Decision Grade: Readiness, Mission Impacts, and Classified Data in the Defense Budgeting Process

DTIC Science & Technology

2015-10-23

AU/ACSC/2015 DECISION-GRADE: READINESS, MISSION IMPACTS , AND CLASSIFIED DATA IN THE DEFENSE BUDGETING PROCESS by Ryan M. Harrell, Maj, USAF A... impacts . This research provides suggestions to improve the venerable PPBE system by investigating ‘how does’ and ‘how should’ the DOD use planning guidance...readiness reporting, this effort analyzes the impact of overclassification and redefines readiness to provide decision-grade analysis to Congress. 1

CAUT Analysis of Federal Budget 2013

ERIC Educational Resources Information Center

Canadian Association of University Teachers, 2013

2013-01-01

The 2013 federal Budget was delivered ironically the same day as the Parliamentary Budget Officer was in court seeking more information about the impact of the government's $5.2 billion in spending cuts announced last year. The lack of budgetary transparency and accountability has become a hallmark of the Conservative government. Anyone expecting…

Developing guidance for budget impact analysis.

PubMed

Trueman, P; Drummond, M; Hutton, J

2001-01-01

The role of economic evaluation in the efficient allocation of healthcare resources has been widely debated. Whilst economic evidence is undoubtedly useful to purchasers, it does not address the issue of affordability which is an increasing concern. Healthcare purchasers are concerned not just with maximising efficiency but also with the more simplistic goal of remaining within their annual budgets. These two objectives are not necessarily consistent. This paper examines the issue of affordability, the relationship between affordability and efficiency and builds the case for why there is a growing need for budget impact models to complement economic evaluation. Guidance currently available for such models is also examined and it is concluded that this guidance is currently insufficient. Some of these insufficiencies are addressed and some thoughts on what constitutes best practice in budget impact modelling are suggested. These suggestions include consideration of transparency, clarity of perspective, reliability of data sources, the relationship between intermediate and final end-points and rates of adoption of new therapies. They also include the impact of intervention by population subgroups or indications, reporting of results, probability of re-deploying resources, the time horizon, exploring uncertainty and sensitivity analysis, and decision-maker access to the model. Due to the nature of budget impact models, the paper does not deliver stringent methodological guidance on modelling. The intention was to provide some suggestions of best practice in addition to some foundations upon which future research can build.

Incorporating Budget Impact Analysis in the Implementation of Complex Interventions: A Case of an Integrated Intervention for Multimorbid Patients within the CareWell Study.

PubMed

Soto-Gordoa, Myriam; Arrospide, Arantzazu; Merino Hernández, Marisa; Mora Amengual, Joana; Fullaondo Zabala, Ane; Larrañaga, Igor; de Manuel, Esteban; Mar, Javier

2017-01-01

To develop a framework for the management of complex health care interventions within the Deming continuous improvement cycle and to test the framework in the case of an integrated intervention for multimorbid patients in the Basque Country within the CareWell project. Statistical analysis alone, although necessary, may not always represent the practical significance of the intervention. Thus, to ascertain the true economic impact of the intervention, the statistical results can be integrated into the budget impact analysis. The intervention of the case study consisted of a comprehensive approach that integrated new provider roles and new technological infrastructure for multimorbid patients, with the aim of reducing patient decompensations by 10% over 5 years. The study period was 2012 to 2020. Given the aging of the general population, the conventional scenario predicts an increase of 21% in the health care budget for care of multimorbid patients during the study period. With a successful intervention, this figure should drop to 18%. The statistical analysis, however, showed no significant differences in costs either in primary care or in hospital care between 2012 and 2014. The real costs in 2014 were by far closer to those in the conventional scenario than to the reductions expected in the objective scenario. The present implementation should be reappraised, because the present expenditure did not move closer to the objective budget. This work demonstrates the capacity of budget impact analysis to enhance the implementation of complex interventions. Its integration in the context of the continuous improvement cycle is transferable to other contexts in which implementation depth and time are important. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Budget impact analysis of pemetrexed introduction: case study from a teaching hospital perspective, Thailand.

PubMed

Chanjaruporn, Farsai; Roughead, Elizabeth E; Sooksriwong, Cha-oncin; Kaojarern, Sming

2011-09-01

Thailand does not currently require Budget Impact Analysis (BIA) assessment. The present study aimed to estimate the annual drug cost and the incremental impact on the hospital pharmaceutical budget of the introduction of pemetrexed to a Thai teaching hospital. The budget impact model was conducted in accordance with the Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). The model variables consisted of number of patients, growth rate of lung cancer, uptake rate of pemetrexed over time, unit prices of drugs, and the length and cost of treatment. Sensitivity analysis was performed to determine changes in budgetary impact due to variation of parameters or assumptions in the model. The introduction of pemetrexed was estimated to cause considerable costs for the teaching hospital. In the base-case analysis, the incremental costs were estimated at 8,553,984 Baht in the first year increasing to 12, 118, 144 Baht, 17,820,800 Baht and 17,820,800 Baht in the following years. The 4-year net budgetary impact was 20,154,480 Baht or approximately 127,560 Baht per patient. Sensitivity analyses found that number of treatment cycles andproportion of patients assumed to be treated with pemetrexed were the two most important influencing factors in the model. New costly innovative interventions should be evaluated using the BIA model to determine whether they are affordable. The Thai government should consider requiring the BIA study as one of the requirements for drug submission to assist in the determination of listing and subsidizing decision for medicines.

Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis.

PubMed

Arrospide, Arantzazu; Rue, Montserrat; van Ravesteyn, Nicolien T; Comas, Merce; Soto-Gordoa, Myriam; Sarriugarte, Garbiñe; Mar, Javier

2016-06-01

Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness and budget impact from 1996 to 2011. A discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess the impact of parameters uncertainty. The actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY. All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health Service by 5.2 million euros from year 2000 onwards. The BC screening programme in the Basque Country proved to be cost-effective during the evaluated period and determined an affordable budget impact. These results confirm the epidemiological benefits related to the centralised screening system and support the continuation of the programme.

Budget impact analysis of thrombolysis for stroke in Spain: a discrete event simulation model.

PubMed

Mar, Javier; Arrospide, Arantzazu; Comas, Mercè

2010-01-01

Thrombolysis within the first 3 hours after the onset of symptoms of a stroke has been shown to be a cost-effective treatment because treated patients are 30% more likely than nontreated patients to have no residual disability. The objective of this study was to calculate by means of a discrete event simulation model the budget impact of thrombolysis in Spain. The budget impact analysis was based on stroke incidence rates and the estimation of the prevalence of stroke-related disability in Spain and its translation to hospital and social costs. A discrete event simulation model was constructed to represent the flow of patients with stroke in Spain. If 10% of patients with stroke from 2000 to 2015 would receive thrombolytic treatment, the prevalence of dependent patients in 2015 would decrease from 149,953 to 145,922. For the first 6 years, the cost of intervention would surpass the savings. Nevertheless, the number of cases in which patient dependency was avoided would steadily increase, and after 2006 the cost savings would be greater, with a widening difference between the cost of intervention and the cost of nonintervention, until 2015. The impact of thrombolysis on society's health and social budget indicates a net benefit after 6 years, and the improvement in health grows continuously. The validation of the model demonstrates the adequacy of the discrete event simulation approach in representing the epidemiology of stroke to calculate the budget impact.

Budget impact analysis of everolimus for the treatment of hormone receptor positive, human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in the United States.

PubMed

Xie, Jipan; Diener, Melissa; De, Gourab; Yang, Hongbo; Wu, Eric Q; Namjoshi, Madhav

2013-01-01

To estimate the budget impact of everolimus as the first and second treatment option after letrozole or anastrozole (L/A) failure for post-menopausal women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC). Pharmacy and medical budget impacts (2011 USD) were estimated over the first year of everolimus use in HR+, HER2- ABC from a US payer perspective. Epidemiology data were used to estimate target population size. Pre-everolimus entry treatment options included exemestane, fulvestrant, and tamoxifen. Pre- and post-everolimus entry market shares were estimated based on market research and assumptions. Drug costs were based on wholesale acquisition cost. Patients were assumed to be on treatment until progression or death. Annual medical costs were calculated as the average of pre- and post-progression medical costs weighted by the time in each period, adjusted for survival. One-way and two-way sensitivity analyses were conducted to assess the model robustness. In a hypothetical 1,000,000 member plan, 72 and 159 patients were expected to be candidates for everolimus treatment as first and second treatment option, respectively, after L/A failure. The total budget impact for the first year post-everolimus entry was $0.044 per member per month [PMPM] (pharmacy budget: $0.058 PMPM; medical budget: -$0.014 PMPM), assuming 10% of the target population would receive everolimus. The total budget impacts for the first and second treatment options after L/A failure were $0.014 PMPM (pharmacy budget: $0.018; medical budget: -$0.004) and $0.030 PMPM (pharmacy budget: $0.040; medical budget: -$0.010), respectively. Results remained robust in sensitivity analyses. Assumptions about some model input parameters were necessary and may impact results. Increased pharmacy costs for HR+, HER2- ABC following everolimus entry are expected to be partially offset by reduced medical service costs. Pharmacy and total budget increases were modest.

Budget Impact Analysis of Prolonged Half-Life Recombinant FVIII Therapy for Hemophilia in the United States.

PubMed

McMullen, Suzanne; Buckley, Brieana; Hall, Eric; Kendter, Jon; Johnston, Karissa

2017-01-01

Hemophilia A is a factor VIII deficiency, associated with spontaneous, recurrent bleeding episodes. This may lead to comorbidities such as arthropathy and joint replacement, which contribute to morbidity and increased health care expenditure. Recombinant factor VIII Fc fusion protein (rFVIIIFc), a prolonged half-life factor therapy, requires fewer infusions, resulting in reduced treatment burden. Use a budget impact analysis to assess the potential economic impact of introducing rFVIIIFc to a formulary from the perspective of a private payer in the United States. The budget impact model was developed to estimate the potential economic impact of adding rFVIIIFc to a private payer formulary across a 2-year time period. The eligible patient population consisted of inhibitor-free adults with severe hemophilia A, receiving recombinant-based episodic or prophylaxis treatment regimens. Patients were assumed to switch from conventional recombinant factor treatment to rFVIIIFc. Only medication costs were included in the model. The introduction of rFVIIIFc is estimated to have a budget impact of 1.4% ($0.12 per member per month) across 2 years for a private payer population of 1,000,000 (estimated 19.7 individuals receiving treatment for hemophilia A). The introduction of rFVIIIFc is estimated to prevent 124 bleeds across 2 years at a cost of $1891 per bleed avoided. Hemophilia A is a rare disease with a low prevalence; therefore, the overall cost to society of introducing rFVIIIFc is small. Considerations for comprehensively assessing the budget impact of introducing rFVIIIFc should include episodic and prophylaxis regimens, bleed avoidance, and annual factor consumption required under alternative scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Budget impact analysis of medicines: updated systematic review and implications.

PubMed

Faleiros, Daniel Resende; Álvares, Juliana; Almeida, Alessandra Maciel; de Araújo, Vânia Eloisa; Andrade, Eli Iola Gurgel; Godman, Brian B; Acurcio, Francisco A; Guerra Júnior, Augusto A

2016-01-01

This evaluation determines whether published studies to date meet the key characteristics identified for budget impact analyses (BIA) for medicines, accomplished through a systematic review and assessment against identified key characteristics. Studies from 2001-2015 on 'budget impact analysis' with 'drug' interventions were assessed, selected based on their titles/abstracts and full texts, and their characteristics checked according to key criteria. Out of 1,984 studies, 92 were subsequently identified for review. Of these, 95% were published in Europe and the USA. 2012 saw the largest number of publications (16%) with a decline thereafter. 48% met up to 7 out of the 9 key characteristics. Only 22% stated no conflict of interest. The results indicate low adherence to the key characteristics that should be considered for BIAs and strong conflict of interest. This is an issue since BIAs can be of fundamental importance in managing the entry of new medicines including reimbursement decisions.

78 FR 8295 - Guarantees for Bonds Issued for Community or Economic Development Purposes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

.... V. Rulemaking Analysis A. Executive Order (E.O.) 12866; Regulatory Impact Analysis It has been... Budget. The Regulatory Impact Analysis prepared by the CDFI Fund for the interim rule is provided below... Community Investment Impact System (CIIS), which collects data from CDFIs that have received awards from the...

Budget impact analysis of vaccination against Haemophilus influenzae type b as a part of a Pentavalent vaccine in the childhood immunization schedule of Iran.

PubMed

Teimouri, Fatemeh; Kebriaeezadeh, Abbas; Zahraei, Seyed Mohsen; Gheiratian, MohammadMahdi; Nikfar, Shekoufeh

2017-01-14

Health decision makers need to know the impact of the development of a new intervention on the public health and health care costs so that they can plan for economic and financial objectives. The aim of this study was to determine the budget impact of adding Haemophilus influenzae type b (Hib) as a part of a Pentavalent vaccine (Hib-HBV-DTP) to the national childhood immunization schedule of Iran. An excel-based model was developed to determine the costs of including the Pentavalent vaccine in the national immunization program (NIP), comparing the present schedule with the previous one (including separate DTP and hepatitis B vaccines). The total annual costs included the cost of vaccination (the vaccine and syringe) and the cost of Hib treatment. The health outcome was the estimated annual cases of the diseases. The net budget impact was the difference in the total annual cost between the two schedules. Uncertainty about the vaccine effectiveness, vaccination coverage, cost of the vaccine, and cost of the diseases were handled through scenario analysis. The total cost of vaccination during 5 years was $18,060,463 in the previous program and $67,774,786 in the present program. Inclusion of the Pentavalent vaccine would increase the vaccination cost about $49 million, but would save approximately $6 million in the healthcare costs due to reduction of disease cases and treatment costs. The introduction of the Pentavalent vaccine resulted in a net increase in the healthcare budget expenditure across all scenarios from $43.4 million to $50.7 million. The results of this study showed that the inclusion of the Pentavalent vaccine in the NIP of Iran had a significant impact on the health care budget and increased the financial burden on the government. Budget impact of including Pentavalent vaccine in the national immunization schedule of Iranᅟ.

A budget impact model for biosimilar infliximab in Crohn's disease in Bulgaria, the Czech Republic, Hungary, Poland, Romania, and Slovakia.

PubMed

Brodszky, Valentin; Rencz, Fanni; Péntek, Márta; Baji, Petra; Lakatos, Péter L; Gulácsi, László

2016-01-01

To estimate the budget impact of the introduction of biosimilar infliximab for the treatment of Crohn's disease (CD) in Bulgaria, the Czech Republic, Hungary, Poland, Romania and Slovakia. A 3-year, prevalence-based budget impact analysis for biosimilar infliximab to treat CD was developed from third-party payers' perspective. The model included various scenarios depending on whether interchanging originator infliximab with biosimilar infliximab was allowed or not. Total cost savings achieved in biosimilar scenario 1 (interchanging not allowed) and BSc2 (interchanging allowed in 80% of the patients) were estimated to €8.0 million and €16.9 million in the six countries. Budget savings may cover the biosimilar infliximab therapy for 722-1530 additional CD patients. Introduction of biosimilar infliximab to treat CD may offset the inequity in access to biological therapy for CD between Central and Eastern European countries.

Crizotinib treatment for advanced non-small-cell lung cancer patients: a budget impact analysis based in Thailand.

PubMed

Thongprasert, Sumitra; Permsuwan, Unchalee

2017-05-01

With the advent of the anaplastic lymphoma kinase (ALK) inhibitor, treatment of ALK-positive advanced non-small-cell lung cancer (NSCLC) patients has become more effective while drug costs are still a major concern. This study aimed to estimate the budget impact of crizotinib versus other standard therapies in Thai advanced NSCLC patients with ALK rearrangement. The budget impact model was developed to estimate the net budget impact of crizotinib compared with no crizotinib considering the payer's perspective over a three-year period. Costs included drugs, ALK testing by FISH, adverse event treatment, administration and monitoring, and best supportive care. Data on costs and population were from a database in Thailand. Costs were presented for the year 2015. A univariate sensitivity analysis was performed to investigate the robustness of our findings. The total net budget impact of crizotinib in three years was 125,576,699 THB (3,480,507 USD), 91,156,049 THB (2,526,498 USD), and 42,724,760 THB (1,184,167 USD) respectively. When considering only patients receiving crizotinib, the expenditure increased by 41,199.70 THB (1141.90 USD), 20,755.02 THB (575.25 USD), and 8834.73 THB (244.87 USD) per patient per month. The main driven costs were from the cost of ALK testing and drugs. Despite its treatment value in ALK-positive patients, crizotinib can only be affordable for Thai patients within upper middle or high economic status. Availability for all patients under current payment models is limited.

The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting.

PubMed

Freijer, Karen; Nuijten, Mark J C; Schols, Jos M G A

2012-01-01

A health economic analysis was performed to assess the economic impact on the national health care budget of using oral nutritional supplements (ONS), being a food for special medical purposes also known as medical nutrition, for the treatment of disease related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (>5 years) with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings), when all eligible patients are treated. The additional costs of ONS (€ 57 million) are more than balanced by a reduction of other health care costs, e.g., re-/hospitalization (€ 70 million). Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands.

Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model.

PubMed

Arrospide, Arantzazu; Idigoras, Isabel; Mar, Javier; de Koning, Harry; van der Meulen, Miriam; Soto-Gordoa, Myriam; Martinez-Llorente, Jose Miguel; Portillo, Isabel; Arana-Arri, Eunate; Ibarrondo, Oliver; Lansdorp-Vogelaar, Iris

2018-04-25

The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. This economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis.

A Comparative Analysis Of Congressional Budget Adjustments For U.S. Special Operations Command

DTIC Science & Technology

2011-12-01

Impact from 2008-2010.........................20 a. Unfunded Requirements .........................................................21 b. Earmarks...recommendations: • How have USSOCOM appropriations changed since September 11, 2001? • What impact have manpower increases had on USSOCOM...Spending for Procurement (FY 2000 to 2010) 4. Analysis of Congressional Impact from 2008-2010 In order to analyze the congressional impact on

A Comparative Analysis of Congressional Budget Adjustments for U.S. Special Operations Command

DTIC Science & Technology

2011-12-01

Impact from 2008-2010.........................20 a. Unfunded Requirements .........................................................21 b. Earmarks...recommendations: • How have USSOCOM appropriations changed since September 11, 2001? • What impact have manpower increases had on USSOCOM...Spending for Procurement (FY 2000 to 2010) 4. Analysis of Congressional Impact from 2008-2010 In order to analyze the congressional impact on

Topical treatment utilization for patients with atopic dermatitis in the United States, and budget impact analysis of crisaborole ointment, 2.

PubMed

Clark, Ryan; Bozkaya, Duygu; Levenberg, Mark; Faulkner, Steven; Smith, Timothy W; Gerber, Robert A

2018-05-21

Atopic dermatitis (AD), a chronic inflammatory skin disease, is often treated with topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Crisaborole ointment is a non-steroidal, phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate AD. In December 2016, crisaborole was approved in the US for mild-to-moderate AD in patients ≥2 years of age. To evaluate real-world utilization and cost of TCS and TCI in the US and estimate the budget impact of crisaborole over 2 years from a third-party payer perspective. TCS and TCI prescriptions in 2015 for patients ≥2 years of age with ≥1 AD diagnosis in the Truven Health Analytics MarketScan Commercial and Medicare Supplemental Research Databases were analyzed for patients receiving TCI or TCS alone or in combination (TCS/TCI population) and patients receiving TCI alone or in combination with TCS (TCI population). A budget impact model used TCS and TCI market shares, annual use, and cost per prescription. Crisaborole uptake rates of 4.7% (TCS) and 20.2% (TCI), with an annual increase of 1% in year 2, were assumed. Budget impact was calculated as total and per-member-per-month (PMPM) cost over 2 years for a health plan of 1 million members. Annual prescriptions/patient ranged from 1.36-6.41; annual cost/patient was $53-$1,465. The budget impact of crisaborole over 2 years in the TCS/TCI population was $350,946 (PMPM, $0.015), with increases of $162,106 in year 1 (PMPM, $0.014) and $188,841 in year 2 (PMPM, $0.016). The budget impact in the TCI population was -$22,871, with decreases of $11,160 in year 1 and $11,712 in year 2 (each PMPM, -$0.001). For both populations, one-way sensitivity analyses showed that budget impact was most sensitive to changes in crisaborole cost and annual use. From US payer perspectives, adoption of crisaborole results in modest pharmacy budget impact/savings.

Just how important is a good season start? Overall team performance and financial budget of elite soccer clubs.

PubMed

Lago-Peñas, Carlos; Sampaio, Jaime

2015-01-01

The aim of the current study was (i) to identify how important is a good season start on elite soccer teams' performance and (ii) to examine whether this impact is related to the clubs' financial budget. The match performances and annual budgets of all teams were collected from the English FA Premier League, French Ligue 1, Spanish La Liga, Italian Serie A and German Bundesliga for three consecutive seasons (2010-2011 to 2012-2013). A k-means cluster analysis classified the clubs according to their budget as High Range Budget Clubs, Upper-Mid Range Budget Clubs, Lower-Mid Range Budget Clubs and Low Range Budget Clubs. Data were examined through linear regression models. Overall, the results suggested that the better the team performance at the beginning of the season, the better the ranking at the end of the season. However, the impact of the effect depended on the clubs' annual budget, with lower budgets being associated with a greater importance of having a good season start (P < 0.01). Moreover, there were differences in trends across the different leagues. These variables can be used to develop accurate models to estimate final rankings. Conversely, Lower-Mid and Lower Range Budget Clubs can benefit from fine-tuning preseason planning in order to accelerate the acquisition of optimal performances.

7 CFR 2003.6 - Office of the Under Secretary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... accounting purposes, all of the staff offices under the Deputy Under Secretary for P&P are housed in RBS. (1) The Budget Analysis Division assesses potential impacts of alternative policies on the mission area's..., administrative and procurement services, information resources management and automated data systems. For budget...

Budget impact analysis of chronic kidney disease mass screening test in Japan.

PubMed

Kondo, Masahide; Yamagata, Kunihiro; Hoshi, Shu-Ling; Saito, Chie; Asahi, Koichi; Moriyama, Toshiki; Tsuruya, Kazuhiko; Konta, Tsuneo; Fujimoto, Shouichi; Narita, Ichiei; Kimura, Kenjiro; Iseki, Kunitoshi; Watanabe, Tsuyoshi

2014-12-01

Our recently published cost-effectiveness study on chronic kidney disease mass screening test in Japan evaluated the use of dipstick test, serum creatinine (Cr) assay or both in specific health checkup (SHC). Mandating the use of serum Cr assay additionally, or the continuation of current policy mandating dipstick test only was found cost-effective. This study aims to examine the affordability of previously suggested reforms. Budget impact analysis was conducted assuming the economic model would be good for 15 years and applying a population projection. Costs expended by social insurers without discounting were counted as budgets. Annual budget impacts of mass screening compared with do-nothing scenario were calculated as ¥79-¥-1,067 million for dipstick test only, ¥2,505-¥9,235 million for serum Cr assay only and ¥2,517-¥9,251 million for the use of both during a 15-year period. Annual budget impacts associated with the reforms were calculated as ¥975-¥4,129 million for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥963-¥4,113 million for mandating serum Cr assay only and abandoning dipstick test. Estimated values associated with the reform from ¥963-¥4,129 million per year over 15 years are considerable amounts of money under limited resources. The most impressive finding of this study is the decreasing additional expenditures in dipstick test only scenario. This suggests that current policy which mandates dipstick test only would contain medical care expenditure.

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain.

PubMed

Sabatelli, L; Seppälä, U; Sastre, J; Crater, G

Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.

Adoption of Biosimilar Infliximab for Rheumatoid Arthritis, Ankylosing Spondylitis, and Inflammatory Bowel Diseases in the EU5: A Budget Impact Analysis Using a Delphi Panel

PubMed Central

Kanters, Tim A.; Stevanovic, Jelena; Huys, Isabelle; Vulto, Arnold G.; Simoens, Steven

2017-01-01

Introduction: Introducing biosimilar infliximab for the treatment in rheumatology (rheumatoid arthritis and ankylosing spondylitis) and inflammatory bowel disease (Crohn's disease and ulcerative colitis) may reduce treatment costs associated with biologics. This study aimed to investigate the budget impact of adopting biosimilar infliximab in five European countries, considering that the budget impact includes the adoption of biosimilar infliximab and the availability of biologic alternatives such as vedolizumab, biosimilar etanercept, biosimilar rituximab, and other relevant factors. Methods: An existing budget impact model was adapted to forecast the budget impact in the UK, Germany, France, Spain, and Italy. Epidemiological parameters were derived from published literature reviewed in July 2015. Current market shares of biologics were derived from Therapy Watch (2012/2013 data). Respondents in a Delphi panel, conducted in 2015 and consisting of several leading rheumatologists and gastroenterologists from different nationalities, were asked to forecast uptake of biosimilar infliximab and estimate the proportion of patients eligible for a particular type of biological treatment, including biosimilar infliximab. Scenario analyses assessed the influence of various factors, including price reductions, on the budget. Results: Uptake of biosimilar infliximab was particularly expected for naïve patients; switching patients that already received other biologics was not expected much. Market shares after 5 years of biosimilar infliximab were ~2% in rheumatology in all five countries and in gastroenterology ranged from 4% in France to over 30% in Italy. Except for France, budgets were expected to decrease for rheumatologic diseases. For gastroenterology, budgets were expected to decrease in Spain and Italy. Budgets were expected to increase substantially in the UK and Germany, due to the introduction of vedolizumab in the studied period. In France, budget was expected to slightly increase for ankylosing spondylitis, Crohn's Disease, and ulcerative collitis. Savings in budget were expected in all countries, for all diseases, when larger price discounts on biosimilar infliximab were used. Discussion and Conclusion: This study has shown that only when price reductions are large enough (i.e., 50% or more), physicians indicated that they will prescribe biosimilars. Policy makers should ensure substantial price reductions and stimulate physicians to use biosimilar products, to obtain savings in healthcare budgets. PMID:28620302

Adoption of Biosimilar Infliximab for Rheumatoid Arthritis, Ankylosing Spondylitis, and Inflammatory Bowel Diseases in the EU5: A Budget Impact Analysis Using a Delphi Panel.

PubMed

Kanters, Tim A; Stevanovic, Jelena; Huys, Isabelle; Vulto, Arnold G; Simoens, Steven

2017-01-01

Introduction: Introducing biosimilar infliximab for the treatment in rheumatology (rheumatoid arthritis and ankylosing spondylitis) and inflammatory bowel disease (Crohn's disease and ulcerative colitis) may reduce treatment costs associated with biologics. This study aimed to investigate the budget impact of adopting biosimilar infliximab in five European countries, considering that the budget impact includes the adoption of biosimilar infliximab and the availability of biologic alternatives such as vedolizumab, biosimilar etanercept, biosimilar rituximab, and other relevant factors. Methods: An existing budget impact model was adapted to forecast the budget impact in the UK, Germany, France, Spain, and Italy. Epidemiological parameters were derived from published literature reviewed in July 2015. Current market shares of biologics were derived from Therapy Watch (2012/2013 data). Respondents in a Delphi panel, conducted in 2015 and consisting of several leading rheumatologists and gastroenterologists from different nationalities, were asked to forecast uptake of biosimilar infliximab and estimate the proportion of patients eligible for a particular type of biological treatment, including biosimilar infliximab. Scenario analyses assessed the influence of various factors, including price reductions, on the budget. Results: Uptake of biosimilar infliximab was particularly expected for naïve patients; switching patients that already received other biologics was not expected much. Market shares after 5 years of biosimilar infliximab were ~2% in rheumatology in all five countries and in gastroenterology ranged from 4% in France to over 30% in Italy. Except for France, budgets were expected to decrease for rheumatologic diseases. For gastroenterology, budgets were expected to decrease in Spain and Italy. Budgets were expected to increase substantially in the UK and Germany, due to the introduction of vedolizumab in the studied period. In France, budget was expected to slightly increase for ankylosing spondylitis, Crohn's Disease, and ulcerative collitis. Savings in budget were expected in all countries, for all diseases, when larger price discounts on biosimilar infliximab were used. Discussion and Conclusion: This study has shown that only when price reductions are large enough (i.e., 50% or more), physicians indicated that they will prescribe biosimilars. Policy makers should ensure substantial price reductions and stimulate physicians to use biosimilar products, to obtain savings in healthcare budgets.

Vaccines are different: A systematic review of budget impact analyses of vaccines.

PubMed

Loze, Priscilla Magalhaes; Nasciben, Luciana Bertholim; Sartori, Ana Marli Christovam; Itria, Alexander; Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho

2017-05-15

Several countries require manufacturers to present a budget impact analysis (BIA), together with a cost-effectiveness analysis, to support national funding requests. However, guidelines for conducting BIA of vaccines are scarce. To analyze the methodological approaches used in published budget impact analysis (BIA) of vaccines, discussing specific methodological issues related to vaccines. This systematic review of the literature on BIA of vaccines was carried out in accordance with the Centre for Reviews and Dissemination - CRD guidelines. We searched multiple databases: MedLine, Embase, Biblioteca Virtual de Saúde (BVS), Cochrane Library, DARE Database, NHS Economic Evaluation Database (NHS EED), HTA Database (via Centre for Reviews and Dissemination - CRD), and grey literature. Two researchers, working independently, selected the studies and extracted the data. The methodology quality of individual studies was assessed using the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. A qualitative narrative synthesis was conducted. Twenty-two studies were reviewed. The most frequently evaluated vaccines were pneumococcal (41%), influenza (23%) and rotavirus (18%). The target population was stated in 21 studies (95%) and the perspective was clear in 20 (91%). Only 36% reported the calculations used to complete the BIA, 27% informed the total and disaggregated costs for each time period, and 9% showed the change in resource use for each time period. More than half of the studies (55%, n=12) reported less than 50% of the items recommended in the checklist. The production of BIA of vaccines has increased from 2009. The report of the methodological steps was unsatisfactory, making it difficult to assess the validity of the results presented. Vaccines specific issues should be discussed in international guidelines for BIA of vaccines, to improve the quality of the studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed

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

2014-04-01

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

Targeted erlotinib for first-line treatment of advanced non-small cell lung cancer: a budget impact analysis.

PubMed

Bajaj, Preeti S; Veenstra, David L; Goertz, Hans-Peter; Carlson, Josh J

2014-08-01

A recent phase III trial showed that patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor specific EGFR mutations significantly benefit from first-line treatment with erlotinib compared to chemotherapy. This study sought to estimate the budget impact if coverage for EGFR testing and erlotinib as first-line therapy were provided in a hypothetical 500,000-member managed care plan. The budget impact model was developed from a US health plan perspective to evaluate administration of the EGFR test and treatment with erlotinib for EGFR-positive patients, compared to non-targeted treatment with chemotherapy. The eligible patient population was estimated from age-stratified SEER incidence data. Clinical data were derived from key randomized controlled trials. Costs related to drug, administration, and adverse events were included. Sensitivity analyses were conducted to assess uncertainty. In a plan of 500,000 members, it was estimated there would be 91 newly diagnosed advanced NSCLC patients annually; 11 are expected to be EGFR-positive. Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib. Overall health plan expenditures would increase by $0.013 per member per month (PMPM). This increase is largely attributable to erlotinib drug costs, in part due to lengthened progression-free survival and treatment periods experienced in erlotinib-treated patients. EGFR testing contributes slightly, whereas adverse event costs mitigate the budget impact. The budget impact did not exceed $0.019 PMPM in sensitivity analyses. Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients' quality-of-life were included.

Criteria-Based Resource Allocation: A Tool to Improve Public Health Impact.

PubMed

Graham, J Ross; Mackie, Christopher

2016-01-01

Resource allocation in local public health (LPH) has been reported as a significant challenge for practitioners and a Public Health Services and Systems Research priority. Ensuring available resources have maximum impact on community health and maintaining public confidence in the resource allocation process are key challenges. A popular strategy in health care settings to address these challenges is Program Budgeting and Marginal Analysis (PBMA). This case study used PBMA in an LPH setting to examine its appropriateness and utility. The criteria-based resource allocation process PBMA was implemented to guide the development of annual organizational budget in an attempt to maximize the impact of agency resources. Senior leaders and managers were surveyed postimplementation regarding process facilitators, challenges, and successes. Canada's largest autonomous LPH agency. PBMA was used to shift 3.4% of the agency budget from lower-impact areas (through 34 specific disinvestments) to higher-impact areas (26 specific reinvestments). Senior leaders and managers validated the process as a useful approach for improving the public health impact of agency resources. However, they also reported the process may have decreased frontline staff confidence in senior leadership. In this case study, PBMA was used successfully to reallocate a sizable portion of an LPH agency's budget toward higher-impact activities. PBMA warrants further study as a tool to support optimal resource allocation in LPH settings.

Decentralization and health resource allocation: a case study at the district level in Indonesia.

PubMed

Abdullah, Asnawi; Stoelwinder, Johannes

2008-01-01

Health resource allocation has been an issue of political debate in many health systems. However, the debate has tended to concentrate on vertical allocation from the national to regional level. Allocation within regions or institutions has been largely ignored. This study was conducted to contribute analysis to this gap. The objective was to investigate health resource allocation within District Health Offices (DHOs) and to compare the trends and patterns of several budget categories before and after decentralization. The study was conducted in three districts in the Province of Nanggroe Aceh Darussalam. Six fiscal year budgets, two before decentralization and four after, were studied. Data was collected from the Local Government Planning Office and DHOs. Results indicated that in the first year of implementing a decentralization policy, the local government budget rose sharply, particularly in the wealthiest district. In contrast, in relatively poor districts the budget was only boosted slightly. Increasing total local government budgets had a positive impact on increasing the health budget. The absolute amount of health budgets increased significantly, but by percentage did not change very much. Budgets for several projects and budget items increased significantly, but others, such as health promotion, monitoring and evaluation, and public-goods-related activities, decreased. This study concluded that decentralization in Indonesia had made a positive impact on district government fiscal capacity and had affected DHO budgets positively. However, an imbalanced budget allocation between projects and budget items was obvious, and this needs serious attention from policy makers. Otherwise, decentralization will not significantly improve the health system in Indonesia.

Budget impact of polio immunization strategy for India: introduction of one dose of inactivated poliomyelitis vaccine and reductions in supplemental polio immunization.

PubMed

Khan, M M; Sharma, S; Tripathi, B; Alvarez, F P

2017-01-01

To conduct a budget impact analysis (BIA) of introducing the immunization recommendations of India Expert Advisory Group (IEAG) for the years 2015-2017. The recommendations include introduction of one inactivated poliomyelitis vaccine (IPV) dose in the regular child immunization programme along with reductions in oral polio vaccine (OPV) doses in supplemental programmes. This is a national level analysis of budget impact of new polio immunization recommendations. Since the states of India vary widely in terms of size, vaccine coverage and supplemental vaccine needs, the study estimated the budget impact for each of the states of India separately to derive the national level budget impact. Based on the recommendations of IEAG, the BIA assumes that all children in India will get an IPV dose at 14 weeks of age in addition to the OPV and DPT (or Pentavalent-3) doses. Cost of introducing the IPV dose was estimated by considering vaccine price and vaccine delivery and administration costs. The cost savings associated with the reduction in number of doses of OPV in supplemental immunization were also estimated. The analysis used India-specific or international cost parameters to estimate the budget impact. Introduction of one IPV dose will increase the cost of vaccines in the regular immunization programme from $20 million to $47 million. Since IEAG recommends lower intensity of supplemental OPV vaccination, polio vaccine cost of supplemental programme is expected to decline from $72 million to $53 million. Cost of administering polio vaccines will also decline from $124 million to $105 million mainly due to the significantly lower intensity of supplemental polio vaccination. The net effect of adopting IEAG's recommendations on polio immunization turns out to be cost saving for India, reducing total polio immunization cost by $6 million. Additional savings could be achieved if India adopts the new policy regarding the handling of multi-dose vials after opening. Introduction of three doses of IPV with the existing polio immunization schedule will increase the budget requirement by $102 million but replacing OPV doses with IPV will increase the budget by about $59 million. Discontinuation of supplemental OPV immunization with replacement of OPV by IPV will reduce the Government of India's (GOI) polio immunization budget by $99 million. Although the overall cost of polio programme will decline with the adoption of IEAG's recommendations, state-level costs will vary widely. In states like Kerala, Karnataka, Uttar Pradesh and Andhra Pradesh, cost of polio immunization will increase while in Punjab and Jharkhand the costs will remain more or less constant. Significant cost reductions will happen in states with high intensity of supplemental polio immunizations (Bihar, Haryana and Delhi). The cost of procuring polio vaccines will more than double from $20 million to about $47 million requiring allocation of additional foreign exchanges. In some states (like Bihar), the decline in polio-related employment will be very high requiring reallocation of personnel from polio to other programmes. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Analysis of the Climate Change Technology Initiative

EIA Publications

1999-01-01

Analysis of the impact of specific policies on the reduction of carbon emissions and their impact on U.S. energy use and prices in the 2008-2012 time frame. Also, analyzes the impact of the President's Climate Change Technology Initiative, as defined for the 2000 budget, on reducing carbon emissions from the levels forecast in the Annual Energy Outlook 1999 reference case.

The Budget Impact of Biosimilar Infliximab (Remsima®) for the Treatment of Autoimmune Diseases in Five European Countries.

PubMed

Jha, Ashok; Upton, Alex; Dunlop, William C N; Akehurst, Ron

2015-08-01

Inflammatory autoimmune diseases (rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis, and psoriatic arthritis) have a considerable impact on patients' quality of life and healthcare budgets. Biosimilar infliximab (Remsima(®)) has been authorized by the European Medicines Agency for the management of inflammatory autoimmune diseases based on a data package demonstrating efficacy, safety, and quality comparable to the reference infliximab product (Remicade(®)). This analysis aims to estimate the 1-year budget impact of the introduction of Remsima in five European countries. A budget impact model for the introduction of Remsima in Germany, the UK, Italy, the Netherlands, and Belgium was developed over a 1-year time horizon. Infliximab-naïve and switch patient groups were considered. Only direct drug costs were included. The model used the drug-acquisition cost of Remicade. The list price of Remsima was not known at the time of the analysis, and was assumed to be 10-30% less than that of Remicade. Key variables were tested in the sensitivity analysis. The annual cost savings resulting from the introduction of Remsima were projected to range from €2.89 million (Belgium, 10% discount) to €33.80 million (Germany, 30% discount). If any such savings made were used to treat additional patients with Remsima, 250 (Belgium, 10% discount) to 2602 (Germany, 30% discount) additional patients could be treated. The cumulative cost savings across the five included countries and the six licensed disease areas were projected to range from €25.79 million (10% discount) to €77.37 million (30% discount). Sensitivity analyses showed the number of patients treated with infliximab to be directly correlated with projected cost savings, with disease prevalence and patient weight having a smaller impact, and incidence the least impact. The introduction of Remsima could lead to considerable drug cost-related savings across the six licensed disease areas in the five European countries. Mundipharma International Ltd.

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

PubMed Central

2013-01-01

Objectives In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance. PMID:23551943

Budget impact analysis of darbepoetin alfa every 3 weeks versus epoetin alfa every week for the treatment of chemotherapy-induced anaemia from a US payer's perspective.

PubMed

Rubin, Robert J; Glaspy, John A; Adams, John L; Mafilios, Michael S; Wang, Sharon M; Viswanathan, Hema N; Kallich, Joel D

2008-01-01

This analysis was conducted to compare the direct medical costs of treatment with darbepoetin alfa every 3 weeks (Q3W) and epoetin alfa every week (QW) in patients with chemotherapy-induced anaemia (CIA) from the payer's perspective. An analysis was conducted from a US health plan perspective to compare the annual budget impact for CIA with darbepoetin alfa Q3W and epoetin alfa QW over a 16-week treatment period. Dosing regimens were obtained from registration clinical trials. Mean doses, including dose adjustments, were 375.6 microg Q3W for darbepoetin alfa and 43,187 U QW for epoetin alfa. Costs of medical resources included drug acquisition and administration costs. The base case analysis resulted in a per-patient budget impact of $8,544 and $8,667 for darbepoetin alfa and epoetin alfa, respectively. Per member per month cost was $0.90 for darbepoetin alfa and $0.91 for epoetin alfa, based on an estimate of 2,735 CIA patients in a health plan population of 2.17 million. The analysis was most sensitive to drug dose, treatment period and drug price. Results suggest that per-patient direct medical costs of CIA treatment, when initiated at labelled starting doses, are comparable for darbepoetin alfa Q3W and epoetin alfa QW.

Rapid diagnostic test for G6PD deficiency in Plasmodium vivax-infected men: a budget impact analysis based in Brazilian Amazon.

PubMed

Peixoto, Henry Maia; Brito, Marcelo Augusto Mota; Romero, Gustavo Adolfo Sierra; Monteiro, Wuelton Marcelo; de Lacerda, Marcus Vinícius Guimarães; de Oliveira, Maria Regina Fernandes

2017-01-01

The aim of this study was to estimate the incremental budget impact (IBI) of a rapid diagnostic test to detect G6PDd in male patients infected with Plasmodium vivax in the Brazilian Amazon, as compared with the routine protocol recommended in Brazil which does not include G6PDd testing. The budget impact analysis was performed from the perspective of the Brazilian health system, in the Brazilian Amazon for the years 2013, 2014 and 2015. The analysis used a decision model to compare two scenarios: the first consisting of the routine recommended in Brazil which does not include prior diagnosis of dG6PD, and the second based on the use of RDT CareStart™ G6PD (CS-G6PD) in all male subjects diagnosed with vivax malaria. The expected implementation of the diagnostic test was 30% in the first year, 70% the second year and 100% in the third year. The analysis identified negative IBIs which were progressively smaller in the 3 years evaluated. The sensitivity analysis showed that the uncertainties associated with the analytical model did not significantly affect the results. A strategy based on the use of CS-G6PD would result in better use of public resources in the Brazilian Amazon. © 2016 John Wiley & Sons Ltd.

Analysis of FY 1990 Budget Proposals and Their Impact on Low Income Programs.

ERIC Educational Resources Information Center

Center on Budget and Policy Priorities, Washington, DC.

Despite claims that benefits for the needy have not been reduced, the Reagan Administration's final budget for fiscal year 1990 is marked by substantial reductions in programs for the poor. Actual spending for low-income programs would be sliced $6.75 billion below current levels. Medicaid, which provides health care coverage for poor families…

The influence of fiscal rules on healthcare policy in the United States and the Netherlands.

PubMed

Schakel, H Christiaan; Jeurissen, Patrick; Glied, Sherry

2017-10-01

Governments use fiscal rules to put a framework and limits on how budgetary challenges are addressed, but the rules themselves are still an understudied area among health policy scholars. For a long time, healthcare held a somewhat separate status because of the reliance on entitlements and dedicated revenue streams. However, the combined forces of advocates for integral decision-making, central budget control and the increasing costs might shift healthcare towards budgetary frameworks that currently apply to other spending categories. In this paper, we study fiscal rules that the US and the Netherlands have adopted since 2010 and their impact on healthcare policy. Our analysis shows that fiscal rules can have an impact on the rationing of healthcare. In the studied timeframe, the rules seem to have more impact on budget outcomes than on the budget process itself. In addition, the convergence of fiscal and program policy objectives seems to be better accomplished in a budgetary system that applies enforceable budget ceilings. Budgeting for health entitlements requires a comprehensive and tailor-made approach and the composition of traditional rules might not fully answer to the complexities of healthcare policy. This paper aims to contribute to that debate and the way we think about healthcare budgeting. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

PubMed

Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

2018-05-03

Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

Budget impact analysis of insulin therapies and associated delivery systems.

PubMed

Lee, Lauren J; Smolen, Lee J; Klein, Timothy M; Foster, Shonda A; Whiteman, Doug; Jorgenson, James A; Hultgren, Steve

2012-06-01

A budget impact analysis of insulin therapies and associated delivery systems is presented. Based on inputted procurement totals, per-item costs (based on 2011 average wholesale price), insulin distribution system (floor stock or individual patient supply), waste, and treatment protocols for a specified time frame, the budget impact model approximated the number of patients treated with subcutaneous insulin, costs, utilization, waste, and injection mechanism (pen safety needle or syringe) costs. To calculate net changes, results of one-year 3-mL vial use were subtracted from one-year 10-mL vial or 3-mL pen use. Switching from a 10-mL vial to a 3-mL vial was associated with reductions in both costs and waste. The net reductions in costs and waste ranged from $15,482 and 120,000 IU, respectively, for floor-stock 10-mL vial to floor-stock 3-mL vial conversion to $871,548 and 6,750,000 IU, respectively, for individual patient supply 10-mL vial to floor-stock 3-mL vial conversion. Switching from floor-stock 10-mL vials to individual patient supply 3-mL vials increased costs and waste by $164,659 and 1,275,000 IU, respectively. Converting from individual patient supply 3-mL pens to individual patient supply 3-mL vials reduced costs by $117,236 but did not decrease waste. A budget impact analysis of the conversion of either 10-mL insulin vials or 3-mL insulin pens to 3-mL insulin vials found reductions in both cost and waste, except when converting from floor-stock 10-mL vials to individual patient supply 3-mL vials.

A public health and budget impact analysis of vaccinating the elderly and at-risk adults with the 23-valent pneumococcal polysaccharide vaccine or 13-valent pneumococcal conjugate vaccine in the UK.

PubMed

Jiang, Yiling; Gauthier, Aline; Keeping, Sam; Carroll, Stuart

2014-12-01

Since the introduction of the routine childhood immunization, a change in epidemiology of pneumococcal disease has been seen in both children and adults. This study aimed to quantify the public health and budget impact of pneumococcal vaccination of the elderly and those in at risk groups in the UK. The model was adapted from a previous population-based Markov model. At-risk adults and the elderly were assumed to receive PPV23 or PCV13 vaccination or no vaccination. Over the study period (2012-2016), PPV23 vaccination led to a reduction in the number of invasive pneumococcal disease cases in most scenarios. The net budget impact ranged between £15 and £39 million (vs no vaccination) or between -£116 and -£93 million (vs PCV13). PPV23 vaccination program remains the optimal strategy from public health and budgetary perspectives despite epidemiological changes. PCV13 is likely to impose a significant budget with limited health benefits.

Ready-to-use pre-filled syringes of atropine for anaesthesia care in French hospitals - a budget impact analysis.

PubMed

Benhamou, Dan; Piriou, Vincent; De Vaumas, Cyrille; Albaladejo, Pierre; Malinovsky, Jean-Marc; Doz, Marianne; Lafuma, Antoine; Bouaziz, Hervé

2017-04-01

Patient safety is improved by the use of labelled, ready-to-use, pre-filled syringes (PFS) when compared to conventional methods of syringe preparation (CMP) of the same product from an ampoule. However, the PFS presentation costs more than the CMP presentation. To estimate the budget impact for French hospitals of switching from atropine in ampoules to atropine PFS for anaesthesia care. A model was constructed to simulate the financial consequences of the use of atropine PFS in operating theatres, taking into account wastage and medication errors. The model tested different scenarios and a sensitivity analysis was performed. In a reference scenario, the systematic use of atropine PFS rather than atropine CMP yielded a net one-year budget saving of €5,255,304. Medication errors outweighed other cost factors relating to the use of atropine CMP (€9,425,448). Avoidance of wastage in the case of atropine CMP (prepared and unused) was a major source of savings (€1,167,323). Significant savings were made by means of other scenarios examined. The sensitivity analysis suggests that the results obtained are robust and stable for a range of parameter estimates and assumptions. The financial model was based on data obtained from the literature and expert opinions. The budget impact analysis shows that even though atropine PFS is more expensive than atropine CMP, its use would lead to significant cost savings. Savings would mainly be due to fewer medication errors and their associated consequences and the absence of wastage when atropine syringes are prepared in advance. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Modeling the budget impact of long-acting injectable paliperidone palmitate in the treatment of schizophrenia in Japan

PubMed Central

Mahlich, Jörg; Nishi, Masamichi; Saito, Yoshimichi

2015-01-01

Background The cost of schizophrenia in Japan is high and new long-acting injectable (LAI) antipsychotics might be able to reduce costs by causing a reduction of hospital stays. We aim to estimate budget effects of the introduction of a new 1-month LAI, paliperidone palmitate, in Japan. Methods A budget impact analysis was conducted from a payer perspective. The model took direct costs of illness into account (ie, costs for inpatient and outpatient services, as well as drug costs). The robustness of the model was checked using a sensitivity analysis. Results According to our calculations, direct total costs of schizophrenia reach 710,500 million yen a year (US$6 billion). These costs decrease to 691,000 million yen (US$5.9 billion) 3 years after the introduction of paliperidone palmitate. Conclusion From a payer point of view, the introduction of a new treatment for schizophrenia in Japan helps to save resources and is not associated with a higher financial burden. PMID:26045674

Analytic Calculation of Noise Power Robbing, NPR, and Polarization Isolation Degradation

NASA Technical Reports Server (NTRS)

Peters, Robert; Woolner, Peter; Ekelman, Ernest

2008-01-01

Three Geostationary Operational Environmental Satellite (GOES) R transponders (services) required analysis and measurements to develop an accurate link budget. These are a) Search and Rescue transponder which suffers from power robbing due to thermal uplink noise, b) the Data Collection Platform Report which suffers from degradation due to NPR (Noise Power Ratio), and c) GOES Rebroadcast transponder which uses a dual circular downlink L band for which there was no depolarization data. The first two services required development of extended link budget to analytically calculate the impact of these degradations which are shown to have a significant impact on the link budget. The third service required measurements of atmospheric L band CP depolarization as there were no known previous measurements and results are reported her

Drug reimbursement recommendations by the National Institute for Health and Clinical Excellence: have they impacted the National Health Service budget?

PubMed

Mauskopf, Josephine; Chirila, Costel; Birt, Julie; Boye, Kristina S; Bowman, Lee

2013-04-01

Determine whether reimbursement restrictions recommended by the National Institute for Health and Clinical Excellence (NICE) have impacted the United Kingdom (UK) National Health Service (NHS) budget. Data were abstracted from NICE guidance documents and costing statements through March 2011. Estimated maximum and adjusted potential budget impact (PBI) on the NHS was derived using estimates of the UK marketing-approved population and the annual cost for the new drug. Descriptive and logistic analyses were used to estimate the correlation between the degree of restrictions on reimbursement recommended by NICE for each new drug indication and the PBI controlling for clinical effectiveness and cost-effectiveness. PBI was significantly correlated with the degree of reimbursement restrictions. In descriptive analysis, the adjusted PBI for drugs that were recommended without restrictions was £20.3 million (SD = 22.2) compared with £49.8 million (SD = 90.8) for those recommended with restrictions and £71.1 million (SE = 99.9) for those not recommended. In logistic analysis, the odds ratio for less restrictive reimbursement was 0.848 (95% CI, 0.762-0.945) for each £20 million increase in the adjusted PBI. Results were similar using the maximum PBI. After controlling for clinical effectiveness and cost-effectiveness, the degree of reimbursement restriction recommended by NICE remains significantly correlated with the PBI, despite that fact that the NICE decision process does not consider budget impact. This correlation might be due to NICE consideration of effectiveness and cost-effectiveness for subgroups of the approved population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The effect of new biosimilars in rheumatology and gastroenterology specialities on UK healthcare budgets: Results of a budget impact analysis.

PubMed

Aladul, Mohammed I; Fitzpatrick, Raymond W; Chapman, Stephen R

2018-05-15

The approval of new biosimilars of infliximab, etanercept and adalimumab by the European Medicines Agency is expected to produce further cost savings to the healthcare system budget. This study aimed to estimate the budget impact of the introduction of new biosimilars Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® in rheumatology and gastroenterology specialities in the UK. A published budget impact model was adapted to estimate the expected cost savings following the entry of new biosimilars Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® in the UK over three-year time horizon. This model was based on retrospective market shares of biologics used in rheumatology and gastroenterology which were derived from DEFINE Software and healthcare professional perspectives. The model predicted that infliximab and etanercept biosimilars would replace their corresponding reference agents by 2020. Adalimumab biosimilars were predicted to achieve 19% of the rheumatology and gastroenterology market by 2020. Without the introduction of further biosimilars, the model predicted a reduction in expenditure of £44 million on biologics over the next three years. With the entry of Flixabi ® , Erelzi ® , Solymbic ® , Amgevita ® and Imraldi ® the model estimates cumulative savings of £285 million by 2020. The introduction of new infliximab, etanercept and adalimumab biosimilars will be associated with considerable cost savings and have a substantial favourable impact on the UK NHS budget. The number of biosimilars and time of entry of is critical to create competition which will result in maximum cost savings. Copyright © 2018 Elsevier Inc. All rights reserved.

BUDGET IMPACT ANALYSIS OF BELIMUMAB IN TREATING SYSTEMIC LUPUS ERYTHEMATOSUS.

PubMed

Pierotti, Francesca; Palla, Iaria; Pippo, Lara; Lorenzoni, Valentina; Turchetti, Giuseppe

2016-01-01

The study evaluates the costs of systemic lupus erythematosus (SLE) and the budget impact due to the introduction of belimumab in the Italian setting. Adaptation to the Italian setting of a budget impact model with a time horizon of 4 years (year 0 without belimumab, years 1-3 with belimumab) to compare treatment, administration, and clinical monitoring costs of standard therapy and of the alternative scenario in which belimumab is administered in addition to the standard therapy to the subgroup of patients selected according to the label approved by the European Medicines Agency. The model takes also into account the costs of flares. Over 3 years, belimumab is able to prevent cumulatively 1,111 severe flares and 3,631 nonsevere flares with a total saving for the Italian National Health System (NHS) of approximately €6.2 million. Budget impact ranges from €4.4 million in the first year to €20.3 million in the third year. The decrease in the number of flare partially counterbalances the costs of the new technology (impact attenuation of approximately 16 percent). These data elucidate the importance to control and monitor the disease progression and to prevent exacerbations, which are the major causes of the increase in costs paid by the NHS and by the society. The financial impact could be replicate on a regional basis, to inform local decision makers. Further developments are possible as the model does not consider the additional clinical and economic benefits of reduced damage accrual and slowed disease progression.

Age- and risk-related appropriateness of the use of available influenza vaccines in the Italian elderly population is advantageous: results from a budget impact analysis

PubMed Central

BARBIERI, M.; CAPRI, S.; WAURE, C. DE; BOCCALINI, S.; PANATTO, D.

2017-01-01

Summary Introduction Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and intradermal TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile. Methods A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly individuals could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65-74 years and at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65-74-year-olds and all subjects aged ≥ 75 years. Results Switching to the alternative scenario would result in both significant health benefits and net budget savings. Particularly, it would be possible to prevent an additional 8201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy being associated with slightly higher vaccination costs, the total savings derived from fewer influenza events completely resets this increase with net budget savings of € 0.13 million. Conclusions An immunization policy in which influenza vaccines are administered according to the age and risk profile of Italian elderly individuals is advisable. PMID:29707658

Age- and risk-related appropriateness of the use of available influenza vaccines in the Italian elderly population is advantageous: results from a budget impact analysis.

PubMed

Barbieri, M; Capri, S; Waure, C DE; Boccalini, S; Panatto, D

2017-12-01

Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and intradermal TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile. A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly individuals could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65-74 years and at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65-74-year-olds and all subjects aged ≥ 75 years. Switching to the alternative scenario would result in both significant health benefits and net budget savings. Particularly, it would be possible to prevent an additional 8201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy being associated with slightly higher vaccination costs, the total savings derived from fewer influenza events completely resets this increase with net budget savings of € 0.13 million. An immunization policy in which influenza vaccines are administered according to the age and risk profile of Italian elderly individuals is advisable.

Budget impact analysis of biosimilar infliximab (CT-P13) for the treatment of rheumatoid arthritis in six Central and Eastern European countries.

PubMed

Brodszky, Valentin; Baji, Petra; Balogh, Orsolya; Péntek, Márta

2014-05-01

The first biosimilar monoclonal antibody (infliximab, CT-P13) was registered by the European Medicines Agency in 2013 for the treatment of several inflammatory conditions including rheumatoid arthritis (RA). Biosimilar infliximab is first being marketed in the Central and Eastern European countries. This paper presents the estimated budget impact of the introduction of biosimilar infliximab in RA over a 3-year time period in six selected countries, namely Bulgaria, the Czech Republic, Hungary, Poland, Romania and Slovakia. A prevalence-based model was constructed for budget impact analysis. Two scenarios were compared to the reference scenario (RSc) where no biosimilar infliximab is available: biosimilar scenario 1 (BSc1), where interchanging the originator infliximab with biosimilar infliximab is disallowed, and only patients who start new biological therapy are allowed to use biosimilar infliximab; as well as biosimilar scenario 2 (BSc2), where interchanging the originator infliximab with biosimilar infliximab is allowed, and 80% of patients treated with originator infliximab are interchanged to biosimilar infliximab. Compared to the RSc, the net savings are estimated to be €15.3 or €20.8 M in BSc1 and BSc2, respectively, over the 3 years. If budget savings were spent on reimbursement of additional biosimilar infliximab treatment, approximately 1,200 or 1,800 more patients could be treated in the six countries within 3 years in the two biosimilar scenarios, respectively. The actual saving is most sensitive to the assumption of the acquisition cost of the biosimilar drug and to the initial number of patients treated with biological therapy. The study focused on one indication (RA) and demonstrated that the introduction of biosimilar infliximab can lead to substantial budget savings in health care budgets. Further savings are expected for other indications where biosimilar medicines are implemented.

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System.

PubMed

Nguyen, John T; Rich, Josiah D; Brockmann, Bradley W; Vohr, Fred; Spaulding, Anne; Montague, Brian T

2015-08-01

Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

Budget Impact Analysis of Biosimilar Trastuzumab for the Treatment of Breast Cancer in Croatia.

PubMed

Cesarec, August; Likić, Robert

2017-04-01

Breast cancer is the most common cancer in women and has considerable impact on healthcare budgets and patients' quality of life. Trastuzumab (Herceptin ® ) is a monoclonal antibody directed against the human epidermal growth factor receptor (HER2) for the treatment of breast cancer. Several trastuzumab biosimilars are currently in development. In 2015, trastuzumab was the drug with the highest financial consumption among all drugs in Croatia. This model estimates the 1-year budget impact of the introduction of biosimilar trastuzumab in Croatia. A budget impact model, based on approvals for trastuzumab treatment in 2015, was developed for the introduction of biosimilars. Two biosimilar scenarios were developed: biosimilar scenario 1, based on all approvals in 2015, and biosimilar scenario 2, based on approvals after February 2015 and the reimbursement of the subcutaneous formulation of trastuzumab in Croatia. Only trastuzumab-naïve patients and drug-acquisition costs were used in the model. Uptake of biosimilar was assumed at 50 %. Scenarios were calculated with price discounts of 15, 25 and 35 %. The robustness of the model was tested by extensive sensitivity analyses. The projected drug cost savings from the introduction of biosimilar trastuzumab range from €0.26 million (scenario 2, 15 % price discount) to €0.69 million (scenario 1, 35 % price discount). If budget savings were reinvested to treat additional patients with trastuzumab, 14 (scenario 2, 15 % price discount) to 47 (scenario 1, 35 % price discount) additional patients could be treated. Sensitivity analyses showed that the incidence of breast cancer had the highest impact on the model, with a 10 % decrease in incidence leading to an 11.3 % decrease in projected savings. The introduction of biosimilar trastuzumab could lead to significant drug cost savings in Croatia.

[Health financing conditions in large cities in Brazil].

PubMed

de Lima, Luciana Dias; de Andrade, Carla Lourenço Tavares

2009-10-01

We evaluated the funding of the Brazilian Unified National Health System (SUS) in municipalities with more than 100,000 inhabitants. The main goal was to evaluate the impact of policies for health resource allocation within the municipal budget. A database was organized with information from revenues reported by municipalities in the Information System on Government Health Budgets (SIOPS) for the year 2005. Reported budgets were compared and correlated to the municipalities' geographic location. We conducted a cluster analysis to create more homogeneous groups according to health-related budget. The study showed a major variability among different regions and States, with varying degrees of municipal dependence on external funds. Although the large variability in sources may indicate multiple strategies for ensuring the necessary budget funds, the study suggests some barriers to public health funding in larger municipalities.

A Budget Impact Model for Paclitaxel-eluting Stent in Femoropopliteal Disease in France

DOE Office of Scientific and Technical Information (OSTI.GOV)

De Cock, Erwin, E-mail: erwin.decock@unitedbiosource.com; Sapoval, Marc, E-mail: Marc.sapoval2@egp.aphp.fr; Julia, Pierre, E-mail: pierre.julia@egp.aphp.fr

2013-04-15

The Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent. A model was developed in Microsoft Excel to estimate the impact of a progressive transition from BMS to Zilver PTX over a 5-year horizon. The number of patients undergoing SFA stenting was estimated on the basis of hospital episode data. The analysis from the payermore » perspective used French reimbursement tariffs. Target lesion revascularization (TLR) after primary stent placement was the primary outcome. TLR rates were based on 2-year data from the Zilver PTX single-arm study (6 and 9 %) and BMS rates reported in the literature (average 16 and 22 %) and extrapolated to 5 years. Net budget impact was expressed as the difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only. The model estimated a net cumulative 5-year budget reduction of Euro-Sign 6,807,202 for a projected population of 82,316 patients (21,361 receiving Zilver PTX). Base case results were confirmed in sensitivity analyses. Adoption of Zilver PTX could lead to important savings for the French public health care payer. Despite higher initial reimbursement for the Zilver PTX stent, fewer expected SFA reinterventions after the primary stenting procedure result in net savings.« less

Budget impact analysis in Spanish patients with Dupuytren's contracture: fasciectomy vs. collagenase Clostridium histolyticum.

PubMed

De Salas-Cansado, M; Cuadros, M; Del Cerro, M; Arandes, J M

2013-04-01

The aim of this study was to estimate the budget impact of collagenase Clostridium histolyticum (CCH) vs. fasciectomy (FSC) surgery for the treatment of Dupuytren's disease (DD) in Spain. A cost minimization analysis was adopted (effectiveness was assumed to be equivalent for both techniques). DD related costs were considered. CCH costs (including drug, administration and visits) were obtained from clinical trials and a real-life study. FSC costs (including type of admission, visits, operating room, re-admissions, tests, drugs and rehabilitation costs) were collected through a retrospective, observational, local study. Unit costs were obtained from local database systems (e-SALUD and BOT). Results were presented from the NHS perspective for the next 3 years. We assumed that there were 5100 fasciectomies per year (with a 5% annual increase) and that 20%, 30% and 40% of them will annually utilize CCH. In addition, a 10%, 15% and 20% of untreated diagnosed patients were expected to receive CCH. All the data were validated through an expert panel. A sensitivity analysis was performed with the main variables. The average FSC cost was €2250 (72% inpatients), €1703 for outpatients and €2467 for inpatients. The average CCH cost was €1220 (1.5 vial/injection and four visits) and could drop to €898 (1.1 vial/injections and three visits). The accumulated 3years budget impact analysis (BIA) was 45,971€ (K€-2993(1); 3870). According to this study, the inclusion of the CCH should produce a 3-year cumulative budgetary impact of €45,971 (K€-2993; 3870) for the NHS. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Budget Impact Analysis to Estimate the Cost Dynamics of Treating Refractory Gastroesophageal Reflux Disease With Radiofrequency Energy: a Payer Perspective.

PubMed

Gregory, David; Scotti, Dennis J; Buck, Daniel; Triadafilopoulos, George

2016-05-01

A minimally invasive endoscopic treatment that utilizes radio-frequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer perspective to estimate the direct medical costs of treatment for the refractory GERD patient population and to estimate the budgetary impact of further extending the RFE treatment option to other target populations. A retrospective analysis of claims designed to assess the longitudinal costs and budget impact on payer expenditures associated with managing and treating GERD surgically (Nissen fundoplication [NF]), endoscopically (RFE), or medically was performed. Both Medicare and commercially insured claims databases were interrogated for such population-level analyses. At current adoption rates (less than 1% of procedures), RFE demonstrated overall cost savings ranging from 7.3% to 50.5% in the 12-month time period following the index procedure (inclusive of procedure costs) when compared to medical management and fundoplication across the commercial and Medicare patient populations. Increasing the total number of RFE procedures to 2% of total cases performed generated per-member, per-month (PMPM) savings of $0.28 in the Medicare population and $0.37 in the commercially insured population. Further increases yielded higher PMPM savings. Adding to the clinical importance of RFE in filling the gap between medical and surgical management, this economic analysis demonstrates to payers that the adoption of RFE can create notable savings to their plans when compared to surgery or medical management.

Budget impact analysis of gene expression tests to aid therapy decisions for breast cancer patients in Germany.

PubMed

Lux, M P; Nabieva, N; Hildebrandt, T; Rebscher, H; Kümmel, S; Blohmer, J-U; Schrauder, M G

2018-02-01

Many women with early-stage, hormone receptor-positive breast cancer may not benefit from adjuvant chemotherapy. Gene expression tests can reduce chemotherapy over- and undertreatment by providing prognostic information on the likelihood of recurrence and, with Oncotype DX, predictive information on chemotherapy benefit. These tests are currently not reimbursed by German healthcare payers. An analysis was conducted to evaluate the budget impact of gene expression tests in Germany. Costs of gene expression tests and medical and non-medical costs associated with treatment were assessed from healthcare payer and societal perspectives. Costs were estimated from data collected at a university hospital and were combined with decision impact data for Oncotype DX, MammaPrint, Prosigna and EndoPredict (EPclin). Changes in chemotherapy use and budget impact were evaluated over 1 year for 20,000 women. Chemotherapy was associated with substantial annual costs of EUR 19,003 and EUR 84,412 per therapy from the healthcare payer and societal perspective, respectively. Compared with standard care, only Oncotype DX was associated with cost savings to healthcare payers and society (EUR 5.9 million and EUR 253 million, respectively). Scenario analysis showed that both women at high clinical but low genomic risk and low clinical but high genomic risk were important contributors to costs. Oncotype DX was the only gene expression test that was estimated to reduce costs versus standard care in Germany. The reimbursement of Oncotype DX testing in standard clinical practice in Germany should be considered. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health and budget impact of combined HIV prevention - first results of the BELHIVPREV model.

PubMed

Vermeersch, Sebastian; Callens, Steven; De Wit, Stéphane; Goffard, Jean-Christophe; Laga, Marie; Van Beckhoven, Dominique; Annemans, Lieven

2018-02-01

We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data. The analysis was performed from a healthcare payer perspective with a 15-year-time horizon. It considers subpopulation differences, HIV infections diagnosed in Belgium having occurred prior to migration, and the effects of an ageing HIV population. Without additional prevention measures, the annual number of new HIV diagnoses rises to over 1350 new diagnoses in 2030 as compared to baseline, resulting in a budget expenditure of €260.5 million. Implementation of outreach+TasP and outreach+TasP+PrEP results in a decrease in the number of new HIV diagnoses to 865 and 663 per year, respectively. Respective budget impacts decrease by €20.6 million and €33.7 million. Foregoing additional investments in prevention is not an option. An approach combining TasP, outreach and PrEP is most effective in reducing the number of new HIV diagnoses and the HIV treatment budget. Our model is the first pragmatic HIV model in Belgium estimating the consequences of a combined preventive approach on the HIV epidemiology and its economic burden assuming other prevention efforts such as condom use and harm reduction strategies remain the same.

Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

PubMed

Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

2014-06-01

The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

The Impact of Global Budgets on Pharmaceutical Spending and Utilization

PubMed Central

Fendrick, A. Mark; Song, Zirui; Landon, Bruce E.; Safran, Dana Gelb; Mechanic, Robert E.; Chernew, Michael E.

2014-01-01

In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC), in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications. PMID:25500751

School Budgeting and School Performance: The Impact of New York City's Performance Driven Budgeting Initiative.

ERIC Educational Resources Information Center

Stiefel, Leanna; Schwartz, Amy Ellen; Portas, Carole; Kim, Dae Yeop

2003-01-01

Analyzes the impact of Performance Driven Budgeting (PDB), a school-based budgeting initiative, on student test scores in the fourth and fifth grades and on spending patterns in selected New York City schools. Finds that PDB has a positive effect on some student test scores and leads to a change in the mix of spending, but not its level. (Contains…

Mask characterization for CDU budget breakdown in advanced EUV lithography

NASA Astrophysics Data System (ADS)

Nikolsky, Peter; Strolenberg, Chris; Nielsen, Rasmus; Nooitgedacht, Tjitte; Davydova, Natalia; Yang, Greg; Lee, Shawn; Park, Chang-Min; Kim, Insung; Yeo, Jeong-Ho

2012-11-01

As the ITRS Critical Dimension Uniformity (CDU) specification shrinks, semiconductor companies need to maintain a high yield of good wafers per day and a high performance (and hence market value) of finished products. This cannot be achieved without continuous analysis and improvement of on-product CDU as one of the main drivers for process control and optimization with better understanding of main contributors from the litho cluster: mask, process, metrology and scanner. In this paper we will demonstrate a study of mask CDU characterization and its impact on CDU Budget Breakdown (CDU BB) performed for an advanced EUV lithography with 1D and 2D feature cases. We will show that this CDU contributor is one of the main differentiators between well-known ArFi and new EUV CDU budgeting principles. We found that reticle contribution to intrafield CDU should be characterized in a specific way: mask absorber thickness fingerprints play a role comparable with reticle CDU in the total reticle part of the CDU budget. Wafer CD fingerprints, introduced by this contributor, may or may not compensate variations of mask CD's and hence influence on total mask impact on intrafield CDU at the wafer level. This will be shown on 1D and 2D feature examples in this paper. Also mask stack reflectivity variations should be taken into account: these fingerprints have visible impact on intrafield CDs at the wafer level and should be considered as another contributor to the reticle part of EUV CDU budget. We observed also MEEF-through-field fingerprints in the studied EUV cases. Variations of MEEF may also play a role for the total intrafield CDU and may be taken into account for EUV Lithography. We characterized MEEF-through-field for the reviewed features, the results to be discussed in our paper, but further analysis of this phenomenon is required. This comprehensive approach to characterization of the mask part of EUV CDU characterization delivers an accurate and integral CDU Budget Breakdown per product/process and Litho tool. The better understanding of the entire CDU budget for advanced EUVL nodes achieved by Samsung and ASML helps to extend the limits of Moore's Law and to deliver successful implementation of smaller, faster and smarter chips in semiconductor industry.

Budget Impact Analysis of PCSK9 Inhibitors for the Management of Adult Patients with Heterozygous Familial Hypercholesterolemia or Clinical Atherosclerotic Cardiovascular Disease.

PubMed

Mallya, Usha G; Boklage, Susan H; Koren, Andrew; Delea, Thomas E; Mullins, C Daniel

2018-01-01

The aim of this study was to assess the budget impact of introducing the proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) alirocumab and evolocumab to market for the treatment of adults with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular (CV) disease requiring additional lowering of low-density lipoprotein cholesterol (LDL-C). A 3-year model estimated the costs of lipid-modifying therapy (LMT) and CV events to a hypothetical US health plan of 1 million members, comparing two scenarios-with and without the availability of PCSK9i as add-on therapy to statins. Proportions of patients with uncontrolled LDL-C despite receiving statins, and at risk of CV events, were estimated from real-world data. Total undiscounted annual LMT costs (2017 prices, including PCSK9i costs of $14,563.50), dispensing and healthcare costs, including the costs of CV events, were estimated for all prevalent patients in the target population, based on baseline risk factors. Maximum PCSK9i utilization of 1-5% over 3 years according to risk group (following the same pattern as current ezetimibe use), and 5-10% as a secondary scenario, were assumed. Total healthcare budget impacts per target patient (and per member) per month for years 1, 2 and 3 were $3.62($0.10), $7.22($0.20) and $10.79($0.30), respectively, assuming 1-5% maximum PCSK9i utilization, and $15.81($0.44), $31.52($0.88) and $47.12($1.31), respectively, assuming 5-10% utilization. Results were sensitive to changes in model timeframe, years to maximum PCSK9i utilization and PCSK9i costs. The budget impact of PCSK9i as add-on therapy to statins for patients with hypercholesterolemia is relatively low compared with published estimates for other specialty biologics. Drug cost rebates and discounts are likely to further reduce budget impact.

The financial impact of increasing home-based high dose haemodialysis and peritoneal dialysis.

PubMed

Liu, Frank Xiaoqing; Treharne, Catrin; Culleton, Bruce; Crowe, Lydia; Arici, Murat

2014-10-02

Evidence suggests that high dose haemodialysis (HD) may be associated with better health outcomes and even cost savings (if conducted at home) versus conventional in-centre HD (ICHD). Home-based regimens such as peritoneal dialysis (PD) are also associated with significant cost reductions and are more convenient for patients. However, the financial impact of increasing the use of high dose HD at home with an increased tariff is uncertain. A budget impact analysis was performed to investigate the financial impact of increasing the proportion of patients receiving home-based dialysis modalities from the perspective of the England National Health Service (NHS) payer. A Markov model was constructed to investigate the 5 year budget impact of increasing the proportion of dialysis patients receiving home-based dialysis, including both high dose HD at home and PD, under the current reimbursement tariff and a hypothetically increased tariff for home HD (£575/week). Five scenarios were compared with the current England dialysis modality distribution (prevalent patients, 14.1% PD, 82.0% ICHD, 3.9% conventional home HD; incident patients, 22.9% PD, 77.1% ICHD) with all increases coming from the ICHD population. Under the current tariff of £456/week, increasing the proportion of dialysis patients receiving high dose HD at home resulted in a saving of £19.6 million. Conducting high dose HD at home under a hypothetical tariff of £575/week was associated with a budget increase (£19.9 million). The costs of high dose HD at home were totally offset by increasing the usage of PD to 20-25%, generating savings of £40.0 million - £94.5 million over 5 years under the increased tariff. Conversely, having all patients treated in-centre resulted in a £172.6 million increase in dialysis costs over 5 years. This analysis shows that performing high dose HD at home could allow the UK healthcare system to capture the clinical and humanistic benefits associated with this therapy while limiting the impact on the dialysis budget. Increasing the usage of PD to 20-25%, the levels observed in 2005-2008, will totally offset the additional costs and generate further savings.

Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia.

PubMed

Afiatin; Khoe, Levina Chandra; Kristin, Erna; Masytoh, Lusiana Siti; Herlinawaty, Eva; Werayingyong, Pitsaphun; Nadjib, Mardiati; Sastroasmoro, Sudigdo; Teerawattananon, Yot

2017-01-01

This study aims to assess the value for money and budget impact of offering hemodialysis (HD) as a first-line treatment, or the HD-first policy, and the peritoneal dialysis (PD) first policy compared to a supportive care option in patients with end-stage renal disease (ESRD) in Indonesia. A Markov model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years (LYs) and quality-adjusted life years (QALYs). Three policy options were compared, i.e., the PD-first policy, HD-first policy, and supportive care. The PD-first policy for ESRD patients resulted in 5.93 life years, equal to the HD-first policy, with a slightly higher QALY gained (4.40 vs 4.34). The total lifetime cost for a patient under the PD-first policy is around 700 million IDR, which is lower than the cost under the HD-first policy, i.e. 735 million IDR per patient. Compared to supportive care, the incremental cost-effectiveness ratio of the PD-first policy is 193 million IDR per QALY, while the HD-first policy resulted in 207 million IDR per QALY. Budget impact analysis indicated that the required budget for the PD-first policy is 43 trillion IDR for 53% coverage and 75 trillion IDR for 100% coverage in five years, which is less than the HD-first policy, i.e. 88 trillion IDR and 166 trillion IDR. The PD-first policy was found to be more cost-effective compared to the HD-first policy. Budget impact analysis provided evidence on the enormous financial burden for the country if the current practice, where HD dominates PD, continues for the next five years.

The Impact of Current Economic Crisis on Community Colleges

ERIC Educational Resources Information Center

Okpala, Comfort O.; Hopson, Linda; Okpala, Amon O.

2011-01-01

The focus of the study was to examine the impact of the recession on (1) community college funding, (2) community college student support services, and (3) on student enrollment. This study relied on data from document analysis and interview of community college personnel and students. The current crisis has resulted in a steep budget reduction to…

The impact of global budgets on pharmaceutical spending and utilization: early experience from the alternative quality contract.

PubMed

Afendulis, Christopher C; Fendrick, A Mark; Song, Zirui; Landon, Bruce E; Safran, Dana Gelb; Mechanic, Robert E; Chernew, Michael E

2014-01-01

In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC), in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications. © The Author(s) 2014.

Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

PubMed

Palli, Swetha R; Rizzo, John A; Heidrich, Natalie

2018-06-01

The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.

The budget impact and cost-effectiveness of defibrotide for treatment of veno-occlusive disease with multi-organ dysfunction in patients post-hematopoietic stem cell transplant.

PubMed

Veenstra, David L; Guzauskas, Gregory F; Villa, Kathleen F; Boudreau, Denise M

2017-05-01

A Phase-3 study of defibrotide compared with historical controls demonstrated a 23% improvement in 100-day survival post-hematopoietic stem cell transplantation (HSCT) among patients with veno-occlusive disease with multi-organ dysfunction (VOD with MOD). To estimate the budget impact and cost-effectiveness of introducing defibrotide to a transplant center. The authors developed a budget impact model from the perspective of a bone-marrow transplant center. It was estimated that 2.3% of adults and 4.2% of children would develop VOD with MOD following HSCT based on a retrospective hospital database analysis and the effect that treating patients with defibrotide would have on costs for adult and pediatric centers was estimated. A cost-utility analysis (CUA) was also developed to capture the long-term cost-effectiveness of defibrotide. Projected life expectancies in the two groups were estimated based on trial data, transplant registry data, studies of long-term survival among HSCT patients, and US population life-tables. There was an estimated 3% increase ($330,706) per year in total adult transplantation center costs associated with adopting defibrotide, and a <1% increase ($106,385) for pediatric transplant centers, assuming 100 transplants per year. In the CUA, the lifetime increase in cost per patient was $106,928, life expectancy increased by 3.74 years, and quality-adjusted life-years (QALYs) increased by 2.24. The incremental cost-effectiveness ratio (ICER) was $47,736 per QALY gained; 88% probability defibrotide was cost-effective at a $100,000/QALY threshold. The budget impact of defibrotide for a transplant center is relatively modest compared to the overall cost of transplantation. Defibrotide provides an important survival advantage for VOD with MOD patients, and the life years gained lead to defibrotide being highly cost-effective.

Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model.

PubMed

Comas, Mercè; Arrospide, Arantzazu; Mar, Javier; Sala, Maria; Vilaprinyó, Ester; Hernández, Cristina; Cots, Francesc; Martínez, Juan; Castells, Xavier

2014-01-01

To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.

Budget Impact Analysis of Switching to Digital Mammography in a Population-Based Breast Cancer Screening Program: A Discrete Event Simulation Model

PubMed Central

Comas, Mercè; Arrospide, Arantzazu; Mar, Javier; Sala, Maria; Vilaprinyó, Ester; Hernández, Cristina; Cots, Francesc; Martínez, Juan; Castells, Xavier

2014-01-01

Objective To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. Methods A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Results Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Conclusions Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs. PMID:24832200

Budget Impact Analysis of Against Colorectal Cancer In Our Neighborhoods (ACCION): A Successful Community-Based Colorectal Cancer Screening Program for a Medically Underserved Minority Population.

PubMed

Kim, Bumyang; Lairson, David R; Chung, Tong Han; Kim, Junghyun; Shokar, Navkiran K

2017-06-01

Given the uncertain cost of delivering community-based cancer screening programs, we developed a Markov simulation model to project the budget impact of implementing a comprehensive colorectal cancer (CRC) prevention program compared with the status quo. The study modeled the impacts on the costs of clinical services, materials, and staff expenditures for recruitment, education, fecal immunochemical testing (FIT), colonoscopy, follow-up, navigation, and initial treatment. We used data from the Against Colorectal Cancer In Our Neighborhoods comprehensive CRC prevention program implemented in El Paso, Texas, since 2012. We projected the 3-year financial consequences of the presence and absence of the CRC prevention program for a hypothetical population cohort of 10,000 Hispanic medically underserved individuals. The intervention cohort experienced a 23.4% higher test completion rate for CRC prevention, 8 additional CRC diagnoses, and 84 adenomas. The incremental 3-year cost was $1.74 million compared with the status quo. The program cost per person was $261 compared with $86 for the status quo. The costs were sensitive to the proportion of high-risk participants and the frequency of colonoscopy screening and diagnostic procedures. The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Proceedings of the 2010 AFMS Medical Research Symposium. Volume 2. Operational and Medical Track: Abstracts and Presentations.

DTIC Science & Technology

2011-03-15

2  Impact of Alternating Days of Intermittent Hypoxic Exposure (IHE) on Physical and Cognitive Performance...60  Management and Treatment of Pediatric Obesity in a Military Outpatient Setting ................................. 71  Budget Impact Analysis of...Bariatric Surgery for Morbid Obesity ........................................................... 78  Pilot Study of A Diabetes Prevention Program in A

The cost-effectiveness and budget impact of stepwise addition of bolus insulin in the treatment of type 2 diabetes: evaluation of the FullSTEP trial.

PubMed

Saunders, Rhodri; Lian, Jean; Karolicki, Boris; Valentine, William

2014-12-01

Abstract Background and aims: Intensification of basal insulin-only therapy in type 2 diabetes is often achieved through addition of bolus insulin 3-times daily. The FullSTEP trial demonstrated that stepwise addition (SWA) of bolus insulin aspart was non-inferior to full basal-bolus (FBB) therapy and reduced the rate of hypoglycemia. Here the cost-effectiveness and budget impact of SWA is evaluated. Cost-effectiveness and budget impact models were developed to assess the cost and quality-of-life (QoL) implications of intensification using SWA compared with FBB in the US setting. At assessment, SWA patients added one bolus dose to their current regimen if the HbA1c target was not met. SWA patients reaching three bolus doses used FBB event rates. Outcomes were evaluated at trial end and projected annually up to 5 years. Models captured hypoglycemic events, the proportion meeting HbA1c target, and self-measured blood glucose. Event rates and QoL utilities were taken from trial data and published literature. Costs were evaluated from a healthcare-payer perspective, reported in 2013 USD, and discounted (like clinical outcomes) at 3.5% annually. This analysis applies to patients with HbA1c 7.0-9.0% and body mass index <40 kg/m(2). SWA was associated with improved QoL and reduced costs compared with FBB. Improvement in QoL and cost reduction were driven by lower rates of hypoglycemia. Sensitivity analyses showed that outcomes were most influenced by the cost of bolus insulin and QoL impact of symptomatic hypoglycemia. Budget impact analysis estimated that, by moving from FBB to SWA, a health plan with 77,000 patients with type 2 diabetes, of whom 7.8% annually intensified to basal-bolus therapy, would save USD 1304 per intensifying patient over the trial period. SWA of bolus insulin should be considered a beneficial and cost-saving alternative to FBB therapy for the intensification of treatment in type 2 diabetes.

Budget impact of everolimus for the treatment of progressive, well-differentiated, non-functional neuroendocrine tumors of gastrointestinal or lung origin that are advanced or metastatic.

PubMed

Rose, Darya B; Nellesen, Dave; Neary, Maureen P; Cai, Beilei

2017-04-01

Advanced neuroendocrine tumors (NETs) are a rare malignancy with considerable need for effective therapies. Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) in 2016 for treatment of adults with progressive, well-differentiated, non-functional NETs of gastrointestinal (GI) or lung origin that are unresectable, locally advanced, or metastatic. To assess the 3-year budget impact for a typical US health plan following availability of everolimus for treatment of GI and lung NETs. Methods An economic model was developed that considered two perspectives: an entire health plan and a pharmacy budget. The total budget impact included costs of drug therapies, administration, hospitalizations, physician visits, monitoring, and adverse events (AEs). The pharmacy model only considered drug costs. In a US health plan with 1 million members, the model estimated 66 patients with well-differentiated, non-functional, and advanced or metastatic GI NETs and 20 with lung NETs undergoing treatment each year. Total budget impact in the first through third year after FDA approval ranged from $0.0568-$0.1443 per member per month (PMPM) for GI NETs and from $0.0181-$0.0355 PMPM for lung NETs. The total budget impact was lower than the pharmacy budget impact because it included cost offsets from administration and AE management for everolimus compared with alternative therapies (e.g. chemotherapies). Because GI and lung NETs are rare diseases with limited published data, several assumptions were made that may influence interpretation of results. The budget impact for everolimus was minimal in this rare disease area with a high unmet need, largely due to low disease prevalence. These results should be considered in the context of significant clinical benefits potentially provided by everolimus, including significantly longer progression-free survival (PFS) for advanced GI and lung NET patients.

42 CFR 457.140 - Budget.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Budget. 457.140 Section 457.140 Public Health... Child Health Insurance Programs and Outreach Strategies § 457.140 Budget. The State plan, or plan amendment that has a significant impact on the approved budget, must include a budget that describes the...

The drug budget silo mentality: the Dutch case.

PubMed

Koopmanschap, Marc A; Rutten, Frans F H

2003-01-01

This article provides a broad outline of developments in the Dutch health-care policy related to the costs, budgeting, and reimbursement of pharmaceuticals. In-hospital drugs costs are part of hospital budgets, whereas for the main part of costs, nonhospital drugs, no strict budget exists. The government sets a goal for the annual cost increase of nonhospital drugs, but has only limited means to enforce that goal. Two measures were implemented to reduce drug prices: a reference price system and a price law. Both measures had a modest and temporary impact on drug prices during the 1990s. In limiting the utilization of drugs, the package of reimbursed drugs has been restricted. This led to a shift from public to private costs and possible substitution of cheaper not reimbursed drugs by more expensive reimbursed drugs. An electronic prescription system was implemented to encourage rational prescription. Although 70% of the Dutch general practitioners reported to use the system, the estimated savings on drug costs appear to be modest and far less than expected. The use of economic evaluation for reimbursement decisions will increase. From 2005 onward a pharmacoeconomic study and budget impact analysis is formally required for new nonclustered drugs seeking a premium price. Furthermore, in the future the health-care insurers will get a more prominent role in limiting the costs of drugs and enhancing the efficient use of drugs within their overall budgets. Health-care insurers may choose which drugs to purchase and reimburse and they can negotiate drug prices with the pharmaceutical industry, wholesalers, and local pharmacists.

Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments.

PubMed

Lin, Feng; Lasry, Arielle; Sansom, Stephanie L; Wolitski, Richard J

2013-01-01

In the wake of a national economic downturn, the state of California, in 2009-2010, implemented budget cuts that eliminated state funding of HIV prevention and testing. To mitigate the effect of these cuts remaining federal funds were redirected. This analysis estimates the impact of these budget cuts and reallocation of resources on HIV transmission and associated HIV treatment costs. We estimated the effect of the budget cuts and reallocation for California county health departments (excluding Los Angeles and San Francisco) on the number of individuals living with or at-risk for HIV who received HIV prevention services. We used a Bernoulli model to estimate the number of new infections that would occur each year as a result of the changes, and assigned lifetime treatment costs to those new infections. We explored the effect of redirecting federal funds to more cost-effective programs, as well as the potential effect of allocating funds proportionately by transmission category. We estimated that cutting HIV prevention resulted in 55 new infections that were associated with $20 million in lifetime treatment costs. The redirection of federal funds to more cost-effective programs averted 15 HIV infections. If HIV prevention funding were allocated proportionately to transmission categories, we estimated that HIV infections could be reduced below the number that occurred annually before the state budget cuts. Reducing funding for HIV prevention may result in short-term savings at the expense of additional HIV infections and increased HIV treatment costs. Existing HIV prevention funds would likely have a greater impact on the epidemic if they were allocated to the more cost-effective programs and the populations most likely to acquire and transmit the infection.

[Budget impact of the incorporation of GeneXpert MTB/RIF for diagnosis of pulmonary tuberculosis from the perspective of the Brazilian Unified National Health System, Brazil, 2013-2017].

PubMed

Pinto, Márcia Ferreira Teixeira; Steffen, Ricardo; Entringer, Aline; Costa, Ana Carolina Carioca da; Trajman, Anete

2017-10-09

The study aimed to estimate the budget impact of GeneXpert MTB/RIF for diagnosis of tuberculosis from the perspective of the Brazilian National Program for Tuberculosis Control, drawing on a static model using the epidemiological method, from 2013 to 2017. GeneXpert MTB/RIF was compared with two diagnostic sputum smear tests. The study used epidemiological, population, and cost data, exchange rates, and databases from the Brazilian Unified National Health System. Sensitivity analysis of scenarios was performed. Incorporation of GeneXpert MTB/RIF would cost BRL 147 million (roughly USD 45 million) in five years and would have an impact of 23 to 26% in the first two years and some 11% between 2015 and 2017. The results can support Brazilian and other Latin American health administrators in planning and managing the decision on incorporating the technology.

Mask characterization for critical dimension uniformity budget breakdown in advanced extreme ultraviolet lithography

NASA Astrophysics Data System (ADS)

Nikolsky, Peter; Strolenberg, Chris; Nielsen, Rasmus; Nooitgedacht, Tjitte; Davydova, Natalia; Yang, Greg; Lee, Shawn; Park, Chang-Min; Kim, Insung; Yeo, Jeong-Ho

2013-04-01

As the International Technology Roadmap for Semiconductors critical dimension uniformity (CDU) specification shrinks, semiconductor companies need to maintain a high yield of good wafers per day and high performance (and hence market value) of finished products. This cannot be achieved without continuous analysis and improvement of on-product CDU as one of the main drivers for process control and optimization with better understanding of main contributors from the litho cluster: mask, process, metrology and scanner. We will demonstrate a study of mask CDU characterization and its impact on CDU Budget Breakdown (CDU BB) performed for advanced extreme ultraviolet (EUV) lithography with 1D (dense lines) and 2D (dense contacts) feature cases. We will show that this CDU contributor is one of the main differentiators between well-known ArFi and new EUV CDU budgeting principles. We found that reticle contribution to intrafield CDU should be characterized in a specific way: mask absorber thickness fingerprints play a role comparable with reticle CDU in the total reticle part of the CDU budget. Wafer CD fingerprints, introduced by this contributor, may or may not compensate variations of mask CDs and hence influence on total mask impact on intrafield CDU at the wafer level. This will be shown on 1D and 2D feature examples. Mask stack reflectivity variations should also be taken into account: these fingerprints have visible impact on intrafield CDs at the wafer level and should be considered as another contributor to the reticle part of EUV CDU budget. We also observed mask error enhancement factor (MEEF) through field fingerprints in the studied EUV cases. Variations of MEEF may play a role towards the total intrafield CDU and may need to be taken into account for EUV lithography. We characterized MEEF-through-field for the reviewed features, with results herein, but further analysis of this phenomenon is required. This comprehensive approach to quantifying the mask part of the overall EUV CDU contribution helps deliver an accurate and integral CDU BB per product/process and litho tool. The better understanding of the entire CDU budget for advanced EUVL nodes achieved by Samsung and ASML helps extend the limits of Moore's Law and to deliver successful implementation of smaller, faster and smarter chips in semiconductor industry.

The effects of budget, delegation, and other variables on the future of school nursing.

PubMed

Tetuan, Theresa M; Akagi, Cynthia G

2004-12-01

The purpose of this exploratory research study was to survey Kansas school nurses to determine the impact of budget, delegation, and other variables on the future of school nursing. Issues of education and certification status, educational budget, delegation, school nurse-to-student ratio, number of school buildings assigned, Metropolitan Statistical Area, and years of school nursing experience were also investigated. The Budget Impact School Nurse Questionnaire online survey was used to gather data. Findings revealed that school nurses were well prepared academically, but that many school nurses lacked certification. The use of UAPs and the future of school nursing were significantly affected by budget constraints, delegation, number of buildings assigned, legislative contact, and Metropolitan Statistical Area (urban location). Education in delegation and years of experience as a school nurse significantly affected opportunities for health education. The findings depicted budget, school nurse staffing, delegation, and geographic areas as the main variables that have an impact on school nursing.

Analysis & commentary. Health care reform is likely to widen federal budget deficits, not reduce them.

PubMed

Holtz-Eakin, Douglas; Ramlet, Michael J

2010-06-01

The federal government faces a daunting fiscal outlook, which makes the budgetary impact of the Patient Protection and Affordable Care Act even more important. The official Congressional Budget Office (CBO) analysis indicates modest deficit reduction over the next ten years and beyond. We examine the underpinnings of the CBO's projection and conclude that it is built on a shaky foundation of omitted costs, premiums shifted from other entitlements, and politically dubious spending cuts and revenue increases. A more comprehensive and realistic projection suggests that the new reform law will raise the deficit by more than $500 billion during the first ten years and by nearly $1.5 trillion in the following decade.

Can we afford to offer pre-exposure prophylaxis to MSM in Catalonia? Cost-effectiveness analysis and budget impact assessment.

PubMed

Reyes-Urueña, J; Campbell, C; Diez, E; Ortún, V; Casabona, J

2018-06-01

Pre-exposure prophylaxis (PrEP) effectiveness has been well established. This study aims to assess the cost-effectiveness of providing PrEP, estimate the number of eligible MSM, and its budget impact in Catalonia. Cost-effectiveness analysis compared costs of on daily basis and "on demand" PrEP to prevent one infection with lifetime costs of one HIV infection. We estimated the total cost of providing PrEP by estimating number of eligible MSM, and included in the budget impact assessment antiretroviral and laboratory costs. Costs were lower for the on-demand PrEP group by €64015.1 and the incremental benefit was nearly 15 life-years and 17 quality-adjusted life-years gained. The incremental cost-effectiveness ratio (ICER) was cost-effective at €6281.62 when undiscounted PrEP was given daily. On-demand PrEP can be considered cost-saving in 20 years if the price is reduced by 90%. The number of eligible MSM in Catalonia ranges from 5,989 to 10,972. At current antiretroviral costs, the annual cost would range between €25.3-46.7 million/year (on demand PrEP), and €42.9-78.7 million/year (daily basis PrEP). PrEP is most cost-effective if targeted towards groups with high incidence rates of over 3%/year. Beneficial ICER depends on reducing the current price of Truvada® and ensuring that effectiveness is maintained at high levels.

Budget Impact Analysis of Oral Fisiogen Ferro Forte® versus Intravenous Iron for the Management of Iron Deficiency in Chronic Kidney Disease in Spain.

PubMed

Darbà, Josep; Ascanio, Meritxell

2018-06-22

Iron deficiency is a frequent complication of chronic kidney disease (CKD) that is associated with a decrease in the quality of life of patients and an increase in the risk of other clinical complications. Iron therapy represents one of the fundamentals of patients with CKD. Sucrosomial ® oral iron allows Fisiogen Ferro Forte ® to be used in all patients who are intolerant to treatment by the oral route of administration, or who present with malabsorption of conventional oral iron preparations. The main objective of this study was to assess the economic impact of the oral iron Fisiogen Ferro Forte ® for the management of iron deficiency in CKD patients in Spain. A 4-year budget impact model was developed for the period 2017-2020 for CKD patients with iron deficiency who were candidates for intravenous iron due to a lack of response to oral iron, from the perspective of the Spanish healthcare system. Three subgroups of CKD patients were included in the analysis: predialysis, peritoneal dialysis, and post-transplant. The intravenous iron formulations Ferinject ® , Venofer ® , and Feriv ® were considered appropriate comparators to be used in the model. National data on the prevalence of CKD for the three subgroups of patients were obtained from the literature, and input data on drug utilization and outpatient hospitalizations associated with iron administration were obtained by consulting nephrologists. Nephrology experts were also asked about resources used during medical visits and monitoring tests. Based on the unit costs for each iron therapy and the resources used, the total treatment cost per patient associated with each product was obtained to estimate the global budget impact of increasing the use of Fisiogen Ferro Forte ® . The average annual budget savings due to an increase in Fisiogen Ferro Forte ® and a decrease in intravenous iron have been estimated at €398,685, €180,937, and €195,842 over 4 years for the predialysis, peritoneal dialysis, and post-transplant groups, respectively. The increase in the use of Fisiogen Ferro Forte ® leads to overall budget savings of €775,464 for the Spanish National Health Service over 4 years.

Combining the benefits of decision science and financial analysis in public health management: a county-specific budgeting and planning model.

PubMed

Fos, Peter J; Miller, Danny L; Amy, Brian W; Zuniga, Miguel A

2004-01-01

State public health agencies are charged with providing and overseeing the management of basic public health services on a population-wide basis. These activities have a re-emphasized focus as a result of the events of September 11, 2001, the subsequent anthrax events, and the continuing importance placed on bioterrorism preparedness, West Nile virus, and emerging infectious diseases (eg, monkeypox, SARS). This has added to the tension that exists in budgeting and planning, given the diverse constituencies that are served in each state. State health agencies must be prepared to allocate finite resources in a more formal manner to be able to provide basic public health services on a routine basis, as well as during outbreaks. This article describes the use of an analytical approach to assist financial analysis that is used for budgeting and planning in a state health agency. The combined benefits of decision science and financial analysis are needed to adequately and appropriately plan and budget to meet the diverse needs of the populations within a state. Health and financial indicators are incorporated into a decision model, based on multicriteria decision theory, that has been employed to acquire information about counties and public health programs areas within a county, that reflect the impact of planning and budgeting efforts. This information can be used to allocate resources, to distribute funds for health care services, and to guide public health finance policy formulation and implementation.

Status Report on the Impact on New York City of President Reagan's Proposed Budget Cuts.

ERIC Educational Resources Information Center

Community Service Society of New York, NY.

This report describes the effects that President Reaqan's proposed budget cuts will have on New York City. The report lists each affected program, the proposed cuts, Senate action, the House Budget Committee recommendation, and the impact on New York City. Areas covered by the program cuts reviewed include: (1) employment; (2) income security; (3)…

Using economic evaluations to make formulary coverage decisions. So much for guidelines.

PubMed

Anis, A H; Gagnon, Y

2000-07-01

It is mandatory for drug manufacturers requesting formulary inclusion under the British Columbia (BC) provincial drug plan to submit a pharmacoeconomic analysis according to published guidelines. These submissions are reviewed by the Pharmacoeconomic Initiative (PI) of BC. To assess the compliance of submitted studies with specific criteria outlined in the guidelines, to assess the methodological quality of individual submissions, and to demonstrate the importance of submitting guidelines-compliant pharmacoeconomic analyses. All submissions between January 1996 and April 1999 assessed by the PI of BC were included. Submissions were reviewed according to a checklist to establish compliance with respect to choice of comparator drug, study perspective, sensitivity analysis, analytical horizon and discounting. Submissions were examined for association between analytical technique and author, and between source of submission and compliance. Association between compliance and recommendation for approval was also examined. 95 applications were reviewed. Seven submitted no analyses. There were 25 cost-comparison/consequence, 14 cost-effectiveness, 11 cost-minimisation, 9 cost-utility/benefit and 29 budget-impact analyses. 65 of these 88 submissions failed to comply with guidelines. Of these, 45% used an inappropriate comparator drug, 61% lacked a sensitivity analysis, 73% used a third-party payer and excluded a societal perspective, 66% did not provide a long term evaluation and 25% did not specify any time horizon. 80% of noncompliant studies were cost-comparison/consequence or budget-impact analyses (p < 0.001, Fisher's Exact). Of 25 cost-comparison/consequence and 29 budget-impact analyses, 19 (76%) and 24 (83%), respectively, were industry-conducted, whereas cost-effectiveness (11 of 14) and cost-utility/benefit (6 of 9) analyses were mostly subcontracted to private consultants or academics (p < 0.001, Fisher's Exact). 74% of all submissions (compliant and noncompliant) were not recommended by the PI for listing as a provincial drug plan benefit, 16% received approval for restricted benefit and 9% were recommended as full benefit. 80% of the noncompliant submissions were not recommended (p = 0.06, Fisher's Exact test). Moreover, a strong association between type of analysis and type of recommendation was found (p = 0.03, Fisher's Exact test). Cost-comparison/consequence and budget-impact analyses were less likely to be recommended. IMPLICATIONS OF FINDINGS: Our findings show poor compliance with guidelines, especially among industry-conducted studies. Possible explanations are lack of expertise in pharmacoeconomics and/or scepticism regarding the importance of guidelines and submission quality in decision making. As corroborated by the strong associations between type of recommendation and compliance, and between type of recommendation and type of analysis, these 2 characteristics have a significant impact on decision making.

Footprint of recycled water subsidies downwind of Lake Michigan

USDA-ARS?s Scientific Manuscript database

Continental evaporation is a significant and dynamic flux within the atmospheric water budget, but few methods provide robust observational constraints on the large-scale hydroclimatological and hydroecological impacts of this ‘recycled-water’ flux. We demonstrate a geospatial analysis that provides...

Budget impact of pasireotide LAR for the treatment of acromegaly, a rare endocrine disorder.

PubMed

Zhang, J J; Nellesen, D; Ludlam, W H; Neary, M P

2016-01-01

Acromegaly is a rare disorder characterized by the over-production of growth hormone (GH). Patients often experience a range of chronic comorbidities including hypertension, cardiac dysfunction, diabetes, osteoarthropathy, and obstructive sleep apnea. Untreated or inadequately controlled patients incur substantial healthcare costs, while normalization of GH levels may reduce morbidity and mortality rates to be comparable to the general population. To assess the 3-year budget impact of pasireotide LAR on a US managed care health plan following pasireotide LAR availability. Two separate economic models were developed: one from the perspective of an entire health plan and another from the perspective of a pharmacy budget. The total budget impact model includes costs of drug therapies and other costs for treatment, monitoring, management of adverse events, and comorbidities. The pharmacy cost calculator only considers drug costs. The total estimated budget impact associated with the introduction of pasireotide LAR is 0.31 cents ($0.0031) per member per month (PMPM) in the first year, 0.78 cents ($0.0078) in the second year, and 1.42 cents ($0.0142) in the third year following FDA approval. Costs were similar or lower from a pharmacy budget impact perspective. For each patient achieving disease control, cost savings from reduced comorbidities amounted to $10,240 per year. Published data on comorbidities for acromegaly are limited. In the absence of data on acromegaly-related costs for some comorbidities, comorbidity costs for the general population were used (may be under-estimates). The budget impact of pasireotide LAR is expected to be modest, with an expected increase of 1.42 cents PMPM on the total health plan budget in the third year after FDA approval. The efficacy of pasireotide LAR in acromegaly, as demonstrated in head-to-head trials compared with currently available treatment options, is expected to be associated with a reduction of the prevalence of comorbidities.

A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand.

PubMed

Leelahavarong, Pattara; Chaikledkaew, Usa; Hongeng, Suradej; Kasemsup, Vijj; Lubell, Yoel; Teerawattananon, Yot

2010-07-16

Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis. A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained. Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year. At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.

Cost-effectiveness and budget impact analysis of a population-based screening program for colorectal cancer.

PubMed

Pil, L; Fobelets, M; Putman, K; Trybou, J; Annemans, L

2016-07-01

Colorectal cancer (CRC) is one of the leading causes of cancer mortality in Belgium. In Flanders (Belgium), a population-based screening program with a biennial immunochemical faecal occult blood test (iFOBT) in women and men aged 56-74 has been organised since 2013. This study assessed the cost-effectiveness and budget impact of the colorectal population-based screening program in Flanders (Belgium). A health economic model was conducted, consisting of a decision tree simulating the screening process and a Markov model, with a time horizon of 20years, simulating natural progression. Predicted mortality and incidence, total costs, and quality-adjusted life-years (QALYs) with and without the screening program were calculated in order to determine the incremental cost-effectiveness ratio of CRC screening. Deterministic and probabilistic sensitivity analyses were conducted, taking into account uncertainty of the model parameters. Mortality and incidence were predicted to decrease over 20years. The colorectal screening program in Flanders is found to be cost-effective with an ICER of 1681/QALY (95% CI -1317 to 6601) in males and €4,484/QALY (95% CI -3254 to 18,163). The probability of being cost-effective given a threshold of €35,000/QALY was 100% and 97.3%, respectively. The budget impact analysis showed the extra cost for the health care payer to be limited. This health economic analysis has shown that despite the possible adverse effects of screening and the extra costs for the health care payer and the patient, the population-based screening program for CRC in Flanders is cost-effective and should therefore be maintained. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand

PubMed Central

2010-01-01

Background Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis. Methods A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained. Results Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year. Conclusions At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand. PMID:20633303

[Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation].

PubMed

Ramón-Jerónimo, Juan Manuel; Flórez-López, Raquel; Domínguez-Lario, Natalia

2018-03-01

To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation. Qualitative study (case study) based on grounded theory performed between January and June 2014. Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain. UGCAP managers and Health Area (CEO) managers. Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes. Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation. This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers' autonomy and improving staff commitment through training and professional development programs. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

A cost-effectiveness and budget impact analysis of first-line fidaxomicin for patients with Clostridium difficile infection (CDI) in Germany.

PubMed

Watt, Maureen; McCrea, Charles; Johal, Sukhvinder; Posnett, John; Nazir, Jameel

2016-10-01

Clostridium difficile infection (CDI) represents a significant economic healthcare burden, especially the cost of recurrent disease. Fidaxomicin produced significantly lower recurrence rates and higher sustained cure rates in clinical trials. We evaluated the cost-effectiveness and budget impact of fidaxomicin compared with vancomycin in Germany in the first-line treatment of patient subgroups with CDI at increased risk of recurrence. A semi-Markov model was used to compare the cost-effectiveness and budget impact of fidaxomicin vs. vancomycin from a payer perspective in Germany. The model cycle length was 10 days. The time horizon was 1 year. Model inputs were probability of clinical cure, 30-day probability of recurrence, and 30-day attributable mortality based on evidence from two randomized controlled trials comparing fidaxomicin and vancomycin in patients with CDI. Cost-effectiveness outcomes were cost per quality-adjusted life year gained, cost per bed-day saved, and cost per recurrence avoided. Despite higher drug acquisition costs, fidaxomicin was dominant in the cancer subgroup (less costly and more effective) and cost-effective in the other subgroups, with incremental cost-effectiveness ratios vs. vancomycin ranging from €26,900 to €44,500. Hospitalization costs of the first-line treatment of CDI with fidaxomicin vs. vancomycin were lower in every patient subgroup, resulting in budget impacts ranging from -€1325 (in patients ≥65 years) to -€2438 (in cancer patients). Reductions in the cost of treating recurrence with fidaxomicin ranged from -€574.32 per patient in those receiving concomitant antibiotics to -€1500.68 per patient in renally impaired patients. In patient subgroups with CDI at increased recurrence risk, fidaxomicin was cost-effective vs. vancomycin, and less costly and more effective in patients with cancer.

A Primer on the Budget Resolution's Impact on Education Funding

ERIC Educational Resources Information Center

Delisle, Jason

2008-01-01

The budget resolution put forward by Congress each year--which sets out the congressional budget plan for the next five years--and the ensuing budget process itself are enormously significant for education funding. However, the arcane procedures under which Congress produces and acts upon the budget resolution are often confusing to the media and…

The National Potential of Home Equity Conversion.

ERIC Educational Resources Information Center

Jacobs, Bruce

1986-01-01

Examined the potential effects of converting home equity into spendable income using "reverse mortgages." Analysis revealed that reverse mortgage loans could have a substantial impact on the budgets of many elderly homeowners, with impressive percentage increases in income and decreases in poverty rates. (Author/ABB)

Estudio de impacto presupuestal de Daclatasvir asociado a Asunaprevir desde la perspectiva del sistema de salud público chileno.

PubMed

Vargas, C; Espinoza, M A; Giglio, A; Soza, A

2017-12-01

To assess the impact on the 2015 national health budget of incorporating Daclatasvir/Asunaprevir (DCV / ASV) for the treatment of Hepatitis C genotype 1b (HC1b) in Chile. A Chilean HC1b patients cohort was modelled using local prevalence and incidence data. Two scenarios were built and compared, one were all patients receive Peginterferon/Ribavirin (PR) and another were all patients are treated with DCV/ASV. The analysis was conducted from the perspective of public health system of Chile assuming 100% reimbursement and a time horizon of 5 years. Costs associated with drug treatment, adverse events, other relevant resources and costs associated with disease complications were used. At a total DCV/ASV treatment price of USD $55,039, an additional of USD $65,6MM are required during the first year (prevalent cases) equivalent to 0.71% of the 2015 national health budget. From year 2 (incident cases), an additional of USD $12,3MM are needed (0.13% of the 2015 health budget). A price reduction of 33% (USD $36,693), requires an additional of USD $38,2MM the first year and USD $7,16MM from the second year (0.11% and 0.6% of the health budget). If the treatment price is reduced further (USD $18,347), an additional USD $10,9MM are required for the first year and USD $2,03MM from the second year (0.3% and 0.057% of the 2015 heath budget). The impact on the health budget ranges between 0.3% and 0.71% the first year and decreases to less than 0.15% from the second year considering the price assessed price range. Copyright © 2017. Published by Elsevier Inc.

Budget analysis of Escherichia coli at a southern Lake Michigan Beach

USGS Publications Warehouse

Thupaki, P.; Phanikumar, M.S.; Beletsky, D.; Schwab, D.J.; Nevers, M.B.; Whitman, R.L.

2010-01-01

Escherichia coli (EC) concentrations at two beaches impacted by river plume dynamics in southern Lake Michigan were analyzed using three-dimensional hydrodynamic and transport models. The relative importance of various physical and biological processes influencing the fate and transport of EC were examined via budget analysis and a first-order sensitivity analysis of model parameters. The along-shore advective fluxofEC(CFU/m2·s)was found to be higher compared to its crossshore counterpart; however, the sum of diffusive and advective components was of a comparable magnitude in both directions showing the importance of cross-shore exchange in EC transport. Examination of individual terms in the EC mass balance equation showed that vertical turbulent mixing in the water column dominated the overall EC transport for the summer conditions simulated. Dilution due to advection and diffusion accounted for a large portion of the total EC budget in the nearshore, and the net EC loss rate within the water column (CFU/m3·s) was an order of magnitude smaller compared to the horizontal and vertical transport rates. This result has important implications for modeling EC at recreational beaches; however, the assessment of the magnitude of EC loss rate is complicated due to the strong coupling between vertical exchange and depth-dependent EC loss processes such as sunlight inactivation and settling. Sensitivity analysis indicated that solar inactivation has the greatest impact on EC loss rates. Although these results are site-specific, they clearly bring out the relative importance of various processes involved.

PubMed Central

DAMONTI, A.; MORELLI, P.; MUSSI, M.; PATREGNANI, C.; GARAGIOLA, E.; FOGLIA, E.; PAGANI, R.; CARMINATI, R.; PORAZZI, E.

2015-01-01

Summary Introduction. The objective of this paper is the comparison between two different technologies used for the removal of a uterine myoma, a frequent benign tumor: the standard technology currently used, laparoscopy, and an innovative one, colpoceliotomy. It was considered relevant to evaluate the real and the potential effects of the two technologies implementation and, in addition, the consequences that the introduction or exclusion of the innovative technology would have for both the National Health System (NHS) and the entire community. Methods. The comparison between these two different technologies, the standard and the innovative one, was conducted using a Health Technology Assessment (HTA). In particular, in order to analyse their differences, a multi-dimensional approach was considered: effectiveness, costs and budget impact analysis data were collected, applying different instruments, such as the Activity Based Costing methodology (ABC), the Cost-Effectiveness Analysis (CEA) and the Budget Impact Analysis (BIA). Organisational, equity and social impact were also evaluated. Results. The results showed that the introduction of colpoceliotomy would provide significant economic savings to the Regional and National Health Service; in particular, a saving of € 453.27 for each surgical procedure. Discussion. The introduction of the innovative technology, colpoceliotomy, could be considered a valuable tool; one offering many advantages related to less invasiveness and a shorter surgical procedure than the standard technology currently used (laparoscopy). PMID:26900330

Multi-Year Revenue and Expenditure Forecasting for Small Municipal Governments.

DTIC Science & Technology

1981-03-01

Management Audit Econometric Revenue Forecast Gap and Impact Analysis Deterministic Expenditure Forecast Municipal Forecasting Municipal Budget Formlto...together with a multi-year revenue and expenditure forecasting model for the City of Monterey, California. The Monterey model includes an econometric ...65 5 D. FORECAST BASED ON THE ECONOMETRIC MODEL ------- 67 E. FORECAST BASED ON EXPERT JUDGMENT AND TREND ANALYSIS

Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium–olodaterol for patients with COPD in the Netherlands

PubMed Central

van Boven, Job FM; Kocks, Janwillem WH; Postma, Maarten J

2016-01-01

Purpose The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost–utility and budget impact of tiotropium–olodaterol FDC in patients with moderate to very severe COPD in the Netherlands. Patients and methods A cost–utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second) were obtained from the tiotropium–olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium–olodaterol FDC was compared with tiotropium. Cost–utility analysis was performed from the Dutch health care payer’s perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence. Results As a result of cost increases, combined with quality-adjusted life-year (QALY) gains, results showed that tiotropium–olodaterol FDC had an incremental cost-effectiveness ratio of €7,004/QALY. Without discounting, the incremental cost-effectiveness ratio was €5,981/QALY. Results were robust in univariate and probabilistic sensitivity analyses. Budget impact was estimated at €4.3 million over 5 years assuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-year incremental cost increases of €1.7, €2.6, and €3.4 million, respectively. Conclusion Tiotropium–olodaterol FDC can be considered a cost-effective treatment under current Dutch cost-effectiveness thresholds. PMID:27703341

Cost-effectiveness and budget impact of the fixed-dose dual bronchodilator combination tiotropium-olodaterol for patients with COPD in the Netherlands.

PubMed

van Boven, Job Fm; Kocks, Janwillem Wh; Postma, Maarten J

2016-01-01

The fixed-dose dual bronchodilator combination (FDC) of tiotropium and olodaterol showed increased effectiveness regarding lung function and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with the use of its mono-components. Yet, while effectiveness and safety have been shown, the health economic implication of this treatment is still unknown. The aim of this study was to assess the cost-utility and budget impact of tiotropium-olodaterol FDC in patients with moderate to very severe COPD in the Netherlands. A cost-utility study was performed, using an individual-level Markov model. To populate the model, individual patient-level data (age, height, sex, COPD duration, baseline forced expiratory volume in 1 second) were obtained from the tiotropium-olodaterol TOnado trial. In the model, forced expiratory volume in 1 second and patient-level data were extrapolated to utility and survival, and treatment with tiotropium-olodaterol FDC was compared with tiotropium. Cost-utility analysis was performed from the Dutch health care payer's perspective using a 15-year time horizon in the base-case analysis. The standard Dutch discount rates were applied (costs: 4.0%; effects: 1.5%). Both univariate and probabilistic sensitivity analyses were performed. Budget impact was annually assessed over a 5-year time horizon, taking into account different levels of medication adherence. As a result of cost increases, combined with quality-adjusted life-year (QALY) gains, results showed that tiotropium-olodaterol FDC had an incremental cost-effectiveness ratio of €7,004/QALY. Without discounting, the incremental cost-effectiveness ratio was €5,981/QALY. Results were robust in univariate and probabilistic sensitivity analyses. Budget impact was estimated at €4.3 million over 5 years assuming 100% medication adherence. Scenarios with 40%, 60%, and 80% adherence resulted in lower 5-year incremental cost increases of €1.7, €2.6, and €3.4 million, respectively. Tiotropium-olodaterol FDC can be considered a cost-effective treatment under current Dutch cost-effectiveness thresholds.

Cage Regional Energy Budgets from the GLAS 4TH Order Model

NASA Technical Reports Server (NTRS)

Herman, G. F.; Alexder, M. A.; Shubert, S. D.

1984-01-01

The status and future plans of a study to (1) assess the accuracy of regional energy balance calculations obtained from the 4th-order model, (2) determine the impact of satellite data on the calculations, and (3) determine their utility for ocean energy transport studies are discussed. An equation is presented which models the vertically-integrated, time and areally-averaged total energy content of a region of the atmosphere extending from the surface to the top of the atmosphere. All of the terms of the equation were evaluated using early versions of the GLAS FGGE IIIb analysis, and analysis with satellite data deleted. Results show that the budget is dominated by the surface fluxes, net radiation, and horizontal atmospoheric divergence.

Littoral Sediment Budget for the Mississippi Sound Barrier Islands

DTIC Science & Technology

2012-07-01

Sound are driven by longshore transport processes associated with storm and normal wave and current conditions. Although beach erosion and washover...from storm impacts (Figure 1.1). Figure 1.1. High-altitude imagery of the northern Gulf of Mexico between New Orleans, LA and Pensacola, FL...increasing storm damage. A comprehensive evaluation of storm impacts requires analysis of historical shoreline and bathymetry data sets to document the

The impact of the Balanced Budget Act on the utilization and financial condition of children's services in California hospitals.

PubMed

McCue, Michael J

2002-01-01

The objective of this study was to evaluate the utilization and financial performance of children's services after the Balanced Budget Act of 1997. The author analyzed these performance factors by hospital ownership, HMO penetration, and disproportionate share hospitals. Using data from California hospitals and conducting an analysis from 1997 to 1999, the author found that public hospitals were able to increase their profits from pediatric and neonatal intensive care services. The study also revealed that DSH hospitals located in high HMO penetration markets reduced their operating losses in nursery and pediatric services.

A Study of Surface Temperatures, Clouds and Net Radiation

NASA Technical Reports Server (NTRS)

Dhuria, Harbans

1996-01-01

This study focused on the seasonal relationships and interactions of climate parameters such as the surface temperatures, net radiation, long wave flux, short wave flux, and clouds on a global basis. Five years of observations (December 1984 to November 1989) from the Earth Radiation Budget Experiment (ERBE) and the International Satellite Cloud Climatology Program (ISCCP) were used to study both seasonal variations and interannual variations by use of a basic radiation budget equation. In addition, the study was extended to include an analysis of the cloud forcing due El-Nino's impact on the ERBE parameters.

Hydrologic analysis of a residential green infrastructure project Cincinnati OH, USA

EPA Science Inventory

•Context –current strains on municipal budgets throughout the US •Goal –demonstrate effective implementation of low-cost methods to reduce some typical impacts of urbanization on stormwater discharge, such as: •increased flashiness •decreased infiltration •degraded water qu...

Ceftaroline fosamil use in hospitalized patients with acute bacterial skin and skin structure infections: Budget impact analysis from a hospital perspective.

PubMed

Huang, Xingyue; Beresford, Eric; Lodise, Thomas; Friedland, H David

2013-06-15

The budgetary impact of adding ceftaroline fosamil to a hospital formulary for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) was evaluated. A three-year hospital budget impact model was constructed with three initial treatment options for ABSSSIs: ceftaroline fosamil, vancomycin plus aztreonam, and other vancomycin-containing regimens. The target population was hospitalized adult patients with an ABSSSI. Clinical cure rates with initial treatment were assumed to be similar to those from ceftaroline fosamil clinical trials. Patients who did not respond to initial treatment were assumed to be treated successfully with second-line antimicrobial therapy. Length of stay and cost per hospital day (by success or failure with initial treatment) were estimated based on a large database from more than 100 U.S. hospitals. Other model inputs included the annual number of ABSSSI admissions, projected annual case growth rate, proportion of ABSSSI target population receiving vancomycin-containing regimen, expected proportion of ABSSSI target population to be treated with ceftaroline fosamil, drug acquisition cost, cost of antibiotic administration, and cost of vancomycin monitoring. Sensitivity analysis using 95% confidence limits of clinical cure rates was also performed. The estimated total cost of care for treating a patient with an ABSSSI was $395 lower with ceftaroline fosamil ($15,087 versus $15,482) compared with vancomycin plus aztreonam and $72 lower ($15,087 versus $15,159) compared with other vancomycin-containing regimens. Model estimates indicated that adding ceftaroline fosamil to the hospital formulary would not have a negative effect on a hospital's budget for ABSSSI treatment.

What is the budget impact of a new treatment or new health technology arriving on the market?

PubMed

Dervaux, Benoit; Le Fur, Camille; Dubois, Sophie; Josseran, Anne

2017-02-01

In France, market access for innovative drugs (level I, II & III improvement of medical service rendered having significant impact on health insurance expenditure) involves medico-economic evaluation. In addition to cost-effectiveness analysis (CEA), budget impact analysis (BIA) can be performed, especially since the sustainability of the health insurance system has become a growing concern for all stakeholders. The members of the Giens 2016 round table discussed the contribution of BIA based on a review of the literature on distribution models, the participants' experiences including experience related to the modalities of hospital assessments, and examples from other countries. The round table established recommendations on four elements of interest: 1: the use of BIA from a contractual point of view - between manufacturers and the French Economic Committee for Health Products - during the price negotiations process, and from a prospective point of view within the framework of the annual review of budget expenditures; the definition of the target population and the rhythm of a health product's distribution are also major elements; 2: the interpretation of BIA results in light of CEA results: for what products and at what moment in the life cycle of these products; 3: the integration of the rhythm of a health product's distribution into the BIA; 4: preoccupations about how the level of health product implementation is integrated into the BIA in terms of opportunity cost and organisational quality for the promoter. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

Impact of orphan drugs on Latvian budget.

PubMed

Logviss, Konstantins; Krievins, Dainis; Purvina, Santa

2016-05-11

Number of orphan medicinal products on the market and number of rare disease patients, taking these usually expensive products, are increasing. As a result, budget impact of orphan drugs is growing. This factor, along with the cost-effectiveness of orphan drugs, is often considered in the reimbursement decisions, directly affecting accessibility of rare disease therapies. The current study aims to assess the budget impact of orphan drugs in Latvia. Our study covered a 5-year period, from 2010 to 2014. Impact of orphan drugs on Latvian budget was estimated from the National Health Service's perspective. It was calculated in absolute values and relative to total pharmaceutical market and total drug reimbursement budget. A literature review was performed for comparison with other European countries. Orphan drug annual expenditure ranged between EUR 2.065 and 3.065 million, with total 5-year expenditure EUR 12.467 million. It constituted, on average, 0.84 % of total pharmaceutical market and 2.14 % of total drug reimbursement budget, respectively. Average annual per patient expenditures varied widely, from EUR 1 534 to EUR 580 952. The most costly treatment was enzyme replacement therapy (Elaprase) for MPS II. Glivec had the highest share (34 %) of the total orphan drug expenditure. Oncological drugs represented more than a half of the total orphan drug expenditure, followed by drugs for metabolic and endocrine conditions and medicines for cardiopulmonary diseases. Three indications: Ph+ CML, MPS II, and PAH accounted for nearly 90 % of the total orphan drug expenditure. Budget impact of orphan drugs in Latvia is very small. It increased slightly over a period of five years, due to the slight increase in the number of patients and the number of orphan drugs reimbursed. Current Latvian drug reimbursement system is not sufficient for most orphan drugs.

The Budget Impact of Including Necitumumab on the Formulary for First-Line Treatment of Metastatic Squamous Non-Small Cell Lung Cancer: U.S. Commercial Payer and Medicare Perspectives.

PubMed

Bly, Christopher A; Molife, Cliff; Brown, Jacqueline; Tawney, Mahesh K; Carter, Gebra Cuyun; Cinfio, Frank N; Klein, Robert W

2018-06-01

Necitumumab (Neci) was the first biologic approved by the FDA for use in combination with gemcitabine and cisplatin (Neci + GCis) in first-line treatment of metastatic squamous non-small cell lung cancer (msqNSCLC). The potential financial impact on a health plan of adding Neci + GCis to drug formularies may be important to value-based decision makers in the United States, given ever-tightening budget constraints. To estimate the budget impact of introducing Neci + GCis for first-line treatment of msqNSCLC from U.S. commercial and Medicare payer perspectives. The budget impact model estimates the costs of msqNSCLC before and after adoption of Neci + GCis in hypothetical U.S. commercial and Medicare health plans over a 3-year time horizon. The eligible patient population was estimated from U.S. epidemiology statistics. Clinical data were obtained from randomized clinical trials, U.S. prescribing information, and clinical guidelines. Market share projections were based on market research data. Cost data were obtained from online sources and published literature. The incremental aggregate annual health plan, per-patient-per-year (PPPY), and per-member-per-month (PMPM) costs were estimated in 2015 U.S. dollars. One-way sensitivity analyses were conducted to assess the effect of model parameters on results. In a hypothetical 1,000,000-member commercial health plan with an estimated population of 30 msqNSCLC patients receiving first-line chemotherapy, the introduction of Neci + GCis at an initial market share of approximately 5% had an overall year 1 incremental budget impact of $88,394 ($3,177 PPPY, $0.007 PMPM), representing a 2.9% cost increase and reaching $304,079 ($10,397 PPPY, $0.025 PMPM) or a 7.4% cost increase at a market share of 14.7% in year 3. This increase in total costs was largely attributable to Neci drug costs and, in part, due to longer survival and treatment duration for patients treated with Neci+GCis. Overall, treatment costs increased by $81,812 (13.5%), and disease costs increased by $7,951 (0.4%), whereas adverse event costs decreased by $1,368 (0.5%) in year 1. From the Medicare perspective, the overall year 1 incremental budget impact was $438,056 ($0.037 PMPM, $3,112 PPPY), representing a 3.0% cost increase. The higher incremental budget in Medicare, compared with commercial plans, was due to higher msqNSCLC incidence in the older Medicare patients (154 vs. 30 patients, respectively). Results were most sensitive to Neci drug costs. Based on projected market shares, coverage for first-line therapy with Neci + GCis appeared to modestly affect overall U.S. health care budgets for msqNSCLC-related care. Given the small eligible patient population, the PMPM budgetary impact on a commercial health plan of reimbursing Neci + GCis in the first year was less than $0.01, rising with increased use of Neci + GCis to $0.025 in the third year. The real-world effect of Neci + GCis needs to be evaluated to validate this analysis; however, these findings may help policymakers in making coverage decisions for Neci + GCis. This study was funded by Eli Lilly and Company. Molife, Brown, Tawney, and Cuyun Carter are equity holders and employees of Eli Lilly and Company. Bly, Cinfio, and Klein are employees of Medical Decision Modeling, which received funding from Eli Lilly and Company to conduct this research and prepare this manuscript.

Understanding the Effectiveness of Carbon Dioxide Removal to Reduce the Impacts of Climate Change.

NASA Astrophysics Data System (ADS)

Scott, V.; Tett, S. F.; Brander, M.

2017-12-01

The current Nationally Determined Contributions to the Paris Agreement suggest exceeding the emissions budgets corresponding to the below 2°C and 1.5°C temperature targets. To address this the future application of Carbon Dioxide Removal (CDR) is proposed to recapture excess emissions at a later time, so keeping the total net emissions within budget. This assumes that the climate change impact of CO2 emitted now can be fully compensated by a matched CO2 removal in the future. However, the impacts from this pathway of emissions budget overshoot and subsequent recapture may differ from those resulting from a pathway where emissions are held within budget with no temporary overshoot. These pathway dependent impacts could give rise to different climatic and societal futures despite the total net emissions being the same. Using a low resolution fully coupled Earth System Model with an interactive carbon cycle, we present an investigation into the pathway dependence of climate change impacts and how these relate to the scale and duration of the emissions budget overshoot and subsequent recapture. From this we discuss the effectiveness of CDR in avoiding climate change impacts relative to more immediate emissions reductions. We consider how this relative effectiveness might be reflected in GHG accounting methods and national GHG accounts, and explore the implications for Article 2 of the Paris Agreement, where holding temperatures to the targets is recognised to "significantly reduce the risks and impacts of climate change".

Budget Reform to Improve Higher Education Quality.

ERIC Educational Resources Information Center

Folger, John

A national project designed to examine issues of budget reform and quality improvement in higher education is described. The focus is state-level budget practices and their impact on institutions. Most of the funding for quality improvement has been categorical: a small percent of the budget is set aside to achieve particular quality or…

76 FR 58089 - Guaranteed Loan Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-20

... as salaries, has no impact on the budget authority for loan funds. FSA budget for administrative... increase to 1.5 percent is required now because as proposed in the 2012 budget FSA will have less authority to fund guaranteed loans. Based on the proposed 2012 budget, the fee will need to be increased to 1.5...

76 FR 55675 - Information Collections Being Submitted for Review and Approval to the Office of Management and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... to the Office of Management and Budget AGENCY: Federal Communications Commission. ACTION: Notice and... and Budget (OMB) control number. DATES: Written comments should be submitted on or before October 11... hours. Annual Cost Burden: $3,310,700.00. Privacy Act Impact Assessment: No impact(s). Nature and Extent...

Portfolio theory and cost-effectiveness analysis: a further discussion.

PubMed

Sendi, Pedram; Al, Maiwenn J; Rutten, Frans F H

2004-01-01

Portfolio theory has been suggested as a means to improve the risk-return characteristics of investments in health-care programs through diversification when costs and effects are uncertain. This approach is based on the assumption that the investment proportions are not subject to uncertainty and that the budget can be invested in toto in health-care programs. In the present paper we develop an algorithm that accounts for the fact that investment proportions in health-care programs may be uncertain (due to the uncertainty associated with costs) and limited (due to the size of the programs). The initial budget allocation across programs may therefore be revised at the end of the investment period to cover the extra costs of some programs with the leftover budget of other programs in the portfolio. Once the total budget is equivalent to or exceeds the expected costs of the programs in the portfolio, the initial budget allocation policy does not impact the risk-return characteristics of the combined portfolio, i.e., there is no benefit from diversification anymore. The applicability of portfolio methods to improve the risk-return characteristics of investments in health care is limited to situations where the available budget is much smaller than the expected costs of the programs to be funded.

Budget impact of tegaserod on a managed care organization formulary.

PubMed

Bloom, Michael A; Barghout, Victoria; Kahler, Kristijan H; Bentkover, Judith; Kurth, Hannah; Gralnek, Ian M; Spiegel, Brennan M R

2005-04-01

We sought to develop a budget impact model that assesses the economic effect of adding tegaserod for the management of irritable bowel syndrome (IBS) with constipation to the formulary of a managed care organization (MCO). The model estimates the per patient economic impact and the per member, per month (PMPM) economic impact of patients 6 months before and 6 months after the initiation of tegaserod. Resource utilization data, taken from medical and pharmacy administrative claims data, were based on a retrospective, longitudinal study of 3365 patients administered tegaserod through a large, geographically diverse MCO. Costs were estimated for 2 patient subgroups, women with IBS and other gastrointestinal (GI) diagnoses. Sensitivity analyses were performed by varying several model input parameters. The base-case model resulted in an incremental PMPM budget impact associated with the use of tegaserod of 0.01 dollars. Total per patient budget impact (for all resources, including tegaserod) for a 6-month period was 274.34 dollars for women with IBS and 301.84 dollars for women with other GI diagnoses. Overall, 25.9% (29.0% for women with IBS group and 21.9% for women with other GI diagnoses group) of the cost of tegaserod was offset by decreases in resource utilization. Key drivers of post-tegaserod reductions in resource costs were hospital stays, outpatient office visits, emergency department visits, endoscopic procedures, and nonendoscopic procedures. Tegaserod therapy can decrease GI-related resource utilization, resulting in a significant cost-offset percentage. When the associated budget impact of adding tegaserod to its formulary is absorbed across an entire MCO population, the PMPM impact of tegaserod is small.

Carbon budget of tropical forests in Southeast Asia and the effects of deforestation: an approach using a process-based model and field measurements

NASA Astrophysics Data System (ADS)

Adachi, M.; Ito, A.; Ishida, A.; Kadir, W. R.; Ladpala, P.; Yamagata, Y.

2011-09-01

More reliable estimates of the carbon (C) stock within forest ecosystems and C emission induced by deforestation are urgently needed to mitigate the effects of emissions on climate change. A process-based terrestrial biogeochemical model (VISIT) was applied to tropical primary forests of two types (a seasonal dry forest in Thailand and a rainforest in Malaysia) and one agro-forest (an oil palm plantation in Malaysia) to estimate the C budget of tropical ecosystems in Southeast Asia, including the impacts of land-use conversion. The observed aboveground biomass in the seasonal dry tropical forest in Thailand (226.3 t C ha-1) and the rainforest in Malaysia (201.5 t C ha-1) indicate that tropical forests of Southeast Asia are among the most C-abundant ecosystems in the world. The model simulation results in rainforests were consistent with field data, except for the NEP, however, the VISIT model tended to underestimate C budget and stock in the seasonal dry tropical forest. The gross primary production (GPP) based on field observations ranged from 32.0 to 39.6 t C ha-1 yr-1 in the two primary forests, whereas the model slightly underestimated GPP (26.5-34.5 t C ha-1 yr-1). The VISIT model appropriately captured the impacts of disturbances such as deforestation and land-use conversions on the C budget. Results of sensitivity analysis showed that the proportion of remaining residual debris was a key parameter determining the soil C budget after the deforestation event. According to the model simulation, the total C stock (total biomass and soil C) of the oil palm plantation was about 35% of the rainforest's C stock at 30 yr following initiation of the plantation. However, there were few field data of C budget and stock, especially in oil palm plantation. The C budget of each ecosystem must be evaluated over the long term using both the model simulations and observations to understand the effects of climate and land-use conversion on C budgets in tropical forest ecosystems.

Newark Public Schools: Budget Impacts of Underfunding and Rapid Charter Growth

ERIC Educational Resources Information Center

Farrie, Danielle; Johnson, Monete

2015-01-01

The budget of the State-operated Newark Public Schools (NPS) is now in its fourth year of crisis. The district is currently struggling to close a $13 million budget hole almost halfway into the school year. Most importantly, the ongoing budget crisis has eroded essential resources in district schools, depriving students of the opportunity for a…

Impact of Parameterized Lee Wave Drag on the Energy Budget of an Eddying Global Ocean Model

DTIC Science & Technology

2013-08-26

Teixeira, J., Peng, M., Hogan, T.F., Pauley, R., 2002. Navy Operational Global Atmospheric Prediction System (NOGAPS): Forcing for ocean models...Impact of parameterized lee wave drag on the energy budget of an eddying global ocean model David S. Trossman a,⇑, Brian K. Arbic a, Stephen T...input and output terms in the total mechanical energy budget of a hybrid coordinate high-resolution global ocean general circulation model forced by winds

The Impact of the Administration's 1987 Budget Proposal on Child Nutrition Programs. Hearing before the Subcommittee on Elementary, Secondary, and Vocational Education of the Committee on Education and Labor, House of Representatives, Ninety-Ninth Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Education and Labor.

This hearing examined the impact of the Administration's 1987 budget proposal on child nutrition programs, which were cut significantly. A spokesperson for the Department of Agriculture testified that the proposed budget was designed to preserve benefits for those truly in need, to provide for the national defense, to maintain taxes at the current…

The ALMA CONOPS project: the impact of funding decisions on observatory performance

NASA Astrophysics Data System (ADS)

Ibsen, Jorge; Hibbard, John; Filippi, Giorgio

2014-08-01

In time when every penny counts, many organizations are facing the question of how much scientific impact a budget cut can have or, putting it in more general terms, which is the science impact of alternative (less costly) operational modes. In reply to such question posted by the governing bodies, the ALMA project had to develop a methodology (ALMA Concepts for Operations, CONOPS) that attempts to measure the impact that alternative operational scenarios may have on the overall scientific production of the Observatory. Although the analysis and the results are ALMA specific, the developed approach is rather general and provides a methodology for a cost-performance analysis of alternatives before any radical alterations to the operations model are adopted. This paper describes the key aspects of the methodology: a) the definition of the Figures of Merit (FoMs) for the assessment of quantitative science performance impacts as well as qualitative impacts, and presents a methodology using these FoMs to evaluate the cost and impact of the different operational scenarios; b) the definition of a REFERENCE operational baseline; c) the identification of Alternative Scenarios each replacing one or more concepts in the REFERENCE by a different concept that has a lower cost and some level of scientific and/or operational impact; d) the use of a Cost-Performance plane to graphically combine the effects that the alternative scenarios can have in terms of cost reduction and affected performance. Although is a firstorder assessment, we believe this approach is useful for comparing different operational models and to understand the cost performance impact of these choices. This can be used to take decision to meet budget cuts as well as in evaluating possible new emergent opportunities.

7 CFR 2.30 - Director, Office of Budget and Program Analysis.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Director, Office of Budget and Program Analysis. 2.30... Officers and Agency Heads § 2.30 Director, Office of Budget and Program Analysis. (a) The following... Program Analysis: (1) Serve as the Department's Budget Officer and exercise general responsibility and...

Long-term changes in river system hydrology in Texas

NASA Astrophysics Data System (ADS)

Zhang, Yiwen; Wurbs, Ralph

2018-06-01

Climate change and human actives are recognized as a topical issue that change long-term water budget, flow-frequency, and storage-frequency characteristics of different river systems. Texas is characterized by extreme hydrologic variability both spatially and temporally. Meanwhile, population and economic growth and accompanying water resources development projects have greatly impacted river flows throughout Texas. The relative effects of climate change, water resources development, water use, and other factors on long-term changes in river flow, reservoir storage, evaporation, water use, and other components of the water budgets of different river basins of Texas have been simulated in this research using the monthly version of the Water Rights Analysis Package (WRAP) modelling system with input databases sets from the Texas Commission on Environmental Quality (TCEQ) and Texas Water Development Board (TWDB). The results show that long-term changes are minimal from analysis monthly precipitation depths. Evaporation rates vary greatly seasonally and for much of the state appear to have a gradually upward trend. River/reservoir system water budgets and river flow characteristics have changed significantly during the past 75 years in response to water resources development and use.

Decision making in the Navy Budget Office.

DTIC Science & Technology

1986-06-01

The primary objective of this thesis is to familiarize the reader with the budget decision making pocesses and considerations which influence the ...formulation of the Department of the navy’s (DON) budget from perspective of the Office of Budget and Reports (OBR), the impact of resource allocation...budgetary) decisions upon the overall framwork within which DON budgetary decisions are made, the organizational

Diagnosing MJO Destabilization and Propagation with the Moisture and MSE Budgets

NASA Astrophysics Data System (ADS)

Maloney, Eric; Wolding, Brandon

2015-04-01

Novel diagnostics obtained as an extension of empirical orthogonal function analysis are used as a composting basis to gain insight into MJO dynamics through examination of reanalysis moisture and moist static energy budgets. The net effect of vertical moisture advection and cloud processes was found to be a modest positive feedback to column moisture anomalies during both enhanced and suppressed phases of the MJO. This positive feedback is regionally strengthened by anomalous surface fluxes of latent heat. The modulation of horizontal synoptic scale eddy mixing acts as a negative feedback to column moisture anomalies, while anomalous winds acting against the mean state moisture gradient aid in eastward propagation. These processes act in a systematic fashion across the Indian Ocean and oceanic regions of the Maritime Continent. The ability to approximately close the MSE budget serves an important role in constraining the moisture budget, whose residual is several times larger than the total and horizontal advective moisture tendencies. Comparison with TRMM precipitation anomalies suggests that the moisture budget residual results from an underestimation by ERAi of variations in both total precipitation and vertical moisture advection associated with the MJO. The results of this study support the concept of the MJO as a moisture-mode. This analysis is extended to examine the impact of boundary layer convergence driven by MJO SST anomalies on the vertically-integrated moisture budget. Results from a coupled version of the SP-CAM suggest that SST-driven moisture convergence anomalies are of a sufficient amplitude to be important for MJO propagation and destabilization, and may help explain why coupled models produce better simulations of the MJO than uncoupled models.

Latin American Clinical Epidemiology Network Series - Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile.

PubMed

De la Puente, Catherine; Vallejos, Carlos; Bustos, Luis; Zaror, Carlos; Velasquez, Monica; Lanas, Fernando

2017-06-01

To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. Cost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. The ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US$). In the budget impact analysis for the baseline scenario, considering 100% of treatment, coverage, and adherence, ticagrelor represented an additional cost of CLP 5,233,854,272, for 979 QALYs gained compared with clopidogrel. Ticagrelor is cost-effective in comparison with clopidogrel for the secondary prevention of acute coronary syndrome. These findings are similar to those reported in other international cost-effectiveness studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Public Budgeting: The Compromises Among the Sound Budgeting Principles in Contingency Funding

DTIC Science & Technology

2017-06-01

sound decisions (including the full financial costs and benefits of the budget decisions, and the impacts thereof) and be made accessible to all...is also seen when all relevant data and costs projections result, in a timely manner, in a budget document that is accessible by the public . A medium...include all relevant data and costs projections, and makes information accessible to the public for review in a timely manner. The budget

Impact of Medicare's prospective payment system on hospitals, skilled nursing facilities, and home health agencies: how the Balanced Budget Act of 1997 may have altered service patterns for Medicare providers.

PubMed

Kulesher, Robert R

2006-01-01

The prospective payment system is one of many changes in reimbursement that has affected the delivery of health care. Originally developed for the payment of inpatient hospital services, it has become a major factor in how all health insurance is reimbursed. The policy implications extend beyond the Medicare program and affect the entire health care delivery system. Initially implemented in 1982 for payments to hospitals, prospective payment system was extended to payments for skilled nursing facility and home health agency services by the Balanced Budget Act of 1997. The intent of the Balanced Budget Act was to bring into balance the federal budget through reductions in spending. The decisions that providers have made to mitigate the impact are a function of ownership type, organizational mission, and current level of Medicare participation. This article summarizes the findings of several initial studies on the Balanced Budget Act's impact and discusses how changes in Medicare reimbursement policy have influenced the delivery of health care for the general public and for Medicare beneficiaries.

[Contribution of economic evaluation and budget impact analysis to public decision in health: the example of breast cancer].

PubMed

Perrier, L; Philip, T

2010-03-01

The aim of this paper is to draw the reader's attention to the problem of dissemination of costly innovations, particularly in the field of oncology, in a context of scarce resources.Comparison of five economic aggregates related to health and the gross domestic product captures the weight of this sector in the national economy but also its cost to the community. A focus on oncology shows that during the year 2004, the cost of cancer in France, all sites being taken into account, amounted to 10.9 billion euros and the societal cost to 32 billion euros (2% of gross domestic product). The cost of breast cancer (36% of all female cancers) reached 1.5 billion euros for treatment and 3.5 billion euros for societal expenses (0.2% of gross domestic product). Due to the significant, rapid expansion of these costs (+19.2% in 2006 and 18.5% in 2007 for diagnosis-related group outliers) but also to the scarcity of resources, the development of costly innovations remains problematic. This article, based on concrete examples of breast cancer treatment, provides information on the contribution of health technology assessment (particularly cost-utility and budget impact analyses) to public decision. Economic evaluation, in particular, cost-utility assessment, allows comparison of costs and consequences (generic result usually expressed in quality-adjusted life years) in order to prioritize diagnostic and/or therapeutic strategies and to make choices based on social acceptability. Budget impact analysis, without consideration of efficacy, makes it possible to balance the financing needs arising from the adoption of a costly innovation with the paying capabilities of a given institution.

The Value of Performance Measurement in Promoting Improvements in Women's Health.

PubMed

Siu, Emily C Y; Levinton, Carey; Brown, Adalsteinn D

2009-11-01

To determine the factors associated with the use and impact of performance data relevant to women's health. We developed a survey on six levels of information use based on Knott and Wildavsky's (1980) policy utilization framework and used this survey to determine Ontario hospital administrators' use of women's health report indicators. We related responses to this survey to six potentially relevant organizational factors, such as women's health as a written hospital priority, a women's health program and hospital budget size, using correlation and multiple-regression analysis. Only women's health in a written hospital priority (p=0.01) and hospital budget (p=0.02, log transformed) were significantly associated with the highest level of use when all organizational factors were considered. These findings suggest that the use of women's health performance indicators is strongly related to the size of the hospital budget and to organizational commitment to women's health.

Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

PubMed Central

Jørgensen, Jesper; Kefalas, Panos

2017-01-01

ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

Development of Ocean Noise "Budgets"

NASA Astrophysics Data System (ADS)

D'Spain, G. L.; Miller, J. H.; Frisk, G. V.; Bradley, D. L.

2003-12-01

The National Oceanographic Partnership Program recently sponsored the third U.S. National Academy of Sciences study on the potential impact of manmade sound on the marine environment. Several recommendations for future research are made by the 11-member committee in their report titled Ocean Noise and Marine Mammals (National Academies Press, 2003). This presentation will focus on the subset of recommendations related to a "noise budget", i.e., an accounting of the relative contributions of various sources to the ocean noise field. A noise budget is defined in terms of a specific metric of the sound field. The metric, or budget "currency", typically considered is the acoustic pressure spectrum integrated over space and time, which is proportional to the total mechanical energy in the acoustic field. However, this currency may not be the only one of relevance to marine animals. Each of the various ways in which sound can potentially impact these animals, e.g., temporary threshold shift, masking, behavior disruption, etc, probably depends upon a different property, or set of properties, of the sound field. Therefore, a family of noise budgets based on various currencies will be required for complete evaluation of the potential impact of manmade noise on the marine environment. Validation of noise budgets will require sustained, long term measurements of the underwater noise field.

Carbon budget of tropical forests in Southeast Asia and the effects of deforestation: an approach using a process-based model and field measurements

NASA Astrophysics Data System (ADS)

Adachi, M.; Ito, A.; Ishida, A.; Kadir, W. R.; Ladpala, P.; Yamagata, Y.

2011-03-01

More reliable estimates of carbon (C) stock within forest ecosystems and C emission induced by deforestation are urgently needed to mitigate the effects of emissions on climate change. A process-based terrestrial biogeochemical model (VISIT) was applied to tropical primary forests of two types (a seasonal dry forest in Thailand and a rainforest in Malaysia) and one agro-forest (an oil palm plantation in Malaysia) to estimate the C budget of tropical ecosystems, including the impacts of land-use conversion, in Southeast Asia. Observations and VISIT model simulations indicated that the primary forests had high photosynthetic uptake: gross primary production was estimated at 31.5-35.5 t C ha-1 yr-1. In the VISIT model simulation, the rainforest had a higher total C stock (plant biomass and soil organic matter, 301.5 t C ha-1) than that in the seasonal dry forest (266.5 t C ha-1) in 2008. The VISIT model appropriately captured the impacts of disturbances such as deforestation and land-use conversions on the C budget. Results of sensitivity analysis implied that the ratio of remaining residual debris was a key parameter determining the soil C budget after deforestation events. The C stock of the oil palm plantation was about 46% of the rainforest's C at 30 yr following initiation of the plantation, when the ratio of remaining residual debris was assumed to be about 33%. These results show that adequate forest management is important for reducing C emission from soil and C budget of each ecosystem must be evaluated over a long term using both the model simulations and observations.

Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses

PubMed Central

Tarricone, Rosanna

2017-01-01

Objectives This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. Design A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Setting Italian Healthcare Service perspective. Population Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Main outcome measures Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. Results The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Conclusions Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent catheterisation in patients with spinal cord injury. PMID:28096251

Paclitaxel Drug-Eluting Stents in Peripheral Arterial Disease: A Health Technology Assessment

PubMed Central

2015-01-01

Background Peripheral arterial disease is a condition in which atherosclerotic plaques partially or completely block blood flow to the legs. Although percutaneous transluminal angioplasty and metallic stenting have high immediate success rates in treating peripheral arterial disease, long-term patency and restenosis rates in long and complex lesions remain unsatisfactory. Objective The objective of this analysis was to evaluate the clinical effectiveness, safety, cost-effectiveness and budget impact of Zilver paclitaxel self-expanding drug-eluting stents for the treatment of de novo or restenotic lesions in above-the-knee peripheral arterial disease. Data Sources Literature searches were performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews. For the economic review, a search filter was applied to limit search results to economics-related literature. Data sources for the budget impact analysis included expert opinion, published literature, and Ontario administrative data. Review Methods Systematic reviews, meta-analyses, randomized controlled trials, and observational studies were included in the clinical effectiveness review, and full economic evaluations were included in the economic literature review. Studies were included if they examined the effect of Zilver paclitaxel drug-eluting stents in de novo or restenotic lesions in above-the-knee arteries. For the budget impact analysis, 3 scenarios were constructed based on different assumptions. Results One randomized controlled trial reported a significantly higher patency rate with Zilver paclitaxel drug-eluting stents for lesions ≤ 14 cm than with angioplasty or bare metal stents. One observational study showed no difference in patency rates between Zilver paclitaxel drug-eluting stents and paclitaxel drug-coated balloons. Zilver paclitaxel drug-eluting stents were associated with a significantly higher event-free survival rate than angioplasty, but the event-free survival rate was similar for Zilver paclitaxel drug-eluting stents and paclitaxel drug-coated balloons. No economic evaluations compared Zilver paclitaxel drug-eluting stents with bare metal stents or angioplasty for peripheral arterial disease. A budget impact analysis showed that the cost savings associated with funding of Zilver paclitaxel drug-eluting stents would be $470,000 to $640,000 per year, assuming that the use of the Zilver paclitaxel drug-eluting stent was associated with a lower risk of subsequent revascularization. Conclusions Based on evidence of low to moderate quality, Zilver paclitaxel drug-eluting stents were associated with a higher patency rate than angioplasty or bare metal stents, and with fewer adverse events than angioplasty. The effectiveness and safety of Zilver paclitaxel drug-eluting stents and paclitaxel drug-coated balloons were similar. PMID:26719778

The utility of the historical record in assessing future carbon budgets

NASA Astrophysics Data System (ADS)

Millar, R.; Friedlingstein, P.; Allen, M. R.

2017-12-01

It has long been known that the cumulative emissions of carbon dioxide (CO2) is the most physically relevant determiner of long-lived anthropogenic climate change, with an approximately linear relationship between CO2-induced global mean surface warming and cumulative emissions. The historical observational record offers a way to constrain the relationship between cumulative carbon dioxide emission and global mean warming using observations to date. Here we show that simple regression analysis indicates that the 1.5°C carbon budget would be exhausted after nearly three decades of current emissions, substantially in excess of many estimates from Earth System Models. However, there are many reasons to be cautious about carbon budget assessments from the historical record alone. Accounting for the uncertainty in non-CO2 radiative forcing using a simple climate model and a standard optimal fingerprinting detection attribution technique gives substantial uncertainty in the contribution of CO2 warming to date, and hence the transient climate response to cumulative emissions. Additionally, the existing balance between CO2 and non-CO2 forcing may change in the future under ambitious mitigation scenarios as non-CO2 emissions become more (or less) important to global mean temperature changes. Natural unforced variability can also have a substantial impact on estimates of remaining carbon budgets. By examining all warmings of a given magnitude in both the historical record and past and future ESM simulations we quantify the impact unforced climate variability may have on estimates of remaining carbon budgets, derived as a function of estimated non-CO2 warming and future emission scenario. In summary, whilst the historical record can act as a useful test of climate models, uncertainties in the response to future cumulative emissions remain large and extrapolations of future carbon budgets from the historical record alone should be treated with caution.

Budget Impact of Introducing Linagliptin into Bosnia and Herzegovina Health Insurance Drug Reimbursement List in 2016-2018.

PubMed

Catic, Tarik; Lekic, Lana; Zah, Vlad; Tabakovic, Vedad

2017-09-01

Diabetes is reaching epidemiological scales worldwide. Beside health implications diabetes bears significant financial impact on health systems. Different treatment options aiming to prevent diabetes complications are available. Dipeptidyl-peptidase-IV (DPP-4) inhibitors like linagliptin are usually add-on therapy to metformin in order to achieve glycemic control. Expenditure for oral antidiabetic medicines in Bosnia and Herzegovina (B&H) is low accounting for only 2.53% of the total drug market expenditure. Linagliptin is not reimbursed in B&H mainly due to it's perception of high cost medication. To assess budget impact (BI) of introducing linagliptin into health insurance reimbursement list in B&H through development of the budget impact model (BIM). Budget impact model was developed using Microsoft Excel 2010 based on current legislation and practice in B&H. Local epidemiology data and data on drug consumption from government reports in 2014 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with linagliptin reimbursed and compared. Inclusion of linagliptin into reimbursement list in Canton Sarajevo and Canton Tuzla would have positive budget impact on national level of B&H resulting in total savings of 18,194€, 235,570€ and 699,472€, in 2016, 2017 and 2018, respectively. Introduction of linagliptin into reimbursement list would decrease total costs for DPP-4 inhibitors and is favorable for positive decision on reimbursement in B&H. Applying BIM in decision making would assure better allocation and planning of resources at any region or administrative level in B&H.

Rising Capital: The Impact Of China’s Economic Growth On U.S. National Security

DTIC Science & Technology

2011-10-23

in the Asia Pacific. China decides to manage international perceptions and prevent further impact to its own economy. China agrees to appreciate the... House Armed Services Committee Republican Staff, “Assessment of Impacts of Budget Cuts,” 22 September 2011, 3-4. 145 Ibid., 7 146 Col Joseph A...wp11-14.pdf , 16. 168 House Armed Services Committee Republican Staff, “Assessment of Impacts of Budget Cuts,” 22 September 2011. 169 National

Impact of anomalous forest fire on aerosol radiative forcing and snow cover over Himalayan region

NASA Astrophysics Data System (ADS)

Bali, Kunal; Mishra, Amit Kumar; Singh, Sachchidanand

2017-02-01

Forest fires are very common in tropical region during February-May months and are known to have significant impact on ecosystem dynamics. Moreover, aerosols emitted from these burning activities significantly modulate the Earth's radiation budget. In present study, we investigated the anomalous forest fire events and their impact on atmospheric radiation budget and glaciated snow cover over the Himalayan region. We used multiple dataset derived from satellites [Moderate Resolution Spectroradiometer (MODIS) and Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO)] and reanalysis models [Global Fire Assimilation System (GFAS), Second Modern-Era Retrospective analysis for Research and Application (MERRA-2) and ERA-interim] to evaluate the effect of biomass burning aerosols on radiation budget. April 2016 is associated with anomalous fire activities over lower Himalayan region in the last fourteen years (2003-2016). The model estimated organic carbon (OC) and black carbon (BC) emission reaches up to ∼3 × 104 and ∼2 × 103 μg/m2/day, respectively during the biomass burning period of April 2016. The meteorological data analysis accompanied with CALIOP aerosol vertical profile shows that these carbonaceous aerosols could reach up to ∼5-7 km altitude and could be transported towards glaciated region of upper Himalayas. The large amount of BC/OC from biomass burning significantly modulates the atmospheric radiation budget. The estimated columnar heating rate shows that these carbonaceous aerosols could heat up the atmosphere by ∼0.04-0.06 K/day in April-2016 with respect to non-burning period (2015). The glaciated snow cover fractions are found to be decreasing by ∼5-20% in 2016 as compared to long term mean (2003-2016). The combined analyses of various climatic factors, fires and associated BC emissions show that the observed snow cover decrease could be results of increased surface/atmospheric temperature due to combined effect of large scale climatic changes and BC absorption. Our results suggest that biomass burning can have significant effects on the Himalayan region, particularly in view of its importance in hydrological cycle and ecosystem.

Budget Impact of Enzalutamide for Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer.

PubMed

Bui, Cat N; O'Day, Ken; Flanders, Scott; Oestreicher, Nina; Francis, Peter; Posta, Linda; Popelar, Breanna; Tang, Hong; Balk, Mark

2016-02-01

Prostate cancer is expected to account for approximately one quarter of all new diagnoses of cancer in American men in 2015. The cost of prostate cancer care is expected to reach $15.1 billion by the year 2020, up from $11.9 billion in 2010. Given the high burden of prostate cancer, health care payers are interested in quantifying the potential budget impact of new therapies. To estimate the budget impact of enzalutamide for the treatment of chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) from a U.S. payer perspective. A model was developed to assess the budget impact of enzalutamide for treatment of chemotherapy-naïve mCRPC patients in a hypothetical 1-million-member U.S. health plan over a 1-year time horizon. Comparators included abiraterone acetate, sipuleucel-T, radium Ra 223 dichloride, and docetaxel. Epidemiologic data, including National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) incidence rates, were used to estimate the number of chemotherapy-naïve mCRPC patients. Dosing, administration, duration of therapy, and adverse event rates were based on package inserts and pivotal studies. Drug costs were obtained from RED BOOK and Centers for Medicare & Medicaid Services (CMS) average sales price pricing files, costs of administration and monitoring from the CMS physician fee schedule, and adverse events from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and published literature. Market shares were estimated for each comparator before and after adoption of enzalutamide. The incremental aggregate budget impact, per patient per year (PPPY), per patient per month (PPPM), and per member per month (PMPM), was calculated. One-way sensitivity analyses were performed. In a population of 115 chemotherapy-naïve mCRPC patients, adopting enzalutamide had an annual incremental budget impact of $510,641 ($4,426 PPPY, $369 PPPM, and $0.04 PMPM). Results were most sensitive to enzalutamide drug cost, size of the chemotherapy-naïve mCRPC patient population, and enzalutamide adoption rate. Results indicate a modest 1-year budget impact of adopting enzalutamide for chemotherapy-naïve mCRPC patients, partly because of the cost offset of a moderate incidence of adverse events and lack of additional required monitoring.

Budget impact model of adding erlotinib to a regimen of gemcitabine for the treatment of locally advanced, nonresectable or metastatic pancreatic cancer.

PubMed

Danese, Mark D; Reyes, Carolina; Northridge, Kelly; Lubeck, Deborah; Lin, Chin-Yu; O'Connor, Paula

2008-04-01

The aim of this study was to determine the budget impact of adding erlotinib to a US health plan insurer's formulary as a combination therapy with gemcitabine for the treatment of nonresectable pancreatic cancer. An Excel-based budget impact model was developed to evaluate the costs for National Comprehensive Cancer Network guideline-recommended treatment options for patients with locally advanced, nonresectable or metastatic pancreatic cancer from the perspective of a US managed care plan. The model compared treatment with gemcitabine alone and in combination with erlotinib, including the costs of treatment, adverse events (AEs), and administration. Inputs for the model were derived from the Surveillance, Epidemiology and End Results Cancer Registry, clinical trials, and publicly available sources and were varied in sensitivity analyses to identify influential inputs. The model addressed first-line use in a single indication and assumed that the proportion of patients aged >or=65 years in a managed care organization was the same as in the general population. The model did not account for patient copayments for oral medications, a factor that could lower a plan's overall cost further than estimated herein. For a hypothetical managed care plan with 500,000 members, the model estimated 43 newly diagnosed pancreatic cancer cases each year, of which 56% (n=24) would be treated with gemcitabine as first-line therapy. Assuming that erlotinib were added to the treatment regimen in 40% (n=10) of gemcitabine-treated patients for 15.7 weeks of therapy per patient, the expected 1-year cost in 2006 dollars would be US $466,700 compared with $346,700 had all patients been treated with gemcitabine alone. Administration costs accounted for 10% to 12% of total costs, while AE management costs made up 14% to 16% of total costs. These estimates corresponded to an incremental cost of $120,000, or $0.020 per member per month (PMPM). The results were relatively insensitive to drug costs, drug administration costs, and costs of treatment of AEs based on sensitivity analyses. In this analysis of the budget impact of adding to the health plan formulary erlotinib to a regimen of gemcitabine as first-line treatment of locally advanced, nonresectable or metastatic pancreatic cancer in the United States, the budget impact was $0.020 PMPM. The relatively low incidence of pancreatic cancer and the assumption of treating only 23% of these patients with erlotinib were likely the principal reasons for the low budgetary impact of erlotinib. In this model and using these reasonable assumptions, the results suggested that the incremental cost impact on a PMPM basis may be small.

Coping with Hard Times: Budget Cutbacks in Human Service Organizations. Part 1: An Analysis of the Emergence and Recognition of Cutbacks.

ERIC Educational Resources Information Center

Murray, Victor; Jick, Todd D.

This paper presents a conceptual framework for analyzing the impact of funding cutbacks on human services organizations (HSOs). HSOs include publicly-funded educational, health, welfare, and cultural organizations. The framework identifies five categories of variables which influence an organization's reaction to cutbacks. Category one, "objective…

Higher Education Expenditures and State Balanced Budget Requirements: Is There a Relationship?

ERIC Educational Resources Information Center

Serna, Gabriel R.; Harris, Gretchen

2014-01-01

While recent research has shown that restrictive state fiscal policies, such as tax and expenditure limitations (TELs), matter for state spending to public higher education, no study has examined the impacts that other restrictive state fiscal policies might have on expenditures to this same sector. In this analysis we examine the relationship…

[Care for elderly patients in Africa: Analysis of the financial implications of the SESAME plan on the budget of the regional hospital center in Thies, Senegal].

PubMed

Faye, A; Diousse, P; Seck, I; Diongue, M; Ndiaye, P; Diagne-Camara, M; Tal-Dia, A; Dia, La

2010-04-01

The SESAME plan has been implemented at the Thies Regional Hospital Center (TRHC) for one year. The purpose of this study was to analyze the financial implications of the plan on the hospital budget for the sustainability of care for persons aged 60 and over. This descriptive study included analysis of budget data from October 2006 to September 2007 plus information obtained by interviewing the accountant and head of SESAME plan. The number of patients managed, sources of CHRT funding, grants from various SESAME plan partners, and expenditures for each partner were determined. The weight of the SESAME plan in the CHRT operating budget was determined by calculating the ratio of the overall cost of care for elderly persons in relation to the hospital's revenues and SESAME grants. During the study period, the CHRT received a total of 17375 elderly persons including 89% with no pension or social security. The institute pension scheme (IPRES) covered 21% of the plan as compared to 79% for the state. Utilization plan grants in relation to funding source was 41% for IPRES and 124% for the State. The total cost of services provided to beneficiaries of the SESAME plan exceeded the aggregate amount by 26 083 847 CFA francs. The weight of the SESAME plan in the operating cost of the CHRT was 17%. Prefinancing a plan to cover elderly care in hospitals should be sufficient to prevent deficits from impacting negatively on the operating budget of the hospital.

Ulipristal acetate for pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands: cost minimization analysis and budget impact analysis.

PubMed

Zakiyah, N; van Asselt, A D I; Postma, M J

2017-03-01

Ulipristal acetate has been found to be non-inferior to other pre-operative treatments of uterine fibroids, particularly leuprolide. The objective of this study was to assess the pharmacoeconomic profile of ulipristal acetate compared to leuprolide for the pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands. The analysis was performed and applied within the framework of the ulipristal acetate submission for reimbursement in 2012. A decision model was developed to compare the total costs of ulipristal acetate compared to leuprolide, the standard care in The Netherlands. The target population of this study corresponded to the type of patients included in the PEARL II clinical trial; i.e. women of reproductive age requiring pre-operative treatment for uterine fibroids. Sensitivity analysis was implemented to assess uncertainties. Data regarding costs, effects, and other input parameters were obtained from relevant published literatures, the Dutch Healthcare Insurance Board, and expert opinion obtained by means of a panel of experts from several medical centers in The Netherlands. In The Netherlands, the total costs of ulipristal acetate and leuprolide were estimated at €4,216,027 and €4,218,095, respectively. The annual savings of ulipristal acetate were, therefore, estimated at €2,068. The major driver of this cost difference was the cost of administration for leuprolide. Sensitivity analyses showed that ulipristal acetate mostly remained cost-saving over a range of assumptions. The budget impact analysis indicated that the introduction of ulipristal acetate was estimated to result in cost savings in the first 3 years following the introduction. The results of this study were used in the decision on reimbursement of ulipristal acetate according to the Dutch Reference Pricing system in 2012. Ulipristal acetate was cost saving compared to leuprolide and has the potential to provide substantial savings on the healthcare budget in The Netherlands.

Three-year cost-effectiveness model for non-animal stabilized hyaluronic acid and dextranomer copolymer compared with sacral nerve stimulation after conservative therapy for the management of fecal incontinence.

PubMed

Bernstein, Mitchell A; Purdy, Christopher H; Becker, Alison; Magar, Raf

2014-06-01

Two new therapies for fecal incontinence (FI) are now available: non-animal stabilized hyaluronic acid and dextranomer copolymer (NASHA/Dx) and sacral nerve stimulation (SNS). This study aimed to determine the cost-effectiveness of NASHA/Dx compared with SNS and conservative therapy (CT) for the treatment of FI after CT failure. Decision tree models with Markov subbranches were developed to compare all direct costs and outcomes during a 3-year period from the viewpoint of the US third-party payer. Costs (in 2013 US dollars) of devices, medical and surgical care, and hospitalization were included. Outcomes included quality-adjusted life-years (QALYs) and incontinence-free days (IFDs). Both costs and outcomes were discounted at an annual rate of 3%. The incremental cost-effectiveness ratio was calculated for each outcome. One-way and probabilistic sensitivity analyses were performed to examine robustness of results and model stability. A budget impact analysis was also undertaken to estimate the potential cost and savings of NASHA/Dx for a payer with 1,000,000 covered lives. For the 3-year cost-effectiveness models, the expected cost was $9053 for CT, $14,962 for NASHA/Dx, and $33,201 for SNS. The numbers of QALYs were 1.769, 1.929, and 2.004, respectively. The numbers of IFDs were 128.8, 267.6, and 514.8, respectively. The incremental cost-effectiveness ratios per additional IFD gained were $42.60 for NASHA/Dx vs CT, $73.76 for SNS vs NASHA/Dx, and $62.55 for SNS vs CT. The incremental costs per QALY gained were $37,036 for NASHA/Dx vs CT, $244,509 for SNS vs NASHA/Dx, and $103,066 for SNS vs CT. The budget impact analysis evaluated the financial effect on the health care system of the use of NASHA/Dx and SNS. For the scenarios evaluated, when all of the patients receive NASHA/Dx, the net annual effect to the health care payer budget ranged from $571,455 to $2,857,275. When all of the patients receive SNS, the net annual effect to the health care payer budget ranged from $1,959,323 to $9,796,613. Both NASHA/Dx and SNS have produced significant improvements in FI symptoms for affected patients. NASHA/Dx is a cost-effective and more efficient use of resources for the treatment of FI when compared with SNS. The budget impact analysis suggests that although reimbursement for NASHA/Dx treatment initially adds costs to the health care system, it is significantly less expensive than SNS for patients who are candidates for either treatment. Copyright © 2014 The Authors. Published by EM Inc USA.. All rights reserved.

Using disease management and market reforms to address the adverse economic effects of drug budgets and price and reimbursement regulations in Germany.

PubMed

Schwermann, Tim; Greiner, Wolfgang; v d Schulenburg, J M Graf

2003-01-01

Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is per-capita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. This article describes and analyzes these governmental initiatives as well as other market reforms. Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.

Economic analysis and budget impact of clostridial collagenase ointment compared with medicinal honey for treatment of pressure ulcers in the US.

PubMed

Mearns, Elizabeth S; Liang, Michael; Limone, Brendan L; Gilligan, Adrienne M; Miller, Jeffrey D; Schaum, Kathleen D; Waycaster, Curtis R

2017-01-01

Pressure ulcer (PU) treatment poses significant clinical and economic challenges to health-care systems. The aim of this study was to assess the cost-effectiveness and budget impact of enzymatic debridement with clostridial collagenase ointment (CCO) compared with autolytic debridement with medicinal honey (MH) for PU treatment from a US payer/Medicare perspective in the hospital outpatient department setting. A cost-effectiveness analysis using a Markov model was developed using a 1-week cycle length across a 1-year time horizon. The three health states were inflammation/senescence, granulation/proliferation (ie, patients achieving 100% granulation), and epithelialization. Data sources included the US Wound Registry, Medicare fee schedules, and other published clinical and cost studies about PU treatment. In the base case analysis over a 1-year time horizon, CCO was the economically dominant strategy (ie, simultaneously conferring greater benefit at less cost). Patients treated with CCO experienced 22.7 quality-adjusted life weeks (QALWs) at a cost of $6,161 over 1 year, whereas MH patients experienced 21.9 QALWs at a cost of $7,149. Patients treated with CCO achieved 11.5 granulation weeks and 6.0 epithelization weeks compared with 10.6 and 4.4 weeks for MH, respectively. The number of clinic visits was 40.1 for CCO vs 43.4 for MH, and the number of debridements was 12.3 for CCO compared with 17.6 for MH. Probabilistic sensitivity analyses determined CCO dominant in 72% of 10,000 iterations and cost-effective in 91%, assuming a benchmark willingness-to-pay threshold of $50,000/quality-adjusted life year ($962/QALW). The budget impact analysis showed that for every 1% of patients shifted from MH to CCO, a cost savings of $9,883 over 1 year for a cohort of 1,000 patients was observed by the payer. The results of these economic analyses suggest that CCO is a cost-effective, economically dominant alternative to MH in the treatment of patients with PUs in the hospital outpatient department setting.

Cost analysis of the development and implementation of a spatial decision support system for malaria elimination in Solomon Islands.

PubMed

Marston, Luke; Kelly, Gerard C; Hale, Erick; Clements, Archie C A; Hodge, Andrew; Jimenez-Soto, Eliana

2014-08-18

The goal of malaria elimination faces numerous challenges. New tools are required to support the scale up of interventions and improve national malaria programme capacity to conduct detailed surveillance. This study investigates the cost factors influencing the development and implementation of a spatial decision support system (SDSS) for malaria elimination in the two elimination provinces of Isabel and Temotu, Solomon Islands. Financial and economic costs to develop and implement a SDSS were estimated using the Solomon Islands programme's financial records. Using an ingredients approach, verified by stakeholders and operational reports, total costs for each province were quantified. A budget impact sensitivity analysis was conducted to investigate the influence of variations in standard budgetary components on the costs and to identify potential cost savings. A total investment of US$ 96,046 (2012 constant dollars) was required to develop and implement the SDSS in two provinces (Temotu Province US$ 49,806 and Isabel Province US$ 46,240). The single largest expense category was for computerized equipment totalling approximately US$ 30,085. Geographical reconnaissance was the most expensive phase of development and implementation, accounting for approximately 62% of total costs. Sensitivity analysis identified different cost factors between the provinces. Reduced equipment costs would deliver a budget saving of approximately 10% in Isabel Province. Combined travel costs represented the greatest influence on the total budget in the more remote Temotu Province. This study provides the first cost analysis of an operational surveillance tool used specifically for malaria elimination in the South-West Pacific. It is demonstrated that the costs of such a decision support system are driven by specialized equipment and travel expenses. Such factors should be closely scrutinized in future programme budgets to ensure maximum efficiencies are gained and available resources are allocated effectively.

78 FR 70586 - Technical Support Document: Technical Update of the Social Cost of Carbon for Regulatory Impact...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-26

... OFFICE OF MANAGEMENT AND BUDGET Technical Support Document: Technical Update of the Social Cost of... Budget, Executive Office of the President. ACTION: Notice of availability and request for comments. SUMMARY: The Office of Management and Budget (OMB) requests comments on the Technical Support Document...

The Effects of Budget, Delegation, and Other Variables on the Future of School Nursing

ERIC Educational Resources Information Center

Tetuan, Theresa M.; Akagi, Cynthia G.

2004-01-01

The purpose of this exploratory research study was to survey Kansas school nurses to determine the impact of budget, delegation, and other variables on the future of school nursing. Issues of education and certification status, educational budget, delegation, school nurse-to-student ratio, number of school buildings assigned, Metropolitan…

Missan Surgical Hospital Under the Economic Support Fund Al Amarah, Iraq

DTIC Science & Technology

2009-07-16

budget shortages resulting from the reduction in crude oil prices will continue to impact the GOI’s ability to adequately equip, operate, and maintain...staff to operate and maintain the hospital. However, the reduction in oil prices resulted in budget shortages, which delayed the Iraqi funding...operating budget.” The recent fluctuation in oil prices has resulted in budget uncertainty for the GOI, including the funding of projects for the

Cost-Benefit Analysis of a Support Program for Nursing Staff.

PubMed

Moran, Dane; Wu, Albert W; Connors, Cheryl; Chappidi, Meera R; Sreedhara, Sushama K; Selter, Jessica H; Padula, William V

2017-04-27

A peer-support program called Resilience In Stressful Events (RISE) was designed to help hospital staff cope with stressful patient-related events. The aim of this study was to evaluate the impact of the RISE program by conducting an economic evaluation of its cost benefit. A Markov model with a 1-year time horizon was developed to compare the cost benefit with and without the RISE program from a provider (hospital) perspective. Nursing staff who used the RISE program between 2015 and 2016 at a 1000-bed, private hospital in the United States were included in the analysis. The cost of running the RISE program, nurse turnover, and nurse time off were modeled. Data on costs were obtained from literature review and hospital data. Probabilities of quitting or taking time off with or without the RISE program were estimated using survey data. Net monetary benefit (NMB) and budget impact of having the RISE program were computed to determine cost benefit to the hospital. Expected model results of the RISE program found a net monetary benefit savings of US $22,576.05 per nurse who initiated a RISE call. These savings were determined to be 99.9% consistent on the basis of a probabilistic sensitivity analysis. The budget impact analysis revealed that a hospital could save US $1.81 million each year because of the RISE program. The RISE program resulted in substantial cost savings to the hospital. Hospitals should be encouraged by these findings to implement institution-wide support programs for medical staff, based on a high demand for this type of service and the potential for cost savings.

Budget Impact of Introducing Linagliptin into Bosnia and Herzegovina Health Insurance Drug Reimbursement List in 2016-2018

PubMed Central

Catic, Tarik; Lekic, Lana; Zah, Vlad; Tabakovic, Vedad

2017-01-01

Introduction: Diabetes is reaching epidemiological scales worldwide. Beside health implications diabetes bears significant financial impact on health systems. Different treatment options aiming to prevent diabetes complications are available. Dipeptidyl-peptidase-IV (DPP-4) inhibitors like linagliptin are usually add-on therapy to metformin in order to achieve glycemic control. Expenditure for oral antidiabetic medicines in Bosnia and Herzegovina (B&H) is low accounting for only 2.53% of the total drug market expenditure. Linagliptin is not reimbursed in B&H mainly due to it’s perception of high cost medication. Aim: To assess budget impact (BI) of introducing linagliptin into health insurance reimbursement list in B&H through development of the budget impact model (BIM). Material and methods: Budget impact model was developed using Microsoft Excel 2010 based on current legislation and practice in B&H. Local epidemiology data and data on drug consumption from government reports in 2014 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with linagliptin reimbursed and compared. Results: Inclusion of linagliptin into reimbursement list in Canton Sarajevo and Canton Tuzla would have positive budget impact on national level of B&H resulting in total savings of 18,194€, 235,570€ and 699,472€, in 2016, 2017 and 2018, respectively. Conclusion: Introduction of linagliptin into reimbursement list would decrease total costs for DPP-4 inhibitors and is favorable for positive decision on reimbursement in B&H. Applying BIM in decision making would assure better allocation and planning of resources at any region or administrative level in B&H. PMID:29109662

Assessing the Value of Biosimilars: A Review of the Role of Budget Impact Analysis.

PubMed

Simoens, Steven; Jacobs, Ira; Popovian, Robert; Isakov, Leah; Shane, Lesley G

2017-10-01

Biosimilar drugs are highly similar to an originator (reference) biologic, with no clinically meaningful differences in terms of safety or efficacy. As biosimilars offer the potential for lower acquisition costs versus the originator biologic, evaluating the economic implications of the introduction of biosimilars is of interest. Budget impact analysis (BIA) is a commonly used methodology. This review of published BIAs of biosimilar fusion proteins and/or monoclonal antibodies identified 12 unique publications (three full papers and nine congress posters). When evaluated alongside professional guidance on conducting BIA, the majority of BIAs identified were generally in line with international recommendations. However, a lack of peer-reviewed journal articles and considerable shortcomings in the publications were identified. Deficiencies included a limited range of cost parameters, a reliance on assumptions for parameters such as uptake and drug pricing, a lack of expert validation, and a limited range of sensitivity analyses that were based on arbitrary ranges. The rationale for the methods employed, limitations of the BIA approach, and instructions for local adaptation often were inadequately discussed. To understand fully the potential economic impact and value of biosimilars, the impact of biosimilar supply, manufacturer-provided supporting services, and price competition should be included in BIAs. Alternative approaches, such as cost minimization, which requires evidence demonstrating similarity to the originator biologic, and those that integrate a range of economic assessment methods, are needed to assess the value of biosimilars.

Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries: A Cost-effectiveness Modeling Analysis.

PubMed

Paternina-Caicedo, Angel; De la Hoz-Restrepo, Fernando; Alvis-Guzmán, Nelson

2015-07-01

The competing choices of vaccination with either RV1 or RV5, the potential budget impact of vaccines on the EPI with different prices and new evidence make important an updated analysis for health decision makers in each country. The objective of this study is to assess cost-effectiveness of the monovalent and pentavalent rotavirus vaccines and impact on children deaths, inpatient and outpatient visits in 116 low and middle income countries that represent approximately 99% of rotavirus mortality. A decision tree model followed hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year averted, comparing no vaccination with either monovalent or pentavalent mass introduction. Vaccine price was assumed fixed for all world low-income and middle-income countries. Around 292,000 deaths, 3.34 million inpatient cases and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 54.7% of inpatient cases and 45.4% of deaths. Pentavalent vaccination would prevent 51.4% of inpatient cases and 41.1% of deaths. The vaccine was cost-effective in all world countries in the base-case scenario for both vaccines. Cost per disability-adjusted life-year averted in all selected countries was I$372 for monovalent, and I$453 for pentavalent vaccination. Rotavirus vaccine is cost-effective in most analyzed countries. Despite cost-effectiveness analysis is a useful tool for decision making in middle-income countries, for low-income countries health decision makers should also assess the impact of introducing either vaccine on local resources and budget impact analysis of vaccination.

The Budget and Economic Outlook: Fiscal Years 2001-2010

DTIC Science & Technology

2000-01-01

CONGRESS OF THE UNITED STATES CONGRESSIONAL BUDGET OFFICE The Budget and Economic Outlook: Fiscal Years 2001-2010 Debt Held by the Public Under...20000223 042 THE BUDGET AND ECONOMIC OUTLOOK: FISCAL YEARS 2001-2010 The Congress of the United States Congressional Budget Office NOTES...recommendations. The analysis of the economic outlook presented in Chapter 2 was prepared by the Macroeco- nomic Analysis Division under the direction

Personalization in the health care system: do personal health budgets have an impact on outcomes and cost?

PubMed

Jones, Karen; Forder, Julien; Caiels, James; Welch, Elizabeth; Glendinning, Caroline; Windle, Karen

2013-10-01

In England's National Health Service, personal health budgets are part of a growing trend to give patients more choice and control over how health care services are managed and delivered. The personal health budget programme was launched by the Department of Health in 2009, and a three-year independent evaluation was commissioned with the aim of identifying whether the initiative ensured better health- and care-related outcomes and at what cost when compared to conventional service delivery. The evaluation used a pragmatic controlled trial design to compare the outcomes and costs of patients selected to receive a personal health budget with those continuing with conventional support arrangements (control group). Just over 1000 individuals were recruited into the personal health budget group and 1000 into the control group in order to ensure sufficient statistical power, and followed for 12 months. The use of personal health budgets was associated with significant improvement in patients' care-related quality of life and psychological wellbeing at 12 months. Personal health budgets did not appear to have an impact on health status, mortality rates, health-related quality of life or costs over the same period. With net benefits measured in terms of care-related quality of life on the adult social care outcome toolkit measure, personal health budgets were cost-effective: that is, budget holders experienced greater benefits than people receiving conventional services, and the budgets were worth the cost. The evaluation provides support for the planned wider roll-out of personal health budgets in the English NHS after 2014 in so far as the localities in the pilot sample are representative of the whole country.

Federal Budget Analysis on Children's Social Services Programs. FY 1985.

ERIC Educational Resources Information Center

Capitol Publications, Inc., Arlington, VA.

To help subscribers better understand the federal budget, the editorial staff of "Report on Preschool Programs" has prepared this special analysis of the fiscal 1985 budget. The first section presents an overview of President Reagan's fiscal 1985 budget request and reports congressional reactions. Information focuses on the Social…

The University Corporatization Shift: A Longitudinal Analysis of University Admission Handbooks, 1980 to 2010

ERIC Educational Resources Information Center

Davidson, Cliff

2015-01-01

This paper explores university corporatization and its impact on university literature, examining the frequency and placement of content in the admissions handbooks (viewbooks) of six Ontario universities from 1980 to 2010, at five-year intervals. Government budget cuts implemented in the mid-1990s served as a point of interest in the timing of…

Office of Strategic Programs FY 2017 Budget At-A-Glance

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2016-03-01

The Office of Strategic Programs (OSP) increases the overall effectiveness and impact of all EERE activities through key cross-cutting initiatives and strategic analysis, communications, and technology-to-market activities. OSP’s work directly contributes to EERE’s mission, facilitates and amplifies the successes of EERE technology offices, and soundly and consistently informs the Assistant Secretary’s decisions.

Methods for Sexually Transmitted Disease Prevention Programs to Estimate the Health and Medical Cost Impact of Changes in Their Budget.

PubMed

Chesson, Harrell W; Ludovic, Jennifer A; Berruti, Andrés A; Gift, Thomas L

2018-01-01

The purpose of this article was to describe methods that sexually transmitted disease (STD) programs can use to estimate the potential effects of changes in their budgets in terms of disease burden and direct medical costs. We proposed 2 distinct approaches to estimate the potential effect of changes in funding on subsequent STD burden, one based on an analysis of state-level STD prevention funding and gonorrhea case rates and one based on analyses of the effect of Disease Intervention Specialist (DIS) activities on gonorrhea case rates. We also illustrated how programs can estimate the impact of budget changes on intermediate outcomes, such as partner services. Finally, we provided an example of the application of these methods for a hypothetical state STD prevention program. The methods we proposed can provide general approximations of how a change in STD prevention funding might affect the level of STD prevention services provided, STD incidence rates, and the direct medical cost burden of STDs. In applying these methods to a hypothetical state, a reduction in annual funding of US $200,000 was estimated to lead to subsequent increases in STDs of 1.6% to 3.6%. Over 10 years, the reduction in funding totaled US $2.0 million, whereas the cumulative, additional direct medical costs of the increase in STDs totaled US $3.7 to US $8.4 million. The methods we proposed, though subject to important limitations, can allow STD prevention personnel to calculate evidence-based estimates of the effects of changes in their budget.

Comparison of vials and prefilled pens of a rapid-acting insulin analog on pharmacy budgets in a long-term care setting.

PubMed

Eby, Elizabeth L; Smolen, Lee J; Pitts, Amber C; Krueger, Linda A; Andrews, Jeffrey Scott

2014-12-01

Estimate budgetary impact for skilled nursing facility converting from individual patient supply (IPS) delivery of rapid-acting insulin analog (RAIA) 10-mL vials or 3-mL prefilled pens to 3-mL vials. A budget-impact model used insulin volume purchased and assumptions of length of stay (LOS), daily RAIA dose, and delivery protocol to estimate the cost impact of using 3-mL vials. Skilled nursing facility. Medicare Part A patients. Simulations conducted using 12-month current and future scenarios. Comparisons of RAIA use for 13- and 28-day LOS. RAIA costs and savings, waste reduction. For patients with 13-day LOS using 20 units/day of IPS insulin, the model estimated a 70% reduction in RAIA costs and units purchased and a 95% waste reduction for the 3-mL vial compared with the 10-mL vial. The estimated costs for prefilled pen use were 58% lower than for use of 10-mL vials. The incremental savings associated with 3-mL vial use instead of prefilled pens was 28%, attributable to differences in per-unit cost of insulin in vials versus prefilled pens. Using a more conservative scenario of 28-day LOS at 20 units/day, the model estimated a 40% reduction in RAIA costs and units purchased, resulting in a 91% reduction in RAIA waste for the 3-mL vial, compared with 10-mL vial. Budget-impact analysis of conversion from RAIA 10-mL vials or 3-mL prefilled pens to 3-mL vials estimated reductions in both insulin costs and waste across multiple scenarios of varying LOS and patient daily doses for skilled nursing facility stays.

Budget impact analysis-principles of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force.

PubMed

Sullivan, Sean D; Mauskopf, Josephine A; Augustovski, Federico; Jaime Caro, J; Lee, Karen M; Minchin, Mark; Orlewska, Ewa; Penna, Pete; Rodriguez Barrios, Jose-Manuel; Shau, Wen-Yi

2014-01-01

Budget impact analyses (BIAs) are an essential part of a comprehensive economic assessment of a health care intervention and are increasingly required by reimbursement authorities as part of a listing or reimbursement submission. The objective of this report was to present updated guidance on methods for those undertaking such analyses or for those reviewing the results of such analyses. This update was needed, in part, because of developments in BIA methods as well as a growing interest, particularly in emerging markets, in matters related to affordability and population health impacts of health care interventions. The Task Force was approved by the International Society for Pharmacoeconomics and Outcomes Research Health Sciences Policy Council and appointed by its Board of Directors. Members were experienced developers or users of BIAs; worked in academia and industry and as advisors to governments; and came from several countries in North America and South America, Oceania, Asia, and Europe. The Task Force solicited comments on the drafts from a core group of external reviewers and, more broadly, from the membership of the International Society for Pharmacoeconomics and Outcomes Research. The Task Force recommends that the design of a BIA for a new health care intervention should take into account relevant features of the health care system, possible access restrictions, the anticipated uptake of the new intervention, and the use and effects of the current and new interventions. The key elements of a BIA include estimating the size of the eligible population, the current mix of treatments and the expected mix after the introduction of the new intervention, the cost of the treatment mixes, and any changes expected in condition-related costs. Where possible, the BIA calculations should be performed by using a simple cost calculator approach because of its ease of use for budget holders. In instances, however, in which the changes in eligible population size, disease severity mix, or treatment patterns cannot be credibly captured by using the cost calculator approach, a cohort or patient-level condition-specific model may be used to estimate the budget impact of the new intervention, accounting appropriately for those entering and leaving the eligible population over time. In either case, the BIA should use data that reflect values specific to a particular decision maker's population. Sensitivity analysis should be of alternative scenarios chosen from the perspective of the decision maker. The validation of the model should include at least face validity with decision makers and verification of the calculations. Data sources for the BIA should include published clinical trial estimates and comparator studies for the efficacy and safety of the current and new interventions as well as the decision maker's own population for the other parameter estimates, where possible. Other data sources include the use of published data, well-recognized local or national statistical information, and, in special circumstances, expert opinion. Reporting of the BIA should provide detailed information about the input parameter values and calculations at a level of detail that would allow another modeler to replicate the analysis. The outcomes of the BIA should be presented in the format of interest to health care decision makers. In a computer program, options should be provided for different categories of costs to be included or excluded from the analysis. We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and offer a common reporting format that will promote standardization and transparency. Adherence to these good research practice principles would not necessarily supersede jurisdiction-specific BIA guidelines but may support and enhance local recommendations or serve as a starting point for payers wishing to promulgate methodology guidelines. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

Economic Analysis: An Approach to Provide Basic Guidance for Conducting and Reviewing Economic Analysis within the Venezuelan Navy.

DTIC Science & Technology

1986-06-01

la Armada (EMGAR)-- Staff of the Navy ------------------------- 18 b. Direction de Presupuesto Programac ion Ecomica (DIPPE)-Direction of Budget and...Economic Programming -------------------- 18 c. Cornite De Programacion y Presupuesto (CPP)-- Programming and Budget Committee-----------18 3. Major...development. This analysis is included in the annual budget. b. Direction de Presupuesto Programaclon Ecomica (DIPPE)- Direction of Budget and Economic

Exploring the impact of network tariffs on household electricity expenditures using load profiles and socio-economic characteristics

NASA Astrophysics Data System (ADS)

Azarova, Valeriya; Engel, Dominik; Ferner, Cornelia; Kollmann, Andrea; Reichl, Johannes

2018-04-01

Growing self-generation and storage are expected to cause significant changes in residential electricity utilization patterns. Commonly applied volumetric network tariffs may induce imbalance between different groups of households and their respective contribution to recovering the operating costs of the grid. Understanding consumer behaviour and appliance usage together with socio-economic factors can help regulatory authorities to adapt network tariffs to new circumstances in a fair way. Here, we assess the effects of 11 network tariff scenarios on household budgets using real load profiles from 765 households. Thus we explore the possibly disruptive impact of applying peak-load-based tariffs on the budgets of households when they have been mainly charged for consumed volumes before. Our analysis estimates the change in household network expenditure for different combinations of energy, peak and fixed charges, and can help to design tariffs that recover the costs needed for the sustainable operation of the grid.

Budget Impact Analysis of Afatinib for First-Line Treatment of Patients with Metastatic Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor Exon 19 Deletions or Exon 21 Substitution Mutations in a U.S. Health Plan.

PubMed

Graham, Jonathan; Earnshaw, Stephanie; Burslem, Kate; Lim, Jonathan

2018-06-01

Afatinib is 1 of 3 tyrosine kinase inhibitors approved in the United States for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) exon 19 deletions (del19) or exon 21 (L858R) substitution mutations. In clinical trials, afatinib has demonstrated improvement in progression-free survival versus standard chemotherapy and gefitinib. To analyze the impact of increases in afatinib treatment share on the cost and health outcomes in a commercial health plan in the United States. A decision model was developed to evaluate the budget impact of increases in afatinib share for the first-line treatment of patients with metastatic NSCLC with EGFR del19 or L858R substitution mutations over a 5-year time horizon. The model compared the total annual costs for a health plan with 1 million covered lives in a scenario in which afatinib share increased 5 percentage points annually to one in which all treatment shares remained constant over time. The number of patients eligible for treatment was estimated using published incidence data. Therapies included in the model were afatinib, erlotinib, gefitinib, and the chemotherapy doublet, pemetrexed in combination with cisplatin. The mean time spent by patients in progression-free and progressive disease states was based on survival data from clinical trials and a network meta-analysis. Therapy-related costs included monthly drug acquisition and administration costs and costs of managing adverse reactions. Disease management costs were also assessed in the model. Scenario analyses were performed to assess alternative scenarios of afatinib treatment share. Additionally, a one-way sensitivity analysis was performed to test the robustness of the model, given parameter uncertainty. Using the base-case parameter assumptions and a 5-percentage-point annual increase in afatinib treatment share, we estimated the total budget increases in years 1 through 5 to be $1,606, $65,542, $140,564, $209,272, and $303,368, respectively. These budget increases translated to per-member-per-month increases ranging from $0.00 to $0.03 in years 1 to 5. The increase in afatinib use resulted in the proportion of the treated population (134 patients treated over 5 years) remaining in progression-free disease increasing from 23.7% to 26.2% at the end of year 5, versus if afatinib treatment share had stayed constant. Increasing the treatment share of afatinib in a health plan for the first-line treatment of NSCLC with EGFR del19 or L858R mutations was estimated to increase the proportion of treated patients remaining in progression-free disease, while having small budget impact to the health plan. Boehringer Ingelheim Pharmaceuticals funded this study research and was involved in all stages of study conduct, including the analysis of data, and also undertook all costs associated with the development and publication of this manuscript. Graham and Earnshaw are employees of RTI Health Solutions, an independent contract research organization that has received research funding for this and other studies from Boehringer Ingelheim Pharmaceuticals. Lim and Burslem are employees of Boehringer Ingelheim Pharmaceuticals, which developed and produces afatinib, along with other pharmaceutical products.

Size, Stability and Incremental Budgeting Outcomes in Public Universities.

ERIC Educational Resources Information Center

Schick, Allen G.; Hills, Frederick S.

1982-01-01

Examined the influence of relative size in the analysis of total dollar and workforce budgets, and changes in total dollar and workforce budgets when correlational/regression methods are used. Data suggested that size dominates the analysis of total budgets, and is not a factor when discretionary dollar increments are analyzed. (JAC)

Estimating the budget impact of orphan medicines in Europe: 2010 - 2020.

PubMed

Schey, Carina; Milanova, Tsveta; Hutchings, Adam

2011-09-27

Orphan drugs are a growing issue of importance to European healthcare policy makers. The success of orphan drug legislation in Europe has resulted in an increasing number of licensed medicines for rare diseases, and many more yet unlicensed products have received orphan drug designation. Increasingly the concerns amongst policy makers relate to issues of patient access and affordability, yet few studies have sought to estimate the future budget impact of orphan drugs. The aim of this study was to predict the total cost of orphan medicines in Europe between 2010 and 2020 as a percentage of total European pharmaceutical expenditure. A disease-based epidemiological model was created based upon trends in the designation and approval of new orphan medicines, prevalence estimates for orphan diseases, and historical price and sales data for orphan drugs in Europe (defined as Eurozone + UK). The analysis incorporated two stages: 1) Predicting the number of diseases for which new orphan drugs will be approved over the next decade, based on an analysis of trends from the EU registry of orphan medicines; 2) Estimating the average ex-factory drug cost across an orphan disease life cycle, from the year in which the first orphan medicine is launched to the point where the first medicine loses marketing exclusivity. The two sets of information were combined to quantify the annual cost of orphan drugs from 2010 through 2020. The results from the model predicted a steady increase in the cumulative number of diseases for which an orphan drug is approved, averaging just over 5 new diseases per year over the next 10 years. The annual per patient cost of existing orphan drugs was seen to vary between €1,251 and €407,631, with the median cost being €32,242 per year. The share of the total pharmaceutical market represented by orphan drugs is predicted to increase from 3.3% in 2010 to a peak of 4.6% in 2016 after which it is expected to level off through 2020, as growth falls into line with that in the wider pharmaceutical market. In sensitivity analysis peak-year orphan drug budget impact ranged between 3% - 6.6%. Although European orphan drug legislation has led to an increase in the number of approved orphan drugs, the growth in cost, as a proportion of total pharmaceutical expenditure, is likely to plateau over the next decade as orphan growth rates converge on those in the broader pharmaceutical market. Given the assumptions and simplifications inherent in such a projection, there is uncertainty around the base case forecast and further research is needed to monitor how trends develop. However, fears that growth in orphan drug expenditure will lead to unsustainable cost escalation do not appear to be justified. Furthermore, based on the results of this budget impact forecast, the European orphan drug legislation is not leading to a disproportionate impact on pharmaceutical expenditure.

Estimating the budget impact of orphan medicines in Europe: 2010 - 2020

PubMed Central

2011-01-01

Background Orphan drugs are a growing issue of importance to European healthcare policy makers. The success of orphan drug legislation in Europe has resulted in an increasing number of licensed medicines for rare diseases, and many more yet unlicensed products have received orphan drug designation. Increasingly the concerns amongst policy makers relate to issues of patient access and affordability, yet few studies have sought to estimate the future budget impact of orphan drugs. The aim of this study was to predict the total cost of orphan medicines in Europe between 2010 and 2020 as a percentage of total European pharmaceutical expenditure. Methods A disease-based epidemiological model was created based upon trends in the designation and approval of new orphan medicines, prevalence estimates for orphan diseases, and historical price and sales data for orphan drugs in Europe (defined as Eurozone + UK). The analysis incorporated two stages: 1) Predicting the number of diseases for which new orphan drugs will be approved over the next decade, based on an analysis of trends from the EU registry of orphan medicines; 2) Estimating the average ex-factory drug cost across an orphan disease life cycle, from the year in which the first orphan medicine is launched to the point where the first medicine loses marketing exclusivity. The two sets of information were combined to quantify the annual cost of orphan drugs from 2010 through 2020. Results The results from the model predicted a steady increase in the cumulative number of diseases for which an orphan drug is approved, averaging just over 5 new diseases per year over the next 10 years. The annual per patient cost of existing orphan drugs was seen to vary between €1,251 and €407,631, with the median cost being €32,242 per year. The share of the total pharmaceutical market represented by orphan drugs is predicted to increase from 3.3% in 2010 to a peak of 4.6% in 2016 after which it is expected to level off through 2020, as growth falls into line with that in the wider pharmaceutical market. In sensitivity analysis peak-year orphan drug budget impact ranged between 3% - 6.6%. Conclusions Although European orphan drug legislation has led to an increase in the number of approved orphan drugs, the growth in cost, as a proportion of total pharmaceutical expenditure, is likely to plateau over the next decade as orphan growth rates converge on those in the broader pharmaceutical market. Given the assumptions and simplifications inherent in such a projection, there is uncertainty around the base case forecast and further research is needed to monitor how trends develop. However, fears that growth in orphan drug expenditure will lead to unsustainable cost escalation do not appear to be justified. Furthermore, based on the results of this budget impact forecast, the European orphan drug legislation is not leading to a disproportionate impact on pharmaceutical expenditure. PMID:21951518

Global volcanic emissions: budgets, plume chemistry and impacts

NASA Astrophysics Data System (ADS)

Mather, T. A.

2012-12-01

Over the past few decades our understanding of global volcanic degassing budgets, plume chemistry and the impacts of volcanic emissions on our atmosphere and environment has been revolutionized. Global volcanic emissions budgets are needed if we are to make effective use of regional and global atmospheric models in order to understand the consequences of volcanic degassing on global environmental evolution. Traditionally volcanic SO2 budgets have been the best constrained but recent efforts have seen improvements in the quantification of the budgets of other environmentally important chemical species such as CO2, the halogens (including Br and I) and trace metals (including measurements relevant to trace metal atmospheric lifetimes and bioavailability). Recent measurements of reactive trace gas species in volcanic plumes have offered intriguing hints at the chemistry occurring in the hot environment at volcanic vents and during electrical discharges in ash-rich volcanic plumes. These reactive trace species have important consequences for gas plume chemistry and impacts, for example, in terms of the global fixed nitrogen budget, volcanically induced ozone destruction and particle fluxes to the atmosphere. Volcanically initiated atmospheric chemistry was likely to have been particularly important before biological (and latterly anthropogenic) processes started to dominate many geochemical cycles, with important consequences in terms of the evolution of the nitrogen cycle and the role of particles in modulating the Earth's climate. There are still many challenges and open questions to be addressed in this fascinating area of science.

An Economic Evaluation of Neonatal Screening for Inborn Errors of Metabolism Using Tandem Mass Spectrometry in Thailand.

PubMed

Thiboonboon, Kittiphong; Leelahavarong, Pattara; Wattanasirichaigoon, Duangrurdee; Vatanavicharn, Nithiwat; Wasant, Pornswan; Shotelersuk, Vorasuk; Pangkanon, Suthipong; Kuptanon, Chulaluck; Chaisomchit, Sumonta; Teerawattananon, Yot

2015-01-01

Inborn errors of metabolism (IEM) are a rare group of genetic diseases which can lead to several serious long-term complications in newborns. In order to address these issues as early as possible, a process called tandem mass spectrometry (MS/MS) can be used as it allows for rapid and simultaneous detection of the diseases. This analysis was performed to determine whether newborn screening by MS/MS is cost-effective in Thailand. A cost-utility analysis comprising a decision-tree and Markov model was used to estimate the cost in Thai baht (THB) and health outcomes in life-years (LYs) and quality-adjusted life year (QALYs) presented as an incremental cost-effectiveness ratio (ICER). The results were also adjusted to international dollars (I$) using purchasing power parities (PPP) (1 I$ = 17.79 THB for the year 2013). The comparisons were between 1) an expanded neonatal screening programme using MS/MS screening for six prioritised diseases: phenylketonuria (PKU); isovaleric acidemia (IVA); methylmalonic acidemia (MMA); propionic acidemia (PA); maple syrup urine disease (MSUD); and multiple carboxylase deficiency (MCD); and 2) the current practice that is existing PKU screening. A comparison of the outcome and cost of treatment before and after clinical presentations were also analysed to illustrate the potential benefit of early treatment for affected children. A budget impact analysis was conducted to illustrate the cost of implementing the programme for 10 years. The ICER of neonatal screening using MS/MS amounted to 1,043,331 THB per QALY gained (58,647 I$ per QALY gained). The potential benefits of early detection compared with late detection yielded significant results for PKU, IVA, MSUD, and MCD patients. The budget impact analysis indicated that the implementation cost of the programme was expected at approximately 2,700 million THB (152 million I$) over 10 years. At the current ceiling threshold, neonatal screening using MS/MS in the Thai context is not cost-effective. However, the treatment of patients who were detected early for PKU, IVA, MSUD, and MCD, are considered favourable. The budget impact analysis suggests that the implementation of the programme will incur considerable expenses under limited resources. A long-term epidemiological study on the incidence of IEM in Thailand is strongly recommended to ascertain the magnitude of problem.

An Economic Evaluation of Neonatal Screening for Inborn Errors of Metabolism Using Tandem Mass Spectrometry in Thailand

PubMed Central

Thiboonboon, Kittiphong; Leelahavarong, Pattara; Wattanasirichaigoon, Duangrurdee; Vatanavicharn, Nithiwat; Wasant, Pornswan; Shotelersuk, Vorasuk; Pangkanon, Suthipong; Kuptanon, Chulaluck; Chaisomchit, Sumonta; Teerawattananon, Yot

2015-01-01

Background Inborn errors of metabolism (IEM) are a rare group of genetic diseases which can lead to several serious long-term complications in newborns. In order to address these issues as early as possible, a process called tandem mass spectrometry (MS/MS) can be used as it allows for rapid and simultaneous detection of the diseases. This analysis was performed to determine whether newborn screening by MS/MS is cost-effective in Thailand. Method A cost-utility analysis comprising a decision-tree and Markov model was used to estimate the cost in Thai baht (THB) and health outcomes in life-years (LYs) and quality-adjusted life year (QALYs) presented as an incremental cost-effectiveness ratio (ICER). The results were also adjusted to international dollars (I$) using purchasing power parities (PPP) (1 I$ = 17.79 THB for the year 2013). The comparisons were between 1) an expanded neonatal screening programme using MS/MS screening for six prioritised diseases: phenylketonuria (PKU); isovaleric acidemia (IVA); methylmalonic acidemia (MMA); propionic acidemia (PA); maple syrup urine disease (MSUD); and multiple carboxylase deficiency (MCD); and 2) the current practice that is existing PKU screening. A comparison of the outcome and cost of treatment before and after clinical presentations were also analysed to illustrate the potential benefit of early treatment for affected children. A budget impact analysis was conducted to illustrate the cost of implementing the programme for 10 years. Results The ICER of neonatal screening using MS/MS amounted to 1,043,331 THB per QALY gained (58,647 I$ per QALY gained). The potential benefits of early detection compared with late detection yielded significant results for PKU, IVA, MSUD, and MCD patients. The budget impact analysis indicated that the implementation cost of the programme was expected at approximately 2,700 million THB (152 million I$) over 10 years. Conclusion At the current ceiling threshold, neonatal screening using MS/MS in the Thai context is not cost-effective. However, the treatment of patients who were detected early for PKU, IVA, MSUD, and MCD, are considered favourable. The budget impact analysis suggests that the implementation of the programme will incur considerable expenses under limited resources. A long-term epidemiological study on the incidence of IEM in Thailand is strongly recommended to ascertain the magnitude of problem. PMID:26258410

Proceedings of a Workshop on Polar Stratospheric Clouds: Their Role in Atmospheric Processes

NASA Technical Reports Server (NTRS)

Hamill, P. (Editor); Mcmaster, L. R. (Editor)

1984-01-01

The potential role of polar stratospheric clouds in atmospheric processes was assessed. The observations of polar stratospheric clouds with the Nimbus 7 SAM II satellite experiment were reviewed and a preliminary analysis of their formation, impact on other remote sensing experiments, and potential impact on climate were presented. The potential effect of polar stratospheric clouds on climate, radiation balance, atmospheric dynamics, stratospheric chemistry and water vapor budget, and cloud microphysics was assessed. Conclusions and recommendations, a synopsis of materials and complementary material to support those conclusions and recommendations are presented.

Revisiting global mean sea level budget closure : Preliminary results from an integrative study within ESA's Climate Change Initiative -Sea level Budget Closure-Climate Change Initiative

NASA Astrophysics Data System (ADS)

Palanisamy, H.; Cazenave, A. A.

2017-12-01

The global mean sea level budget is revisited over two time periods: the entire altimetry era, 1993-2015 and the Argo/GRACE era, 2003-2015 using the version '0' of sea level components estimated by the SLBC-CCI teams. The SLBC-CCI is an European Space Agency's project on sea level budget closure using CCI products. Over the entire altimetry era, the sea level budget was performed as the sum of steric and mass components that include contributions from total land water storage, glaciers, ice sheets (Greenland and Antarctica) and total water vapor content. Over the Argo/GRACE era, it was performed as the sum of steric and GRACE based ocean mass. Preliminary budget analysis performed over the altimetry era (1993-2015) results in a trend value of 2.83 mm/yr. On comparison with the observed altimetry-based global mean sea level trend over the same period (3.03 ± 0.5 mm/yr), we obtain a residual of 0.2 mm/yr. In spite of a residual of 0.2 mm/yr, the sea level budget result obtained over the altimetry era is very promising as this has been performed using the version '0' of the sea level components. Furthermore, uncertainties are not yet included in this study as uncertainty estimation for each sea level component is currently underway. Over the Argo/GRACE era (2003-2015), the trend estimated from the sum of steric and GRACE ocean mass amounts to 2.63 mm/yr while that observed by satellite altimetry is 3.37 mm/yr, thereby leaving a residual of 0.7 mm/yr. Here an ensemble GRACE ocean mass data (mean of various available GRACE ocean mass data) was used for the estimation. Using individual GRACE data results in a residual range of 0.5 mm/yr -1.1 mm/yr. Investigations are under way to determine the cause of the vast difference between the observed sea level and the sea level obtained from steric and GRACE ocean mass. One main suspect is the impact of GRACE data gaps on sea level budget analysis due to lack of GRACE data over several months since 2011. The current action plan of the project is to work on an accurate closure of the sea level budget using both the above performed methodologies. We also intend to provide a standardized uncertainty estimation and to correctly identify the causes leading to sea level budget non-closure if that is the case.

Pembrolizumab as second-line therapy in non-small cell lung cancer in northern Norway: budget impact and expected gain—a model-based analysis

PubMed Central

Norum, Jan; Antonsen, Margareth Aarag; Tollåli, Terje; Al-Shibli, Khalid; Andersen, Gry; Svanqvist, Kristin Helene; Helbekkmo, Nina

2017-01-01

Background Pembrolizumab is a new drug approved in several countries for second-line therapy in non-small cell lung cancer (NSCLC) being programmed cell death ligand (PD-L1) positive. This drug has a high cost, and the cost-effectiveness ratio has been debated. Patients and methods The budget impact to the Northern Norwegian Regional Health Authority trust of implementing pembrolizumab in second-line therapy in patients with PD-L1-positive NSCLC was calculated. A model was developed employing data from the Cancer Registry of Norway, the KEYNOTE-010 study, the price list from The Hospital Pharmacy of North Norway, the cost of analysing PD-L1 expression and the cost of travelling. Today’s cost of second-line therapy was compared with the new standard employing pembrolizumab. The sale price of pembrolizumab in Norway was not published due to price confidentiality. Norwegian krone (NKr) was converted into Euros (€) at a rate of 1€=Nkr 8.8138. (Bank of Norway, 21 February 2017). Results 105 new patients were identified available for pembrolizumab per year. The annual cost of pembrolizumab was €5.2 million, hospital pharmacy administration costs €0.1 million, PD-L1 testing €0.3 million, oncologist/pulmonologist/nurses €0.2 million, radiology €0.06 million and transportation €0.4 million. Savings due to avoided present second-line therapy was calculated €0.4 million. Consequently, the cost of implementing pembrolizumab was €5.5 million and the annual budget impact was €5.0 million. A mean gain of at least 9 months per patient treated was necessary to make pembrolizumab cost-effective. Conclusions The net budget impact of pembrolizumab was €5.0 million. The expenditure could not be indicated cost-effective. Price confidentiality is a growing problem in health economics and it has become a ‘menu without prices’ setting. PMID:29209527

Developing the knowledge base about carers and personalisation: contributions made by an exploration of carers' perspectives on personal budgets and the carer-service user relationship.

PubMed

Larkin, Mary

2015-01-01

This qualitative study aimed to explore an under-researched issue within the emerging body of research about carers and personalisation - the carer-service user relationship. It was carried out across 11 English local authorities between 2011 and 2012 and focused on the impact of a change in the service user's social care arrangements to a personal budget on this relationship. Using purposive sampling and explicit inclusion criteria, data were gathered through semi-structured in-depth interviews with 23 carers in long-term dyadic relationships with an adult in receipt of social care who had changed to a personal budget. The interviews explored carers' perceptions of the carer-service user relationship before and after the advent of the personal budget and changes that had occurred. The findings were thematically analysed and reflect the fact that in addition to the effects of the move to a personal budget on the carer-service user relationship, the interviewees talked at length about a range of other effects of this move. Just over half of those interviewed felt that the personal budget had enhanced the carer-service user relationship. The other effects were both positive and negative. Three quarters reported positive outcomes, such as feeling happier, healthier and having more control over their lives. Although two thirds experienced negative feelings about having less involvement in the service user's care, these feelings eased over time and if they had confidence in the quality of the care. Over half found administering the personal budget stressful. Further analysis of these findings showed the study contributes not only to existing knowledge about the carer-service user relationship within personalisation but also to knowledge about the effects of personalisation on carers more generally. It therefore simultaneously develops the emergent knowledge base about carers and personalisation. Recommendations based on this analysis are made about future practice and research. © 2014 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

The sensitivity to land use and climate variations in the whitewater river basin, kansas, USA: Closing the water budget using groundwater models

NASA Astrophysics Data System (ADS)

Beeson, P.; Duffy, C.; Springer, E.

2003-04-01

A water budget was developed using groundwater models to assess the impact of land use and climate variability on the Whitewater River Basin located in southeastern Kansas within the ARM-SGP as part of the DOE Water Cycle Pilot Study. The Whitewater River Basin has an area of 1,100 km2, an elevation range of 380 - 470 m above mean sea level, and an average annual precipitation of 858 mm. Time series and geospatial analysis are used to identify significant spatial structure and dominant temporal modes in the watershed runoff and groundwater response. Space-time analyses confirmed the hydrogeologic conceptual model developed from the hydrostratigraphic information provided by existing geologic studies and over 2,000 wells located in the area. The groundwater-surface water interactions are identified by time series analysis of stream discharge, precipitation, temperature, and water levels in wells. Singular spectrum analysis suggests a two layer leaky perched system with strong influences of daily, monthly, seasonal, and interannual oscillations. The geospatial analysis identifies the important length scales and the time series analysis the corresponding time scales, which must be incorporated in the model. The fine scale layering, which creates the perched leaky top layer, was represented by using an anisotropy ratio. This ratio was determined from select well data to be 100 (Kh/Kv), by calculating the vertical conductivity from harmonic mean and horizontal conductivity from arithmetic mean. MODFLOW is used to assess the importance of groundwater when attempting to close the water budget. The R-squared value between MODFLOW predicted and observed head values for the watershed was 0.85 indicating a good fit. Mean recharge was estimated to be approximately 17 percent of total annual precipitation. The approach presented here is an initial attempt to examine the importance of groundwater in the water budget of a relatively small river basin.

The relationship between budget allocated and budget utilized of faculties in an academic institution

NASA Astrophysics Data System (ADS)

Aziz, Wan Noor Hayatie Wan Abdul; Aziz, Rossidah Wan Abdul; Shuib, Adibah; Razi, Nor Faezah Mohamad

2014-06-01

Budget planning enables an organization to set priorities towards achieving certain goals and to identify the highest priorities to be accomplished with the available funds, thus allowing allocation of resources according to the set priorities and constraints. On the other hand, budget execution and monitoring enables allocated funds or resources to be utilized as planned. Our study concerns with investigating the relationship between budget allocation and budget utilization of faculties in a public university in Malaysia. The focus is on the university's operations management financial allocation and utilization based on five categories which are emolument expenditure, academic or services and supplies expenditure, maintenance expenditure, student expenditure and others expenditure. The analysis on financial allocation and utilization is performed based on yearly quarters. Data collected include three years faculties' budget allocation and budget utilization performance involving a sample of ten selected faculties of a public university in Malaysia. Results show that there are positive correlation and significant relationship between quarterly budget allocation and quarterly budget utilization. This study found that emolument give the highest contribution to the total allocation and total utilization for all quarters. This paper presents some findings based on statistical analysis conducted which include descriptive statistics and correlation analysis.

Public Health and Budget Impact of Probiotics on Common Respiratory Tract Infections: A Modelling Study

PubMed Central

Lenoir-Wijnkoop, Irene; Gerlier, Laetitia; Bresson, Jean-Louis; Le Pen, Claude; Berdeaux, Gilles

2015-01-01

Objectives Two recent meta-analyses by the York Health Economics Consortium (YHEC) and Cochrane demonstrated probiotic efficacy in reducing the duration and number of common respiratory tract infections (CRTI) and associated antibiotic prescriptions. A health-economic analysis was undertaken to estimate the public health and budget consequences of a generalized probiotic consumption in France. Methods A virtual age- and gender-standardized population was generated using a Markov microsimulation model. CRTI risk factors incorporated into this model were age, active/passive smoking and living in a community setting. Incidence rates and resource utilization were based on the 2011-2012 flu season and retrieved from the French GPs Sentinelles network. Results of both meta-analyses were independently applied to the French population to estimate CRTI events, assuming a generalized probiotic use compared to no probiotics during winter months: -0.77 days/CRTI episode (YHEC scenario) or odds-ratio 0.58 for ≥1 CRTI episode (Cochrane scenario) with vs. without probiotics. Economic perspectives were National Health System (NHS), society, family. Outcomes included cost savings related to the reduced numbers of CRTI episodes, days of illness, number of antibiotic courses, sick leave days, medical and indirect costs. Results For France, generalized probiotic use would save 2.4 million CRTI-days, 291,000 antibiotic courses and 581,000 sick leave days, based on YHEC data. Applying the Cochrane data, reductions were 6.6 million CRTI days, 473,000 antibiotic courses and 1.5 million sick days. From the NHS perspective, probiotics’ economic impact was about €14.6 million saved according to YHEC and €37.7 million according to Cochrane. Higher savings were observed in children, active smokers and people with more frequent human contacts. Conclusions Public health and budget impact of probiotics are substantial, whether they reduce CRTI episodes frequency or duration. Noteworthy, the 2011-12 winter CRTI incidence was low and this analysis focused on the fraction of CRTI patients consulting a practitioner. PMID:25859849

Department of Defense Laboratory Civilian Science and Engineering Workforce - 2013

DTIC Science & Technology

2013-10-01

was completed by the Institute for Defense Analysis (IDA) in 20091 with an update prepared by the Defense Laboratories Office (DLO) in 2011. By...demographics will emerge giving decision- and policy-makers greater clarity about the impacts of budgets and macro scale policies on this important...Physiology 819 Environmental Engineering 1382 Food Technology 414 Entomology 830 Mechanical Engineering 1384 Textile Technology 415 Toxicology 840

Comparison of modeling approaches for carbon partitioning: Impact on estimates of global net primary production and equilibrium biomass of woody vegetation from MODIS GPP

Treesearch

Takeshi Ise; Creighton M. Litton; Christian P. Giardina; Akihiko Ito

2010-01-01

Partitioning of gross primary production (GPP) to aboveground versus belowground, to growth versus respiration, and to short versus long�]lived tissues exerts a strong influence on ecosystem structure and function, with potentially large implications for the global carbon budget. A recent meta-analysis of forest ecosystems suggests that carbon partitioning...

Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines

PubMed Central

2013-01-01

Background Responsibility for planning and delivery of health services in the Philippines is devolved to the local government level. Given the recognised need to strengthen capacity for local planning and budgeting, we implemented Investment Cases (IC) for Maternal, Neonatal and Child Health (MNCH) in three selected sub-national units: two poor, rural provinces and one highly-urbanised city. The IC combines structured problem-solving by local policymakers and planners to identify key health system constraints and strategies to scale-up critical MNCH interventions with a decision-support model to estimate the cost and impact of different scaling-up scenarios. Methods We outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach. Results Local officials found the structured analysis of health system constraints helpful to identify problems and select locally appropriate strategies. In particular the process was an improvement on standard approaches that focused only on supply-side issues. However, the lack of data available at the local level is a major impediment to planning. While the majority of the strategies recommended by the IC were incorporated into the 2011 plans and budgets in the three study sites, one key strategy in the participating city was subsequently reversed in 2012. Higher level systemic issues are likely to have influenced use of evidence in plans and budgets and implementation of strategies. Conclusions Efforts should be made to improve locally-representative data through routine information systems for planning and monitoring purposes. Even with sound plans and budgets, evidence is only one factor influencing investments in health. Political considerations at a local level and issues related to decentralisation, influence prioritisation and implementation of plans. In addition to the strengthening of capacity at local level, a parallel process at a higher level of government to relieve fund channelling and coordination issues is critical for any evidence-based planning approach to have a significant impact on health service delivery. PMID:23343218

Cost-effectiveness of everolimus for second-line treatment of metastatic renal cell carcinoma in Serbia.

PubMed

Mihajlović, Jovan; Pechlivanoglou, Petros; Sabo, Ana; Tomić, Zdenko; Postma, Maarten J

2013-12-01

New targeted therapeutics for metastatic renal cell carcinoma (mRCC) enable an increment in progression-free survival (PFS) ranging from 2 to 6 months. Compared with best supportive care, everolimus demonstrated an additional PFS of 3 months in patients with mRCC whose disease had progressed on sunitinib and/or sorafenib. The only targeted therapy for mRCC currently reimbursed in Serbia is sunitinib. The aim of this study was to estimate the cost-effectiveness and the budget impact of the introduction of everolimus in Serbia in comparison to best supportive care, for mRCC patients refractory to sunitinib. A Markov model was designed corresponding with Serbian treatment protocols. A health care payer perspective was taken, including direct costs only. Treated and untreated cohorts were followed up over 18 cycles, each cycle lasting 8 weeks, which covered the lifetime horizon of mRCC patients refractory to the first-line treatment. Annual discounted rates of 1.5% for effectiveness and 3% for costs were applied. Transitions between health states were modeled by time-dependent probabilities extracted from published Kaplan-Meier curves of PFS and overall survival (OS). Utility values were obtained from the appraisals of other mRCC treatments. One-way and probabilistic sensitivity analyses were done to test the robustness and uncertainty of the base-case estimate. Lastly, the potential impacts of everolimus on the overall health care expenditures on annual and 4-year bases were estimated in the budget-impact analysis. The incremental cost-effectiveness ratio for everolimus was estimated at €86,978 per quality-adjusted life-year. Sensitivity analysis identified the hazard multiplier, a statistical approximator of OS gain, as the main driver of everolimus cost-effectiveness. Furthermore, probabilistic sensitivity analyses revealed a wide 95% CI around the base-case incremental cost-effectiveness ratio estimate (€32,594-€425,258 per quality-adjusted life-year). Finally, an average annual budgetary impact of everolimus in first 4 years after its potential reimbursement would be around €270,000, contributing to <1% of the total budget in Serbian oncology. Everolimus as a second-line treatment of mRCC is not likely to be a cost-effective option under the present conditions in Serbia, with a relatively limited impact on its budget in oncology. A major constraint on the estimation of the cost-effectiveness of everolimus relates to the uncertainty around the everolimus effect on extending OS. However, prior to a final decision on the acceptance/rejection of everolimus, reassessment of the whole therapeutic group might be needed to construct an economically rational treatment strategy within the mRCC field. © 2013 Elsevier HS Journals, Inc. All rights reserved.

Producing an integrated climate-land-energy-water (CLEW) model for glaciated regions in the developing world

NASA Astrophysics Data System (ADS)

Delman, E. M.; Thomas, B. F.; Famiglietti, J. S.

2013-12-01

Growing concern over the impact of climate change on global freshwater resources has spurred a demand for practical, basin-specific adaptation tools. The potential for water stress is particularly inflated in the glaciated watersheds of the developing world; widespread and rapid glacial retreat has forced regional resource managers to reconcile the reality of a diminishing supply with an overall increase in demand, while accounting for the underlying geopolitical and cultural context. An integrated approach, such as the development of a Climate-Land-Energy-Water (CLEW) model that examines relationships among climate, land-use, and the energy and water sectors, can be used to assess the impact of different climate change scenarios on basin sustainability and vulnerability. This study will first constrain the hydrologic budget in the Río Santa Watershed of Peru using satellite imagery, historical and contemporary stream discharge data, hydrologic modeling, climatic data analysis, and isotopic and chemical tracers. Ultimately, glacier retreat will be examined at the watershed scale and be used as an input in the CLEW model framework to assess hydrologic budget scenarios and the subsequent impact on regional economic and environmental sustainability.

Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

PubMed

Rognoni, Carla; Tarricone, Rosanna

2017-01-17

This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Italian Healthcare Service perspective. Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent catheterisation in patients with spinal cord injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Dutasteride plus tamsulosin fixed-dose combination first-line therapy versus tamsulosin monotherapy in the treatment of benign prostatic hyperplasia: a budget impact analysis in the Greek healthcare setting.

PubMed

Geitona, Maria; Karabela, Pinelopi; Katsoulis, Ioannis A; Kousoulakou, Hara; Lyberopoulou, Eleni; Bitros, Eleftherios; Xaplanteris, Loukas; Papanicolaou, Sotiria

2014-09-26

The purpose of this study was to explore the budget impact of dutasteride plus tamsulosin fixed-dose combination (DUT + TAM FDC) versus tamsulosin monotherapy, in the treatment of patients with benign prostatic hyperplasia (BPH) from the perspective of the Greek healthcare insurance system. A Microsoft Excel-based model was developed to estimate the financial consequences of adopting DUT + TAM FDC within the Greek healthcare setting. The model, compared six mutually exclusive health states in two alternative treatment options: current standard of care and the introduction of DUT + TAM FDC in the market. The model used clinical inputs from the CombAT study; data on resource use associated with the management of BPH in Greece were derived from expert panel, and unit cost data were derived from official reimbursement tariffs. A payer perspective was taken into account. As patient distribution data between public and private sectors are not available in Greece two scenarios were investigated, considering the whole eligible population in each scenario. A 4 year time horizon was taken into account and included treatment costs, number of transurethral resections of the prostate (TURPs) and acute urinary retention (AUR) episodes avoided. The clinical benefit from the market adoption of DUT + TAM FDC in Greece was 1,758 TURPs and 972 episodes of AUR avoided cumulatively in a four year period. The increase in total costs from the gradual introduction of DUT + TAM FDC to the Greek healthcare system ranges from €1.3 million in the first year to €5.8 million in the fourth year, for the public sector, and €1.2 million to €4.0 million, for the private sector. This represents an increase of 1.91% to 7.94% for the public sector and 1.10% 3.29% in the private sector, during the 4-year time horizon. Budget impact analysis (BIA) results indicated that the gradual introduction of DUT + TAM FDC, would increase the overall budget of the disease, however providing better clinical outcomes. DUT + TAM FDC drug acquisition cost is partly offset by the reduction in the costs associated with the treatment of the disease.

An AHP-based approach to prioritizing resources for highway routine maintenance.

DOT National Transportation Integrated Search

2013-09-01

The Texas Department of Transportation has been experiencing maintenance budget fluctuations recently. The : budget shortage has a negative impact on the agencys maintenance strategies and results in the undesirable : deterioration of highway cond...

Budgeting for Exploration: the History and Political Economy of Planetary Science

NASA Astrophysics Data System (ADS)

Callahan, Jason

2013-10-01

The availability of financial resources continues to be one of the greatest limiting factors to NASA’s planetary science agenda. Historians and members of the space science community have offered many explanations for the scientific, political, and economic actions that combine to form NASA’s planetary science efforts, and this essay will use budgetary and historical analysis to examine how each of these factors have impacted the funding of U.S. exploration of the solar system. This approach will present new insights into how the shifting fortunes of the nation’s economy or the changing priorities of political leadership have affected government investment in science broadly, and space science specifically. This paper required the construction of a historical NASA budget data set displaying layered fiscal information that could be compared equivalently over time. This data set was constructed with information collected from documents located in NASA’s archives, the Library of Congress, and at the Office of Management and Budget at the White House. The essay will examine the effects of the national gross domestic product, Federal debt levels, the budgets of other Federal agencies engaged in science and engineering research, and party affiliation of leadership in Congress and the White House on the NASA budget. It will also compare historic funding levels of NASA’s astrophysics, heliophysics, and Earth science efforts to planetary science funding. By examining the history of NASA’s planetary science efforts through the lens of the budget, this essay will provide a clearer view of how effectively the planetary science community has been able to align its goals with national science priorities.

Review of the University of Alaska FY 1986 Operating and Capital Budgets. Submitted to the Governor and the Fourteenth Alaska State Legislature. Document No. 85-3.

ERIC Educational Resources Information Center

Alaska State Commission on Postsecondary Education, Juneau.

A review of the University of Alaska's operating and capital budget submission for fiscal year 1986 is presented, directed at the educational and programmatic impact of the budget request. Five recommendations endorsed by the Alaska Commission on Postsecondary Education are analyzed. Additional contents include: summary information for the…

Review of the University of Alaska FY 1985 Operating and Capital Budgets. Submitted to the Governor and the Thirteenth Alaska State Legislature.

ERIC Educational Resources Information Center

Alaska State Commission on Postsecondary Education, Juneau.

A review of the University of Alaska's operating and capital budget submission for fiscal year 1985 is presented. The review is directed at the educational and programmatic impact of the budget request. In addition, 11 recommendations endorsed by the Alaska Commission on Postsecondary Education are analyzed. Additional contents include: the…

78 FR 60998 - Strategies To Accelerate the Testing and Adoption of Pay for Success (PFS) Financing Models

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

.... What is the purpose of the new PFS Incentive Fund? Over the past three years, multiple states and local...\\ THE BUDGET FOR FISCAL YEAR 2014--See page 978 of the President's FY 2014 Budget Appendix (see http... and social impact bonds. \\3\\ THE BUDGET FOR FISCAL YEAR 2014--See page 978 of the President's FY 2014...

Managing oral phosphate binder medication expenditures within the Medicare bundled end-stage renal disease prospective payment system: economic implications for large U.S. dialysis organizations.

PubMed

Park, Haesuk; Rascati, Karen L; Keith, Michael S

2015-06-01

From January 2016, payment for oral-only renal medications (including phosphate binders and cinacalcet) was expected to be included in the new Medicare bundled end-stage renal disease (ESRD) prospective payment system (PPS). The implementation of the ESRD PPS has generated concern within the nephrology community because of the potential for inadequate funding and the impact on patient quality of care. To estimate the potential economic impact of the new Medicare bundled ESRD PPS reimbursement from the perspective of a large dialysis organization in the United States. We developed an interactive budget impact model to evaluate the potential economic implications of Medicare payment changes to large dialysis organizations treating patients with ESRD who are receiving phosphate binders. In this analysis, we focused on the budget impact of the intended 2016 integration of oral renal drugs, specifically oral phosphate binders, into the PPS. We also utilized the model to explore the budgetary impact of a variety of potential shifts in phosphate binder market shares under the bundled PPS from 2013 to 2016. The base model predicts that phosphate binder costs will increase to $34.48 per dialysis session in 2016, with estimated U.S. total costs for phosphate binders of over $682 million. Based on these estimates, a projected Medicare PPS $33.44 reimbursement rate for coverage of all oral-only renal medications (i.e., phosphate binders and cinacalcet) would be insufficient to cover these costs. A potential renal drugs and services budget shortfall for large dialysis organizations of almost $346 million was projected. Our findings suggest that large dialysis organizations will be challenged to manage phosphate binder expenditures within the planned Medicare bundled rate structure. As a result, large dialysis organizations may have to make treatment choices in light of potential inadequate funding, which could have important implications for the quality of care for patients with ESRD.

Study protocol: incentives for increased access to comprehensive family planning for urban youth using a benefits card in Uganda. A quasi-experimental study.

PubMed

Nuwasiima, Afra; Nuwamanya, Elly; Navvuga, Patricia; Babigumira, Janet U; Asiimwe, Francis T; Lubinga, Solomon J; Babigumira, Joseph B

2017-10-27

The use of contraception is one of the most cost-effective public health interventions and has the potential to prevent about 30% of maternal and 10% of child deaths in developing countries. Voucher-based initiatives for family planning are an effective and viable means of increasing contraceptive use. In this paper, we present a protocol for a pilot study of a novel incentive, a family planning benefits card (FPBC) program to increase uptake of family planning services among urban poor youth in Uganda while leveraging private sector funding. The study employs both impact and health economic evaluation methods to assess the effect of the FPBC program. We propose a quasi-experimental study design with two separate pre- and post-samples to measure program effectiveness. The main outcome of the impact evaluation is the percentage change in the prevalence of modern contraceptive use and unmet need for contraception. We will also conduct model-based incremental cost-effectiveness and budget impact analyses. The main outcomes of the economic evaluation are the cost per enrolled youth and cost per pregnancy averted, and cost per disability-adjusted life-year (DALY) averted. We will also pilot a corporate social responsibility model of sponsorship for the FPBC program in partnership with local corporations. Budget impact analysis will examine the potential affordability of scaling up the FPBC program and the fiscal implications of this scale up to the corporate social responsibility (CSR) budgets of partner corporations, the government, and the individual taxpayer. In this study, we propose an impact and economic evaluation to establish the proof concept of using a FPBC program to increase uptake of family planning services among urban poor youth in Uganda. The results of this study will present stakeholders in Uganda and internationally with a potentially viable option for corporate-sponsored access to family planning in urban poor communities. MUREC1/7 No. 10/05-17. Registered 19th July 2017.

Cost-utility and budget impact analysis of primary prevention with alendronate of osteoporotic hip fractures in Catalonia.

PubMed

Pueyo, María J; Larrosa, Marta; Surís, Xavier; Garcia-Ruiz, Antonio J

2012-01-01

To determine whether primary drug prevention of osteoporotic hip fracture is a useful measure in Catalonia and what would be their budgetary impact. We performed a cost-utility social perspective study with a time horizon of 10 to 20 years. Univariate sensitivity analysis was performed. Doing nothing is compared with an intervention that includes screening for osteoporosis in women> 64 years and in those diagnosed and who received treatment with generic alendronate for 10 years. Decision trees are developed for groups of 65-69, 70-74 and 75-79. HF data is from 2009 hospital discharges .Costs are derived from fees paid by public insurance. In 2009 there were 9262 HF. The direct cost was € 55 million (€ 5,943.4/patient). The total cost was € 227 million for 10 years. The intervention dominates in all age groups in a 20 year perspective. In any horizon and age group, the different scenario puts the value per QALY below or within the proposed values for Spain. The budgetary impact is estimated at € 8.9 million which increased by 31% the actual direct cost, and 0.5% of the public pharmacy budget. Considering the total costs and the prospect of 20 years, annual savings of 7.4 million € were seen. The prevention of HF with alendronate in osteoporotic women>64 years is cost-useful in the long term (20 years) with a low budgetary impact in the 75-79 year group. Copyright © 2011 Elsevier España, S.L. All rights reserved.

7 CFR 2.501 - Director, Office of Budget and Program Analysis.

Code of Federal Regulations, 2011 CFR

2011-01-01

... authority are made by the Chief Financial Officer to the Director, Office of Budget and Program Analysis: (1... 7 Agriculture 1 2011-01-01 2011-01-01 false Director, Office of Budget and Program Analysis. 2.501... OF AGRICULTURE AND GENERAL OFFICERS OF THE DEPARTMENT Delegations of Authority by the Chief Financial...

Measurement of Carbon Dioxide Column via Space Borne Laser Absorption

NASA Technical Reports Server (NTRS)

Heaps, WIlliam S.

2007-01-01

In order to better understand the budget of carbon dioxide in the Earth's atmosphere it is necessary to develop a global high precision understanding of the carbon dioxide column. In order to uncover the 'missing sink that is responsible for the large discrepancies in the budget as we presently understand it calculation has indicated that measurement accuracy on the order of 1 ppm is necessary. Because typical column average CO2 has now reached 380 ppm this represents a precision on the order of .25% for these column measurements. No species has ever been measured from space at such a precision. In recognition of the importance of understanding the CO2 budget in order to evaluate its impact on global warming the National Research Council in its decadal survey report to NASA recommended planning for a laser based total CO2 mapping mission in the near future. The extreme measurement accuracy requirements on this mission places very strong requirements on the laser system used for the measurement. This work presents an analysis of the characteristics necessary in a laser system used to make this measurement. Consideration is given to the temperature dependence, pressure broadening, and pressure shift of the CO2 lines themselves and how these impact the laser system characteristics Several systems for meeting these requirements that are under investigation at various institutions in the US as well as Europe will be discussed.

Determinants of Change in the Cost-effectiveness Threshold.

PubMed

Paulden, Mike; O'Mahony, James; McCabe, Christopher

2017-02-01

The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency of existing interventions, and the development of new health technologies. We consider the anticipated direction of impact that would affect the threshold following a change in each of these determinants. Where the health care system is technically efficient, an increase in the health care budget unambiguously raises the threshold, whereas an increase in the demand for existing, non-marginal health interventions unambiguously lowers the threshold. Improvements in the technical efficiency of existing interventions may raise or lower the threshold, depending on the cause of the improvement in efficiency, whether the intervention is already funded, and, if so, whether it is marginal. New technologies may also raise or lower the threshold, depending on whether the new technology is a substitute for an existing technology and, again, whether the existing technology is marginal. Our analysis permits health economists and decision makers to assess if and in what direction the threshold may change over time. This matters, as threshold changes impact the cost-effectiveness of interventions that require decisions now but have costs and effects that fall in future periods.

Novel methodology for pharmaceutical expenditure forecast.

PubMed

Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

The value appreciation of new drugs across countries today features a disruption that is making the historical data that are used for forecasting pharmaceutical expenditure poorly reliable. Forecasting methods rarely addressed uncertainty. The objective of this project was to propose a methodology to perform pharmaceutical expenditure forecasting that integrates expected policy changes and uncertainty (developed for the European Commission as the 'EU Pharmaceutical expenditure forecast'; see http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). 1) Identification of all pharmaceuticals going off-patent and new branded medicinal products over a 5-year forecasting period in seven European Union (EU) Member States. 2) Development of a model to estimate direct and indirect impacts (based on health policies and clinical experts) on savings of generics and biosimilars. Inputs were originator sales value, patent expiry date, time to launch after marketing authorization, price discount, penetration rate, time to peak sales, and impact on brand price. 3) Development of a model for new drugs, which estimated sales progression in a competitive environment. Clinical expected benefits as well as commercial potential were assessed for each product by clinical experts. Inputs were development phase, marketing authorization dates, orphan condition, market size, and competitors. 4) Separate analysis of the budget impact of products going off-patent and new drugs according to several perspectives, distribution chains, and outcomes. 5) Addressing uncertainty surrounding estimations via deterministic and probabilistic sensitivity analysis. This methodology has proven to be effective by 1) identifying the main parameters impacting the variations in pharmaceutical expenditure forecasting across countries: generics discounts and penetration, brand price after patent loss, reimbursement rate, the penetration of biosimilars and discount price, distribution chains, and the time to reach peak sales for new drugs; 2) estimating the statistical distribution of the budget impact; and 3) testing different pricing and reimbursement policy decisions on health expenditures. This methodology was independent of historical data and appeared to be highly flexible and adapted to test robustness and provide probabilistic analysis to support policy decision making.

Transient Elastography and Controlled Attenuation Parameter for Diagnosing Liver Fibrosis and Steatosis in Ontario: An Economic Analysis

PubMed Central

Thavorn, K; Coyle, D

2015-01-01

Background Liver fibrosis is characterized by a buildup of connective tissue due to chronic liver damage. Steatosis is the collection of excessive amounts of fat inside liver cells. Liver biopsy remains the gold standard for the diagnosis of liver fibrosis and steatosis, but its use as a diagnostic tool is limited by its invasive nature and high cost. Objectives To evaluate the cost-effectiveness and budget impact of transient elastography (TE) with and without controlled attenuation parameter (CAP) for the diagnosis of liver fibrosis or steatosis in patients with hepatitis B, hepatitis C, alcoholic liver disease, and nonalcoholic fatty liver disease. Data Sources An economic literature search was performed using computerized databases. For primary economic and budget impact analyses, we obtained data from various sources, such as the Health Quality Ontario evidence-based analysis, published literature, and the Institute for Clinical Evaluative Sciences. Review Methods A systematic review of existing TE cost-effectiveness studies was conducted, and a primary economic evaluation was undertaken from the perspective of the Ontario Ministry of Health and Long-Term Care. Decision analytic models were used to compare short-term costs and outcomes of TE compared to liver biopsy. Outcomes were expressed as incremental cost per correctly diagnosed cases gained. A budget impact analysis was also conducted. Results We included 10 relevant studies that evaluated the cost-effectiveness of TE compared to other noninvasive tests and to liver biopsy; no cost-effectiveness studies of TE with CAP were identified. All studies showed that TE was less expensive but associated with a decrease in the number of correctly diagnosed cases. TE also improved quality-adjusted life-years in patients with hepatitis B and hepatitis C. Our primary economic analysis suggested that TE led to cost savings but was less effective than liver biopsy in the diagnosis of liver fibrosis. TE became more economically attractive with a higher degree of liver fibrosis. TE with CAP was also less expensive and less accurate than liver biopsy. Limitations The model did not take into account long-term costs and consequences associated with TE and liver biopsy and did not include costs to patients and their families, or patient preferences related to diagnostic information. Conclusions TE showed potential cost savings compared to liver biopsy. Further investigation is needed to determine the long-term impacts of TE on morbidity and mortality in Canada and the optimal diagnostic modality for liver fibrosis and steatosis. PMID:26664666

Proposal of Polish guidelines for conducting financial analysis and their comparison to existing guidance on budget impact in other countries.

PubMed

Orlewska, Ewa; Mierzejewski, Piotr

2004-01-01

Financial analysis (budget impact analysis, BIA) is increasingly required by decision-makers to ascertain the macroeconomic consequences of new product reimbursement in addition to proof of cost-effectiveness. Poland is in the process of drafting country-specific guidelines for BIA, positioned as complementary to economic evaluation in decision-making The aim of this article is to present the Polish project and compare it with currently available guidance. A checklist was developed that focuses on issues that are unique to BIA. An analysis of the differences between different national guidelines and their Polish counterparts was subsequently undertaken. The Polish project of BIA guidelines is composed of two sections. The first section presents the objective, the use of BIA, the responsibility for the preparation, and the target audience. The second section presents important methodological aspects that researchers should keep in mind when carrying out BIA. In comparison to existing guidance the Polish project appears to be more detailed. It includes more precise recommendations on perspective, time horizon, and reliability of data sources; reporting of results; rates of adoption of new therapies; and the probability of redeploying resources. Although there is an increased demand for BIA, there is only limited guidance on how such studies should be undertaken. It is hoped that the Polish guidelines can contribute to the development of such analyses and deliver benefit for Polish health-care decision-makers and beyond.

General methodology: Costing, budgeting, and techniques for benefit-cost and cost-effectiveness analysis

NASA Technical Reports Server (NTRS)

Stretchberry, D. M.; Hein, G. F.

1972-01-01

The general concepts of costing, budgeting, and benefit-cost ratio and cost-effectiveness analysis are discussed. The three common methods of costing are presented. Budgeting distributions are discussed. The use of discounting procedures is outlined. The benefit-cost ratio and cost-effectiveness analysis is defined and their current application to NASA planning is pointed out. Specific practices and techniques are discussed, and actual costing and budgeting procedures are outlined. The recommended method of calculating benefit-cost ratios is described. A standardized method of cost-effectiveness analysis and long-range planning are also discussed.

The Fiscal Year 1993 Bush Budget: Still Not Tackling the Nation's Problems.

ERIC Educational Resources Information Center

Greenstein, Robert; Leonard, Paul A.

On January 29, 1992, the Bush Administration unveiled its fiscal year 1993 budget. An examination of the budget reveals a substantial gap between the administration's rhetoric concerning the budget and what the budget actually contains. An analysis reveals a budget that continues to give priority to defense over domestic spending, one that favors…

Capsule Endoscopy in the Assessment of Obscure Gastrointestinal Bleeding: An Economic Analysis

PubMed Central

Palimaka, S; Blackhouse, Gord; Goeree, Ron

2015-01-01

Background Small-bowel capsule endoscopy is a tool used to visualize the small bowel to identify the location of bleeds in obscure gastrointestinal bleeding (OGIB). Capsule endoscopy is currently funded in Ontario in cases where there has been a failure to identify a source of bleeding via conventional diagnostic procedures. In Ontario, capsule endoscopy is a diagnostic option for patients whose findings on esophagogastroduodenoscopy, colonoscopy, and push enteroscopy have been negative (i.e., the source of bleeding was not found). Objectives This economic analysis aims to estimate the budget impact of different rates of capsule endoscopy use as a complement to push enteroscopy procedures in patients aged 18 years and older. Data Sources Population-based administrative databases for Ontario were used to identify patients receiving push enteroscopy and small-bowel capsule endoscopy in the fiscal years 2008 to 2012. Review Methods A systematic literature search was performed to identify economic evaluations of capsule endoscopy for the investigation of OGIB. Studies were assessed for their methodological quality and their applicability to the Ontarian setting. An original budget impact analysis was performed using data from Ontarian administrative sources and published literature. The budget impact was estimated for different levels of use of capsule endoscopy as a complement to push enteroscopy due to the uncertain clinical utility of the capsule based on current clinical evidence. The analysis was conducted from the provincial public payer perspective. Results With varying rates of capsule endoscopy use, the budgetary impact spans from savings of $510,000,1 when no (0%) push enteroscopy procedures are complemented with capsule endoscopy, to $2,036,000, when all (100%) push enteroscopy procedures are complemented with capsule endoscopy. A scenario where 50% of push enteroscopy procedures are complemented with capsule endoscopy (expected use based on expert opinion) would result in additional expenditure of about $763,000. Limitations In the literature on OGIB, estimates of rebleeding rates after endoscopic procedures or spontaneous cessation rates are unreliable, with a lack of data. Rough estimates from expert consultation can provide an indication of expected additional use of capsule endoscopy; however, a wide range of capsule uses was explored. Conclusions The budgetary impact in the first year in Ontario of capsule endoscopy use to complement push enteroscopy procedures ranges from $510,000 in savings to an additional expenditure of $2,036,000 (at 0% and 100% push enteroscopy procedures complemented, respectively). The expected scenario of 50% of push enteroscopy procedures likely to benefit from the use of capsule endoscopy, based on expert opinion, would result in additional expenditures of $763,000 in the first year. PMID:26355732

Estimation of lung cancer diagnosis and treatment costs based on a patient-level analysis in Catalonia (Spain).

PubMed

Corral, Julieta; Espinàs, Josep Alfons; Cots, Francesc; Pareja, Laura; Solà, Judit; Font, Rebeca; Borràs, Josep Maria

2015-02-21

Assessing of the costs of treating disease is necessary to demonstrate cost-effectiveness and to estimate the budget impact of new interventions and therapeutic innovations. However, there are few comprehensive studies on resource use and costs associated with lung cancer patients in clinical practice in Spain or internationally. The aim of this paper was to assess the hospital cost associated with lung cancer diagnosis and treatment by histology, type of cost and stage at diagnosis in the Spanish National Health Service. A retrospective, descriptive analysis on resource use and a direct medical cost analysis were performed. Resource utilisation data were collected by means of patient files from nine teaching hospitals. From a hospital budget impact perspective, the aggregate and mean costs per patient were calculated over the first three years following diagnosis or up to death. Both aggregate and mean costs per patient were analysed by histology, stage at diagnosis and cost type. A total of 232 cases of lung cancer were analysed, of which 74.1% corresponded to non-small cell lung cancer (NSCLC) and 11.2% to small cell lung cancer (SCLC); 14.7% had no cytohistologic confirmation. The mean cost per patient in NSCLC ranged from 13,218 Euros in Stage III to 16,120 Euros in Stage II. The main cost components were chemotherapy (29.5%) and surgery (22.8%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs but an increase in chemotherapy costs. In SCLC patients, the mean cost per patient was 15,418 Euros for limited disease and 12,482 Euros for extensive disease. The main cost components were chemotherapy (36.1%) and other inpatient costs (28.7%). In both groups, the Kruskall-Wallis test did not show statistically significant differences in mean cost per patient between stages. This study provides the costs of lung cancer treatment based on patient file reviews, with chemotherapy and surgery accounting for the major components of costs. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.

Impact of the macroeconomic factors on university budgeting the US and Russia

NASA Astrophysics Data System (ADS)

Bogomolova, Arina; Balk, Igor; Ivachenko, Natalya; Temkin, Anatoly

2017-10-01

This paper discuses impact of macroeconomics factor on the university budgeting. Modern developments in the area of data science and machine learning made it possible to utilise automated techniques to address several problems of humankind ranging from genetic engineering and particle physics to sociology and economics. This paper is the first step to create a robust toolkit which will help universities sustain macroeconomic challenges utilising modern predictive analytics techniques.

Review of the University of Alaska FY 1987 Operating and Capital Budgets. Submitted to the Governor and the Fourteenth Alaska State Legislature. Document No. 86-3.

ERIC Educational Resources Information Center

Alaska State Commission on Postsecondary Education, Juneau.

A review of the University of Alaska's operating and capital budget submission for fiscal year 1987 is presented, with attention to the educational and programmatic impact of the budget request. Information is provided on project components for which funding increments are requested. Included are data to assist decision-makers in reviewing the…

Drug Policy in the Czech Republic.

PubMed

Skoupá, Jana

2017-09-01

The legal background of the current pharmaceutical pricing and reimbursement (P&R) setting in the Czech Republic is based on Act 48/1997. Since 2008, the P&R process has been coordinated by the State Institute for Drug Control, which is the main stakeholder in the decision-making process; marketing authorization holders and insurance funds (IFs) also participate. To present a general overview of the current Czech health care system and its P&R principles. The study used publicly available sources concerning health care, mainly acts related to public health care and public health care insurance, public notices related to P&R setting, and statistical data. Regulation covers P&R. The official price represents the highest exfactory price, which cannot be exceeded. It is calculated as the mean of the three lowest prices in the European Union reference basket. Reimbursement is based on the lowest price per daily dose across the whole European Union. For reimbursement, products can be clustered into jumbo groups (mutually interchangeable), stated by law. In each group, reimbursement is set at the lowest price of any substance within the group. For highly innovative drugs a temporary reimbursement can be granted for a period of 3 years. During the administrative proceeding, efficacy, safety, cost-effectiveness, and budget impact are assessed. The cost-effectiveness principles are aligned with the guidelines of the National Institute for Health and Clinical Care Excellence, preferring cost-utility analyses. The willingness-to-pay threshold has been implicitly set at 3 times the gross domestic product per capita. Products exceeding this threshold are subject to further risk-sharing negotiations. Budget impact is becoming increasingly important mainly for IFs. The IFs have recently introduced their own methodology, which allows only products with a budget impact in the range of CZK16 to CZK48 million (CZK = Czech koruna; ∼€600,000 to €1.8 million) to enter the system. Products exceeding this budget impact have to negotiate risk-sharing schemes, mainly further discounts and/or budget caps. The Czech pricing and reimbursement system is rather complex, taking into account clinical evidence, cost-effectiveness and budget impact. The strict regulations are a result of financial scarcity. Copyright © 2017. Published by Elsevier Inc.

Health economic assessment: a methodological primer.

PubMed

Simoens, Steven

2009-12-01

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments.

Health Economic Assessment: A Methodological Primer

PubMed Central

Simoens, Steven

2009-01-01

This review article aims to provide an introduction to the methodology of health economic assessment of a health technology. Attention is paid to defining the fundamental concepts and terms that are relevant to health economic assessments. The article describes the methodology underlying a cost study (identification, measurement and valuation of resource use, calculation of costs), an economic evaluation (type of economic evaluation, the cost-effectiveness plane, trial- and model-based economic evaluation, discounting, sensitivity analysis, incremental analysis), and a budget impact analysis. Key references are provided for those readers who wish a more advanced understanding of health economic assessments. PMID:20049237

The prevention of postmenopausal osteoporotic fractures: results of the Health Technology Assessment of a new antiosteoporotic drug.

PubMed

de Waure, Chiara; Specchia, Maria Lucia; Cadeddu, Chiara; Capizzi, Silvio; Capri, Stefano; Di Pietro, Maria Luisa; Veneziano, Maria Assunta; Gualano, Maria Rosaria; Kheiraoui, Flavia; La Torre, Giuseppe; Nicolotti, Nicola; Sferrazza, Antonella; Ricciardi, Walter

2014-01-01

The Health Technology Assessment (HTA) approach was applied to denosumab in the prevention of osteoporotic fractures in postmenopausal women. Epidemiological, clinical, technical, economic, organizational, and ethical aspects were considered. Medical electronic databases were accessed to evaluate osteoporosis epidemiology and therapeutical approaches. A budget impact and a cost-effectiveness analyses were performed to assess economic implications. Clinical benefits and patient needs were considered with respect to organizational and ethical evaluation. In Italy around four millions women are affected by osteoporosis and have a higher risk for fractures with 70,000 women being hospitalized every year. Bisphosphonates and strontium ranelate are recommended as first line treatment for the prevention of osteoporotic fractures. Denosumab is effective in reducing vertebral, nonvertebral, and hip/femoral fractures with an advantage of being administered subcutaneously every six months. The budget impact analysis estimated a reduction in costs for the National Health Service with the introduction of denosumab. Furthermore, the economic analysis demonstrated that denosumab is cost-effective in comparison to oral bisphosphonates and strontium ranelate. Denosumab can be administered in outpatients by involving General Practitioners in the management. Ethical evaluation is positive because of its efficacy and compliance. Denosumab could add value in the prevention of osteoporotic fractures.

A note on the depreciation of the societal perspective in economic evaluation of health care.

PubMed

Johannesson, M

1995-07-01

It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive 'health care budget' should be used to maximize the health effects. This paper provides a criticism of the 'health care budget' approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any cost paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the 'health care budget' perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care.

HIV Tests And New Diagnoses Declined After California Budget Cuts, But Reallocating Funds Helped Reduce Impact

PubMed Central

Leibowitz, Arleen A.; Brynes, Karen; Wynn, Adriane; Farrell, Kevin

2014-01-01

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and access lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California’s HIV resource allocation change between 2009 and 2011 (state fiscal years). We found that HIV tests declined from 66,629 to 53,760 (19 percent) in local health jurisdictions with high HIV burden. In low-burden jurisdictions, HIV tests declined from 20,302 to 2,116 (90 percent). New HIV/AIDS diagnoses fell from 2,434 in 2009 to 2,235 in 2011 (calendar years) in high-burden jurisdictions and from 346 to 327 in low-burden ones. California’s budget crunch prompted state and local programs to redirect remaining HIV funds from risk reduction education to testing activities. Thus, the impact of the budget cuts on HIV tests and new HIV diagnoses was smaller than might have been expected given the size of the cuts. As California’s fiscal outlook improves, we recommend that the state restore supplemental funding for HIV prevention and testing. PMID:24590939

On the feasibility of benefit-cost analysis applied to remote sensing projects. [California water resources

NASA Technical Reports Server (NTRS)

Merewitz, L.

1973-01-01

The following step-wise procedure for making a benefit-cost analysis of using remote sensing techniques could be used either in the limited context of California water resources, or a context as broad as the making of integrated resource surveys of the entire earth resource complex on a statewide, regional, national, or global basis. (1) Survey all data collection efforts which can be accomplished by remote sensing techniques. (2) Carefully inspect the State of California budget and the Budget of the United States Government to find annual cost of data collection efforts. (3) Decide the extent to which remote sensing can obviate each of the collection efforts. (4) Sum the annual costs of all data collection which can be equivalently accomplished through remote sensing. (5) Decide what additional data could and would be collected through remote sensing. (6) Estimate the value of this information. It is not harmful to do a benefit-cost analysis so long as its severe limitations are recalled and it is supplemented with socio-economic impact studies.

Phase Offsets and the Energy Budgets of Hot Jupiters

NASA Astrophysics Data System (ADS)

Schwartz, Joel C.; Kashner, Zane; Jovmir, Diana; Cowan, Nicolas B.

2017-12-01

Thermal phase curves of short-period planets on circular orbits provide joint constraints on the fraction of incoming energy that is reflected (Bond albedo) and the fraction of absorbed energy radiated by the night hemisphere (heat recirculation efficiency). Many empirical studies of hot Jupiters have implicitly assumed that the dayside is the hottest hemisphere and the nightside is the coldest hemisphere. For a given eclipse depth and phase amplitude, an orbital lag between a planet’s peak brightness and its eclipse—a phase offset—implies that planet’s nightside emits greater flux. To quantify how phase offsets impact the energy budgets of short-period planets, we compile all infrared observations of the nine planets with multi-band eclipse depths and phase curves. Accounting for phase offsets shifts planets to lower Bond albedo and greater day-night heat transport, usually by ≲1σ. For WASP-12b, the published phase variations have been analyzed in two different ways, and the inferred energy budget depends sensitively on which analysis one adopts. Our fiducial scenario supports a Bond albedo of {0.27}-0.13+0.12, significantly higher than the published optical geometric albedo, and a recirculation efficiency of {0.03}-0.02+0.07, following the trend of larger day-night temperature contrast with greater stellar irradiation. If instead we adopt the alternative analysis, then WASP-12b has a Bond albedo consistent with zero and a much higher recirculation efficiency. To definitively determine the energy budget of WASP-12b, new observational analyses will be necessary.

Using referrals and priority-setting rules to risk adjust budgets: the case of regional psychiatric centers.

PubMed

Holman, Per Arne; Grepperud, Sverre; Tanum, Lars

2011-03-01

An important objective of many health care systems is to ensure equal access to health care services. One way of achieving this is by having universal coverage (low or absent out-of-pockets payments) combined with tax-financed transfers (block grants) to providers with a catchment area responsibility. However, a precondition for equal access in such systems is that providers have similar capacities -- meaning that budgets must be perfectly adjusted for variations in treatment costs not being under the control of providers (risk adjustment). This study presents a method that can be applied to adjust global budgets for variation in health risks. The method is flexible in the sense that it takes into account the possibility that variation in needs may depend on the degree of rationing in supplying health care services. The information being available from referrals is used to risk-adjust budgets. An expert panel ranks each individual on the basis of need. The ranking is performed according to priority-setting criteria for health care services. In addition, the panel suggests an adequate treatment profile (treatment category and treatment intensity) for each referral reviewed. By coupling the treatment profiles with cost information, risk-adjusted budgets are derived. Only individuals found to have a sufficiently high ranking (degree of need) will impact the derived risk-adjusted formula. The method is applied to four Regional Psychiatric Centers (RPC) supplying (i) outpatient services, (ii) day-patient care, and (iii) inpatient treatment for adults. The budget reallocations needed (positive and negative) to achieve an equal capacity across providers range between 10% and 42% of the current budgets. Our method can identify variations across providers when it comes to actual capacity and suggests budget reallocations that make the capacities to be equal across providers. In the case of the Regional Psychiatric Centers (RPCs) considered in this analysis, significant deviations in capacities are identified across providers and catchment areas. Thus, significant social gains can be gained, in terms of improved equal access, if our methodology is applied to risk adjust global budgets.

Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

PubMed

Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

2017-01-01

Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel ® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact on health plan's budgets. Pfizer Inc.

The influence of land-use change and landscape dynamics on the climate system: relevance to climate-change policy beyond the radiative effect of greenhouse gases.

PubMed

Pielke, Roger A; Marland, Gregg; Betts, Richard A; Chase, Thomas N; Eastman, Joseph L; Niles, John O; Niyogi, Dev Dutta S; Running, Steven W

2002-08-15

Our paper documents that land-use change impacts regional and global climate through the surface-energy budget, as well as through the carbon cycle. The surface-energy budget effects may be more important than the carbon-cycle effects. However, land-use impacts on climate cannot be adequately quantified with the usual metric of 'global warming potential'. A new metric is needed to quantify the human disturbance of the Earth's surface-energy budget. This 'regional climate change potential' could offer a new metric for developing a more inclusive climate protocol. This concept would also implicitly provide a mechanism to monitor potential local-scale environmental changes that could influence biodiversity.

Municipal consortia for medicine procurement: impact on the stock-out and budget.

PubMed

Amaral, Silvâni Maria Sehnem de; Blatt, Carine Raquel

2011-08-01

The study evaluated the impact of the consortia on the budget and shortage of medicines for the basic pharmaceutical assistance component in Indaial municipality, Southern Brazil. The number of items with a stock out for at least one day decreased by 12% from 2008 to 2007 and 48% from 2009 to 2007; total costs decreased by 33%, when comparing procurement by consortia (2009) to municipal procurement (2007), and by 18% when compared to the average values of the 2009 Health Prices Database from the Ministry of Health. The procurement of medicines by the consortia decreased stock outs and represented an economy of scale, allowing for the procurement of a greater quantity of products with the same budget.

The joint measuring campaign 1979 in Ruthe (West Germany) description and preliminary data

NASA Technical Reports Server (NTRS)

Vanderploeg, R. R.; Tassone, G.; Vonhoyningen-Huene, J. (Principal Investigator)

1979-01-01

The measurements and observations performed as part of the TELLUS project on soil moisture and heat budget evaluations of selected areas in the vecinity of Ruthe, West Germany are presented and discussed. The main lines of investigation include evapotranspiration and moisture content in bare soils covered by vegetation, interactions between natural phenomena and mesoscale heat budget, and man made changes and their impact on regional heat budget.

A new conceptual model to understand the water budget of an Irrigated Basin with Groundwater Dependent Ecosystems

NASA Astrophysics Data System (ADS)

Foglia, L.; McNally, A.; Harter, T.

2012-12-01

The Scott River is one of four major tributaries in the Klamath River Basin that provide cold water habitat for salmonid populations. The Scott Valley is also a major agricultural growing region with extensive alfalfa and hay productions that are key to the local economy. Due to the Mediterranean climate in the area, discharge rates in the river are highly seasonal. Almost all annual discharge occurs during the winter precipitation season and spring snowmelt. During the summer months (July through September), the main-stem river becomes disconnected from its tributaries throughout much of Scott Valley and relies primarily on baseflow from the Scott Valley aquifer. Scott Valley agriculture relies on a combination of surface water and groundwater supplies for crop irrigation during April through September. Conflicts between ecosystem services needs to guarantee a sustainable water quality (mainly in-stream temperature) for the native salmon population and water demands for agricultural irrigation motivated the development of a new conceptual model for the evaluation of the soil-water budget throughout the valley, as a basis for developing alternative surface water and groundwater management practices. The model simulates daily hydrologic fluxes at the individual field scale (100 - 200 m), allocates water resources to nearby irrigation systems, and tracks soil moisture to determine groundwater recharge. The water budget model provides recharge and pumping values for each field. These values in turn are used as inputs for a valley-wide groundwater model developed with MODFLOW-2000. In a first step, separate sensitivity analysis and calibration of the groundwater model is used to provide insights on the accuracy of the recharge and pumping distribution estimated with the water budget model. In a further step, the soil water budget and groundwater flow models will be coupled and sensitivity analysis and calibration will be performed simultaneously. Field-based, local-scale analysis allows for the evaluation of different management alternatives and their impact on recharge to groundwater or the streamflow. Management alternatives to be evaluated will include, for example, artificially increased spring irrigation recharge, deficit irrigation, use of more efficient irrigation practices. Furthermore, from the perspective of the local groundwater committee, it will be critical to be able to evaluate the effect of each field on the total water budget.

Ozone and carbon monoxide budgets over the Eastern Mediterranean.

PubMed

Myriokefalitakis, S; Daskalakis, N; Fanourgakis, G S; Voulgarakis, A; Krol, M C; Aan de Brugh, J M J; Kanakidou, M

2016-09-01

The importance of the long-range transport (LRT) on O3 and CO budgets over the Eastern Mediterranean has been investigated using the state-of-the-art 3-dimensional global chemistry-transport model TM4-ECPL. A 3-D budget analysis has been performed separating the Eastern from the Western basins and the boundary layer (BL) from the free troposphere (FT). The FT of the Eastern Mediterranean is shown to be a strong receptor of polluted air masses from the Western Mediterranean, and the most important source of polluted air masses for the Eastern Mediterranean BL, with about 40% of O3 and of CO in the BL to be transported from the FT aloft. Regional anthropogenic sources are found to have relatively small impact on regional air quality in the area, contributing by about 8% and 18% to surface levels of O3 and CO, respectively. Projections using anthropogenic emissions for the year 2050 but neglecting climate change calculate a surface O3 decrease of about 11% together with a surface CO increase of roughly 10% in the Eastern Mediterranean. Copyright © 2016 Elsevier B.V. All rights reserved.

Defense Budgeting in a Constrained Economy: Reengineering the Budget Process to Meet the Challenge of a Modernizing Zimbabwe Defense Force

DTIC Science & Technology

1998-06-01

Public Policy Analysis and Management Vol. 5 (Connecticut: JAI Press Inc ., 1992) 20. 38 Thomas A Simcik, Reengineering the Navy Program Objective...Winston Inc .,1969. Olvey, Lee D. The Economics of National Security, Avery Publishing Group : 1984. Premchand, A., Government Budgeting And Expenditure... the current process is presented and analyzed against relevant theory on policy analysis , reengineering, and contemporary budgeting systems, in

The reservoir of ozone in the boundary layer of the eastern United States and its potential impact on the global tropospheric ozone budget

NASA Technical Reports Server (NTRS)

Vukovich, F. M.; Fishman, J.; Browell, E. V.

1985-01-01

An analysis of available ozone data in the eastern two-thirds of the United States indicates that a substantial reservoir of ozone is present in the summertime. Five-year mean concentrations range from 40 to 65 ppbv. The reservoir covered an area of several million square kilometers and extends vertically from the surface to 1 to 2 km. The vertical distribution of ozone in the reservoir during midday supports a transport of additional ozone from the boundary layer to the free troposphere. Data are presented demonstrating the potential effect of transport by convective clouds and by the sea breeze circulation - mechanisms by which ozone may be transported out of the boundary layer into the free troposphere. The potential impact of this reservoir on the tropospheric ozone budget is discussed. It is shown that if less than half of the ozone mass in this reservoir is transported to the free troposphere, then the amount of ozone transported out of the boundary layer approximates the amount of ozone transported downward during a tropopause fold event.

77 FR 1743 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-11

... OFFICE OF MANAGEMENT AND BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs AGENCY: Office of Management and Budget. ACTION: Revisions to Appendix C of OMB Circular A-94. SUMMARY: The Office of Management and Budget revised Circular A-94 in 1992. The revised Circular specified...

Are early cannulation arteriovenous grafts (ecAVG) a viable alternative to tunnelled central venous catheters (TCVCs)? An observational "virtual study" and budget impact analysis.

PubMed

Aitken, Emma; Iqbal, Kashfa; Thomson, Peter; Kasthuri, Ram; Kingsmore, David

2016-05-07

Early cannulation arteriovenous grafts (ecAVGs) are advocated as an alternative to tunnelled central venous catheters (TCVCs). A real-time observational "virtual study" and budget impact model was performed to evaluate a strategy of ecAVG as a replacement to TCVC as a bridge to definitive access creation. Data on complications and access-related bed days was collected prospectively for all TCVCs inserted over a six-month period (n = 101). The feasibility and acceptability of an alternative strategy (ecAVGs) was also evaluated. A budget impact model comparing the two strategies was performed. Autologous access in the form of native fistula was the goal wherever possible. We found 34.7% (n = 35) of TCVCs developed significant complications (including 17 culture-proven bacteraemia and one death from line sepsis). Patients spent an average of 11.9 days/patient/year in hospital as a result of access-related complications. The wait for TCVC insertion delayed discharge in 35 patients (median: 6 days). The ecAVGs were a practical and acceptable alternative to TCVCs in over 80% of patients. Over a 6-month period, total treatment costs per patient wereGBP5882 in the TCVC strategy and GBP4954 in the ecAVG strategy, delivering potential savings ofGBP927 per patient. The ecAVGs had higher procedure and re-intervention costs (GBP3014 vs. GBP1836); however, these were offset by significant reductions in septicaemia treatment costs (GBP1322 vs. GBP2176) and in-patient waiting time bed costs (GBP619 vs. GBP1870). Adopting ecAVGs as an alternative to TCVCs in patients requiring immediate access for haemodialysis may provide better individual patient care and deliver cost savings to the hospital.

STRATEGIC PROVIDER BEHAVIOR UNDER GLOBAL BUDGET PAYMENT WITH PRICE ADJUSTMENT IN TAIWAN†,‡

PubMed Central

CHEN, BRADLEY; FAN, VICTORIA Y.

2017-01-01

Global budget payment is one of the most effective strategies for cost containment, but its impacts on provider behavior have not been explored in detail. This study examines the theoretical and empirical role of global budget payment on provider behavior. The study proposes that global budget payment with price adjustment is a form of common-pool resources. A two-product game theoretic model is derived, and simulations demonstrate that hospitals are expected to expand service volumes, with an emphasis on products with higher price–marginal cost ratios. Next, the study examines the early effects of Taiwan’s global budget payment system using a difference-in-difference strategy and finds that Taiwanese hospitals exhibited such behavior, where the pursuit of individual interests led to an increase in treatment intensities. Furthermore, hospitals significantly increased inpatient service volume for regional hospitals and medical centers. In contrast, local hospitals, particularly for those without teaching status designation, faced a negative impact on service volume, as larger hospitals were better positioned to induce demand and pulled volume away from their smaller counterparts through more profitable services and products such as radiology and pharmaceuticals. PMID:25132007

Strategic Provider Behavior Under Global Budget Payment with Price Adjustment in Taiwan.

PubMed

Chen, Bradley; Fan, Victoria Y

2015-11-01

Global budget payment is one of the most effective strategies for cost containment, but its impacts on provider behavior have not been explored in detail. This study examines the theoretical and empirical role of global budget payment on provider behavior. The study proposes that global budget payment with price adjustment is a form of common-pool resources. A two-product game theoretic model is derived, and simulations demonstrate that hospitals are expected to expand service volumes, with an emphasis on products with higher price-marginal cost ratios. Next, the study examines the early effects of Taiwan's global budget payment system using a difference-in-difference strategy and finds that Taiwanese hospitals exhibited such behavior, where the pursuit of individual interests led to an increase in treatment intensities. Furthermore, hospitals significantly increased inpatient service volume for regional hospitals and medical centers. In contrast, local hospitals, particularly for those without teaching status designation, faced a negative impact on service volume, as larger hospitals were better positioned to induce demand and pulled volume away from their smaller counterparts through more profitable services and products such as radiology and pharmaceuticals. Copyright © 2014 John Wiley & Sons, Ltd.

Complete energetic description of hydrokinetic turbine impact on flow channel dynamics

NASA Astrophysics Data System (ADS)

Brasseale, E.; Kawase, M.

2016-02-01

Energy budget analysis on tidal channels quantifies and demarcates the impacts of marine renewables on environmental fluid dynamics. Energy budget analysis assumes the change in total kinetic energy within a volume of fluid can be described by the work done by each force acting on the flow. In a numerically simulated channel, the balance between energy change and work done has been validated up to 5% error.The forces doing work on the flow include pressure, turbulent dissipation, and stress from the estuary floor. If hydrokinetic turbines are installed in an estuarine channel to convert tidal energy into usable power, the dynamics of the channel change. Turbines provide additional pressure work against the flow of the channel which will slow the current and lessen turbulent dissipation and bottom stress. These losses may negatively impact estuarine circulation, seafloor scour, and stratification.The environmental effects of turbine deployment have been quantified using a three dimensional, Reynolds-averaged, Navier-Stokes model of an idealized flow channel situated between the ocean and a large estuarine basin. The channel is five kilometers wide, twenty kilometers long and fifty meters deep, and resolved to a grid size of 10 meters by 10 meters by 1 meter. Tidal currents are simulated by an initial difference in sea surface height across the channel of 160 centimeters from the channel entrance to the channel exit. This creates a pressure gradient which drives flow through the channel. Tidal power turbines are represented as disks that force the channel in proportion to the strength of the current. Three tidal turbines twenty meters in diameters have been included in the model to simulate the impacts of a pilot scale test deployment.This study is the first to appreciate the energetic impact of marine renewables in a three dimensional model through the energy equation's constituent terms. This study provides groundwork for understanding and predicting the environmental impacts of marine renewables.

Measuring direct and indirect costs of land retirement in an irrigated river basin: A budgeting regional multiplier approach

NASA Astrophysics Data System (ADS)

Hamilton, Joel; Whittlesey, Norman K.; Robison, M. Henry; Willis, David

2002-08-01

This analysis addresses three important conceptual problems in the measurement of direct and indirect costs and benefits: (1) the distribution of impacts between a regional economy and the encompassing state economy; (2) the distinction between indirect impacts and indirect costs (IC), focusing on the dynamic time path unemployed resources follow to find alternative employment; and (3) the distinction among the affected firms' microeconomic categories of fixed and variable costs as they are used to compute regional direct and indirect costs. It uses empirical procedures that reconcile the usual measures of economic impact provided by input/output models with the estimates of economic costs and benefits required for analysis of welfare changes. The paper illustrates the relationships and magnitudes involved in the context of water policy issues facing the Pecos River Basin of New Mexico.

Overview: Western Regional applications Program (WRAP) status

NASA Technical Reports Server (NTRS)

Norman, S. M.

1981-01-01

Interactions with all 14 of the states in the Western Region over the past three years are reviewed from NASA's perspective. Outreach and training programs using the M mobile analysis and training extension van, the University Program, classes at the Ames Center, demonstration tests with state agencies, and surveying the needs of local governments are highlighted. Planned activities, the continuance of ASVT's, and the impact of the budget cuts on NASA'S technology program are also considered.

Impacts of Large-Scale Circulation on Convection: A 2-D Cloud Resolving Model Study

NASA Technical Reports Server (NTRS)

Li, X; Sui, C.-H.; Lau, K.-M.

1999-01-01

Studies of impacts of large-scale circulation on convection, and the roles of convection in heat and water balances over tropical region are fundamentally important for understanding global climate changes. Heat and water budgets over warm pool (SST=29.5 C) and cold pool (SST=26 C) were analyzed based on simulations of the two-dimensional cloud resolving model. Here the sensitivity of heat and water budgets to different sizes of warm and cold pools is examined.

Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy

PubMed Central

Restelli, Umberto; Saibene, Gabriella; Nardulli, Patrizia; Di Turi, Roberta; Bonizzoni, Erminio; Scolari, Francesca; Perrone, Tania; Croce, Davide; Celio, Luigi

2017-01-01

Objective To evaluate the efficiency of resources allocation and sustainability of the use of netupitant+palonosetron (NEPA) for chemotherapy-induced nausea and vomiting (CINV) prophylaxis assuming the Italian National Health Service (NHS) perspective. A published Markov model was adapted to assess the incremental cost-utility ratio of NEPA compared with aprepitant (APR) + palonosetron (PALO), fosaprepitant (fAPR) + PALO, APR + ondansetron (ONDA), fAPR + ONDA in patients receiving a highly emetogenic chemotherapy (HEC) and with APR + PALO and fAPR + PALO in patients receiving a moderately emetogenic chemotherapy (MEC). Setting Oncology hospital department in Italy. Methods A Markov model was used to determine the impact of NEPA on the budget of the Italian NHS on a 5-day time horizon, corresponding to the acute and delayed CINV prophylaxis phases. Direct medical costs considered were related to antiemetic drugs, adverse events management, CINV episodes management. Clinical and quality of life data referred to previously published works. The budget impact analysis considered the aforementioned therapies plus PALO alone (for HEC and MEC) on a 5-year time horizon, comparing two scenarios: one considering the use of NEPA and one not considering its use. Primary and secondary outcome measures Incremental cost per quality adjusted life year (QALY) and differential economic impact for the Italian NHS between the two scenarios considered. Results NEPA is more effective and less expensive (dominant) compared with APR + PALO (for HEC and MEC), fAPR + PALO (for HEC and MEC), APR + ONDA (for HEC), fAPR + ONDA (for HEC). The use of NEPA would lead to a 5-year cost decrease of €63.7 million (€42.7 million for HEC and €20.9 million for MEC). Conclusions NEPA allows an efficient allocation of resources for the Italian NHS and it is sustainable, leading to a cost decrease compared with a scenario which does not consider its use. PMID:28765126

Expected cost effectiveness of high-dose trivalent influenza vaccine in US seniors.

PubMed

Chit, Ayman; Roiz, Julie; Briquet, Benjamin; Greenberg, David P

2015-01-29

Seniors are particularly vulnerable to complications resulting from influenza infection. Numerous influenza vaccines are available to immunize US seniors, and practitioners must decide which product to use. Options include trivalent and quadrivalent standard-dose inactivated influenza vaccines (IIV3 and IIV4 respectively), as well as a high-dose IIV3 (HD). Our research examines the public health impact, budget impact, and cost-utility of HD versus IIV3 and IIV4 for immunization of US seniors 65 years of age and older. Our model was based on US influenza-related health outcome data. Health care costs and vaccine prices were obtained from the Centers for Medicare and Medicaid Services. Efficacies of IIV3 and IIV4 were estimated from various meta-analyses of IIV3 efficacy. The results of a head-to-head randomized controlled trial of HD vs. IIV3 were used to estimate relative efficacy of HD. Conservatively, herd protection was not considered. Compared to IIV3, HD would avert 195,958 cases of influenza, 22,567 influenza-related hospitalizations, and 5423 influenza-related deaths among US seniors. HD generates 29,023 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $154 million. The Incremental Cost Effectiveness Ratio (ICER) for this comparison is $5299/QALY. 71% of the probabilistic sensitivity analysis (PSA) simulations were <$100,000/QALY. Compared to IIV4, HD would avert 169,257 cases of influenza, 21,222 hospitalizations and 5212 deaths. HD generates 27,718 more QALYs and a net societal budget impact of -$17 million and as such dominates IIV4. For this comparison, 81% of PSA simulations were <$100,000/QALY. HD is expected to achieve significant reductions in influenza-related morbidity and mortality. Further, HD is a cost effective alternative to both IIV3 and IIV4 in seniors. Our conclusions were robust in the face of sensitivity analyses. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Use of the partial farm budget technique to predict the economic impact of the flock management decision to use B-mode ultrasonographic pregnancy diagnosis.

PubMed

Sprecher, D J; Ley, W B; Whittier, W D; Bowen, J M; Thatcher, C D; Pelzer, K D; Moore, J M

1989-07-15

A computer spreadsheet was developed to predict the economic impact of a management decision to use B-mode ultrasonographic ovine pregnancy diagnosis. The spreadsheet design and spreadsheet cell formulas are provided. The program used the partial farm budget technique to calculate net return (NR) or cash flow changes that resulted from the decision to use ultrasonography. Using the program, either simple pregnancy diagnosis or pregnancy diagnosis with the ability to determine singleton or multiple pregnancies may be compared with no flock ultrasonographic pregnancy diagnosis. A wide range of user-selected regional variables are used to calculate the cash flow changes associated with the ultrasonography decisions. A variable may be altered through a range of values to conduct a sensitivity analysis of predicted NR. Example sensitivity analyses are included for flock conception rate, veterinary ultrasound fee, and the price of corn. Variables that influence the number of cull animals and the cost of ultrasonography have the greatest impact on predicted NR. Because the determination of singleton or multiple pregnancies is more time consuming, its economic practicality in comparison with simple pregnancy diagnosis is questionable. The value of feed saved by identifying and separately feeding ewes with singleton pregnancies is not offset by the increased ultrasonography cost.

Cities and “budget-based” management of the energy-water-climate nexus: Case studies in transportation policy, infrastructure systems, and urban utility risk management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sperling, Joshua B.; Ramaswami, Anu

This article reviews city case studies to inform a framework for developing urban infrastructure design standards and policy instruments that together aim to pursue energy efficiency and greenhouse gas mitigation through city carbon budgets and water use efficiency and climate risk adaptation through city water budgets. Here, this article also proposes combining carbon and water budgeting at the city-scale for achieving successful coupled city carbon and water budget (CCCWB) programs. Under a CCCWB program, key actors including local governments, infrastructure designers/operators, and households would be assigned a GHG emissions and water 'budget' and be required by state or federal levelsmore » to keep within this budget through the use of flexibility mechanisms, incentive programs, and sanctions. Multiple incentives and cross-scale governance arrangements would be tied to energy-water systems integration, resource-efficient transportation and infrastructure development, and effective monitoring and management of energy use, emissions, climate risks to, and security of energy-water-transport-food and other critical systems. As a first step to promote strategies for CCCWB development, we systematically review approaches of and shortcomings to existing budget-based programs in the UK and US, and suggest improvements in three areas: measurement, modeling effectiveness of interventions for staying within a budget, and governance. To date, the majority of climate action or sustainability plans by cities, while mentioning climate impacts as a premise for the plan, do not address these impacts in the plan. They focus primarily on GHG mitigation while ignoring resource depletion challenges and energy-climate-water linkages, whereby water supplies can begin to limit energy production and energy shifts to mitigate climate change can limit water availability. Coupled carbon-water budget plans, programs, and policies - described in this study- may address these concerns as well as the emerging trends that will exacerbate these problems - e.g., including population growth, climatic changes, and emerging policy choices that are not coordinated. Cities and 'Budget-Based' Management of the Energy-Water-Climate Nexus: Case Studies to Inform Strategy for Integrated Performance- and Incentive-Based Design and Policy Instruments.« less

Cities and “budget-based” management of the energy-water-climate nexus: Case studies in transportation policy, infrastructure systems, and urban utility risk management

DOE PAGES

Sperling, Joshua B.; Ramaswami, Anu

2017-11-03

This article reviews city case studies to inform a framework for developing urban infrastructure design standards and policy instruments that together aim to pursue energy efficiency and greenhouse gas mitigation through city carbon budgets and water use efficiency and climate risk adaptation through city water budgets. Here, this article also proposes combining carbon and water budgeting at the city-scale for achieving successful coupled city carbon and water budget (CCCWB) programs. Under a CCCWB program, key actors including local governments, infrastructure designers/operators, and households would be assigned a GHG emissions and water 'budget' and be required by state or federal levelsmore » to keep within this budget through the use of flexibility mechanisms, incentive programs, and sanctions. Multiple incentives and cross-scale governance arrangements would be tied to energy-water systems integration, resource-efficient transportation and infrastructure development, and effective monitoring and management of energy use, emissions, climate risks to, and security of energy-water-transport-food and other critical systems. As a first step to promote strategies for CCCWB development, we systematically review approaches of and shortcomings to existing budget-based programs in the UK and US, and suggest improvements in three areas: measurement, modeling effectiveness of interventions for staying within a budget, and governance. To date, the majority of climate action or sustainability plans by cities, while mentioning climate impacts as a premise for the plan, do not address these impacts in the plan. They focus primarily on GHG mitigation while ignoring resource depletion challenges and energy-climate-water linkages, whereby water supplies can begin to limit energy production and energy shifts to mitigate climate change can limit water availability. Coupled carbon-water budget plans, programs, and policies - described in this study- may address these concerns as well as the emerging trends that will exacerbate these problems - e.g., including population growth, climatic changes, and emerging policy choices that are not coordinated. Cities and 'Budget-Based' Management of the Energy-Water-Climate Nexus: Case Studies to Inform Strategy for Integrated Performance- and Incentive-Based Design and Policy Instruments.« less

77 FR 35391 - Franklin Budget Car Sales, Inc.; Analysis of Proposed Consent Order To Aid Public Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-13

... FEDERAL TRADE COMMISSION [File No. 102 3094] Franklin Budget Car Sales, Inc.; Analysis of Proposed Consent Order To Aid Public Comment AGENCY: Federal Trade Commission. ACTION: Proposed Consent Agreement... from Franklin's Budget Car Sales, Inc., also doing business as Franklin Toyota/Scion (``Franklin Toyota...

Choosing health: qualitative evidence from the experiences of personal health budget holders.

PubMed

Davidson, Jacqueline; Baxter, Kate; Glendinning, Caroline; Irvine, Annie

2013-10-01

Personal health budgets were piloted in the English National Health Service between 2009 and 2012. Semi-structured interviews with a sub-sample of early budget holders aimed to explore their experiences of receiving and using a budget. Over 2000 people from 20 pilot sites were recruited to a multi-method evaluation of the personal health budget pilots. A sub-sample of 58 people was selected for qualitative interviews three months after the offer of a budget; 52 were re-interviewed six months later. The purposively selected sample reflected a range of health conditions, locality, age and gender. Personal health budgets were reported to have positive impacts on health, health care and relatives/family. Benefits often extended beyond the condition for which the budget had been awarded. However, interviewees rarely knew the level of their budget; some reported difficulty in agreeing acceptable uses for their budget; and delays could occur in procuring chosen services or equipment. Patients' experiences offer valuable insights for the roll-out of personal health budgets beyond the pilot phase. Flexibility in how budgets are used may allow maximum benefits to be derived. Clear information about what budgets can and cannot be used for, with suggestions offered, will be useful. People with newly diagnosed or recent sudden onset conditions may need more help to plan their support, but all budget holders are likely to benefit from regular contact with staff for reassurance and continued motivation.

Second-moment budgets in cloud topped boundary layers: A large-eddy simulation study

NASA Astrophysics Data System (ADS)

Heinze, Rieke; Mironov, Dmitrii; Raasch, Siegfried

2015-06-01

A detailed analysis of second-order moment budgets for cloud topped boundary layers (CTBLs) is performed using high-resolution large-eddy simulation (LES). Two CTBLs are simulated—one with trade wind shallow cumuli, and the other with nocturnal marine stratocumuli. Approximations to the ensemble-mean budgets of the Reynolds-stress components, of the fluxes of two quasi-conservative scalars, and of the scalar variances and covariance are computed by averaging the LES data over horizontal planes and over several hundred time steps. Importantly, the subgrid scale contributions to the budget terms are accounted for. Analysis of the LES-based second-moment budgets reveals, among other things, a paramount importance of the pressure scrambling terms in the Reynolds-stress and scalar-flux budgets. The pressure-strain correlation tends to evenly redistribute kinetic energy between the components, leading to the growth of horizontal-velocity variances at the expense of the vertical-velocity variance which is produced by buoyancy over most of both CTBLs. The pressure gradient-scalar covariances are the major sink terms in the budgets of scalar fluxes. The third-order transport proves to be of secondary importance in the scalar-flux budgets. However, it plays a key role in maintaining budgets of TKE and of the scalar variances and covariance. Results from the second-moment budget analysis suggest that the accuracy of description of the CTBL structure within the second-order closure framework strongly depends on the fidelity of parameterizations of the pressure scrambling terms in the flux budgets and of the third-order transport terms in the variance budgets. This article was corrected on 26 JUN 2015. See the end of the full text for details.

Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research.

PubMed

van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

2018-01-01

The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2) developing a costing tool to support reviewers of grant proposals in assessing whether the proposed budget is realistic. For granted study proposals from the Netherlands Organization for Health Research and Development (ZonMw), type of study, potential cost drivers, proposed budget, and general characteristics were extracted. Regression analysis was conducted in an attempt to generate a 'predicted budget' for certain combinations of cost drivers, for implementation in the costing tool. Of 133 drug-related research grant proposals, 74 were included for complete data extraction. Because an association between cost drivers and budgets was not confirmed, we could not generate a predicted budget based on regression analysis, but only historic reference budgets given certain study characteristics. The costing tool was designed accordingly, i.e. with given selection criteria the tool returns the range of budgets in comparable studies. This range can be used in VOI analysis to estimate whether the expected net benefit of sampling will be positive to decide upon the net value of future research. The absence of association between study characteristics and budgets may indicate inconsistencies in the budgeting or granting process. Nonetheless, the tool generates useful information on historical budgets, and the option to formally relate VOI to budgets. To our knowledge, this is the first attempt at creating such a tool, which can be complemented with new studies being granted, enlarging the underlying database and keeping estimates up to date.

Affordability of programmes to prevent spontaneous preterm birth in Austria: a budget impact analysis.

PubMed

Zechmeister-Koss, Ingrid; Piso, Brigitte

2014-02-01

Preterm birth is a rising health problem in Europe generally, and in Austria specifically. Decision makers require objective information on the effects and costs of measures to prevent preterm birth. We undertook a budget impact analysis from a public payer perspective and for a 1-year and 5-year time horizon for five prevention approaches to reduce preterm birth. These were cervix screening + progesterone application, progesterone injection, smoking cessation, fish oil supplementation and infection screening. We analysed affordability in terms of programme costs and potential cost savings. Programme costs range from below €50 000 (cervix screening in high-risk pregnancy) to €500 000 (universal infection screening). The lowest health effects have been shown for smoking cessation programmes (-10 preterm births per year), whereas infection screening demonstrated the largest effect (-230 preterm births per year). In the base-case analysis, all programmes are potentially cost saving (-€500 000 to -€13 million per year). In the sensitivity analyses, preterm birth costs, target group size and (partly) unit costs of programme components have an influence on potential cost savings. However, except for two programmes, the results are robust concerning an overall economic net benefit of the programmes analysed compared with no programme. The study is mainly limited by the quality of some cost data and choice of the reference scenario. When considering potential cost savings, the five prevention programmes analysed seem affordable, with cervix screening and infection screening likely being the most promising in Austria.

Quantifying Diurnal Cloud Radiative Effects by Cloud Type in the Tropical Western Pacific

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burleyson, Casey D.; Long, Charles N.; Comstock, Jennifer M.

2015-06-01

Cloud radiative effects are examined using long-term datasets collected at the three Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facilities in the tropical western Pacific. We quantify the surface radiation budget, cloud populations, and cloud radiative effects by partitioning the data by cloud type, time of day, and as a function of large scale modes of variability such as El Niño Southern Oscillation (ENSO) phase and wet/dry seasons at Darwin. The novel facet of our analysis is that we break aggregate cloud radiative effects down by cloud type across the diurnal cycle. The Nauru cloud populations andmore » subsequently the surface radiation budget are strongly impacted by ENSO variability whereas the cloud populations over Manus only shift slightly in response to changes in ENSO phase. The Darwin site exhibits large seasonal monsoon related variations. We show that while deeper convective clouds have a strong conditional influence on the radiation reaching the surface, their limited frequency reduces their aggregate radiative impact. The largest source of shortwave cloud radiative effects at all three sites comes from low clouds. We use the observations to demonstrate that potential model biases in the amplitude of the diurnal cycle and mean cloud frequency would lead to larger errors in the surface energy budget compared to biases in the timing of the diurnal cycle of cloud frequency. Our results provide solid benchmarks to evaluate model simulations of cloud radiative effects in the tropics.« less

ARM Research in the Equatorial Western Pacific: A Decade and Counting

NASA Technical Reports Server (NTRS)

Long, C. N.; McFarlane, S. A.; DelGenio, A.; Minnis, P.; Ackerman, T. S.; Mather, J.; Comstock, J.; Mace, G. G.; Jensen, M.; Jakob, C.

2013-01-01

The tropical western Pacific (TWP) is an important climatic region. Strong solar heating, warm sea surface temperatures, and the annual progression of the intertropical convergence zone (ITCZ) across this region generate abundant convective systems, which through their effects on the heat and water budgets have a profound impact on global climate and precipitation. In order to accurately evaluate tropical cloud systems in models, measurements of tropical clouds, the environment in which they reside, and their impact on the radiation and water budgets are needed. Because of the remote location, ground-based datasets of cloud, atmosphere, and radiation properties from the TWP region have come primarily from short-term field experiments. While providing extremely useful information on physical processes, these short-term datasets are limited in statistical and climatological information. To provide longterm measurements of the surface radiation budget in the tropics and the atmospheric properties that affect it, the Atmospheric Radiation Measurement program established a measurement site on Manus Island, Papua New Guinea, in 1996 and on the island republic of Nauru in late 1998. These sites provide unique datasets now available for more than 10 years on Manus and Nauru. This article presents examples of the scientific use of these datasets including characterization of cloud properties, analysis of cloud radiative forcing, model studies of tropical clouds and processes, and validation of satellite algorithms. New instrumentation recently installed at the Manus site will provide expanded opportunities for tropical atmospheric science.

Budgeting in Tertiary Educational Institutions: An Analysis.

ERIC Educational Resources Information Center

Shand, D. A.

1982-01-01

Administrators should examine the role and limitations of their budgeting systems and consider overemphasis on control of spending rather than efficiency or effectiveness, limitations on cash-based budgeting, need for information on operating costs, and the short range and fragmented nature of most budgets. (MSE)

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment

PubMed Central

Lee, Christine; Tu, Hong Anh; Weir, Mark; Holubowich, Corinne

2016-01-01

Background Retinitis pigmentosa is a group of genetic disorders that involves the breakdown and loss of photoreceptors in the retina, resulting in progressive retinal degeneration and eventual blindness. The Argus II Retinal Prosthesis System is the only currently available surgical implantable device approved by Health Canada. It has been shown to improve visual function in patients with severe visual loss from advanced retinitis pigmentosa. The objective of this analysis was to examine the clinical effectiveness, cost-effectiveness, budget impact, and safety of the Argus II system in improving visual function, as well as exploring patient experiences with the system. Methods We performed a systematic search of the literature for studies examining the effects of the Argus II retinal prosthesis system in patients with advanced retinitis pigmentosa, and appraised the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria, focusing on visual function, functional outcomes, quality of life, and adverse events. We developed a Markov decision-analytic model to assess the cost-effectiveness of the Argus II system compared with standard care over a 10-year time horizon. We also conducted a 5-year budget impact analysis. We used a qualitative design and an interview methodology to examine patients’ lived experience, and we used a modified grounded theory methodology to analyze information from interviews. Transcripts were coded, and themes were compared against one another. Results One multicentre international study and one single-centre study were included in the clinical review. In both studies, patients showed improved visual function with the Argus II system. However, the sight-threatening surgical complication rate was substantial. In the base-case analysis, the Argus II system was cost-effective compared with standard care only if willingness-to-pay was more than $207,616 per quality-adjusted life-year. The 5-year budget impact of funding the Argus II system ranged from $800,404 to $837,596. Retinitis pigmentosa significantly affects people's ability to navigate physical and virtual environments. Argus II was described as enabling the fundamental elements of sight. As such, it had a positive impact on quality of life for people with retinitis pigmentosa. Conclusions Based on evidence of moderate quality, patients with advanced retinitis pigmentosa who were implanted with the Argus II retinal prosthesis system showed significant improvement in visual function, real-life functional outcomes, and quality of life, but there were complications associated with the surgery that could be managed through standard ophthalmologic treatments. The costs for the technology are high. PMID:27468325

Retinal Prosthesis System for Advanced Retinitis Pigmentosa: A Health Technology Assessment.

PubMed

2016-01-01

Retinitis pigmentosa is a group of genetic disorders that involves the breakdown and loss of photoreceptors in the retina, resulting in progressive retinal degeneration and eventual blindness. The Argus II Retinal Prosthesis System is the only currently available surgical implantable device approved by Health Canada. It has been shown to improve visual function in patients with severe visual loss from advanced retinitis pigmentosa. The objective of this analysis was to examine the clinical effectiveness, cost-effectiveness, budget impact, and safety of the Argus II system in improving visual function, as well as exploring patient experiences with the system. We performed a systematic search of the literature for studies examining the effects of the Argus II retinal prosthesis system in patients with advanced retinitis pigmentosa, and appraised the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria, focusing on visual function, functional outcomes, quality of life, and adverse events. We developed a Markov decision-analytic model to assess the cost-effectiveness of the Argus II system compared with standard care over a 10-year time horizon. We also conducted a 5-year budget impact analysis. We used a qualitative design and an interview methodology to examine patients' lived experience, and we used a modified grounded theory methodology to analyze information from interviews. Transcripts were coded, and themes were compared against one another. One multicentre international study and one single-centre study were included in the clinical review. In both studies, patients showed improved visual function with the Argus II system. However, the sight-threatening surgical complication rate was substantial. In the base-case analysis, the Argus II system was cost-effective compared with standard care only if willingness-to-pay was more than $207,616 per quality-adjusted life-year. The 5-year budget impact of funding the Argus II system ranged from $800,404 to $837,596. Retinitis pigmentosa significantly affects people's ability to navigate physical and virtual environments. Argus II was described as enabling the fundamental elements of sight. As such, it had a positive impact on quality of life for people with retinitis pigmentosa. Based on evidence of moderate quality, patients with advanced retinitis pigmentosa who were implanted with the Argus II retinal prosthesis system showed significant improvement in visual function, real-life functional outcomes, and quality of life, but there were complications associated with the surgery that could be managed through standard ophthalmologic treatments. The costs for the technology are high.

The Impact of Budget Cuts on Three Directorates of the National Science Foundation.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

This report provides comments and opinions from National Science Foundation (NSF) officials on proposed agency budget cuts which could affect three NSF Directorates: Science and Engineering; Biological, Behavioral, and Social Sciences; and Scientific, Technological, and International Affairs. Specific topics discussed focus on personnel levels,…

44 CFR 1.9 - Regulatory impact analyses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... all notices of proposed rulemaking and all final rules, to the Director, Office of Management and... shall be transmitted, along with the proposed rule, to the Director, Office of Management and Budget, at..., along with a notice of proposed rulemaking, to the Director, Office of Management and Budget, at least...

44 CFR 1.9 - Regulatory impact analyses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... all notices of proposed rulemaking and all final rules, to the Director, Office of Management and... shall be transmitted, along with the proposed rule, to the Director, Office of Management and Budget, at..., along with a notice of proposed rulemaking, to the Director, Office of Management and Budget, at least...

77 FR 65541 - Agency Information Collection Activities; Submission to the Office of Management and Budget for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-29

... DEPARTMENT OF EDUCATION [Docket No. ED-2012-ICCD-0045] Agency Information Collection Activities; Submission to the Office of Management and Budget for Review and Approval; Comment Request; Impact Evaluation of Teacher and Leader Evaluation Systems AGENCY: Department of Education (ED), Institute of Education...

Impacts of Climate Change and Land use Changes on Land Surface Radiation and Energy Budgets

USDA-ARS?s Scientific Manuscript database

Land surface radiation and energy budgets are critical to address a variety of scientific and application issues related to climate trends, weather predictions, hydrologic and biogeophysical modeling, and the monitoring of ecosystem health and agricultural crops. This is an introductory paper to t...

Making Sense of Dollars and Cents

ERIC Educational Resources Information Center

Sorenson, Richard

2010-01-01

Principals must devote a vast amount of time and energy to campus funding and budgetary issues because budgeting and accounting procedures are an integral part of an effective instructional program. In fact, a principal's role in the budgetary process significantly impacts both budget development and instructional planning. Principals who fail to…

A Children's Defense Budget: An Analysis of the FY 1987 Federal Budget and Children.

ERIC Educational Resources Information Center

Children's Defense Fund, Washington, DC.

This analysis of the implications for children of the FY 1987 Federal budget begins by criticizing the Reagan administration's policy on poor children and families and recommending needed action. Chapter 1 provides a rationale for investing in children and families. Specific attention is given to costs of child poverty, declining Federal help for…

Impacts of Student Fee Increase and Budget Changes on Enrollment and Financial Aid in the California Community Colleges. A Report to the Legislature, Pursuant to Provisions of the 2003-04 Budget Act

ERIC Educational Resources Information Center

California Community Colleges, Chancellor's Office, 2005

2005-01-01

This report examines the effects of the fee increase from $11 to $18 per unit that occurred in Fall 2003, along with the effects of budget reductions in the California Community College (CCC) system that occurred beginning in Fiscal Year (FY) 2002-03. In addition, the report provides summary results of an increase in financial aid provided to the…

Budget impact of treating commercially insured type 1 and type 2 diabetes patients in the United States with insulin degludec compared to insulin glargine.

PubMed

Weatherall, James; Bloudek, Lisa; Buchs, Sarah

2017-02-01

To quantify the annual budget impact if all US commercially insured type 1 diabetes mellitus patients on basal-bolus therapy (T1DM BBT ), type 2 diabetes mellitus patients on basal-oral therapy (T2DM BOT ), and type 2 diabetes mellitus patients on basal-bolus therapy (T2DM BBT ) switched from insulin glargine (IGlar) to insulin degludec (IDeg). A short-term (1 year) budget impact model was developed to evaluate the costs of IDeg vs. IGlar in three treatment groups (T1DM BBT , insulin-naïve T2DM BOT , and T2DM BBT ) through a simulation for a potential US health plan population of 35 million. The analysis captured direct medical costs associated with insulin treatment (insulin, needles, and self-monitored glucose testing) and costs related to managing hypoglycemic episodes. There were a total of 59,780 T1DM BBT patients, 383,145 T2DM BOT patients, and 171,325 T2DM BBT patients expected to be using long-acting insulin. A sensitivity analysis on the entire US population was also conducted. Among T1DM BBT patients, IDeg was associated with an annual cost savings of -$357.13 per patient per year (PPPY), driven primarily by reduced insulin utilization. IDeg was also found to be cost saving among T2DM BOT patients (-$1206.61 PPPY), driven primarily by reductions in the cost of treating severe hypoglycemic episodes. Among T2DM BBT patients, IDeg was associated with an additional cost to the plan of $1420.04 PPPY; however, this result was driven by a higher insulin dose for IDeg compared to IGlar. Overall, IDeg demonstrated cost savings of $240 million per year, which accounted for total cost savings of 3.5% vs. IGlar. The results of this analysis suggest that the reduced insulin utilization and fewer hypoglycemic episodes associated with IDeg may translate into reduced costs for payers. The model is limited by simplification of a complex disease state and assumptions surrounding disease state, treatment patterns, and costs. Therefore, results may not accurately reflect actual health plans or real-world practice patterns.

Budget impact analysis on erythropoiesis-stimulating agents use for the management of chemotherapy-induced anaemia in Greece.

PubMed

Nikolaidi, Eleftheria; Hatzikou, Magdalini; Geitona, Mary

2013-07-16

Chemotherapy-induced anaemia is a common and significant complication of chemotherapy treatment. Blood transfusion and administration of Erythropoiesis-Stimulating Agents (ESAs) either alone or in combination with iron are the most widely used therapeutic options. In Greece, ESAs are among the top ten therapeutic groups with the highest pharmaceutical expenditure, since they are fully reimbursed by social security funds. The objective of the study is to determine potential cost savings related with the use of biosimilar over originator ESAs for the management of the newly diagnosed chemotherapy-induced anemic patients. A budget impact analysis has been carried through the elaboration of national epidemiological, clinical and economic data. Epidemiological data derived from WHO (GLOBOCAN) and the European Cancer Anaemia Survey. Clinical data reflect oncology patients' disease management. ESAs consumption was based on data from the biggest social security fund (IKA). The administration of ESAs under different dosing schemes and time periods has been estimated by separating them in originators and biosimilars as well as by classifying anaemic patients in responders and non-responders. Cost analysis is based on newly diagnosed patients' alternative treatment scenarios. Treatment costs and prices are used in 2012 values. The Social Security Funds's perspective was undertaken. Based on the annual incidence rates, 2.551 newly diagnosed chemotherapy-induced anemic patients are expected to be treated with ESAs. Average cost of treatment on originators ESAs for responders is €2.887 for the 15-week ESAs treatment and €5.019 for non-responders, while on biosimilars €2.623 and €4.009 respectively. Treatment cost on biosimilars is 10.1% lower than originators for responders and 25.2% for non-responders. Budget impact estimates show that treating anemic patients with originator ESAs was estimated at €10.084.800 compared to €8.460.119 when biosimilar ESAs were used, leading to an overall 19,20% cost reduction favoring biosimilars. In Greece, the treatment on biosimilar ESAs seems to be a cost saving option over originators for the newly diagnosed chemotherapy-induced anemic patients, since it corresponds to 5% of the annual overall consumption and expands patients' access to ESAs treatment. Health care decision making should rely on evidence based treatments in order to achieve social funds' sustainability in an era of economic recession.

Budget impact model of Mydrane®, a new intracameral injectable used for intra-operative mydriasis, from a UK hospital perspective.

PubMed

Davey, Keith; Chang, Bernard; Purslow, Christine; Clay, Emilie; Vataire, Anne-Lise

2018-04-19

During cataract surgery, maintaining an adequate degree of mydriasis throughout the entire operation is critical to allow for visualisation of the capsulorhexis and the crystalline lens. Good anaesthesia is also essential for safe intraocular surgery. Mydrane® is a new injectable intracameral solution containing two mydriatics (tropicamide 0.02% and phenylephrine 0.31%) and one anaesthetic (lidocaine 1%) that was developed as an alternative to the conventional topical pre-operative mydriatics used in cataract surgery. This study aimed to estimate the budget impact across a one year time frame using Mydrane® instead of topical dilating eye drops, for a UK hospital performing 3,000 cataract operations a year. A budget impact model (BIM) was developed to compare the economic outcomes associated with the use of Mydrane® versus topical drops (tropicamide 0.5% and phenylephrine 10%) in patients undergoing cataract surgery in a UK hospital. The outcomes of interest included costs and resource use (e.g. clinician time, mydriasis failures, operating room time, number of patients per vial of therapy etc.) associated with management of mydriasis in patients undergoing cataract surgery. All model inputs considered the UK hospital perspective without social or geographical variables. Deterministic sensitivity analyses were also performed to assess the model uncertainty. Introduction of Mydrane® is associated with a cost saving of £6,251 over 3,000 cataract surgeries in one year. The acquisition costs of the Mydrane® (£18,000 by year vs. £3,330 for eye drops) were balanced by substantial reductions in mainly nurses' costs and time, plus a smaller contribution from savings in surgeons' costs (£20,511) and lower costs associated with auxiliary dilation (£410 due to avoidance of additional dilation methods). Results of the sensitivity analyses confirmed the robustness of the model to the variation of inputs. Except for the duration of one session of eye drop instillation and the cost of Mydrane®, Mydrane® achieved an incremental cost gain compared to tropicamide/phenylephrine eye drops. Despite a higher acquisition cost of Mydrane®, the budget impact of Mydrane® on hospital budgets is neutral. Mydrane® offers a promising alternative to traditional regimes using eye drops, allowing for a better patient flow and optimisation of the surgery schedule with neutral budget impact.

The federal and Ontario budgets of 2012: what's in it for health equity?

PubMed

Ruckert, Arne

2012-07-18

Health equity has started to receive significant attention among Canadian policy-makers, with acknowledgement at both the federal and provincial levels of the importance of reducing health inequities. However, a challenging budget environment has led to a number of budget cutbacks in areas that are likely to negatively influence social determinants of health, such as housing, education, and social assistance. This article analyzes both the federal and Ontario budgets of 2012 and their potential impacts on and implications for health equity. Even though health care services have largely remained untouched in both budgets, the article argues that existing health inequities will be further amplified through the implementation of cutbacks in sectors other than health, given the importance of social determinants of health (SDH) for health equity outcomes.

A Predictive Model to Estimate Cost Savings of a Novel Diagnostic Blood Panel for Diagnosis of Diarrhea-predominant Irritable Bowel Syndrome.

PubMed

Pimentel, Mark; Purdy, Chris; Magar, Raf; Rezaie, Ali

2016-07-01

A high incidence of irritable bowel syndrome (IBS) is associated with significant medical costs. Diarrhea-predominant IBS (IBS-D) is diagnosed on the basis of clinical presentation and diagnostic test results and procedures that exclude other conditions. This study was conducted to estimate the potential cost savings of a novel IBS diagnostic blood panel that tests for the presence of antibodies to cytolethal distending toxin B and anti-vinculin associated with IBS-D. A cost-minimization (CM) decision tree model was used to compare the costs of a novel IBS diagnostic blood panel pathway versus an exclusionary diagnostic pathway (ie, standard of care). The probability that patients proceed to treatment was modeled as a function of sensitivity, specificity, and likelihood ratios of the individual biomarker tests. One-way sensitivity analyses were performed for key variables, and a break-even analysis was performed for the pretest probability of IBS-D. Budget impact analysis of the CM model was extrapolated to a health plan with 1 million covered lives. The CM model (base-case) predicted $509 cost savings for the novel IBS diagnostic blood panel versus the exclusionary diagnostic pathway because of the avoidance of downstream testing (eg, colonoscopy, computed tomography scans). Sensitivity analysis indicated that an increase in both positive likelihood ratios modestly increased cost savings. Break-even analysis estimated that the pretest probability of disease would be 0.451 to attain cost neutrality. The budget impact analysis predicted a cost savings of $3,634,006 ($0.30 per member per month). The novel IBS diagnostic blood panel may yield significant cost savings by allowing patients to proceed to treatment earlier, thereby avoiding unnecessary testing. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Global budgets in Maryland: early evidence on revenues, expenses, and margins in regulated and unregulated services.

PubMed

Malmmose, Margit; Mortensen, Karoline; Holm, Claus

2018-04-02

Maryland implemented one of the most aggressive payment innovations the nation has seen in several decades when it introduced global budgets in all its acute care hospitals in 2014. Prior to this, a pilot program, total patient revenue (TPR), was established for 8 rural hospitals in 2010. Using financial hospital report data from the Health Services Cost Review Commission from 2007 to 2013, we examined the hospitals' financial results including revenue, costs, and profit/loss margins to explore the impact of the adoption of the TPR pilot global budget program relative to the remaining hospitals in the state. We analyze financial results for both regulated (included in the global budget and subject to rate-setting) and unregulated services in order to capture a holistic image of the hospitals' actual revenue, cost and margin structures. Common size and difference-in-differences analyses of the data suggest that regulated profit ratios for treatment hospitals increased (from 5% in 2007 to 8% in 2013) and regulated expense-to-gross patient revenue ratios decreased (75% in 2007 and 68% in 2013) relative to the controls. Simultaneously, the profit margins for treatment hospitals' unregulated services decreased (- 12% in 2007 and - 17% in 2013), which reduced the overall margin significantly. This analysis therefore indicates cost shifting and less profit gain from the program than identified by solely focusing on the regulated margins.

Human impacts on terrestrial hydrology: climate change versus pumping and irrigation

NASA Astrophysics Data System (ADS)

Ferguson, Ian M.; Maxwell, Reed M.

2012-12-01

Global climate change is altering terrestrial water and energy budgets, with subsequent impacts on surface and groundwater resources; recent studies have shown that local water management practices such as groundwater pumping and irrigation similarly alter terrestrial water and energy budgets over many agricultural regions, with potential feedbacks on weather and climate. Here we use a fully-integrated hydrologic model to directly compare effects of climate change and water management on terrestrial water and energy budgets of a representative agricultural watershed in the semi-arid Southern Great Plains, USA. At local scales, we find that the impacts of pumping and irrigation on latent heat flux, potential recharge and water table depth are similar in magnitude to the impacts of changing temperature and precipitation; however, the spatial distributions of climate and management impacts are substantially different. At the basin scale, the impacts on stream discharge and groundwater storage are remarkably similar. Notably, for the watershed and scenarios studied here, the changes in groundwater storage and stream discharge in response to a 2.5 °C temperature increase are nearly equivalent to those from groundwater-fed irrigation. Our results imply that many semi-arid basins worldwide that practice groundwater pumping and irrigation may already be experiencing similar impacts on surface water and groundwater resources to a warming climate. These results demonstrate that accurate assessment of climate change impacts and development of effective adaptation and mitigation strategies must account for local water management practices.

Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis.

PubMed

Padula, William V; Heru, Shiona; Campbell, Jonathan D

2016-04-01

Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3% (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). U.S. transgender population starting before transitional therapy. No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000-22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints--HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85% of simulations. Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.

A comparative review of the pharmacoeconomic guidelines in South Africa.

PubMed

Carapinha, João L

2017-01-01

To compare the pharmacoeconomic guidelines in South Africa (SA) with other middle- and high-income countries. A comparative review of key features of the pharmacoeconomic guidelines in SA was undertaken using the Comparative Table of Pharmacoeconomic Guidelines developed by the International Society of Pharmacoeconomics and Outcomes Research, and published country-level pharmacoeconomics guidelines. A random sample of guidelines in high- and middle-income countries were analyzed if data on all key features were available. Key features of the pharmacoeconomic guidelines in SA were compared with those in other countries, and divergent features were identified and elaborated. Five upper middle-income countries (Brazil, Colombia, Cuba, Malaysia, and Mexico), one lower middle-income country (Egypt), and six high-income countries (Germany, Ireland, Norway, Portugal, Taiwan, and the Netherlands) were analyzed. The pharmacoeconomic guidelines in SA differ in important areas when compared with other countries. In SA, the study perspective and costs are limited to private health-insurance companies, complex modelling is discouraged and models require pre-approval, equity issues are not explicitly stated, a budget impact analysis is not required, and pharmacoeconomic submissions are voluntary. Future updates to the pharmacoeconomic guidelines in SA may include a societal perspective with limitations, incentivize complex and transparent models, and integrate equity issues. The pharmacoeconomic guidelines could be improved by addressing conflicting objectives with policies on National Health Insurance, incentivize private health insurance companies to disclose reimbursement data, and require the inclusion of a budget impact analysis in all pharmacoeconomic submissions. Further research is also needed on the impact of mandatory pharmacoeconomic submissions in middle-income countries.

Budget Analysis: Review of the Governor's Proposed Budget, 1999-00.

ERIC Educational Resources Information Center

New York State Office of the Comptroller, Albany.

This report provides an overview of the 1999-2000 executive budget for New York State. The budget calls for $72.7 billion in all funds spending and proposes that a $1.8 billion surplus from the 1998-99 fiscal year be used to fill budget gaps in fiscal years 2000-01 and 2001-02. The report focuses on spending for education, health and social…

Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures.

PubMed

Danzon, Patricia M

2018-03-01

To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Physician Reaction to Price Changes: An Episode-of-Care Analysis

PubMed Central

Lee, A. James; Mitchell, Janet B.

1994-01-01

Physicians may respond to fee reductions in a variety of ways. This episode-of-care analysis examines the impact of surgical fee reductions (mandated by the Omnibus Budget Reconciliation Acts [OBRAs] of 1986-87) on the overall pattern and cost of health care services provided in association with the surgical procedure itself. The study focuses on six procedure groups: cataract extractions; total hip replacement; total knee replacement; coronary artery bypass graft (CABG) surgery; upper gastrointestinal (GI) endoscopy; and prostatectomy. Only two of these procedures give significant evidence for the existence of a service volume offset to the fee reductions. PMID:10172299

Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases.

PubMed

Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

2016-01-01

In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15-75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings.

Impact of biomass burning plume on radiation budget and atmospheric dynamics over the arctic

NASA Astrophysics Data System (ADS)

Lisok, Justyna; Pedersen, Jesper; Ritter, Christoph; Markowicz, Krzysztof M.; Malinowski, Szymon; Mazzola, Mauro; Udisti, Roberto; Stachlewska, Iwona S.

2018-04-01

The aim of the research was to determine the impact of July 2015 biomass burning event on radiative budget, atmospheric stratification and turbulence over the Arctic using information about the vertical structure of the aerosol load from the ground-based data. MODTRAN simulations indicated very high surface radiative cooling (forcing of -150 Wm-2) and a heating rate of up to 1.8 Kday-1 at 3 km. Regarding LES results, a turbulent layer at around 3 km was clearly seen after 48 h of simulation.

Impact of Budget Cuts on Children: Background Materials for Joint Hearing of the Subcommittee on Oversight of the Committee on Ways and Means and the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, U.S. House of Representatives, 97th Congress, 2nd Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Ways and Means.

Prepared for joint hearings on the impact of the proposed budget cuts on programs affecting children, these background materials describe the main programs which serve children in five general areas. These areas are health services for mothers and children, child nutrition programs, aid to families with dependent children, day care and other child…

Beyond Zero Based Budgeting.

ERIC Educational Resources Information Center

Ogden, Daniel M., Jr.

1978-01-01

Suggests that the most practical budgeting system for most managers is a formalized combination of incremental and zero-based analysis because little can be learned about most programs from an annual zero-based budget. (Author/IRT)

Novel methodology for pharmaceutical expenditure forecast

PubMed Central

Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

Background and objective The value appreciation of new drugs across countries today features a disruption that is making the historical data that are used for forecasting pharmaceutical expenditure poorly reliable. Forecasting methods rarely addressed uncertainty. The objective of this project was to propose a methodology to perform pharmaceutical expenditure forecasting that integrates expected policy changes and uncertainty (developed for the European Commission as the ‘EU Pharmaceutical expenditure forecast’; see http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). Methods 1) Identification of all pharmaceuticals going off-patent and new branded medicinal products over a 5-year forecasting period in seven European Union (EU) Member States. 2) Development of a model to estimate direct and indirect impacts (based on health policies and clinical experts) on savings of generics and biosimilars. Inputs were originator sales value, patent expiry date, time to launch after marketing authorization, price discount, penetration rate, time to peak sales, and impact on brand price. 3) Development of a model for new drugs, which estimated sales progression in a competitive environment. Clinical expected benefits as well as commercial potential were assessed for each product by clinical experts. Inputs were development phase, marketing authorization dates, orphan condition, market size, and competitors. 4) Separate analysis of the budget impact of products going off-patent and new drugs according to several perspectives, distribution chains, and outcomes. 5) Addressing uncertainty surrounding estimations via deterministic and probabilistic sensitivity analysis. Results This methodology has proven to be effective by 1) identifying the main parameters impacting the variations in pharmaceutical expenditure forecasting across countries: generics discounts and penetration, brand price after patent loss, reimbursement rate, the penetration of biosimilars and discount price, distribution chains, and the time to reach peak sales for new drugs; 2) estimating the statistical distribution of the budget impact; and 3) testing different pricing and reimbursement policy decisions on health expenditures. Conclusions This methodology was independent of historical data and appeared to be highly flexible and adapted to test robustness and provide probabilistic analysis to support policy decision making. PMID:27226843

Arms Transfers to Venezuela: A Comparative and Critical Analysis of the Acquisition Process (1980-1996).

DTIC Science & Technology

1999-03-01

Budget (Oficina Central de Presupuesto [OCEPRE]), which is the presidential agency with overall responsibility to formulate the national budget...Budget (Oficina Central de Presupuesto OCEPRE), and they receive a special treatment in the Venezuelan Budgetary process. The OCEPRE is the...the Central Office of Budget (Oficina Central de Presupuesto , OCEPRE). This occurs when funds for weapons acquisitions come from the ordinary budget

Logging-related increases in stream density in a northern California watershed

Treesearch

Matthew S. Buffleben

2012-01-01

Although many sediment budgets estimate the effects of logging, few have considered the potential impact of timber harvesting on stream density. Failure to consider changes in stream density could lead to large errors in the sediment budget, particularly between the allocation of natural and anthropogenic sources of sediment.This study...

Prospective Impact of Responsibility Center Budgeting on Communication and Theatre Programs: View from a State Supported University.

ERIC Educational Resources Information Center

Dick, Robert C.

In response to the nationwide trend toward increased financial pressures and growing demands by state legislatures for accountability, several large universities (including Indiana University) have adopted various forms of "responsibility center budgeting" (RCB), which has fiscal implications for programs in speech communication and…

Can-Do Spirit: Facing the Challenges of Budget Cuts

ERIC Educational Resources Information Center

Edwards, Buffy

2012-01-01

In this era of higher student enrollment coupled with budget cuts, some school library professionals are considering retirement, while others are standing up to defend the profession they know has a strong positive impact on student learning. Many school librarians who weather difficulties do so by choosing to find energy in the challenges of…

What's Missing from the Debate on Seniority? A Policy Brief

ERIC Educational Resources Information Center

Center for Education Organizing (NJ1), 2011

2011-01-01

As states across the country face unprecedented budget shortfalls, communities as well as policymakers are trying to stave off the potentially devastating impacts of budget cuts on schools and other basic services. Many public school systems are facing significant shortfalls, forcing "reductions in force" or RIFs, of teachers and other school…

Cinematic Creativity and Production Budgets: Does Money Make the Movie?

ERIC Educational Resources Information Center

Simonton, Dean Keith

2005-01-01

Although filmmaking requires substantial capital investment, it is not known whether cinematic creativity is positively correlated with the size of the film's budget. Therefore, budgetary impact was investigated in a sample of feature films released between 1997 and 2001. Although production costs were positively related to box office success (as…

78 FR 69396 - Agency Information Collection Activities; Submission to the Office of Management and Budget for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-19

... DEPARTMENT OF EDUCATION [Docket No.: ED-2013-ICCD-0122] Agency Information Collection Activities; Submission to the Office of Management and Budget for Review and Approval; Comment Request; Impact Aid...), Department of Education (ED). ACTION: Notice. SUMMARY: In accordance with the Paperwork Reduction Act of 1995...

The Impact of a Professional Development Program on Elementary Teachers' Science Knowledge and Pedagogical Skills

ERIC Educational Resources Information Center

Ferreira, Maria Madalena

2015-01-01

Teacher professional development plays an important role in a teacher's growth and every year school districts spend a large portion of their budgets in professional development activities. However, as districts face increasing budget cuts, funds for professional development compete against other district priorities. As a result, partnerships…

Using Monte Carlo simulation to examine the economic cost and impact of HLB

USDA-ARS?s Scientific Manuscript database

Crop budgets are a useful and integral tool for producers in making sound business decisions. Although, not without shortcomings. Typically, crop and enterprise budgets are static and examine prices at one point in time. In order to assess changing prices, for inputs and or production, it is typi...

Funding Federal Civil Rights Enforcement. A Report.

ERIC Educational Resources Information Center

Ball, Conner

This study examines many measures of enforcement output and outcomes that help to demonstrate the real impact of funding levels. The information, unless otherwise indicated was drawn from the U.S. Office of Management and Budget (OMB) and agency budget documents for Fiscal Years 1979 through 1996. Resources provided for civil rights enforcement…

Priority setting in healthcare: towards guidelines for the program budgeting and marginal analysis framework.

PubMed

Peacock, Stuart J; Mitton, Craig; Ruta, Danny; Donaldson, Cam; Bate, Angela; Hedden, Lindsay

2010-10-01

Economists' approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) priority setting exercise. PBMA is a framework that explicitly recognizes the need to balance pragmatic and ethical considerations with economic rationality when making resource allocation decisions. While the ten guidelines are drawn from the PBMA framework, they may be generalized across a range of economic approaches to priority setting.

Pharmacoeconomic Analysis in Saudi Arabia: An Overdue Agenda Item for Action

PubMed Central

Al-Jazairi, Abdulrazaq S.; Al-Qadheeb, Nada S.; Ajlan, Aziza

2011-01-01

Pharmacoeconomics is a branch of health economics related to the most economical and efficient use of pharmaceuticals. Pharmacoeconomic research identifies, measures and compares the costs and outcomes (clinical, economic and humanistic) of pharmaceutical products and services. Pharmacoeconomic evaluation can play a significant role in the efficient allocation of resources in healthcare systems with constrained budgets. Countries are trying to control the rising costs of health care in their aging population. They are all asking the same question: Is the new drug good value for money; and if so, what is the society willing to pay for it? This article reviews the importance of, and the need for, adaptation of pharmacoeconomic analysis to the conditions in Saudi Arabia. It will shed some light on the important steps for converting the concept into practice, including the need for identifying the willing-to-pay (WTP) or the threshold cutoff, the existence of a real cost for each utility, the nonexistence of an pharmacoeconomic advisory forum, pharmaceutical budget allocation, and the impact of pharmaceutical marketing. It will also provide recommendations for easing any challenges that might jeopardize the conduct of such analysis in Saudi Arabia. PMID:21808106

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

PubMed

Martinez-Sanchez, Veronica; Levis, James W; Damgaard, Anders; DeCarolis, Joseph F; Barlaz, Morton A; Astrup, Thomas F

2017-03-21

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" and "externality costs". Budget costs include market goods and services (economic impact), whereas externality costs include effects outside the economic system (e.g., environmental impact). This study demonstrates the applicability of S-LCC to SWM life-cycle optimization through a case study based on an average suburban U.S. county of 500 000 people generating 320 000 Mg of waste annually. Estimated externality costs are based on emissions of CO 2 , CH 4 , N 2 O, PM 2.5 , PM 10 , NO x , SO 2 , VOC, CO, NH 3 , 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 SO 2 , NO x , PM 2.5 , CH 4 , fossil CO 2 , and NH 3 emissions. S-LCC proved to be a valuable tool for policy analysis, but additional data on key externality costs such as organic compounds emissions to water would improve future analyses.

A mathematical model for maximizing the value of phase 3 drug development portfolios incorporating budget constraints and risk.

PubMed

Patel, Nitin R; Ankolekar, Suresh; Antonijevic, Zoran; Rajicic, Natasa

2013-05-10

We describe a value-driven approach to optimizing pharmaceutical portfolios. Our approach incorporates inputs from research and development and commercial functions by simultaneously addressing internal and external factors. This approach differentiates itself from current practices in that it recognizes the impact of study design parameters, sample size in particular, on the portfolio value. We develop an integer programming (IP) model as the basis for Bayesian decision analysis to optimize phase 3 development portfolios using expected net present value as the criterion. We show how this framework can be used to determine optimal sample sizes and trial schedules to maximize the value of a portfolio under budget constraints. We then illustrate the remarkable flexibility of the IP model to answer a variety of 'what-if' questions that reflect situations that arise in practice. We extend the IP model to a stochastic IP model to incorporate uncertainty in the availability of drugs from earlier development phases for phase 3 development in the future. We show how to use stochastic IP to re-optimize the portfolio development strategy over time as new information accumulates and budget changes occur. Copyright © 2013 John Wiley & Sons, Ltd.

Traveltime budgets and mobility in urban areas

DOT National Transportation Integrated Search

1974-05-01

The study tests by empirical comparative analysis the concept that tripmakers have a stable daily traveltime budget and discusses the implication of such a budget to transportation modeling techniques and the evaluation of alternative transportation ...

Alaska Department of Labor Administrative Services Division

Science.gov Websites

Sections Fiscal Research & Analysis Procurement Data Processing Budget Links State Employee Directory FY 2019 DOLWD Budget (Proposed) FY 2018 DOLWD Budget (Enacted) FY 2018 Indirect Cost Proposal FY 2016

Assessing the role of prevention partnerships in STD prevention: a review of comprehensive STD prevention systems progress reports.

PubMed

Hogben, Matthew; Hood, Julia; Collins, Dayne; McFarlane, Mary

2013-11-01

Systematic analysis of STD programme data contributes to a national portrait of sexually transmitted disease (STD) prevention activities, including research and evaluation specifically designed to optimise programme efficiency and impact. We analysed the narrative of the 2009 annual progress reports of the US Comprehensive STD Prevention Systems cooperative agreement for 58 STD programmes, concentrating on programme characteristics and partnerships. Programmes described 516 unique partnerships with a median of seven organisations cited per STD programme. Non-profit organisations (including service providers) were most frequently cited. Higher gonorrhoea morbidity was associated with reporting more partnerships; budget problems were associated with reporting fewer. Challenges to engaging in partnerships included budget constraints, staff turnover and low interest. Data provide a source of information for judging progress in programme collaboration and for informing a sustained programme-focused research and evaluation agenda.

Impact of Modified System of Objectified Judgement Analysis (SOJA) methodology on prescribing costs of ACE inhibitors.

PubMed

Alabbadi, Ibrahim; Crealey, Grainne; Scott, Michael; Baird, Simon; Trouton, Tom; Mairs, Jill; McElnay, James

2006-01-01

System of Objectified Judgement Analysis (SOJA) is a structured approach to the selection of drugs for formulary inclusion. How- ever, while SOJA is a very important advance in drug selection for formulary purposes, it is hospital based and can only be applied to one indication at a time. In SOJA, cost has been given a primary role in the selection process as it has been included as a selection criterion from the start. Cost may therefore drive the selection of a particular drug product at the expense of other basic criteria such as safety or efficacy. The aims of this study were to use a modified SOJA approach in the selection of ACE inhibitors (ACEIs) for use in a joint formulary that bridges primary and secondary care within a health board in Northern Ireland, and to investigate the potential impact of the joint formulary on prescribing costs of ACEIs in that health board. The modified SOJA approach involved four phases in sequence: an evidence-based pharmacotherapeutic evaluation of all available ACEI drug entities, a separate safety/risk assessment analysis of products containing agents that exceeded the pharmacotherapeutic threshold, a budget-impact analysis and, finally, the selection of product lines. A comprehensive literature review and expert panel judgement informed the selection of criteria (and their relative weighting) for the pharmacotherapeutic evaluation. The resultant criteria/scoring system was circulated (in questionnaire format) to prescribers and stakeholders for comment. Based on statistical analysis of the latter survey results, the final scoring system was developed. Drug entities that exceeded the evidence threshold were sequentially entered into the second and third phases of the process. Five drug entities (11 currently available in the UK) exceeded the evidence threshold and 22 of 26 submitted product lines containing these drug entities satisfied the safety/risk assessment criteria. Three product lines, each containing a different drug entity, were selected for formulary inclusion after budget impact analysis was performed. The estimated potential annual cost savings for ACEIs (based on estimated annual usage in defined daily doses) for this particular health board was 42%. The modified SOJA approach has a significant contribution to make in containing the costs of ACEIs. Applying modified SOJA as a practical method for all indications will allow the development of a unified formulary that bridges secondary and primary care.

The Seasonal Cycle of the Radiation Budget and Cloud Radiative Effect in the Amazon Rainforest of Brazil

NASA Astrophysics Data System (ADS)

Collow, A.; Miller, M. A.

2015-12-01

The Amazon Rainforest of Brazil is a region with potential climate sensitivities, especially with ongoing land surface changes and biomass burning aerosols due to deforestation. Ubiquitous moisture in the area make clouds a common feature over the Amazon Rainforest and along with the influences from deforestation have a significant impact on the radiation budget. This region experiences a seasonal contrast in clouds, precipitation, and aerosols making it an ideal location to study the relationship between these variables and the radiation budget. An internationally sponsored campaign entitled GOAmazon2014/15 included a deployment of an Atmospheric Radiation Measurement (ARM) Mobile Facility, which collected comprehensive measurements using in situ and remote sensors. Observations of clouds, aerosols, and radiative fluxes from the first year of the deployment are analyzed in conjunction with top of the atmosphere (TOA) observations from the Clouds and the Earth's Radiant Energy System (CERES) and analyses from the newly released Modern Era Retrospective Analysis for Research and Applications Version-2 (MERRA-2). The combination of surface and TOA observations allows for the calculation of radiative flux divergence and cloud radiative effect (CRE) within the column, while the comparison to MERRA-2 enables the verification of a new reanalysis product and a view of the spatial variation of the radiation budget. Clouds are very reflective in the area, creating a cooling effect in the shortwave (SW) at the surface, with some seasonality present due to the reduction of optically thick clouds in the dry season. Clouds have little effect on the column itself in the SW due to the balance between the reflective and absorbing properties of the clouds with the majority of the impact on the atmosphere from clouds warming in the longwave. Influences of aerosols are seen in the dry season, and an increase in moisture above the Amazon River and its tributaries enhance the CRE.

An Analysis of the President’s 2015 Budget

DTIC Science & Technology

2014-04-01

President’s tax proposals that were prepared by the staff of the Joint Committee on Taxation (JCT).1 In conjunction with analyzing the President’s budget...more details about the President’s tax proposals, see Joint Committee on Taxation , Estimated Budget Effects of the Revenue Provisions Contained in...in CBO’s Estimate of the President’s Budget (Billions of dollars) Sources: Congressional Budget Office; staff of the Joint Committee on Taxation

Surface forcing of non-stand-replacing fires in Siberian larch forests

NASA Astrophysics Data System (ADS)

Chen, Dong; Loboda, Tatiana V.

2018-04-01

Wildfires are the dominant disturbance agent in the Siberian larch forests. Extensive low- to mediate-intensity non-stand-replacing fires are a notable property of fire regime in these forests. Recent large scale studies of these fires have focused mostly on their impacts on carbon budget; however, their potential impacts on energy budget through post-fire albedo changes have not been considered. This study quantifies the post-fire surface forcing for Siberian larch forests that experienced non-stand-replacing fires between 2001 and 2012 using the full record of MODIS MCD43A3 albedo product and a burned area product developed specifically for the Russian forests. Despite a large variability, the mean effect of non-stand-replacing fires imposed through albedo is a negative forcing which lasts for at least 14 years. However, the magnitude of the forcing is much smaller than that imposed by stand-replacing fires, highlighting the importance of differentiating between the two fire types in the studies involving the fire impacts in the region. The results of this study also show that MODIS-based summer differenced normalized burn ratio (dNBR) provides a reliable metric for differentiating non-stand-replacing from stand-replacing fires with an overall accuracy of 88%, which is of considerable importance for future work on modeling post-fire energy budget and carbon budget in the region.

Development and application of a comprehensive simulation model to evaluate impacts of watershed structures and irrigation water use on streamflow and groundwater: The case of Wet Walnut Creek Watershed, Kansas, USA

USGS Publications Warehouse

Ramireddygari, S.R.; Sophocleous, M.A.; Koelliker, J.K.; Perkins, S.P.; Govindaraju, R.S.

2000-01-01

This paper presents the results of a comprehensive modeling study of surface and groundwater systems, including stream-aquifer interactions, for the Wet Walnut Creek Watershed in west-central Kansas. The main objective of this study was to assess the impacts of watershed structures and irrigation water use on streamflow and groundwater levels, which in turn affect availability of water for the Cheyenne Bottoms Wildlife Refuge Management area. The surface-water flow model, POTYLDR, and the groundwater flow model, MODFLOW, were combined into an integrated, watershed-scale, continuous simulation model. Major revisions and enhancements were made to the POTYLDR and MODFLOW models for simulating the detailed hydrologic budget for the Wet Walnut Creek Watershed. The computer simulation model was calibrated and verified using historical streamflow records (at Albert and Nekoma gaging stations), reported irrigation water use, observed water-level elevations in watershed structure pools, and groundwater levels in the alluvial aquifer system. To assess the impact of watershed structures and irrigation water use on streamflow and groundwater levels, a number of hypothetical management scenarios were simulated under various operational criteria for watershed structures and different annual limits on water use for irrigation. A standard 'base case' was defined to allow comparative analysis of the results of different scenarios. The simulated streamflows showed that watershed structures decrease both streamflows and groundwater levels in the watershed. The amount of water used for irrigation has a substantial effect on the total simulated streamflow and groundwater levels, indicating that irrigation is a major budget item for managing water resources in the watershed. (C) 2000 Elsevier Science B.V.This paper presents the results of a comprehensive modeling study of surface and groundwater systems, including stream-aquifer interactions, for the Wet Walnut Creek Watershed in west-central Kansas. The main objective of this study was to assess the impacts of watershed structures and irrigation water use on streamflow and groundwater levels, which in turn affect availability of water for the Cheyenne Bottoms Wildlife Refuge Management area. The surface-water flow model, POTYLDR, and the groundwater flow model, MODFLOW, were combined into an integrated, watershed-scale, continuous simulation model. Major revisions and enhancements were made to the POTYLDR and MODFLOW models for simulating the detailed hydrologic budget for the Wet Walnut Creek Watershed. The computer simulation model was calibrated and verified using historical streamflow records (at Albert and Nekoma gaging stations), reported irrigation water use, observed water-level elevations in watershed structure pools, and groundwater levels in the alluvial aquifer system. To assess the impact of watershed structures and irrigation water use on streamflow and groundwater levels, a number of hypothetical management scenarios were simulated under various operational criteria for watershed structures and different annual limits on water use for irrigation. A standard `base case' was defined to allow comparative analysis of the results of different scenarios. The simulated streamflows showed that watershed structures decrease both streamflows and groundwater levels in the watershed. The amount of water used for irrigation has a substantial effect on the total simulated streamflow and groundwater levels, indicating that irrigation is a major budget item for managing water resources in the watershed.A comprehensive simulation model that combines the surface water flow model POTYLDR and the groundwater flow model MODFLOW was used to study the impacts of watershed structures (e.g., dams) and irrigation water use (including stream-aquifer interactions) on streamflow and groundwater. The model was revised, enhanced, calibrated, and verified, then applied to evaluate the hydrologic budget for Wet Wal

The Economic Impact of Biosimilars on Chronic Immune-Mediated Inflammatory Diseases.

PubMed

Pentek, Marta; Zrubka, Zsombor; Gulacsi, Laszlo

2017-01-01

Biological drugs represent highly effective but costly treatments for chronic immunemediated inflammatory diseases posing substantial burden on health care budgets. Introduction of biosimilars since 2013 has brought forward the potential of market competition, and as a societal benefit, the hope of increased access at a lower cost. We aim to provide a descriptive review on economic aspects and market changes related to the introduction of biosimilar drugs. Our focus is on chronic immune-mediated inflammatory conditions in rheumatology, gastroenterology and dermatology. Based on available literature data, we discuss the determinants of access to biological treatment, summarize the available health economic evidences with special focus on cost-utility and budget impact analyses. Market penetration of biosimilars and their overall impact on biological markets are analyzed. Biosimilar markets are country specific due to differences in the regulatory and reimbursement systems. Cost-utility analyses suggest, that given the lower price of biosimilars, formerly established biological treatment sequence practices and the eligibility criteria for biological treatment deserve reconsideration. Budget impact analyses forecasted significant budget savings in various diagnoses and countries, providing opportunity for the treatment of more patients. Biosimilars may contribute to better patient-access and provide savings to governments. To increase their acceptability, further clinical evidences and real world experiences are needed, as well as education of physicians and patients. The high biosimilar penetration rates in Norway, Denmark and Poland suggest that policies which support interchanging from the reference product may be important drivers of biosimilar uptake. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Formula Budgeting for Higher Education: State Practices in 1979-80. Working Paper Series.

ERIC Educational Resources Information Center

Gross, Francis M.

Budget formulas used by states for state-supported colleges and universities are described, along with budgeting guidelines. A comparative analysis of the budget formulas in use in 1979-1980 reveals the similarities and differences in design among 19 states. Functional areas of expenditure used in the formula calculation are also compared for each…

Using Regression Analysis in Departmental Budget Allocations. IR Applications, Volume 24, November 1, 2009

ERIC Educational Resources Information Center

Luna, Andrew L.; Brennan, Kelly A.

2009-01-01

This study uses a regression model to determine if a significant difference exists between the actual budget allocation that an academic department received and the model's predicted budget allocation for that same department. Budget data from a Southeastern Master's/Comprehensive state university were used as the dependent variable, and the…

A New Direction: The Clinton Budget and Economic Plan.

ERIC Educational Resources Information Center

Greenstein, Robert; Leonard, Paul

This booklet offers an in-depth analysis of the Clinton Administration budget and economic plan. The initial overview explains why the budget can be regarded as both a poverty-reduction and deficit-reduction budget. Chapter 2 offers detailed descriptions of the three main components of the plan--the deficit reduction measure (i.e., spending cuts…

Effects of Global Budgeting on the Distribution of Dentists and Use of Dental Care in Taiwan

PubMed Central

Hsueh, Ya-Seng A; Lee, Shoou-Yih D; Huang, Yu-Tung A

2004-01-01

Objective To examine the effects of global budgeting on the distribution of dentists and the use and cost of dental care in Taiwan. Data Sources (1) Monthly dental claim data from January 1996 to December 2001 for the entire insured population in Taiwan. (2) The 1996–2001 population information for the cities, counties and townships in Taiwan, abstracted from the Taiwan-Fukien Demographic Fact Book. Study Design Longitudinal, using the autocorrelation model. Principal Findings Results indicated decline in dental care utilization, particularly after the implementation of dental global budgeting. With few exceptions, dental global budgeting did not improve the distribution of dental care and dentist supply. Conclusions The experience of the dental global budget program in Taiwan suggested that dental global budgeting might contain dental care utilization and that several conditions might have to be met in order for the reimbursement system to have effective redistributive impact on dental care and dentist supply. PMID:15544648

Optimal dynamic control of invasions: applying a systematic conservation approach.

PubMed

Adams, Vanessa M; Setterfield, Samantha A

2015-06-01

The social, economic, and environmental impacts of invasive plants are well recognized. However, these variable impacts are rarely accounted for in the spatial prioritization of funding for weed management. We examine how current spatially explicit prioritization methods can be extended to identify optimal budget allocations to both eradication and control measures of invasive species to minimize the costs and likelihood of invasion. Our framework extends recent approaches to systematic prioritization of weed management to account for multiple values that are threatened by weed invasions with a multi-year dynamic prioritization approach. We apply our method to the northern portion of the Daly catchment in the Northern Territory, which has significant conservation values that are threatened by gamba grass (Andropogon gayanus), a highly invasive species recognized by the Australian government as a Weed of National Significance (WONS). We interface Marxan, a widely applied conservation planning tool, with a dynamic biophysical model of gamba grass to optimally allocate funds to eradication and control programs under two budget scenarios comparing maximizing gain (MaxGain) and minimizing loss (MinLoss) optimization approaches. The prioritizations support previous findings that a MinLoss approach is a better strategy when threats are more spatially variable than conservation values. Over a 10-year simulation period, we find that a MinLoss approach reduces future infestations by ~8% compared to MaxGain in the constrained budget scenarios and ~12% in the unlimited budget scenarios. We find that due to the extensive current invasion and rapid rate of spread, allocating the annual budget to control efforts is more efficient than funding eradication efforts when there is a constrained budget. Under a constrained budget, applying the most efficient optimization scenario (control, minloss) reduces spread by ~27% compared to no control. Conversely, if the budget is unlimited it is more efficient to fund eradication efforts and reduces spread by ~65% compared to no control.

Diffusion of innovations: treatment of Alzheimer's disease in Germany.

PubMed

Ruof, Jörg; Mittendorf, Thomas; Pirk, Olaf; von der Schulenburg, J-Matthias Graf

2002-04-01

Systematic barriers seem to slow down the market penetration of innovative acethylcholinesterase (AChE) inhibitors in Alzheimer's disease. The goal of our study was to examine the diffusion of AChE inhibitors into the German market in more detail. On the basis of using the ongoing surveillance panel of the Institute of Medical Statistic (IMS) Health, the prescription patterns of 100 physicians (72 general practitioners, 28 neurologists) were examined. In addition, structured telephone interviews with the same 100 physicians were conducted. The interview included the assessment of a hypothetical treatment situation (i.e. physicians were asked what they would prescribe if a close relative of theirs had Alzheimer's disease) as well as qualitative items examining the physicians' attitudes towards AChE inhibitors and the perceived impact on drug budgets. As a major result, the analysis revealed that neurologists prescribed AChE inhibitors to 44.6% of their patients, while general practitioners only treated 9.0% of their patients with AChE inhibitors. The analysis of the qualitative items revealed positive attitudes regarding the safety and efficacy of AChE inhibitors, but negative attitudes regarding the budgetary limitations to prescribing these drugs. A correlation of r=0.21 (P<0.05) was found between the perceived impact on drug budgets and the adoption of AChE inhibitors and a correlation of r=0.32 (P<0.002) was seen between the physician's specialty and the adoption of AChE inhibitors. These data show that, while the AChE inhibitor adoption process has passed the early stages, various barriers slow down the final stages of AChE inhibitor adoption. The drug budget in particular seems to inhibit the adoption of the innovation by the majority of general practitioners. This leads to a more short-term cost control strategy instead of long-term disease management and cost saving approaches.

Analysis of the United States Computer Emergency Readiness Team’s (U.S. CERT) EINSTEIN III Intrusion Detection System, and Its Impact on Privacy

DTIC Science & Technology

2013-03-01

Arlington, VA 22202–4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704–0188) Washington DC 20503. 1. AGENCY USE ONLY...University, 2004 Submitted in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN INFORMATION TECHNOLOGY MANAGEMENT...Fulp Second Reader Dr. Dan Boger Chair, Department of Information Sciences iv THIS PAGE INTENTIONALLY LEFT BLANK v ABSTRACT To secure

Defence Industrial Policies and Their Impact on Acquisition Outcomes: A Comparative Analysis of the United Kingdom and Australia

DTIC Science & Technology

2012-09-01

this case, there is a price premium relative to globally least-cost purchases if such capabilities exist elsewhere and are being employed at a level of...operational sovereignty and security, and the technology areas where MOD would rely on international defence cooperation or open global technology...planning assumptions (i.e. future budgets) • What was required for retention in the UK industrial base 10 • Overview of the global defence market

Ship Track Cloud Analysis for the North Pacific Area

DTIC Science & Technology

1988-09-01

referred to as CBD ) have theorized that the impact of aerosols on the radiation budget, due to their interaction with clouds, may be several times...tracks in regions where they were known to exist. While this study was limnited to a few test cases. it did prove thc feasibility of developing2 a...on 13 July 1987 C. OBJECTIVES AND ORGANIZATION The goal of this thesis is to generalize the work of CBD . This effort will have two basic objectives

Make or Buy: An Analysis of the Impacts of 3D Printing Operations, 3D Laser Scanning Technology, and Collaborative Product Lifecycle Management on Ship Maintenance and Modernization Cost Savings

DTIC Science & Technology

2015-03-21

3 Navy Depot Maintenance Strategic Plan (2014– 2019 ... Tech Center in-sourcing initiative saves between $52 and $203 million in data system costs over the life of the project. The Army claims in...maintenance budgets at the DOD and the Navy are highlighted, and the Navy Depot Maintenance Strategic Plan (2014– 2019 ) is introduced. The Problem

ARM Research in the Equatorial Western Pacific: A Decade and Counting

DOE Office of Scientific and Technical Information (OSTI.GOV)

Long, Charles N.; McFarlane, Sally A.; Del Genio, Anthony D.

2013-05-22

The tropical western Pacific (TWP) is an important climatic region. Strong solar heating, warm sea surface temperatures and the annual progression of the Intertropical Convergence Zone (ITCZ) across this region generate abundant convective systems, which through their effects on the heat and water budgets have a profound impact on global climate and precipitation. To accurately represent tropical cloud systems in models, measurements of tropical clouds, the environment in which they reside, and their impact on the radiation and water budgets are needed. Because of the remote location, ground-based datasets of cloud, atmosphere, and radiation properties from the TWP region havemore » traditionally come primarily from short-term field experiments. While providing extremely useful information on physical processes, these datasets are limited in statistical and climatological information because of their short duration. To provide long-term measurements of the surface radiation budget in the tropics, and the atmospheric properties that affect it, the Atmospheric Radiation Measurement program established a measurement site on Manus Island, Papua New Guinea in 1996 and on the island republic of Nauru in late 1998. These sites provide unique datasets available from more than 10 years of operation in the equatorial western Pacific on Manus and Nauru. We present examples of the scientific use of these datasets including characterization of cloud properties, analysis of cloud radiative forcing, model studies of tropical clouds and processes, and validation of satellite algorithms. We also note new instrumentation recently installed at the Manus site that will expand opportunities for tropical atmospheric science.« less

A critical systematic review of budget impact analyses on drugs in the EU countries.

PubMed

van de Vooren, Katelijne; Duranti, Silvy; Curto, Alessandro; Garattini, Livio

2014-02-01

Budget impact analysis (BIA) is a relatively recent technique that is supposed to be complementary to more established economic evaluations (EEs). We reviewed the BIAs published on drugs in the EU since December 2008, to assess whether these studies have improved in quality in the last few years. We conducted a literature search on the international databases PubMed and EMBASE. The selected articles were screened using a two-step approach to assess (1) their main methodological characteristics and (2) the level of adherence to the latest BIA definition. The assessment was made by two independent reviewers and any disagreement was resolved through discussion. Eventually, 17 articles were reviewed. Thirteen referred to a stand-alone BIA not accompanying a full EE, only nine focussed on a new treatment, 15 were sponsored by the manufacturer of the drug of reference, all but one claiming savings for healthcare budgets. The quality of methods was poor in many of the studies, and only a few of them attempted to estimate real local costs in a credible way. Therefore, the crucial items that in theory make a BIA different from other types of EEs were often the major points of weakness of the studies reviewed. Our review confirmed that the BIA is not yet a well-established technique in the literature and many published studies still fail to reach an acceptable quality. In particular, BIAs funded by pharmaceutical companies appear to be tailored to show short-term savings induced by new, highly priced products.

Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

PubMed Central

Rautenberg, Tamlyn Anne; Zerwes, Ute; Lee, Way Seah

2018-01-01

Objective To perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia. Methods A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components. Results According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of −RM 1,272,833/quality-adjusted life year (USD −312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of −RM 73,193,603 (USD −17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components. Conclusion Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios. PMID:29588606

Investigating the financial impact of porcine reproductive and respiratory syndrome on smallholder pig farmers in Cambodia.

PubMed

Zhang, A; Young, J R; Suon, S; Ashley, K; Windsor, P A; Bush, R D

2017-04-01

Porcine reproductive and respiratory syndrome (PRRS) was first identified in Cambodia in 2010, causing serious problems on affected farms, although the costs of the disease have not been well defined. The household financial impact of a PRRS outbreak in Cambodia was investigated using partial budget analysis, examining the economic benefit of three proposed interventions: (i) quarterly PRRS vaccine use, (ii) biosecurity implementation, and (iii) implementation of vaccination and biosecurity. The analyses were applied to three farm models: (i) a two-sow breeder; (ii) a five-pig fattener; and (iii) a single-sow, three-pig farrow-to-finish/breeder. Data was derived from a knowledge, attitude, and practice survey of 240 smallholder farmers (61 with pigs) from 16 villages across 5 provinces, plus case studies of 12 farmers selected for more detailed financial analysis. The study indicated that financial losses associated with PRRS were severe, with a 25% mean loss to the annual household income of 61 interviewed farmers. Partial budget analysis identified a strongly positive incentive for vaccination and biosecurity to be implemented in combination, with the highest annual net benefit of USD 357.10 realised by the breeder system. However, due to current scarcity of the PRRS vaccine and its high cost to smallholders, biosecurity interventions may be more cost-effective, especially for low PRRS incidence regions. It was concluded that PRRS critically constrains the profitability of smallholder pig farms and that these findings will assist development of village-level livestock disease risk management programmes that encourage adoption of vaccination and biosecurity practices to enhance farmer livelihoods in Cambodia.

Barriers to and Budget Impact of Lumbar Total Disc Replacement Utilization.

PubMed

Sandhu, Faheem; Blumenthal, Scott; Grunch, Betsy; Kimball, Bent; Ferko, Nicole; Hollmann, Sarah

2017-12-15

: Evidence on the favorable efficacy, safety, and cost effectiveness of lumbar total disc replacement (TDR) compared with fusion for lumbar degenerative disc disease is mounting; however, a key barrier identified for TDR utilization is lack of coverage by US health insurers. Although economic considerations in a fee-for-service model should not be a determining factor in patient access, concerns regarding the budget impact of lumbar TDR surgery may unfortunately underlie coverage decisions. On the basis of the data available and economic modeling, the panel agreed that there is no indication that there would be a dramatic increase in patients seeking lumbar TDR. Considering several possible scenarios on potential growth in TDR utilization with coverage, as well as growth in the overall surgical pool of patients, economic modeling demonstrated that adoption of lumbar TDR would result in minimal or no budget impact for commercial insurance plans. Considering these model results and the economic literature, the panel concluded that adopting lumbar TDR within a coverage policy is expected to remain cost neutral for the insurer.

State/federal interaction of LANDSAT system and related technical assistance

NASA Technical Reports Server (NTRS)

Tesser, P. A.

1981-01-01

The history of state involvement in LANDSAT systems planning and related efforts is described. Currently 16 states have visual LANDSAT capabilities and 10 others are planning on developing such capabilities. The federal government's future plans for the LANDSAT system, the impacts of recent budget decisions on the systems, and the FY 82 budget process are examined.

77 FR 45350 - Information Collection Being Submitted for Review and Approval to the Office of Management and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-31

... to the Office of Management and Budget AGENCY: Federal Communications Commission. ACTION: Notice and... of Management and Budget (OMB) control number. DATES: Written comments should be submitted on or... the do-not-call registry in 2009. See 74 FR 17863, April 17, 2009. Privacy Impact Assessment: Yes. The...

Implications of Project-Based Funding of Research on Budgeting and Financial Management in Public Universities

ERIC Educational Resources Information Center

Raudla, Ringa; Karo, Erkki; Valdmaa, Kaija; Kattel, Rainer

2015-01-01

The main goal of the paper is to explore--both theoretically and empirically--the implications of project-based research funding for budgeting and financial management at public universities. The theoretical contribution of the paper is to provide a synthesized discussion of the possible impacts of project-based funding on university financial…

Effects of elevated atmospheric CO2 and tropospheric O3 on tree branch growth and implications for hydraulic budgeting

Treesearch

L. Rhea; J. King; Mark Kubiske; N. Saliendra; R. Teclaw

2010-01-01

The forest hydrologic budget may be impacted by increasing CO2 and tropospheric O3. Efficient means to quantify such effects are beneficial. We hypothesized that changes in the balance of canopy interception, stem flow, and through-fall in the presence of elevated CO2 and O3...

Bark beetle-induced tree mortality alters stand energy budgets due to water budget changes

Treesearch

David E. Reed; Brent E. Ewers; Elise Pendall; John Frank; Robert Kelly

2016-01-01

Insect outbreaks are major disturbances that affect a land area similar to that of forest fires across North America. The recent mountain pine bark beetle (Dendroctonus ponderosae) outbreak and its associated blue stain fungi (Grosmannia clavigera) are impacting water partitioning processes of forests in the Rocky Mountain region as the spatially heterogeneous...

Public Higher-Education Systems Face Painful Choices as Three Northeastern States Confront Massive Deficits.

ERIC Educational Resources Information Center

Blumenstyk, Goldie

1989-01-01

Massachusetts, Connecticut, and New York face giant deficits in their state budgets. The financial impact of the 1986 federal tax reform law was underestimated by colleges and income estimates were overly optimistic for 1988 and 1989. Unpopular, new taxes are seen as the way to solve the budget crunch. (MLW)

The Deficit and the Federal Budget. 1983 National Issues Forum.

ERIC Educational Resources Information Center

Melville, Keith, Ed.

Although designed for participants in the National Issues Forum, this booklet, which describes the impact of the federal deficit and the federal budget process, is also useful for secondary school social studies. The six sections begin with an introduction describing why the deficit grows yearly and why it is difficult for Congress to stop its…

Impact of a financial risk-sharing scheme on budget-impact estimations: a game-theoretic approach.

PubMed

Gavious, Arieh; Greenberg, Dan; Hammerman, Ariel; Segev, Ella

2014-06-01

As part of the process of updating the National List of Health Services in Israel, health plans (the 'payers') and manufacturers each provide estimates on the expected number of patients that will utilize a new drug. Currently, payers face major financial consequences when actual utilization is higher than the allocated budget. We suggest a risk-sharing model between the two stakeholders; if the actual number of patients exceeds the manufacturer's prediction, the manufacturer will reimburse the payers by a rebate rate of α from the deficit. In case of under-utilization, payers will refund the government at a rate of γ from the surplus budget. Our study objective was to identify the optimal early estimations of both 'players' prior to and after implementation of the risk-sharing scheme. Using a game-theoretic approach, in which both players' statements are considered simultaneously, we examined the impact of risk-sharing within a given range of rebate proportions, on players' early budget estimations. When increasing manufacturer's rebate α to be over 50 %, then manufacturers will announce a larger number, and health plans will announce a lower number of patients than they would without risk sharing, thus substantially decreasing the gap between their estimates. Increasing γ changes players' estimates only slightly. In reaction to applying a substantial risk-sharing rebate α on the manufacturer, both players are expected to adjust their budget estimates toward an optimal equilibrium. Increasing α is a better vehicle for reaching the desired equilibrium rather than increasing γ, as the manufacturer's rebate α substantially influences both players, whereas γ has little effect on the players behavior.

Resolving the "Cost-Effective but Unaffordable" Paradox: Estimating the Health Opportunity Costs of Nonmarginal Budget Impacts.

PubMed

Lomas, James; Claxton, Karl; Martin, Stephen; Soares, Marta

2018-03-01

Considering whether or not a proposed investment (an intervention, technology, or program of care) is affordable is really asking whether the benefits it offers are greater than its opportunity cost. To say that an investment is cost-effective but not affordable must mean that the (implicit or explicit) "threshold" used to judge cost-effectiveness does not reflect the scale and value of the opportunity costs. Existing empirical estimates of health opportunity costs are based on cross-sectional variation in expenditure and mortality outcomes by program budget categories (PBCs) and do not reflect the likely effect of nonmarginal budget impacts on health opportunity costs. The UK Department of Health regularly updates the needs-based target allocation of resources to local areas of the National Health Service (NHS), creating two subgroups of local areas (those under target allocation and those over). These data provide the opportunity to explore how the effects of changes in health care expenditure differ with available resources. We use 2008-2009 data to evaluate two econometric approaches to estimation and explore a range of criteria for accepting subgroup specific effects for differences in expenditure and outcome elasticities across the 23 PBCs. Our results indicate that health opportunity costs arising from an investment imposing net increases in expenditure are underestimated unless account is taken of likely nonmarginal effects. They also indicate the benefits (reduced health opportunity costs or increased value-based price of a technology) of being able to "smooth" these nonmarginal budget impacts by health care systems borrowing against future budgets or from manufacturers offering "mortgage" type arrangements. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Influence of the Madden-Julian oscillation and Caribbean low-level jet on east Pacific easterly waves

NASA Astrophysics Data System (ADS)

Maloney, E. D.; Whitaker, J.

2017-12-01

The east Pacific warm pool in which easterly waves (EWs) exist exhibits basic state variability associated with the Madden-Julian oscillation (MJO) and Caribbean low-level jet (CLLJ). This study compares and contrasts composite changes in the background environment, eddy kinetic energy EKE budget, moisture budget, and EW tracks during MJO and CLLJ events. While previous studies have shown that the MJO influences jet activity in the east Pacific, the influence of the MJO and CLLJ on EWs is not synonymous. The MJO has a more extensive influence in the main EW path along the Central American coast, while the CLLJ is a stronger modulator of the ITCZ. Anomalous low-level westerly MJO and CLLJ periods are associated with favorable conditions for EW development along the main EW path, although the impact of the MJO is more extensive. Easterly MJO and CLLJ periods support enhanced EW development along the ITCZ, although the CLLJ is a greater modulator of EW tracks in this region, likely associated with basic state changes that favor convection and its influence on the EKE budget. EW growth in the ITCZ during easterly MJO periods is more reliant on barotropic conversion as an energy source than for strong CLLJ period waves, when EAPE to EKE conversion associated with ITCZ convection is more important. A moisture budget analysis for ITCZ waves shows that strong CLLJ period waves have stronger horizontal advection in front of the wave axis relative to easterly MJO periods waves. These differences in horizontal advection are interpreted in the context of a linearized horizontal advection budget. The results highlight that the influence of these phenomena on east Pacific EWs should be considered distinct.

The impact of global budgeting on health service utilization, health care expenditures, and quality of care among patients with pneumonia in Taiwan.

PubMed

Lin, C-Y; Ma, T; Lin, C-C; Kao, C-H

2016-02-01

This study evaluated the effect of global budgeting on health service utilization, health care expenditures, and the quality of care among patients with pneumonia in Taiwan. The National Health Insurance Research Database (NHIRD) was used for analysis. Data on patients diagnosed with pneumonia during 2000-2001 (the prebudget group) were used as the baseline data, and data on patients diagnosed with pneumonia during 2004-2005 (the postbudget group) were used as the postintervention data. The length of stay (LOS), diagnostic costs, drug costs, therapy costs, total costs, risk of readmission within 14 days, and risk of revisiting the Emergency Department (ED) within 3 days of discharge before and after implementing the global budget system were analyzed and compared. Data on 32,535 patients with pneumonia were analyzed. The mean LOS increased from 6.36 ± 0.07 to 10.78 ± 0.09 days after implementing the global budget system. The mean total costs in the prebudget and postbudget groups were 22,697.82 ± 542.40 and 62,016.7 ± 793.19 New Taiwan dollars (NT$), respectively. The mean rate of revisiting the ED within 3 days decreased from 5.5 ± 0.2 % to 4.6 ± 0.1 % in the prebudget and postbudget groups, respectively. The mean rates of readmission within 14 days before were 6.1 ± 0.2 % and 8.2 ± 0.2 % in the prebudget and postbudget groups, respectively. Global budgeting is associated with a significantly longer LOS, higher health care costs, and poorer quality of care among patients with pneumonia.

Mitigation of Syngas Cooler Plugging and Fouling

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bockelie, Michael J.

This Final Report summarizes research performed to develop a technology to mitigate the plugging and fouling that occurs in the syngas cooler used in many Integrated Gasification Combined Cycle (IGCC) plants. The syngas cooler is a firetube heat exchanger located downstream of the gasifier. It offers high thermal efficiency, but its’ reliability has generally been lower than other process equipment in the gasification island. The buildup of ash deposits that form on the fireside surfaces in the syngas cooler (i.e., fouling) lead to reduced equipment life and increased maintenance costs. Our approach to address this problem is that fouling ofmore » the syngas cooler cannot be eliminated, but it can be better managed. The research program was funded by DOE using two budget periods: Budget Period 1 (BP1) and Budget Period 2 (BP2). The project used a combination of laboratory scale experiments, analysis of syngas cooler deposits, modeling and guidance from industry to develop a better understanding of fouling mechanisms and to develop and evaluate strategies to mitigate syngas cooler fouling and thereby improve syngas cooler performance. The work effort in BP 1 and BP 2 focused on developing a better understanding of the mechanisms that lead to syngas cooler plugging and fouling and investigating promising concepts to mitigate syngas cooler plugging and fouling. The work effort focused on the following: • analysis of syngas cooler deposits and fuels provided by an IGCC plant collaborating with this project; • performing Jet cleaning tests in the University of Utah Laminar Entrained Flow Reactor to determine the bond strength between an ash deposit to a metal plate, as well as implementing planned equipment modifications to the University of Utah Laminar Entrained Flow Reactor and the one ton per day, pressurized Pilot Scale Gasifier; • performing Computational Fluid Dynamic modeling of industrially relevant syngas cooler configurations to develop a better understanding of deposit formation mechanisms; • performing Techno-Economic-Analysis for a representative IGCC plant to investigate the impact on plant economics, in particular the impacts on the Cost of Electricity (COE), due to plant shutdowns caused by syngas cooler plugging and fouling and potential benefits to plant economics of developing strategies to mitigate syngas cooler fouling; and • performing modeling and pilot scale tests to investigate the potential benefits of using a sorbent (fuel additive) to capture the vaporized metals that result in syngas cooler fouling. All project milestones for BP 1 and BP 2 were achieved. DOE was provided a briefing on our accomplishments in BP1 and BP2 and our proposed plans for Budget Period 3 (BP 3). Based on our research the mitigation technology selected to investigate in BP 3 was the use of a sorbent that can be injected into the gasifier with the fuel slurry to capture vaporized metals that lead to the deposit formation in the syngas cooler. The work effort proposed for BP 3 would have focused on addressing concerns raised by gasification industry personnel for the impacts on gasifier performance of sorbent injection, so that at the end of BP 3 the use of sorbent injection would be at “pre-commercial” stage and ready for use in a Field Demonstration that could be funded by industry or DOE. A Budget Continuation Application (BCA) was submitted to obtain funding for BP3 DOE but DOE chose to not fund the proposed BP3 effort.« less

The effects of atmospheric chemistry on radiation budget in the Community Earth Systems Model

NASA Astrophysics Data System (ADS)

Choi, Y.; Czader, B.; Diao, L.; Rodriguez, J.; Jeong, G.

2013-12-01

The Community Earth Systems Model (CESM)-Whole Atmosphere Community Climate Model (WACCM) simulations were performed to study the impact of atmospheric chemistry on the radiation budget over the surface within a weather prediction time scale. The secondary goal is to get a simplified and optimized chemistry module for the short time period. Three different chemistry modules were utilized to represent tropospheric and stratospheric chemistry, which differ in how their reactions and species are represented: (1) simplified tropospheric and stratospheric chemistry (approximately 30 species), (2) simplified tropospheric chemistry and comprehensive stratospheric chemistry from the Model of Ozone and Related Chemical Tracers, version 3 (MOZART-3, approximately 60 species), and (3) comprehensive tropospheric and stratospheric chemistry (MOZART-4, approximately 120 species). Our results indicate the different details in chemistry treatment from these model components affect the surface temperature and impact the radiation budget.

Wavefront error budget and optical manufacturing tolerance analysis for 1.8m telescope system

NASA Astrophysics Data System (ADS)

Wei, Kai; Zhang, Xuejun; Xian, Hao; Rao, Changhui; Zhang, Yudong

2010-05-01

We present the wavefront error budget and optical manufacturing tolerance analysis for 1.8m telescope. The error budget accounts for aberrations induced by optical design residual, manufacturing error, mounting effects, and misalignments. The initial error budget has been generated from the top-down. There will also be an ongoing effort to track the errors from the bottom-up. This will aid in identifying critical areas of concern. The resolution of conflicts will involve a continual process of review and comparison of the top-down and bottom-up approaches, modifying both as needed to meet the top level requirements in the end. As we all know, the adaptive optical system will correct for some of the telescope system imperfections but it cannot be assumed that all errors will be corrected. Therefore, two kinds of error budgets will be presented, one is non-AO top-down error budget and the other is with-AO system error budget. The main advantage of the method is that at the same time it describes the final performance of the telescope, and gives to the optical manufacturer the maximum freedom to define and possibly modify its own manufacturing error budget.

The impact of physician-level drug budgets on prescribing behavior.

PubMed

Fischer, Katharina Elisabeth; Koch, Taika; Kostev, Karel; Stargardt, Tom

2018-03-01

To contain pharmaceutical spending, drug budgets have been introduced across health systems. Apart from analyzing whether drug budgets fulfill their overall goal of reducing spending, changes in the cost and quality of prescribing and the enforcement mechanisms put in place need evaluation to assess the effectiveness of drug budgets at the physician level. In this study, we aim to analyze the cost and quality of prescribing conditional on the level of utilization of the drug budget and in view of varying levels of enforcement in cases of overspending. We observed drug budget utilization in a panel of 440 physicians in three federal states of Germany from 2005 to 2011. At the physician level, we retrospectively calculated drug budgets, the level of drug budget utilization, and differentiated by varying levels of enforcement where physicians overspent their budgets (i.e., more than 115/125% of the drug budget). Using lagged dependent-variable regression models, we analyzed whether the level of drug budget utilization in the previous year affected current prescribing in terms of various indicators to describe the cost and quality of prescribing. We controlled for patient and physician characteristics. The mean drug budget utilization is 92.3%. The level of drug budget utilization influences selected dimensions of cost and quality of prescribing (i.e., generic share (estimate 0.000215; p = 0.0246), concentration of generic brands (estimate 0.000585; p = 0.0056) and therapeutic substances (estimate -0.000060; p < 0.0001) and the share of potentially inappropriate medicines in the elderly (estimate 0.001; p < 0.0001)), whereas the level of enforcement does not. Physicians seem to gradually adjust their prescription patterns, especially in terms of generic substitution.

Remote coral reefs can sustain high growth potential and may match future sea-level trends

PubMed Central

Perry, Chris T.; Murphy, Gary N.; Graham, Nicholas A. J.; Wilson, Shaun K.; Januchowski-Hartley, Fraser A.; East, Holly K.

2015-01-01

Climate-induced disturbances are contributing to rapid, global-scale changes in coral reef ecology. As a consequence, reef carbonate budgets are declining, threatening reef growth potential and thus capacity to track rising sea-levels. Whether disturbed reefs can recover their growth potential and how rapidly, are thus critical research questions. Here we address these questions by measuring the carbonate budgets of 28 reefs across the Chagos Archipelago (Indian Ocean) which, while geographically remote and largely isolated from compounding human impacts, experienced severe (>90%) coral mortality during the 1998 warming event. Coral communities on most reefs recovered rapidly and we show that carbonate budgets in 2015 average +3.7 G (G = kg CaCO3 m−2 yr−1). Most significantly the production rates on Acropora-dominated reefs, the corals most severely impacted in 1998, averaged +8.4 G by 2015, comparable with estimates under pre-human (Holocene) disturbance conditions. These positive budgets are reflected in high reef growth rates (4.2 mm yr−1) on Acropora-dominated reefs, demonstrating that carbonate budgets on these remote reefs have recovered rapidly from major climate-driven disturbances. Critically, these reefs retain the capacity to grow at rates exceeding measured regional mid-late Holocene and 20th century sea-level rise, and close to IPCC sea-level rise projections through to 2100. PMID:26669758

Remote coral reefs can sustain high growth potential and may match future sea-level trends.

PubMed

Perry, Chris T; Murphy, Gary N; Graham, Nicholas A J; Wilson, Shaun K; Januchowski-Hartley, Fraser A; East, Holly K

2015-12-16

Climate-induced disturbances are contributing to rapid, global-scale changes in coral reef ecology. As a consequence, reef carbonate budgets are declining, threatening reef growth potential and thus capacity to track rising sea-levels. Whether disturbed reefs can recover their growth potential and how rapidly, are thus critical research questions. Here we address these questions by measuring the carbonate budgets of 28 reefs across the Chagos Archipelago (Indian Ocean) which, while geographically remote and largely isolated from compounding human impacts, experienced severe (>90%) coral mortality during the 1998 warming event. Coral communities on most reefs recovered rapidly and we show that carbonate budgets in 2015 average +3.7 G (G = kg CaCO3 m(-2) yr(-1)). Most significantly the production rates on Acropora-dominated reefs, the corals most severely impacted in 1998, averaged +8.4 G by 2015, comparable with estimates under pre-human (Holocene) disturbance conditions. These positive budgets are reflected in high reef growth rates (4.2 mm yr(-1)) on Acropora-dominated reefs, demonstrating that carbonate budgets on these remote reefs have recovered rapidly from major climate-driven disturbances. Critically, these reefs retain the capacity to grow at rates exceeding measured regional mid-late Holocene and 20th century sea-level rise, and close to IPCC sea-level rise projections through to 2100.

Planning and Budgeting for Nutrition Programs in Tanzania: Lessons Learned From the National Vitamin A Supplementation Program.

PubMed

Lyatuu, Margaret Benjamin; Mkumbwa, Temina; Stevenson, Raz; Isidro, Marissa; Modaha, Francis; Katcher, Heather; Dhillon, Christina Nyhus

2016-05-03

Micronutrient deficiency in Tanzania is a significant public health problem, with vitamin A deficiency (VAD) affecting 34% of children aged 6 to 59 months. Since 2007, development partners have worked closely to advocate for the inclusion of twice-yearly vitamin A supplementation and deworming (VASD) activities with budgets at the subnational level, where funding and implementation occur. As part of the advocacy work, a VASD planning and budgeting tool (PBT) was developed and is used by district officials to justify allocation of funds. Helen Keller International (HKI) and the Tanzania Food and Nutrition Centre (TFNC) conduct reviews of VASD funds and health budgets annually in all districts to monitor the impact of advocacy efforts. This paper presents the findings of the fiscal year (FY) 2010 district budget annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in FY 2010? (2) how many funds were allocated specifically to twice-yearly VASD activities in FY 2010? and (3) how have VASD funding allocations changed over time? Budgets from all 133 districts in Tanzania were accessed, reviewed and documented to identify line item funds allocated for VASD and other nutrition activities in FY 2010. Retrospective data from prior annual reviews for VASD were used to track trends in funding. The data were collected using specific data forms and then transcribed into an excel spreadsheet for analysis. The total funds allocated in Tanzania's districts in FY 2010 amounted to US$1.4 million of which 92% were for VASD. Allocations for VASD increased from US$0.387 million to US$1.3 million between FY 2005 and FY 2010. Twelve different nutrition activities were identified in budgets across the 133 districts. Despite the increased trend, the percentage of districts allocating sufficient funds to implement VAS (as defined by cost per child) was just 21%. District-driven VAS funding in Tanzania continues to be allocated by districts consistently, although adequacy of funding is a concern. However, regular administrative data point to fairly high and consistent coverage rates for VAS across the country (over 80% over the last 10 years). Although this analysis may have omitted some nutrition-specific funding not identified in district budget data, it represents a reliable reflection of the nutrition funding landscape in FY 2010. For this year, total district nutrition allocations add up to only 2% of the amount needed to implement nutrition services at scale according to Tanzania's National Nutrition Strategy Implementation Plan. VASD advocacy and planning support at the district level has succeeded in ensuring district allocations for the program. To promote sustainable implementation of other nutrition interventions in Tanzania, more funds must be allocated and guidance must be accompanied by tools that enable planning and budgeting at the district level. © 2016 by Kerman University of Medical Sciences

Planning and Budgeting for Nutrition Programs in Tanzania: Lessons Learned From the National Vitamin A Supplementation Program

PubMed Central

Lyatuu, Margaret Benjamin; Mkumbwa, Temina; Stevenson, Raz; Isidro, Marissa; Modaha, Francis; Katcher, Heather; Dhillon, Christina Nyhus

2016-01-01

Background: Micronutrient deficiency in Tanzania is a significant public health problem, with vitamin A deficiency (VAD) affecting 34% of children aged 6 to 59 months. Since 2007, development partners have worked closely to advocate for the inclusion of twice-yearly vitamin A supplementation and deworming (VASD) activities with budgets at the subnational level, where funding and implementation occur. As part of the advocacy work, a VASD planning and budgeting tool (PBT) was developed and is used by district officials to justify allocation of funds. Helen Keller International (HKI) and the Tanzania Food and Nutrition Centre (TFNC) conduct reviews of VASD funds and health budgets annually in all districts to monitor the impact of advocacy efforts. This paper presents the findings of the fiscal year (FY) 2010 district budget annual review. The review was intended to answer the following questions regarding district-level funding: (1) how many funds were allocated to nutrition-specific activities in FY 2010? (2) how many funds were allocated specifically to twice-yearly VASD activities in FY 2010? and (3) how have VASD funding allocations changed over time? Methods: Budgets from all 133 districts in Tanzania were accessed, reviewed and documented to identify line item funds allocated for VASD and other nutrition activities in FY 2010. Retrospective data from prior annual reviews for VASD were used to track trends in funding. The data were collected using specific data forms and then transcribed into an excel spreadsheet for analysis. Results: The total funds allocated in Tanzania’s districts in FY 2010 amounted to US$1.4 million of which 92% were for VASD. Allocations for VASD increased from US$0.387 million to US$1.3 million between FY 2005 and FY 2010. Twelve different nutrition activities were identified in budgets across the 133 districts. Despite the increased trend, the percentage of districts allocating sufficient funds to implement VAS (as defined by cost per child) was just 21%. Discussion: District-driven VAS funding in Tanzania continues to be allocated by districts consistently, although adequacy of funding is a concern. However, regular administrative data point to fairly high and consistent coverage rates for VAS across the country (over 80% over the last 10 years). Although this analysis may have omitted some nutrition-specific funding not identified in district budget data, it represents a reliable reflection of the nutrition funding landscape in FY 2010. For this year, total district nutrition allocations add up to only 2% of the amount needed to implement nutrition services at scale according to Tanzania’s National Nutrition Strategy Implementation Plan. Conclusion: VASD advocacy and planning support at the district level has succeeded in ensuring district allocations for the program. To promote sustainable implementation of other nutrition interventions in Tanzania, more funds must be allocated and guidance must be accompanied by tools that enable planning and budgeting at the district level. PMID:27694649

Economics of nuclear power and climate change mitigation policies.

PubMed

Bauer, Nico; Brecha, Robert J; Luderer, Gunnar

2012-10-16

The events of March 2011 at the nuclear power complex in Fukushima, Japan, raised questions about the safe operation of nuclear power plants, with early retirement of existing nuclear power plants being debated in the policy arena and considered by regulators. Also, the future of building new nuclear power plants is highly uncertain. Should nuclear power policies become more restrictive, one potential option for climate change mitigation will be less available. However, a systematic analysis of nuclear power policies, including early retirement, has been missing in the climate change mitigation literature. We apply an energy economy model framework to derive scenarios and analyze the interactions and tradeoffs between these two policy fields. Our results indicate that early retirement of nuclear power plants leads to discounted cumulative global GDP losses of 0.07% by 2020. If, in addition, new nuclear investments are excluded, total losses will double. The effect of climate policies imposed by an intertemporal carbon budget on incremental costs of policies restricting nuclear power use is small. However, climate policies have much larger impacts than policies restricting the use of nuclear power. The carbon budget leads to cumulative discounted near term reductions of global GDP of 0.64% until 2020. Intertemporal flexibility of the carbon budget approach enables higher near-term emissions as a result of increased power generation from natural gas to fill the emerging gap in electricity supply, while still remaining within the overall carbon budget. Demand reductions and efficiency improvements are the second major response strategy.

Economics of nuclear power and climate change mitigation policies

PubMed Central

Bauer, Nico; Brecha, Robert J.; Luderer, Gunnar

2012-01-01

The events of March 2011 at the nuclear power complex in Fukushima, Japan, raised questions about the safe operation of nuclear power plants, with early retirement of existing nuclear power plants being debated in the policy arena and considered by regulators. Also, the future of building new nuclear power plants is highly uncertain. Should nuclear power policies become more restrictive, one potential option for climate change mitigation will be less available. However, a systematic analysis of nuclear power policies, including early retirement, has been missing in the climate change mitigation literature. We apply an energy economy model framework to derive scenarios and analyze the interactions and tradeoffs between these two policy fields. Our results indicate that early retirement of nuclear power plants leads to discounted cumulative global GDP losses of 0.07% by 2020. If, in addition, new nuclear investments are excluded, total losses will double. The effect of climate policies imposed by an intertemporal carbon budget on incremental costs of policies restricting nuclear power use is small. However, climate policies have much larger impacts than policies restricting the use of nuclear power. The carbon budget leads to cumulative discounted near term reductions of global GDP of 0.64% until 2020. Intertemporal flexibility of the carbon budget approach enables higher near-term emissions as a result of increased power generation from natural gas to fill the emerging gap in electricity supply, while still remaining within the overall carbon budget. Demand reductions and efficiency improvements are the second major response strategy. PMID:23027963

Mapping and monitoring of sediment budgets and river change by means of UAS multi-scale, high-resolution imageries

NASA Astrophysics Data System (ADS)

Chang, Kuo-Jen; Tseng, Chih-Ming

2017-04-01

Due to the high seismicity and high annual rainfall, numerous landslides triggered every year and severe impacts affect the island Taiwan. Global warming and sea-level rise with increasing frequency and magnitude of storms and typhoons has resulted in an increase of natural hazards, and strong impacts on human life. A consequence of a change of the rainfall regime, increase of intensity and in a reduction of the duration of the events may have dramatic impacts. Heavy rainfall precipitations are one of the major triggering factors for landslides. Typhoon Morakot in 2009 brought extreme and long-time rainfall, and caused severe disasters. After 2009, numerous debris and sediment deposition increased greatly due to the severe landslides in upstream area. Detail morphological records may able to reveal the environment changes. This kind of analysis is based on the concept of DEM of difference (DoD) to evaluate the sediment budgets during climate and geo-hazard events. The aerial photographs generated digital surface models (DSMs) before and after Typhoon Morakot, and the subsequent multi-periods of imageries is thus been conducted in this study. In recent years, the remote sensing technology improves rapidly, providing a wide range of image, essential and precious information. In order quantify the hazards in different time; we try to integrate several technologies, especially by unmanned aircraft system (UAS), to decipher the consequence and the potential hazard, and the social impact. In order to monitoring the sediment budget of the study area, we integrates several methods, including, 1) Remote-sensing images gathered by UAS and by aerial photos taken in different periods; 2) field in-situ geologic investigation; 3) Differential GPS, RTK GPS in-site geomatic measurements; 4) Construct the DTMs before and after landslide, as well as the subsequent periods using UAS and aerial photos. We finally acquired 7 DEMs, prior to post-events, from 2009-2015. The precision of the dataset been verified firstly. The migration of the debris is well defined from DEMs and been calculated. The sediment budgets are thus been evaluated. The riverbed migration is affect both by natural sediment deposition and by human activities. The profile of the riverbed is blocked mainly in the midstream area. One-half of the debris still rested on the mid- to upstream, and in the up-slope. To the end, the UAS and the methodology used in this study is been adjusted and is capable to apply to other region for hazard monitoring, mitigation and planning.

Data analysis and software support for the Earth radiation budget experiment

NASA Technical Reports Server (NTRS)

Edmonds, W.; Natarajan, S.

1987-01-01

Computer programming and data analysis efforts were performed in support of the Earth Radiation Budget Experiment (ERBE) at NASA/Langley. A brief description of the ERBE followed by sections describing software development and data analysis for both prelaunch and postlaunch instrument data are presented.

[Budget impact analysis of antiretroviral therapy. A reflection based on the GESIDA guidelines].

PubMed

2012-01-01

The latest version of the Spanish clinical practice guidelines on antiretroviral therapy (ART) in HIV-infected adults, developed by the Spanish AIDS Study Group (GESIDA) and the National AIDS Plan, recommends initiating ART early in certain circumstances. The aim of this study was to estimate the budget impact of this recommendation by using the data from the VACH cohort. We considered a scenario in which all naïve asymptomatic patients would initiate ART if they had <500 lymphocytes, or a CD4/μL count >500/μL if they were older than 55 years, or had high viral load, liver disease, chronic kidney disease or high cardiovascular risk. The study was designed as a cost analysis in terms of annual pharmaceutical expenditure. The only costs included were those relating to the ART combinations analyzed. To estimate these costs, we assumed that this guideline had a penetration of 80%, an adherence of 95% and 12% dropouts. A total of 12,500 patients were reviewed. Of these, 1,127 (10%) had not initiated ART; CD4 lymphocyte count was 350-500 in 294 (26.1%) and > 500 in 685 (60.8%). If the new clinical practice guideline were applied, 45.2% of naïve patients (95% CI: 42.4%-48.2%) would be advised to start ART. Carrying out this recommendation in hospitals of the VACH cohort would require an additional annual investment of € 3,270,975 and would increase the overall cost of antiretroviral drugs by 3%. In the framework of health economics, incorporating economic impact estimates - such as those performed in this study - into clinical practice guidelines would be advisable to increase their feasibility. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

78 FR 6140 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... OFFICE OF MANAGEMENT AND BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs AGENCY: Office of Management and Budget. ACTION: Revisions to Appendix C of OMB Circular A-94. [[Page 6141

Phosphorus and water budgets in an agricultural basin.

PubMed

Faridmarandi, Sayena; Naja, Ghinwa M

2014-01-01

Water and phosphorus (P) budgets of a large agricultural basin located in South Florida (Everglades Agricultural Area, EAA) were computed from 2005 to 2012. The annual surface outflow P loading from the EAA averaged 157.2 mtons originating from Lake Okeechobee (16.4 mtons, 10.4%), farms (131.0 mtons, 83.4%), and surrounding basins (9.8 mtons, 6.2%) after attenuation. Farms, urban areas, and the adjacent C-139 basin contributed 186.1, 15.6, and 3.8 mtons/yr P to the canals, respectively. The average annual soil P retention was estimated at 412.5 mtons. Water and P budgets showed seasonal variations with high correlation between rainfall and P load in drainage and surface outflows. Moreover, results indicated that the canals acted as a P sink storing 64.8 mtons/yr. To assess the P loading impact of farm drainage on the canals and on the outflow, dimensionless impact factors were developed. Sixty-two farms were identified with a high and a medium impact factor I1 level contributing 44.5% of the total drainage P load to the canals, while their collective area represented less than 23% of the EAA area (172 farms). Optimizing the best management practice (BMP) strategies on these farms could minimize the environmental impacts on the downstream sensitive wetlands areas.

Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence.

PubMed

Wetzelaer, Pim; Lokkerbo, Joran; Arntz, Arnoud; van Aselt, Thea; Smit, Filip; Evers, Silvia

2017-12-01

Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use. The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of 2.367 million (95% C.I.: 1,717,000 - 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the comparator condition and the assumption of high intervention costs. We present a method for the synthesis of evidence from different types of studies in a way that respects the uncertainty surrounding those findings. Limitations of the study pertain to the inclusion of findings from studies with suboptimal designs, the transferability of research findings, and uncertainty regarding the time horizon considered. More research is needed on the sensitivity of our findings to the choice of included studies based on the comparator condition. THE results suggest that the provision of specialized outpatient psychotherapy for BPD leads to a reduction in other health care resource use. Overall, the results are promising and encourage future studies on aspects that are currently still uncertain. The results may support policy makers in deciding whether or not to allocate health care budget for the provision of specialized outpatient psychotherapy for patients with BPD in the Netherlands. The results provide important directions for future research. This includes the need for future studies to make a comparison between specialized outpatient psychotherapy and treatment as usual and to have longer follow-up time.

Minimal investment risk of a portfolio optimization problem with budget and investment concentration constraints

NASA Astrophysics Data System (ADS)

Shinzato, Takashi

2017-02-01

In the present paper, the minimal investment risk for a portfolio optimization problem with imposed budget and investment concentration constraints is considered using replica analysis. Since the minimal investment risk is influenced by the investment concentration constraint (as well as the budget constraint), it is intuitive that the minimal investment risk for the problem with an investment concentration constraint can be larger than that without the constraint (that is, with only the budget constraint). Moreover, a numerical experiment shows the effectiveness of our proposed analysis. In contrast, the standard operations research approach failed to identify accurately the minimal investment risk of the portfolio optimization problem.

Colorado Children's Budget 2013

ERIC Educational Resources Information Center

Buck, Beverly; Baker, Robin

2013-01-01

The "Colorado Children's Budget" presents and analyzes investments and spending trends during the past five state fiscal years on services that benefit children. The "Children's Budget" focuses mainly on state investment and spending, with some analysis of federal investments and spending to provide broader context of state…

Transfer Trajectory Design for the Mars Atmosphere and Volatile Evolution (MAVEN) Mission

NASA Technical Reports Server (NTRS)

Folta, David; Demcak, Stuart; Young, Brian; Berry, Kevin

2013-01-01

The Mars Atmosphere and Volatile Evolution (MAVEN) mission will determine the history of the loss of volatiles from the Martian atmosphere from a highly inclined elliptical orbit. MAVEN will launch from Cape Canaveral Air Force Station on an Atlas-V 401 during an extended 36-day launch period opening November 18, 2013. The MAVEN Navigation and Mission Design team performed a Monte Carlo analysis of the Type-II transfer to characterize; dispersions of the arrival B-Plane, trajectory correction maneuvers (TCMs), and the probability of Mars impact. This paper presents detailed analysis of critical MOI event coverage, maneuver constraints, deltaV-99 budgets, and Planetary Protection requirements.

Balancing the Books: Analyzing the Impact of a Federal Budget Deliberative Simulation on Student Learning and Opinion

ERIC Educational Resources Information Center

Levy, Dena; Orr, Susan

2014-01-01

The federal budget and the rising national debt are crucial concerns in American politics. Yet, they are issues about which average citizens, and particularly young citizens, are presumed to have limited knowledge and very little to say. They are also topics that are not generally seen as engaging to students in introductory political science…

Strategic Planning For The Fire Service

DTIC Science & Technology

2016-03-01

Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington...scenarios were drawn from FEMA’s Strategic Foresight Initiative, which identified drivers that are expected to impact emergency managers ’ operations in the...governmental budgets, emergency management , Urban Areas Security Initiative (UASI) grants, coercive federalism, 2007–2008 financial crisis

The Effects of Economic and Demographic Changes on States and Local Budgets.

ERIC Educational Resources Information Center

Wallace, Sally

As policymakers consider whether and how to fill the expected revenue gap, they will need to be aware of the fiscal, legal, and political challenges ahead. The changing trends in the economy and population and their prospective impacts on state and local government budgets are the focus of this paper. Its goal is to help policymakers at all levels…

Striving to Provide Innovative Orientation and Mobility Services in Times of Diminishing Resources

ERIC Educational Resources Information Center

Barrella, Kristi; Besden, Cheryl; Crow, Nita; Greenberg, Maya Delgado; Shrieves, Gary; Smith, Katie A.; Vickroy, Marcia

2011-01-01

Like many other states, California is facing a daunting budget deficit, reportedly about $19 billion. Delayed budgets have held up the disbursement of money, affecting school programs in districts as well as at the California School for the Blind (CSB). The current financial constraints have had an impact on CSB's programs. Its department of seven…

Program budgeting and marginal analysis: a case study in chronic airflow limitation.

PubMed

Crockett, A; Cranston, J; Moss, J; Scown, P; Mooney, G; Alpers, J

1999-01-01

Program budgeting and marginal analysis is a method of priority-setting in health care. This article describes how this method was applied to the management of a disease-specific group, chronic airflow limitation. A sub-program flow chart clarified the major cost drivers. After assessment of the technical efficiency of the sub-programs and careful and detailed analysis, incremental and decremental wish lists of activities were established. Program budgeting and marginal analysis provides a framework for rational resource allocation. The nurturing of a vigorous program management group, with members representing all participants in the process (including patients/consumers), is the key to a successful outcome.

Use of a mobile terrestrial laser system to quantify the impact of rigid coastal protective structures on sandy beaches, Quebec, Canada

NASA Astrophysics Data System (ADS)

Van-Wierts, S.; Bernatchez, P.

2012-04-01

Coastal erosion is an important issue within the St-Lawrence estuary and gulf, especially in zones of unconsolidated material. Wide beaches are important coastal environments; they act as a buffer against breaking waves by absorbing and dissipating their energy, thus reducing the rate of coastal erosion. They also offer protection to humans and nearby ecosystems, providing habitat for plants, animals and lifeforms such as algae and microfauna. Conventional methods, such as aerial photograph analysis, fail to adequately quantify the morphosedimentary behavior of beaches at the scale of a hydrosedimentary cells. The lack of reliable and quantitative data leads to considerable errors of overestimation and underestimation of sediment budgets. To address these gaps and to minimize acquisition costs posed by airborne LiDAR survey, a mobile terrestrial LiDAR has been set up to acquire topographic data of the coastal zone. The acquisition system includes a LiDAR sensor, a high precision navigation system (GPS-INS) and a video camera. Comparison of LiDAR data with 1050 DGPS control points shows a vertical mean absolute error of 0.1 m in beach areas. The extracted data is used to calculate sediment volumes, widths, slopes, and a sediment budget index. A high accuracy coastal characterization is achieved through the integration of laser data and video. The main objective of this first project using this system is to quantify the impact of rigid coastal protective structures on sediment budget and beach morphology. Results show that the average sediment volume of beaches located before a rock armour barrier (12 m3/m) were three times narrower than for natural beaches (35,5 m3/m). Natural beaches were also found to have twice the width (25.4 m) of the beaches bordering inhabited areas (12.7 m). The development of sediment budget index for beach areas is an excellent proxy to quickly identify deficit areas and therefore the coastal segments most at risk of erosion. The obtained LiDAR coverage also revealed that beach profiles made at an interval of more than 200 m on diversified coasts lead to results significantly different from reality. However, profile intervals have little impact on long uniform beaches.

Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy.

PubMed

Restelli, Umberto; Saibene, Gabriella; Nardulli, Patrizia; Di Turi, Roberta; Bonizzoni, Erminio; Scolari, Francesca; Perrone, Tania; Croce, Davide; Celio, Luigi

2017-08-01

To evaluate the efficiency of resources allocation and sustainability of the use of netupitant+palonosetron (NEPA) for chemotherapy-induced nausea and vomiting (CINV) prophylaxis assuming the Italian National Health Service (NHS) perspective. A published Markov model was adapted to assess the incremental cost-utility ratio of NEPA compared with aprepitant (APR) + palonosetron (PALO), fosaprepitant (fAPR) + PALO, APR + ondansetron (ONDA), fAPR + ONDA in patients receiving a highly emetogenic chemotherapy (HEC) and with APR + PALO and fAPR + PALO in patients receiving a moderately emetogenic chemotherapy (MEC). Oncology hospital department in Italy. A Markov model was used to determine the impact of NEPA on the budget of the Italian NHS on a 5-day time horizon, corresponding to the acute and delayed CINV prophylaxis phases. Direct medical costs considered were related to antiemetic drugs, adverse events management, CINV episodes management. Clinical and quality of life data referred to previously published works. The budget impact analysis considered the aforementioned therapies plus PALO alone (for HEC and MEC) on a 5-year time horizon, comparing two scenarios: one considering the use of NEPA and one not considering its use. Incremental cost per quality adjusted life year (QALY) and differential economic impact for the Italian NHS between the two scenarios considered. NEPA is more effective and less expensive (dominant) compared with APR + PALO (for HEC and MEC), fAPR + PALO (for HEC and MEC), APR + ONDA (for HEC), fAPR + ONDA (for HEC). The use of NEPA would lead to a 5-year cost decrease of €63.7 million (€42.7 million for HEC and €20.9 million for MEC). NEPA allows an efficient allocation of resources for the Italian NHS and it is sustainable, leading to a cost decrease compared with a scenario which does not consider its use. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Budget impact analysis of 8 hormonal contraceptive options.

PubMed

Crespi, Simone; Kerrigan, Matthew; Sood, Vipan

2013-07-01

To develop a model comparing costs of 8 hormonal contraceptives and determine whether acquisition costs for implants and intrauterine devices (IUDs) were offset by decreased pregnancy-related costs over a 3-year time horizon from a managed care perspective. A model was developed to assess the budget impact of branded or generic oral contraceptives (OCs), quarterly intramuscular depot medroxyprogesterone, etonogestrel/ethinyl estradiol vaginal ring, etonogestrel implant, levonorgestrel IUD, norelgestromin/ethinyl estradiol transdermal contraceptive, and ethinyl estradiol/levonorgestrel extended-cycle OC. Major variables included drug costs, typical use failure rates, discontinuation rates, and pregnancy costs. The base case assessed costs for 1000 women initiating each of the hormonal contraceptives. The etonogestrel implant and levonorgestrel IUD resulted in the fewest pregnancies, 63 and 85, respectively, and the least cost, $1.75 million and $2.0 million, respectively. In comparison, generic OC users accounted for a total of 243 pregnancies and $3.4 million in costs. At the end of year 1, costs for the etonogestrel implant ($800,471) and levonorgestrel IUD ($949,721) were already lower than those for generic OCs ($1,146,890). Sensitivity analysis showed that the cost of pregnancies, not product acquisition cost, was the primary cost driver. Higher initial acquisition costs for the etonogestrel implant and levonorgestrel IUD were offset within 1 year by lower contraceptive failure rates and consequent pregnancy costs. Thus, after accounting for typical use failure rates of contraceptive products, the etonogestrel implant and levonorgestrel IUD emerged as the least expensive hormonal contraceptives.

Impact of Climate Variability and Landscape Patterns on Water Budget and Nutrient Loads in a Peri-urban Watershed: A Coupled Analysis Using Process-based Hydrological Model and Landscape Indices.

PubMed

Li, Chongwei; Zhang, Yajuan; Kharel, Gehendra; Zou, Chris B

2018-06-01

Nutrient discharge into peri-urban streams and reservoirs constitutes a significant pressure on environmental management, but quantitative assessment of non-point source pollution under climate variability in fast changing peri-urban watersheds is challenging. Soil and Water Assessment Tool (SWAT) was used to simulate water budget and nutrient loads for landscape patterns representing a 30-year progression of urbanization in a peri-urban watershed near Tianjin metropolis, China. A suite of landscape pattern indices was related to nitrogen (N) and phosphorous (P) loads under dry and wet climate using CANOCO redundancy analysis. The calibrated SWAT model was adequate to simulate runoff and nutrient loads for this peri-urban watershed, with Nash-Sutcliffe coefficient (NSE) and coefficient of determination (R 2 ) > 0.70 and percentage bias (PBIAS) between -7 and +18 for calibration and validation periods. With the progression of urbanization, forest remained the main "sink" landscape while cultivated and urban lands remained the main "source" landscapes with the role of orchard and grassland being uncertain and changing with time. Compared to 1984, the landscape use pattern in 2013 increased nutrient discharge by 10%. Nutrient loads modelled under wet climate were 3-4 times higher than that under dry climate for the same landscape pattern. Results indicate that climate change could impose a far greater impact on runoff and nutrient discharge in a peri-urban watershed than landscape pattern change.

Impact of Climate Variability and Landscape Patterns on Water Budget and Nutrient Loads in a Peri-urban Watershed: A Coupled Analysis Using Process-based Hydrological Model and Landscape Indices

NASA Astrophysics Data System (ADS)

Li, Chongwei; Zhang, Yajuan; Kharel, Gehendra; Zou, Chris B.

2018-06-01

Nutrient discharge into peri-urban streams and reservoirs constitutes a significant pressure on environmental management, but quantitative assessment of non-point source pollution under climate variability in fast changing peri-urban watersheds is challenging. Soil and Water Assessment Tool (SWAT) was used to simulate water budget and nutrient loads for landscape patterns representing a 30-year progression of urbanization in a peri-urban watershed near Tianjin metropolis, China. A suite of landscape pattern indices was related to nitrogen (N) and phosphorous (P) loads under dry and wet climate using CANOCO redundancy analysis. The calibrated SWAT model was adequate to simulate runoff and nutrient loads for this peri-urban watershed, with Nash-Sutcliffe coefficient (NSE) and coefficient of determination ( R 2) > 0.70 and percentage bias (PBIAS) between -7 and +18 for calibration and validation periods. With the progression of urbanization, forest remained the main "sink" landscape while cultivated and urban lands remained the main "source" landscapes with the role of orchard and grassland being uncertain and changing with time. Compared to 1984, the landscape use pattern in 2013 increased nutrient discharge by 10%. Nutrient loads modelled under wet climate were 3-4 times higher than that under dry climate for the same landscape pattern. Results indicate that climate change could impose a far greater impact on runoff and nutrient discharge in a peri-urban watershed than landscape pattern change.

[Cost effectiveness and budget impact analysis of inhaled nitric oxide in a neonatal unit from the perspective of the public health system].

PubMed

Kilchemmann Fuentes, Carlos; Vallejos Vallejos, Carlos; Román Navarro, Andrés

Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software. The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos (€15,000) per patient treated, with an ICER compared with the usual care of $23 million pesos (€30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit. From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Health care prices, the federal budget, and economic growth.

PubMed

Monaco, R M; Phelps, J H

1995-01-01

Rising health care spending, led by rising prices, has had an enormous impact on the economy, especially on the federal budget. Our work shows that if rapid growth in health care prices continues, under current institutional arrangements, real economic growth and employment will be lower during the next two decades than if health price inflation were somehow reduced. How big the losses are and which sectors bear the brunt of the costs vary depending on how society chooses to fund the federal budget deficit that stems from the rising cost of federal health care programs.

Drug Policy in Poland.

PubMed

Jahnz-Różyk, Karina; Kawalec, Pawel; Malinowski, Krzysztof; Czok, Katarzyna

2017-09-01

We presented a general overview of the health care system as well as the pricing and reimbursement environment in Poland. Poland aims to ensure proper access to safe and effective medicines while reducing patients' share in treatment costs. Nevertheless, the co-payment for pharmacotherapy is still high (more than 60%). The key policymaker and regulator in the system is the Ministry of Health, which is supported by the Polish Agency for Health Technology Assessment and Tariff System (Agencja Oceny Technologii Medycznych i Taryfikacji), responsible for evaluating applicant drugs, and the Economic Commission, responsible for negotiating the official sales prices and conditions for reimbursement with pharmaceutical companies (e.g., level of reimbursement and risk-sharing scheme agreements). The Agency for Health Technology Assessment and Tariff System dossier is obligatory for reimbursement application and includes the analysis of clinical effectiveness, economic analysis (with the threshold of quality-adjusted life-year established as no more than 3 times the gross domestic product per capita), and the analysis of budget impact. In Poland, only a positive list of reimbursed drugs is published and it is updated every 2 months. The following levels of reimbursement are in use: 100%, 70%, 50%, and lump sum (about €0.8). The first reimbursement decision is given for a period of 2 years only, the second for 3 years, and the third for 5 years. There is no separate budget or special legal regulations for orphan drugs. Generic substitution of drugs is desired but not mandatory. Physicians are not assigned with pharmaceutical budgets. The access to real-world data is limited; the only registers available are for drugs used in drug programs. Copyright © 2017. Published by Elsevier Inc.

Budget impact of somatostatin analogs as treatment for metastatic gastroenteropancreatic neuroendocrine tumors in US hospitals.

PubMed

Ortendahl, Jesse D; Pulgar, Sonia J; Mirakhur, Beloo; Cox, David; Bentley, Tanya Gk; Phan, Alexandria T

2017-01-01

With the introduction of new therapies, hospitals have to plan spending limited resources in a cost-effective manner. To assist in identifying the optimal treatment for patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors, budget impact modeling was used to estimate the financial implications of adoption and diffusion of somatostatin analogs (SSAs). A hypothetical cohort of 500 gastroenteropancreatic neuroendocrine tumor patients was assessed in an economic model, with the proportion with metastatic disease treated with an SSA estimated using published data. Drug acquisition, preparation, and administration costs were based on national pricing databases and published literature. Octreotide dosing was based on published estimates of real-world data, whereas for lanreotide, real-world dosing was unavailable and we therefore used the highest indicated dosing. Alternative scenarios reflecting the proportion of patients receiving lanreotide or octreotide were considered to estimate the incremental budget impact to the hospital. In the base case, 313 of the initial 500 gastroenteropancreatic neuroendocrine tumor patients were treated with an SSA. The model-predicted per-patient cost was US$83,473 for lanreotide and US$89,673 for octreotide. With a hypothetical increase in lanreotide utilization from 5% to 30% of this population, the annual model-projected hospital costs decreased by US$488,615. When varying the inputs in one-way sensitivity analyses, the results were most sensitive to changes in dosing assumptions. Results suggest that factors beyond drug acquisition cost can influence the budget impact to a hospital. When considering preparation and administration time, and real-world dosing, use of lanreotide has the potential to reduce health care expenditures associated with metastatic gastroenteropancreatic neuroendocrine tumor treatments.

Army Industrial Fund Analytical Study (AIFAS).

DTIC Science & Technology

1984-08-01

Directorate b. Team Members Mr. Joel S. Gordon Mr. Charles Weber c. Other Contributors Mr. Carl B. Bates, Analysis Support Directorate 2. PRODUCT REVIEW...OSD OSD/OMB operati renie budget (COB) ___ budget rve guidance guidance MACGM I I ProgramI Prga MCOIMietr budget COBI iretr decisions VIACOMI

Earth radiation budget experiment software development

NASA Technical Reports Server (NTRS)

Edmonds, W. L.

1985-01-01

Computer programming and analysis efforts were carried out in support of the Earth Radiation Budget Experiment (ERBE) at NASA/Langley. The Earth Radiation Budget Experiment is described as well as data acquisition, analysis and modeling support for the testing of ERBE instruments. Also included are descriptions of the programs developed to analyze, format and display data collected during testing of the various ERBE instruments. Listings of the major programs developed under this contract are located in an appendix.

Big emitting nations and the 2°C target:beyond integrated assessment

NASA Astrophysics Data System (ADS)

Bows-Larkin, Alice; Sharmina, Maria; Kuriakose, Jaise; Anderson, Kevin

2015-04-01

This year, the United Nations Conference of the Parties in Paris is tasked with delivering a land-mark agreement on avoiding the 2°C warming associated with 'dangerous interference with the climate system'. If this happens, it will re-invigorate analyses of how global and national energy systems can deliver the rates of mitigation accompanying the 2°C threshold. Commonly such studies rely on detailed integrated assessment models combining economic and physical relationships to describe climate and energy systems. These allow the user to develop 'feasible' scenarios in terms of technology, infrastructure and efficiency change. This paper reflects upon the reliance of decision makers on the outcomes of these models, and their suitability for producing plausible outcomes. One criticism is how they can explore future societies under the pressures of climate change mitigation and adaptation given that their economic parameterisations are underpinned by historical relationships fit for a world unperturbed by climate change. A second relates to their theoretical basis being appropriate for articulating the outcome of marginal change, when the very futures they are set up to explore involve non-marginal adjustments - very radical cuts in CO2, or severe climate change impacts. Quantifying societal responses within such models is a particular challenge. Finally, these models downplay risks through disregarding low-probability, high-impact events and their consequences, including wars and migration. It is argued here that as currently formulated these tools are unsuitable for modelling the revolutionary transformations necessary to stay within 2°C carbon budgets, or similarly, futures with higher levels of warming and subsequent impacts. To address this deficiency, this paper takes a complementary approach to contextually explore the 'possibility space' appropriate for avoiding 2°C. In contrast to exercises that build future scenarios using 'immutable' relationships within and between the energy and climate systems, a more transparent and dynamic framing based on highly constrained cumulative carbon budgets is proposed. Building on previous assessments that use a similar approach by authors Anderson and Bows, this analysis looks beyond the contested 'Annex 1' and 'non-Annex 1' division to backcast what the remaining CO2 budget implies for the world's top emitting nations. The analysis takes the top 25 nations, responsible for 85% of global CO2, and groups these nations on the basis of similarities within their energy systems. Using a range of explicit variables a suite of scenarios for these groups, as well as the 'rest of the world', 'deforestation' and 'bunker fuel CO2' are then developed, all constrained within a range of 2°C carbon budgets. By varying the levels of near-term emissions from each group's energy system, under a highly constrained CO2 budget, important sensitivities are revealed. Results demonstrate the significance of the coming 1-5 years' levels of emissions of the highest emitting groups and the importance of bunker-fuel emissions in shaping our collective futures. They also illustrate that only non-marginal futures with radical transitions across all energy systems can now be reconciled with the 2°C policy objective.

On the Utilization of Ice Flow Models and Uncertainty Quantification to Interpret the Impact of Surface Radiation Budget Errors on Estimates of Greenland Ice Sheet Surface Mass Balance and Regional Estimates of Mass Balance

NASA Astrophysics Data System (ADS)

Schlegel, N.; Larour, E. Y.; Gardner, A. S.; Lang, C.; Miller, C. E.; van den Broeke, M. R.

2016-12-01

How Greenland ice flow may respond to future increases in surface runoff and to increases in the frequency of extreme melt events is unclear, as it requires detailed comprehension of Greenland surface climate and the ice sheet's sensitivity to associated uncertainties. With established uncertainty quantification tools run within the framework of Ice Sheet System Model (ISSM), we conduct decadal-scale forward modeling experiments to 1) quantify the spatial resolution needed to effectively force distinct components of the surface radiation budget, and subsequently surface mass balance (SMB), in various regions of the ice sheet and 2) determine the dynamic response of Greenland ice flow to variations in components of the net radiation budget. The Glacier Energy and Mass Balance (GEMB) software is a column surface model (1-D) that has recently been embedded as a module within ISSM. Using the ISSM-GEMB framework, we perform sensitivity analyses to determine how perturbations in various components of the surface radiation budget affect model output; these model experiments allow us predict where and on what spatial scale the ice sheet is likely to dynamically respond to changes in these parameters. Preliminary results suggest that SMB should be forced at at least a resolution of 23 km to properly capture dynamic ice response. In addition, Monte-Carlo style sampling analyses reveals that the areas with the largest uncertainty in mass flux are located near the equilibrium line altitude (ELA), upstream of major outlet glaciers in the North and West of the ice sheet. Sensitivity analysis indicates that these areas are also the most vulnerable on the ice sheet to persistent, far-field shifts in SMB, suggesting that continued warming, and upstream shift in the ELA, are likely to result in increased velocities, and consequentially SMB-induced thinning upstream of major outlet glaciers. Here, we extend our investigation to consider various components of the surface radiation budget separately, in order to determine how and where errors in these fields may independently impact ice flow. This work was performed at the California Institute of Technology's Jet Propulsion Laboratory under a contract with the National Aeronautics and Space Administration's Cryosphere and Interdisciplinary Research in Earth Science Programs.

Economic Impact of Increased Utilization of Multivariate Assay Testing to Guide the Treatment of Ovarian Cancer: Implications for Payers.

PubMed

Brodsky, Burton S; Owens, Gary M; Scotti, Dennis J; Needham, Keith A; Cool, Christina L

2017-10-01

Ovarian cancer is the eighth most common cancer among women, but ranks fifth in cancer-related causes of death, the majority of which are detected in late stages, after the cancer has metastasized. The CA125 test is the standard of care for assessing suspicious pelvic masses. However, the primary use of CA125 is to monitor treatment progress rather than to screen for disease, and its sensitivity is exceedingly low, unlike the multivariate assay OVA1. A cost-effective treatment of ovarian cancer requires early and accurate diagnosis of pelvic masses and reduced referrals of patients with benign tumors to a gynecologic oncologist. To analyze the economic impact of increased utilization of a multivariate assay, such as OVA1, to guide the treatment of ovarian cancer. The study population was drawn from Medicare and commercial health plan claims data. A budget impact model was constructed to estimate the economic consequences of substituting the multivariate assay OVA1 to replace the single biomarker assay CA125 to assess the likelihood of pelvic mass malignancy in premenopausal and/or postmenopausal women. All patients selected for the analysis had CA125 testing before surgical intervention. A total of 92,843 health plan members were included for analysis, comprising 48,113 commercially insured members and 44,730 Medicare beneficiaries. Estimates of future health plan expenditures, which were calculated from base-case assumptions, projected overall savings of $0.05 per-member per-month (PMPM) for commercially insured members and $0.01 PMPM for Medicare beneficiaries as a result of increased utilization of OVA1. Sensitivity analysis revealed potential savings of up to $0.17 PMPM for commercially insured patients and up to $0.05 for Medicare beneficiaries. The results of the budget impact model support the use of OVA1 instead of CA125 by indicating that modest cost-savings can be achieved, while reaping the clinical benefits of improved diagnostic accuracy, early disease detection, and reductions in multiple, and possibly unnecessary, referrals to gynecologic oncologists.

Assessment of the GHG budget mitigation potential of intercrops: analysis on several trials and intercrops species in the Southwest of France.

NASA Astrophysics Data System (ADS)

Ferlicoq, M.; Ceschia, E.; Brut, A.; VandeWalle, A.

2012-04-01

To reduce organic carbon loss from the soil and nitrate leaching to groundwater, the European directives have promoted Good Agricultural Practices (GAP), such as the use of intercrops (IC). As shown by Béziat et al. 2009, Ceschia et al. 2010, the IC (or voluntary regrowth from the previous crop) limit net CO2 release from the ecosystem or even contribute to carbon storage during their development. However, the seeding and destruction of IC can be difficult on soil with high clay content, especially when soil is wet, and they must be destroyed early enough so that the nitrogen they contain can be released in the soil and used by the following crops. For these reasons, the Midi-Pyrenees Agriculture Department obtained a 2-year temporary derogation to test the implementation of several nitrates catch crops (mustard, diploïd oat, black oat, oat/vetch, oat/phacelia) on clay soils in order to evaluate the best management practices for growing and destroying them. Their impact on the next crop development was also analysed. In this study, the CESBIO helped the Midi-Pyrénées Agriculture Department to 1) calculate a carbon budget for the different trials and 2) to estimate GHG budgets for those trials by using a life cycle analysis (LCA) approach. Emissions associated to Field Operations (FO) were estimated based on study by Ceschia et al. (2010). During long periods of bare soil, the net CO2 flux is reduced to heterotrophic respiration. Since this component of NEE is not measured on the IC sites, it has been estimated using data from a GHG-Europe instrumented site in the same region, the same year and on similar soils (Auradé site, Gers). Heterotrophic respiration was estimated to range between 96.4 and 131 g eq-C m-2 during the IC cycle that lasted between 65 and 89 days. At the end of the IC period, biomass was (in g eq-C) 0.77, 0.18, 9.89, 0.42, 0.48 for mustard, diploïd oat, black oat, oat/vetch, oat/phacelia respectively. The low amount of biomass is explained by a very dry summer in 2009. FO ranged between 9.9 and 12.7 for the different trials. Compared to the other terms, they have a relative low impact on the GHG budget. They represented at most 13g eq-C during the IC period, 60% of those emissions are caused by the use of machinery. GHG budgets over the IC period are largely positive (source effect), due to low biomass production, mainly because of poor emergence and/or development. Still carbon fixation in the biomass mitigated the emissions. To balance the GHG budget, biomass production should be doubled for mustard (1.5 ton biomass ha-1) which is realistic and increased by a factor 4 for oat/phacelia and oat/vetch associations. In general, we can conclude that except for the black oat (biomass production is too low), these intercrops improve the GHG budget. Nevertheless, to get real advantages from these intercrops, they need to produce more than 0.26 t/ ha to compensate technical operations and additional CO2 emissions associated to IC decomposition will have to be assessed.

Solution of Stochastic Capital Budgeting Problems in a Multidivisional Firm.

DTIC Science & Technology

1980-06-01

linear programming with simple recourse (see, for example, Dantzig (9) or Ziemba (35)) - 12 - and has been applied to capital budgeting problems with...New York, 1972 34. Weingartner, H.M., Mathematical Programming and Analysis of Capital Budgeting Problems, Markham Pub. Co., Chicago, 1967 35. Ziemba

Costing bias in economic evaluations.

PubMed

Frappier, Julie; Tremblay, Gabriel; Charny, Mark; Cloutier, L Martin

2015-01-01

Determining the cost-effectiveness of healthcare interventions is key to the decision-making process in healthcare. Cost comparisons are used to demonstrate the economic value of treatment options, to evaluate the impact on the insurer budget, and are often used as a key criterion in treatment comparison and comparative effectiveness; however, little guidance is available to researchers for establishing the costing of clinical events and resource utilization. Different costing methods exist, and the choice of underlying assumptions appears to have a significant impact on the results of the costing analysis. This editorial describes the importance of the choice of the costing technique and it's potential impact on the relative cost of treatment options. This editorial also calls for a more efficient approach to healthcare intervention costing in order to ensure the use of consistent costing in the decision-making process.

Administrative Relief for Grantees impacted by Hurricanes Harvey, Irma, and Maria

EPA Pesticide Factsheets

On October 26, 2017, the Office of Management and Budget issued the attached memorandum, Administrative Relief for Grantees impacted by Hurricanes, to provide Federal agencies with flexibility to assist their grant applicants and recipients.

Economics of human performance and systems total ownership cost.

PubMed

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.

Health plan budget impact analysis for pimecrolimus.

PubMed

Chang, Jane; Sung, Jennifer

2005-01-01

Budget impact models are useful tools for managed care organizations to make drug formulary decisions. The objective of this study was to estimate the incremental budgetary change in per-member-per-month (PMPM) medical and pharmacy costs for atopic dermatitis (AD) or eczema after the introduction of pimecrolimus cream 1%, a topical calcineurin inhibitor. Estimates of the percentage of patients seeking care, treatment patterns, and quantities of medications dispensed for AD were measured using 2001 and 2002 medical and pharmacy records in a proprietary database for health plans distributed throughout the United States. Approximately 2.5 million health plan members had continuous health insurance coverage during the study period. Costs for medications were assigned using the 2003 wholesale acquisition cost, and costs for physician visits were based on average 2003 Medicare reimbursement rates. Efficacy data from clinical trials were used to model the impact of pimecrolimus on subsequent physician visits. Sensitivity analyses were performed to evaluate the impact of varying the percentage of patients seeking care, practice patterns, medication quantities, percentage of pimecrolimus users, and levels of patient cost sharing. The estimated percentage of health plan members seeking care for AD in 2001 was 3.2%. The estimated total cost PMPM for AD treatment prior to introduction of pimecrolimus was 0.362 dollars for all covered lives, assuming no patient cost sharing. In the year after its introduction, 5.2% of the AD population filled a prescription for pimecrolimus. The incremental increase in pharmacy benefit cost was 0.008 dollars PMPM in 2003 dollars, but the total incremental medical and pharmacy cost was 0.002 dollars PMPM after accounting for the projected reduction in physician visit costs, representing a 0.7% increase in all AD-related costs. Based on sensitivity analyses, the incremental total cost PMPM after the introduction of pimecrolimus ranged from -0.004 dollars to 0.026 dollars. Using claims data for the medical treatment of AD in 2001-2002 and the utilization of pimecrolimus, the addition of pimecrolimus as a treatment option for AD had a minimal impact on PMPM costs for AD-related care in 2003 dollars. As with all pharmacoeconomic models, health plans should perform their own budget forecasting using assumptions derived from their own pharmacy and medical claims data.

Keeping Teachers on the Job Costs Less than Advertised. Policy Memorandum #168

ERIC Educational Resources Information Center

Bivens, Josh

2010-01-01

A misplaced obsession with the size of federal budget deficits remains the single biggest obstacle to enacting new measures to create jobs on a scale commensurate with the crisis in the American labor market. Even assuming that budget scoring rules can't be changed, at the very least policy makers should be aware of the true impact a given piece…

How Do the Location, Size and Budget of Open Space Conservation Affect Land Values?

Treesearch

JunJie Wu; Wenchao Xu; Ralph J. Alig

2016-01-01

In this article we present a model to examine the optimal location, size, and budget of open space conservation and the resulting impact on land values and local fiscal conditions in an urban area. Results indicate that open space conservation can transform the defining features of an urban landscape. A well-designed open space conservation program can improve...

Congressional Budget Action for Fiscal Year 2012 and Its Impact on Education Funding. Issue Brief

ERIC Educational Resources Information Center

Delisle, Jason

2011-01-01

The fiscal year 2012 budget process has been anything but typical or predictable. While fiscal year 2012 starts in just a few weeks on October 1, 2011, the annual appropriations process is far from complete, and funding for federal education programs has not yet been finalized. Nevertheless, congressional action in the months that have led up to…

Upgrading the Space Shuttle.

DTIC Science & Technology

1999-01-01

Motors, Honda , Toyota , and Nissan ). By learning from and applying the technologies developed elsewhere, NASA could greatly leverage its funding for...assessing risks to the shuttle. The committee believes that this tool has the potential to be very helpful in assessing and comparing the impact of...environmental regulations). Figure 2-2 shows how the S&PU budget compared to the total shuttle budget during four different years since 1985

A Worm in the Apple? The Implications of Seniority-Based Teacher Layoffs. NRI Working Paper 2011-01

ERIC Educational Resources Information Center

Goldhaber, Dan

2011-01-01

Stories abound about the staffing cuts that will have to be made currently, and in the next couple of years, as the ripple effects of the economic crisis impact local and state education budgets. Major budget cuts make teacher layoffs a near inevitability. This raises two very timely questions: what now determines which teachers are laid off, and…

Deficit Financing of Schools? The Impact of Statutory Change on School District Borrowing Behavior.

ERIC Educational Resources Information Center

Edlefson, Carla

In the 70s and 80s, Ohio relaxed its balanced-budget laws to give school districts more options for borrowing over the end of the fiscal year. Two provisions that permit districts to borrow against next year's revenues in order to balance the current year's budget include the Emergency School Advancement program and the Spending Reserve. This…

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysis.

PubMed

Marton, James; Ketsche, Patricia G; Zhou, Mei

2010-07-01

Faced with state budget troubles, policymakers may introduce or increase State Children's Health Insurance Program (SCHIP) premiums for children in the highest program income eligibility categories. In this paper we compare the responses of SCHIP recipients in a state (Kentucky) that introduced SCHIP premiums for the first time at the end of 2003 with the responses of recipients in a state (Georgia) that increased existing SCHIP premiums in mid-2004. We start with a theoretical examination of how these different policies create different changes to family budget constraints and produce somewhat different financial incentives for recipients. Next we empirically model the impact of these policies using a competing risk approach to differentiate exits due to transfers to other eligibility categories of public coverage from exiting the public health insurance system. In both states we find a short-run increase in the likelihood that children transfer to lower- income eligibility/lower-premium categories of SCHIP. We also find a short-run increase in the rate at which children transfer from SCHIP to Medicaid in Kentucky, which is consistent with our theoretical model. These findings have important financial implications for state budgets, as the matching rates and premium levels are different for different eligibility categories of public coverage. Copyright (c) 2009 John Wiley & Sons, Ltd.

Defining the Impact of Public Administration Programmes for Public Sector Organizations

ERIC Educational Resources Information Center

Broucker, Bruno

2015-01-01

In times of financial and economic crises, public organizations seem to cut their budgets for training and education, especially when the impact of a programme is questioned. Therefore, PA programmes need to clarify what impact can be expected and what individual and organizational processes are influencing the impact of a PA programme on the…

The impact of the economic downturn on environmental health services and professionals in North Carolina.

PubMed

Weston-Cox, Paula

2012-06-01

The objective of the authors' study was to examine the impact of the economic recession on the environmental health profession between budget year (BY) 2006-2007 and BY 2010-2011 in the following areas: (1) environmental health department fees for services; (2) changes in staffing levels, benefits, or pay; (3) changes in staff responsibilities; and (4) the impact to the private environmental sector compared to public environmental health professionals. Data were summarized from the following surveys: North Carolina Environmental Health Supervisors Association Fee and Economic Surveys; University of North Carolina Chapel Hill School of Government Current Salary Index; and a created online survey of private-sector environmental professionals. Total fees in the public sector for services have risen for most environmental health departments, but not enough to offset budget reductions. All of the counties that participated in the survey either have reduced staff, pay, or benefits due to budget cuts, and some counties utilized staff in other areas through cross-training. The private environmental sector also reduced staff in response to a reduced workload. Public sector employers may have difficulties retaining existing employees and recruiting new employees over the long-term in the current economic climate.

Partitioning the Water Budget in a Glacierized Basin

NASA Astrophysics Data System (ADS)

O'Neel, S.; Sass, L.; McGrath, D.; McNeil, C.; Myers, K. F.; Bergstrom, A.; Koch, J. C.; Ostman, J. S.; Arendt, A. A.; LeWinter, A.; Larsen, C. F.; Marshall, H. P.

2017-12-01

Glaciers couple to the ecosystems in which they reside through their mass balance and subsequent runoff. The unique timing and composition of glacier runoff notably impacts ecological and socio-economically important processes, including thermal modulation of streams, nearshore primary production, and groundwater exchange. Predicting how these linkages will evolve as glaciers continue to retreat requires a better understanding of basin- to region-scale water budgets. Here we develop a partitioned water balance for Alaska's Wolverine Glacier basin for 2016. Our presentation will highlight mass-balance forcing and sensitivity, as well as analyses of hydrometric and geochemical partitioning. These observations provide constraints for hypsometry-based regional projections of glacier change, which form the basis of future biogeochemical scenarios. Local climate records show relatively minor warming and drying over the 1967 -2016 interval, yet the impact on the glacier was substantial; the average annual balance rate over the study interval is -0.5 m/yr. We performed a sensitivity experiment that suggests that elevation-independent processes drive first-order variability in glacier-wide mass balance solutions Analysis of runoff and precipitation data suggest that previously ignored components of the hydrologic cycle (groundwater, evapotranspiration, off-glacier snowpack storage, and snow redistribution) may substantially contribute to the basin wide water budget. Initial geochemical assessments (carbon, water isotopes, major ions) highlight unique source signatures (glacier-derived, snow-melt, groundwater), which will be further explored using a mixing model approach. Applying a range of climate forcings over centennial time-scales suggests the regional equilibrium line altitude is likely to increase by more than 100 m, which will result in extensive glacier area losses. Such changes will likely modify the runoff from this basin by increasing inter-annual streamflow variability and increasing the fraction of runoff delivered early in the melt season.

Break-even Analysis: Tool for Budget Planning

ERIC Educational Resources Information Center

Lohmann, Roger A.

1976-01-01

Multiple funding creates special management problems for the administrator of a human service agency. This article presents a useful analytic technique adapted from business practice that can help the administrator draw up and balance a unified budget. Such a budget also affords reliable overview of the agency's financial status. (Author)

Analysis of surface energy budget data over varying land-cover conditions.

USDA-ARS?s Scientific Manuscript database

The surface energy budget plays an important role in boundary-layer meteorology and quantifying these budgets over varying land surface types is important in studying land-atmosphere interactions. In late April 2007, eddy covariance towers were erected at four sites in the Little Washita Watershed i...

Impact of fire on global land carbon, water, and energy budgets and climate during the 20th century through changing ecosystems

NASA Astrophysics Data System (ADS)

Li, F.; Lawrence, D. M.; Bond-Lamberty, B. P.; Levis, S.

2016-12-01

Fire is an integral Earth system process and the primary form of terrestrial ecosystem disturbance on a global scale. Here we provide the first quantitative assessment and understanding on fire's impact on global land carbon, water, and energy budgets and climate through changing ecosystems. This is done by quantifying the difference between 20th century fire-on and fire-off simulations using the Community Earth System Model (CESM1.2). Results show that fire decreases the net carbon gain of global terrestrial ecosystems by 1.0 Pg C/yr averaged across the 20th century, as a result of biomass and peat burning (1.9 Pg C/yr) partly offset by changing gross primary productivity, respiration, and land-use carbon loss (-0.9 Pg C/yr). In addition, fire's effect on global carbon budget intensifies with time. Fire significantly reduces land evapotranspiration (ET) by 600 km3/yr and increases runoff, but has limited impact on precipitation. The impact on ET and runoff is most clearly seen in the tropical savannas, African rainforest, and some boreal and Southern Asian forests mainly due to fire-induced reduction in the vegetation canopy. It also weakens both the significant upward trend in global land ET prior to the 1950s and the downward trend from 1950 to 1985 by 35%. Fire-induced changes in land ecosystems affects global energy budgets by significantly reducing latent heating and surface net radiation. Fire changes surface radiative budget dominantly by raising surface upward longwave radiation and net longwave radiation. It also increases the global land average surface air temperature (Tas) by 0.04°C, and significantly increases wind speed and decreases surface relative humidity. The fire-induced change in wind speed, Tas, and relative humidity implies a positive feedback loop between fire and climate. Moreover, fire-induced changes in land ecosystems contribute 20% of strong global land warming during 1910-1940, which provides a new mechanism for the early 20th century global land warming. The results emphasize the importance of fire disturbance in the Earth's carbon, water, and energy cycles and climate by changing terrestrial ecosystems.

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

PubMed Central

Biz, Aline Navega; Caetano, Rosângela

2015-01-01

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer. METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used. RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively. CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated. PMID:26274871

Does state budget pressure matter for uncompensated care spending in hospitals? Findings from Texas and California.

PubMed

Chang, Jongwha; Patel, Isha; Suh, Won S; Lin, Hsien-Chang; Kim, Sunjung; Balkrishnan, Rajesh

2012-01-01

This study examined the impact of state budget cuts on uncompensated care at general acute care hospital organizations. This study capitalized on the variations in the states of Texas and California to form a natural experiment testing the joint impact of budget cut status on uncompensated care costs, as well as specific charity care costs and bad debt expenses from indigent patients. Budget cuts in the state of Texas occurred in the year 2004. Information was obtained from the Texas Department of Health and the California Department of Health Services regarding financial characteristics of hospitals and from the American Hospital Directory annual survey regarding organizational characteristics of hospitals. We created three dependent variables: R(UC) (the ratio of total uncompensated care costs to gross patient revenue), R(CC) (the ratio of charity care to total patient revenue) and R(BD) (the ratio of bad debt expenses to gross patient revenue). Using a two-period panel data set and individual hospital fixed effects, we captured hospital uncompensated care spending that could also have influenced budget cut status. Additionally, the impact of the state budget cut status on hospitals' uncompensated care spending, charity care spending and bad debt expenses was also estimated using the similar methodology. In this study, we included 416 (in Texas) and 352 (in California) public, not-for-profit (NFP) and for-profit (FP) hospitals that completed the annual survey during the study period 2002-2005. For the state of Texas, results from the fixed effect model confirmed that the year 2005 was directly related to increased R(UC) and R(CC) . The coefficients of 2005 were significantly and positively associated with R(UC) (0.43, p < 0.05) and R(CC) (0.29, p < 0.05). These results supported the findings that the R(UC) and the R(CC) would be more positively associated with 2005 than any other year, with other things being equal. However, for the state of California, even though the coefficient of 2005 was significant and positively associated with R(CC) (0.31, p < 0.05), the coefficient of uncompensated care spending was not statistically significant for 2005. The healthcare industry is characterized by increased regulation, a growing number of uninsured patients, increasingly stringent reimbursement and competitive practices among hospitals and other providers. Federal and state healthcare agencies are restricting the criteria for eligibility for outlier payments and uncompensated care provisions. Tax exempt status of many NFP hospitals is being examined and tied to specific performances, particularly the provision of uncompensated care. This study provides evidence of the impact of budget cut pressure on uncompensated care provided in Texas general acute care hospitals. Copyright © 2012 John Wiley & Sons, Ltd.

Recombinant or urinary follicle-stimulating hormone? A cost-effectiveness analysis derived by particularizing the number needed to treat from a published meta-analysis.

PubMed

Ola, B; Papaioannou, S; Afnan, M A; Hammadieh, N; Gimba, S

2001-06-01

To demonstrate that particularizing pooled results of a meta-analysis can derive incremental cost effectiveness of superovulation with recombinant follicle-stimulating hormones (rFSH) vs. the highly purified urinary form (uFSH) for assisted conception. A retrospective study. An assisted conception unit in the United Kingdom. One hundred forty-five fresh in vitro fertilization (IVF) and 58 fresh intracytoplasmic sperm injection (ICSI) cycles. rFSH vs. uFSH. Incremental cost-effectiveness (i.e., cost needed to treat, or CNT) and budget-impact analyses of rFSH vs. uFSH. In women less than 30 years old, the clinical pregnancy rate was 37.7% (95% CI 24.8%-52.1%), the particularized number needed to treat (pNNT) was -19, and the cost needed to treat was 5070.51 pounds sterling (3660.53 pounds sterling to 7619.32 pounds sterling). For the 30- to 35-year-old age group, the clinical pregnancy rate was 29.9% (95% CI 20.0%--41.4%), the particularized number needed to treat was -24, and CNT was 7335.59 pounds stering (5284.11 pounds sterling to 10,941.22 pounds sterling). For the 36- to 40-year-old age group, the clinical pregnancy rate was 30.6.0% (95% CI 19.6%--43.7%), the particularized number needed to treat was -23.0, and the CNT was 8569.67 pounds sterling (5998.70 pounds sterling to 13,413.24 pounds sterling). The CNT and thus the budget impact analyses (the extra number of cycles that can be funded by the CNT) both increase directly with age of the patient, and inversely with the clinical pregnancy rate.

Drivers and predictions of coral reef carbonate budget trajectories

PubMed Central

Graham, Nicholas A. J.; Jennings, Simon; Perry, Chris T.

2017-01-01

Climate change is one of the greatest threats to the long-term maintenance of coral-dominated tropical ecosystems, and has received considerable attention over the past two decades. Coral bleaching and associated mortality events, which are predicted to become more frequent and intense, can alter the balance of different elements that are responsible for coral reef growth and maintenance. The geomorphic impacts of coral mass mortality have received relatively little attention, particularly questions concerning temporal recovery of reef carbonate production and the factors that promote resilience of reef growth potential. Here, we track the biological carbonate budgets of inner Seychelles reefs from 1994 to 2014, spanning the 1998 global bleaching event when these reefs lost more than 90% of coral cover. All 21 reefs had positive budgets in 1994, but in 2005 budgets were predominantly negative. By 2014, carbonate budgets on seven reefs were comparable with 1994, but on all reefs where an ecological regime shift to macroalgal dominance occurred, budgets remained negative through 2014. Reefs with higher massive coral cover, lower macroalgae cover and lower excavating parrotfish biomass in 1994 were more likely to have positive budgets post-bleaching. If mortality of corals from the 2016 bleaching event is as severe as that of 1998, our predictions based on past trends would suggest that six of eight reefs with positive budgets in 2014 would still have positive budgets by 2030. Our results highlight that reef accretion and framework maintenance cannot be assumed from the ecological state alone, and that managers should focus on conserving aspects of coral reefs that support resilient carbonate budgets. PMID:28123092

Drivers and predictions of coral reef carbonate budget trajectories.

PubMed

Januchowski-Hartley, Fraser A; Graham, Nicholas A J; Wilson, Shaun K; Jennings, Simon; Perry, Chris T

2017-01-25

Climate change is one of the greatest threats to the long-term maintenance of coral-dominated tropical ecosystems, and has received considerable attention over the past two decades. Coral bleaching and associated mortality events, which are predicted to become more frequent and intense, can alter the balance of different elements that are responsible for coral reef growth and maintenance. The geomorphic impacts of coral mass mortality have received relatively little attention, particularly questions concerning temporal recovery of reef carbonate production and the factors that promote resilience of reef growth potential. Here, we track the biological carbonate budgets of inner Seychelles reefs from 1994 to 2014, spanning the 1998 global bleaching event when these reefs lost more than 90% of coral cover. All 21 reefs had positive budgets in 1994, but in 2005 budgets were predominantly negative. By 2014, carbonate budgets on seven reefs were comparable with 1994, but on all reefs where an ecological regime shift to macroalgal dominance occurred, budgets remained negative through 2014. Reefs with higher massive coral cover, lower macroalgae cover and lower excavating parrotfish biomass in 1994 were more likely to have positive budgets post-bleaching. If mortality of corals from the 2016 bleaching event is as severe as that of 1998, our predictions based on past trends would suggest that six of eight reefs with positive budgets in 2014 would still have positive budgets by 2030. Our results highlight that reef accretion and framework maintenance cannot be assumed from the ecological state alone, and that managers should focus on conserving aspects of coral reefs that support resilient carbonate budgets. © 2017 The Authors.

An Analysis of the President’s 2014 Budget

DTIC Science & Technology

2013-05-01

Administration’s, and incorporates estimates by the staff of the Joint Committee on Taxation (JCT) for the President’s tax proposals.1 In conjunction...consequences for the budget: 1. For more details about the President’s tax proposals, see Joint Committee on Taxation , Estimated Budget Effects of the Revenue...Congressional Budget Office; staff of the Joint Committee on Taxation . Note: n.a. = not applicable; GDP = gross domestic product. a. Negative numbers

Cost-analysis of the WHO Essential Medicines List in A Resource-Limited Setting: Experience from A District Hospital in India.

PubMed

Alvarez-Uria, Gerardo; Thomas, Dixon; Zachariah, Seeba; Byram, Rajarajeshwari; Kannan, Shanmugamari

2014-05-01

The World Health Organization (WHO) has been publishing the essential medicines list (EML) since 1977. The EML includes the most efficacious, safe and cost-effective drugs for the most relevant public health conditions worldwide. The WHO performs a cost-effectiveness analysis within each therapeutic group, but very little is known about which therapeutic groups are costliest for hospitals that adopt the WHO EML concept. In this study, we have described the annual consumption of medicines in a district hospital in India, that limited the list of available drugs according to the WHO EML concept. Only 21 drugs constituted 50% of the hospital spending. Anti-infective medicines accounted for 41% of drug spending, especially antiretrovirals which were used to treat HIV infection. Among other therapeutic groups, insulin had the highest impact on the hospital budget. We identified medicines used in perinatal care, which included anti-D immunoglobulin and lung surfactants, that were used rarely, but bore a relatively high cost burden. The results of this study indicate that, in district that adopt the WHO EML, antiretrovirals and antibiotics were the top therapeutic groups for the drug hospital budgets.

Using Benefit-Cost Analysis to Scale Up Early Childhood Programs through Pay-for-Success Financing

PubMed Central

Temple, Judy A.; Reynolds, Arthur J.

2016-01-01

Increasing access to high-quality preschool programs is a high priority at local, state, and federal levels. Recently, two initiatives to expand preschool programming in Illinois and Utah have used funds from private investors to scale up existing programs. Private-sector social impact investors provide funding to nonprofit or public preschool providers to increase the number of children served. If the measured outcomes from preschool participation meet pre-determined goals, then the estimated government cost savings arising from these preschool interventions are used to repay the investors. Social impact investing with a “Pay for Success” contract can help budget-constrained governments expand proven or promising preventive interventions without the need to increase taxes. Cost-benefit analysis plays a crucial role in helping to identify which social, educational or health interventions are suitable for this type of innovative financing. Cost-benefit analysts are needed to design the structure of the success payments that the government will make to the private investors. This paper describes social impact borrowing as a new method for financing public services, outlines the contribution of cost-benefit analysis, and discusses the innovative use of social impact financing to promote scaling up of the evidence-based Child Parent Centers and other early childhood programs. PMID:27882288

Cost Effectiveness of Free Access to Smoking Cessation Treatment in France Considering the Economic Burden of Smoking-Related Diseases

PubMed Central

Cadier, Benjamin; Durand-Zaleski, Isabelle; Thomas, Daniel; Chevreul, Karine

2016-01-01

Context In France more than 70,000 deaths from diseases related to smoking are recorded each year, and since 2005 prevalence of tobacco has increased. Providing free access to smoking cessation treatment would reduce this burden. The aim of our study was to estimate the incremental cost-effectiveness ratios (ICER) of providing free access to cessation treatment taking into account the cost offsets associated with the reduction of the three main diseases related to smoking: lung cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). To measure the financial impact of such a measure we also conducted a probabilistic budget impact analysis. Methods and Findings We performed a cost-effectiveness analysis using a Markov state-transition model that compared free access to cessation treatment to the existing coverage of €50 provided by the French statutory health insurance, taking into account the cost offsets among current French smokers aged 15–75 years. Our results were expressed by the incremental cost-effectiveness ratio in 2009 Euros per life year gained (LYG) at the lifetime horizon. We estimated a base case scenario and carried out a Monte Carlo sensitivity analysis to account for uncertainty. Assuming a participation rate of 7.3%, the ICER value for free access to cessation treatment was €3,868 per LYG in the base case. The variation of parameters provided a range of ICER values from -€736 to €15,715 per LYG. In 99% of cases, the ICER for full coverage was lower than €11,187 per LYG. The probabilistic budget impact analysis showed that the potential cost saving for lung cancer, COPD and CVD ranges from €15 million to €215 million at the five-year horizon for an initial cessation treatment cost of €125 million to €421 million. Conclusion The results suggest that providing medical support to smokers in their attempts to quit is very cost-effective and may even result in cost savings. PMID:26909802

Impact of fire on global land surface air temperature and energy budget for the 20th century due to changes within ecosystems

NASA Astrophysics Data System (ADS)

Li, Fang; Lawrence, David M.; Bond-Lamberty, Ben

2017-04-01

Fire is a global phenomenon and tightly interacts with the biosphere and climate. This study provides the first quantitative assessment and understanding of fire’s influence on the global annual land surface air temperature and energy budget through its impact on terrestrial ecosystems. Fire impacts are quantified by comparing fire-on and fire-off simulations with the Community Earth System Model (CESM). Results show that, for the 20th century average, fire-induced changes in terrestrial ecosystems significantly increase global land annual mean surface air temperature by 0.18 °C, decrease surface net radiation and latent heat flux by 1.08 W m-2 and 0.99 W m-2, respectively, and have limited influence on sensible heat flux (-0.11 W m-2) and ground heat flux (+0.02 W m-2). Fire impacts are most clearly seen in the tropical savannas. Our analyses suggest that fire increases surface air temperature predominantly by reducing latent heat flux, mainly due to fire-induced damage to the vegetation canopy, and decreases net radiation primarily because fire-induced surface warming significantly increases upward surface longwave radiation. This study provides an integrated estimate of fire and induced changes in ecosystems, climate, and energy budget at a global scale, and emphasizes the importance of a consistent and integrated understanding of fire effects.

The seasonal cycle of low stratiform clouds

NASA Technical Reports Server (NTRS)

Klein, Stephen A.; Hartmann, Dennis L.

1993-01-01

The seasonal cycle of low stratiform clouds is studied using data from surface-based cloud climatologies. The impact of low clouds on the radiation budget is illustrated by comparison of data from the Earth Radiation Budget Experiment with the cloud climatologies. Ten regions of active stratocumulus convection are identified. These regions fall into four categories: subtropical marine, midlatitude marine, Arctic stratus, and Chinese stratus. With the exception of the Chinese region, all the regions with high amounts of stratus clouds are over the oceans. In all regions except the Arctic, the season of maximum stratus corresponds to the season of greatest lower-troposphere static stability. Interannual variations in stratus cloud amount also are related to changes in static stability. A linear analysis indicates that a 6 percent increase in stratus fractional area coverage is associated with each 1 C increase in static stability. Over midlatitude oceans, sky-obscuring fog is a large component of the summertime stratus amount. The amount of fog appears to be related to warm advection across sharp gradients of SST.

The Seasonal Cycle of Low Stratiform Clouds.

NASA Astrophysics Data System (ADS)

Klein, Stephen A.; Hartmann, Dennis L.

1993-08-01

The seasonal cycle of low stratiform clouds is studied using data from surface-based cloud climatologies. The impact of low clouds on the radiation budget is illustrated by comparison of data from the Earth Radiation Budget Experiment with the cloud climatologies. Ten regions of active stratocumulus convection are identified. These regions fall into four categories: subtropical marine, midlatitude marine, Arctic stratus, and Chinese stratus. With the exception of the Chinese region, all the regions with high amounts of stratus clouds are over the oceans.In all regions except the Arctic, the season of maximum stratus corresponds to the season of greatest lower-troposphere static stability. Interannual variations in stratus cloud amount also are related to changes in static stability. A linear analysis indicates that a 6% increase in stratus fractional area coverage is associated with each 1°C increase in static stability. Over midlatitude oceans, sky-obscuring fog is a large component of the summertime stratus amount. The amount of fog appears to be related to warm advection across sharp gradients of SST.

Optimal resource allocation for defense of targets based on differing measures of attractiveness.

PubMed

Bier, Vicki M; Haphuriwat, Naraphorn; Menoyo, Jaime; Zimmerman, Rae; Culpen, Alison M

2008-06-01

This article describes the results of applying a rigorous computational model to the problem of the optimal defensive resource allocation among potential terrorist targets. In particular, our study explores how the optimal budget allocation depends on the cost effectiveness of security investments, the defender's valuations of the various targets, and the extent of the defender's uncertainty about the attacker's target valuations. We use expected property damage, expected fatalities, and two metrics of critical infrastructure (airports and bridges) as our measures of target attractiveness. Our results show that the cost effectiveness of security investment has a large impact on the optimal budget allocation. Also, different measures of target attractiveness yield different optimal budget allocations, emphasizing the importance of developing more realistic terrorist objective functions for use in budget allocation decisions for homeland security.

CAUT Analysis of Federal Budget 2012

ERIC Educational Resources Information Center

Canadian Association of University Teachers, 2012

2012-01-01

The 2012 federal Budget marks the beginning of a painful and unnecessary fiscal retrenchment. Despite boasting one of the lowest debt-to-GDP ratios amongst industrialized countries, the Conservative government is pressing ahead with deep cuts of more than $5 billion across departmental budgets by 2014-15. For post-secondary education and research,…

Budget Brief: 2015 Proposed Budget Milwaukee Public Schools

ERIC Educational Resources Information Center

Allen, Vanessa; Chapman, Anne; Henken, Rob

2014-01-01

In this report, the authors provide a detailed analysis of the major changes in revenue and expenditures in the Milwaukee Public Schools (MPS) 2015 proposed budget, and the manner in which MPS has responded to recent legislative changes and turbulent workforce challenges. The objective is to provide an independent assessment of the district's…

Budget Impact of Adding Ivabradine to Standard of Care in Patients with Chronic Systolic Heart Failure in the United States.

PubMed

Borer, Jeffrey S; Kansal, Anuraag R; Dorman, Emily D; Krotneva, Stanimira; Zheng, Ying; Patel, Harshali K; Tavazzi, Luigi; Komajda, Michel; Ford, Ian; Böhm, Michael; Kielhorn, Adrian

2016-09-01

Heart failure (HF) costs $21 billion annually in direct health care costs, 80% of which is directly attributable to hospitalizations. The SHIFT clinical study demonstrated that ivabradine plus standard of care (SoC) reduced HF-related and all-cause hospitalizations compared with SoC alone. To estimate the budget impact of ivabradine from a U.S. commercial payer perspective. A budget impact model estimated the per-member-per month (PMPM) impact of introducing ivabradine to existing formularies by comparing a reference scenario (SoC) and a new drug scenario (ivabradine + SoC) in hypothetical 1 million-member commercial and Medicare Advantage plans. In both scenarios, U.S. claims data were used for the reference cumulative annual rates of hospitalizations (HF, non-HF cardiovascular [CV], and non-CV), and hospitalization rates were adjusted using SHIFT data. The model controlled for mortality risk using SHIFT and U.S. life table data, and hospitalization costs were obtained from U.S. claims data: HF-related = $37,507; non-HF CV = $28,951; and non-CV = $17,904. The annualized wholesale acquisition cost of ivabradine was $4,500, with baseline use for this new drug at 2%, increasing 2% per year. Based on the approved U.S. indication, approximately 2,000 commercially insured patients from a 1 million-member commercial plan were eligible to receive ivabradine. Ivabradine resulted in a PMPM cost savings of $0.01 and $0.04 in years 1 and 3 of the core model, respectively. After including the acquisition price for ivabradine, the model showed a decrease in total costs in the commercial ($991,256 and $474,499, respectively) and Medicare populations ($13,849,262 and $4,280,291, respectively) in year 1. This decrease was driven by ivabradine's reduction in hospitalization rates. For the core model, the estimated pharmacy-only PMPM in year 1 was $0.01 for the commercial population and $0.24 for the Medicare Advantage population. Adding ivabradine to SoC led to lower average annual treatment costs. The negative PMPM budget impact indicates that ivabradine is an affordable option for U.S. payers. This study was funded by Amgen. Patel is employed by Amgen; Kielhorn was employed by Amgen at the time of the study but is no longer affiliated with Amgen. Borer, Böhm, Ford, and Komajda have received scientific support, consultative fees, and/or speakers honoraria from Servier and Amgen in connection with SHIFT, the trial underlying this analysis. Borer also has received consultative fees from Celladon, Pfizer, ARMGO, Cardiorentis, Novartis, and Takeda USA. Kansal, Dorman, Krotneva, and Zheng are employees of Evidera, which was hired to assist with this study. Tavazzi has received research grants and consultation fees from Servier in connection with this study and has had advisory board memberships with Boston Scientific, Servier, Cardiorentis, Medtronic, St. Jude Medical, and CVie Therapeutics. Study concept and design were contributed by Dorman and Keilhorn, along with the other authors. Tavazzi, Komajda, Ford, BÖhm, and Borer oversaw collection of the data. Tavazzi, Komajda, Ford, BÖhm, and Borer (along with Karl Swedberg) formed the Executive Committee of SHIFT, the trial underlying this analysis. The manuscript was written by Kansal, along with the other authors, and revised by Borer and Patel, with assistance from the other authors.

Federal Grants: Design Improvements Could Help Federal Resources Go Further. Report to the Chairman, Committee on the Budget, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Accounting and Information Management Div.

Intergovernmental grants are a significant part of both federal and state budgets. This report examines the federal grant-in-aid system from the perspective of fiscal impact. It focuses on the extent to which the grant system succeeds in two objectives: (1) encouraging states to use federal dollars to supplement rather than replace their own…

Effects of Budget Reductions on Army Acquisition Support of Equipping and Modernization Goals

DTIC Science & Technology

2015-04-16

overall Army budgets are significantly reduced (34% since 2008), maintaining the entire equipment portfolio reduces the funding available to meet...the Mission Command portfolio , examine their impact on equipping and modernization, and make recommendations on how to divest the equipment no longer... portfolio of equipment being managed and the link to the new Defense guidance and Army equipping guidance and modernization plans. Any systems or programs

Global Patterns of Legacy Nitrate Storage in the Vadose Zone

NASA Astrophysics Data System (ADS)

Ascott, M.; Gooddy, D.; Wang, L.; Stuart, M.; Lewis, M.; Ward, R.; Binley, A. M.

2017-12-01

Global-scale nitrogen (N) budgets have been developed to quantify the impact of man's influence on the nitrogen cycle. However, these budgets often do not consider legacy effects such as accumulation of nitrate in the deep vadose zone. In this presentation we show that the vadose zone is an important store of nitrate which should be considered in future nitrogen budgets for effective policymaking. Using estimates of depth to groundwater and nitrate leaching for 1900-2000, we quantify for the first time the peak global storage of nitrate in the vadose zone, estimated as 605 - 1814 Teragrams (Tg). Estimates of nitrate storage are validated using previous national and basin scale estimates of N storage and observed groundwater nitrate data for North America and Europe. Nitrate accumulation per unit area is greatest in North America, China and Central and Eastern Europe where thick vadose zones are present and there is an extensive history of agriculture. In these areas the long solute travel time in the vadose zone means that the anticipated impact of changes in agricultural practices on groundwater quality may be substantially delayed. We argue that in these areas use of conventional nitrogen budget approaches is inappropriate and their continued use will lead to significant errors.

Mitigation of Sri Lanka Island Effects in Colombo Sounding Data during DYNAMO

NASA Astrophysics Data System (ADS)

Ciesielski, P. E.; Johnson, R. H.; Yoneyama, K.

2013-12-01

During the Dynamics of the MJO (DYNAMO) field campaign, upper-air soundings were launched at Colombo, Sri Lanka as part of the enhanced northern sounding array (NSA) of the experiment. The Colombo soundings were affected at low-levels by diurnal heating of this large island and by flow blocking due to elevated terrain to the east of the Colombo site. Because of the large spacing between sounding sites, these small-scale effects are aliased onto the larger scale impacting analyses and atmospheric budgets over the DYNAMO NSA. To mitigate these local island effects on the large-scale budgets, a procedure was designed which uses ECMWF-analyzed fields in the vicinity of Sri Lanka to estimate open-ocean conditions (i.e, as if this island were not present). These 'unperturbed' ECMWF fields at low-levels are then merged with observed Colombo soundings. This procedure effectively mutes the blocking effects and large diurnal cycle observed in the low-level Colombo fields. In westerly flow regimes, adjusted Colombo winds increase the low-level westerlies by 2-3 m/s with a similar increase of the low-level easterlies in easterly flow regimes. In general, over the NSA the impact of the adjusted Colombo winds results in more low-level divergence (convergence), more mid-level subsidence (rising motion) and reduced (increased) rainfall during the westerly (easterly) wind regimes. In comparison to independent TRMM rainfall estimates, both the mean budget-derived rainfall and its temporal correlation are improved by using the adjusted Colombo soundings. In addition, use of the 'unperturbed' fields result in a more realistic moisture budget analyses, both in its diurnal cycle and during the build-up phase of the November MJO when a gradual deepening of apparent drying was observed. Overall, use of the adjusted Colombo soundings appears to have a beneficial impact on the NSA analyses and budgets.

The impact of Earth system feedbacks on carbon budgets and climate response.

PubMed

Lowe, Jason A; Bernie, Daniel

2018-05-13

A number of studies have examined the size of the allowable global cumulative carbon budget compatible with limiting twenty-first century global average temperature rise to below 2°C and below 1.5°C relative to pre-industrial levels. These estimates of cumulative emissions have a number of uncertainties including those associated with the climate sensitivity and the global carbon cycle. Although the IPCC fifth assessment report contained information on a range of Earth system feedbacks, such as carbon released by thawing of permafrost or methane production by wetlands as a result of climate change, the impact of many of these Earth system processes on the allowable carbon budgets remains to be quantified. Here, we make initial estimates to show that the combined impact from typically unrepresented Earth system processes may be important for the achievability of limiting warming to 1.5°C or 2°C above pre-industrial levels. The size of the effects range up to around a 350 GtCO 2 budget reduction for a 1.5°C warming limit and around a 500 GtCO 2 reduction for achieving a warming limit of 2°C. Median estimates for the extra Earth system forcing lead to around 100 GtCO 2 and 150 GtCO 2 , respectively, for the two warming limits. Our estimates are equivalent to several years of anthropogenic carbon dioxide emissions at present rates. In addition to the likely reduction of the allowable global carbon budgets, the extra feedbacks also bring forward the date at which a given warming threshold is likely to be exceeded for a particular emission pathway.This article is part of the theme issue 'The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'. © 2018 The Author(s).

The impact of Earth system feedbacks on carbon budgets and climate response

NASA Astrophysics Data System (ADS)

Lowe, Jason A.; Bernie, Daniel

2018-05-01

A number of studies have examined the size of the allowable global cumulative carbon budget compatible with limiting twenty-first century global average temperature rise to below 2°C and below 1.5°C relative to pre-industrial levels. These estimates of cumulative emissions have a number of uncertainties including those associated with the climate sensitivity and the global carbon cycle. Although the IPCC fifth assessment report contained information on a range of Earth system feedbacks, such as carbon released by thawing of permafrost or methane production by wetlands as a result of climate change, the impact of many of these Earth system processes on the allowable carbon budgets remains to be quantified. Here, we make initial estimates to show that the combined impact from typically unrepresented Earth system processes may be important for the achievability of limiting warming to 1.5°C or 2°C above pre-industrial levels. The size of the effects range up to around a 350 GtCO2 budget reduction for a 1.5°C warming limit and around a 500 GtCO2 reduction for achieving a warming limit of 2°C. Median estimates for the extra Earth system forcing lead to around 100 GtCO2 and 150 GtCO2, respectively, for the two warming limits. Our estimates are equivalent to several years of anthropogenic carbon dioxide emissions at present rates. In addition to the likely reduction of the allowable global carbon budgets, the extra feedbacks also bring forward the date at which a given warming threshold is likely to be exceeded for a particular emission pathway. This article is part of the theme issue `The Paris Agreement: understanding the physical and social challenges for a warming world of 1.5°C above pre-industrial levels'.

77 FR 63240 - Telephone Consumer Protection Act of 1991

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... and Budget (OMB) has approved, for a period of three years, the information collection associated with... registry in 2009. See 74 FR 17863, April 17, 2009. Privacy Impact Assessment: Yes. The Privacy Impact.../Privacy_Impact_Assessment.html . Note: The Commission will prepare a revision to the SORN and PIA to cover...

75 FR 4818 - Notice of Public Information Collection Being Reviewed by the Federal Communications Commission...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-29

... and Budget (OMB), via fax at (202) 395-5167, or via the Internet at [email protected] and.... Total Annual Cost: None. Privacy Act Impact Assessment: No impact(s). Nature and Extent of... things, the Second Order adopts a children's programming preemption policy. This policy requires all...

Financing Public Higher Education: The Impact of Responsibility Center Management on a Public Research University

ERIC Educational Resources Information Center

Pappone, David J.

2016-01-01

To explore the impacts on public universities of implementing an incentive-based budgeting system, this dissertation focuses on one university's extensive experience with Responsibility Center Management. The financial and non-financial impacts of Responsibility Center Management will be considered by examining the extent to which commonly held…

A Multi-Objective Decision-Making Model for Resources Allocation in Humanitarian Relief

DTIC Science & Technology

2007-03-01

Applied Mathematics and Computation 163, 2005, pp756 19. Malczewski, J., GIS and Multicriteria Decision Analysis , John Wiley and Sons, New York... used when interpreting the results of the analysis . (Raimo et al. 2002) (7) Sensitivity analysis Sensitivity analysis in a DA process answers...Budget Scenario Analysis The MILP is solved ( using LINDO 6.1) for high, medium and low budget scenarios in both damage degree levels. Tables 17 and

Uncertainty Budget Analysis for Dimensional Inspection Processes (U)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valdez, Lucas M.

2012-07-26

This paper is intended to provide guidance and describe how to prepare an uncertainty analysis of a dimensional inspection process through the utilization of an uncertainty budget analysis. The uncertainty analysis is stated in the same methodology as that of the ISO GUM standard for calibration and testing. There is a specific distinction between how Type A and Type B uncertainty analysis is used in a general and specific process. All theory and applications are utilized to represent both a generalized approach to estimating measurement uncertainty and how to report and present these estimations for dimensional measurements in a dimensionalmore » inspection process. The analysis of this uncertainty budget shows that a well-controlled dimensional inspection process produces a conservative process uncertainty, which can be attributed to the necessary assumptions in place for best possible results.« less

Defining and Measuring the Affordability of New Medicines: A Systematic Review.

PubMed

Antoñanzas, Fernando; Terkola, Robert; Overton, Paul M; Shalet, Natalie; Postma, Maarten

2017-08-01

In many healthcare systems, affordability concerns can lead to restrictions on the use of expensive efficacious therapies. However, there does not appear to be any consensus as to the terminology used to describe affordability, or the thresholds used to determine whether new drugs are affordable. The aim of this systematic review was to investigate how affordability is defined and measured in healthcare. MEDLINE, EMBASE and EconLit databases (2005-July 2016) were searched using terms covering affordability and budget impact, combined with definitions, thresholds and restrictions, to identify articles describing a definition of affordability with respect to new medicines. Additional definitions were identified through citation searching, and through manual searches of European health technology assessment body websites. In total, 27 definitions were included in the review. Of these, five definitions described affordability in terms of the value of a product; seven considered affordability within the context of healthcare system budgets; and 15 addressed whether products are affordable in a given country based on economic factors. However, there was little in the literature to indicate that the price of medicines is considered alongside both their value to individual patients and their budget impact at a population level. Current methods of assessing affordability in healthcare may be limited by their focus on budget impact. A more effective approach may involve a broader perspective than is currently described in the literature, to consider the long-term benefits of a therapy and cost savings elsewhere in the healthcare system, as well as cooperation between healthcare payers and the pharmaceutical industry to develop financing models that support sustainability as well as innovation.

Modern Era Retrospective-analysis for Research and Applications (MERRA) Global Water and Energy Budgets

NASA Technical Reports Server (NTRS)

Bosilovich, Michael G.; Robertson, Franklin R.; Chen, Junye

2008-01-01

The Modern. Era Retrospective-analysis for Research and Applications (MERRA) reanalyses has produced several years of data, on the way to a completing. the 1979-present modern satellite era. Here, we present a preliminary evaluation of those years currently available, includin g comparisons with the existing long reanalyses (ERA40, JRA25 and NCE P I and II) as well as with global data sets for the water and energy cycle Time series shows that the MERRA budgets can change with some of the variations in observing systems. We will present all terms of the budgets in MERRA including the time rates of change and analysis increments (tendency due to the analysis of observations)

Impact of the FY 2009 Building Technologies Program on United States Employment and Earned Income

DOE Office of Scientific and Technical Information (OSTI.GOV)

Livingston, Olga V.; Scott, Michael J.; Hostick, Donna J.

2008-06-17

The Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy (EERE) is interested in assessing the potential economic impacts of its portfolio of subprograms on national employment and income. A special purpose input-output model called ImSET is used in this study of 14 Building Technologies Program subprograms in the EERE final FY 2009 budget request to the Office of Management and Budget in February 2008. Energy savings, investments, and impacts on U.S. national employment and earned income are reported by subprogram for selected years to the year 2025. Energy savings and investments from these subprograms have the potentialmore » of creating a total of 258,000 jobs and about $3.7 billion in earned income (2007$) by the year 2025.« less

[Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China].

PubMed

Lin, Y; Zhang, S X; Yang, P C; Cai, Y L; Zou, Y H

2017-07-10

Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined, the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state. Only when the annual budget reaches 688.8 million yuan (RMB), the goal of PMTCT would be fully realized. Conclusions: The PMTCT strategy in China was cost effective, and the cost is not beyond the financial budget needed and the willing to pay. The strategy, which is consistent with the global hepatitis B elimination efforts, should be conducted widely in China.

Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees.

PubMed

Erus, Burcay; Aktakke, Nazli

2012-06-01

The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.

Recommendations to Strengthen Civil Society and Balance Michigan's State Budget, 2nd Edition. An Analysis of Fiscal-Year 2003-04 Appropriations and Recommendations for 2004-05. Revision of the March 2003 Study. A Mackinac Center Report

ERIC Educational Resources Information Center

LaFaive, Michael D.

2004-01-01

As the debate rages in Lansing over the size and scope of the 2004-2005 Fiscal Year state budget, the Mackinac Center for Public Policy is republishing and updating budget cutting ideas from its March 2003 study, "Recommendations to Strengthen Civil Society and Balance Michigan's Budget." The 2003 study made over 200 recommendations…

Effects of Energy Needs and Expenditures on U.S. Public Schools. Statistical Analysis Report.

ERIC Educational Resources Information Center

Smith, Timothy; Porch, Rebecca; Farris, Elizabeth; Fowler, William

This report provides national estimates on energy needs and expenditures of U.S. public school districts. The survey provides estimates of Fiscal Year (FY) 2000 energy expenditures, FY 2001 energy budgets and expenditures, and FY 2002 energy budgets; methods used to cover energy budget shortfalls in FY 2001; and possible reasons for those…

Summary and Analysis of President Obama's Education Budget Request, Fiscal Year 2012: Issue Brief

ERIC Educational Resources Information Center

New America Foundation, 2011

2011-01-01

President Barack Obama submitted his third budget request to Congress on February 14th, 2011. The detailed budget request includes proposed funding levels for federal programs and agencies in aggregate for the upcoming 10 fiscal years, and specific fiscal year 2012 funding levels for individual programs subject to appropriations. Congress will use…

The Budget Enforcement Act: Implications for Children and Families.

ERIC Educational Resources Information Center

Baehler, Karen

This analysis of the Budget Enforcement Act of 1990 (BEA) and its implications for public financing of education and other children's services notes that voters want more and better education and related services, and at the same time want to pay less in taxes and balance budgets at every governmental level. The first section details recent…

Analysis of President Bush's Education Budget Request: Fiscal Year 2009

ERIC Educational Resources Information Center

New America Foundation, 2009

2009-01-01

President George W. Bush submitted his eighth and final budget request to the Congress on Monday. Under the proposal, fiscal year 2009 discretionary spending--spending subject to annual appropriations--would be at the same level as in the prior year for domestic programs and agencies not involved in homeland security efforts. The budget request…

An Analysis and Allocation System for Library Collections Budgets: The Comprehensive Allocation Process (CAP)

ERIC Educational Resources Information Center

Lyons, Lucy Eleonore; Blosser, John

2012-01-01

The "Comprehensive Allocation Process" (CAP) is a reproducible decision-making structure for the allocation of new collections funds, for the reallocation of funds within stagnant budgets, and for budget cuts in the face of reduced funding levels. This system was designed to overcome common shortcomings of current methods. Its philosophical…

Design of an environmental field observatory for quantifying the urban water budget

Treesearch

Claire Welty; Andrew J. Miller; Kenneth T. Belt; James A. Smith; Lawrence E. Band; Peter M. Groffman; Todd M. Scanlon; Juying Warner; Robert J. Ryan; Robert J. Shedlock; Michael P. McGuire

2007-01-01

Quantifying the water budget of urban areas presents special challenges, owing to the influence of subsurface infrastructure that can cause short-circuiting of natural flowpaths. In this paper we review some considerations for data collection and analysis in support of determining urban water budget components, with a particular emphasis on groundwater, using Baltimore...

Water Budget in the UAE for Applications in Food Security.

NASA Astrophysics Data System (ADS)

Gonzalez Sanchez, R.; Ouarda, T.; Marpu, P. R.; Pearson, S.

2014-12-01

The current rate of population growth combined with climate change, have increased the impact on natural resources globally, especially water, land and energy, and therefore the food availability. Arid and semi-arid countries are highly vulnerable to these threats being already aware of the scarcity of resources depending mainly on imports. This study focuses on the UAE, with a very low rainfall, high temperatures and a very high rate of growth. It represents the perfect scenario to study the adaptive strategies that would allow to alleviate the effects of changing climate conditions and increase of population. Water is a key factor to food security especially in dry regions like the UAE, therefore, the first step of this approach is to analyze the water budget, first at a global scale (UAE), and after at smaller scales where particular and in-depth studies can be performed. The water budget is represented by the following equation: total precipitation and desalinated water minus the evapotranspiration equals the change in the terrestrial water storage. The UAE is highly dependent on desalinated water, therefore, this factor is included as a water input in the water budget. The procedure adopted in this study is applicable to other Gulf countries where desalination represents a large component of the water budget. Remotely sensed data will be used to obtain the components of the water budget equation performing a preliminary study of the suitability of TRMM data to estimate the precipitation in the UAE by comparison with six ground stations in the country. GRACE and TRMM data will then be used to obtain the terrestrial water storage and the precipitation respectively. The evapotranspiration will be estimated from the water budget equation and maps of these three variables will be obtained. This spatial analysis of the water resources will help to determine the best areas for cultivation and whether it can be planned in a way that increases the agricultural productivity. Subsequent studies on land and energy resources combined with legal aspects in the UAE, will be used to obtain a food security atlas. These results will lead to a more efficient management of the resources not only on a national scale but also on a regional scale that can aid in sustainable development and a better resource use in the UAE and ultimately, in the gulf region.

To Stay or Not to Stay: Non-Combatant Evacuation Operations and Their Impact on Host Nation/Regional Stability

DTIC Science & Technology

2014-06-13

School in partial satisfaction of the requirements of a Master of Science Degree in Joint Campaign Planning and Strategy. The contents of this...conflicted claims. Japan, Taiwan, Vietnam, Malaysia , Philippines and Brunei have continued to assert their territorial claims which have resulted in...In the United States, budget constraints and sequestration avoidance remain a concern as the administration and Congress manage the budget

Outcome based state budget allocation for diabetes prevention programs using multi-criteria optimization with robust weights.

PubMed

Mehrotra, Sanjay; Kim, Kibaek

2011-12-01

We consider the problem of outcomes based budget allocations to chronic disease prevention programs across the United States (US) to achieve greater geographical healthcare equity. We use Diabetes Prevention and Control Programs (DPCP) by the Center for Disease Control and Prevention (CDC) as an example. We present a multi-criteria robust weighted sum model for such multi-criteria decision making in a group decision setting. The principal component analysis and an inverse linear programming techniques are presented and used to study the actual 2009 budget allocation by CDC. Our results show that the CDC budget allocation process for the DPCPs is not likely model based. In our empirical study, the relative weights for different prevalence and comorbidity factors and the corresponding budgets obtained under different weight regions are discussed. Parametric analysis suggests that money should be allocated to states to promote diabetes education and to increase patient-healthcare provider interactions to reduce disparity across the US.

Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis

PubMed Central

Gajic-Veljanoski, O.; Pham, B.; Pechlivanoglou, P.; Krahn, M.; Higgins, Caroline; Bielecki, Joanna

2016-01-01

Background Minimal residual disease (MRD) testing by higher performance techniques such as flow cytometry and polymerase chain reaction (PCR) can be used to detect the proportion of remaining leukemic cells in bone marrow or peripheral blood during and after the first phases of chemotherapy in children with acute lymphoblastic leukemia (ALL). The results of MRD testing are used to reclassify these patients and guide changes in treatment according to their future risk of relapse. We conducted a systematic review of the economic literature, cost-effectiveness analysis, and budget-impact analysis to ascertain the cost-effectiveness and economic impact of MRD testing by flow cytometry for management of childhood precursor B-cell ALL in Ontario. Methods A systematic literature search (1998–2014) identified studies that examined the incremental cost-effectiveness of MRD testing by either flow cytometry or PCR. We developed a lifetime state-transition (Markov) microsimulation model to quantify the cost-effectiveness of MRD testing followed by risk-directed therapy to no MRD testing and to estimate its marginal effect on health outcomes and on costs. Model input parameters were based on the literature, expert opinion, and data from the Pediatric Oncology Group of Ontario Networked Information System. Using predictions from our Markov model, we estimated the 1-year cost burden of MRD testing versus no testing and forecasted its economic impact over 3 and 5 years. Results In a base-case cost-effectiveness analysis, compared with no testing, MRD testing by flow cytometry at the end of induction and consolidation was associated with an increased discounted survival of 0.0958 quality-adjusted life-years (QALYs) and increased discounted costs of $4,180, yielding an incremental cost-effectiveness ratio (ICER) of $43,613/QALY gained. After accounting for parameter uncertainty, incremental cost-effectiveness of MRD testing was associated with an ICER of $50,249/QALY gained. In the budget-impact analysis, the 1-year cost expenditure for MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL was estimated at $340,760. We forecasted that the province would have to pay approximately $1.3 million over 3 years and $2.4 million over 5 years for MRD testing by flow cytometry in this population. Conclusions Compared with no testing, MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL represents good value for money at commonly used willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY. PMID:27099644

Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis.

PubMed

2016-01-01

Minimal residual disease (MRD) testing by higher performance techniques such as flow cytometry and polymerase chain reaction (PCR) can be used to detect the proportion of remaining leukemic cells in bone marrow or peripheral blood during and after the first phases of chemotherapy in children with acute lymphoblastic leukemia (ALL). The results of MRD testing are used to reclassify these patients and guide changes in treatment according to their future risk of relapse. We conducted a systematic review of the economic literature, cost-effectiveness analysis, and budget-impact analysis to ascertain the cost-effectiveness and economic impact of MRD testing by flow cytometry for management of childhood precursor B-cell ALL in Ontario. A systematic literature search (1998-2014) identified studies that examined the incremental cost-effectiveness of MRD testing by either flow cytometry or PCR. We developed a lifetime state-transition (Markov) microsimulation model to quantify the cost-effectiveness of MRD testing followed by risk-directed therapy to no MRD testing and to estimate its marginal effect on health outcomes and on costs. Model input parameters were based on the literature, expert opinion, and data from the Pediatric Oncology Group of Ontario Networked Information System. Using predictions from our Markov model, we estimated the 1-year cost burden of MRD testing versus no testing and forecasted its economic impact over 3 and 5 years. In a base-case cost-effectiveness analysis, compared with no testing, MRD testing by flow cytometry at the end of induction and consolidation was associated with an increased discounted survival of 0.0958 quality-adjusted life-years (QALYs) and increased discounted costs of $4,180, yielding an incremental cost-effectiveness ratio (ICER) of $43,613/QALY gained. After accounting for parameter uncertainty, incremental cost-effectiveness of MRD testing was associated with an ICER of $50,249/QALY gained. In the budget-impact analysis, the 1-year cost expenditure for MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL was estimated at $340,760. We forecasted that the province would have to pay approximately $1.3 million over 3 years and $2.4 million over 5 years for MRD testing by flow cytometry in this population. Compared with no testing, MRD testing by flow cytometry in newly diagnosed patients with precursor B-cell ALL represents good value for money at commonly used willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY.

Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines.

PubMed

Haasis, Manuel Alexander; Ceria, Joyce Anne; Kulpeng, Wantanee; Teerawattananon, Yot; Alejandria, Marissa

2015-01-01

The objective of this study is to assess the value for money of introducing pneumococcal conjugate vaccines as part of the immunization program in a lower-middle income country, the Philippines, which is not eligible for GAVI support and lower vaccine prices. It also includes the newest clinical evidence evaluating the efficacy of PCV10, which is lacking in other previous studies. A cost-utility analysis was conducted. A Markov simulation model was constructed to examine the costs and consequences of PCV10 and PCV13 against the current scenario of no PCV vaccination for a lifetime horizon. A health system perspective was employed to explore different funding schemes, which include universal or partial vaccination coverage subsidized by the government. Results were presented as incremental cost-effectiveness ratios (ICERs) in Philippine peso (Php) per QALY gained (1 USD = 44.20 Php). Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. With universal vaccination at a cost per dose of Php 624 for PCV10 and Php 700 for PCV13, both PCVs are cost-effective compared to no vaccination given the ceiling threshold of Php 120,000 per QALY gained, yielding ICERs of Php 68,182 and Php 54,510 for PCV10 and PCV13, respectively. Partial vaccination of 25% of the birth cohort resulted in significantly higher ICER values (Php 112,640 for PCV10 and Php 84,654 for PCV13) due to loss of herd protection. The budget impact analysis reveals that universal vaccination would cost Php 3.87 billion to 4.34 billion per annual, or 1.6 to 1.8 times the budget of the current national vaccination program. The inclusion of PCV in the national immunization program is recommended. PCV13 achieved better value for money compared to PCV10. However, the affordability and sustainability of PCV implementation over the long-term should be considered by decision makers.

Ocean heat budget analysis on sea surface temperature anomaly in western Indian Ocean during strong-weak Asian summer monsoon

NASA Astrophysics Data System (ADS)

Fathrio, Ibnu; Manda, Atsuyoshi; Iizuka, Satoshi; Kodama, Yasu-Masa; Ishida, Sachinobu

2018-05-01

This study presents ocean heat budget analysis on seas surface temperature (SST) anomalies during strong-weak Asian summer monsoon (southwest monsoon). As discussed by previous studies, there was close relationship between variations of Asian summer monsoon and SST anomaly in western Indian Ocean. In this study we utilized ocean heat budget analysis to elucidate the dominant mechanism that is responsible for generating SST anomaly during weak-strong boreal summer monsoon. Our results showed ocean advection plays more important role to initate SST anomaly than the atmospheric prcess (surface heat flux). Scatterplot analysis showed that vertical advection initiated SST anomaly in western Arabian Sea and southwestern Indian Ocean, while zonal advection initiated SST anomaly in western equatorial Indian Ocean.

Evaluation of the Modern Era Retrospective-Analysis for Research and Applications (MERRA) Global Water and Energy Budgets

NASA Technical Reports Server (NTRS)

Bosilovich, Michael G.; Robertson, F. R.; Chen, J.

2010-01-01

The Modern Era Retrospective-analysis for Research and Applications (MERRA) reanalyses has completed 27 years of data) soon to be caught up to present. Here) we present an evaluation of those years currently available) including comparisons with the existing long reanalyses (ERA40) JRA25 and NCEP I and II) as well as with global data sets for the water and energy cycle. Time series shows that the MERRA budgets can change with some of the variations in observing systems, but that the magnitude of energy imbalance in the system is improved with more observations. We will present all terms of the budgets in MERRA including the time rates of change and analysis increments (tendency due to the analysis of observations).

What if the Hubbard Brook weirs had been built somewhere else? Spatial uncertainty in the application of catchment budgets

NASA Astrophysics Data System (ADS)

Bailey, S. W.

2016-12-01

Nine catchments are gaged at Hubbard Brook Experimental Forest, Woodstock, NH, USA, with weirs installed on adjacent first-order streams. These catchments have been used as unit ecosystems for analysis of chemical budgets, including evaluation of long term trends and response to disturbance. This study examines uncertainty in the representativeness of these budgets to other nearby catchments, or as representatives of the broader northern hardwood ecosystem, depending on choice of location of the stream gaging station. Within forested northern hardwood catchments across the Hubbard Brook region, there is relatively little spatial variation in amount or chemistry of precipitation inputs or in amount of streamwater outputs. For example, runoff per unit catchment area varies by less than 10% at gaging stations on first to sixth order streams. In contrast, concentrations of major solutes vary by an order of magnitude or more across stream sampling sites, with a similar range in concentrations seen within individual first order catchments as seen across the third order Hubbard Brook valley or across the White Mountain region. These spatial variations in stream chemistry are temporally persistent across a range of flow conditions. Thus first order catchment budgets vary greatly depending on very local variations in stream chemistry driven by choice of the site to develop a stream gage. For example, carbon output in dissolved organic matter varies by a factor of five depending on where the catchment output is defined at Watershed 3. I hypothesize that catchment outputs from first order streams are driven by spatially variable chemistry of shallow groundwater, reflecting local variations in the distribution of soils and vegetation. In contrast, spatial variability in stream chemistry decreases with stream order, hypothesized to reflect deeper groundwater inputs on larger streams, which are more regionally uniform. Thus, choice of a gaging site and definition of an ecosystem as a unit of analysis at a larger scale, such as the Hubbard Brook valley, would have less impact on calculated budgets than at the headwater scale. Monitoring of a larger catchment is more likely to be representative of other similar sized catchments. However, particular research questions may be better studied at the smaller headwater scale.

Cost-effectiveness and budget impact of interferon-free direct-acting antiviral-based regimens for hepatitis C treatment: the French case.

PubMed

Deuffic-Burban, S; Obach, D; Canva, V; Pol, S; Roudot-Thoraval, F; Dhumeaux, D; Mathurin, P; Yazdanpanah, Y

2016-10-01

We evaluated the cost-effectiveness and the budget impact of new DAA-based regimen use in France. A Markov model simulated chronic hepatitis C (CHC) treatment interventions with IFN-based and IFN-free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). It also assessed the budget impact over 5 years of treating all CHC-screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1-4, the initiation of IFN-free regardless of fibrosis was a cost-effective strategy compared to prior standard of care (SOC) initiated at stage F2: €40 400-88 300/QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2-3, the most cost-effective strategy was IFN-based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/QALY gained, respectively; the strategy with IFN-free regimens being more effective but not cost-effective at current costs. The budget impact of treating all CHC-screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAAs and whether one treats G2-3 with IFN-based or IFN-free new DAAs. In France, treatment initiation with new DDAs regardless of fibrosis stage is cost-effective, but would add 3.5-7.2 billion € to an already overburdened medical care system. © 2016 John Wiley & Sons Ltd.

Engineering Considerations Applied to Starshade Repointing

NASA Technical Reports Server (NTRS)

Rioux, Norman; Dichmann, Donald; Domagal-Goldman, Shawn; Mandell, Avi; Roberge, Aki; Starke, Chris; Stoneking, Eric; Willis, Dewey

2016-01-01

Engineering analysis has been carried out on orbit dynamics that drive the delta-v budget for repointing a free-flying starshade occulter for viewing exoplanets with a space telescope. This analysis has application to the design of starshade spacecraft and yield calculations of observations of exoplanets using a space telescope and a starshade. Analysis was carried out to determine if there may be some advantage for the global delta-v budget if the telescope performs orbit changing delta-v maneuvers as part of the telescope-starshade alignment for observing exoplanets. Analysis of the orbit environmental forces at play found no significant advantage in having the telescope participate in delta-v maneuvers for exoplanet observation repointing. A separate analysis of starshade delta-v for repointing found that the orbit dynamics of the starshade is driven by multiple simultaneous variables that need to be considered together in order to create an effective estimate of delta-v over an exoplanet observation campaign. These include area of the starshade, dry mass of the starshade spacecraft, and propellant mass of the starshade spacecraft. Solar radiation pressure has the potential to play a dominant role in the orbit dynamics and delta-v budget. SRP effects are driven by the differences in the mass, area, and coefficients of reflectivity of the observing telescope and the starshade. The propellant budget cannot be effectively estimated without a conceptual design of a starshade spacecraft including the propulsion system. The varying propellant mass over the mission is a complexity that makes calculating the propellant budget less straightforward.

Describing an Environment for a Self-Sustaining Technology Transfer Service in a Small Research Budget University: A Case Study

ERIC Educational Resources Information Center

Nieb, Sharon Lynn

2014-01-01

This single-site qualitative study sought to identify the characteristics that contribute to the self sustainability of technology transfer services at universities with small research budgets through a case study analysis of a small research budget university that has been operating a financially self-sustainable technology transfer service for…

Proposed U.S. Space Weather Budget for Fiscal Year 2011 Would Fund Key Programs

NASA Astrophysics Data System (ADS)

Showstack, Randy

2010-09-01

The proposed U.S. federal budget for space weather research for fiscal year (FY) 2011 would provide funding for key space weather programs within several U.S. agencies, including NASA, NOAA, the National Science Foundation (NSF), and the Air Force. Funding for the programs comes ahead of the upcoming solar maximum, a period of the solar cycle with heightened solar activity, projected for 2013. Several officials indicated that while funding is not tied to a particular solar maximum or minimum, available assets could help with studying and preparing for the solar maximum. The proposed FY 2011 budget for the Heliophysics Division within NASA's Science Mission Directorate is $641.9 million, compared with the FY 2010 enacted budget of $627.4 million. Within the proposed budget is $166.9 million for heliophysics research, down slightly from $173 million for FY 2010. The proposed budget would include $31.7 million for heliophysics research and analysis (compared with $31 million for FY 2010); $66.7 million for “other missions and data analysis,” including Cluster II, the Advanced Composition Explorer (ACE), and the Time History of Events and Macroscale Interactions during Substorms (THEMIS) mission; and $48.9 million for sounding rockets.

Cost-effectiveness of the streamflow-gaging program in Wyoming

USGS Publications Warehouse

Druse, S.A.; Wahl, K.L.

1988-01-01

This report documents the results of a cost-effectiveness study of the streamflow-gaging program in Wyoming. Regression analysis or hydrologic flow-routing techniques were considered for 24 combinations of stations from a 139-station network operated in 1984 to investigate suitability of techniques for simulating streamflow records. Only one station was determined to have sufficient accuracy in the regression analysis to consider discontinuance of the gage. The evaluation of the gaging-station network, which included the use of associated uncertainty in streamflow records, is limited to the nonwinter operation of the 47 stations operated by the Riverton Field Office of the U.S. Geological Survey. The current (1987) travel routes and measurement frequencies require a budget of $264,000 and result in an average standard error in streamflow records of 13.2%. Changes in routes and station visits using the same budget, could optimally reduce the standard error by 1.6%. Budgets evaluated ranged from $235,000 to $400,000. A $235,000 budget increased the optimal average standard error/station from 11.6 to 15.5%, and a $400,000 budget could reduce it to 6.6%. For all budgets considered, lost record accounts for about 40% of the average standard error. (USGS)

Global HIV/AIDS Epidemic

MedlinePlus

... In 1999, President Clinton announced the Leadership and Investment in Fighting and Epidemic (LIFE) Initiative to address ... Foundation analysis of data from the Office of Management and Budget, Agency Congressional Budget Justifications, and Congressional ...

[Payment by performance to improve the nutritional status of children: impact of budget support agreements in three peruvian regions with a high prevalence of chronic malnutrition in children in 2010-2014].

PubMed

Cruzado de la Vega, Viviana

2017-01-01

To estimate the impact of a payment scheme by performance, known as a budget support agreement, applied by the government in three regions in Peru with the highest rates of chronic malnutrition (CM) in children in 2008-Apurimac, Ayacucho, and Huancavelica-on indicators of health service coverage (immunization, childhood growth and development, and iron supplementation) and the nutritional status of children (malnutrition, anemia, and diarrhea). These agreements were used to transfer resources to the budgets of these regions with the condition of fulfilling management commitments and coverage goals with a view toward improving the nutritional status of children. Based on data from the Demographic and Family Health Survey conducted from 2008 to 2014, evolution of the indicators in a sample of children residing in the areas where the support programs were signed was compared to that of a control sample in the period in which the agreements were in force and in the subsequent years to estimate differences in the impact of this support strategy. There was a positive impact of the programs on the increase in vaccination coverage provided by the basic health system and rotavirus vaccination, which consequently reduced the rates of diarrhea and malnutrition. The scheme was effective in increasing the vaccination coverage and reducing CM but did not seem to improve the coverage of other benefits, including childhood growth and iron supplementation to children and mothers.

Assessing Hydrological and Energy Budgets in Amazonia through Regional Downscaling, and Comparisons with Global Reanalysis Products

NASA Astrophysics Data System (ADS)

Nunes, A.; Ivanov, V. Y.

2014-12-01

Although current global reanalyses provide reasonably accurate large-scale features of the atmosphere, systematic errors are still found in the hydrological and energy budgets of such products. In the tropics, precipitation is particularly challenging to model, which is also adversely affected by the scarcity of hydrometeorological datasets in the region. With the goal of producing downscaled analyses that are appropriate for a climate assessment at regional scales, a regional spectral model has used a combination of precipitation assimilation with scale-selective bias correction. The latter is similar to the spectral nudging technique, which prevents the departure of the regional model's internal states from the large-scale forcing. The target area in this study is the Amazon region, where large errors are detected in reanalysis precipitation. To generate the downscaled analysis, the regional climate model used NCEP/DOE R2 global reanalysis as the initial and lateral boundary conditions, and assimilated NOAA's Climate Prediction Center (CPC) MORPHed precipitation (CMORPH), available at 0.25-degree resolution, every 3 hours. The regional model's precipitation was successfully brought closer to the observations, in comparison to the NCEP global reanalysis products, as a result of the impact of a precipitation assimilation scheme on cumulus-convection parameterization, and improved boundary forcing achieved through a new version of scale-selective bias correction. Water and energy budget terms were also evaluated against global reanalyses and other datasets.

Medicine expenses and obesity in Brazil: an analysis based on the household budget survey.

PubMed

Canella, Daniela S; Novaes, Hillegonda M D; Levy, Renata B

2016-01-20

Obesity can be considered a global public health problem that affects virtually all countries worldwide and results in greater use of healthcare services and higher healthcare costs. We aimed to describe average monthly household medicine expenses according to source of funding, public or private, and to estimate the influence of the presence of obese residents in households on total medicine expenses. This study was based on data from the 2008-2009 Brazilian Household Budget Survey, with a representative population sample of 55,970 households as study units. Information on nutritional status and medicines acquired and their cost in the past 30 days were analyzed. A two-part model was employed to assess the influence of obesity on medicine expenses, with monthly household medicine expenses per capita as outcome, presence of obese in the household as explanatory variable, and adjustment for confounding variables. Out-of-pocket expenses on medicines were always higher than the cost of medicines obtained through the public sector, and 32 % of households had at least one obese as resident. Monthly household expenses on medicines per capita in households with obese was US$ 20.40, 16 % higher than in households with no obese. An adjusted model confirmed that the presence of obese in the households increased medicine expenses. Obesity is associated with additional medicine expenses, increasing the negative impact on household budgets and public expenditure.

Impact of new medical technologies on health expenditures in Israel 2000-07.

PubMed

Rabinovich, Mordechai; Wood, Francis; Shemer, Joshua

2007-01-01

The aim of this study was to estimate the impact of new medical technologies on public healthcare expenditures in Israel over the period 2000-07. For each year, government estimates for the costs of new technologies recommended as high-priority for public funding were summarized. The ratio of projected costs of these technologies to total public healthcare expenditures was calculated and compared with actual governmental budget allocations for new technologies. Funding all new high-priority medical technologies would have increased healthcare expenditures by 2.1 percent per year. Government allocations for new technologies raised expenditures by 1.0 percent per year. New medical technologies significantly increase healthcare expenditures in Israel. Budgetary constraints have reduced their actual impact by 52 percent. This study indicates the need for an annual addition of 2 percent to public healthcare budget for funding new high-priority technologies.

Pharmaceutical expenditure forecast model to support health policy decision making.

PubMed

Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project 'European Union (EU) Pharmaceutical expenditure forecast' - http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). A model was built to assess policy scenarios' impact on the pharmaceutical budgets of seven member states of the EU, namely France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. The following scenarios were tested: expanding the UK policies to EU, changing time to market access, modifying generic price and penetration, shifting the distribution chain of biosimilars (retail/hospital). Applying the UK policy resulted in dramatic savings for Germany (10 times the base case forecast) and substantial additional savings for France and Portugal (2 and 4 times the base case forecast, respectively). Delaying time to market was found be to a very powerful tool to reduce pharmaceutical expenditure. Applying the EU transparency directive (6-month process for pricing and reimbursement) increased pharmaceutical expenditure for all countries (from 1.1 to 4 times the base case forecast), except in Germany (additional savings). Decreasing the price of generics and boosting the penetration rate, as well as shifting distribution of biosimilars through hospital chain were also key methods to reduce pharmaceutical expenditure. Change in the level of reimbursement rate to 100% in all countries led to an important increase in the pharmaceutical budget. Forecasting pharmaceutical expenditure is a critical exercise to inform policy decision makers. The most important leverages identified by the model on pharmaceutical budget were driven by generic and biosimilar prices, penetration rate, and distribution. Reducing, even slightly, the prices of generics had a major impact on savings. However, very aggressive pricing of generic and biosimilar products might make this market unattractive and can be counterproductive. Worth noting, delaying time to access innovative products was also identified as an effective leverage to increase savings but might not be a desirable policy for breakthrough products. Increasing patient financial contributions, either directly or indirectly via their private insurances, is a more likely scenario rather than expanding the national pharmaceutical expenditure coverage.

Pharmaceutical expenditure forecast model to support health policy decision making

PubMed Central

Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

Background and objective With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project ‘European Union (EU) Pharmaceutical expenditure forecast’ – http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). Methods A model was built to assess policy scenarios’ impact on the pharmaceutical budgets of seven member states of the EU, namely France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. The following scenarios were tested: expanding the UK policies to EU, changing time to market access, modifying generic price and penetration, shifting the distribution chain of biosimilars (retail/hospital). Results Applying the UK policy resulted in dramatic savings for Germany (10 times the base case forecast) and substantial additional savings for France and Portugal (2 and 4 times the base case forecast, respectively). Delaying time to market was found be to a very powerful tool to reduce pharmaceutical expenditure. Applying the EU transparency directive (6-month process for pricing and reimbursement) increased pharmaceutical expenditure for all countries (from 1.1 to 4 times the base case forecast), except in Germany (additional savings). Decreasing the price of generics and boosting the penetration rate, as well as shifting distribution of biosimilars through hospital chain were also key methods to reduce pharmaceutical expenditure. Change in the level of reimbursement rate to 100% in all countries led to an important increase in the pharmaceutical budget. Conclusions Forecasting pharmaceutical expenditure is a critical exercise to inform policy decision makers. The most important leverages identified by the model on pharmaceutical budget were driven by generic and biosimilar prices, penetration rate, and distribution. Reducing, even slightly, the prices of generics had a major impact on savings. However, very aggressive pricing of generic and biosimilar products might make this market unattractive and can be counterproductive. Worth noting, delaying time to access innovative products was also identified as an effective leverage to increase savings but might not be a desirable policy for breakthrough products. Increasing patient financial contributions, either directly or indirectly via their private insurances, is a more likely scenario rather than expanding the national pharmaceutical expenditure coverage. PMID:27226830

Financial risk-sharing in updating the National List of Health Services in Israel: stakeholders' perceived interests.

PubMed

Hammerman, Ariel; Feder-Bubis, Paula; Greenberg, Dan

2012-01-01

Risk-sharing is being considered by many health care systems to address the financial risk associated with the adoption of new technologies. We explored major stakeholders' views toward the potential implementation of a financial risk-sharing mechanism regarding budget-impact estimates for adding new technologies to the Israeli National List of Health Services. According to our proposed scheme, health plans will be partially compensated by technology sponsors if the actual use of a technology is substantially higher than what was projected and health plans will refund the government for budgets that were not fully utilized. By using a semi-structured protocol, we interviewed major stakeholders involved in the process of updating the National List of Health Services (N = 31). We inquired into participants' views toward our proposed risk-sharing mechanism, whether the proposed scheme would achieve its purpose, its feasibility of implementation, and their opinion on the other stakeholders' incentives. Participants' considerations were classified into four main areas: financial, administrative/managerial, impact on patients' health, and influence on public image. Most participants agreed that the conceptual risk-sharing scheme will improve the accuracy of early budget estimates and were in favor of the proposed scheme, although Ministry of Finance officials tended to object to it. The successful implementation of risk-sharing schemes depends mainly on their perception as a win-win situation by all stakeholders. The perception exposed by our participants that risk-sharing can be a tool for improving the accuracy of early budget-impact estimates and the challenges pointed by them are relevant to other health care systems also and should be considered when implementing similar schemes. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Palliative radiotherapy practice within Western European countries: impact of the radiotherapy financing system?

PubMed

Lievens, Y; Van den Bogaert, W; Rijnders, A; Kutcher, G; Kesteloot, K

2000-09-01

To analyze the reimbursement modalities for radiotherapy in the different Western European countries, as well as to investigate if these differences have an impact on the palliative radiotherapy practice for bone metastases. A questionnaire was sent to 565 radiotherapy centres included in the 1997 ESTRO directory. In this questionnaire the reimbursement strategy applied in the different centres was assessed, with respect to the use of a budget (departmental or hospital budget), case payment and/or fee-for-service reimbursement. The differences were analyzed according to country and to type and size of the radiotherapy centre. A total of 170 centres (86% of the responders) returned the questionnaire. Most frequent is budget reimbursement: some form of budget reimbursement is found in 69% of the centres, whereas 46% of the centres are partly reimbursed through fee-for-service and 35% through case payment. The larger the department, the more frequent the reimbursement through a budget or a case payment system and the less the importance of fee-for-service reimbursement (chi(2): P=0.0012; logit: P=0.0055). Whereas private centres are almost equally reimbursed by fee-for-service financing as by budget or case payment, radiotherapy departments in university hospitals receive the largest part of their financial resources through a budget or by case payment (83%) (chi(2): P=0.002; logit: P=0.0073). A correlation between the country and the radiotherapy reimbursement system was also demonstrated (P=0.002), radiotherapy centres in Spain, the Netherlands and the United Kingdom being almost entirely reimbursed through a budget and/or case payment and centres in Germany and Switzerland mostly through a fee-for-service system. In budget and case payment financing lower total number of fractions and lower total dose (chi(2): P=0.003; logit: P=0.0120) as well as less shielding blocks (chi(2): P=0.003; logit: P=0.0066) are used. A same tendency is found for the use of isodose calculations and field set-up, but without being statistically significant (P=0.264 and P=0.061 res.). The type of the centre and the reimbursement modality influence the fractionation regimen independently (P=0.0274). This is not the case for the centre size and the reimbursement, which were found to exert correlated effects on the fractionation schedule (P=0.1042). Reimbursement systems seem to influence radiotherapy practice. One should therefore aim to develop reimbursement criteria that pursue to deliver, not only the best qualitative, but also the most cost-effective treatments to the patients.

Upscaling the impact of convective overshooting (COV) through BRAMS: a continental and wet-season scale study of the water vapour (WV) budget in the tropical tropopause layer (TTL).

NASA Astrophysics Data System (ADS)

Behera, Abhinna; Rivière, Emmanuel; Marécal, Virginie; Rysman, Jean-François; Claud, Chantal; Burgalat, Jérémie

2017-04-01

The stratospheric water vapour (WV) has a conceding impact on the radiative and chemical budget of Earth's atmosphere. The convective overshooting (COV) at the tropics is well admitted for playing a role in transporting directly WV to the stratosphere. Nonetheless, its impact on the lower stratosphere is yet to be determined at global scale, as the satellite and other air-borne measurements are not of having fine enough resolution to quantify this impact at large scale. Therefore, efforts have been made to quantify the influence of COV over the WV budget in the tropical tropopause layer (TTL) through modelling. Our approach is to build two synthetic tropical wet-seasons; where one would be having only deep convection (DC) but no COV at all, and the second one would be having the COV, and in both cases the WV budget in the TTL would be estimated. Before that, a French-Brazilian TRO-pico campaign was carried out at Bauru, Brazil in order to understand the influence of COV on the WV budget in the TTL. The radio-sounding, and the small balloon-borne WV measurements from the campaign are being utilized to validate the model simulation. Brazilian version of Regional Atmospheric Modeling System (BRAMS) is used with a single grid system to simulate a WV variability in a wet-season. Grell's convective parameterization with ensemble closure, microphysics with double moment scheme and 7 types of hydrometeors are incorporated to simulate the WV variability for a wet-season at the tropics. The grid size of simulation is chosen to be 20 km x 20 km horizontally and from surface to 30 km altitude, so that there cannot be COV at all, only DC due to such a relatively coarse resolution. The European Centre for Medium-range Weather Forecasts (ECMWF) operational analyses data are used every 6 hours for grid initialization and boundary conditions, and grid center nudging. The simulation is carried out for a full wet-season (Nov 2012 - Mar 2013) at Brazilian scale, so that it would coincide with the TRO-pico campaign measurements. As of first step, we have already shown that, this model with only DC is well capable of producing key features of the TTL. Hence in the second step, keeping all the settings same in the model, a sub-grid scale process/parameterization is being developed in order to reproduce COV in the model. Then, we would be able to compare these two atmospheres, and it would describe quantitatively the impact of COV on the WV budget in the TTL at a continental scale. This on-going work reports about the further advancement done to introduce the COV parameterization in BRAMS by incorporating the information from satellite-borne and balloon-borne measurements. The preliminary results of the simulation with COV nudging, achieved till date of EGU assembly, will be presented.

Historical sediment budget and present-day catchment-shoreline coupling at Twofold Bay, southeastern Australia

NASA Astrophysics Data System (ADS)

Tamura, T.; Oliver, T.; Hudson, J.; Woodroffe, C. D.

2017-12-01

Considering projected impacts of sea-level rise in the 21st century on sandy shorelines, an understanding of long-term sediment budget for individual beaches or coastal compartments supports assessments of shoreline stability. We examined a low-lying coastal beach-ridge barrier in Twofold Bay using optically stimulated luminescence (OSL) dating , airborne LiDAR, sedimentological analysis and seismic data to assess changes in rates of sediment supply to this shoreline through time. Calculations of barrier volume, Twofold Bay bay-floor sediment volume and estimates of sediment delivery from a proximal river system provide a broad-scale assessment of past-sediment budget. Between ca. 7500 years ago and 1500 years ago, sources of sediment for shoreline progradation at Boydtown were bay-floor sediments either inherited or moved into the embayment during late-stage transgression. Progradation rate between ca. 7500-1500 years ago was 0.16 m/yr with subaerial barrier volume accumulating at 0.46 m3/m/yr. Between ca. 1500 years and present day, the Towamba River to the south has delivered additional sediment to the Boydtown shoreline more than doubling shoreline progradation rate to 0.65 m/yr and subaerial barrier accumulation has risen to 1.83 m3/m/yr. The delivery of fluvial sediment from the Towamba River was restricted to the past ca. 1500 years as prior to this, estuary infilling prevented floods delivering sediments to the bay. This recent historical coupling of river sand supply and shoreline progradation rate implies that anthropogenic modifications to the Towamba River catchment such as river damming, or climatic changes reducing rainfall or runoff, would negatively impact the Boydtown Beach shoreline. Conversely increased rainfall or deforestation may increase sediment discharge due to upstream erosion. The Boydtown shoreline within Twofold Bay may be able to maintain its current position in the coming century if fluvial sediment delivery continues. The fact that other shorelines within Twofold Bay are seemingly unaffected by the Towamba River, and most shorelines in southeast Australia receive minimal fluvial sediment input, further emphasises the need to consider nearshore sediment reserves in order to accurately determine sea-level rise impacts on sandy shorelines.

75 FR 13549 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

... directly to the following: Office of Management and Budget, Paperwork Reduction Project, Fax: 202-395-7285... OMB Review; Comment Request Title: ANA Project Impact Assessment Survey. OMB No.: New Collection. Description: The information collected by the Project Impact Assessment Survey is needed for two main reasons...

Dairy production systems in the United States: Nutrient budgets and environmental impacts

USDA-ARS?s Scientific Manuscript database

Across the diversity of US dairy production systems, nutrient management priorities range widely, from feeding regimes to manure handling, storage and application to crop systems. To assess nutrient management and environmental impacts of dairy production systems in the US, we evaluated nutrient bud...

Estimated Budget Impact of Increased Use of Mirabegron, A Novel Treatment for Overactive Bladder.

PubMed

Perk, Sinem; Wielage, Ronald C; Campbell, Noll L; Klein, Timothy M; Perkins, Anthony; Posta, Linda M; Yuran, Thomas; Klein, Robert W; Ng, Daniel B

2016-09-01

Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment. Since mirabegron does not affect the cholinergic pathways, it is unlikely to contribute to a patient's ACB. To estimate the health care costs associated with the pharmacological treatment of OAB with mirabegron and antimuscarinics from U.S. commercial payer and Medicare Advantage perspectives, using a budget impact model. For this budget impact model, 2 analyses were performed. The primary analysis estimated the budgetary impact of increasing the use of mirabegron in a closed patient cohort treated with oral pharmacological treatments. The secondary analysis modeled the economic impact in an open cohort by allowing untreated patients to begin treatment with mirabegron after potential contraindication, intolerance, or lack of effectiveness of antimuscarinics. The analyses were performed over a 3-year time horizon. The economic impact of increased mirabegron use was quantified using direct medical costs, including prescription costs and health resource utilization (HRU) costs. Costs of comorbidities included pharmacy and medical costs of treating OAB-related urinary tract infections (UTI), skin rashes, and depression. An analysis of a large single-site integrated health network database was commissioned to quantify ACB-related HRU in terms of the increases in yearly outpatient and emergency department visits. Based on this analysis, the model associated each unit increase in ACB score with increased HRU and probability of mild cognitive impairment. Clinical outcomes of increased use of mirabegron were presented as the number of AEs and comorbidity episodes that could be avoided. One-way sensitivity analyses were performed to quantify the expected budget impact over the range of uncertainty for the key input variables. Primary analysis calculated the impact of increasing the use of mirabegron from 4.5% to 5.3%, 7.1%, and 9.4% in years 1, 2, and 3, respectively, among oral pharmacological OAB treatments that included generic and branded antimuscarinics: oxybutynin, tolterodine, trospium, darifenacin, fesoterodine, and solifenacin. For a 1 million-member U.S. commercial payer plan, the total prescription costs increased, and the total medical costs decreased during the 3-year time horizon, yielding increases of $0.005, $0.016, and $0.031 from current per member per month (PMPM) costs and $0.90, $2.92, and $5.53 from current per treated member per month (PTMPM) costs, an average of less than 2% of current OAB treatment costs. For the Medicare Advantage plan, the resulting incremental PMPM costs were $0.010, $0.034, and $0.065, and the incremental PTMPM costs were $0.93, $3.04, and $5.76; all were less than 4% of the current cost. The secondary analysis estimated the budgetary effects of reducing the untreated population by 1% annually by initiating treatment with mirabegron. For a commercial payer, this resulted in PMPM cost increases of $0.156, $0.311, and $0.467 from the current value, while the incremental PTMPM cost increased by $6.17, $11.67, and $16.61. For the Medicare Advantage plan, the incremental increases in PMPM costs were $0.277, $0.553, and $0.830, and in PTMPM costs were $6.42, $12.15, and $17.29. Clinically, treating more OAB patients resulted in fewer OAB-related comorbidities from both health plan perspectives, since most events associated with nontreatment could be avoided. In the Medicare Advantage population of the secondary analysis, the total numbers of avoided events were predicted as 452 UTIs, 2,598 depression diagnoses, and 3,020 skin rashes during the time horizon of the model. Mirabegron addresses an unmet need for therapy for certain OAB patients, for whom antimuscarinics are not recommended because of a risk of cognitive impairment and who are intolerant to the anticholinergic AEs. Using mirabegron involves moderate additional economic cost to a commercial or Medicare Advantage health plan for which medical cost savings can offset a substantial part of increased pharmacy costs. Funding for this study was provided by Astellas. Perk, Wielage, T. Klein, and R. Klein are employed by Medical Decision Modeling, a contract research company that was paid to perform the described outcomes research and build the model contained in this study. Campbell and Perkins are employed by the Regenstrief Institute, which conducted a database analysis for this research. Campbell reports consultancy fees from Astellas, as well as pending grants from Merck, Sharpe, and Dohme Corp. Posta, Yuran, and Ng are employed by Astellas Pharma Global Development, the developer of mirabegron. Study concept and design were contributed by Perk, Wielage, R. Klein, and Ng. Campbell, T. Klein, and Perkins took the lead in data collection, assisted by Perk, Wielage, and Ng. Data interpretation was performed by Posta and Yuran, along with Perk, Wielage, R. Klein, Ng, Campbell, and Perkins. The manuscript was written by Perk and R. Klein, along with Wielage, T. Klein, Posta, Yuran, and Ng, and revised by all the authors.

Observations from Oversight Organizations Impacting Operations Iraqi Freedom and Enduring Freedom Beginning FY 2003 Through FY 2009

DTIC Science & Technology

2010-08-30

the base budget.41 41 USAAA Report No. A-2009-0188- FFM . 22 Chapter 2. Actions Taken by...Report No. A-2009-0212-FFS, “Requirements for Mobilized Soldiers,” September 17, 2009 Army Audit Agency Report No. A-2009-0188- FFM , “Assessing... FFM , “Assessing Future Base Budget Requirements, Manning Program Evaluation Group (FOUO),” March 3, 2009 32 Army Audit Agency Report No. A-2009

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management.

PubMed

Cox, Jonathan Ms; Steel, Nicholas; Clark, Allan B; Kumaravel, Bharathy; Bachmann, Max O

2013-06-01

Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. A retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. The age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. Referral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). Referral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review.

Human Systems Roadmap Review

DTIC Science & Technology

2016-02-09

Impact of Human Systems Community of Interest D O T M L P F $450M COI Budget Has Broad Impact in Several DOTMLPF Areas Decision Making Selection...and fit to a military career. • 26 personality dimensions such as optimism, excitement seeking, and non- delinquency • Applicant chooses from...Adaptive Collaborative Control Technologies ( IMPACT ) architecture designed • IMPACT “DoD Virtual Lab” established (Year 1) • 1 operator x 6 vehicles

Nutrition sensitivity of the 2014 budget statement of Republic of Ghana.

PubMed

Laar, Amos; Aryeetey, Richmond N O; Akparibo, Robert; Zotor, Francis

2015-11-01

Ghana's Constitution and several international treaties she has ratified demonstrate support for fundamental human rights to nutrition and freedom from hunger. However, it is unknown how this support is being translated into investment in nutrition. National budgets are important vehicles through which governments communicate intent to address pertinent national challenges. The present paper assesses the nutrition sensitivity of Ghana's budget statement for the year ending 31 December 2014. We perused the budget in its entirety, examining allocations to various sectors with the goal of identifying support for direct nutrition interventions. We examined allocations to various sectors as per cent of gross domestic product (GDP). The review shows that the total revenue and grants for the 2014 fiscal year is Ghana Cedis (GH¢) 26 001·9 million (25 % of GDP). The total expenditure for the same period is estimated at GH¢34 956·8 million (33·1 % of GDP). The health sector is allocated GH¢3 353 707 814 (3·8 % of GDP). As of 28 October 2014, the Bank of Ghana's Official Exchange Rate was US$1 = GH¢3·20. It is one of the key sectors whose interventions directly or indirectly impact on nutrition. However, the proportion of the national budget that goes to direct nutrition interventions is not evident in the budget. Nutrition is embedded in other budget lines. Allocations to relevant nutrition-sensitive sectors are very low (<0·5 % of GDP). We conclude that Ghana's 2014 budget statement pays scant attention to nutrition. By embedding nutrition in other budget lines, Ghana runs the risk of perpetually rolling out national spending actions insensitive to nutrition.

Science Under Sequestration: How will a decade of science funding cuts affect you?

NASA Astrophysics Data System (ADS)

Landau, E. A.; Hankin, E. R.; Uhlenbrock, K.

2013-12-01

Budget sequestration is now a reality for the United States. From 2013-2021, $1.2 trillion in funding will be cut indiscriminately from most federal spending programs. These funding cuts impact scientific research and development, STEM education programs, federal grants, and many other aspects of science. Although the cuts are just beginning, impacts are already being felt by the scientific community. The reach and degree of impacts will likely worsen with time. To better understand how recent U.S government budget policy is impacting Earth and space science, AGU has collected data from its members in two surveys, sent in March and July of 2013. Over 1,600 scientists responded to the July survey. Specifically, the surveys were designed to determine how sequestration and/or government travel restrictions affect scientists' ability to conduct research, attend scientific conferences, and identify any other impacts. This discussion will reveal what impacts scientists are seeing across sectors, look at early trends, and provide insight on the next eight years and what impacts may lay ahead. We are providing this information at the AGU Fall Meeting venue in order to help prepare the Earth and space science community for impacts, and to engage the community on this important policy issue.

Analysis of the climate variability on Lake Nasser evaporation based on the Bowen ratio energy budget method.

PubMed

Elsawwaf, Mohamed; Willems, Patrick

2012-04-01

Variations in lake evaporation have a significant impact on the energy and water budgets of lakes. Understanding these variations and the role of climate is important for water resources management as well as predicting future changes in lake hydrology as a result of climate change. This study presents a comprehensive, 10-year analysis of seasonal, intraseasonal, and interannual variations in lake evaporation for Lake Nasser in South Egypt. Meteorological and lake temperature measurements were collected from an instrumented platform (Raft floating weather station) at 2 km upstream ofthe Aswan High Dam. In addition to that, radiation measurements at three locations on the lake: Allaqi, Abusembel and Arqeen (respectively at 75, 280 and 350 km upstream of the Aswan High Dam) are used. The data were analyzed over 14-day periods from 1995 to 2004 to provide bi-weekly energy budget estimates of evaporation rate. The mean evaporation rate for lake Nasser over the study period was 5.88 mm day(-1), with a coefficient of variation of 63%. Considerable variability in evaporation rates was found on a wide range of timescales, with seasonal changes having the highest coefficient of variation (32%), followed by the intraseasonal (28%) and interannual timescales (11.6%; for summer means). Intraseasonal changes in evaporation were primarily associated with synoptic weather variations, with high evaporation events tending to occur during incursions of cold, dry air (due, in part, to the thermal lag between air and lake temperatures). Seasonal variations in evaporation were largely driven by temperature and net energy advection, but are out-of-phase with changes in wind speed. On interannual timescales, changes in summer evaporation rates were strongly associated with changes in net energy advection and showed only moderate connections to variations in temperature or humidity.

Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis.

PubMed

Yang, Juan; Atkins, Katherine E; Feng, Luzhao; Pang, Mingfan; Zheng, Yaming; Liu, Xinxin; Cowling, Benjamin J; Yu, Hongjie

2016-11-11

To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national "free-at-the-point-of-care" vaccination program for priority populations recommended by the World Health Organization. In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures. Regular reimbursement policies for influenza vaccination are available in 61 mutually exclusive regions, comprising 8 provinces, 45 prefectures, and 8 counties, which were reimbursed by the local Government Financial Department or Basic Social Medical Insurance (BSMI). Finance-reimbursed vaccination was offered mainly for the elderly, and school children for free in Beijing, Dongli district in Tianjin, Karamay, Shenzhen and Xinxiang cities. BSMI-reimbursement policies were limited to specific medical insurance beneficiaries with distinct differences in the reimbursement fractions. The average national vaccination coverage was just 1.5-2.2% between 2004 and 2014. A free national vaccination program for priority populations (n=416million), would cost government US$ 757million (95% CI 726-789) annually (uptake rate=20%). An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Pharmacy benefit forecast for a new interferon Beta-1a for the treatment of multiple sclerosis: development of a first-line decision tool for pharmacy-budget planning using administrative claims data.

PubMed

Meyer, Christina M; Phipps, Robert; Cooper, Deborah; Wright, Alan

2003-01-01

To estimate the incremental change in pharmacy per-member-permonth (PMPM) costs, according to various formulary designs, for a new interferon beta-1a product (IB1a2) using administrative claims data. Cross-sectional sex- and age-specific disease prevalence and treatment rates for relapsing, remitting multiple sclerosis (RRMS) patients were measured using integrated medical and pharmacy claims data from a 500,000- member employer group in the southern United States. Migration to IB1a2 from other drugs in the class was based on market-share data for new and existing RRMS patients. Duration of therapy was estimated by analyzing claims for current RRMS therapies. Daily therapy cost was provided by the manufacturer of IB1a2, adjusted for migration from other therapies, and multiplied by estimated volume to predict incremental and total PMPM cost impact. Market-share estimates were used to develop a PMPM cost forecast for the next 2 years. PMPM cost estimates were calculated for preferred (copayment tier 2) and nonpreferred (copayment tier 3) formulary designs with and without prior authorization (PA). One-way sensitivity analysis was performed to assess the influence of product pricing, duration of therapy, and other market factors. Annual incremental PMPM change was $0.047 for the scenario of third copayment tier with PA. The incremental change was greatest for those aged 55 to 65 years ($0.056 PMPM) and did not vary greatly by benefit design. Duration of therapy had the greatest impact on the PMPM estimate across benefit designs. IB1a2 will not cause a significant change in managed care pharmacy budgets under a variety of formulary conditions, according to this crosssectional analysis of current care-seeking behavior by RRMS patients. Economic impact may differ if IB1a2 expands RRMS patients. treatment-seeking behavior.

Direct Radiative Impacts of Central American Biomass Burning Smoke Aerosols: Analysis from a Coupled Aerosol-Radiation-Meteorology Model RAMS-AROMA

NASA Astrophysics Data System (ADS)

Wang, J.; Christopher, S. A.; Nair, U. S.; Reid, J. S.; Prins, E. M.

2005-12-01

Considerable efforts including various field experiments have been carried out in the last decade for studying the regional climatic impact of smoke aerosols produced by biomass burning activities in Africa and South America. In contrast, only few investigations have been conducted for Central American Biomass Burning (CABB) region. Using a coupled aerosol-radiation-meteorology model called RAMS-AROMA together with various ground-based observations, we present a comprehensive analysis of the smoke direct radiative impacts on the surface energy budget, boundary layer evolution, and e precipitation process during the CABB events in Spring 2003. Quantitative estimates are also made regarding the transboundary carbon mass to the U.S. in the form of smoke particles. Buult upon the Regional Atmospheric Modeling System (RAMS) mesoscale model, the RAMS AROMA has several features including Assimilation and Radiation Online Modeling of Aerosols (AROMA) algorithms. The model simulates smoke transport by using hourly smoke emission inventory from the Fire Locating and Modeling of Burning Emissions (FLAMBE) geostationary satellite database. It explicitly considers the smoke effects on the radiative transfer at each model time step and model grid, thereby coupling the dynamical processes and aerosol transport. Comparison with ground-based observation show that the simulation realistically captured the smoke transport timeline and distribution from daily to hourly scales. The effects of smoke radiative extinction on the decrease of 2m air temperature (2mT), diurnal temperature range (DTR), and boundary layer height over the land surface are also quantified. Warming due to smoke absorption of solar radiation can be found in the lower troposphere over the ocean, but not near the underlying land surface. The increase of boundary layer stability produces a positive feedback where more smoke particles are trapped in the lower boundary layer. These changes in temperature, surface energy budget and the atmospheric lapse rate have important ramification for the simulation of precipitations.

Kinetic energy budgets in areas of intense convection

NASA Technical Reports Server (NTRS)

Fuelberg, H. E.; Berecek, E. M.; Ebel, D. M.; Jedlovec, G. J.

1980-01-01

A kinetic energy budget analysis of the AVE-SESAME 1 period which coincided with the deadly Red River Valley tornado outbreak is presented. Horizontal flux convergence was found to be the major kinetic energy source to the region, while cross contour destruction was the major sink. Kinetic energy transformations were dominated by processes related to strong jet intrusion into the severe storm area. A kinetic energy budget of the AVE 6 period also is presented. The effects of inherent rawinsonde data errors on widely used basic kinematic parameters, including velocity divergence, vorticity advection, and kinematic vertical motion are described. In addition, an error analysis was performed in terms of the kinetic energy budget equation. Results obtained from downward integration of the continuity equation to obtain kinematic values of vertical motion are described. This alternate procedure shows promising results in severe storm situations.

GCIP water and energy budget synthesis (WEBS)

USGS Publications Warehouse

Roads, J.; Lawford, R.; Bainto, E.; Berbery, E.; Chen, S.; Fekete, B.; Gallo, K.; Grundstein, A.; Higgins, W.; Kanamitsu, M.; Krajewski, W.; Lakshmi, V.; Leathers, D.; Lettenmaier, D.; Luo, L.; Maurer, E.; Meyers, T.; Miller, D.; Mitchell, Ken; Mote, T.; Pinker, R.; Reichler, T.; Robinson, D.; Robock, A.; Smith, J.; Srinivasan, G.; Verdin, K.; Vinnikov, K.; Vonder, Haar T.; Vorosmarty, C.; Williams, S.; Yarosh, E.

2003-01-01

As part of the World Climate Research Program's (WCRPs) Global Energy and Water-Cycle Experiment (GEWEX) Continental-scale International Project (GCIP), a preliminary water and energy budget synthesis (WEBS) was developed for the period 1996-1999 fromthe "best available" observations and models. Besides this summary paper, a companion CD-ROM with more extensive discussion, figures, tables, and raw data is available to the interested researcher from the GEWEX project office, the GAPP project office, or the first author. An updated online version of the CD-ROM is also available at http://ecpc.ucsd.edu/gcip/webs.htm/. Observations cannot adequately characterize or "close" budgets since too many fundamental processes are missing. Models that properly represent the many complicated atmospheric and near-surface interactions are also required. This preliminary synthesis therefore included a representative global general circulation model, regional climate model, and a macroscale hydrologic model as well as a global reanalysis and a regional analysis. By the qualitative agreement among the models and available observations, it did appear that we now qualitatively understand water and energy budgets of the Mississippi River Basin. However, there is still much quantitative uncertainty. In that regard, there did appear to be a clear advantage to using a regional analysis over a global analysis or a regional simulation over a global simulation to describe the Mississippi River Basin water and energy budgets. There also appeared to be some advantage to using a macroscale hydrologic model for at least the surface water budgets. Copyright 2003 by the American Geophysical Union.

Imperatives for Change; A Management Improvement Analysis of the Seattle Public Library. A Report to the Board of Trustees.

ERIC Educational Resources Information Center

Public Affairs Counseling, San Francisco, CA.

To develop organizational recommendations, propose new management procedures, and assist in budget preparation, a management improvement analysis was undertaken at the Seattle Public Library. Discussions were held with library board and supervising staff on all aspects of organization, operations, and services; a trial budget procedure was…

[Outpatient management of patients with deep vein thrombosis and cancer: a study of safety, cost and budget impact].

PubMed

Jara Palomares, Luis; Caballero Eraso, Candela; Elías Hernández, Teresa; Ferrer Galván, Marta; Márquez Peláez, Sergio; Cayuela, Aurelio; Alfaro, María José; Barrot Cortés, Emilia; Otero Candelera, Remedios

2012-04-07

This is a safety and cost comparison study with an analysis of budgetary impact of ambulatory management of patients with cancer and deep vein thrombosis (DVT) compared with hospital management. Prospective observational study of patients with known malignancy and diagnosed with DVT from 2003 to 2007. The outcome variables were mortality, relapse and bleeding in one month. We conducted an economic analysis to evaluate the comparative cost of ambulatory patients. Three hundred and seventeen patients, 55 (17%) had cancer. The mean age of patients was 63 ± 11 years. There were 2 hemorrhagic events, 2 recurrences and 6 deaths in one month of follow-up. Of all patients, only 7 (13,7%) required hospitalization. All but one deaths were due to progression of the underlying disease. Economic analysis concluded that outpatient management is 6 times less expensive than hospital management, which would imply a cost reduction of 85%. Specialized outpatient treatment of cancer patients with DVT is safe and could save significant financial resources. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Estimation of Hepatitis C Disease Burden and Budget Impact of Treatment Using Health Economic Modeling.

PubMed

Chhatwal, Jagpreet; Chen, Qiushi; Aggarwal, Rakesh

2018-06-01

Oral direct-acting antiviral agents have revolutionized treatment of hepatitis C virus (HCV) infection. Nonetheless, barriers exist to elimination of HCV as a public health threat including low uptake of treatment, limited budget allocations for HCV treatment, and low awareness rates of HCV status among infected people. Mathematical modeling provides a systematic framework to analyze and compare potential solutions and elimination strategies by simulating the HCV epidemic under different conditions. Such models evaluate impact of interventions in advance of implementation. This article describes key components of developing an HCV burden model and illustrates its use by simulating the HCV epidemic in the United States. Copyright © 2018 Elsevier Inc. All rights reserved.

The Impact of Elementary Gifted Mathematics Programming: Moving into Middle School Research Using the ECLS-K Database

ERIC Educational Resources Information Center

Zayac, Joanne M.

2013-01-01

With tightened school budgets, school administrators need to know the short term and long range effects of providing gifted programs at the elementary level. Programming opportunities in elementary school have direct impact on middle school and this, in turn impacts high school and college course selection. This study used the Early Childhood…

Projected Benefits of Federal Energy Efficiency and Renewable Energy Programs - FY 2008 Budget Request

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

2007-03-01

This document summarizes the results of the benefits analysis of EERE's programs, as described in the FY 2008 Budget Request. EERE estimates benefits for its overall portfolio and for each of its nine Research, Development, Demonstration, and Deployment (RD3) programs. Benefits for the FY 2008 budget request are estimated for the midterm (2008-2030) and long term (2030-2050).

Implementation of noise budgets for civil airports

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bishop, D.E.

1982-01-01

An increasing number of airports are faced with the need for establishing a lid on the noise from aircraft operations and for developing programs for reducing airport noise on a year-to-year basis. As an example, the California Airport Noise Standard acts to impose such programs on a number of airports in California. Any airport faced with the need to establish a quantitative reduction of noise obviously wants to achieve this reduction with the least impact on numbers of operations and reduction in air transportation services to the community. A reduction in noise and an increase in operations usually can bemore » achieved only by encouraging use of the quietest aircraft available and, further adding incentives for operating procedures that minimize noise. One approach in administering airport noise reduction is to adopt an airport noise budget. As used in this paper, the noise budget concept implies that quantitative limits on the noise environment and on the noise contributions by major airport users will be established. Having methods for enforcing compliance with the airport budget for those airport users that exceed their budget will be established. Thus, the noise budget provides airport management, and major airport users, with quantitative measures for defining noise goals, and actual progress in achieving such goals.« less

Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II).

PubMed

Anselmino, Marco; Bammer, Tanja; Fernández Cebrián, José Maria; Daoud, Frederic; Romagnoli, Giuliano; Torres, Antonio

2009-11-01

This study aimed to establish a payer-perspective cost-effectiveness and budget impact model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs. conventional treatment (CT) in patients with a body mass index (BMI) > or = 35 kg x m(-2) and type 2 diabetes mellitus (T2DM) in Austria, Italy, and Spain. A health economics model described in a previous publication was applied to resource utilization and cost data in AGB, GBP, and CT from Austria, Italy, and Spain in 2009. The base case time scope is 5 years; the annual discount rate for utilities and costs is 3.5%. In Austria and Italy, both AGB and GBP are cost-saving and are thus dominant in terms of incremental cost-effectiveness ratio compared to CT. In Spain, AGB and GBP yield a moderate cost increase but are cost-effective, assuming a willingness-to-pay threshold of 30,000 euro per quality adjusted life-year. Under worst-case analysis, AGB and GBP remain cost-saving or around breakeven in Austria and Italy and remain cost-effective in Spain. In patients with T2DM and BMI > or = 35 kg x m(-2) at 5-year follow-up vs. CT, AGB and GBP are not only clinically effective and safe but represent satisfactory value for money from a payer perspective in Austria, Italy, and Spain.

Modelling the resource implications and budget impact of managing cow milk allergy in Australia.

PubMed

Guest, J F; Nagy, E

2009-02-01

To estimate the resource implications and budget impact of current clinical practice for managing cow milk allergy (CMA) in Australia, from the perspective of the publicly funded healthcare system. A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the expected 6-monthly levels of healthcare resource use and corresponding costs attributable to managing 6150 new CMA sufferers following referral to a specialist. The expected 6-monthly costs of managing 6150 newly-diagnosed infants with CMA following referral to a specialist was an estimated (Australian dollars, AU$) AU$6.5 million at 2006/07 prices. Clinical nutrition preparations were found to be the primary cost driver accounting for 62% of the total 6-monthly cost and clinician visits were the secondary cost driver accounting for up to a further 28% of the total 6-monthly cost. Sensitivity analysis showed there would be fewer visits to hospital-based paediatric gastroenterologists and paediatric immunologists/allergists if all newly-diagnosed patients were prescribed an amino acid formula (AAF) following referral to a specialist, instead of being managed according to current practice. CMA imposes a substantial burden on the publicly funded healthcare system in Australia. However, using an AAF as the initial treatment for CMA can potentially release limited hospital resources for alternative use within the paediatric healthcare system.

Global Energy and Water Budgets in MERRA

NASA Technical Reports Server (NTRS)

Bosilovich, Michael G.; Robertson, Franklin R.; Chen, Junye

2010-01-01

Reanalyses, retrospectively analyzing observations over climatological time scales, represent a merger between satellite observations and models to provide globally continuous data and have improved over several generations. Balancing the Earth s global water and energy budgets has been a focus of research for more than two decades. Models tend to their own climate while remotely sensed observations have had varying degrees of uncertainty. This study evaluates the latest NASA reanalysis, called the Modern Era Retrospective-analysis for Research and Applications (MERRA), from a global water and energy cycles perspective. MERRA was configured to provide complete budgets in its output diagnostics, including the Incremental Analysis Update (IAU), the term that represents the observations influence on the analyzed states, alongside the physical flux terms. Precipitation in reanalyses is typically sensitive to the observational analysis. For MERRA, the global mean precipitation bias and spatial variability are more comparable to merged satellite observations (GPCP and CMAP) than previous generations of reanalyses. Ocean evaporation also has a much lower value which is comparable to observed data sets. The global energy budget shows that MERRA cloud effects may be generally weak, leading to excess shortwave radiation reaching the ocean surface. Evaluating the MERRA time series of budget terms, a significant change occurs, which does not appear to be represented in observations. In 1999, the global analysis increments of water vapor changes sign from negative to positive, and primarily lead to more oceanic precipitation. This change is coincident with the beginning of AMSU radiance assimilation. Previous and current reanalyses all exhibit some sensitivity to perturbations in the observation record, and this remains a significant research topic for reanalysis development. The effect of the changing observing system is evaluated for MERRA water and energy budget terms.

[Impact of the funding reform of teaching hospitals in Brazil].

PubMed

Lobo, M S C; Silva, A C M; Lins, M P E; Fiszman, R

2009-06-01

To assess the impact of funding reform on the productivity of teaching hospitals. Based on the Information System of Federal University Hospitals of Brazil, 2003 and 2006 efficiency and productivity were measured using frontier methods with a linear programming technique, data envelopment analysis, and input-oriented variable returns to scale model. The Malmquist index was calculated to detect changes during the study period: 'technical efficiency change,' or the relative variation of the efficiency of each unit; and 'technological change' after frontier shift. There was 51% mean budget increase and improvement of technical efficiency of teaching hospitals (previously 11, 17 hospitals reached the empirical efficiency frontier) but the same was not seen for the technology frontier. Data envelopment analysis set benchmark scores for each inefficient unit (before and after reform) and there was a positive correlation between technical efficiency and teaching intensity and dedication. The reform promoted management improvements but there is a need of further follow-up to assess the effectiveness of funding changes.

The impact of IMF conditionality on government health expenditure: A cross-national analysis of 16 West African nations.

PubMed

Stubbs, Thomas; Kentikelenis, Alexander; Stuckler, David; McKee, Martin; King, Lawrence

2017-02-01

How do International Monetary Fund (IMF) policy reforms-so-called 'conditionalities'-affect government health expenditures? We collected archival documents on IMF programmes from 1995 to 2014 to identify the pathways and impact of conditionality on government health spending in 16 West African countries. Based on a qualitative analysis of the data, we find that IMF policy reforms reduce fiscal space for investment in health, limit staff expansion of doctors and nurses, and lead to budget execution challenges in health systems. Further, we use cross-national fixed effects models to evaluate the relationship between IMF-mandated policy reforms and government health spending, adjusting for confounding economic and demographic factors and for selection bias. Each additional binding IMF policy reform reduces government health expenditure per capita by 0.248 percent (95% CI -0.435 to -0.060). Overall, our findings suggest that IMF conditionality impedes progress toward the attainment of universal health coverage. Copyright © 2016 Elsevier Ltd. All rights reserved.

Federal Trade Commission Semiannual Regulatory Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... 15, 2010, by the Office of Management and Budget in accordance with the provisions of Executive Order... have a significant economic impact on a substantial number of small entities; and any rules that the... requirement to identify rulemakings that are likely to have some impact on small entities but are not subject...

75 FR 21951 - Semiannual Regulatory Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... 15, 2010, by the Office of Management and Budget in accordance with the provisions of Executive Order... have a significant economic impact on a substantial number of small entities; and any rules that the... requirement to identify rulemakings that are likely to have some impact on small entities but are not subject...

Design Matters: The Impact of CAPI on Interview Length

ERIC Educational Resources Information Center

Watson, Nicole; Wilkins, Roger

2015-01-01

Computer-assisted personal interviewing (CAPI) offers many attractive benefits over paper-and-pencil interviewing. There is, however, mixed evidence on the impact of CAPI on interview "length," an important survey outcome in the context of length limits imposed by survey budgets and concerns over respondent burden. In this article,…

Modeled Full-Flight Aircraft Emissions Impacts on Air Quality and Their Sensitivity to Grid Resolution

EPA Science Inventory

Aviation is a unique anthropogenic source with four-dimensional varying emissions, peaking at cruise altitudes (9–12 km). Aircraft emission budgets in the upper troposphere lower stratosphere region and their potential impacts on upper troposphere and surface air quality ar...

A Clear View

ERIC Educational Resources Information Center

Giblin, Kathryn

2009-01-01

From around the corner to around the nation, schools and universities are looking to reduce their energy bills. Some are concerned about fuel costs and the impact on their operating budgets; others are motivated by the desire to reduce their carbon footprints and their impacts on the environment. Professionally installed window film can play a key…

Impact of Front Range sources on reactive nitrogen concentrations and deposition in Rocky Mountain National Park

PubMed Central

Prenni, Anthony J.; Sullivan, Amy P.; Evanoski-Cole, Ashley R.; Fischer, Emily V.; Callahan, Sara; Sive, Barkley C.; Zhou, Yong; Schichtel, Bret A.; Collett Jr, Jeffrey L.

2018-01-01

Human influenced atmospheric reactive nitrogen (RN) is impacting ecosystems in Rocky Mountain National Park (ROMO). Due to ROMO’s protected status as a Class 1 area, these changes are concerning, and improving our understanding of the contributions of different types of RN and their sources is important for reducing impacts in ROMO. In July–August 2014 the most comprehensive measurements (to date) of RN were made in ROMO during the Front Range Air Pollution and Photochemistry Éxperiment (FRAPPÉ). Measurements included peroxyacetyl nitrate (PAN), C1–C5 alkyl nitrates, and high-time resolution NOx, NOy, and ammonia. A limited set of measurements was extended through October. Co-located measurements of a suite of volatile organic compounds provide information on source types impacting ROMO. Specifically, we use ethane as a tracer of oil and gas operations and tetrachloroethylene (C2Cl4) as an urban tracer to investigate their relationship with RN species and transport patterns. Results of this analysis suggest elevated RN concentrations are associated with emissions from oil and gas operations, which are frequently co-located with agricultural production and livestock feeding areas in the region, and from urban areas. There also are periods where RN at ROMO is impacted by long-range transport. We present an atmospheric RN budget and a nitrogen deposition budget with dry and wet components. Total deposition for the period (7/1–9/30) was estimated at 1.58 kg N/ha, with 87% from wet deposition during this period of above average precipitation. Ammonium wet deposition was the dominant contributor to total nitrogen deposition followed by nitrate wet deposition and total dry deposition. Ammonia was estimated to be the largest contributor to dry deposition followed by nitric acid and PAN (other species included alkyl nitrates, ammonium and nitrate). All three species are challenging to measure routinely, especially at high time resolution.

Permafrost thaw strongly reduces allowable CO2 emissions for 1.5°C and 2°C

NASA Astrophysics Data System (ADS)

Kechiar, M.; Gasser, T.; Kleinen, T.; Ciais, P.; Huang, Y.; Burke, E.; Obersteiner, M.

2017-12-01

We quantify how the inclusion of carbon emission from permafrost thaw impacts the budgets of allowable anthropogenic CO2 emissions. We use the compact Earth system model OSCAR v2.2 which we expand with a permafrost module calibrated to emulate the behavior of the complex models JSBACH, ORCHIDEE and JULES. When using the "exceedance" method and with permafrost thaw turned off, we find budgets very close to the CMIP5 models' estimates reported by IPCC. With permafrost thaw turned on, the total budgets are reduced by 3-4%. This corresponds to a 33-45% reduction of the remaining budget for 1.5°C, and a 9-13% reduction for 2°C. When using the "avoidance" method, however, permafrost thaw reduces the total budget by 3-7%, which corresponds to reductions by 33-56% and 56-79% of the remaining budget for 1.5°C and 2°C, respectively. The avoidance method relies on many scenarios that actually peak below the target whereas the exceedance method overlooks the carbon emitted by thawed permafrost after the temperature target is reached, which explains the difference. If we use only the subset of scenarios in which there is no net negative emissions, the permafrost-induced reduction in total budgets rises to 6-15%. Permafrost thaw therefore makes the emission budgets strongly path-dependent. We also estimate budgets of needed carbon capture in scenarios overshooting the temperature targets. Permafrost thaw strongly increases these capture budgets: in the case of a 1.5°C target overshot by 0.5°C, which is in line with the Paris agreement, about 30% more carbon must be captured. Our conclusions are threefold. First, inclusion of permafrost thaw systematically reduces the emission budgets, and very strongly so if the temperature target is overshot. Second, the exceedance method, that is the only one that complex models can follow, only partially accounts for the effect of slow non-linear processes such as permafrost thaw, leading to overestimated budgets. Third, the newfound strong path-dependency of the budgets renders the concept more delicate to use. For instance, using a budget that implicitly assumes a large development of negative emission technologies may lead to missing the target if these are not as scalable as anticipated.

The impact of National Institutes of Health funding on U.S. cardiovascular disease research.

PubMed

Lyubarova, Radmila; Itagaki, Brandon K; Itagaki, Michael W

2009-07-29

Intense interest surrounds the recent expansion of US National Institutes of Health (NIH) budgets as part of economic stimulus legislation. However, the relationship between NIH funding and cardiovascular disease research is poorly understood, making the likely impact of this policy change unclear. The National Library of Medicine's PubMed database was searched for articles published from 1996 to 2006, originating from U.S. institutions, and containing the phrases "cardiolog," "cardiovascular," or "cardiac," in the first author's department. Research methodology, journal of publication, journal impact factor, and receipt of NIH funding were recorded. Differences in means and trends were tested with t-tests and linear regression, respectively, with P < or = 0.05 for significance. Of 117,643 world cardiovascular articles, 36,684 (31.2%) originated from the U.S., of which 10,293 (28.1%) received NIH funding. The NIH funded 40.1% of U.S. basic science articles, 20.3% of overall clinical trials, 18.1% of randomized-controlled, and 12.2% of multicenter clinical trials. NIH-funded and total articles grew significantly (65 articles/year, P < 0.001 and 218 articles/year, P < 0.001, respectively). The proportion of articles receiving NIH funding was stable, but grew significantly for basic science and clinical trials (0.87%/year, P < 0.001 and 0.67%/year, P = 0.029, respectively). NIH-funded articles had greater journal impact factors than non NIH-funded articles (5.76 vs. 3.71, P < 0.001). NIH influence on U.S. cardiovascular research expanded in the past decade, during the period of NIH budget doubling. A substantial fraction of research is now directly funded and thus likely sensitive to budget fluctuations, particularly in basic science research. NIH funding predicts greater journal impact.

AIDS (Acquired Immune Deficiency Syndrome): Views on the Administration’s Fiscal Year 1989 Public Health Service Budget

DTIC Science & Technology

1988-06-01

200,000 for the CenterE for Disease Control (CDC) to study AIDS. For fiscal year 1989, the proposed federal PHS budget increased to $1.3 billion for...to educate the public, $40( million (31 percent); -- epidemiological studies and surveillance to understand and track the spread of the disease , $229...potential impact of the AIDS epidemic. Investing in prevention now can help contain the direct and indirect costs of the disease in the future. As it

Hearing on Education Funding and Budget Proposals for Federal Education Efforts. Joint Hearing before the Subcommittees on Postsecondary Education and Elementary, Secondary, and Vocational Education. of the Committee on Education and Labor. House of Representatives, One Hundred First Congress, First Session (Missoula, Montana, March 31, 1989).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Education and Labor.

An examination of the fiscal year 1990 national educational budget and assessment of its potential impact on education in the northwestern United States, particularly in Montana and Washington, are contained in this joint hearing report. Statements, prepared statements, letters, and supplemental materials are presented on the following topics: the…

Kinetic energy budget during strong jet stream activity over the eastern United States

NASA Technical Reports Server (NTRS)

Fuelberg, H. E.; Scoggins, J. R.

1980-01-01

Kinetic energy budgets are computed during a cold air outbreak in association with strong jet stream activity over the eastern United States. The period is characterized by large generation of kinetic energy due to cross-contour flow. Horizontal export and dissipation of energy to subgrid scales of motion constitute the important energy sinks. Rawinsonde data at 3 and 6 h intervals during a 36 h period are used in the analysis and reveal that energy fluctuations on a time scale of less than 12 h are generally small even though the overall energy balance does change considerably during the period in conjunction with an upper level trough which moves through the region. An error analysis of the energy budget terms suggests that this major change in the budget is not due to random errors in the input data but is caused by the changing synoptic situation. The study illustrates the need to consider the time and space scales of associated weather phenomena in interpreting energy budgets obtained through use of higher frequency data.

Analysis of the Diurnal Cycle of Precipitation and its Relation to Cloud Radiative Forcing Using TRMM Products

NASA Technical Reports Server (NTRS)

Randall, David A.; Fowler, Laura D.; Lin, Xin

1998-01-01

In order to improve our understanding of the interactions between clouds, radiation, and the hydrological cycle simulated in the Colorado State University General Circulation Model (CSU GCM), we focused our research on the analysis of the diurnal cycle of precipitation, top-of-the-atmosphere and surface radiation budgets, and cloudiness using 10-year long Atmospheric Model Intercomparison Project (AMIP) simulations. Comparisons the simulated diurnal cycle were made against the diurnal cycle of Earth Radiation Budget Experiment (ERBE) radiation budget and International Satellite Cloud Climatology Project (ISCCP) cloud products. This report summarizes our major findings over the Amazon Basin.