive Marginal Costs-Based Distributed Economic Control of Microgrid Clusters Considering Line Loss

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Xiaoqian Zhou

2017-12-01

Full Text Available When several microgrids (MG are interconnected into microgrid clusters (MGC, they have great potential to improve their reliability. Traditional droop control tends to make the total operating costs higher as the power is distributed by capacity ratios of distributed energy resources (DERs. This paper proposes an adaptive distributed economic control for islanded microgrids which considers line loss, specifically, an interesting marginal costs-based economic droop control is proposed, and consensus-based adaptive controller is applied, to deal with power limits and capacity constraints for storage. The whole expense can be effectively lowered by achieving identical marginal costs for DERs in MGC. Specially, the capacity constraints only for storages are also included to do further optimization. Moreover, consensus-based distributed secondary controllers are used to rapidly restore system frequency and voltage magnitudes. The above controllers only need to interact with neighbor DERs by a sparse communication network, eliminating the necessity of a central controller and enhancing the stability. A MGC, incorporating three microgrids, is used to verify the effectiveness of the proposed methods.

Costs of regulatory compliance: categories and estimating techniques

International Nuclear Information System (INIS)

Schulte, S.C.; McDonald, C.L.; Wood, M.T.; Cole, R.M.; Hauschulz, K.

1978-10-01

Use of the categorization scheme and cost estimating approaches presented in this report can make cost estimates of regulation required compliance activities of value to policy makers. The report describes a uniform assessment framework that when used would assure that cost studies are generated on an equivalent basis. Such normalization would make comparisons of different compliance activity cost estimates more meaningful, thus enabling the relative merits of different regulatory options to be more effectively judged. The framework establishes uniform cost reporting accounts and cost estimating approaches for use in assessing the costs of complying with regulatory actions. The framework was specifically developed for use in a current study at Pacific Northwest Laboratory. However, use of the procedures for other applications is also appropriate

Dynamic cost control information system for nuclear power plant construction

International Nuclear Information System (INIS)

Wang Yongqing; Liu Wei

1998-01-01

The authors first introduce the cost control functions of some overseas popular project management software at present and the specific ways of cost control of nuclear power plant construction in China. Then the authors stress the necessity of cost and schedule control integration and present the concept of dynamic cost control, the design scheme of dynamic cost control information system and the data structure modeling. Based on the above, the authors can develop the system which has the functions of dynamic estimate, cash flow management and cost optimization for nuclear engineering

Above Bonneville passage and propagation cost effectiveness analysis

International Nuclear Information System (INIS)

Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

1993-05-01

We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region

Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

Energy Technology Data Exchange (ETDEWEB)

Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

1993-05-01

We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

Comparative study of the effects of treatment techniques on the ...

African Journals Online (AJOL)

This paper reports the effects of some fibre treatment techniques namely: mercerization, acetylation and semi-carbonisation on the performance of Kenaf fibres. The treated kenaf fibres which are considered biodegradable, cost effective, renewable and user friendly have been used as a possible base friction material for ...

The comparative cost-effectiveness of colorectal cancer screening using faecal immunochemical test vs. colonoscopy.

Science.gov (United States)

Wong, Martin C S; Ching, Jessica Y L; Chan, Victor C W; Sung, Joseph J Y

2015-09-04

Faecal immunochemical tests (FITs) and colonoscopy are two common screening tools for colorectal cancer(CRC). Most cost-effectiveness studies focused on survival as the outcome, and were based on modeling techniques instead of real world observational data. This study evaluated the cost-effectiveness of these two tests to detect colorectal neoplastic lesions based on data from a 5-year community screening service. The incremental cost-effectiveness ratio (ICER) was assessed based on the detection rates of neoplastic lesions, and costs including screening compliance, polypectomy, colonoscopy complications, and staging of CRC detected. A total of 5,863 patients received yearly FIT and 4,869 received colonoscopy. Compared with FIT, colonoscopy detected notably more adenomas (23.6% vs. 1.6%) and advanced lesions or cancer (4.2% vs. 1.2%). Using FIT as control, the ICER of screening colonoscopy in detecting adenoma, advanced adenoma, CRC and a composite endpoint of either advanced adenoma or stage I CRC was US$3,489, US$27,962, US$922,762 and US$23,981 respectively. The respective ICER was US$3,597, US$439,513, -US$2,765,876 and US$32,297 among lower-risk subjects; whilst the corresponding figure was US$3,153, US$14,852, US$184,162 and US$13,919 among higher-risk subjects. When compared to FIT, colonoscopy is considered cost-effective for screening adenoma, advanced neoplasia, and a composite endpoint of advanced neoplasia or stage I CRC.

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.

Stochastic Feedforward Control Technique

Science.gov (United States)

Halyo, Nesim

1990-01-01

Class of commanded trajectories modeled as stochastic process. Advanced Transport Operating Systems (ATOPS) research and development program conducted by NASA Langley Research Center aimed at developing capabilities for increases in capacities of airports, safe and accurate flight in adverse weather conditions including shear, winds, avoidance of wake vortexes, and reduced consumption of fuel. Advances in techniques for design of modern controls and increased capabilities of digital flight computers coupled with accurate guidance information from Microwave Landing System (MLS). Stochastic feedforward control technique developed within context of ATOPS program.

Components of the costs of controlling quality: a transaction cost economics approach.

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Stiles, R A; Mick, S S

1997-01-01

This article identifies the components that contribute to a healthcare organization's costs in controlling quality. A central tenet of our argument is that at its core, quality is the result of a series of transactions among members of a diverse network. Transaction cost economics is applied internally to analyze intraorganizational transactions that contribute to quality control, and questions for future research are posed.

Cost-effectiveness and radiological risk associated with mass chest screening

International Nuclear Information System (INIS)

Stieve, F.E.

1987-01-01

This report presents in summary the cost effectiveness and radiological risks associated with mass chest tuberculosis screening in major European countries. The state of tuberculosis in west Europe, the cost effectiveness of mass screening, international standards regarding radiation doses as well as the need for quality control are addressed

Design techniques for mutlivariable flight control systems

Science.gov (United States)

1981-01-01

Techniques which address the multi-input closely coupled nature of advanced flight control applications and digital implementation issues are described and illustrated through flight control examples. The techniques described seek to exploit the advantages of traditional techniques in treating conventional feedback control design specifications and the simplicity of modern approaches for multivariable control system design.

Decentralized guaranteed cost static output feedback vibration control for piezoelectric smart structures

International Nuclear Information System (INIS)

Jiang, Jian-ping; Li, Dong-xu

2010-01-01

This paper is devoted to the study of the decentralized guaranteed cost static output feedback vibration control for piezoelectric smart structures. A smart panel with collocated piezoelectric actuators and velocity sensors is modeled using a finite element method, and then the size of the model is reduced in the state space using the modal Hankel singular value. The necessary and sufficient conditions of decentralized guaranteed cost static output feedback control for the reduced system have been presented. The decentralized and centralized static output feedback matrices can be obtained from solving two linear matrix inequalities. A comparison between centralized control and decentralized control is performed in order to investigate their effectiveness in suppressing vibration of a smart panel. Numerical results show that when the system is subjected to initial displacement or white noise disturbance, the decentralized and centralized controls are both very effective and the control results are very close

Cost-effectiveness of salpingotomy and salpingectomy in women with tubal pregnancy (a randomized controlled trial)

NARCIS (Netherlands)

Broekmans, FJM; Mol, F.; Mello, N.M.; Strandell, Annika; Strandell, Karin; Jurkovic, Davor; Ross, Jackie; Barnhart, K.; Yalcinkaya, Tamer; Verhoeve, H.R.; Graziosi, G.C.M.; Koks, Carolien A M; Klinte, Ingmar; Hogstrom, Lars; Janssen, Ineke; Kragt, Harry; Hoek, Annemieke; Trimbos-Kemper, Trudy; Willemsen, Wim; Ankum, W.M.; Mol, Benwillem; Wely, M.; van der Veen, Fulco; Hajenius, Petra J

2015-01-01

STUDY QUESTION: Is salpingotomy cost effective compared with salpingectomy in women with tubal pregnancy and a healthy contralateral tube? SUMMARY ANSWER: Salpingotomy is not cost effective over salpingectomy as a surgical procedure for tubal pregnancy, as its costs are higher without a better

Tokamak impurity-control techniques

International Nuclear Information System (INIS)

Schmidt, J.A.

1980-01-01

A brief review is given of the impurity-control functions in tokamaks, their relative merits and disadvantages and some prominent edge-interaction-control techniques, and there is a discussion of a new proposal, the particle scraper, and its potential advantages. (author)

A Cost Effective Solution for Development Environment for Data Acquisition, Monitoring and Simulation of PLC Controlled Applications

Directory of Open Access Journals (Sweden)

O. Bjelica

2014-06-01

Full Text Available It is very important to test and monitor the operation of Programmable Logic Controller (PLC in real time (online. Nowadays, conventional, but expensive monitoring systems for PLCs, such as Supervisory Control and Data Acquisition (SCADA systems, software and hardware simulators (or debuggers, are widely used. This paper proposes a user friendly and cost-effective development environment for monitoring, data acquisition and online simulation of applications with PLC. The purpose of this solution is to simulate the process which is controlled by the PLC. The performances of the proposed development environment are presented on the examples of washing machine and dishwasher simulators.

Locally optimal control under unknown dynamics with learnt cost function: application to industrial robot positioning

Science.gov (United States)

Guérin, Joris; Gibaru, Olivier; Thiery, Stéphane; Nyiri, Eric

2017-01-01

Recent methods of Reinforcement Learning have enabled to solve difficult, high dimensional, robotic tasks under unknown dynamics using iterative Linear Quadratic Gaussian control theory. These algorithms are based on building a local time-varying linear model of the dynamics from data gathered through interaction with the environment. In such tasks, the cost function is often expressed directly in terms of the state and control variables so that it can be locally quadratized to run the algorithm. If the cost is expressed in terms of other variables, a model is required to compute the cost function from the variables manipulated. We propose a method to learn the cost function directly from the data, in the same way as for the dynamics. This way, the cost function can be defined in terms of any measurable quantity and thus can be chosen more appropriately for the task to be carried out. With our method, any sensor information can be used to design the cost function. We demonstrate the efficiency of this method through simulating, with the V-REP software, the learning of a Cartesian positioning task on several industrial robots with different characteristics. The robots are controlled in joint space and no model is provided a priori. Our results are compared with another model free technique, consisting in writing the cost function as a state variable.

Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial.

Science.gov (United States)

Mori, Amani Thomas; Kampata, Linda; Musonda, Patrick; Johansson, Kjell Arne; Robberstad, Bjarne; Sandøy, Ingvild

2017-12-19

Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living. The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives. While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be

Cost-effectiveness of Intensive Blood Pressure Management

DEFF Research Database (Denmark)

Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

2016-01-01

Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age...... and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times...

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.

The OPTIMIST study: optimisation of cost effectiveness through individualised FSH stimulation dosages for IVF treatment. A randomised controlled trial

Directory of Open Access Journals (Sweden)

van Tilborg Theodora C

2012-09-01

Full Text Available Abstract Background Costs of in vitro fertilisation (IVF are high, which is partly due to the use of follicle stimulating hormone (FSH. FSH is usually administered in a standard dose. However, due to differences in ovarian reserve between women, ovarian response also differs with potential negative consequences on pregnancy rates. A Markov decision-analytic model showed that FSH dose individualisation according to ovarian reserve is likely to be cost-effective in women who are eligible for IVF. However, this has never been confirmed in a large randomised controlled trial (RCT. The aim of the present study is to assess whether an individualised FSH dose regime based on an ovarian reserve test (ORT is more cost-effective than a standard dose regime. Methods/Design Multicentre RCT in subfertile women indicated for a first IVF or intracytoplasmic sperm injection cycle, who are aged  Discussion The results of this study will be integrated into a decision model that compares cost-effectiveness of the three dose-adjustment strategies to a standard dose strategy. The study outcomes will provide scientific foundation for national and international guidelines. Trial registration NTR2657

Cost-effectiveness of laser Doppler imaging in burn care in the Netherlands

Directory of Open Access Journals (Sweden)

Hop M Jenda

2013-02-01

Full Text Available Abstract Background Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate. Laser Doppler imaging (LDI is a technique with which a more accurate (>95% estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary. Methods/design A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2–5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: ‘new diagnostic strategy’ versus ‘current diagnostic strategy’. The results of the LDI-scan will only be provided to the treating clinician in the ‘new diagnostic strategy’ group. The main endpoint is the effect of LDI on wound healing time. In addition we measure: a the effect of LDI on other patient outcomes (quality of life, scar quality, b the effect of LDI on diagnostic and therapeutic decisions, and c the effect of LDI on total (medical and non-medical costs and cost-effectiveness. Discussion This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness. Trial registration NCT01489540

Identifying and quantifying energy savings on fired plant using low cost modelling techniques

International Nuclear Information System (INIS)

Tucker, Robert; Ward, John

2012-01-01

Research highlights: → Furnace models based on the zone method for radiation calculation are described. → Validated steady-state and transient models have been developed. → We show how these simple models can identify the best options for saving energy. → High emissivity coatings predicted to give performance enhancement on a fired heater. → Optimal heat recovery strategies on a steel reheating furnace are predicted. -- Abstract: Combustion in fired heaters, boilers and furnaces often accounts for the major energy consumption on industrial processes. Small improvements in efficiency can result in large reductions in energy consumption, CO 2 emissions, and operating costs. This paper will describe some useful low cost modelling techniques based on the zone method to help identify energy saving opportunities on high temperature fuel-fired process plant. The zone method has for many decades, been successfully applied to small batch furnaces through to large steel-reheating furnaces, glass tanks, boilers and fired heaters on petrochemical plant. Zone models can simulate both steady-state furnace operation and more complex transient operation typical of a production environment. These models can be used to predict thermal efficiency and performance, and more importantly, to assist in identifying and predicting energy saving opportunities from such measures as: ·Improving air/fuel ratio and temperature controls. ·Improved insulation. ·Use of oxygen or oxygen enrichment. ·Air preheating via flue gas heat recovery. ·Modification to furnace geometry and hearth loading. There is also increasing interest in the application of refractory coatings for increasing surface radiation in fired plant. All of the techniques can yield savings ranging from a few percent upwards and can deliver rapid financial payback, but their evaluation often requires robust and reliable models in order to increase confidence in making financial investment decisions. This paper gives

Cost-effectiveness analysis in minimally invasive spine surgery.

Science.gov (United States)

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

2014-06-01

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

Exploring the comparative cost-effectiveness of economic incentive and command-and-control instruments, and of renewable energy technologies in PM10 emission control: A case study of Lima-Callao, Peru

Science.gov (United States)

Kroeger, Timm

Much economic literature expounds the superior cost-effectiveness of economic incentive (EI) policies over command-and-control (CAC) ones, based on appealing theoretical arguments. However, one of the assumptions underlying much of this literature is that monitoring and enforcement (M&E) of policies are not only feasible, but essentially costless. In reality, M&E are never costless and sometimes infeasible, and, crucially, M&E requirements vary across policy types. Furthermore, in technical economic terms, cost-effectiveness is defined with respect to variable costs only; however, in choosing among policies, the objective generally is to identify that with the lowest total (variable plus fixed) cost per unit abatement, which in its own right may be termed cost-effective. The neglect of M&E and of fixed costs throws up the question of the validity of much of the policy advice that draws on the environmental economics literature for developing countries, where the institutional capacity for effective M&E often is strongly limited, and where creating this capacity will require considerable infrastructure investments. The limited institutional capacity also has led to the suggestion that in developing countries, conventional environmental policies, such as input or output taxes, emission charges, or standards, may be less cost-effective than non-conventional environmental policies, such as direct public provision of electricity from renewable sources, because the M&E capacity required for the implementation of non-conventional policies is often less stringent. I test the hypotheses of superior cost-effectiveness of EI over CAC and of non-conventional over conventional environmental policy instruments. The samples of pollution control policies used to test the hypotheses are drawn from a list of frequently recommended urban air pollution abatement measures for developing countries, plus two renewable energy sources. Both sets of environmental policy types are compared

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

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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.

Supersonic impinging jet noise reduction using a hybrid control technique

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Wiley, Alex; Kumar, Rajan

2015-07-01

Control of the highly resonant flowfield associated with supersonic impinging jet has been experimentally investigated. Measurements were made in the supersonic impinging jet facility at the Florida State University for a Mach 1.5 ideally expanded jet. Measurements included unsteady pressures on a surface plate near the nozzle exit, acoustics in the nearfield and beneath the impingement plane, and velocity field using particle image velocimetry. Both passive control using porous surface and active control with high momentum microjet injection are effective in reducing nearfield noise and flow unsteadiness over a range of geometrical parameters; however, the type of noise reduction achieved by the two techniques is different. The passive control reduces broadband noise whereas microjet injection attenuates high amplitude impinging tones. The hybrid control, a combination of two control methods, reduces both broadband and high amplitude impinging tones and surprisingly its effectiveness is more that the additive effect of the two control techniques. The flow field measurements show that with hybrid control the impinging jet is stabilized and the turbulence quantities such as streamwise turbulence intensity, transverse turbulence intensity and turbulent shear stress are significantly reduced.

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

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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

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

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

2012-01-01

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

Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial

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Blom Marco M

2013-01-01

Full Text Available Abstract Background The number of people with dementia is rising rapidly as a consequence of the greying of the world population. There is an urgent need to develop cost effective approaches that meet the needs of people with dementia and their family caregivers. Depression, feelings of burden and caregiver stress are common and serious health problems in these family caregivers. Different kinds of interventions are developed to prevent or reduce the negative psychological consequences of caregiving. The use of internet interventions is still very limited, although they may be a cost effective way to support family caregivers in an earlier stage and diminish their psychological distress in the short and longer run. Methods/design A pragmatic randomized controlled trial is designed to evaluate the effectiveness and cost-effectiveness of ‘Mastery over Dementia’, an internet intervention for caregivers of people with dementia. The intervention aims at prevention and decrease of psychological distress, in particular depressive symptoms. The experimental condition consists of an internet course with 8 sessions and a booster session over a maximum period of 6 months guided by a psychologist. Caregivers in the comparison condition receive a minimal intervention. In addition to a pre and post measurement, an intermediate measurement will be conducted. In addition, there will be two follow-up measurements 3 and 6 months after post-treatment in the experimental group only. To study the effectiveness of the intervention, depressive symptoms are used as the primary outcome, whereas symptoms of anxiety, role overload and caregiver perceived stress are used as secondary outcomes. To study which caregivers profit most of the internet intervention, several variables that may modify the impact of the intervention are taken into account. Regarding the cost-effectiveness, an economic evaluation will be conducted from a societal perspective. Discussion This

Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial.

Science.gov (United States)

Blom, Marco M; Bosmans, Judith E; Cuijpers, Pim; Zarit, Steve H; Pot, Anne Margriet

2013-01-10

The number of people with dementia is rising rapidly as a consequence of the greying of the world population. There is an urgent need to develop cost effective approaches that meet the needs of people with dementia and their family caregivers. Depression, feelings of burden and caregiver stress are common and serious health problems in these family caregivers. Different kinds of interventions are developed to prevent or reduce the negative psychological consequences of caregiving. The use of internet interventions is still very limited, although they may be a cost effective way to support family caregivers in an earlier stage and diminish their psychological distress in the short and longer run. A pragmatic randomized controlled trial is designed to evaluate the effectiveness and cost-effectiveness of 'Mastery over Dementia', an internet intervention for caregivers of people with dementia. The intervention aims at prevention and decrease of psychological distress, in particular depressive symptoms. The experimental condition consists of an internet course with 8 sessions and a booster session over a maximum period of 6 months guided by a psychologist. Caregivers in the comparison condition receive a minimal intervention. In addition to a pre and post measurement, an intermediate measurement will be conducted. In addition, there will be two follow-up measurements 3 and 6 months after post-treatment in the experimental group only. To study the effectiveness of the intervention, depressive symptoms are used as the primary outcome, whereas symptoms of anxiety, role overload and caregiver perceived stress are used as secondary outcomes. To study which caregivers profit most of the internet intervention, several variables that may modify the impact of the intervention are taken into account. Regarding the cost-effectiveness, an economic evaluation will be conducted from a societal perspective. This study will provide evidence about the effectiveness and cost-effectiveness

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

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

2011-01-04

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

Controlling fuel costs: Procurement strategies and regulatory standards

International Nuclear Information System (INIS)

Einhorn, H.A.; Levi, B.I.

1992-01-01

Since the oil price shocks and inflation of the 1970s, regulatory authorities and utilities have devoted considerable attention to controlling energy costs while maintaining reliable service. Although much of this concern has been directed towards capital cost containment, increasing scrutiny has been applied to a broad range of variable costs, especially to fuel procurement expenditures. With some 40% to 65% of the electric utility industry's annual operation and maintenance expenses paid to secure fuel supplies, even a small difference in fuel costs could have a substantial impact on costs to ratepayers. This increased attention to fuel cost containment can be expected to intensify as implementation of the 1990 amendments to the Clean Air Act affects fuel purchase decisions. To assure that fuel is purchased in a responsible and cost-effective manner, some state jurisdictions have initiated periodic reviews (audits) of the procurement practices that electric utilities follow when purchasing fuel. While a utility must demonstrate how it purchases fuel, there is wide variation in interest and scope of audits among jurisdictions. In this paper, the authors review: (1) the regulatory environment within which fuel procurement and audits occur, and (2) some particularly controversial issues that will receive increasing attention as the practice of conducting fuel procurement audits spreads

Effectiveness and cost-effectiveness of humanistic counselling in schools for young people with emotional distress (ETHOS): study protocol for a randomised controlled trial.

Science.gov (United States)

Stafford, Megan Rose; Cooper, Mick; Barkham, Michael; Beecham, Jeni; Bower, Peter; Cromarty, Karen; Fugard, Andrew J B; Jackson, Charlie; Pearce, Peter; Ryder, Rebekah; Street, Cathy

2018-03-09

One in ten children in Britain have been identified as experiencing a diagnosable mental health disorder. School-based humanistic counselling (SBHC) may help young people identify, address, and overcome psychological distress. Data from four pilot trials suggest that SBHC may be clinically effective. However, a fully powered randomised controlled trial (RCT) is needed to provide a robust test of its effectiveness, to assess its cost-effectiveness, and to determine the process of change. The Effectiveness and Cost-effectiveness Trial of Humanistic Counselling in Schools (ETHOS) is a two-arm, parallel-group RCT comparing the clinical and cost-effectiveness of SBHC with Pastoral Care as Usual (PCAU) in school settings. Eligibility criteria for young people include being between 13 and 16 years of age and experiencing moderate to severe levels of emotional distress. Participants are randomised to receive either SBHC or PCAU. SBHC is delivered in up to 10 weekly, individual sessions in their school with a qualified, experienced counsellor who has also received training using a clinical practice manual. Adherence to the SBHC model is assessed by a sub-team of auditors and in clinical supervision. PCAU consists of the schools' pre-existing systems for supporting the emotional health and well-being of students. The primary outcomes are psychological distress measured using the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE) and costs evaluated using the Client Service Receipt Inventory (CSRI). Secondary outcomes include psychological difficulties, levels of depression, anxiety and self-esteem, well-being, school engagement, educational outcomes and achievement of personal goals. Qualitative interviews with participants, parents and school staff will look to identify the mechanisms of change in SBHC. Researchers administering the measures are blind to allocation. The trial requires n = 306 participants (n = 153 in each group), with 90% power to detect a