WorldWideScience

Sample records for total external costs

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

    Directory of Open Access Journals (Sweden)

    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.

  2. External costs of electricity

    International Nuclear Information System (INIS)

    Rabl, A.; Spadaro, J.V.

    2005-01-01

    This article presents a synthesis of the ExternE project (External costs of Energy) of the European community about the external costs of power generation. Pollution impacts are calculated using an 'impact pathways' analysis, i.e. an analysis of the emission - dispersion - dose-response function - cost evaluation chain. Results are presented for different fuel cycles (with several technological variants) with their confidence intervals. The environmental impact costs are particularly high for coal: for instance, in France, for coal-fired power plants it is of the same order as the electricity retail price. For natural gas, this cost is about a third of the one for coal. On the contrary, the environmental impact costs for nuclear and renewable energies are low, typically of few per cent of the electricity price. The main part of these costs corresponds to the sanitary impacts, in particular the untimely mortality. In order to avoid any controversy about the cost evaluation of mortality, the reduction of the expectation of life due to the different fuel cycles is also indicated and the risks linked with nuclear energy are presented using several comparisons. (J.S.)

  3. The external costs of electricity

    International Nuclear Information System (INIS)

    Rabl, A.; Spadaro, J.V.

    2001-01-01

    This article presents an overview of the ExtrenE project (external costs of electricity) of the European Commission (EC). The damage caused by pollution has been calculated through analyses of the impact pathways which involve an analysis of the emission - dispersion - dose-response function - monetary estimation chain. The results are introduced for various cycles of combustible fuels (with several technological variants), indicating the confidence intervals. The cost of the damage is particularly high for coal. For example, for the coal-fired power stations in France (with the emission levels of 1995) it is approximately equal to the sales price of electricity. For natural gas, the cost of damage is approximately one-third that of coal. On the other hand, the damage costs for nuclear fuel and most forms of renewable energy are low, at a maximum just a few percent of the electricity price. The greatest part of these costs arises from health impact, particularly premature death. In order to avoid the controversy inherent in making a monetary assessment of mortality, especially if this is imposed upon future generations, the reduction in life expectancy due to the various combustible cycles is also indicated and the risks of nuclear energy are put into perspective via several comparisons. (authors)

  4. The external cruising costs of parking

    NARCIS (Netherlands)

    Inci, E.; van Ommeren, J.N.; Kobus, Martijn

    2017-01-01

    Existing work emphasizes the importance of traffic congestion externalities, but typically ignores cruising-for-parking externalities. We estimate the marginal external cruising costs of parking—that is, the time costs that an additional parked car imposes on drivers by inducing them to cruise for

  5. External costs of material recycling strategies for fusion power plants

    International Nuclear Information System (INIS)

    Hallberg, B.; Aquilonius, K.; Lechon, Y.; Cabal, H.; Saez, R.M.; Schneider, T.; Lepicard, S.; Ward, D.; Hamacher, T.; Korhonen, R.

    2003-01-01

    This paper is based on studies performed within the framework of the project Socio-Economic Research on Fusion (SERF3). Several fusion power plant designs (SEAFP Models 1-6) were compared focusing on part of the plant's life cycle: environmental impact of recycling the materials. Recycling was considered for materials replaced during normal operation, as well as materials from decommissioning of the plant. Environmental impact was assessed and expressed as external cost normalised with the total electrical energy output during plant operation. The methodology used for this study has been developed by the Commission of the European Union within the frame of the ExternE project. External costs for recycling, normalised with the energy production during plant operation, are very low compared with those for other energy sources. Results indicate that a high degree of recycling is preferable, at least when considering external costs, because external costs of manufacturing of new materials and disposal costs are higher

  6. External costs of nuclear-generated electricity

    International Nuclear Information System (INIS)

    Rotaru, I.; Glodeanu, F.; Popescu, D.; Andrei, V.

    2004-01-01

    External costs of nuclear power include: future financial liabilities arising from decommissioning and dismantling of nuclear facilities, health and environmental impacts of radioactivity releases in routine operation, radioactive waste disposal and effects of severe accidents. The nuclear energy industry operates under regulations that impose stringent limits to atmospheric emissions and liquid effluents from nuclear facilities as well as requiring the containment and confinement of solid radioactive waste to ensure its isolation from the biosphere as long as it may be harmful for human health and the environment. The capital and operating costs of nuclear power plants and fuel cycle facilities already internalize a major portion of the above-mentioned potential external costs, and these are reflected in the prices paid by consumers of nuclear-generated electricity. The externality related to potential health and environmental impacts of radioactive releases during routine operations have been assessed in a large number of comprehensive studies, in particular the ExternE project that was created in the framework of the European Commission. With regard to effects of severe nuclear accidents, a special legal regime, the third-party liability system, has been implemented to provide limited third party liability coverage in the event of a nuclear accident. The nuclear plant owners are held liable for some specified first substantial part of damages to third parties, and must secure insurance coverage adequate to cover this part. The Government provides coverage for some specified substantial second part of the damages, with any remaining damages to be considered by the national legislation. Thus, the costs of an incident or accident are fully internalized in the costs borne by the nuclear plant owners. Externalities of energy are not limited to environmental and health related impacts, but may result also from macro-economic, policy or strategic factors not reflected

  7. Renewable energy: Externality costs as market barriers

    International Nuclear Information System (INIS)

    Owen, Anthony D.

    2006-01-01

    This paper addresses the impact of environmentally based market failure constraints on the adoption of renewable energy technologies through the quantification in financial terms of the externalities of electric power generation, for a range of alternative commercial and almost-commercial technologies. It is shown that estimates of damage costs resulting from combustion of fossil fuels, if internalised into the price of the resulting output of electricity, could lead to a number of renewable technologies being financially competitive with generation from coal plants. However, combined cycle natural gas technology would have a significant financial advantage over both coal and renewables under current technology options and market conditions. On the basis of cost projections made under the assumption of mature technologies and the existence of economies of scale, renewable technologies would possess a significant social cost advantage if the externalities of power production were to be 'internalised'. Incorporating environmental externalities explicitly into the electricity tariff today would serve to hasten this transition process. (author)

  8. Theory and practice of internalization of external costs

    International Nuclear Information System (INIS)

    Bonus, H.

    1995-01-01

    External costs are those parts of total costs which bypass the market. To internalize them means to confront economic agents with the true costs and benefits of their economic activities. The concept of internalization does not really meet the requirements of preserving ecological equilibrium. Defining ecological constraints fits the needs much better. Implicit in ecological constraints are shadow prices. To let them emerge, markets for tradable emission permits would be appropriate. Carbon dioxide is used as an example. (author) 7 refs

  9. Cost minimization of generation, storage, and new loads, comparing costs with and without externalities

    DEFF Research Database (Denmark)

    Noel, Lance Douglas; Brodie, Joseph; Kempton, Willett

    2017-01-01

    G) technology, and building heat) are modeled within the PJM Interconnection. The corresponding electric systems are then operated and constrained to meet the load every hour over four years. The total cost of each energy system is calculated, both with and without externalities, to find the least...... cost energy systems. Using today’s costs of conventional and renewable electricity and without adding any externalities, the cost-minimum system includes no renewable generation, but does include EVs. When externalities are included, however, the most cost-effective to system covers 50% of the electric...... load with renewable energy and runs reliably without need for either new conventional generation or purpose-built storage. The three novel energy policy implications of this research are: (1) using today’s cost of renewable electricity and estimates of externalities, it is cost effective to implement...

  10. External costs and taxes in heat supply systems

    International Nuclear Information System (INIS)

    Karlsson, Aasa; Gustavsson, Leif

    2003-01-01

    A systems approach was used to compare different heating systems from a consumer perspective. The whole energy system was considered from natural resources to the required energy services. District heating, electric heat pumps, electric boilers, natural-gas-, oil- or pellet-fired local boilers were considered when supplying heat to a detached house. The district heat production included wood-chip-fired and natural-gas-fired cogeneration plants. Electricity other than cogenerated electricity was produced in wood-chip- and natural-gas-fired stand-alone power plants. The analysis includes four tax scenarios, as well as the external cost of environmental and health damage arising from energy conversion emission based on the ExternE study of the European Commission. The most cost-efficient systems were the natural-gas and oil boiler systems, followed by the heat pump and district heating systems, when the external cost and taxes were excluded. When including the external costs of CO 2 emission, the wood-fuel-based systems were much more cost efficient than the fossil-fuel-based systems, also when CO 2 capture and storage were applied. The external costs are, however, highly uncertain. Taxes steer towards lowering energy use and lowering CO 2 emission if they are levied solely on all the fossil-fuel-related emission and fuel use in the systems. If consumer electricity and heat taxes are used, the taxes have an impact on the total cost, regardless of the fuel used, thereby benefiting fuel-based local heating systems. The heat pump systems were the least affected by taxes, due to their high energy efficiency. The electric boiler systems were the least cost-efficient systems, also when the external cost and taxes were included

  11. Approaches in estimation of external cost for fuel cycles in the ExternE project

    International Nuclear Information System (INIS)

    Afanas'ev, A.A.; Maksimenko, B.N.

    1998-01-01

    The purposes, content and main results of studies realized within the frameworks of the International Project ExternE which is the first comprehensive attempt to develop general approach to estimation of external cost for different fuel cycles based on utilization of nuclear and fossil fuels, as well as on renewable power sources are discussed. The external cost of a fuel cycle is treated as social and environmental expenditures which are not taken into account by energy producers and consumers, i.e. these are expenditures not included into commercial cost nowadays. The conclusion on applicability of the approach suggested for estimation of population health hazards and environmental impacts connected with electric power generation growth (expressed in money or some other form) is made

  12. External costs of electricity production: recent developments

    International Nuclear Information System (INIS)

    Beutier, D.

    1995-01-01

    The external costs of energy use, or the environmental effects not included in the market pricing system, must at some point be borne by society. This paper argues that the true cost of energy, including the remedying or prevention of its environmetnal consequences, should be included in the price paid by the consumer as this is the only effective method of minimizing the burden of environmental damage. The difficulties of quantifying the value of such damage and internalising it within power prices is described with reference to work in a number of countries. (UK)

  13. External risk factors affecting construction costs

    Science.gov (United States)

    Mubarak, Husin, Saiful; Oktaviati, Mutia

    2017-11-01

    Some risk factors can have impacts on the cost, time, and performance. Results of previous studies indicated that the external conditions are among the factors which give effect to the contractor in the completion of the project. The analysis in the study carried out by considering the conditions of the project in the last 15 years in Aceh province, divided into military conflict phase (2000-2004), post tsunami disaster rehabilitation and reconstruction phase (2005-2009), and post-rehabilitation and reconstruction phase (2010-present). This study intended to analyze the impact of external risk factors, primarily related to the impact on project costs and to investigate the influence of the risk factors and construction phases impacted the project cost. Data was collected by using a questionnaire distributed in 15 large companies qualification contractors in Aceh province. Factors analyzed consisted of socio-political, government policies, natural disasters, and monetary conditions. Data were analyzed using statistical application of severity index to measure the level of risk impact. The analysis results presented the tendency of impact on cost can generally be classified as low. There is only one variable classified as high-impact, variable `fuel price increases', which appear on the military conflict and post tsunami disaster rehabilitation and reconstruction periods. The risk impact on costs from the factors and variables classified with high intensity needs a serious attention, especially when the high level impact is followed by the high frequency of occurrences.

  14. 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

  15. External costs of electricity production under scrutiny

    International Nuclear Information System (INIS)

    Wagner, H.J.; Melchert, A.

    1993-01-01

    After a short introduction into the problems and questions surrounding the issue of external costs Chapter 2 presents the most important results of the studies under review and analysis in this work. Occasionally, minor discrepancies were found between the results given in the summary of a study and the data reported in the relevant chapters. Chapter 3 identifies and discusses differences in perspective between the studies under consideration. Chapter 4 analyses the most important premises and parameters adopted in the studies for the calculation of overall costs and net benefits of the different modes of electricity production. This serves to probe the reliability of the data, plausibility of the premises, and nature of the presupposed relationships. Chapter 5 examines the relationships of time assumed in the studies and gives a first comment on the more advanced Prognos study. Chapter 6, finally, offers a summarizing evaluation. (orig./UA) [de

  16. Hydropower - internalized costs and externalized benefits

    International Nuclear Information System (INIS)

    Koch, F.H.

    2002-01-01

    The benefits of hydropower consist of the minimal level of noxious and greenhouse gas emissions, it's energy security from political instability, and its renewable, non-depletable nature. The costs of hydropower consist of negative effects on the river ecosystem and of social changes in communities in the vicinity of large projects. Public awareness of these costs has increased dramatically during the past two decades, and new hydro projects will not get approval unless adequate mitigation measures are taken to avoid, offset, or compensate for adverse environmental and social effects. To a very large extent, the hydropower industry has internalized what were previously social and environmental externalities. However, hydropower operators do not receive any compensation for the benefits, and to date their competitors (coal, natural gas, oil) have not been required to internalize their adverse environmental externalities. (emissions, depletion of supplies, and sometimes dependence on imported primary energy sources). This creates an uneven playing field, and the hydropower industry enthusiastically welcomes a discussion of this issue, and eventually measures to rectify the situation. The IEA Hydropower Agreement has completed a major international study on the environmental and social impacts of hydropower, and one major component of this study was a Life Cycle Assessment and comparison of all the most important electricity generation technologies. (author)

  17. The avoided external costs of using wind energy

    Energy Technology Data Exchange (ETDEWEB)

    Markandya, A [Harvard Inst. for International Development, Cambridge, MA (United States)

    1996-12-31

    This article discusses the external costs of electricity generated by conventional fossil fuel sources, such as coal and nuclear power. It compares the costs of electricity generated with coal with that generated with wind. A measure of the benefits of wind energy is the difference between these two external costs. The methodology used for the estimation of the external costs, as well as the estimates of these costs, are taken from the EC ExternE study, financed by DGXII of the European Commission. The present author was a lead economist for that study. (author)

  18. The avoided external costs of using wind energy

    International Nuclear Information System (INIS)

    Markandya, A.

    1995-01-01

    This article discusses the external costs of electricity generated by conventional fossil fuel sources, such as coal and nuclear power. It compares the costs of electricity generated with coal with that generated with wind. A measure of the benefits of wind energy is the difference between these two external costs. The methodology used for the estimation of the external costs, as well as the estimates of these costs, are taken from the EC ExternE study, financed by DGXII of the European Commission. The present author was a lead economist for that study. (author)

  19. The avoided external costs of using wind energy

    Energy Technology Data Exchange (ETDEWEB)

    Markandya, A. [Harvard Inst. for International Development, Cambridge, MA (United States)

    1995-12-31

    This article discusses the external costs of electricity generated by conventional fossil fuel sources, such as coal and nuclear power. It compares the costs of electricity generated with coal with that generated with wind. A measure of the benefits of wind energy is the difference between these two external costs. The methodology used for the estimation of the external costs, as well as the estimates of these costs, are taken from the EC ExternE study, financed by DGXII of the European Commission. The present author was a lead economist for that study. (author)

  20. Review on studies for external cost of nuclear power generation

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-12-15

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

  1. Review on studies for external cost of nuclear power generation

    International Nuclear Information System (INIS)

    Park, Byung Heung; Ko, Won Il

    2015-01-01

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

  2. Cost minimization of generation, storage, and new loads, comparing costs with and without externalities

    International Nuclear Information System (INIS)

    Noel, Lance; Brodie, Joseph F.; Kempton, Willett; Archer, Cristina L.; Budischak, Cory

    2017-01-01

    Highlights: • The study models a large regional transmission organization, with various amounts of renewable energy. • The cost of 86 million iterations of energy systems is calculated, with and without externalities. • When including externalities, society should implement 50% renewable energy. - Abstract: The goal of this research is to understand the economics of anticipated large-scale changes in the electric system. 86 million different combinations of renewable generation (wind and solar), natural gas, and three storage types (hydrogen storage, electric vehicles equipped with vehicle-to-grid (V2G) technology, and building heat) are modeled within the PJM Interconnection. The corresponding electric systems are then operated and constrained to meet the load every hour over four years. The total cost of each energy system is calculated, both with and without externalities, to find the least cost energy systems. Using today’s costs of conventional and renewable electricity and without adding any externalities, the cost-minimum system includes no renewable generation, but does include EVs. When externalities are included, however, the most cost-effective to system covers 50% of the electric load with renewable energy and runs reliably without need for either new conventional generation or purpose-built storage. The three novel energy policy implications of this research are: (1) using today’s cost of renewable electricity and estimates of externalities, it is cost effective to implement 240 GW of renewable electricity to meet 50% of the total electric load; (2) there is limited need to construct new natural gas power plants, especially from a system-wide perspective; and (3) existing coal plants may still be useful to the energy system, and instead of being retired, should be repurposed to occasionally provide generation.

  3. Calculation of freight externality costs for South Africa

    Directory of Open Access Journals (Sweden)

    Stefaan Swarts

    2012-11-01

    Full Text Available The purpose of this study is to quantify the marginal external costs associated with freight transport in South Africa. Six cost elements are included as externality cost items, namely, costs related to accidents, emissions, roadway land availability, policing, noise and congestion. Inputs in the calculations were a gravity-oriented freight flow model, a road transport cost model, actual transport costs for other modes, a warehousing cost survey, an inventory delay calculation and various national sources of information such as accident statistics and government budgets. Estimation techniques resulted in advances for externality cost measurement in South Africa. The quantification of the cost elements will be used to update the South African Freight Demand Model. The results show that the cost of transportation would have been 20% more if external factors were taken into account. The marginal rates of externalities can be used to develop scenarios based on alternative choices for South Africa's freight transport infrastructure configuration.

  4. External effects and social costs of road transport

    NARCIS (Netherlands)

    Verhoef, E.T.

    1994-01-01

    The article contains a welfare economic analysis of road transport's external effects. First, we discuss the definition of external effects. Applying this definition, it is concluded that road transport activities give rise to a wide range of external costs. However, there are no external benefits

  5. External costs of energy - do the answers match the questions? Looking back at 10 years of ExternE

    International Nuclear Information System (INIS)

    Krewitt, W.

    2002-01-01

    While the claim for 'getting prices right' is quite popular in conceptual policy papers, the implementation of appropriate internalisation strategies is still hampered by a lack of reliable external cost data. Great expectations were set into the ExternE project, a major research programme launched by the European Commission at the beginning of the 1990s to provide a scientific basis for the quantification of energy related externalities and to give guidance supporting the design of internalisation measures. After more than a decade of research, the ExternE label became a well recognised standard source for external cost data. Looking back into the ExternE history, the paper pursues how emerging new scientific insights and changing background assumptions affected external cost estimates and related recommendations to policy over time. Based on ExternE results, the usefulness and inherent limitations of external cost estimates for impact categories like climate change or nuclear waste disposal is discussed. The paper also gives examples on how external costs in spite of remaining uncertainties are successfully used to support environmental policy. (Author)

  6. External costs of electricity production: case study Croatia

    International Nuclear Information System (INIS)

    Bozicevic Vrhovcak, Maja; Tomsic, Zeljko; Debrecin, Nenad

    2005-01-01

    Because electricity production is one of the major sources of pollution, and at the same time is the most centralised one, environmental issues in power system operation and planning are gaining ever-increasing attention. It is very difficult to compare environmental impacts of various electricity generation technologies and fuel types because they are extremely divergent. The most widely accepted common denominator today is the so-called external cost by which a monetary value is associated with environmental damage. In this paper, damages to human health resulting from Croatian thermal power plants annual operation are presented. Stack emissions have been translated into ambient concentrations by atmospheric dispersion modelling. Existing data on relations between human health degradation and ground concentrations of the analysed pollutants have been used. Geographic information software has been used in order to account for spatially dependent data. Monetary values have been assigned to the estimated human health damage. External costs resulting from impact of Croatian thermal power plants airborne emissions on human health have been calculated. The total Croatian thermal power system external costs, resulting from impacts on human health, are presented and discussed

  7. 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

  8. External costs from electricity generation of China up to 2030 in energy and abatement scenarios

    International Nuclear Information System (INIS)

    Zhang, Qingyu; Weili, Tian; Yumei, Wei; Yingxu, Chen

    2007-01-01

    This paper presents estimated external costs of electricity generation in China under different scenarios of long-term energy and environmental policies. Long-range Energy Alternatives Planning (LEAP) software is used to develop a simple model of electricity demand and to estimate gross electricity generation in China up to 2030 under these scenarios. Because external costs for unit of electricity from fossil fuel will vary in different government regulation periods, airborne pollutant external costs of SO 2 , NO x , PM 10 , and CO 2 from fired power plants are then estimated based on emission inventories and environmental cost for unit of pollutants, while external costs of non-fossil power generation are evaluated with external cost for unit of electricity. The developed model is run to study the impact of different energy efficiency and environmental abatement policy initiatives that would reduce total energy requirement and also reduce external costs of electricity generation. It is shown that external costs of electricity generation may reduce 24-55% with three energy policies scenarios and may further reduce by 20.9-26.7% with two environmental policies scenarios. The total reduction of external costs may reach 58.2%. (author)

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

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

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

  10. 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...

  11. 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.

  12. ExternE transport methodology for external cost evaluation of air pollution

    DEFF Research Database (Denmark)

    Jensen, S. S.; Berkowicz, R.; Brandt, J.

    The report describes how the human exposure estimates based on NERI's human exposure modelling system (AirGIS) can improve the Danish data used for exposure factors in the ExternE Transport methodology. Initially, a brief description of the ExternE Tranport methodology is given and it is summarised...

  13. External Costs Related to Power Production Technologies

    DEFF Research Database (Denmark)

    Ibsen, Liselotte Schleisner; Nielsen, Per Sieverts

    1997-01-01

    of the Danish part of the project is to implement the framework for externality evaluation, for three different power plants located in Denmark. The paper will focus on the assessment of the impacts of the whole fuel cycles for wind, natural gas and biogas. Priority areas for environmental impact assessment...

  14. The Implementation of Marginal External Cost Pricing in Road Transport

    OpenAIRE

    Verhoef, Erik T.

    1998-01-01

    This paper discusses a number of issues that will become increasingly important nowthat the concept of marginal external cost pricing becomes more likely to be implementedas a policy strategy in transport in reality. The first part of the paper deals with thelong-run efficiency of marginal external cost pricing. It is shown that such prices notonly optimize short-run mobility, given the shape and position of the relevant demandand cost curves, but even more importantly, also optimally affect ...

  15. Internalising external costs of electricity and heat production in a municipal energy system

    International Nuclear Information System (INIS)

    Holmgren, Kristina; Amiri, Shahnaz

    2007-01-01

    Both energy supply and waste treatment give rise to negative effects on the environment, so-called external effects. In this study, monetary values on external costs collected from the EU's ExternE project are used to evaluate inclusion of these costs in comparison with an energy utility perspective including present policy instruments. The studied object is a municipal district heating system with a waste incineration plant as the base supplier of heat. The evaluation concerns fuels used for heat production and total electricity production, for scenarios with external costs included and for a scenario using the present policy instrument. Impacts of assumptions on marginal power producers (coal or natural gas power plants) are investigated, since locally produced electricity is assumed to replace marginal power and thus is credited for the avoided burden. Varying levels of external costs for carbon dioxide emissions are analysed. The method used is an economic optimisation model, MODEST. The conclusion is that present policy instruments are strong incentives for cogeneration, even when external costs are included. Waste is fully utilised in all scenarios. In cases where coal is the marginal power producer, more electricity is produced; when natural gas is the marginal power producer, less is produced. There are several uncertainties in the data for external costs, both methodological and ethical. In the ExternE data, not all environmental impacts are included. For waste incineration, ashes are not included, and another difficulty is how to treat the avoided burden of other waste treatment methods

  16. Neuraxial blockade for external cephalic version: Cost analysis.

    Science.gov (United States)

    Yamasato, Kelly; Kaneshiro, Bliss; Salcedo, Jennifer

    2015-07-01

    Neuraxial blockade (epidural or spinal anesthesia/analgesia) with external cephalic version increases the external cephalic version success rate. Hospitals and insurers may affect access to neuraxial blockade for external cephalic version, but the costs to these institutions remain largely unstudied. The objective of this study was to perform a cost analysis of neuraxial blockade use during external cephalic version from hospital and insurance payer perspectives. Secondarily, we estimated the effect of neuraxial blockade on cesarean delivery rates. A decision-analysis model was developed using costs and probabilities occurring prenatally through the delivery hospital admission. Model inputs were derived from the literature, national databases, and local supply costs. Univariate and bivariate sensitivity analyses and Monte Carlo simulations were performed to assess model robustness. Neuraxial blockade was cost saving to both hospitals ($30 per delivery) and insurers ($539 per delivery) using baseline estimates. From both perspectives, however, the model was sensitive to multiple variables. Monte Carlo simulation indicated neuraxial blockade to be more costly in approximately 50% of scenarios. The model demonstrated that routine use of neuraxial blockade during external cephalic version, compared to no neuraxial blockade, prevented 17 cesarean deliveries for every 100 external cephalic versions attempted. Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.

  17. 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.

  18. External costs of nuclear: Greater or less than the alternatives?

    International Nuclear Information System (INIS)

    Rabl, Ari; Rabl, Veronika A.

    2013-01-01

    Since Fukushima many are calling for a shutdown of nuclear power plants. To see whether such a shutdown would reduce the risks for health and environment, the external costs of nuclear electricity are compared with alternatives that could replace it. The frequency of catastrophic nuclear accidents is based on the historical record, about one in 25 years for the plants built to date, an order of magnitude higher than the safety goals of the U.S. Nuclear Regulatory Commission. Impacts similar to Chernobyl and Fukushima are assumed to estimate the cost. A detailed comparison is presented with wind as alternative with the lowest external cost. The variability of wind necessitates augmentation by other sources, primarily fossil fuels, because storage at the required scale is in most regions too expensive. The external costs of natural gas combined cycle are taken as 0.6 €cent/kWh due to health effects of air pollution and 1.25 €cent/kWh due to greenhouse gases (at 25€/t CO 2 eq ) for the central estimate, but a wide range of different parameters is also considered, both for nuclear and for the alternatives. Although the central estimate of external costs of the wind-based alternative is higher than that of nuclear, the uncertainty ranges overlap. - Highlights: ► The external costs of nuclear electricity are compared with the alternatives. ► Frequency and cost of nuclear accidents based on Chernobyl and Fukushima. ► Detailed comparison with wind as alternative with the lowest external costs. ► High external cost of wind because of natural gas backup (storage too limited). ► External costs of wind higher than nuclear but uncertainty ranges overlap

  19. Salvage of infected total knee arthroplasty with Ilizarov external fixator

    Directory of Open Access Journals (Sweden)

    Venkata Gurava Reddy

    2011-01-01

    Full Text Available Background: Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA. Materials and Methods: 16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator. Results: Union was achieved in 15 patients (93.75%. The mean duration for union (frame application time in these patients was 28.33 weeks (range 22 to 36 weeks. Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034. Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035. Conclusion: Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.

  20. Power generation choices: costs, risks and externalities

    International Nuclear Information System (INIS)

    1994-01-01

    This document from OECD deals with the choices between the different means of producing electricity: supply and demand trends, power generation choices, management of development and technologies, environmental impacts and costs around energy sources. Separate abstracts were prepared for all the papers of this volume. (TEC)

  1. Internalisation of external costs in Switzerland and in Europe

    International Nuclear Information System (INIS)

    Mauch, U.

    1995-01-01

    Plans and resistance for internalising the external costs are discussed taking the conditions in Switzerland and in other countries of Europe into account. Internalisation is seen as signpost to regressive development. (author) 5 figs., 4 tabs

  2. The external cost of the nuclear fuel cycle

    International Nuclear Information System (INIS)

    Schieber, C.; Schneider, T.

    2002-01-01

    The external cost of the nuclear fuel cycle has been evaluated in the particular context of France as part of the European Commission's ExternE project. All the steps in the fuel cycle which involve the use of cutting edge technology were taken into consideration, from mining of uranium ores to waste disposal, via construction, dismantling of nuclear power plants and the transport of radioactive materials. The general methodology adopted in the study, known as the 'Impact Pathway Analysis', is based on a sequence of evaluations from source terms to the potential= effects on man and the environment, and then to their monetary evaluation, using a single framework devised for all the fuel cycles considered in the ExternE project. The resulting external cost is in the range of 2 to 3 mEuro/kWh when no discount rate is applied, and around 0.1 mEuro/kWh when a discount rate of 3% is considered. Further developments have been made on the external cost of a nuclear accident and on the integration of risk aversion in its evaluation. It appeared that the external cost of a nuclear accident would be about 0.04 mEuro/kWh, instead of 0.002 mEuro/kWh without taking risk aversion into account. (authors)

  3. Investment Timing When External Financing Is Costly

    DEFF Research Database (Denmark)

    Hirth, Stefan; Uhrig-Homburg, Marliese

    2010-01-01

    This paper analyzes the investment timing of firms facing two dimensions of financing constraints: Liquidity constraints and capital market frictions inducing financing costs. We show that liquidity constraints are not sufficient to explain voluntary investment delay. However, when additionally...... considering financing costs, we can explain both voluntary delay and acceleration of investment. More precisely, we find that investment thresholds are U-shaped in liquid funds. For high-liquidity firms, investment thresholds are decreasing (i.e. accelerated investment takes place) in either dimension...... of financing constraint. In contrast, investment thresholds are increasing (i.e. investment is further delayed) in either form of financing constraint for low-liquidity firms. For intermediate levels of liquidity, investment thresholds are U-shaped in market frictions....

  4. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs

    International Nuclear Information System (INIS)

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO 2 and NO x . Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society. The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both the value of statistical life (VSL) and the amended human capital (AHC) approach were applied for external costs estimation, which could provide the upper and lower bound of the external costs due to PM2.5. To fully understand the uncertainty levels, the external cost distribution was determined via Monte Carlo simulation based on the uncertainty of the parameters such as PM2.5 concentration, exposure-response coefficients, and economic cost per case. The results showed that the external costs were equivalent to around 0.3% (AHC, China's guideline: C 0  = 35 μg/m 3 ) to 0.9% (VSL, WHO guideline: C 0  = 10 μg/m 3 ) of regional GDP depending on the valuation method and on the assumed baseline PM2.5 concentration (C 0 ). Among all the health impacts, the economic loss due to premature deaths accounted for more than 80% of the overall external costs. The results of this study could help policymakers prioritizing the PM2.5 pollution control interventions and internalize the external costs through the application of economic policy instruments. - Highlights:

  5. Life-cycle analysis and external costs in transportation

    International Nuclear Information System (INIS)

    Delucchi, M.A.

    2002-01-01

    The assessment of greenhouse gas impacts in the US shows that against a baseline gasoline vehicle, the impact of including the full fuel cycle generally reduces the relative advantages of alternative transportation fuels. While a switch to diesel is estimated to save 30% as compared to gasoline, the savings from natural gas/LPG are (around 20%), for ethanol from corn (8%) and for battery electricity vehicles using power from coal (6%) are much smaller. This is largely due to the use of LCA rather than end-use comparisons. However, the results also show that there would be large savings from the use of ethanol from fuel cells using methanol (39%) or natural gas (50%), while ethanol from wood in a conventional engine appears to have the greatest savings (63%). In external costs of motor vehicle use, analysis results were presented for both air pollution and energy security impacts (including SPR, military expenditures, macro-economic costs and pecuniary costs) as well as water pollution, noise and congestion impacts. The results suggest that externalities amount to 1.2 US cents per mile travelled in gasoline powered vehicle. The most significant externality is related to air pollution. Costs associated with US defence, the SPR, and climate change are quite insignificant. The only other variable of significance is the impact on the economy, through the transfer of wealth outside the US (referred to as 'pecuniary externality') and the oil price shock impacts on the economy. A comparison of external costs and subsidies for different transportation modes in the US (gas or electric cars, transit bus, light rail, heavy rail) showed that subsidies available to public transit system greatly outweigh the benefit in reduced externalities avoided. In the comparison of social costs of transportation alternatives, differences in external cost, while not trivial, are outweighed by the differences in direct costs or in subsidies. (author)

  6. External costs related to power production technologies. ExternE national implementation for Denmark

    International Nuclear Information System (INIS)

    Schleisner, L.; Sieverts Nielsen, P.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results; to aggregate these site- and technology-specific results to more general figures. The current report covers the results of the national implementation for Denmark. Three different fuel cycles have been chosen as case studies. These are fuel cycles for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant based on biogas. The report covers all the details of the application of the methodology to these fuel cycles aggregation to a national level. (au) EU-JOULE 3. 59 tabs., 25 ills., 61 refs

  7. External costs related to power production technologies. ExternE national implementation for Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, L; Sieverts Nielsen, P

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results; to aggregate these site- and technology-specific results to more general figures. The current report covers the results of the national implementation for Denmark. Three different fuel cycles have been chosen as case studies. These are fuel cycles for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant based on biogas. The report covers all the details of the application of the methodology to these fuel cycles aggregation to a national level. (au) EU-JOULE 3. 59 tabs., 25 ills., 61 refs.

  8. External costs related to power production technologies. ExternE national implementation for Denmark

    International Nuclear Information System (INIS)

    Schleisner, L.; Sieverts Nielsen, P.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results, to aggregate these site- and technology-specific results to more general figures. The current report covers the detailed information concerning the ExternE methodology. Importance is attached to the computer system used in the project and the assessment of air pollution effects on health, materials and ecological effects. Also the assessment of global warming damages are described. Finally the report covers the detailed information concerning the national implementation for Denmark for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant base on biogas. (au) EU-JOULE 3. 79 tabs., 11 ills., 201 refs

  9. External costs related to power production technologies. ExternE national implementation for Denmark

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, L; Sieverts Nielsen, P [eds.

    1997-12-01

    The objective of the ExternE National Implementation project has been to establish a comprehensive and comparable set of data on externalities of power generation for all EU member states and Norway. The tasks include the application of the ExternE methodology to the most important fuel cycles for each country as well as to update the already existing results, to aggregate these site- and technology-specific results to more general figures. The current report covers the detailed information concerning the ExternE methodology. Importance is attached to the computer system used in the project and the assessment of air pollution effects on health, materials and ecological effects. Also the assessment of global warming damages are described. Finally the report covers the detailed information concerning the national implementation for Denmark for an offshore wind farm and a wind farm on land, a decentralised CHP plant based on natural gas and a decentralised CHP plant base on biogas. (au) EU-JOULE 3. 79 tabs., 11 ills., 201 refs.

  10. Welfare effects of the internalization of external cost

    International Nuclear Information System (INIS)

    Lijesen, M.; Korteweg, J.A.; Derriks, H.

    2009-03-01

    The effect of passing through the cost of external effects such as accidents, environment and noise to traffic and transport have been mapped. In nine out of the ten examined variants this 'internalization' will lead to an increase in welfare in the Netherlands. Internalization leads to a decrease of external costs of over 100 million to more than 1.7 billion euros annually. Internalization also brings about collection costs, international transfers and logistic adjustments. The balance of these effects varies from a welfare loss of 20 million euros to a welfare increase of 1.2 billion euros annually. [nl

  11. Externality costs by emission. E. Particulates

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Fossil-fuel-fired electricity generating systems, particularly coal and oil-fired facilities, are significant emitters of particulate matter. The major components of particulate emissions from a power plant include ash, which is made up of heavy metals, radioactive isotopes and hydrocarbons, and sulfates (SO 4 ) and nitrates (NO 3 ), which are formed by reaction of sulfur dioxide (SO 2 ) and nitrogen oxides (NO x ) in the atmosphere. The smallest ash particulates (including sulfates and nitrates) cause human respiratory effects and impaired visibility. Other effects may include materials damage due to soiling and possibly corrosion, damage to domestic and wild flora through deposition of particulates on foliage, and possible health effects on domestic animals and wild fauna. Several studies focus on the direct effects of high ambient levels of small particulates. This chapter reviews the available literature on the effects of particulate emissions on humans and their environment, and attempts to assign a cost figure to the environmental effects and human health impairments associated with particulate matter emissions. Specifically, this report focuses on the effects of particulates related to human health, visibility, flora, fauna and materials

  12. External costs of electricity; Les couts externes de l'electricite

    Energy Technology Data Exchange (ETDEWEB)

    Rabl, A. [Ecole des Mines de Paris, 75 (France); Spadaro, J.V. [International Atomic Energy Agency (IAEA), Vienna (Austria)

    2005-07-01

    This article presents a synthesis of the ExternE project (External costs of Energy) of the European community about the external costs of power generation. Pollution impacts are calculated using an 'impact pathways' analysis, i.e. an analysis of the emission - dispersion - dose-response function - cost evaluation chain. Results are presented for different fuel cycles (with several technological variants) with their confidence intervals. The environmental impact costs are particularly high for coal: for instance, in France, for coal-fired power plants it is of the same order as the electricity retail price. For natural gas, this cost is about a third of the one for coal. On the contrary, the environmental impact costs for nuclear and renewable energies are low, typically of few per cent of the electricity price. The main part of these costs corresponds to the sanitary impacts, in particular the untimely mortality. In order to avoid any controversy about the cost evaluation of mortality, the reduction of the expectation of life due to the different fuel cycles is also indicated and the risks linked with nuclear energy are presented using several comparisons. (J.S.)

  13. External Costs of Transport in the U.S.

    OpenAIRE

    Delucchi, Mark A.; McCubbin, Donald R.

    2010-01-01

    In this chapter we report estimates of the external costs of transport in the United States.1 Generally, we cover road, rail, air, and water transport; passenger transport and freight transport; and congestion, accident, air pollution, climate change, noise, water pollution, and energy-security costs. However, we were not able to find estimates for all cost categories; in particular, there are fewer estimates for freight transport than for passenger transport, fewer estimates for water transp...

  14. Quantifying the external cost of oil consumption within the context of sustainable development

    International Nuclear Information System (INIS)

    Abdel Sabour, S.A.

    2005-01-01

    The concept of sustainability implies that the flow of services derived from the use of natural capital must be constant over time and should be obtained at a constant price. For a depletable resource such as oil, the future generations are highly impacted due to the consumption behavior of the current generation. Since the ultimate oil stock within the Earth declines with cumulative consumption, excessive consumption of oil now reduces the availability of oil for future needs. Moreover, since oil reserves are normally extracted in the order of ascending cost and descending quality, excessive consumption of relatively high-quality, cheap oil reserves by the current generation raises the cost at which future generations can meet their needs of oil and hence imposes an external cost on the future generations. This study aims to quantify the external cost of consuming a barrel of oil within the context of sustainable development. An option-pricing model is developed to quantify this external cost assuming that the external cost of consuming a barrel of oil now equals the value of the option to get a barrel of oil in the future at the same current cost. Then, the total cost of consuming a barrel of oil now, that should be used in lifecycle costing to design more sustainable products, is the summation of the oil price and the external cost

  15. Transaction costs, externalities and information technology in health care.

    Science.gov (United States)

    Ferguson, B; Keen, J

    1996-01-01

    This paper discusses some of the economic issues which underpin the rationale for investment in information and communications technologies (ICTs). Information imperfections lead to significant transaction costs (search, negotiating and monitoring) which in turn confer a negative externality on parties involved in exchange. This divergence in private and social costs leads to a degree of resource misallocation (efficiency loss) which, uncorrected, results in a sub-optimal outcome. Traditional solutions to this problem are to rely upon direct government action to reduce the costs of transacting between market agents, or to employ tax/subsidy measures and other legislative action to achieve the desired market outcome. Three key policy questions are raised in the context of the NHS purchaser/provider relationship. Firstly, what is the optimum level of transaction costs; secondly, can ICTs assist in lowering the level of transaction costs to the optimum level; thirdly, who should bear the investment cost in reducing the level of transaction costs? The issue of property rights in different information systems is discussed and raises interesting policy questions about how much investment should be undertaken centrally rather than devolved to a more local level. In some ways this economic framework offers a post hoc justification of why different ICT systems have been introduced at various levels of the NHS. Essentially this reduces to the problem of externalities: providing good information confers a positive externality: not providing relevant, timely and accurate information confers a negative externality, by increasing further the level of transaction costs. The crucial role which ICT systems can play lies in attempting to reduce the level of transaction costs and driving the market towards what Dahlman has described as the transaction-cost-constrained equilibrium.

  16. Internalization of external costs for nuclear power in Romania

    International Nuclear Information System (INIS)

    Andrei, Veronica; Ghita, Sorin; Ionita, Gheorghe; Gheorghe-Sorescu, Antonius; Glodeanu, Florin

    2006-01-01

    A technology that competes against alternatives on a full cost basis is not sustainable - no matter how environmentally friendly is. Competitive performance, however, means more than lower costs. Additional factors as the following have to be considered as criteria ensuring a sustainable energy development: - environmentally compatibility - intergenerational compatibility - power demand compatibility - socio-political compatibility - geopolitical compatibility. Some factors are less difficult to express in al.) Recent Cold Fterms (e.g. the economic value of degraded public health) than others (e.g. the economic value of reliable supplies or lack of public acceptance) but their quantifications are fraught with uncertainty, vary greatly from location to location and cannot be generalized. Still, these factors often tilt the balance in favor or disfavor of a particular technology. From a public perspective, a set of costs called 'external costs' are important. By definition these costs are external to standard private sector cost accounting schemes. They are necessarily paid for, not as a cost of doing business, but by society. The concept of externalities has been referred to in the economic literature since early in the 20th century. In 1974, the Council of OECD recommended the application by governments of the 'Polluter Pays Principle', defined in the early 1970s as a means to allocate costs of pollution prevention and control measures to pollutants, and thereby to consumers of their products, rather than to society as a whole. The externality may be defined as 'a cost or benefit that is not included in the market price of a commodity because it is not included in the supply price or demand price. An externality is produced when the economic activity of one actor (or group of actors) has a positive or negative impact on the welfare function of another actor (or group of actors) and when the former fails to be fully compensated, or to fully compensate the latter

  17. The external costs of a sedentary life-style.

    Science.gov (United States)

    Keeler, E B; Manning, W G; Newhouse, J P; Sloss, E M; Wasserman, J

    1989-01-01

    Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise. PMID:2502036

  18. 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....

  19. The evaluation of external costs from energy sources

    International Nuclear Information System (INIS)

    Lee, R.; Valette, P.; Krupnick, A.; Markandya, A.

    1994-01-01

    The paper outlines the progress of the joint EC-US Fuel Cycle study. This study seeks to provide a methodological framework for precisely the evaluation of external costs over the complete fuel cycle, from fuel extraction to decommissioning, conservation technologies, solar and wind power. (authors). 19 refs., 4 figs

  20. Socio-economic research on fusion. SERF 1997-98. Macro Tast E2: External costs and benefits. Task 2: Comparison of external costs

    International Nuclear Information System (INIS)

    Schleisner, Lotte; Korhonen, Riitta

    1998-12-01

    This report is part of the SERF (Socio-Economic Research on Fusion) project, Macro Task E2, which covers External Costs and Benefits. The report is the documentation of Task 2, Comparison of External Costs. The aim of Task 2 Comparison of External Costs, has been to compare the external costs of the fusion energy with those from other alternative energy generation technologies. In this task identification and quantification of the external costs for wind energy and photovoltaic have been performed by Risoe, while identification and quantification of the external cost for nuclear fission and fossil fuels have been discussed by VTT. The methodology used for the assessment of the externalities of the fuel cycles selected has been the one developed within the ExternE Project. First estimates for the externalities of fusion energy have been under examination in Macrotask E2. Externalities of fossil fuels and nuclear fission have already been evaluated in the ExternE project and a vast amount of material for different sites in various countries is available. This material is used in comparison. In the case of renewable wind energy and photovoltaic are assessed separately. External costs of the various alternatives may change as new technologies are developed and costs can to a high extent be avoided (e.g. acidifying impacts but also global warming due to carbon dioxide emissions). Also fusion technology can experience major progress and some important cost components probably can be avoided already by 2050. (EG)

  1. Socio-economic research on fusion. SERF 1997-98. Macro Tast E2: External costs and benefits. Task 2: Comparison of external costs

    Energy Technology Data Exchange (ETDEWEB)

    Schleisner, Lotte; Korhonen, Riitta

    1998-12-01

    This report is part of the SERF (Socio-Economic Research on Fusion) project, Macro Task E2, which covers External Costs and Benefits. The report is the documentation of Task 2, Comparison of External Costs. The aim of Task 2 Comparison of External Costs, has been to compare the external costs of the fusion energy with those from other alternative energy generation technologies. In this task identification and quantification of the external costs for wind energy and photovoltaic have been performed by Risoe, while identification and quantification of the external cost for nuclear fission and fossil fuels have been discussed by VTT. The methodology used for the assessment of the externalities of the fuel cycles selected has been the one developed within the ExternE Project. First estimates for the externalities of fusion energy have been under examination in Macrotask E2. Externalities of fossil fuels and nuclear fission have already been evaluated in the ExternE project and a vast amount of material for different sites in various countries is available. This material is used in comparison. In the case of renewable wind energy and photovoltaic are assessed separately. External costs of the various alternatives may change as new technologies are developed and costs can to a high extent be avoided (e.g. acidifying impacts but also global warming due to carbon dioxide emissions). Also fusion technology can experience major progress and some important cost components probably can be avoided already by 2050. (EG) 36 refs.

  2. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs.

    Science.gov (United States)

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-07-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO 2 and NO x . Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society. The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both the value of statistical life (VSL) and the amended human capital (AHC) approach were applied for external costs estimation, which could provide the upper and lower bound of the external costs due to PM2.5. To fully understand the uncertainty levels, the external cost distribution was determined via Monte Carlo simulation based on the uncertainty of the parameters such as PM2.5 concentration, exposure-response coefficients, and economic cost per case. The results showed that the external costs were equivalent to around 0.3% (AHC, China's guideline: C 0  = 35 μg/m 3 ) to 0.9% (VSL, WHO guideline: C 0  = 10 μg/m 3 ) of regional GDP depending on the valuation method and on the assumed baseline PM2.5 concentration (C 0 ). Among all the health impacts, the economic loss due to premature deaths accounted for more than 80% of the overall external costs. The results of this study could help policymakers prioritizing the PM2.5 pollution control interventions and internalize the external costs through the application of economic policy instruments. Copyright © 2017

  3. An inventory of measures for internalising external costs in transport

    Energy Technology Data Exchange (ETDEWEB)

    Van Essen, H.; Nelissen, D.; Smit, M.; Van Grinsven, A.; Aarnink, S. [CE Delft, Delft (Netherlands); Breemersch, T. [Transport and Mobility Leuven TML, Leuven (Belgium); Martino, A.; Rosa, C.; Parolin, R. [Trasporti e Territorio TRT, Brussels (Belgium); Harmsen, J. [Sustainable Transport and Logistics TNO, Rotterdam (Netherlands)

    2012-11-15

    This study provides an overview of all existing and close to implementation pricing policies in transport. It supported the European Commission with the evaluation of existing pricing policies in the light of Article 11.4 of the revised Eurovignette Directive. The study covers all existing pricing instruments in all transport modes in all EU Member States. In addition it includes data on revenues and administrative costs and some comparisons across Member States and transport modes. The most recent data have been gathered: data for 2010 and where possible 2011. Also the link with external and infrastructure costs is discussed, and where possible, high level comparisons have been made.

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

    Directory of Open Access Journals (Sweden)

    Lacy, Kyle

    2015-01-01

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

  5. The Externe project. Assessment of the external costs of the natural gas fuel cycle

    International Nuclear Information System (INIS)

    Holland, M.R.

    1997-01-01

    A detailed bottom-up methodology for assessment of the external costs of energy has been developed by a multi-disciplinary, pan-European team as part of the European Commissions's JOULE Programme. The consequences of the generation of electricity from fossil, nuclear and renewable technologies, in terms of damages to human health, buildings and the wider environment, have been assessed within a consistent framework. The potential application of the results in cost-benefit analysis, power system optimisation, emissions charging, etc. is also now under investigation. The analysis starts with definition of the fuel cycle, and specification of the technologies and locations to be considered. Results to date show that for typical modern examples of power plants burning different fossil fuels, externalities (including possible global warming effects) are lowest for gas-burning plant. (R.P.)

  6. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs

    DEFF Research Database (Denmark)

    Hao, Yin; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO2 and NOx. Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society....... The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well...... as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both...

  7. Integration of risk aversion in the evaluation of the external cost of a nuclear accident

    International Nuclear Information System (INIS)

    Eeckhoudt, L.; Schieber, C.; Schneider, Th.

    1998-01-01

    Full text of publication follows: the external costs of fuel cycles used in the production of electricity are those imposed on society and environment that are not accounted for by the producers and consumers of energy. Within the evaluation of the external cost of the nuclear fuel cycle, the evaluation of a nuclear accident has to be addressed. For this purpose, the basic approach consists in calculating the expected value of various occident scenarios. the main criticism of this approach is that there is a discrepancy between the social acceptability of the risk and the average monetary value which corresponds in principle to the compensation of the consequences for each individual of the population affected by the accident. The aim of this paper is to propose a methodology for the integration of risk aversion, relying on the expected utility approach, as well as a numerical application based on the French data for the external cost of a nuclear accident. Although a huge range of values has been published for the relative risk aversion coefficient, it seems reasonable to adopt a value of 2 for the specific case of nuclear accident. This leads to an estimated multiplying coefficient approximately equal to 20 to be applied to the expected external cost of a nuclear accident corresponding to a release of about 1% of the core. In this case, the external cost of the nuclear accident is estimated to 0.046 mECU/kWh (i.e. about 50% of the total external costs of the nuclear fuel cycle estimated at 0.1 mECU/kWh with a 3% discount rate), instead of 0.0023 mECU/kWh without taking into account risk aversion. (authors)

  8. External costs of PM2.5 pollution in Beijing, China

    DEFF Research Database (Denmark)

    Hao, Yin; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO2 and NOx. Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society....... The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well...... as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both...

  9. Direct cost comparison of totally endoscopic versus open ear surgery.

    Science.gov (United States)

    Patel, N; Mohammadi, A; Jufas, N

    2018-02-01

    Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

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

    Directory of Open Access Journals (Sweden)

    Luigi Ranieri

    2018-03-01

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

  11. Evaluation of Cost and Effectiveness of Decontamination Scenarios on External Radiation Exposure in Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Yasutaka, T.; Naito, W. [National Institute of Advanced Industrial Science and Technology (Japan)

    2014-07-01

    trillion JPY. Our results suggest that the cost of removal was estimated to account for approximately 60% of the total cost in the decontamination implementation areas, while the cost of storage and transport was estimated to account for more than 70% in the special decontamination areas. In addition, the costs of decontamination per person per unit area are estimated to vary greatly. Appropriate selection of decontamination methods may significantly decrease decontamination costs, allowing more meaningful decontamination in terms of the limited budget. Our analysis can help in examining the prioritization of decontamination areas from the viewpoints of cost and effectiveness in reducing the external dose. Decontamination strategies should be determined according to air dose rates and future land-use plans. Document available in abstract form only. (authors)

  12. Use of external cost assessment and multi-criteria decision analysis for comparative evaluation of options for electricity supply

    International Nuclear Information System (INIS)

    Hirschberg, S.; Dones, R.; Gantner, U.

    2001-01-01

    The paper addresses external cost and multi-criteria analyses carried out for selected future electricity generating systems of interest under the Swiss conditions. The external cost estimates are based on an application of the 'impact pathway approach', enhanced by earlier experience from extensive Life Cycle Assessment (LCA). The estimated total costs, i.e. the sum of internal and external costs, may serve as a measure of economic and environmental efficiency of energy systems. The multi-criteria approach allows a more explicit consideration of the social dimension, which is highly important for the decision-making process. The applications of multi-criteria analyses illustrate the sensitivity of the results to the range of preferences expressed in the energy debate. Certain patterns in system ranking can be observed in spite of these sensitivities. Both total cost assessment and multi-criteria analysis are found to be useful, complementary instruments to support procedures for decision-making. (author)

  13. Use of external cost assessment and multi-criteria decision analysis for comparative evaluation of options for electricity supply

    International Nuclear Information System (INIS)

    Hirschberg, Stefan; Dones, Roberto; Gantner, Urs

    2000-01-01

    This paper addresses external cost and multi-criteria analyses carried out for selected future electricity generating systems of interest under the Swiss. conditions. The external cost estimates are based on an application of the 'impact pathway approach', enriched by earlier experience from extensive Life Cycle Assessment (LCA). The estimated total costs, i.e. the sum of internal and external costs may serve as a measure of economic and environmental efficiency of energy systems. The multi-criteria approach allows a more explicit consideration of the social dimension, highly important for the decision process. The applications of multi-criteria analysis illustrate the sensitivity of the results to a range of preferences expressed in the energy debate. Certain patterns in systems ranking can be observed in spite of these sensitivities. Both total cost assessment and multi-criteria analysis are found to be useful, complementary instruments to support the decision process. (author)

  14. Assessment of health-cost externalities of air pollution at the national level using the EVA model system

    Energy Technology Data Exchange (ETDEWEB)

    Brandt, J.; Silver, J.D.; Frohn, L.M. (and others)

    2011-07-15

    Air pollution has significant negative impacts on human health and well-being, which entail substantial economic consequences. We have developed an integrated model system, EVA (External Valuation of Air pollution; Frohn et al., 2005; Andersen et al., 2007; Brandt et al., 2010), to assess health-related economic externalities of air pollution resulting from specific emission sources or sectors. The EVA system was initially developed to assess externalities from power production, but in this study it is extended to evaluate costs at the national level from all major emission sectors. In this study, we estimate the impacts and total externality costs from the main emission sectors in Denmark, representing the 10 major SNAP codes. Furthermore, we assess the impacts and externality costs of all emissions simultaneously from the whole of Europe as well as from international ship traffic in general, since this sector seems to be very important but is currently unregulated. (Author)

  15. Inclusion of external costs: what are the possible approaches?

    International Nuclear Information System (INIS)

    Bauduin, P.

    1995-01-01

    Failing to consider external environmental costs is a source of inefficiency in terms of public welfare. However, the economist who goes beyond this simple statement of fact and tries to remedy the situation is faced with a double-edged question. First, how can the individual behavior of the economic players be effectively oriented so as to be compatible with the collective requirements of air and water quality, landscaping, and so forth? And secondly, how can these requirements or social gains be measured against the cost of the corresponding environmental preservation measures? As concerns regulating individual behavior, the present article identifies the conditions under which one or another environmental policy may be preferable. There is no simple rule for choosing a given instrument, however, because of the frequently complex problems and the diversity of the contexts in which they arise. When it comes to putting a money figure on environmental quality, there are some original economic methods that can be proposed, and the principles of these are reviewed briefly. These methods may be of assistance in the debate and in the decision-making process; but then again, their difficulties and limitations should be kept in mind, and the necessary precautions should be taken. (author)

  16. Optimized electricity expansions with external costs internalized and risk of severe accidents as a new criterion in the decision analysis

    Energy Technology Data Exchange (ETDEWEB)

    Martin del Campo M, C.; Estrada S, G. J., E-mail: cmcm@fi-b.unam.mx [UNAM, Facultad de Ingenieria, Departamento de Sistemas Energeticos, Paseo Cuauhnahuac 8532, 62550 Jiutepec, Morelos (Mexico)

    2011-11-15

    The external cost of severe accidents was incorporated as a new element for the assessment of energy technologies in the expansion plans of the Mexican electric generating system. Optimizations of the electric expansions were made by internalizing the external cost into the objective function of the WASP-IV model as a variable cost, and these expansions were compared with the expansion plans that did not internalize them. Average external costs reported by the Extern E Project were used for each type of technology and were added to the variable component of operation and maintenance cost in the study cases in which the externalises were internalized. Special attention was paid to study the convenience of including nuclear energy in the generating mix. The comparative assessment of six expansion plans was made by means of the Position Vector of Minimum Regret Analysis (PVMRA) decision analysis tool. The expansion plans were ranked according to seven decision criteria which consider internal costs, economical impact associated with incremental fuel prices, diversity, external costs, foreign capital fraction, carbon-free fraction, and external costs of severe accidents. A set of data for the calculation of the last criterion was obtained from a Report of the European Commission. We found that with the external costs included in the optimization process of WASP-IV, better electric expansion plans, with lower total (internal + external) generating costs, were found. On the other hand, the plans which included the participation of nuclear power plants were in general relatively more attractive than the plans that did not. (Author)

  17. 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.

  18. Impact of Total, Internal and External Government Debt on Interest Rate in Pakistan

    OpenAIRE

    Perveen, Asma; Munir, Kashif

    2017-01-01

    The objective of the study is to examine impact of total, internal and external government debt on nominal interest rate in Pakistan. To attain these objectives, the study used annual time series data from 1973 to 2016. The study used loanable fund theory as theoretical model and ARDL bound testing approach for cointegration and Granger causality test to estimate the results. The results of the study found negative relation between total government debt, external debt and nominal interest rat...

  19. 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.

  20. The valuation of external costs: An overview of issues and state actions

    International Nuclear Information System (INIS)

    Caverhill, E.J.

    1992-01-01

    The valuation of externalities helps determine the cost effectiveness of environmentally superior resources that would not be cost effective on a direct cost comparison to utility avoided costs. Explicitly monetizing externalities appears to be the best way to meet the criteria of consistency across resource options and pollutants and allowing selection of societally least-cost resources among a variety of resource types. Environmental costs should be defined so as not to exclude any potential external effects, including all environmental, social, and economic effects. For practical purposes, the definition could probably include only environmental externalities without materially affecting resource decisions in the foreseeable future for most North American utilities. More specifically, a comprehensive list of external costs should at least include emissions of pollutants such as SO 2 , CO, NO x , volatile organics, and greenhouse gases; thermal effluents; solid wastes; risk of catastrophic accidents; and for hydro projects, destruction of habitat and recreational areas, and mercury accumulation in reservoirs. Environmental effects should then be counted and valued, most commonly by damage costing or regulatory cost of control. Some utilities and other parties have proposed a market-based approach to valuing externalities, determining the marginal cost of controlling emissions by the market price of emissions allowances. Quantification of environmental costs, ensuring consistency among externality sources, and estimation of avoided externality costs are also discussed. Examples are presented of externality values selected in a number of areas of the USA. 11 refs., 5 figs

  1. A general approach to total repair cost limit replacement policies

    Directory of Open Access Journals (Sweden)

    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.

  2. LCA and external costs in comparative assessment of electricity chains. Decision support for sustainable electricity provision?

    International Nuclear Information System (INIS)

    Voss, A.

    2002-01-01

    The provision of energy and electricity plays an important role in a country's economic and environmental performance and the sustainability of its development. Sustainable development of the energy and electricity sector depends on finding ways of meeting energy service demands of the present generation that are economically viable, environmentally sound, and socially acceptable and do not jeopardize the ability of future generations to meet their own energy needs. Life Cycle Assessment (LCA) and external cost valuation are considered to offer opportunities to assist energy policy in a comprehensive comparative evaluation of electricity supply options with regard to the different dimensions of sustainable energy provision as well as in the implementation of appropriate internalization strategies. The paper addresses life cycle assessment and external cost analysis carried out for selected electricity systems of interest under German conditions. Results from a comprehensive comparative assessment of various electricity supply options with regard to their environmental impacts, health risks, raw materials requirements as well as their resulting external cost will be summarised. The use of LCA based indicators for assessing the relative sustainability of electricity systems and the use of total (internal plus external) cost assessment as measure of economic and environmental efficiency of energy systems will be discussed. Open problems related to life cycle analysis of energy chains and the assessment of environmental damage costs are critically reviewed, to illustrate how in spite of existing uncertainties the state of the art results may provide helpful energy policy decision support. The paper starts with some remarks on what the concept of sustainability in terms of energy systems means. (author)

  3. 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.

  4. Internalizing external environmental costs of agriculture into product prices, Case study for milk and potatoes

    NARCIS (Netherlands)

    Masselink, Dirk Jan

    2007-01-01

    Society has to pay large amounts of money to compensate for the environmental damages caused by farm emissions. These external costs are not fully accounted for in product prices and internalization of these external costs into the cost price of agricultu

  5. 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

  6. Internalization of external cost for the production and distribution of electricity in Flanders, Belgium

    International Nuclear Information System (INIS)

    Torfs, R.; De Nocker, L.; Schrooten, L.; Aernouts, K.; Liekens, I.

    2005-04-01

    This report elaborates the external costs of electricity production and distribution in Flanders, Belgium, and tests them against prices and taxes for electricity use. The authors examined whether these external costs decrease in time and whether such a decrease leads to internalization in the price for the users through taxes, levies or other economic instruments. The external costs mainly include external environmental costs caused by air pollution and greenhouse gases, but also damage caused by accidents, hindrance and radioactive substances that may be released. [nl

  7. 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

  8. Estimation of external costs of energy production in Finland

    International Nuclear Information System (INIS)

    Estlander, A.; Otterstroem, T.

    1994-01-01

    The goal of the project is to develop a method for estimation of external costs of energy production in Finland. The purpose of the method is to take into account all the most important impacts on health, materials and the environment. The study will assess environmental effects of emissions from Finnish energy production on people and the environment locally (population centres), nationally (Finland) and globally. The different energy production forms to be included in the study are heat and electric energy generated with coal, natural gas, fuel oil and peat (not industry's energy production). Local and national environmental impact assessment is carried out within the Finnish borders. The economic influence of emissions (in particular greenhouse gases) originating outside Finland but with global impact will also be assessed, as far as Finland is concerned. When studying the amounts of emissions the whole fuel chain is taken into account: production, processing or transport, storage in the different stages of the chain of use, and end use. The main components under review are SO 2 , NO x , CO 2 , H x C y , CO, particulates and a couple of heavy metals. In addition. the study considers ozone (O 3 ), which is formed in the atmosphere. The primary monetary valuation method used is the indirect monetarization. which is based on dose-response functions and the use of both market prices and willingness-to-pay assessments. The method to be developed during the project for monetary valuation of effects caused by emissions on health, materials and the environment can be utilized in further monetarization studies. The results of the work can used to assess the profitability of energy production plants and energy companies from the economic point of view

  9. [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.

  10. Pricing landfill externalities: emissions and disamenity costs in Cape Town, South Africa

    CSIR Research Space (South Africa)

    Nahman, Anton

    2011-10-01

    Full Text Available ; ranging from 7% to 32% of overall costs. This illustrates the importance of taking external costs into account in comparing waste management alternatives, in order to reduce the likelihood of inappropriate decisions being made....

  11. Externality costs of the coal-fuel cycle: The case of Kusile Power Station

    Directory of Open Access Journals (Sweden)

    Nonophile P. Nkambule

    2017-09-01

    Full Text Available Coal-based electricity is an integral part of daily life in South Africa and globally. However, the use of coal for electricity generation carries a heavy cost for social and ecological systems that goes far beyond the price we pay for electricity. We developed a model based on a system dynamics approach for understanding the measurable and quantifiable coal-fuel cycle burdens and externality costs, over the lifespan of a supercritical coal-fired power station that is fitted with a flue-gas desulfurisation device (i.e. Kusile Power Station. The total coal-fuel cycle externality cost on both the environment and humans over Kusile's lifespan was estimated at ZAR1 449.9 billion to ZAR3 279 billion or 91c/kWh to 205c/kWh sent out (baseline: ZAR2 172.7 billion or 136c/kWh. Accounting for the life-cycle burdens and damages of coal-derived electricity conservatively, doubles to quadruples the price of electricity, making renewable energy sources such as wind and solar attractive alternatives. Significance: The use of coal for electricity generation carries a heavy cost for social and ecological systems that goes far beyond the price we pay for electricity. The estimation of social costs is particularly important to the electric sector because of non-differentiation of electricity prices produced from a variety of sources with potentially very dissimilar environmental and human health costs. Because all electricity generation technologies are associated with undesirable side effects in their fuelcycle and lifespan, comprehensive comparative analyses of life-cycle costs of all power generation technologies is indispensable to guide the development of future energy policies in South Africa.

  12. 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 ...

  13. Road user charges for heavy goods vehicles (HGV):Tables with external costs of air pollution

    OpenAIRE

    Andersen, Mikael Skou

    2013-01-01

    In this report, the European Environment Agency (EEA) presents updated estimates of the external costs of air pollution for different categories of heavy goods vehicles (HGVs). This report on road transport is a continuation of previous reporting from EEA on estimates for the external costs of air pollution from industrial facilities (EEA, 2011).

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

    Science.gov (United States)

    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.

  15. 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.

  16. The external costs of electricity generation: a comparison of generation technologies

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemiroglu, E [Economics for the Environment Consultancy, London (United Kingdom)

    1995-12-01

    Electricity generation, like any economic activity, leads to costs that can be grouped in two categories: (a) private or internal and (b) external. Private costs are those paid by the buyers and sellers of energy within the market system. The external costs, however, are not included in the market price mechanism as they accrue to third parties other than the buyer and the seller. External costs include environmental external costs and non-environmental external costs. There are two conditions for the existence of external costs: (a) market failure, or the inability of markets to account for the cost of environmental impacts of energy generation and the market structure and (b) government or policy failure, or the policies that cause private generators to pay either higher or lower costs than they would if these interventions did not exist. A third reason can be added for the existence of non-environmental externalities: energy security, or certain costs faced by society as a result of over-reliance on imported energy. Section A introduces the concept of external costs and benefits. Section B looks at the environmental externalities of energy generation. The procedure is to develop the methodology to estimate what are known as externality adders, i.e. a monetary value for the environmental costs and benefits associated with selected generation technologies, expressed in pence per kilowatt-hour. The result is an `adder` because, in principle, the sum can be added to the private cost of generating electricity to obtain a measure of the `full` or `social` cost. The selected generation technologies are conventional coal, wind power, small-scale hydro, energy crops, incineration of municipal solid waste and energy recovery from landfill. The data reported are based on the application of the technologies in Scotland, but the methodology can be applied anywhere. Section C takes a brief look at the non-environmental externalities including the general theory and evidence

  17. The external costs of electricity generation: a comparison of generation technologies

    International Nuclear Information System (INIS)

    Ozdemiroglu, E.

    1995-01-01

    Electricity generation, like any economic activity, leads to costs that can be grouped in two categories: (a) private or internal and (b) external. Private costs are those paid by the buyers and sellers of energy within the market system. The external costs, however, are not included in the market price mechanism as they accrue to third parties other than the buyer and the seller. External costs include environmental external costs and non-environmental external costs. There are two conditions for the existence of external costs: (a) market failure, or the inability of markets to account for the cost of environmental impacts of energy generation and the market structure and (b) government or policy failure, or the policies that cause private generators to pay either higher or lower costs than they would if these interventions did not exist. A third reason can be added for the existence of non-environmental externalities: energy security, or certain costs faced by society as a result of over-reliance on imported energy. Section A introduces the concept of external costs and benefits. Section B looks at the environmental externalities of energy generation. The procedure is to develop the methodology to estimate what are known as externality adders, i.e. a monetary value for the environmental costs and benefits associated with selected generation technologies, expressed in pence per kilowatt-hour. The result is an 'adder' because, in principle, the sum can be added to the private cost of generating electricity to obtain a measure of the 'full' or 'social' cost. The selected generation technologies are conventional coal, wind power, small-scale hydro, energy crops, incineration of municipal solid waste and energy recovery from landfill. The data reported are based on the application of the technologies in Scotland, but the methodology can be applied anywhere. Section C takes a brief look at the non-environmental externalities including the general theory and evidence

  18. Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

    Science.gov (United States)

    van der Kamp, Jonathan; Bachmann, Till M

    2015-03-03

    "Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making.

  19. Are there SO2 externality costs beyond the Clean Air Act Amendments of 1990?

    International Nuclear Information System (INIS)

    Sanghi, A.; Joseph, A.L.

    1992-01-01

    Inclusion of environmental externality costs in the selection of utility resources has become a reality in New York, Massachusetts, Nevada and California. Soon several other jurisdictions are likely to join these states in using environmental externality costs in decision-making. The consideration of environmental externalities are bound to profoundly affect utility decision-making in the future. So far attention has focused largely on air emission externalities of SO 2 , NO x and CO 2 . However, the recent Clean Air Act Amendments (CAAA) will reduce SO 2 emissions from utilities by about 50 percent. With such a large reduction in SO 2 loading, the question has been raised as to the need to further consider SO 2 externality costs in decision-making. This paper comments on this issue. By using generation and emission data from New York utilities, the paper shows that SO 2 emission externalities exist even after complying with requirements of the CAAA

  20. 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.

  1. Socio-Economic research on fusion SERF 3(2001-2003) External Costs of Fusion

    International Nuclear Information System (INIS)

    Lechon, Y.; Saez, R.; Cabal, H.

    2003-01-01

    Based on SEAFP project (Raeder et al, 1995) findings a preliminary assessment of environmental external costs associated to fusion power was performed under the framework of the first phase of the SERF (Socioeconomic Research on Fusion) project (Saez et al, 1999). This study showed very low external costs of fusion power compared with other traditional and new energy generating technologies. In order to update the assessment of externalities of fusion power, SERF2 project a new plant was included and an analysis of the key variables influencing the external cost was carried out. In the new phase of the SERF project, SERF3, three new additional plant models have been introduced with the aim of assessing the possibilities of silicon carbide to be used as structural material for fusion power plants. Furthermore, comparison of fusion external costs with those of other generation technologies in the state of technology development expected for 2050 has been also performed. (Author)

  2. 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...

  3. Audio Teleconferencing: Low Cost Technology for External Studies Networking.

    Science.gov (United States)

    Robertson, Bill

    1987-01-01

    This discussion of the benefits of audio teleconferencing for distance education programs and for business and government applications focuses on the recent experience of Canadian educational users. Four successful operating models and their costs are reviewed, and it is concluded that audio teleconferencing is cost efficient and educationally…

  4. Cost and effectiveness of decontamination strategies in radiation contaminated areas in Fukushima in regard to external radiation dose.

    Science.gov (United States)

    Yasutaka, Tetsuo; Naito, Wataru; Nakanishi, Junko

    2013-01-01

    The objective of the present study is to evaluate the cost and effectiveness of decontamination strategies in the special decontamination areas in Fukushima in regard to external radiation dose. A geographical information system (GIS) was used to relate the predicted external dose in the affected areas to the number of potential inhabitants and the land use in the areas. A comprehensive review of the costs of various decontamination methods was conducted as part of the analysis. The results indicate that aerial decontamination in the special decontamination areas in Fukushima would be effective for reducing the air dose rate to the target level in a short period of time in some but not all of the areas. In a standard scenario, analysis of cost and effectiveness suggests that decontamination costs for agricultural areas account for approximately 80% of the total decontamination cost, of which approximately 60% is associated with storage. In addition, the costs of decontamination per person per unit area are estimated to vary greatly. Appropriate selection of decontamination methods may significantly decrease decontamination costs, allowing more meaningful decontamination in terms of the limited budget. Our analysis can help in examining the prioritization of decontamination areas from the viewpoints of cost and effectiveness in reducing the external dose. Decontamination strategies should be determined according to air dose rates and future land-use plans.

  5. Evaluation of Delivery Costs for External Beam Radiation Therapy and Brachytherapy for Locally Advanced Cervical Cancer Using Time-Driven Activity-Based Costing.

    Science.gov (United States)

    Bauer-Nilsen, Kristine; Hill, Colin; Trifiletti, Daniel M; Libby, Bruce; Lash, Donna H; Lain, Melody; Christodoulou, Deborah; Hodge, Constance; Showalter, Timothy N

    2018-01-01

    To evaluate the delivery costs, using time-driven activity-based costing, and reimbursement for definitive radiation therapy for locally advanced cervical cancer. Process maps were created to represent each step of the radiation treatment process and included personnel, equipment, and consumable supplies used to deliver care. Personnel were interviewed to estimate time involved to deliver care. Salary data, equipment purchasing information, and facilities costs were also obtained. We defined the capacity cost rate (CCR) for each resource and then calculated the total cost of patient care according to CCR and time for each resource. Costs were compared with 2016 Medicare reimbursement and relative value units (RVUs). The total cost of radiation therapy for cervical cancer was $12,861.68, with personnel costs constituting 49.8%. Brachytherapy cost $8610.68 (66.9% of total) and consumed 423 minutes of attending radiation oncologist time (80.0% of total). External beam radiation therapy cost $4055.01 (31.5% of total). Personnel costs were higher for brachytherapy than for the sum of simulation and external beam radiation therapy delivery ($4798.73 vs $1404.72). A full radiation therapy course provides radiation oncologists 149.77 RVUs with intensity modulated radiation therapy or 135.90 RVUs with 3-dimensional conformal radiation therapy, with total reimbursement of $23,321.71 and $16,071.90, respectively. Attending time per RVU is approximately 4-fold higher for brachytherapy (5.68 minutes) than 3-dimensional conformal radiation therapy (1.63 minutes) or intensity modulated radiation therapy (1.32 minutes). Time-driven activity-based costing was used to calculate the total cost of definitive radiation therapy for cervical cancer, revealing that brachytherapy delivery and personnel resources constituted the majority of costs. However, current reimbursement policy does not reflect the increased attending physician effort and delivery costs of brachytherapy. We

  6. Estimating External Costs of Transportation in Regional Areas: Using Available Statistical Data the Case of the Region of Campania

    Directory of Open Access Journals (Sweden)

    Mariano Gallo

    2010-04-01

    health, it required to give a value to human life and to health damages. The results show as the largest costs are due to air pollution (38.0 % and accidents (28.2 %; noise amounts to 18.4 %, while less importance is assumed by congestion (10.6 % and greenhouse gas emissions (4.8 %. Moreover, the results show also as the amount of external costs overcomes 4 € billions per year and is equal about to 4.7 % of regional GDP; in particular, it is highlighted as the environmental costs (greenhouse gas emissions, air pollution and noise overcome 60 % of total costs. The obtained results have shown as the external costs are significant respect to other costs of transportation systems and as they should be always evaluated when public funds are invested for improving transportation systems.

  7. The Cost Implications in Ontario, Alberta, and British Columbia of Early Versus Delayed External Cephalic Version in the Early External Cephalic Version 2 (EECV2) Trial.

    Science.gov (United States)

    Ahmed, Rashid J; Gafni, Amiram; Hutton, Eileen K

    2016-03-01

    According to the Early External Cephalic Version (EECV2) Trial, planning external cephalic version (ECV) early in pregnancy results in fewer breech presentations at delivery compared with delayed external cephalic version. A Cochrane review conducted after the EECV2 Trial identified an increase in preterm birth associated with early ECV. We examined whether a policy of routine early ECV (i.e., before 37 weeks' gestation) is more or less costly than a policy of delayed ECV. We undertook this analysis from the perspective of a third-party payer (Ministry of Health). We applied data, using resources reported in the EECV2 Trial, to the Canadian context using 10 hospital unit costs and 17 physician service/procedure unit costs. The data were derived from the provincial health insurance plan schedule of medical benefits in three Canadian provinces (Ontario, Alberta, and British Columbia). The difference in mean total costs between study groups was tested for each province separately. We found that planning early ECV results in higher costs than planning delayed ECV. The mean costs of all physician services/procedures and hospital units for planned ECV compared with delayed ECV were $7997.32 versus $7263.04 in Ontario (P < 0.001), $8162.82 versus $7410.55 in Alberta (P < 0.001), and $8178.92 versus $7417.04 in British Columbia (P < 0.001), respectively. From the perspective of overall cost, our analyses do not support a policy of routinely planning ECV before 37 weeks' gestation. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  8. External costs of the urban solid wastes collect; Custos externos da coleta de residuos solidos urbanos

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Luciano Basto; Cruz, Luiz Eduardo Reis da

    2002-07-01

    This work performs a comparison of the urban solid wastes collect through the use of two alternatives: traditional and selective collect, by using the social, operational and external costs (environmental and social). The work demonstrates that, nevertheless the initial costs of the selective collects are higher than the traditional collects, the traditional aggregated social costs are inversely proportional to the traditional collect.

  9. External Costs Associated with Electricity Generation in Lithuania: Impact of Ignalina NPP Closure

    International Nuclear Information System (INIS)

    Streimikiene, D.

    2000-01-01

    Sustainability and development have been founded on continuing growth in energy demand and distribution, and management of natural resources through proper allocation and efficiency. It is clear that the use of energy in all its forms and applications provides an enormous benefit to society. However, it is also associated with numerous environmental and social challenges, such as, e.g., the health effects of air pollution. These burdens are referred to as external costs, as they have not been included in the market price of energy. The purpose of externalities research is to quantify damages in order to allow rational decisions to be made that weigh the benefits of actions to reduce externalities against the costs of doing so. Ultimately, market failure could be reduced by internalization of the external costs during energy planning. The paper deals with the problems of external costs associated with electricity generation in Lithuania and evaluates the environmental impact related to increased atmospheric pollution when the first unit at Ignalina NPP will be closed in 2005. Simplified methodology for the evaluation of external costs based on Impact Pathway Approach developed by International Atomic Energy Agency was applied. Achieved results indicate that due to the increased atmospheric pollution the external costs associated with electricity generation in the case of the first unit closure at Ignalina NPP would amount to 130 million USD. (author)

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

    Science.gov (United States)

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

    2013-07-01

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

  11. Long-dated evaluation of the external costs of the nuclear

    International Nuclear Information System (INIS)

    Le Dars, A.; Schneider, T.

    2002-09-01

    Since the middle of the years 1990, the European Commission developed an ''ExternE'' methodology to propose an homogenous evaluation of the sanitary and environmental external costs of the various energy sectors in Europe. This document discusses the taking into account of the long-dated and analyzes the interests and the limits of the monetary evaluation, in terms of external costs, of the nuclear choice. It is organized in three chapters: 1. a presentation and a discussion on the various evaluation of the ''ExternE'' methodology; 2. a description of the available methods for the monetary evaluation of the long-dated impacts and more particularly the analysis of the monetary values actualization principle; 3. highlighted of the impacts for which the monetary evaluations exist. (A.L.B.)

  12. 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

  13. Internalisation of external cost in the power generation sector: Analysis with Global Multi-regional MARKAL model

    International Nuclear Information System (INIS)

    Rafaj, Peter; Kypreos, Socrates

    2007-01-01

    The Global MARKAL-Model (GMM), a multi-regional 'bottom-up' partial equilibrium model of the global energy system with endogenous technological learning, is used to address impacts of internalisation of external costs from power production. This modelling approach imposes additional charges on electricity generation, which reflect the costs of environmental and health damages from local pollutants (SO 2 , NO x ) and climate change, wastes, occupational health, risk of accidents, noise and other burdens. Technologies allowing abatement of pollutants emitted from power plants are rapidly introduced into the energy system, for example, desulphurisation, NO x removal, and CO 2 scrubbers. The modelling results indicate substantial changes in the electricity production system in favour of natural gas combined cycle, nuclear power and renewables induced by internalisation of external costs and also efficiency loss due to the use of scrubbers. Structural changes and fuel switching in the electricity sector result in significant reduction of emissions of both local pollution and CO 2 over the modelled time period. Strong decarbonisation impact of internalising local externalities suggests that ancillary benefits can be expected from policies directly addressing other issues then CO 2 mitigation. Finally, the detailed analysis of the total generation cost of different technologies points out that inclusion of external cost in the price of electricity increases competitiveness of non-fossil generation sources and fossil power plants with emission control

  14. External Costs as Driving Forces of Land Use Changes

    Directory of Open Access Journals (Sweden)

    Dirk Loehr

    2010-04-01

    Full Text Available Land conversion is often not carried out in a sustainable way. The loss of arable land and biodiversity, concern about food security and rising costs of infrastructure due to urban sprawl are just some of the problems under discussion. This paper compares Germany, China and Cambodia. The article points out that, despite huge differences in institutions and governance, unsustainable land use changes mostly have some patterns in common: The beneficiaries of land conversion are often well-organized actors, whereas the costs of land conversion are often shifted to poorly organized groups and to society as a whole. A sustainable land use policy has to look for a better coupling of benefits and costs of land use changes. In order to achieve this goal, the article suggests completing the planning law with a suitable economic framework.

  15. Generation choices as influenced by costs, risks and externalities -Germany

    International Nuclear Information System (INIS)

    Strauss, L.

    1994-01-01

    Power generation in Germany is dealing with social acceptability, cost considerations, governmental decisions and protection legislation. In the future, political and sociological factors will become more and more important: social acceptability of the energy sources choice is the most significant factor decision as the future pattern of power generation. (TEC)

  16. Pricing landfill externalities: Emissions and disamenity costs in Cape Town, South Africa

    International Nuclear Information System (INIS)

    Nahman, Anton

    2011-01-01

    Highlights: → The paper estimates landfill externalities associated with emissions, disamenities and transport. → Transport externalities vary from 24.22 to 31.42 Rands per tonne. → Costs of emissions (estimated using benefits transfer) vary from 0.07 to 28.91 Rands per tonne. → Disamenities (estimated using hedonic pricing) vary from 0.00 to 57.46 Rands per tonne. → Overall, external costs for urban landfills exceed those of a regional landfill. - Abstract: The external (environmental and social) costs of landfilling (e.g. emissions to air, soil and water; and 'disamenities' such as odours and pests) are difficult to quantify in monetary terms, and are therefore not generally reflected in waste disposal charges or taken into account in decision making regarding waste management options. This results in a bias against alternatives such as recycling, which may be more expensive than landfilling from a purely financial perspective, but preferable from an environmental and social perspective. There is therefore a need to quantify external costs in monetary terms, so that different disposal options can be compared on the basis of their overall costs to society (financial plus external costs). This study attempts to estimate the external costs of landfilling in the City of Cape Town for different scenarios, using the benefits transfer method (for emissions) and the hedonic pricing method (for disamenities). Both methods (in particular the process of transferring and adjusting estimates from one study site to another) are described in detail, allowing the procedures to be replicated elsewhere. The results show that external costs are currently R111 (in South African Rands, or approximately US$16) per tonne of waste, although these could decline under a scenario in which energy is recovered, or in which the existing urban landfills are replaced with a new regional landfill.

  17. The external costs of the nuclear fuel cycle: implementation in France

    International Nuclear Information System (INIS)

    Dreicer, M.; Tort, V.; Margerie, H.

    1995-08-01

    In 1991 the European Community and the US Department of Energy initiated a joint research project to assess the external costs of fuel cycles used to generate electricity. The intention of this project, called the EC-US External Costs of Fuel Cycles Project (ECFC), was to develop a conceptual approach, consistent methodology and identify future research in the assessment of the externalities. A second phase of the project continued in Europe (with a new name ''ExternE'') and expanded to include the implementation of the consistent methodology in various EC countries. This report presents the final results of the French Implementation for the nuclear fuel cycle. (author). 37 refs., 11 figs., 24 tabs

  18. The external costs of the nuclear fuel cycle: implementation in France

    Energy Technology Data Exchange (ETDEWEB)

    Dreicer, M.; Tort, V.; Margerie, H.

    1995-08-01

    In 1991 the European Community and the US Department of Energy initiated a joint research project to assess the external costs of fuel cycles used to generate electricity. The intention of this project, called the EC-US External Costs of Fuel Cycles Project (ECFC), was to develop a conceptual approach, consistent methodology and identify future research in the assessment of the externalities. A second phase of the project continued in Europe (with a new name ``ExternE``) and expanded to include the implementation of the consistent methodology in various EC countries. This report presents the final results of the French Implementation for the nuclear fuel cycle. (author). 37 refs., 11 figs., 24 tabs.

  19. 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

  20. Internalizing the external costs of biogas supply chains in the Italian energy sector

    International Nuclear Information System (INIS)

    Patrizio, P.; Leduc, S.; Chinese, D.; Kraxner, F.

    2017-01-01

    In Italy biogas support schemes are being revised to include subsidies for the production of biomethane. Energy policies should foster environmentally optimal solutions, especially because social acceptance issues often arise in the case of biogas. In this paper we use the external cost methodology to quantify the environmental impact of airborne emissions associated with biogas-based energy vectors and their corresponding fossil substitutes These are evaluated at supply chain level and incorporated in a spatially explicit optimization model. The method is applied to northern Italy to compare the potential impact of alternative policy options. It is found that, while the external costs of biogas-based pathways are always lower than corresponding fossil fuel based pathways, the differences are generally so small that policies based on internalization of external costs alone would not lead to further development of biogas-based technologies. For all utilization pathways, consideration of local externalities leads to a less favourable evaluation of biogas-based technologies, which results in external costs even higher than the substituted fossil fuel if biogas is allocated to local heating. - Highlights: • A MILP model has been developed to optimize the economic and environmental performance of the biogas supply chain. • The external costs methodology has been included in the optimization process. • The emissions of the most relevant pollutants generated along the supply chain have been included in the assessment. • Different biogas utilization pathways have been considered.

  1. Treatment of cervical carcinoma by total hysterectomy and postoperative external irradiation

    International Nuclear Information System (INIS)

    Papavasiliou, C.; Yiogarakis, D.; Pappas, J.; Keramopoulos, A.

    1980-01-01

    The survival rates of 36 patients with early cervical carcinoma who had undergone total hysterectomy and bilateral salpingoophorectomy (THBSO) were compared to the survival rates of 41 patients who were subjected to the radical operation. As an integral part of their therapy both groups postoperatively received adequate doses of external beam supervoltage irradiation. Satisfactory results were obtained in both groups of patients. According to these results THBSO followed by postoperative radiotherapy is adequate treatment for early cervical carcinoma. In comparison to the radical operation or curietherapy alone this type of treatment has the advantage of requiring less surgical or radiotherapeutic expertise; it probably is associated with less morbidity

  2. The External Cost Evaluation of the Nuclear Severe Accident Using CVM

    International Nuclear Information System (INIS)

    Lee, Yong Suk; Lee, Byung Chul

    2006-01-01

    The external cost of energy can be defined as 'the cost not included in the energy market price', such as air pollution, noise, etc. Within the evaluation of the external cost of nuclear energy, the estimation of the external cost of severe accident is one of the major topics to be addressed. For the evaluation of the external cost of severe accident, the effect of risk aversion of the public against the severe accident must be addressed, because people are more concerned about low probability - high consequence events than about high probability - low consequence events having the same mean damage. It is generally recognized that there is a discrepancy between the social acceptability of the risk and the average monetary value which corresponds in principle to the compensation of the consequences for each individual of the population affected by the accident. In this paper, the CVM (Contingent Valuation Method) is used to integrate the risk aversion in the external costs of nuclear severe accidents in Korea

  3. Pricing landfill externalities: emissions and disamenity costs in Cape Town, South Africa.

    Science.gov (United States)

    Nahman, Anton

    2011-01-01

    The external (environmental and social) costs of landfilling (e.g. emissions to air, soil and water; and 'disamenities' such as odours and pests) are difficult to quantify in monetary terms, and are therefore not generally reflected in waste disposal charges or taken into account in decision making regarding waste management options. This results in a bias against alternatives such as recycling, which may be more expensive than landfilling from a purely financial perspective, but preferable from an environmental and social perspective. There is therefore a need to quantify external costs in monetary terms, so that different disposal options can be compared on the basis of their overall costs to society (financial plus external costs). This study attempts to estimate the external costs of landfilling in the City of Cape Town for different scenarios, using the benefits transfer method (for emissions) and the hedonic pricing method (for disamenities). Both methods (in particular the process of transferring and adjusting estimates from one study site to another) are described in detail, allowing the procedures to be replicated elsewhere. The results show that external costs are currently R111 (in South African Rands, or approximately US$16) per tonne of waste, although these could decline under a scenario in which energy is recovered, or in which the existing urban landfills are replaced with a new regional landfill. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

    Ottinger, R.L.

    1990-01-01

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

  5. Pesticide Environmental Accounting: a method for assessing the external costs of individual pesticide applications.

    Science.gov (United States)

    Leach, A W; Mumford, J D

    2008-01-01

    The Pesticide Environmental Accounting (PEA) tool provides a monetary estimate of environmental and health impacts per hectare-application for any pesticide. The model combines the Environmental Impact Quotient method and a methodology for absolute estimates of external pesticide costs in UK, USA and Germany. For many countries resources are not available for intensive assessments of external pesticide costs. The model converts external costs of a pesticide in the UK, USA and Germany to Mediterranean countries. Economic and policy applications include estimating impacts of pesticide reduction policies or benefits from technologies replacing pesticides, such as sterile insect technique. The system integrates disparate data and approaches into a single logical method. The assumptions in the system provide transparency and consistency but at the cost of some specificity and precision, a reasonable trade-off for a method that provides both comparative estimates of pesticide impacts and area-based assessments of absolute impacts.

  6. Scale Economies and Industry Agglomeration Externalities: A Dynamic Cost Function Approach

    OpenAIRE

    Donald S. Siegel; Catherine J. Morrison Paul

    1999-01-01

    Scale economies and agglomeration externalities are alleged to be important determinants of economic growth. To assess these effects, the authors outline and estimate a microfoundations model based on a dynamic cost function specification. This model provides for the separate identification of the impacts of externalities and cyclical utilization on short- and long-run scale economies and input substitution patterns. The authors find that scale economies are prevalent in U.S manufacturing; co...

  7. Cost of generating tritium internal and external to a tokamak hybrid reactor

    International Nuclear Information System (INIS)

    Crotzer, M.E.; Heck, F.M.; Steinke, K.C.

    1981-01-01

    The costs associated with producing tritium internal and external to a thorium-based tokamak hybrid are estimated for a number of scenarios and the resulting impact on the symbiotic system cost of electricity calculated. For tritium generation within the hybrid, both continuous and batch production is analyzed. For external production, the lithium-bearing blanket is replaced with thorium and the tritium is generated in the client fission reactors. Continuous tritium production within the hybrid is found to increase the cost of electricity from 1.4 to 4.0 mills/kW-h. Batch tritium production can increase the cost of electricity by 10 mills/kW-h. Producing tritium outside the hybrid, and thereby enhancing client support, increases the cost of electricity from 1.8 to 4.1 mills/kW-h

  8. Measuring the environmental benefits of hydrogen transportation fuel cycles under uncertainty about external costs

    International Nuclear Information System (INIS)

    Chernyavs'ka, Liliya; Gulli, Francesco

    2010-01-01

    In this paper, we attempt to measure the environmental benefits of hydrogen deployment in the transportation sector. We compare the hydrogen pathways to the conventional transportation fuel cycles in terms of external costs, estimated using the results of the most accurate methodologies available in this field. The central values of performed analysis bring us ambiguous results. The external cost of the best conventional solution ('oil to diesel hybrid internal-combustion engine') in some cases is just higher and in others just lower than that of the best fossil fuel to hydrogen solution ('natural gas to hydrogen fuel cell'). Nevertheless, by accounting for the uncertainty about external costs, we are able to remove this ambiguity highlighting that the hydrogen pathway provides significant environmental benefits ,especially in densely populated areas, assuming 100% city driving.

  9. Estimation of environmental external costs between coal fired power plant and nuclear power plant

    International Nuclear Information System (INIS)

    Moon, G. H.; Kim, S. S.

    2000-01-01

    First of all, this study evaluated the impacts on the health and the environment of air pollutants emitted from coal power plant and nuclear power pant, two major electric power generating options in Korea. Then, the environmental external costs of those two options were estimated by transforming the health and environment impact into monetary values. To do this, AIRPACTS and Impacts of Atmospheric Release model developed by IAEA were used. The environmental external cost of Samcheonpo coal power plant was estimated about 25 times as much as that of Younggwang nuclear power plant. This result implies that nuclear power plant is a clean technology compared with coal power plant. This study suggests that the external cost should be reflected in the electric system expansion plan in order to allocate energy resources efficiently and to reduce economic impact stemming from the environmental regulation emerged recently on a global level

  10. External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hun; Kang, Hyun Gook [KAIST, Daejeon (Korea, Republic of)

    2016-05-15

    The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion.

  11. External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

    International Nuclear Information System (INIS)

    Lee, Sang Hun; Kang, Hyun Gook

    2016-01-01

    The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion

  12. Road user charges for heavy goods vehicles (HGV). Tables with external costs of air pollution

    Energy Technology Data Exchange (ETDEWEB)

    Skou Andersen, M.

    2013-02-15

    In this report, the European Environment Agency (EEA) presents updated estimates of the external costs of air pollution for different categories of heavy goods vehicles (HGVs). The amended Eurovignette Directive (2011/76/EU) relating to the charging of HGVs for use of major European motorways prescribes that from 2013, Member States may include air pollution costs in any charging structure for roads under the Trans-European Network (TEN-T) and for comparable domestic motorways. The tables published here provide the basis for the inclusion of a vehicle-specific air pollution component in road user charges. Air pollution costs have been calculated on the basis of the formula prescribed in the directive, taking into account the fact that road transport emissions are mixed in a low volume of air. Following Article 9 in the Eurovignette Directive, additional revenues from external-cost charges must be used by Member States to benefit the transport sector and promote sustainable mobility. Making use of scientific developments subsequent to the 2007 Handbook of external costs (Maibach et al., 2008), the EEA is able to provide an updated estimate of the external costs of air pollution from road transport. The tables in this report indicate for each country and for the relevant vehicle categories, estimates of the external costs of air pollution in 2010 prices. The high level of detail gives member countries an informed basis to group the vehicle categories for administrative purposes. The tables also include estimates for three non-EU member countries of the EEA, of which one (Switzerland) pioneered the first HGV road user charge in Europe. (LN)

  13. Pesticide Environmental Accounting: A method for assessing the external costs of individual pesticide applications

    International Nuclear Information System (INIS)

    Leach, A.W.; Mumford, J.D.

    2008-01-01

    The Pesticide Environmental Accounting (PEA) tool provides a monetary estimate of environmental and health impacts per hectare-application for any pesticide. The model combines the Environmental Impact Quotient method and a methodology for absolute estimates of external pesticide costs in UK, USA and Germany. For many countries resources are not available for intensive assessments of external pesticide costs. The model converts external costs of a pesticide in the UK, USA and Germany to Mediterranean countries. Economic and policy applications include estimating impacts of pesticide reduction policies or benefits from technologies replacing pesticides, such as sterile insect technique. The system integrates disparate data and approaches into a single logical method. The assumptions in the system provide transparency and consistency but at the cost of some specificity and precision, a reasonable trade-off for a method that provides both comparative estimates of pesticide impacts and area-based assessments of absolute impacts. - A method to estimate the external costs of a pesticide application based on the ecotoxicology, environmental behaviour and application rate of an active ingredient

  14. 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

  15. Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: External humidifier versus heat and moisture exchanger

    NARCIS (Netherlands)

    Mérol, Jean-Claude; Charpiot, Anne; Langagne, Thibault; Hémar, Patrick; Ackerstaff, Annemieke H.; Hilgers, Frans J. M.

    2012-01-01

    Objectives/Hypothesis: Assessment of immediate postoperative airway humidification after total laryngectomy (TLE), comparing the use of an external humidifier (EH) with humidification through a heat and moisture exchanger (HME). Study Design: Randomized controlled trial (RCT). Methods: Fifty-three

  16. Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: external humidifier versus heat and moisture exchanger

    NARCIS (Netherlands)

    Mérol, J.-C.; Charpiot, A.; Langagne, T.; Hémar, P.; Ackerstaff, A.H.; Hilgers, F.J.M.

    2012-01-01

    Objectives/Hypothesis: Assessment of immediate postoperative airway humidification after total laryngectomy (TLE), comparing the use of an external humidifier (EH) with humidification through a heat and moisture exchanger (HME). Study Design: Randomized controlled trial (RCT). Methods: Fifty-three

  17. Effects of internalising external production costs in a North European power market

    International Nuclear Information System (INIS)

    Munksgaard, J.; Ramskov, J.

    2002-01-01

    The aim of integrating national power markets is to improve the overall efficiency thereby making a potential for reducing electricity prices. However, efficiency is not necessarily improved if external environmental protection costs are neglected. In this paper, we analyse the effects of regulating an integrated power market by using environmental producer taxes based on external production costs. The analysis is based on an empirical equilibrium model for the North European power market. The results show that internalising costs will increase electricity producer prices by 40-50% in the period from 1995 to 2020. Further, demand for electricity will be reduced by 10%. We conclude, however, that in order to achieve the national Kyoto targets of reducing CO 2 emissions, further regulation is needed, such as national CO 2 taxes or cost efficient mechanisms like tradeable permits and joint implementation. (author)

  18. Evaluation of Externality Costs in Life-Cycle Optimization of Municipal Solid Waste Management Systems

    DEFF Research Database (Denmark)

    Martinez Sanchez, Veronica; Levis, James W.; Damgaard, Anders

    2017-01-01

    The development of sustainable solid waste management (SWM) systems requires consideration of both economic and environmental impacts. Societal life-cycle costing (S-LCC) provides a quantitative framework to estimate both economic and environmental impacts, by including "budget costs...... suburban U.S. county of 500 000 people generating 320 000 Mg of waste annually. Estimated externality costs are based on emissions of CO2, CH4, N2O, PM2.5, PM10, NOx, SO2, VOC, CO, NH3, Hg, Pb, Cd, Cr (VI), Ni, As, and dioxins. The results indicate that incorporating S-LCC into optimized SWM strategy...... development encourages the use of a mixed waste material recovery facility with residues going to incineration, and separated organics to anaerobic digestion. Results are sensitive to waste composition, energy mix and recycling rates. Most of the externality costs stem from SO2, NOx, PM2.5, CH4, fossil CO2...

  19. Methodology of social and environmental external costs estimation in the Ukraine’s energy sector

    Directory of Open Access Journals (Sweden)

    Karaieva Nataliia Veniaminivna

    2016-09-01

    Full Text Available Paper objective is analysis of the external costs assessment model for the eco-social damage, and/or human capital losses caused by environmental pollution from the energy enterprises in Ukraine. Using the given method, necessary initial socio-economic parameters were defined and used for calculating the social costs of capital health losses in Ukraine due to deterioration of the environment, and due to the negative impact of energy sector on the air quality for the period 2002-2013. On the proposed technique determines the range value of social losses due to the negative impact of energy on air quality in Ukraine excluding future external costs for years 2002 – 2013 ranges from 1.6 – 4.5% of GDP, and the range of values of taking into account future costs is 2.0 – 6.2% of GDP.

  20. Assessment of health-cost externalities of air pollution at the national level using the EVA model system. CEEH scientific report no. 3

    Energy Technology Data Exchange (ETDEWEB)

    Brandt, J.; Silver, J.D.; Christensen, Jesper H. (and others)

    2011-03-15

    Air pollution has significant negative impacts on human health and well-being, which entail substantial economic consequences. We have developed an integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors. The EVA system was initially developed to assess externalities from power production, but in this study it is extended to evaluate external costs at the national level from all major emission sectors. The essential idea behind the EVA system is that state-of-the-art scientific methods are used in all the individual parts of the impact-pathway chain and to make the best scientific basis for sound political decisions with respect to emission control. In this report, we estimate the impacts and total health-related external costs from the main emission sectors in Denmark, represented by the 10 major SNAP (Selected Nomenclature for Sources of Air Pollution); categories as well as all emission sectors simultaneously. Besides these major categories, we assess the external costs from international ship traffic, since this sector is an important contributor to air pollution in Denmark. Furthermore, we assess the impacts and externalities of all emissions from the Northern Hemisphere simultaneously (including natural emissions) to estimate the total health-related external costs from the total air pollution levels in Europe, and these results are compared to similar results obtained in the Clean Air For Europe (CAFE) project. Both for international ship traffic and for the total air pollution levels, results are presented for present and future conditions, represented by the years 2000, 2007, 2011 and 2020. The major results and conclusions concerning external costs within Denmark can be summarised as follows: 1) The main emission sectors in Denmark contributing to health-related external costs in Denmark

  1. 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.

  2. Climate change in the framework of external costs of energy systems

    International Nuclear Information System (INIS)

    Mayerhofer, P.

    1994-01-01

    Due to the continuing controversies concerning external costs of energy systems, the Commission of the European Union and the US-Department of Energy initiated a common project, External Costs of Fuel Cycles. The purpose of this project is to develop methodologies for the assessment of site-specific external costs on a marginal basis using a damage-function approach. For the assessment of climate change itself physical models are available. Here, the PC-model IMAGE developed by RIVM has been used for the time period up to 2100. Beyond this year, the carbon cycle is modeled with a response function. For the derivation of damage costs, a linear relationship between the global temperature change and the damage costs has been assumed. Thus, damage costs in the range of 0.10 to 0.53 US-cents/kWh for a discount rate of 3% are assessed for typical German fossil energy systems. The highest uncertainties are attached to the discount rate, the range for the climate sensitivity, and the forms of the global warming damage function. These points also have the strongest influence on the results. Hence, future research should be directed to the further analysis of these points. 30 refs., 5 figs., 5 tabs

  3. External costs in the global energy optimization models. A tool in favour of sustain ability

    International Nuclear Information System (INIS)

    Cabal Cuesta, H.

    2007-01-01

    The aim of this work is the analysis of the effects of the GHG external costs internalization in the energy systems. This may provide a useful tool to support decision makers to help reaching the energy systems sustain ability. External costs internalization has been carried out using two methods. First, CO 2 externalities of different power generation technologies have been internalized to evaluate their effects on the economic competitiveness of these present and future technologies. The other method consisted of analysing and optimizing the global energy system, from an economic and environmental point of view, using the global energy optimization model generator, TIMES, with a time horizon of 50 years. Finally, some scenarios regarding environmental and economic strategic measures have been analysed. (Author)

  4. Estimating the Costs and Benefits of EMU : The Impact of External Shocks on Labour Markets

    NARCIS (Netherlands)

    Belke, A.; Gros, D.

    1997-01-01

    Discussions of the economic costs and benefits of EMU usually take as their basis the optimum currency area (OCA) approach. This approach starts from the premise that when an external shock hits the economy, it is easier to adjust the exchange rate than domestic prices or wages. Most economists

  5. A geographically resolved method to estimate levelized power plant costs with environmental externalities

    International Nuclear Information System (INIS)

    Rhodes, Joshua D.; King, Carey; Gulen, Gürcan; Olmstead, Sheila M.; Dyer, James S.; Hebner, Robert E.; Beach, Fred C.; Edgar, Thomas F.; Webber, Michael E.

    2017-01-01

    In this analysis we developed and applied a geographically-resolved method to calculate the Levelized Cost of Electricity (LCOE) of new power plants on a county-by-county basis while including estimates of some environmental externalities. We calculated the LCOE for each county of the contiguous United States for 12 power plant technologies. The minimum LCOE option for each county varies based on local conditions, capital and fuel costs, environmental externalities, and resource availability. We considered ten scenarios that vary input assumptions. We present the results in a map format to facilitate comparisons by fuel, technology, and location. For our reference analysis, which includes a cost of $62/tCO_2 for CO_2 emissions natural gas combined cycle, wind, and nuclear are most often the lowest-LCOE option. While the average cost increases when internalizing the environmental externalities (carbon and air pollutants) is small for some technologies, the local cost differences are as high as $0.62/kWh for coal (under our reference analysis). These results display format, and online tools could serve as an educational tool for stakeholders when considering which technologies might or might not be a good fit for a given locality subject to system integration considerations. - Highlights: • We propose a method to add externalities to LCOE. • We present the least cost technology for every county in the US. • The cheapest technology depends on many characteristics of that locale. • We present online tools for users to change our assumptions. • Our tools are useful in discussing the impact of policy on the cost of electricity.

  6. A comparison of two methods for estimating the technical costs of external beam radiation therapy

    International Nuclear Information System (INIS)

    Hayman, James A.; Lash, Kathy A.; Tao, May L.; Halman, Marc A.

    2000-01-01

    Purpose: To accurately assess the cost-effectiveness of treatment with external beam radiation, it is necessary to have accurate estimates of its cost. One of the most common methods for estimating technical costs has been to convert Medicare charges into costs using Medicare Cost-to-Charge Ratios (CCR). More recently, health care organizations have begun to invest in sophisticated cost-accounting systems (CAS) that are capable of providing procedure-specific cost estimates. The purpose of this study was to examine whether these competing approaches result in similar cost estimates for four typical courses of external beam radiation therapy (EBRT). Methods and Materials: Technical costs were estimated for the following treatment courses: 1) a palliative 'simple' course of 10 fractions using a single field without blocks; 2) a palliative 'complex' course of 10 fractions using two opposed fields with custom blocks; 3) a curative course of 30 fractions for breast cancer using tangent fields followed by an electron beam boost; and 4) a curative course of 35 fractions for prostate cancer using CT-planning and a 4-field technique. Costs were estimated using the CCR approach by multiplying the number of units of each procedure billed by its Medicare charge and CCR and then summing these costs. Procedure-specific cost estimates were obtained from a cost-accounting system, and overall costs were then estimated for the CAS approach by multiplying the number of units billed by the appropriate unit cost estimate and then summing these costs. All costs were estimated using data from 1997. The analysis was also repeated using data from another academic institution to estimate their costs using the CCR and CAS methods, as well as the appropriate relative value units (RVUs) and conversion factor from the 1997 Medicare Fee Schedule to estimate Medicare reimbursement for the four treatment courses. Results: The estimated technical costs for the CCR vs. CAS approaches for the four

  7. External-beam boost prior to total-body irradiation in relapsed NHL transplant patients

    Energy Technology Data Exchange (ETDEWEB)

    Monson, Jedidiah M; Neuberg, Donna; Freedman, Arnold S; Tarbell, Nancy J; Nadler, Lee M; Mauch, Peter

    1995-07-01

    PURPOSE: To determine the impact of an external beam boost (EBB) on the outcome, relapse pattern and normal tissue toxicities of patients undergoing total-body irradiation (TBI) prior to bone marrow transplantation (BMT) for relapsed NHL. MATERIALS AND METHODS: Between 1982 and 1994, 299 patients at our institution underwent BMT for relapsed NHL. Patients underwent induction chemotherapy (CT) followed by conditioning with cyclophosphamide and 12 Gy TBI delivered in 6 fractions over 3 days. A total of 77 patients had persistent gross disease, defined as 2 cm or greater, after induction CT and received an EBB prior to BMT (EBB cohort). The median EBB dose was 28.8 Gy (range, 5-63), the median field size was 13 cm{sup 2} (range, 5-29.4) and the median time from EBB to BMT was 3 weeks (range, 1-20). A total of 222 patients were free of measurable disease or had disease measuring <2cm after CT and did not receive EBB (no-EBB cohort). To assess normal tissue toxicity, patients' simulation films and/or treatment records were reviewed for all 77 patients treated with local EBB and estimates were made of the percentage lung, heart and kidney in the radiation field. RESULTS: A total of 79 of 222 patients (36%) in the no-EBB cohort have relapsed; 33 of 77 patients (43%) in the EBB cohort have relapsed (p=0.28, by Fisher exact test). Median time to relapse after BMT was 54 months for the no-EBB cohort and 38 months for the EBB cohort (p=0.26, by log-rank test). The 3-year actuarial freedom from relapse (deaths in remission censored) was 59% for the no-EBB cohort (90% CI: 52-66%) and 51% for the EBB cohort (90% CI: 40-62%). Data on site of relapse was available for 101 of the 112 relapses (75 no-EBB, 26 EBB). For the no-EBB cohort 33 of 75 relapses (44%) were in sites of prior nodal disease only. For the EBB cohort, 12 of 26 relapses (46%) were in sites of prior nodal disease only, of these, only 6 (23%) were within the EBB treatment field. A total of 26 patients had thoracic

  8. The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

    2018-02-21

    In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

  9. Impact Of Total Quality Management (TQM), Activity Based Costing ...

    African Journals Online (AJOL)

    Time (JIT), and Total Quality Management (TQM) as strategic initiatives lead to improved financial performance in the Turkish textile industry. Strong evidence emerged that there is a strong positive association between using ABC, JIT or TQM ...

  10. Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: external humidifier versus heat and moisture exchanger.

    Science.gov (United States)

    Mérol, Jean-Claude; Charpiot, Anne; Langagne, Thibault; Hémar, Patrick; Ackerstaff, Annemieke H; Hilgers, Frans J M

    2012-02-01

    Assessment of immediate postoperative airway humidification after total laryngectomy (TLE), comparing the use of an external humidifier (EH) with humidification through a heat and moisture exchanger (HME). Randomized controlled trial (RCT). Fifty-three patients were randomized into the standard (control) EH (N = 26) or the experimental HME arm (N = 27). Compliance, pulmonary and sleeping problems, patients' and nursing staff satisfaction, nursing time, and cost-effectiveness were assessed with trial-specific structured questionnaires and tally sheets. In the EH arm data were available for all patients, whereas in the HME arm data were incomplete for four patients. The 24/7 compliance rate in the EH arm was 12% and in the HME arm 87% (77% if the four nonevaluable patients are considered noncompliant). Compliance and patients' satisfaction were significantly better, and the number of coughing episodes, mucus expectoration for clearing the trachea, and sleeping disturbances were significantly less in the HME arm (P humidification by means of an HME over the use of an EH after TLE. This study therefore underlines that HMEs presently can be considered the better option for early postoperative airway humidification after TLE. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  11. HIGH ECCENTRICITY EOQ TOTAL COST FUNCTION YIELDS JIT RESULTs

    Directory of Open Access Journals (Sweden)

    Willian Roach

    2010-06-01

    Full Text Available No estoque de bens perecíveis, o custo de armazenamento H é muito maior do que o previsto na fórmula clássica do lote econômico do pedido (EOQ. Para bens perecíveis, a função custo total no EOQ é um pico e não uma reta horizontal. Esta forma pontiaguda leva o modelo EOQ a produzir entregas just in time (JIT - resultados semelhantes. O efeito pontiagudo (excentricidade da curva de custo total do lote econômico EOQ depende apenas do custo de armazenamento (H e não da demanda anual (D ou do custo do pedido (S. D e S determinam o nível (altura da curva de custo total do estoque (TC, mas não a forma.

  12. Sensitivity of total stress to changes in externally applied water pressure in KBS-3 buffer bentonite

    International Nuclear Information System (INIS)

    Harrington, J.F.; Birchall, D.J.

    2007-04-01

    In the current Swedish repository design concept, composite copper and steel canisters containing spent nuclear fuel will be placed in large diameter disposal boreholes drilled into the floor of the repository tunnels. The space around each canister will be filled with pre-compacted bentonite which over time will draw in the surrounding ground water and swell, closing up any construction joints. However, for the purposes of performance assessment, it is necessary to consider the effect of glacial loading of a future repository and its impact on the mechanical behaviour of the bentonite, in particular, the sensitivity of total stress to changes in porewater pressure (backpressure). Two experimental histories have been undertaken using a custom-designed constant volume and radial flow (CVRF) apparatus. In both tests backpressure was varied in a number of incremental and decremental cycles while total stress, porewater pressure and volumetric flow rate were continuously monitored. The swelling pressure of the buffer clay at dry densities of 1.8 Mg/m 3 and 1.61 Mg/m 3 was determined to be around 5.5 MPa and 7.2 MPa respectively. For initial ascending porewater pressure histories the average proportionality factor α ranged from 0.86 and 0.92. Data exhibited a general trend of increasing α with increasing backpressure. In test Mx80-11 this was supported by analysis of the water inflow data which indicated a reduction in system compressibility. Asymptotic values of porewater pressure within the clay are in good agreement with externally applied backpressure values. Inspection of data provides no evidence for the development of hydraulic thresholds within the clay, subject to the boundary conditions of this test geometry. Analysis of the stress data demonstrates significant hysteresis between ascending and descending porewater pressure histories. The amount of hysteresis appears to be linked to the magnitude of the backpressure applied to the specimen, suggesting some

  13. Sensitivity of total stress to changes in externally applied water pressure in KBS-3 buffer bentonite

    Energy Technology Data Exchange (ETDEWEB)

    Harrington, J.F.; Birchall, D.J. [British Geological Survey, Chemical and Biological Hazards Programme, Kingsley Dunham Centre (United Kingdom)

    2007-04-15

    In the current Swedish repository design concept, composite copper and steel canisters containing spent nuclear fuel will be placed in large diameter disposal boreholes drilled into the floor of the repository tunnels. The space around each canister will be filled with pre-compacted bentonite which over time will draw in the surrounding ground water and swell, closing up any construction joints. However, for the purposes of performance assessment, it is necessary to consider the effect of glacial loading of a future repository and its impact on the mechanical behaviour of the bentonite, in particular, the sensitivity of total stress to changes in porewater pressure (backpressure). Two experimental histories have been undertaken using a custom-designed constant volume and radial flow (CVRF) apparatus. In both tests backpressure was varied in a number of incremental and decremental cycles while total stress, porewater pressure and volumetric flow rate were continuously monitored. The swelling pressure of the buffer clay at dry densities of 1.8 Mg/m{sup 3} and 1.61 Mg/m{sup 3} was determined to be around 5.5 MPa and 7.2 MPa respectively. For initial ascending porewater pressure histories the average proportionality factor {alpha} ranged from 0.86 and 0.92. Data exhibited a general trend of increasing {alpha} with increasing backpressure. In test Mx80-11 this was supported by analysis of the water inflow data which indicated a reduction in system compressibility. Asymptotic values of porewater pressure within the clay are in good agreement with externally applied backpressure values. Inspection of data provides no evidence for the development of hydraulic thresholds within the clay, subject to the boundary conditions of this test geometry. Analysis of the stress data demonstrates significant hysteresis between ascending and descending porewater pressure histories. The amount of hysteresis appears to be linked to the magnitude of the backpressure applied to the specimen

  14. External costs of cadmium emissions to soil: a drawback of phosphorus fertilizers

    DEFF Research Database (Denmark)

    Pizzol, Massimo; C.R. Smart, James; Thomsen, Marianne

    2014-01-01

    are exposed to cadmium through their diet causing potential adverse health impacts. Future scenarios for cadmium emissions to soil via agricultural applications of inorganic and organic fertilizers in Denmark were defined. A simplified fate and speciation model allowed the increase in soil cadmium......Abstract: In this study the Impact-Pathway Approach methodology was applied for monetary valuation of health impacts due to cadmium emitted to soil as a micro-pollutant present in phosphorus fertilizers. Due to the high persistency of cadmium in soil, and high soil-to-plant transfer rates, humans...... ammonium phosphate) and mineral fertilizer produced the lowest external health costs, followed by the fertilizer products wastewater sludge and pig manure. The external cost estimates produced in this study could be used to design economic policy instruments to encourage use of cleaner fertilizer products....

  15. External cost of coal based electricity generation:A tale of Ahmedabad city

    DEFF Research Database (Denmark)

    Mahapatra, Diptiranjan; Shukla, Priyadarshi; Dhar, Subash

    2012-01-01

    Electricity production causes unintended impacts.Theire xclusion by the market leads to suboptimal resource allocations.Monetizing and internalizing of external costs, though challenging and debatable, leads to a better allocation of economic resources and welfare. In this paper, a life-cycle ana......Electricity production causes unintended impacts.Theire xclusion by the market leads to suboptimal resource allocations.Monetizing and internalizing of external costs, though challenging and debatable, leads to a better allocation of economic resources and welfare. In this paper, a life......–response functions, we make an attempt to estimate the damages to human health, crops, and building materials resulting from the operation of coal power plants and its associated mines. Further, we use geographic information system to account for spatially dependent data. Finally, monetary values have been assigned...

  16. External cost of coal based electricity generation: A tale of Ahmedabad city

    International Nuclear Information System (INIS)

    Mahapatra, Diptiranjan; Shukla, Priyadarshi; Dhar, Subash

    2012-01-01

    Electricity production causes unintended impacts. Their exclusion by the market leads to suboptimal resource allocations. Monetizing and internalizing of external costs, though challenging and debatable, leads to a better allocation of economic resources and welfare. In this paper, a life-cycle analysis (LCA) on the production of electricity from conventional coal based electricity generation system has been performed in order to examine the environmental impacts of coal based electricity generating systems in the twin-city of Ahmedabad and Gandhinagar in western India. By using dose–response functions, we make an attempt to estimate the damages to human health, crops, and building materials resulting from the operation of coal power plants and its associated mines. Further, we use geographic information system to account for spatially dependent data. Finally, monetary values have been assigned to estimate the damage to human health, crops and building materials. This study reveals that the health as well as on non-health impacts of air pollution resulting from coal based electricity generation may not be ignored both in absolute as well as economic value terms. Highlights: ► External cost from coal power generating systems has been calculated. ► We use LCA approach to monetize externalities. ► Geographic information software has been used to account for spatially dependent data. ► This study monetizes damages only to human health, crops, and building materials. ► We finally recommend policy directions to arrest this externality.

  17. External costs of the nuclear fuel cycle. A scoping study to determine the external costs of the Dutch nuclear fuel cycle in accordance with the EC/US methodology

    Energy Technology Data Exchange (ETDEWEB)

    Dodd, D H

    1995-10-01

    This report describes the results of a scoping study to estimate the external costs of the Dutch nuclear fuel cycle. This study was performed within the framework of the Commission of the European Community`s External Costs of Fuel Cycles project. The external costs of a fuel cycle are those costs which are excluded from the standard calculation of the cost of electricity. These costs are borne by society as a whole and include, in particular, the health and environmental costs which result from the operation of the facilities involved in a given fuel cycle. At present the uranium enrichment, electricity generation and interim storage stages of the nuclear fuel cycle take place in the Netherlands. These stages of the Dutch nuclear fuel cycle have been studied in detail and the external costs associated with thse stages estimated using up-to-date site specific data. The other stages of the Dutch nuclear fuel cycle do not currently take place in the Netherlands. In general the external costs associated with these stages have been estimated using data from the literature. Relatively few transports of radioactive materials associated with the Dutch nuclear fuel cycle take place in the Netherlands and the external costs associated with all transports has been based on values in the literature. (orig.).

  18. External costs of the nuclear fuel cycle. A scoping study to determine the external costs of the Dutch nuclear fuel cycle in accordance with the EC/US methodology

    International Nuclear Information System (INIS)

    Dodd, D.H.

    1995-10-01

    This report describes the results of a scoping study to estimate the external costs of the Dutch nuclear fuel cycle. This study was performed within the framework of the Commission of the European Community's External Costs of Fuel Cycles project. The external costs of a fuel cycle are those costs which are excluded from the standard calculation of the cost of electricity. These costs are borne by society as a whole and include, in particular, the health and environmental costs which result from the operation of the facilities involved in a given fuel cycle. At present the uranium enrichment, electricity generation and interim storage stages of the nuclear fuel cycle take place in the Netherlands. These stages of the Dutch nuclear fuel cycle have been studied in detail and the external costs associated with thse stages estimated using up-to-date site specific data. The other stages of the Dutch nuclear fuel cycle do not currently take place in the Netherlands. In general the external costs associated with these stages have been estimated using data from the literature. Relatively few transports of radioactive materials associated with the Dutch nuclear fuel cycle take place in the Netherlands and the external costs associated with all transports has been based on values in the literature. (orig.)

  19. Weighing the costs: Implementing the SLMTA programme in Zimbabwe using internal versus external facilitators

    Directory of Open Access Journals (Sweden)

    Edwin Shumba

    2014-11-01

    Objectives: To evaluate the financial costs of SLMTA implementation using two models (external facilitators; and internal local or MoHCW facilitators from the perspective of the implementing partner and to estimate resources needed to scale up the programme nationally in all 10 provinces. Methods: The average expenditure per laboratory was calculated based on accounting records; calculations included implementing partner expenses but excluded in-kind contributions and salaries of local facilitators and trainees. We also estimated theoretical financial costs, keeping all contextual variables constant across the two models. Resource needs for future national expansion were estimated based on a two-phase implementation plan, in which 12 laboratories in each of five provinces would implement SLMTA per phase; for the internal facilitator model, 20 facilitators would be trained at the beginning of each phase. Results: The average expenditure to implement SLMTA in 11 laboratories using external facilitators was approximately US$5800 per laboratory; expenditure in 19 laboratories using internal facilitators was approximately $6000 per laboratory. The theoretical financial cost of implementing a 12-laboratory SLMTA cohort keeping all contextual variables constant would be approximately $58 000 using external facilitators; or $15 000 using internal facilitators, plus $86 000 to train 20 facilitators. The financial cost for subsequent SLMTA cohorts using the previously-trained internal facilitators would be approximately $15 000, yielding a break-even point of 2 cohorts, at $116 000 for either model. Estimated resources required for national implementation in 120 laboratories would therefore be $580 000 using external facilitators ($58 000 per province and $322 000 using internal facilitators ($86 000 for facilitator training in each of two phases plus $15 000 for SLMTA implementation in each province. Conclusion: Investing in training of internal facilitators will

  20. Evaluating external costs of human health and environmental impacts using IAEA model SIMPACTS

    International Nuclear Information System (INIS)

    Bobric, Elena; Jelev, Adrian

    2005-01-01

    SIMPACTS (Simplified Approach for Estimating Impacts and External Costs of Electricity Generation) model developed at the International Atomic Energy Agency is a powerful and convenient tool for evaluating external costs induced by different energy sources. The model was developed for industrial countries and for developing countries as well where studies of alternatives of sustainable energy policies are conducted. The SIMPACTS allow the decision making factors involved in energy policy to have reasonable estimates of environment impacts and relating costs appealing to a rather low number of input parameters. The paper aims at analyzing by means of SIMPACTS the environmental impact produced by Cernavoda NPP operation in two cases: a) the impact of the Cernavoda NPP itself; b) the impact of an hypothetical coal based power plant of the same power level and located on the Cernavoda NPP site. The SIMPACTS modules AIRPACTS and NUCPACTS were applied to assess the impacts on human health, agricultural crops and building materials from exposure to routine atmospheric emissions and as well to quantify and value the adverse effects on human health due to routine atmospheric release of radionuclides from the NPP, via radioactive waste ground disposal or resulting from accidents in nuclear facility, respectively. The conclusion of this study based on SIMPACTS model application to assess the health effects and damage cost per year is that the Cernavoda NPP presents the lower health effects and damage cost comparing with power plants of other types

  1. Assessment of external costs for transport project evaluation: Guidelines in some European countries

    Energy Technology Data Exchange (ETDEWEB)

    Petruccelli, Umberto, E-mail: umberto.petruccelli@unibas.it

    2015-09-15

    Many studies about the external costs generated by the transport system have been developed in the last twenty years. To standardize methodologies and assessment procedures to be used in the evaluation of the projects, some European countries recently have adopted specific guidelines that differ from each other in some aspects even sensibly. This paper presents a critical analysis of the British, Italian and German guidelines and is aimed at cataloguing the external cost types regarded and the assessment methods indicated as well as to highlight the differences of the results, in terms of applicability and reliability. The goal is to contribute to a European standardization process that would lead to the drafting of guidelines suited for all EU countries. - Highlights: • The analyzed guidelines agree on the methods to evaluate costs from air pollution, greenhouse gases and accidents. • They recommend respectively: dose-resp. approach; costs to reduce/permit emissions; whole direct, indirect and social costs. • For noise, DE guide indicates defensive expenditure or SP methods; IT guide, SP method; UK guide, the hedonic prices one. • For on territory impact, DE guide regards only the barrier effect; the IT one, also the soil consumption and system effects. • British guide proposes a qualitative methodology to estimate the impact on various landscapes and environments.

  2. Exploring Eco-Costs and Externalities Absorption Policies and Procedures in the Context of Global Warming

    Directory of Open Access Journals (Sweden)

    Gina Raluca Guse

    2011-06-01

    Full Text Available A set of recent international studies reveal the scarcity of coherent entity-level estimation systems able to lead to an adequate identification and valuation of social and environmental performance, despite the large number of entities claiming their concern for the environmental impact of their business activities.The status quo is mainly caused by the lack of domain-specific accounting regulation, along with a general "information gap" in the field of the potential benefits eco-costs and externalities absorption may generate. Eco-costs and externalities absorption technologies for the costing model are still going through their experimental stages, aiming to reflect both the historicalpolitical context and the philosophical motivations of an organization's management and stakeholders. We held as appropriate (and the paper at hand will speak for the intent to promote this class of technologies for the Romanianbusiness environment, mainly by reviewing the relevant literature in the field and developing an eco-costing model able to provide cost levels consistent with the sustainable development goals.

  3. Internalisation of external costs in the Polish power generation sector: A partial equilibrium model

    International Nuclear Information System (INIS)

    Kudelko, Mariusz

    2006-01-01

    This paper presents a methodical framework, which is the basis for the economic analysis of the mid-term planning of development of the Polish energy system. The description of the partial equilibrium model and its results are demonstrated for different scenarios applied. The model predicts the generation, investment and pricing of mid-term decisions that refer to the Polish electricity and heat markets. The current structure of the Polish energy sector is characterised by interactions between the supply and demand sides of the energy sector. The supply side regards possibilities to deliver fuels from domestic and import sources and their conversion through transformation processes. Public power plants, public CHP plants, industry CHP plants and municipal heat plants represent the main producers of energy in Poland. Demand is characterised by the major energy consumers, i.e. industry and construction, transport, agriculture, trade and services, individual consumers and export. The relationships between the domestic electricity and heat markets are modelled taking into account external costs estimates. The volume and structure of energy production, electricity and heat prices, emissions, external costs and social welfare of different scenarios are presented. Results of the model demonstrate that the internalisation of external costs through the increase in energy prices implies significant improvement in social welfare

  4. Total cost of performing analog-to-digital upgrades

    International Nuclear Information System (INIS)

    Albrigo, T.

    1993-01-01

    The financial well-being of nuclear power plants in the United States is dependent on reducing costs. Rapid advances in industrial technology have created a conundrum for utility executives and their engineering staffs. Digital technology is being touted as beneficial in many ways; however, a number of significant issues have been raised regarding the adequacy and financial viability of digital systems in nuclear power plants. Actual or perceived problems with digital system design, development, and installation have caused significant financial losses for nuclear utilities. This paper provides a list of problems that must be considered in performing an analog-to-digital conversion or for doing a large digital upgrade. It is desirable that the full financial risks associated with these types of upgrades are considered. Specific problems encountered at Palo Verde nuclear generating station are reviewed to emphasize some of the problem areas

  5. Estimation of the external cost of energy production based on fossil fuels in Finland and a comparison with estimates of external costs of wind power

    Energy Technology Data Exchange (ETDEWEB)

    Otterstroem, T [Ekono Energy Ltd, Helsinki (Finland)

    1996-12-31

    Ekono Energy Ltd. and Soil and Water Ltd. participated in 1993 - 1994 in the SIHTI 2 research programme of the Ministry of Trade and Industry by carrying out the project `Estimation of the extremal cost of energy production in Finland`. The aim of the survey was to assess the external costs of Finnish energy production which are incurred by the environmental impacts of emissions during the life cycles of fossil fuels. To this end, the survey studied the environmental impacts of emissions on a local level (population centres), on a national level (Finland) and on a global level. The main target was to develop a method for calculating the economic value of these impacts. The method was applied to the emissions in 1990. During the survey, the main emphasis was put on developing and applying indirect valuation methods. An indirect method proceeds through dose-response functions. The dose-response function links a certain emission quantity, concentration or deposition to the extent or intensity of the effect. When quantitative data on hazards is available, it is possible to carry out monetary valuation by means of market prices or people`s otherwise expressed willingness to pay (WTP). Monetary valuation includes many uncertainty factors, of which the most significant with regard to this study are the transferability of dose-response functions and willingness-to-pay values from different kinds of conditions, additivity of damage values, uncertainty factors and problems related to discounting

  6. Estimation of the external cost of energy production based on fossil fuels in Finland and a comparison with estimates of external costs of wind power

    International Nuclear Information System (INIS)

    Otterstroem, T.

    1995-01-01

    Ekono Energy Ltd. and Soil and Water Ltd. participated in 1993 - 1994 in the SIHTI 2 research programme of the Ministry of Trade and Industry by carrying out the project 'Estimation of the extremal cost of energy production in Finland'. The aim of the survey was to assess the external costs of Finnish energy production which are incurred by the environmental impacts of emissions during the life cycles of fossil fuels. To this end, the survey studied the environmental impacts of emissions on a local level (population centres), on a national level (Finland) and on a global level. The main target was to develop a method for calculating the economic value of these impacts. The method was applied to the emissions in 1990. During the survey, the main emphasis was put on developing and applying indirect valuation methods. An indirect method proceeds through dose-response functions. The dose-response function links a certain emission quantity, concentration or deposition to the extent or intensity of the effect. When quantitative data on hazards is available, it is possible to carry out monetary valuation by means of market prices or people's otherwise expressed willingness to pay (WTP). Monetary valuation includes many uncertainty factors, of which the most significant with regard to this study are the transferability of dose-response functions and willingness-to-pay values from different kinds of conditions, additivity of damage values, uncertainty factors and problems related to discounting

  7. Estimation of the external cost of energy production based on fossil fuels in Finland and a comparison with estimates of external costs of wind power

    Energy Technology Data Exchange (ETDEWEB)

    Otterstroem, T. [Ekono Energy Ltd, Helsinki (Finland)

    1995-12-31

    Ekono Energy Ltd. and Soil and Water Ltd. participated in 1993 - 1994 in the SIHTI 2 research programme of the Ministry of Trade and Industry by carrying out the project `Estimation of the extremal cost of energy production in Finland`. The aim of the survey was to assess the external costs of Finnish energy production which are incurred by the environmental impacts of emissions during the life cycles of fossil fuels. To this end, the survey studied the environmental impacts of emissions on a local level (population centres), on a national level (Finland) and on a global level. The main target was to develop a method for calculating the economic value of these impacts. The method was applied to the emissions in 1990. During the survey, the main emphasis was put on developing and applying indirect valuation methods. An indirect method proceeds through dose-response functions. The dose-response function links a certain emission quantity, concentration or deposition to the extent or intensity of the effect. When quantitative data on hazards is available, it is possible to carry out monetary valuation by means of market prices or people`s otherwise expressed willingness to pay (WTP). Monetary valuation includes many uncertainty factors, of which the most significant with regard to this study are the transferability of dose-response functions and willingness-to-pay values from different kinds of conditions, additivity of damage values, uncertainty factors and problems related to discounting

  8. 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

  9. 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

  10. Dispersion of pollutants, environmental externalities due to a pulverized coal power plant and their effect on the cost of electricity

    International Nuclear Information System (INIS)

    Czarnowska, Lucyna; Frangopoulos, Christos A.

    2012-01-01

    Energy conversion systems generate pollution that causes damages to the environment and the society. The objective of this work is to study the dispersion of pollutants and assess the environmental and social cost due to pollution from such a system. For this purpose, a pulverized coal power plant is selected. Using thermodynamic principles combined with empirical techniques, the quantities of pollutants emitted by the plant are estimated. Then, using the EcoSenseWeb software, which is based on the results of the ExternE project, the external environmental cost (externalities) of pollution is assessed. The plant is considered as located in four different cities in Poland and the externalities are calculated for each city separately. It is shown that the external environmental cost has a strong influence on the unit cost of electricity. In addition, the dispersion of pollutants is presented for the plant located in Olsztyn city. Furthermore, the plant is considered as located near the capitals of European countries and the environmental externalities are calculated for each city. The neighboring countries that are strongly affected by the plant in each particular city are identified. The sensitivity of the unit cost of electricity to certain important parameters is investigated. -- Highlights: ► The external cost of pollution has a significant impact on the cost of electricity. ► The results depend on the particular plant, location and level (local-global). ► Externalities make the installation of abatement equipment economical. ► The source location of emissions has a significant effect on the external cost. ► The transboundary pollution has a strong effect on the environmental cost.

  11. Electrochromic Windows: Process and Fabrication Improvements for Lower Total Costs

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burdis; Neil Sbar

    2007-03-31

    The overall goal with respect to the U.S. Department of Energy (DOE) is to achieve significant national energy savings through maximized penetration of EC windows into existing markets so that the largest cumulative energy reduction can be realized. The speed with which EC windows can be introduced and replace current IGU's (and current glazings) is clearly a strong function of cost. Therefore, the aim of this project was to investigate possible improvements to the SageGlass{reg_sign} EC glazing products to facilitate both process and fabrication improvements resulting in lower overall costs. The project was split into four major areas dealing with improvements to the electrochromic layer, the capping layer, defect elimination and general product improvements. Significant advancements have been made in each of the four areas. These can be summarized as follows: (1) Plasma assisted deposition for the electrochromic layer was pursued, and several improvements made to the technology for producing a plasma beam were made. Functional EC devices were produced using the new technology, but there are still questions to be answered regarding the intrinsic properties of the electrochromic films produced by this method. (2) The capping layer work was successfully implemented into the existing SageGlass{reg_sign} product, thereby providing a higher level of transparency and somewhat lower reflectivity than the 'standard' product. (3) Defect elimination is an ongoing effort, but this project spurred some major defect reduction programs, which led to significant improvements in yield, with all the implicit benefits afforded. In particular, major advances were made in the development of a new bus bar application process aimed at reducing the numbers of 'shorts' developed in the finished product, as well as making dramatic improvements in the methods used for tempering the glass, which had previously been seen to produce a defect which appeared as a

  12. Long-dated evaluation of the external costs of the nuclear; L'evaluation des couts externes a long terme de la filiere nucleaire: interets et limites

    Energy Technology Data Exchange (ETDEWEB)

    Le Dars, A.; Schneider, T

    2002-09-01

    Since the middle of the years 1990, the European Commission developed an ''ExternE'' methodology to propose an homogenous evaluation of the sanitary and environmental external costs of the various energy sectors in Europe. This document discusses the taking into account of the long-dated and analyzes the interests and the limits of the monetary evaluation, in terms of external costs, of the nuclear choice. It is organized in three chapters: 1. a presentation and a discussion on the various evaluation of the ''ExternE'' methodology; 2. a description of the available methods for the monetary evaluation of the long-dated impacts and more particularly the analysis of the monetary values actualization principle; 3. highlighted of the impacts for which the monetary evaluations exist. (A.L.B.)

  13. Using wood products to mitigate climate change: External costs and structural change

    Energy Technology Data Exchange (ETDEWEB)

    Sathre, Roger; Gustavsson, Leif [Ecotechnology, Mid Sweden University, 831 25 Oestersund (Sweden)

    2009-02-15

    In this study we examine the use of wood products as a means to mitigate climate change. We describe the life cycle of wood products including forest growth, wood harvest and processing, and product use and disposal, focusing on the multiple roles of wood as both material and fuel. We present a comparative case study of a building constructed with either a wood or a reinforced concrete frame. We find that the production of wood building material uses less energy and emits less carbon than the production of reinforced concrete material. We compare the relative cost of the two building methods without environmental taxation, under the current Swedish industrial energy taxation regime, and in scenarios that incorporate estimates of the full social cost of carbon emission. We find that the inclusion of climate-related external costs improves the economic standing of wood construction vis-a-vis concrete construction. We conclude that policy instruments that internalise the external costs of carbon emission should encourage a structural change toward the increased use of sustainably produced wood products. (author)

  14. Cost of goods sold and total cost of delivery for oral and parenteral vaccine packaging formats.

    Science.gov (United States)

    Sedita, Jeff; Perrella, Stefanie; Morio, Matt; Berbari, Michael; Hsu, Jui-Shan; Saxon, Eugene; Jarrahian, Courtney; Rein-Weston, Annie; Zehrung, Darin

    2018-03-14

    Despite limitations of glass packaging for vaccines, the industry has been slow to implement alternative formats. Polymer containers may address many of these limitations, such as breakage and delamination. However, the ability of polymer containers to achieve cost of goods sold (COGS) and total cost of delivery (TCOD) competitive with that of glass containers is unclear, especially for cost-sensitive low- and lower-middle-income countries. COGS and TCOD models for oral and parenteral vaccine packaging formats were developed based on information from subject matter experts, published literature, and Kenya's comprehensive multiyear plan for immunization. Rotavirus and inactivated poliovirus vaccines (IPV) were used as representative examples of oral and parenteral vaccines, respectively. Packaging technologies evaluated included glass vials, blow-fill-seal (BFS) containers, preformed polymer containers, and compact prefilled auto-disable (CPAD) devices in both BFS and preformed formats. For oral vaccine packaging, BFS multi-monodose (MMD) ampoules were the least expensive format, with a COGS of $0.12 per dose. In comparison, oral single-dose glass vials had a COGS of $0.40. BFS MMD ampoules had the lowest TCOD of oral vaccine containers at $1.19 per dose delivered, and ten-dose glass vials had a TCOD of $1.61 per dose delivered. For parenteral vaccines, the lowest COGS was achieved with ten-dose glass vials at $0.22 per dose. In contrast, preformed CPAD devices had the highest COGS at $0.60 per dose. Ten-dose glass vials achieved the lowest TCOD of the parenteral vaccine formats at $1.56 per dose delivered. Of the polymer containers for parenteral vaccines, BFS MMD ampoules achieved the lowest TCOD at $1.89 per dose delivered, whereas preformed CPAD devices remained the most expensive format, at $2.25 per dose delivered. Given their potential to address the limitations of glass and reduce COGS and TCOD, polymer containers deserve further consideration as alternative

  15. HUBUNGAN STRUKTUR KEPEMILIKAN DAN EXTERNAL MONITORING TERHADAP AGENCY COST DAN ALIRAN KAS

    Directory of Open Access Journals (Sweden)

    Yustina Ade

    2017-03-01

    Full Text Available Capital credit was credit given by private/government public bank to solve theproblem of liquidation on companies. In a small company, inhibiting liquidation andinformation which was asymmetric influenced manpower recruitment, especially in managerlevel and it could make adverse selction problem. In agency theory, it was mentioned thatagency problem could appear if there was a different self-interest between (1 capital ownerand manager (2 capital owner and bank. This research was aimed to analyze if ownershipstructure and external monitoring had influence to agency cost and whether agency cost hadinfluence to cash flow. The samples of this research were small companies running inmanufatures, corporation, and which got capital credit. Samples taken were 101 companiesand the analyzes method used was SEM. This research concluded that agency cost was in smallcompanies that the manager was not the capital owner, but there was no indication of moralhazard.

  16. 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....

  17. Externality costing for hydroelectric projects: Is it desirable? Is it possible?

    International Nuclear Information System (INIS)

    Bernier, L.

    1992-01-01

    The assignment of monetary values to environmental and social impacts of hydroelectric projects is discussed. The strengths and weaknesses of the economic approach to externality costing are noted. The problem to be faced is that environmental externalities associated with a hydro project very often involve resources that have little or no relation with the market, such as disturbances of land not used for commercial activities. The valuation of externalities related to thermal power plants is examined to provide lessons for quantifying the externalities of hydro projects. One observation is that there is very little information on the real impacts of such phenomena as the release of greenhouse gases, making quantification of their effect difficult; another is that impacts from atmospheric emissions are well in excess of simple deterioration of material goods or recreational activities that have some relationship to the market. Applied to hydro projects, the lessons from these observations indicate that there are no exact and homogeneous measurement units for impacts of actions such as diking or alteration of wildlife habitats. One approach that has been tried is the contingent valuation method, which relies on asking respondents how much they would pay to avoid an impact or risk. This approach is criticized and it is suggested to experiment with a review of the tradeoffs between several possible environmental impacts defined in a precise manner

  18. External costs of atmospheric Pb emissions: valuation of neurotoxic impacts due to inhalation

    Directory of Open Access Journals (Sweden)

    Frohn Lise

    2010-02-01

    Full Text Available Abstract Background The Impact Pathway Approach (IPA is an innovative methodology to establish links between emissions, related impacts and monetary estimates. Only few attempts have so far been presented regarding emissions of metals; in this study the external costs of airborne lead (Pb emissions are assessed using the IPA. Exposure to Pb is known to provoke impacts especially on children's cognition. As cognitive abilities (measured as IQ, intelligence quotient are known to have implications for lifetime income, a pathway can be established leading from figures for Pb emissions to the implied loss in earnings, and on this basis damage costs per unit of Pb emission can be assessed. Methods Different types of models are here linked. It is relatively straightforward to establish the relationship between Pb emissions and consequent increase in air-Pb concentration, by means of a Gaussian plume dispersion model (OML. The exposed population can then be modelled by linking the OML-output to population data nested in geo-referenced grid cells. Less straightforward is to establish the relationship between exposure to air-Pb concentrations and the resulting blood-Pb concentration. Here an Age-Dependent Biokinetic Model (ADBM for Pb is applied. On basis of previous research which established links between increases in blood-Pb concentrations during childhood and resulting IQ-loss we arrive at our results. Results External costs of Pb airborne emissions, even at low doses, in our site are in the range of 41-83 €/kg emitted Pb, depending on the considered meteorological year. This estimate applies only to the initial effects of air-Pb, as our study does not address the effects due to the Pb environmental-accumulation and to the subsequent Pb re-exposure. These are likely to be between one and two orders of magnitude higher. Conclusions Biokinetic modelling is a novel tool not previously included when applying the IPA to explore impacts of Pb emissions

  19. Evaluation of the external costs of energy production in the Helsinki metropolitan area

    International Nuclear Information System (INIS)

    Otterstroem, T.

    1995-01-01

    The aim of the research is to evaluate the external costs of energy production at Helsinki metropolitan area (Helsinki, Espoo, Vantaa). The previously developed valorization method for effects on population centres is adjusted. All the main health, material and environmental effects will be taken into account in the research. The effects of emissions of the energy production of the Helsinki metropolitan area on concentrations of the impurities in the air and through them on human and environment will be evaluated. The estimates will be based on the relativistic fuels consumption and the emission data of Helsinki metropolitan area. Life-cycle reasoning will be applied so that the emissions of the main components of the fuels used in the metropolitan area will be included in the estimation. The cost-effectiveness of the investments will be estimated by comparing the environmental investments of energy boards with the external costs. The methods of this work can be applied to estimation of the profitability of energy production plants from the point of view of national economy also elsewhere in the country

  20. Accounting for external costs in a study of a Swedish district-heating system - An assessment of environmental policies

    International Nuclear Information System (INIS)

    Fahlen, E.; Ahlgren, E.O.

    2010-01-01

    Sweden has historically had strict emission control by implementation of economic policy instruments with the aim of internalising the external costs of air pollution. This study aims to evaluate how well current Swedish policy instruments reflect the environmental costs associated with heat generation in several district-heating (DH) plants in the DH system of Goeteborg. Furthermore, it aims to simulate and evaluate the operation of the DH system based on its social cost-effectiveness which takes into account the DH system's private and external costs (non-internalised environmental costs). The study shows that the economic policy instruments do not fully internalise all external costs whereas for certain technologies, the costs in terms of taxes, emission permits, environmental fees, etc. are higher than the environmental costs caused by the pollutants, given the environmental cost estimates used in the study. The simulation results show that the deviating internalisation of external costs affects the economic ranking of the different plants within the studied DH system. The estimated loss in social-cost effectiveness of the operation of the DH system of Goeteborg is noticable but relatively small if compared to the variable heat generation costs for most of the studied DH plants.

  1. Cost-effectiveness of radiotherapy during surgery compared with external radiation therapy in the treatment of women with breast cancer

    Directory of Open Access Journals (Sweden)

    Hedie Mosalanezhad

    2016-04-01

    Full Text Available Introduction: Intraoperative radiation therapy device (IORT is one of the several options for partial breast irradiation. IORT is sent to the tumor bed during surgery and can be replaced with conventional standard therapy (EBRT. The aim of this study was to evaluate the safety and effectiveness of IORT machine compared with EBRT and to determine the dominant option in terms of the cost-effectiveness. Method: This study was conducted in two phases; the first phase was a comprehensive review of the electronic databases search that was extracted after extraction and selection of the articles used in this article on effectiveness outcomes. Data collection form was completed by professionals and experts to estimate the cost of treatment, intraoperative radiotherapy and radiotherapy cost when using external radiation therapy process; direct costs were considered from the perspective of service provider and they were calculated in the second phase to determine the option of cost-effective ICER. Excel software was used for data analysis and sensitivity analysis was performed to determine the strength of the results of cost-effectiveness. Results:18 studies were selected but only 8 of them were shown to have acceptable quality. The consequences like “rate of cancer recurrence”, “seroma”, “necrosis”, “toxic”, “skin disorders and delayed wound healing” and “spread the pain” were among the consequences used in the selected articles. The total costs for each patient during a course of treatment for EBRT and IORT were estimated 1398 and $5337.5, respectively. During the analysis, cost-effectiveness of the consequences of cancer recurrence, seroma, necrosis and skin disorders and delayed wound healing ICER was calculated. And IORT was found to be the dominant supplier in all cases. Also, in terms of implications of toxicity and prevalence of pain, IORT had a lower cost and better effectiveness and consequently the result was more cost

  2. 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.

  3. External costs of atmospheric Pb emissions: valuation of neurotoxic impacts due to inhalation

    DEFF Research Database (Denmark)

    Pizzol, Massimo; Thomsen, Marianne; Frohn, Lise

    2010-01-01

    The Impact Pathway Approach (IPA) is an innovative methodology to establish links between emissions, related impacts and monetary estimates. Only few attempts have so far been presented regarding emissions of metals; in this study the external costs of airborne lead (Pb) emissions are assessed...... using the IPA. Exposure to Pb is known to provoke impacts especially on children's cognition. As cognitive abilities (measured as IQ, intelligence quotient) are known to have implications for lifetime income, a pathway can be established leading from figures for Pb emissions to the implied loss...

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

    Science.gov (United States)

    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.

  5. 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.

  6. 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

  7. 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

  8. Coming out ahead: the cost effectiveness of external cephalic version using spinal anesthesia

    Science.gov (United States)

    2014-01-01

    Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades. External cephalic version (ECV) is recommended at term by most professional organizations in an effort to reduce the prospect of cesarean deliveries. The authors propose the use of regional anesthesia to increase efficacy and reduce cost in the care of patients who undergo ECV in an effort to convert a breech presentation to a vertex counterpart. Despite emerging evidence of the advantages, obstacles to more comprehensive implementation of this approach continue to exist, which include patient acceptance, provider experience, and safety concerns. The addition of tocolytics and use of regional anesthesia for secondary ECV efforts have also been considered as options to increase success and reduce cost. This is a commentary on http://www.ijhpr.org/content/3/1/5. PMID:24565024

  9. Saskatchewan external cost review : report prepared by a Joint Oil and Gas Industry - Saskatchewan Energy and Mines Committee

    International Nuclear Information System (INIS)

    Anon.

    1996-11-01

    The external costs associated with the operating phase of oil and gas wells in Saskatchewan, were reviewed. The report identified external costs and compared their competitiveness with those of other producing jurisdictions. The profitability of the oil and gas industry in Saskatchewan was also assessed in an effort to provide industry and government with an informational package for use for discussion purposes. The study showed that (1) the oil and gas industry has been a major force for economic growth within Saskatchewan, (2) the province will continue to face stiff competition from other jurisdictions for new oil and gas investment dollars, (3) the system used for determining and administering external costs vary widely from one jurisdiction to another, and (4) a number of external costs are not sensitive to well production rates or commodity price movements. tabs., figs

  10. Integrated framework for the external cost assessment of nuclear power plant accident considering risk aversion: The Korean case

    International Nuclear Information System (INIS)

    Lee, Sang Hun; Kang, Hyun Gook

    2016-01-01

    Recently, the estimation of accident costs within the social costs of nuclear power plants (NPPs) has garnered substantial interest. In particular, the risk aversion behavior of the public toward an NPP accident is considered an important factor when integrating risk aversion into NPP accident cost. In this study, an integrated framework for the external cost assessment of NPP accident that measures the value of statistical life (VSL) and the relative risk aversion (RRA) coefficient for NPP accident based on an individual-level survey is proposed. To derive the willingness to pay and the RRA coefficient for NPP accident risks, a survey was conducted on a sample of 1550 individuals in Korea. The estimation obtained a mean VSL of USD 2.78 million and an RRA coefficient of 1.315. Based on the estimation results in which various cost factors were considered, a multiplication factor of 5.16 and an external cost of NPP accidents of 4.39E−03 USD-cents/kW h were estimated. This study is expected to provide insight to energy policy decision-makers on analyzing the economic validity of NPP compared to other energy sources by reflecting the estimated external cost of NPP accident into the unit electricity generation cost of NPP. - Highlights: •External cost assessment framework for NPP is proposed considering risk aversion. •VSL was derived from WTP for mortality risk reduction from hypothetical NPP accident. •RRA was derived to integrate public risk aversion into external cost of NPP accident. •Individual-level survey was conducted to derive WTP and RRA for NPP accident risk. •The external cost was estimated considering the direct cost factors of NPP accident.

  11. LIFE CYCLE COSTING DAN EKSTERNALITAS BIODIESEL DARI MINYAK SAWIT DAN MINYAK ALGA DI INDONESIA (Life Cycle Costing and Externities of Palm and Algal Biodiesel in Indonesia

    Directory of Open Access Journals (Sweden)

    Arif Dwi Santoso

    2014-10-01

    perannya dalam mitigasi GRK yang turut memperbesar peluang sebagai bahan utama biodiesel di masa depan.   ABSTRACT The high cost of biodiesel production was to be an obstacle conversion to biodiesel fuel including Indonesia due to anticipate the energy crisis. The high cost of production due to the variable cost of production has not fully comparable reflect the overall potential contained in biodiesel. Potential biodiesel belonging to the commodity nature of the environment such as renewable biomass, low in land use, and environmentally friendly should be included in the calculation in order to obtain an objective comparison of the calculations.This study aimed to evaluate the effect of adding commodities to the structure of the production cost of biodiesel between palm oil and algal oil. Estimated value of the commodity by the method of benefit transfer method shows the value used is the approach gains willingness to pay (WTP. Environmental commodity values referenced from the calculation software Environmental Priority Strategy (EPS version 2000. For the case of Indonesia, the commodity value of the elasticity was infered EPS basis of comparison of income per capita of Sweden and Indonesia.The results stated that the analysis of life cycle costing (LCC applied by adding variable externalities can provide detailed information about the composition of biodiesel production costs and can be used as a method to get a total picture of the most competitive production costs from several sources. The analysis also concluded that the externality variables also affect the total cost of biodiesel production by up to 14%. Profitability analysis stated that the algal biomass for biodiesel production more secure and sustainable than palm biomass due to technical and non-technical constraints on the production of algal biomass more easier to treat but it also advantages role in GHG mitigation that helped widen the opportunities as the main ingredient of biodiesel in the futur

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

    Science.gov (United States)

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

    2010-01-21

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

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

    Directory of Open Access Journals (Sweden)

    Carvalho Brendan

    2010-01-01

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

  14. 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

  15. On the contribution of external cost calculations to energy system governance: the case of a potential large-scale nuclear accident

    NARCIS (Netherlands)

    Laes, E.; Meskens, G.; van der Sluijs, J.P.|info:eu-repo/dai/nl/073427489

    2011-01-01

    The European Commission's ExternE Project has made major advances in the quantification of external costs of electricity. Although some impacts cannot be valued, important conclusions are possible. This paper outlines some provisional implications for energy policy. External costs are technology

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

    International Nuclear Information System (INIS)

    Eto, J.H.; Helcke, G.

    1991-01-01

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

  17. Strategies for reducing implant costs in the revision total knee arthroplasty episode of care.

    Science.gov (United States)

    Elbuluk, Ameer M; Old, Andrew B; Bosco, Joseph A; Schwarzkopf, Ran; Iorio, Richard

    2017-12-01

    Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models. Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014. Average cost of components for each case was calculated and compared to the total hospital cost for that admission. Costs for an all-component revision were then compared to a proposed "direct to hospital" (DTH) standardized pricing model and a fixed price revision option. Potential savings were calculated from these figures. On average, 28% of the total hospital cost was spent on implants for rTKA. The average cost for revision of all components was $13,640 and ranged from $3000 to $28,000. On average, this represented 32.7% of the total hospital cost. Direct to hospital implant pricing could potentially save approximately $7000 per rTKA, and the fixed pricing model could provide a further $1000 reduction per rTKA-potentially saving $8000 per case on implants alone. Alternative implant pricing models could help lower the total cost of rTKA, which would allow hospitals to achieve significant cost containment.

  18. 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.

  19. External Costs and Benefits of Energy. Methodologies, Results and Effects on Renewable Energies Competitivity

    International Nuclear Information System (INIS)

    Saez, R.; Cabal, H.; Varela, M.

    1999-01-01

    This study attempts to give a summarised vision of the concept of eternality in energy production, the social and economic usefulness of its evaluation and consideration as support to the political decision-marking in environmental regulation matters, technologies selection of new plants, priorities establishment on energy plans, etc. More relevant environmental externalisation are described, as are the effects on the health, ecosystems, materials and climate, as well as some of the socioeconomic externalisation such as the employment, increase of the GDP and the reduction and depletion of energy resources. Different methodologies used during the last years have been reviewed as well as the principals resulted obtained in the most relevant studies accomplished internationally on this topic. Special mention has deserved the European study National Implementation of the Extern E Methodology in the EU . Results obtained are represented in Table 2 of this study. Also they are exposed, in a summarised way, the results obtained in the evaluation of environmental externalisation of the Spanish electrical system in function of the fuel cycle. In this last case the obtained results are more approximated since have been obtained by extrapolation from the obtained for ten representative plants geographically distributed trough the Peninsula. Finally it has been analysed the influence that the internalization of the external costs of conventional energies can have in the competitiveness and in te market of renewable energy, those which originate less environmental effects and therefore produce much smaller external costs. The mechanisms of internalization and the consideration on the convenience or not of their incorporation in the price of energy have been also discussed. (Author) 30 refs

  20. 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.

  1. [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.

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

    Directory of Open Access Journals (Sweden)

    Wittbrodt ET

    2018-05-01

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

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

    Science.gov (United States)

    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.

  4. 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....

  5. Some Simple Arguments about Cost Externalization and its Relevance to the Price of Fusion Energy

    International Nuclear Information System (INIS)

    Budny, R.; Winfree, R.

    1999-01-01

    The primary goal of fusion energy research is to develop a source of energy that is less harmful to the environment than are the present sources. A concern often expressed by critics of fusion research is that fusion energy will never be economically competitive with fossil fuels, which in 1997 provided 75% of the world's energy. And in fact, studies of projected fusion electricity generation generally project fusion costs to be higher than those of conventional methods. Yet it is widely agreed that the environmental costs of fossil fuel use are high. Because these costs aren't included in the market price, and furthermore because many governments subsidize fossil fuel production, fossil fuels seem less expensive than they really are. Here we review some simple arguments about cost externalization which provide a useful background for discussion of energy prices. The collectively self-destructive behavior that is the root of many environmental problems, including fossil fuel use, was termed ''the tragedy of the commons'' by the biologist G. Hardin. Hardin's metaphor is that of a grazing commons that is open to all. Each herdsman, in deciding whether to add a cow to his herd, compares the benefit of doing so, which accrues to him alone, to the cost, which is shared by all the herdsmen using the commons, and therefore adds his cow. In this way individually rational behavior leads to the collective destruction of the shared resource. As Hardin pointed out, pollution is one kind of tragedy of the commons. CO 2 emissions and global warming are in this sense classic tragedies

  6. 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.

  7. Minimising negative externalities cost using 0-1 mixed integer linear programming model in e-commerce environment

    Directory of Open Access Journals (Sweden)

    Akyene Tetteh

    2017-04-01

    Full Text Available Background: Although the Internet boosts business profitability, without certain activities like efficient transportation, scheduling, products ordered via the Internet may reach their destination very late. The environmental problems (vehicle part disposal, carbon monoxide [CO], nitrogen oxide [NOx] and hydrocarbons [HC] associated with transportation are mostly not accounted for by industries. Objectives: The main objective of this article is to minimising negative externalities cost in e-commerce environments. Method: The 0-1 mixed integer linear programming (0-1 MILP model was used to model the problem statement. The result was further analysed using the externality percentage impact factor (EPIF. Results: The simulation results suggest that (1 The mode of ordering refined petroleum products does not impact on the cost of distribution, (2 an increase in private cost is directly proportional to the externality cost, (3 externality cost is largely controlled by the government and number of vehicles used in the distribution and this is in no way influenced by the mode of request (i.e. Internet or otherwise and (4 externality cost may be reduce by using more ecofriendly fuel system.

  8. Economic benefits, external costs and the regulation of unconventional gas in the United States

    International Nuclear Information System (INIS)

    Cronshaw, Ian; Grafton, R. Quentin

    2016-01-01

    We review the economic benefits and external costs of unconventional gas production (UCG) in the United States from a policy perspective. Based on an overview of state regulation in Pennsylvania, a state that has witnessed very rapid growth of gas production over the past 5 years, and global experiences we present 10 key principles that are proposed to reduce the risks and to increase the net rewards of UCG. Application of these principles has the potential to reduce the risks of UCG, especially at a local level, while maximizing the benefits of gas developments. - Highlights: • SWOT summary of unconventional gas developments. • Risks and returns of unconventional gas highlighted. • 10 principles given to reduce risks and increase rewards of gas extraction.

  9. EVA – a non-linear Eulerian approach for assessment of health-cost externalities of air pollution

    DEFF Research Database (Denmark)

    Andersen, Mikael Skou; Frohn, Lise Marie; Nielsen, Jytte Seested

    2006-01-01

    of the emissions. External cost estimates based on the Eulerian approach, on the other hand, are in mutual conformity. The existence of non-linear dynamics and possible thresholds, both in the atmospheric modelling and in the dose-response functions for health effects, need further attention and should......Integrated models which are used to account for the external costs of air pollution have to a considerable extent ignored the non-linear dynamics of atmospheric science. In order to bridge the gap between economic analysis and environmental modelling an integrated model EVA, based on a Eulerian...... for the final external cost estimates of the Eulerian approach is explored. Uncertainties in the health costs estimates are endemic in particular for mortality, but in order to achieve a common baseline the approach recommended by the OECD has been employed for the valuation part. This approach implies the use...

  10. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

  13. 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....

  14. 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.

  15. 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

  16. 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.

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

    International Nuclear Information System (INIS)

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

    1994-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-07-01

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

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. Total costs and benefits of biomass in selected regions of the European Union - BioCosts

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, A de; Costa, F B [Coimbra Univ. (Portugal). Inst. de Sistemas e Robotica; Bauen, A [London Univ. (United Kingdom). Div. of Life Sciences; and others

    1998-11-01

    In the BioCosts project, representative biomass-to-electricity and biomass-to-transport-service fuel cycles located at different sites within the European Union have been evaluated concerning their environmental and economic performance. Each case study was compared to a fossil-fuel fired reference case. The case studies examined comprise: utilisation of forestry residues in the Naessjoe circulating fluidized bed combustion plant, Sweden, versus the use of Polish coal in the same plant; utilisation of forestry residues and short-rotation coppice for industrial combined heat and power production in Mangualde, Portugal, versus the use of fuel oil in an engine generating heat and power; production of biogas from manure slurry for municipal combined heat and power generation at Hashoej, Denmark, versus the use of Danish natural gas in the same engine; gasification of woody biomass for combined heat and power generation in Vaernamo, Sweden, and Eggborough, UK, versus the use of coal in the Naessjoe plant mentioned above and a UK power plant; production of cold-pressed rape-seed oil and its use in a cogeneration plant at Weissenburg, Germany, versus the use of diesel fuel in a similar engine; production of rape-seed oil methyl ester and its use for goods transport in Germany, versus the use of diesel fuel in the same fleet of trucks; production of ethyl tertiary butyl ether from sugar beets and sweet sorghum for transport applications in France, versus the use of methyl tertiary butyl ether from fossil sources for the same purpose 130 refs, 25 figs, 42 tabs. Research funded in part by the European Commission in the JOULE III programme

  4. External Costs of Risky Health Behaviors Associated with Leading Actual Causes of Death in the U.S.: A Review of the Evidence and Implications for Future Research

    Directory of Open Access Journals (Sweden)

    Armineh Zohrabian

    2010-06-01

    Full Text Available This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question. We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change. The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics.

  5. Environmental externalities: Applying the concept to Asian coal-based power generation. [Includes external environmental and societal costs and methods of evaluating them

    Energy Technology Data Exchange (ETDEWEB)

    Szpunar, C.B.; Gillette, J.L.

    1993-03-01

    This report examines the concept of environmental externality. It discusses various factors -- the atmospheric transformations, relationship of point-source emissions to ambient air quality, dose-response relationships, applicable cause-and-effect principles, and risk and valuation research -- that are considered by a number of state utilities when they apply the environmental externality concept to energy resource planning. It describes a methodology developed by Argonne National Laboratory for general use in resource planning, in combination with traditional methods that consider the cost of electricity production. Finally, it shows how the methodology can be applied in Indonesia, Thailand, and Taiwan to potential coal-fired power plant projects that will make use of clean coal technologies.

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

    International Nuclear Information System (INIS)

    Frankl, P.

    2002-01-01

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

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

    Science.gov (United States)

    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.

  8. 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

  9. 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.

  10. Achieving low effluent NO3-N and TN concentrations in low influent chemical oxygen demand (COD) to total Kjeldahl nitrogen (TKN) ratio without using external carbon source

    Science.gov (United States)

    Cao, Jiashun; Oleyiblo, Oloche James; Xue, Zhaoxia; Otache, Y. Martins; Feng, Qian

    2015-07-01

    Two mathematical models were used to optimize the performance of a full-scale biological nutrient removal (BNR) activated treatment plant, a plug-flow bioreactors operated in a 3-stage phoredox process configuration, anaerobic anoxic oxic (A2/O). The ASM2d implemented on the platform of WEST2011 software and the BioWin activated sludge/anaerobic digestion (AS/AD) models were used in this study with the aim of consistently achieving the designed effluent criteria at a low operational cost. Four ASM2d parameters (the reduction factor for denitrification , the maximum growth rate of heterotrophs (µH), the rate constant for stored polyphosphates in PAOs ( q pp), and the hydrolysis rate constant ( k h)) were adjusted. Whereas three BioWin parameters (aerobic decay rate ( b H), heterotrophic dissolved oxygen (DO) half saturation ( K OA), and Y P/acetic) were adjusted. Calibration of the two models was successful; both models have average relative deviations (ARD) less than 10% for all the output variables. Low effluent concentrations of nitrate nitrogen (N-NO3), total nitrogen (TN), and total phosphorus (TP) were achieved in a full-scale BNR treatment plant having low influent chemical oxygen demand (COD) to total Kjeldahl nitrogen (TKN) ratio (COD/TKN). The effluent total nitrogen and nitrate nitrogen concentrations were improved by 50% and energy consumption was reduced by approximately 25%, which was accomplished by converting the two-pass aerobic compartment of the plug-flow bioreactor to anoxic reactors and being operated in an alternating mode. Findings in this work are helpful in improving the operation of wastewater treatment plant while eliminating the cost of external carbon source and reducing energy consumption.

  11. 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.

  12. Mental states inside out: switching costs for emotional and nonemotional sentences that differ in internal and external focus.

    Science.gov (United States)

    Oosterwijk, Suzanne; Winkielman, Piotr; Pecher, Diane; Zeelenberg, René; Rotteveel, Mark; Fischer, Agneta H

    2012-01-01

    Mental states-such as thinking, remembering, or feeling angry, happy, or dizzy-have a clear internal component. We feel a certain way when we are in these states. These internal experiences may be simulated when people understand conceptual references to mental states. However, mental states can also be described from an "external" perspective, for example when referring to "smiling." In those cases, simulation of visible outside features may be more relevant for understanding. In a switching costs paradigm, we presented semantically unrelated sentences describing emotional and nonemotional mental states while manipulating their internal or external focus. The results show that switching costs occur when participants shift between sentences with an internal and an external focus. This suggests that different forms of simulation underlie understanding these sentences. In addition, these effects occurred for emotional and nonemotional mental states, suggesting that they are grounded in a similar way-through the process of simulation.

  13. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

    NARCIS (Netherlands)

    Berdowski, Jocelyn; Kuiper, Mathijs J.; Dijkgraaf, Marcel G. W.; Tijssen, Jan G. P.; Koster, Rudolph W.

    2010-01-01

    Background: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac

  14. 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

  15. 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.

  16. Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer.

    Science.gov (United States)

    McGuffin, M; Merino, T; Keller, B; Pignol, J-P

    2017-03-01

    Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  17. 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 ...

  18. 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.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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

  4. 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.…

  5. 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.

  6. 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...

  7. Cost of the external MTR-fuel cycle. (Uranium , reprocessing and related services)

    International Nuclear Information System (INIS)

    Mueller, H.; Gruber, G.

    1991-01-01

    This paper points out how the RERTR program has affected NUKEM's fuel supplies for MTRs and how the prices in the External MTR Fuel Cycle have developed during this period. In addition other potential fuel sources and services on the External MTR Fuel Cycle are given. (orig.)

  8. 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.

  9. 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.

  10. Using Electromagnetic Algorithm for Total Costs of Sub-contractor Optimization in the Cellular Manufacturing Problem

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Shahriari

    2016-12-01

    Full Text Available In this paper, we present a non-linear binary programing for optimizing a specific cost in cellular manufacturing system in a controlled production condition. The system parameters are determined by the continuous distribution functions. The aim of the presented model is to optimize the total cost of imposed sub-contractors to the manufacturing system by determining how to allocate the machines and parts to each seller. In this system, DM could control the occupation level of each machine in the system. For solving the presented model, we used the electromagnetic meta-heuristic algorithm and Taguchi method for determining the optimal algorithm parameters.

  11. 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.

  12. 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.

  13. Cost optimization of ADS design: Comparative study of externally driven heterogeneous and homogeneous two-zone subcritical reactor systems

    International Nuclear Information System (INIS)

    Gulik, Volodymyr; Tkaczyk, Alan H.

    2014-01-01

    Highlights: • The optimization of two-zone homogeneous subcritical systems has been performed. • A Serpent model for two-zone heterogeneous subcritical systems has been developed. • The optimization of two-zone heterogeneous subcritical systems has been carried out. • Economically optimal core composition of two-zone subcritical system was found. • The neutron spectra of the heterogeneous subcritical systems have been obtained. - Abstract: Subcritical systems driven by external neutron sources, commonly known as Accelerator-Driven System (ADS), are one type of advanced nuclear reactor exhibiting attractive characteristics, distinguished from the traditional critical systems by their intrinsic safety features. In addition, an ADS can be used for the transmutation of the nuclear waste, accumulated during the operation of existing reactors. The optimization of a subcritical nuclear reactor in terms of materials (fuel content, coolant, etc.), geometrical, and economical parameters is a crucial step in the process of their design and construction. This article describes the optimization modeling performed for homogeneous and heterogeneous two-zone subcritical systems in terms of geometry of the fuel zones. Economical assessment was also carried out for the costs of the fuel in the core of the system. Optimization modeling was performed with the Serpent-1.1.18 Monte Carlo code. The model of a two-zone subcritical system with a fast inner and a thermal gas-cooled graphite-moderated outer zone was developed, simulated, and analyzed. The optimal value for the pitch of fuel elements in the thermal outer zone was investigated from the viewpoint of the cost of subcritical system. As the main goal of ADS development is nuclear waste transmutation, neutron spectra for both fast and thermal zones were obtained for different system configurations. The results of optimization modeling of homogeneous and heterogeneous two-zone subcritical systems show that an optimal

  14. Social costs of energy consumption. External effects of electricity consumption in the Federal Republic of Germany. Soziale Kosten des Energieverbrauchs. Externe Effekte des Elektrizitaetsverbrauchs in der Bundesrepublik Deutschland

    Energy Technology Data Exchange (ETDEWEB)

    Hohmeyer, O

    1988-01-01

    This study provides a first systematic quantification and conversion into monetary terms of the relevant social costs and benefits, in order to create a basis for corrective measures with respect to the use of wind power and the photovoltaic use of solar energy. Four main areas of social costs of energy systems are looked at in the study: Environmental costs, including the effect on human health. Inadequate consideration of the long-term shortage of resources in present-day market prices. Macroeconomic effects such as changes in the net product or employment. Subsidies via state agencies, which are made partly in the form of direct payments and partly in an indirect way in the form of state services. State subsidies in the area of research and development can be subsumed under the last point. In each of these main fields there is a multiplicity of separate external effects which are dealt with at length in a special chapter. (orig./UA) With 20 figs., 24 tabs.

  15. Monetization of External Costs Using Lifecycle Analysis—A Comparative Case Study of Coal-Fired and Biomass Power Plants in Northeast China

    Directory of Open Access Journals (Sweden)

    Lingling Wang

    2015-02-01

    Full Text Available In this study, the structures of external costs are built in line with coal-fired and biomass power plant life cycle activities in Northeast China. The external cost of coal-fired and biomass power plants was compared, using the lifecycle approach. In addition, the external costs of a biomass power plant are calculated for each stage for comparison with those of a coal-fired power plant. The results highlight that the external costs of a coal-fired plant are 0.072 US $/kWh, which are much higher than that of a biomass power plant, 0.00012 US$/kWh. The external cost of coal-fired power generation is as much as 90% of the current price of electricity generated by coal, while the external cost of a biomass power plant is 1/1000 of the current price of electricity generated by biomass. In addition, for a biomass power plant, the external cost associated with SO2, NOX, and PM2.5 are particularly lower than those of a coal-fired power plant. The prospect of establishing precise estimations for external cost mechanisms and sustainable energy policies is discussed to show a possible direction for future energy schemes in China. The paper has significant value for supporting the biomass power industry and taxing or regulating coal-fired power industry to optimize the energy structure in China.

  16. 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...

  17. Energy tax harmonization in the European Union: a proposal based on the internalization of environmental external costs

    International Nuclear Information System (INIS)

    Dorigoni, S.; Gulli, F.

    2002-01-01

    Energy tax harmonization is a crucial step towards the creation of a single market. In this article the possibility of achieving such an objective is discussed. The paper consists of two sections. In the first the European taxation on energy products is analysed. This analysis is useful in showing the differences that exist between the European countries that account for the difficulties met so far in the process of harmonization. In this respect we comment on the recent proposal of the Directive of the European Union, which lays down the obligation of minimum levels of taxation in all European member states. In the second section, after simulating the effects related to the adoption of a common environmental taxation (a first best solution based on the internalization of environmental external costs), we propose, as a second best solution, an excise tax harmonization model taking into consideration the specificity of each country and being, as far as possible, coherent with the environmental objective. This model proposes: the introduction of a minimum level of taxation on all products equal to the external cost due to the greenhouse effect (a common carbon tax); the possibility, given to the member states, of deviating from such minimum levels, in accordance with their specific requirements, internalizing in the price of the different products, by means of taxes additional to that CO 2 minimum, the external costs associated with other pollutant agents (the same in all countries); the opportunity, in case it should be necessary to exceed the entire external cost, for the member states to apply increases that are in accordance with the environmental objective. (author)

  18. Incorporating a total cost perspective intothe purchasing strategy : A case study of amedium sized retail compan

    OpenAIRE

    EKSTRÖM, MARCUS; FAHNEHJELM, CAROLINA

    2016-01-01

    The retail industry is today characterized by downward price pressure, and the increasedcompetition in the industry has led to pressure on profit margins. Purchasing and supply chainmanagement have become areas of increased strategic importance and play a crucial role inthe business performance. This study aims to extend previous literature in these fields byproviding the existing research with an empirical study on how the purchasing strategy canincorporate a total cost perspective of the su...

  19. Life cycle inventory and external costs of the gas fuel cycle. An overview of the main results and a brief comparison with other fuels

    International Nuclear Information System (INIS)

    Torfs, R.; De Nocker, L.; Wouters, G.

    1999-01-01

    In the context of a research project funded by the Belgian electricity utilities Electrabel/SPE, VITO made a life cycle inventory of the primary energy use and airborne emissions (including greenhouse gases, SO2 and NOx) of different fuels. Consequently, the impacts of these pollutants on human health, manmade and the natural environment are quantified and these impacts are valued in monetary terms. This analysis is based on the European ExternE methodology to estimate the external costs of energy. The LCI and external cost analysis confirm clearly that natural gas is a relative clean fossil fuel cycle. External cost are in the range of 1.2 to 2.6 EUROcent /kWh, which roughly corresponds from 30 % to 80 % of the private production costs. These results are introduced into a software module, which allows the utilities to compare economic costs and environmental benefits of different measures to reduce CO2 emissions. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

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

  1. 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.

  2. Assessing Air Pollutant-Induced, Health-Related External Costs in the Context of Nonmarginal System Changes: A Review.

    Science.gov (United States)

    Bachmann, Till M

    2015-08-18

    Marginal analysis is the usual approach to environmental economic assessment, for instance, of health-related external costs due to energy-associated air pollutant emissions. However, nonlinearity exists in all steps of their assessment, i.e., atmospheric dispersion, impact assessment, and monetary valuation. Dedicated assessments thus appear necessary when evaluating large systems or their changes such as in green accounting or the implications of economy-wide energy transitions. Corresponding approaches are reviewed. Tools already exist that allow assessing a marginal change (e.g., one power plant's emissions) for different background emission scenarios that merely need to be defined and implemented. When assessing nonmarginal changes, the top-down approach is considered obsolete, and four variants of the bottom-up approach with different application domains were identified. Variants 1 and 2 use precalculated external cost factors with different levels of sophistication, suitable for energy systems modeling, optimizing for social (i.e., private and external) costs. Providing more reliable results due to more detailed modeling, emission sources are assessed individually or jointly in variants 3 and 4, respectively. Aiming at considering nonlinearity more fully and simultaneously following marginal analysis principles, I propose a variant 3-based approach, subdividing an aggregate (i.e., a nonmarginal change) into several smaller changes. Its strengths and drawbacks, notably the associated effort, are discussed.

  3. 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.

  4. Biotype assessment and evaluation as a method to quantify the external costs related to surface brown coal mining

    International Nuclear Information System (INIS)

    Kabrna, M.; Peleska, O.

    2009-01-01

    Externalities express the uncompensated effects of human individuals on each other and on nature. Externalities include costs and benefits which impact human individuals and environment and are not included in the costs and benefits of their creators and are often defined as the differences between social costs or revenues from economic activity and private costs or revenues. Surface brown coal mining can be characterized by a large range of adverse environmental effects. In order to compensate for the environmental damage caused by mining activities in the Czech Republic, various environmental fees paid by mining companies were introduced to the Czech legislation. The Hessian method of quantifying impacts on the environment is an expert methods that is appropriate for the evaluating environmental damage caused by large-scale impacts on landscape. This paper described the methodology of the Hessian method and its application to a selected opencast mine in north-western Bohemia called the Vrsany-Sverma mine. The paper also discussed current environmental charges in the Czech Republic. It was concluded that the calculated amount of environmental damage caused by surface mining balances the amount of environmental fees currently paid by mining companies. 4 refs., 1 tab.

  5. Full environmental life cycle cost analysis of concentrating solar power technology: contribution of externalities to overall energy costs

    NARCIS (Netherlands)

    Corona, B.; Cerrajero, E.; San Miguel, G.

    2016-01-01

    The aim of this work is to investigate the use of Full Environmental Life Cycle Costing (FeLCC) methodology to evaluate the economic performance of a 50 MW parabolic trough Concentrated Solar Power (CSP) plant operating in hybrid mode with different natural gas inputs (between 0% and 30%). The

  6. Methodology of Evaluation of the Impact of Picking Area Location on the Total Costs of Warehouse

    Directory of Open Access Journals (Sweden)

    Apsalons Raitis

    2017-12-01

    Full Text Available The picking system and the layout of the picking area are the key drivers for the evaluation of a warehouse picking cost. There are five variants for organizing the picking process of orders in a warehouse. The choice of a specific variant depends on the total cost of picking. The picking cost is evaluated within an uninterrupted picking process. It means that no stock out occurs in the time period of the picking process. The storing area and the picking area are created as two separate zones for picking quantities of the customer’s orders; the principle of division of orders is observed strictly. Referring to the locations of stock keeping units (SKU, two approaches of the layout of SKU in the picking area can be estimated. The first one is the single picking location for each single SKU, where replenishment is realized in the picking process. The second one - various picking locations for each single SKU, and the replenishment here is realized just only prior to a picking process or after it. The main benefits of the economy of the picking cost as far as these two approaches are concerned are the shortest picking route in the first case and one common replenishment option in the second case.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. 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.

  11. Social profile and cost analysis of deep infection following total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Vera Lucia Frazão

    Full Text Available ABSTRACT OBJECTIVE: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. METHODS: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. RESULTS: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. CONCLUSION: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.

  12. Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

    Science.gov (United States)

    Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

    2018-04-01

    Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

  13. 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.

  14. Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.

    Science.gov (United States)

    Bilgili, Mustafa Gökhan; Erçin, Ersin; Peker, Gökhan; Kural, Cemal; Başaran, Serdar Hakan; Duramaz, Altuğ; Avkan, Cevdet

    2014-06-01

    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. Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Retrospective comparative study. 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. 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 (pblood 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.

  15. The Feasibility of a Land Ferry System to Reduce Highway Maintenance Cost and Associated Externalities

    Directory of Open Access Journals (Sweden)

    Steve J. Merrill

    2016-01-01

    Full Text Available This study provides an economic evaluation for a Land Ferry, which is a rail system capable of carrying trucks and all other types of vehicles, passengers, and cargo. The Land Ferry system involves a sliding loading system to roll heavy loads onto a flatbed; as a result, loading and unloading of all vehicles and cargo could be accomplished simultaneously. The evaluation for this system included (1 the design of a new track alignment over which the Land Ferry system would run, (2 evaluation of various sources of power, (3 estimation of how many local jobs the Land Ferry would generate, and (4 a benefit-cost analysis. It was estimated that the Land Ferry would create over 45,788 temporary jobs in Nevada during the three-year construction period and 318 permanent jobs during operation. The majority of the benefits were attributed to savings in travel time ($356.4 M, vehicle operating costs ($1000.4 M, reduction of accidents ($544.6 M, and pavement maintenance ($503.2 M. These benefits would be a consequence of the shift of trucks from the highway, thus resulting in higher speeds, decrease fuel consumption, and decrease vehicle maintenance costs. The overall benefit-cost ratio of 1.7 implies a cost-effective project.

  16. [A totally implantable venous access device. Implantation in general or local anaesthesia? A retrospective cost analysis].

    Science.gov (United States)

    Schuld, J; Richter, S; Moussavian, M R; Kollmar, O; Schilling, M K

    2009-08-01

    Implantation of venous access port systems can be performed in local or general anesthesia. In spite of the increasing rate of interventionally implanted systems, the surgical cut-down represents a safe alternative. Thus, the question arises whether--in context to the increasing health-economic pressure--open implantation in general anesthesia is still a feasible alternative to implantation in local anesthesia regarding OR efficiency and costs. In a retrospective analysis, 993 patients receiving a totally implantable venous access device between 2001 and 2007 were evaluated regarding OR utilization, turnover times, intraoperative data and costs. Implantations in local (LA) and general anesthesia (GA) were compared. GA was performed in 762 cases (76.6 %), LA was performed in 231 patients (23.3 %). Mean operation time was similar in both groups (LA 47.27 +/- 1.40 min vs. GA 45.41 +/- 0.75 min, p = 0.244). Patients receiving local anesthesia had a significantly shorter stay in the OR unit (LA 95.9 +/- 1.78 min vs. GA 105.92 +/- 0.92 min; p cut (LA 39.57 +/- 0.69 min vs. GA 50.46 +/- 0.52 min; p material costs were significantly lower in the LA group compared with the GA group (LA: 400.72 +/- 8.25 euro vs. GA: 482.86 +/- 6.23 euro; p systems in local anesthesia is superior in comparison to the implantation under general anesthesia regarding procedural times in the OR unit and costs. With the same operation duration, but less personnel and material expenditure, implantation in local anesthesia offers a potential economic advantage by permitting faster changing times. Implantation in GA only should be performed at a special request by the patient or in difficult venous conditions. Georg Thieme Verlag Stuttgart.New York.

  17. Total heat loss coefficient of flat roof constructions with external insulation in tapered layers including the effects of thermal bridges

    DEFF Research Database (Denmark)

    Rose, Jørgen; Svendsen, Svend

    2005-01-01

    In order to achieve durability of flat roofs with external insulation, it is necessary to secure proper drainage of the roof, i.e. to avoid water leaking into the insulation. The design of the tapered insulation of the roof is quite difficult as requirements with respect to both drainage...

  18. Power generation choices: an international perspective on costs, risks and externalities

    International Nuclear Information System (INIS)

    Carle, R.; Moynet, G.

    1994-01-01

    In France, as in other countries, it is no longer possible to discuss issues relating to the power or electricity generating sector without taking account of a wide range of sociological, political and environmental factors. Given the uncertainty regarding either the short-or long-term impact of such factors, analysts can no longer rely on forecasts and need to adopt an approach based on the use of extremely wide-ranging scenarios. Many researchers are currently examining ways in which these factors might be incorporated into economic calculations in the form of externalities. Such externalities cannot be properly taken into account, however, until we have reliable methods and databases with which to quantify them. At present they are taken into account implicitly. Thus the extensive nuclear power programme launched by the French Government in the 1970s was aimed at securing advantages in both economic and environmental terms. These advantages may be seen today in the structure of France's energy supply. (authors). 1 tab

  19. Road pricing, air pollution and external costs; Road pricing, luftforurening og eksternalitetsomkostninger

    Energy Technology Data Exchange (ETDEWEB)

    Solvang Jensen, S.; Ketzel, M. (Aarhus Univ., Danmarks Miljoeundersoegelser, Afd. for Atmosfaerisk Miljoe, Roskilde (Denmark)); Skou Andersen, M. (Aarhus Univ., Danmarks Miljoeundersoegelser, Afd. for Systemanalyse, Roskilde (Denmark))

    2010-06-15

    The objective of this assessment is to improve the foundation for decision-making about introduction of a road pricing system that aims to reduce the health impacts and social costs of traffic-related air pollution. The analysis focuses on how road emissions, air quality, population exposure, and social costs of air pollution depend on geography (different city sizes and rural areas) and time of the day (rush hours versus non-rush hours). A review of Danish studies related to road pricing has also been carried out to assess the expected effect of road pricing on traffic performance (km travelled), vehicle composition and speed that are factors affecting air pollution. (LN)

  20. Patient costs associated with external beam radiotherapy treatment for localized prostate cancer: the benefits of hypofractionated over conventionally fractionated radiotherapy.

    Science.gov (United States)

    Sethukavalan, Perakaa; Cheung, Patrick; Tang, Colin I; Quon, Harvey; Morton, Gerard; Nam, Robert; Loblaw, Andrew

    2012-04-01

    To estimate the out-of-pocket costs for patients undergoing external beam radiotherapy (EBRT) for prostate cancer and calculate the patient-related savings of being treated with a 5-fraction versus a standard 39-fraction approach. Seventy patients accrued to the pHART3 (n = 84) study were analyzed for out-of-pocket patient costs as a result of undergoing treatment. All costs are in Canadian dollars. Using the postal code of the patient's residence, the distance between the hospital and patient home was found using Google Maps. The Canada Revenue Agency automobile allowance rate was then applied to determine the cost per kilometer driven. The average cost of travel from the hospital and pHART3 patient's residence was $246 per person after five trips. In a standard fractionation regimen, pHART3 patients would have incurred an average cost of $1921 after 39 visits. The patients receiving hypofractionated radiotherapy would have paid an average of $38 in parking while those receiving conventional treatment would have paid $293. The difference in out-of-pocket costs for the patients receiving a standard versus hypofractionated treatment was $1930. Medium term prospective data shows that hypofractionated radiotherapy is an effective treatment method for localized prostate cancer. Compared to standard EBRT, hypofractionated radiotherapy requires significantly fewer visits. Due to the long distance patients may have to travel to the cancer center and the expense of parking, the short course treatment saves each patient an average of $1900. A randomized study of standard versus hypofractionated accelerated radiotherapy should be conducted to confirm a favorable efficacy and tolerability profile of the shorter fractionation scheme.

  1. 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

  2. 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

  3. Improvement of the assessment of the external costs of severe nuclear accidents

    International Nuclear Information System (INIS)

    Markandya, A.; Dale, N.; Schneider, T.

    1998-12-01

    The first part of this document presents a bibliographic study on the accidents costs. The second part is devoted to an empirical study realized in Spain, concerning the risk assessment by experts. The third part proposes an approach in terms of hope of utility for the aversion calculation facing the major risks. The last part presents the probabilities transformations taking into account the human perception of the risk. (A.L.B.)

  4. Distributed Flexibility Management Targeting Energy Cost and Total Power Limitations in Electricity Distribution Grids

    DEFF Research Database (Denmark)

    Bessler, Sanford; Kemal, Mohammed Seifu; Silva, Nuno

    2018-01-01

    Demand Management uses the interaction and information exchange between multiple control functions in order to achieve goals that can vary in different application contexts. Since there are several stakeholders involved, these may have diverse objectives and even use different architectures...... to actively manage power demand. This paper utilizes an existing distributed demand management architecture in order to provide the following contributions: (1) It develops and evaluates a set of algorithms that combine the optimization of energy costs in scenarios of variable day-ahead prices with the goal...... to improve distribution grid operation reliability, here implemented by a total Power limit. (2) It evaluates the proposed scheme as a distributed system where flexibility information is exchanged with the existing industry standard OpenADR. A Hardware-in-the-Loop testbed realization demonstrates...

  5. Noninvasive Hemoglobin Monitoring: A Rapid, Reliable, and Cost-Effective Method Following Total Joint Replacement.

    Science.gov (United States)

    Martin, J Ryan; Camp, Christopher L; Stitz, Amber; Young, Ernest Y; Abdel, Matthew P; Taunton, Michael J; Trousdale, Robert T

    2016-03-02

    Noninvasive hemoglobin (nHgb) monitoring was initially introduced in the intensive care setting as a means of rapidly assessing Hgb values without performing a blood draw. We conducted a prospective analysis to compare reliability, cost, and patient preference between nHgb monitoring and invasive Hgb (iHgb) monitoring performed via a traditional blood draw. We enrolled 100 consecutive patients undergoing primary or revision total hip or total knee arthroplasty. On postoperative day 1, nHgb and iHgb values were obtained within thirty minutes of one another. iHgb and nHgb values, cost, patient satisfaction, and the duration of time required to obtain each reading were recorded. The concordance correlation coefficient (CCC) was utilized to evaluate the agreement of the two Hgb measurement methods. Paired t tests and Wilcoxon signed-rank tests were utilized to compare mean Hgb values, time, and pain for all readings. The mean Hgb values did not differ significantly between the two measurement methods: the mean iHgb value (and standard deviation) was 11.3 ± 1.4 g/dL (range, 8.2 to 14.3 g/dL), and the mean nHgb value was 11.5 ± 1.8 g/dL (range, 7.0 to 16.0 g/dL) (p = 0.11). The CCC between the two Hgb methods was 0.69. One hundred percent of the patients with an nHgb value of ≥ 10.5 g/dL had an iHgb value of >8.0 g/dL. The mean time to obtain an Hgb value was 0.9 minute for the nHgb method and 51.1 minutes for the iHgb method (p measurement, resulting in a savings of $26 per Hgb assessment when the noninvasive method is used. Noninvasive Hgb monitoring was found to be more efficient, less expensive, and preferred by patients compared with iHgb monitoring. Providers could consider screening total joint arthroplasty patients with nHgb monitoring and only order iHgb measurement if the nHgb value is protocol had been applied to the first blood draw in our 100 patients, approximately $2000 would have been saved. Extrapolated to the U.S. total joint arthroplasty practice

  6. Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.

    Science.gov (United States)

    Nichols, Christine I; Vose, Joshua G; Nunley, Ryan M

    2017-09-01

    In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  7. Factors Influencing the Total Inpatient Pharmacy Cost at a Tertiary Hospital in Malaysia: A Retrospective Study

    Science.gov (United States)

    Ali Jadoo, Saad Ahmed

    2018-01-01

    The steady growth of pharmaceutical expenditures is a major concern for health policy makers and health care managers in Malaysia. Our study examined the factors affecting the total inpatient pharmacy cost (TINPC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). In this retrospective study, we used 2011 administration electronic prescriptions records and casemix databases at UKMMC to examine the impact of sociodemographic, diagnostic, and drug variables on the TINPC. Bivariate and multivariate analyses of the factors associated with TINPC were conducted. The mean inpatient pharmacy cost per patient was USD 102.07 (SD = 24.76). In the multivariate analysis, length of stay (LOS; B = 0.349, P < .0005) and severity level III (B = 0.253, P < .0005) were the primary factors affecting the TINPC. For each day increase in the LOS and each increase of a case of severity level III, there was an increase of approximately USD 11.97 and USD 171.53 in the TINPC per year, respectively. Moreover, the number of prescribed items of drugs and supplies was positively associated with the TINPC (B = 0.081, P < .0005). Gender appears to have affected the TINPC; male patients seem to be associated with a higher TINPC than females (mean = 139.55, 95% confidence interval [CI]: 112.97-166.13, P < .001). Surgical procedures were associated with higher cost than medical cases (mean = 87.93, 95% CI: 61.00-114.85, P < .001). Malay (MYR 242.02, SD = 65.37) and Chinese (MYR 214.66, SD = 27.99) ethnicities contributed to a lower TINPC compared with Indian (MYR 613.93, SD = 98.41) and other ethnicities (MYR 578.47, SD = 144.51). A longer hospitalization period accompanied by major complications and comorbidities had the greatest influence on the TINPC. PMID:29436248

  8. Update of the external cost for environmental damage (for Flanders) with regard to air pollution and climatic change; Actualisering van de externe milieuschadekosten (algemeen voor Vlaanderen) met betrekking tot luchtverontreiniging en klimaatverandering

    Energy Technology Data Exchange (ETDEWEB)

    De Nocker, L.; Michiels, H.; Deutsch, F.; Lefebvre, W.; Buekers, J.; Torfs, R. [Unit Ruimtelijke Milieuaspecten, VITO, Mol (Belgium)

    2010-12-15

    This report contains a set of indicators for calculating external costs of air-polluting substances and greenhouse gases. The external costs of environmental damage relate to the damage to human health, eco systems, buildings and economy as a result of an activity. This leads to loss of welfare for inhabitants in Flanders and abroad for the current and future generations. The magnitude and evolution of the external or environmental damage cost resulting from air pollution is one of the indicators for the MIRA report that translates the state of the environment into consequences for man and economy. [Dutch] Dit rapport bevat een set van kengetallen voor de berekening van de externe kosten van luchtverontreinigende stoffen en broeikasgassen. De externe kosten of milieuschadekosten hebben betrekking op de schade aan menselijke gezondheid, ecosystemen, gebouwen en economie als gevolg van een activiteit. Dit leidt tot een verlies aan welvaart voor inwoners in Vlaanderen en het buitenland, voor deze en toekomstige generaties. De omvang en evolutie van de externe of milieuschadekosten ten gevolge van luchtverontreiniging ia 1 van de indicatoren voor het MIRA rapport die de toestand van het milieu vertaalt naar gevolgen voor mens en economie.

  9. 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

  10. Force Structure: Restructuring and Rebuilding the Army Will Cost Billions of Dollars for Equipment but the Total Cost Is Uncertain

    National Research Council Canada - National Science Library

    St. Laurent, Janet A

    2008-01-01

    .... Several factors are contributing to the uncertainties about future costs. First, the Army's $43.6 funding plan for equipping modular units was based on preliminary modular unit designs and did not fully consider the needs of National Guard units...

  11. On revealing the vertical structure of nanoparticle films with elemental resolution: A total external reflection X-ray standing waves study

    Energy Technology Data Exchange (ETDEWEB)

    Zargham, Ardalan, E-mail: zargham@ifp.uni-bremen.d [Institute of Solid State Physics, University of Bremen, Otto-Hahn-Allee 1, 28359 Bremen (Germany); Schmidt, Thomas; Flege, Jan Ingo; Sauerbrey, Marc; Hildebrand, Radowan [Institute of Solid State Physics, University of Bremen, Otto-Hahn-Allee 1, 28359 Bremen (Germany); Roehe, Sarah; Baeumer, Marcus [Applied and Physical Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen (Germany); Falta, Jens [Institute of Solid State Physics, University of Bremen, Otto-Hahn-Allee 1, 28359 Bremen (Germany)

    2010-02-15

    We present a promising combination of methods to precisely determine the morphology of nanostructures, drawing on the example of monodisperse CoPt{sub 3} nanoparticle films deposited by spin coating and dip coating techniques on functionalized Au substrates. Ex-situ X-ray standing waves in total external reflection combined with X-ray reflectivity measurements were employed to determine element-specific atomic-density distributions in vertical direction.

  12. 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

  13. articles: The implementation of marginal external cost pricing in road transport Long run vs short run and first-best vs second-best

    OpenAIRE

    Erik T. Verhoef

    2000-01-01

    This article discusses a number of issues that will become increasingly important now that the concept of marginal external cost pricing becomes more likely to be implemented as a policy strategy in transport in reality. The first part of the article deals with the long-run efficiency of marginal external cost pricing. It is shown that such prices not only optimize short-run mobility, given the shape and position of the relevant demand and cost curves, but even more importantly, also optimall...

  14. EFFECT OF EXTERNAL ENVIRONMENT ORGANIZATION AND APPLICATION OF TOTAL QUALITY MANAGEMENT (TQM AND PERFORMANCE OF THE COMPANY AND ITS EFFECT ON COMPETITIVE ADVANTAGE IN PTISM BOGASARI FLOURMILLS, JAKARTA

    Directory of Open Access Journals (Sweden)

    Ana Retno Mawarti

    2016-04-01

    Full Text Available This research aimed to discover the impact of external environment and Total Quality Management implementation on company performance in order to create competitive advantage in PT. ISM Bogasari Flourmills. This research is an associative explanatory research with quantitative method. The data sources used are primary data and secondary data. The primary data collected by spreading 122 questionnaires to employees of PT. ISM Bogasari on chief officers level, assistant manager level, and manager level. Sampling method used is Proportion able Stratified Random Sampling. The result showed that external environment with indicator of complexity, dynamics and environment carrying capacity, has positive and significant impact on company’s performance. Total Quality Management implementation with indicators of costumer focus, continuous refinement and staff training program, brings positive and significant impact on company’s performance. The company’s performance with its indicators of efficiency, effectiveness, and adaptability, has positive and significant impact on the creation of competitive advantage. The Research also proved that external environment and Total Quality Management Implementation directly affect the creation of competitive advantage.

  15. External costs as a measure of environmental impact in the generation of electricity in Poland

    Science.gov (United States)

    Cel, W.; Czechowska-Kosacka, A.; Kujawska, Justyna; Wasąg, H.

    2018-05-01

    The depletion of natural resources, rising fossil fuel prices and growing environmental awareness, are leading to an increase in the popularity of renewable energy sources. In Poland, the share of energy derived from renewable sources continues to grow and now stands at 12.9% of the country’s gross electricity consumption. Energy from renewable sources in Poland is 60€ more expensive per MWh than energy from conventional sources. According to the European Climate and Energy Package, Poland is committed to increasing its share of renewable energy to 15% in 2020, and a further 5% by 2030. It is very important to ensure that the increase in the share of renewable energy will increase the price of energy for the end users. To convince the public of the need to incur greater costs in the purchase of “green” power, we should put forward arguments showing the benefits of its use. The aim of this paper is to demonstrate the viability of support through a system of certification for renewable energy sources and also to estimate the potential increase in energy prices caused by raising RES contribution.

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

    Directory of Open Access Journals (Sweden)

    Derek A. Haas, MBA

    2017-03-01

    Conclusions: 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.

  17. Assessing energy projects from the viewpoint of individual economic branches and total economy. The role of economic efficiency analysis, cost-benefit analysis and multicriteria methods

    International Nuclear Information System (INIS)

    Sell, A.

    1992-01-01

    Energy is an extremely important good and means of production not only for the individual branches of economy but, due to its essential meaning to the development of a region or a national economy and its external effects connected with production and consumption, also of great interest to all economic branches. This article deals with the relation of analyses in individual economical branches and those in total economy and with the question of what the importance of cost-benefit analyses and other methods is in the analysis in total economy. The author also mentions the planning as in the special literature the planning and evaluation phases are not analytically separated which is seen especially in the discussion about the multi-criteria methods. (orig.) [de

  18. 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.

  19. ExternE National Implementation Finland

    Energy Technology Data Exchange (ETDEWEB)

    Pingoud, K; Maelkki, H; Wihersaari, M; Pirilae, P [VTT Energy, Espoo (Finland); Hongisto, M [Imatran Voima Oy, Vantaa (Finland); Siitonen, S [Ekono Energy Ltd, Espoo (Finland); Johansson, M [Finnish Environment Institute, Helsinki (Finland)

    1999-07-01

    ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

  20. ExternE National Implementation Finland

    International Nuclear Information System (INIS)

    Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P.; Hongisto, M.; Siitonen, S.; Johansson, M.

    1999-01-01

    ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

  1. ExternE National Implementation Finland

    Energy Technology Data Exchange (ETDEWEB)

    Pingoud, K.; Maelkki, H.; Wihersaari, M.; Pirilae, P. [VTT Energy, Espoo (Finland); Hongisto, M. [Imatran Voima Oy, Vantaa (Finland); Siitonen, S. [Ekono Energy Ltd, Espoo (Finland); Johansson, M. [Finnish Environment Institute, Helsinki (Finland)

    1999-07-01

    ExternE National Implementation is a continuation of the ExternE Project, funded in part by the European Commission's Joule III Programme. This study is the result of the ExternE National Implementation Project for Finland. Three fuel cycles were selected for the Finnish study: coal, peat and wood-derived biomass, which together are responsible for about 40% of total electricity generation in Finland and about 75% of the non-nuclear fuel based generation. The estimated external costs or damages were dominated by the global warming (GW) impacts in the coal and peat fuel cycles, but knowledge of the true GW impacts is still uncertain. From among other impacts that were valued in monetary terms the human health damages due to airborne emissions dominated in all the three fuel cycles. Monetary valuation for ecosystem impacts is not possible using the ExternE methodology at present. The Meri-Pori power station representing the coal fuel cycle is one of the world's cleanest and most efficient coal-fired power plants with a condensing turbine. The coal is imported mainly from Poland. The estimated health damages were about 4 mECU/kWh, crop damages an order of magnitude lower and damages caused to building materials two orders of magnitude lower. The power stations of the peat and biomass fuel cycles are of CHP type, generating electricity and heat for the district heating systems of two cities. Their fuels are of domestic origin. The estimated health damages allocated to electricity generation were about 5 and 6 mECU/kWh, respectively. The estimates were case-specific and thus an generalisation of the results to the whole electricity generation in Finland is unrealistic. Despite the uncertainties and limitations of the methodology, it is a promising tool in the comparison of similar kinds of fuel cycles, new power plants and pollution abatement technologies and different plant locations with each other. (orig.)

  2. Infrastructure expenditures and costs. Practical guidelines to calculate total infrastructure costs for five modes of transport. Final report

    International Nuclear Information System (INIS)

    2005-11-01

    Transport infrastructures in general, and the Trans European Transport Network (TEN-T) in particular, play an important role in achieving the medium and long-term objectives of the European Union. In view of this, the Commission has recently adopted a revision of the guidelines for the TEN-T. The main consequences of this revision are the need for a better understanding of the investments made by the member states in the TEN-T and the need for ensuring optimal consistency in the reporting by the Members States of such investments. With Regulation number 1108/70 the Council of the European Communities introduced an accounting system for expenditure on infrastructure in respect of transport by rail, road and inland waterways. The purpose of this regulation is to introduce a standard and permanent accounting system for infrastructure expenditures. However maritime and aviation infrastructure were not included. Further, the need for an effective and easy to apply classification for infrastructure investments concerning all five transport modes was still pending. Therefore, DG TREN has commissioned ECORYS Transport and CE Delft to study the expenditures and costs of infrastructure, to propose an adequate classification of expenditures, and to propose a method for translating data on expenditures into data on costs. The objectives of the present study are threefold: To set out a classification of infrastructure expenditures, in order to increase knowledge of expenditures related to transport infrastructures. This classification should support a better understanding of fixed and variable infrastructure costs; To detail the various components of such expenditures for five modes of transportation, which would enable the monitoring of infrastructure expenditures and costs; and to set up a methodology to move from annual series of expenditures to costs, including fixed and variable elements.

  3. Low-cost, digital lock-in module with external reference for coating glass transmission/reflection spectrophotometer

    Science.gov (United States)

    Alonso, R.; Villuendas, F.; Borja, J.; Barragán, L. A.; Salinas, I.

    2003-05-01

    A versatile, low-cost, digital signal processor (DSP) based lock-in module with external reference is described. This module is used to implement an industrial spectrophotometer for measuring spectral transmission and reflection of automotive and architectonic coating glasses over the ultraviolet, visible and near-infrared wavelength range. The light beams are modulated with an optical chopper. A digital phase-locked loop (DPLL) is used to lock the lock-in to the chop frequency. The lock-in rejects the ambient radiation and permits the spectrophotometer to work in the presence of ambient light. The algorithm that implements the dual lock-in and the DPLL in the DSP56002 evaluation module from Motorola is described. The use of a DSP allows implementation of the lock-in and DPLL by software, which gives flexibility and programmability to the system. Lock-in module cost, under 300 euro, is an important parameter taking into account that two modules are used in the system. Besides, the algorithms implemented in this DSP can be directly implemented in the latest DSP generations. The DPLL performance and the spectrophotometer are characterized. Capture and lock DPLL ranges have been measured and checked to be greater than the chop frequency drifts. The lock-in measured frequency response shows that the lock-in performs as theoretically predicted.

  4. Risk and Cost of 90-Day Complications in Morbidly and Superobese Patients After Total Knee Arthroplasty.

    Science.gov (United States)

    Meller, Menachem M; Toossi, Nader; Johanson, Norman A; Gonzalez, Mark H; Son, Min-Sun; Lau, Edmund C

    2016-10-01

    This study investigated the risk and cost of postoperative complications associated with morbid and super obesity after total knee arthroplasty (TKA). A retrospective cohort study was conducted of patients who underwent TKA using Medicare hospital claims data. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code V85.4x was used to identify morbidly obese patients (body mass index [BMI] ≥40 kg/m(2)) and superobese patients (BMI ≥50 kg/m(2)) in 2011-2013. Patients without any BMI-related diagnosis codes were used as controls. Twelve complications occurred in the 90-day period after TKA were analyzed using multivariate Cox models, adjusting for patient demographic, morbidity, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through subsequent 90 days. Morbidly obese patients showed a significantly elevated risk in most complications examined, with a 2-fold or higher risk in dislocation and wound dehiscence. In addition, death, periprosthetic joint infection, acute renal failure, and knee revision had significant hazard ratios between 1.5 and 2.0. However, risk of deep vein thrombosis and acute myocardial infarction did not increase for the morbidly obese patients. Superobese patients had significant increase in risk of infection, wound dehiscence, acute renal failures, revisions, death, and readmission compared with patients with BMI 40-49 kg/m(2). Significant dose-response trend was found between the level of BMI and risk for death, dislocation, implant failure, infection, readmission, revision, wound dehiscence, and acute renal failure. Controlling for patient and institutional factors, each TKA had an average total hospital charges of $75,884 among superobese patients, compared to $65,118 for the control group, a difference of $10,767. Medicare payment for the superobese patients was also higher, but only by $2703. Morbidly obese patients pose a significantly

  5. Determination of solid surface composition by the X-ray fluorescence method under total external reflection with angular scanning

    International Nuclear Information System (INIS)

    Krasnolutskij, V.P.

    2000-01-01

    Possibilities of determination of composition of surface layers by X-ray fluorescence analysis under total reflection of incident radiation with angular scanning of a target are investigated. For the case of the GaAs target it is shown that the sensibility of this method is sufficient for a control of element composition in layer of thickness 1 nm. A simple method for solution of inverse task of analysis of a two component medium is considered [ru

  6. 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...

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

    Science.gov (United States)

    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.

  8. External costs due to congestion, accidents, energy consumption and emissions before and into the economic crisis: Pilot study along selected roadways of Thessaloniki, Greece

    Directory of Open Access Journals (Sweden)

    Sotiriou Matina

    2015-01-01

    Full Text Available Prior to the economic crisis, forecasts indicated a continuous increase of traffic in European cities, highlighting the need of a policy to alleviate the external impacts of transport. The crisis, however, generated pressures on all sectors of activity, with transport being an indicative example. The reduction of income and employment, the increased vehicle maintenance and renewal costs and the transport related taxation seem to affect the transport system and its external impacts. Thus, taking for granted that Europe will eventually achieve “sustainable recovery” from the crisis, the current period presents an opportunity for promoting sustainable mobility policies and interventions in the most affected by the crisis European cities. Towards this goal, it is essential to capitalise on contemporary techniques for the monitoring of changes in transport external costs. The purpose of the paper is the development of a methodology for the estimation of external costs due to congestion, air pollution, climate change and accidents, based on road traffic data. The methodology is applied along road arteries in Thessaloniki for the period “before and after” the emergence of the crisis. As a result, an overall decrease in external costs is observed, creating an unforeseen “surplus” for the society during the crisis.

  9. The true costs of participatory sanitation: Evidence from community-led total sanitation studies in Ghana and Ethiopia.

    Science.gov (United States)

    Crocker, Jonny; Saywell, Darren; Shields, Katherine F; Kolsky, Pete; Bartram, Jamie

    2017-12-01

    Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34-$81.56 per household targeted in Ghana, and $14.15-$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93-$22.36 per household targeted in Ghana, and $2.35-$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behavior-change programs. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  10. Cardiopulmonary exercise testing responses to different external portable drivers in a patient with a CardioWest Total Artificial Heart.

    Science.gov (United States)

    Tarzia, Vincenzo; Braccioni, Fausto; Bortolussi, Giacomo; Buratto, Edward; Gallo, Michele; Bottio, Tomaso; Vianello, Andrea; Gerosa, Gino

    2016-06-01

    Management of patients treated with CardioWest Total Artificial Heart (CW-TAH) as a bridge to heart transplantation (HTx) is complicated by difficulties in determining the optimal timing of transplantation. We present a case of a 53-year-old man supported as an outpatient with a CW-TAH, whose condition deteriorated following exchange of the portable driver. The patient was followed-up with serial cardiopulmonary exercise testing (CPET) which demonstrated a fall of peak VO2 to below 12 ml/kg/min following driver substitution, and the patient was subsequently treated with urgent orthotopic HTx. This case highlights the potential utility of CPET as a means for monitoring and indicating timing of HTx in patients with CW-TAH, as well as the potential for clinical deterioration following portable driver substitution.

  11. 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

  12. Internal and External Intertextuality as a ‘Total Novel’ Formula in Noaptea de Sânziene by Mircea Eliade

    Directory of Open Access Journals (Sweden)

    Mihaela RUSU

    2014-12-01

    Full Text Available One of the possible grids of analysis of Mircea Eliade’s novel Noaptea de Sânziene (The Forbidden Forest is intertextuality, which aims at tracing the presence of a text within another text, in view of relating the author’s creativity and the reader’s vigilance. The fictional world of the novel in focus provides the reader with the image of a few intellectual characters which live their personal experience through the fundamental myths of the European space (Ulysses, Percival, Tristan and Isolde, feeling that the modern man relives the experiences of the mythical one. The quotation of a few lines from Dante’s Inferno comes to reinforce the idea that the protagonists are in search for identity in the maze of their lives, seen as an archetype of the world. War, death, and the world’s decay, which take place under their eyes, are expressed using the principles of Hindu philosophy: the world goes through a sombre age named kali-yuga, a form of dissolution which is a requisite for its (recreation. This mixture of direct references to representative European literary works and allusions to Hindu philosophy supports Eliade’s efforts in creating the first total novel in Romanian literature, a work which provides the informed reader with a journey through literary spaces.

  13. 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.

  14. Federal Regulations: Efforts to Estimate Total Costs and Benefits of Rules

    Science.gov (United States)

    2004-04-07

    the Chamber of Commerce , academicians, the media, and others, and is sometimes cited with a high degree of certainty ." For example, some articles...House of Representatives, Feb . 25,2004; and testimony of William P . Kovacs, Vice President, U .S. Chamber of Commerce , before the Subcommittee on Energy...estimated the annual cost to employers of the Family and Medical Leave Act at $825 million, but that the Chamber of Commerce estimated the cost at between $3

  15. On the contribution of external cost calculations to energy system governance: The case of a potential large-scale nuclear accident

    International Nuclear Information System (INIS)

    Laes, Erik; Meskens, Gaston; Sluijs, Jeroen P. van der

    2011-01-01

    The contribution of nuclear power to a sustainable energy future is a contested issue. This paper presents a critical review of an attempt to objectify this debate through the calculation of the external costs of a potential large-scale nuclear accident in the ExternE project. A careful dissection of the ExternE approach resulted in a list of 30 calculation steps and assumptions, from which the 6 most contentious ones were selected through a stakeholder internet survey. The policy robustness and relevance of these key assumptions were then assessed in a workshop using the concept of a 'pedigree of knowledge'. Overall, the workshop outcomes revealed the stakeholder and expert panel's scepticism about the assumptions made: generally these were considered not very plausible, subjected to disagreement, and to a large extent inspired by contextual factors. Such criticism indicates a limited validity and useability of the calculated nuclear accident externality as a trustworthy sustainability indicator. Furthermore, it is our contention that the ExternE project could benefit greatly - in terms of gaining public trust - from employing highly visible procedures of extended peer review such as the pedigree assessment applied to our specific case of the external costs of a potential large-scale nuclear accident. - Highlights: → Six most contentious assumptions were selected through a stakeholder internet survey. → Policy robustness of these assumptions was assessed in a pedigree assessment workshop. → Assumptions were considered implausible, controversial, and inspired by contextual factors. → This indicates a limited validity and useability as a trustworthy sustainability indicator.

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

    Science.gov (United States)

    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

  17. Characterization of a Low-Cost Optical Flow Sensor When Using an External Laser as a Direct Illumination Source

    Directory of Open Access Journals (Sweden)

    Jordi Palacín

    2011-12-01

    Full Text Available In this paper, a low cost optical flow sensor is combined with an external laser device to measure surface displacements and mechanical oscillations. The measurement system is based on applying coherent light to a diffuser surface and using an optical flow sensor to analyze the reflected and transferred light to estimate the displacement of the surface or the laser spot. This work is focused on the characterization of this measurement system, which can have the optical flow sensor placed at different angles and distances from the diffuser surface. The results have shown that the displacement of the diffuser surface is badly estimated when the optical mouse sensor is placed in front of the diffuser surface (angular orientation >150° while the highest sensitivity is obtained when the sensor is located behind the diffuser surface and on the axis of the laser source (angular orientation 0°. In this case, the coefficient of determination of the measured displacement, R2, was very high (>0.99 with a relative error of less than 1.29%. Increasing the distance between the surface and the sensor also increased the sensitivity which increases linearly, R2 = 0.99. Finally, this measurement setup was proposed to measure very low frequency mechanical oscillations applied to the laser device, up to 0.01 Hz in this work. The results have shown that increasing the distance between the surface and the optical flow sensor also increases the sensitivity and the measurement range.

  18. 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.

  19. The effect of feed-in tariffs on the production cost and the landscape externalities of wind power generation in West Saxony, Germany

    International Nuclear Information System (INIS)

    Drechsler, Martin; Meyerhoff, Jürgen; Ohl, Cornelia

    2012-01-01

    Although wind power is currently the most efficient source of renewable energy, the cost of wind electricity still exceeds the market price. Subsidies in the form of feed-in tariffs (FIT) have been introduced in many countries to support the expansion of wind power. These tariffs are highly debated. Proponents say they are necessary to pave the way for decarbonising energy production. Opponents argue they prevent a welfare-optimal energy supply. Thus, in a case study we try to shed light on the welfare economic aspect of FIT by combining spatial modelling and economic valuation of landscape externalities of wind turbines. We show for the planning region West Saxony, Germany, that setting FIT in a welfare optimal manner is a challenging task. If set too high the production costs are overly increased, lowering social welfare. If set too low energy production targets may not be reached and/or external costs are overly increased, again lowering social welfare. Taking a closer look at the tariffs offered by the German Renewable Sources Energy Act we find for West Saxony that the tariffs quite well meet economic welfare considerations. One should note, however, that this finding might apply only to the present data set. - Highlights: ► We analyse the effect of feed-in tariffs on the cost of wind power production. ► Low tariffs imply low production costs but high external costs. ► High tariffs imply high production costs but low external costs. ► Optimal tariff is a delicate balance between opposing policy goals.

  20. Correction of tibial malunion in a patient with ipsilateral total knee and ankle prostheses using external ring fixation and the ilizarov method

    Directory of Open Access Journals (Sweden)

    Alexander M Smith

    2017-01-01

    Full Text Available Total ankle replacement (TAR aims at reestablishing a functional and painless ankle joint while maintaining motion and preventing adjacent joint arthritis. TAR can be complicated by comorbidities such as ipsilateral knee arthritis and deformity with subsequent arthroplasty and/or other lower extremity malalignment issues. We present a case of a 67-year-old female with severe right ankle pain and a history of ipsilateral subtalar and calcaneocuboid fusion, bilateral total knee arthroplasty, and a malunion of a conservatively treated ipsilateral segmental tibial fracture. Following TAR, there was recurrent lateral hindfoot pain due to subtle malalignment from the tibial malunion which resulted in persistent hindfoot valgus. This caused symptomatic subfibular impingement in addition to limb length discrepancy. To address that, a circular external fixator was applied to realign the ankle and lengthen the tibia, eliminating pain and avoiding complications with either implant.

  1. 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

  2. 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)

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

    Science.gov (United States)

    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.

  4. Evaluation of the Influence of the Logistic Operations Reliability on the Total Costs of a Supply Chain

    Directory of Open Access Journals (Sweden)

    Lukinskiy Valery

    2016-12-01

    Full Text Available Nowadays in logistics integral processes between the material and related flows in supply chains are getting developed more and more. However, in spite of increasing volume of statistical data which reflect the integral processes, the influence evaluation issues of the logistic operations reliability indexes on the total logistics costs remain open and require the corresponding researches implementation.

  5. Reducing Customers’ Total Cost of Ownership Within a Software Supply Network

    NARCIS (Netherlands)

    Slinger, S.R.L.; Rijsemus, W.

    2006-01-01

    This paper describes how the company Cordys avoids the ERP problems from the last 15 years by improving the software release, delivery, deployment, and maintenance processes. These ERP problems, such as costly ERP migrations and highly complex maintenance procedures, are circumvented by the

  6. RANKED SET SAMPLING FOR ECOLOGICAL RESEARCH: ACCOUNTING FOR THE TOTAL COSTS OF SAMPLING

    Science.gov (United States)

    Researchers aim to design environmental studies that optimize precision and allow for generalization of results, while keeping the costs of associated field and laboratory work at a reasonable level. Ranked set sampling is one method to potentially increase precision and reduce ...

  7. Total and Marginal Cost Analysis for a High School Based Bystander Intervention

    Science.gov (United States)

    Bush, Joshua L.; Bush, Heather M.; Coker, Ann L.; Brancato, Candace J.; Clear, Emily R.; Recktenwald, Eileen A.

    2018-01-01

    Costs of providing the Green Dot bystander-based intervention, shown to be effective in the reduction of sexual violence among Kentucky high school students, were estimated based on data from a large cluster-randomized clinical trial. Rape Crisis Center Educators were trained to provide Green Dot curriculum to students. Implementing Green Dot in…

  8. Functional and oncologic outcomes after excision of the total femur in primary bone tumors: Results with a low cost total femur prosthesis

    Directory of Open Access Journals (Sweden)

    Ajay Puri

    2012-01-01

    Full Text Available Background: The extent of tumor may necessitate resection of the complete femur rarely to achieve adequate oncologic clearance in bone sarcomas. We present our experience with reconstruction in such cases using an indigenously manufactured, low-cost, total femoral prosthesis (TFP. We assessed the complications of the procedure, the oncologic and functional outcomes, and implant survival. Materials and Methods: Eight patients (four males and four females with a mean age of 32 years, operated between December 2003 and June 2009, had a TFP implanted. The diagnosis included osteogenic sarcoma (5, Ewing′s sarcoma (1, and chondrosarcoma (2. Mean followup was 33 months (9-72 months for all and 40 months (24-72 months in survivors. They were evaluated by Musculoskeletal Tumor Society score, implant survival as well as patient survival. Results: There was one local recurrence and five of seven patients are currently alive at the time of last followup. The Musculoskeletal Tumor Society score for patients ranged from 21 to 25 with a mean of 24 (80%. The implant survival was 88% at 5 years with only one TFP needing removal because of infection. Conclusions: A TFP in appropriately indicated patients with malignant bone tumors is oncologically safe. A locally manufactured, cost-effective implant provided consistent and predictable results after excision of the total femur with good functional outcomes.

  9. Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

    Science.gov (United States)

    Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

    2006-11-01

    Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

  10. 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

  11. Deep water tie-back economics capex vs opex and the total costs

    Energy Technology Data Exchange (ETDEWEB)

    Tarlton, Oran D. [Oil States Industries Inc., Arlington, TX (United States)

    2005-07-01

    This paper explores the real cost and time benefits associated with the current, past, and future contracting strategies associated with subsea developments. It looks at the real cost associated with out sourcing engineering development and the impact of engineering, procurement, installation, and construction (EPIC) contracts. Development costs are first and foremost in the minds of operators as a field is analyzed for development potential. The cycle starts with an analysis of the geological information to estimate the potential value in the field. It proceeds to conceptual design where the first development methodology and cost estimates are prepared. If the project is initially viable it will proceed from conceptual design to Front End Engineering and Design (FEED) where a complete development plan is prepared with possible options and recommendations. Engineering companies may as a part of the FEED prepare a Request for Quotation (RFQ) which is sent to potential suppliers. As part of a FEED contract, an engineering company may also review responses to the RFQ and provide recommendations for selected suppliers. Typically large subsea projects are divided into several major categories such as: topsides; subsea production systems; wells; subsea umbilical risers and glow lines (SURF), and commissioning in order to simplify management and procurement. Many times these contracts are awarded as EPIC contracts to further simplify management and internal procurement efforts. A case study is presented which challenges current contracting strategies and presents an option for a lower cost and a better way forward with respect to the short term and a focus on the long term. (author)

  12. Total cost of ownership of CHP SOFC systems: Effect of installation context

    International Nuclear Information System (INIS)

    Arduino, Francesco; Santarelli, Massimo

    2016-01-01

    Solid oxide fuel cells (SOFC) are one of the most interesting between the emerging technologies for energy production. Although some information about the production cost of these devices are already known, their operational cost has not been studied yet with sufficient accuracy. This paper presents a life cycle cost (LCC) analysis of CHP (combined heat and power) SOFC systems performed in hospitals located in various cities of the US and one in Italy. In this study the strong effects of the installation context will be analyzed using a customized use phase model for each location. The cost effectiveness of these devices has been proved without credits in Mondovi (IT), New York (NY) and Minneapolis (MN) where the payback time goes from 10 to 7 years. Considering the credits, it is possible to obtain economic feasibility also in Chicago (IL) and reduce the payback for other cities to values from 4 to 6 years. In other cities like Phoenix (AZ) and Houston (TX) the payback can’t be reached in any case. The life cycle impact assessment analysis has shown how, even in the cities with cleaner electricity grid, there is a reduction in the emissions of both greenhouse gases and pollutants. - Highlights: •Life cycle cost analysis has been performed for CHP SOFC systems. •The strong effects of the installation context have been analyzed. •Economic feasibility has been proven in new york, Minneapolis and Mondovi. •Economic feasibility can’t be reached in phoenix and Houston. •SOFC always provide a reduction in the emissions of greenhouse gases and pollutant.

  13. Total cost of ownership of electric vehicles compared to conventional vehicles: A probabilistic analysis and projection across market segments

    International Nuclear Information System (INIS)

    Wu, Geng; Inderbitzin, Alessandro; Bening, Catharina

    2015-01-01

    While electric vehicles (EV) can perform better than conventional vehicles from an environmental standpoint, consumers perceive them to be more expensive due to their higher capital cost. Recent studies calculated the total cost of ownership (TCO) to evaluate the complete cost for the consumer, focusing on individual vehicle classes, powertrain technologies, or use cases. To provide a comprehensive overview, we built a probabilistic simulation model broad enough to capture most of a national market. Our findings indicate that the comparative cost efficiency of EV increases with the consumer's driving distance and is higher for small than for large vehicles. However, our sensitivity analysis shows that the exact TCO is subject to the development of vehicle and operating costs and thus uncertain. Although the TCO of electric vehicles may become close to or even lower than that of conventional vehicles by 2025, our findings add evidence to past studies showing that the TCO does not reflect how consumers make their purchase decision today. Based on these findings, we discuss policy measures that educate consumers about the TCO of different vehicle types based on their individual preferences. In addition, measures improving the charging infrastructure and further decreasing battery cost are discussed. - Highlights: • Calculates the total cost of ownership across competing vehicle technologies. • Uses Monte Carlo simulation to analyse distributions and probabilities of outcomes. • Contains a comprehensive assessment across the main vehicle classes and use cases. • Indicates that cost efficiency of technology depends on vehicle class and use case. • Derives specific policy measures to facilitate electric vehicle diffusion

  14. Ranking periodic ordering models on the basis of minimizing total inventory cost

    Directory of Open Access Journals (Sweden)

    Mohammadali Keramati

    2015-06-01

    Full Text Available This paper aims to provide proper policies for inventory under uncertain conditions by comparing different inventory policies. To review the efficiency of these algorithms it is necessary to specify the area in which each of them is applied. Therefore, each of the models has been reviewed under different forms of retailing and they are ranked in terms of their expenses. According to the high values of inventories and their impacts on the costs of the companies, the ranking of various models using the simulation annealing algorithm are presented, which indicates that the proposed model of this paper could perform better than other alternative ones. The results also indicate that the suggested algorithm could save from 4 to 29 percent on costs of inventories.

  15. Implementation of Distance Support (DS) to Reduce Total Ownership Cost (R-TOC)

    Science.gov (United States)

    2012-02-01

    Policy of 22 Mar 2007, states that DS combines people, processes and technology into a collaborative infrastructure regardless of geographic location...Tech Assist Data for Submarine Enterprise 120 FTA Events Performed 164 MH Via On-Si te Support Average Cost Per Event (Based on $60.00 Per Hour...CFFC/Command Policy) 16% Success Rate Overa l l On Al l FTA Events 37% Success Rate On Out-Of-Area Events Average MHs Per Event 19 MH Via DS

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

    OpenAIRE

    Mustafa Gökhan Bilgili; Ersin Erçin; Cemal Kural; Altuğ Duramaz; Cevdet Avkan; Gökhan Peker; Serdar Hakan Başaran

    2014-01-01

    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 ...

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

    Science.gov (United States)

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

    2016-12-01

    Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies. © 2016 European Society of Endocrinology.

  18. Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

    Science.gov (United States)

    Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

    2017-01-01

    Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

  19. Feasibility studies to improve plant availability and reduce total installed cost in IGCC plants

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, Kevin [General Electric Company, Houston, TX (United States); Anasti, William [General Electric Company, Houston, TX (United States); Fang, Yichuan [General Electric Company, Houston, TX (United States); Subramanyan, Karthik [General Electric Company, Houston, TX (United States); Leininger, Tom [General Electric Company, Houston, TX (United States); Zemsky, Christine [General Electric Company, Houston, TX (United States)

    2015-03-30

    The main purpose of this project is to look at technologies and philosophies that would help reduce the costs of an Integrated Gasification Combined Cycle (IGCC) plant, increase its availability or do both. GE’s approach to this problem is to consider options in three different areas: 1) technology evaluations and development; 2) constructability approaches; and 3) design and operation methodologies. Five separate tasks were identified that fall under the three areas: Task 2 – Integrated Operations Philosophy; Task 3 – Slip Forming of IGCC Components; Task 4 – Modularization of IGCC Components; Task 5 – Fouling Removal; and Task 6 – Improved Slag Handling. Overall, this project produced results on many fronts. Some of the ideas could be utilized immediately by those seeking to build an IGCC plant in the near future. These include the considerations from the Integrated Operations Philosophy task and the different construction techniques of Slip Forming and Modularization (especially if the proposed site is in a remote location or has a lack of a skilled workforce). Other results include ideas for promising technologies that require further development and testing to realize their full potential and be available for commercial operation. In both areas GE considers this project to be a success in identifying areas outside the core IGCC plant systems that are ripe for cost reduction and ity improvement opportunities.

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

    Science.gov (United States)

    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

  1. External Costs and Benefits of Energy. Methodologies, Results and Effects on Renewable Energies Competitivity; Costes y Beneficios Externos de la Energia. Metodologias, Resultados e Influencia sobre la Competitividad de las Energias Renovables

    Energy Technology Data Exchange (ETDEWEB)

    Saez, R; Cabal, H; Varela, M [CIEMAT. Madrid (Spain)

    1999-09-01

    This study attempts to give a summarised vision of the concept of externally in energy production, the social and economic usefulness of its evaluation and consideration as support to the political decision-marking in environmental regulation matters, technologies selection of new plants, priorities establishment on energy plans, etc. More relevant environmental externalities are described, as are the effects on the health, ecosystems, materials and climate, as well as some of the socioeconomic externalities such as the employment, increase of the GDP and the reduction and depletion of energy resources. Different methodologies used during the last years have been reviewed as well as the principals results obtained in the most relevant studies accomplished internationally on this topic. Special mention has deserved the European study National Implementation of the ExternE Methodology in the EU. Results obtained are represented in Table 2 of this study. Also they are exposed, in a summarised way, the results obtained in the evaluation of environmental externalities of the Spanish electrical system in function of the fuel cycle. In this last case the obtained results are more approximated since have been obtained by extrapolation from the obtained for ten representative plants geographically distributed trough the Peninsula. Finally it has been analysed the influence that the internalization of the external costs of conventional energies can have in the competitiveness and in the market of renewable energy, those which originate less environmental effects and therefore produce much smaller external costs. The mechanisms of internalization and the consideration on the convenience or not of their incorporation in the price of energy have been also discussed. (Author) 30 refs.

  2. Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

    Science.gov (United States)

    Demos, Harry A; Lin, Zilan X; Barfield, William R; Wilson, Sylvia H; Robertson, Dawn C; Pellegrini, Vincent D

    2017-08-01

    Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation. TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed. Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. 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.

  4. Power plant allocation in East Kalimantan considering total cost and emissions

    Science.gov (United States)

    Muslimin; Utomo, D. S.

    2018-04-01

    The fulfillment of electricity need in East Kalimantan is the responsibility of State Electricity Company/Perusahaan Listrik Negara (PLN). But PLN faces constraints in the lack of generating capacity it has. So the allocation of power loads in East Kalimantan has its own challenges. Additional power supplies from other parties are required. In this study, there are four scenarios tested to meet the electricity needs in East Kalimantan with the goal of minimizing costs and emissions. The first scenario is only by using PLN power plant. The second scenario is by combining PLN + Independent Power Producer (IPP) power plants. The third scenario is by using PLN + Rented power plants. The fourth scenario is by using PLN + Excess capacity generation. Numerical experiment using nonlinear programming is conducted with the help of the solver. The result shows that in the peak load condition, the best combination is scenario 2 (PLN + IPP). While at the lowest load condition, the cheapest scenario is PLN + IPP while the lowest emission is PLN + Rent.

  5. A total cost perspective on use of polymeric materials in solar collectors – Importance of environmental performance on suitability

    International Nuclear Information System (INIS)

    Carlsson, Bo; Persson, Helena; Meir, Michaela; Rekstad, John

    2014-01-01

    Highlights: • A polymeric solar collector system was compared with two traditional ones. • It was found the best in terms of climatic performance per solar heat collected. • The differences in climatic cost between the systems compared however are small. • The low climatic cost makes solar heating better compared to natural gas heating. • Use of Ecoindicator 99 for environmental cost makes solar heating even better. - Abstract: To assess the suitability of solar collector systems in which polymeric materials are used versus those in which more traditional materials are used, a case study was undertaken. In this case study a solar heating system with polymeric solar collectors was compared with two equivalent but more traditional solar heating systems: one with flat plate solar collectors and one with evacuated tube solar collectors. To make the comparison, a total cost accounting approach was adopted. The life cycle assessment (LCA) results clearly indicated that the polymeric solar collector system is the best as regards climatic and environmental performance when they are expressed in terms of the IPPC 100 a indicator and the Ecoindicator 99, H/A indicator, respectively. In terms of climatic and environmental costs per amount of solar heat collected, the differences between the three kinds of collector systems were small when compared with existing energy prices. With the present tax rates, it seems unlikely that the differences in environmental and climatic costs will have any significant influence on which system is the most favoured, from a total cost point of view. In the choice between a renewable heat source and a heat source based on the use of a fossil fuel, the conclusion was that for climatic performance to be an important economic factor, the tax or trade rate of carbon dioxide emissions must be increased significantly, given the initial EU carbon dioxide emission trade rate. The rate would need to be at least of the same order of magnitude

  6. Internal-external malalignment of the femoral component in kinematically aligned total knee arthroplasty increases tibial force imbalance but does not change laxities of the tibiofemoral joint.

    Science.gov (United States)

    Riley, Jeremy; Roth, Joshua D; Howell, Stephen M; Hull, Maury L

    2018-06-01

    The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces) and changes in laxities caused by  2° and 4° of internal-external (I-E) malalignment of the femoral component in kinematically aligned total knee arthroplasty. Because I-E malalignment would introduce the greatest changes to the articular surfaces near 90° of flexion, the hypotheses were that the tibial force imbalance would be significantly increased near 90° flexion and that primarily varus-valgus laxity would be affected near 90° flexion. Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced I-E malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured from 0° to 120° flexion using a custom tibial force sensor. Bidirectional laxities in four degrees of freedom were measured from 0° to 120° flexion using a custom load application system. Tibial force imbalance increased the greatest at 60° flexion where a regression analysis against the degree of I-E malalignment yielded sensitivities (i.e. slopes) of 30 N/° (medial tibial force > lateral tibial force) and 10 N/° (lateral tibial force > medial tibial force) for internal and external malalignments, respectively. Valgus laxity increased significantly with the 4° external component with the greatest increase of 1.5° occurring at 90° flexion (p < 0.0001). With the tibial component correctly aligned, I-E malalignment of the femoral component caused significant increases in tibial force imbalance. Minimizing I-E malalignment lowers the increase in the tibial force imbalance. By keeping

  7. Valuing Externalities of Watershed Restoration and Erosion Control Projects in Mediterranean Basins: A Comparative Analysis of the Contingent Valuation and Replacement Cost Methods

    OpenAIRE

    Saez, Maria Del Carmen Almansa; Calatrava-Requena, Javier

    2002-01-01

    The methodology used for Economic Valuation of the Externalities generated by the Watershead Restoration and Erosion Control Projects in the Hydrographic Basins of the Mediterranean Slope, is based on the Replacement Cost Method. Environmental Economics, however, today offer us other methodological possibilities, whose application to the valuation of this type of project may prove to be of interest. It is the case of the Contingent Valuation Method used for the evaluation of the effects of th...

  8. External costs of atmospheric lead emissions from a waste-to-energy plant: a follow-up assessment of indirect neurotoxic impacts via topsoil ingestion

    DEFF Research Database (Denmark)

    Pizzol, Massimo; Møller, Flemming; Thomsen, Marianne

    2013-01-01

    The link between anthropogenic emissions and the monetary value of their impacts, so-called external cost, can be determined via the impact pathway approach. This method is used in the present study to calculate the indirect costs, via topsoil ingestion, of lead emitted into atmosphere from a waste......-to-energy facility in Denmark. The Operational Meteorological air-quality model, the Simplified Fate and Speciation Model, and the Age Dependent Biokinetic Model are used to determine the metals’ atmospheric transport, its deposition and accumulation in topsoil, and its bio-accumulation in the human body...

  9. Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

    Science.gov (United States)

    Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

    2015-12-01

    To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  10. Benefits of using customized instrumentation in total knee arthroplasty: results from an activity-based costing model.

    Science.gov (United States)

    Tibesku, Carsten O; Hofer, Pamela; Portegies, Wesley; Ruys, C J M; Fennema, Peter

    2013-03-01

    The growing demand for total knee arthroplasty (TKA) associated with the efforts to contain healthcare expenditure by advanced economies necessitates the use of economically effective technologies in TKA. The present analysis based on activity-based costing (ABC) model was carried out to estimate the economic value of patient-matched instrumentation (PMI) compared to standard surgical instrumentation in TKA. The costs of the two approaches, PMI and standard instrumentation in TKA, were determined by the use of ABC which measures the cost of a particular procedure by determining the activities involved and adding the cost of each activity. Improvement in productivity due to increased operating room (OR) turn-around times was determined and potential additional revenue to the hospital by the efficient utilization of gained OR time was estimated. Increased efficiency in the usage of OR and utilization of surgical trays were noted with patient-specific approach. Potential revenues to the hospital were estimated with the use of PMI by efficient utilization of time saved in OR. Additional revenues of 78,240 per year were estimated considering utilization of gained OR time to perform surgeries other than TKA. The analysis suggests that use of PMI in TKA is economically effective when compared to standard instrumentation.

  11. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    Science.gov (United States)

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. 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

    Directory of Open Access Journals (Sweden)

    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.

  13. Assessment of the external costs of the coal fuel cycle and the wind energy cycle in Spain

    International Nuclear Information System (INIS)

    Linares, P.; Montes, J.; Saez, R.M.

    1995-09-01

    This study is part of the ExternE Project, a joint effort of the European Commission and the US Dept. of Energy to assess the externalities of different fuel cycles, and quantify them in monetary terms, as kWh price adders. For Spain, this assessment has been carried out for a coal plant hypothetically sited in Valdecaballeros, in Southwestern Spain, and for an existing farm in Cabo Villano, in the Northwestern corner. In this first stage, only environmental externalities have been assessed. The first section contains a description of the methodology used in the European project, based mostly on a damage function approach, and its adaptation to Spanish conditions. In the last section, this methodology has been applied to the fuel cycles mentioned. The impacts assessed have been, for the coal fuel cycle, health effects, agricultural and forest production losses, and global warming. For wind energy, the main impacts considered have been noise, loss of visual amenity, accidents and global warning. The results obtained can only be considered as underestimates, as there are still impacts that have not been assessed or quantified, specially for the coal fuel cycle. Thus, further research is needed for a complete assessment

  14. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

    Science.gov (United States)

    Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

    2014-10-01

    Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

  15. Ab initio supercell calculations of the (0001) α-Cr2O3 surface with a partially or totally Al-substituted external layer

    International Nuclear Information System (INIS)

    Sun Jizhong; Stirner, Thomas

    2009-01-01

    Ab initio supercell calculations employing the periodic Hartree-Fock formalism are presented of the (0001) α-Cr 2 O 3 surface with a partially or totally Al-substituted external layer. In the simulations a fraction of the Cr atoms at the surface of the chromia slab are replaced by Al atoms, and the Al surface coverage is varied between zero (pure chromia) and 100% (Al-terminated chromia). The surface Al atoms are found to relax inwards considerably, with the magnitude of the relaxation decreasing with increasing Al surface coverage. The calculations also reveal that the surface energy of the slab decreases with increasing Al coverage. Finally, the electronic properties at the surface of the Al-substituted (0001) α-Cr 2 O 3 slabs are investigated. Here the calculations show that the substitution of Cr by Al gives rise to an increase in the covalency of the Al-O bonds compared to slabs of pure alumina. In contrast, the influence of the surface Al atoms on the electrostatic potential in the (0001) plane of metal ions is relatively small. These findings support the utilisation of α-chromia substrates for the templated growth of α-alumina, which is consistent with recent experiments.

  16. Estimation of Externalities for Juragua Nuclear Project

    International Nuclear Information System (INIS)

    Mora, H. R.; Carbonell, L. T.

    2002-01-01

    Estimation of externalities allows taking into account environmental impacts due to any activity in total costs calculation. In the present work, the external costs of electricity generation from nuclear energy were calculated considering three scenarios: normal operation (routine releases), accident situation and solid waste disposal. A comparison between these results and those obtained for electricity generation from fossil fuels was made. IAEA proposals of Simplified methodologies were used for externality calculations. The Juragua project was selected as a study case; it is based in two energetic blocks both PWR, VVER 440/318 type with a plant capacity of 417 MWe each. Four impact ways were considered for all scenarios: (1) Inhalation of radionuclides in the air, (2) External irradiation from radionuclides immersed in clouds, (3) External irradiation from deposited radionuclides and (4) Ingestion of radionuclides in agricultural products. Besides, two impact categories (local and regional) for all scenarios were considered. The total cost of externalities was 0.01425 c/kWh, value smaller than the one obtained for electricity generation from fossil fuel (0.256 c/kWh). For the normal operation scenario, the external cost calculated was 0.00112 c/kWh, for accident situation 0.01103 c/kWh, and for the solid wastes management scenario 0.0021 c/kWh. The high value obtained for solid waste disposal scenario is due to repository placement features. (author)

  17. Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease.

    Science.gov (United States)

    Ament, Jared D; Yang, Zhuo; Nunley, Pierce; Stone, Marcus B; Kim, Kee D

    2014-12-01

    Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis, while preserving motion. While anterior cervical discectomy and fusion (ACDF) has been the standard of care for 2-level disease, a randomized clinical trial (RCT) suggested similar outcomes. Cost-effectiveness of this intervention has never been elucidated. To determine the cost-effectiveness of CTDR compared with ACDF. Data were derived from an RCT that followed up 330 patients over 24 months. The original RCT consisted of multi-institutional data including private and academic institutions. Using linear regression for the current study, health states were constructed based on the stratification of the Neck Disability Index and a visual analog scale. Data from the 12-item Short-Form Health Survey questionnaires were transformed into utilities values using the SF-6D mapping algorithm. Costs were calculated by extracting Diagnosis-Related Group codes from institutional billing data and then applying 2012 Medicare reimbursement rates. The costs of complications and return-to-work data were also calculated. A Markov model was built to evaluate quality-adjusted life-years (QALYs) for both treatment groups. The model adopted a third-party payer perspective and applied a 3% annual discount rate. Patients included in the original RCT had to be diagnosed as having radiculopathy or myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment for at least 6 weeks or demonstrated progressive symptoms. Incremental cost-effectiveness ratio of CTDR compared with ACDF. A strong correlation (R2 = 0.6864; P sensitivity analysis, the incremental cost-effectiveness ratio value stays below the threshold of $50,000 per QALY in most scenarios (range, -$58,194 to $147,862 per QALY). The incremental cost-effectiveness ratio of CTDR compared with traditional ACDF is lower than the commonly accepted threshold of $50,000 per QALY. This remains true with varying input

  18. Muscle-invasive bladder cancer treated with external beam radiation: influence of total dose, overall treatment time, and treatment interruption on local control

    International Nuclear Information System (INIS)

    Moonen, L.; Voet, H. van der; Nijs, R. de; Horenblas, S.; Hart, A.A.M.; Bartelink, H.

    1998-01-01

    Purpose: To evaluate and eventually quantify a possible influence of tumor proliferation during the external radiation course on local control in muscle invasive bladder cancer. Methods and Materials: The influence of total dose, overall treatment time, and treatment interruption has retrospectively been analyzed in a series of 379 patients with nonmetastasized, muscle-invasive transitional cell carcinoma of the urinary bladder. All patients received external beam radiotherapy at the Netherlands Cancer Institute between 1977 and 1990. Total dose varied between 50 and 75 Gy with a mean of 60.5 Gy and a median of 60.4 Gy. Overall treatment time varied between 20 and 270 days with a mean of 49 days and a median of 41 days. Number of fractions varied between 17 and 36 with a mean of 27 and a median of 26. Two hundred and forty-four patients had a continuous radiation course, whereas 135 had an intended split course or an unintended treatment interruption. Median follow-up was 22 months for all patients and 82 months for the 30 patients still alive at last follow-up. A stepwise procedure using proportional hazard regression has been used to identify prognostic treatment factors with respect to local recurrence as sole first recurrence. Results: One hundred and thirty-six patients experienced a local recurrence and 120 of these occurred before regional or distant metastases. The actuarial local control rate was 40.3% at 5 years and 32.3% at 10 years. In a multivariate analysis total dose showed a significant association with local control (p 0.0039), however in a markedly nonlinear way. In fact only those patients treated with a dose below 57.5 Gy had a significant higher bladder relapse rate, whereas no difference in relapse rate was found among patients treated with doses above 57.5 Gy. This remained the case even after adjustment for overall treatment time and all significant tumor and patient characteristics. The Normalized Tumor Dose (NTD) (α/β = 10) and NTD (

  19. A Flexible Job Shop Scheduling Problem with Controllable Processing Times to Optimize Total Cost of Delay and Processing

    Directory of Open Access Journals (Sweden)

    Hadi Mokhtari

    2015-11-01

    Full Text Available In this paper, the flexible job shop scheduling problem with machine flexibility and controllable process times is studied. The main idea is that the processing times of operations may be controlled by consumptions of additional resources. The purpose of this paper to find the best trade-off between processing cost and delay cost in order to minimize the total costs. The proposed model, flexible job shop scheduling with controllable processing times (FJCPT, is formulated as an integer non-linear programming (INLP model and then it is converted into an integer linear programming (ILP model. Due to NP-hardness of FJCPT, conventional analytic optimization methods are not efficient. Hence, in order to solve the problem, a Scatter Search (SS, as an efficient metaheuristic method, is developed. To show the effectiveness of the proposed method, numerical experiments are conducted. The efficiency of the proposed algorithm is compared with that of a genetic algorithm (GA available in the literature for solving FJSP problem. The results showed that the proposed SS provide better solutions than the existing GA.

  20. A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals.

    Science.gov (United States)

    van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A

    2016-10-01

    Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  1. Energy, Pollutant Emissions and Other Negative Externality Savings from Curbing Individual Motorized Transportation (IMT: A Low Cost, Low Technology Scenario Analysis in Brazilian Urban Areas

    Directory of Open Access Journals (Sweden)

    Ursula Maruyama

    2012-03-01

    Full Text Available This article examines the inefficient use of resources in the Brazilian transportation system. The energy use growth and external cost generation in this essential economic sector are considerable, and the trend is towards an increasing problem in the coming years. The continued expansion of Brazilian cities and the increase in demand for mobility is a result of a substantial growth in the number of road transport users, as increased earnings enable lower income groups to acquire and use individual motorized means of transport. The aim of this paper is to estimate the potential gains from reducing individual motorized transport by the year 2020. This investigation concludes that in a conservationist scenario, by prioritizing low cost, low technology public policies—which include operation of Bus Rapid Transit systems, walking and cycling facilities and congestion charges, among others—it should be possible to save over USD 30 billion and USD 26 billion in external transportation and infrastructure costs, respectively, up to 2020. In addition, these public policies can save more than 35 million Tons of Oil Equivalents in energy consumption and avoid almost 4,000 thousand tons of local pollution emissions and 37,500 thousand tons of GHG emissions in the same period.

  2. Awareness of external costs - helps to improve environmental protection. The methodological convention for estimates of environmental externalities: the energy and transport sectors as examples; Externe Kosten kennen - Umwelt besser schuetzen. Die Methodenkonvention zur Schaetzung externer Kosten am Beispiel Energie und Verkehr

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-04-15

    Today, environmental policy has to face economic considerations more than in former times. By means of an economic valuation of environmental damage, it is possible to estimate the economic utility of environmental policy measures. This is important because today's environmental policy prevents tomorrow's environmental damage. At present, there is no other field where this fact has become as obvious as in climate policy. All recent publications have provided evidence that climate protection is worthwhile because the costs of climate protection measures are lower than those resulting from inactivity. Economic valuation means to weigh a number of choices and targets against each other. Valuation requires value judgements. How to define a damage event? How to weigh different goods which deserve protection against each other and damage occurring today against that occurring in the future? How to deal with uncertainty with regard to future returns and risks? These are only a few of the problems depending on value judgements that we have to face. This applies in general and not only in economic valuation. The Methodological Convention elaborated by the Federal Environment Agency addresses these problems. It has been the intention of the authors to explain and substantiate their value judgements and the criteria underlying the valuation of environmental damage (as well as that of environmental damage that has been avoided). Thus, the Federal Environment Agency wishes to make a contribution to transparency and consistency of decision-making in environmental policy. The principles of valuation suggested may be used for example to substantiate cost rates for external costs incurred by energy production and transport. The exemplary calculations have demonstrated that the internalization of environmental costs has been achieved in part only. Policy makers may choose different ways to gradually improve this situation. Internalization does not necessarily mean that

  3. 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

  4. Walking- and cycling track networks in Norwegian cities : cost-benefit analyses including health effects and external costs of road traffic : summary

    Science.gov (United States)

    2002-04-01

    Cost- benefit analyses of walking- and cycling track net-works in three Norwegian cities are presented in this study. A project group working with a National Cycling Strategy in Norway initialised the study. Motivation for starting the study is the P...

  5. 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.

  6. Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

    Science.gov (United States)

    Balegar V, Kiran Kumar; Azeem, Mohammad Irfan; Spence, Kaye; Badawi, Nadia

    2013-01-01

    To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  7. 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...

  8. Development and application of performance and cost models for the externally-fired combined cycle. Task 1, Volume 2. Topical report, June 1995

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, P.; Frey, H. [North Carolina State Univ., Raleigh, NC (United States); Rubin, E.S. [Carnegie Mellon Univ., Pittsburgh, PA (United States)

    1995-07-01

    Increasing restrictions on emission of pollutants from conventional pulverized coal fired steam (PCFS) plant generating electrical power is raising capital and operating cost of these plants and at the same time lowering plant efficiency. This is creating a need for alternative technologies which result in lower emissions of regulated pollutants and which are thermally more efficient. Natural gas-fired combined cycle power generation systems have lower capital cost and higher efficiencies than conventional coal fired steam plants, and at this time they are the leading contender for new power plant construction in the U.S. But the intermediate and long term cost of these fuels is high and there is uncertainty regarding their long-term price and availability. Coal is a relatively low cost fuel which will be abundantly available in the long term. This has motivated the development of advanced technologies for power production from coal which will have advantages of other fuels. The Externally Fired Combined Cycle (EFCC) is one such technology. Air pollution control/hot gas cleanup issues associated with this technology are described.

  9. [Fuel Rod Consolidation Project]: The estimated total life cycle cost for the 30-year operation of prototypical consolidation demonstration equipment: Volume 4, Phase 2

    International Nuclear Information System (INIS)

    1987-01-01

    The Total Life Cycle Costs have been developed for the construction, operation and decommissioning of a single line of hot-cell-enclosed production consolidation equipment operating on spent fuel at the rate of 750 MTU/year for 30 years. The cost estimate is for a single production line that is part of an overall facility at either a Monitored Retrievable Storage or a Repository facility. This overall facility would include other capabilities and possibly other consolidation lines. However, no costs were included in the cost estimate for other portions of the plant, except that staff costs include an overhead charge that reflects the overhead support services in an overall facility

  10. Human health-related externalities in energy system modelling the case of the Danish heat and power sector

    DEFF Research Database (Denmark)

    Zvingilaite, Erika

    2011-01-01

    and power sector verifies that it is cheaper for the society to include externalities in the planning of an energy system than to pay for the resulting damages later. Total health costs decrease by around 18% and total system costs decrease by nearly 4% when health externalities are included...

  11. Regional Externalities

    NARCIS (Netherlands)

    Heijman, W.J.M.

    2007-01-01

    The book offers practical and theoretical insights in regional externalities. Regional externalities are a specific subset of externalities that can be defined as externalities where space plays a dominant role. This class of externalities can be divided into three categories: (1) externalities

  12. 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

  13. The long-term life cycle private and external costs of high coal usage in the US

    International Nuclear Information System (INIS)

    Bergerson, Joule; Lave, Lester

    2007-01-01

    Using four times as much coal in 2050 for electricity production need not degrade air quality or increase greenhouse gas emissions. Current SO x and NO x emissions from the power sector could be reduced from 12 to less than 1 and from 5 to 2 million tons annually, respectively, using advanced technology. While direct CO 2 emissions from new power plants could be reduced by over 87%, life cycle emissions could increase by over 25% due to the additional coal that is required to be mined and transported to compensate for the energy penalty of the carbon capture and storage technology. Strict environmental controls push capital costs of pulverized coal (PC) and integrated coal gasification combined cycle (IGCC) plants to $1500-1700/kW and $1600-2000/kW, respectively. Adding carbon capture and storage (CCS) increases costs to $2400-2700/kW and $2100-3000/kW (2005 dollars), respectively. Adding CCS reduces the 40-43% efficiency of the ultra-supercritical PC plant to 31-34%; adding CCS reduces the 32-38% efficiency of the GE IGCC plant to 27-33%. For IGCC, PC, and natural gas combined cycle (NGCC) plants, the carbon dioxide tax would have to be $53, $74, and $61, respectively, to make electricity from a plant with CCS cheaper. Capturing and storing 90% of the CO 2 emissions increases life cycle costs from 5.4 to 11.6 cents/kWh. This analysis shows that 90% CCS removal efficiency, although being a large improvement over current electricity generation emissions, results in life cycle emissions that are large enough that additional effort is required to achieve significant economy-wide reductions in the US for this large increase in electricity generation using either coal or natural gas

  14. Autologous Stem Cell Transplantation in Patients With Multiple Myeloma: An Activity-based Costing Analysis, Comparing a Total Inpatient Model Versus an Early Discharge Model.

    Science.gov (United States)

    Martino, Massimo; Console, Giuseppe; Russo, Letteria; Meliado', Antonella; Meliambro, Nicola; Moscato, Tiziana; Irrera, Giuseppe; Messina, Giuseppe; Pontari, Antonella; Morabito, Fortunato

    2017-08-01

    Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs. The TIM and EDOM models involved a total cost of €28,615.15 and €16,499.43, respectively. In the TIM model, the phase with the greatest economic impact was the posttransplant (recovery and hematologic engraftment) with 36.4% of the total cost, whereas in the EDOM model, the phase with the greatest economic impact was the pretransplant (chemo-mobilization, apheresis procedure, cryopreservation, and storage) phase, with 60.4% of total expenses. In an analysis of each episode, the TIM model comprised a higher absorption than the EDOM. In particular, the posttransplant represented 36.4% of the total costs in the TIM and 17.7% in EDOM model, respectively. The estimated reduction in cost per patient using an EDOM model was over €12,115.72. The repayment of the DRG in Calabrian Region for the ASCT procedure is €59,806. Given the real cost of the transplant, the estimated cost saving per patient is €31,190.85 in the TIM model and €43,306.57 in the EDOM model. In conclusion, the actual repayment of the DRG does not correspond to the real cost of the ASCT procedure in Italy. Moreover, using the EDOM, the cost of ASCT is approximately the half of the TIM model. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. How generation choices are influenced by costs, risks and externalities: the generation planning process in Ontario, Canada

    International Nuclear Information System (INIS)

    Marriage, E.A.; Rogers, M.S.

    1994-01-01

    Ontario Hydro is responsible for generating, supplying and delivering electricity throughout Ontario, Canada. Installed generation capacity of 32 GW consists of 20% hydro-electric (6.4 GW), 35% fossil (11.3 GW) and 40% nuclear (14.2 GW). Ontario Hydro' s planning process has evolved significantly since its decision in the late 1970's to build the 4-unit 3500 MW Darlington Nuclear Station. The emergence of environmental issues as a primary consideration, increased awareness of financial and regulatory risks, and uncertainty about the load forecast and the impact of demand management programs on the load have all contributed to the changed planning process. This paper discusses Ontario Hydro's responses to these changes such as: increased public involvement in the decision-making process; the use of a broader range of options including demand management and non-utility generation; optimizing the use of the existing system; more complete risk analyses of generation options, and recent attempts to incorporate externalities into the decision-making process. (authors). 3 figs

  16. The effect of fiscal incentives on market penetration of electric vehicles: A pairwise comparison of total cost of ownership

    International Nuclear Information System (INIS)

    Lévay, Petra Zsuzsa; Drossinos, Yannis; Thiel, Christian

    2017-01-01

    An important barrier to electric vehicle (EV) sales is their high purchase price compared to internal combustion engine (ICE) vehicles. We conducted total cost of ownership (TCO) calculations to study how costs and sales of EVs relate to each other and to examine the role of fiscal incentives in reducing TCO and increasing EV sales. We composed EV-ICE vehicle pairs that allowed cross-segment and cross-country comparison in eight European countries. Actual car prices were used to calculate the incentives for each model in each country. We found a negative TCO-sales relationship that differs across car segments. Compared to their ICE vehicle pair, big EVs have lower TCO, higher sales, and seem to be less price responsive than small EVs. Three country groups can be distinguished according to the level of fiscal incentives and their impact on TCO and EV sales. In Norway, incentives led to the lowest TCO for the EVs. In the Netherlands, France, and UK the TCO of EVs is close to the TCO of the ICE pairs. In the other countries the TCO of EVs exceeds that of the ICE vehicles. We found that exemptions from flat taxes favour big EVs, while lump-sum subsidies favour small EVs. - Highlights: • Pairwise comparison of EV and ICE vehicle TCO and sales in eight European countries. • In NO, EV TCO is lower than ICE TCO; in NL, FR, and UK, EV TCO is slightly higher. • Compared to ICE vehicles, big EVs have lower TCO and higher sales than small EVs. • Exemptions from flat taxes favour big EVs, lump-sum subsidies favour small EVs. • Most popular EV models: Tesla Model S, Nissan Leaf, Mitsubishi Outlander PHEV.

  17. Joint estimation of vertical total electron content (VTEC) and satellite differential code biases (SDCBs) using low-cost receivers

    Science.gov (United States)

    Zhang, Baocheng; Teunissen, Peter J. G.; Yuan, Yunbin; Zhang, Hongxing; Li, Min

    2018-04-01

    Vertical total electron content (VTEC) parameters estimated using global navigation satellite system (GNSS) data are of great interest for ionosphere sensing. Satellite differential code biases (SDCBs) account for one source of error which, if left uncorrected, can deteriorate performance of positioning, timing and other applications. The customary approach to estimate VTEC along with SDCBs from dual-frequency GNSS data, hereinafter referred to as DF approach, consists of two sequential steps. The first step seeks to retrieve ionospheric observables through the carrier-to-code leveling technique. This observable, related to the slant total electron content (STEC) along the satellite-receiver line-of-sight, is biased also by the SDCBs and the receiver differential code biases (RDCBs). By means of thin-layer ionospheric model, in the second step one is able to isolate the VTEC, the SDCBs and the RDCBs from the ionospheric observables. In this work, we present a single-frequency (SF) approach, enabling the joint estimation of VTEC and SDCBs using low-cost receivers; this approach is also based on two steps and it differs from the DF approach only in the first step, where we turn to the precise point positioning technique to retrieve from the single-frequency GNSS data the ionospheric observables, interpreted as the combination of the STEC, the SDCBs and the biased receiver clocks at the pivot epoch. Our numerical analyses clarify how SF approach performs when being applied to GPS L1 data collected by a single receiver under both calm and disturbed ionospheric conditions. The daily time series of zenith VTEC estimates has an accuracy ranging from a few tenths of a TEC unit (TECU) to approximately 2 TECU. For 73-96% of GPS satellites in view, the daily estimates of SDCBs do not deviate, in absolute value, more than 1 ns from their ground truth values published by the Centre for Orbit Determination in Europe.

  18. 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.

  19. A pilot study to evaluate the cost-effectiveness of ondansetron and granisetron in fractionated total body irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Gibbs, S.J.; Cassoni, A.M. [Middlesex Hospital, London (United Kingdom)

    1996-11-01

    The duration of the antiemetic effect of granisetron was examined in a pilot study of patients (n = 26) undergoing a standard emetogenic stimulus in the form of total body irradiation fractionated over 3-4 days, in a randomized comparison with twice-daily ondansetron. A single intravenous dose of granisetron at the onset of therapy was effective over the entire follow-up period in 50% (6/12) of patients, compared with 77% (10/13) prescribed twice-daily oral ondansetron for 3 or 4 days. The response rate within the first 24 hours from the start of irradiation was 67% (8/12) for granisetron and 77% (10/13) for ondansetron. Granisetron and ondansetron was therefore of similar efficacy within the first 24-hour period, but granisetron was less efficaceous more than 24 hours after the onset of therapy. Patients who required a second dose of granisetron did so at intervals of 12, 42, 47 and 48 hours following the first fraction of radiotherapy. The cost per patient in this study was 48 for granisetron and {sub 1}54 for ondanestron, but the dose scheduling we used cannot be recommended in view of the lower effectiveness of granisetron. (author).

  20. A pilot study to evaluate the cost-effectiveness of ondansetron and granisetron in fractionated total body irradiation

    International Nuclear Information System (INIS)

    Gibbs, S.J.; Cassoni, A.M.

    1996-01-01

    The duration of the antiemetic effect of granisetron was examined in a pilot study of patients (n = 26) undergoing a standard emetogenic stimulus in the form of total body irradiation fractionated over 3-4 days, in a randomized comparison with twice-daily ondansetron. A single intravenous dose of granisetron at the onset of therapy was effective over the entire follow-up period in 50% (6/12) of patients, compared with 77% (10/13) prescribed twice-daily oral ondansetron for 3 or 4 days. The response rate within the first 24 hours from the start of irradiation was 67% (8/12) for granisetron and 77% (10/13) for ondansetron. Granisetron and ondansetron was therefore of similar efficacy within the first 24-hour period, but granisetron was less efficaceous more than 24 hours after the onset of therapy. Patients who required a second dose of granisetron did so at intervals of 12, 42, 47 and 48 hours following the first fraction of radiotherapy. The cost per patient in this study was 48 for granisetron and 1 54 for ondanestron, but the dose scheduling we used cannot be recommended in view of the lower effectiveness of granisetron. (author)

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

    Science.gov (United States)

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

    2017-12-01

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

  2. Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes.

    Science.gov (United States)

    van Hasselt, Martijn; McCall, Nancy; Keyes, Vince; Wensky, Suzanne G; Smith, Kevin W

    2015-02-01

    To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Individual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. © Health Research and Educational Trust.

  3. Multi-objective ACO algorithms to minimise the makespan and the total rejection cost on BPMs with arbitrary job weights

    Science.gov (United States)

    Jia, Zhao-hong; Pei, Ming-li; Leung, Joseph Y.-T.

    2017-12-01

    In this paper, we investigate the batch-scheduling problem with rejection on parallel machines with non-identical job sizes and arbitrary job-rejected weights. If a job is rejected, the corresponding penalty has to be paid. Our objective is to minimise the makespan of the processed jobs and the total rejection cost of the rejected jobs. Based on the selected multi-objective optimisation approaches, two problems, P1 and P2, are considered. In P1, the two objectives are linearly combined into one single objective. In P2, the two objectives are simultaneously minimised and the Pareto non-dominated solution set is to be found. Based on the ant colony optimisation (ACO), two algorithms, called LACO and PACO, are proposed to address the two problems, respectively. Two different objective-oriented pheromone matrices and heuristic information are designed. Additionally, a local optimisation algorithm is adopted to improve the solution quality. Finally, simulated experiments are conducted, and the comparative results verify the effectiveness and efficiency of the proposed algorithms, especially on large-scale instances.

  4. ExternE: Externalities of energy Vol. 5. Nuclear

    International Nuclear Information System (INIS)

    Dreicer, M.; Tort, V.; Manen, P.

    1995-01-01

    Since the early 1970s, there has been increased interest in the environmental impacts that are caused by the generation of electricity. The comparative risk assessment studies at that time used mainly deaths and injuries as impact indicators. By the end of the 1980s studies changed to the assessment of the costs imposed on society and the environment that were not included in the market price of the energy produced, the so-called external costs. The preliminary studies that were published set the conceptual basis, grounded in neo-classical economics, for the valuation of the health and environmental impacts that could be assessed. As a consequence of the many questions raised by the methodologies employed by these early studies, Directorate General XII (DG XII) of the Commission of the European Communities established a collaborative research programme with the United States Department of Energy to identify an appropriate methodology for this type of work. Following the completion of this collaboration, the DG XII programme has continued as the ExternE project. The main objective of the work carried out at CEPN was to develop an impact pathway methodology for the nuclear fuel cycle that would be consistent with the methodologies developed for other fuel cycles, without loosing the nuclear-specific techniques required for a proper evaluation. In this way, comparisons between the different fuel cycles would be possible. This report presents the methodology and demonstration of the results in the context of the French nuclear fuel cycle. The United States team at Oak Ridge National Laboratory has previously issued a draft report on the results of their assessment. The French fuel cycle was broken down into 8 separate stages. Reference sites and 1990s technology were chosen to represent the total nuclear fuel cycle, as it exists today. In addition, the transportation of material between the sites was considered. The facilities are assessed for routine operation, except

  5. Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing.

    Science.gov (United States)

    DiGioia, Anthony M; Greenhouse, Pamela K; Giarrusso, Michelle L; Kress, Justina M

    2016-01-01

    The Affordable Care Act accelerates health care providers' need to prepare for new care delivery platforms and payment models such as bundling and reference-based pricing (RBP). Thriving in this environment will be difficult without knowing the true cost of care delivery at the level of the clinical condition over the full cycle of care. We describe a project in which we identified true costs for both total hip and total knee arthroplasty. With the same tool, we identified cost drivers in each segment of care delivery and collected patient experience information. Combining cost and experience information with outcomes data we already collect allows us to drive costs down while protecting outcomes and experiences, and compete successfully in bundling and RBP programs. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Use of Six Sigma Worksheets for assessment of internal and external failure costs associated with candidate quality control rules for an ADVIA 120 hematology analyzer.

    Science.gov (United States)

    Cian, Francesco; Villiers, Elisabeth; Archer, Joy; Pitorri, Francesca; Freeman, Kathleen

    2014-06-01

    Quality control (QC) validation is an essential tool in total quality management of a veterinary clinical pathology laboratory. Cost-analysis can be a valuable technique to help identify an appropriate QC procedure for the laboratory, although this has never been reported in veterinary medicine. The aim of this study was to determine the applicability of the Six Sigma Quality Cost Worksheets in the evaluation of possible candidate QC rules identified by QC validation. Three months of internal QC records were analyzed. EZ Rules 3 software was used to evaluate candidate QC procedures, and the costs associated with the application of different QC rules were calculated using the Six Sigma Quality Cost Worksheets. The costs associated with the current and the candidate QC rules were compared, and the amount of cost savings was calculated. There was a significant saving when the candidate 1-2.5s, n = 3 rule was applied instead of the currently utilized 1-2s, n = 3 rule. The savings were 75% per year (£ 8232.5) based on re-evaluating all of the patient samples in addition to the controls, and 72% per year (£ 822.4) based on re-analyzing only the control materials. The savings were also shown to change accordingly with the number of samples analyzed and with the number of daily QC procedures performed. These calculations demonstrated the importance of the selection of an appropriate QC procedure, and the usefulness of the Six Sigma Costs Worksheet in determining the most cost-effective rule(s) when several candidate rules are identified by QC validation. © 2014 American Society for Veterinary Clinical Pathology and European Society for Veterinary Clinical Pathology.

  7. Differentiated sales and vehicles taxes. An assessment of instruments for the internalization of external costs of transport

    International Nuclear Information System (INIS)

    Schol, E.

    1995-12-01

    The level of differentiation of the sales and annual vehicle taxes is based on the avoidance costs of noise and air pollution caused by transportation. The assessment is made on economic, ecological, technical and political criteria. The basic assumption of this report is that a system of differentiated sales and annual vehicle taxes for passenger cars will be an additional instrument to an energy/CO 2 tax (or levy). The reason is that due to the far reaching characteristics, the incentives for innovation and the fact that fuel taxes are relatively easy to implement, the core of any internalization strategy at an international level should consist of a taxation on fuel. In this report the discussion of instruments is at the European Community level. On the base of this preliminary research it can be concluded that differentiated sales and annual vehicle taxes have no strong negative impacts, but also have not many strong positive impacts. The instruments will not lead to strong positive impacts on the environment. One of the reasons is that both tax systems are related to vehicle ownership and not to vehicle use. There is a stronger relationship between vehicle use and emissions than between vehicle ownership and emissions. However, the instruments probably are technically as well as politically feasible and will give an incentive for the development and sale of cleaner and more quiet vehicles within the European Union. 1 figs., 9 tabs., 22 refs

  8. The advanced launch system: Application of total quality management principles to low-cost space transportation system development

    Science.gov (United States)

    Wolfe, M. G.; Rothwell, T. G.; Rosenberg, D. A.; Oliver, M. B.

    Recognizing that a major inhibitor of man's rapid expansion of the use of space is the high cost (direct and induced) of space transportation, the U.S. has embarked on a major national program to radically reduce the cost of placing payloads into orbit while, at the same time, making equally radical improvements inlaunch system operability. The program is entitled "The Advanced Launch System" (ALS) and is a joint Department of Defense/National Aeronautics and Space Administration (DoD/NASA) program which will provide launch capability in the post 2000 timeframe. It is currently in Phase II (System Definition), which began in January 1989, and will serve as a major source of U.S. launch system technology over the next several years. The ALS is characterized by a new approach to space system design, development, and operation. The practices that are being implemented by the ALS are expected to affect the management and technical operation of all future launch systems. In this regard, the two most significant initiatives being implemented on the ALS program are the practices of Total Quality Management (TQM) and the Unified Information System (Unis). TQM is a DoD initiative to improve the quality of the DoD acquisition system, contractor management systems, and the technical disciplines associated with the design, development, and operation of major systems. TQM has been mandated for all new programs and affects the way every group within the system currently does business. In order to implement the practices of TQM, new methods are needed. A program on the scale of the ALS generates vast amounts of information which must be used effectively to make sound decisions. Unis is an information network that will connect all ALS participants throughout all phases of the ALS development. Unis is providing support for project management and system design, and in following phases will provide decision support for launch operations, computer integrated manufacturing, automated

  9. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

    Science.gov (United States)

    Copanitsanou, Panagiota; Valkeapää, Kirsi; Cabrera, Esther; Katajisto, Jouko; Leino-Kilpi, Helena; Sigurdardottir, Arun K; Unosson, Mitra; Zabalegui, Adelaida; Lemonidou, Chryssoula

    2017-04-01

    Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research. © 2016 Wiley Periodicals, Inc.

  10. Energy management for cost reduction in the production. TEEM - Total Energy Efficiency Management; Energiemanagement zur Kostensenkung in der Produktion. TEEM - Total Energy Efficiency Management

    Energy Technology Data Exchange (ETDEWEB)

    Westkaemper, Engelbert; Verl, Alexander (eds.)

    2009-07-01

    Within the workshop of the Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Stuttgart, Federal Republic of Germany) at 6th October, 2009, in Stuttgart the following lectures were held: (1) Presentation of Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Engelbert Westkaemper); (2) TEEM - Total Energy Efficiency Management - ''With energy management to an energy efficient production'' (Alexander Schloske); (3) DIN EN 16001 Introduction of an energy management system - utilization and advantages for companies (Sylvia Wahren); (4) Analysis of the energy efficiency with power flow - Support and implementation at factory planning and optimization of production (Klaus Erlach); (5) Total Energy Efficiency Management - Approaches at the company Kaercher in injection moulding for example (Axel Leschtar); (6) Modelling the embodied product energy (Shahin Rahimifard); (7) Acquisition of energy data in the production - Technologies and possibilities (Joachim Neher); (8) Active energy management by means of an ''energy control centre'' - Analysis of the real situation and upgrading measures in the production using coating plants as an example (Wolfgang Klein); (9) Visualisation and simulation of energy values in the digital factory (Carmen Constantinescu, Axel Bruns).

  11. Assessment of the externalities of biomass energy for electricity production

    Energy Technology Data Exchange (ETDEWEB)

    Linares, P; Leal, J; Saez, R M

    1996-10-01

    This study presents a methodology for the quantification of the socioeconomic and environmental externalities of the biomass fuel cycle. It is based on the one developed by the ExternE Project of the European Commission, based in turn in the damage function approach, and which has been extended and modified for a better adaptation to biomass energy systems. The methodology has been applied to a 20 MW biomass power plant, fueled by Cynara cardunculus, in southern Spain. The externalities addressed have been macroeconomic effects, employment, CO{sub 2}, fixation, erosion, and non-point source pollution. The results obtained should be considered only as subtotals, since there are still other externalities to be quantified. anyway, and in spite of the uncertainty existing, these results suggest that total cost (those including internal and external costs) of biomass energy are lower than those of conventional energy sources, what, if taken into account, would make biomass more competitive than it is now. (Author)

  12. Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.

    Science.gov (United States)

    Olsen, Margaret A; Tian, Fang; Wallace, Anna E; Nickel, Katelin B; Warren, David K; Fraser, Victoria J; Selvam, Nandini; Hamilton, Barton H

    2017-02-01

    To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution. The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable cost of serious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.

  13. Estimating Total Program Cost of a Long-Term, High-Technology, High-Risk Project with Task Durations and Costs That May Increase Over Time

    National Research Council Canada - National Science Library

    Brown, Gerald G; Grose, Roger T; Koyak, Robert A

    2006-01-01

    .... Each task suffers some risk of delay and changed cost. Ignoring budget constraints, we use Monte Carlo simulation of the duration of each task in the project to infer the probability distribution of the project completion time...

  14. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

    NARCIS (Netherlands)

    Retèl, Valesca P.; van den Boer, Cindy; Steuten, Lotte M. G.; Okła, Sławomir; Hilgers, Frans J.; van den Brekel, Michiel W.

    2015-01-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore,

  15. Predictors for total hospital and cardiology cost claims among patients with atrial fibrillation initiating dabigatran or acenocoumarol in the Netherlands

    NARCIS (Netherlands)

    Jacobs, M S; van Leent, M W J; Tieleman, R G; Jansman, F G A; Cao, Q; Postma, M J; van Hulst, M

    2017-01-01

    Aims: The prevalence of atrial fibrillation (AF) has increased over the past years due to aging of the population, and healthcare costs associated with AF reflect a significant financial burden. The aim of this study was to explore predictors for the real-world AF-related in-hospital costs in

  16. 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

  17. Comparación de costes de tres tratamientos del cáncer de próstata localizado en España: prostatectomía radical, braquiterapia prostática y radioterapia conformacional externa 3D Cost comparison of three treatments for localized prostate cancer in Spain: radical prostatectomy, prostate brachytherapy and external 3D conformal radiotherapy

    Directory of Open Access Journals (Sweden)

    Virginia Becerra Bachino

    2011-02-01

    statistically significant: medians were €3,229.10, €5,369.00 and €6,265.60, respectively, for the groups of patients treated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy, (p<0.001. In the multivariate analysis (adjusted R²=0.8, the average costs of brachytherapy and external radiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729, respectively. Conclusions: Radical prostatectomy proved to be the most expensive treatment option. Overall, the estimated costs in our study were lower than those published elsewhere. Most of the costs were explained by the therapeutic option and neither comorbidity nor risk groups showed an effect on total costs independent of treatment.

  18. Cost optimization for buildings with hybrid ventilation systems

    Science.gov (United States)

    Ji, Kun; Lu, Yan

    2018-02-13

    A method including: computing a total cost for a first zone in a building, wherein the total cost is equal to an actual energy cost of the first zone plus a thermal discomfort cost of the first zone; and heuristically optimizing the total cost to identify temperature setpoints for a mechanical heating/cooling system and a start time and an end time of the mechanical heating/cooling system, based on external weather data and occupancy data of the first zone.

  19. Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative.

    Science.gov (United States)

    Behery, Omar A; Kouk, Shalen; Chen, Kevin K; Mullaly, Kathleen A; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

    2018-03-01

    The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs. A cohort of 615 elective, primary total hip and knee arthroplasty subjects discharged to an SNF under the Bundled Payments for Care Improvement from 2014 to 2016 were included in our analysis. Patients were grouped into one of the 3 categories of SNF alignment: group 1: non-partners; group 2: agreement-based partners; group 3: institution-owned partners. Demographics, comorbidities, length of stay (LOS) at SNF, and associated costs during the 90-day post-operative period were compared between the 3 groups. Mean index hospital LOS was statistically shortest in group 3 (mean 2.7 days vs 3.5 for groups 1 and 2, P = .001). SNF LOS was also shortest in group 3 (mean 11 days vs 19 and 21 days in groups 2 and 1 respectively, P Total SNF costs and total 90-day costs were both significantly lower in group 3 compared with groups 1 and 2 (P total 90-day costs, without increased risk of readmissions, compared with other SNFs. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Externalities: Their role and value in near-term solar power implementation

    International Nuclear Information System (INIS)

    Swindler, G.

    1992-01-01

    The total cost of electricity includes social and environmental costs, or externalities, that have traditionally been discluded from the cost of energy. Under current regulatory and public pressure to account for these costs as they vary between generating resources, externalities are being reviewed and are gradually being added to the construction and operation costs of all generating resources. Accounting for externalities is described as being obligatory for the electric utility industry. This paper analyzes a variety of quantifiable externalities in comparing solar and wind power to coal, nuclear, natural gas and oil. The inclusion of externalities in full-cost resource accounting is shown to make renewable resources such as solar and wind more competitive in a levelized market

  1. Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model.

    Directory of Open Access Journals (Sweden)

    Hideki Higashi

    Full Text Available BACKGROUND: Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. METHODOLOGY/PRINCIPAL FINDINGS: We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively. However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. CONCLUSIONS/SIGNIFICANCE: Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements.

  2. Estimating externalities of coal fuel cycles. Report No. 3 on the external costs and benefits of fuel cycles: a study by the US Department of Energy and the Commission of the European Communities

    International Nuclear Information System (INIS)

    1994-09-01

    The report, one of a series of eight reports, is primarily about a methodology for estimating coal fuel cycle externalities. The study considered the stages of a typical coal fuel cycle and identified the more important ones: coal mining coal transportation, and electric power generation. Chapter headings are: introduction; alternative contexts for the study; prior studies of damages and benefits; methods development; organization, interpretation and use of results; reference technology and sites; priority impact-pathways for the coal fuel cycle; estimating the externalities of coal mining; estimating coal transportation externalities; estimating-the externalities of electric power generation; tabulation of numerical results; and fundings, conclusions, and recommendations. The study demonstrated the application of the damage function approach to estimating the externalities of coal fuel cycles. A number of analytical methods were applied within that framework to several impact-pathways. 580 refs., 40 figs., 130 tabs., 3 apps

  3. Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae complex multiple drugs resistance: A clinical case report

    Directory of Open Access Journals (Sweden)

    V. Amorese

    2017-01-01

    Conclusion: The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.

  4. Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan.

    Science.gov (United States)

    Chen, Chien-Min; Ke, Yen-Liang

    2016-02-01

    One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.

  5. Energy policy and externalities

    International Nuclear Information System (INIS)

    Bertel, E.; Fraser, P.

    2002-01-01

    External costs of energy have been assessed in a number of authoritative and reliable studies based upon widely accepted methodologies such as life cycle analysis (LCA). However, although those costs are recognised by most stakeholders and decision makers, results from analytical work on externalities and LCA studies are seldom used in policy making. The International Energy Agency (IEA) and the Nuclear Energy Agency (NEA) convened a joint workshop in November 2001 to offer experts and policy makers an opportunity to present state-of-the-art results from analytical work on externalities and debate issues related to the relevance of external costs and LCA for policy-making purposes. The findings from the workshop highlight the need for further work in the field and the potential rote of international organisations like the IEA and the NEA in this context. (authors)

  6. A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

    Science.gov (United States)

    Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine

    2017-08-01

    Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.

  7. It Is a Brave New World: Alternative Payment Models and Value Creation in Total Joint Arthroplasty: Creating Value for TJR, Quality and Cost-Effectiveness Programs.

    Science.gov (United States)

    Chen, Kevin K; Harty, Jonathan H; Bosco, Joseph A

    2017-06-01

    The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty. These methods are to: (1) improve outcomes greater than the increased costs to achieve this improvement, (2) decrease costs without affecting outcomes, and (3) decrease costs while simultaneously improving outcomes. Following these guidelines will help practitioners thrive in a bundled care environment. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. 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

  9. A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly.

    Science.gov (United States)

    Osterhoff, Georg; O'Hara, Nathan N; D'Cruz, Jennifer; Sprague, Sheila A; Bansback, Nick; Evaniew, Nathan; Slobogean, Gerard P

    2017-03-01

    There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis. On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure. In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA. Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team.

    Science.gov (United States)

    Arana, Melissa; Harper, Licia; Qin, Huanying; Mabrey, Jay

    The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.

  11. Externalities - an analysis using the EU ExternE-results

    International Nuclear Information System (INIS)

    2003-10-01

    The EU project ExternE quantified the externalities for the different energy technologies. In this work, the ExternE results are used in a MARKAL-analysis for the Nordic countries. The analysis does not go into detail, but gives some interesting indications: The external costs are not fully covered in the Nordic energy systems, the present taxes and charges are not high enough. The emissions from the energy systems would be strongly reduced, if taxes/environmental charges were set at the level ExternE calculate. The emissions from power production would be reduced most. Renewable energy sources and natural gas dominate the energy systems in the ExternE case

  12. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness.

    Science.gov (United States)

    van der Woude, J A D; Nair, S C; Custers, R J H; van Laar, J M; Kuchuck, N O; Lafeber, F P J G; Welsing, P M J

    2016-01-01

    In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90-95% for the younger age categories. A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient.

  13. Early assessment of the likely cost-effectiveness of a new technology: A Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement.

    Science.gov (United States)

    Dong, Hengjin; Buxton, Martin

    2006-01-01

    The objective of this study is to apply a Markov model to compare cost-effectiveness of total knee replacement (TKR) using computer-assisted surgery (CAS) with that of TKR using a conventional manual method in the absence of formal clinical trial evidence. A structured search was carried out to identify evidence relating to the clinical outcome, cost, and effectiveness of TKR. Nine Markov states were identified based on the progress of the disease after TKR. Effectiveness was expressed by quality-adjusted life years (QALYs). The simulation was carried out initially for 120 cycles of a month each, starting with 1,000 TKRs. A discount rate of 3.5 percent was used for both cost and effectiveness in the incremental cost-effectiveness analysis. Then, a probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations. Computer-assisted TKR was a long-term cost-effective technology, but the QALYs gained were small. After the first 2 years, the incremental cost per QALY of computer-assisted TKR was dominant because of cheaper and more QALYs. The incremental cost-effectiveness ratio (ICER) was sensitive to the "effect of CAS," to the CAS extra cost, and to the utility of the state "Normal health after primary TKR," but it was not sensitive to utilities of other Markov states. Both probabilistic and deterministic analyses produced similar cumulative serious or minor complication rates and complex or simple revision rates. They also produced similar ICERs. Compared with conventional TKR, computer-assisted TKR is a cost-saving technology in the long-term and may offer small additional QALYs. The "effect of CAS" is to reduce revision rates and complications through more accurate and precise alignment, and although the conclusions from the model, even when allowing for a full probabilistic analysis of uncertainty, are clear, the "effect of CAS" on the rate of revisions awaits long-term clinical evidence.

  14. The ExternE project: methodology, objectives and limitations

    International Nuclear Information System (INIS)

    Rabl, A.; Spadaro, J.V.

    2002-01-01

    This paper presents a summary of recent studies on external costs of energy systems, in particular the ExternE (External Costs of Energy) Project of the European Commission. To evaluate the impact and damage cost of a pollutant, one needs to carry out an impact pathway analysis; this involves the calculation of increased pollutant concentrations in all affected regions due to an incremental emission (e.g. μg/m 3 of particles, using models of atmospheric dispersion and chemistry), followed by the calculation of physical impacts (e.g. number of cases of asthma due to these particles, using a dose-response function). The entire so-called fuel chain (or fuel cycle) is evaluated and compared on the basis of delivered end use energy. Even though the uncertainties are large, the results provide substantial evidence that the classical air pollutants (particles, NO x and SO x ) from the combustion of fossil fuels impose a heavy toll, in addition to the cost of global warming. The external costs are especially large for coal; even for 'good current technology' they may be comparable to the price of electricity. For natural gas the external costs are about a third to a half of coal. The external costs of nuclear are small compared to the price of electricity (at most a few %), and so are the external costs of most renewable energy systems. (authors)

  15. Seven-year cost-effectiveness of ProDisc-C total disc replacement: results from investigational device exemption and post-approval studies.

    Science.gov (United States)

    Radcliff, Kris; Lerner, Jason; Yang, Chao; Bernard, Thierry; Zigler, Jack E

    2016-05-01

    OBJECTIVE The purpose of this study was to evaluate the 7-year cost-effectiveness of cervical total disc replacement (CTDR) versus anterior cervical discectomy and fusion (ACDF) for the treatment of patients with single-level symptomatic degenerative disc disease. A change in the spending trajectory for spine care is to be achieved, in part, through the selection of interventions that have been proven effective yet cost less than other options. This analysis complements and builds upon findings from other cost-effectiveness evaluations of CTDR through the use of long-term, patient-level data from a randomized study. METHODS This was a 7-year health economic evaluation comparing CTDR versus ACDF from the US commercial payer perspective. Prospectively collected health care resource utilization and treatment effects (quality-adjusted life years [QALYs]) were obtained from individual patient-level adverse event reports and SF-36 data, respectively, from the randomized, multicenter ProDisc-C total disc replacement investigational device exemption (IDE) study and post-approval study. Statistical distributions for unit costs were derived from a commercial claims database and applied using Monte Carlo simulation. Patient-level costs and effects were modeled via multivariate probabilistic analysis. Confidence intervals for 7-year costs, effects, and net monetary benefit (NMB) were obtained using the nonparametric percentile method from results of 10,000 bootstrap simulations. The robustness of results was assessed through scenario analysis and within a parametric regression model controlling for baseline variables. RESULTS Seven-year follow-up data were available for more than 70% of the 209 randomized patients. In the base-case analysis, CTDR resulted in mean per-patient cost savings of $12,789 (95% CI $5362-$20,856) and per-patient QALY gains of 0.16 (95% CI -0.073 to 0.39) compared with ACDF over 7 years. CTDR was more effective and less costly in 90.8% of probabilistic

  16. Cost-Effectiveness of Five Commonly Used Prosthesis Brands for Total Knee Replacement in the UK: A Study Using the NJR Dataset.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available There is a lack of evidence on the effectiveness or cost-effectiveness of alternative brands of prosthesis for total knee replacement (TKR. We compared patient-reported outcomes, revision rates, and costs, and estimated the relative cost-effectiveness of five frequently used cemented brands of unconstrained prostheses with fixed bearings (PFC Sigma, AGC Biomet, Nexgen, Genesis 2, and Triathlon.We used data from three national databases for patients who had a TKR between 2003 and 2012, to estimate the effect of prosthesis brand on post-operative quality of life (QOL (EQ-5D-3L in 53 126 patients at six months. We compared TKR revision rates by brand over 10 years for 239 945 patients. We used a fully probabilistic Markov model to estimate lifetime costs and quality-adjusted life years (QALYs, incremental cost effectiveness ratios (ICERs, and the probability that each prosthesis brand is the most cost effective at alternative thresholds of willingness-to-pay for a QALY gain.Revision rates were lowest with the Nexgen and PFC Sigma (2.5% after 10 years in 70-year-old women. Average lifetime costs were lowest with the AGC Biomet (£9 538; mean post-operative QOL was highest with the Nexgen, which was the most cost-effective brand across all patient subgroups. For example, for 70-year-old men and women, the ICERs for the Nexgen compared to the AGC Biomet were £2 300 per QALY. At realistic cost per QALY thresholds (£10 000 to £30 000, the probabilities that the Nexgen is the most cost-effective brand are about 98%. These results were robust to alternative modelling assumptions.AGC Biomet prostheses are the least costly cemented unconstrained fixed brand for TKR but Nexgen prostheses lead to improved patient outcomes, at low additional cost. These results suggest that Nexgen should be considered as a first choice prosthesis for patients with osteoarthritis who require a TKR.

  17. Control Analysis Of Tobacco Raw Material Supplies Using Eoq Method Economic Order Quantity To Reach Efficiency Total Costs Of Raw Material In Pr. Sukun

    Directory of Open Access Journals (Sweden)

    Wiwik Sudarwati

    2017-07-01

    Full Text Available The raw material inventory control system determines and guarantees the availability of raw material stock in the right quantity quality and timing. The problem in this research is the procurement of raw materials of tobacco. PR. Sukun still often experiences the excess. This is related to the frequency of raw material purchases and the quantity of raw material purchases which can lead to waste of working capital embedded in raw material inventory raw material ordering costs and raw material storage costs. The purpose of this research is to know how to make an efficiency level in procurement of raw material inventory between EOQ method compared with policy of PR. Sukun. The type of research used is analytic descriptive type. Data analysis begins by analyzing raw material quantity comparison total raw material inventory cost and raw material cost between PR Sukun policy with EOQ method. Based on the results of research known that by using EOQ method can be much more efficient compared to policy of PR. Sukun. The quantity and frequency of purchasing raw materials is less but still take into account the safety stock and reorder point so the production process is not disturbed. In addition the cost of purchasing ordering costs and raw materials storage costs less so as to create efficiencies on the cost of raw materials inventory. PR. Sukun in the procurement of raw material inventory should use EOQ method to be more efficient and take into account the safety stock and reorder point to avoid the inventory excess of raw materials.

  18. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study.

    Science.gov (United States)

    Eibich, Peter; Dakin, Helen A; Price, Andrew James; Beard, David; Arden, Nigel K; Gray, Alastair M

    2018-04-10

    To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS). Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases. UK secondary care. Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year. EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement. Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution. Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with

  19. The cost of post-operative shed blood salvage after total knee arthroplasty: an analysis of 1,093 consecutive procedures

    Science.gov (United States)

    Muñoz, Manuel; Ariza, Daniel; Campos, Arturo; Martín-Montañez, Elisa; Pavía, José

    2013-01-01

    Background Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20–50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. Materials and methods Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT®, Wellspect HealthCare and ConstaVac CBC II®, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis. Results Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € −51.9 to € 49.9/patient for ConstaVac CBCII). Discussion Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin cost-saving, its efficacy could be increased by

  20. Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.

    Science.gov (United States)

    Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro

    2017-06-07

    The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.

  1. The total cost of logistics in supplier selection, under conditions of multiple sourcing, multiple criteria and capacity constraint

    Directory of Open Access Journals (Sweden)

    Elnaz Bani

    2016-06-01

    Full Text Available This paper presents a mathematical model to solve a multi-objective decision making supplier selection problem. The proposed problem considers three objective functions: the first objective function minimizes the cost of purchasing the products while the second objective function minimizes the due dates and finally the third objective function maximizes the customer satisfaction. The resulted problem is formulated as mixed integer programming and, therefore, we use invasive weed optimization technique to solve the resulted problem. The performance of the proposed model is compared with NSGA II based on different criteria such as mean ideal distance and quality matrix. The preliminary results indicate that the proposed model performs relatively well compared with alternative method.

  2. Estimating fuel cycle externalities: Analytical methods and issues. Report number 2 on the external costs and benefits of fuel cycles: A study by the U.S. Department of Energy and the Commission of the European Communities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-07-01

    This report, the second in a series of eight reports, is part of a joint study by the U.S. Department of Energy (DOE) and the Commission of the European Communities (EC) 'on the externalities of fuel cycles.' Part I illustrates the use of the atmospheric dispersion and transformation modeling that this study recommends for airborne pollutants in the coal, biomass, oil, and natural gas fuel cycles. Part II of this volume contains a paper which reviews the scientific literature on ecological impacts associated with power plant discharges. Part III contains papers summarizing the relevant health effects literature. Part IV contains papers on methods of economic evaluation. Part V contains four papers on various issues related to the estimation of externalities and their use in public policy. The final part is Part VI, and it contains a paper which describes a system for summarizing analysts' assessments of the quality of the information that an analysis uses to estimate externalities. This system allows analysts to provide information, not only on their best estimates, but also on a range of estimates, on uncertainty, on the quality of the data, and on other factors that better reflect the full dimension of making estimates under uncertainty. The system has broad applicability beyond fuel cycle externalities, as well.

  3. Estimating fuel cycle externalities: Analytical methods and issues. Report number 2 on the external costs and benefits of fuel cycles: A study by the U.S. Department of Energy and the Commission of the European Communities

    International Nuclear Information System (INIS)

    1994-07-01

    This report, the second in a series of eight reports, is part of a joint study by the U.S. Department of Energy (DOE) and the Commission of the European Communities (EC) 'on the externalities of fuel cycles.' Part I illustrates the use of the atmospheric dispersion and transformation modeling that this study recommends for airborne pollutants in the coal, biomass, oil, and natural gas fuel cycles. Part II of this volume contains a paper which reviews the scientific literature on ecological impacts associated with power plant discharges. Part III contains papers summarizing the relevant health effects literature. Part IV contains papers on methods of economic evaluation. Part V contains four papers on various issues related to the estimation of externalities and their use in public policy. The final part is Part VI, and it contains a paper which describes a system for summarizing analysts' assessments of the quality of the information that an analysis uses to estimate externalities. This system allows analysts to provide information, not only on their best estimates, but also on a range of estimates, on uncertainty, on the quality of the data, and on other factors that better reflect the full dimension of making estimates under uncertainty. The system has broad applicability beyond fuel cycle externalities, as well

  4. A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting

    Directory of Open Access Journals (Sweden)

    Zindel Sonja

    2012-07-01

    Full Text Available Abstract Background Patients undergoing major orthopaedic surgery (MOS, such as total hip (THR or total knee replacement (TKR, are at high risk of developing venous thromboembolism (VTE. For thromboembolism prophylaxis, the oral anticoagulant rivaroxaban has recently been included in the German diagnosis related group (DRG system. However, the cost-effectiveness of rivaroxaban is still unclear from both the German statutory health insurance (SHI and the German hospital perspective. Objectives To assess the cost-effectiveness of rivaroxaban from the German statutory health insurance (SHI perspective and to analyse financial incentives from the German hospital perspective. Methods Based on data from the RECORD trials and German cost data, a decision tree was built. The model was run for two settings (THR and TKR and two perspectives (SHI and hospital per setting. Results Prophylaxis with rivaroxaban reduces VTE events (0.02 events per person treated after TKR; 0.007 after THR compared with enoxaparin. From the SHI perspective, prophylaxis with rivaroxaban after TKR is cost saving (€27.3 saving per patient treated. However, the cost-effectiveness after THR (€17.8 cost per person remains unclear because of stochastic uncertainty. From the hospital perspective, for given DRGs, the hospital profit will decrease through the use of rivaroxaban by €20.6 (TKR and €31.8 (THR per case respectively. Conclusions Based on our findings, including rivaroxaban for reimbursement in the German DRG system seems reasonable. Yet, adequate incentives for German hospitals to use rivaroxaban are still lacking.

  5. Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

    Directory of Open Access Journals (Sweden)

    Umer Chaudhry Muhammad

    2011-05-01

    Full Text Available Abstract Background & Purpose Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery. Methodology This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5% knees (group-I had received tranexamic acid (by surgeon preference while the remaining fifty-two patients with 66 (51.5% knees (group-II had did not received any tranexamic acid either pre- or post-operatively. Results The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral and 2695 ml (bilateral. In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral and 1.94 gm/dl (bilateral, with a mean drainage of 826 ml (unilateral and 1288 ml (bilateral (p-value Interpretation Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

  6. Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.

    Science.gov (United States)

    Skaar, Daniel D; Park, Taehwan; Swiontkowski, Marc F; Kuntz, Karen M

    2015-11-01

    Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis. A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies. The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures. The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  7. ExternE: Externalities of energy Vol. 2. Methodology

    International Nuclear Information System (INIS)

    Berry, J.; Holland, M.; Watkiss, P.

    1995-01-01

    This report describes the methodology used by the ExternE Project of the European Commission (DGXII) JOULE Programme for assessment of the external costs of energy. It is one of a series of reports describing analysis of nuclear, fossil and renewable fuel cycles for assessment of the externalities associated with electricity generation. Part I of the report deals with analysis of impacts, and Part II with the economic valuation of those impacts. Analysis is conducted on a marginal basis, to allow the effect of an incremental investment in a given technology to be quantified. Attention has been paid to the specificity of results with respect to the location of fuel cycle activities, the precise technologies used, and the type and source of fuel. The main advantages of this detailed approach are as follows: It takes full and proper account of the variability of impacts that might result from different power projects; It is more transparent than analysis based on hypothetically 'representative' cases for each of the different fuel cycles; It provides a framework for consistent comparison between fuel cycles. A wide variety of impacts have been considered. These include the effects of air pollution on the natural and human environment, consequences of accidents in the workplace, impacts of noise and visual intrusion on amenity, and the effects of climate change arising from the release of greenhouse gases. Wherever possible we have used the 'impact pathway' or 'damage function' approach to follow the analysis from identification of burdens (e.g. emissions) through to impact assessment and then valuation in monetary terms. This has required a detailed knowledge of the technologies involved, pollutant dispersion, analysis of effects on human and environmental health, and economics. In view of this the project brought together a multi-disciplinary team with experts from many European countries and the USA. The spatial and temporal ranges considered in the analysis are

  8. 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.

  9. The impact of external donor support through the U.S. President's Emergency Plan for AIDS Relief on the cost of red cell concentrate in Namibia, 2004-2011.

    Science.gov (United States)

    Pitman, John P; Bocking, Adele; Wilkinson, Robert; Postma, Maarten J; Basavaraju, Sridhar V; von Finckenstein, Bjorn; Mataranyika, Mary; Marfin, Anthony A; Lowrance, David W; Sibinga, Cees Th Smit

    2015-04-01

    External assistance can rapidly strengthen health programmes in developing countries, but such funding can also create sustainability challenges. From 2004-2011, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided more than $ 8 million to the Blood Transfusion Service of Namibia (NAMBTS) for supplies, equipment, and staff salaries. This analysis describes the impact that support had on actual production costs and the unit prices charged for red cell concentrate (RCC) units issued to public sector hospitals. A costing system developed by NAMBTS to set public sector RCC unit prices was used to describe production costs and unit prices during the period of PEPFAR scale-up (2004-2009) and the 2 years in which PEPFAR support began to decline (2010-2011). Hypothetical production costs were estimated to illustrate differences had PEPFAR support not been available. Between 2004-2006, NAMBTS sold 22,575 RCC units to public sector facilities. During this time, RCC unit prices exceeded per unit cost-recovery targets by between 40.3% (US$ 16.75 or N$ 109.86) and 168.3% (US$ 48.72 or N$ 333.28) per year. However, revenue surpluses dwindled between 2007 and 2011, the final year of the study period, when NAMBTS sold 20,382 RCC units to public facilities but lost US$23.31 (N$ 170.43) on each unit. PEPFAR support allowed NAMBTS to leverage domestic cost-recovery revenue to rapidly increase blood collections and the distribution of RCC. However, external support kept production costs lower than they would have been without PEPFAR. If PEPFAR funds had not been available, RCC prices would have needed to increase by 20% per year to have met annual cost-recovery targets and funded the same level of investments as were made with PEPFAR support. Tracking the subsidising influence of external support can help blood services make strategic investments and plan for unit price increases as external funds are withdrawn.

  10. Environmental externalities related to power production on biogas and natural gas based on the EU ExternE methodology

    DEFF Research Database (Denmark)

    Nielsen, Per Sieverts; Ibsen, Liselotte Schleisner

    1998-01-01

    This paper assesses the environmental impacts and external costs from selected electricity generation systems in Denmark. The assessment is carried out as part of the ExternE National Implementation, which is the second phase of the ExternE project and involves case studies from all Western...... European countries. The project use a “bottom-up” methodology to evaluate the external costs associated with a wide range of different fuel cycles. The project has identified priority impacts, where most are impacts from air emissions. Externalities due to atmospheric emissions are calculated through...

  11. Association between muscle atrophy/weakness and health care costs and utilization among patients receiving total knee replacement surgery: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Chen SY

    2013-08-01

    Full Text Available Shih-Yin Chen,1 Ning Wu,1 Yuan-Chi Lee,1 Yang Zhao21Health Economics and Epidemiology, Evidera, Lexington, Massachusetts, 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USAPurpose: The aim of the study reported here was to examine health care resource utilization, costs, and risk of rehospitalization for total knee replacement (TKR patients with and without muscle atrophy/weakness (MAW.Patients and methods: Individuals aged 50–64 years with commercial insurance or 65+ years with Medicare Supplemental Insurance (Medicare who had a hospitalization for TKR between January 1, 2006 and September 30, 2009 were identified from a large US claims database. First hospitalization for TKR was defined as the index stay. All patients were classified into three cohorts according to when MAW was diagnosed relative to TKR: pre-MAW, post-MAW, and no MAW. The association between MAW and health care costs over the 12-month post-index period and the probability of rehospitalization were assessed via multivariate regressions.Results: The study sample included 53,696 Medicare and 46,058 commercial insurance TKR patients. Controlling for cross-cohort differences, both the pre- and post-MAW cohorts had significantly higher total health care costs (Medicare US$4,201 and US$9,404 higher, commercial insurance US$2,737 and US$6,640 higher, respectively than the no MAW cohort (all P < 0.05. The post-MAW cohort in both populations was also more likely to have any all-cause or replacement-related rehospitalization compared with the no MAW cohort.Conclusion: Among US patients undergoing TKR, those with MAW had higher health care utilization and costs than patients without MAW.Keywords: rehospitalization, resource utilization, Medicare, health insurance, USA

  12. External corners as heat bridges

    Energy Technology Data Exchange (ETDEWEB)

    Berber, J.

    1984-08-01

    The maximum additional heat loss in vertical external corners depending on wall thickness is determined. In order to amire at a low k-value, a much smaller wall thickness is required in externally insulated walls than in monolithic constructions; the greater loss of heat bridge with external insulation stands in contrast to a higher loss in thick, monolithic walls. In relation to total losses, the additional losses through external corners are practically negligible.

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

    Directory of Open Access Journals (Sweden)

    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

  14. a Circleless "2D/3D Total STATION": a Low Cost Instrument for Surveying, Recording Point Clouds, Documentation, Image Acquisition and Visualisation

    Science.gov (United States)

    Scherer, M.

    2013-07-01

    Hardware and software of the universally applicable instrument - referred to as a 2D/3D total station - are described here, as well as its practical use. At its core it consists of a 3D camera - often also called a ToF camera, a pmd camera or a RIM-camera - combined with a common industrial 2D camera. The cameras are rigidly coupled with their optical axes in parallel. A new type of instrument was created mounting this 2D/3D system on a tripod in a specific way. Because of it sharing certain characteristics with a total station and a tacheometer, respectively, the new device was called a 2D/3D total station. It may effectively replace a common total station or a laser scanner in some respects. After a brief overview of the prototype's features this paper then focuses on the methodological characteristics for practical application. Its usability as a universally applicable stand-alone instrument is demonstrated for surveying, recording RGB-coloured point clouds as well as delivering images for documentation and visualisation. Because of its limited range (10m without reflector and 150 m to reflector prisms) and low range accuracy (ca. 2 cm to 3 cm) compared to present-day total stations and laser scanners, the practical usage of the 2D/3D total station is currently limited to acquisition of accidents, forensic purpuses, speleology or facility management, as well as architectural recordings with low requirements regarding accuracy. However, the author is convinced that in the near future advancements in 3D camera technology will allow this type of comparatively low cost instrument to replace the total station as well as the laser scanner in an increasing number of areas.

  15. Plerixafor mobilization leads to a lower ratio of CD34+ cells to total nucleated cells which results in greater storage costs.

    Science.gov (United States)

    Tanhehco, Yvette C; Adamski, Jill; Sell, Mary; Cunningham, Kathleen; Eisenmann, Christa; Magee, Deborah; Stadtmauer, Edward A; O'Doherty, Una

    2010-01-01

    Plerixafor (Mozobil, AMD3100) with granulocyte-colony stimulating factor (G-CSF) mobilizes more CD34+ cells/kg compared to G-CSF alone. Given that plerixafor enhances mobilization of multiple white blood cell lineages, we determined if more storage space is required for products collected from patients mobilized with plerixafor. A review of the medical records of 15 patients mobilized with chemotherapy and G-CSF (control) and 14 patients mobilized with plerixafor plus G-CSF (plerixafor) was performed. Data on demographics, baseline characteristics, CD34+ cells/kg, total nucleated cells, total mononuclear cells, total apheresis sessions, and total bags for storage were collected. Mean values were determined and compared using Student's t-test. We found that the proportion of CD34+ cells among total nucleated cells was less in the plerixafor group compared to the control group (P = 0.0427). More nucleated cells (10.7 x 10(10) vs. 7.1 x 10(10), P =0.0452) and mononuclear cells (9.7 x 10(10) vs. 5.9 x 10(10), P = 0.0059) were mobilized with plerixafor plus G-CSF. However, there was no significant difference in CD34+ cells/kg, total CD34+ cells or the proportion of mononuclear cells among total nucleated cells between the two groups. More storage bags were required for the plerixafor group compared to the control group (15 vs. 9, P = 0.0299). Mobilization with plerixafor plus G-CSF resulted in a smaller proportion of CD34+ cells collected and a greater number of storage bags. An increase in the number of bags required for stem cell storage may be logistically problematic and will also lead to increased costs for storage of stem cells.

  16. Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality

    Directory of Open Access Journals (Sweden)

    Jimenez-Trujillo Isabel

    2011-02-01

    Full Text Available Abstract Background Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS, costs and in-hospital mortality (IHM of patients undergoing primary total hip arthroplasty (THA over an 8-year study period in Spain. Methods We selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51 between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index. Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM. Results We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p Conclusions The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.

  17. ExternE: Externalities of energy Vol. 1. Summary

    International Nuclear Information System (INIS)

    Holland, M.; Berry, J.

    1995-01-01

    There is a growing requirement for policy analysts to take account of the environment in their decision making and to undertake the specified cost-benefit analysis. Within the European Union this is reflected in the 5th Environmental Action Programme, and the Commission's White Paper entitled 'Growth, competitiveness, employment and the ways forward to the 21st century'. This has led to a need for evaluation of environmental externalities. The ExternE Project commenced in 1991 as the European part of a collaborative study between the European Commission and the US Department of Energy. It aims to be the first systematic approach to the evaluation of external costs of a wide range of different fuel cycles. The project will result in an operational accounting framework for the quantification and monetarisation of priority environmental and other externalities. This framework will allow the calculation of the marginal external costs and benefits for specific power plants, at specific sites using specified technologies. There are three major phases in the project. Phase 1 was undertaken in collaboration with the US Department of Energy. In this phase the teams jointly developed the conceptual approach and methodology and shared scientific information for application to a number of fuel cycles. On the European side work concentrated on the nuclear and coal fuel cycles which together were expected to raise many of the fundamental issues in fuel cycle analysis. The project is currently nearing completion of Phase 2. During this phase the methodology has been applied to a wide range of different fossil, nuclear and renewable fuel cycles for power generation and energy conservation options. Also a series of National Implementation Programmes is underway in which the methodology and accounting framework are being applied to reference sites throughout Europe. In addition the general methodology is being extended to address the evaluation of externalities associated with

  18. Externalities of fuel cycles 'ExternE' project. Summary report

    International Nuclear Information System (INIS)

    Holland, M.; Berry, J.

    1994-01-01

    There is a growing requirement for policy analysts to take account of the environment in their decision making and to undertake the specified cost-benefit analysis. Within the European Union this is reflected in the 5th Environmental Action Programme, and the Commission's White Paper entitled 'Growth, competitiveness, employment and the ways forward to the 21st century'. This has led to a need for evaluation of environmental externalities. The ExternE Project commenced in 1991 as the European part of a collaborative study between the European Commission and the US Department of Energy. It aims to be the first systematic approach to the evaluation of external costs of a wide range of different fuel cycles. The project will result in an operational accounting framework for the quantification and monetarisation of priority environmental and other externalities. This framework will allow the calculation of the marginal external costs and benefits for specific power plants, at specific sites using specified technologies. There are three major phases in the project. Phase I was undertaken in collaboration with the US Department of Energy. In this phase the teams jointly developed the conceptual approach and methodology and shared scientific information for application to a number of fuel cycles. On the European side work concentrated on the nuclear and coal fuel cycles which together were expected to raise many of the fundamental issues in fuel cycle analysis. The project is currently nearing completion of Phase 2. During this phase the methodology has been applied to a wide range of different fossil, nuclear and renewable fuel cycles for power generation and energy conservation options. Also a series of National Implementation Programmes are underway in which the methodology and accounting framework are being applied to reference sites throughout Europe. In addition the general methodology is being extended to address the evaluation of externalities associated with

  19. [External cephalic version].

    Science.gov (United States)

    Navarro-Santana, B; Duarez-Coronado, M; Plaza-Arranz, J

    2016-08-01

    To analyze the rate of successful external cephalic versions in our center and caesarean sections that would be avoided with the use of external cephalic versions. From January 2012 to March 2016 external cephalic versions carried out at our center, which were a total of 52. We collected data about female age, gestational age at the time of the external cephalic version, maternal body mass index (BMI), fetal variety and situation, fetal weight, parity, location of the placenta, amniotic fluid index (ILA), tocolysis, analgesia, and newborn weight at birth, minor adverse effects (dizziness, hypotension and maternal pain) and major adverse effects (tachycardia, bradycardia, decelerations and emergency cesarean section). 45% of the versions were unsuccessful and 55% were successful. The percentage of successful vaginal delivery in versions was 84% (4% were instrumental) and 15% of caesarean sections. With respect to the variables studied, only significant differences in birth weight were found; suggesting that birth weight it is related to the outcome of external cephalic version. Probably we did not find significant differences due to the number of patients studied. For women with breech presentation, we recommend external cephalic version before the expectant management or performing a cesarean section. The external cephalic version increases the proportion of fetuses in cephalic presentation and also decreases the rate of caesarean sections.

  20. Comparison of turnaround time and total cost of HIV testing before and after implementation of the 2014 CDC/APHL Laboratory Testing Algorithm for diagnosis of HIV infection.

    Science.gov (United States)

    Chen, Derrick J; Yao, Joseph D

    2017-06-01

    Updated recommendations for HIV diagnostic laboratory testing published by the Centers for Disease Control and Prevention and the Association of Public Health Laboratories incorporate 4th generation HIV immunoassays, which are capable of identifying HIV infection prior to seroconversion. The purpose of this study was to compare turnaround time and cost between 3rd and 4th generation HIV immunoassay-based testing algorithms for initially reactive results. The clinical microbiology laboratory database at Mayo Clinic, Rochester, MN was queried for 3rd generation (from November 2012 to May 2014) and 4th generation (from May 2014 to November 2015) HIV immunoassay results. All results from downstream supplemental testing were recorded. Turnaround time (defined as the time of initial sample receipt in the laboratory to the time the final supplemental test in the algorithm was resulted) and cost (based on 2016 Medicare reimbursement rates) were assessed. A total of 76,454 and 78,998 initial tests were performed during the study period using the 3rd generation and 4th generation HIV immunoassays, respectively. There were 516 (0.7%) and 581 (0.7%) total initially reactive results, respectively. Of these, 304 (58.9%) and 457 (78.7%) were positive by supplemental testing. There were 10 (0.01%) cases of acute HIV infection identified with the 4th generation algorithm. The most frequent tests performed to confirm an HIV-positive case using the 3rd generation algorithm, which were reactive initial immunoassay and positive HIV-1 Western blot, took a median time of 1.1 days to complete at a cost of $45.00. In contrast, the most frequent tests performed to confirm an HIV-positive case using the 4th generation algorithm, which included a reactive initial immunoassay and positive HIV-1/-2 antibody differentiation immunoassay for HIV-1, took a median time of 0.4 days and cost $63.25. Overall median turnaround time was 2.2 and 1.5 days, and overall median cost was $63.90 and $72.50 for

  1. Aboriginal research coalition externalities associated with energy production: Types, measures and integration

    International Nuclear Information System (INIS)

    Goodman, I.

    1992-01-01

    A system that has evolved to determine the environmental externalities associated with energy generation is described. The system involves identification and understanding of the activity being considered (power generation from a specific type of plant), effects such as air pollution, measures such as pollution control that can influence the levels of the preceding effects, the resources affected, impacts on human resource uses, and the values humans place on the use of the resources. Considerations in estimating external costs are then discussed. These include property rights, air emissions, electromagnetic fields, pollution control effectiveness and costs, valuation of air emissions, water quality and quantity, effects on fisheries and recreational activities, and effects of dams and inundation. A least-cost, or integrated management process, selects the combination of electricity supply and demand sources that have the least social cost. Total externality costs are estimated, based on emissions or effects from each source multiplied by unit costs, and control measures selected. The external costs are combined with the usual fixed and variable cost calculations to provide a total social cost measure. This monetization procedure allows a complete accounting of all costs to society on an equal basis. 53 refs., 4 figs

  2. An integer batch scheduling model considering learning, forgetting, and deterioration effects for a single machine to minimize total inventory holding cost

    Science.gov (United States)

    Yusriski, R.; Sukoyo; Samadhi, T. M. A. A.; Halim, A. H.

    2018-03-01

    This research deals with a single machine batch scheduling model considering the influenced of learning, forgetting, and machine deterioration effects. The objective of the model is to minimize total inventory holding cost, and the decision variables are the number of batches (N), batch sizes (Q[i], i = 1, 2, .., N) and the sequence of processing the resulting batches. The parts to be processed are received at the right time and the right quantities, and all completed parts must be delivered at a common due date. We propose a heuristic procedure based on the Lagrange method to solve the problem. The effectiveness of the procedure is evaluated by comparing the resulting solution to the optimal solution obtained from the enumeration procedure using the integer composition technique and shows that the average effectiveness is 94%.

  3. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    International Nuclear Information System (INIS)

    Kickuth, Ralph; Anderson, Suzanne; Peter-Salonen, Kristiina; Laemmle, Bernhard; Eggli, Stefan; Triller, Juergen

    2006-01-01

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization

  4. Malignant external otitis

    International Nuclear Information System (INIS)

    Dupuch, K.M.; Iryboz, T.; Firat, M.; Levy, C.; Tubiana, J.M.

    1991-01-01

    This paper illustrates the value of CT and MR in early diagnosis and spread of malignant external otitis. The authors retrospectively analyzed 15 patients with proved malignant external otitis examined with postcontrast high-resolution CT (15/15) and MR (6/15) (T1- and T2-weighting). Gallium studies were done in 6/15 patients. Early diagnosis was made when CT demonstrated a soft-tissue mass of the external auditory canal associated with scattered zones of cortical bone erosions (13/15). Spread of the disease was better delineated by MR than CT, especially skull base extension (6/15). Temporomandibular joint involvement with extension into parotid or/and masticator spaces 6/15 was as well detected with CT as with MR. If CT remains the first and best procedure for diagnosis, MR - despite its cost - appears a good procedure to depict exact anatomic spread, allowing therapeutic management

  5. Externalities in utility resource selection: A means to formally recognize the envionmental benefits of wind farms

    International Nuclear Information System (INIS)

    Birner, S.

    1992-01-01

    Wind can only make its full contribution to the minimization of the total cost of energy services if it is valued for all the costs that it avoids, including avoided environmental costs. Means of incorporating environmental costs, or externalities, into utility planning decisions are described. Externalities are defined as uncompensated costs or benefits of an action borne by a party other than the one causing the costs. A simple example of the use of externalities in utility resource selection is presented, comparing costs of a coal-fired power plant and a wind farm. Externalities of wind farms are analyzed and found to be very low. An examination of some aspects of legislation in the USA and Canada shows a trend for utility commissions and other regulatory bodies to determine that including externalitites lies within their mandate. By formally recognizing and accounting for the environmental benefits of wind farms, it is seen that externalities can have a significant effect on utility demand for wind energy. A review of USA state actions regarding externalities is appended. 10 refs

  6. Electricity generation and environmental externalities: Case studies, September 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-28

    Electricity constitutes a critical input in sustaining the Nation`s economic growth and development and the well-being of its inhabitants. However, there are byproducts of electricity production that have an undesirable effect on the environment. Most of these are emissions introduced by the combustion of fossil fuels, which accounts for nearly 70 percent of the total electricity generated in the United States. The environmental impacts (or damages) caused by these emissions are labeled environmental ``externalities.`` Included in the generic term ``externality`` are benefits or costs resulting as an unintended byproduct of an economic activity that accrue to someone other than the parties involved in the activity. This report provides an overview of the economic foundation of externalities, the Federal and State regulatory approaches, and case studies of the impacts of the externality policies adopted by three States.

  7. Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hayeon, E-mail: kimh2@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Rajagopalan, Malolan S.; Beriwal, Sushil; Huq, M. Saiful [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Smith, Kenneth J. [Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100

  8. Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

    International Nuclear Information System (INIS)

    Kim, Hayeon; Rajagopalan, Malolan S.; Beriwal, Sushil; Huq, M. Saiful; Smith, Kenneth J.

    2015-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100

  9. A Determination of Military and Civilian Personnel Costs as Related to a Member of Technical Staff

    Science.gov (United States)

    1992-06-01

    Costs, 1986 4 2. Direct Total Manpower Bidget Costs, 1992 5 3. Pay Raises 1985-1992 6 4. Support Costs 9 5. Internal Support Personnel 10 6. External...34 Incremental Costs of Military and Civilian Manpower in the Military Services." This docu- ment provides the basis for this section. The report assesses...6 Aug 91. MTS Workyear Cost Comparison. Internal AFSC paper, 20 November 1990. Palmer, Adele R., Osbaldeston, David J., Incremental Costs of Military

  10. Productivity Change and Externalities

    DEFF Research Database (Denmark)

    Kravtsova, Victoria

    2014-01-01

    This paper contributes to the analysis of the impact of externalities on the host country's total factor productivity by taking into account different dimensions of spillover effects. Namely, engagement in exporting and foreign ownership is generally perceived as being beneficial to individual...... firms and the economy as a whole. The approach used in the current research accounts for different internal as well as external factors that individual firms face and evaluates the effect on changes in productivity, technology as well as the efficiency of domestic firms. The empirical analysis focuses...... on Hungary. While the country leads the group of post-socialist countries in the amount of attracted foreign direct investments (FDI) the effect of this policy on the economy remains unclear. The research finds that different externalities play a different role in productivity, technological and efficiency...

  11. Control of external radiation exposure

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Control of external radiation exposure: working time, working distance, shielding: Total Linear Attenuation Coefficient, Half-Value Layer (HVL), Tenth-Value Layer (TVL); Build-up Factor

  12. COMPARISON OF TWO TOTAL RNA EXTRACTION PROTOCOLS FROM CHO-K1 CELLS FOR RT-PCR: CUT-OFF COST FOR RESEARCHERS

    Directory of Open Access Journals (Sweden)

    Vasila Packeer Mohamed

    2014-05-01

    Full Text Available ABSTRACT: Various methods have been described to extract RNA from adherent mammalian cells. RNA isolation in conjunction with reverse transcription polymerase chain reaction (RT-PCR is a valuable tool used to study gene expression profiling. This approach is now being used in mammalian cell bioprocessing to help understand and improve the system. The objective of this study was to compare and determine the most suitable RNA extraction method for CHO-K1 cells in a setting where a relatively large amount of samples was involved. Total RNA was extracted using Total RNA purification kit (without DNase treatment; Norgen, Canada and RNeasy mini kit (with DNase treatment; Qiagen, USA respectively. The extracted RNA was then reverse transcribed, and the cDNA was subjected to PCR-amplifying 18S. Yield from RNeasy kit was significantly higher (0.316 ± 0.033 µg/µl; p=0.004 than Total RNA purification kit (0.177 ± 0.0243 µg/µl. However, RNA purity for both methods was close to 2.0 and there was no significant difference between the methods. Total RNA purification kit is less expensive than RNeasy kit. Since there is no DNase treatment step in the former, extraction time for RNA is shorter. When the extracted RNA was subjected to RT-PCR, both methods were able to show detection of 18S at 219 bp.   Therefore, this study demonstrates that both protocols are suitable for RNA extraction for CHO-K1 cells. RNeasy mini kit (Qiagen is recommended if higher yields is the primary concern and Total RNA Purification kit (Norgen is recommended if time and cost are concerned. ABSTRAK: Pelbagai kaedah telah digunakan untuk mengekstrak RNA daripada sel mamalia lekat.  Pemencilan RNA dengan menggunakan reaksi rantai polimerase transkripsi berbalik (RT-PCR merupakan kaedah penting yang digunakan dalam mengkaji pernyataan gen berprofil.  Pendekatan ini kini digunakan dalam pemprosesan bio sel mamalia untuk memahami dan menambah baik sistem.  Tujuan kajian dijalankan

  13. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

    Science.gov (United States)

    Van Dongen, Hans P A.; Maislin, Greg; Mullington, Janet M.; Dinges, David F.

    2003-01-01

    were near-linearly related to the cumulative duration of wakefulness in excess of 15.84 h (s.e. 0.73 h). CONCLUSIONS: Since chronic restriction of sleep to 6 h or less per night produced cognitive performance deficits equivalent to up to 2 nights of total sleep deprivation, it appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults. Sleepiness ratings suggest that subjects were largely unaware of these increasing cognitive deficits, which may explain why the impact of chronic sleep restriction on waking cognitive functions is often assumed to be benign. Physiological sleep responses to chronic restriction did not mirror waking neurobehavioral responses, but cumulative wakefulness in excess of a 15.84 h predicted performance lapses across all four experimental conditions. This suggests that sleep debt is perhaps best understood as resulting in additional wakefulness that has a neurobiological "cost" which accumulates over time.

  14. Externalities and the Coase Theorem: A Diagrammatic Presentation

    Science.gov (United States)

    Halteman, James

    2005-01-01

    In intermediate microeconomic textbooks the reciprocal nature of externalities is presented using numerical examples of costs and benefits. This treatment of the Coase theorem obscures the fact that externality costs and benefits are best understood as being on a continuum where costs vary with the degree of intensity of the externality. When…

  15. Checklists for external validity

    DEFF Research Database (Denmark)

    Dyrvig, Anne-Kirstine; Kidholm, Kristian; Gerke, Oke

    2014-01-01

    to an implementation setting. In this paper, currently available checklists on external validity are identified, assessed and used as a basis for proposing a new improved instrument. METHOD: A systematic literature review was carried out in Pubmed, Embase and Cinahl on English-language papers without time restrictions....... The retrieved checklist items were assessed for (i) the methodology used in primary literature, justifying inclusion of each item; and (ii) the number of times each item appeared in checklists. RESULTS: Fifteen papers were identified, presenting a total of 21 checklists for external validity, yielding a total...... of 38 checklist items. Empirical support was considered the most valid methodology for item inclusion. Assessment of methodological justification showed that none of the items were supported empirically. Other kinds of literature justified the inclusion of 22 of the items, and 17 items were included...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-09-15

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

  17. Energy security externalities and fuel cycle comparisons

    International Nuclear Information System (INIS)

    Bohi, D.; Toman, M.

    1994-01-01

    Externalities related to 'energy security' may be one way in which the full social costs of energy use diverge from the market prices of energy commodities. Such divergences need to be included in reckoning the full costs of different fuel cycles. In this paper we critically examine potential externalities related to energy security and issues related to the measurement of 2 these externalities, in the context of fuel cycle comparisons

  18. Energy security externalities and fuel cycle comparisons

    Energy Technology Data Exchange (ETDEWEB)

    Bohi, D; Toman, M

    1994-07-01

    Externalities related to 'energy security' may be one way in which the full social costs of energy use diverge from the market prices of energy commodities. Such divergences need to be included in reckoning the full costs of different fuel cycles. In this paper we critically examine potential externalities related to energy security and issues related to the measurement of 2 these externalities, in the context of fuel cycle comparisons.

  19. Conceptual challenges for internalising externalities

    DEFF Research Database (Denmark)

    Miguel, Brandão; Weidema, Bo Pedersen

    2013-01-01

    We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii...... geographical and especially temporal distance between the benefitting actor and the victim of the external cost, the involvement of a non-governmental intermediate actor becomes increasingly necessary to provide the short-term capital required to ensure a successful implementation....

  20. Performance Targets and External Benchmarking

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.

    Research on relative performance measures, transfer pricing, beyond budgeting initiatives, target costing, piece rates systems and value based management has for decades underlined the importance of external benchmarking in performance management. Research conceptualises external benchmarking...... as a market mechanism that can be brought inside the firm to provide incentives for continuous improvement and the development of competitive advances. However, whereas extant research primarily has focused on the importance and effects of using external benchmarks, less attention has been directed towards...... the conditions upon which the market mechanism is performing within organizations. This paper aims to contribute to research by providing more insight to the conditions for the use of external benchmarking as an element in performance management in organizations. Our study explores a particular type of external...

  1. External effects in Swiss hydropower

    International Nuclear Information System (INIS)

    Hauenstein, W.; Bonvin, J.; Vouillamoz, J.

    1999-01-01

    The article discusses the external costs and benefits of hydropower that are not internalised in normal book-keeping. Several negative and positive effects are discussed. The results of a study that addressed the difficult task of quantifying these external effects are presented. An assessment of the results gained shows that difficulties are to be met regarding system limits, methods of expressing the effects in monetary terms and ethical factors. The report also examines the consideration of external effects as a correction factor for falsified market prices for electricity

  2. [Are Higher Prices for Larger Femoral Heads in Total Hip Arthroplasty Justified from the Perspective of Health Care Economics? An Analysis of Costs and Effects in Germany].

    Science.gov (United States)

    Grunert, R; Schleifenbaum, S; Möbius, R; Sommer, G; Zajonz, D; Hammer, N; Prietzel, T

    2017-02-01

    Background: In total hip arthroplasty (THA), femoral head diameter has not been regarded as a key parameter which should be restored when reconstructing joint biomechanics and geometry. Apart from the controversial discussion on the advantages and disadvantages of using larger diameter heads, their higher cost is another imp