Direct Medical Costs of Hospitalizations for Cardiovascular Diseases in Shanghai, China

Science.gov (United States)

Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

2015-01-01

Abstract Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs. To develop a time series model using Box–Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai. Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030. From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04–4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05–1.19 billion) without additional government interventions. Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers. PMID:25997060

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

Directory of Open Access Journals (Sweden)

Leitão Raquel Jales

2006-01-01

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

Total Cost of Ownership and Cost-to-Serve

DEFF Research Database (Denmark)

Zachariassen, Frederik

2007-01-01

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

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

Science.gov (United States)

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

2017-05-03

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

Total cost of ownership in the services sector: A case study

NARCIS (Netherlands)

K. Hurkens (Krisje); W. van der Valk (Wendy); J.Y.F. Wynstra (Finn)

2006-01-01

textabstractFew detailed studies exist of the trade-offs to be made when developing a comprehensive, strategically focused total cost of ownership (TCO) model. Moreover, most studies of TCO have been conducted in manufacturing firms, with little or no TCO research directed toward service

Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain, according to disability

Directory of Open Access Journals (Sweden)

Gubieras Laura

2006-11-01

Full Text Available Abstract Background Multiple sclerosis (MS is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia and grouped according to their disability (EDSS. Methods We analysed data from 200 MS patients, who answered a questionnaire on resource consumption, employment and economical status. Mean age was 41.6 years, mean EDSS 2.7, 65.5% of patients were female, 79.5% had a relapsing-remitting course, and 67.5% of them were receiving immunomodulatory treatment (IT. Patients were grouped into five EDSS stages. Data from the questionnaires, hospital charts, Catalan Health Service tariffs, and figures from Catalan Institute of Statistics were used to calculate the direct and indirect costs. The cost-of-illness method, and the human capital approach for indirect costs, were applied. Sensitivity analyses were performed to strengthen results. Results The mean total annual cost of MS per patient results 24272 euros. This cost varied according to EDSS: 14327 euros (EDSS = 0, 18837 euros (EDSS = 1–3, 27870 euros (EDSS = 3.5–5.5, 41198 euros (EDSS = 6–7 and 52841 euros (EDSS>7.5. When the mean total annual costs was adjusted by the mean % of patients on IT in our Unit (31% the result was 19589 euros. The key-drivers for direct costs were IT in low EDSS stages, and caregiver costs in high stages. Indirect costs were assessed in terms of the loss of productivity when patients stop working. Direct costs accounted for around 60% of total costs in all EDSS groups. IT accounts from 78% to 11% of direct costs, and decreased as disability progressed. Conclusion The total mean social costs of MS in a

Using value-based total cost of ownership (TCO) measures to inform subsystem trade-offs

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Radziwill, Nicole M.; DuPlain, Ronald F.

2010-07-01

Total Cost of Ownership (TCO) is a metric from management accounting that helps expose both the direct and indirect costs of a business decision. However, TCO can sometimes be too simplistic for "make vs. buy" decisions (or even choosing between competing design alternatives) when value and extensibility are more critical than total cost. A three-dimensional value-based TCO, which was developed to clarify product decisions for an observatory prior to Final Design Review (FDR), will be presented in this session. This value-based approach incorporates priority of requirements, satisfiability of requirements, and cost, and can be easily applied in any environment.

Total generating costs: coal and nuclear plants

International Nuclear Information System (INIS)

1979-02-01

The study was confined to single and multi-unit coal- and nuclear-fueled electric-generating stations. The stations are composed of 1200-MWe PWRs; 1200-MWe BWRs; 800-and 1200-MWe High-Sulfur Coal units, and 800- and 1200-MWe Low-Sulfur Coal units. The total generating cost estimates were developed for commercial operation dates of 1985 and 1990; for 5 and 8% escalation rates, for 10 and 12% discount rates; and, for capacity factors of 50, 60, 70, and 80%. The report describes the methodology for obtaining annualized capital costs, levelized coal and nuclear fuel costs, levelized operation and maintenance costs, and the resulting total generating costs for each type of station. The costs are applicable to a hypothetical Middletwon site in the Northeastern United States. Plant descriptions with general design parameters are included. The report also reprints for convenience, summaries of capital cost by account type developed in the previous commercial electric-power cost studies. Appropriate references are given for additional detailed information. Sufficient detail is given to allow the reader to develop total generating costs for other cases or conditions

Direct and indirect costs of surgically treated pelvic fractures.

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Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

2016-03-01

Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p fractures are associated with both high direct costs and substantial productivity loss.

Cost-identification analysis of total laryngectomy: an itemized approach to hospital costs.

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Dedhia, Raj C; Smith, Kenneth J; Weissfeld, Joel L; Saul, Melissa I; Lee, Steve C; Myers, Eugene N; Johnson, Jonas T

2011-02-01

To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Case series with chart review. Large tertiary care teaching hospital system. Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Mean total hospital costs were $29,563 (range, $10,915 to $120,345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6-43), and median Charlson comorbidity index score was 8 (2-16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46,831 vs $24,601, P cost differences with stratification based on previous radiation therapy ($27,598 vs $29,915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29,483 vs $29,609 without readmission, P = .97). This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.

48 CFR 31.202 - Direct costs.

Science.gov (United States)

2010-10-01

... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 31.202 Direct... amount as an indirect cost if the accounting treatment— (1) Is consistently applied to all final cost... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Direct costs. 31.202...

The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

Science.gov (United States)

Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Tzanakis, Nikos; Toumbis, Michalis; Vassilakopoulos, Theodoros

2017-01-01

COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

A decision-making framework for total ownership cost management of complex systems: A Delphi study

Science.gov (United States)

King, Russel J.

This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

Science.gov (United States)

Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

2015-05-01

Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

Total life cycle cost model for electric power stations

International Nuclear Information System (INIS)

Cardullo, M.W.

1995-01-01

The Total Life Cycle Cost (TLCC) model for electric power stations was developed to provide a technology screening model. The TLCC analysis involves normalizing cost estimates with respect to performance standards and financial assumptions and preparing a profile of all costs over the service life of the power station. These costs when levelized present a value in terms of a utility electricity rate. Comparison of cost and the pricing of the electricity for a utility shows if a valid project exists. Cost components include both internal and external costs. Internal costs are direct costs associated with the purchase, and operation of the power station and include initial capital costs, operating and maintenance costs. External costs result from societal and/or environmental impacts that are external to the marketplace and can include air quality impacts due to emissions, infrastructure costs, and other impacts. The cost stream is summed (current dollars) or discounted (constant dollars) to some base year to yield a overall TLCC of each power station technology on a common basis. While minimizing life cycle cost is an important consideration, it may not always be a preferred method for some utilities who may prefer minimizing capital costs. Such consideration does not always result in technology penetration in a marketplace such as the utility sector. Under various regulatory climates, the utility is likely to heavily weigh initial capital costs while giving limited consideration to other costs such as societal costs. Policy makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. The TLCC analysis model for power stations was developed to facilitate consideration of all perspectives

Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury.

Science.gov (United States)

Badke, Guilherme Lellis; Araujo, João Luiz Vitorino; Miura, Flávio Key; Guirado, Vinicius Monteiro de Paula; Saade, Nelson; Paiva, Aline Lariessy Campos; Avelar, Tiago Marques; Pedrozo, Charles Alfred Grander; Veiga, José Carlos Esteves

2018-04-01

Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

The economic implications of a multimodal analgesic regimen for patients undergoing major orthopedic surgery: a comparative study of direct costs.

Science.gov (United States)

Duncan, Christopher M; Hall Long, Kirsten; Warner, David O; Hebl, James R

2009-01-01

Total knee and total hip arthoplasty (THA) are 2 of the most common surgical procedures performed in the United States and represent the greatest single Medicare procedural expenditure. This study was designed to evaluate the economic impact of implementing a multimodal analgesic regimen (Total Joint Regional Anesthesia [TJRA] Clinical Pathway) on the estimated direct medical costs of patients undergoing lower extremity joint replacement surgery. An economic cost comparison was performed on Mayo Clinic patients (n = 100) undergoing traditional total knee or total hip arthroplasty using the TJRA Clinical Pathway. Study patients were matched 1:1 with historical controls undergoing similar procedures using traditional anesthetic (non-TJRA) techniques. Matching criteria included age, sex, surgeon, type of procedure, and American Society of Anesthesiologists (ASA) physical status (PS) classification. Hospital-based direct costs were collected for each patient and analyzed in standardized inflation-adjusted constant dollars using cost-to-charge ratios, wage indexes, and physician services valued using Medicare reimbursement rates. The estimated mean direct hospital costs were compared between groups, and a subgroup analysis was performed based on ASA PS classification. The estimated mean direct hospital costs were significantly reduced among TJRA patients when compared with controls (cost difference, 1999 dollars; 95% confidence interval, 584-3231 dollars; P = 0.0004). A significant reduction in hospital-based (Medicare Part A) costs accounted for the majority of the total cost savings. Use of a comprehensive, multimodal analgesic regimen (TJRA Clinical Pathway) in patients undergoing lower extremity joint replacement surgery provides a significant reduction in the estimated total direct medical costs. The reduction in mean cost is primarily associated with lower hospital-based (Medicare Part A) costs, with the greatest overall cost difference appearing among patients

Clinical benefit and cost effectiveness of total knee arthroplasty in the older patient

Directory of Open Access Journals (Sweden)

Krummenauer F

2009-02-01

Full Text Available Abstract Purpose Total knee arthroplasty (TKA is an effective, but also cost-intensive health care procedure for the elderly. Furthermore, bearing demographic changes in Western Europe in mind, TKA-associated financial investment for health care insurers will increase notably and thereby catalyze discussions on ressource allocation to Orthopedic surgery. To derive a quantitative rationale for such discussions within Western Europe's health care systems, a prospective assessment of both the benefit of TKA from a patient's perspective as well as its cost effectiveness from a health care insurer's perspective was implemented. Methods A prospective cost effectiveness trial recruited a total of 65 patients (60% females, who underwent TKA in 2006; median age of patients was 66 years (interquartile range 61 - 74 years. Before and three months after surgery patients were interviewed by means of the EuroQol-5D and the WOMAC questionnaires to assess their individual benefit due to TKA and the subsequent inpatient rehabilitation. Both questionnaires' benefit estimates were transformed into the number of gained quality adjusted life years [QALYs]. Total direct cost estimates for the overall care were based on German DRG and rehabilitation cost rates [€]. The primary clinical endpoint of the investigation was the individual number of QALYs gained by TKA based on the WOMAC interview; the primary health economic endpoint was the marginal cost effectiveness ratio (MCER relating the costs to the associated gain in quality of life [€/QALY]. Results Total direct costs for the overall procedure were estimed 9549 € in median. The WOMAC based interview revealed an overall gain of 4.59 QALYs (interquartile range 2.39 - 6.21 QALYs, resulting in marginal costs of 1795 €/QALY (1488 - 3288 €/QALY. The corresponding EuroQol based estimates were 2.93 QALYs (1.75 - 5.59 QALYs and 3063 €/QALY (1613 - 5291 €/QALY. Logistic regression modelling identified the

The direct and indirect costs of Dravet Syndrome.

Science.gov (United States)

Whittington, Melanie D; Knupp, Kelly G; Vanderveen, Gina; Kim, Chong; Gammaitoni, Arnold; Campbell, Jonathan D

2018-03-01

The objective of this study was to estimate the annual direct and indirect costs associated with Dravet Syndrome (DS). A survey was electronically administered to the caregivers of patients with DS treated at Children's Hospital Colorado. Survey domains included healthcare utilization of the patient with DS and DS caregiver work productivity and activity impairment. Patient healthcare utilization was measured using modified questions from the National Health Interview Survey; caregiver work productivity and activity impairment were measured using modified questions from the Work Productivity and Activity Impairment questionnaire. Direct costs were calculated by multiplying the caregiver-reported healthcare utilization rates by the mean unit cost for each healthcare utilization category. Indirect costs included lost productivity, income loss, and lost leisure time. The indirect costs were a function of caregiver-reported hours spent caregiving and an hourly unit cost. The survey was emailed to 60 DS caregivers, of which 34 (57% response rate) responded. Direct costs on average were $27,276 (95% interval: $15,757, $41,904) per patient with DS. Hospitalizations ($11,565 a year) and in-home medical care visits ($9894 a year) were substantial cost drivers. Additionally, caregivers reported extensive time spent providing care to an individual with DS. This caregiver time resulted in average annual indirect costs of $81,582 (95% interval: $57,253, $110,151), resulting in an average total annual financial burden of $106,378 (95% interval: $78,894, $137,906). Dravet Syndrome results in substantial healthcare utilization, financial burden, and time commitment. Establishing evidence on the financial burden of DS is essential to understanding the overall impact of DS, identifying potential areas for support needs, and assessing the impact of novel treatments as they become available. Based on the study findings, in-home visits, hospitalizations, and lost productivity and

Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty.

Science.gov (United States)

Bachman, Daniel; Nyland, John; Krupp, Ryan

2016-02-18

To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

[Direct costs of medical care for patients with type 2 diabetes mellitus in Mexico micro-costing analysis].

Science.gov (United States)

Rodríguez Bolaños, Rosibel de Los Ángeles; Reynales Shigematsu, Luz Myriam; Jiménez Ruíz, Jorge Alberto; Juárez Márquezy, Sergio Arturo; Hernández Ávila, Mauricio

2010-12-01

Estimate the direct cost of medical care incurred by the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) for patients with type 2 diabetes mellitus (DM2). The clinical files of 497 patients who were treated in secondary and tertiary medical care units in 2002-2004 were reviewed. Costs were quantified using a disease costing approach (DCA) from the provider's perspective, a micro-costing technique, and a bottom-up methodology. Average annual costs by diagnosis, complication, and total cost were estimated. Total IMSS DM2 annual costs were US$452 064 988, or 3.1% of operating expenses. The annual average cost per patient was US$3 193.75, with US$2 740.34 per patient without complications and US$3 550.17 per patient with complications. Hospitalization and intensive care bed-days generated the greatest expenses. The high cost of providing medical care to patients with DM2 and its complications represents an economic burden that health institutions should consider in their budgets to enable them to offer quality service that is both adequate and timely. Using the micro-costing methodology allows an approximation to real data on utilization and management of the disease.

Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

NARCIS (Netherlands)

P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

2016-01-01

textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost

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

Science.gov (United States)

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

2010-01-01

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

Economics of human performance and systems total ownership cost.

Science.gov (United States)

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

2012-01-01

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

Total hip arthroplasty revision due to infection: a cost analysis approach.

Science.gov (United States)

Klouche, S; Sariali, E; Mamoudy, P

2010-04-01

The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection

Costs of endometriosis in Austria: a survey of direct and indirect costs.

Science.gov (United States)

Prast, Johanna; Oppelt, Peter; Shamiyeh, Andreas; Shebl, Omar; Brandes, Iris; Haas, Dietmar

2013-09-01

The literature includes a wealth of medical data on endometriosis, but the economic significance of the condition has so far been neglected. An analysis of hospital costs for endometriosis in Austria was, therefore, carried out for economic purposes. Seventy-three patients with endometriosis were included in the study. A bottom-up approach was used to collect data on the average hospital costs of an endometriosis patient over a time period of 1 year. In addition, a prevalence approach was used that allows subsequent estimation of the total costs of endometriosis for the health-care system in Austria for that period. Retrospective questionnaire survey was conducted. The average annual costs of one case of endometriosis are 7,712, with 5,605.55 attributable to direct costs and 2,106.34 to indirect costs. This indicates an overall economic burden of 328 million. In-patient care (45 %) and loss of productivity (27 %) were identified as the major cost factors. The patients themselves pay for 13 % of the costs (through out-of-pocket payments). This study impressively demonstrates the financial burden on the economy and on each individually affected patient caused by the disease of endometriosis. The massive consumption of resources represents a high level of usage of the medical services provided. The question arises as to whether more timely diagnosis, followed by better-targeted treatment, might have the potential to reduce these costs. The overall economic burden of endometriosis in Austria is currently comparable with that of Parkinson's disease.

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

Science.gov (United States)

Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho

2015-01-01

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study

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Cristiana M. Toscano

2018-01-01

Full Text Available The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1 peripheral neuropathy without ulcer, (2 non-infected foot ulcer, (3 infected foot ulcer, and (4 clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP (1 Int$ = 1.748 BRL. We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13% was for inpatient, and Int$ 333.5 million (87% for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

Science.gov (United States)

Toscano, Cristiana M; Sugita, Tatiana H; Rosa, Michelle Q M; Pedrosa, Hermelinda C; Rosa, Roger Dos S; Bahia, Luciana R

2018-01-08

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we

THE COST OF PRODUCTION UNDER DIRECT COSTING AND ABSORPTION COSTING – A COMPARATIVE APPROACH

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Bunea-Bontaş Cristina Aurora

2013-04-01

Full Text Available Managerial accounting has an important role in strategic management of a company, being designed especially for managers, in order to optimise their decision regarding operating activities. One of the objectives of managerial accounting is the cost calculation, for measuring inventory costs, and the costs and profitability of products and services. Cost calculation systems can vary in terms of which costs are assigned to cost objects, two significant calculation systems being adopted by the costing theory: full cost accounting, which includes all costs of production as product costs, and partial cost accounting, which includes only those costs that vary with output. This article provides a comparative approach regarding the differences between the calculation of the cost of production under direct costing and absorption costing. It also examines the implication of using each of these calculation systems on the financial position and financial performance of the companies reported on the statement of financial position and the income statement. Finally, the advantages of using direct costing for internal reporting are discussed, considering that this method is not acceptable for external reporting to stockholders and other external users.

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

Science.gov (United States)

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

2016-12-01

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

Cost-effectivness analysis of total thyroidectomy vs radioiodine for Graves disease

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Prokić Anđelka

2013-01-01

Full Text Available Among the patients suffering from hyperthyroidism 60-80% have Graves' disease. The initial therapy of Graves's disease are antithyroid drugs. If the remission is not achieved after 12-18 months, the patients should be directed to surgical treatment or to the therapy with radioactive iodine. The aim of this study was to compare cost/effectiveness ratios for radioactive iodine and total thyroidectomy. The analysis was made using Markov model, from the perspective of Republic Fund for Health Insurance in Serbia. Duration of one cycle in the model is six months, and the time horizon is 30 years. Monte Carlo simulation was performed for 1000 virtual patients as well as the analysis of sensitivity with the variation of parameters ± 50%. For total thyroidectomy the insurance should provide 138.389,72 RSD / 57, 83 QALY i.e. 2.393,04 dinars for one quality-adjusted life year, and for radioactive iodine the insurance should provide 110.043,64 RSD / 57,82 QALY i.e. 1.903,37 dinars for one quality-adjusted life year. This economic analysis showed that radioactive iodine has better ratio of costs to clinical effectiveness as opposed to total thyroidectomy.

Direct medical costs and medication compliance among fibromyalgia patients: duloxetine initiators vs. pregabalin initiators.

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Sun, Peter; Peng, Xiaomei; Sun, Steve; Novick, Diego; Faries, Douglas E; Andrews, Jeffrey S; Wohlreich, Madelaine M; Wu, Andrew

2014-01-01

To assess and compare direct medical costs and medication compliance between patients with fibromyalgia who initiated duloxetine and patients with fibromyalgia who initiated pregabalin in 2008. A retrospective cohort study design was used based on a large US national commercial claims database (2006 to 2009). Patients with fibromyalgia aged 18 to 64 who initiated duloxetine or pregabalin in 2008 and who had continuous health insurance 1 year preceding and 1 year following the initiation were selected into duloxetine cohort or pregabalin cohort based on their initiated agent. Medication compliance was measured by total supply days, medication possession ratio (MPR), and proportion of patients with MPR ≥ 0.8. Direct medical costs were measured by annual costs per patient and compared between the cohorts in the year following the initiation. Propensity score stratification and bootstrapping methods were used to adjust for distribution bias, as well as cross-cohort differences in demographic, clinical and economic characteristics, and medication history prior to the initiation. Both the duloxetine (n = 3,033) and pregabalin (n = 4,838) cohorts had a mean initiation age around 49 years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P costs ($2,994.9 vs. $4,949.6, P costs ($8,259.6 vs. $10,312.2, P costs ($5,214.6 vs. $5,290.8, P > 0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P compliance and consumed less inpatient, outpatient, and total medical costs than those who initiated pregabalin. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands.

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Kik, Sandra V; Olthof, Sandra P J; de Vries, Jonie T N; Menzies, Dick; Kincler, Naomi; van Loenhout-Rooyakkers, Joke; Burdo, Conny; Verver, Suzanne

2009-08-05

In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1-6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted euro353. Most costs were spent when being hospitalized. Time loss (mean 81 days) was mainly due to hospitalization (19 days) and additional work days lost (60 days), and corresponded with a cost estimation of euro2603. Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands

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Kincler Naomi

2009-08-01

Full Text Available Abstract Background In low tuberculosis (TB incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. Methods A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1–6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. Results In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted €353. Most costs were spent when being hospitalized. Time loss (mean 81 days was mainly due to hospitalization (19 days and additional work days lost (60 days, and corresponded with a cost estimation of €2603. Conclusion Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

Bearing Procurement Analysis Method by Total Cost of Ownership Analysis and Reliability Prediction

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Trusaji, Wildan; Akbar, Muhammad; Sukoyo; Irianto, Dradjad

2018-03-01

In making bearing procurement analysis, price and its reliability must be considered as decision criteria, since price determines the direct cost as acquisition cost and reliability of bearing determine the indirect cost such as maintenance cost. Despite the indirect cost is hard to identify and measured, it has high contribution to overall cost that will be incurred. So, the indirect cost of reliability must be considered when making bearing procurement analysis. This paper tries to explain bearing evaluation method with the total cost of ownership analysis to consider price and maintenance cost as decision criteria. Furthermore, since there is a lack of failure data when bearing evaluation phase is conducted, reliability prediction method is used to predict bearing reliability from its dynamic load rating parameter. With this method, bearing with a higher price but has higher reliability is preferable for long-term planning. But for short-term planning the cheaper one but has lower reliability is preferable. This contextuality can give rise to conflict between stakeholders. Thus, the planning horizon needs to be agreed by all stakeholder before making a procurement decision.

Direct health care costs associated with asthma in British Columbia

Science.gov (United States)

Sadatsafavi, Mohsen; Lynd, Larry; Marra, Carlo; Carleton, Bruce; Tan, Wan C; Sullivan, Sean; FitzGerald, J Mark

2010-01-01

BACKGROUND: A better understanding of health care costs associated with asthma would enable the estimation of the economic burden of this increasingly common disease. OBJECTIVE: To determine the direct medical costs of asthma-related health care in British Columbia (BC). METHODS: Administrative health care data from the BC Linked Health Database and PharmaNet database from 1996 to 2000 were analyzed for BC residents five to 55 years of age, including the billing information for physician visits, drug dispensations and hospital discharge records. A unit cost was assigned to physician/emergency department visits, and government reimbursement fees for prescribed medications were applied. The case mix method was used to calculate hospitalization costs. All costs were reported in inflation-adjusted 2006 Canadian dollars. RESULTS: Asthma resulted in $41,858,610 in annual health care-related costs during the study period ($331 per patient-year). The major cost component was medications, which accounted for 63.9% of total costs, followed by physician visits (18.3%) and hospitalization (17.8%). When broader definitions of asthma-related hospitalizations and physician visits were used, total costs increased to $56,114,574 annually ($444 per patient-year). There was a statistically significant decrease in the annual per patient cost of hospitalizations (P<0.01) over the study period. Asthma was poorly controlled in 63.5% of patients, with this group being responsible for 94% of asthma-related resource use. CONCLUSION: The economic burden of asthma is significant in BC, with the majority of the cost attributed to poor asthma control. Policy makers should investigate the reason for lack of proper asthma control and adjust their policies accordingly to improve asthma management. PMID:20422063

Direct cost associated with acquired brain injury in Ontario

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Chen Amy

2012-08-01

-65% of the total treatment cost in the first year overwhelming all other cost components. Conclusions The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.

A general approach to total repair cost limit replacement policies

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F. Beichelt

2014-01-01

Full Text Available A common replacement policy for technical systems consists in replacing a system by a new one after its economic lifetime, i.e. at that moment when its long-run maintenance cost rate is minimal. However, the strict application of the economic lifetime does not take into account the individual deviations of maintenance cost rates of single systems from the average cost development. Hence, Beichet proposed the total repair cost limit replacement policy: the system is replaced by a new one as soon as its total repair cost reaches or exceeds a given level. He modelled the repair cost development by functions of the Wiener process with drift. Here the same policy is considered under the assumption that the one-dimensional probability distribution of the process describing the repair cost development is given. In the examples analysed, applying the total repair cost limit replacement policy instead of the economic life-time leads to cost savings of between 4% and 30%. Finally, it is illustrated how to include the reliability aspect into the policy.

Electrostatic direct energy converter performance and cost scaling laws

International Nuclear Information System (INIS)

Hoffman, M.A.

1977-08-01

This study is concerned with electrostatic type direct energy converters for direct recovery of a large fraction of the plasma ion energy from fusion reactors. Simplified equations are presented for each of the important loss mechanisms in both single-stage direct converters and multistage ''Venetian Blind'' type direct converters. These equations can be used to estimate the efficiency and electric power output of the direct converter subsystem. Scaling relations for the cost of each major component in the direct converter subsystem are also given; these include the vacuum tank, direct converter modules, the DC power conditioning equipment, cryogenic vacuum pumping system and the thermal bottoming plant. The performance and cost scaling laws have been developed primarily for use in overall fusion power plant systems codes. However, to illustrate their utility, cost-effectiveness studies of two specific reference direct converter designs are presented in terms of the specific capital costs (i.e., the capital cost per unit electric power produced) for the Direct Converter Subsystem alone. Some examples of design improvements which can significantly reduce the specific capital costs of the Direct Converter Subsystem are also given

Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

Science.gov (United States)

de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

2015-01-01

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

THEORETICAL AND PRACTICAL CONSIDERATIONS REGARDING THE COST CALCULATION USING DIRECT COSTING

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Cristina Aurora, Bunea-Bontaş

2012-01-01

Full Text Available The definition of the cost of production as applied to inventories refers to the acquisition and production cost, and its determination involves many considerations. This article emphasizes a comparative approach of the calculation of production cost under direct costing and absorption costing, and examines the impact of using these calculation systems on the financial performance of the companies presented in the income statement.

Direct costs of unintended pregnancy in the Russian federation.

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Lowin, Julia; Jarrett, James; Dimova, Maria; Ignateva, Victoria; Omelyanovsky, Vitaly; Filonenko, Anna

2015-02-01

In 2010, almost every third pregnancy in Russia was terminated, indicating that unintended pregnancy (UP) is a public health problem. The aim of this study was to estimate the direct cost of UP to the healthcare system in Russia and the proportion attributable to using unreliable contraception. A cost model was built, adopting a generic payer perspective with a 1-year time horizon. The analysis cohort was defined as women of childbearing age between 18 and 44 years actively seeking to avoid pregnancy. Model inputs were derived from published sources or government statistics with a 2012 cost base. To estimate the number of UPs attributable to unreliable methods, the model combined annual typical use failure rates and age-adjusted utilization for each contraceptive method. Published survey data was used to adjust the total cost of UP by the number of UPs that were mistimed rather than unwanted. Scenario analysis considered alternate allocation of methods to the reliable and unreliable categories and estimate of the burden of UP in the target sub-group of women aged 18-29 years. The model estimated 1,646,799 UPs in the analysis cohort (women aged 18-44 years) with an associated annual cost of US$783 million. The model estimated 1,019,371 UPs in the target group of 18-29 years, of which 88 % were attributable to unreliable contraception. The total cost of UPs in the target group was estimated at approximately US$498 million, of which US$441 million could be considered attributable to the use of unreliable methods. The cost of UP attributable to use of unreliable contraception in Russia is substantial. Policies encouraging use of reliable contraceptive methods could reduce the burden of UP.

28 CFR 100.14 - Directly allocable costs.

Science.gov (United States)

2010-07-01

... in accordance with the accounting principles used by the carrier in the preparation of their... costs is the cost accounting period during which such costs are incurred and accumulated for... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Directly allocable costs. 100.14 Section...

Patients direct costs to undergo TB diagnosis.

Science.gov (United States)

de Cuevas, Rachel M Anderson; Lawson, Lovett; Al-Sonboli, Najla; Al-Aghbari, Nasher; Arbide, Isabel; Sherchand, Jeevan B; Nnamdi, Emenyonu E; Aseffa, Abraham; Yassin, Mohammed A; Abdurrahman, Saddiq T; Obasanya, Joshua; Olanrewaju, Oladimeji; Datiko, Daniel; Theobald, Sally J; Ramsay, Andrew; Squire, S Bertel; Cuevas, Luis E

2016-03-24

A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable. We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75(th) quartile were considered to have high expenditure (cases) and compared with patients with costs <75(th) quartile to identify factors associated with high expenditure. The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy. The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.

19 CFR 10.814 - Direct costs of processing operations.

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2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Direct costs of processing operations. 10.814... Free Trade Agreement Rules of Origin § 10.814 Direct costs of processing operations. (a) Items included. For purposes of § 10.810(b) of this subpart, the words “direct costs of processing operations”, with...

19 CFR 10.774 - Direct costs of processing operations.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Direct costs of processing operations. 10.774... Free Trade Agreement Rules of Origin § 10.774 Direct costs of processing operations. (a) Items included. For purposes of § 10.770(b) of this subpart, the words “direct costs of processing operations”, with...

Costs and consequences of direct-to-consumer advertising for clopidogrel in Medicaid.

Science.gov (United States)

Law, Michael R; Soumerai, Stephen B; Adams, Alyce S; Majumdar, Sumit R

2009-11-23

Direct-to-consumer advertising (DTCA) is assumed to be a major driver of rising pharmaceutical costs. Yet, research on how it affects costs is limited. Therefore, we studied clopidogrel, a commonly used and heavily marketed antiplatelet agent, which was first sold in 1998 and first direct-to-consumer advertised in 2001. We examined pharmacy data from 27 Medicaid programs from 1999 through 2005. We used interrupted time series analysis to analyze changes in the number of units dispensed, cost per unit dispensed, and total pharmacy expenditures after DTCA initiation. In 1999 and 2000, there was no DTCA for clopidogrel; from 2001 through 2005, DTCA spending exceeded $350 million. Direct-to-consumer advertising did not change the preexisting trend in the number of clopidogrel units dispensed per 1000 enrollees (P = .10). However, there was a sudden and sustained increase in cost per unit of $0.40 after DTCA initiation (95% confidence interval, $0.31-$0.49; P consumer advertising was not associated with an increase in clopidogrel use over and above preexisting trends. However, Medicaid pharmacy expenditures increased substantially after the initiation of DTCA because of a concomitant increase in the cost per unit. If drug price increases after DTCA initiation are common, there are important implications for payers and for policy makers in the United States and elsewhere.

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

Science.gov (United States)

Dolecheck, K; Bewley, J

2018-03-20

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

Association of Hospital Costs With Complications Following Total Gastrectomy for Gastric Adenocarcinoma.

Science.gov (United States)

Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E

2017-10-01

Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD

Total staff costs to implement a decision support system in nursing

Directory of Open Access Journals (Sweden)

Valéria Castilho

2014-01-01

Full Text Available OBJECTIVE: to identify the direct labor (DL costs to put in practice a decision support system (DSS in nursing at the University Hospital of the University of São Paulo (HU-USP. METHOD: the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. RESULTS: the DL cost corresponded to R$ 752,618.56 (100%, R$ 26,000.00 (3.45% of which were funded by a funding agency, while R$ 726,618.56 (96,55% came from Hospital and University resources. CONCLUSION: considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.

21 CFR 862.1110 - Bilirubin (total or direct) test system.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bilirubin (total or direct) test system. 862.1110... Systems § 862.1110 Bilirubin (total or direct) test system. (a) Identification. A bilirubin (total or direct) test system is a device intended to measure the levels of bilirubin (total or direct) in plasma...

Direct costs associated with chronic kidney disease among type 2 diabetic patients in India

Directory of Open Access Journals (Sweden)

K Satyavani

2014-01-01

Full Text Available The aim of this study was to estimate the direct costs of medical care among hospitalized type 2 diabetic patients with chronic kidney disease (CKD. A total of 209 (M:F, 133:76 patients were divided into groups based on the severity of kidney disease. Group 1 subjects had undergone renal transplantation (n = 12, group 2 was CKD patients on hemodialysis (n = 45, group 3 was patients with CKD, prior to end-stage renal disease (ESRD (n = 66, and group 4 (n = 86 consisted of subjects without any complications. Details about expenditure per hospitalization, length of stay during admission, direct medical and nonmedical cost, expenditure for the previous two years, and source of bearing the expenditure were recorded in a questionnaire. Diabetic patients with CKD prior to ESRD spend more per hospitalization than patients without any complications. [Median ₹ 12,664 vs. 3,214]. The total median cost of CKD patients on hemodialysis was significantly higher than other CKD patients (INR 61,170 vs. 12,664. The median cost involved in kidney transplantation was ₹ 392,920. The total expenditure for hospital admissions in two years was significantly higher for dialysis than transplantation. Patients on hemodialysis or kidney transplantation tend to stay longer as inpatient admissions. The source of funds for the expenditure was mainly personal savings (46%. The expenditure on hospital admissions for CKD was considerably higher, and so, there is a need to develop a protocol on a cost-effective strategy for the treatment of CKD.

Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

Directory of Open Access Journals (Sweden)

Darbà J

2015-07-01

over 6 months for direct medical-, social-, indirect-, and informal-care costs were estimated at €1,028.10 (€1,655.00, €843.80 (€2,684.80, €464.20 (€1,639.00, and €33,232.20 (€30,898.90, respectively. Dependence was independently and significantly associated with direct medical-, social-, informal-, and total-care costs. Conclusion: The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Interventions that reduce patient dependence on caregivers may be associated with important reduction in direct medical-, social-, informal-, and total-care costs. Keywords: Alzheimer, Dependence Scale, direct medical care costs, social care costs, indirect care costs, informal care costs.

Costs and benefits of direct-to-consumer advertising: the case of depression.

Science.gov (United States)

Block, Adam E

2007-01-01

Direct-to-consumer advertising (DTCA) is legal in the US and New Zealand, but illegal in the rest of the world. Little or no research exists on the social welfare implications of DTCA. To quantify the total costs and benefits associated with both appropriate and inappropriate care due to DTCA, for the case of depression. A cost-benefit model was developed using parameter estimates from available survey, epidemiological and experimental data. The model estimates the total benefits and costs (year 2002 values) of new appropriate and inappropriate care stimulated by DTCA for depression. Uncertainty in model parameters is addressed with sensitivity analyses. This study provides evidence that 94% of new antidepressant use due to DTCA is from non-depressed individuals. However, the average health benefit to each new depressed user is 63-fold greater than the cost per treatment, creating a positive overall social welfare effect; a net benefit of >72 million US dollars. This analysis suggests that DTCA may lead to antidepressant treatment in 15-fold as many non-depressed people as depressed people. However, the costs of treating non-depressed people may be vastly outweighed by the much larger benefit accruing to treated depressed individuals. The cost-benefit ratio can be improved through better targeting of advertisements and higher quality treatment of depression.

Direct healthcare costs of selected diseases primarily or partially transmitted by water.

Science.gov (United States)

Collier, S A; Stockman, L J; Hicks, L A; Garrison, L E; Zhou, F J; Beach, M J

2012-11-01

Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.

The total lifetime health cost savings of smoking cessation to society

DEFF Research Database (Denmark)

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

2005-01-01

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

Direct costs and cost-effectiveness of dual-source computed tomography and invasive coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease.

Science.gov (United States)

Dorenkamp, Marc; Bonaventura, Klaus; Sohns, Christian; Becker, Christoph R; Leber, Alexander W

2012-03-01

The study aims to determine the direct costs and comparative cost-effectiveness of latest-generation dual-source computed tomography (DSCT) and invasive coronary angiography for diagnosing coronary artery disease (CAD) in patients suspected of having this disease. The study was based on a previously elaborated cohort with an intermediate pretest likelihood for CAD and on complementary clinical data. Cost calculations were based on a detailed analysis of direct costs, and generally accepted accounting principles were applied. Based on Bayes' theorem, a mathematical model was used to compare the cost-effectiveness of both diagnostic approaches. Total costs included direct costs, induced costs and costs of complications. Effectiveness was defined as the ability of a diagnostic test to accurately identify a patient with CAD. Direct costs amounted to €98.60 for DSCT and to €317.75 for invasive coronary angiography. Analysis of model calculations indicated that cost-effectiveness grew hyperbolically with increasing prevalence of CAD. Given the prevalence of CAD in the study cohort (24%), DSCT was found to be more cost-effective than invasive coronary angiography (€970 vs €1354 for one patient correctly diagnosed as having CAD). At a disease prevalence of 49%, DSCT and invasive angiography were equally effective with costs of €633. Above a threshold value of disease prevalence of 55%, proceeding directly to invasive coronary angiography was more cost-effective than DSCT. With proper patient selection and consideration of disease prevalence, DSCT coronary angiography is cost-effective for diagnosing CAD in patients with an intermediate pretest likelihood for it. However, the range of eligible patients may be smaller than previously reported.

The economic impact of chronic fatigue syndrome in Georgia: direct and indirect costs

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Brimmer Dana J

2011-01-01

Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a debilitating chronic illness affecting at least 4 million people in the United States. Understanding its cost improves decisions regarding resource allocation that may be directed towards treatment and cure, and guides the evaluation of clinical and community interventions designed to reduce the burden of disease. Methods This research estimated direct and indirect costs of CFS and the impact on educational attainment using a population-based, case-control study between September 2004 and July 2005, Georgia, USA. Participants completed a clinical evaluation to confirm CFS, identify other illnesses, and report on socioeconomic factors. We estimated the effect of CFS on direct medical costs (inpatient hospitalizations, provider visits, prescription medication spending, other medical supplies and services and loss in productivity (employment and earnings with a stratified sample (n = 500 from metropolitan, urban, and rural Georgia. We adjusted medical costs and earnings for confounders (age, sex, race/ethnicity, education, and geographic strata using econometric models and weighted estimates to reflect response-rate adjusted sampling rates. Results Individuals with CFS had mean annual direct medical costs of $5,683. After adjusting for confounding factors, CFS accounted for $3,286 of these costs (p Conclusions Study results indicate that chronic fatigue syndrome may lead to substantial increases in healthcare costs and decreases in individual earnings. Studies have estimated up to 2.5% of non-elderly adults may suffer from CFS. In Georgia, a state with roughly 5.5 million people age 18-59, illness could account for $452 million in total healthcare expenditures and $1.2 billion of lost productivity.

The direct cost of "Thriasio" school screening program

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Maziotou Christina

2007-05-01

Full Text Available Abstract Background There is great diversity in the policies for scoliosis screening worldwide. The initial enthusiasm was succeeded by skepticism and the worth of screening programs has been challenged. The criticisms of school screening programs cite mainly the negative psychological impact on children and their families and the increased financial cost of visits and follow-up radiographs. The purpose of this report is to evaluate the direct cost of performing the school screening in a district hospital. Methods A cost analysis was performed for the estimation of the direct cost of the "Thriasio" school-screening program between January 2000 and May 2006. The analysis involved all the 6470 pupils aged 6–18 years old who were screened at schools for spinal deformities during this period. The factors which were taken into consideration in order to calculate the direct cost of the screening program were a the number of the examiners b the working hours, c the examiners' salary, d the cost of transportation and finally e the cost of examination per child. Results During the examined period 20 examiners were involved in the program and worked for 1949 working hours. The hourly salary for the trainee doctors was 6.80 euro, for the Health Visitors 6.70 euro and for the Physiotherapists 5.50 euro in current prices. The cost of transportation was 32 euro per year. The direct cost for the examination of each child for the above studied period was calculated to be 2.04 euro. Conclusion The cost of our school-screening program is low. The present study provides a strong evidence for the continuation of the program when looking from a financial point of view.

Controlling costs without compromising quality: paying hospitals for total knee replacement.

Science.gov (United States)

Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

2010-10-01

Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P costs ($12,773-$11,512; P costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

Managing the total cost of risk exposures through risk mapping techniques

International Nuclear Information System (INIS)

Unione, A.J.; Rode, D.M.

1998-01-01

In a competitive power market, power producers are exposed to an increasingly broad spectrum of financial risks. The cumulative impact of these financial risks is known collectively as the Total of Cost of Risk. The concept of Total of Cost of Risk presents the business reality of a company's exposure to potentially devastating financial consequences in an integrated and useful way. In this way, a strategy of managing Total Cost of Risk in the most cost effective way can become a means of ensuring long term business health and security. This paper will examine the use of risk mapping as a tool for visually understanding Total Cost of Risk, thus creating an enhanced situational awareness and an integrated basis for risk management decision. The evaluation process, available through the use of risk maps allows the power producers to pro-actively implement prudent business decisions concerning the design, operation and maintenance of power plants. Risk mapping is thus a means for harmonizing operational objectives, such as improved plant reliability, with corporate strategies and goals in terms of an effective risk management program

Determination of the frequency and direct cost of the adverse drug events in Argentina.

Science.gov (United States)

Izquierdo, Estela; Rodríguez, Claudio; Pampliega, Eneas; Filinger, Ester

2009-05-01

To determine the frequency and the direct costs of adverse drug reactions, in an ambulatory population of the City of Buenos Aires, Argentina and its area of influence. A retrospective study was done during a period of three months on approximately 300.000 residents of the Buenos Aires area, gathering data according to the selected variables by means of the electronic capture of prescriptions dispensed in pharmacies of the area. This method enables the detection and registration of potential conflicts that may arise between a prescribed drug and factors such as: patient's demographic, clinical and drug profile. The analysis unit was defined as the happening of a moderate or severe adverse event reported by the system. The selected variables were the incidence of these effects and the direct cost was calculated as the value of the drugs that induced the adverse event. The events were classified according to the following interactions: a) drug-drug, b) drug-pediatrics, c) drug-gender, d) drug-pregnancy and abuse of controlled substances. The observed frequency shows great variability and the shortage of available data for ambulatory populations. We found 6.74% of reported events over the total of processed items, which generated an additional cost equivalent to 4.58% of the total pharmaceutical expenses. This study has only evaluated the cost occurred by the use of a drug that will lead to an adverse reaction. Moderate and severe reactions were included regardless of the important indirect costs, hospitalization costs, tests, physician fees, etc.

Direct diabetes-related costs in young patients with early-onset, long-lasting type 1 diabetes.

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Christina Bächle

Full Text Available OBJECTIVE: To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. RESEARCH DESIGN AND METHODS: Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2 years, mean diabetes duration 10.9 (SD 1.9 years, as of 31.12.2007. Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV. Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance. Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors. RESULTS: Mean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943-4,881. Costs for glucose self-monitoring were the main cost category (28.5%, followed by costs for continuous subcutaneous insulin infusion (25.0%, diabetes-related hospitalizations (22.1% and insulin (18.4%. Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs. CONCLUSIONS: Main cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

Direct costs of first-generation protease inhibitors for the treatment of genotype 1 chronic hepatitis C viral infection.

Science.gov (United States)

Sethi, N; Tapper, E B; Vong, A; Sethi, S; Rourke, M; Afdhal, N H

2015-12-01

To evaluate the cost-effectiveness of Hepatitis C therapy, robust real-world data are needed to understand the costs and benefits of treatment alternatives. The objective of this study was to evaluate the true direct cost of treatment in an unselected sequential population of patients treated at a tertiary care centre for hepatitis C virus genotype 1. A total of 200 consecutive patients were treated with interferon, ribavirin and a first-generation direct-acting antiviral agent (DAA) between 2011 and 2013. A total of 41% had cirrhosis, 31% were prior relapsers, and 41% were prior partial or null responders. Costs used were wholesale acquisition cost prices for medications, average hospital costs per day for each diagnosis code based on US inpatient hospital charges. All costs were adjusted to 2013 dollars. Sustained virologic response (SVR) was achieved in 97 patients (48.5%). A total of 14% experienced relapse, 19% breakthrough or nonresponse, and 18.5% discontinued secondary to side effects. Twenty per cent of patients had at least one hospitalization attributable to a complication of therapy. Thirty-seven per cent of patients required erythropoietin-stimulating agents, 16% received filgastrim, and 15% needed a red blood cell transfusion. The mean overall cost of treatment was $83,851 per patient. The cost per SVR was $172,889; $266,670 for patients with cirrhosis. The costs per SVR after treatment with first-generation DAAs are dependent on the stage of disease and therapy side effects. These real-world costs significantly exceed those described in prior cost-effectiveness assessments and should be used instead for future studies. © 2015 John Wiley & Sons Ltd.

Predonation Direct and Indirect Costs Incurred by Adults Who Donated a Kidney: Findings From the KDOC Study.

Science.gov (United States)

Rodrigue, J R; Schold, J D; Morrissey, P; Whiting, J; Vella, J; Kayler, L K; Katz, D; Jones, J; Kaplan, B; Fleishman, A; Pavlakis, M; Mandelbrot, D A

2015-09-01

Limited information exists on the predonation costs incurred by eventual living kidney donors (LKDs). Expenses related to completion of the donation evaluation were collected from 194 LKDs participating in the multi-center, prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 187, 96%) reported one or more direct costs, including ground transportation (80%), healthcare (24%), lodging (17%) and air transportation (14%), totaling $101 484 (USD; mean = $523 ± 942). Excluding paid vacation or sick leave, donor and companion lost wages totaled $35 918 (mean = $187 ± 556) and $14 378 (mean = $76 ± 311), respectively. One-third of LKDs used paid vacation or sick leave to avoid incurring lost wages. Few LKDs reported receiving financial support from the transplant candidate (6%), transplant candidate's family (3%), a nonprofit organization (3%), the National Living Donor Assistance Center (7%), or transplant center (3%). Higher total costs were significantly associated with longer distance traveled to the transplant center (p costs were not associated with age, sex, race/ethnicity, household income, marital status, insurance status, or transplant center. Moderate predonation direct and indirect costs are common for adults who complete the donation evaluation. Potential LKDs should be advised of these possible costs, and the transplant community should examine additional strategies to reimburse donors for them. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

[Total knee and hip prosthesis: variables associated with costs].

Science.gov (United States)

Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

2013-01-01

The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

48 CFR 9904.407 - Use of standard costs for direct material and direct labor.

Science.gov (United States)

2010-10-01

... ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.407 Use of standard costs for direct...

Procedure for estimating permanent total enclosure costs

Energy Technology Data Exchange (ETDEWEB)

Lukey, M.E.; Prasad, C.; Toothman, D.A.; Kaplan, N.

1999-07-01

Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use permanent total enclosures (PTEs). By definition, an enclosure which meets the US Environmental Protection Agency's five-point criteria is a PTE and has a capture efficiency of 100%. Since costs play an important role in regulatory development, in selection of control equipment, and in control technology evaluations for permitting purposes, EPA has developed a Control Cost Manual for estimating costs of various items of control equipment. EPA's Manual does not contain any methodology for estimating PTE costs. In order to assist environmental regulators and potential users of PTEs, a methodology for estimating PTE costs was developed under contract with EPA, by Pacific Environmental Services, Inc. (PES) and is the subject of this paper. The methodology for estimating PTE costs follows the approach used for other control devices in the Manual. It includes procedures for sizing various components of a PTE and for estimating capital as well as annual costs. It contains verification procedures for demonstrating compliance with EPA's five-point criteria. In addition, procedures are included to determine compliance with Occupational Safety and Health Administration (OSHA) standards. Meeting these standards is an important factor in properly designing PTEs. The methodology is encoded in Microsoft Exel spreadsheets to facilitate cost estimation and PTE verification. Examples are given throughout the methodology development and in the spreadsheets to illustrate the PTE design, verification, and cost estimation procedures.

Procedure for estimating permanent total enclosure costs

Energy Technology Data Exchange (ETDEWEB)

Lukey, M E; Prasad, C; Toothman, D A; Kaplan, N

1999-07-01

Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use permanent total enclosures (PTEs). By definition, an enclosure which meets the US Environmental Protection Agency's five-point criteria is a PTE and has a capture efficiency of 100%. Since costs play an important role in regulatory development, in selection of control equipment, and in control technology evaluations for permitting purposes, EPA has developed a Control Cost Manual for estimating costs of various items of control equipment. EPA's Manual does not contain any methodology for estimating PTE costs. In order to assist environmental regulators and potential users of PTEs, a methodology for estimating PTE costs was developed under contract with EPA, by Pacific Environmental Services, Inc. (PES) and is the subject of this paper. The methodology for estimating PTE costs follows the approach used for other control devices in the Manual. It includes procedures for sizing various components of a PTE and for estimating capital as well as annual costs. It contains verification procedures for demonstrating compliance with EPA's five-point criteria. In addition, procedures are included to determine compliance with Occupational Safety and Health Administration (OSHA) standards. Meeting these standards is an important factor in properly designing PTEs. The methodology is encoded in Microsoft Exel spreadsheets to facilitate cost estimation and PTE verification. Examples are given throughout the methodology development and in the spreadsheets to illustrate the PTE design, verification, and cost estimation procedures.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals.

Science.gov (United States)

Lima, Antônio Fernandes Costa

2017-04-01

to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked) time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL). Hospital C presented the highest mean direct cost (BRL 184.52), 5.23 times greater than the value for Hospital A (BRL 35.29) and 3.91 times greater than Hospital B (BRL 47.22). the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013.

Science.gov (United States)

Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S

2017-03-01

Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift

Total cost of ownership: Getting past the 10% solution

International Nuclear Information System (INIS)

Anderson, R.F.

1996-01-01

As the refining industry strives to succeed in a more-competitive world, some fresh ideas are needed to counter the headlines of plant closings, layoffs, and corporate restructurings. Other industries facing the same pressures have discovered opportunities to reduce cost in a more human and effective manner by using some tools borrowed from the Total Quality process to enhance the procurement process. Experience suggests that the purchase cost is a small fraction of the actual cost of a commodity and is often dwarfed by hidden costs. Discovering and eliminating the hidden costs of variation, nonoptimal operations, and poorly aligned vendor relations is vital to economic survival. The purpose of this paper is to suggest some fresh approaches to vendor-customer relations that can dramatically reduce undesired costs

Variation in the cost of care for primary total knee arthroplasties.

Science.gov (United States)

Haas, Derek A; Kaplan, Robert S

2017-03-01

The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. Hospital and physician personnel costs were calculated using time-driven activity-based costing. Consumable supply costs, such as the prosthetic implant, were calculated using purchase prices, and postacute care costs were measured using either internal costs or external claims as reported by each hospital. Despite having similar patient demographics and readmission and complication rates, the average cost of care for total knee arthroplasty across the hospitals varied by a factor of about 2 to 1. Even after adjusting for differences in internal labor cost rates, the hospital at the 90th percentile of cost spent about twice as much as the one at the 10th percentile of cost. The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals

Directory of Open Access Journals (Sweden)

Antônio Fernandes Costa Lima

Full Text Available ABSTRACT Objective: to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. Method: this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL. Results: Hospital C presented the highest mean direct cost (BRL 184.52, 5.23 times greater than the value for Hospital A (BRL 35.29 and 3.91 times greater than Hospital B (BRL 47.22. Conclusion: the costing method used in this study can be reproduced at other dialysis centers to inform strategies aimed at efficient allocation of necessary human resources to successfully monitor conventional hemodialysis.

Direct cost of monitoring conventional hemodialysis conducted by nursing professionals

OpenAIRE

Lima, Antônio Fernandes Costa

2017-01-01

ABSTRACT Objective: to analyze the mean direct cost of conventional hemodialysis monitored by nursing professionals in three public teaching and research hospitals in the state of São Paulo, Brazil. Method: this was a quantitative, explorative and descriptive investigation, based on a multiple case study approach. The mean direct cost was calculated by multiplying (clocked) time spent per procedure by the unit cost of direct labor. Values were calculated in Brazilian real (BRL). Results: H...

Change in the direct cost of treatment for children and adolescents with hyperkinetic disorder in Germany over a period of four years

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Rothenberger Aribert

2009-01-01

Full Text Available Abstract Background In many developed countries, the treatment of hyperkinetic disorder (or ADHD consumes a considerable amount of resources. The primary aim of this study was to determine change in the direct cost of treatment for children and adolescents with hyperkinetic disorder in Germany over time, and compare the cost with the cost of treatment for two physical disorders: epilepsy and asthma. Methods The German Federal Statistical Office provided data on the direct cost of treating hyperkinetic disorder, epilepsy and asthma in Germany for 2002, 2004, and 2006. The direct costs of treatment incurred by hyperkinetic disorder in these years were compared with those incurred by epilepsy and asthma. Results The total direct cost of treatment for the hyperkinetic disorder was € 177 million in 2002, € 234 million in 2004, and € 341 million in 2006. The largest proportion of the cost was incurred by the age group Conclusion The direct cost of treatment for hyperkinetic disorder in the age group

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

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Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

Construction engineering inspection direct cost survey.

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2014-07-01

The objective of the study was to provide a rationale to Georgia Department of Transportation : (GDOT) for Direct Costs in terms of salary and wages charged by qualified independent : contractors performing Construction Engineering Inspection (CEI) s...

Management of leg and pressure ulcer in hospitalized patients: direct costs are lower than expected.

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Assadian, Ojan; Oswald, Joseph S; Leisten, Rainer; Hinz, Peter; Daeschlein, Georg; Kramer, Axel

2011-01-01

In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of € 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients. The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany. Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 75±12 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented. Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined. An average of € 1,342 per patient (€ 48/d) was spent for treatment of leg ulcer (staff costs € 581, consumables € 458, surgical procedures € 189, and diagnostic procedures € 114). On average, each wound dressing change caused additional costs of € 15. For pressure ulcer, € 991 per patient (€ 52/d) was spent on average (staff costs € 313, consumables € 618, and for surgical procedures € 60). Each wound dressing change resulted in additional costs of € 20 on average. When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this

Lifestyle factors, direct and indirect costs for a Brazilian airline company

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Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

2014-01-01

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. PMID:26039398

Lifestyle factors, direct and indirect costs for a Brazilian airline company.

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Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

2014-12-01

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Lifestyle factors, direct and indirect costs for a Brazilian airline company

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Fabiana Maluf Rabacow

2014-12-01

Full Text Available OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking, was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

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Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p cost drivers were the cost of the implant and

Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

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Gosse, Conrad A.; Clarens, Andres F.

2013-03-01

Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users.

Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

International Nuclear Information System (INIS)

Gosse, Conrad A; Clarens, Andres F

2013-01-01

Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users. (letter)

Direct healthcare costs of spinal disorders in Brazil

NARCIS (Netherlands)

Luiz Carregaro, Rodrigo; da Silva, Everton Nunes; van Tulder, Maurits

2018-01-01

OBJECTIVES: To investigate the direct healthcare costs of spinal disorders in Brazil, over 2016. METHODS: Prevalence-based cost-of-illness study, top-down approach and public healthcare system's perspective. International Classification of Diseases codes related to spinal disorders were included.

Effect of Body Mass Index and Psychosocial Traits on Total Knee Replacement Costs in Patients with Osteoarthritis.

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Waimann, Christian A; Fernandez-Mazarambroz, Rodrigo J; Cantor, Scott B; Lopez-Olivo, Maria A; Barbo, Andrea G; Landon, Glenn C; Siff, Sherwin J; Lin, Heather; Suarez-Almazor, Maria E

2016-08-01

Clinical and psychosocial attributes are associated with clinical outcomes after total knee replacement (TKR) surgery in patients with osteoarthritis (OA), but their relationship with TKR-related costs is less clear. Our objective was to evaluate the effect of clinical and psychosocial attributes on TKR costs. We conducted a 6-month prospective cohort study of patients with knee OA who underwent TKR. We examined baseline demographic, clinical [body mass index (BMI) and comorbidities], and psychosocial attributes (social support, locus of control, coping, depression, anxiety, stress, and self-efficacy); baseline and 6-month OA clinical outcomes [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function]; and 6-month direct and indirect TKR-related costs. Multiple regression was performed to identify determinants of TKR-related costs. We included 212 patients; 66% were women, 71% were white, and the mean age was 65.2 years. The mean baseline WOMAC pain score was 55 (SD 19) and WOMAC function score was 54 (SD 20). Mean total TKR-related costs were US$30,831 (SD $9893). Multivariate regression analyses showed that increasing BMI and anxiety levels and decreasing levels of positive social interactions were associated with increased costs. A lower cost scenario with a lower range of normal BMI (19.5), highest positive social interaction, and no anxiety predicted TKR costs to be $22,247. Predicted costs in obese patients (BMI 36) with lowest positive social interaction and highest anxiety were $58,447. Increased baseline BMI, anxiety, and poor social support lead to higher TKR-related costs in patients with knee OA. Preoperative interventions targeting these factors may reduce TKR-related costs, and therefore be cost-effective.

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

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Wittbrodt ET

2018-05-01

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

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

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

2017-01-01

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

Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology.

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Tan, Siok Swan; Bakker, Jan; Hoogendoorn, Marga E; Kapila, Atul; Martin, Joerg; Pezzi, Angelo; Pittoni, Giovanni; Spronk, Peter E; Welte, Robert; Hakkaart-van Roijen, Leona

2012-01-01

The objective of the present study was to measure and compare the direct costs of intensive care unit (ICU) days at seven ICU departments in Germany, Italy, the Netherlands, and the United Kingdom by means of a standardized costing methodology. A retrospective cost analysis of ICU patients was performed from the hospital's perspective. The standardized costing methodology was developed on the basis of the availability of data at the seven ICU departments. It entailed the application of the bottom-up approach for "hotel and nutrition" and the top-down approach for "diagnostics," "consumables," and "labor." Direct costs per ICU day ranged from €1168 to €2025. Even though the distribution of costs varied by cost component, labor was the most important cost driver at all departments. The costs for "labor" amounted to €1629 at department G but were fairly similar at the other departments (€711 ± 115). Direct costs of ICU days vary widely between the seven departments. Our standardized costing methodology could serve as a valuable instrument to compare actual cost differences, such as those resulting from differences in patient case-mix. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Total life-cycle cost analysis of conventional and alternative fueled vehicles

International Nuclear Information System (INIS)

Cardullo, M.W.

1993-01-01

Total Life-Cycle Cost (TLCC) Analysis can indicate whether paying higher capital costs for advanced technology with low operating and/or environmental costs is advantageous over paying lower capital costs for conventional technology with higher operating and/or environmental costs. While minimizing total life-cycle cost is an important consideration, the consumer often identifies non-cost-related benefits or drawbacks that make more expensive options appear more attractive. The consumer is also likely to heavily weigh initial capital costs while giving limited consideration to operating and/or societal costs, whereas policy-makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. This paper summarizes a TLCC model which was developed to facilitate consideration of the various factors involved in both individual and societal policy decision making. The model was developed as part of a US Department of Energy Contract and has been revised to reflect changes necessary to make the model more realistic. The model considers capital, operating, salvage, and environmental costs for cars, vans, and buses using conventional and alternative fuels. The model has been developed to operate on an IBM or compatible personal computer platform using the commercial spreadsheet program MicroSoft Excell reg-sign Version 4 for Windows reg-sign and can be easily kept current because its modular structure allows straightforward access to embedded data sets for review and update

Leveraging Real-World Evidence in Disease-Management Decision-Making with a Total Cost of Care Estimator.

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Nguyen, Thanh-Nghia; Trocio, Jeffrey; Kowal, Stacey; Ferrufino, Cheryl P; Munakata, Julie; South, Dell

2016-12-01

Health management is becoming increasingly complex, given a range of care options and the need to balance costs and quality. The ability to measure and understand drivers of costs is critical for healthcare organizations to effectively manage their patient populations. Healthcare decision makers can leverage real-world evidence to explore the value of disease-management interventions in shifting total cost trends. To develop a real-world, evidence-based estimator that examines the impact of disease-management interventions on the total cost of care (TCoC) for a patient population with nonvalvular atrial fibrillation (NVAF). Data were collected from a patient-level real-world evidence data set that uses the IMS PharMetrics Health Plan Claims Database. Pharmacy and medical claims for patients meeting the inclusion or exclusion criteria were combined in longitudinal cohorts with a 180-day preindex and 360-day follow-up period. Descriptive statistics, such as mean and median patient costs and event rates, were derived from a real-world evidence analysis and were used to populate the base-case estimates within the TCoC estimator, an exploratory economic model that was designed to estimate the potential impact of several disease-management activities on the TCoC for a patient population with NVAF. Using Microsoft Excel, the estimator is designed to compare current direct costs of medical care to projected costs by varying assumptions on the impact of disease-management activities and applying the associated changes in cost trends to the affected populations. Disease-management levers are derived from literature-based concepts affecting costs along the NVAF disease continuum. The use of the estimator supports analyses across 4 US geographic regions, age, cost types, and care settings during 1 year. All patients included in the study were continuously enrolled in their health plan (within the IMS PharMetrics Health Plan Claims Database) between July 1, 2010, and June 30

Design of High-Efficiency and Low-Cost Six-Phase Permanent Magnet Synchronous Generator for Direct-Drive Small-Scale Wind Power Application

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M. E. Moazzen

2017-06-01

Full Text Available Permanent magnet synchronous generators (PMSG have a huge potential for direct-drive wind power applications. Therefore, optimal design of these generators is necessary to maximize their efficiency and to reduce their manufacturing cost and total volume. In this paper, an optimal design of a six-phase 3.5 KW direct-drive PMSG to generate electricity for domestic needs is performed. The aim of optimal design is to reduce the manufacturing cost, losses and total volume of PMSG. To find the best design, single/multi-objective design optimization is carried out. Cuckoo optimization algorithm (COA is adopted to solve the optimization problem. Comparison between the results of the single-objective and multi-objective models shows that simultaneous optimization of manufacturing cost, losses and total volume leads to more suitable design for PMSG. Finally, finite-element method (FEM is employed to validate the optimal design, which show a good agreement between the theoretical work and simulation results.

UTILITATEA ANALIZEI RELAŢIEI COST-VOLUM-PROFIT ÎN METODA DIRECT-COSTING PENTRU PROCESUL DECIZIONAL

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Nelea CHIRILOV

2016-12-01

Full Text Available În acest articol este analizată relaţia cost-volum-profit în scopul optimizării profitului şi fundamentării unor decizii economice optime. Sunt prezentate studii de caz metodologice menite să evidenţieze necesitatea indicatorilor: pragul de rentabilitate, marja de contribuţie, rezerva stabilităţii financiare, volumul vânzărilor necesar obţinerii profitului dorit, preţul marginal. Rezultatele obţinute sunt prezentate şi analizate de autori. Articolul se încheie cu concluziile autorilor privind avantajele oferite de calculele şi analizele ce pot fi efectuate pe baza relaţiei cost-volum-profit în metoda direct-costing pentru procesul decizional.THE UTILITY OF ANALYZING COST-VOLUME-PROFIT RELATIONSHIP THROUGH THE DIRECT-COSTING METHOD FOR DECISION MAKING PROCESSIn this article it is analyzed the cost-volume-profit relationship with the aim of profit optimization and elaboration of optimum economic decisions. The statement also reflects methodological case studies which highlight the necessity of the following indicators: break-even point, contribution margin, reserve of financial stability, sales volume required for obtaining target profit, marginal price. The results are presented and are analyzed by authors. The article ends up with the conclusions of the authors with regards to advantages provided by the calculations and analysis which can be performed on the basis of cost-volume-profit relationship through the direct-costing method for decision making process.

High direct costs of medical care in patients with Type 1 diabetes attending a referral clinic in a government-funded hospital in Northern India.

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Katam, Kishore K; Bhatia, Vijayalakshmi; Dabadghao, Preeti; Bhatia, Eesh

2016-01-01

There is little information regarding costs of managing type 1 diabetes mellitus (T1DM) from low- and middle-income countries. We estimated direct costs of T1DM in patients attending a referral diabetes clinic in a governmentfunded hospital in northern India. We prospectively enrolled 88 consecutive T1DM patients (mean [SD] age 15.3 [8] years) with age at onset clinic of our institution. Data on direct costs were collected for a 12 months-6 months retrospectively followed by 6 months prospectively. Patients belonged predominantly (77%) to the middle socioeconomic strata (SES); 81% had no access to government subsidy or health insurance. The mean direct cost per patient-year of T1DM was `27 915 (inter-quartile range [IQR] `19 852-32 856), which was 18.6% (7.1%-30.1%) of the total family income. A greater proportion of income was spent by families of lower compared to middle SES (32.6% v. 6.6%, p<0.001). The mean out-of-pocket payment for diabetes care ranged from 2% to 100% (mean 87%) of the total costs. The largest expenditure was on home blood glucose monitoring (40%) and insulin (39.5%). On multivariate analysis, total direct cost was associated with annual family income (β=0.223, p=0.033), frequency of home blood glucose monitoring (β=0.249, p=0.016) and use of analogue insulin (β=0.225, p=0.016). Direct costs of T1DM were high; in proportion to their income the costs were greater in the lower SES. The largest expenditure was on home blood glucose monitoring and insulin. Support for insulin and glucose testing strips for T1DM care is urgently required.

Burden and direct costs of non infectious uveitis in Spain.

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Adán-Civera, Alfredo Manuel; Benítez-Del-Castillo, José Manuel; Blanco-Alonso, Ricardo; Pato-Cour, Esperanza; Sellas-Fernández, Agustí; Bañares-Cañizares, Antonio

2016-01-01

There is no updated information on epidemiology and cost of management of non infectious uveitis (NIU) in Spain. This study assessed the frequency of various types of uveítis as well as associated costs of resources used in their management. NIU epidemiological data and direct costs were collected from a literature search. This was complemented with consensus information from 2 expert panel meetings and data from questionnaires to ophthalmologists and rheumatologists, experts on these conditions. Healthcare resources costs were obtained from the Oblikue database, from a medical society and from approved drug prices in Spain. During 2011 the estimate number of NIU was 9,398 (45% male, 70% aged 16-65 years). Incidence per type of uveitis was: acute anterior uveitis (AAU) 55%; posterior uveitis (PU) and pan-uveitis (PanU) 15% each; adult chronic anterior uveitis, paediatric chronic anterior uveitis and intermediate uveitis 5% each. Among total costs (77,834,282.10€), initial drug therapy was the highest (43,602,359.29€), followed by surgical treatment of complications (8,367,420.43€). With respect to types of uveitis, PanU (26,692,948.29€), PU (22,283,330.50€) and AAU (14,336,755.38€) showed the highest associated costs. Non infectious uveitis is associated to high costs in Spain, both in its diagnosis and in its treatment. Early diagnosis and treatment should allow for substantial savings for the National Health System. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment.

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Khan, M A; Walley, J D; Witter, S N; Imran, A; Safdar, N

2002-06-01

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the

Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts.

Science.gov (United States)

Altawalbeh, Shoroq M; Saul, Melissa I; Seybert, Amy L; Thorpe, Joshua M; Kane-Gill, Sandra L

2018-04-01

To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost per case or total cost? The potential of prevention of hand injuries in young children – Retrospective and prospective studies

Directory of Open Access Journals (Sweden)

Carlsson Katarina

2008-07-01

Full Text Available Abstract Background Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996–2003. Methods Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed. Results Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days. Conclusion The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.

Understanding the direct and indirect costs of patients with schizophrenia [v2; ref status: indexed, http://f1000r.es/5ow

Directory of Open Access Journals (Sweden)

Kazuhiro Tajima-Pozo

2015-08-01

Full Text Available Background: Schizophrenia is a disabling mental disorder with high prevalence and that usually  requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. Objective: The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. Results: Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even moreimportant part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. Conclusions: Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them.

Retail clinic utilization associated with lower total cost of care.

Science.gov (United States)

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

2013-04-01

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

Determining the total cost of reverse supply chain operations for original equipment manufacturers

DEFF Research Database (Denmark)

Larsen, Samuel Brüning; Jacobsen, Peter

2014-01-01

When original equipment manufacturers (OEM) examine whether or not to invest in a reverse supply chain (RSC), managers need insight into not only the cost savings and new revenue streams the RSC enables, but also the total cost of the RSC itself. Using case study research the study examines what...... cost parameters constitute the total cost (TC) of the RSC. The specific RSC that the study seeks the TC for consists of 1) end-product refurbishing, 2) component refurbishing, and 3) sales of used materials back to original suppliers or independent recyclers for materials recycling....

Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

Science.gov (United States)

Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-08-01

To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

Direct medical costs of motorcycle crashes in Ontario.

Science.gov (United States)

Pincus, Daniel; Wasserstein, David; Nathens, Avery B; Bai, Yu Qing; Redelmeier, Donald A; Wodchis, Walter P

2017-11-20

There is no reliable estimate of costs incurred by motorcycle crashes. Our objective was to calculate the direct costs of all publicly funded medical care provided to individuals after motorcycle crashes compared with automobile crashes. We conducted a population-based, matched cohort study of adults in Ontario who presented to hospital because of a motorcycle or automobile crash from 2007 through 2013. For each case, we identified 1 control absent a motor vehicle crash during the study period. Direct costs for each case and control were estimated in 2013 Canadian dollars from the payer perspective using methodology that links health care use to individuals over time. We calculated costs attributable to motorcycle and automobile crashes within 2 years using a difference-in-differences approach. We identified 26 831 patients injured in motorcycle crashes and 281 826 injured in automobile crashes. Mean costs attributable to motorcycle and automobile crashes were $5825 and $2995, respectively ( p motorcycle crashes compared with automobile crashes (2194 injured annually/100 000 registered motorcycles v. 718 injured annually/100 000 registered automobiles; incidence rate ratio [IRR] 3.1, 95% confidence interval [CI] 2.8 to 3.3, p motorcycles v. 12 severe injuries annually/100 000 registered automobiles; IRR 10.4, 95% CI 8.3 to 13.1, p motorcycle in Ontario costs the public health care system 6 times the amount of each registered automobile. Medical costs may provide an additional incentive to improve motorcycle safety. © 2017 Joule Inc. or its licensors.

Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

Science.gov (United States)

Schousboe, J T; Paudel, M L; Taylor, B C; Kats, A M; Virnig, B A; Dowd, B E; Langsetmo, L; Ensrud, K E

2017-03-01

Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted. The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

Hybrid Cloud Computing Architecture Optimization by Total Cost of Ownership Criterion

Directory of Open Access Journals (Sweden)

Elena Valeryevna Makarenko

2014-12-01

Full Text Available Achieving the goals of information security is a key factor in the decision to outsource information technology and, in particular, to decide on the migration of organizational data, applications, and other resources to the infrastructure, based on cloud computing. And the key issue in the selection of optimal architecture and the subsequent migration of business applications and data to the cloud organization information environment is the question of the total cost of ownership of IT infrastructure. This paper focuses on solving the problem of minimizing the total cost of ownership cloud.

Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study.

Science.gov (United States)

Asres, Abyot; Jerene, Degu; Deressa, Wakgari

2018-05-21

Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients. A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost. Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7-318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43-184.22) and US$93.75 (56.91-141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23-48.31) and US$35.02 (0-70.04). Patient delay days (p < 0.001), provider delay days (p < 0.001), number of healthcare facilities visited until TB diagnosis (p < 0.001), and TB diagnosis at private facilities (p = 0.02) independently predicted increased pre-diagnosis cost. Similarly, rural residence (p < 0.001), hospitalization during anti-TB treatment (p < 0.001), patient delay days (p < 0.001), and provider delay days (p < 0.001) predicted increased post-diagnosis costs. TB patients

Direct medical cost of influenza-related hospitalizations among severe acute respiratory infections cases in three provinces in China.

Directory of Open Access Journals (Sweden)

Lei Zhou

Full Text Available BACKGROUND: Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. METHODS: Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital's Hospital Information System (HIS and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range and median (interquartile range [IQR] costs were calculated and compared among children (≤15 years, adults (16-64 years and elderly (≥65 years groups. Factors influencing cost were analyzed. RESULTS: A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range direct medical cost was $1,797 ($80-$27,545 for all hospitalizations, and the median (IQR direct medical cost was $231 ($164, $854 ($890, and $2,263 ($7,803 for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. CONCLUSION: Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies.

Minimizing total costs of forest roads with computer-aided design ...

Indian Academy of Sciences (India)

imum total road costs, while conforming to design specifications, environmental ..... quality, and enhancing fish and wildlife habitat, an appropriate design ..... Soil, Water and Timber Management: Forest Engineering Solutions in Response to.

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

Energy Technology Data Exchange (ETDEWEB)

Wright, G.W.

1978-09-18

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

Capital-cost behavior: is nuclear different

International Nuclear Information System (INIS)

Lotze, C.D.; Riordan, B.J.

1978-01-01

The capital costs of coal-fired and nuclear power plants are found to be comparable when costs for pollution control are included. Trends in capital costs reveal a similar rate gain that retains the same economic balance. Graphs of selected cost indices are used to show that the rapid increase in direct construction costs is not unique to nuclear plants, those of hydroelectric plants as well as coal-fired having the same pattern. Comparisons of indirect capital costs, based on analyses of direct capital and total capital costs, show estimated average growth rates of total costs to be 14% for coal and 13.6% for nuclear, while direct cost growth rates are 10.2% and 10.4%. The economics of market competition can be expected to push alternative energy source projects into balance

Evaluation of the Total Cost of Ownership of Fuel Cell-Powered Material Handling Equipment

Energy Technology Data Exchange (ETDEWEB)

Ramsden, T.

2013-04-01

This report discusses an analysis of the total cost of ownership of fuel cell-powered and traditional battery-powered material handling equipment (MHE, or more typically 'forklifts'). A number of fuel cell MHE deployments have received funding support from the federal government. Using data from these government co-funded deployments, DOE's National Renewable Energy Laboratory (NREL) has been evaluating the performance of fuel cells in material handling applications. NREL has assessed the total cost of ownership of fuel cell MHE and compared it to the cost of ownership of traditional battery-powered MHE. As part of its cost of ownership assessment, NREL looked at a range of costs associated with MHE operation, including the capital costs of battery and fuel cell systems, the cost of supporting infrastructure, maintenance costs, warehouse space costs, and labor costs. Considering all these costs, NREL found that fuel cell MHE can have a lower overall cost of ownership than comparable battery-powered MHE.

Correlation of total, diffuse, and direct solar radiation

Science.gov (United States)

Buyco, E. H.; Namkoong, D.

1977-01-01

Present requirements for realistic solar energy system evaluations necessitate a comprehensive body of solar-radition data. The data should include both diffuse and direct solar radiation as well as their total on an hourly (or shorter) basis. In general, however, only the total solar radiation values were recorded. This report presents a correlation that relates the diffuse component of an hourly total solar radiation value to the total radiation ratio of the maximum value attainable. The data used were taken at the Blue Hill Observatory in Milton, Massachusetts, for the period 1952. The relation - in the form of the data plots - can be used in situations in which only the hourly total radiation data are available but the diffuse component is desired.

Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.

Science.gov (United States)

Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John

2015-02-01

Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Preliminary analysis of total cost and life quality for elder patients with femoral neck fracture].

Science.gov (United States)

Liu, Haonan; He, Liang; Zhang, Guilin; Gong, Xiaofeng; Li, Ning

2015-09-01

To analyze the total cost and life quality of the femoral neck fracture patients who received different surgery and supplement comprehensive data of osteoporotic fracture. One hundred and five patients above 60-year old who were diagnosed femoral neck fracture and received operation in Department of Orthopedics ＆ Traumatology, Beijing Jishuitan Hospital were admitted into our study from August 2013 to December. According to the type of surgery there were 52 and 53 cases in internal fixation (IF) group and hemiarthroplasty (HA) group respectively. At first we collected the medical expense of the patients before and during hospitalization. And then the 1-year medical and non-medical expenses were collected by the cost diary ever 3 months after discharge. At the last follow-up we evaluated the life quality by the EuroQol-5 Dimensions (EQ-5D) and calculated the total cost. Outcome All the patients completed the operation successfully. No nonunion or delayed union cases in IF group, and no cases received revision surgery in both groups. The total average cost was 59 584.9 yuan including 79.1% medical cost and 20.9% non-medical cost. The primary treatment cost accounts for 84.1% of the medical cost. The cost for home care accounts for 90.7% of the non-medical care. The total and medical cost of IF group just account for 40.3% and 38.5% of the HA group and the non-medical showed no significant difference between the 2 groups (P>0.05). In addition the data of life quality and walking capability also showed no significant difference. The main cost for the femoral neck fracture is medical expense in 1-year follow-up. Both surgeries can provide satisfactory outcome, however IF may be more cost-effective compared to the HA because of the less total cost.

Allocation base of general production costs as optimization of prime costs

Directory of Open Access Journals (Sweden)

Levytska I.O.

2017-03-01

Full Text Available Qualified management aimed at optimizing financial results is the key factor in today's society. Effective management decisions depend on the necessary information about the costs of production process in all its aspects – their structure, types, accounting policies of reflecting costs. General production costs, the so-called indirect costs that are not directly related to the production process, but provide its functioning in terms of supporting structural divisions and create the necessary conditions of production, play a significant role in calculating prime costs of goods (works, services. However, the accurate estimate of prime costs of goods (works, services should be determined with the value of indirect costs (in other words, general production costs, and properly determined with the base of their allocation. The choice of allocation base of general production costs is the significant moment, depending on the nature of business, which must guarantee fair distribution regarding to the largest share of direct expenses in the total structure of production costs. The study finds the essence of general production costs based on the analysis of key definitions of leading Ukrainian economists. The optimal allocation approach of general production costs is to calculate these costs as direct production costs within each subsidiary division (department separately without selecting a base as the main one to the their total amount.

Reduction of Total Ownership Costs (R-TOC) Best Practices Guide

National Research Council Canada - National Science Library

Reed, Danny

2003-01-01

The purpose of the Reduction of Total Ownership Costs (R-TOC) program is to achieve readiness improvements in weapon systems by improving the reliability of the systems or the efficiency of the processes used to support...

evaluation of total annual costs of heat exchanger networks using

African Journals Online (AJOL)

user

after solving the first problem using RPA based heat integration gave a minimum total annual cost (TAC) of $237, ... mathematical programming and non-RPA based Hint software. ... The concept of pinch analysis evolved over the years.

Total joint Perioperative Surgical Home: an observational financial review.

Science.gov (United States)

Raphael, Darren R; Cannesson, Maxime; Schwarzkopf, Ran; Garson, Leslie M; Vakharia, Shermeen B; Gupta, Ranjan; Kain, Zeev N

2014-01-01

The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. Ad hoc interventions have reported marginal cost reduction, but it has become clear that sustainability lies only in complete restructuring of care delivery. The Perioperative Surgical Home (PSH) model, a patient-centered and physician-led multidisciplinary system of coordinated care, was implemented at UC Irvine Health in 2012 for patients undergoing primary elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). This observational study examines the costs associated with this initiative. The direct cost of materials and services (excluding professional fees and implants) for a random index sample following the Total Joint-PSH pathway was used to calculate per diem cost. Cost of orthopedic implants was calculated based on audit-verified direct cost data. Operating room and post-anesthesia care unit time-based costs were calculated for each case and analyzed for variation. Benchmark cost data were obtained from literature search. Data are presented as mean ± SD (coefficient of variation) where possible. Total per diem cost was $10,042 ± 1,305 (13%) for TKA and $9,952 ± 1,294 (13%) for THA. Literature-reported benchmark per diem cost was $17,588 for TKA and $16,267 for THA. Implant cost was $7,482 ± 4,050 (54%) for TKA and $9869 ± 1,549 (16%) for THA. Total hospital cost was $17,894 ± 4,270 (24%) for TKA and $20,281 ± 2,057 (10%) for THA. In-room to incision time cost was $1,263 ± 100 (8%) for TKA and $1,341 ± 145 (11%) for THA. Surgery time cost was $1,558 ± 290 (19%) for TKA and $1,930 ± 374 (19%) for THA. Post-anesthesia care unit time cost was $507 ± 187 (36%) for TKA and $557 ± 302 (54%) for THA. Direct hospital costs were driven substantially below USA benchmark levels using the Total Joint-PSH pathway. The incremental

Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.

Science.gov (United States)

Hamuryudan, Vedat; Direskeneli, Haner; Ertenli, Ihsan; Inanc, Murat; Karaaslan, Yasar; Oksel, Fahrettin; Ozbek, Suleyman; Pay, Salih; Terzioglu, Ender; Balkan Tezer, Dilara; Hacibedel, Basak; Akkoc, Nurullah

2016-01-01

To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696). RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

Direct medical costs of accidental falls for adults with transfemoral amputations.

Science.gov (United States)

Mundell, Benjamin; Maradit Kremers, Hilal; Visscher, Sue; Hoppe, Kurtis; Kaufman, Kenton

2017-12-01

Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. We describe the direct medical costs of falls in adults with a transfemoral amputation. This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.

Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

International Nuclear Information System (INIS)

Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

1989-01-01

The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

French government to trim direct stake in Total

International Nuclear Information System (INIS)

Anon.

1992-01-01

This paper reports that the French government has decided to slash its direct stake in partly state owned oil company Total to 5% from 31.7%, a surprise move expected to raise 10 billion francs ($1.8 billion). At the same time, other state owned entities will be asked to boost their combined 2.2% stake in Total to 10%, leaving the government with a net 15% interest in Total vs. the current 34%. Initially, state owned insurance companies Groupe des Assurances Nationales and Assurances Generale de France will be asked to hike their stakes in Total, but others could be asked to join if needed to meet the 10% target. The government the its phase-down of participation in Total, established in 1924 to manage French interests in Iraq Petroleum Co., was prompted by the evolution of the oil context, which differs greatly from what had prompted a significant stake of the state in Total's capital

En differentieret tilgang til total cost of ownership (TCO)

DEFF Research Database (Denmark)

Zachariassen, Frederik

2010-01-01

Økonomistyring er en nødvendig brik i forsøget på at kunne styre dele af eller hele forsyningskæden, og til dette bruges diverse økonomistyringsværktøjer. Denne artikel omhandler økonomistyringsværktøjet 'total cost of ownership', og hvordan dette kan bruges til at forbedre samarbejdet med...

Direct and Indirect Costs Following Living Kidney Donation: Findings From the KDOC Study.

Science.gov (United States)

Rodrigue, J R; Schold, J D; Morrissey, P; Whiting, J; Vella, J; Kayler, L K; Katz, D; Jones, J; Kaplan, B; Fleishman, A; Pavlakis, M; Mandelbrot, D A

2016-03-01

Some living kidney donors (LKDs) incur costs associated with donation, although these costs are not well characterized in the United States. We collected cost data in the 12 mo following donation from 182 LKDs participating in the multicenter prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 167, 92%) had one direct cost or more following donation, including ground transportation (86%), health care (41%), meals (53%), medications (36%), lodging (23%), and air transportation (12%). LKDs missed 33 072 total work hours, 40% of which were unpaid and led to $302 175 in lost wages (mean $1660). Caregivers lost $68 655 in wages (mean $377). Although some donors received financial assistance, 89% had a net financial loss in the 12-mo period, with one-third (33%) reporting a loss exceeding $2500. Financial burden was higher for those with greater travel distance to the transplant center (Spearman's ρ = 0.26, p neutrality for LKDs must be an immediate priority for the transplant community, governmental agencies, insurance companies, nonprofit organizations, and society at large. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

Directory of Open Access Journals (Sweden)

Ali KURT

2016-03-01

Full Text Available Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between cost leadership strategy, total quality management applications and firms’ financial performance has been gathered. In addition, the relationship between TQM applications and financial performance has also been gathered.

Direct and indirect economic costs among private-sector employees with osteoarthritis.

Science.gov (United States)

Berger, Ariel; Hartrick, Craig; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-11-01

To estimate direct and indirect economic costs among private-sector employees with osteoarthritis (OA). Using a large US employer benefits database, we identified all employees with evidence of OA during calendar year 2007, and compared their costs of health care and work loss to age-and-sex-matched employees without evidence of OA in that year. Private-sector employees with OA (n = 2399) averaged 62.9 days of absenteeism versus 36.7 days among matched comparators (n = 2399) (P Private-sector employees with OA have higher direct and indirect costs than those without this condition.

Comparing Methods for Estimating Direct Costs of Adverse Drug Events.

Science.gov (United States)

Gyllensten, Hanna; Jönsson, Anna K; Hakkarainen, Katja M; Svensson, Staffan; Hägg, Staffan; Rehnberg, Clas

2017-12-01

To estimate how direct health care costs resulting from adverse drug events (ADEs) and cost distribution are affected by methodological decisions regarding identification of ADEs, assigning relevant resource use to ADEs, and estimating costs for the assigned resources. ADEs were identified from medical records and diagnostic codes for a random sample of 4970 Swedish adults during a 3-month study period in 2008 and were assessed for causality. Results were compared for five cost evaluation methods, including different methods for identifying ADEs, assigning resource use to ADEs, and for estimating costs for the assigned resources (resource use method, proportion of registered cost method, unit cost method, diagnostic code method, and main diagnosis method). Different levels of causality for ADEs and ADEs' contribution to health care resource use were considered. Using the five methods, the maximum estimated overall direct health care costs resulting from ADEs ranged from Sk10,000 (Sk = Swedish krona; ~€1,500 in 2016 values) using the diagnostic code method to more than Sk3,000,000 (~€414,000) using the unit cost method in our study population. The most conservative definitions for ADEs' contribution to health care resource use and the causality of ADEs resulted in average costs per patient ranging from Sk0 using the diagnostic code method to Sk4066 (~€500) using the unit cost method. The estimated costs resulting from ADEs varied considerably depending on the methodological choices. The results indicate that costs for ADEs need to be identified through medical record review and by using detailed unit cost data. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Supplier managed inventory in the OEM supply chain : the impact of relationship types on total costs and cost distribution

NARCIS (Netherlands)

Nyen, van P.L.M.; Bertrand, J.W.M.; Ooijen, van H.P.G.; Vandaele, N.J.

2009-01-01

We investigate the impact of four variants of supplier managed inventory on total costs and cost distribution in a capital goods supply chain consisting of a parts supplier who delivers parts to an original equipment manufacturer’s assembly plant. The four supplier managed inventory variants differ

Permanent magnet design for magnetic heat pumps using total cost minimization

Science.gov (United States)

Teyber, R.; Trevizoli, P. V.; Christiaanse, T. V.; Govindappa, P.; Niknia, I.; Rowe, A.

2017-11-01

The active magnetic regenerator (AMR) is an attractive technology for efficient heat pumps and cooling systems. The costs associated with a permanent magnet for near room temperature applications are a central issue which must be solved for broad market implementation. To address this problem, we present a permanent magnet topology optimization to minimize the total cost of cooling using a thermoeconomic cost-rate balance coupled with an AMR model. A genetic algorithm identifies cost-minimizing magnet topologies. For a fixed temperature span of 15 K and 4.2 kg of gadolinium, the optimal magnet configuration provides 3.3 kW of cooling power with a second law efficiency (ηII) of 0.33 using 16.3 kg of permanent magnet material.

Marginal Abatement Cost of CO2 in China Based on Directional Distance Function: An Industry Perspective

Directory of Open Access Journals (Sweden)

Bowen Xiao

2017-01-01

Full Text Available Industrial sectors account for around 70% of the total energy-related CO2 emissions in China. It is of great importance to measure the potential for CO2 emissions reduction and calculate the carbon price in industrial sectors covered in the Emissions Trading Scheme and carbon tax. This paper employs the directional distance function to calculate the marginal abatement costs of CO2 emissions during 2005–2011 and makes a comparative analysis between our study and the relevant literature. Our empirical results show that the marginal abatement costs vary greatly from industry to industry: high marginal abatement costs occur in industries with low carbon intensity, and vice versa. In the application of the marginal abatement cost, the abatement distribution scheme with minimum cost is established under different abatement targets. The conclusions of abatement distribution scheme indicate that those heavy industries with low MACs and high carbon intensity should take more responsibility for emissions reduction and vice versa. Finally, the policy implications for marginal abatement cost are provided.

Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: executive summary

International Nuclear Information System (INIS)

1985-04-01

The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's Civilian Radioactive Waste Management Progrram is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 is sufficient to cover the cost of the program. This report is an input into the third evaluation of the adequacy of the fee. The total-system cost for the reference waste-management program in this analysis is estimated to be 24 to 30 billion (1984) dollars. For the sensitivity cases studied in this report, the costs could be as high as 35 billion dollars and as low as 21 billion dollars. Because factors like repository location, the quantity of waste generated, transportation-cask technology, and repository startup dates exert substantial impacts on total-system costs, there are several tradeoffs between these factors, and these tradeoffs can greatly influence the total cost of the program. The total-system cost for the reference program described in this report is higher by 3 to 5 billion dollars, or 15 to 20%, than the cost for the reference program of the TSLCC analysis of April 1984. More than two-thirds of this increase is in the cost of repository construction and operation. These repository costs have increased because of changing design concepts, different assumptions about the effort required to perform the necessary activities, and a change in the source data on which the earlier analysis was based. Development and evaluation costs have similarly increased because of a net addition to the work content. Transportation costs have increased because of different assumptions about repository locations and several characteristics of the transportation system. It is expected that the estimates of total-system costs will continue to change in response to both an evolving program strategy and better definition of the work required to achieve the program objectives

Lifestyle factors, direct and indirect costs for a Brazilian airline company

NARCIS (Netherlands)

F.M. Rabacow (Fabiana Maluf); O. Do Carmo Luiz (Olinda); A.M. Malik (Ana Maria); A. Burdorf (Alex)

2014-01-01

textabstractObjective: To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. Methods: In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.

Science.gov (United States)

Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J

2016-01-01

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost

evaluation of total annual costs of heat exchanger networks using

African Journals Online (AJOL)

This study presents pinch analysis of some heat exchanger networks (HENs) problems using Hint integration (HINT) software. Three examples reported to have been solved using different approaches by various researchers to obtain the least possible total annual cost (TAC) were solved using the Hint software. In this work ...

Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China.

Science.gov (United States)

Yong, Ma; Xianjun, Xiong; Jinghu, Li; Yunyun, Fang

2018-02-01

Objectives The aim of the present study was to determine the direct medical costs of hospitalisations for ischaemic stroke (IS) in-patients with different types of health insurance in China and to analyse the demographic characteristics of hospitalised patients, based on data supplied by the China Health Insurance Research Association (CHIRA). Methods A nationwide and cross-sectional sample of IS in-patients with International Classifications of Diseases 10th Revision (ICD-10) Code I63 who were ensured under either the Basic Medical Insurance Scheme for Employees (BMISE) or the Basic Medical Insurance Scheme for Urban Residents (BMISUR) was extracted from the CHIRA claims database. A retrospective analysis was used with regard to patient demographics, total hospital charges and costs. Results Of the 49588 hospitalised patients who had been diagnosed with IS in the CHIRA claims database, 28850 (58.2%) were men (mean age 67.34 years) and 20738 (41.8%) were women (mean age 69.75 years). Of all patients, 40347 (81.4%) were insured by the BMISE, whereas 8724 (17.6%) were insured by the BMISUR; the mean age of these groups was 68.55 and 67.62 years respectively. For BMISE-insured in-patients, the cost per hospitalisation was RMB10131 (95% confidence interval (CI) 10014-10258), the cost per hospital day was RMB787 (95% CI 766-808), the out-of-pocket costs per patient were RMB2346 (95% CI 2303-2388) and the reimbursement rate was 74.61% (95% CI 74.48-74.73%). For BMISUR-insured in-patients the cost per hospitalisation was RMB7662 (95% CI 7473-7852), the cost per hospital day was RMB744 (95% CI 706-781), the out-of-pocket costs per patient were RMB3356 (95% CI 3258-3454) and the reimbursement rate was 56.46% (95% CI 56.08-56.84%). Conclusions Costs per hospitalisation, costs per hospital day and the reimbursement rate were higher for BMISE- than BMISUR-insured in-patients, but BMISE-insured patients had lower out-of-pocket costs. The financial burden was higher for BMISUR

Total cost estimates for large-scale wind scenarios in UK

International Nuclear Information System (INIS)

Dale, Lewis; Milborrow, David; Slark, Richard; Strbac, Goran

2004-01-01

The recent UK Energy White Paper suggested that the Government should aim to secure 20% of electricity from renewable sources by 2020. A number of estimates of the extra cost of such a commitment have been made, but these have not necessarily included all the relevant cost components. This analysis sets out to identify these and to calculate the extra cost to the electricity consumer, assuming all the renewable electricity is sourced from wind energy. This enables one of the more controversial issues--the implications of wind intermittency--to be addressed. The basis of the assumptions associated with generating costs, extra balancing costs and distribution and transmission system reinforcement costs are all clearly identified and the total costs of a '20% wind' scenario are compared with a scenario where a similar amount of energy is generated by gas-fired plant. This enables the extra costs of the renewables scenario to be determined. The central estimate of the extra costs to electricity consumers is just over 0.3 p/kW h in current prices (around 5% extra on average domestic unit prices). Sensitivity analyses examine the implications of differing assumptions. The extra cost would rise if the capital costs of wind generation fall slower than anticipated, but would fall if gas prices rise more rapidly than has been assumed, or if wind plant are more productive. Even if it is assumed that wind has no capacity displacement value, the added cost to the electricity consumer rises by less than 0.1 p/kW h. It is concluded that there does not appear to be any technical reason why a substantial proportion of the country's electricity requirements could not be delivered by wind

Impact Of Health Care Delivery System Innovations On Total Cost Of Care.

Science.gov (United States)

Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J

2017-03-01

Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.

The adoption of total cost of ownership for sourcing decisions - a structural equations analysis

NARCIS (Netherlands)

Wouters, Marc; Anderson, James C.; Wynstra, Finn

2005-01-01

This study investigates the adoption of total cost of ownership (TCO) analysis to improve sourcing decisions. TCO can be seen as an application of activity based costing (ABC) that quantifies the costs that are involved in acquiring and using purchased goods or services. TCO supports purchasing

Making Choices: Self-Directed Teams or Total Quality Management?

Science.gov (United States)

Holpp, Lawrence

1992-01-01

Describes differences between total quality management and self-directed teams in terms of job design, decision making, flexibility, supervision, labor relations, quality, customers, and training. Offers suggestions for which method to choose when. (SK)

Cost Accounting as a Tool for Increasing Cost Transparency in Selective Hepatic Transarterial Chemoembolization.

Science.gov (United States)

Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V

2015-12-01

To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center. The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated. A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs. Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

Science.gov (United States)

Chin, Garwin; Wright, David J.; Snir, Nimrod; Schwarzkopf, Ran

2018-01-01

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. PMID:26387923

Internal Logistics System Selection with Total Cost of Ownership Analysis

Science.gov (United States)

Araújo, Inês; Pimentel, Carina; Godina, Radu; Matias, João C. O.

2017-06-01

In this paper a methodology was followed in order to support the decision-making of one industrial unit regarding its internal logistics system. The addressed factory was facing issues with their internal logistics approach. Some alternatives were pointed out and a proper total cost of ownership (TCO) analysis was developed. This analysis was taken in order to demonstrate the more cost-effective solution for the internal logistics system. This tool is more and more valued by the companies, due to their willing to reduce the costs that are associated with the way of doing business. Despite the proposal of the best choice for the internal logistics system of the enterprise, this study also intends to present some conclusions about the match between the nature of the industrial unit and the logistics systems that best fit the requirements of those.

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Direct costs of processing operations performed in... processing operations performed in the beneficiary developing country. (a) Items included in the direct costs of processing operations. As used in § 10.176, the words “direct costs of processing operations...

Labor Costs and Foreign Direct Investment: A Panel VAR Approach

OpenAIRE

Bahar Bayraktar-Sağlam; Selin Sayek Böke

2017-01-01

This paper examines the endogenous interaction between labor costs and Foreign Direct Investment (FDI) in the OECD countries via the Panel VAR approach under system GMM estimates for the period 1995–2009. The available data allows identifying the relevance of the components of labor costs, and allows a detailed analysis across different sectors. Empirical findings have revealed that sectoral composition of FDI and the decomposition of labor costs play a significant role in investigating the d...

Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

Science.gov (United States)

Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

2015-12-01

The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

International Nuclear Information System (INIS)

Strauss, Jonathan B.; Chen, Sea S.; Shah, Anand P.; Coon, Alan B.; Dickler, Adam

2008-01-01

Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered

Time-based analysis of total cost of patient episodes: a case study of hip replacement.

Science.gov (United States)

Peltokorpi, Antti; Kujala, Jaakko

2006-01-01

Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

12 CFR Appendix K to Part 226 - Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions

Science.gov (United States)

2010-01-01

... Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions (a... loan cost rate for various transactions, as well as instructions, explanations, and examples for.... (2) Term of the transaction. For purposes of total annual loan cost disclosures, the term of a...

Cost of rheumatoid arthritis in a selected population from Argentina in the prebiologic therapy era

Directory of Open Access Journals (Sweden)

Catay E

2012-08-01

Full Text Available Erika Catay,1 Cecilia Castel del Cid,1 Lorena Narváez,1 Edson J Velozo,1 Javier E Rosa,1,2 Luis J Catoggio,1,2 Enrique R Soriano1,21Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, 2University Institute Hospital Italiano de Buenos Aires, School of Medicine, PM Catoggio Foundation, Buenos Aires, ArgentinaBackground: The present study aimed to estimate the cost of rheumatoid arthritis and its components in a university hospital-based health management organization in Argentina, during the prebiologic era.Methods: A one-year (2002 observational prevalence, cost-of illness study of patients with rheumatoid arthritis from the societal perspective was performed in a hospital-based health management organization population. Direct medical costs were obtained using administrative databases. Direct nonmedical and indirect costs were obtained from a semistructured questionnaire. Indirect costs included work absenteeism, permanent work disability, and housework lost for housewives, using the human capital approach. Costs are expressed in 2002 US dollars per patient per year.Results: A total of 165 patients (84% females, of mean age 61 ± 15 years and with a mean disease duration of 8.5 ± 8.3 years were included. Mean total direct medical costs were US$1862 (95% confidence interval [CI] 828–2899. Mean direct nonmedical costs were US$222 (95% CI 149–294. Mean indirect costs were US$1008 (95% CI 606–1412. The annual mean total cost was US$3093 without biologics. Hospitalizations represented 73% of total direct medical costs while drugs and outpatient procedures represented 16% and 8% of total direct medical costs, respectively. Sixty percent of the total costs were related to direct medical costs, while indirect costs represented 33% of total costs.Conclusion: In our population, annual mean total costs in the prebiologic therapy era were mainly driven by direct medical costs. Even without the use of biologic agents

Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study.

Science.gov (United States)

Ludvigsson, Mikael; Bernfort, Lars; Marcusson, Jan; Wressle, Ewa; Milberg, Anna

2018-03-15

This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD. A prospective population-based study was undertaken on 85-year-old persons in Sweden. Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression. For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity. SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Preliminary estimates of the total-system cost for the restructured program: An addendum to the May 1989 analysis of the total-system life cycle cost for the Civilian Radioactive Waste Management Program

International Nuclear Information System (INIS)

1990-12-01

The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 - a fee levied on electricity generated and sold by commercial nuclear power plants - is sufficient to cover the cost of the program. This report provides cost estimates for the sixth annual evaluation of the adequacy of the fee. The costs contained in this report represent a preliminary analysis of the cost impacts associated with the Secretary of Energy's Report to Congress on Reassessment of the Civilian Radioactive Waste Management Program issued in November 1989. The major elements of the restructured program announced in this report which pertain to the program's life-cycle costs are: a prioritization of the scientific investigations program at the Yucca Mountain candidate site to focus on identification of potentially adverse conditions, a delay in the start of repository operations until 2010, the start of limited waste acceptance at the monitored retrievable storage (MRS) facility in 1998, and the start of waste acceptance at the full-capability MRS facility in 2,000. Based on the restructured program, the total-system cost for the system with a repository at the candidate site at Yucca Mountain in Nevada, a facility for monitored retrievable storage (MRS), and a transportation system is estimated at $26 billion (expressed in constant 1988 dollars). In the event that a second repository is required and is authorized by the Congress, the total-system cost is estimated at $34 to $35 billion, depending on the quantity of spent fuel and high-level waste (HLW) requiring disposal. 17 figs., 17 tabs

[Direct service costs of diabetes mellitus hospitalisations in the Mexican Institute of Social Security].

Science.gov (United States)

Salas-Zapata, Leonardo; Palacio-Mejía, Lina Sofía; Aracena-Genao, Belkis; Hernández-Ávila, Juan Eugenio; Nieto-López, Emmanuel Salvador

To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security METHODS: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The Evolution of Cost/Schedule Control (Direct Labor) in Naval Shipyards

National Research Council Canada - National Science Library

Gessis, Scott N

1992-01-01

The evolution of a Cost/Schedule Control System (C/SCS), for direct labor, in naval shipyards can be traced from the cost/schedule control concept used in the Air Force in the 1960s, as an initiative toward more reliable data...

Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.

Science.gov (United States)

Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria

2015-01-01

Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

Development of subcontractor indirect cost and other direct cost at the DOE Fernald Site

International Nuclear Information System (INIS)

Cossman, R.L.

1994-01-01

The Fernald Environmental Restoration Management Corporation (FERMCO) took great strides in the development of cost estimates at Fernald. There have been many opportunities to improve on how the policies and procedures pertaining to cost estimates were to be implemented. As FERMCO took over the existing Fernald facility, the Project Controls Division began to format the estimating procedures and tools to do business at Fernald. The Estimating Department looked at the problems that pre-existed at the site. One of the key problems that FERMCO encountered was how to summarized the direct and indirect accounts of each subcontracted estimate. Direct costs were broken down by prime and sub-prime accounts. This presented a level of detail that had not been experienced at the site before; it also created many issues concerning accounts and definitions to be applied to ''all other accounts associated with a project.'' Existing subcontract indirect cost accounts were reviewed from existing historical estimates. It was found that some were very detailed and some were not. The Estimating Department was given the task of standardizing the accounts and percentages for each of the subcontractor indirect costs. Then, as the project progressed, the percentages could be revised with actual estimates, subcontract comparisons, or with level of effort (LOE) accounts, which would represent qualified people assigned a task for the completion of each project. The approach is to assign particular employees to perform a specific task within a project from start to finish, and then to reassign the individual(s) to a new project (if it was available) integrating the expertise available with the skills required by the other operable units

Direct medical costs of serious gastrointestinal ulcers among users of NSAIDs

NARCIS (Netherlands)

Vonkeman, H.E.; Klok, R.M.; Postma, M.J.; Brouwers, J.R.B.J.; van de Laar, M.A.F.J.

2007-01-01

Background: The occurrence and prevention of gastrointestinal ulcers during use of NSAIDs has become a major healthcare issue. Objective: To determine the direct medical costs of serious NSAID-related ulcer complications. Method: An observational cost-of-illness study was conducted in a large

Cost of illness and determinants of costs among patients with gout.

Science.gov (United States)

Spaetgens, Bart; Wijnands, José M A; van Durme, Caroline; van der Linden, Sjef; Boonen, Annelies

2015-02-01

To estimate costs of illness in a cross-sectional cohort of patients with gout attending an outpatient rheumatology clinic, and to evaluate which factors contribute to higher costs. Altogether, 126 patients with gout were clinically assessed. They completed a series of questionnaires. Health resource use was collected using a self-report questionnaire that was cross-checked with the electronic patient file. Productivity loss was assessed by the Work Productivity and Activity Impairment Questionnaire, addressing absenteeism and presenteeism. Resource use and productivity loss were valued by real costs, and annual costs per patient were calculated. Factors contributing to incurring costs above the median were explored using logistic univariable and multivariable regression analysis. Mean (median) annual direct costs of gout were €5647 (€1148) per patient. Total costs increased to €6914 (€1279) or €10,894 (€1840) per patient per year when adding cost for absenteeism or both absenteeism and presenteeism, respectively. Factors independently associated with high direct and high indirect costs were a positive history of cardiovascular disease, functional limitations, and female sex. In addition, pain, gout concerns, and unmet gout treatment needs were associated with high direct costs. The direct and indirect costs-of-illness of gout are primarily associated with cardiovascular disease, functional limitations, and female sex.

Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program

International Nuclear Information System (INIS)

1989-05-01

The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 -- a fee levied on electricity generated in commercial nuclear power plants -- is sufficient to cover the cost of the program. This report provides cost estimates for the sixth annual evaluation of the adequacy of the fee and is consistent with the program strategy and plans contained in the DOE's Draft 1988 Mission Plan Amendment. The total-system cost for the system with a repository at Yucca Mountain, Nevada, a facility for monitored retrievable storage (MRS), and a transportation system is estimated at $24 billion (expressed in constant 1988 dollars). In the event that a second repository is required and is authorized by the Congress, the total-system cost is estimated at $31 to $33 billion, depending on the quantity of spent fuel to be disposed of. The $7 billion cost savings for the single-repository system in comparison with the two-repository system is due to the elimination of $3 billion for second-repository development and $7 billion for the second-repository facility. These savings are offset by $2 billion in additional costs at the first repository and $1 billion in combined higher costs for the MRS facility and transportation. 55 refs., 2 figs., 24 tabs

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

Science.gov (United States)

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

Labor Costs and Foreign Direct Investment: A Panel VAR Approach

Directory of Open Access Journals (Sweden)

Bahar Bayraktar-Sağlam

2017-09-01

Full Text Available This paper examines the endogenous interaction between labor costs and Foreign Direct Investment (FDI in the OECD countries via the Panel VAR approach under system GMM estimates for the period 1995–2009. The available data allows identifying the relevance of the components of labor costs, and allows a detailed analysis across different sectors. Empirical findings have revealed that sectoral composition of FDI and the decomposition of labor costs play a significant role in investigating the dynamic association between labor costs and FDI. Further, results suggest that labor market policies should focus on productivity-enhancing tools in addition to price hindering tools.

G-CSF in solid tumor chemotherapy: a tailored regimen reduces febrile neutropenia, treatment delays and direct costs.

Science.gov (United States)

Tsavaris, Nicolas; Kosmas, Christos; Gouveris, Panagiotis; Vadiak, Maria; Dimitrakopoulos, Antonis; Karadima, Dimitra; Pagouni, Efterpi; Panagiotakopoulos, George; Tzima, Evanthia; Ispoglou, Sevasti; Sakelariou, Dimitris; Koufos, Christos

2004-02-01

Current guidelines do not recommend G-CSF for patients with risk factors for neutropenia. One-hundred patients undergoing chemotherapy were randomized to treatment with G-CSF at 5 Kg/kg for established febrile neutropenia (ANC <1000/microl) (Group A) or G-CSF at 263 Kg/day if ANC was 1500/microl or less on the day of the expected nadir, with the duration of treatment determined by the severity of neutropenia (Group B). The number of doses of G-CSF was similar in the two groups. There were 34 cases of febrile neutropenia in Group A, but none in Group B (p=0.0001). Hospital admission for febrile neutropenia, antibiotic use and delays in chemotherapy were all significantly more common in Group A. Total direct costs were estimated to be 66, 646 for Group A and 47, 119 for Group B. Tailoring treatment does not increase G-CSF use, but significantly reduces febrile neutropenia and treatment delays and lowers direct costs.

Societal costs of multiple sclerosis in Ireland.

Science.gov (United States)

Carney, Peter; O'Boyle, Derek; Larkin, Aidan; McGuigan, Christopher; O'Rourke, Killian

2018-05-01

This paper evaluates the impact of multiple sclerosis (MS) in Ireland, and estimates the associated direct, indirect, and intangible costs to society based on a large nationally representative sample. A questionnaire was developed to capture the demographics, disease characteristics, healthcare use, informal care, employment, and wellbeing. Referencing international studies, standardized survey instruments were included (e.g. CSRI, MFIS-5, EQ-5D) or adapted (EDSS) for inclusion in an online survey platform. Recruitment was directed at people with MS via the MS Society mailing list and social media platforms, as well as in traditional media. The economic costing was primarily conducted using a 'bottom-up' methodology, and national estimates were achieved using 'prevalence-based' extrapolation. A total of 594 people completed the survey in full. The sample had geographic, disease, and demographic characteristics indicating good representativeness. At an individual level, average societal cost was estimated at €47,683; the average annual costs for those with mild, moderate, and severe MS were calculated as €34,942, €57,857, and €100,554, respectively. For a total Irish MS population of 9,000, the total societal costs of MS amounted to €429m. Direct costs accounted for just 30% of the total societal costs, indirect costs amounted to 50% of the total, and intangible or QoL costs represented 20%. The societal cost associated with a relapse in the sample is estimated as €2,438. The findings highlight that up to 70% of the total costs associated with MS are not routinely counted. These "hidden" costs are higher in Ireland than the rest of Europe, due in part to significantly lower levels of workforce participation, a higher likelihood of permanent workforce withdrawal, and higher levels of informal care needs. The relationship between disease progression and costs emphasize the societal importance of managing and slowing the progression of the illness.

Estimated cost of overactive bladder in Thailand.

Science.gov (United States)

Prasopsanti, Kriangsak; Santi-Ngamkun, Apirak; Pornprasit, Kanokwan

2007-11-01

To estimate the annual direct and indirect costs of overactive bladder (OAB) in indigenous Thai people aged 18 years and over in the year 2005. Economically based models using diagnostic and treatment algorithms from clinical practice guidelines and current disease prevalence data were used to estimate direct and indirect costs of OAB. Prevalence and event probability estimates were obtained from the literature, national data sets, and expert opinion. Costs were estimated from a small survey using a cost questionnaire and from unit costs of King Chulalongkorn Memorial Hospital. The annual cost of OAB in Thailand is estimated as 1.9 billion USD. It is estimated to consume 1.14% of national GDP The cost includes 0.33 billion USD for direct medical costs, 1.3 billion USD for direct, nonmedical costs and 0.29 billion USD for indirect costs of lost productivity. The largest costs category was direct treatment costs of comorbidities associated with OAB. Costs of OAB medication accountedfor 14% of the total costs ofOAB.

Direct analysis of biological samples by total reflection X-ray fluorescence

International Nuclear Information System (INIS)

Lue M, Marco P.; Hernandez-Caraballo, Edwin A.

2004-01-01

The technique of total reflection X-ray fluorescence (TXRF) is well suited for the direct analysis of biological samples due to the low matrix interferences and simultaneous multi-element nature. Nevertheless, biological organic samples are frequently analysed after digestion procedures. The direct determination of analytes requires shorter analysis time, low reactive consumption and simplifies the whole analysis process. On the other hand, the biological/clinical samples are often available in minimal amounts and routine studies require the analysis of large number of samples. To overcome the difficulties associated with the analysis of organic samples, particularly of solid ones, different procedures of sample preparation and calibration to approach the direct analysis have been evaluated: (1) slurry sampling, (2) Compton peak standardization, (3) in situ microwave digestion, (4) in situ chemical modification and (5) direct analysis with internal standardization. Examples of analytical methods developed by our research group are discussed. Some of them have not been previously published, illustrating alternative strategies for coping with various problems that may be encountered in the direct analysis by total reflection X-ray fluorescence spectrometry

Report on the Audit of Foreign Direct Selling Costs

National Research Council Canada - National Science Library

1990-01-01

This is our final report on the Audit of Foreign Direct Selling Costs. The Contract Management Directorate made the audit from October 1989 to January 1990 in response to a requirement in U.S.C., title 10, Sec. 2324(f)(5...

Total, direct, and indirect effects of paan on oral cancer.

Science.gov (United States)

Merchant, Anwar T; Pitiphat, Waranuch

2015-03-01

Paan (betel leaf and betel nut quid) used with or without tobacco has been positively associated with oral cancer. Oral submucous fibrosis (OSMF), a precancerous condition caused by paan, lies on the causal pathway between paan use and oral cancer. The purpose of this analysis was to estimate the effect of paan consumption on oral cancer risk when it is mediated by OSMF. We used mediation methods proposed by VanderWeele, which are based on causal inference principles, to characterize the total, direct, and indirect effects of paan, consumed with and without tobacco, on oral cancer mediated by OSMF. We reanalyzed case-control data collected from three hospitals in Karachi, Pakistan, between July 1996 and March 1998. For paan without tobacco, the total effect on oral cancer was OR 7.39, 95 % CI 1.01, 38.11, the natural indirect effect (due to OSMF among paan users) was OR 2.48, 95 % CI 0.99, 10.44, and the natural direct effect (due to paan with OSMF absent) was OR 3.32, 95 % CI 0.68, 10.07. For paan with tobacco, the total direct effect was OR 15.68, 95 % CI 3.00, 54.90, the natural indirect effect was OR 2.18, 95 % CI 0.82, 5.52, and the natural direct effect was OR 7.27, 95 % CI 2.15, 20.43. Paan, whether or not it contained tobacco, raised oral cancer risk irrespective of OSMF. Oral cancer risk was higher among those who used paan with tobacco.

The clinical characteristics and direct medical cost of influenza in hospitalized children: a five-year retrospective study in Suzhou, China.

Directory of Open Access Journals (Sweden)

Tao Zhang

Full Text Available BACKGROUND: There have been few studies on children hospitalized with influenza published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven influenza hospitalized children in Suzhou, China. METHODS: Retrospective study on children with documented influenza infection hospitalized at Suzhou Children Hospital during 2005-2009 was conducted using a structured chart review instrument. RESULTS: A total of 480 children were positive by immuno-fluorescent assay for influenza during 2005-2009. The hospitalizations for influenza occurred in 8-12 months of the year, most commonly in the winter with a second late summer peak (August-September. Influenza A accounted for 86.3%, and of these 286 (59.6% were male, and 87.2% were 60 months old had shorter hospital stay (OR = 0.45; children with oxygen treatment tended to have longer hospital stays than those without oxygen treatment (OR = 2.14. The mean cost of each influenza-related hospitalization was US$ 624 (US$ 1323 for children referred to ICU and US$ 617 for those cared for on the wards. High risk children had higher total cost than low-risk patients. CONCLUSION: Compared to other countries, in Suzhou, children hospitalized with influenza have longer hospital stay and higher percentage of pneumonia. The direct medical cost is high relative to family income. Effective strategies of influenza immunization of young children in China may be beneficial in addressing this disease burden.

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

Science.gov (United States)

Bergevin, Anna; Zick, Cathleen D; McVicar, Stephanie Browning; Park, Albert H

2015-12-01

In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. The CMV education and treatment program costs are modest and show potential for significant cost savings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

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

2017-11-01

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

The total lifetime costs of smoking

DEFF Research Database (Denmark)

Rasmussen, S.R.; Prescott, E.; Sørensen, T.I.A.

2004-01-01

Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy.......Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy....

Cost-effectiveness of hepatitis C treatment using generic direct-acting antivirals available in India.

Directory of Open Access Journals (Sweden)

Rakesh Aggarwal

Full Text Available Availability of directly-acting antivirals (DAAs has changed the treatment landscape of hepatitis C virus (HCV infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective.A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs. Model parameters were estimated from published studies. Cost-effectiveness of HCV treatment using available DAAs was calculated, using a payer's perspective. We estimated quality-adjusted life years (QALYs, disability-adjusted life years (DALYs, total costs, and incremental cost-effectiveness ratio of DAAs versus no treatment. One-way and probabilistic sensitivity analyses were conducted.Compared with no treatment, the use of generic DAAs in Indian HCV patients would increase the life expectancy by 8.02 years, increase QALYs by 3.89, avert 19.07 DALYs, and reduce the lifetime healthcare costs by $1,309 per-person treated. Treatment became cost-effective within 2 years, and cost-saving within 10 years of its initiation overall and within 5 years in persons with cirrhosis. Treating 10,000 HCV-infected persons could prevent 3400-3850 decompensated cirrhosis, 1800-2500 HCC, and 4000-4550 liver-related deaths. The results were sensitive to the costs of DAAs, pre- and post-treatment diagnostic tests and management of cirrhosis, and quality of life after sustained virologic response.Treatment with generic DAAs available in India will improve patient outcomes, provide a good value for money within 2 years, and be ultimately cost-saving. Therefore, in this and similar settings, HCV treatment should be a priority from a public health as well an economic perspective.

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Mahayni, Malek A.

2011-07-01

Finding optimal paths in directed graphs is a wide area of research that has received much of attention in theoretical computer science due to its importance in many applications (e.g., computer networks and road maps). Many algorithms have been developed to solve the optimal paths problem with different kinds of graphs. An algorithm that solves the problem of paths’ optimization in directed graphs relative to different cost functions is described in [1]. It follows an approach extended from the dynamic programming approach as it solves the problem sequentially and works on directed graphs with positive weights and no loop edges. The aim of this thesis is to implement and evaluate that algorithm to find the optimal paths in directed graphs relative to two different cost functions ( , ). A possible interpretation of a directed graph is a network of roads so the weights for the function represent the length of roads, whereas the weights for the function represent a constraint of the width or weight of a vehicle. The optimization aim for those two functions is to minimize the cost relative to the function and maximize the constraint value associated with the function. This thesis also includes finding and proving the relation between the two different cost functions ( , ). When given a value of one function, we can find the best possible value for the other function. This relation is proven theoretically and also implemented and experimented using Matlab®[2].

Patients are paying too much for tuberculosis: a direct cost-burden evaluation in Burkina Faso.

Science.gov (United States)

Laokri, Samia; Drabo, Maxime Koiné; Weil, Olivier; Kafando, Benoît; Dembélé, Sary Mathurin; Dujardin, Bruno

2013-01-01

Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing "free care" for Tuberculosis (TB) diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access. Straddling 2007 and 2008, in-depth interviews were conducted over a year among smear-positive pulmonary tuberculosis patients in six rural districts of Burkina Faso. Out-of-pocket expenses (direct costs) associated with TB were collected according to the different stages of their healthcare pathway. Median direct cost associated with TB was US$101 (n = 229) (i.e. 2.8 months of household income). Respectively 72% of patients incurred direct costs during the pre-diagnosis stage (i.e. self-medication, travel, traditional healers' services), 95% during the diagnosis process (i.e. user fees, travel costs to various providers, extra sputum smears microscopy and chest radiology), 68% during the intensive treatment (i.e. medical and travel costs) and 50% during the continuation treatment (i.e. medical and travel costs). For the diagnosis stage, median direct costs already amounted to 35% of overall direct costs. The patient care pathway analysis in rural Burkina Faso showed substantial direct costs and healthcare system delay within a "free care" policy for TB diagnosis and treatment. Whether in terms of redefining the free TB package or rationalizing the care pathway, serious efforts must be undertaken to make "free" health care more affordable for the patients. Locally relevant for TB, this case-study in Burkina Faso has a real potential to document how health programs' weaknesses can be identified and solved.

Patients are paying too much for tuberculosis: a direct cost-burden evaluation in Burkina Faso.

Directory of Open Access Journals (Sweden)

Samia Laokri

Full Text Available BACKGROUND: Paying for health care may exclude poor people. Burkina Faso adopted the DOTS strategy implementing "free care" for Tuberculosis (TB diagnosis and treatment. This should increase universal health coverage and help to overcome social and economic barriers to health access. METHODS: Straddling 2007 and 2008, in-depth interviews were conducted over a year among smear-positive pulmonary tuberculosis patients in six rural districts of Burkina Faso. Out-of-pocket expenses (direct costs associated with TB were collected according to the different stages of their healthcare pathway. RESULTS: Median direct cost associated with TB was US$101 (n = 229 (i.e. 2.8 months of household income. Respectively 72% of patients incurred direct costs during the pre-diagnosis stage (i.e. self-medication, travel, traditional healers' services, 95% during the diagnosis process (i.e. user fees, travel costs to various providers, extra sputum smears microscopy and chest radiology, 68% during the intensive treatment (i.e. medical and travel costs and 50% during the continuation treatment (i.e. medical and travel costs. For the diagnosis stage, median direct costs already amounted to 35% of overall direct costs. CONCLUSIONS: The patient care pathway analysis in rural Burkina Faso showed substantial direct costs and healthcare system delay within a "free care" policy for TB diagnosis and treatment. Whether in terms of redefining the free TB package or rationalizing the care pathway, serious efforts must be undertaken to make "free" health care more affordable for the patients. Locally relevant for TB, this case-study in Burkina Faso has a real potential to document how health programs' weaknesses can be identified and solved.

The cost of hemodialysis in a large hemodialysis center

Directory of Open Access Journals (Sweden)

Khalid Al Saran

2012-01-01

Full Text Available To assess the cost of hemodialysis (HD delivered at our center according to the treatment protocols based on the current Kidney Disease Outcome Quality Initiative (K/DOQI guidelines, we analyzed our cost data during the period from 1st of January 2007 to 30th of June 2010. The methods were used to determine both direct costs (related to dialysis treatment such as dialysis disposables, dialysis related drugs, medical personnel, out-patient medications, laboratory and other ancillary services and overhead costs (building, maintenance and engineering costs, housekeeping, and administrative personnel. During the study period, an average of 2,500 HD sessions per month were performed for 200 patients. The mean total cost per HD session was calculated as 297 US dollars (USD [1,114 Saudi Riyals (SR], and the mean total cost of dialysis per patient per year was 46,332 USD (173,784 SR. Direct costs contributed to 81.15% of the total cost from which the personnel cost represented 41.11% and dialysis disposables represented 13.64%, while medications (outpatient and intravenous dialysis related medications including albumin, erythropoiesis stimulating agents, iron and vitamin D3 accounted for 12.47% of the total cost. Our total cost level is well below the average cost in the industrialized countries.

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. Caribbean Basin Initiative § 10.197 Direct costs of processing operations... operations. As used in § 10.195 and § 10.198, the words “direct costs of processing operations” mean those...

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma.

Science.gov (United States)

Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M

2016-04-01

The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P total health care costs and $2599 (95% CI, $1985-$3212; P total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

Science.gov (United States)

Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

2016-01-01

Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

A feasibility study on direct methanol fuel cells for laptop computers based on a cost comparison with lithium-ion batteries

International Nuclear Information System (INIS)

Wee, Jung-Ho

2007-01-01

This paper compares the total cost of direct methanol fuel cell (DMFC) and lithium (Li)-ion battery systems when applied as the power supply for laptop computers in the Korean environment. The average power output and operational time of the laptop computers were assumed to be 20 W and 3000 h, respectively. Considering the status of their technologies and with certain conditions assumed, the total costs were calculated to be US$140 for the Li-ion battery and US$362 for DMFC. The manufacturing costs of the DMFC and Li-ion battery systems were calculated to be $16.65 W -1 and $0.77 W h -1 , and the energy consumption costs to be $0.00051 W h -1 and $0.00032 W h -1 , respectively. The higher fuel consumption cost of the DMFC system was due to the methanol (MeOH) crossover loss. Therefore, the requirements for DMFCs to be able to compete with Li-ion batteries in terms of energy cost include reducing the crossover level to at an order magnitude of -9 and the MeOH price to under $0.5 kg -1 . Under these conditions, if the DMFC manufacturing cost could be reduced to $6.30 W -1 , then the DMFC system would become at least as competitive as the Li-ion battery system for powering laptop computers in Korea. (author)

A METHOD OF THE MINIMIZING OF THE TOTAL ACQUISITIONS COST WITH THE INCREASING VARIABLE DEMAND

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ELEONORA IONELA FOCȘAN

2015-12-01

Full Text Available Over time, mankind has tried to find different ways of costs reduction. This subject which we are facing more often nowadays, has been detailed studied, without reaching a general model, and also efficient, regarding the costs reduction. Costs reduction entails a number of benefits over the entity, the most important being: increase revenue and default to the profit, increase productivity, a higher level of services / products offered to clients, and last but not least, the risk mitigation of the economic deficit. Therefore, each entity search different modes to obtain most benefits, for the company to succeed in a competitive market. This article supports the companies, trying to make known a new way of minimizing the total cost of acquisitions, by presenting some hypotheses about the increasing variable demand, proving them, and development of formulas for reducing the costs. The hypotheses presented in the model described below, can be maximally exploited to obtain new models of reducing the total cost, according to the modes of the purchase of entities which approach it.

Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

Science.gov (United States)

Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

2016-03-01

The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

Total, Direct, and Indirect Effects in Logit Models

DEFF Research Database (Denmark)

Karlson, Kristian Bernt; Holm, Anders; Breen, Richard

It has long been believed that the decomposition of the total effect of one variable on another into direct and indirect effects, while feasible in linear models, is not possible in non-linear probability models such as the logit and probit. In this paper we present a new and simple method...... average partial effects, as defined by Wooldridge (2002). We present the method graphically and illustrate it using the National Educational Longitudinal Study of 1988...

Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both.

Science.gov (United States)

Ghushchyan, Vahram; Nair, Kavita V; Page, Robert L

2015-01-01

The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities. A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions. ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.

Cost of disorders of the brain in Denmark

DEFF Research Database (Denmark)

Olesen, J.; Sobocki, P.; Truelsen, T.

2008-01-01

The cost of brain disorders in Denmark is unknown and such information is important to decision makers. The aims of the study were to estimate the total number of subjects with brain diseases, and the associated direct and indirect expenses in Denmark. This was part of a larger pan-European study...... drug consumption was used for treatment of brain diseases. Expenses to brain diseases constituted 3% of the gross domestic product. Brain disorders are very prevalent in Denmark and they cause high societal and personal cost Udgivelsesdato: 2008......The cost of brain disorders in Denmark is unknown and such information is important to decision makers. The aims of the study were to estimate the total number of subjects with brain diseases, and the associated direct and indirect expenses in Denmark. This was part of a larger pan-European study......,000 and 340,000 patients, respectively. The total expenses for all selected brain diseases were 37.3 billion DKR. Affective disorders, dependency, dementia and stroke were the most costly diseases. An estimated 12% of all direct costs in the Danish health system were spent on brain diseases; 9% of the total...

Efforts to Support Consumer Enrollment Decisions Using Total Cost Estimators: Lessons from the Affordable Care Act’s Marketplaces.

Science.gov (United States)

Giovannelli, Justin; Curran, Emily

2017-02-01

Issue: Policymakers have sought to improve the shopping experience on the Affordable Care Act’s marketplaces by offering decision support tools that help consumers better understand and compare their health plan options. Cost estimators are one such tool. They are designed to provide consumers a personalized estimate of the total cost--premium, minus subsidy, plus cost-sharing--of their coverage options. Cost estimators were available in most states by the start of the fourth open enrollment period. Goal: To understand the experiences of marketplaces that offer a total cost estimator and the interests and concerns of policymakers from states that are not using them. Methods: Structured interviews with marketplace officials, consumer enrollment assisters, technology vendors, and subject matter experts; analysis of the total cost estimators available on the marketplaces as of October 2016. Key findings and conclusions: Informants strongly supported marketplace adoption of a total cost estimator. Marketplaces that offer an estimator faced a range of design choices and varied significantly in their approaches to resolving them. Interviews suggested a clear need for additional consumer testing and data analysis of tool usage and for sustained outreach to enrollment assisters to encourage greater use of the estimators.

Cost of asthma in the Asia-Pacific region

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C. K. W. Lai

2006-06-01

Full Text Available The substantial morbidity caused by asthma suggests that the disease is associated with a large economic burden. The current study analysed the burden of asthma in eight countries in the Asia-Pacific region. Responses to questions regarding resource use from a survey of people with asthma were analysed. Unit costs were obtained for each resource use element. Individual patient costs were estimated and means calculated for each country. A multivariate model was developed to identify potential predictors of resource use. Annual per-patient direct costs ranged from US$108 for Malaysia to US$1,010 for Hong Kong. When productivity costs were included, total per-patient societal costs ranged from US$184 in Vietnam to US$1,189 in Hong Kong. Urgent care costs were responsible for 18–90% of total per-patient direct costs. Overall, total per-patient direct costs were equivalent to 13% of per capita gross domestic product and 300% of per capita healthcare spending. Extremes of age, greater severity of asthma, and poorer general health status were predictive of high cost. The per-patient cost of asthma in these countries is high, particularly when seen in the context of overall per-patient healthcare spending. Strategies to improve asthma control are likely to not only improve patient outcomes, but also to decrease societal costs.

Study of the standard direct costs of various techniques of advanced endoscopy. Comparison with surgical alternatives.

Science.gov (United States)

Loras, Carme; Mayor, Vicenç; Fernández-Bañares, Fernando; Esteve, Maria

2018-03-12

The complexity of endoscopy has carried out an increase in cost that has a direct effect on the healthcare systems. However, few studies have analyzed the cost of advanced endoscopic procedures (AEP). To carry out a calculation of the standard direct costs of AEP, and to make a financial comparison with their surgical alternatives. Calculation of the standard direct cost in carrying out each procedure. An endoscopist detailed the time, personnel, materials, consumables, recovery room time, stents, pathology and medication used. The cost of surgical procedures was the average cost recorded in the hospital. Thirty-eight AEP were analyzed. The technique showing lowest cost was gastroscopy + APC (€116.57), while that with greatest cost was ERCP with cholangioscopy + stent placement (€5083.65). Some 34.2% of the procedures registered average costs of €1000-2000. In 57% of cases, the endoscopic alternative was 2-5 times more cost-efficient than surgery, in 31% of cases indistinguishable or up to 1.4 times more costly. Standard direct cost of the majority of AEP is reported using a methodology that enables easy application in other centers. For the most part, endoscopic procedures are more cost-efficient than the corresponding surgical procedure. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Changes in Energy Cost and Total External Work of Muscles in Elite Race Walkers Walking at Different Speeds

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Chwała Wiesław

2014-12-01

Full Text Available The aim of the study was to assess energy cost and total external work (total energy depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers.

Report on the Audit of Foreign Direct Selling Costs

Science.gov (United States)

1990-09-18

This is our final report on the Audit of Foreign Direct Selling Costs. The Contract Management Directorate made the audit from October 1989 to...The objective of the audit was to assess whether DoD regulations provided the appropriate incentives to stimulate exports by the. U.S. Defense

The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites.

Science.gov (United States)

Zou, Yaming; Liao, Yu; Liu, Fengying; Chen, Lei; Shen, Hongcheng; Huang, Shujie; Zheng, Heping; Yang, Bin; Hao, Yuantao

2017-11-01

Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

Science.gov (United States)

Slover, James D; Mullaly, Kathleen A; Payne, Ashley; Iorio, Richard; Bosco, Joseph

2016-12-01

The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies. We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility. The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted. The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: Volume 2, Supporting information

International Nuclear Information System (INIS)

1987-06-01

This report provides cost estimates for the fifth evaluation of the adequacy of the fee and is consistent with the program strategy and plans. The total-system cost for the reference cases in the improved-performance system is estimated at $32.1 to $38.2 billion (expressed in constant 1986 collars) over the entire life of the system, or $1.5 to $1.6 billion more than that of the authorized system (i.e., the system without an MRS facility). The current estimate of the total-system cost for the reference cases in the improved-performance system is $3.8 to $5.4 billion higher than the estimate for the same system in the 1986 TSLCC analysis. In the case with the maximum increase, nearly all of the higher cost is due to a $5.2-billion increase in the costs of development and evaluation (D and E); all other system costs are essentially unchanged. The cost difference between the improved-performance system and the authorized system is smaller than the difference estimated in last year's TSLCC analysis. Volume 2 presents the detailed results for the 1987 analysis of the total-system life cycle cost (TSLCC). It consists of four sections: Section A presents the yearly flows of waste between waste-management facilities for the 12 aggregate logistics cases that were studied; Section B presents the annual total-system costs for each of the 30 TSLCC cases by major cost category; Section C presents the annual costs for the disposal of 16,000 canisters of defense high-level waste (DHLW) by major cost category for each of the 30 TSLCC cases; and Section D presents a summary of the cost-allocation factors that were calculated to determine the defense waste share of the total-system costs

Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

Science.gov (United States)

Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

2016-09-01

The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

Linking the spare parts management with the total costs of ownership: An agenda for future research

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Orlando Duran

2016-12-01

Full Text Available Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC. Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view. Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO. Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

Linking the spare parts management with the total costs of ownership: An agenda for future research

International Nuclear Information System (INIS)

Duran, O.; Roda, I.; Macchi, M.

2016-01-01

Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

Linking the spare parts management with the total costs of ownership: An agenda for future research

Energy Technology Data Exchange (ETDEWEB)

Duran, O.; Roda, I.; Macchi, M.

2016-07-01

Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

Episode of Care Payments in Total Joint Arthroplasty and Cost Minimization Strategies.

Science.gov (United States)

Nwachukwu, Benedict U; O'Donnell, Evan; McLawhorn, Alexander S; Cross, Michael B

2016-02-01

Total joint arthroplasty (TJA) is receiving significant attention in the US health care system for cost containment strategies. Specifically, payer organizations have embraced and are implementing bundled payment schemes in TJA. Consequently, hospitals and providers involved in the TJA care cycle have sought to adapt to the new financial pressures imposed by episode of care payment models by analyzing what components of the total "event" of a TJA are most essential to achieve a good outcome after TJA. As part of this review, we analyze and discuss a health economic study by Snow et al. As part of their study, the authors aimed to understand the association between preoperative physical therapy (PT) and post-acute care resource utilization, and its effect on the total cost of care during total joint arthroplasty. The purpose of this current review therefore is to (1) describe and analyze the findings presented by Snow et al. and (2) provide a framework for analyzing and critiquing economic analyses in orthopedic surgery. The study under review, while having important strengths, has several notable limitations that are important to keep in mind when making policy and coverage decisions. We support cautious interpretation and application of study results, and we encourage maintained attention to economic analysis in orthopedics as well as continued care path redesign to maximize value for patients and health care providers.

The costs of breast cancer in a Mexican public health institution

Directory of Open Access Journals (Sweden)

Jacobo Alejandro Gómez-Rico

2008-11-01

Full Text Available Jacobo Alejandro Gómez-Rico1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Consuelo Rubio-Poo21Universidad Autónoma Metropolitano–Xochimilco (UAM-X, Departments: Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS; 2Universidad Nacional Autónoma de México (UNAM, Faculty of Professional Studies-Zaragoza (FES-ZaragozaAbstract: Breast cancer (BC is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94 were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.Keywords: breast cancer, Mexican women, direct and indirect costs

Clinical and cost effectiveness-related aspects of retransfusion in total hip and knee arthroplasty.

Science.gov (United States)

Dobosz, Bartłomiej; Dutka, Julian; Dutka, Lukasz; Maleta, Paweł

2012-01-01

An increasing demand for blood products forces the rationalisation of management and conservation of blood. The aim of the study is to evaluate the possibility of retransfusion of blood conservation and the cost-effectiveness of this procedure when employed in Total Hip Replacement and Total Knee Arthroplasty. This prospective cohort study involved two groups of patients. Group I comprised 50 patients who underwent blood retransfusion and in several cases had supplementary allogeneic transfusion. Group II, a control group, consisted of 50 patients who did not receive retransfusion. The retransfusion in Group I enabled the recovery of a mean amount of 364.5 ml (± 52.7) of blood in THR patients and 403.8 ml (± 110.7) in TKA patients. Demand for allogeneic blood transfusions in Group I versus Group II was 46% lower in THR patients and 42% lower in TKA patients. The blood recovered for retransfusion is biologically valuable with regard to cellular elements and plasma chemistries. In the costs evaluation, the total savings in Group I were 5,000 PLN. Retransfusion of recuperated blood from postoperative drainage tubing is a simple and safe method that provides clinical and cost-effectiveness advantages.

Direct costs of chronic obstructive pulmonary disease among managed care patients

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An

2010-09-01

Full Text Available Anand A Dalal1, Laura Christensen2, Fang Liu3, Aylin A Riedel31US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 2Health Economics Outcomes Research, i3 Innovus, Ann Arbor, MI, USA; 3Health Economics Outcomes Research, i3 Innovus, Eden Prairie, MN, USAPurpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD among commercially insured patients in the US.Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days, emergency department (ED, standard inpatient admission, and intensive care unit (ICU cohorts. Patient-level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.Results: Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD annual COPD-related health care costs (2008 US$ increased across the cohorts (P < 0.001, ranging from $2003 ($3238 to $43,461 ($76,159 per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD episode-level costs were $305 ($310 for an outpatient visit, $274 ($336 for an urgent outpatient visit, $327 ($65 for an ED visit, $9745 ($2968 for a standard admission, and $33,440 for an ICU stay.Conclusion: Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs

Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece.

Science.gov (United States)

Tsifetaki, Niki; Migkos, Michail P; Papagoras, Charalampos; Voulgari, Paraskevi V; Athanasakis, Kostas; Drosos, Alexandros A

2015-06-01

To investigate the total annual direct cost of patients with spondyloarthritis (SpA) in Greece. Retrospective study with 156 patients diagnosed and followed up in the rheumatology clinic of the University Hospital of Ioannina. Sixty-four had ankylosing spondylitis (AS) and 92 had psoriatic arthritis (PsA). Health resource use for each patient was elicited through a retrospective chart review that documented the use of monitoring visits, medications, laboratory/diagnostic tests, and inpatient stays for the previous year from the date that the review took place. Costs were calculated from a third-party payer perspective and are reported in 2014 euros. The mean ± SD annual direct cost for the patients with SpA reached €8680 ± 6627. For the patients with PsA and AS, the cost was estimated to be €8097 ± 6802 and €9531 ± 6322, respectively. The major cost was medication, which represented 88.9%, 88.2%, and 89.3% of the mean total direct cost for SpA, AS, and PsA, respectively. The annual amount of the scheduled tests for all patients corresponded to 7.5%, and for those performed on an emergency basis, 1.1%. Further, the cost for scheduled and emergency hospitalization, as well as the cost of scheduled visits to an outpatient clinic, corresponded to 2.5% of the mean total annual direct cost for the patients with SpA. SpA carries substantial financial cost, especially in the era of new treatment options. Adequate access and treatment for patients with SpA remains a necessity, even in times of fiscal constraint. Thus, the recommendations of the international scientific organizations should be considered when administering high-cost drugs such as biological treatments.

Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.

Science.gov (United States)

Childs, John D; Wu, Samuel S; Teyhen, Deydre S; Robinson, Michael E; George, Steven Z

2014-04-01

Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing

Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States.

Science.gov (United States)

Adam, E A; Collier, S A; Fullerton, K E; Gargano, J W; Beach, M J

2017-10-01

National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.

Cost-effectiveness analysis for the implementation of the EU Water Framework Directive

NARCIS (Netherlands)

van Engelen, D.M.; Seidelin, Christian; van der Veeren, Rob; Barton, David N.; Queb, Kabir

2008-01-01

The EU Water Framework Directive (WFD) prescribes cost-effectiveness analysis (CEA) as an economic tool for the minimisation of costs when formulating programmes of measures to be implemented in the European river basins by the year 2009. The WFD does not specify, however, which approach to CEA has

Cost of Illness of Chronic Hepatitis B Infection in Vietnam

NARCIS (Netherlands)

Tu, Hong Anh T.; Woerdenbag, Herman J.; Riewpaiboon, Arthorn; Kane, Sumit; Le, Diep M.; Postma, Maarten J.; Li, Shu Chuen

2012-01-01

To estimate the total financial burden of chronic hepatitis B virus (HBV) infection for Vietnam by quantifying the direct medical, the direct nonmedical, and indirect costs among patients with various stages of chronic HBV infection. Direct medical cost data were retrieved retrospectively from

A direct healthcare cost analysis of the cryopreserved versus fresh transfer policy at the blastocyst stage.

Science.gov (United States)

Papaleo, Enrico; Pagliardini, Luca; Vanni, Valeria Stella; Delprato, Diana; Rubino, Patrizia; Candiani, Massimo; Viganò, Paola

2017-01-01

A cost analysis covering direct healthcare costs relating to IVF freeze-all policy was conducted. Normal- and high- responder patients treated with a freeze-all policy (n = 63) compared with fresh transfer IVF (n = 189) matched by age, body mass index, duration and cause of infertility, predictive factors for IVF (number of oocytes used for fertilization) and study period, according to a 1:3 ratio were included. Total costs per patient (€6952 versus €6863) and mean costs per live birth were similar between the freeze-all strategy (€13,101, 95% CI 10,686 to 17,041) and fresh transfer IVF (€15,279, 95% CI 13,212 to 18,030). A mean per live birth cost-saving of €2178 (95% CI -1810 to 6165) resulted in a freeze-all strategy owing to fewer embryo transfer procedures (1.29 ± 0.5 versus 1.41 ± 0.7); differences were not significant. Sensitivity analysis revealed that the freeze-all strategy remained cost-effective until the live birth rate is either higher or only slightly lower (≥-0.59%) in the freeze-all group compared with fresh cycles. A freeze-all policy does not increase costs compared with fresh transfer, owing to negligible additional expenses, i.e. vitrification, endometrial priming and monitoring, against fewer embryo transfer procedures required to achieve pregnancy. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

The costs of hepatitis A infections in South Korea

Directory of Open Access Journals (Sweden)

Kyohyun Kim

2014-08-01

Full Text Available OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case. Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate.

523 factors influencing direct costs dynamics of building projects

African Journals Online (AJOL)

Osondu

2013-08-16

Aug 16, 2013 ... effect of the direct cost variation factors (p-values between 0.365 and 0.930). Construction, resources, and performance factors are the most significant of the groups (MS range = 3.66 to 4.33), though no .... financial control on site ranked first and second ... order according to the consultants were, inflation.

Use of predefined biochemical admission profiles does not reduce the number of tests or total cost

DEFF Research Database (Denmark)

Pareek, Manan; Haidl, Felix; Folkestad, Lars

2014-01-01

The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost.......The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost....

The cost of schizophrenia in Japan

Directory of Open Access Journals (Sweden)

Sado M

2013-05-01

Full Text Available Mitsuhiro Sado,1 Ataru Inagaki,2 Akihiro Koreki,1 Martin Knapp,3 Lee Andrew Kissane,4 Masaru Mimura,1 Kimio Yoshimura4 1Department of Neuropsychiatry, Keio University School of Medicine, 2Center for Clinical Psychopharmacology, Institute of Neuropsychiatry, Tokyo, Japan; 3Department of Social Policy, London School of Economics and Political Science, London, UK; 4Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan Introduction: Schizophrenia is a disorder that produces considerable burdens due to its often relapsing/remitting or chronic longitudinal course. This burden is felt not only by patients themselves, but also by their families and health care systems. Although the societal burden caused by this disorder has been evaluated in several countries, the magnitude of the societal cost of schizophrenia in Japan has never been estimated. The aim of this study is to clarify the societal burden of schizophrenia by estimating the cost of schizophrenia in Japan in 2008. Methods: A human capital approach was adopted to estimate the cost of schizophrenia. The total cost of schizophrenia was calculated as the sum of the direct, morbidity, and mortality costs. Schizophrenia was defined as disorders coded as F20.0–F20.9 according to the International Classification of Diseases-10. The data required to estimate the total cost was collected from publicly available statistics or previously reported studies. Results: The total cost of schizophrenia in Japan in 2008 was JPY 2.77 trillion (USD 23.8 billion. While the direct cost was JPY 0.770 trillion (USD 6.59 billion, the morbidity and mortality costs were JPY 1.85 trillion (USD 15.8 billion and JPY 0.155 trillion (USD 1.33 billion, respectively. Conclusion: The societal burden caused by schizophrenia is tremendous in Japan, similar to that in other developed countries where published data exist. Compared with other disorders, such as depression or anxiety disorders

A new methodology for modeling of direct landslide costs for transportation infrastructures

Science.gov (United States)

Klose, Martin; Terhorst, Birgit

2014-05-01

The world's transportation infrastructure is at risk of landslides in many areas across the globe. A safe and affordable operation of traffic routes are the two main criteria for transportation planning in landslide-prone areas. The right balancing of these often conflicting priorities requires, amongst others, profound knowledge of the direct costs of landslide damage. These costs include capital investments for landslide repair and mitigation as well as operational expenditures for first response and maintenance works. This contribution presents a new methodology for ex post assessment of direct landslide costs for transportation infrastructures. The methodology includes tools to compile, model, and extrapolate landslide losses on different spatial scales over time. A landslide susceptibility model enables regional cost extrapolation by means of a cost figure obtained from local cost compilation for representative case study areas. On local level, cost survey is closely linked with cost modeling, a toolset for cost estimation based on landslide databases. Cost modeling uses Landslide Disaster Management Process Models (LDMMs) and cost modules to simulate and monetize cost factors for certain types of landslide damage. The landslide susceptibility model provides a regional exposure index and updates the cost figure to a cost index which describes the costs per km of traffic route at risk of landslides. Both indexes enable the regionalization of local landslide losses. The methodology is applied and tested in a cost assessment for highways in the Lower Saxon Uplands, NW Germany, in the period 1980 to 2010. The basis of this research is a regional subset of a landslide database for the Federal Republic of Germany. In the 7,000 km² large Lower Saxon Uplands, 77 km of highway are located in potential landslide hazard area. Annual average costs of 52k per km of highway at risk of landslides are identified as cost index for a local case study area in this region. The

The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

OpenAIRE

Ali KURT; Cemal ZEHİR

2016-01-01

Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between ...

Assessment of direct causes and costs of medical admissions in Bingham University Teaching Hospital – Jos, Nigeria

Directory of Open Access Journals (Sweden)

Peter U Bassi

2017-01-01

Full Text Available >Background: As health-care costs continue to rise and the population ages, an individual Nigerian continues to experience financial hardship in settling medical bills, especially when health insurance schemes are still far from reality for most Nigerians, making health-care financing burdensome in Nigeria like many developing countries. This has made out-of-pocket expenditure the most common form of health-care financing.Aims: This study assessed the average costs, duration, and causes of inpatient admission so as to know the direct costs associated with medical care for proper health-care planning.Settings and Design: This was a pilot study of a prospective cohort design whereby all patients were admitted to medical wards during the study period.Materials and Methods: Cost analysis was performed from the societal perspective, but included only direct medical care cost for this analysis. Patients input charts and pharmacy dispensing charts of all patients admitted to medical wards between May and July 2015 were reviewed. All costs were in local currency (Naira using the average exchange rates proposed by Central Bank of Nigeria for June 2015.Statistical sAnalysis Used: Statistical analysis was carried out using SPSS version 20.Results: A total of 293 out of 320 patients met inclusion criteria and were assessed. Female patients admitted during the study period had an overall higher mean cost of care ₦84, 303.94 ± 6860.56 (95% confidence interval [CI]: 68,991.65–96,103.27 compared to male patients ₦68, 601.59 ± 57,178.37 (95% CI: 59,081.51–78,121.67 (P < 0.102. Civil servants had higher mean overall costs of care ₦90, 961.70 ± 105,175.62 (95% CI: 65,883.46–116,039.94 (P < 0.203.Conclusions: The higher prevalence of female patients with higher mean cost of inpatient care in this study suggests that Jos females may be more health conscious than their male counterparts. Overall mean cost of inpatient care stay was not proportional to

Exposure to second-hand smoke and direct healthcare costs in children – results from two German birth cohorts, GINIplus and LISAplus

Directory of Open Access Journals (Sweden)

Batscheider Ariane

2012-10-01

Full Text Available Abstract Background Although the negative health consequences of the exposure to second hand tobacco smoke during childhood are already known, evidence on the economic consequences is still rare. The aim of this study was to estimate excess healthcare costs of exposure to tobacco smoke in German children. Methods The study is based on data from two birth cohort studies of 3,518 children aged 9-11 years with information on healthcare utilisation and tobacco smoke exposure: the GINIplus study (German Infant Study On The Influence Of Nutrition Intervention Plus Environmental And Genetic Influences On Allergy Development and the LISAplus study (Influence of Life-Style Factors On The Development Of The Immune System And Allergies In East And West Germany Plus The Influence Of Traffic Emissions And Genetics. Direct medical costs were estimated using a bottom-up approach (base year 2007. We investigated the impact of tobacco smoke exposure in different environments on the main components of direct healthcare costs using descriptive analysis and a multivariate two-step regression analysis. Results Descriptive analysis showed that average annual medical costs (physician visits, physical therapy and hospital treatment were considerably higher for children exposed to second-hand tobacco smoke at home (indoors or on patio/balcony compared with those who were not exposed. Regression analysis confirmed these descriptive trends: the odds of positive costs and the amount of total costs are significantly elevated for children exposed to tobacco smoke at home after adjusting for confounding variables. Combining the two steps of the regression model shows smoking attributable total costs per child exposed at home of €87 [10–165] (patio/balcony and €144 [6–305] (indoors compared to those with no exposure. Children not exposed at home but in other places showed only a small, but not significant, difference in total costs compared to those with no exposure

Analysis for the high-level waste disposal cost object

International Nuclear Information System (INIS)

Kim, S. K.; Lee, J. R.; Choi, J. W.; Han, P. S.

2003-01-01

The purpose of this study is to analyse the ratio of cost object in terms of the disposal cost estimation. According to the result, the ratio of operating cost is the most significant object in total cost. There are a lot of differences between the disposal costs and product costs in view of their constituents. While the product costs may be classified by the direct materials cost, direct manufacturing labor cost, and factory overhead the disposal cost factors should be constituted by the technical factors and the non-technical factors

Cost of treatment for breast cancer in central Vietnam

Directory of Open Access Journals (Sweden)

Nguyen Hoang Lan

2013-02-01

Full Text Available Background: In recent years, cases of breast cancer have been on the rise in Vietnam. To date, there has been no study on the financial burden of the disease. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam. Methods: Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Cost analysis was conducted from the health care payers’ perspective. Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. For each cost category, the mean, standard deviation, median, and cost range were estimated. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. Results: The total direct medical cost for a 5-year treatment course for breast cancer in central Vietnam was estimated at $975 per patient (range: $11.7–$3,955. The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%. Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter. The absence of health insurance was the main factor limiting service uptake. Conclusion: From the health care payers’ perspective, the Government subsidization of public hospital charges lowered the direct medical costs of a 5-year treatment course for primary breast cancer in central Vietnam. However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance.

COST OF DISORDERS OF THE BRAIN IN SLOVENIA*

Directory of Open Access Journals (Sweden)

David B.Vodušek

2008-05-01

Full Text Available Whereas there are many publications on disorders of, for instance, heart or kidney function, there are few, if any, on brain disorders, which are traditionally viewed separately asmental, neurological or neurosurgical disorders. There are, however, marked similaritiesand shared interests between the fields and, most importantly, basic neuroscience is equally relevant for all clinical problems. The European Brain Council has analysed the burdenand the cost of brain disorders in Europe. The aim of the present text is to report data forSlovenia.Twelve different disorders (or groups of disorders of brain believed to have the highestcost (addiction, affective disorders, anxiety disorders, brain tumours, dementia, epilepsy,migraine and other headaches, multiple sclerosis, Parkinson’s disease, psychotic disorders,stroke, and trauma were analysed. Epidemiology data for Europe were collected as12-month prevalence data for disorders by country and stratified according to age,gender, and disorder severity. Because little original data were available for Slovenia,extrapolated data were used. Health economic data (representing direct medical costs,direct non-medical costs, and indirect costs being transformed into euros for the year2004 were entered into a health economic model.The total number of brain disorders in Slovenia amounted to 570,000 in 2004, and whencorrected for co-morbidity, 1/5 of the Slovenian population have a brain disorder. Inparticular, this is 39,000 alcohol dependents and illicit drug dependants, 105.000 affectivedisorders, 195,000 anxiety disorders, 178,000 migraine, etc. The total cost of all includedbrain disorders in Slovenia was estimated at 833 million euros, the most costly beingaffective disorders, dementia, and addiction. It should be mentioned that both the epidemiological data and the resulting cost are significantly underestimated for several disorders,particularly stroke. Direct health care cost mounted to 403 million

Risk factors and direct medical cost of early versus late unplanned readmissions among diabetes patients at a tertiary hospital in Singapore.

Science.gov (United States)

Png, May Ee; Yoong, Joanne; Chen, Cynthia; Tan, Chuen Seng; Tai, E Shyong; Khoo, Eric Y H; Wee, Hwee Lin

2018-02-20

To examine the risk factors and direct medical costs associated with early (≤30 days) versus late (31-180 days) unplanned readmissions among patients with type 2 diabetes in Singapore. Risk factors and associated costs among diabetes patients were investigated using electronic medical records from a local tertiary care hospital from 2010 to 2012. Multivariable logistic regression was used to identify risk factors associated with early and late unplanned readmissions while a generalized linear model was used to estimate the direct medical cost. Sensitivity analysis was also performed. A total of 1729 diabetes patients had unplanned readmissions within 180 days of an index discharge. Length of index stay (a marker of acute illness burden) was one of the risk factors associated with early unplanned readmission while patient behavior-related factors, like diabetes-related medication adherence, were associated with late unplanned readmission. Adjusted mean cost of index admission was higher among patients with unplanned readmission. Sensitivity analysis yielded similar results. Existing routinely captured data can be used to develop prediction models that flag high risk patients during their index admission, potentially helping to support clinical decisions and prevent such readmissions.

Estimate of the cost of multiple sclerosis in Spain by literature review.

Science.gov (United States)

Fernández, Oscar; Calleja-Hernández, Miguel Angel; Meca-Lallana, José; Oreja-Guevara, Celia; Polanco, Ana; Pérez-Alcántara, Ferran

2017-08-01

Multiple Sclerosis (MS) is a progressive disease leading to increasing disability and costs. A literature review was carried out to identify MS costs and to estimate its economic burden in Spain. Areas Covered: The public electronic databases PubMed, ScienceDirect and IBECS were consulted and a manual review of communications presented at related congresses was carried out. A total of 225 references were obtained, of which 43 were finally included in the study. Expert Commentary: Three major cost groups were identified: direct healthcare costs, direct non-healthcare costs and indirect costs. There is a direct relationship between disease progression and increased costs, mainly direct non-healthcare costs (greater need for informal care) and indirect costs (greater loss of productivity). The total cost associated with MS in Spain is €1,395 million per year, and that the mean annual cost per patient is €30,050. Beyond costs, a large impact on the quality of life of patients, with an annual loss of up to 13,000 quality-adjusted life years was also estimated. MS has a large economic impact on Spanish society and a significant impact on the quality of life of patients.

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

Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty

DEFF Research Database (Denmark)

Andreasen, Signe E; Holm, Henriette B; Jørgensen, Mira

2017-01-01

this between 2 departments with different logistical set-ups. METHODS: Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish...... orthopedic departments with standardized fast-track settings, but different logistical set-ups. RESULTS: Length of stay was median 2 days in both departments. TDABC revealed minor differences in the perioperative settings between departments, but the total cost excluding the prosthesis was similar at USD......-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare...

The direct and ecological costs of an ant-plant symbiosis.

Science.gov (United States)

Frederickson, Megan E; Ravenscraft, Alison; Miller, Gabriel A; Arcila Hernández, Lina M; Booth, Gregory; Pierce, Naomi E

2012-06-01

How strong is selection for cheating in mutualisms? The answer depends on the type and magnitude of the costs of the mutualism. Here we investigated the direct and ecological costs of plant defense by ants in the association between Cordia nodosa, a myrmecophytic plant, and Allomerus octoarticulatus, a phytoecious ant. Cordia nodosa trees produce food and housing to reward ants that protect them against herbivores. For nearly 1 year, we manipulated the presence of A. octoarticulatus ants and most insect herbivores on C. nodosa in a full-factorial experiment. Ants increased plant growth when herbivores were present but decreased plant growth when herbivores were absent, indicating that hosting ants can be costly to plants. However, we did not detect a cost to ant colonies of defending host plants against herbivores. Although this asymmetry in costs suggests that the plants may be under stronger selection than the ants to cheat by withholding investment in their partner, the costs to C. nodosa are probably at least partly ecological, arising because ants tend scale insects on their host plants. We argue that ecological costs should favor resistance or traits other than cheating and thus that neither partner may face much temptation to cheat.

Near-term Forecasting of Solar Total and Direct Irradiance for Solar Energy Applications

Science.gov (United States)

Long, C. N.; Riihimaki, L. D.; Berg, L. K.

2012-12-01

Integration of solar renewable energy into the power grid, like wind energy, is hindered by the variable nature of the solar resource. One challenge of the integration problem for shorter time periods is the phenomenon of "ramping events" where the electrical output of the solar power system increases or decreases significantly and rapidly over periods of minutes or less. Advance warning, of even just a few minutes, allows power system operators to compensate for the ramping. However, the ability for short-term prediction on such local "point" scales is beyond the abilities of typical model-based weather forecasting. Use of surface-based solar radiation measurements has been recognized as a likely solution for providing input for near-term (5 to 30 minute) forecasts of solar energy availability and variability. However, it must be noted that while fixed-orientation photovoltaic panel systems use the total (global) downwelling solar radiation, tracking photovoltaic and solar concentrator systems use only the direct normal component of the solar radiation. Thus even accurate near-term forecasts of total solar radiation will under many circumstances include inherent inaccuracies with respect to tracking systems due to lack of information of the direct component of the solar radiation. We will present examples and statistical analyses of solar radiation partitioning showing the differences in the behavior of the total/direct radiation with respect to the near-term forecast issue. We will present an overview of the possibility of using a network of unique new commercially available total/diffuse radiometers in conjunction with a near-real-time adaptation of the Shortwave Radiative Flux Analysis methodology (Long and Ackerman, 2000; Long et al., 2006). The results are used, in conjunction with persistence and tendency forecast techniques, to provide more accurate near-term forecasts of cloudiness, and both total and direct normal solar irradiance availability and

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

Science.gov (United States)

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

2007-06-01

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

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

Science.gov (United States)

Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K

2008-09-01

To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

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

Science.gov (United States)

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

2018-05-01

clinical characteristics. A second analysis, conducted among the migraine patients only, compared the odds of having a short-term disability claim between (1) patients treated with acute or preventive migraine medications only during the baseline period and patients with no migraine treatment during baseline and (2) patients treated with both acute and preventive migraine medications during the baseline period and patients with no migraine treatment during baseline, after controlling for patient demographic and clinical characteristics. Migraine patients had total annual direct plus indirect costs that were $8924 (in 2014 United States dollars) higher than those of demographically similar individuals without evidence of migraine. Migraine patients' mean annual direct all-cause healthcare costs were $6575 higher than those of matched patients without migraine ($11,010 [standard deviation = $19,663] vs $4436 [standard deviation=$13,081]; P costs were $2350 higher in the migraine cohort than in the matched no migraine patients ($11,294 vs $8945. Migraine patients were 2.0 times more likely as their nonmigraine counterparts to use opioids (45.5% vs 21.9%; P cost burden in the United States. Compared to matched nonmigraine patients, migraine patients were more likely to have work loss and longer periods of work loss, leading to significantly higher indirect costs. Migraine patients also had higher levels of healthcare utilization, despite the relatively stable prevalence of migraine and the available acute and preventive treatment options for migraine management. © 2018 American Headache Society.

Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

Science.gov (United States)

Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

2017-03-01

To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

The importance of the property total cost on the formulation of the policy for acquisition of the government enterprises from the energy sector; A importancia do custo total de propriedade na formulacao da politica de aquisicao das empresas estatais do setor de energia

Energy Technology Data Exchange (ETDEWEB)

Melo, Andre Cristiano Silva; Ignacio, Anibal Alberto Vilcapoma; Fernandes, Elton; Sampaio, Lea Maria Dantas; Araujo, Renato Samuel Barbosa de [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Nucleo de Estudos de Tecnologia, Gestao e Logistica; Cardoso, Flavio Correa; Moreira, Pedro de Souza; Silva, Sergio Vargas da [FURNAS Centrais Eletricas S.A., Rio de Janeiro, RJ (Brazil). Dept. de Aquisicoes de Materiais

2006-07-01

This article discusses the approach to total cost of the property (TCP) as an instrument for the formulation of policies for acquisitions of the Brazilian electric sector enterprises. Also the article discusses legal aspects which rules the acquisition processes such as the Law 8666/93, the Decree 2745/98 and the Law Sarbanes and Oxley which regulates the enterprises which stocks in the US stock exchanges. This article points out in the direction to alternatives and perspectives for the formulation of a new policy of acquisition not priorizing the less buying price, but also the life cycle of the product, viewing the reduction of the total costs of the enterprises assets, as the high investments are forecasted for the electric sector.

Modelling Common Agricultural Policy-Water Framework Directive interactions and cost-effectiveness of measures to reduce nitrogen pollution.

Science.gov (United States)

Mouratiadou, Ioanna; Russell, Graham; Topp, Cairistiona; Louhichi, Kamel; Moran, Dominic

2010-01-01

Selecting cost-effective measures to regulate agricultural water pollution to conform to the Water Framework Directive presents multiple challenges. A bio-economic modelling approach is presented that has been used to explore the water quality and economic effects of the 2003 Common Agricultural Policy Reform and to assess the cost-effectiveness of input quotas and emission standards against nitrate leaching, in a representative case study catchment in Scotland. The approach combines a biophysical model (NDICEA) with a mathematical programming model (FSSIM-MP). The results indicate only small changes due to the Reform, with the main changes in farmers' decision making and the associated economic and water quality indicators depending on crop price changes, and suggest the use of target fertilisation in relation to crop and soil requirements, as opposed to measures targeting farm total or average nitrogen use.

Cost-effectiveness of additional catheter-directed thrombolysis for deep vein thrombosis

Science.gov (United States)

ENDEN, T.; RESCH, S.; WHITE, C.; WIK, H. S.; KLØW, N. E.; SANDSET, P. M.

2013-01-01

Summary Background Additional treatment with catheter-directed thrombolysis (CDT) has recently been shown to reduce post-thrombotic syndrome (PTS). Objectives To estimate the cost effectiveness of additional CDT compared with standard treatment alone. Methods Using a Markov decision model, we compared the two treatment strategies in patients with a high proximal deep vein thrombosis (DVT) and a low risk of bleeding. The model captured the development of PTS, recurrent venous thromboembolism and treatment-related adverse events within a lifetime horizon and the perspective of a third-party payer. Uncertainty was assessed with one-way and probabilistic sensitivity analyzes. Model inputs from the CaVenT study included PTS development, major bleeding from CDT and utilities for post DVT states including PTS. The remaining clinical inputs were obtained from the literature. Costs obtained from the CaVenT study, hospital accounts and the literature are expressed in US dollars ($); effects in quality adjusted life years (QALY). Results In base case analyzes, additional CDT accumulated 32.31 QALYs compared with 31.68 QALYs after standard treatment alone. Direct medical costs were $64 709 for additional CDT and $51 866 for standard treatment. The incremental cost-effectiveness ratio (ICER) was $20 429/QALY gained. One-way sensitivity analysis showed model sensitivity to the clinical efficacy of both strategies, but the ICER remained < $55 000/QALY over the full range of all parameters. The probability that CDT is cost effective was 82% at a willingness to pay threshold of $50 000/QALY gained. Conclusions Additional CDT is likely to be a cost-effective alternative to the standard treatment for patients with a high proximal DVT and a low risk of bleeding. PMID:23452204

Perineal tap water burns in the elderly: at what cost?

Science.gov (United States)

Potter, Michael D E; Maitz, Peter K M; Kennedy, Peter J; Goltsman, David

2017-11-01

Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population-specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns. Six elderly patients (75-92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into 'direct' and 'indirect' costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs. Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9-21% (mean 12.8%). Length of stay ranged from 26-98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01). Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort. © 2016 Royal Australasian College of Surgeons.

Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: Radiation exposure and cost analysis

Energy Technology Data Exchange (ETDEWEB)

Huppertz, Alexander, E-mail: Alexander.Huppertz@charite.de [Imaging Science Institute Charite Berlin, Robert-Koch-Platz 7, D-10115 Berlin (Germany); Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Radmer, Sebastian, E-mail: s.radmer@immanuel.de [Department of Orthopedic Surgery and Rheumatology, Immanuel-Krankenhaus, Koenigstr. 63, D-14109, Berlin (Germany); Asbach, Patrick, E-mail: Patrick.Asbach@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Juran, Ralf, E-mail: ralf.juran@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Schwenke, Carsten, E-mail: carsten.schwenke@scossis.de [Biostatistician, Scossis Statistical Consulting, Zeltinger Str. 58G, D-13465 Berlin (Germany); Diederichs, Gerd, E-mail: gerd.diederichs@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Hamm, Bernd, E-mail: Bernd.Hamm@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Sparmann, Martin, E-mail: m.sparmann@immanuel.de [Department of Orthopedic Surgery and Rheumatology, Immanuel-Krankenhaus, Koenigstr. 63, D-14109, Berlin (Germany)

2011-06-15

Computed tomography (CT) was used for preoperative planning of minimal-invasive total hip arthroplasty (THA). 92 patients (50 males, 42 females, mean age 59.5 years) with a mean body-mass-index (BMI) of 26.5 kg/m{sup 2} underwent 64-slice CT to depict the pelvis, the knee and the ankle in three independent acquisitions using combined x-, y-, and z-axis tube current modulation. Arthroplasty planning was performed using 3D-Hip Plan (Symbios, Switzerland) and patient radiation dose exposure was determined. The effects of BMI, gender, and contralateral THA on the effective dose were evaluated by an analysis-of-variance. A process-cost-analysis from the hospital perspective was done. All CT examinations were of sufficient image quality for 3D-THA planning. A mean effective dose of 4.0 mSv (SD 0.9 mSv) modeled by the BMI (p < 0.0001) was calculated. The presence of a contralateral THA (9/92 patients; p = 0.15) and the difference between males and females were not significant (p = 0.08). Personnel involved were the radiologist (4 min), the surgeon (16 min), the radiographer (12 min), and administrative personnel (4 min). A CT operation time of 11 min and direct per-patient costs of 52.80 Euro were recorded. Preoperative CT for THA was associated with a slight and justifiable increase of radiation exposure in comparison to conventional radiographs and low per-patient costs.

Direct Cost of Treating Acute Psychotic Episodes in Nnewi, South ...

African Journals Online (AJOL)

Background: Major psychotic disorders such as the schizophrenias consume a high proportion of health budgets in developed countries. The economic implications of acute psychotic disorders in Nigeria have not been well documented. Aim: To estimate the direct cost of treating patients with acute psychotic episodes in a ...

Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both

Directory of Open Access Journals (Sweden)

Ghushchyan V

2014-12-01

Full Text Available Vahram Ghushchyan,1,2 Kavita V Nair,2 Robert L Page II2,3 1College of Business and Economics, American University of Armenia, Yerevan, Armenia; 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA; 3Department of Physical Medicine, School of Medicine, University of Colorado, Aurora, CO, USA Background: The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS alone and with common cardiovascular comorbidities. Methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF, ACS with heart failure (HF, and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Results: Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191 followed by ACS with HF ($32,871±2,853, ACS with AF ($25,192±2,253, and ACS only ($17,954±563. Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719–9,427, $11,297 (95% CI 5,610–16,985, and $15,761 (95% CI 4,784–26,738 higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767, when compared with patients

[Financial burden of hepatitis B-related diseases and factors influencing the costs in Shenzhen, China].

Science.gov (United States)

Liang, Sen; Zhang, Shun-xiang; Ma, Qi-shan; Xiao, He-wei; Lü, Qiu-ying; Xie, Xu; Mei, Shu-jiang; Hu, Dong-sheng; Zhou, Bo-ping; Li, Bing; Chen, Jing-fang; Cui, Fu-qiang; Wang, Fu-zhen; Liang, Xiao-feng

2010-12-01

To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the

Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

Science.gov (United States)

Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

2015-08-01

To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

Is total pancreatectomy as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy? A single center, prospective, observational study.

Science.gov (United States)

Casadei, Riccardo; Ricci, Claudio; Taffurelli, Giovanni; Guariniello, Anna; Di Gioia, Anthony; Di Marco, Mariacristina; Pagano, Nico; Serra, Carla; Calculli, Lucia; Santini, Donatella; Minni, Francesco

2016-09-01

Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy. A single center, prospective, observational trial, regarding postoperative outcomes, long-term results, and cost-effectiveness, in a tertiary referral center was conducted, comparing consecutive patients who underwent elective total pancreatectomy and/or pancreaticoduodenectomy. Seventy-three consecutive elective total pancreatectomies and 184 pancreaticoduodenectomies were compared. There were no significant differences regarding postoperative outcomes and overall survival. The quality of life, evaluated in 119 patients according to the EQ-5D-5L questionnaire, showed that there were no significant differences regarding the five items considered. The mean EQ-5D-5L score was similar in the two procedures (total pancreatectomy = 0.872, range 0.345-1.000; pancreaticoduodenectomy = 0.832, range 0.393-1.000; P = 0.320). The impact of diabetes according to the Problem Areas in Diabetes (PAID) questionnaire did not show any significant differences except for question 13 (total pancreatectomy = 0.60; pancreaticoduodenectomy = 0.19; P = 0.022). The cost-effectiveness analysis suggested that the quality-adjusted life year was not significantly different between the two procedures (total pancreatectomy = 0.910, range 0.345-1.000; pancreaticoduodenectomy = 0.910, range -0.393-1.000; P = 0.320). From this study, it seems reasonable to suggest that total pancreatectomy can be considered as safe, feasible, and efficacious as PD and acceptable in terms of cost-effectiveness.

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

Science.gov (United States)

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

2012-01-01

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

Reducing total health burden from 2001 to 2009: an employer counter-trend success story and its implications for health care reform.

Science.gov (United States)

Allen, Harris; Rogers, William H; Bunn, William B; Pikelny, Dan B; Naim, Ahmad B

2012-08-01

To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs. Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001-2002 to 2008-2009. Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred. Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.

The costs to the NHS of multiple births after IVF treatment in the UK.

Science.gov (United States)

Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

2006-01-01

To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

Science.gov (United States)

Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

2017-01-01

Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients.

Science.gov (United States)

Sills, E Scott; Collins, Gary S; Salem, Shala A; Jones, Christopher A; Peck, Alison C; Salem, Rifaat D

2012-08-30

During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and $654.55 +/- 106.34, respectively (p cost difference increased. This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.

Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program. Volume 1. The analysis and its results

International Nuclear Information System (INIS)

1986-04-01

The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 is sufficient to cover the cost of the program. This report provides cost estimates for the fourth evaluation of the adequacy of the fee. The total-system cost for the reference authorized-system program is estimated to be 24 to 32 billion (1985) dollars. The total-system cost for the reference improved-performance system is estimated to be 26 to 34 billion dollars. A number of sensitivity cases were analyzed. For the authorized system, the costs for the sensitivity cases studied range from 21 to 39 billion dollars. For the improved-performance system, which includes a facility for monitored retrievable storage, the total-system cost in the sensitivity cases is estimated to be as high as 41 billion dollars. The factors that affect costs more than any other single factor for both the authorized and the improved-performance systems are delays in repository startup. A preliminary analysis of the impact of extending the burnup of nuclear fuel in the reactor was also performed; its results indicate that the impact is insignificant: the total-system cost is essentially unchanged from the comparable constant-burnup cases. The current estimate of the the total-system cost for the reference authorized system is zero to 3 billion dollars (9%) higher than the estimate for the reference system in the January 1985 TSLCC analysis

Cost Analysis of Direct Methanol Fuel Cell Stacks for Mass Production

Directory of Open Access Journals (Sweden)

Mauro Francesco Sgroi

2016-11-01

Full Text Available Fuel cells are very promising technologies for efficient electrical energy generation. The development of enhanced system components and new engineering solutions is fundamental for the large-scale deployment of these devices. Besides automotive and stationary applications, fuel cells can be widely used as auxiliary power units (APUs. The concept of a direct methanol fuel cell (DMFC is based on the direct feed of a methanol solution to the fuel cell anode, thus simplifying safety, delivery, and fuel distribution issues typical of conventional hydrogen-fed polymer electrolyte fuel cells (PEMFCs. In order to evaluate the feasibility of concrete application of DMFC devices, a cost analysis study was carried out in the present work. A 200 W-prototype developed in the framework of a European Project (DURAMET was selected as the model system. The DMFC stack had a modular structure allowing for a detailed evaluation of cost characteristics related to the specific components. A scale-down approach, focusing on the model device and projected to a mass production, was used. The data used in this analysis were obtained both from research laboratories and industry suppliers specialising in the manufacturing/production of specific stack components. This study demonstrates that mass production can give a concrete perspective for the large-scale diffusion of DMFCs as APUs. The results show that the cost derived for the DMFC stack is relatively close to that of competing technologies and that the introduction of innovative approaches can result in further cost savings.

Leisure-time physical activity and direct cost of short-term sickness absence among Finnish municipal employees.

Science.gov (United States)

Tolonen, Anu; Rahkonen, Ossi; Lahti, Jouni

2017-03-04

We aimed to examine the direct costs of short-term (1-14 days) sickness absence and the effect of employees' physical activity on the costs. The Finnish Helsinki Health Study survey (2007) was used in the analysis (n = 3,935). Physical activity was classified into inactive, moderately active, and vigorously active. Sickness absence (3 years follow-up) and salary data were derived from the employer's registers. On average, an employee was absent 6 days a year due to short-term sickness absence, with a production loss of 2,350 EUR during the 3 years. The vigorously active had less sickness absence than those less active. The direct cost of sickness absence of a vigorously active employee was 404 EUR less than that of an inactive employee. Promoting physical activity among employees may decrease direct cost of short-term sickness absence.

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

Directory of Open Access Journals (Sweden)

Wu J

2015-04-01

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

14 CFR Appendix A to Subpart 1214... - Costs for Which NASA Shall Be Reimbursed

Science.gov (United States)

2010-01-01

... Foreign Users Who Have Made Substantial Investment in the STS Program Pt. 1214, Subpt. 1214.2, App. A.... Total Operating Costs include all direct and indirect costs, excluding costs of composing the use charge. Such costs include direct program charges for manpower, expended hardware, refurbishment of hardware...

Determination production costs using PBC method

Directory of Open Access Journals (Sweden)

Todić Vladimir V.

2014-01-01

Full Text Available Basic characteristics of modern markets make requirements in quality increasing, decreasing prices and shortening delivery of products. In the middle of this requirements are production costs for whose determination are developed many traditional and alternative methods including PBC method (Process Based Costing. This method enables precisely locating and calculating indirect production costs, and with determined direct costs enables determination of total production costs. This paper shows usage of PBC method for determination production costs for three forms of processing cutting tools.

Tolerance to bovine clinical mastitis: Total, direct, and indirect milk losses.

Science.gov (United States)

Detilleux, J

2018-04-01

The objectives of this paper were to estimate direct and indirect milk losses associated with mastitis. Indirect losses, linked to indirect tolerance, are mediated by the increase in milk somatic cell count (SCC) in response to bacterial infection. Direct losses, linked to weak direct tolerance, are not mediated by the increase in SCC. So far, studies have evaluated milk loss associated with clinical mastitis without considering both components, which may lead to biased estimates of their sum; that is, the total loss in milk. A total of 43,903 test-day records on milk and SCC from 3,716 cows and 5,858 lactations were analyzed with mediation mixed models and health trajectories to estimate the amount of direct, indirect, and total milk losses after adjustment for known and potentially unmeasured (sensitivity analyses) confounding factors. Estimates were formalized under the counterfactual causal theory of causation. In this study, milk losses were mostly mediated by an increase in SCC. They were highest in the first month of lactation, when SCC were highest. Milk losses were estimated at 0.5, 0.8, and 1.1 kg/d in first, second, and third and greater parity, respectively. Two phases described how changes in milk were associated with changes in SCC: on average, one occurred before and one after the day preceding the clinical diagnosis. In both phases, changes in milk were estimated at 1 mg/d per 10 3 cells/mL. After adjusting for known confounders, cow effect accounted for 20.7 and 64.2% of the variation in milk in the first and second phases, respectively. This suggests that deviations from the resilient path were highest during the second phase of inflammation and that selection for cows more tolerant to mastitis is feasible. As discussed herein, epigenetic regulation of macrophage polarization may contribute to the variation in milk observed in the second phase. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

[Cost analysis of treatment for severe rheumatoid arthritis in a city in southern Brazil].

Science.gov (United States)

Buendgens, Fabíola Bagatini; Blatt, Carine Raquel; Marasciulo, Antônio Carlos Estima; Leite, Silvana Nair; Farias, Mareni Rocha

2013-11-01

Treatment of rheumatoid arthritis involves the use of medicines, non-pharmaceutical therapies, medical appointments, and complimentary tests, among other procedures. Based on sources of payment, this article presents the direct medical costs related to treatment of rheumatoid arthritis. The cost analysis included 103 patients with severe rheumatoid arthritis treated at the Specialized Division of Pharmaceutical Care in Florianopolis, Santa Catarina State, Brazil. Total annual direct cost was R$ 2,045,596.55 (approximately one million US dollars), or R$ 19,860.16 per patient/year (slightly less than ten thousand US dollars). Total cost breakdown was as follows: 90.8% for medicines, 2.5% for hospitalizations, 2.2% for complimentary tests, 2.1% for medical appointments, and 2.4% for all other costs. The public sector accounted for 73.6% of the total direct medical costs and 79.3% of the cost of medicines. The cost analysis provided a profile of how a group of individuals with a chronic non-communicable disease that requires resources circulates in the public-private mix that characterizes the Brazilian health system.

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Abubeker, Jewahir Ali

2011-05-14

This paper is devoted to the consideration of an algorithm for sequential optimization of paths in directed graphs relative to di_erent cost functions. The considered algorithm is based on an extension of dynamic programming which allows to represent the initial set of paths and the set of optimal paths after each application of optimization procedure in the form of a directed acyclic graph.

Stochastic modelling of direct costs of pancreas disease (PD) in Norwegian farmed Atlantic salmon (Salmo salar L.).

Science.gov (United States)

Aunsmo, Arnfinn; Valle, Paul Steinar; Sandberg, Marianne; Midtlyng, Paul Johan; Bruheim, Torkjel

2010-02-01

An economic model for estimating the direct costs of disease in industrial aquaculture was developed to include the following areas: biological losses, extraordinary costs, costs of treatment, costs of prevention and insurance pay-out. Direct costs of a pancreas disease (PD) outbreak in Norwegian farmed Atlantic salmon were estimated in the model, using probability distributions for the biological losses and expenditures associated with the disease. The biological effects of PD on mortality, growth, feed conversion and carcass quality and their correlations, together with costs of prevention were established using elicited data from an expert panel, and combined with basal losses in a control model. Extraordinary costs and costs associated with treatment were collected through a questionnaire sent to staff managing disease outbreaks. Norwegian national statistics for 2007 were used for prices and production costs in the model. Direct costs associated with a PD-outbreak in a site stocked with 500,000 smolts (vs. a similar site without the disease) were estimated to NOK (Norwegian kroner) 14.4 million (5% and 95% percentile: 10.5 and 17.8) (NOK=euro0.12 or $0.17 for 2007). Production was reduced to 70% (5% and 95% percentile: 57% and 81%) saleable biomass, and at an increased production cost of NOK 6.0 per kg (5% and 95% percentile: 3.5 and 8.7). Copyright 2009 Elsevier B.V. All rights reserved.

Costs of dementia in the Czech Republic.

Science.gov (United States)

Holmerová, Iva; Hort, Jakub; Rusina, Robert; Wimo, Anders; Šteffl, Michal

2017-11-01

The aim of this study was to estimate the cost of dementia in the Czech Republic. One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables. The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p Republic. Both total and indirect care costs increased significantly the cognition declined.

Cost-of-illness analysis of type 2 diabetes mellitus in Iran.

Directory of Open Access Journals (Sweden)

Mehdi Javanbakht

Full Text Available Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM and its complications in Iran in 2009 year.This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups.The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD including 2.04±0.28 billion direct (medical and non-medical costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9% and drugs (23.8% were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost, nephropathy (23% and ophthalmic complications (14%. Indirect costs include temporarily disability (335.7 million, permanent disability (452.4 million and reduced productivity due to premature mortality (950.3 million.T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority.

Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: Volume 1, The analysis and its results

International Nuclear Information System (INIS)

1987-06-01

This report provides cost estimates for the fifth evaluation of the adequacy of the fee and is consistent with the program strategy and plans. The total-system cost for the reference cases in the improved-performance system is estimated at $32.1 to $38.2 billion (expressed in constant 1986 dollars) over the entire life of the system...or $1.5 to $1.6 billion more than that of the authorized system (i.e., the system without an MRS facility). The current estimate of the total-system cost for the reference cases in the improved-performance system is $3.8 to $5.4 billion higher than the estimate for the same system in the 1986 TSLCC analysis. In the case with the maximum increase, nearly all of the higher cost is due to a $5.2-billion increase in the costs of development and evaluation (D and E); all other system costs are essentially unchanged. The cost difference between the improved-performance system and the authorized system is smaller than the difference estimated in last year's TSLCC analysis. Volume 2 presents the detailed results for the 1987 analysis of the total-system life cycle cost (TSLCC). It consists of four sections: Section A presents the yearly flows of waste between waste-management facilities for the 12 aggregate logistics cases that were studied; Section B presents the annual total-system costs for each of the 30 TSLCC cases by major cost category; Section C presents the annual costs for the disposal of 16,000 canisters of defense high-level waste (DHLW) by major cost category for each of the 30 TSLCC cases; and Section D presents a summary of the cost-allocation factors that were calculated to determine the defense waste share of the total-system costs

Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

DEFF Research Database (Denmark)

Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M.

2016-01-01

INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

Cost Modeling for Fabrication of Direct Drive Inertial Fusion Energy Targets

International Nuclear Information System (INIS)

Rickman, William Samuel; Goodin, Daniel T.

2003-01-01

Chemical engineering analyses are underway for a commercial-scale [1000-MW(electric)] divinyl benzene foam-based Inertial Fusion Energy (IFE) Target Fabrication Facility (TFF). This facility is designed to supply 500,000, 4-mm-outer diameter targets per day - coated via interfacial polycondensation, dried with supercritical CO 2 , sputter coated with Au and/or Pd, and filled with deuterium-tritium layered at cryogenic temperatures and injected into the fusion chamber. Such targets would be used in a direct-drive IFE power plant.The work uses manufacturing processes being developed in the laboratory, chemical engineering scaleup principles, and established cost-estimating methods. The plant conceptual design includes a process flow diagram, mass and energy balances, equipment sizing and sketches, storage tanks, and facility views.The cost estimate includes both capital and operating costs. Initial results for a TFF dedicated to one 1000-MW(electric) plant indicate that the costs per target are well within the commercially viable range. Larger TFF plants [3000 MW(electric)] are projected to lead to significantly reduced costs per injected target. Additional cost reductions are possible by producing dried, sputter-coated empty shells at a central facility that services multiple power plants.The results indicate that the installed capital cost is about $100 million and the annual operating costs will be about $20 million, for a cost per target of about $0.17 each. These design and cost projections assume that a significant process development and scaleup program is successfully completed for all of the basic unit operations included in the facility

COMPARISON OF DIRECT COSTS OF DABIGATRAN AND WARFARIN THERAPY IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION DURING PREPARATION FOR ELECTIVE CARDIOVERSION IN THE REAL CLINICAL PRACTICE

Directory of Open Access Journals (Sweden)

L. E. Kuvshinova

2015-09-01

Full Text Available Aim. To compare direct medical costs of dabigatran and warfarin therapy in patients with non-valvular atrial fibrillation (NVAF during preparation for elective cardioversion. Material and methods. An open non-randomized study was conducted to evaluate direct medical costs (cost of drug, cost of the international normalized ratio (INR adjust- ment in outpatient clinic, cost of visits to cardiologist. Patients (n=62 with persistent NVAF (AF paroxysm duration > 48 hours were enrolled. All of them requested medical as- sistance and were decided to perform an elective cardioversion. The patients received warfarin (n=32 or dabigatran (n=30. The patients of the both groups were similar in the main clinical characteristics and thromboembolic risk levels according to CHA2DS2-VASc scale.Results. Treatment duration before elective cardioversion was 21±2 and 30.5±4.5 days for dabigatran and warfarin groups, respectively (p<0.05. Average costs of visits to cardiologists were 3,720 and 744 RUB in warfarin and dabigatran groups, respectively (p<0.05, and drug costs were 53.63 and 1,172.01 RUB, respectively (p<0.05. The costs of laboratory INR monitoring were 3,058 RUB in warfarin group. Total costs per patient were 6,831.63 and 1,916.01 RUB in warfarin and dabigatran groups, respectively (p<0.05. Conclusion. In the real clinical practice in patients with NVAF dabigatran antithromboembolic therapy substantially reduces direct medical costs in comparison with warfarin ther- apy during preparation for elective cardioversion. Dabigatran therapy reduces time from the decision of elective cardioversion and antithromboembolic therapy start to car- dioversion performance.

COMPARISON OF DIRECT COSTS OF DABIGATRAN AND WARFARIN THERAPY IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION DURING PREPARATION FOR ELECTIVE CARDIOVERSION IN THE REAL CLINICAL PRACTICE

Directory of Open Access Journals (Sweden)

L. E. Kuvshinova

2013-01-01

Full Text Available Aim. To compare direct medical costs of dabigatran and warfarin therapy in patients with non-valvular atrial fibrillation (NVAF during preparation for elective cardioversion. Material and methods. An open non-randomized study was conducted to evaluate direct medical costs (cost of drug, cost of the international normalized ratio (INR adjust- ment in outpatient clinic, cost of visits to cardiologist. Patients (n=62 with persistent NVAF (AF paroxysm duration > 48 hours were enrolled. All of them requested medical as- sistance and were decided to perform an elective cardioversion. The patients received warfarin (n=32 or dabigatran (n=30. The patients of the both groups were similar in the main clinical characteristics and thromboembolic risk levels according to CHA2DS2-VASc scale.Results. Treatment duration before elective cardioversion was 21±2 and 30.5±4.5 days for dabigatran and warfarin groups, respectively (p<0.05. Average costs of visits to cardiologists were 3,720 and 744 RUB in warfarin and dabigatran groups, respectively (p<0.05, and drug costs were 53.63 and 1,172.01 RUB, respectively (p<0.05. The costs of laboratory INR monitoring were 3,058 RUB in warfarin group. Total costs per patient were 6,831.63 and 1,916.01 RUB in warfarin and dabigatran groups, respectively (p<0.05. Conclusion. In the real clinical practice in patients with NVAF dabigatran antithromboembolic therapy substantially reduces direct medical costs in comparison with warfarin ther- apy during preparation for elective cardioversion. Dabigatran therapy reduces time from the decision of elective cardioversion and antithromboembolic therapy start to car- dioversion performance.

Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study

Science.gov (United States)

Muñoz, Manuel; Gómez-Ramírez, Susana; Martín-Montañez, Elisa; Naveira, Enrique; Seara, Javier; Pavía, José

2014-01-01

Background Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20–50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective. Materials and methods Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (control group) or with post-operative intravenous iron (iron group), were retrospectively reviewed. Acquisition and administration costs of iron (iron sucrose or ferric carboxymaltose) and allogeneic red cell concentrates, haemoglobin measurements, and prolonged stay in hospital were used for blood management cost analysis. Results Patients in the iron group received 600 mg intravenous iron, without clinically relevant incidents, and had a lower allogeneic transfusion rate (11.5% vs 26.4% for the iron and control groups, respectively; p=0.001). The reduction in transfusion rate was more pronounced in anaemic patients (17% vs 40%; p=0.015) than in non-anaemic ones (9.6% vs 21.2%; p=0.011). There were no differences with respect to post-operative infection rate. Patients receiving allogeneic transfusion stayed in hospital longer (+1.9 days [95% CI: 1.2–2.6]). As intravenous iron reduces the allogeneic transfusion rate, both iron formulations were cost-neutral in the different cost scenarios (−25.5 to 62.1 €/patient for iron sucrose, and −51.1 to 64.4 €/patient for ferric carboxymaltose). Discussion In patients presenting with or without pre-operative anaemia, post-operative intravenous iron after total lower limb arthroplasty seems to be safe and is associated with reduced transfusion rates, without incremental costs. For anaemic patients, its efficacy could be increased by associating some other blood-saving method. PMID:24120595

Understanding Costs of Care in the Operating Room.

Science.gov (United States)

Childers, Christopher P; Maggard-Gibbons, Melinda

2018-04-18

Increasing value requires improving quality or decreasing costs. In surgery, estimates for the cost of 1 minute of operating room (OR) time vary widely. No benchmark exists for the cost of OR time, nor has there been a comprehensive assessment of what contributes to OR cost. To calculate the cost of 1 minute of OR time, assess cost by setting and facility characteristics, and ascertain the proportion of costs that are direct and indirect. This cross-sectional and longitudinal analysis examined annual financial disclosure documents from all comparable short-term general and specialty care hospitals in California from fiscal year (FY) 2005 to FY2014 (N = 3044; FY2014, n = 302). The analysis focused on 2 revenue centers: (1) surgery and recovery and (2) ambulatory surgery. Mean cost of 1 minute of OR time, stratified by setting (inpatient vs ambulatory), teaching status, and hospital ownership. The proportion of cost attributable to indirect and direct expenses was identified; direct expenses were further divided into salary, benefits, supplies, and other direct expenses. In FY2014, a total of 175 of 302 facilities (57.9%) were not for profit, 78 (25.8%) were for profit, and 49 (16.2%) were government owned. Thirty facilities (9.9%) were teaching hospitals. The mean (SD) cost for 1 minute of OR time across California hospitals was $37.45 ($16.04) in the inpatient setting and $36.14 ($19.53) in the ambulatory setting (P = .65). There were no differences in mean expenditures when stratifying by ownership or teaching status except that teaching hospitals had lower mean (SD) expenditures than nonteaching hospitals in the inpatient setting ($29.88 [$9.06] vs $38.29 [$16.43]; P = .006). Direct expenses accounted for 54.6% of total expenses ($20.40 of $37.37) in the inpatient setting and 59.1% of total expenses ($20.90 of $35.39) in the ambulatory setting. Wages and benefits accounted for approximately two-thirds of direct expenses (inpatient, $14.00 of $20

(Super Variable Costing-Throughput Costing)

OpenAIRE

Çakıcı, Cemal

2006-01-01

(Super Variable Costing-Throughput Costing) The aim of this study is to explain the super-variable costing method which is a new subject in cost and management accounting and to show it’s working practicly.Shortly, super-variable costing can be defined as a costing method which is use only direct material costs in calculate of product costs and treats all costs except these (direct labor and overhead) as periad costs or operating costs.By using super-variable costing method, product costs ar...

The current total economic burden of diabetes mellitus in the Netherlands.

Science.gov (United States)

Peters, M L; Huisman, E L; Schoonen, M; Wolffenbuttel, B H R

2017-09-01

Insight into the total economic burden of diabetes mellitus (DM) is essential for decision makers and payers. Currently available estimates for the Netherlands only include part of the total burden or are no longer up-to-date. Therefore, this study aimed to determine the current total economic burden of DM and its complications in the Netherlands, by including all the relevant cost components. The study combined a systematic literature review to identify all relevant published information and a targeted review to identify relevant information in the grey literature. The identified evidence was then combined to estimate the current total economic burden. In 2016, there were an estimated 1.1 million DM patients in the Netherlands, of whom approximately 10% had type 1 and 90% had type 2 DM. The estimated current total economic burden of DM was € 6.8 billion in 2016. Healthcare costs (excluding costs of complications) were € 1.6 billion, direct costs of complications were € 1.3 billion and indirect costs due to productivity losses, welfare payments and complications were € 4.0 billion. DM and its complications pose a substantial economic burden to the Netherlands, which is expected to rise due to changing demographics and lifestyle. Indirect costs, such as welfare payments, accounted for a large portion of the current total economic burden of DM, while these cost components are often not included in cost estimations. Publicly available data for key cost drivers such as complications were scarce.

Cost analysis of microtia treatment in the Netherlands.

Science.gov (United States)

Kolodzynski, M N; van Hövell Tot Westerflier, C V A; Kon, M; Breugem, C C

2017-09-01

Ear reconstruction for microtia is a challenging procedure. Although analyzing esthetic outcome is crucial, there is a paucity of information with regard to financial aspects of microtia reconstruction. This study was conducted to analyze the costs associated with ear reconstruction with costal cartilage in patients with microtia. Ten consecutive children with autologous ear reconstruction of a unilateral microtia were included in this analysis. All patients had completed their treatment protocol for ear reconstruction. Direct costs (admission to hospital, diagnostics, and surgery) and indirect cost (travel expenses and absence from work) were obtained retrospectively. The overall mean cumulative cost per patient was €14,753. Direct and indirect costs were €13,907 and €846, respectively. Hospital admission and surgery cover 55% and 32% of all the costs, respectively. This study analyzes the costs for autologous ear reconstruction. Hospital admission and surgery are the most important factors of the total costs. Total costs could be decreased by possibly decreasing admission days and surgical time. These data can be used for choosing and developing future treatment strategies. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Assessing the Total cost of ownership of ERP systems : Case study analysis on the factors behind customer costs in recent minor implementations

OpenAIRE

Rydgård, Göran; Palmberg, Nils

2010-01-01

This master’s thesis presents a model for calculating the total cost of ownership (TCO) of relatively small ERP implementations, including two years of running the system. The main factors affecting the cost items in the model are also analyzed, based in part on four case projects that the consultancy company Acando has carried out recently and in part on literature. The case projects were investigated through interviews with key actors in the projects from Acando and the customer, and throug...

Laboratory cost and utilization containment.

Science.gov (United States)

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

1991-01-01

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

Is integrated nursing home care cheaper than traditional care? A cost comparison.

Science.gov (United States)

Paulus, Aggie T G; van Raak, Arno J A; Maarse, Hans J A M

2008-12-01

It is generally assumed that integrated care has a cost-saving potential in comparison with traditional care. However, there is little evidence on this potential with respect to integrated nursing home care. DESIGN/METHODS/SETTINGS/PARTICIPANTS: Between 1999 and 2003, formal and informal caregivers of different nursing homes in the Netherlands recorded activities performed for residents with somatic or psycho-social problems. In total, 23,380 lists were analysed to determine the average costs of formal and informal care per activity, per type of resident and per nursing home care type. For formal care activities, the total personnel costs per minute (in Euro) were calculated. For informal care costs, two shadow prices were used. Compared to traditional care, integrated care had lower informal direct care costs per resident and per activity and lower average costs per direct activity (for a set of activities performed by formal caregivers). The total average costs per resident per day and the costs of formal direct care per resident, however, were higher as were the costs of delivering a set of indirect activities to residents with somatic problems. The general assumption that integrated care has a cost-saving potential (per resident or per individual activity) was only partially supported by our research. Our study also raised issues which should be investigated in future research on integrated nursing home care.

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Abubeker, Jewahir Ali; Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail

2011-01-01

This paper is devoted to the consideration of an algorithm for sequential optimization of paths in directed graphs relative to di_erent cost functions. The considered algorithm is based on an extension of dynamic programming which allows

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

Science.gov (United States)

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

2013-09-01

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

A low-cost transportable ground station for capture and processing of direct broadcast EOS satellite data

Science.gov (United States)

Davis, Don; Bennett, Toby; Short, Nicholas M., Jr.

1994-01-01

The Earth Observing System (EOS), part of a cohesive national effort to study global change, will deploy a constellation of remote sensing spacecraft over a 15 year period. Science data from the EOS spacecraft will be processed and made available to a large community of earth scientists via NASA institutional facilities. A number of these spacecraft are also providing an additional interface to broadcast data directly to users. Direct broadcast of real-time science data from overhead spacecraft has valuable applications including validation of field measurements, planning science campaigns, and science and engineering education. The success and usefulness of EOS direct broadcast depends largely on the end-user cost of receiving the data. To extend this capability to the largest possible user base, the cost of receiving ground stations must be as low as possible. To achieve this goal, NASA Goddard Space Flight Center is developing a prototype low-cost transportable ground station for EOS direct broadcast data based on Very Large Scale Integration (VLSI) components and pipelined, multiprocessing architectures. The targeted reproduction cost of this system is less than $200K. This paper describes a prototype ground station and its constituent components.

Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.

Directory of Open Access Journals (Sweden)

Matthias Stoll

Full Text Available UNLABELLED: BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. METHODS: Antiretroviral regimens (ART from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. RESULTS: During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70. Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively. Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. CONCLUSIONS: Analysis of the data of this nationwide study reflects disease-specific health services research

Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.

Science.gov (United States)

Stoll, Matthias; Kollan, Christian; Bergmann, Frank; Bogner, Johannes; Faetkenheuer, Gerd; Fritzsche, Carlos; Hoeper, Kirsten; Horst, Heinz-August; van Lunzen, Jan; Plettenberg, Andreas; Reuter, Stefan; Rockstroh, Jürgen; Stellbrink, Hans-Jürgen; Hamouda, Osamah; Bartmeyer, Barbara

2011-01-01

BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. Antiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. Analysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of

Direct and correlated responses to selection for total weight of lamb ...

African Journals Online (AJOL)

Unknown

productivity and that each of these components can be used as a selection criterion, as each has a direct impact on total ewe ... of lamb weaned per ewe joined is more efficient than selection for number of lambs born, number of lambs weaned or weaning ... The estimated grazing capacity is 5.5 ha per small stock unit.

The cost of systemic therapy for metastatic colorectal carcinoma in Slovenia: discrepancy analysis between cost and reimbursement

International Nuclear Information System (INIS)

Mesti, Tanja; Boshkoska, Biljana Mileva; Kos, Mitja; Tekavčič, Metka; Ocvirk, Janja

2015-01-01

The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to €3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was €1,900,757.80. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was €1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used

Sequential Optimization of Paths in Directed Graphs Relative to Different Cost Functions

KAUST Repository

Mahayni, Malek A.

2011-01-01

developed to solve the optimal paths problem with different kinds of graphs. An algorithm that solves the problem of paths’ optimization in directed graphs relative to different cost functions is described in [1]. It follows an approach extended from

Low cost digital wind speed meter with wind direction using PIC16F877A

Energy Technology Data Exchange (ETDEWEB)

Sujod, M.Z.; Ismail, M.M. [Malaysia Pahang Univ., Pahang (Malaysia). Faculty of Electrical and Electronics Engineering

2008-07-01

Weather measurement tools are necessary to determine the actual weather and forecasting. Wind is one of the weather elements that can be measured using an anemometer which is a device for measuring the velocity or the pressure of the wind. It is one of the instruments used in weather stations. This paper described a circuit design for speed and direction of the meter and created a suitable programming to measure and display the wind speed meter and direction. A microcontroller (PIC16F877A) was employed as the central processing unit for digital wind speed and direction meter. The paper presented and discussed the hardware and software implementation as well as the calibration and results. The paper also discussed cost estimation and future recommendations. It was concluded that the hardware and software implementation were carefully selected after considering the development cost where the cost was much lower than the market prices. 4 refs., 8 figs.

Direct health services costs of providing assisted reproduction services in older women.

Science.gov (United States)

Maheshwari, Abha; Scotland, Graham; Bell, Jacqueline; McTavish, Alison; Hamilton, Mark; Bhattacharya, Siladitya

2010-02-01

To assess the total health service costs incurred for each live birth achieved by older women undergoing IVF compared with costs in younger women. Retrospective cross-sectional analysis. In vitro fertilization unit and maternity hospital in a tertiary care setting. Women who underwent their first cycle of IVF between 1997 and 2006. Bottom-up costs were calculated for all interventions in the IVF cycle. Early pregnancy and antenatal care costs were obtained from National Health Service reference costs, Information Services Division Scotland, and local departmental costs. Cost per live birth. The mean cost per live birth (95% confidence interval [CI]) in women undergoing IVF at the age of > or =40 years was pound 40,320 (pound 27,105- pound 65,036), which is >2.5 times higher than those aged 35-39 years (pound 17,096 [pound 15,635- pound 18,937]). The cost per ongoing pregnancy was almost three times in women aged > or =40 (pound 31,642 [pound 21,241- pound 58,979]) compared with women 35-39 years of age (pound 11,300 [pound 10,006- pound 12,938]). The cost of a live birth after IVF rises significantly at the age of 40 years owing to lower success rates. Most of the extra cost is due to the low success of IVF treatment, but some of it is due to higher rates of early pregnancy loss. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Estimated annual cost of arterial hypertension treatment in Brazil.

Science.gov (United States)

Dib, Murilo W; Riera, Rachel; Ferraz, Marcos B

2010-02-01

To estimate the direct annual cost of systemic arterial hypertension (SAH) treatment in Brazil's public and private health care systems, assess its economic impact on the total health care budget, and determine its proportion of the 2005 gross domestic product (GDP). A decision tree model was used to determine direct costs based on estimated use of various resources in SAH diagnosis and care, including treatment (medication and non-medication), complementary exams, doctor visits, nutritional assessments, and emergency room visits. Estimated direct annual cost of SAH treatment was approximately US$ 398.9 million for the public health care system and US$ 272.7 million for the private system, representing 0.08% of the 2005 GDP (ranging from 0.05% to 0.16%). With total health care expenses comprising about 7.6% of Brazil's GDP, this cost represented 1.11% of overall health care costs (0.62% to 2.06%)-1.43% of total expenses for the Unified Healthcare System (Sistema Unico de Saúde, SUS) (0.79% to 2.75%) and 0.83% of expenses for the private health care system (0.47% to 1.48%). Conclusion. To guarantee public or private health care based on the principles of universality and equality, with limited available resources, efforts must be focused on educating the population on prevention and treatment compliance in diseases such as SAH that require significant health resources.

Analysing uncertainty around costs of innovative medical technologies: the case of fibrin sealant (QUIXIL) for total knee replacement.

NARCIS (Netherlands)

Steuten, Lotte Maria Gertruda; Vallejo-Torres, Laura; Bastide, Philippe; Buxton, Martin J.

2009-01-01

This paper presents a relatively simple cost model comparing the costs of using a commercial fibrin sealant (QUIXIL®) in addition to conventional haemostatic treatment vs. conventional treatment alone in total knee replacement (TKR) surgery, and demonstrates and discusses how one- and two-way

Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.

Science.gov (United States)

Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

2016-09-01

To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these

Multi-Product Total Cost of Function for Higher Education: A Case of Bible Colleges.

Science.gov (United States)

Koshal, Rajindar K.; Koshal, Manjulika; Gupta, Ashok

2001-01-01

This study empirically estimates a multiproduct total cost function and output relationship for comprehensive U.S. universities. Statistical results for 184 Bible colleges suggest that there are both economies of scale and of scope in higher education. Additionally, product-specific economies of scope exist for all output levels and activities.…

The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock.

Science.gov (United States)

Khwannimit, Bodin; Bhurayanontachai, Rungsun

2015-10-01

The costs of severe sepsis care from middle-income countries are lacking. This study investigated direct intensive care unit (ICU) costs and factors that could affect the financial outcomes. A prospective cohort study was conducted in the medical ICU of a tertiary referral university teaching hospital in Thailand. A total of 897 patients were enrolled in the study, with 683 (76.1%) having septic shock. Community-, nosocomial, and ICU-acquired infections were documented in 574, 282, and 41 patients, respectively. The median ICU costs per patient were $2716.5 ($1296.1-$5367.6) and $599.9 ($414.3-$948.6) per day. The ICU costs accounted for 64.7% of the hospital costs. In 2008 to 2011, the ICU costs significantly decreased by 40% from $3542.5 to $2124.9, whereas, the daily ICU costs decreased only 3.3% from $609.7 to $589.7. By multivariate logistic regression analysis, age, nosocomial or ICU infection, admission from the emergency department, number of organ failures, ICU length of stay, and fluid balance the first 72 hours were independently associated with ICU costs. The ICU costs of severe sepsis management significantly declined in our study. However, the ICU costs were a financial burden accounting for two thirds of the hospital costs. It is essential for intensivists to contribute a high standard of care within a restricted budget. Copyright © 2015 Elsevier Inc. All rights reserved.

Direct costs associated with the appropriateness of hospital stay in elderly population

Directory of Open Access Journals (Sweden)

Sánchez-García Sergio

2009-08-01

Full Text Available Abstract Background Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. Methods Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP. Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS, in Mexico City. Results The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8 of hospital stay, of which 12.4% (n = 90 were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7. The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89. The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2 – US$4,931.4, while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7 – US$6,198.3, (p Conclusion Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.

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

Directory of Open Access Journals (Sweden)

Dzhedzhula Viacheslav V.

2014-01-01

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

Cost-of-treatment of clinically stable severe mental lilnesses in India

Directory of Open Access Journals (Sweden)

Siddharth Sarkar

2017-01-01

Full Text Available Background and Aims: The cost-of-treatment studies can help to make informed decisions while planning health-care services. This study is aimed to assess direct costs of outpatient treatment of four common chronic severe mental illnesses in a tertiary care hospital in South India. Methods: The patients with ICD-10 diagnoses of schizophrenia, unspecified nonorganic psychosis, bipolar disorder, and recurrent depression were recruited by purposive sampling from a government teaching hospital in South India. The total cost-of-treatment to the patient and the hospital was computed for each disorder as a percentage of the per-capita income of an individual patient. Results: The study comprised a total of 140 patients. The average monthly total cost-of-treatment was Indian Rupees (INR 770 (95% confidence interval of 725 to 815, or approximately US$ 12.8. The monthly total cost-of-treatment was INR 720 for schizophrenia, INR 750 for unspecified nonorganic psychosis, INR 830 for bipolar disorder, and INR 790 for recurrent depression, with no significant differences between groups. On an average, 22.8% of total cost-of-treatment was borne by the patient, and the rest by the hospital. The patients spent a median of 12% of their per-capita income on treatment related to direct costs. Conclusions: Despite substantial government subsidies, patients do incur some expenses in treatment of chronic psychiatric illnesses. The attempts to reduce treatment and travel costs can facilitate psychiatric care to larger number of individuals.

The economic costs of alcohol consumption in Thailand, 2006.

Science.gov (United States)

Thavorncharoensap, Montarat; Teerawattananon, Yot; Yothasamut, Jomkwan; Lertpitakpong, Chanida; Thitiboonsuwan, Khannika; Neramitpitagkul, Prapag; Chaikledkaew, Usa

2010-06-09

There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006. This is a prevalence-based, cost-of-illness study. The estimated costs in this study included both direct and indirect costs. Direct costs included health care costs, costs of law enforcement, and costs of property damage due to road-traffic accidents. Indirect costs included costs of productivity loss due to premature mortality, and costs of reduced productivity due to absenteeism and presenteeism (reduced on-the-job productivity). The total economic cost of alcohol consumption in Thailand in 2006 was estimated at 156,105.4 million baht (9,627 million US$ PPP) or about 1.99% of the total Gross Domestic Product (GDP). Indirect costs outweigh direct costs, representing 96% of the total cost. The largest cost attributable to alcohol consumption is that of productivity loss due to premature mortality (104,128 million baht/6,422 million US$ PPP), followed by cost of productivity loss due to reduced productivity (45,464.6 million baht/2,804 million US$ PPP), health care cost (5,491.2 million baht/339 million US$ PPP), cost of property damage as a result of road traffic accidents (779.4 million baht/48 million US$ PPP), and cost of law enforcement (242.4 million baht/15 million US$ PPP), respectively. The results from the sensitivity analysis revealed that the cost ranges from 115,160.4 million baht to 214,053.0 million baht (7,102.1 - 13,201 million US$ PPP

One Improvement Method of Reducing Duration Directly to Solve Time-Cost Tradeoff Problem

Science.gov (United States)

Jian-xun, Qi; Dedong, Sun

Time and cost are two of the most important factors for project plan and schedule management, and specially, time-cost tradeoff problem is one classical problem in project scheduling, which is also a difficult problem. Methods of solving the problem mainly contain method of network flow and method of mending the minimal cost. Thereinto, for the method of mending the minimal cost is intuitionistic, convenient and lesser computation, these advantages make the method being used widely in practice. But disadvantage of the method is that the result of each step is optimal but the terminal result maybe not optimal. In this paper, firstly, method of confirming the maximal effective quantity of reducing duration is designed; secondly, on the basis of above method and the method of mending the minimal cost, the main method of reducing duration directly is designed to solve time-cost tradeoff problem, and by analyzing validity of the method, the method could obtain more optimal result for the problem.

Cost Savings of Nuclear Power with Total Fuel Reprocessing

International Nuclear Information System (INIS)

Solbrig, Charles W.; Benedict, Robert W.

2006-01-01

The cost of fast reactor (FR) generated electricity with pyro-processing is estimated in this article. It compares favorably with other forms of energy and is shown to be less than that produced by light water reactors (LWR's). FR's use all the energy in natural uranium whereas LWR's utilize only 0.7% of it. Because of high radioactivity, pyro-processing is not open to weapon material diversion. This technology is ready now. Nuclear power has the same advantage as coal power in that it is not dependent upon a scarce foreign fuel and has the significant additional advantage of not contributing to global warming or air pollution. A jump start on new nuclear plants could rapidly allow electric furnaces to replace home heating oil furnaces and utilize high capacity batteries for hybrid automobiles: both would reduce US reliance on oil. If these were fast reactors fueled by reprocessed fuel, the spent fuel storage problem could also be solved. Costs are derived from assumptions on the LWR's and FR's five cost components: 1) Capital costs: LWR plants cost $106/MWe. FR's cost 25% more. Forty year amortization is used. 2) The annual O and M costs for both plants are 9% of the Capital Costs. 3) LWR fuel costs about 0.0035 $/kWh. Producing FR fuel from spent fuel by pyro-processing must be done in highly shielded hot cells which is costly. However, the five foot thick concrete walls have the advantage of prohibiting diversion. LWR spent fuel must be used as feedstock for the FR initial core load and first two reloads so this FR fuel costs more than LWR fuel. FR fuel costs much less for subsequent core reloads ( 6 /MWe. The annual cost for a 40 year licensed plant would be 2.5 % of this or less if interest is taken into account. All plants will eventually have to replace those components which become radiation damaged. FR's should be designed to replace parts rather than decommission. The LWR costs are estimated to be 2.65 cents/kWh. FR costs are 2.99 cents/kWh for the first

A Total Cost of Ownership Model for Low Temperature PEM Fuel Cells in Combined Heat and Power and Backup Power Applications

Energy Technology Data Exchange (ETDEWEB)

University of California, Berkeley; Wei, Max; Lipman, Timothy; Mayyas, Ahmad; Chien, Joshua; Chan, Shuk Han; Gosselin, David; Breunig, Hanna; Stadler, Michael; McKone, Thomas; Beattie, Paul; Chong, Patricia; Colella, Whitney; James, Brian

2014-06-23

A total cost of ownership model is described for low temperature proton exchange membrane stationary fuel cell systems for combined heat and power (CHP) applications from 1-250kW and backup power applications from 1-50kW. System designs and functional specifications for these two applications were developed across the range of system power levels. Bottom-up cost estimates were made for balance of plant costs, and detailed direct cost estimates for key fuel cell stack components were derived using design-for-manufacturing-and-assembly techniques. The development of high throughput, automated processes achieving high yield are projected to reduce the cost for fuel cell stacks to the $300/kW level at an annual production volume of 100 MW. Several promising combinations of building types and geographical location in the U.S. were identified for installation of fuel cell CHP systems based on the LBNL modelling tool DER CAM. Life-cycle modelling and externality assessment were done for hotels and hospitals. Reduced electricity demand charges, heating credits and carbon credits can reduce the effective cost of electricity ($/kWhe) by 26-44percent in locations such as Minneapolis, where high carbon intensity electricity from the grid is displaces by a fuel cell system operating on reformate fuel. This project extends the scope of existing cost studies to include externalities and ancillary financial benefits and thus provides a more comprehensive picture of fuel cell system benefits, consistent with a policy and incentive environment that increasingly values these ancillary benefits. The project provides a critical, new modelling capacity and should aid a broad range of policy makers in assessing the integrated costs and benefits of fuel cell systems versus other distributed generation technologies.

A Tactical Database for the Low Cost Combat Direction System

Science.gov (United States)

1990-12-01

A Tactical Database for the Low Cost Combat Direction System by Everton G. de Paula Captain, Brazilian Air Force B.S., Instituto Tecnologico de...objects as a unit. The AVANCE object management system [Ref. 29] uses the timestamp 156 model (pessimistic approach) for concurrency control. The Vbase...are no longer used). In AVANCE [Ref. 291, garbage collection is performed on user request. In GemStone [Ref. 25], garbage collection is executed in

Cost analysis of surgically treated pressure sores stage III and IV.

Science.gov (United States)

Filius, A; Damen, T H C; Schuijer-Maaskant, K P; Polinder, S; Hovius, S E R; Walbeehm, E T

2013-11-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Cost of disorders of the brain in Luxembourg.

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Bisdorff, A; Sobocki, P; Cloos, J M; Andrée, C; Graziano, M E

2006-01-01

Brain disorders (psychiatric, neurological and neurosurgical diseases) are leading causes of disease and disability. According to WHO data they cause 35% of the burden of all diseases in Europe. The present study aims to estimate the cost of defined brain disorders and adds all selected disorders to arrive at the total cost for Luxembourg. A model combining published economic and epidemiological data retrieved from the OECD (Organization for Economic Co-operation and Development) and Eurostat databases on brain disorders in Europe (EU member countries, Iceland, Norway and Switzerland) was used. We transformed and converted data for a defined period into the same currency (Euro 2004) and adjusted country specific economic data for purchasing power and relative size of economy and imputed data where no local data were available. There are an estimated 123000 people in Luxembourg currently living with a brain disorder. The total annual cost of brain disorders is estimated at Euro 500 million in 2004 or an average of Euro 1100 per inhabitant. Mental disorders constitute 62% of the total cost (excluding dementia), followed by neurological diseases (excluding dementia) 22%, neurosurgical diseases excluding herniated discs 2.2%. Direct medical expenditures (outpatient care, hospitalization, drugs) have a share of 32%, direct non-medical costs (social services, informal care, adaptation, transportation) 18% and indirect costs (sick leave, early retirement and premature death) 51%.

Cost Linkages Transmit Volatility Across Markets

DEFF Research Database (Denmark)

Nguyen, Daniel Xuyen; Schaur, Georg

We present and test a model relating a firm's idiosyncratic cost, its exporting status, and the volatilities of its domestic and export sales. In prior models of trade, supply costs for domestic and exports were linear and thus additively separable. We introduce a nonlinear cost function in order...... to link the domestic and export supply costs. This theoretical contribution has two new implications for the exporting firm. First, the demand volatility in the foreign market now directly affects the firm's domestic sales volatility. Second, firms hedge domestic demand volatility with exports. The model...... has several testable predictions. First, larger firms have lower total and domestic sales volatilities. Second, foreign market volatility increases domestic sales volatilities for exporters. Third, exporters allocate output across both markets in order to reduce total sales volatility. We find...

Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

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Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

2014-01-01

Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon

Economic cost and epidemiological characteristics of patients with fibromyalgia claims.

Science.gov (United States)

Robinson, Rebecca L; Birnbaum, Howard G; Morley, Melissa A; Sisitsky, Tamar; Greenberg, Paul E; Claxton, Ami J

2003-06-01

Fibromyalgia (FM) is characterized by widespread pain that can lead to significant patient disability, complex management decisions for physicians, and economic burden on society. We investigated the total costs of FM in an employer population. Administrative claims data of a Fortune 100 manufacturer were used to quantify direct (i.e., medical and pharmaceutical claims) and indirect (i.e., disability claims and imputed absenteeism) costs associated with FM. A total of 4699 patients with at least one FM claim between 1996 and 1998 were contrasted with a 10% random sample of the overall beneficiary population. Employee-only subsets of both samples also were drawn. Medical utilization, receipt of prescription drugs, and annual total costs were proportionately similar yet significantly greater among FM claimants than the overall sample (all p < 0.0001). Total annual costs for FM claimants were $5945 versus $2486 for the typical beneficiary (p < 0.0001). Six percent of these costs were attributable to FM-specific claims. The prevalence of disability was twice as high among FM employees than overall employees (p < 0.0001). For every dollar spent on FM-specific claims, the employer spent another $57 to $143 on additional direct and indirect costs. Hidden costs of disability and comorbidities greatly increase the true burden of FM. Regardless of the clinical understanding of FM, when a claim for FM is present, considerable costs are involved. Findings suggest that within the management of FM there may be large cost-offset opportunities for reductions in patient, physician, and employer burdens.

New simple spectrophotometric assay of total carotenes in margarines

NARCIS (Netherlands)

Luterotti, S.; Bicanic, D.D.; Pozgaj, R.

2006-01-01

Direct and reliable spectrophotometric method for assaying total carotenes (TC) in margarines with the minimum of sample manipulation is proposed. For the first time saponification step used in determination of carotenes in margarines was omitted leading to a substantial cost saving and reduction of

Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty?

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Sarah E. Rudasill, BA

2018-06-01

Conclusions: These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.

Comparison of costs of percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients with angina pectoris

NARCIS (Netherlands)

C. van Halem; F. van den Brink; P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); K.J. Meeter; E. Bos (Egbert); F.J. van Dalen (Frederik); M.J.B.M. van den Brand (Marcel)

1990-01-01

textabstractTo determine the costs of a procedure, the total costs of the department that provides the service must be considered and, in addition, the direct cost of the specific procedure. Applying this principle to the cost accounting of angioplasty and bypass surgery results in a direct, i.e.

Integrated batch production and maintenance scheduling for multiple items processed on a deteriorating machine to minimize total production and maintenance costs with due date constraint

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Zahedi Zahedi

2016-04-01

Full Text Available This paper discusses an integrated model of batch production and maintenance scheduling on a deteriorating machine producing multiple items to be delivered at a common due date. The model describes the trade-off between total inventory cost and maintenance cost as the increase of production run length. The production run length is a time bucket between two consecutive preventive maintenance activities. The objective function of the model is to minimize total cost consisting of in process and completed part inventory costs, setup cost, preventive and corrective maintenance costs and rework cost. The problem is to determine the optimal production run length and to schedule the batches obtained from determining the production run length in order to minimize total cost.

Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

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Sills E

2012-08-01

Full Text Available Abstract Background During in vitro fertilization (IVF, fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. Methods Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. Results Completed questionnaires (n = 71 revealed a mean +/− SD patient age of 34 +/− 4.1 yrs. Most (83.1% had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s. When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/− 11.75 and $654.55 +/− 106.34, respectively (p  Conclusions This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

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Mustafa Gökhan Bilgili

2014-06-01

Full Text Available Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05 and cost was higher in Group 1 (p<0.05. Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women.

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Caitlin J McCabe

Full Text Available BACKGROUND: In HIV-infected pregnant women, viral suppression prevents mother-to-child HIV transmission. Directly observed highly-active antiretroviral therapy (HAART enhances virological suppression, and could prevent transmission. Our objective was to project the effectiveness and cost-effectiveness of directly observed administration of antiretroviral drugs in pregnancy. METHODS AND FINDINGS: A mathematical model was created to simulate cohorts of one million asymptomatic HIV-infected pregnant women on HAART, with women randomly assigned self-administered or directly observed antiretroviral therapy (DOT, or no HAART, in a series of Monte Carlo simulations. Our primary outcome was the quality-adjusted life expectancy in years (QALY of infants born to HIV-infected women, with the rates of Caesarean section and HIV-transmission after DOT use as intermediate outcomes. Both self-administered HAART and DOT were associated with decreased costs and increased life-expectancy relative to no HAART. The use of DOT was associated with a relative risk of HIV transmission of 0.39 relative to conventional HAART; was highly cost-effective in the cohort as a whole (cost-utility ratio $14,233 per QALY; and was cost-saving in women whose viral loads on self-administered HAART would have exceeded 1000 copies/ml. Results were stable in wide-ranging sensitivity analyses, with directly observed therapy cost-saving or highly cost-effective in almost all cases. CONCLUSIONS: Based on the best available data, programs that optimize adherence to HAART through direct observation in pregnancy have the potential to diminish mother-to-child HIV transmission in a highly cost-effective manner. Targeted use of DOT in pregnant women with high viral loads, who could otherwise receive self-administered HAART would be a cost-saving intervention. These projections should be tested with randomized clinical trials.