Avionics performance analysis: A historical review and a current assessment of flight instrumentation and control systems in civil aviation

NASA Technical Reports Server (NTRS)

1978-01-01

The role of flight instrumentation and control systems in the advancement of civil aviation to the safest form of commercial transportation is discussed. Safety, cost reduction, and increased capabilities provided by recent developments are emphasized. Cost/performance considerations are considered in terms of determining the relative values of comparable systems or the absolute worth of a system.

The Medicare bundled payment pilot program participation considerations.

PubMed

Pearce, Jonathan W; Harris, John M

2010-09-01

The Medicare bundled payment pilot program is scheduled to begin in January 2013 and will run for five years. The program holds the promise of increased alignment between hospitals and physicians, presenting opportunities for hospital cost reduction and improvements in quality. Nonetheless, the program carries fixed costs and assumption of risks that hospitals need to evaluate as they deliberate over whether to seek to participate in the program.

Earth Observatory Satellite system definition study. Report no. 4: Management approach recommendations

NASA Technical Reports Server (NTRS)

1974-01-01

A management approach for the Earth Observatory Satellite (EOS) which will meet the challenge of a constrained cost environment is presented. Areas of consideration are contracting techniques, test philosophy, reliability and quality assurance requirements, commonality options, and documentation and control requirements. The various functional areas which were examined for cost reduction possibilities are identified. The recommended management approach is developed to show the primary and alternative methods.

The concentration principle applied to spaceborne solar arrays. Application to the coorbiting platform mission: Studies synthesis

NASA Astrophysics Data System (ADS)

Laget, R.

1986-01-01

Studies that led to selection of the distributed concentration biplane concept for the solar cell generator to be flown on the coorbiting platform mission, and the major characteristics of such a spaceborne solar array are summarized. It is concluded that there is not a considerable interest in concentration either for array area reduction or cost reduction, although improvements of 15% for both domains are feasible. Only predevelopment activities to verify concentrator performances and system studies to assess respective importance of cost and area saving may increase the level of interest of concentrator solar arrays for this kind of mission.

Understanding Acceptable Level of Risk: Incorporating the Economic Cost of Under-Managing Invasive Species.

PubMed

Davidson, Alisha D; Hewitt, Chad L; Kashian, Donna R

2015-01-01

Management of nonindigenous species includes prevention, early detection and rapid response and control. Early detection and rapid response depend on prioritizing and monitoring sites at risk for arrival or secondary spread of nonindigenous species. Such monitoring efforts require sufficient biosecurity budgets to be effective and meet management or policy directives for reduced risk of introduction. Such consideration of risk reduction is rarely considered, however. Here, we review the concepts of acceptable level of risk (ALOR) and associated costs with respect to nonindigenous species and present a framework for aligning risk reduction priorities with available biosecurity resources. We conclude that available biosecurity resources may be insufficient to attain stated and desired risk reduction. This outcome highlights the need to consider policy and management directives when beginning a biosecurity program to determine the feasibility of risk reduction goals, given available resources.

Energy efficient engine: Flight propulsion system preliminary analysis and design

NASA Technical Reports Server (NTRS)

Johnston, R. P.; Beitler, R. S.; Bobinger, R. O.; Broman, C. L.; Gravitt, R. D.; Heineke, H.; Holloway, P. R.; Klem, J. S.; Nash, D. O.; Ortiz, P.

1980-01-01

The characteristics of an advanced flight propulsion system (FPS), suitable for introduction in the late 1980's to early 1990's, was more fully defined. It was determined that all goals for efficiency, environmental considerations, and economics could be met or exceeded with the possible exception of NOx emission. In evaluating the FPS, all aspects were considered including component design, performance, weight, initial cost, maintenance cost, engine system integration (including nacelle), and aircraft integration considerations. The current FPS installed specific fuel consumption was reduced 14.2% from that of the CF6-50C reference engine. When integrated into an advanced, subsonic, study transport, the FPS produced a fuel burn savings of 15 to 23% and a direct operating cost reduction of 5 to 12% depending on the mission and study aircraft characteristics relative to the reference engine.

An evaluation of costs and benefits of a vehicle periodic inspection scheme with six-monthly inspections compared to annual inspections.

PubMed

Keall, Michael D; Newstead, Stuart

2013-09-01

Although previous research suggests that safety benefits accrue from periodic vehicle inspection programmes, little consideration has been given to whether the benefits are sufficient to justify the often considerable costs of such schemes. Methodological barriers impede many attempts to evaluate the overall safety benefits of periodic vehicle inspection schemes, including this study, which did not attempt to evaluate the New Zealand warrant of fitness scheme as a whole. Instead, this study evaluated one aspect of the scheme: the effects of doubling the inspection frequency, from annual to biannual, when the vehicle reaches six years of age. In particular, reductions in safety-related vehicle faults were estimated together with the value of the safety benefits compared to the costs. When merged crash data, licensing data and roadworthiness inspection data were analysed, there were estimated to be improvements in injury crash involvement rates and prevalence of safety-related faults of respectively 8% (95% CI 0.4-15%) and 13.5% (95% CI 12.8-14.2%) associated with the increase from annual to 6-monthly inspections. The wide confidence interval for the drop in crash rate shows considerably statistical uncertainty about the precise size of the drop. Even assuming that this proportion of vehicle faults prevented by doubling the inspection frequency could be maintained over the vehicle age range 7-20 years, the safety benefits are very unlikely to exceed the additional costs of the 6-monthly inspections to the motorists, valued at $NZ 500 million annually excluding the overall costs of administering the scheme. The New Zealand warrant of fitness scheme as a whole cannot be robustly evaluated using the analysis approach used here, but the safety benefits would need to be substantial--yielding an unlikely 12% reduction in injury crashes--for benefits to equal costs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Changes in Consumer Cost-Sharing for Health Plans Sold in the ACA's Insurance Marketplaces, 2015 to 2016.

PubMed

Gabel, Jon; Green, Matthew; Call, Adrienne; Whitmore, Heidi; Stromberg, Sam; Oran, Rebecca

2016-05-01

This brief examines changes in consumer health plan cost-sharing--deductibles, copayments, coinsurance, and out-of-pocket limits--for coverage offered in the Affordable Care Act's marketplaces between 2015 and 2016. Three of seven measures studied rose moderately in 2016, an increase attributable in part to a shift in the mix of plans offered in the marketplaces, from plans with higher actuarial value (platinum and gold plans) to those that have less generous coverage (bronze and silver plans). Nearly 60 percent of enrollees in marketplace plans receive cost-sharing reductions as part of income-based assistance. For enrollees without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits remain considerably higher under bronze and silver plans than under employer-based plans; cost-sharing is similar in gold plans and employer plans. Marketplace plans are more likely than employer-based plans to impose a deductible for prescription drugs but no less likely to do so for primary care visits.

OAST Space Theme Workshop. Volume 3: Working group summary. 2: Data handling, communications (E-2). A. Statement. B. Technology needs (form 1). C. Priority assessment (form 2)

NASA Technical Reports Server (NTRS)

1976-01-01

Technologies required to support the stated OAST thrust to increase information return by X1000, while reducing costs by a factor of 10 are identified. The most significant driver is the need for an overall end-to-end data system management technology. Maximum use of LSI component technology and trade-offs between hardware and software are manifest in most all considerations of technology needs. By far, the greatest need for data handling technology was identified for the space Exploration and Global Services themes. Major advances are needed in NASA's ability to provide cost effective mass reduction of space data, and automated assessment of earth looking imagery, with a concomitant reduction in cost per useful bit. A combined approach embodying end-to-end system analysis, with onboard data set selection, onboard data processing, highly parallel image processing (both ground and space), low cost, high capacity memories, and low cost user data distribution systems would be necessary.

CARBON FIBER COMPOSITES IN HIGH VOLUME

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

Warren, Charles David; Das, Sujit; Jeon, Dr. Saeil

2014-01-01

Vehicle lightweighting represents one of several design approaches that automotive and heavy truck manufacturers are currently evaluating to improve fuel economy, lower emissions, and improve freight efficiency (tons-miles per gallon of fuel). With changes in fuel efficiency and environmental regulations in the area of transportation, the next decade will likely see considerable vehicle lightweighting throughout the ground transportation industry. Greater use of carbon fiber composites and light metals is a key component of that strategy. This paper examines the competition between candidate materials for lightweighting of heavy vehicles and passenger cars. A 53-component, 25 % mass reduction, body-in-white cost analysismore » is presented for each material class, highlighting the potential cost penalty for each kilogram of mass reduction and then comparing the various material options. Lastly, as the cost of carbon fiber is a major component of the elevated cost of carbon fiber composites, a brief look at the factors that influence that cost is presented.« less

Assessment of Cost Impacts of Using Non-Toxic Propulsion in Satellites

NASA Astrophysics Data System (ADS)

Schiebener, P. J.; Gies, O.; Stuhlberger, J.; Schmitz, H.-D.

2002-01-01

The growing costs of space missions, the need for increased mission performance, and concerns associated with environmental issues deeply influence propulsion system design and propellant selection criteria. A propellant's performance was defined in the past exclusively in terms of specific impulse and density, but now high-performance, non-toxic, non-sophisticated mono- propellant systems are key drivers, and are considered for development to replace the traditional hydrazine (N2H4) mono-propellant thrusters. The mono-propellants under consideration are propellant formulations, which should be environmentally friendly, should have a high density, equal or better performance and better thermal characteristics than hydrazine. These considerations raised interest specially in the candidates of Hydroxylammonium Nitrate (HAN)-based propellants, Ammoniumdinitramide (ADN)-based propellants, Tri-ethanol (TEAN)-based propellants, Hydrazinium Nitroformate (HNF)-based propellants, Hydrogen Peroxide (H2O2)-based propellants. A near-term objective in consideration of satellite related process optimisation is to significantly reduce on-ground operations costs and at the same time improve mission performance. A far-term objective is to obtain a system presenting a very high performance, illustrated by a high specific impulse. Moving to a "non-toxic" propulsion system seems to be a solution to these two goals. The sought after benefits for non-toxic spacecraft mono-propellant propulsion are under investigation taking into account the four main parameters which are mandatory for customer satisfaction while meeting the price constraints: - Reliability, availability, maintainability and safety, - Manufacturing, assembly, integration and test, - Launch preparation and support, - Ground support equipment. These benefits of non-toxic mono-propellants can be proven by various examples, like an expected reduction of development costs due the non-toxicity of propellants which might allow "easier" design, reducing some inhibits for ground safety, leading to a shorter development time, and consequently to reduced program costs. Operational costs could be reduced due to the use of non-toxic propellant. Their non-toxicity, in comparison to the traditional propellants, will avoid special safety procedures and also parallelisation of processes during all phases of AIT and launch preparations. The costs directly associated with propellant handling, transport and storage should be lower, also follow-on costs risk is minimised because of the elimination or significant reduction of toxic and carcinogenic characteristics of the propellants. The physical characteristic and properties of some of the propellants formulations mentioned, like a higher density than hydrazine, support the beneficial aspects: a global S/C weight reduction could be achieved due to smaller tanks.

Potential Means of Cost Reduction in Grade Crossing Motorist-Warning Control Equipment : Volume 2. Comparison of Solid State and Relay Devices and Techniques

DOT National Transportation Integrated Search

1977-12-01

Consideration is given to the properties of solid-state circuits, miniature relays and large gravity-operated relays when applied to control systems for grade crossings equipped with train-activated motorist warnings. Factors discussed include origin...

Which types of hospital mergers save consumers money?

PubMed

Connor, R A; Feldman, R D; Dowd, B E; Radcliff, T A

1997-01-01

This study analyzes the changes in costs and prices from 1986 to 1994 for more than 3,500 U.S. short-term general hospitals, including 122 horizontal mergers. These mergers were generally financially beneficial to consumers, providing average price reductions of approximately 7 percent. Merger-related price reductions were considerably less in market areas with higher market concentration levels. Merger-related price reductions in areas with higher penetration by health maintenance organizations (HMOs) were approximately twice those in areas with lower HMO penetration. Merger-related price reductions were greater for low-occupancy hospitals, nonteaching hospitals, nonsystem hospitals, similar-size hospitals, and hospitals with greater premerger service duplication.

Waste reduction and recycling initiatives in Japanese cities: lessons from Yokohama and Kamakura.

PubMed

Hotta, Yasuhiko; Aoki-Suzuki, Chika

2014-09-01

Waste reduction and recycling at the city level will acquire greater significance in the near future due to rising global volumes of waste. This paper seeks to identify policy-relevant drivers for successful promotion of waste reduction and recycling. Factors influencing the success of waste reduction and recycling campaigns are identified. Two case study cities in Japan which depict the successful use of the 3Rs (reduce, reuse and recycle) at the municipal level are presented. In these cases, the existence of incinerators, which are generally considered as disincentives for recycling, was not functioning as a disincentive but rather as an incentive for waste reduction. Owing to the high cost of incineration facilities, the movement to close incinerators has become a strong incentive for waste reduction and recycling in these two cities. The study suggests that careful consideration is necessary when making decisions concerning high-cost waste treatment facilities with high installation, maintenance and renewal outlays. In addition, intensive source separation and other municipal recycling initiatives have a high potential for producing positive results. © The Author(s) 2014.

Saugus River and Tributaries Flood Damage Reduction Study: Lynn, Malden, Revere and Saugus, Massachusetts. Section 1. Feasibility Report.

DTIC Science & Technology

1989-12-01

57 Table 5 Sensitivity Analysis - Point of Pines LPP 61 Table 6 Plan Comparison 64 Table 7 NED Plan Project Costs 96 Table 8 Estimated Operation...Costs 99 Table 13 Selected Plan/Estimated Annual Benefits 101 Table 14 Comparative Impacts - NED Regional Floodgate Plan 102 Table 15 Economic Analysis ...Includes detailed descriptions, plans and profiles and design considerations of the selected plan; coastal analysis of the shorefront; detailed project

Marginal abatement cost curves for NOx that account for ...

EPA Pesticide Factsheets

A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their respective cost effectiveness. Alternative measures, such as renewable electricity, energy efficiency, and fuel switching (RE/EE/FS), are not considered as it is difficult to quantify their abatement potential. In this paper, we demonstrate the use of an energy system model to develop a MACC for nitrogen oxides (NOx) that incorporates both end-of-pipe controls and these alternative measures. We decompose the MACC by sector, and evaluate the cost-effectiveness of RE/EE/FS relative to end-of-pipe controls. RE/EE/FS are shown to produce considerable emission reductions after end-of-pipe controls have been exhausted. Furthermore, some RE/EE/FS are shown to be cost-competitive with end-of-pipe controls. Demonstrate how the MARKAL energy system model can be used to evaluate the potential role of renewable electricity, energy efficiency and fuel switching (RE/EE/FS) in achieving NOx reductions. For this particular analysis, we show that RE/EE/FSs are able to increase the quantity of NOx reductions available for a particular marginal cost (ranging from $5k per ton to $40k per ton) by approximately 50%.

Reagent and labor cost optimization through automation of fluorescence in situ hybridization (FISH) with the VP 2000: an Italian case study.

PubMed

Zanatta, Lucia; Valori, Laura; Cappelletto, Eleonora; Pozzebon, Maria Elena; Pavan, Elisabetta; Dei Tos, Angelo Paolo; Merkle, Dennis

2015-02-01

In the modern molecular diagnostic laboratory, cost considerations are of paramount importance. Automation of complex molecular assays not only allows a laboratory to accommodate higher test volumes and throughput but also has a considerable impact on the cost of testing from the perspective of reagent costs, as well as hands-on time for skilled laboratory personnel. The following study tracked the cost of labor (hands-on time) and reagents for fluorescence in situ hybridization (FISH) testing in a routine, high-volume pathology and cytogenetics laboratory in Treviso, Italy, over a 2-y period (2011-2013). The laboratory automated FISH testing with the VP 2000 Processor, a deparaffinization, pretreatment, and special staining instrument produced by Abbott Molecular, and compared hands-on time and reagent costs to manual FISH testing. The results indicated significant cost and time saving when automating FISH with VP 2000 when more than six FISH tests were run per week. At 12 FISH assays per week, an approximate total cost reduction of 55% was observed. When running 46 FISH specimens per week, the cost saving increased to 89% versus manual testing. The results demonstrate that the VP 2000 processor can significantly reduce the cost of FISH testing in diagnostic laboratories. © 2014 Society for Laboratory Automation and Screening.

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.

PubMed

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2016-05-01

While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. © The Author(s) 2015.

Laser power beaming applications and technology

NASA Astrophysics Data System (ADS)

Burke, Robert J.; Cover, Ralph A.; Curtin, Mark S.; Dinius, R.; Lampel, Michael C.

1994-05-01

Beaming laser energy to spacecraft has important economic potential. It promises significant reduction in the cost of access to space, for commercial and government missions. While the potential payoff is attractive, existing technologies perform the same missions and the keys to market penetration for power beaming are a competitive cost and a schedule consistent with customers' plans. Rocketdyne is considering these questions in the context of a commercial enterprise -- thus, evaluation of the requirements must be done based on market assessments and recognition that significant private funding will be involved. It is in the context of top level business considerations that the technology requirements are being assessed and the program being designed. These considerations result in the essential elements of the development program. Since the free electron laser is regarded as the `long pole in the tent,' this paper summarizes Rocketdyne's approach for a timely, cost-effective program to demonstrate an FEL capable of supporting an initial operating capability.

New Opportunitie s for Small Satellite Programs Provided by the Falcon Family of Launch Vehicles

NASA Astrophysics Data System (ADS)

Dinardi, A.; Bjelde, B.; Insprucker, J.

2008-08-01

The Falcon family of launch vehicles, developed by Space Exploration Technologies Corporation (SpaceX), are designed to provide the world's lowest cost access to orbit. Highly reliable, low cost launch services offer considerable opportunities for risk reduction throughout the life cycle of satellite programs. The significantly lower costs of Falcon 1 and Falcon 9 as compared with other similar-class launch vehicles results in a number of new business case opportunities; which in turn presents the possibility for a paradigm shift in how the satellite industry thinks about launch services.

Engine dynamic analysis with general nonlinear finite element codes

NASA Technical Reports Server (NTRS)

Adams, M. L.; Padovan, J.; Fertis, D. G.

1991-01-01

A general engine dynamic analysis as a standard design study computational tool is described for the prediction and understanding of complex engine dynamic behavior. Improved definition of engine dynamic response provides valuable information and insights leading to reduced maintenance and overhaul costs on existing engine configurations. Application of advanced engine dynamic simulation methods provides a considerable cost reduction in the development of new engine designs by eliminating some of the trial and error process done with engine hardware development.

Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV), 2017-2030

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

Cook, Jeffrey J.; Ardani, Kristen B.; Margolis, Robert M.

The installed cost of solar photovoltaics (PV) has fallen rapidly in recent years and is expected to continue declining in the future. In this report, we focus on the potential for continued PV cost reductions in the residential market. From 2010 to 2017, the levelized cost of energy (LCOE) for residential PV declined from 52 cents per kilowatt-hour (cents/kWh) to 16 cents/kWh (Fu et al. 2017). The U.S. Department of Energy's (DOE's) Solar Energy Technologies Office (SETO) recently set new LCOE targets for 2030, including a target of 5 cents/kWh for residential PV. We present a roadmap for achieving themore » SETO 2030 residential PV target. Because the 2030 target likely will not be achieved under business-as-usual trends (NREL 2017), we examine two key market segments that demonstrate significant opportunities for cost savings and market growth: installing PV at the time of roof replacement and installing PV as part of the new home construction process. Within both market segments, we identify four key cost-reduction opportunities: market maturation, business model integration, product innovation, and economies of scale. To assess the potential impact of these cost reductions, we compare modeled residential PV system prices in 2030 to the National Renewable Energy Laboratory's (NREL's) quarter one 2017 (Q1 2017) residential PV system price benchmark (Fu et al. 2017). We use a bottom-up accounting framework to model all component and project-development costs incurred when installing a PV system. The result is a granular accounting for 11 direct and indirect costs associated with installing a residential PV system in 2030. All four modeled pathways demonstrate significant installed-system price savings over the Q1 2017 benchmark, with the visionary pathways yielding the greatest price benefits. The largest modeled cost savings are in the supply chain, sales and marketing, overhead, and installation labor cost categories. When we translate these installed-system costs into LCOE, we find that the less-aggressive pathways achieve significant cost reductions, but may not achieve the 2030 LCOE target. On the other hand, both visionary pathways could get very close to (for roof replacement) or achieve (for new construction) the 2030 target. Our analysis has two key implications. First, because installed-system soft cost reductions account for about 65 percent of the LCOE reductions in 2030 for both visionary pathways, residential PV stakeholders may need to emphasize these soft cost reductions to achieve the 2030 target. Second, capturing these savings will likely require considerable innovation in the technologies and business practices employed by the PV industry.« less

Evaluation of Prototype Commercial Media for the Production of Fusarium Head Hlight Antagonist Cryptococcus flavescens OH 182.9

USDA-ARS?s Scientific Manuscript database

Using biological control as part of the integrated management of Fusarium head blight (FHB) is understudied yet has considerable potential for significantly contributing to the reduction of FHB and deoxynivalenol (DON) in wheat. However, the development of a cost-effective, commercially feasible li...

Analyzing costs of space debris mitigation methods

NASA Astrophysics Data System (ADS)

Wiedemann, C.; Krag, H.; Bendisch, J.; Sdunnus, H.

2004-01-01

The steadily increasing number of space objects poses a considerable hazard to all kinds of spacecraft. To reduce the risks to future space missions different debris mitigation measures and spacecraft protection techniques have been investigated during the last years. However, the economic efficiency has not been considered yet in this context. Current studies have the objective to evaluate the mission costs due to space debris in a business as usual (no mitigation) scenario compared to the missions costs considering debris mitigation. The aim is an estimation of the time until the investment in debris mitigation will lead to an effective reduction of mission costs. This paper presents the results of investigations on the key issues of cost estimation for spacecraft and the influence of debris mitigation and shielding on cost. Mitigation strategies like the reduction of orbital lifetime and de- or re-orbit of non-operational satellites are methods to control the space debris environment. These methods result in an increase of costs. In a first step the overall costs of different types of unmanned satellites are analyzed. A selected cost model is simplified and generalized for an application on all operational satellites. In a next step the influence of space debris on cost is treated, if the implementation of mitigation strategies is considered.

Assessing the potential effects and cost-effectiveness of programmatic herpes zoster vaccination of elderly in the Netherlands

PubMed Central

2010-01-01

Background Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and cost-effectiveness of programmatic HZ vaccination of elderly in the Netherlands have been assessed according to a framework that was developed to support evidence-based decision making regarding inclusion of new vaccines in the Dutch National Immunization Program. Methods An analytical framework was used combining a checklist, which structured relevant data on the vaccine, pathogen and disease, and a cost-effectiveness analysis. The cost-effectiveness analysis was performed from a societal perspective, using a Markov-cohort-model. Simultaneous vaccination with influenza was assumed. Results Due to the combination of waning immunity after vaccination and a reduced efficacy of vaccination at high ages, the most optimal cost-effectiveness ratio (€21716 per QALY) for HZ vaccination in the Netherlands was found for 70-year olds. This estimated ratio is just above the socially accepted threshold in the Netherlands of €20000 per QALY. If additional reduction of postherpetic neuralgia was included, the cost-effectiveness ratio improved (~€10000 per QALY) but uncertainty for this scenario is high. Conclusions Vaccination against HZ at the age of 70 years seems marginally cost-effective in the Netherlands. Due to limited vaccine efficacy a considerable part of the disease burden caused by HZ will remain, even with optimal acceptance of programmatic vaccination. PMID:20707884

Assessing the potential effects and cost-effectiveness of programmatic herpes zoster vaccination of elderly in the Netherlands.

PubMed

van Lier, Alies; van Hoek, Albert Jan; Opstelten, Wim; Boot, Hein J; de Melker, Hester E

2010-08-13

Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and cost-effectiveness of programmatic HZ vaccination of elderly in the Netherlands have been assessed according to a framework that was developed to support evidence-based decision making regarding inclusion of new vaccines in the Dutch National Immunization Program. An analytical framework was used combining a checklist, which structured relevant data on the vaccine, pathogen and disease, and a cost-effectiveness analysis. The cost-effectiveness analysis was performed from a societal perspective, using a Markov-cohort-model. Simultaneous vaccination with influenza was assumed. Due to the combination of waning immunity after vaccination and a reduced efficacy of vaccination at high ages, the most optimal cost-effectiveness ratio (21716 euro per QALY) for HZ vaccination in the Netherlands was found for 70-year olds. This estimated ratio is just above the socially accepted threshold in the Netherlands of 20000 euro per QALY. If additional reduction of postherpetic neuralgia was included, the cost-effectiveness ratio improved (approximately 10000 euro per QALY) but uncertainty for this scenario is high. Vaccination against HZ at the age of 70 years seems marginally cost-effective in the Netherlands. Due to limited vaccine efficacy a considerable part of the disease burden caused by HZ will remain, even with optimal acceptance of programmatic vaccination.

EoC Study Update to Examine the Cost, Schedule and Technical Changes to NASA Projects

NASA Technical Reports Server (NTRS)

Bitten, Bob; Emmons, Debra; Shinn, Stephen; Scolese, Chris

2018-01-01

The original National Aeronautics and Space Administration (NASA) Explanation of Change (EoC) study was conducted in 2010 to understand the underlying causes of cost and schedule growth. The first study consisted of 25 missions launched from 2000 to 2010 and looked at the events that led to growth. These events were categorized into different bins that were rolled up to quantify whether the growth was due to internal planning, or internal execution, or from external forces and found that the growth was evenly distributed among those three categories. The result of the study presented nine considerations focused at reducing growth due to project external events and internal planning events. Although no one 'magic bullet' consideration was discovered in the previous work, the nine considerations taken as a whole were postulated to help reduce cost and schedule change in future NASA missions. A recent update was conducted that included investigating 8 missions developed since the previous study to determine if the results were different. Cost, schedule, and mass increases were analyzed from the start of Phase B through Preliminary Design Review and Critical Design Review to Launch. As shown in this paper, the results are better with overall cost and schedule growth being reduced. The paper will show a comparison of the previous results to the updated results to show specific reductions and provide an explanation of which recommendations were followed.

Regulatory impact analysis: benefits and costs of proposed surface water treatment rule and total coliform rule

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

Not Available

1987-09-01

This report contains an analysis of the costs and benefits of controlling microbial contaminants in drinking water through the promulgation of two regulations: (1) the Surface Water Treatment Rule (SWTR); and (2) the Total Coliform Rule. This regulatory impact analysis (RIA) was prepared in accordance with Executive Order 12291, which requires that the costs and benefits of all major rules be examined and compared. The major topical areas covered in the RIA are as follows: problem definition; market imperfections, the need for federal regulation, and consideration of regulatory alternatives; assessment of total costs; assessment of benefits; regulatory flexibility act andmore » Paperwork Reduction Act analyses; and a summary of costs and benefits.« less

Development of a multiobjective optimization tool for the selection and placement of best management practices for nonpoint source pollution control

NASA Astrophysics Data System (ADS)

Maringanti, Chetan; Chaubey, Indrajeet; Popp, Jennie

2009-06-01

Best management practices (BMPs) are effective in reducing the transport of agricultural nonpoint source pollutants to receiving water bodies. However, selection of BMPs for placement in a watershed requires optimization of the available resources to obtain maximum possible pollution reduction. In this study, an optimization methodology is developed to select and place BMPs in a watershed to provide solutions that are both economically and ecologically effective. This novel approach develops and utilizes a BMP tool, a database that stores the pollution reduction and cost information of different BMPs under consideration. The BMP tool replaces the dynamic linkage of the distributed parameter watershed model during optimization and therefore reduces the computation time considerably. Total pollutant load from the watershed, and net cost increase from the baseline, were the two objective functions minimized during the optimization process. The optimization model, consisting of a multiobjective genetic algorithm (NSGA-II) in combination with a watershed simulation tool (Soil Water and Assessment Tool (SWAT)), was developed and tested for nonpoint source pollution control in the L'Anguille River watershed located in eastern Arkansas. The optimized solutions provided a trade-off between the two objective functions for sediment, phosphorus, and nitrogen reduction. The results indicated that buffer strips were very effective in controlling the nonpoint source pollutants from leaving the croplands. The optimized BMP plans resulted in potential reductions of 33%, 32%, and 13% in sediment, phosphorus, and nitrogen loads, respectively, from the watershed.

ENGINEERING ECONOMIC ANALYSIS OF A PROGRAM FOR ARTIFICIAL GROUNDWATER RECHARGE.

USGS Publications Warehouse

Reichard, Eric G.; Bredehoeft, John D.

1984-01-01

This study describes and demonstrates two alternate methods for evaluating the relative costs and benefits of artificial groundwater recharge using percolation ponds. The first analysis considers the benefits to be the reduction of pumping lifts and land subsidence; the second considers benefits as the alternative costs of a comparable surface delivery system. Example computations are carried out for an existing artificial recharge program in Santa Clara Valley in California. A computer groundwater model is used to estimate both the average long term and the drought period effects of artificial recharge in the study area. Results indicate that the costs of artificial recharge are considerably smaller than the alternative costs of an equivalent surface system. Refs.

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics.

PubMed

Larson, Trent; Gudavalli, Ravindra; Prater, Dean; Sutton, Scott

2015-04-01

Respiratory inhalers constitute a large percentage of hospital pharmacy expenditures. Metered-dose inhaler (MDI) canisters usually contain enough medication to last 2 to 4 weeks, while the average hospital stay for acute hospitalizations of respiratory illnesses is only 4-5 days. Hospital pharmacies are often unable to operationalize relabeling of inhalers at discharge to meet regulatory requirements. This dilemma produces drug wastage. The common canister (CC) approach is a method some hospitals implemented in an effort to minimize the costs associated with this issue. The CC program uses a shared inhaler, an individual one-way valve holding chamber, and a cleaning protocol. This approach has been the subject of considerable controversy. Proponents of the CC approach reported considerable cost savings to their institutions. Opponents of the CC approach are not convinced the benefits outweigh even a minimal risk of cross-contamination since adherence to protocols for hand washing and disinfection of the MDI device cannot be guaranteed to be 100% (pathogens from contaminated devices can enter the respiratory tract through inhalation). Other cost containment strategies, such as unit dose nebulizers, may be useful to realize similar reductions in pharmacy drug costs while minimizing the risks of nosocomial infections and their associated medical costs. The CC strategy may be appropriate for some hospital pharmacies that face budget constraints, but a full evaluation of the risks, benefits, and potential costs should guide those who make hospital policy decisions.

Evolution of Archival Storage (from Tape to Memory)

NASA Technical Reports Server (NTRS)

Ramapriyan, Hampapuram K.

2015-01-01

Over the last three decades, there has been a significant evolution in storage technologies supporting archival of remote sensing data. This section provides a brief survey of how these technologies have evolved. Three main technologies are considered - tape, hard disk and solid state disk. Their historical evolution is traced, summarizing how reductions in cost have helped being able to store larger volumes of data on faster media. The cost per GB of media is only one of the considerations in determining the best approach to archival storage. Active archives generally require faster response to user requests for data than permanent archives. The archive costs have to consider facilities and other capital costs, operations costs, software licenses, utilities costs, etc. For meeting requirements in any organization, typically a mix of technologies is needed.

Reduction in Costs after Treating Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder.

PubMed

Ikic, Vedrana; Belanger, Claude; Bouchard, Stephane; Gosselin, Patrick; Langlois, Frederic; Labrecque, Joane; Dugas, Michel J; Marchand, Andre

2017-03-01

Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups. At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CADUSD 2,000.48 (SD = USD 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up. Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.

Economic considerations in the use of inhaled anesthetic agents.

PubMed

Golembiewski, Julie

2010-04-15

To describe the components of and factors contributing to the costs of inhaled anesthesia, basis for quantifying and comparing these costs, and practical strategies for performing pharmacoeconomic analyses and reducing the costs of inhaled anesthetic agents. Inhaled anesthesia can be costly, and some of the variable costs, including fresh gas flow rates and vaporizer settings, are potential targets for cost savings. The use of a low fresh gas flow rate maximizes rebreathing of exhaled anesthetic gas and is less costly than a high flow rate, but it provides less control of the level of anesthesia. The minimum alveolar concentration (MAC) hour is a measure that can be used to compare the cost of inhaled anesthetic agents at various fresh gas flow rates. Anesthesia records provide a sense of patterns of inhaled anesthetic agent use, but the amount of detail can be limited. Cost savings have resulted from efforts to reduce the direct costs of inhaled anesthetic agents, but reductions in indirect costs through shortened times to patient recovery and discharge following the judicious use of these agents are more difficult to demonstrate. The patient case mix, fresh gas flow rates typically used during inhaled anesthesia, availability and location of vaporizers, and anesthesia care provider preferences and practices should be taken into consideration in pharmacoeconomic evaluations and recommendations for controlling the costs of inhaled anesthesia. Understanding factors that contribute to the costs of inhaled anesthesia and considering those factors in pharmacoeconomic analyses and recommendations for use of these agents can result in cost savings.

Closing the Loop--Improving Energy Management in Schools. Energy Research Group Report.

ERIC Educational Resources Information Center

Isaacs, Nigel; Donn, Michael

A study of the energy savings potential in New Zealand schools demonstrates that considerable reductions in energy costs can be achieved through energy management. An initial examination of available 1985 light, heat, and water expenditures for 268 secondary schools (84 percent of the secondary schools in New Zealand) is followed by the selection…

Cost-effectiveness of alternative outpatient pelvic inflammatory disease treatment strategies.

PubMed

Smith, Kenneth J; Ness, Roberta B; Wiesenfeld, Harold C; Roberts, Mark S

2007-12-01

Effectiveness differences between outpatient pelvic inflammatory disease (PID) treatment regimens are uncertain, but significant differences in cost exist. To examine the influence of antibiotic costs on PID therapy cost-effectiveness. The authors used a Markov decision model to estimate the cost-effectiveness of recommended antibiotic regimens for PID and performed a value of information analysis to guide future research. Antibiotic costs vary between USD 43 and USD188. Pairwise comparisons, assuming a hypothetical 1% relative risk reduction in PID complications with the more expensive regimen, showed economically reasonable cost-effectiveness ratios. Value of information and sample size considerations support further investigation to detect 10% PID complication rate differences between regimens with >or=USD 50 cost differences. Within the cost range of recommended regimens, use of more expensive antibiotics would be economically reasonable if relatively small decreases in PID complication rates exist. Further investigation of effectiveness differences between regimens is needed.

Economic lot sizing in a production system with random demand

NASA Astrophysics Data System (ADS)

Lee, Shine-Der; Yang, Chin-Ming; Lan, Shu-Chuan

2016-04-01

An extended economic production quantity model that copes with random demand is developed in this paper. A unique feature of the proposed study is the consideration of transient shortage during the production stage, which has not been explicitly analysed in existing literature. The considered costs include set-up cost for the batch production, inventory carrying cost during the production and depletion stages in one replenishment cycle, and shortage cost when demand cannot be satisfied from the shop floor immediately. Based on renewal reward process, a per-unit-time expected cost model is developed and analysed. Under some mild condition, it can be shown that the approximate cost function is convex. Computational experiments have demonstrated that the average reduction in total cost is significant when the proposed lot sizing policy is compared with those with deterministic demand.

Clinical outcomes and incremental costs from a medication adherence pilot intervention targeting low-income patients with diabetes at risk of cost-related medication nonadherence.

PubMed

Ryan, John G; Fedders, Mark; Jennings, Terri; Vittoria, Isabel; Yanes, Melissa

2014-12-01

The extent to which reducing cost-related barriers affects diabetes outcomes and medication adherence among uninsured patients is not known. The purpose of these analyses was to understand the clinical impact and cost considerations of a prescription assistance program targeting low-income, minority patients with diabetes and at high risk for cost-related medication nonadherence. Patients received diabetes medications without copayments for 12 months. Change in diabetes control was calculated by using glycosylated hemoglobin (HbA1c) level at follow-up compared with baseline. Clinical data were collected from the electronic health record. Medication adherence for diabetes medications was estimated by using proportion of days covered (PDC). Incremental acquisition and per-patient costs, based on actual hospital medication costs, were calculated for different baseline HbA1c levels. Patients with baseline HbA1c levels ≥7%, ≥8%, and ≥9% experienced mean HbA1c reductions of 0.82% (P = 0.008), 1.02% (P = 0.010), and 1.47% (P = 0.010), respectively, during the 12-month period. The average PDC was 70.55%; 45.24% had a PDC ≥80%, indicating an adequate level of medication adherence. Medication adherence ≥80% was associated with ethnicity (P = 0.015), whereas mean PDC was associated with number of diabetes medication classes used (P = 0.031). Acquisition cost for 1242 prescriptions filled by 103 patients was $13,365.82, representing per-patient costs of $132.39; however, as baseline targets increased, acquisition costs decreased and per-patient costs increased from $10,682.59 and $169.56 to $6509.91 and $192.27, respectively. Clinically significant reductions in HbA1c levels were achieved for all patients, although greater reductions were achieved with modest per-patient cost increases when considering patients with uncontrolled diabetes. Incorporating a multifactorial intervention to address cost-related medication nonadherence with a behavior change component may yield greater reductions in HbA1c with improved diabetes outcomes and meaningful hospital-based cost savings. Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.

Radiation Hardness Assurance (RHA): Challenges and New Considerations

NASA Technical Reports Server (NTRS)

Campola, Michael J.

2017-01-01

Radiation Hardness Assurance (RHA) challenges associated with the use of commercial-off-the-shelf (COTS) components and emerging technologies are cause for risk acceptance in space flight missions. The RHA flow includes environment definition, hazard evaluation, requirements definition, evaluation of design, and design trades to accommodate the risk a project or program takes. The varied missions profiles and environments don't necessarily benefit from the same risk reduction efforts or cost reduction attempts. The level of effort within the RHA flow can be tailored to minimize risk based on the environment or design criticality.

Concepts for Distributed Engine Control

NASA Technical Reports Server (NTRS)

Culley, Dennis E.; Thomas, Randy; Saus, Joseph

2007-01-01

Gas turbine engines for aero-propulsion systems are found to be highly optimized machines after over 70 years of development. Still, additional performance improvements are sought while reduction in the overall cost is increasingly a driving factor. Control systems play a vitally important part in these metrics but are severely constrained by the operating environment and the consequences of system failure. The considerable challenges facing future engine control system design have been investigated. A preliminary analysis has been conducted of the potential benefits of distributed control architecture when applied to aero-engines. In particular, reductions in size, weight, and cost of the control system are possible. NASA is conducting research to further explore these benefits, with emphasis on the particular benefits enabled by high temperature electronics and an open-systems approach to standardized communications interfaces.

Spacelab user interaction

NASA Technical Reports Server (NTRS)

1975-01-01

The results of the third and final phase of a study undertaken to define means of optimizing the Spacelab experiment data system by interactively manipulating the flow of data were presented. A number of payload applicable interactive techniques and an integrated interaction system for each of two possible payloads are described. These interaction systems have been functionally defined and are accompanied with block diagrams, hardware specifications, software sizing and speed requirements, operational procedures and cost/benefits analysis data for both onboard and ground based system elements. It is shown that accrued benefits are attributable to a reduction in data processing costs obtained by, generally, a considerable reduction in the quantity of data that might otherwise be generated without interaction. One other additional anticipated benefit includes the increased scientific value obtained by the quicker return of all useful data.

Purchasing factor concentrates in the 21st century through competitive tendering.

PubMed

Hay, C R M

2013-09-01

The increasing intensity of treatment, the widespread adoption of factor VIII and IX prophylaxis and increasing usage over the past decade have led to haemophilia becoming an almost uniquely expensive condition to treat. The average adult with severe haemophilia A in the UK used 250,000 IU of factor VIII in 2011/2012, at a cost in excess of £ 100,000 p.a. The cost to the end-user may be considerably higher than this for some US patients supplied by home care companies with high on-costs. This has led to a high level of administrative scrutiny of treatment and an imperative to procure clotting factor concentrates more efficiently and collectively. National procurement schemes have run successfully in various countries and will become commoner. The UK system of procurement is described. This system, following EU procurement rules, evaluated products technically and by price. The price of bioequivalent products was determined by reverse e-auction. Considerable cost reductions were achieved whilst retaining all suppliers and maintaining a degree of prescribing freedom. Elements of this system could be more widely applied. © 2013 John Wiley & Sons Ltd.

High-Speed, High-Temperature Finger Seal Test Evaluated

NASA Technical Reports Server (NTRS)

Proctor, Margaret P.

2003-01-01

A finger seal, designed and fabricated by Honeywell Engines, Systems and Services, was tested at the NASA Glenn Research Center at surface speeds up to 1200 ft/s, air temperatures up to 1200 F, and pressures across the seal of 75 psid. These are the first test results obtained with NASA s new High-Temperature, High-Speed Turbine Seal Test Rig (see the photograph). The finger seal is an innovative design recently patented by AlliedSignal Engines, which has demonstrated considerably lower leakage than commonly used labyrinth seals and is considerably cheaper than brush seals. The cost to produce finger seals is estimated to be about half of the cost to produce brush seals. Replacing labyrinth seals with fingers seals at locations that have high-pressure drops in gas turbine engines, typically main engine and thrust seals, can reduce air leakage at each location by 50 percent or more. This directly results in a 0.7- to 1.4-percent reduction in specific fuel consumption and a 0.35- to 0.7-percent reduction in direct operating costs . Because the finger seal is a contacting seal, this testing was conducted to address concerns about its heat generation and life capability at the higher speeds and temperatures required for advanced engines. The test results showed that the seal leakage and wear performance are acceptable for advanced engines.

ACCOMPLISHMENTS OF THE AMERICAN-POLISH PROGRAM FOR ELIMINATION OF LOW EMISSIONS IN KRAKOW

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

BUTCHER,T.A.; PIERCE,B.

1998-11-05

In 1991, US and Polish officials signed a Memorandum of Understanding formally initiating and directing the Cracow Clean Fossil Fuels and Energy Efficiency Program. Developing a program approach for the most effective use of the available funds required considerable effort on the part of all project participants. The team recognized early that the cost of solving the low emissions problem even in only one city far exceeded the amount of available US funds. Economic conditions in Poland limited availability of local capital funds for environmental projects. Imposing environmental costs on struggling companies or city residents under difficult conditions of themore » early 1990's required careful consideration of the economic and political impacts. For all of these reasons the program sought to identify technologies for achieving air quality goals which, through improved efficiency and/or reduced fuel cost, could be so attractive economically as to lead to self-sustaining activities beyond the end of the formal project. The effort under this program has been focused into 5 main areas of interest as follows: (1) Energy Conservation and Extension of Central Station District Heating; (2) Replacement of Coal- and Coke-Fired Boilers with Natural Gas-Fired Boilers; (3) Replacement of Coal-Fired Home Stoves with Electric Heating Appliances; (4) Reduction of Emissions from Stoker-Fired Boiler Houses; and (5) Reduction of Emissions from Coal-Fired Home Heating Stoves.« less

Review of Mitigation Costs for Stabilizing Greenhouse Gas Concentrations

NASA Astrophysics Data System (ADS)

van Ruijven, B. J.; O'Neill, B. C.

2014-12-01

Mitigation of greenhouse gas emissions to avoid future climate change comes at a cost, because low-emission technologies are more expensive than GHG-emitting technology options. The increase in mitigation cost is not linearly related to the stabilization level, though: the first emission reductions are relatively cheap, but deeper emission reductions become more expensive. Therefore, emission reduction to medium levels of GHG concentrations , such as 4.5 or 6 W/m2, is considerably cheaper than emission reduction to low levels of GHG concentrations, such as 2.6 or 3.7 W/m2. Moreover, mitigation costs are influenced by many other aspects than the targeted mitigation level alone, such as whether or not certain technologies are available or societally acceptable (Kriegler et al., 2014); the rate of technological progress and cost reduction of low-emission technologies; the level of final energy demand (Riahi et al., 2011), and the level of global cooperation and trade in emission allowances (den Elzen and Höhne, 2010). This paper reviews the existing literature on greenhouse gas mitigation costs. We analyze the available data on mitigation costs and draw conclusions on how these change for different stabilization levels of GHG concentrations. We will take into account the aspects of technology, energy demand, and cooperation in distinguishing differences between scenarios and stabilization levels. References: den Elzen, M., Höhne, N., 2010. Sharing the reduction effort to limit global warming to 2C. Climate Policy 10, 247-260. Kriegler, E., Weyant, J., Blanford, G., Krey, V., Clarke, L., Edmonds, J., Fawcett, A., Luderer, G., Riahi, K., Richels, R., Rose, S., Tavoni, M., Vuuren, D., 2014. The role of technology for achieving climate policy objectives: overview of the EMF 27 study on global technology and climate policy strategies. Climatic Change, 1-15. Riahi, K., Dentener, F., Gielen, D., Grubler, A., Jewell, J., Klimont, Z., Krey, V., McCollum, D., Pachauri, S., Rao, S., van Ruijven, B., van Vuuren, D.P., Wilson, C., 2011. Energy Pathways for Sustainable Development, The Global Energy Assessment: Toward a More Sustainable Future. IIASA, Laxenburg, Austria and Cambridge University Press, Cambridge, UK.

Dietary fibre intakes and reduction in functional constipation rates among Canadian adults: a cost-of-illness analysis

PubMed Central

Abdullah, Mohammad M. H.; Gyles, Collin L.; Marinangeli, Christopher P. F.; Carlberg, Jared G.; Jones, Peter J. H.

2015-01-01

Background Evidence-based research highlights beneficial impacts of dietary fibre on several aspects of the gut pathophysiology that are accompanied by a considerable financial burden in healthcare services. Recommended intakes of dietary fibre may thus associate with financial benefits at a population level. Objective We sought to systematically assess the potential annual savings in healthcare costs that would follow the reduction in rates of functional constipation and irregularity with increased dietary fibre intakes among Canadian adults. Design A cost-of-illness analysis was developed on the basis of current and recommended levels of fibre intake in Canada, constipation reduction per 1 g fibre intake, proportion of adults who are likely to consume fibre-rich diets, and population expected to respond to fibre intake. Sensitivity analyses covering a range of assumptions were further implemented within the economic simulation. Results Our literature searches assumed a 1.8% reduction in constipation rates with each 1 g/day increase in fibre intake. With intakes corresponding to the Institute of Medicine's adequate levels of 38 g/day for men and 25 g/day for women, among 5 and 100% of the adult populations, anywhere between CAD$1.5 and CAD$31.9 million could be saved on constipation-related healthcare costs annually. Each 1 g/day increase in dietary fibre was estimated to result in total annual healthcare cost savings that ranged between CAD$0.1 and CAD$2.5 million. Conclusions The present research suggests an economic value of increasing dietary fibre intake beyond its well-known health benefits. Healthy-eating behaviours consistent with the recommended intakes of dietary fibre by the general public should hence be advocated as a practical approach for reducing costs associated with the management of constipation in Canada. PMID:26652739

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

PubMed Central

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2015-01-01

Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID:26294218

Hydrogen energy systems studies. Final technical report

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

Ogden, J.M.; Kreutz, T.; Kartha, S.

1996-08-13

The results of previous studies suggest that the use of hydrogen from natural gas might be an important first step toward a hydrogen economy based on renewables. Because of infrastructure considerations (the difficulty and cost of storing, transmitting and distributing hydrogen), hydrogen produced from natural gas at the end-user`s site could be a key feature in the early development of hydrogen energy systems. In the first chapter of this report, the authors assess the technical and economic prospects for small scale technologies for producing hydrogen from natural gas (steam reformers, autothermal reformers and partial oxidation systems), addressing the following questions:more » (1) What are the performance, cost and emissions of small scale steam reformer technology now on the market? How does this compare to partial oxidation and autothermal systems? (2) How do the performance and cost of reformer technologies depend on scale? What critical technologies limit cost and performance of small scale hydrogen production systems? What are the prospects for potential cost reductions and performance improvements as these technologies advance? (3) How would reductions in the reformer capital cost impact the delivered cost of hydrogen transportation fuel? In the second chapter of this report the authors estimate the potential demand for hydrogen transportation fuel in Southern California.« less

Treatment cost of patients with maxillofacial fractures at the University Hospital in Mostar 2002-2006.

PubMed

Jurić, Mario; Novakovic, Josip; Carapina, Mirela; Kneiević, Ervin

2010-03-01

The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.

Kinky thresholds revisited: opportunity costs differ in the NE and SW quadrants.

PubMed

Eckermann, Simon

2015-02-01

Historically, a kinked threshold line on the cost-effectiveness plane at the origin was suggested due to differences in willingness to pay (WTP) for health gain with trade-offs in the north-east (NE) quadrant versus willingness to accept (WTA) cost reductions for health loss with trade-offs in the south-west (SW) quadrant. Empirically, WTA is greater than WTP for equivalent units of health, a finding supported by loss aversion under prospect theory. More recently, appropriate threshold values for health effects have been shown to require an endogenous consideration of the opportunity cost of alternative actions in budget-constrained health systems, but also allocative and displacement inefficiency observed in health system practice. Allocative and displacement inefficiency arise in health systems where the least cost-effective program in contraction has a higher incremental cost-effectiveness ratio (ICER = m) than the most cost-effective program in expansion (ICER = n) and displaced services (ICER = d), respectively. The health shadow price derived by Pekarsky, [Formula: see text] reflects the opportunity cost of best alternative adoption and financing actions in reimbursing new technology with expected incremental costs and net effect allowing for allocative (n < m), and displacement, inefficiency (d < m). This provides an appropriate threshold value for the NE quadrant. In this paper, I show that for trade-offs in the SW quadrant, where new strategies have lower expected net cost while lower expected net effect than current practice, the opportunity cost is contraction of the least cost-effective program, with threshold ICER m. That is, in the SW quadrant, the cost reduction per unit of decreased effect should be compared with the appropriate opportunity cost, best alternative generation of funding. Consequently, appropriate consideration of opportunity cost produces a kink in the threshold at the origin, with the health shadow price in the NE quadrant and ICER of the least cost-effective program in contraction (m) in the SW quadrant having the same general shape as that previously suggested by WTP versus WTA. The extent of this kink depends on the degree of allocative and displacement inefficiency, with no kink in the threshold line strictly only appropriate with complete allocative and displacement efficiency, that is n = d = m.

A 200-kW wind turbine generator conceptual design study

NASA Technical Reports Server (NTRS)

1979-01-01

A conceptual design study was conducted to define a 200 kW wind turbine power system configuration for remote applications. The goal was to attain an energy cost of 1 to 2 cents per kilowatt-hour at a 14-mph site (mean average wind velocity at an altitude of 30 ft.) The costs of the Clayton, New Mexico, Mod-OA (200-kW) were used to identify the components, subsystems, and other factors that were high in cost and thus candidates for cost reduction. Efforts devoted to developing component and subsystem concepts and ideas resulted in a machine concept that is considerably simpler, lighter in weight, and lower in cost than the present Mod-OA wind turbines. In this report are described the various innovations that contributed to the lower cost and lighter weight design as well as the method used to calculate the cost of energy.

Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial.

PubMed

Burdette, Todd E; Kerrigan, Carolyn L; Homa, Karen; Homa, Karen A

2011-10-01

The authors hypothesized that the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio) might outperform electrocautery in bilateral breast reduction surgery, possibly resulting in (1) shorter operative times, (2) lower postoperative fluid drainage rates, and (3) reduced postoperative pain scores. Thirty-one patients were evaluated in a matched-pair design, with random (blinded) assignment of one side to the Harmonic Scalpel, with the other side defaulting to electrocautery. Main outcome measures were: (1) resection/hemostasis time, (2) drainage volume, and (3) postoperative pain. The authors also compared the learning curves, operative time versus specimen weights, complications, and costs for the devices. There was a statistically significant (but not clinically significant) difference between the median times for the Harmonic Scalpel (33 minutes) and electrocautery (31 minutes) (p=0.02). There was no statistical difference in drainage scores, and pain scores were equivalent. The analysis of specimen weight versus resection/hemostasis time showed no correlation. There were more complications on the breasts reduced with the Harmonic device, but due to the small sample size, the complication results were not statistically significant. Start-up costs for the devices were comparable, but the per-procedure cost for the Harmonic device was considerably higher. The Harmonic Scalpel is roughly equivalent to electrocautery in breast reduction surgery in terms of resection/hemostasis time, serous drainage, and postoperative pain. Though the Harmonic device may be excellent for other surgical procedures, its high cost suggests that surgeons and institutions can confidently forgo its use in breast reduction surgery. Therapeutic, II.

Measures for the reduction of sinter formations in tunnels

NASA Astrophysics Data System (ADS)

Harer, Gerhard

2017-09-01

A considerable part of the maintenance costs of tunnel structures is related to the inspection, maintenance and repair of the drainage system. The drainage system of tunnels is frequently clogged with Calcium precipitates. Cleaning and water conditioning are costintensive for operating companies. Apart from the direct costs associated with inspection, maintenance and repair works of the drainage system indirect costs are generated, such as by the blocking of the tunnel while inspection, maintenance or repair or by the reduction of the permitted operation speed. Sintering and clogging of the drainage systems is mainly caused by dissolution of cement minerals in concrete and mortar and/or by inadequate design and construction of the drainage system and/or grubby workmanship. With long-term studies and in-situ experiments in Austria traffic tunnels the specific input factors for sinter mechanism have been identified and appropriate counter measures could be defined. In particular modified mix designs for shotcretes and mortars have proven to bring a significant beneficial effect. By means of constructional measures and by the application of hardness stabilizers a further reduction of hard deposits inside the drainage system is achievable. The paper will deal with the specific aspects and will propose adequate counter measures.

Reducing surface water pollution through the assessment of the cost-effectiveness of BMPs at different spatial scales.

PubMed

Panagopoulos, Y; Makropoulos, C; Mimikou, M

2011-10-01

Two kinds of agricultural Best Management Practices (BMPs) were examined with respect to cost-effectiveness (CE) in reducing sediment, nitrates-nitrogen (NO(3)-N) and total phosphorus (TP) losses to surface waters of the Arachtos catchment in Western Greece. The establishment of filter strips at the edge of fields and a non-structural measure, namely fertilization reduction in alfalfa, combined with contour farming and zero-tillage in corn and reduction of animal numbers in pastureland, were evaluated. The Soil and Water Assessment Tool (SWAT) model was used as the non-point-source (NPS) estimator, while a simple economic component was developed estimating BMP implementation cost as the mean annual expenses needed to undertake and operate the practice for a 5-year period. After each BMP implementation, the ratio of their CE in reducing pollution was calculated for each Hydrologic Response Unit (HRU) separately, for each agricultural land use type entirely and for the whole catchment. The results at the HRU scale are presented comprehensively on a map, demonstrating the spatial differentiation of CE ratios across the catchment that enhances the identification of locations where each BMP is most advisable for implementation. Based on the analysis, a catchment management solution of affordable total cost would include the expensive measure of filter strips in corn and only in a small number of pastureland fields, in combination with the profitable measure of reducing fertilization to alfalfa fields. When examined for its impact on river loads at the outlet, the latter measure led to a 20 tn or 8% annual decrease of TP from the baseline with savings of 15€/kg of pollutant reduction. Filter strips in corn fields reduced annual sediments by 66 Ktn or 5%, NO(3)-N by 71 tn or 9.5% and TP by 27 tn or 10%, with an additional cost of 3.1 €/tn, 3.3 €/kg and 8.1 €/kg of each pollutant respectively. The study concludes that considerable reductions of several pollutant types at the same time can be achieved, even at low total cost, by combining targeted BMP implementation strategies only in small parts of the catchment, also enabling policy makers to take local socio-economic constraints into consideration. The methodology and the results presented aim to facilitate decision making for a cost-effective management of diffuse pollution by enabling modelers and researchers to make rapid and reliable BMP cost estimations and thus being able to calculate their CE at the local level in order to identify the most suitable areas for their implementation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pharmacoeconomics of inhaled anesthetic agents: considerations for the pharmacist.

PubMed

Chernin, Eric L

2004-10-15

Types of economic analyses used for inhaled anesthetic agents, factors to consider in calculating the cost of inhaled anesthetics, limitations of pharmacoeconomic studies of these agents, and strategies for controlling inhaled anesthetic costs are discussed. Inhaled anesthetic agents comprise a substantial component of drug budgets. Calculation of the cost of administering an inhaled anesthetic should take into consideration the cost per mL, potency, waste, concentration and duration of gas delivery, fresh gas flow rate, molecular weight, and density. The use of newer inhaled anesthetic agents with low solubility in blood and tissue provides a more rapid recovery from anesthesia than older, more soluble agents, and also provides the same level of control of depth of anesthesia at a lower fresh gas flow rate and possibly a lower cost than older agents at a higher fresh gas flow rate. A more rapid recovery may facilitate fast-track recovery and yield cost savings if it allows the completion of additional surgical cases or allows a reduction in personnel overtime expenses. Interpretation of pharmacoeconomic studies of inhaled anesthetics requires an appreciation of the limitations in methodology and ability to extrapolate results from one setting to another. Pharmacists' efforts to reduce anesthetic waste and collaborate with anesthesiologists to improve the use of these agents can help contain costs, but improving scheduling and efficiency in the operating room has a greater potential to reduce operating room costs. Much can be done to control costs of anesthetic agents without compromising availability of these agents and patient care.

Modal cost analysis for simple continua

NASA Technical Reports Server (NTRS)

Hu, A.; Skelton, R. E.; Yang, T. Y.

1988-01-01

The most popular finite element codes are based upon appealing theories of convergence of modal frequencies. For example, the popularity of cubic elements for beam-like structures is due to the rapid convergence of modal frequencies and stiffness properties. However, for those problems in which the primary consideration is the accuracy of response of the structure at specified locations, it is more important to obtain accuracy in the modal costs than in the modal frequencies. The modal cost represents the contribution of a mode in the norm of the response vector. This paper provides a complete modal cost analysis for simple continua such as beam-like structures. Upper bounds are developed for mode truncation errors in the model reduction process and modal cost analysis dictates which modes to retain in order to reduce the model for control design purposes.

A simulation model to estimate cost-offsets for a disease-management program for chronic kidney disease.

PubMed

Gandjour, Afschin; Tschulena, Ulrich; Steppan, Sonja; Gatti, Emanuele

2015-04-01

The aim of this paper is to develop a simulation model that analyzes cost-offsets of a hypothetical disease management program (DMP) for patients with chronic kidney disease (CKD) in Germany compared to no such program. A lifetime Markov model with simulated 65-year-old patients with CKD was developed using published data on costs and health status and simulating the progression to end-stage renal disease (ESRD), cardiovascular disease and death. A statutory health insurance perspective was adopted. This modeling study shows considerable potential for cost-offsets from a DMP for patients with CKD. The potential for cost-offsets increases with relative risk reduction by the DMP and baseline glomerular filtration rate. Results are most sensitive to the cost of dialysis treatment. This paper presents a general 'prototype' simulation model for the prevention of ESRD. The model allows for further modification and adaptation in future applications.

Evaluating the financial efficiency of energy and water saving installations in passive house

NASA Astrophysics Data System (ADS)

Stec, Agnieszka; Mazur, Aleksandra; Słyś, Daniel

2017-11-01

The article contains the outcomes of the Life Cycle Cost analysis for alternative energy and water sources utilized in passive buildings. The solutions taken into account included: heat pumps, solar collectors, photovoltaic panels, Drain Water Heat Recovery units, Rain Water Harvesting Systems and Greywater Recycling Systems. In addition, air pollution emission reduction was also calculated for all the installation variants analyzed. The analysis have shown that the systems under consideration could serve as alternatives for traditional installations. Their use has resulted in reductions in the consumption of fossil fuels and natural water resources, thus contributing to environmental improvements.

Pricing effects on food choices.

PubMed

French, Simone A

2003-03-01

Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.

Modeling and control of beam-like structures

NASA Technical Reports Server (NTRS)

Hu, A.; Skelton, R. E.; Yang, T. Y.

1987-01-01

The most popular finite element codes are based upon appealing theories of convergence of modal frequencies. For example, the popularity of cubic elements for beam-like structures is due to the rapid convergence of modal frequencies and stiffness properties. However, for those problems in which the primary consideration is the accuracy of response of the structure at specified locations it is more important to obtain accuracy in the modal costs than in the modal frequencies. The modal cost represents the contribution of a mode in the norm of the response vector. This paper provides a complete modal cost analysis for beam-like continua. Upper bounds are developed for mode truncation errors in the model reduction process and modal cost analysis dictates which modes to retain in order to reduce the model for control design purposes.

Optical phased array configuration for an extremely large telescope.

PubMed

Meinel, Aden Baker; Meinel, Marjorie Pettit

2004-01-20

Extremely large telescopes are currently under consideration by several groups in several countries. Extrapolation of current technology up to 30 m indicates a cost of over dollars 1 billion. Innovative concepts are being explored to find significant cost reductions. We explore the concept of an Optical Phased Array (OPA) telescope. Each element of the OPA is a separate Cassegrain telescope. Collimated beams from the array are sent via an associated set of delay lines to a central beam combiner. This array of small telescope elements offers the possibility of starting with a low-cost array of a few rings of elements, adding structure and additional Cass elements until the desired diameter telescope is attained. We address the salient features of such an extremely large telescope and cost elements relative to more conventional options.

A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking

PubMed Central

Malcolm, Philippe; Derave, Wim; Galle, Samuel; De Clercq, Dirk

2013-01-01

Background Even though walking can be sustained for great distances, considerable energy is required for plantarflexion around the instant of opposite leg heel contact. Different groups attempted to reduce metabolic cost with exoskeletons but none could achieve a reduction beyond the level of walking without exoskeleton, possibly because there is no consensus on the optimal actuation timing. The main research question of our study was whether it is possible to obtain a higher reduction in metabolic cost by tuning the actuation timing. Methodology/Principal Findings We measured metabolic cost by means of respiratory gas analysis. Test subjects walked with a simple pneumatic exoskeleton that assists plantarflexion with different actuation timings. We found that the exoskeleton can reduce metabolic cost by 0.18±0.06 W kg−1 or 6±2% (standard error of the mean) (p = 0.019) below the cost of walking without exoskeleton if actuation starts just before opposite leg heel contact. Conclusions/Significance The optimum timing that we found concurs with the prediction from a mathematical model of walking. While the present exoskeleton was not ambulant, measurements of joint kinetics reveal that the required power could be recycled from knee extension deceleration work that occurs naturally during walking. This demonstrates that it is theoretically possible to build future ambulant exoskeletons that reduce metabolic cost, without power supply restrictions. PMID:23418524

The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies.

PubMed

Jensen, Henning Tarp; Keogh-Brown, Marcus R; Smith, Richard D; Chalabi, Zaid; Dangour, Alan D; Davies, Mike; Edwards, Phil; Garnett, Tara; Givoni, Moshe; Griffiths, Ulla; Hamilton, Ian; Jarrett, James; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Haines, Andy

We employ a single-country dynamically-recursive Computable General Equilibrium model to make health-focussed macroeconomic assessments of three contingent UK Greenhouse Gas (GHG) mitigation strategies, designed to achieve 2030 emission targets as suggested by the UK Committee on Climate Change. In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures are included; our household energy efficiency strategy is likely to breakeven only over the long term after the investment programme has ceased (beyond our 20 year time horizon). We conclude that UK policy makers will, most likely, have to adopt elements which involve initial net societal costs in order to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote internalization of externalities. Health co-benefits can play a crucial role in bringing down net costs, but our results also suggest the need for adopting holistic assessment methodologies which give proper consideration to welfare-improving health co-benefits with potentially negative economic repercussions (such as increased longevity).

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

PubMed

Wonderling, D; McDermott, C; Buxton, M; Kinmonth, A L; Pyke, S; Thompson, S; Wood, D

1996-05-18

To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. 13 general practices across Britain. 4185 men aged 40-59 and their 2827 partners. Nurse led programme using a family centered approach, with follow up according to degree of risk. Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women.

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

PubMed Central

Wonderling, D.; McDermott, C.; Buxton, M.; Kinmonth, A. L.; Pyke, S.; Thompson, S.; Wood, D.

1996-01-01

OBJECTIVE--To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. DESIGN--Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. SETTING--13 general practices across Britain. SUBJECTS--4185 men aged 40-59 and their 2827 partners. INTERVENTION--Nurse led programme using a family centered approach, with follow up according to degree of risk. MAIN OUTCOME MEASURES--Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. RESULTS--Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). CONCLUSIONS--The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women. PMID:8634617

Reduction of radiation dose and imaging costs in scoliosis radiography. Application of large-screen image intensifier photofluorography

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

Manninen, H.; Kiekara, O.; Soimakallio, S.

1988-04-01

Photofluorography using a large-field image intensifier (Siemens Optilux 57) was applied to scoliosis radiography and compared with a full-size rare-earth screen/film technique. When scoliosis radiography (PA-projection) was performed on 25 adolescent patients, the photofluorographs were found to be of comparable diagnostic quality with full-size films. A close correspondence between the imaging techniques was found in the Cobb angle measurements as well as in the grading of rotation with the pedicle method. The use of photofluorography results in a radiation dose reduction of about one-half and considerable savings in direct imaging costs and archive space. In our opinion the method ismore » particularly well-suited for follow-up and screening evaluation of scoliosis, but in tall patients the image field size of 40 x 40 cm restricts its usefulness as initial examination.« less

Structure/Property Relationships of Cyanate Ester Resins from Renewable Sources

DTIC Science & Technology

2013-04-11

derived from lignin . These materials possess favorable thermal and water uptake properties with dry glass transition temperatures above 200°C and wet...distribution is unlimited. Creosol as a Monomer Source 7 • Input material cost is an important consideration for cyanate ester resins • Lignin is...from lignin • Oxidative and reductive coupling reactions lead to precursor phenols, which are then treated with cyanogen bromide to generate cyanate

Cost-effectiveness of standard vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)-guided prostate biopsy prophylaxis.

PubMed

Adibi, Mehrad; Pearle, Margaret S; Lotan, Yair

2012-07-01

Multiple studies have shown an increase in the hospital admission rates due to infectious complications after transrectal ultrasonography (TRUS)-guided prostate biopsy (TRUSBx), mostly related to a rise in the prevalence of fluoroquinolone-resistant organisms. As a result, multiple series have advocated the use of more intensive prophylactic antibiotic regimens to augment the effect of the widely used fluoroquinolone prophylaxis for TRUSBx. The present study compares the cost-effectiveness fluoroquinolone prophylaxis to more intensive prophylactic antibiotic regimens, which is an important consideration for any antibiotic regimen used on a wide-scale for TRUSBx prophylaxis. To compare the cost-effectiveness of fluoroquinolones vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)-guided prostate biopsy (TRUSBx) prophylaxis. Risk of hospital admission for infectious complications after TRUSBx was determined from published data. The average cost of hospital admission due to post-biopsy infection was determined from patients admitted to our University hospital ≤1 week of TRUSBx. A decision tree analysis was created to compare cost-effectiveness of standard vs intensive antibiotic prophylactic regimens based on varying risk of infection, cost, and effectiveness of the intensive antibiotic regimen. Baseline assumption included cost of TRUSBx ($559), admission rate (1%), average cost of admission ($5900) and cost of standard and intensive antibiotic regimens of $1 and $33, respectively. Assuming a 50% risk reduction in admission rates with intensive antibiotics, the standard regimen was slightly less costly with average cost of $619 vs $622, but was associated with twice as many infections. Sensitivity analyses found that a 1.1% risk of admission for quinolone-resistant infections or a 54% risk reduction attributed to the more intensive antibiotic regimen will result in cost-equivalence for the two regimens. Three-way sensitivity analyses showed that small increases in probability of admission using the standard antibiotics or greater risk reduction using the intensive regimen result in the intensive prophylactic regimen becoming substantially more cost-effectiveness even at higher costs. As the risk of admission for infectious complications due to TRUSBx increases, use of an intensive prophylactic antibiotic regimen becomes significantly more cost-effective than current standard antibiotic prophylaxis. © 2011 BJU INTERNATIONAL.

Harvesting forest biomass for energy in Minnesota: An assessment of guidelines, costs and logistics

NASA Astrophysics Data System (ADS)

Saleh, Dalia El Sayed Abbas Mohamed

The emerging market for renewable energy in Minnesota has generated a growing interest in utilizing more forest biomass for energy. However, this growing interest is paralleled with limited knowledge of the environmental impacts and cost effectiveness of utilizing this resource. To address environmental and economic viability concerns, this dissertation has addressed three areas related to biomass harvest: First, existing biomass harvesting guidelines and sustainability considerations are examined. Second, the potential contribution of biomass energy production to reduce the costs of hazardous fuel reduction treatments in these trials is assessed. Third, the logistics of biomass production trials are analyzed. Findings show that: (1) Existing forest related guidelines are not sufficient to allow large-scale production of biomass energy from forest residue sustainably. Biomass energy guidelines need to be based on scientific assessments of how repeated and large scale biomass production is going to affect soil, water and habitat values, in an integrated and individual manner over time. Furthermore, such guidelines would need to recommend production logistics (planning, implementation, and coordination of operations) necessary for a potential supply with the least site and environmental impacts. (2) The costs of biomass production trials were assessed and compared with conventional treatment costs. In these trials, conventional mechanical treatment costs were lower than biomass energy production costs less income from biomass sale. However, a sensitivity analysis indicated that costs reductions are possible under certain site, prescriptions and distance conditions. (3) Semi-structured interviews with forest machine operators indicate that existing fuel reduction prescriptions need to be more realistic in making recommendations that can overcome operational barriers (technical and physical) and planning and coordination concerns (guidelines and communications) identified by machine operators, and which are necessary for a viable biomass energy production system. The results of this dissertation suggest that once biomass energy production is intended, incorporating an early understanding of production logistics while developing environmentally sensitive guidelines and site-specific prescriptions can improve biomass energy production, costs, performance and sustainability.

Energy efficient engine: Flight propulsion system, preliminary analysis and design update

NASA Technical Reports Server (NTRS)

Stearns, E. M.

1982-01-01

The preliminary design of General Electric's Energy Efficient Engine (E3) was reported in detail in 1980. Since then, the design has been refined and the components have been rig-tested. The changes which have occurred in the engine and a reassessment of the economic payoff are presented in this report. All goals for efficiency, environmental considerations, and economic payoff are being met. The E3 Flight Propulsion System has 14.9% lower sfc than a CF6-50C. It provides a 7.1% reduction in direct operating cost for a short haul domestic transport and 14.5% reduction for an international long distance transport.

Using probabilistic terrorism risk modeling for regulatory benefit-cost analysis: application to the Western hemisphere travel initiative in the land environment.

PubMed

Willis, Henry H; LaTourrette, Tom

2008-04-01

This article presents a framework for using probabilistic terrorism risk modeling in regulatory analysis. We demonstrate the framework with an example application involving a regulation under consideration, the Western Hemisphere Travel Initiative for the Land Environment, (WHTI-L). First, we estimate annualized loss from terrorist attacks with the Risk Management Solutions (RMS) Probabilistic Terrorism Model. We then estimate the critical risk reduction, which is the risk-reducing effectiveness of WHTI-L needed for its benefit, in terms of reduced terrorism loss in the United States, to exceed its cost. Our analysis indicates that the critical risk reduction depends strongly not only on uncertainties in the terrorism risk level, but also on uncertainty in the cost of regulation and how casualties are monetized. For a terrorism risk level based on the RMS standard risk estimate, the baseline regulatory cost estimate for WHTI-L, and a range of casualty cost estimates based on the willingness-to-pay approach, our estimate for the expected annualized loss from terrorism ranges from $2.7 billion to $5.2 billion. For this range in annualized loss, the critical risk reduction for WHTI-L ranges from 7% to 13%. Basing results on a lower risk level that results in halving the annualized terrorism loss would double the critical risk reduction (14-26%), and basing the results on a higher risk level that results in a doubling of the annualized terrorism loss would cut the critical risk reduction in half (3.5-6.6%). Ideally, decisions about terrorism security regulations and policies would be informed by true benefit-cost analyses in which the estimated benefits are compared to costs. Such analyses for terrorism security efforts face substantial impediments stemming from the great uncertainty in the terrorist threat and the very low recurrence interval for large attacks. Several approaches can be used to estimate how a terrorism security program or regulation reduces the distribution of risks it is intended to manage. But, continued research to develop additional tools and data is necessary to support application of these approaches. These include refinement of models and simulations, engagement of subject matter experts, implementation of program evaluation, and estimating the costs of casualties from terrorism events.

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

Cossu, R.; Masi, S., E-mail: salvatore.masi@unibas.it

Highlights: • We focused on the dynamics the formation of operational costs of waste management. • We provide the basic elements to compose a picture of economic management. • We present a reflection on the last hidden costs associated with the consumption of goods and packaging. • Reduction of waste production. - Abstract: This paper focuses on the dynamics the formation of operational costs of waste management in Italy and the effect of economic measures. Currently incentives and penalties have been internalized by the system no differently from other cost items and revenues. This has greatly influenced the system directingmore » it towards solutions that are often distant from the real environmental objectives. Based on an analysis of disaggregated costs of collection treatment and recovery, we provide the basic elements to compose a picture of economic management in various technical–organizational scenarios. In the light of the considerations contained in the paper it is proposed, e.g. for controlled landfills, that the ecotax, currently based on weight, could be replaced by one based on the volume consumption. Likewise, for tax reduction on disposal system, instead a pre-treatment might ask an environmental balance of the overall system. The article presents a reflection on the last hidden costs associated with the consumption of goods and packaging, and how to reduce waste production is the necessary path to be followed in ecological and economic perspectives.« less

Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model

PubMed Central

2014-01-01

Background Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. Methods Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose–response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. Results The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. Conclusions Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes. PMID:24739472

Performance Prediction and Validation: Data, Frameworks, and Considerations

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

Tinnesand, Heidi

2017-05-19

Improving the predictability and reliability of wind power generation and operations will reduce costs and potentially establish a framework to attract new capital into the distributed wind sector, a key cost reduction requirement highlighted in results from the distributed wind future market assessment conducted with dWind. Quantifying and refining the accuracy of project performance estimates will also directly address several of the key challenges identified by industry stakeholders in 2015 as part of the distributed wind resource assessment workshop and be cross-cutting for several other facets of the distributed wind portfolio. This presentation covers the efforts undertaken in 2016 tomore » address these topics.« less

Oral ciprofloxacin: a pharmacoeconomic evaluation of its use in the treatment of serious infections.

PubMed

Balfour, J A; Faulds, D

1993-05-01

The broad spectrum of antibacterial activity and favourable pharmacokinetic profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard parenteral therapies (usually aminoglycoside/beta-lactam combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissue, and bones and joints. Oral ciprofloxacin is considerably less expensive than most parenteral therapies, does not necessitate therapeutic drug monitoring and can be administered on an outpatient basis. In addition, administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxacin for parenteral therapy in the treatment of serious infections can achieve considerable savings in drug acquisition costs, and labour and supplies associated with parenteral drug administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various parenteral agents, from the beginning of treatment, or after 3 days' parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for parenteral therapy in the treatment of serious infections.

Endocrine therapy for breast cancer prevention in high-risk women: clinical and economic considerations.

PubMed

Groom, Amy G; Younis, Tallal

2016-01-01

The global burden of breast cancer highlights the need for primary prevention strategies that demonstrate both favorable clinical benefit/risk profile and good value for money. Endocrine therapy with selective estrogen-receptor modulators (SERMs) or aromatase inhibitors (AIs) has been associated with a favorable clinical benefit/risk profile in the prevention of breast cancer in women at high risk of developing the disease. The available endocrine therapy strategies differ in terms of their relative reductions of breast cancer risk, potential side effects, and upfront drug acquisition costs, among others. This review highlights the clinical trials of SERMs and AIs for the primary prevention of breast cancer, and the cost-effectiveness /cost-utility studies that have examined their "value for money" in various health care jurisdictions.

Integrated control of emission reductions, energy-saving, and cost-benefit using a multi-objective optimization technique in the pulp and paper industry.

PubMed

Wen, Zongguo; Xu, Chang; Zhang, Xueying

2015-03-17

Reduction of water pollutant emissions and energy consumption is regarded as a key environmental objective for the pulp and paper industry. The paper develops a bottom-up model called the Industrial Water Pollutant Control and Technology Policy (IWPCTP) based on an industrial technology simulation system and multiconstraint technological optimization. Five policy scenarios covering the business as usual (BAU) scenario, the structural adjustment (SA) scenario, the cleaner technology promotion (CT) scenario, the end-treatment of pollutants (EOP) scenario, and the coupling measures (CM) scenario have been set to describe future policy measures related to the development of the pulp and paper industry from 2010-2020. The outcome of this study indicates that the energy saving amount under the CT scenario is the largest, while that under the SA scenario is the smallest. Under the CT scenario, savings by 2020 include 70 kt/year of chemical oxygen demand (COD) emission reductions and savings of 7443 kt of standard coal, 539.7 ton/year of ammonia nitrogen (NH4-N) emission reductions, and savings of 7444 kt of standard coal. Taking emission reductions, energy savings, and cost-benefit into consideration, cleaner technologies like highly efficient pulp washing, dry and wet feedstock preparation, and horizontal continuous cooking, medium and high consistency pulping and wood dry feedstock preparation are recommended.

Mechanisms of metal sorption by biochars: Biochar characteristics and modifications.

PubMed

Li, Hongbo; Dong, Xiaoling; da Silva, Evandro B; de Oliveira, Letuzia M; Chen, Yanshan; Ma, Lena Q

2017-07-01

Biochar produced by thermal decomposition of biomass under oxygen-limited conditions has received increasing attention as a cost-effective sorbent to treat metal-contaminated waters. However, there is a lack of information on the roles of different sorption mechanisms for different metals and recent development of biochar modification to enhance metal sorption capacity, which is critical for biochar field application. This review summarizes the characteristics of biochar (e.g., surface area, porosity, pH, surface charge, functional groups, and mineral components) and main mechanisms governing sorption of As, Cr, Cd, Pb, and Hg by biochar. Biochar properties vary considerably with feedstock material and pyrolysis temperature, with high temperature producing biochars with higher surface area, porosity, pH, and mineral contents, but less functional groups. Different mechanisms dominate sorption of As (complexation and electrostatic interactions), Cr (electrostatic interactions, reduction, and complexation), Cd and Pb (complexation, cation exchange, and precipitation), and Hg (complexation and reduction). Besides sorption mechanisms, recent advance in modifying biochar by loading with minerals, reductants, organic functional groups, and nanoparticles, and activation with alkali solution to enhance metal sorption capacity is discussed. Future research needs for field application of biochar include competitive sorption mechanisms of co-existing metals, biochar reuse, and cost reduction of biochar production. Published by Elsevier Ltd.

[Development of the German diagnosis-related groups (G-DRG) for ophthalmology from 2004 to 2012].

PubMed

Schargus, M; Gass, P; Neubauer, A; Kotas, M

2014-04-01

In 2003 the German diagnosis-related groups (G-DRG) were introduced for reimbursement of inpatient treatment. The aim of this study was to analyze the development of G-DRGs in ophthalmology in Germany (MDC02) from 2004 to 2012 by means of data from the Institute for the Reimbursement System in Hospitals (InEK). The data regarding costs, cost weighting and mean length of stay (LOS) from the G-DRG reports of the InEK from 2004 to 2012 in 9 representative surgical and non-surgical ophthalmological treatment case groups were analyzed. Differences in the coding system as well as alterations between the G-DRGs over the course of time were taken into consideration. The cost weightings were calculated taking the year 2004 as the baseline and are presented in the form of graphs. The selected cases cover 54% of all G-DRG cases used by the InEK for G-DRG calculations. For 6 out of the 9 case groups there was a cost/reimbursement reduction by nearly one third of the calculated costs by InEK from 2004 to 2012. Only one case group showed an increase in costs by 23% which can be explained by alterations in graft costs in this case group. The mean LOS decreased over the time period in the 9 groups investigated by up to 40% and on average by -22.3%. The annually calculated costs of the InEK directly influence the calculation of the cost weightings and reimbursement and are therefore important for every hospital. During the time period analyzed a high reduction in costs and LOS in the majority of the analyzed case groups were found.

Effect of prospective reimbursement on nursing home costs.

PubMed Central

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-01-01

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems. PMID:8463109

Effect of prospective reimbursement on nursing home costs.

PubMed

Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

1993-04-01

This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

Economic impact study: neuromuscular training reduces the burden of injuries and costs compared to standard warm-up in youth soccer.

PubMed

Marshall, Deborah A; Lopatina, Elena; Lacny, Sarah; Emery, Carolyn A

2016-11-01

There is randomised controlled trial (RCT) evidence that neuromuscular training (NMT) programmes can reduce the risk of injury in youth soccer. We evaluated the cost-effectiveness of such an NMT prevention strategy compared to a standard of practice warm-up. A cost-effectiveness analysis was conducted alongside a cluster RCT. Injury incidence rates were adjusted for cluster using Poisson regression analyses. Direct healthcare costs and injury incidence proportions were adjusted for cluster using bootstrapping. The joint uncertainty surrounding the cost and injury rate and proportion differences was estimated using bootstrapping with 10 000 replicates. Along with a 38% reduction in injury risk (rate difference=-1.27/1000 player hours (95% CI -0.33 to -2.2)), healthcare costs were reduced by 43% in the NMT group (-$689/1000 player hours (95% CI -$1741 to $234)) compared with the control group. 90% of the bootstrapped ratios were in the south-west quadrant of the cost-effectiveness plane, showing that the NMT programme was dominant (more effective and less costly) over standard warm-up. Projecting results onto 58 100 Alberta youth soccer players, an estimated 4965 injuries and over $2.7 million in healthcare costs would be conservatively avoided in one season with implementation of a neuromuscular training prevention programme. Implementation of an NMT prevention programme in youth soccer is effective in reducing the burden of injury and leads to considerable reduction in costs. These findings inform practice and policy supporting the implementation of NMT prevention strategies in youth soccer nationally and internationally. 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/.

Mobile app self-care versus in-office care for stress reduction: a cost minimization analysis.

PubMed

Luxton, David D; Hansen, Ryan N; Stanfill, Katherine

2014-12-01

We calculated the cost of providing stress reduction care with a mobile phone app (Breathe2Relax) in comparison with normal in-person care, the standard method for managing stress in military and civilian populations. We conducted a cost-minimization analysis. The total cost to the military healthcare system of treating 1000 patients with the app was $106,397. Treating 1000 patients with in-office care cost $68,820. Treatment using the app became less expensive than in-office treatment at approximately 1600 users. From the perspective of the civilian healthcare system, treatment using the app became less expensive than in-office treatment at approximately 1500 users. An online tool was used to obtain data about the number of app downloads and usage sessions. A total of 47,000 users had accessed the app for 10-30 min sessions in the 2.5 years since the release of the app. Assuming that all 47,000 users were military beneficiaries, the savings to the military healthcare system would be $2.7 million; if the 47,000 users were civilian, the savings to the civilian healthcare system would be $2.9 million. Because of the large number of potential users, the total societal savings resulting from self-care using the app may be considerable. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Study of the application of advanced technologies to laminar flow control systems for subsonic transports. Volume 1: Summary

NASA Technical Reports Server (NTRS)

Sturgeon, R. F.; Bennett, J. A.; Etchberger, F. R.; Ferrill, R. S.; Meade, L. E.

1976-01-01

A study was conducted to evaluate the technical and economic feasibility of applying laminar flow control to the wings and empennage of long-range subsonic transport aircraft compatible with initial operation in 1985. For a design mission range of 10,186 km (5500 n mi), advanced technology laminar-flow-control (LFC) and turbulent-flow (TF) aircraft were developed for both 200 and 400-passenger payloads, and compared on the basis of production costs, direct operating costs, and fuel efficiency. Parametric analyses were conducted to establish the optimum geometry for LFC and TF aircraft, advanced LFC system concepts and arrangements were evaluated, and configuration variations maximizing the effectiveness of LFC were developed. For the final LFC aircraft, analyses were conducted to define maintenance costs and procedures, manufacturing costs and procedures, and operational considerations peculiar to LFC aircraft. Compared to the corresponding advanced technology TF transports, the 200- and 400-passenger LFC aircraft realized reductions in fuel consumption up to 28.2%, reductions in direct operating costs up to 8.4%, and improvements in fuel efficiency, in ssm/lb of fuel, up to 39.4%. Compared to current commercial transports at the design range, the LFC study aircraft demonstrate improvements in fuel efficiency up to 131%. Research and technology requirements requisite to the development of LFC transport aircraft were identified.

Socio-economic and Engineering Assessments of Renewable Energy Cost Reduction Potential

NASA Astrophysics Data System (ADS)

Seel, Joachim

This dissertation combines three perspectives on the potential of cost reductions of renewable energy--a relevant topic, as high energy costs have traditionally been cited as major reason to vindicate developments of fossil fuel and nuclear power plants, and to justify financial support mechanisms and special incentives for renewable energy generators. First, I highlight the role of market and policy drivers in an international comparison of upfront capital expenses of residential photovoltaic systems in Germany and the United States that result in price differences of a factor of two and suggest cost reduction opportunities. In a second article I examine engineering approaches and siting considerations of large-scale photovoltaic projects in the United States that enable substantial system performance increases and allow thus for lower energy costs on a levelized basis. Finally, I investigate future cost reduction options of wind energy, ranging from capital expenses, operating expenses, and performance over a project's lifetime to financing costs. The assessment shows both substantial further cost decline potential for mature technologies like land-based turbines, nascent technologies like fixed-bottom offshore turbines, and experimental technologies like floating offshore turbines. The following paragraphs summarize each analysis: International upfront capital cost comparison of residential solar systems: Residential photovoltaic (PV) systems were twice as expensive in the United States as in Germany in 2012. This price discrepancy stems primarily from differences in non-hardware or "soft" costs between the two countries, of which only 35% be explained by differences in cumulative market size and associated learning. A survey of German PV installers was deployed to collect granular data on PV soft costs in Germany, and the results are compared to those of a similar survey of U.S. PV installers. Non-module hardware costs and all analyzed soft costs are lower in Germany, especially for customer acquisition, installation labor, and profit/overhead costs, but also for expenses related to permitting, interconnection, and inspection procedures. Additional costs occur in the United States due to state and local sales taxes, smaller average system sizes, and longer project-development times. To reduce the identified additional costs of residential PV systems, the United States could introduce policies that enable a robust and lasting market while minimizing market fragmentation. Regularly declining incentives offering a transparent and certain value proposition might help accelerate PV cost reductions in the United States. Performance analysis of large-scale solar installations in the United States: This paper presents the first known use of multi-variate regression techniques to statistically explore empirical variation in utility-scale PV project performance across the United States. Among a sample of 128 utility-scale PV projects totaling 3,201 MWAC, net capacity factors in 2014 varied by more than a factor of two. Regression models developed for this analysis find that just three highly significant independent variables can explain 92% of this project-level variation. Adding the commercial operation year as a fourth independent variable and three interactive variables improves the model further and reveals interesting relationships. Taken together, the empirical data and statistical modeling results presented in this paper can provide a useful indication of the level of performance that solar project developers and investors can expect from various project configurations in different regions of the United States. Moreover, the tight relationship between fitted and actual capacity factors should instill confidence among investors that the utility-scale projects in this sample have largely performed as predicted by our models, with no significant outliers to date. Holistic assessment of future cost reduction opportunities of wind energy applications: Wind energy supply has grown rapidly over the last decade. However, the long-term contribution of wind to future energy supply, and the degree to which policy support is necessary to motivate higher levels of deployment, depends on the future costs of both onshore and offshore wind. Here, I summarize the results of an expert elicitation survey of 163 of the world's foremost wind experts, aimed at better understanding future costs and technology advancement possibilities. Results suggest significant opportunities for cost reductions, but also underlying uncertainties. Costs could be even lower: experts predict a 10% chance that reductions will be more than 40% by 2030 and more than 50% by 2050. The main identified drivers for near term cost reductions are rotor-related advancements and taller towers for onshore installations, fixed-bottom offshore turbines can benefit from an upscaling in generator capacity, streamlined foundation design and reduced financing costs, while floating offshore turbines require further progress in buoyant support structure design and installation process efficiencies. Insights gained through this expert elicitation complement other tools for evaluating cost-reduction potential, and help inform policy, planning, R&D, and industry strategy. (Abstract shortened by ProQuest.).

Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada

PubMed Central

Pataky, Reka; Gulati, Roman; Etzioni, Ruth; Black, Peter; Chi, Kim N.; Coldman, Andrew J.; Pickles, Tom; Tyldesley, Scott; Peacock, Stuart

2015-01-01

Prostate-specific antigen (PSA) screening for prostate cancer may reduce mortality, but it incurs considerable risk of overdiagnosis and potential harm to quality of life. Our objective was to evaluate the cost-effectiveness of PSA screening, with and without adjustment for quality of life, for the British Columbia (BC) population. We adapted an existing natural history model using BC incidence, treatment, cost and mortality patterns. The modeled mortality benefit of screening derives from a stage-shift mechanism, assuming mortality reduction consistent with the European Study of Randomized Screening for Prostate Cancer. The model projected outcomes for 40 year-old men under 14 combinations of screening ages and frequencies. Cost and utility estimates were explored with deterministic sensitivity analysis. The incremental cost-effectiveness of regular screening ranged from $36,300/LYG, for screening every four years from ages 55-69, to $588,300/LYG, for screening every two years from ages 40-74. The marginal benefits of increasing screening frequency to two years or starting screening at age 40 were small and came at significant cost. After utility adjustment, all screening strategies resulted in a loss of QALYs; however, this result was very sensitive to utility estimates. Plausible outcomes under a range of screening strategies inform discussion of prostate cancer screening policy in BC and similar jurisdictions. Screening may be cost-effective but the sensitivity of results to utility values suggests individual preferences for quality versus quantity of life should be a key consideration. PMID:24443367

Payer and Pharmaceutical Manufacturer Considerations for Outcomes-Based Agreements in the United States.

PubMed

Brown, Joshua D; Sheer, Rich; Pasquale, Margaret; Sudharshan, Lavanya; Axelsen, Kirsten; Subedi, Prasun; Wiederkehr, Daniel; Brownfield, Fred; Kamal-Bahl, Sachin

2018-01-01

Considerable interest exists among health care payers and pharmaceutical manufacturers in designing outcomes-based agreements (OBAs) for medications for which evidence on real-world effectiveness is limited at product launch. To build hypothetical OBA models in which both payer and manufacturer can benefit. Models were developed for a hypothetical hypercholesterolemia OBA, in which the OBA was assumed to increase market access for a newly marketed medication. Fixed inputs were drug and outcome event costs from the literature over a 1-year OBA period. Model estimates were developed using a range of inputs for medication effectiveness, medical cost offsets, and the treated population size. Positive or negative feedback to the manufacturer was incorporated on the basis of expectations of drug performance through changes in the reimbursement level. Model simulations demonstrated that parameters had the greatest impact on payer cost and manufacturer reimbursement. Models suggested that changes in the size of the population treated and drug effectiveness had the largest influence on reimbursement and costs. Despite sharing risk for potential product underperformance, manufacturer reimbursement increased relative to having no OBA, if the OBA improved market access for the new product. Although reduction in medical costs did not fully offset the cost of the medication, the payer could still save on net costs per patient relative to having no OBA by tying reimbursement to drug effectiveness. Pharmaceutical manufacturers and health care payers have demonstrated interest in OBAs, and under a certain set of assumptions both may benefit. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Economics of a reduction in smoking: case study from Heartbeat Wales.

PubMed Central

Phillips, C J; Prowle, M J

1993-01-01

STUDY OBJECTIVE--This study aims to apply economic principles and techniques in evaluating a health promotion programme. DESIGN--This study is an economic appraisal of the Heartbeat Wales no smoking intervention programme. The costs incurred over the four year period 1985-89 have been identified and estimates have been made of the likely future impact of the reduced smoking prevalence within Wales in terms of reduced morbidity and displaced mortality in three disease groups--coronary heart disease, lung cancer, and chronic bronchitis. SETTING--Wales, UK. RESULTS--The net present value of benefits is considerably greater than costs in terms of both the NHS and the economy as a whole in Wales. In addition, the net costs per life year saved shows that the programme generates additional working life years at relatively low cost. Because not all the benefits can be fully attributed to the programme 'impact rates' ranging from 100 to 10% have been applied to the level of benefits. The evidence suggests that even if only 10% of the benefits could be attributed to the programme there is still a positive net present value of benefits. The relative efficiency of this programme has not been considered here. CONCLUSION--Large scale benefits to the NHS and the economy as a whole can be derived from reductions in smoking. PMID:8350035

Rituximab biosimilars.

PubMed

Vital, Edward M; Kay, Jonathan; Emery, Paul

2013-07-01

Rituximab is a monoclonal antibody targeting CD20, used to treat B cell malignancies and B cell-mediated autoimmune diseases. Rituximab has the largest market of any monoclonal antibody therapeutic. Its patent will expire within the next few years and several manufacturers have already produced or are developing rituximab biosimilars that aim to match the innovator rituximab as closely as possible. In this review, we discuss key factors that determine the efficacy of rituximab therapy, potential technical challenges in the manufacture and evaluation of biosimilars, regulatory considerations regarding the review and approval of biosimilars, and the current status of biosimilar rituximab development by various manufacturers. Due to the nature of the topic, literature searches included conference abstracts, regulatory and industry websites as well as peer reviewed literature. Cost is a key limitation of current biologics usage and there is a political impetus to the licensing of biosimilars. Concerns regarding potential dissimilarities of biosimilars are legitimate, but surmountable with techniques for in vitro, in vivo and clinical testing and more clearly defined regulatory requirements. These should provide reassurance to prescribers. However, the cost of manufacturing and licensing a biosimilar remains high and the reduction in cost may be more limited than for a non-biologic small molecule drug and its generic version. This cost reduction will be critical to the impact and use of rituximab biosimilars.

Optimum Landscape Allocation of Conservation Practices for Water Quality and Ecosystem Service Valuation

NASA Astrophysics Data System (ADS)

Dalzell, B. J.; Pennington, D.; Nelson, E.; Mulla, D.; Polasky, S.; Taff, S.

2012-12-01

This study links a spatially-explicit biophysical model (SWAT) with an economic model (InVEST) to identify the economically optimum allocation of conservation practices on the landscape. Combining biophysical and economic analysis allows assessment of the benefits and costs of alternative policy choices through consideration of direct costs and benefits as measured by market transactions as well as non-market benefits and costs from changes in environmental conditions that lead to changes in the provision of ecosystem services. When applied to an agricultural watershed located in South-Central Minnesota, this approach showed that: (1) some modest gains (20% improvement, relative to baseline conditions) in water quality can be achieved without diminishing current economic returns, but that (2) more dramatic reductions in sediment and phosphorus required to meet water quality goals (50% reductions in loadings) will require transitioning land from row crops into perennial vegetation. This shift in land cover will result in a reduction in economic returns unless non-market ecosystem services are also valued. Further results showed that traditional best management practices such as conservation tillage and reduced fertilizer application rates are not sufficient to achieve water quality goals by themselves. Finally, if crop prices drop to pre-2007 levels or valuation of ecosystem services increases, then achieving water quality goals can occur with less of an economic impact to the watershed.

Benefit Evaluation of Implementing BIM in Construction Projects

NASA Astrophysics Data System (ADS)

Chou, Hui-Yu; Chen, Pei-Yu

2017-10-01

Since 2014, public construction projects in Taiwan have progressively undertaken steps to promote the use of Building Information Modelling (BIM) technology, the use of BIM has therefore become a necessity for contractors. However, issues such as the high upfront costs relating to software and hardware setup and BIM user training, combined with the difficulties of incorporating BIM into existing workflow operations and management systems, remain a challenge to contractors. Consequently, the benefits stemming from the BIM implementation in turn will affect the activeness and enthusiasm of contractors to implement BIM. While there have been previous studies abroad where the benefits relating to BIM implementation had been calculated and quantified numerically, a benefit evaluation index would require considerations for regional industry practices and characteristics. This study established a benefit evaluation index and method for the implementation of BIM suitable for contractors in Taiwan. The three main principal indexes are: (1) RCR means the effects of reducing costs associated with rework; (2) SDR & DPR mean the effects of mitigating delays that occur due to construction interface coordination or rework, as well as the effects of reducing the penalty costs associated with overdue delivery; (3) AQE means the effects of improving the ability to estimate the amounts of building materials and resources. This study also performed a benefit evaluation calculation of a real world case study construction project using the first two established indexes. The results showed a 0.16% reduction in rework costs, a 6.49% reduction in delays that occur from construction interface coordination or rework, and a 5.0% reduction in penalty costs associated with overdue deliveries. The results demonstrated the applicability of the benefit evaluation index established in this study for real world construction projects.

The economic impact of project MARS (motivating adolescents to reduce sexual risk).

PubMed

Dealy, Bern C; Horn, Brady P; Callahan, Tiffany J; Bryan, Angela D

2013-09-01

The purpose of this study was to economically evaluate Project MARS (Motivating Adolescents to Reduce Sexual Risk; T. J. Callahan, E. A. Montanaro, R. E. Magnan, & A. D. Bryan, 2013, "Project MARS: Design of a multi-behavior intervention trial for justice-involved youth," Translational Behavioral Medicine, Vol. 3, pp. 122-130), an ongoing, randomized, sexual-risk-reduction intervention for justice-involved youth. We consider the effect of including viral STIs in the economic analysis, and explore the impact of the MARS intervention on the perceived cost of acquiring STIs to justice-involved youth. 206 participants, ages 14 to 18, participated in a sexual-risk-reduction intervention that included screening and treatment for chlamydia and gonorrhea. A Bernoulli probability model was used to estimate averted STIs attributable to the MARS intervention. The economic benefit of averted STIs was monetized using the direct medical cost of treatment. In addition, we used a contingent valuation (willingness-to-pay) model to investigate the impact of the Project MARS on participants' perceived cost of acquiring an STI. Using the standard outcome domains typically used to evaluate STI interventions, Project MARS resulted in a reduction of $2.08 in direct medical costs for every $1 spent. When viral STIs were added to the economic model, a considerable increase in averted direct medical costs ($2.68 for every $1 spent) was found. Preliminary contingent valuation estimates suggest that participants' willingness-to-pay for averted STIs significantly increased after receiving the MARS intervention. From an economic perspective, Project MARS is a worthwhile program to adopt. Future attention should be given to the impact of behavioral interventions on viral infections. PsycINFO Database Record (c) 2013 APA, all rights reserved.

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

PubMed

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

2016-10-01

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

Consequential environmental and economic life cycle assessment of green and gray stormwater infrastructures for combined sewer systems.

PubMed

Wang, Ranran; Eckelman, Matthew J; Zimmerman, Julie B

2013-10-01

A consequential life cycle assessment (LCA) is conducted to evaluate the trade-offs between water quality improvements and the incremental climate, resource, and economic costs of implementing green (bioretention basin, green roof, and permeable pavement) versus gray (municipal separate stormwater sewer systems, MS4) alternatives of stormwater infrastructure expansions against a baseline combined sewer system with combined sewer overflows in a typical Northeast US watershed for typical, dry, and wet years. Results show that bioretention basins can achieve water quality improvement goals (e.g., mitigating freshwater eutrophication) for the least climate and economic costs of 61 kg CO2 eq. and $98 per kg P eq. reduction, respectively. MS4 demonstrates the minimum life cycle fossil energy use of 42 kg oil eq. per kg P eq. reduction. When integrated with the expansion in stormwater infrastructure, implementation of advanced wastewater treatment processes can further reduce the impact of stormwater runoff on aquatic environment at a minimal environmental cost (77 kg CO2 eq. per kg P eq. reduction), which provides support and valuable insights for the further development of integrated management of stormwater and wastewater. The consideration of critical model parameters (i.e., precipitation intensity, land imperviousness, and infrastructure life expectancy) highlighted the importance and implications of varying local conditions and infrastructure characteristics on the costs and benefits of stormwater management. Of particular note is that the impact of MS4 on the local aquatic environment is highly dependent on local runoff quality indicating that a combined system of green infrastructure prior to MS4 potentially provides a more cost-effective improvement to local water quality.

Oral health promotion: the economic benefits to the NHS of increased use of sugarfree gum in the UK.

PubMed

Claxton, L; Taylor, M; Kay, E

2016-02-12

The effect of sugarfree gum (SFG) on the prevention of dental caries has been established for some time. With increased constraints placed on healthcare budgets, the importance of economic considerations in decision-making about oral health interventions has increased. The aim of this study was to demonstrate the potential cost savings in dental care associated with increased levels of SFG usage. The analysis examined the amount of money which would hypothetically be saved if the UK 12-year-old population chewed more SFG. The number of sticks chewed per year and the caries risk reduction were modelled to create a dose response curve. The costs of tooth restoration, tooth extraction in primary care settings and under general anaesthetic were considered, and the effects of caries reduction on these costs calculated. If all members of the UK 12-year-old population chewed SFG frequently (twice a day), the potential cost savings for the cohort over the course of one year were estimated to range from £1.2 to £3.3 million and if they chewed three times a day, £8.2 million could be saved each year. Sensitivity analyses of the key parameters demonstrated that cost savings would still be likely to be observed even in scenarios with less significant increases in SFG use. This study shows that if levels of SFG usage in the teenage population in the UK could be increased, substantial cost savings might be achieved.

Estimating acreage by double sampling using LANDSAT data

NASA Technical Reports Server (NTRS)

Pont, F.; Horwitz, H.; Kauth, R. (Principal Investigator)

1982-01-01

Double sampling techniques employing LANDSAT data for estimating the acreage of corn and soybeans was investigated and evaluated. The evaluation was based on estimated costs and correlations between two existing procedures having differing cost/variance characteristics, and included consideration of their individual merits when coupled with a fictional 'perfect' procedure of zero bias and variance. Two features of the analysis are: (1) the simultaneous estimation of two or more crops; and (2) the imposition of linear cost constraints among two or more types of resource. A reasonably realistic operational scenario was postulated. The costs were estimated from current experience with the measurement procedures involved, and the correlations were estimated from a set of 39 LACIE-type sample segments located in the U.S. Corn Belt. For a fixed variance of the estimate, double sampling with the two existing LANDSAT measurement procedures can result in a 25% or 50% cost reduction. Double sampling which included the fictional perfect procedure results in a more cost effective combination when it is used with the lower cost/higher variance representative of the existing procedures.

Potentialities of TEC topping: A simplified view of parametric effects

NASA Technical Reports Server (NTRS)

Morris, J. F.

1980-01-01

An examination of the benefits of thermionic-energy-conversion (TEC)-topped power plants and methods of increasing conversion efficiency are discussed. Reductions in the cost of TEC modules yield direct decreases in the cost of electricity (COE) from TEC-topped central station power plants. Simplified COE, overall-efficiency charts presented illustrate this trend. Additional capital-cost diminution results from designing more compact furnaces with considerably increased heat transfer rates allowable and desirable for high temperature TEC and heat pipes. Such improvements can evolve of the protection from hot corrosion and slag as well as the thermal expansion compatibilities offered by silicon-carbide clads on TEC-heating surfaces. Greater efficiencies and far fewer modules are possible with high-temperature, high-power-density TEC: This decreases capital and fuel costs much more and substantially increases electric power outputs for fixed fuel inputs. In addition to more electricity, less pollution, and lower costs, TEC topping used directly in coal-combustion products contributes balance-of-payment gains.

An economic evaluation and assessment of environmental impact of the municipal solid waste management system for Taichung City in Taiwan.

PubMed

Chang, Yao-Jen; Chu, Chien-Wei; Lin, Min-Der

2012-05-01

Municipal solid waste management (MSWM) is an important environmental challenge and subject in urban planning. For sustainable MSWM strategies, the critical management factors to be considered include not only economic efficiency of MSW treatment but also life-cycle assessment of the environmental impact. This paper employed linear programming technique to establish optimal MSWM strategies considering economic efficiency and the air pollutant emissions during the life cycle of a MSWM system, and investigated the correlations between the economical optimization and pollutant emissions. A case study based on real-world MSW operating parameters in Taichung City is also presented. The results showed that the costs, benefits, streams of MSW, and throughputs of incinerators and landfills will be affected if pollution emission reductions are implemented in the MSWM strategies. In addition, the quantity of particulate matter is the best pollutant indicator for the MSWM system performance of emission reduction. In particular this model will assist the decision maker in drawing up a friendly MSWM strategy for Taichung City in Taiwan. Recently, life-cycle assessments of municipal solid waste management (MSWM) strategies have been given more considerations. However, what seems to be lacking is the consideration of economic factors and environmental impacts simultaneously. This work analyzed real-world data to establish optimal MSWM strategies considering economic efficiency and the air pollutant emissions during the life cycle of the MSWM system. The results indicated that the consideration of environmental impacts will affect the costs, benefits, streams of MSW, and throughputs of incinerators and landfills. This work is relevant to public discussion and may establish useful guidelines for the MSWM policies.

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

PubMed

Ostovar, Mohamad; Amiri, Mohamad

2013-12-01

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

Conversion of transuranic waste to low level waste by decontamination: a site specific update

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

Allen, R.P.; Hazelton, R.F.

1985-09-01

As a followup to an FY-1984 cost/benefit study, a program was conducted in FY-1985 to transfer to the relevant DOE sites the information and technology for the direct conversion of transuranic (TRU) waste to low-level waste (LLW) by decontamination. As part of this work, the economic evaluation of the various TRUW volume reduction and conversion options was updated and expanded to include site-specific factors. The results show, for the assumptions used, that size reduction, size reduction followed by decontamination, or in situ decontamination are cost effective compared with the no-processing option. The technology transfer activities included site presentations and discussionsmore » with operations and waste management personnel to identify application opportunities and site-specific considerations and constraints that could affect the implementation of TRU waste conversion principles. These discussions disclosed definite potential for the beneficial application of these principles at most of the sites, but also confirmed the existence of site-specific factors ranging from space limitations to LLW disposal restrictions that could preclude particular applications or diminish expected benefits. 8 refs., 2 figs., 4 tabs.« less

Some significant considerations in the planning of sortie missions. [of space transportation system

NASA Technical Reports Server (NTRS)

Loftus, J. P., Jr.; Cour-Palais, B. G.; Moore, J. W.; Lohman, R. L.

1980-01-01

Opportunities and limitations to be considered in the planning of Space Shuttle/Spacelab sortie missions are discussed. As shown by a simple model of the flow of STS equipment through ground processing and flights under ideal conditions, mission duration is constrained by Orbiter availability, which is determined initially by the Orbiter production schedule and the turnaround time required between missions, and by the usage rate and quantity limitations of mission consumables. Additional considerations affecting mission duration include reductions in crew productivity upon increased mission duration and crew size, spacecraft and experiment degradation, equipment and processing facility cost effectiveness, and requirements for a power extension package, which considerations imply that increased allowable landing weight would make co-manifesting (the combination of Spacelab and deliverable payload missions) more attractive. Advantages related to payload recoverability, human presence, ease of access and the availability of different orbits are also pointed out.

A cost assessment of reliability requirements for shuttle-recoverable experiments

NASA Technical Reports Server (NTRS)

Campbell, J. W.

1975-01-01

The relaunching of unsuccessful experiments or satellites will become a real option with the advent of the space shuttle. An examination was made of the cost effectiveness of relaxing reliability requirements for experiment hardware by allowing more than one flight of an experiment in the event of its failure. Any desired overall reliability or probability of mission success can be acquired by launching an experiment with less reliability two or more times if necessary. Although this procedure leads to uncertainty in total cost projections, because the number of flights is not known in advance, a considerable cost reduction can sometimes be achieved. In cases where reflight costs are low relative to the experiment's cost, three flights with overall reliability 0.9 can be made for less than half the cost of one flight with a reliability of 0.9. An example typical of shuttle payload cost projections is cited where three low reliability flights would cost less than $50 million and a single high reliability flight would cost over $100 million. The ratio of reflight cost to experiment cost is varied and its effect on the range in total cost is observed. An optimum design reliability selection criterion to minimize expected cost is proposed, and a simple graphical method of determining this reliability is demonstrated.

Estimating the Economic Potential of Offshore Wind in the United States

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

Beiter, P.; Musial, W.; Smith, A.

The potential for cost reduction and market deployment for offshore wind varies considerably within the United States. This analysis estimates the future economic viability of offshore wind at more than 7,000 sites under a variety of electric sector and cost reduction scenarios. Identifying the economic potential of offshore wind at a high geospatial resolution can capture the significant variation in local offshore resource quality, costs, and revenue potential. In estimating economic potential, this article applies a method initially developed in Brown et al. (2015) to offshore wind and estimates the sensitivity of results under a variety of most likely electricmore » sector scenarios. For the purposes of this analysis, a theoretical framework is developed introducing a novel offshore resource classification system that is analogous to established resource classifications from the oil and gas sector. Analyzing economic potential within this framework can help establish a refined understanding across industries of the technology and site-specific risks and opportunities associated with future offshore wind development. The results of this analysis are intended to inform the development of the U.S. Department of Energy's offshore wind strategy.« less

Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation†

PubMed Central

Paton, F.; Paulden, M.; Chambers, D.; Heirs, M.; Duffy, S.; Hunter, J. M.; Sculpher, M.; Woolacott, N.

2010-01-01

Summary The cost-effectiveness of sugammadex for the routine reversal of muscle relaxation produced by rocuronium or vecuronium in UK practice is uncertain. We performed a systematic review of randomized controlled trials of sugammadex compared with neostigmine/glycopyrrolate and an economic assessment of sugammadex for the reversal of moderate or profound neuromuscular block (NMB) produced by rocuronium or vecuronium. The economic assessment aimed to establish the reduction in recovery time and the ‘value of time saved’ which would be necessary for sugammadex to be potentially cost-effective compared with existing practice. Three trials indicated that sugammadex 2 mg kg−1 (4 mg kg−1) produces more rapid recovery from moderate (profound) NMB than neostigmine/glycopyrrolate. The economic assessment indicated that if the reductions in recovery time associated with sugammadex in the trials are replicated in routine practice, sugammadex would be cost-effective if those reductions are achieved in the operating theatre (assumed value of staff time, £4.44 per minute), but not if they are achieved in the recovery room (assumed value of staff time, £0.33 per minute). However, there is considerable uncertainty in these results. Sugammadex has the potential to be cost-effective compared with neostigmine/glycopyrrolate for the reversal of rocuronium-induced moderate or profound NMB, provided that the time savings observed in trials can be achieved and put to productive use in clinical practice. Further research is required to evaluate the effects of sugammadex on patient safety, predictability of recovery from NMB, patient outcomes, and efficient use of resources. PMID:20935005

Pilot scale nanofiltration treatment of olive mill wastewater: a technical and economical evaluation.

PubMed

Sanches, S; Fraga, M C; Silva, N A; Nunes, P; Crespo, J G; Pereira, V J

2017-02-01

The treatment of large volumes of olive mill wastewater is presently a challenge. This study reports the technical and economical feasibility of a sequential treatment of olive mill wastewater comprising a dissolved air flotation pre-treatment and nanofiltration. Different pilot nanofiltration assays were conducted in a concentration mode up to different volume reduction factors (29, 45, 58, and 81). Data attained demonstrated that nanofiltration can be operated at considerably high volume reduction factors and still be effective towards the removal of several components. A flux decline of approximately 50% was observed at the highest volume reduction factor, mainly due to increase of the osmotic pressure. Considerably high rejections were obtained across all experiments for total suspended solids (83 to >99%), total organic carbon (64 to 99%), chemical oxygen demand (53 to 77%), and oil and grease (67 to >82%). Treated water was in compliance with European legal limits for discharge regarding total suspended solids and oil and grease. The potential recovery of phenolic compounds was evaluated and found not relevant. It was demonstrated that nanofiltration is economically feasible, involving operation costs of approximately 2.56-3.08 €/m 3 , depending on the working plan schedule and volume reduction factor, and requiring a footprint of approximately 52 m 2 to treat 1000 m 3 of olive mill wastewater.

Analyzing costs of space debris mitigation methods

NASA Astrophysics Data System (ADS)

Wiedemann, C.; Krag, H.; Bendisch, J.; Sdunnus, H.

The steadily increasing number of space objects poses a considerable hazard to all kinds of spacecraft. To reduce the risks to future space missions different debris mitigation measures and spacecraft protection techniques have been investigated during the last years. However, the economic efficiency has not been considered yet in this context. This economical background is not always clear to satellite operators and the space industry. Current studies have the objective to evaluate the mission costs due to space debris in a business as usual (no mitigation) scenario compared to the missions costs considering debris mitigation. The aim i an estimation of thes time until the investment in debris mitigation will lead to an effective reduction of mission costs. This paper presents the results of investigations on the key problems of cost estimation for spacecraft and the influence of debris mitigation and shielding on cost. The shielding of a satellite can be an effective method to protect the spacecraft against debris impact. Mitigation strategies like the reduction of orbital lifetime and de- or re-orbit of non-operational satellites are methods to control the space debris environment. These methods result in an increase of costs. In a first step the overall costs of different types of unmanned satellites are analyzed. The key problem is, that it is not possible to provide a simple cost model that can be applied to all types of satellites. Unmanned spacecraft differ very much in mission, complexity of design, payload and operational lifetime. It is important to classify relevant cost parameters and investigate their influence on the respective mission. The theory of empirical cost estimation and existing cost models are discussed. A selected cost model is simplified and generalized for an application on all operational satellites. In a next step the influence of space debris on cost is treated, if the implementation of mitigation strategies is considered.

What implementation interventions increase cancer screening rates? a systematic review

PubMed Central

2011-01-01

Background Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests. Methods Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo. Results The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions. Conclusion The new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research. PMID:21958556

Cost Implications of Value-Based Pricing for Companion Diagnostic Tests in Precision Medicine.

PubMed

Zaric, Gregory S

2016-07-01

Many interpretations of personalized medicine, also referred to as precision medicine, include discussions of companion diagnostic tests that allow drugs to be targeted to those individuals who are most likely to benefit or that allow treatment to be designed in a way such that individuals who are unlikely to benefit do not receive treatment. Many authors have commented on the clinical and competitive implications of companion diagnostics, but there has been relatively little formal analysis of the cost implications of companion diagnostics, although cost reduction is often cited as a significant benefit of precision medicine. We investigate the potential impact on costs of precision medicine implemented through the use of companion diagnostics. We develop a framework in which the costs of companion diagnostic tests are determined by considerations of profit maximization and cost effectiveness. We analyze four scenarios that are defined by the incremental cost-effectiveness ratio of the new drug in the absence of a companion diagnostic test. We find that, in most scenarios, precision medicine strategies based on companion diagnostics should be expected to lead to increases in costs in the short term and that costs would fall only in a limited number of situations.

The reduction of health care costs associated with alcoholism treatment: a 14-year longitudinal study.

PubMed

Holder, H D; Blose, J O

1992-07-01

This study utilized two separate research designs to examine whether the initiation of alcoholism treatment is associated with a change in overall medical care cost in a population of alcoholics enrolled under a health plan sponsored by a large midwestern manufacturing corporation. In the longest longitudinal study of alcoholism treatment costs to date, a review of claims filed from 1974 to 1987 identified 3,729 alcoholics (3,068 of whom received treatment and 661 of whom did not). In one design, a time-series analysis found that following treatment initiation the total health care costs of treated alcoholics--including the cost of alcoholism treatment--declined by 23% to 55% from their highest pretreatment levels. Costs for identified but untreated alcoholics rose following identification. In a second design, analysis of variance was used to control for group differences including pretreatment health status and age. This analysis indicated that the posttreatment costs of treated alcoholics were 24% lower than comparable costs for untreated alcoholics. The study provides considerable evidence that alcoholism treatment can reduce overall medical costs in a heterogeneous alcoholic population (white collar/blue collar; fee-for-service/HMO).

Leukocyte-reduced blood components: patient benefits and practical applications.

PubMed

Higgins, V L

1996-05-01

To review the various types of filters used for red blood cell and platelet transfusions and to explain the trend in the use of leukocyte removal filters, practical information about their use, considerations in the selection of a filtration method, and cost-effectiveness issues. Published articles, books, and the author's experience. Leukocyte removal filters are used to reduce complications associated with transfused white blood cells that are contained in units of red blood cells and platelets. These complications include nonhemolytic febrile transfusion reactions (NHFTRs), alloimmunization and refractoriness to platelet transfusion, transfusion-transmitted cytomegalovirus (CMV), and immunomodulation. Leukocyte removal filters may be used at the bedside, in a hospital blood bank, or in a blood collection center. Factors that affect the flow rate of these filters include the variations in the blood component, the equipment used, and filter priming. Studies on the cost-effectiveness of using leukocyte-reduced blood components demonstrate savings based on the reduction of NHFTRs, reduction in the number of blood components used, and the use of filtered blood components as the equivalent of CMV seronegative-screened products. The use of leukocyte-reduced blood components significantly diminishes or prevents many of the adverse transfusion reactions associated with donor white blood cells. Leukocyte removal filters are cost-effective, and filters should be selected based on their ability to consistently achieve low leukocyte residual levels as well as their ease of use. Physicians may order leukocyte-reduced blood components for specific patients, or the components may be used because of an established institutional transfusion policy. Nurses often participate in deciding on a filtration method, primarily based on ease of use. Understanding the considerations in selecting a filtration method will help nurses make appropriate decisions to ensure quality patient care.

Ultimate disposal of scrubber wastes

NASA Technical Reports Server (NTRS)

Cohenour, B. C.

1978-01-01

Part of the initial concern with using the wet scrubbers on the hypergolic propellants was the subsequential disposal of the liquid wastes. To do this, consideration was given to all possible methods to reduce the volume of the wastes and stay within the guidelines established by the state and federal environmental protection agencies. One method that was proposed was the use of water hyacinths in disposal ponds to reduce the waste concentration in the effluent to less than EPA tolerable levels. This method was under consideration and even in use by private industry, municipal governments, and NASA for upgrading existing wastewater treatment facilities to a tertiary system. The use of water hyacinths in disposal ponds appears to be a very cost-effective method for reduction and disposal of hypergolic propellants.

Least cost pathways to a low carbon electricity system for Australia: impacts of transmission augmentation and extension

NASA Astrophysics Data System (ADS)

Dargaville, R. J.

2016-12-01

Designing the pathway to a low carbon energy system is complex, requiring consideration of the variable nature of renewables at the hourly timescale, emission intensity and ramp rate constraints of dispatchable technologies (both fossil and renewable) and transmission and distribution network limitations. In this work, an optimization framework taking into account these considerations has been applied to find the lowest cost ways to reduce carbon emissions by either 80% or 100% in 2050 while keeping the system operating reliably along the way. Technologies included are existing and advanced coal and gas technologies (with and without carbon capture and storage), rooftop PV, utility scale PV, concentrating solar thermal, hydro with and without pumped storage, bioenergy, and nuclear. In this study we also also the optimisation to increase transmission capacity along existing lines, and to extend key trunk lines into currently unserved areas. These augementations and extensions come at a cost. The otpimisation chooses these options when the benefits of accessing high quality renewable energy resources outweights the costs. Results show that for the 80% emission reduction case, there is limited need for transmission capacity increase, and that the existing grid copes well with the increased flows due to conversion to distrubuted renewable energy resources. However, in the 100% case the increased reliance on renewables means that signficant transmission augmentation is beneficial to the overall cost. This strongly suggests that it is important to understand the long term emission target early so that infrastructure investments can be optimised.

Computing Optimal Stochastic Portfolio Execution Strategies: A Parametric Approach Using Simulations

NASA Astrophysics Data System (ADS)

Moazeni, Somayeh; Coleman, Thomas F.; Li, Yuying

2010-09-01

Computing optimal stochastic portfolio execution strategies under appropriate risk consideration presents great computational challenge. We investigate a parametric approach for computing optimal stochastic strategies using Monte Carlo simulations. This approach allows reduction in computational complexity by computing coefficients for a parametric representation of a stochastic dynamic strategy based on static optimization. Using this technique, constraints can be similarly handled using appropriate penalty functions. We illustrate the proposed approach to minimize the expected execution cost and Conditional Value-at-Risk (CVaR).

Considerations with respect to the design of solar photovoltaic power systems for terrestrial applications

NASA Technical Reports Server (NTRS)

Berman, P. A.

1972-01-01

The various factors involved in the development of solar photovoltaic power systems for terrestrial application are discussed. The discussion covers the tradeoffs, compromises, and optimization studies which must be performed in order to develop a viable terrestrial solar array system. It is concluded that the technology now exists for the fabrication of terrestrial solar arrays but that the economics are prohibitive. Various approaches to cost reduction are presented, and the general requirements for materials and processes to be used are delineated.

Connecting to Thermocouples with Fewer Lead Wires

NASA Technical Reports Server (NTRS)

Goldsby, Jon C.

2003-01-01

A simple technique has been devised to reduce the number of lead wires needed to connect an array of thermocouples to the instruments (e.g., voltmeters) used to read their output voltages. Because thermocouple wires are usually made of expensive metal alloys, reducing the number of lead wires can effect a considerable reduction in the cost of such an array. Reducing the number of wires also reduces the number of terminals and the amount of space needed to accommodate the wires.

A view toward future launch vehicles - A civil perspective

NASA Technical Reports Server (NTRS)

Darwin, Charles R.; Austin, Gene; Varnado, Lee; Eudy, Glenn

1989-01-01

Prospective NASA launch vehicle development efforts, which in addition to follow-on developments of the Space Shuttle encompass the Shuttle-C cargo version, various possible Advanced Launch System (ALS) configurations, and various Heavy Lift Launch System (HLLS) design options. Fully and partially reusable manned vehicle alternatives are also under consideration. In addition to improving on the current Space Shuttle's reliability and flexibility, ALS and HLLV development efforts are expected to concentrate on the reduction of operating costs for the given payload-launch capability.

Cost-effectiveness Analysis of Silver Delivery Approaches in the Management of Partial-thickness Burns.

PubMed

Nherera, Leo; Trueman, Paul; Roberts, Christopher; Berg, Leena

2018-02-23

Burn injury is a common type of traumatic injury that causes considerable morbidity and mortality, resulting in about 30,000 admissions annually in specialist burn centers and costing around $1 billion per year in the United States. One percent silver sulfadiazine has been utilized widely in the management of burns and newer silver dressings are on the market, including nanocrystalline silver dressings, silver-impregnated hydrofiber dressings, and silver-impregnated foam dressings. This study sought to determine the cost effectiveness of the newer silver dressings using clinical data from an indirect treatment comparison using silver sulfadiazine as the baseline. A decision analytic model was developed from a US payer's perspective for burn patients with a total body surface area of < 20%. Outcomes were length of stay, infections and incidence of surgical procedures, quality adjusted life years (QALYs), and cost. The meta-analysis reported a statistically significant reduction in length of hospital stay and clinically important reductions in infections and incidence of surgical procedures in favor of the silver barrier dressing compared with other silver dressings. The estimated QALYs were 0.970 versus 0.969 versus 0.969 and mean cost per patient was $15,892, $23,799, and $24,269 for the nanocrystalline silver dressing, silver-impregnated hydrofiber dressing, and silver-impregnated foam dressing, respectively. The analysis showed the nanocrystalline silver dressing to be a dominant strategy (less costly with better outcomes). These findings were robust to a range of sensitivity analyses. According to data from an indirect treatment comparison, this analysis suggests that nanocrystalline silver dressing is the most cost-effective silver delivery system. Prospective head-to-head research on the costs and outcomes of these silver delivery systems in this patient population is necessary to validate the results of this economic evaluation.

Engineering Transition-Metal-Coated Tungsten Carbides for Efficient and Selective Electrochemical Reduction of CO2 to Methane.

PubMed

Wannakao, Sippakorn; Artrith, Nongnuch; Limtrakul, Jumras; Kolpak, Alexie M

2015-08-24

The design of catalysts for CO2 reduction is challenging because of the fundamental relationships between the binding energies of the reaction intermediates. Metal carbides have shown promise for transcending these relationships and enabling low-cost alternatives. Herein, we show that directional bonding arising from the mixed covalent/metallic character plays a critical role in governing the surface chemistry. This behavior can be described by consideration of individual d-band components. We use this model to predict efficient catalysts based on tungsten carbide with a sub-monolayer of iron adatoms. Our approach can be used to predict site-preference and binding-energy trends for complex catalyst surfaces. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Food loss reduction from an environmental, socio-economic and consumer perspective - The case of the Swiss potato market.

PubMed

Willersinn, Christian; Mouron, Patrik; Mack, Gabriele; Siegrist, Michael

2017-01-01

Potatoes are one of the commodities with the highest loss shares along the entire supply chain. In the present study, we analyzed six potential loss reduction scenarios concerning their environmental-socio-economic sustainability compared with the current situation by using the "SustainOS" methodology. For this purpose, life cycle assessments, full-cost calculations and an online consumer survey were conducted. Environmental improvements through loss reduction were rather small and did not cross limits of significance, but the socio-economic performance of the entire supply chain can be improved considerably. Pearson correlation coefficients and linear regression analyses were used to predict the influence of specific subjective items like the intention to avoid food loss, knowledge related to food loss and consumers' price sensitivity on the assigned preference. Results show that perceived risks, perceived inconvenience and the general acceptance of loss-reducing instruments influence consumers' preferences. Altogether, only three out of six tested scenarios seem realistic: selling unwashed potatoes in a lightproof box, selling unpacked potatoes, and improved quality sorting at farms. For two of the other scenarios, consumers significantly indicated their refusal even if losses decreased considerably, whereas the sixth scenario was unfavorable from a socio-economic perspective. Copyright © 2016 Elsevier Ltd. All rights reserved.

Dish concentrators for solar thermal energy - Status and technology development

NASA Technical Reports Server (NTRS)

Jaffe, L. D.

1981-01-01

Comparisons are presented of point-focusing, or 'dish' solar concentrator system features, development status, and performance levels demonstrated to date. In addition to the requirements of good optical efficiency and high geometric concentration ratios, the most important future consideration in solar thermal energy dish concentrator design will be the reduction of installed and lifetime costs, as well as the materials and labor costs of production. It is determined that technology development initiatives are needed in such areas as optical materials, design wind speeds and wind loads, structural configuration and materials resistance to prolonged exposure, and the maintenance of optical surfaces. The testing of complete concentrator systems, with energy-converting receivers and controls, is also necessary. Both reflector and Fresnel lens concentrator systems are considered.

Scientific return of a lunar elevator

NASA Astrophysics Data System (ADS)

Eubanks, T. M.; Radley, C. F.

2016-11-01

The concept of a space elevator dates back to Tsilokovsky, but they are not commonly considered in near-term plans for space exploration, perhaps because a terrestrial elevator would not be possible without considerable improvements in tether material. A Lunar Space Elevator (LSE), however, can be built with current technology using commercially available tether polymers. This paper considers missions leading to infrastructure capable of shortening the time, lowering the cost and enhancing the capabilities of robotic and human explorers. These missions use planetary scale tethers, strings many thousands of kilometers long stabilized either by rotation or by gravitational gradients. These systems promise major reduction in transport costs versus chemical rockets, in a rapid timeframe, for a modest investment. Science will thus benefit as well as commercial activities.

Assessing Cost-Effectiveness in Obesity (ACE-Obesity): an overview of the ACE approach, economic methods and cost results

PubMed Central

2009-01-01

Background The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study. Methods The Assessing Cost Effectiveness (ACE) approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'. Results The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum) and when expressed as a 'cost per child' estimate (from

Minimum-sized ideal reactor for continuous alcohol fermentation using immobilized microorganism

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

Yamane, T.; Shimizu, S.

Recently, alcohol fermentation has gained considerable attention with the aim of lowering its production cost in the production processes of both fuel ethanol and alcoholic beverages. The over-all cost is a summation of costs of various subsystems such as raw material (sugar, starch, and cellulosic substances) treatment, fermentation process, and alcohol separation from water solutions; lowering the cost of the fermentation processes is very important in lowering the total cost. Several new techniques have been developed for economic continuous ethanol production, use of a continuous wine fermentor with no mechanical stirring, cell recycle combined with continuous removal of ethanol undermore » vaccum, a technique involving a bed of yeast admixed with an inert carrier, and use of immobilized yeast reactors in packed-bed column and in a three-stage double conical fluidized-bed bioreactor. All these techniques lead to increases more or less, in reactor productivity, which in turn result in the reduction of the reactor size for a given production rate and a particular conversion. Since an improvement in the fermentation process often leads to a reduction of fermentor size and hence, a lowering of the initial construction cost, it is important to theoretically arrive at a solution to what is the minimum-size setup of ideal reactors from the viewpoint of liquid backmixing. In this short communication, the minimum-sized ideal reactor for continuous alcohol fermentation using immobilized cells will be specifically discussed on the basis of a mathematical model. The solution will serve for designing an optimal bioreactor. (Refs. 26).« less

Oral health promotion: the economic benefits to the NHS of increased use of sugarfree gum in the UK

PubMed Central

Claxton, L.; Taylor, M.; Kay, E.

2016-01-01

Introduction The effect of sugarfree gum (SFG) on the prevention of dental caries has been established for some time. With increased constraints placed on healthcare budgets, the importance of economic considerations in decision-making about oral health interventions has increased. The aim of this study was to demonstrate the potential cost savings in dental care associated with increased levels of SFG usage. Methods The analysis examined the amount of money which would hypothetically be saved if the UK 12-year-old population chewed more SFG. The number of sticks chewed per year and the caries risk reduction were modelled to create a dose response curve. The costs of tooth restoration, tooth extraction in primary care settings and under general anaesthetic were considered, and the effects of caries reduction on these costs calculated. Results If all members of the UK 12-year-old population chewed SFG frequently (twice a day), the potential cost savings for the cohort over the course of one year were estimated to range from £1.2 to £3.3 million and if they chewed three times a day, £8.2 million could be saved each year. Sensitivity analyses of the key parameters demonstrated that cost savings would still be likely to be observed even in scenarios with less significant increases in SFG use. Conclusion This study shows that if levels of SFG usage in the teenage population in the UK could be increased, substantial cost savings might be achieved. PMID:26868801

Exoskeleton plantarflexion assistance for elderly.

PubMed

Galle, S; Derave, W; Bossuyt, F; Calders, P; Malcolm, P; De Clercq, D

2017-02-01

Elderly are confronted with reduced physical capabilities and increased metabolic energy cost of walking. Exoskeletons that assist walking have the potential to restore walking capacity by reducing the metabolic cost of walking. However, it is unclear if current exoskeletons can reduce energy cost in elderly. Our goal was to study the effect of an exoskeleton that assists plantarflexion during push-off on the metabolic energy cost of walking in physically active and healthy elderly. Seven elderly (age 69.3±3.5y) walked on treadmill (1.11ms 2 ) with normal shoes and with the exoskeleton both powered (with assistance) and powered-off (without assistance). After 20min of habituation on a prior day and 5min on the test day, subjects were able to walk with the exoskeleton and assistance of the exoskeleton resulted in a reduction in metabolic cost of 12% versus walking with the exoskeleton powered-off. Walking with the exoskeleton was perceived less fatiguing for the muscles compared to normal walking. Assistance resulted in a statistically nonsignificant reduction in metabolic cost of 4% versus walking with normal shoes, likely due to the penalty of wearing the exoskeleton powered-off. Also, exoskeleton mechanical power was relatively low compared to previously identified optimal assistance magnitude in young adults. Future exoskeleton research should focus on further optimizing exoskeleton assistance for specific populations and on considerate integration of exoskeletons in rehabilitation or in daily life. As such, exoskeletons should allow people to walk longer or faster than without assistance and could result in an increase in physical activity and resulting health benefits. Copyright © 2016 Elsevier B.V. All rights reserved.

Technical opportunities to reduce global anthropogenic emissions of nitrous oxide

NASA Astrophysics Data System (ADS)

Winiwarter, Wilfried; Höglund-Isaksson, Lena; Klimont, Zbigniew; Schöpp, Wolfgang; Amann, Markus

2018-01-01

We describe a consistent framework developed to quantify current and future anthropogenic emissions of nitrous oxide and the available technical abatement options by source sector for 172 regions globally. About 65% of the current emissions derive from agricultural soils, 8% from waste, and 4% from the chemical industry. Low-cost abatement options are available in industry, wastewater, and agriculture, where they are limited to large industrial farms. We estimate that by 2030, emissions can be reduced by about 6% ±2% applying abatement options at a cost lower than 10 €/t CO2-eq. The largest abatement potential at higher marginal costs is available from agricultural soils, employing precision fertilizer application technology as well as chemical treatment of fertilizers to suppress conversion processes in soil (nitrification inhibitors). At marginal costs of up to 100 €/t CO2-eq, about 18% ±6% of baseline emissions can be removed and when considering all available options, the global abatement potential increases to about 26% ±9%. Due to expected future increase in activities driving nitrous oxide emissions, the limited technical abatement potential available means that even at full implementation of reduction measures by 2030, global emissions can be at most stabilized at the pre-2010 level. In order to achieve deeper reductions in emissions, considerable technological development will be required as well as non-technical options like adjusting human diets towards moderate animal protein consumption.

Oxidative shielding and the cost of reproduction.

PubMed

Blount, Jonathan D; Vitikainen, Emma I K; Stott, Iain; Cant, Michael A

2016-05-01

Life-history theory assumes that reproduction and lifespan are constrained by trade-offs which prevent their simultaneous increase. Recently, there has been considerable interest in the possibility that this cost of reproduction is mediated by oxidative stress. However, empirical tests of this theory have yielded equivocal support. We carried out a meta-analysis to examine associations between reproduction and oxidative damage across markers and tissues. We show that oxidative damage is positively associated with reproductive effort across females of various species. Yet paradoxically, categorical comparisons of breeders versus non-breeders reveal that transition to the reproductive state is associated with a step-change reduction in oxidative damage in certain tissues and markers. Developing offspring may be particularly sensitive to harm caused by oxidative damage in mothers. Therefore, such reductions could potentially function to shield reproducing mothers, gametes and developing offspring from oxidative insults that inevitably increase as a consequence of reproductive effort. According to this perspective, we hypothesise that the cost of reproduction is mediated by dual impacts of maternally-derived oxidative damage on mothers and offspring, and that mothers may be selected to diminish such damage. Such oxidative shielding may explain why many existing studies have concluded that reproduction has little or no oxidative cost. Future advance in life-history theory therefore needs to take account of potential transgenerational impacts of the mechanisms underlying life-history trade-offs. © 2015 Cambridge Philosophical Society.

Measles control in developing and developed countries: the case for a two-dose policy.

PubMed

Tulchinsky, T H; Ginsberg, G M; Abed, Y; Angeles, M T; Akukwe, C; Bonn, J

1993-01-01

Despite major reductions in the incidence of measles and its complications, measles control with a single dose of the currently used. Schwarz strain vaccine has failed to eradicate the disease in the developed countries. In developing countries an enormous toll of measles deaths and disability continues, despite considerable efforts and increasing immunization coverage. Empirical evidence from a number of countries suggests that a two-dose measles vaccination programme, by improving individual protection and heard immunity can make a major contribution to measles control and elimination of local circulation of the disease. Cost-benefit analysis also supports the two-dose schedule in terms of savings in health costs, and total costs to society. A two-dose measles vaccination programme is therefore an essential component of preventive health care in developing, as well as developed countries for the 1990s.

Quantifying the conservation gains from shared access to linear infrastructure.

PubMed

Runge, Claire A; Tulloch, Ayesha I T; Gordon, Ascelin; Rhodes, Jonathan R

2017-12-01

The proliferation of linear infrastructure such as roads and railways is a major global driver of cumulative biodiversity loss. One strategy for reducing habitat loss associated with development is to encourage linear infrastructure providers and users to share infrastructure networks. We quantified the reductions in biodiversity impact and capital costs under linear infrastructure sharing of a range of potential mine to port transportation links for 47 mine locations operated by 28 separate companies in the Upper Spencer Gulf Region of South Australia. We mapped transport links based on least-cost pathways for different levels of linear-infrastructure sharing and used expert-elicited impacts of linear infrastructure to estimate the consequences for biodiversity. Capital costs were calculated based on estimates of construction costs, compensation payments, and transaction costs. We evaluated proposed mine-port links by comparing biodiversity impacts and capital costs across 3 scenarios: an independent scenario, where no infrastructure is shared; a restricted-access scenario, where the largest mining companies share infrastructure but exclude smaller mining companies from sharing; and a shared scenario where all mining companies share linear infrastructure. Fully shared development of linear infrastructure reduced overall biodiversity impacts by 76% and reduced capital costs by 64% compared with the independent scenario. However, there was considerable variation among companies. Our restricted-access scenario showed only modest biodiversity benefits relative to the independent scenario, indicating that reductions are likely to be limited if the dominant mining companies restrict access to infrastructure, which often occurs without policies that promote sharing of infrastructure. Our research helps illuminate the circumstances under which infrastructure sharing can minimize the biodiversity impacts of development. © 2017 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Low Cost Carbon Fibre: Applications, Performance and Cost Models - Chapter 17

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

Warren, Charles David; Wheatley, Dr. Alan; Das, Sujit

2014-01-01

Weight saving in automotive applications has a major bearing on fuel economy. It is generally accepted that, typically, a 10% weight reduction in an automobile will lead to a 6-8% improvement in fuel economy. In this respect, carbon fibre composites are extremely attractive in their ability to provide superlative mechanical performance per unit weight. That is why they are specified for high-end uses such as Formula 1 racing cars and the latest aircraft (e.g. Boeing 787, Airbus A350 and A380), where they comprise over 50% by weight of the structure However, carbon fibres are expensive and this renders their compositesmore » similarly expensive. Research has been carried out at Oak Ridge National Laboratories (ORNL), Tennessee, USA for over a decade with the aim of reducing the cost of carbon fibre such that it becomes a cost-effective option for the automotive industry. Aspects of this research relating to the development of low cost carbon fibre have been reported in Chapter 3 of this publication. In this chapter, the practical industrial applications of low-cost carbon fibre are presented, together with considerations of the performance and cost models which underpin the work.« less

Herd-Level Mastitis-Associated Costs on Canadian Dairy Farms

PubMed Central

Aghamohammadi, Mahjoob; Haine, Denis; Kelton, David F.; Barkema, Herman W.; Hogeveen, Henk; Keefe, Gregory P.; Dufour, Simon

2018-01-01

Mastitis imposes considerable and recurring economic losses on the dairy industry worldwide. The main objective of this study was to estimate herd-level costs incurred by expenditures and production losses associated with mastitis on Canadian dairy farms in 2015, based on producer reports. Previously, published mastitis economic frameworks were used to develop an economic model with the most important cost components. Components investigated were divided between clinical mastitis (CM), subclinical mastitis (SCM), and other costs components (i.e., preventive measures and product quality). A questionnaire was mailed to 374 dairy producers randomly selected from the (Canadian National Dairy Study 2015) to collect data on these costs components, and 145 dairy producers returned a completed questionnaire. For each herd, costs due to the different mastitis-related components were computed by applying the values reported by the dairy producer to the developed economic model. Then, for each herd, a proportion of the costs attributable to a specific component was computed by dividing absolute costs for this component by total herd mastitis-related costs. Median self-reported CM incidence was 19 cases/100 cow-year and mean self-reported bulk milk somatic cell count was 184,000 cells/mL. Most producers reported using post-milking teat disinfection (97%) and dry cow therapy (93%), and a substantial proportion of producers reported using pre-milking teat disinfection (79%) and wearing gloves during milking (77%). Mastitis costs were substantial (662 CAD per milking cow per year for a typical Canadian dairy farm), with a large portion of the costs (48%) being attributed to SCM, and 34 and 15% due to CM and implementation of preventive measures, respectively. For SCM, the two most important cost components were the subsequent milk yield reduction and culling (72 and 25% of SCM costs, respectively). For CM, first, second, and third most important cost components were culling (48% of CM costs), milk yield reduction following the CM events (34%), and discarded milk (11%), respectively. This study is the first since 1990 to investigate costs of mastitis in Canada. The model developed in the current study can be used to compute mastitis costs at the herd and national level in Canada. PMID:29868620

48 CFR 915.404-4-72 - Special considerations for cost-plus-award-fee contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... cost-plus-award-fee contracts. 915.404-4-72 Section 915.404-4-72 Federal Acquisition Regulations System....404-4-72 Special considerations for cost-plus-award-fee contracts. (a) When a contract is to be awarded on a cost-plus-award-fee basis several special considerations are appropriate. Fee objectives for...

Review article: the economic impact of the irritable bowel syndrome.

PubMed

Canavan, C; West, J; Card, T

2014-11-01

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. Appropriate databases were searched for relevant papers using the terms: Irritable Bowel Syndrome; IBS; irritable colon; functional bowel/colonic disease; economics; health care/service costs; health expenditure/resources; health care/service utilisation; productivity. Irritable bowel syndrome impacts most substantially on patients' work and social life. Reduction in QoL is such that on average patients would sacrifice between 10 and 15 years of their remaining life expectancy for an immediate cure. Between 15% and 43% of patients pay for remedies. No studies quantify loss of earnings related to IBS. Direct care costs are substantial; 48% of patients incur some costs in any year with annual international estimates per patient of: USA $742-$7547, UK £90-£316, France €567-€862, Canada $259, Germany €791, Norway NOK 2098 (€262) and Iran $92. Minimising extensive diagnostic investigations could generate savings and has been shown as not detrimental to patients. Cost to industry internationally through absenteeism and presenteeism related to IBS is estimated between £400 and £900 per patient annually. Irritable bowel syndrome is associated with substantial costs to patients, healthcare systems and society. Considerable benefit could be obtained from effective interventions. © 2014 John Wiley & Sons Ltd.

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations.

PubMed

Meuldijk, Denise; McCarthy, Alexandra; Bourke, Marianne E; Grenyer, Brin F S

2017-01-01

Borderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update. Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities. We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found. Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread reductions in healthcare costs.

Cost-Effectiveness Analysis of Tyrosine Kinase Inhibitors for Patients with Advanced Gastrointestinal Stromal Tumors.

PubMed

Nerich, Virginie; Fleck, Camille; Chaigneau, Loïc; Isambert, Nicolas; Borg, Christophe; Kalbacher, Elsa; Jary, Marine; Simon, Pauline; Pivot, Xavier; Blay, Jean-Yves; Limat, Samuel

2017-01-01

The management of advanced gastrointestinal stromal tumors (GISTs) has been modified considerably by the availability of costly tyrosine kinase inhibitors (TKIs); however, the best therapeutic sequence in terms of cost and effectiveness remains unknown. The aim of this study was to compare four potential strategies (reflecting the potential daily practice), each including imatinib 400 mg/day, as first-line treatment: S1 (imatinib 400 /best supportive care [BSC]); S2 (imatinib 400 /imatinib 800 /BSC); S3 (imatinib 400 /sunitinib/BSC); and S4 (imatinib 400 /imatinib 800 /sunitinib/BSC). A Markov model was developed with a hypothetical cohort of patients and a lifetime horizon. Transition probabilities were estimated from the results of clinical trials. The analysis was performed from the French payer perspective, and only direct medical costs were included. Clinical and economic parameters were discounted, and the robustness of results was assessed. The least costly and effective strategy was S1, at a cost of €65,744 for 32.9 life months (reference). S3 was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of €48,277/life-year saved (LYS). S2 was dominated, and S4 yielded an ICER of €363,320/LYS compared with S3. Sensitivity analyses confirmed the robustness of these results; however, when taking into account a price reduction of 80 % for imatinib, S2 and S4 become the most cost-effective strategies. Our approach is innovative to the extent that our analysis takes into account the sequential application of TKIs. The results suggest that the S1 strategy is the best cost-effective strategy, but a price reduction of imatinib impacts on the results. This approach must continue, including new drugs and their impact on the quality of life of patients with advanced GISTs.

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations

PubMed Central

Meuldijk, Denise; McCarthy, Alexandra; Bourke, Marianne E.; Grenyer, Brin F. S.

2017-01-01

Aim Borderline Personality Disorder (BPD) is a common mental health condition with high patterns of service utilisation of inpatient and community treatment. Over the past five years there has been significant growth in research with economic data, making this systematic review a timely update. Methods Empirical studies written in English or German, published up to December 2015, and cited in major electronic databases were examined using the PRISMA systematic review method. Papers were included that had one of the following: data related to cost of BPD to society, the individual, the carer or families; cost benefits of interventions. Reported cost data were inflated to the year 2015 and converted into US- dollars (USD $) using purchasing power parities. Results We identified 30 economic evaluations providing cost data related to interventions for BPD across 134,136 patients. The methodological quality was good, almost all studies fulfilled ≥ 50% of the quality criteria. The mean cost saving for treating BPD with evidence-based psychotherapy across studies was USD $2,987.82 per patient per year. A further mean weighted reduction of USD $1,551 per patient per year (range $83 - $29,392) was found compared to treatment as usual. Evidence-based psychological treatment was both less expensive as well as more effective, despite considerable differences in health cost arrangements between individual studies and countries. Where it was able to be calculated, a significant difference in cost-savings between different types of evidence-based psychotherapies was found. Discussion Individuals with BPD consistently demonstrate high patterns of service utilization and therefore high costs. The findings of this review present a strong argument in favour of prioritizing BPD treatments in reimbursement decisions, both for the affected individual and the family. The provision of evidence based treatment, irrespective of the type of psychological treatment, may lead to widespread reductions in healthcare costs. PMID:28249032

Providing cost-effective treatment of hard-to-heal wounds in the community through use of NPWT.

PubMed

Hampton, Jane

2015-06-01

The treatment of non-healing wounds accounts for a high proportion of wound care costs. Advanced technology treatments, such as negative pressure wound therapy (NPWT), could be cost-effective if they result in faster healing. The objective of this study is to assess the effect on healing and the cost-effectiveness of a single-use NPWT (i.e PICO by Smith & Nephew) when used on hard-to-heal wounds in a community setting. This was a cohort case study in which wounds were treated with NWPT for 2 weeks. Wounds were assessed every 2-4 weeks to a healed state. The weekly cost of treatment prior to intervention, that is, the products used and nurse time, were compared with treatment costs associated with NWPT and after a return to standard treatment. The study included 9 patients with leg ulcers or pressure ulcers that had been slow healing or non-healing for at least 6 weeks. While treated with NPWT, the average weekly reduction in wound size was 21%. The wound size achieved with NPWT was reached on average 10 weeks earlier than predicted. The increased healing rate continued after PICO stopped and 5 wounds healed on average 8 weeks later. Frequency of dressing changes fell from 4 times weekly at baseline to 2 times a week with NPWT and to 1.8 after NPWT stopped. Weekly cost of treatment with NPWT was, on average, 1.6 times higher than the baseline, but fell to 3 times less when NPWT stopped owing to the reduction in dressing changes. The amount of change in healing rate was considerably higher than the increase in costs associated with NPWT. NWPT is a cost-effective treatment for hard-to-heal wounds. Wounds decreased in size and healed more quickly under NWPT treatment than under standard treatment. Additional NPWT costs can be quickly offset by faster healing and a shortened treatment period.

Cost-effectiveness of population-based screening for colorectal cancer: a comparison of guaiac-based faecal occult blood testing, faecal immunochemical testing and flexible sigmoidoscopy

PubMed Central

Sharp, L; Tilson, L; Whyte, S; O'Ceilleachair, A; Walsh, C; Usher, C; Tappenden, P; Chilcott, J; Staines, A; Barry, M; Comber, H

2012-01-01

Background: Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55–74, with reflex faecal immunochemical testing (FIT); (ii) biennial FIT at ages 55–74; and (iii) once-only flexible sigmoidoscopy (FSIG) at age 60. Methods: A state-transition model was used to estimate costs and outcomes for each screening scenario vs no screening. A third party payer perspective was adopted. Probabilistic sensitivity analyses were undertaken. Results: All scenarios would be considered highly cost-effective compared with no screening. The lowest incremental cost-effectiveness ratio (ICER vs no screening €589 per quality-adjusted life-year (QALY) gained) was found for FSIG, followed by FIT (€1696) and gFOBT (€4428); gFOBT was dominated. Compared with FSIG, FIT was associated with greater gains in QALYs and reductions in lifetime cancer incidence and mortality, but was more costly, required considerably more colonoscopies and resulted in more complications. Results were robust to variations in parameter estimates. Conclusion: Population-based screening based on FIT is expected to result in greater health gains than a policy of gFOBT (with reflex FIT) or once-only FSIG, but would require significantly more colonoscopy resources and result in more individuals experiencing adverse effects. Weighing these advantages and disadvantages presents a considerable challenge to policy makers. PMID:22343624

Is Municipal Solid Waste Recycling Economically Efficient?

NASA Astrophysics Data System (ADS)

Lavee, Doron

2007-12-01

It has traditionally been argued that recycling municipal solid waste (MSW) is usually not economically viable and that only when externalities, long-term dynamic considerations, and/or the entire product life cycle are taken into account, recycling becomes worthwhile from a social point of view. This article explores the results of a wide study conducted in Israel in the years 2000 2004. Our results reveal that recycling is optimal more often than usually claimed, even when externality considerations are ignored. The study is unique in the tools it uses to explore the efficiency of recycling: a computer-based simulation applied to an extensive database. We developed a simulation for assessing the costs of handling and treating MSW under different waste-management systems and used this simulation to explore possible cost reductions obtained by designating some of the waste (otherwise sent to landfill) to recycling. We ran the simulation on data from 79 municipalities in Israel that produce over 60% of MSW in Israel. For each municipality, we were able to arrive at an optimal method of waste management and compare the costs associated with 100% landfilling to the costs born by the municipality when some of the waste is recycled. Our results indicate that for 51% of the municipalities, it would be efficient to adopt recycling, even without accounting for externality costs. We found that by adopting recycling, municipalities would be able to reduce direct costs by an average of 11%. Through interviews conducted with representatives of municipalities, we were also able to identify obstacles to the utilization of recycling, answering in part the question of why actual recycling levels in Israel are lower than our model predicts they should be.

Effect of residential air-to-air heat and moisture exchangers on indoor humidity

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

Barringer, C.G.; McGugan, C.A.

1989-01-01

A project was undertaken to develop guidelines for the selection of residential heat and moisture recovery ventilation systems (HRVs) in order to maintain an acceptable indoor humidity for various climatic conditions. These guidelines were developed from reviews on ventilation requirements, HRV performance specifications, and from computer modeling. Space conditions within three house/occupancy models for several types of HRV were simulated for three climatic conditions (Lake Charles, LA; Seattle, WA; and Winnipeg, MB) in order to determine the impact of the HRVs on indoor relative humidity and space-conditioning loads. Results show that when reduction of cooling cost is the main consideration,more » exchangers with moisture recovery are preferable to sensible HRVs. For reduction of heating costs, moisture recovery should be done for ventilation rates greater than about 15 L/s and average winter temperatures less than about (minus) 10{degrees}C if internal moisture generation rates are low. For houses with higher ventilation rates and colder average winter temperatures, exchangers with moisture recovery should be used.« less

Guessing versus Choosing an Upcoming Task

PubMed Central

Kleinsorge, Thomas; Scheil, Juliane

2016-01-01

We compared the effects of guessing vs. choosing an upcoming task. In a task-switching paradigm with four tasks, two groups of participants were asked to either guess or choose which task will be presented next under otherwise identical conditions. The upcoming task corresponded to participants’ guesses or choices in 75 % of the trials. However, only participants in the Choosing condition were correctly informed about this, whereas participants in the Guessing condition were told that tasks were determined at random. In the Guessing condition, we replicated previous findings of a pronounced reduction of switch costs in case of incorrect guesses. This switch cost reduction was considerably less pronounced with denied choices in the Choosing condition. We suggest that in the Choosing condition, the signaling of prediction errors associated with denied choices is attenuated because a certain proportion of denied choices is consistent with the overall representation of the situation as conveyed by task instructions. In the Guessing condition, in contrast, the mismatch of guessed and actual task is resolved solely on the level of individual trials by strengthening the representation of the actual task. PMID:27047423

High-Throughput Fabrication Method for Producing a Silver-Nanoparticles-Doped Nanoclay Polymer Composite with Novel Synergistic Antibacterial Effects at the Material Interface.

PubMed

Cai, Shaobo; Pourdeyhimi, Behnam; Loboa, Elizabeth G

2017-06-28

In this study, we report a high-throughput fabrication method at industrial pilot scale to produce a silver-nanoparticles-doped nanoclay-polylactic acid composite with a novel synergistic antibacterial effect. The obtained nanocomposite has a significantly lower affinity for bacterial adhesion, allowing the loading amount of silver nanoparticles to be tremendously reduced while maintaining satisfactory antibacterial efficacy at the material interface. This is a great advantage for many antibacterial applications in which cost is a consideration. Furthermore, unlike previously reported methods that require additional chemical reduction processes to produce the silver-nanoparticles-doped nanoclay, an in situ preparation method was developed in which silver nanoparticles were created simultaneously during the composite fabrication process by thermal reduction. This is the first report to show that altered material surface submicron structures created with the loading of nanoclay enables the creation of a nanocomposite with significantly lower affinity for bacterial adhesion. This study provides a promising scalable approach to produce antibacterial polymeric products with minimal changes to industry standard equipment, fabrication processes, or raw material input cost.

Putting Order Into the Cloud: Object-oriented UML-based Rule Enforcement for Document and Application Organization

DTIC Science & Technology

2010-09-01

Cloud computing describes a new distributed computing paradigm for IT data and services that involves over-the-Internet provision of dynamically scalable and often virtualized resources. While cost reduction and flexibility in storage, services, and maintenance are important considerations when deciding on whether or how to migrate data and applications to the cloud, large organizations like the Department of Defense need to consider the organization and structure of data on the cloud and the operations on such data in order to reap the full benefit of cloud

High temperature solar thermal technology

NASA Technical Reports Server (NTRS)

Leibowitz, L. P.; Hanseth, E. J.; Peelgren, M. L.

1980-01-01

Some advanced technology concepts under development for high-temperature solar thermal energy systems to achieve significant energy cost reductions and performance gains and thus promote the application of solar thermal power technology are presented. Consideration is given to the objectives, current efforts and recent test and analysis results in the development of high-temperature (950-1650 C) ceramic receivers, thermal storage module checker stoves, and the use of reversible chemical reactions to transport collected solar energy. It is pointed out that the analysis and testing of such components will accelerate the commercial deployment of solar energy.

A Lightweight Loudspeaker for Aircraft Communications and Active Noise Control

NASA Technical Reports Server (NTRS)

Warnaka, Glenn E.; Kleinle, Mark; Tsangaris, Parry; Oslac, Michael J.; Moskow, Harry J.

1992-01-01

A series of new, lightweight loudspeakers for use on commercial aircraft has been developed. The loudspeakers use NdFeB magnets and aluminum alloy frames to reduce the weight. The NdFeB magnet is virtually encapsulated by steel in the new speaker designs. Active noise reduction using internal loudspeakers was demonstrated to be effective in 1983. A weight, space, and cost efficient method for creating the active sound attenuating fields is to use the existing cabin loudspeakers for both communication and sound attenuation. This will require some additional loudspeaker design considerations.

Advancements in rationally designed PGM-free fuel cell catalysts derived from metal–organic frameworks

DOE PAGES

Barkholtz, Heather M.; Liu, Di -Jia

2016-11-14

Over the past several years, metal-organic framework (MOF)-derived platinum group metal free (PGM-free) electrocatalysts have gained considerable attention due to their high efficiency and low cost as potential replacement for platinum in catalyzing oxygen reduction reaction (ORR). In this review, we summarize the recent advancements in design, synthesis and characterization of MOF-derived ORR catalysts and their performances in acidic and alkaline media. As a result, we also discuss the key challenges such as durability and activity enhancement critical in moving forward this emerging electrocatalyst science.

Economic evaluation of targeted cancer interventions: critical review and recommendations.

PubMed

Elkin, Elena B; Marshall, Deborah A; Kulin, Nathalie A; Ferrusi, Ilia L; Hassett, Michael J; Ladabaum, Uri; Phillips, Kathryn A

2011-10-01

Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.

Stranded cost securitization: Analytical considerations

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

Abbott, S.

1997-10-01

Securitization is a promising financing approach by which utilities may recover their stranded costs while lowering their cost of capital, permitting them to offer rate reductions to customers. However, there are important issues to analyze before determining that securitization will be an attractive option for bondholders. To facilitate the transition to a competitive electric market, numerous state legislatures have passed or are considering legislation that, while mandating competition, allows utilities to recover their stranded costs through the imposition of a competitive transition fee. To accommodate securitization of revenues from the fees, statutes typically designate as a property right the futuremore » revenues from these fees and the utility may sell, assign, or transfer the rights to a financing vehicle. Securities may be issued by a trust or other special purpose vehicle supported by future revenues from these fees. Because of the unique characteristics of the highly regulated utility industry and the {open_quotes}asset{close_quotes} that is securitized, the credit analysis of stranded cost securities differs from that of most other assets. For example, underwriting and servicing issues, which are key items of interest in other segments of the ABS market, are less of a concern in a stranded cost context.« less

Cost-effectiveness of a package of interventions for expedited antiretroviral therapy initiation during pregnancy in Cape Town, South Africa

PubMed Central

ZULLIGER, Rose; BLACK, Samantha; HOLTGRAVE, David R.; CIARANELLO, Andrea L.; BEKKER, Linda–Gail; MYER, Landon

2014-01-01

Initiating antiretroviral therapy (ART) early in pregnancy is an important component of effective interventions to prevent the mother-to-child transmission of HIV (PMTCT). The Rapid initiation of ART in Pregnancy (RAP) program was a package of interventions to expedite ART initiation in pregnant women in Cape Town, South Africa. Retrospective, cost-effectiveness, sensitivity and threshold analyses were conducted of the RAP program to determine the cost-utility thresholds for rapid initiation of ART in pregnancy. Costs were drawn from a detailed microcosting of the program. The overall programmatic cost was US$880 per woman and the base case cost-effectiveness ratio was US$1,160 per quality-adjusted life year (QALY) saved. In threshold analyses, the RAP program remained cost-effective if mother-to-child transmission was reduced by ≥0.33%; if ≥1.76 QALY were saved with each averted perinatal infection; or if RAP-related costs were under US$4,020 per woman. The package of rapid initiation services was very cost-effective, as compared to standard services in this setting. Threshold analyses demonstrated that the intervention required minimal reductions in perinatal infections in order to be cost-effective. Interventions for the rapid initiation of ART in pregnancy hold considerable potential as a cost-effective use of limited resources for PMTCT in sub-Saharan Africa. PMID:24122044

[Productivity costs of rheumatoid arthritis in Germany. Cost composition and prediction of main cost components].

PubMed

Merkesdal, S; Huelsemann, J L; Mittendorf, T; Zeh, S; Zeidler, H; Ruof, J

2006-10-01

Identification of predictors for the productivity cost components: (1) sick leave, and (2) work disability in gainfully employed and (3) impaired household productivity in unemployed patients with rheumatoid arthritis (RA) from the societal perspective. Investigation of productivity costs was linked to a multicenter, randomized, controlled trial evaluating the effectiveness of clinical quality management in 338 patients with RA. The productivity losses were assessed according to the German Guidelines on Health Economic Evaluation. By means of multivariate logistic regression analyses, predictors of sick leave, work disability (employed patients, n=96), and for days confined to bed in unemployed patient (n=242) were determined. Mean annual costs of 970 EUR arose per person taking into consideration all patients (453 EUR sick leave, 63 EUR work disability, 454 EUR impaired productivity of unemployed patients). Disease activity, disease severity, and impaired physical function were global predictors for all of the cost components investigated. Sick leave costs were predicted by prior sick leave periods and the vocational status blue collar worker, work disability costs by sociodemographic variables (marital status, schooling), and the productivity costs of unemployed patients by impaired mental health and impaired physical functions. Interventions such as reduction in disease progression and control of disease activity, early vocational rehabilitation measures and vocational retraining in patients at risk of quitting working life, and self-management programs to learn coping strategies might decrease future RA-related productivity costs.

Valuation of plug-in vehicle life-cycle air emissions and oil displacement benefits

PubMed Central

Michalek, Jeremy J.; Chester, Mikhail; Jaramillo, Paulina; Samaras, Constantine; Shiau, Ching-Shin Norman; Lave, Lester B.

2011-01-01

We assess the economic value of life-cycle air emissions and oil consumption from conventional vehicles, hybrid-electric vehicles (HEVs), plug-in hybrid-electric vehicles (PHEVs), and battery electric vehicles in the US. We find that plug-in vehicles may reduce or increase externality costs relative to grid-independent HEVs, depending largely on greenhouse gas and SO2 emissions produced during vehicle charging and battery manufacturing. However, even if future marginal damages from emissions of battery and electricity production drop dramatically, the damage reduction potential of plug-in vehicles remains small compared to ownership cost. As such, to offer a socially efficient approach to emissions and oil consumption reduction, lifetime cost of plug-in vehicles must be competitive with HEVs. Current subsidies intended to encourage sales of plug-in vehicles with large capacity battery packs exceed our externality estimates considerably, and taxes that optimally correct for externality damages would not close the gap in ownership cost. In contrast, HEVs and PHEVs with small battery packs reduce externality damages at low (or no) additional cost over their lifetime. Although large battery packs allow vehicles to travel longer distances using electricity instead of gasoline, large packs are more expensive, heavier, and more emissions intensive to produce, with lower utilization factors, greater charging infrastructure requirements, and life-cycle implications that are more sensitive to uncertain, time-sensitive, and location-specific factors. To reduce air emission and oil dependency impacts from passenger vehicles, strategies to promote adoption of HEVs and PHEVs with small battery packs offer more social benefits per dollar spent. PMID:21949359

Valuation of plug-in vehicle life-cycle air emissions and oil displacement benefits.

PubMed

Michalek, Jeremy J; Chester, Mikhail; Jaramillo, Paulina; Samaras, Constantine; Shiau, Ching-Shin Norman; Lave, Lester B

2011-10-04

We assess the economic value of life-cycle air emissions and oil consumption from conventional vehicles, hybrid-electric vehicles (HEVs), plug-in hybrid-electric vehicles (PHEVs), and battery electric vehicles in the US. We find that plug-in vehicles may reduce or increase externality costs relative to grid-independent HEVs, depending largely on greenhouse gas and SO(2) emissions produced during vehicle charging and battery manufacturing. However, even if future marginal damages from emissions of battery and electricity production drop dramatically, the damage reduction potential of plug-in vehicles remains small compared to ownership cost. As such, to offer a socially efficient approach to emissions and oil consumption reduction, lifetime cost of plug-in vehicles must be competitive with HEVs. Current subsidies intended to encourage sales of plug-in vehicles with large capacity battery packs exceed our externality estimates considerably, and taxes that optimally correct for externality damages would not close the gap in ownership cost. In contrast, HEVs and PHEVs with small battery packs reduce externality damages at low (or no) additional cost over their lifetime. Although large battery packs allow vehicles to travel longer distances using electricity instead of gasoline, large packs are more expensive, heavier, and more emissions intensive to produce, with lower utilization factors, greater charging infrastructure requirements, and life-cycle implications that are more sensitive to uncertain, time-sensitive, and location-specific factors. To reduce air emission and oil dependency impacts from passenger vehicles, strategies to promote adoption of HEVs and PHEVs with small battery packs offer more social benefits per dollar spent.

Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.

PubMed

Stone, Alexander B; Grant, Michael C; Pio Roda, Claro; Hobson, Deborah; Pawlik, Timothy; Wu, Christopher L; Wick, Elizabeth C

2016-03-01

Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program. Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital. Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections. Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A Retrospective, Single-Center Comparative Cost Analysis of OnabotulinumtoxinA and AbobotulinumtoxinA for Cervical Dystonia Treatment.

PubMed

Trosch, Richard M; Shillington, Alicia C; English, Marci L; Marchese, Dominic

2015-10-01

Chemodenervation with botulinum neurotoxin (BoNT) is recommended as first-line treatment for the management of cervical dystonia. The choice of BoNT for treatment is subject to the consideration of several factors, including cost. To compare the costs incurred by patients and payers for onabotulinumtoxinA (ONA) or abobotulinumtoxinA (ABO) for the treatment of cervical dystonia. We conducted a retrospective, noninterventional closed cohort study of cervical dystonia patients within a single U.S. private neurological practice. Patient and payer incurred costs from medical billing records for patients satisfying inclusion and exclusion criteria treated from November 1, 2009, through January 1, 2013, were de-identified and included in the analysis. Forty-seven patients initially treated with at least 3 consecutive cycles of ONA, followed by at least 3 consecutive cycles of ABO were included, representing 282 injection cycles available for analysis. Patients were required to have had a positive response to treatment with both agents and no concomitant treatment with BoNT for any other condition during the analysis period. The analysis compared the primary endpoint of median overall payer and patient incurred costs reimbursed to the clinic under each treatment regimen. For the purposes of this cost analysis, comparable clinical outcomes on both therapies was assumed.   Switching from ONA to ABO resulted in an overall incurred reimbursement cost savings for payers and patients. Median costs per injection cycle for ONA were $1,925 ($0-$2,814) compared with $1,214 ($229-$2,899; P  less than  0.0001) for ABO, representing an approximate 37% reduction in incurred reimbursement costs inclusive of toxin and procedure. Overall toxin reimbursement costs, patient out-of-pocket toxin costs, and the cost of unavoidable waste were also lower when patients were treated with ABO.  For patients treated for cervical dystonia, switching from ONA to ABO resulted in payer and patient reimbursement cost reductions in a single U.S. private practice with outcomes assumed to be similar.

How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India.

PubMed

Azman, Andrew S; Golub, Jonathan E; Dowdy, David W

2014-10-30

Current approaches are unlikely to achieve the aggressive global tuberculosis (TB) control targets set for 2035 and beyond. Active case finding (ACF) may be an important tool for augmenting existing strategies, but the cost-effectiveness of ACF remains uncertain. Program evaluators can often measure the cost of ACF per TB case detected, but how this accessible measure translates into traditional metrics of cost-effectiveness, such as the cost per disability-adjusted life year (DALY), remains unclear. We constructed dynamic models of TB in India, China, and South Africa to explore the medium-term impact and cost-effectiveness of generic ACF activities, conceptualized separately as discrete (2-year) campaigns and as continuous activities integrated into ongoing TB control programs. Our primary outcome was the cost per DALY, measured in relationship to the cost per TB case actively detected and started on treatment. Discrete campaigns costing up to $1,200 (95% uncertainty range [UR] 850-2,043) per case actively detected and started on treatment in India, $3,800 (95% UR 2,706-6,392) in China, and $9,400 (95% UR 6,957-13,221) in South Africa were all highly cost-effective (cost per DALY averted less than per capita gross domestic product). Prolonged integration was even more effective and cost-effective. Short-term assessments of ACF dramatically underestimated potential longer term gains; for example, an assessment of an ACF program at 2 years might find a non-significant 11% reduction in prevalence, but a 10-year evaluation of that same intervention would show a 33% reduction. ACF can be a powerful and highly cost-effective tool in the fight against TB. Given that short-term assessments may dramatically underestimate medium-term effectiveness, current willingness to pay may be too low. ACF should receive strong consideration as a basic tool for TB control in most high-burden settings, even when it may cost over $1,000 to detect and initiate treatment for each extra case of active TB.

Tamoxifen for breast cancer risk reduction: impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis.

PubMed

Melnikow, Joy; Birch, Stephen; Slee, Christina; McCarthy, Theodore J; Helms, L Jay; Kuppermann, Miriam

2008-09-01

In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life. To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction. A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction. Incremental quality-adjusted effectiveness and cost-effectiveness ratios (ICERs) for models including and excluding a utility adjustment for menopausal symptoms were compared with each other and to a global utility model. Two hundred fifty-five women aged 50 and over with estimated 5-year breast cancer risk >or=1.67% participated in utility assessment interviews. Standard gamble utilities were assessed for specified tamoxifen-related health outcomes, current health, and for a global assessment of possible outcomes of tamoxifen use. Inclusion of a utility for menopausal symptoms in the outcome-specific models substantially increased the ICER; at the threshold 5-year breast cancer risk of 1.67%, tamoxifen was dominated. When a global utility for tamoxifen was used in place of outcome-specific utilities, tamoxifen was dominated under all circumstances. CEAs may be profoundly affected by the types of outcomes considered for quality-of-life adjustment and how these outcomes are grouped for utility assessment. Comparisons of ICERs across analyses must consider effects of different approaches to using utilities for quality-of-life adjustment.

Optimal ventilatory patterns in periodic breathing.

PubMed

Ghazanshahi, S D; Khoo, M C

1993-01-01

The goal of this study was to determine whether periodic breathing (PB), which is highly prevalent during sleep at high altitudes, imposes physiological penalties on the respiratory system in the absence of any accompanying disease. Using a computer model of respiratory gas exchange, we compared the effects of a variety of PB patterns on the chemical and mechanical costs of breathing to those resulting from regular tidal breathing. Although PB produced considerable fluctuation in arterial blood gas tensions, for the same cycle-averaged ventilation, higher arterial oxygen saturation and lower arterial carbon dioxide levels were achieved. This result can be explained by the fact that the combination of large breaths and apnea in PB leads to a substantial reduction in dead space ventilation. At the same time, the savings in mechanical cost achieved by the respiratory muscles during apnea partially offset the increase during the breathing phase. Consequently, the "pressure cost," a criterion based on mean inspiratory pressure, was elevated only slightly, although the average work rate of breathing increased significantly. We found that, at extreme altitudes, PB patterns with clusters of 2 to 4 large breaths that alternate with apnea produce the highest arterial oxygenation levels and lowest pressure costs. The common occurrence of PB patterns with closely similar features has been reported in sleeping healthy sojourners at extreme altitudes. Taken together, these findings suggest that PB favors a reduction in the oxygen demands of the respiratory muscles and therefore may not be as detrimental as it is generally believed to be.

48 CFR 970.5215-4 - Cost reduction.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Cost reduction. 970.5215-4... and Operating Contracts 970.5215-4 Cost reduction. As prescribed in 970.1504-5(c), insert the following clause: Cost Reduction (AUG 2009) (a) General. It is the Department of Energy's (DOE's) intent to...

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

PubMed

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

2017-08-01

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

Unveiling N-protonation and anion-binding effects on Fe/N/C-catalysts for O2 reduction in PEM fuel cells

PubMed Central

Herranz, Juan; Jaouen, Frédéric; Lefèvre, Michel; Kramm, Ulrike I.; Proietti, Eric; Dodelet, Jean-Pol; Bogdanoff, Peter; Fiechter, Sebastian; Abs-Wurmbach, Irmgard; Bertrand, Patrick; Arruda, Thomas M.; Mukerjee, Sanjeev

2013-01-01

The high cost of proton-exchange-membrane fuel cells would be considerably reduced if platinumbased catalysts were replaced by iron-based substitutes, which have recently demonstrated comparable activity for oxygen reduction, but whose cause of activity decay in acidic medium has been elusive. Here, we reveal that the activity of Fe/N/C-catalysts prepared through a pyrolysis in NH3 is mostly imparted by acid-resistant FeN4-sites whose turnover frequency for the O2 reduction can be regulated by fine chemical changes of the catalyst surface. We show that surface N-groups protonate at pH 1 and subsequently bind anions. This results in decreased activity for the O2 reduction. The anions can be removed chemically or thermally, which restores the activity of acid-resistant FeN4-sites. These results are interpreted as an increased turnover frequency of FeN4-sites when specific surface N-groups protonate. These unprecedented findings provide new perspective for stabilizing the most active Fe/N/C-catalysts known to date. PMID:24179561

Unveiling N-protonation and anion-binding effects on Fe/N/C-catalysts for O2 reduction in PEM fuel cells.

PubMed

Herranz, Juan; Jaouen, Frédéric; Lefèvre, Michel; Kramm, Ulrike I; Proietti, Eric; Dodelet, Jean-Pol; Bogdanoff, Peter; Fiechter, Sebastian; Abs-Wurmbach, Irmgard; Bertrand, Patrick; Arruda, Thomas M; Mukerjee, Sanjeev

2011-11-18

The high cost of proton-exchange-membrane fuel cells would be considerably reduced if platinumbased catalysts were replaced by iron-based substitutes, which have recently demonstrated comparable activity for oxygen reduction, but whose cause of activity decay in acidic medium has been elusive. Here, we reveal that the activity of Fe/N/C-catalysts prepared through a pyrolysis in NH 3 is mostly imparted by acid-resistant FeN 4 -sites whose turnover frequency for the O 2 reduction can be regulated by fine chemical changes of the catalyst surface. We show that surface N-groups protonate at pH 1 and subsequently bind anions. This results in decreased activity for the O 2 reduction. The anions can be removed chemically or thermally, which restores the activity of acid-resistant FeN 4 -sites. These results are interpreted as an increased turnover frequency of FeN 4 -sites when specific surface N-groups protonate. These unprecedented findings provide new perspective for stabilizing the most active Fe/N/C-catalysts known to date.

The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity.

PubMed

Laxy, Michael; Stark, Renée; Peters, Annette; Hauner, Hans; Holle, Rolf; Teuner, Christina M

2017-08-30

This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31-96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m², this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.

The personal and national costs of lost labour force participation due to arthritis: an economic study

PubMed Central

2013-01-01

Background The costs of arthritis to the individuals and the state are considerable. Methods Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model of 45 to 64 year old Australians built on data from the Australian Bureau of Statistics’ Survey of Disability, Ageing and Carers and STINMOD, an income and savings microsimulation model. Results Individuals aged 45 to 64 years who had retired early due to arthritis had a median value of AU$260 in total weekly income whereas those who were employed full time were likely to average more than five times this. The large national aggregate impact of early retirement due to arthritis includes AU$9.4 billion in lost GDP, attributable to arthritis through its impact on labour force participation. When looking at the ongoing impact of being out of the labour force those who retired from the labour force early due to arthritis were estimated to have a median value of total savings by the time they are 65 of as little as $300 (for males aged 45–54). This is far lower than the median value of savings for those males aged 45–54 who remained in the labour force full time, who would have an estimated $339 100 of savings at age 65. Conclusions The costs of arthritis to the individuals and the state are considerable. The impacts on the state include loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments – in addition to direct health care costs. Individuals bear the economic costs of lost income and the reduction of their savings over the long term. PMID:23452565

Re-thinking incentives and penalties: economic aspects of waste management in Italy.

PubMed

Cossu, R; Masi, S

2013-11-01

This paper focuses on the dynamics the formation of operational costs of waste management in Italy and the effect of economic measures. Currently incentives and penalties have been internalized by the system no differently from other cost items and revenues. This has greatly influenced the system directing it towards solutions that are often distant from the real environmental objectives. Based on an analysis of disaggregated costs of collection treatment and recovery, we provide the basic elements to compose a picture of economic management in various technical-organizational scenarios. In the light of the considerations contained in the paper it is proposed, e.g. for controlled landfills, that the ecotax, currently based on weight, could be replaced by one based on the volume consumption. Likewise, for tax reduction on disposal system, instead a pre-treatment might ask an environmental balance of the overall system. The article presents a reflection on the last hidden costs associated with the consumption of goods and packaging, and how to reduce waste production is the necessary path to be followed in ecological and economic perspectives. Copyright © 2013 Elsevier Ltd. All rights reserved.

Climate change air toxic co-reduction in the context of macroeconomic modelling.

PubMed

Crawford-Brown, Douglas; Chen, Pi-Cheng; Shi, Hsiu-Ching; Chao, Chia-Wei

2013-08-15

This paper examines the health implications of global PM reduction accompanying greenhouse gas emissions reductions in the 180 national economies of the global macroeconomy. A human health effects module based on empirical data on GHG emissions, PM emissions, background PM concentrations, source apportionment and human health risk coefficients is used to estimate reductions in morbidity and mortality from PM exposures globally as co-reduction of GHG reductions. These results are compared against the "fuzzy bright line" that often underlies regulatory decisions for environmental toxics, and demonstrate that the risk reduction through PM reduction would usually be considered justified in traditional risk-based decisions for environmental toxics. It is shown that this risk reduction can be on the order of more than 4 × 10(-3) excess lifetime mortality risk, with global annual cost savings of slightly more than $10B, when uniform GHG reduction measures across all sectors of the economy form the basis for climate policy ($2.2B if only Annex I nations reduce). Consideration of co-reduction of PM-10 within a climate policy framework harmonized with other environmental policies can therefore be an effective driver of climate policy. An error analysis comparing results of the current model against those of significantly more spatially resolved models at city and national scales indicates errors caused by the low spatial resolution of the global model used here may be on the order of a factor of 2. Copyright © 2013 Elsevier Ltd. All rights reserved.

Explanation of Change (EoC) Study: Considerations and Implementation Challenges

NASA Technical Reports Server (NTRS)

Bitten, Robert E.; Emmons, Debra L.; Hart, Matthew J.; Bordi, Francesco; Scolese, Christopher; Hinners, Noel

2013-01-01

This paper discusses the implementation of considerations resulting from a study investigating the cost change experienced by historical NASA science missions. The study investigated historical milestone and monthly status report documentation followed by interviews with key project personnel. The reasons for cost change were binned as being external to NASA, external to the project and internal to the project relative to the project's planning and execution. Based on the results of the binning process and the synthesis of project meetings and interviews, ten considerations were made with the objective to decrease the potential for cost change in future missions. Although no one magic bullet consideration was discovered, the considerations taken as a whole should help reduce cost and schedule change in future NASA missions.

Cost consideration in the clinical guidance documents of physician specialty societies in the United States.

PubMed

Schwartz, Jennifer A T; Pearson, Steven D

2013-06-24

Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Qualitative document review. Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

Intraoperative Considerations for Treatment/Prevention of Prosthetic Joint Infection.

PubMed

Suleiman, Linda I; Mesko, Daniel R; Nam, Denis

2018-06-23

Innovative measures have recently been proposed to prevent periprosthetic joint infection following total hip and knee arthroplasty. We sought to review these recent innovations to determine the reported reduction in periprosthetic joint infection. The most recent literature demonstrates promising results in regard to hydrofiber dressings as an independent risk factor for primary prosthetic joint infection reduction, which in turn is also linked with cost savings. As our understanding of safe yet effective concentrations of antiseptic solutions develops, dilute betadine in particular has demonstrated encouraging efficacy which warrants continued investigation through controlled trials. In summary, we found that the application of a hydrofiber dressing may prove beneficial in decreasing the risk of prosthetic joint infection following primary total hip and knee arthroplasty. The gold standard for an infection prevention protocol continues to be explored and optimized.

A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia

PubMed Central

Chanda, Pascalina; Masiye, Felix; Chitah, Bona M; Sipilanyambe, Naawa; Hawela, Moonga; Banda, Patrick; Okorosobo, Tuoyo

2007-01-01

Background Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. Data gathered by the National Malaria Control Centre has shown that recently observed widespread treatment failure of SP and chloroquine precipitated a surge in malaria-related morbidity and mortality. As a result, the Government has recently replaced chloroquine and SP with combination therapy as first-line treatment for malaria. Despite the acclaimed therapeutic advantages of ACTs over monotherapies with SP and CQ, the cost of ACTs is much greater, raising concerns about affordability in many poor countries such as Zambia. This study evaluates the cost-effectiveness analysis of artemether-lumefantrine, a version of ACTs adopted in Zambia in mid 2004. Methods Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis). Findings The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success) from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line treatment are considered the ICER of AL becomes negative, indicating that there are greater resource savings associated with AL in terms of reduction of costs of complicated malaria treatment. Conclusion This study suggests the decision to adopt AL is justifiable on both economic and public health grounds. PMID:17313682

Real-time alerts and reminders using information systems.

PubMed

Wanderer, Jonathan P; Sandberg, Warren S; Ehrenfeld, Jesse M

2011-09-01

Adoption of information systems throughout the hospital environment has enabled the development of real-time physiologic alerts and clinician reminder systems. These clinical tools can be made available through the deployment of anesthesia information management systems (AIMS). Creating usable alert systems requires understanding of technical considerations. Various successful implementations are reviewed, encompassing cost reduction, improved revenue capture, timely antibiotic administration, and postoperative nausea and vomiting prophylaxis. Challenges to the widespread use of real-time alerts and reminders include AIMS adoption rates and the difficulty in choosing appropriate areas and approaches for information systems support. Copyright © 2011 Elsevier Inc. All rights reserved.

Future Data Communication Architectures for Safety Critical Aircraft Cabin Systems

NASA Astrophysics Data System (ADS)

Berkhahn, Sven-Olaf

2012-05-01

The cabin of modern aircraft is subject to increasing demands for fast reconfiguration and hence flexibility. These demands require studies for new network architectures and technologies of the electronic cabin systems, which consider also weight and cost reductions as well as safety constraints. Two major approaches are in consideration to reduce the complex and heavy wiring harness: the usage of a so called hybrid data bus technology, which enables the common usage of the same data bus for several electronic cabin systems with different safety and security requirements and the application of wireless data transfer technologies for electronic cabin systems.

Commerical Remote Sensing Data Contract

USGS Publications Warehouse

,

2005-01-01

The U. S. Geological Survey's (USGS) Commercial Remote Sensing Data Contracts (CRSDCs) provide government agencies with access to a broad range of commercially available remotely sensed airborne and satellite data. These contracts were established to support The National Map partners, other Federal Civilian agency programs, and Department of Defense programs that require data for the United States and its territories. Experience shows that centralized procurement of remotely sensed data leads to considerable cost savings to the Federal government through volume discounts, reduction of redundant contract administrative costs, and avoidance of duplicate purchases. These contracts directly support the President's Commercial Remote Sensing Space Policy, signed in 2003, by providing a centralized mechanism for civil agencies to acquire commercial remote sensing products to support their mission needs in an efficient and coordinated way. CRSDC administration is provided by the USGS Mid-Continent Mapping Center in Rolla, Missouri.

Life sciences payload definition and integration study. Volume 2: Requirements, design, and planning studies for the carry-on laboratories. [for Spacelab

NASA Technical Reports Server (NTRS)

1974-01-01

The task phase concerned with the requirements, design, and planning studies for the carry-on laboratory (COL) began with a definition of biomedical research areas and candidate research equipment, and then went on to develop conceptual layouts for COL which were each evaluated in order to arrive at a final conceptual design. Each step in this design/evaluation process concerned itself with man/systems integration research and hardware, and life support and protective systems research and equipment selection. COL integration studies were also conducted and include attention to electrical power and data management requirements, operational considerations, and shuttle/Spacelab interface specifications. A COL program schedule was compiled, and a cost analysis was finalized which takes into account work breakdown, annual funding, and cost reduction guidelines.

Effects of cost metric on cost-effectiveness of protected-area network design in urban landscapes.

PubMed

Burkhalter, J C; Lockwood, J L; Maslo, B; Fenn, K H; Leu, K

2016-04-01

A common goal in conservation planning is to acquire areas that are critical to realizing biodiversity goals in the most cost-effective manner. The way monetary acquisition costs are represented in such planning is an understudied but vital component to realizing cost efficiencies. We sought to design a protected-area network within a forested urban region that would protect 17 birds of conservation concern. We compared the total costs and spatial structure of the optimal protected-area networks produced using three acquisition-cost surrogates (area, agricultural land value, and tax-assessed land value). Using the tax-assessed land values there was a 73% and 78% cost savings relative to networks derived using area or agricultural land value, respectively. This cost reduction was due to the considerable heterogeneity in acquisition costs revealed in tax-assessed land values, especially for small land parcels, and the corresponding ability of the optimization algorithm to identify lower-cost parcels for inclusion that had equal value to our target species. Tax-assessed land values also reflected the strong spatial differences in acquisition costs (US$0.33/m(2)-$55/m(2)) and thus allowed the algorithm to avoid inclusion of high-cost parcels when possible. Our results add to a nascent but growing literature that suggests conservation planners must consider the cost surrogate they use when designing protected-area networks. We suggest that choosing cost surrogates that capture spatial- and size-dependent heterogeneity in acquisition costs may be relevant to establishing protected areas in urbanizing ecosystems. © 2015 Society for Conservation Biology.

Reducing robotic prostatectomy costs by minimizing instrumentation.

PubMed

Delto, Joan C; Wayne, George; Yanes, Rafael; Nieder, Alan M; Bhandari, Akshay

2015-05-01

Since the introduction of robotic surgery for radical prostatectomy, the cost-benefit of this technology has been under scrutiny. While robotic surgery professes to offer multiple advantages, including reduced blood loss, reduced length of stay, and expedient recovery, the associated costs tend to be significantly higher, secondary to the fixed cost of the robot as well as the variable costs associated with instrumentation. This study provides a simple framework for the careful consideration of costs during the selection of equipment and materials. Two experienced robotic surgeons at our institution as well as several at other institutions were queried about their preferred instrument usage for robot-assisted prostatectomy. Costs of instruments and materials were obtained and clustered by type and price. A minimal set of instruments was identified and compared against alternative instrumentation. A retrospective review of 125 patients who underwent robotically assisted laparoscopic prostatectomy for prostate cancer at our institution was performed to compare estimated blood loss (EBL), operative times, and intraoperative complications for both surgeons. Our surgeons now conceptualize instrument costs as proportional changes to the cost of the baseline minimal combination. Robotic costs at our institution were reduced by eliminating an energy source like the Ligasure or vessel sealer, exploiting instrument versatility, and utilizing inexpensive tools such as Hem-o-lok clips. Such modifications reduced surgeon 1's cost of instrumentation to ∼40% less compared with surgeon 2 and up to 32% less than instrumentation used by surgeons at other institutions. Surgeon 1's combination may not be optimal for all robotic surgeons; however, it establishes a minimally viable toolbox for our institution through a rudimentary cost analysis. A similar analysis may aid others in better conceptualizing long-term costs not as nominal, often unwieldy prices, but as percent changes in spending. With regard to intraoperative outcomes, the use of a minimally viable toolbox did not result in increased EBL, operative time, or intraoperative complications. Simple changes to surgeon preference and creative utilization of instruments can eliminate 40% of costs incurred on robotic instruments alone. Moreover, EBL, operative times, and intraoperative complications are not compromised as a result of cost reduction. Our process of identifying such improvements is straightforward and may be replicated by other robotic surgeons. Further prospective multicenter trials should be initiated to assess other methods of cost reduction.

Cost-Reduction Roadmap Outlines Two Pathways to Meet DOE Residential Solar

Science.gov Websites

Cost Target for 2030 | News | NREL Cost-Reduction Roadmap Outlines Two Pathways to Meet DOE Residential Solar Cost Target for 2030 News Release: Cost-Reduction Roadmap Outlines Two Pathways to Meet DOE Residential Solar Cost Target for 2030 Installing photovoltaics at the time of roof replacement or as part of

Review of Manganese Processing for Production of TRIP/TWIP Steels, Part 1: Current Practice and Processing Fundamentals

NASA Astrophysics Data System (ADS)

Elliott, R.; Coley, K.; Mostaghel, S.; Barati, M.

2018-02-01

The increasing demand for high-performance steel alloys has led to development of transformation-induced plasticity (TRIP) and twinning-induced plasticity (TWIP) alloys over the past three decades. These alloys offer exceptional combinations of high tensile strength and ductility. Thus, the mechanical behavior of these alloys has been a subject of significant work in recent years. However, the challenge of economically providing Mn in the quantity and purity required by these alloys has received considerably less attention. To enable commercial implementation of ultrahigh-Mn alloys, it is desirable to lower the high material costs associated with their production. Therefore, the present work reviews Mn processing routes in the context of the chemical requirements of these alloys. The aim of this review is to assess the current state of the art regarding reduction of manganese ores and provide a comprehensive reference for researchers working to mitigate material processing costs associated with Mn production. The review is presented in two parts: Part 1 introduces TRIP and TWIP alloys, current industrial practice, and pertinent thermodynamic fundamentals; Part 2 addresses available literature regarding reduction of Mn ores and oxides, and seeks to identify opportunities for future process development.

40 CFR 35.937-6 - Cost and price considerations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Cost and price considerations. 35.937-6...) shall apply. (1) The candidate(s) selected for negotiation shall submit to the grantee for review...) Cost review. (1) The grantee shall review proposed subagreement costs. (2) As a minimum, proposed...

40 CFR 35.937-6 - Cost and price considerations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Cost and price considerations. 35.937-6...) shall apply. (1) The candidate(s) selected for negotiation shall submit to the grantee for review...) Cost review. (1) The grantee shall review proposed subagreement costs. (2) As a minimum, proposed...

Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes

PubMed Central

Roberts, Samantha; Barry, Eleanor; Craig, Dawn; Airoldi, Mara; Bevan, Gwyn; Greenhalgh, Trisha

2017-01-01

Objective Explore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals. Design Systematic review of economic evaluations. Data sources and eligibility criteria Database searches (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. The International Society for Pharmaco-economics and Outcomes Research’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making was used to assess study quality. Results 27 studies were included; all had evaluated lifestyle interventions and 12 also evaluated metformin. Primary studies exhibited considerable heterogeneity in definitions of pre-diabetes and intensity and duration of lifestyle programmes. Lifestyle programmes and metformin appeared to be cost effective in preventing diabetes in high-risk individuals (median incremental cost-effectiveness ratios of £7490/quality-adjusted life-year (QALY) and £8428/QALY, respectively) but economic estimates varied widely between studies. Intervention-only programmes were in general more cost effective than programmes that also included a screening component. The longer the period evaluated, the more cost-effective interventions appeared. In the few studies that evaluated other economic considerations, budget impact of prevention programmes was moderate (0.13%–0.2% of total healthcare budget), financial payoffs were delayed (by 9–14 years) and impact on incident cases of diabetes was limited (0.1%–1.6% reduction). There was insufficient evidence to answer the question of (1) whether lifestyle programmes are more cost effective than metformin or (2) whether low-intensity lifestyle interventions are more cost effective than the more intensive lifestyle programmes that were tested in trials. Conclusions The economics of preventing diabetes are complex. There is some evidence that diabetes prevention programmes are cost effective, but the evidence base to date provides few clear answers regarding design of prevention programmes because of differences in denominator populations, definitions, interventions and modelling assumptions. PMID:29146638

A strategic approach to the unfinished fortification agenda: feasibility, costs, and cost-effectiveness analysis of fortification programs in 48 countries.

PubMed

Fiedler, John L; Macdonald, Barbara

2009-12-01

Food fortification is a promising strategy for combating micronutrient deficiencies, which plague one-third of the world's population. Which foods to fortify, with which micronutrients, and in which countries remain essential questions that to date have not been addressed at the global level. To provide a tool for international agencies to identify and organize the next phase of the unfinished global fortification agenda by prioritizing roughly 250 potential interventions in 48 priority countries. By explicitly defining the structure and operations of the fortification interventions in a detailed and transparent manner, and incorporating a substantial amount of country-specific data, the study also provides a potentially useful starting point for policy discussions in each of the 48 countries, which--it is hoped--will help to catalyze the development of public-private partnerships and accelerate the introduction of fortification and reduction of micronutrient deficiencies. Forty-eight high-priority countries were identified, and the feasibility of fortifying vegetable oil and sugar with vitamin A and fortifying wheat flour and maize flour with two alternative multiple micronutrient formulations was assessed. One hundred twenty-two country-, food-, and fortification formulation-specific interventions were assessed to be feasible, and the costs of each intervention were estimated. Assuming a 30% reduction in the micronutrient deficiencies of the persons consuming the food, the number of disability-adjusted life years (DALYs) saved by each of the programs was estimated. The cost per DALY saved was calculated for each of the 122 interventions, and the interventions were rank-ordered by cost-effectiveness. It is estimated that the 60 most cost-effective interventions would carry a 10-year price tag of US$1 billion and have costs per DALY saved ranging from US$1 to US$134. The single "best bet" intervention--i.e., the most cost-effective intervention--in each of the 48 countries was identified. This study provides a detailed, transparent, evidence-based approach to defining and estimating the costs and cost-effectiveness of the unfinished global fortification agenda in the 48 priority countries. Other considerations in designing a strategic approach to the unfinished global fortification agenda are also discussed.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.

PubMed

Revill, Paul; Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J

2018-01-01

The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.

Use of operating room information system data to predict the impact of reducing turnover times on staffing costs.

PubMed

Dexter, Franklin; Abouleish, Amr E; Epstein, Richard H; Whitten, Charles W; Lubarsky, David A

2003-10-01

Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite's own data. Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.

Cultural Differences in Opportunity Cost Consideration.

PubMed

Zhang, Ning; Ji, Li-Jun; Li, Ye

2017-01-01

Two studies were conducted to investigate cultural differences in opportunity cost consideration between Chinese and Euro-Canadians. Opportunity cost is defined as the cost of a benefit that must be forgone in order to pursue a better alternative (Becker et al., 1974). In both studies, participants read about hypothetical purchase scenarios, and then decided whether they would buy a certain product. Opportunity cost consideration was measured in two ways: (1) participants' thoughts pertaining to other (nonfocal) products while making decisions; (2) participants' decisions not to buy a focal product (Study 1) or a more expensive product (Study 2). Across both indexes, we found that after controlling for individual difference variables and amount of pocket money, Chinese participants in China considered financial opportunity cost more than Euro-Canadians in Study 1. Similar results were observed in Study 2 when comparing Chinese in Canada with Euro-Canadians However, the cultural effect on opportunity cost consideration was confounded by family income in Study 2. Implications for resource management, limitations of the current research and directions for future research are discussed.

Economic cost and epidemiological characteristics of patients with fibromyalgia claims.

PubMed

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

2003-06-01

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

Transmission and Distribution Efficiency Improvement Rearch and Development Survey.

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

Brooks, C.L.; Westinghouse Electric Corporation. Advanced Systems Technology.

Purpose of this study was to identify and quantify those technologies for improving transmission and distribution (T and D) system efficiency that could provide the greatest benefits for utility customers in the Pacific Northwest. Improving the efficiency of transmission and distribution systems offers a potential source of conservation within the utility sector. An extensive review of this field resulted in a list of 49 state-of-the-art technologies and 39 future technologies. Of these, 15 from the former list and 7 from the latter were chosen as the most promising and then submitted to an evaluative test - a modeled sample systemmore » for Benton County PUD, a utility with characteristics typical of a BPA customer system. Reducing end-use voltage on secondary distribution systems to decrease the energy consumption of electrical users when possible, called ''Conservation Voltage Reduction,'' was found to be the most cost effective state-of-the-art technology. Voltampere reactive (var) optimization is a similarly cost effective alternative. The most significant reduction in losses on the transmission and distribution system would be achieved through the replacement of standard transformers with high efficiency transformers, such as amorphous steel transformers. Of the future technologies assessed, the ''Distribution Static VAR Generator'' appears to have the greatest potential for technological breakthroughs and, therefore in time, commercialization. ''Improved Dielectric Materials,'' with a relatively low cost and high potential for efficiency improvement, warrant R and D consideration. ''Extruded Three-Conductor Cable'' and ''Six- and Twelve-Phase Transmission'' programs provide only limited gains in efficiency and applicability and are therefore the least cost effective.« less

Use of the DISST Model to Estimate the HOMA and Matsuda Indexes Using Only a Basal Insulin Assay

PubMed Central

Docherty, Paul D.; Chase, J. Geoffrey

2014-01-01

Background: It is hypothesized that early detection of reduced insulin sensitivity (SI) could prompt intervention that may reduce the considerable financial strain type 2 diabetes mellitus (T2DM) places on global health care. Reduction of the cost of already inexpensive SI metrics such as the Matsuda and HOMA indexes would enable more widespread, economically feasible use of these metrics for screening. The goal of this research was to determine a means of reducing the number of insulin samples and therefore the cost required to provide an accurate Matsuda Index value. Method: The Dynamic Insulin Sensitivity and Secretion Test (DISST) model was used with the glucose and basal insulin measurements from an Oral Glucose Tolerance Test (OGTT) to predict patient insulin responses. The insulin response to the OGTT was determined via population based regression analysis that incorporated the 60-minute glucose and basal insulin values. Results: The proposed method derived accurate and precise Matsuda Indices as compared to the fully sampled Matsuda (R = .95) using only the basal assay insulin-level data and 4 glucose measurements. Using a model employing the basal insulin also allows for determination of the 1-day HOMA value. Conclusion: The DISST model was successfully modified to allow for the accurate prediction an individual’s insulin response to the OGTT. In turn, this enabled highly accurate and precise estimation of a Matsuda Index using only the glucose and basal insulin assays. As insulin assays account for the majority of the cost of the Matsuda Index, this model offers a significant reduction in assay cost. PMID:24876431

Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources.

PubMed

Thomsen, Frederik B; Berg, Kasper D; Røder, M Andreas; Iversen, Peter; Brasso, Klaus

2015-02-01

Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa. In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost. The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction). AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.

Feasibility of reaching world health organization targets for hepatitis C and the cost-effectiveness of alternative strategies.

PubMed

Wisløff, T; White, R; Dalgard, O; Amundsen, E J; Meijerink, H; Kløvstad, H

2018-04-06

New drugs for treating hepatitis C have considerably increased the probability of being cured. Treatment uptake, however, is still low. The objectives of this study were to analyse the impact of initiatives that may increase the proportion of infected people on treatment and interventions aimed at reducing the incidence of new infection among people who inject drugs. A compartmental model for Norway was used to simulate hepatitis C and related complications. We analysed 2 different screening initiatives aimed to increase the proportion of infected people on treatment. Interventions aiming at reducing the hepatitis C incidence analysed were opioid substitution therapy (OST), a clean needle and syringe programme and a combination of both. The most cost-effective strategy for increasing hepatitis C treatment uptake was screening by general practitioners while simultaneously allowing for all infected people to be treated. We estimated that this intervention reduces the incidence of hepatitis C by 2030 by 63% compared with the current incidence. The 2 harm reduction strategies both reduced the incidence of hepatitis C by about 70%. Combining an increase in the current clean needles and syringe programme with OST was clearly the most cost-effective option. This strategy would reduce the incidence of hepatitis C by 80% compared with the current incidence by 2030. Thus, interventions to reduce the burden and spread of hepatitis C are cost-effective. Reaching the WHO target of a 90% reduction in hepatitis C incidence by 2030 may be difficult without combining different initiatives. © 2018 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.

Productivity Savings from Colorectal Cancer Prevention and Control Strategies

PubMed Central

Bradley, Cathy J.; Lansdorp-Vogelaar, Iris; Yabroff, K. Robin; Dahman, Bassam; Mariotto, Angela; Feuer, Eric J.; Brown, Martin L.

2011-01-01

Background Lost productivity represents a considerable portion of the total economic burden of colorectal cancer (CRC), but cost-effectiveness studies of CRC prevention and control have not included these costs and therefore underestimate potential savings from CRC prevention and control. Purpose To use microsimulation modeling study to estimate and project productivity costs of CRC and to model the savings from four approaches to reducing CRC incidence and mortality: risk factor reduction, improved screening, improved treatment, and a simultaneous approach where all three strategies are implemented. Methods A model was developed to project productivity losses from CRC using the U.S. population with CRC incidence and mortality projected through the year 2020. Outcome measures were CRC mortality, morbidity, and productivity savings. Results With 2005 levels in risk factors, screening, and treatment, 48,748 CRC deaths occurred in 2010, amounting to $21 billion of lost productivity. Using prevention and treatment strategies simultaneously, 3586 deaths could have been avoided in 2010, leading to a savings of $1.4 billion. Cumulatively, by 2020, simultaneous strategies that reduce risk factors and increase screening and treatment could result in 101,353 deaths avoided and $33.9 billion in savings in reduced productivity loss. Improved screening rates alone led to nearly $14.7 billion in savings between 2005 and 2020, followed by risk factor reduction ($12.4 billion) and improved treatment ($8.4 billion). Conclusions The savings in productivity loss from strategies to reduce CRC incidence and mortality are substantial, providing evidence that CRC prevention and control strategies are likely to be cost-saving. PMID:21767717

Productivity savings from colorectal cancer prevention and control strategies.

PubMed

Bradley, Cathy J; Lansdorp-Vogelaar, Iris; Yabroff, K Robin; Dahman, Bassam; Mariotto, Angela; Feuer, Eric J; Brown, Martin L

2011-08-01

Lost productivity represents a considerable portion of the total economic burden of colorectal cancer (CRC), but cost-effectiveness studies of CRC prevention and control have not included these costs and therefore underestimate potential savings from CRC prevention and control. To use microsimulation modeling study to estimate and project productivity costs of CRC and to model the savings from four approaches to reducing CRC incidence and mortality: risk factor reduction, improved screening, improved treatment, and a simultaneous approach where all three strategies are implemented. A model was developed to project productivity losses from CRC using the U.S. population with CRC incidence and mortality projected through the year 2020. Outcome measures were CRC mortality, morbidity, and productivity savings. With 2005 levels in risk factors, screening, and treatment, 48,748 CRC deaths occurred in 2010, amounting to $21 billion of lost productivity. Using prevention and treatment strategies simultaneously, 3586 deaths could have been avoided in 2010, leading to a savings of $1.4 billion. Cumulatively, by 2020, simultaneous strategies that reduce risk factors and increase screening and treatment could result in 101,353 deaths avoided and $33.9 billion in savings in reduced productivity loss. Improved screening rates alone led to nearly $14.7 billion in savings between 2005 and 2020, followed by risk factor reduction ($12.4 billion) and improved treatment ($8.4 billion). The savings in productivity loss from strategies to reduce CRC incidence and mortality are substantial, providing evidence that CRC prevention and control strategies are likely to be cost-saving. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.

Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV),

Science.gov Websites

2017-2030 | Solar Research | NREL Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV), 2017-2030 Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV), 2017-2030 This report Office (SETO) residential 2030 photovoltaics (PV) cost target of $0.05 per kilowatt-hour by identifying

Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania.

PubMed

Mangone, Emily R; Agarwal, Smisha; L'Engle, Kelly; Lasway, Christine; Zan, Trinity; van Beijma, Hajo; Orkis, Jennifer; Karam, Robert

2016-01-01

There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program's reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact.

Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania

PubMed Central

Mangone, Emily R.; Agarwal, Smisha; L’Engle, Kelly; Lasway, Christine; Zan, Trinity; van Beijma, Hajo; Orkis, Jennifer; Karam, Robert

2016-01-01

Background There is increasing evidence that mobile phone health interventions (“mHealth”) can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. Methods We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. Results In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. Conclusions These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this strategy was sustainable for the implementer, a central concern is that health information may not reach those who are too poor to pay, limiting the program’s reach and impact. Incorporating strategies presented here may make mHealth programs more appealing to funders and investors but need further consideration to balance sustainability, scale, and impact. PMID:26824747

[Cost analysis of intraoperative neurophysiological monitoring (IOM)].

PubMed

Kombos, T; Suess, O; Brock, M

2002-01-01

A number of studies demonstrate that a significant reduction of postoperative neurological deficits can be achieved by applying intraoperative neurophysiological monitoring (IOM) methods. A cost analysis of IOM is imperative considering the strained financial situation in the public health services. The calculation model presented here comprises two cost components: material and personnel. The material costs comprise consumer goods and depreciation of capital goods. The computation base was 200 IOM cases per year. Consumer goods were calculated for each IOM procedure respectively. The following constellation served as a basis for calculating personnel costs: (a) a medical technician (salary level BAT Vc) for one hour per case; (b) a resident (BAT IIa) for the entire duration of the measurement, and (c) a senior resident (BAT Ia) only for supervision. An IOM device consisting of an 8-channel preamplifier, an electrical and acoustic stimulator and special software costs 66,467 euros on the average. With an annual depreciation of 20%, the costs are 13,293 euros per year. This amounts to 66.46 euros per case for the capital goods. For reusable materials a sum of 0.75 euro; per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euro; per case were,s a sum of 0.75 euros per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euros per case were, calculated for surgery on the peripheral nervous system. They amount to 196.40 euros per case for spinal interventions and to 347.63 euros per case for more complex spinal operations. Operations in the cerebellopontine angle and brain stem cost 376.63 euros and 397.33 euros per case respectively. IOM costs amount to 328.03 euros per case for surgical management of an intracranial aneurysm and to 537.15 euros per case for functional interventions. Expenses run up to 833.63 euros per case for operations near the motor cortex and to 117.65 euros per case for intraoperative speech monitoring. Costs for inpatient medical rehabilitation have increased considerably in recent years. In view of the financial situation, it is necessary to reduce postoperative morbidity and the costs it involves. IOM leads to a reduction of morbidity. The costs for IOM calculated here justify its routine application in view of the legal and socioeconomic consequences of surgery-related neurological deficits.

Model reduction for Space Station Freedom

NASA Technical Reports Server (NTRS)

Williams, Trevor

1992-01-01

Model reduction is an important practical problem in the control of flexible spacecraft, and a considerable amount of work has been carried out on this topic. Two of the best known methods developed are modal truncation and internal balancing. Modal truncation is simple to implement but can give poor results when the structure possesses clustered natural frequencies, as often occurs in practice. Balancing avoids this problem but has the disadvantages of high computational cost, possible numerical sensitivity problems, and no physical interpretation for the resulting balanced 'modes'. The purpose of this work is to examine the performance of the subsystem balancing technique developed by the investigator when tested on a realistic flexible space structure, in this case a model of the Permanently Manned Configuration (PMC) of Space Station Freedom. This method retains the desirable properties of standard balancing while overcoming the three difficulties listed above. It achieves this by first decomposing the structural model into subsystems of highly correlated modes. Each subsystem is approximately uncorrelated from all others, so balancing them separately and then combining yields comparable results to balancing the entire structure directly. The operation count reduction obtained by the new technique is considerable: a factor of roughly r(exp 2) if the system decomposes into r equal subsystems. Numerical accuracy is also improved significantly, as the matrices being operated on are of reduced dimension, and the modes of the reduced-order model now have a clear physical interpretation; they are, to first order, linear combinations of repeated-frequency modes.

The Impact of Company-Level ART Provision to a Mining Workforce in South Africa: A Cost-Benefit Analysis.

PubMed

Meyer-Rath, Gesine; Pienaar, Jan; Brink, Brian; van Zyl, Andrew; Muirhead, Debbie; Grant, Alison; Churchyard, Gavin; Watts, Charlotte; Vickerman, Peter

2015-09-01

HIV impacts heavily on the operating costs of companies in sub-Saharan Africa, with many companies now providing antiretroviral therapy (ART) programmes in the workplace. A full cost-benefit analysis of workplace ART provision has not been conducted using primary data. We developed a dynamic health-state transition model to estimate the economic impact of HIV and the cost-benefit of ART provision in a mining company in South Africa between 2003 and 2022. A dynamic health-state transition model, called the Workplace Impact Model (WIM), was parameterised with workplace data on workforce size, composition, turnover, HIV incidence, and CD4 cell count development. Bottom-up cost analyses from the employer perspective supplied data on inpatient and outpatient resource utilisation and the costs of absenteeism and replacement of sick workers. The model was fitted to workforce HIV prevalence and separation data while incorporating parameter uncertainty; univariate sensitivity analyses were used to assess the robustness of the model findings. As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%-8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%-19%) by 2022. This translates into an average saving of US$950,215 (90% CrI US$220,879-US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs. Although findings are sensitive to assumptions regarding incidence and absenteeism, ART is cost-saving under considerable parameter uncertainty and in all tested scenarios, including when prevalence is reduced to 1%-except when no benefits were paid out to employees leaving the workforce and when absenteeism rates were half of what data suggested. Scaling up ART further through a universal test and treat strategy doubles savings; incorporating ART for family members reduces savings but is still marginally cost-saving compared to no treatment. Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges. Workplace ART provision can be cost-saving for companies in high HIV prevalence settings due to reductions in healthcare costs, absenteeism, and staff turnover. Company-sponsored HIV counselling and voluntary testing with ensuing treatment of all HIV-positive employees and family members should be implemented universally at workplaces in countries with high HIV prevalence.

Implementation of activity-based costing (ABC) to drive cost reduction efforts in a semiconductor manufacturing operation

NASA Astrophysics Data System (ADS)

Naguib, Hussein; Bol, Igor I.; Lora, J.; Chowdhry, R.

1994-09-01

This paper presents a case study on the implementation of ABC to calculate the cost per wafer and to drive cost reduction efforts for a new IC product line. The cost reduction activities were conducted through the efforts of 11 cross-functional teams which included members of the finance, purchasing, technology development, process engineering, equipment engineering, production control, and facility groups. The activities of these cross functional teams were coordinated by a cost council. It will be shown that these activities have resulted in a 57% reduction in the wafer manufacturing cost of the new product line. Factors contributed to successful implementation of an ABC management system are discussed.

A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures.

PubMed

Davis, Erika N; Chung, Kevin C; Kotsis, Sandra V; Lau, Frank H; Vijan, Sandeep

2006-04-01

Open reduction and internal fixation and cast immobilization are both acceptable treatment options for nondisplaced waist fractures of the scaphoid. The authors conducted a cost/utility analysis to weigh open reduction and internal fixation against cast immobilization in the treatment of acute nondisplaced mid-waist scaphoid fractures. The authors used a decision-analytic model to calculate the outcomes and costs of open reduction and internal fixation and cast immobilization, assuming the societal perspective. Utilities were assessed from 50 randomly selected medical students using the time trade-off method. Outcome probabilities taken from the literature were factored into the calculation of quality-adjusted life-years associated with each treatment. The authors estimated medical costs using Medicare reimbursement rates, and costs of lost productivity were estimated by average wages obtained from the U.S. Bureau of Labor Statistics. Open reduction and internal fixation offers greater quality-adjusted life-years compared with casting, with an increase ranging from 0.21 quality-adjusted life-years for the 25- to 34-year age group to 0.04 quality-adjusted life-years for the > or =65-year age group. Open reduction and internal fixation is less costly than casting ($7940 versus $13,851 per patient) because of a longer period of lost productivity with casting. Open reduction and internal fixation is therefore the dominant strategy. When considering only direct costs, the incremental cost/utility ratio for open reduction and internal fixation ranges from $5438 per quality-adjusted life-year for the 25- to 34-year age group to $11,420 for the 55- to 64-year age group, and $29,850 for the > or =65-year age group. Compared with casting, open reduction and internal fixation is cost saving from the societal perspective ($5911 less per patient). When considering only direct costs, open reduction and internal fixation is cost-effective relative to other widely accepted interventions.

48 CFR 52.215-10 - Price Reduction for Defective Certified Cost or Pricing Data.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Price Reduction for... Text of Provisions and Clauses 52.215-10 Price Reduction for Defective Certified Cost or Pricing Data. As prescribed in 15.408(b), insert the following clause: Price Reduction for Defective Certified Cost...

Shining lights: studies that have most influenced the understanding of health promotion's financial impact.

PubMed

Golaszewski, T

2001-01-01

To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. A panel of experts was used to identify the top studies supporting the purpose of this article. Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.

1985 Winners of the Cost Reduction Incentive Awards. Tenth Anniversary.

ERIC Educational Resources Information Center

National Association of College and University Business Officers, Washington, DC.

Fifty-two cost reduction efforts on college and university campuses are described, as part of the Cost Reduction Incentive Awards Program sponsored by the National Association of College and University Business Officers and the United States Steel Foundation. The incentive program is designed to stimulate cost-effective ideas and awareness of the…

PV O&M Cost Model and Cost Reduction

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

Walker, Andy

This is a presentation on PV O&M cost model and cost reduction for the annual Photovoltaic Reliability Workshop (2017), covering estimating PV O&M costs, polynomial expansion, and implementation of Net Present Value (NPV) and reserve account in cost models.

Energy Efficient Engine: Flight propulsion system final design and analysis

NASA Technical Reports Server (NTRS)

Davis, Donald Y.; Stearns, E. Marshall

1985-01-01

The Energy Efficient Engine (E3) is a NASA program to create fuel saving technology for future transport engines. The Flight Propulsion System (FPS) is the engine designed to achieve E3 goals. Achieving these goals required aerodynamic, mechanical and system technologies advanced beyond that of current production engines. These technologies were successfully demonstrated in component rigs, a core engine and a turbofan ground test engine. The design and benefits of the FPS are presented. All goals for efficiency, environmental considerations, and economic payoff were met. The FPS has, at maximum cruise, 10.67 km (35,000 ft), M0.8, standard day, a 16.9 percent lower installed specific fuel consumption than a CF6-50C. It provides an 8.6 percent reduction in direct operating cost for a short haul domestic transport and a 16.2 percent reduction for an international long distance transport.

Noise transmission and reduction in turboprop aircraft

NASA Astrophysics Data System (ADS)

MacMartin, Douglas G.; Basso, Gordon L.; Leigh, Barry

1994-09-01

There is considerable interest in reducing the cabin noise environment in turboprop aircraft. Various approaches have been considered at deHaviland Inc., including passive tuned-vibration absorbers, speaker-based noise cancellation, and structural vibration control of the fuselage. These approaches will be discussed briefly. In addition to controlling the noise, a method of predicting the internal noise is required both to evaluate potential noise reduction approaches, and to validate analytical design models. Instead of costly flight tests, or carrying out a ground simulation of the propeller pressure field, a much simpler reciprocal technique can be used. A capacitive scanner is used to measure the fuselage vibration response on a deHaviland Dash-8 fuselage, due to an internal noise source. The approach is validated by comparing this reciprocal noise transmission measurement with the direct measurement. The fuselage noise transmission information is then combined with computer predictions of the propeller pressure field data to predict the internal noise at two points.

Fosphenytoin. Pharmacoeconomic implications of therapy.

PubMed

Holliday, S M; Benfield, P; Plosker, G L

1998-12-01

Advantages and disadvantages of Fosphenytoin. Advantages. More rapid intravenous administration than phenytoin and no need for an in-line filter. May be administered by intramuscular injection. Lower potential for local tissue and cardiac toxicity than phenytoin. Associated with less pain and phlebitis at the injection site, fewer reductions in infusion rate and fewer changes of administration site because of injection site complications than phenytoin. Benefits in terms of ease of administration and improved tolerability vs phenytoin have pharmacoeconomic implications which may translate into an overall cost advantage. Disadvantages. Approximately 10-fold higher acquisition cost vs phenytoin. Fosphenytoin is a parenterally administered prodrug of phenytoin, used in the treatment of patients with seizures. Advantages of fosphenytoin over phenytoin include more rapid intravenous administration, no need for an intravenous filter, and a lower potential for local tissue and cardiac toxicity. Unlike phenytoin, fosphenytoin may also be administered by intramuscular injection. Pharmacoeconomic data from a small study of patients with acute seizures in a US emergency department showed an overall cost advantage of fosphenytoin over phenytoin, despite a considerably greater acquisition cost of fosphenytoin. The main cost drivers for phenytoin therapy were treatment costs associated with adverse events. In view of the limited pharmacoeconomic data currently available, it is in the interests of individual institutions to conduct their own formal pharmacoeconomic studies applying local cost data and patterns of clinical practise to determine whether fosphenytoin should replace phenytoin on their formularly list.

[Comparative Cost Effectiveness of Clostridium Histolyticum Collagenase (Xiapex®) and Partial Fasciectomy for the Treatment of Dupuytren's Contracture in Austria].

PubMed

Neuwirth, M; Binter, A; Pipam, W; Rab, M

2016-08-01

Since Dupuytren's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs. treatment with Clostridium histolyticum collagenase (CCH). A retrospective monocentric study of the period from 2012 to 2014 comprised 40 patients with previously untreated Dupuytren's contracture of one finger. 20 outpatients received one CCH treatment (Group 1), while 20 inpatients underwent partial fasciectomy (Group 2). The direct pre-interventional treatment and post-interventional costs were compared. The direct post-interventional and postoperative results were comparable. Group 1 (CCH) showed a mean reduction in contracture of 96.4%; in Group 2 (partial fasciectomy), this was 97.7%. There were fewer complications in Group 1 than in Group 2. Mean treatment costs in Group 1 were € 1 458.60 and in Group 2, € 5 315.20. Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature. © Georg Thieme Verlag KG Stuttgart · New York.

The impact of shale gas on the cost and feasibility of meeting climate targets—A global energy system model analysis and an exploration of uncertainties

DOE PAGES

Few, Sheridan; Gambhir, Ajay; Napp, Tamaryn; ...

2017-01-27

There exists considerable uncertainty over both shale and conventional gas resource availability and extraction costs, as well as the fugitive methane emissions associated with shale gas extraction and its possible role in mitigating climate change. This study uses a multi-region energy system model, TIAM (TIMES integrated assessment model), to consider the impact of a range of conventional and shale gas cost and availability assessments on mitigation scenarios aimed at achieving a limit to global warming of below 2 °C in 2100, with a 50% likelihood. When adding shale gas to the global energy mix, the reduction to the global energymore » system cost is relatively small (up to 0.4%), and the mitigation cost increases by 1%–3% under all cost assumptions. The impact of a “dash for shale gas”, of unavailability of carbon capture and storage, of increased barriers to investment in low carbon technologies, and of higher than expected leakage rates, are also considered; and are each found to have the potential to increase the cost and reduce feasibility of meeting global temperature goals. Finally, we conclude that the extraction of shale gas is not likely to significantly reduce the effort required to mitigate climate change under globally coordinated action, but could increase required mitigation effort if not handled sufficiently carefully.« less

The impact of shale gas on the cost and feasibility of meeting climate targets—A global energy system model analysis and an exploration of uncertainties

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

Few, Sheridan; Gambhir, Ajay; Napp, Tamaryn

There exists considerable uncertainty over both shale and conventional gas resource availability and extraction costs, as well as the fugitive methane emissions associated with shale gas extraction and its possible role in mitigating climate change. This study uses a multi-region energy system model, TIAM (TIMES integrated assessment model), to consider the impact of a range of conventional and shale gas cost and availability assessments on mitigation scenarios aimed at achieving a limit to global warming of below 2 °C in 2100, with a 50% likelihood. When adding shale gas to the global energy mix, the reduction to the global energymore » system cost is relatively small (up to 0.4%), and the mitigation cost increases by 1%–3% under all cost assumptions. The impact of a “dash for shale gas”, of unavailability of carbon capture and storage, of increased barriers to investment in low carbon technologies, and of higher than expected leakage rates, are also considered; and are each found to have the potential to increase the cost and reduce feasibility of meeting global temperature goals. Finally, we conclude that the extraction of shale gas is not likely to significantly reduce the effort required to mitigate climate change under globally coordinated action, but could increase required mitigation effort if not handled sufficiently carefully.« less

Cost-of-illness studies of atrial fibrillation: methodological considerations.

PubMed

Becker, Christian

2014-10-01

Atrial fibrillation (AF) is the most common heart rhythm arrhythmia, which has considerable economic consequences. This study aims to identify the current cost-of-illness estimates of AF; a focus was put on describing the studies' methodology. A literature review was conducted. Twenty-eight cost-of-illness studies were identified. Cost-of-illness estimates exist for health insurance members, hospital and primary care populations. In addition, the cost of stroke in AF patients and the costs of post-operative AF were calculated. The methods used were heterogeneous, mostly studies calculated excess costs. The identified annual excess costs varied, even among studies from the USA (∼US$1900 to ∼US$19,000). While pointing toward considerable costs, the cost-of-illness studies' relevance could be improved by focusing on subpopulations and treatment mixes. As possible starting points for subsequent economic studies, the methodology of cost-of-illness studies should be taken into account using methods, allowing stakeholders to find suitable studies and validate estimates.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.

PubMed

Repanos, Costa; Anderson, Daniel; Earnshaw, James; Mitchell, David; Coman, William

2010-06-01

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Economic considerations in coverting from oil/gas firing to coal

NASA Technical Reports Server (NTRS)

Rau, J. G.

1978-01-01

Economic considerations involved in fuel conversion such as from oil and/or gas firing to coal are discussed including investments costs for new facilities and equipment (including air pollution control equipment), operation and maintenance costs, and purchased fuel costs. An analytical approach to assessing the cost effectiveness of fuel conversion in terms of the annual net cost of conversion, the equivalent annual number of barrels of oil saved, and the integral rate of return of the conversion investment is presented. Illustrative numerical examples are presented for typical utility boilers and industrial boiler facilities. A further consideration addressed deals with the impacts of these costs on the overall financial structure of the firm and the ability of the firm to raise the necessary investment captial.

Sustainability of Metal Structures via Spray-Clad Remanufacturing

NASA Astrophysics Data System (ADS)

Smith, Gregory M.; Sampath, Sanjay

2018-04-01

Structural reclamation and remanufacturing is an important future design consideration to allow sustainable recovery of degraded structural metals. Heavy machinery and infrastructure components subjected to extended use and/or environment induced degradation require costly and time-consuming replacement. If these parts can be remanufactured to original tolerances, and returned to service with "as good or better" performance, significant reductions in materials, cost, and environmental impact can be achieved. Localized additive restoration via thermal or cold spray methods is a promising approach in recovering and restoring original design strength of degraded metals. The advent of high velocity spray deposition technologies has allowed deposition of near full density materials. In this review, the fundamental scientific and technological elements of such local additive restoration is contemplated including materials, processes, and methodologies to assess the capabilities of such remanufactured systems. This points to sustainable material reclamation, as well as a route toward resource and process sustainability.

Design of a Low Power, Fast-Spectrum, Liquid-Metal Cooled Surface Reactor System

NASA Astrophysics Data System (ADS)

Marcille, T. F.; Dixon, D. D.; Fischer, G. A.; Doherty, S. P.; Poston, D. I.; Kapernick, R. J.

2006-01-01

In the current 2005 US budget environment, competition for fiscal resources make funding for comprehensive space reactor development programs difficult to justify and accommodate. Simultaneously, the need to develop these systems to provide planetary and deep space-enabling power systems is increasing. Given that environment, designs intended to satisfy reasonable near-term surface missions, using affordable technology-ready materials and processes warrant serious consideration. An initial lunar application design incorporating a stainless structure, 880 K pumped NaK coolant system and a stainless/UO2 fuel system can be designed, fabricated and tested for a fraction of the cost of recent high-profile reactor programs (JIMO, SP-100). Along with the cost reductions associated with the use of qualified materials and processes, this design offers a low-risk, high-reliability implementation associated with mission specific low temperature, low burnup, five year operating lifetime requirements.

Financial barriers to implementing combination vaccines: perspectives from pediatricians and policy makers.

PubMed

Gidengil, Courtney A; Rusinak, Donna; Allred, Norma J; Luff, Donna; Lee, Grace M; Lieu, Tracy A

2009-06-01

To describe the factors that affect the use of new combination vaccines, the authors conducted qualitative interviews with pediatricians (n = 7), state immunization program managers (n = 7), and health insurance plan representatives (n = 6 plans). Respondents from each group identified reduction in pain and potentially increased immunization coverage as key benefits of new combination vaccines. For several pediatricians, low reimbursement for cost of vaccine doses and potential loss of fees for vaccine administration were barriers to using combination vaccines. For most state immunization programs, the higher cost of combination vaccines relative to separate vaccines was an important consideration but not a barrier to adoption. Most insurers were not aware of the financial issues for providers, but some had changed or were willing to change reimbursement to support the use of new combination vaccines. Financial issues for pediatric practices that purchase and provide vaccines for children may be an important barrier to offering combination vaccines.

Temporal and spatial distribution of global mitigation cost: INDCs and equity

NASA Astrophysics Data System (ADS)

Liu, Jing-Yu; Fujimori, Shinichiro; Masui, Toshihiko

2016-11-01

Each country’s Intended Nationally Determined Contribution (INDC) pledges an emission target for 2025 or 2030. Here, we evaluated the INDC inter-generational and inter-regional equity by comparing scenarios with INDC emissions target in 2030 and with an immediate emission reduction associated with a global uniform carbon price using Asian-Pacific Integrated Model/Computable General Equilibrium. Both scenarios eventually achieve 2 °C target. The results showed that, as compared with an immediate emission reduction scenario, the inter-generational equity status is not favorable for INDC scenario and the future generation suffers more from delayed mitigation. Moreover, this conclusion was robust to the wide range of inequality aversion parameter that determines discount rate. On the other hand, the INDC scenario has better inter-regional equity in the early part of the century than does the immediate emission reduction scenario in which we assume a global carbon price during the period up to 2030. However, inter-regional equity worsens later in the century. The additional emissions reduction to the INDC in 2030 would improve both inter- and inter-regional equity as compared to the current INDC. We also suggest that countries should commit to more emissions reductions in the follow-up INDC communications and that continuous consideration for low-income countries is needed for global climate change cooperation after 2030.

NASA/Navy lift/cruise fan cost reduction studies

NASA Technical Reports Server (NTRS)

1977-01-01

Cost reduction studies were performed for the LCF459 turbotip fan for application with the YJ97-GE-100 gas generator in a multimission V/STOL research and technology aircraft. A 20 percent cost reduction of the research configuration based on the original preliminary design was achieved. The trade studies performed and the results in the area of cost reduction and weight are covered. A fan configuration is defined for continuation of the program through the detailed design phase.

Waste reduction plan for The Oak Ridge National Laboratory

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

Schultz, R.M.

1990-04-01

The Oak Ridge National Laboratory (ORNL) is a multipurpose Research and Development (R D) facility. These R D activities generate numerous small waste streams. Waste minimization is defined as any action that minimizes the volume or toxicity of waste by avoiding its generation or recycling. This is accomplished by material substitution, changes to processes, or recycling wastes for reuse. Waste reduction is defined as waste minimization plus treatment which results in volume or toxicity reduction. The ORNL Waste Reduction Program will include both waste minimization and waste reduction efforts. Federal regulations, DOE policies and guidelines, increased costs and liabilities associatedmore » with the management of wastes, limited disposal options and facility capacities, and public consciousness have been motivating factors for implementing comprehensive waste reduction programs. DOE Order 5820.2A, Section 3.c.2.4 requires DOE facilities to establish an auditable waste reduction program for all LLW generators. In addition, it further states that any new facilities, or changes to existing facilities, incorporate waste minimization into design considerations. A more recent DOE Order, 3400.1, Section 4.b, requires the preparation of a waste reduction program plan which must be reviewed annually and updated every three years. Implementation of a waste minimization program for hazardous and radioactive mixed wastes is sited in DOE Order 5400.3, Section 7.d.5. This document has been prepared to address these requirements. 6 refs., 1 fig., 2 tabs.« less

Exercise based transportation reduces oil consumption and carbon emissions

NASA Astrophysics Data System (ADS)

Higgins, P. A.

2004-12-01

Current abuse and misrepresentation of science hinders society's ability to address climate change. Scientific abuse results, in part, from a widespread perception that curbing emissions will require substantial economic, political, or personal sacrifice. Here I provide one example to illustrate that this perception is false. Simply walking or biking the amount recommended for a healthy lifestyle could reduce carbon emissions up to 11 percent if the distances traveled were substituted for car travel. This level of exercise is also sufficient to eliminate obese and overweight conditions in a few years without draconian diet plans. A reduction in carbon dioxide emissions of roughly 35 percent is possible if the revenue saved through decreased health care spending on obesity is redirected toward carbon abatement. This emissions reduction far exceeds that required by the Kyoto Protocol at no net cost. Finally, widespread substitution of driving with distances traveled during recommended daily exercise would considerably ease societal dependence on oil, which leads not only to climate change but also to air pollution, political and economic instability and habitat degradation. Thus, exercise based transportation constitutes a potentially favorable alternative to the energy and diet plans that are currently under consideration and a substantial step toward dealing with the threat of climate change.

Users guide for FRCS: fuel reduction cost simulator software.

Treesearch

Roger D. Fight; Bruce R. Hartsough; Peter Noordijk

2006-01-01

The Fuel Reduction Cost Simulator (FRCS) spreadsheet application is public domain software used to estimate costs for fuel reduction treatments involving removal of trees of mixed sizes in the form of whole trees, logs, or chips from a forest. Equipment production rates were developed from existing studies. Equipment operating cost rates are from December 2002 prices...

Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies

PubMed Central

Altmann, Uwe; Thielemann, Désirée; Zimmermann, Anna; Steffanowski, Andrés; Bruckmeier, Ellen; Pfaffinger, Irmgard; Fembacher, Andrea; Strauß, Bernhard

2018-01-01

Background: In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction. Methods: In a naturalistic longitudinal study, we examined a disorder heterogeneous sample of N = 584 outpatients who were either treated with cognitive-behavioral, psychodynamic, or psychoanalytic therapy. Depression, anxiety, stress, and somatization were assessed with the Patient Health Questionnaire (PHQ). Annual amounts of inpatient costs, outpatient costs, medication costs, days of hospitalization, work disability days, utilization of psychotherapy, and utilization of pharmacotherapy 1 year before therapy and 1 year after therapy were provided by health care insurances. Symptom and cost reduction were analyzed using t-tests. Associations between symptom and cost reduction were examined using partial correlations and hierarchical linear models. Results: Patients who terminated therapy regularly showed the largest symptom reduction (d = 0.981–1.22). Patients who dropped out due to an unproblematic reason and patients who terminated early due to a quality-relevant reason showed significant but small effects of symptom reductions (e.g., depression: d = 0.429 vs. d = 0.366). For patients with a regular end and those dropping out due to a quality-relevant reason, we observed a significant reduction of work disability (diff in % of pre-test value = 56.3 vs. 42.9%) and hospitalization days (52.8 vs. 35.0%). Annual inpatient costs decreased in the group with a regular therapy end (31.5%). Furthermore, reduction of symptoms on the one side and reduction of work disability days and psychotherapy utilization on the other side were significant correlated (r = 0.091–0.135). Conclusion: Health care costs and symptoms were reduced in each of the three groups. The average symptom and cost reduction of patients with a quality-relevant dropout suggested that not each dropout might be seen as therapy failure. PMID:29867697

A Comparative Analysis of Economic Cost of Podoconiosis and Leprosy on Affected Households in the Northwest Region of Cameroon

PubMed Central

Tembei, Ayok M.; Kengne-Ouaffo, Jonas A.; Ngoh, Elvis A.; John, Bonekeh; Nji, Theobald M.; Deribe, Kebede; Enyong, Peter; Nkuo-Akenji, Theresa; Davey, Gail; Wanji, Samuel

2018-01-01

Abstract. Leprosy and podoconiosis (podo) are neglected tropical diseases that cause severe disfigurement and disability, and may lead to catastrophic health expenditure and hinder economic development of affected persons and households. This study compared economic costs of both diseases on affected households with unaffected neighboring households in the Northwest Region (N.W.R.) of Cameroon. A matched comparative cross-sectional design was used enrolling 170 households (43 podo case households, 41 podo control households, 43 leprosy case households, and 43 leprosy control households) from three health districts in the N.W.R. Direct treatment costs for podo averaged 142 United State dollar (USD), compared with zero for leprosy (P < 0.001). This was also reflected in the proportion of annual household income consumed (0.4 versus 0.0, respectively, P < 0.001). Both diseases caused considerable reductions in working days (leprosy 115 versus podo 135 days. P for comparison < 0.001). The average household income was considerably lower in podo-affected households than unaffected households (410 versus 913 USD, P = 0.01), whereas income of leprosy-affected households was comparable to unaffected households (329 versus 399 USD, P = 0.23). Both leprosy and podo cause financial burdens on affected households, but those on podo-affected families are much greater. These burdens occur through direct treatment costs and reduced ability to work. Improved access to public health interventions for podo including prevention, morbidity management and disability prevention are likely to result in economic returns to affected families. In Cameroon, one approach to this would be through subsidized health insurance for these economically vulnerable households. PMID:29460727

A Comparative Analysis of Economic Cost of Podoconiosis and Leprosy on Affected Households in the Northwest Region of Cameroon.

PubMed

Tembei, Ayok M; Kengne-Ouaffo, Jonas A; Ngoh, Elvis A; John, Bonekeh; Nji, Theobald M; Deribe, Kebede; Enyong, Peter; Nkuo-Akenji, Theresa; Davey, Gail; Wanji, Samuel

2018-04-01

Leprosy and podoconiosis (podo) are neglected tropical diseases that cause severe disfigurement and disability, and may lead to catastrophic health expenditure and hinder economic development of affected persons and households. This study compared economic costs of both diseases on affected households with unaffected neighboring households in the Northwest Region (N.W.R.) of Cameroon. A matched comparative cross-sectional design was used enrolling 170 households (43 podo case households, 41 podo control households, 43 leprosy case households, and 43 leprosy control households) from three health districts in the N.W.R. Direct treatment costs for podo averaged 142 United State dollar (USD), compared with zero for leprosy ( P < 0.001). This was also reflected in the proportion of annual household income consumed (0.4 versus 0.0, respectively, P < 0.001). Both diseases caused considerable reductions in working days (leprosy 115 versus podo 135 days. P for comparison < 0.001). The average household income was considerably lower in podo-affected households than unaffected households (410 versus 913 USD, P = 0.01), whereas income of leprosy-affected households was comparable to unaffected households (329 versus 399 USD, P = 0.23). Both leprosy and podo cause financial burdens on affected households, but those on podo-affected families are much greater. These burdens occur through direct treatment costs and reduced ability to work. Improved access to public health interventions for podo including prevention, morbidity management and disability prevention are likely to result in economic returns to affected families. In Cameroon, one approach to this would be through subsidized health insurance for these economically vulnerable households.

The socio-economic dimension of flood risk assessment: insights of KULTURisk framework

NASA Astrophysics Data System (ADS)

Giupponi, Carlo; Gain, Animesh; Mojtahed, Vahid; Balbi, Stefano

2013-04-01

The approaches for vulnerability and risk assessment have found different and often contrasting solutions by various schools of thought. The two most prominent communities in this field are: climate change adaptation (CCA), and disaster risk reduction (DRR). Although those communities have usually in common the aim of reducing socio-economic vulnerability and risk to natural hazards, they have usually referred to different definitions and conceptualizations. For example, the DRR community has always driven more emphasis on the concept of risk and vulnerability is considered as a physical/environmental input for the quantification of risk, while the CCA research stream, mainly under the auspices of the Intergovernmental Panel on Climate Change (IPCC), considered vulnerability as an output deriving from social conditions and processes such as adaptation or maladaptation. Recently, with the publication of the IPCC Special Report on extreme events and disasters (IPCC-SREX), the notions of vulnerability and risk are somehow integrated in order to jointly consider both climate change adaptation and disaster risk management. The IPCC-SREX indeed is expected to significantly contribute to find common language and methodological approaches across disciplines and, therefore, the opportunity emerges for proposing new operational solutions, consistent with the most recent evolution of concepts and terminology. Based on the development of the IPCC Report, the KULTURisk project developed an operational framework to support integrated assessment and decision support through the combination of contributions from diverse disciplinary knowledge, with emphasis on the social and economic dimensions. KIRAF (KULTURisk Integrated Risk Assessment Framework) is specifically aimed at comprehensively evaluate the benefits of risk mitigation measures with consideration of the dynamic context deriving from the consideration of climatic changes and their effects on natural disasters, within the policy framework of climate change adaptation (CCA). Three main innovations are proposed with respect to the current state of the art: (1) to include the social capacities of reducing risk, (2) to go beyond the estimation direct tangible costs, and (3) to provide an operational solution for decision support to assess risks, impacts and the benefits of plausible risk reduction measures, compatible with both the DRR and the CCA literatures. As stated above, the proposed framework is the inclusion of social capacities (adaptive and coping capacities) in the process of translating risk into a comprehensive cost matrix considering not only direct tangible costs (damages), but also the three other components deriving from the combination of tangible/intangible and direct/indirect costs. The proposed KIRAF approach is thus expected to provide: 1) an operational basis for multidisciplinary integration; 2) a flexible reference to deal with heterogeneous case studies and potentially various types of hazards; and 3) a means to support the assessment of alternative risk prevention measures including consideration of social and cultural dimensions.

Cultural Differences in Opportunity Cost Consideration

PubMed Central

Zhang, Ning; Ji, Li-Jun; Li, Ye

2017-01-01

Two studies were conducted to investigate cultural differences in opportunity cost consideration between Chinese and Euro-Canadians. Opportunity cost is defined as the cost of a benefit that must be forgone in order to pursue a better alternative (Becker et al., 1974). In both studies, participants read about hypothetical purchase scenarios, and then decided whether they would buy a certain product. Opportunity cost consideration was measured in two ways: (1) participants' thoughts pertaining to other (nonfocal) products while making decisions; (2) participants' decisions not to buy a focal product (Study 1) or a more expensive product (Study 2). Across both indexes, we found that after controlling for individual difference variables and amount of pocket money, Chinese participants in China considered financial opportunity cost more than Euro-Canadians in Study 1. Similar results were observed in Study 2 when comparing Chinese in Canada with Euro-Canadians However, the cultural effect on opportunity cost consideration was confounded by family income in Study 2. Implications for resource management, limitations of the current research and directions for future research are discussed. PMID:28184202

Costs and cost-effectiveness of full implementation of a biennial faecal occult blood test screening program for bowel cancer in Australia.

PubMed

Pignone, Michael P; Flitcroft, Kathy L; Howard, Kirsten; Trevena, Lyndal J; Salkeld, Glenn P; St John, D James B

2011-02-21

To examine the costs and cost-effectiveness of full implementation of biennial bowel cancer screening for Australian residents aged 50-74 years. Identification of existing economic models from 1993 to 2010 through searches of PubMed and economic analysis databases, and by seeking expert advice; and additional modelling to determine the costs and cost-effectiveness of full implementation of biennial faecal occult blood test screening for the five million adults in Australia aged 50-74 years. Estimated number of deaths from bowel cancer prevented, costs, and cost-effectiveness (cost per life-year gained [LYG]) of biennial bowel cancer screening. We identified six relevant economic analyses, all of which found colorectal cancer (CRC) screening to be very cost-effective, with costs per LYG under $55,000 per year in 2010 Australian dollars. Based on our additional modelling, we conservatively estimate that full implementation of biennial screening for people aged 50-74 years would have gross costs of $150 million, reduce CRC mortality by 15%-25%, prevent 300-500 deaths from bowel cancer, and save 3600-6000 life-years annually, for an undiscounted cost per LYG of $25,000-$41,667, compared with no screening, and not taking cost savings as a result of treatment into consideration. The additional expenditure required, after accounting for reductions in CRC incidence, savings in CRC treatment costs, and existing ad-hoc colonoscopy use, is likely to be less than $50 million annually. Full implementation of biennial faecal occult blood test screening in Australia can reduce bowel cancer mortality, and is an efficient use of health resources that would require modest additional government investment.

Eco-efficience et analyse des couts du cycle de vie: Developpement d'un outil d'aide a la conception dans l'industrie aeronautique

NASA Astrophysics Data System (ADS)

Mami, Fares

The aeronautical sector, responsible for about 3 % of the world emissions of greenhouse gases, predict a 70 % growth in 2025 and 300 % to 500 % in 2050 of its emissions compared to the level of 2005. The decision-makers must thus be supported in their choice of conception to integrate the environmental aspect into the decision-making. Our industrial partner in the aeronautical sector developed an expertise in Life Cycle Assessment (LCA) and seeks to integrate the costs and the environmental impacts in a systematic way into the ecodesign of products. Based on the literature review and the objectives of this research we propose a model of eco-efficiency, which integrates LCA with Life Cycle Costing (LCC). This model is consistent with defined cost cutting and environmental impacts reduction targets and allows a simple interpretation of the results while minimizing the efforts during data collection. The model is applied for 3D printing as an alternative production process in the manufacturing of an aircraft blocker door. 3D printing is a new technology of production working by addition of material and present interesting opportunities of cost cutting and environmental impacts, particularly in the aeronautical domain. The results showed that 3D printing, when associated with improvement in the topology of the part, allows an improvement both on costs and environmental impacts of the part life cycle. Nevertheless, the results are sensitive to the productivity of the 3D printing machine, in particular with costs when the productivity of the 3D printing is reduced. This eco-efficiency model presents several opportunities of improvement. A more elaborate definition of the objectives in reduction of environmental impacts would allow to direct the choices in design to considerations of eco-efficiency at a macro level. Moreover, the integration of the social dimension in the model constitutes an important stage to operationalize the stakes of environmental and social responsibility of the company.

Unmet need for specialised rehabilitation following neurosurgery: can we maximise the potential cost-benefits?

PubMed

Singh, Rajiv; Sinha, Saurabh; Bill, Alan; Turner-Stokes, Lynne

2017-04-01

To identify the needs for specialised rehabilitation provision in a cohort of neurosurgical patients; to determine if these were met, and to estimate the potential cost implications and cost-benefits of meeting any unmet rehabilitation needs. A prospective study of in-patient admissions to a regional neurosurgical ward. Assessment of needs for specialised rehabilitation (Category A or B needs) was made with the Patient Categorisation Tool. The number of patients who were referred and admitted for specialised rehabilitation was calculated. Data from the unit's submission to the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database 2012-2015 were used to estimate the potential mean lifetime savings generated through reduction in the costs of on-going care in the community. Of 223 neurosurgical in-patients over 3 months, 156 (70%) had Category A or B needs. Out of the 105 patients who were eligible for admission to the local specialised rehabilitation service, only 20 (19%) were referred and just 11 (10%) were actually admitted. The mean transfer time was 70.2 (range 28-127) days, compared with the national standard of 42 days. In the 3-year sample, mean savings in the cost of on-going care were £568 per week. Assuming a 10-year reduction in life expectancy, the approximate net lifetime saving for post-neurosurgical patients was estimated as at least £600K per patient. We calculated that provision of additional bed capacity in the specialist rehabilitation unit could generate net savings of £3.6M/bed-year. This preliminary single-centre study identified a considerable gap in provision of specialised rehabilitation for neurosurgical patients, which must be addressed if patients are to fulfil their potential for recovery. A 5-fold increase in bed capacity would cost £9.3m/year, but could lead to potential net savings of £24m/year. Our findings now require confirmation on a wider scale through prospective multi-centre studies.

Multichannel quench-flow microreactor chip for parallel reaction monitoring.

PubMed

Bula, Wojciech P; Verboom, Willem; Reinhoudt, David N; Gardeniers, Han J G E

2007-12-01

This paper describes a multichannel silicon-glass microreactor which has been utilized to investigate the kinetics of a Knoevenagel condensation reaction under different reaction conditions. The reaction is performed on the chip in four parallel channels under identical conditions but with different residence times. A special topology of the reaction coils overcomes the common problem arising from the difference in pressure drop of parallel channels having different length. The parallelization of reaction coils combined with chemical quenching at specific locations results in a considerable reduction in experimental effort and cost. The system was tested and showed good reproducibility in flow properties and reaction kinetic data generation.

What is the added value of ultrasound joint examination for monitoring synovitis in rheumatoid arthritis and can it be used to guide treatment decisions? A systematic review and cost-effectiveness analysis.

PubMed

Simpson, Emma; Hock, Emma; Stevenson, Matt; Wong, Ruth; Dracup, Naila; Wailoo, Allan; Conaghan, Philip; Estrach, Cristina; Edwards, Christopher; Wakefield, Richard

2018-04-01

Synovitis (inflamed joint synovial lining) in rheumatoid arthritis (RA) can be assessed by clinical examination (CE) or ultrasound (US). To investigate the added value of US, compared with CE alone, in RA synovitis in terms of clinical effectiveness and cost-effectiveness. Electronic databases including MEDLINE, EMBASE and the Cochrane databases were searched from inception to October 2015. A systematic review sought RA studies that compared additional US with CE. Heterogeneity of the studies with regard to interventions, comparators and outcomes precluded meta-analyses. Systematic searches for studies of cost-effectiveness and US and treatment-tapering studies (not necessarily including US) were undertaken. A model was constructed that estimated, for patients in whom drug tapering was considered, the reduction in costs of disease-modifying anti-rheumatic drugs (DMARDs) and serious infections at which the addition of US had a cost per quality-adjusted life-year (QALY) gained of £20,000 and £30,000. Furthermore, the reduction in the costs of DMARDs at which US becomes cost neutral was also estimated. For patients in whom dose escalation was being considered, the reduction in number of patients escalating treatment and in serious infections at which the addition of US had a cost per QALY gained of £20,000 and £30,000 was estimated. The reduction in number of patients escalating treatment for US to become cost neutral was also estimated. Fifty-eight studies were included. Two randomised controlled trials compared adding US to a Disease Activity Score (DAS)-based treat-to-target strategy for early RA patients. The addition of power Doppler ultrasound (PDUS) to a Disease Activity Score 28 joints-based treat-to-target strategy in the Targeting Synovitis in Early Rheumatoid Arthritis (TaSER) trial resulted in no significant between-group difference for change in Disease Activity Score 44 joints (DAS44). This study found that significantly more patients in the PDUS group attained DAS44 remission ( p  = 0.03). The Aiming for Remission in Rheumatoid Arthritis (ARCTIC) trial found that the addition of PDUS and grey-scale ultrasound (GSUS) to a DAS-based strategy did not produce a significant between-group difference in the primary end point: composite DAS of < 1.6, no swollen joints and no progression in van der Heijde-modified total Sharp score (vdHSS). The ARCTIC trial did find that the erosion score of the vdHS had a significant advantage for the US group ( p  = 0.04). In the TaSER trial there was no significant group difference for erosion. Other studies suggested that PDUS was significantly associated with radiographic progression and that US had added value for wrist and hand joints rather than foot and ankle joints. Heterogeneity between trials made conclusions uncertain. No studies were identified that reported the cost-effectiveness of US in monitoring synovitis. The model estimated that an average reduction of 2.5% in the costs of biological DMARDs would be sufficient to offset the costs of 3-monthly US. The money could not be recouped if oral methotrexate was the only drug used. Heterogeneity of the trials precluded meta-analysis. Therefore, no summary estimates of effect were available. Additional costs and health-related quality of life decrements, relating to a flare following tapering or disease progression, have not been included. The feasibility of increased US monitoring has not been assessed. Limited evidence suggests that US monitoring of synovitis could provide a cost-effective approach to selecting RA patients for treatment tapering or escalation avoidance. Considerable uncertainty exists for all conclusions. Future research priorities include evaluating US monitoring of RA synovitis in longitudinal clinical studies. This study is registered as PROSPERO CRD42015017216. The National Institute for Health Research Health Technology Assessment programme.

The value of residential photovoltaic systems: A comprehensive assessment

NASA Technical Reports Server (NTRS)

Borden, C. S.

1983-01-01

Utility-interactive photovoltaic (PV) arrays on residential rooftops appear to be a potentially attractive, large-scale application of PV technology. Results of a comprehensive assessment of the value (i.e., break-even cost) of utility-grid connected residential photovoltaic power systems under a variety of technological and economic assumptions are presented. A wide range of allowable PV system costs are calculated for small (4.34 kW (p) sub ac) residential PV systems in various locales across the United States. Primary factor in this variation are differences in local weather conditions, utility-specific electric generation capacity, fuel types, and customer-load profiles that effect purchase and sell-back rates, and non-uniform state tax considerations. Additional results from this analysis are: locations having the highest insolation values are not necessary the most economically attractive sites; residential PV systems connected in parallel to the utility demonstrate high percentages of energy sold back to the grid, and owner financial and tax assumptions cause large variations in break-even costs. Significant cost reduction and aggressive resolution of potential institutional impediments (e.g., liability, standards, metering, and technical integration) are required for a residential PV marker to become a major electric-grid-connected energy-generation source.

Sharing R&D investments in international environmental agreements with asymmetric countries

NASA Astrophysics Data System (ADS)

Biancardi, Marta; Villani, Giovanni

2018-05-01

This paper studies the coalition formation and the stability of the International Environmental Agreements (IEAs) in a pollution abatement dynamic model. We point out two meaningful aspects of this topic. Firstly, we consider asymmetry among countries, dividing them into two types: developed countries with a considerable environmental awareness and developing ones that pay less attention to environmental preservation. In addition, the former have a high-technology industry that allows for a unit abatement cost lower than the latter, and that are characterized by a labour-intensive industrial structure. Secondly, we introduce a positive externality in the cooperation by considering the R&D investment as two costs, namely the research investment and the developing cost. We assume that countries can coordinate their R&D activities by sharing their fixed research investments in order to avoid duplication of green activities. Moreover, by collaborating developing efforts, cooperators benefit from a reduction of a unit abatement cost higher than defectors. On the other hand, although non-cooperators completely support R&D investments for clean technologies, they realize lower abatements and benefits of a spillover effect due to development investments realized by cooperators. These two aspects could encourage the formation of stable coalitions.

Possibilities for the Production of Heavy Water in Argentina. Report No. 90; POSIBILIDADES ARGENTINAS PARA LA PRODUCCION DE AGUA PESADA. Informe No. 90

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

Silberman, E.; Cretella, R.F.

1963-01-01

As an introduction to the problems in the industrial production of heavy water, the industrial plants in operation are briefly described, and the causes determining their evolution are discussed. The industrial methods studied in England, France, Germandy, Sweden, Switzerland, India, Egypt, Japan, and O.E.C.E. for the production of D/sub 2/O are summarized. The market for heavy water is discussed. The factors considered in the selection of the production process to be developed for Argentina are given, and the cost of a H/sub 2/S-- H/sub 2/O exchange installation is determined. The cost of such a plant modified for Argentine needs ismore » then analyzed. It is concluded that the combination of the H/ sub 2/SH/sub 2/O process in a single unit with integral energy supply, coupled with the elimination of auxiliary installations, results in a considerable reduction in operation costs and plant investment, as compared with the cost of the process in the U.S. The plandt construction plan is summarized. (J.S.R.)« less

The value of residential photovoltaic systems: A comprehensive assessment

NASA Astrophysics Data System (ADS)

Borden, C. S.

1983-09-01

Utility-interactive photovoltaic (PV) arrays on residential rooftops appear to be a potentially attractive, large-scale application of PV technology. Results of a comprehensive assessment of the value (i.e., break-even cost) of utility-grid connected residential photovoltaic power systems under a variety of technological and economic assumptions are presented. A wide range of allowable PV system costs are calculated for small (4.34 kW (p) sub ac) residential PV systems in various locales across the United States. Primary factor in this variation are differences in local weather conditions, utility-specific electric generation capacity, fuel types, and customer-load profiles that effect purchase and sell-back rates, and non-uniform state tax considerations. Additional results from this analysis are: locations having the highest insolation values are not necessary the most economically attractive sites; residential PV systems connected in parallel to the utility demonstrate high percentages of energy sold back to the grid, and owner financial and tax assumptions cause large variations in break-even costs. Significant cost reduction and aggressive resolution of potential institutional impediments (e.g., liability, standards, metering, and technical integration) are required for a residential PV marker to become a major electric-grid-connected energy-generation source.

Nutritional, Economic, and Environmental Costs of Milk Waste in a Classroom School Breakfast Program.

PubMed

Blondin, Stacy A; Cash, Sean B; Goldberg, Jeanne P; Griffin, Timothy S; Economos, Christina D

2017-04-01

To measure fluid milk waste in a US School Breakfast in the Classroom Program and estimate its nutritional, economic, and environmental effects. Fluid milk waste was directly measured on 60 elementary school classroom days in a medium-sized, urban district. The US Department of Agriculture nutrition database, district cost data, and carbon dioxide equivalent (CO 2 e) emissions and water footprint estimates for fluid milk were used to calculate the associated nutritional, economic, and environmental costs. Of the total milk offered to School Breakfast Program participants, 45% was wasted. A considerably smaller portion of served milk was wasted (26%). The amount of milk wasted translated into 27% of vitamin D and 41% of calcium required of School Breakfast Program meals. The economic and environmental costs amounted to an estimated $274 782 (16% of the district's total annual School Breakfast Program food expenditures), 644 893 kilograms of CO 2 e, and 192 260 155 liters of water over the school year in the district. These substantial effects of milk waste undermine the School Breakfast Program's capacity to ensure short- and long-term food security and federal food waste reduction targets. Interventions that reduce waste are urgently needed.

Medical cost reductions associated with the usage of novel oral anticoagulants vs warfarin among atrial fibrillation patients, based on the RE-LY, ROCKET-AF, and ARISTOTLE trials.

PubMed

Deitelzweig, Steve; Amin, Alpesh; Jing, Yonghua; Makenbaeva, Dinara; Wiederkehr, Daniel; Lin, Jay; Graham, John

2012-01-01

The randomized clinical trials, RE-LY, ROCKET-AF, and ARISTOTLE, demonstrate that the novel oral anticoagulants (NOACs) are effective options for stroke prevention among non-valvular atrial fibrillation (AF) patients. This study aimed to evaluate the medical cost reductions associated with the use of individual NOACs instead of warfarin from the US payer perspective. Rates for efficacy and safety clinical events for warfarin were estimated as the weighted averages from the RE-LY, ROCKET-AF and ARISTOTLE trials, and event rates for NOACs were determined by applying trial hazard ratios or relative risk ratios to such weighted averages. Incremental medical costs to a US health payer of an AF patient experiencing a clinical event during 1 year following the event were obtained from published literature and inflation adjusted to 2010 cost levels. Medical costs, excluding drug costs, were evaluated and compared for each NOAC vs warfarin. Sensitivity analyses were conducted to determine the influence of variations in clinical event rates and incremental costs on the medical cost reduction. In a patient year, the medical cost reduction associated with NOAC usage instead of warfarin was estimated to be -$179, -$89, and -$485 for dabigatran, rivaroxaban, and apixaban, respectively. When clinical event rates and costs were allowed to vary simultaneously, through a Monte Carlo simulation, the 95% confidence interval of annual medical costs differences ranged between -$424 and +$71 for dabigatran, -$301 and +$135 for rivaroxaban, and -$741 and -$252 for apixaban, with a negative number indicating a cost reduction. Of the 10,000 Monte-Carlo iterations 92.6%, 79.8%, and 100.0% were associated with a medical cost reduction >$0 for dabigatran, rivaroxaban, and apixaban, respectively. Usage of the NOACs, dabigatran, rivaroxaban, and apixaban may be associated with lower medical (excluding drug costs) costs relative to warfarin, with apixaban having the most substantial medical cost reduction.

Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems.

PubMed

Aziz, Muhammad Tahir; Ur-Rehman, Tofeeq; Qureshi, Sadia; Bukhari, Nadeem Irfan

Medication errors in chemotherapy are frequent and lead to patient morbidity and mortality, as well as increased rates of re-admission and length of stay, and considerable extra costs. Objective: This study investigated the proposition that computerised chemotherapy ordering reduces the incidence and severity of chemotherapy protocol errors. A computerised physician order entry of chemotherapy order (C-CO) with clinical decision support system was developed in-house, including standardised chemotherapy protocol definitions, automation of pharmacy distribution, clinical checks, labeling and invoicing. A prospective study was then conducted in a C-CO versus paper based chemotherapy order (P-CO) in a 30-bed chemotherapy bay of a tertiary hospital. Both C-CO and P-CO orders, including pharmacoeconomic analysis and the severity of medication errors, were checked and validated by a clinical pharmacist. A group analysis and field trial were also conducted to assess clarity, feasibility and decision making. The C-CO was very usable in terms of its clarity and feasibility. The incidence of medication errors was significantly lower in the C-CO compared with the P-CO (10/3765 [0.26%] versus 134/5514 [2.4%]). There was also a reduction in dispensing time of chemotherapy protocols in the C-CO. The chemotherapy computerisation with clinical decision support system resulted in a significant decrease in the occurrence and severity of medication errors, improvements in chemotherapy dispensing and administration times, and reduction of chemotherapy cost.

The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures: A Computer Model-Based Evaluation of Three Operative Modalities.

PubMed

Rajan, Prashant V; Qudsi, Rameez A; Dyer, George S M; Losina, Elena

2018-02-07

There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation. We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient's lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty. From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning. When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Coordinating vendor-buyer decisions for imperfect quality items considering trade credit and fully backlogged shortages

NASA Astrophysics Data System (ADS)

Khanna, Aditi; Gautam, Prerna; Jaggi, Chandra K.

2016-03-01

Supply chain management has become a critical issue for modern business environments. In today's world of cooperative decision-making, individual decisions in order to reduce inventory costs may not lead to an overall optimal solution. Coordination is necessary among participants of supply chain to achieve better performance. There are legitimate and important efforts from the vendor to enhance the relation with buyer; one such effort is offering trade credit which has been a driver of growth and development of business between them. The cost of financing is a core consideration in effective financial management, in general and in context of business. Also, due to imperfect production a vendor may produce defective items which results in shortages. Motivated with these aspects, an integrated vendor-buyer inventory model is developed for imperfect quality items with allowable shortages; in which the vendor offers credit period to the buyer for payment. The objective is to minimize the total joint annual costs incurred by the vendor and the buyer by using integrated decision making approach. The expected total annual integrated cost is derived and a solution procedure is provided to find the optimal solution. Numerical analysis shows that the integrated model gives an impressive cost reduction, in comparison to independent decision policies by the vendor and the buyer.

Shared responsibility for managing electronic waste: a case study of Maine, USA.

PubMed

Wagner, Travis P

2009-12-01

Based on high disposal and low recycling rates of electronic waste (e-waste) and continued exportation to developing countries, reliance on municipal responsibility for e-waste management has been unsuccessful in the United States. This case study examines Maine's program, which was the first US state to mandate producer responsibility for recycling household e-waste. Maine's program established a shared cost responsibility among producers, municipalities, and consumers. The study found that Maine's program resulted in a significant reduction in disposal and a corresponding increase in environmentally sound recycling. In the first 3 years of the program, 6.406 million kg of household e-waste was collected and recycled for a population of 1.32 million. The new program, implemented in 2006, increased the number of e-waste items collected and recycled by 108% in the first year, 170% in the second year, and 221% in the third year. The program decreased direct economic costs to municipalities and households because of the shared cost approach and for the first time established costs for producers. There was no empirical evidence indicating that producers have or will improve the recyclability of electronic products to reduce recycling costs. While other weaknesses were that found potentially limit the adoption of Maine's program, its positive aspects warrant consideration by other governments.

Rapid room-temperature synthesis of nanocrystalline spinels as oxygen reduction and evolution electrocatalysts.

PubMed

Cheng, Fangyi; Shen, Jian; Peng, Bo; Pan, Yuede; Tao, Zhanliang; Chen, Jun

2011-01-01

Spinels can serve as alternative low-cost bifunctional electrocatalysts for oxygen reduction/evolution reactions (ORR/OER), which are the key barriers in various electrochemical devices such as metal-air batteries, fuel cells and electrolysers. However, conventional ceramic synthesis of crystalline spinels requires an elevated temperature, complicated procedures and prolonged heating time, and the resulting product exhibits limited electrocatalytic performance. It has been challenging to develop energy-saving, facile and rapid synthetic methodologies for highly active spinels. In this Article, we report the synthesis of nanocrystalline M(x)Mn(3-x)O(4) (M = divalent metals) spinels under ambient conditions and their electrocatalytic application. We show rapid and selective formation of tetragonal or cubic M(x)Mn(3-x)O(4) from the reduction of amorphous MnO(2) in aqueous M(2+) solution. The prepared Co(x)Mn(3-x)O(4) nanoparticles manifest considerable catalytic activity towards the ORR/OER as a result of their high surface areas and abundant defects. The newly discovered phase-dependent electrocatalytic ORR/OER characteristics of Co-Mn-O spinels are also interpreted by experiment and first-principle theoretical studies.

Is the Venner-PneuX Endotracheal Tube System A Cost-Effective Option For Post Cardiac Surgery Care?

PubMed

Andronis, Lazaros; Oppong, Raymond A; Manga, Na'ngono; Senanayake, Eshan; Gopal, Shameer; Charman, Susan; Giri, Ramesh; Luckraz, Heyman

2018-04-27

Ventilator-associated pneumonia (VAP) is common and costly. In a recent randomized controlled trial, the Venner-PneuX (VPX) endotracheal tube system was found to be superior to standard endotracheal tubes (SET) in preventing VAP. However, VPX is considerably more expensive. We evaluated the costs and benefits of VPX to determine whether replacing SET with VPX is a cost-effective option for intensive care units. We developed a decision analytic model to compare intubation with VPX or SET for patients requiring mechanical ventilation post cardiac surgery. The model was populated with existing evidence on costs, effectiveness and quality of life. Cost-effectiveness and cost-utility analyses were conducted from an NHS hospital perspective. Uncertainty was assessed through deterministic and probabilistic sensitivity analyses. Compared to SET, VPX is associated with an expected cost saving of £738 per patient. VPX led to a small increase in quality-adjusted life years (QALYs), indicating that the device is overall less costly and more effective than SET. The probability of VPX being cost-effective at £30,000 per QALY is 97%. VPX would cease to be cost-effective if (i) it led to a risk reduction smaller than 0.02 compared to SET, (ii) the acquisition cost of VPX was as high as £890 or, (iii) the cost of treating a case of VAP was lower than £1,450. VPX resulted in improved outcomes and savings which far offset the cost of the device, suggesting that replacing SET with VPX is overall beneficial. Findings were robust to extreme values of key parameters. Copyright © 2018. Published by Elsevier Inc.

Cost-Effectiveness and Cost-Reduction in United States Colleges and Universities.

ERIC Educational Resources Information Center

Miller, Richard I.; Miller, Peggy M.

1991-01-01

The relationship in college administration between cost effectiveness/cost reduction and planning, management, and evaluation is explored, and approaches to cost accounting and financial ratio analysis are discussed. It is concluded that it is important to emphasize institutional mission and people rather than cost containment and productivity.…

Selection and placement of best management practices used to reduce water quality degradation in Lincoln Lake watershed

NASA Astrophysics Data System (ADS)

Rodriguez, Hector German; Popp, Jennie; Maringanti, Chetan; Chaubey, Indrajeet

2011-01-01

An increased loss of agricultural nutrients is a growing concern for water quality in Arkansas. Several studies have shown that best management practices (BMPs) are effective in controlling water pollution. However, those affected with water quality issues need water management plans that take into consideration BMPs selection, placement, and affordability. This study used a nondominated sorting genetic algorithm (NSGA-II). This multiobjective algorithm selects and locates BMPs that minimize nutrients pollution cost-effectively by providing trade-off curves (optimal fronts) between pollutant reduction and total net cost increase. The usefulness of this optimization framework was evaluated in the Lincoln Lake watershed. The final NSGA-II optimization model generated a number of near-optimal solutions by selecting from 35 BMPs (combinations of pasture management, buffer zones, and poultry litter application practices). Selection and placement of BMPs were analyzed under various cost solutions. The NSGA-II provides multiple solutions that could fit the water management plan for the watershed. For instance, by implementing all the BMP combinations recommended in the lowest-cost solution, total phosphorous (TP) could be reduced by at least 76% while increasing cost by less than 2% in the entire watershed. This value represents an increase in cost of 5.49 ha-1 when compared to the baseline. Implementing all the BMP combinations proposed with the medium- and the highest-cost solutions could decrease TP drastically but will increase cost by 24,282 (7%) and $82,306 (25%), respectively.

An economic case for a cardiovascular polypill? A cost analysis of the Kanyini GAP trial.

PubMed

Laba, Tracey-Lea; Hayes, Alison; Lo, Serigne; Peiris, David P; Usherwood, Tim; Hillis, Graham S; Rafter, Natasha; Reid, Christopher M; Tonkin, Andrew M; Webster, Ruth; Neal, Bruce C; Cass, Alan; Patel, Anushka; Rodgers, Anthony; Jan, Stephen

2014-12-11

To measure the costs of a polypill strategy and compare them with those of usual care in people with established cardiovascular disease (CVD) or at similarly high cardiovascular risk. A within-trial cost analysis of polypill-based care versus usual care with separate medications, using data from the Kanyini Guidelines Adherence with the Polypill (GAP) trial and linked health service and medication administrative claims data. Kanyini GAP participants who consented to Australian Medicare record access. Mean health service and pharmaceutical expenditure per patient per year, estimated with generalised linear models. Costs during the trial (randomisation January 2010 - May 2012, median follow-up 19 months, maximum follow-up 36 months) were inflated to 2012 costs. Our analysis showed a statistically significantly lower mean pharmaceutical expenditure of $989 (95% CI, $648-$1331) per patient per year in the polypill arm compared with usual care (P < 0.001; adjusted, excluding polypill cost). No significant difference was shown in health service expenditure. This study provides evidence of significant cost savings to the taxpayer and Australian Government through the introduction of a CVD polypill strategy. The savings will be less now than during the trial due to subsequent reductions in the costs of usual care. Nonetheless, given the prevalence of CVD in Australia, the introduction of this polypill could increase considerably the efficiency of health care expenditure in Australia. Australian New Zealand Clinical Trials Registry ACTRN126080005833347.

The Impact of Company-Level ART Provision to a Mining Workforce in South Africa: A Cost–Benefit Analysis

PubMed Central

Meyer-Rath, Gesine; Pienaar, Jan; Brink, Brian; van Zyl, Andrew; Muirhead, Debbie; Grant, Alison; Churchyard, Gavin; Watts, Charlotte; Vickerman, Peter

2015-01-01

Background HIV impacts heavily on the operating costs of companies in sub-Saharan Africa, with many companies now providing antiretroviral therapy (ART) programmes in the workplace. A full cost–benefit analysis of workplace ART provision has not been conducted using primary data. We developed a dynamic health-state transition model to estimate the economic impact of HIV and the cost–benefit of ART provision in a mining company in South Africa between 2003 and 2022. Methods and Findings A dynamic health-state transition model, called the Workplace Impact Model (WIM), was parameterised with workplace data on workforce size, composition, turnover, HIV incidence, and CD4 cell count development. Bottom-up cost analyses from the employer perspective supplied data on inpatient and outpatient resource utilisation and the costs of absenteeism and replacement of sick workers. The model was fitted to workforce HIV prevalence and separation data while incorporating parameter uncertainty; univariate sensitivity analyses were used to assess the robustness of the model findings. As ART coverage increases from 10% to 97% of eligible employees, increases in survival and retention of HIV-positive employees and associated reductions in absenteeism and benefit payments lead to cost savings compared to a scenario of no treatment provision, with the annual cost of HIV to the company decreasing by 5% (90% credibility interval [CrI] 2%–8%) and the mean cost per HIV-positive employee decreasing by 14% (90% CrI 7%–19%) by 2022. This translates into an average saving of US$950,215 (90% CrI US$220,879–US$1.6 million) per year; 80% of these cost savings are due to reductions in benefit payments and inpatient care costs. Although findings are sensitive to assumptions regarding incidence and absenteeism, ART is cost-saving under considerable parameter uncertainty and in all tested scenarios, including when prevalence is reduced to 1%—except when no benefits were paid out to employees leaving the workforce and when absenteeism rates were half of what data suggested. Scaling up ART further through a universal test and treat strategy doubles savings; incorporating ART for family members reduces savings but is still marginally cost-saving compared to no treatment. Our analysis was limited to the direct cost of HIV to companies and did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, though in sensitivity analysis our results were found to be robust to changes to these inputs along plausible ranges. Conclusions Workplace ART provision can be cost-saving for companies in high HIV prevalence settings due to reductions in healthcare costs, absenteeism, and staff turnover. Company-sponsored HIV counselling and voluntary testing with ensuing treatment of all HIV-positive employees and family members should be implemented universally at workplaces in countries with high HIV prevalence. PMID:26327271

Two-stage stochastic unit commitment model including non-generation resources with conditional value-at-risk constraints

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

Huang, Yuping; Zheng, Qipeng P.; Wang, Jianhui

2014-11-01

tThis paper presents a two-stage stochastic unit commitment (UC) model, which integrates non-generation resources such as demand response (DR) and energy storage (ES) while including riskconstraints to balance between cost and system reliability due to the fluctuation of variable genera-tion such as wind and solar power. This paper uses conditional value-at-risk (CVaR) measures to modelrisks associated with the decisions in a stochastic environment. In contrast to chance-constrained modelsrequiring extra binary variables, risk constraints based on CVaR only involve linear constraints and con-tinuous variables, making it more computationally attractive. The proposed models with risk constraintsare able to avoid over-conservative solutions butmore » still ensure system reliability represented by loss ofloads. Then numerical experiments are conducted to study the effects of non-generation resources ongenerator schedules and the difference of total expected generation costs with risk consideration. Sen-sitivity analysis based on reliability parameters is also performed to test the decision preferences ofconfidence levels and load-shedding loss allowances on generation cost reduction.« less

Non-Hardware ("Soft") Cost-Reduction Roadmap for Residential and Small Commercial Solar Photovoltaics, 2013-2020

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

Ardani, K.; Seif, D.; Margolis, R.

2013-08-01

The objective of this analysis is to roadmap the cost reductions and innovations necessary to achieve the U.S. Department of Energy (DOE) SunShot Initiative's total soft-cost targets by 2020. The roadmap focuses on advances in four soft-cost areas: (1) customer acquisition; (2) permitting, inspection, and interconnection (PII); (3) installation labor; and (4) financing. Financing cost reductions are in terms of the weighted average cost of capital (WACC) for financing PV system installations, with real-percent targets of 3.0% (residential) and 3.4% (commercial).

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain.

PubMed

Ribed-Sánchez, Borja; González-Gaya, Cristina; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Bule-Farto, Isabel; Pérez de-Oteyza, Jaime

To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Phytoplankton defence mechanisms: traits and trade-offs.

PubMed

Pančić, Marina; Kiørboe, Thomas

2018-05-01

In aquatic ecosystems, unicellular algae form the basis of the food webs. Theoretical and experimental studies have demonstrated that one of the mechanisms that maintain high diversity of phytoplankton is through predation and the consequent evolution of defence mechanisms. Proposed defence mechanisms in phytoplankton are diverse and include physiological (e.g. toxicity, bioluminescence), morphological (e.g. silica shell, colony formation), and behavioural (e.g. escape response) traits. However, the function of many of the proposed defence mechanisms remains elusive, and the costs and benefits (trade-offs) are often unquantified or undocumented. Here, we provide an overview of suggested phytoplankton defensive traits and review their experimental support. Wherever possible we quantify the trade-offs from experimental evidence and theoretical considerations. In many instances, experimental evidence suggests that defences are costless. However, we argue that (i) some costs materialize only under natural conditions, for example, sinking losses, or dependency on the availability of specific nutrients, and (ii) other costs become evident only under resource-deficient conditions where a rivalry for limiting resources between growth and defence occurs. Based on these findings, we suggest two strategies for quantifying the costs of defence mechanisms in phytoplankton: (i) for the evaluation of defence costs that are realized under natural conditions, a mechanistic understanding of the hypothesized component processes is required; and (ii) the magnitude of the costs (i.e. growth reduction) must be assessed under conditions of resource limitation. © 2018 Cambridge Philosophical Society.

Cost-benefit analysis: newborn screening for inborn errors of metabolism in Lebanon.

PubMed

Khneisser, I; Adib, S; Assaad, S; Megarbane, A; Karam, P

2015-12-01

Few countries in the Middle East-North Africa region have adopted national newborn screening for inborn errors of metabolism by tandem mass spectrometry (MS/MS). We aimed to evaluate the cost-benefit of newborn screening for such disorders in Lebanon, as a model for other developing countries in the region. Average costs of expected care for inborn errors of metabolism cases as a group, between ages 0 and 18, early and late diagnosed, were calculated from 2007 to 2013. The monetary value of early detection using MS/MS was compared with that of clinical "late detection", including cost of diagnosis and hospitalizations. During this period, 126000 newborns were screened. Incidence of detected cases was 1/1482, which can be explained by high consanguinity rates in Lebanon. A reduction by half of direct cost of care, reaching on average 31,631 USD per detected case was shown. This difference more than covers the expense of starting a newborn screening programme. Although this model does not take into consideration the indirect benefits of the better quality of life of those screened early, it can be argued that direct and indirect costs saved through early detection of these disorders are important enough to justify universal publicly-funded screening, especially in developing countries with high consanguinity rates, as shown through this data from Lebanon. © The Author(s) 2015.

Assessment of Integrated Pedestrian Protection Systems with Autonomous Emergency Braking (AEB) and Passive Safety Components.

PubMed

Edwards, Mervyn; Nathanson, Andrew; Carroll, Jolyon; Wisch, Marcus; Zander, Oliver; Lubbe, Nils

2015-01-01

Autonomous emergency braking (AEB) systems fitted to cars for pedestrians have been predicted to offer substantial benefit. On this basis, consumer rating programs-for example, the European New Car Assessment Programme (Euro NCAP)-are developing rating schemes to encourage fitment of these systems. One of the questions that needs to be answered to do this fully is how the assessment of the speed reduction offered by the AEB is integrated with the current assessment of the passive safety for mitigation of pedestrian injury. Ideally, this should be done on a benefit-related basis. The objective of this research was to develop a benefit-based methodology for assessment of integrated pedestrian protection systems with AEB and passive safety components. The method should include weighting procedures to ensure that it represents injury patterns from accident data and replicates an independently estimated benefit of AEB. A methodology has been developed to calculate the expected societal cost of pedestrian injuries, assuming that all pedestrians in the target population (i.e., pedestrians impacted by the front of a passenger car) are impacted by the car being assessed, taking into account the impact speed reduction offered by the car's AEB (if fitted) and the passive safety protection offered by the car's frontal structure. For rating purposes, the cost for the assessed car is normalized by comparing it to the cost calculated for a reference car. The speed reductions measured in AEB tests are used to determine the speed at which each pedestrian in the target population will be impacted. Injury probabilities for each impact are then calculated using the results from Euro NCAP pedestrian impactor tests and injury risk curves. These injury probabilities are converted into cost using "harm"-type costs for the body regions tested. These costs are weighted and summed. Weighting factors were determined using accident data from Germany and Great Britain and an independently estimated AEB benefit. German and Great Britain versions of the methodology are available. The methodology was used to assess cars with good, average, and poor Euro NCAP pedestrian ratings, in combination with a current AEB system. The fitment of a hypothetical A-pillar airbag was also investigated. It was found that the decrease in casualty injury cost achieved by fitting an AEB system was approximately equivalent to that achieved by increasing the passive safety rating from poor to average. Because the assessment was influenced strongly by the level of head protection offered in the scuttle and windscreen area, a hypothetical A-pillar airbag showed high potential to reduce overall casualty cost. A benefit-based methodology for assessment of integrated pedestrian protection systems with AEB has been developed and tested. It uses input from AEB tests and Euro NCAP passive safety tests to give an integrated assessment of the system performance, which includes consideration of effects such as the change in head impact location caused by the impact speed reduction given by the AEB.

Cost-Effectiveness Analysis of Surface Flow Constructed Wetlands (SFCW) for Nutrient Reduction in Drainage Discharge from Agricultural Fields in Denmark.

PubMed

Gachango, F G; Pedersen, S M; Kjaergaard, C

2015-12-01

Constructed wetlands have been proposed as cost-effective and more targeted technologies in the reduction of nitrogen and phosphorous water pollution in drainage losses from agricultural fields in Denmark. Using two pig farms and one dairy farm situated in a pumped lowland catchment as case studies, this paper explores the feasibility of implementing surface flow constructed wetlands (SFCW) based on their cost effectiveness. Sensitivity analysis is conducted by varying the cost elements of the wetlands in order to establish the most cost-effective scenario and a comparison with the existing nutrients reduction measures carried out. The analyses show that the cost effectiveness of the SFCW is higher in the drainage catchments with higher nutrient loads. The range of the cost effectiveness ratio on nitrogen reduction differs distinctively with that of catch crop measure. The study concludes that SFCW could be a better optimal nutrients reduction measure in drainage catchments characterized with higher nutrient loads.

Economic analysis of the global polio eradication initiative.

PubMed

Duintjer Tebbens, Radboud J; Pallansch, Mark A; Cochi, Stephen L; Wassilak, Steven G F; Linkins, Jennifer; Sutter, Roland W; Aylward, R Bruce; Thompson, Kimberly M

2010-12-16

The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40-50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains robust over a wide range of assumptions, and that consideration of the additional net benefits of externalities that occurred during polio campaigns to date, such as the mortality reduction associated with delivery of Vitamin A supplements, significantly increases the net benefits. This study finds a strong economic justification for the GPEI despite the rising costs of the initiative. Copyright © 2010 Elsevier Ltd. All rights reserved.

Introducing vaccination against serogroup B meningococcal disease: An economic and mathematical modelling study of potential impact

PubMed Central

Christensen, Hannah; Hickman, Matthew; Edmunds, W. John; Trotter, Caroline L.

2013-01-01

Background Meningococcal disease remains an important cause of morbidity and mortality worldwide. The first broadly effective vaccine against group B disease (which causes considerable meningococcal disease in Europe, the Americas and Australasia) was licensed in the EU in January 2013; our objective was to estimate the potential impact of introducing such a vaccine in England. Methods We developed two models to estimate the impact of introducing a new ‘MenB’ vaccine. The cohort model assumes the vaccine protects against disease only; the transmission dynamic model also allows the vaccine to protect against carriage (accounting for herd effects). We used these, and economic models, to estimate the case reduction and cost-effectiveness of a number of different vaccine strategies. Results We estimate 27% of meningococcal disease cases could be prevented over the lifetime of an English birth cohort by vaccinating infants at 2,3,4 and 12 months of age with a vaccine that prevents disease only; this strategy could be cost-effective at £9 per vaccine dose. Substantial reductions in disease (71%) can be produced after 10 years by routinely vaccinating infants in combination with a large-scale catch-up campaign, using a vaccine which protects against carriage as well as disease; this could be cost-effective at £17 per vaccine dose. Conclusions New ‘MenB’ vaccines could substantially reduce disease in England and be cost-effective if competitively priced, particularly if the vaccines can prevent carriage as well as disease. These results are relevant to other countries, with a similar epidemiology to England, considering the introduction of a new ‘MenB’ vaccine. PMID:23566946

Estimated impact and cost-effectiveness of rotavirus vaccination in India: effects of geographic and economic disparities.

PubMed

Rheingans, Richard; Anderson, John D; Anderson, Benjamin; Chakraborty, Poulomy; Atherly, Deborah; Pindolia, Deepa

2014-08-11

India accounts for 23% of global rotavirus mortality in under-five children, with more than 100,000 deaths from rotavirus annually. Introduction of a vaccine in India is considered to be the most effective intervention for preventing rotavirus mortality. Recent research suggests that there is considerable variation in rotavirus mortality burden across regional, gender and socio-economic subpopulations within India. In addition, there is potential variability in who would likely receive rotavirus vaccine if introduced. We use available household data to estimate heterogeneity in rotavirus mortality risk, vaccination benefits, and cost-effectiveness across geographic and socio-economic groups within India. We account for heterogeneity by modeling estimated three-dose routine vaccinations as a proxy for a generalized rotavirus vaccine, and mortality for subpopulations of children aggregated by region and state, socio-economic status and sex, separately. Results are presented for six geographic regions and for Bihar, Uttar Pradesh, and Madhya Pradesh, three high mortality states accounting for 56% of national mortality estimates. Impact estimates accounting for disparities predict rotavirus vaccine introduction will prevent 35,000 deaths at an average cost of $118/DALY averted (7292 INR/DALY averted). Rotavirus vaccines are most cost-effective for the poor living in high mortality regions and states. Reductions in geographic and socio-economic disparities based on regional estimates could prevent an additional 9400 deaths annually, while reductions in socio-economic disparities in the three highest morality states alone could prevent an additional 10,600 deaths annually. Understanding the impact of heterogeneity can help improve strategies to maximize the benefits of rotavirus vaccination introduction, leading to fewer lives lost as a result of rotavirus disease. Copyright © 2014. Published by Elsevier Ltd.

A white paper: Operational efficiency. New approaches to future propulsion systems

NASA Technical Reports Server (NTRS)

Rhodes, Russel; Wong, George

1991-01-01

Advanced launch systems for the next generation of space transportation systems (1995 to 2010) must deliver large payloads (125,000 to 500,000 lbs) to low earth orbit (LEO) at one tenth of today's cost, or 300 to 400 $/lb of payload. This cost represents an order of magnitude reduction from the Titan unmanned vehicle cost of delivering payload to orbit. To achieve this sizable reduction, the operations cost as well as the engine cost must both be lower than current engine system. The Advanced Launch System (ALS) is studying advanced engine designs, such as the Space Transportation Main Engine (STME), which has achieved notable reduction in cost. The results are presented of a current study wherein another level of cost reduction can be achieved by designing the propulsion module utilizing these advanced engines for enhanced operations efficiency and reduced operations cost.

78 FR 2692 - Agency Information Collection Activities; Proposed New Collection; Comments Requested: COPS...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

... Collection; Comments Requested: COPS Comparative Assessment of Cost Reduction by Agencies Survey ACTION: 30...; comments requested. (2) Title of the Form/Collection: COPS Comparative Assessment of Cost Reduction by... will be asked complete the COPS Comparative Assessment of Cost Reduction Survey. The survey will be...

Energy Cost Reduction for Automotive Service Facilities.

ERIC Educational Resources Information Center

Federal Energy Administration, Washington, DC.

This handbook on energy cost reduction for automotive service facilities consists of four sections. The importance and economic benefits of energy conservation are discussed in the first section. In the second section six energy cost reduction measures are discussed: relamping interior areas; relamping and reducing interior lighting; setting back…

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

PubMed

Wilcox, Meredith L; Mason, Helen; Fouad, Fouad M; Rastam, Samer; al Ali, Radwan; Page, Timothy F; Capewell, Simon; O'Flaherty, Martin; Maziak, Wasim

2015-01-01

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

Flying in a flock comes at a cost in pigeons.

PubMed

Usherwood, James R; Stavrou, Marinos; Lowe, John C; Roskilly, Kyle; Wilson, Alan M

2011-06-22

Flying birds often form flocks, with social, navigational and anti-predator implications. Further, flying in a flock can result in aerodynamic benefits, thus reducing power requirements, as demonstrated by a reduction in heart rate and wingbeat frequency in pelicans flying in a V-formation. But how general is an aerodynamic power reduction due to group-flight? V-formation flocks are limited to moderately steady flight in relatively large birds, and may represent a special case. What are the aerodynamic consequences of flying in the more usual 'cluster' flock? Here we use data from innovative back-mounted Global Positioning System (GPS) and 6-degrees-of-freedom inertial sensors to show that pigeons (1) maintain powered, banked turns like aircraft, imposing dorsal accelerations of up to 2g, effectively doubling body weight and quadrupling induced power requirements; (2) increase flap frequency with increases in all conventional aerodynamic power requirements; and (3) increase flap frequency when flying near, particularly behind, other birds. Therefore, unlike V-formation pelicans, pigeons do not gain an aerodynamic advantage from flying in a flock. Indeed, the increased flap frequency, whether due to direct aerodynamic interactions or requirements for increased stability or control, suggests a considerable energetic cost to flight in a tight cluster flock.

Flying in a flock comes at a cost in pigeons

PubMed Central

Usherwood, James R.; Stavrou, Marinos; Lowe, John C.; Roskilly, Kyle; Wilson, Alan M.

2011-01-01

Flying birds often form flocks, with social1, navigational2 and anti-predator3 implications. Further, flying in a flock can result in aerodynamic benefits, thus reducing power requirements4, as demonstrated by a reduction in heart rate and wingbeat frequency in pelicans flying in a V-formation5. But how general is an aerodynamic power reduction due to group-flight? V-formation flocks are limited to moderately steady flight in relatively large birds, and may represent a special case. What are the aerodynamic consequences of flying in the more usual ‘cluster’ 6,7 flock? Here, we use data from innovative back-mounted GPS and 6 degree of freedom inertial sensors to show that pigeons 1) maintain powered, banked turns like aircraft, imposing dorsal accelerations of up to 2g, effectively doubling body weight and quadrupling induced power requirements; 2) increase flap frequency with increases in all conventional aerodynamic power requirements; and 3) increase flap frequency when flying near, particularly behind, other birds. Therefore, unlike V-formation pelicans, pigeons do not gain an aerodynamic advantage from flying in a flock; indeed, the increased flap frequency – whether due to direct aerodynamic interactions or requirements for increased stability or control – suggests a considerable energetic cost to flight in a tight cluster flock. PMID:21697946

Smart Sensor Demonstration Payload

NASA Technical Reports Server (NTRS)

Schmalzel, John; Bracey, Andrew; Rawls, Stephen; Morris, Jon; Turowski, Mark; Franzl, Richard; Figueroa, Fernando

2010-01-01

Sensors are a critical element to any monitoring, control, and evaluation processes such as those needed to support ground based testing for rocket engine test. Sensor applications involve tens to thousands of sensors; their reliable performance is critical to achieving overall system goals. Many figures of merit are used to describe and evaluate sensor characteristics; for example, sensitivity and linearity. In addition, sensor selection must satisfy many trade-offs among system engineering (SE) requirements to best integrate sensors into complex systems [1]. These SE trades include the familiar constraints of power, signal conditioning, cabling, reliability, and mass, and now include considerations such as spectrum allocation and interference for wireless sensors. Our group at NASA s John C. Stennis Space Center (SSC) works in the broad area of integrated systems health management (ISHM). Core ISHM technologies include smart and intelligent sensors, anomaly detection, root cause analysis, prognosis, and interfaces to operators and other system elements [2]. Sensor technologies are the base fabric that feed data and health information to higher layers. Cost-effective operation of the complement of test stands benefits from technologies and methodologies that contribute to reductions in labor costs, improvements in efficiency, reductions in turn-around times, improved reliability, and other measures. ISHM is an active area of development at SSC because it offers the potential to achieve many of those operational goals [3-5].

[CAP quality management system in clinical laboratory and its issue].

PubMed

Tazawa, Hiromitsu

2004-03-01

The CAP (College of American Pathologists) was established in 1962 and, at present, CAP-accredited laboratories include about 6000 institutions all over the world, mainly in the U.S. The essential purpose of CAP accreditation is high quality reservation and improvement of clinical laboratory services for patient care, and is based on seven points, listed below. (1) Establishment of a laboratory management program and laboratory techniques to assure accuracy and improve overall quality of laboratory services. (2) Maintenance and improvement of accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety and health administration. (4) Reservation of the performance of laboratory services by personnel and proficiency management. (5) Provision of appropriate information to physicians, and contribution to improved quality of patient care by close communication with physicians (improvement in patient care). (6) Reduction of running costs and personnel costs based on evidence by employing the above-mentioned criteria. (7) Reduction of laboratory error. In the future, accreditation and/or certification by organizations such as CAP, ISO, etc., may become a requirement for providing any clinical laboratory services in Japan. Taking the essence of the CAP and the characteristics of the new international standard, ISO151589, into consideration, it is important to choose the best suited accreditation and/or certification depending of the purpose of clinical laboratory.

Yield of ultra-rapid carotid ultrasound and stroke specialist assessment in patients with TIA and minor stroke: an Italian TIA service audit.

PubMed

Gulli, Giosuè; Peron, Elisa; Ricci, Giorgio; Formaglio, Eva; Micheletti, Nicola; Tomelleri, Giampaolo; Moretto, Giuseppe

2014-12-01

In Italy the vast majority of TIA and minor strokes are seen in the A&E. Early diagnosis and management of TIA and minor stroke in this setting is habitually difficult and often lead to cost-ineffective hospital admissions. We set up an ultra-rapid TIA service run by neurovascular physicians based on early specialist assessment and ultrasound vascular imaging. We audit the clinical effectiveness and feasibility of the service and the impact of this service on TIA and minor strokes hospital admissions. We compared the rate of TIA and minor stroke admissions/discharges in the year before (T0) and in the year during which the TIA service was operating (T1). At T1 57 patients had specialist evaluation and 51 (89.5 %) of them were discharged home. Two (3.5 %) patients had recurrent symptoms after discharge. Seven had a pathological carotid Doppler ultrasound. Four of them had hospital admission and subsequent carotid endoarterectomy within a week. Taking the whole neurology department into consideration at T1 there was a 30-41 % reduction in discharges of patients with TIA or minor stroke. Taking the stroke unit section into consideration at T1 there was a 25 % reduction in admissions of patients with NIHSS score <4 and 40 % reduction in admissions of patients with Barthel Index above 80. The model of TIA service we implemented based on ultra-rapid stroke physician assessment and carotid ultrasound investigation is feasible and clinically valid. Indirect evidence suggests that it reduced the rate of expensive TIA/minor stroke hospital admissions.

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

PubMed Central

Walker, Simon; Cambiano, Valentina; Phillips, Andrew; Sculpher, Mark J.

2018-01-01

Background The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. Key issues for economic evaluation The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. Implications The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented. PMID:29293611

InnovaSEC in Action: Cost-effectiveness of Barostim in the Treatment of Refractory Hypertension in Spain.

PubMed

Soto, Marcelo; Sampietro-Colom, Laura; Sagarra, Joan; Brugada-Terradellas, Josep

2016-06-01

In Spain, 0.3% of patients with hypertension are refractory to conventional treatment. The complications resulting from deficient control of this condition can lead to poor quality of life for the patient and considerable health care costs. Barostim is an implantable device designed to lower blood pressure in these patients. The aim of this study was to analyze the cost-effectiveness of Barostim compared with drug therapy in hypertensive patients refractory to conventional treatment (at least 3 antihypertensive drugs, including 1 diuretic agent). We used a Markov model adapted to the epidemiology of the Spanish population to simulate the natural history of a cohort of patients with refractory hypertension over their lifetime. Data on the effectiveness of the treatments studied were obtained from the literature, and data on costs were taken from hospital administrative databases and official sources. Deterministic and probabilistic sensitivity analyses were conducted. Barostim increased the number of quality-adjusted life years by 0.78 and reduced the number of hypertension-associated clinical events. The incremental cost-effectiveness ratio in a cohort of men reached 68 726 euros per year of quality-adjusted life. One of the main elements that makes this technology costly is the need for battery replacement. The results were robust. Barostim is not a cost-effective strategy for the treatment of refractory hypertension in Spain. The cost-effectiveness ratio could be improved by future reductions in the cost of the battery. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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

PubMed

Mabasa, Vincent H; Ma, Johnny

2006-06-01

Therapeutic maximum allowable cost (MAC) is a managed care intervention that uses reference pricing in a therapeutic class or category of drugs or an indication (e.g., heartburn). Therapeutic MAC has not been studied in Canada or the United States. The proton pump inhibitor (PPI) rabeprazole was used as the reference drug in this therapeutic MAC program based on prices for PPIs in the province of Ontario. No PPI is available over the counter in Canada. To evaluate the utilization and anticipated drug cost savings for PPIs in an employer-sponsored drug plan in Canada that implemented a therapeutic MAC program for PPIs. An employer group with an average of 6,300 covered members, which adopted the MAC program for PPIs in June 2003, was compared with a comparison group comprising the book of business throughout Canada (approximately 5 million lives) without a PPI MAC program (non-MAC group). Pharmacy claims for PPIs were identified using the first 6 characters of the generic product identifier (GPI 492700) for a 36-month period from June 1, 2002, through May 31, 2005. The primary comparison was the year prior to the intervention (from June 1, 2002, through May 31, 2003) and the first full year following the intervention (June 1, 2004, through May 31, 2005). Drug utilization was evaluated by comparing the market share of each of the PPIs for the 2 time periods and by the days of PPI therapy per patient per year (PPPY) and days of therapy per prescription (Rx). Drug cost was defined as the cost of the drug (ingredient cost), including allowable provincial pharmacy markup but excluding pharmacy dispense fee. Cost savings were calculated from the allowed drug cost per claim, allowed cost per day, and allowed cost PPPY. (All amounts are in Canadian dollars.) The MAC intervention group experienced an 11.7% reduction in the average cost per day of PPI drug therapy, from 2.14 US dollars in the preperiod to 1.89 US dollars in the postperiod, compared with a 3.7% reduction in the comparison group (2.16 US dollars vs. 2.08 US dollars). Utilization dropped by 11.9% in the intervention group, from 166.7 days of PPI drug therapy PPPY to 146.9 days PPPY, compared with an increase of 7.9% in the comparison group, from 136.1 days to 146.8 days PPPY. The combined effect of the decrease in drug cost per day and utilization was a 22.1% reduction in allowed drug cost PPPY in the intervention (MAC) group (from 357 US dollars to 278 US dollars PPPY) versus a 4.1% increase in the comparison group (from 293 US dollars to 305 US dollars PPPY). A MAC program for PPIs for one employer in Canada was associated with savings for the drug plan sponsor of approximately 8% in actual drug cost per day of therapy compared with the comparison group. Total savings after consideration of utilization was approximately 26% for the intervention group versus the comparison group.

Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti.

PubMed

Jacquet, Vary; Morose, Willy; Schwartzman, Kevin; Oxlade, Olivia; Barr, Graham; Grimard, Franque; Menzies, Dick

2006-08-15

Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives. Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$. Starting in 2003, DOTS expansion in Haiti is anticipated to cost $4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion. A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion.

Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

PubMed Central

Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

2014-01-01

Objective We determined the minimum mortality reduction that helicopter emergency medical services (HEMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of minor injury patients. Methods We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective over a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality adjusted life year (QALY) gained compared to ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma (NSCOT), National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. Results HEMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the NSCOT cohort) to cost less than $100,000 per QALY gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per QALY. HEMS becomes more cost-effective with significant reductions in minor injury patients triaged to air transport or if long-term disability outcomes are improved. Conclusions HEMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably to other interventions considered cost-effective. Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction. Reducing overtriage of minor injury patients to HEMS would improve its cost-effectiveness. PMID:23582619

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

PubMed

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

2016-12-15

How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO 2 ) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×10 6 compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases. Copyright © 2016 Elsevier B.V. All rights reserved.

Cost of photovoltaic energy systems as determined by balance-of-system costs

NASA Technical Reports Server (NTRS)

Rosenblum, L.

1978-01-01

The effect of the balance-of-system (BOS), i.e., the total system less the modules, on photo-voltaic energy system costs is discussed for multikilowatt, flat-plate systems. Present BOS costs are in the range of 10 to 16 dollars per peak watt (1978 dollars). BOS costs represent approximately 50% of total system cost. The possibility of future BOS cost reduction is examined. It is concluded that, given the nature of BOS costs and the lack of comprehensive national effort focussed on cost reduction, it is unlikely that BOS costs will decline greatly in the next several years. This prognosis is contrasted with the expectations of the Department of Energy National Photovoltaic Program goals and pending legislation in the Congress which require a BOS cost reduction of an order of magnitude or more by the mid-1980s.

The relationship between health risks and health and productivity costs among employees at Pepsi Bottling Group.

PubMed

Henke, Rachel M; Carls, Ginger S; Short, Meghan E; Pei, Xiaofei; Wang, Shaohung; Moley, Susan; Sullivan, Mark; Goetzel, Ron Z

2010-05-01

To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

Cost-Effectiveness Analysis of Atorvastatin versus Rosuvastatin in Primary and Secondary Cardiovascular Prevention Populations in Brazil and Columbia.

PubMed

Mould-Quevedo, Joaquín F; Gutiérrez-Ardila, Magda Vianey; Ordóñez Molina, Jaime Eduardo; Pinsky, Brett; Vargas Zea, Nicolás

2014-12-01

Latin America has witnessed a marked increase in cardiovascular (CV) disease, the leading cause of death in many countries. The benefits of lipid-lowering therapy to reduce CV-related events are widely accepted. Clinical evidence suggests that rosuvastatin is associated with slightly greater reductions in low-density lipoprotein cholesterol levels than is atorvastatin at comparable doses. Rosuvastatin, however, is often priced at a premium. Our objective was to examine the cost-effectiveness of using atorvastatin versus rosuvastatin in reducing CV events in Brazil and Colombia using real-world prices. A global Markov cohort model of primary and secondary CV prevention was developed and adapted to Brazilian and Colombian settings. The risks and costs of major CV events and efficacy, adherence, and costs of statins were considered. Total gains in life-years, quality-adjusted life-years, major CV events avoided, and costs over the lifetime horizon were estimated. Several dose comparisons were considered. In the Colombian analyses, differences in drug costs between therapies were considerable while outcomes were similar. The incremental cost per quality-adjusted life-year gained for rosuvastatin versus atorvastatin was more than $700,000 and $200,000 in primary and secondary prevention, respectively. Brazilian analyses found lower incremental cost-effectiveness ratios for rosuvastatin at some dose comparisons due to similar pricing between statins. Sensitivity analyses revealed that changes in treatment efficacy and adherence had the largest impact on results. In primary and secondary CV prevention, the efficacy advantage of rosuvastatin was minimal, while its acquisition cost was higher, particularly in Colombia. The incremental cost-effectiveness ratios were, therefore, generally in favor of atorvastatin being the cost-effective option. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada.

PubMed

Mullen, Kerri-Anne; Coyle, Douglas; Manuel, Douglas; Nguyen, Hai V; Pham, Ba'; Pipe, Andrew L; Reid, Robert D

2015-09-01

Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Techno-economic analysis of the industrial production of a low-cost enzyme using E. coli: the case of recombinant β-glucosidase.

PubMed

Ferreira, Rafael da Gama; Azzoni, Adriano Rodrigues; Freitas, Sindelia

2018-01-01

The enzymatic conversion of lignocellulosic biomass into fermentable sugars is a promising approach for producing renewable fuels and chemicals. However, the cost and efficiency of the fungal enzyme cocktails that are normally employed in these processes remain a significant bottleneck. A potential route to increase hydrolysis yields and thereby reduce the hydrolysis costs would be to supplement the fungal enzymes with their lacking enzymatic activities, such as β-glucosidase. In this context, it is not clear from the literature whether recombinant E. coli could be a cost-effective platform for the production of some of these low-value enzymes, especially in the case of on-site production. Here, we present a conceptual design and techno-economic evaluation of the production of a low-cost industrial enzyme using recombinant E. coli . In a simulated baseline scenario for β-glucosidase demand in a hypothetical second-generation ethanol (2G) plant in Brazil, we found that the production cost (316 US$/kg) was higher than what is commonly assumed in the literature for fungal enzymes, owing especially to the facility-dependent costs (45%) and to consumables (23%) and raw materials (25%). Sensitivity analyses of process scale, inoculation volume, and volumetric productivity indicated that optimized conditions may promote a dramatic reduction in enzyme cost and also revealed the most relevant factors affecting production costs. Despite the considerable technical and economic uncertainties that surround 2G ethanol and the large-scale production of low-cost recombinant enzymes, this work sheds light on some relevant questions and supports future studies in this field. In particular, we conclude that process optimization, on many fronts, may strongly reduce the costs of E. coli recombinant enzymes, in the context of tailor-made enzymatic cocktails for 2G ethanol production.

Reductions in U.S. Costs to Station Forces in the Federal Republic of Germany and the United Kingdom Are Unlikely.

DTIC Science & Technology

1984-07-31

AD-A144 501 REDUCTIONS IN US COSTS TO STATION FORCES IN THE FEDERAL i/’i REPUBLIC OF GERMA..(U) GENERAL ACCOUNTING OFFICE WASHINGTON DC RESOURCES...COMPTROLLER GENERAL Report To The Chairman Subcommittee On Defense, Senate p Committee On Appropriations OF THE UNITED STATES 0 lot Reductions In U.S. Costs To...reducing the costs of sta- tioning U.S. Forces in Europe through in- creased cost sharing by the European allies. The Federal Republic of Germany and

Costs of mitigating CO2 emissions from passenger aircraft

NASA Astrophysics Data System (ADS)

Schäfer, Andreas W.; Evans, Antony D.; Reynolds, Tom G.; Dray, Lynnette

2016-04-01

In response to strong growth in air transportation CO2 emissions, governments and industry began to explore and implement mitigation measures and targets in the early 2000s. However, in the absence of rigorous analyses assessing the costs for mitigating CO2 emissions, these policies could be economically wasteful. Here we identify the cost-effectiveness of CO2 emission reductions from narrow-body aircraft, the workhorse of passenger air transportation. We find that in the US, a combination of fuel burn reduction strategies could reduce the 2012 level of life cycle CO2 emissions per passenger kilometre by around 2% per year to mid-century. These intensity reductions would occur at zero marginal costs for oil prices between US$50-100 per barrel. Even larger reductions are possible, but could impose extra costs and require the adoption of biomass-based synthetic fuels. The extent to which these intensity reductions will translate into absolute emissions reductions will depend on fleet growth.

Technical considerations for designing low-cost, long-wave infrared objectives

NASA Astrophysics Data System (ADS)

Desroches, Gerard; Dalzell, Kristy; Robitaille, Blaise

2014-06-01

With the growth of uncooled infrared imaging in the consumer market, the balance between cost implications and performance criteria in the objective lens must be examined carefully. The increased availability of consumer-grade, long-wave infrared cameras is related to a decrease in military usage but it is also due to the decreasing costs of the cameras themselves. This has also driven up demand for low-cost, long-wave objectives that can resolve smaller pixels while maintaining high performance. Smaller pixels are traditionally associated with high cost objectives because of higher resolution requirements but, with careful consideration of all the requirements and proper selection of materials, costs can be moderated. This paper examines the cost/performance trade-off implications associated with optical and mechanical requirements of long-wave infrared objectives. Optical performance, f-number, field of view, distortion, focus range and thermal range all affect the cost of the objective. Because raw lens material cost is often the most expensive item in the construction, selection of the material as well as the shape of the lens while maintaining acceptable performance and cost targets were explored. As a result of these considerations, a low-cost, lightweight, well-performing objective was successfully designed, manufactured and tested.

Expert elicitation survey on future wind energy costs

DOE PAGES

Wiser, Ryan; Jenni, Karen; Seel, Joachim; ...

2016-09-12

Wind energy supply has grown rapidly over the last decade. However, the long-term contribution of wind to future energy supply, and the degree to which policy support is necessary to motivate higher levels of deployment, depends - in part - on the future costs of both onshore and offshore wind. In this paper, we summarize the results of an expert elicitation survey of 163 of the world's foremost wind experts, aimed at better understanding future costs and technology advancement possibilities. Results suggest significant opportunities for cost reductions, but also underlying uncertainties. Under the median scenario, experts anticipate 24-30% reductions bymore » 2030 and 35-41% reductions by 2050 across the three wind applications studied. Costs could be even lower: experts predict a 10% chance that reductions will be more than 40% by 2030 and more than 50% by 2050. Insights gained through expert elicitation complement other tools for evaluating cost-reduction potential, and help inform policy and planning, R & D and industry strategy.« less

Expert elicitation survey on future wind energy costs

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

Wiser, Ryan; Jenni, Karen; Seel, Joachim

Wind energy supply has grown rapidly over the last decade. However, the long-term contribution of wind to future energy supply, and the degree to which policy support is necessary to motivate higher levels of deployment, depends -- in part -- on the future costs of both onshore and offshore wind. Here, we summarize the results of an expert elicitation survey of 163 of the world's foremost wind experts, aimed at better understanding future costs and technology advancement possibilities. Results suggest significant opportunities for cost reductions, but also underlying uncertainties. Under the median scenario, experts anticipate 24-30% reductions by 2030 andmore » 35-41% reductions by 2050 across the three wind applications studied. Costs could be even lower: experts predict a 10% chance that reductions will be more than 40% by 2030 and more than 50% by 2050. Insights gained through expert elicitation complement other tools for evaluating cost-reduction potential, and help inform policy and planning, R&D and industry strategy.« less

Expert elicitation survey on future wind energy costs

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

Wiser, Ryan; Jenni, Karen; Seel, Joachim

Wind energy supply has grown rapidly over the last decade. However, the long-term contribution of wind to future energy supply, and the degree to which policy support is necessary to motivate higher levels of deployment, depends - in part - on the future costs of both onshore and offshore wind. In this paper, we summarize the results of an expert elicitation survey of 163 of the world's foremost wind experts, aimed at better understanding future costs and technology advancement possibilities. Results suggest significant opportunities for cost reductions, but also underlying uncertainties. Under the median scenario, experts anticipate 24-30% reductions bymore » 2030 and 35-41% reductions by 2050 across the three wind applications studied. Costs could be even lower: experts predict a 10% chance that reductions will be more than 40% by 2030 and more than 50% by 2050. Insights gained through expert elicitation complement other tools for evaluating cost-reduction potential, and help inform policy and planning, R & D and industry strategy.« less

Evaluation of the performance of a passive-active vibration isolation system

NASA Astrophysics Data System (ADS)

Sun, L. L.; Hansen, C. H.; Doolan, C.

2015-01-01

The behavior of a feedforward active isolation system subjected to actuator output constraints is investigated. Distributed parameter models are developed to analyze the system response, and to produce a transfer matrix for the design of an integrated passive-active isolation system. Cost functions considered here comprise a combination of the vibration transmission energy and the sum of the squared control forces. The example system considered is a rigid body connected to a simply supported plate via two isolation mounts. The overall isolation performance is evaluated by numerical simulation. The results show that the control strategies which rely on unconstrained actuator outputs may give substantial power transmission reductions over a wide frequency range, but also require large control force amplitudes to control excited vibration modes of the system. Expected power transmission reductions for modified control strategies that incorporate constrained actuator outputs are considerably less than typical reductions with unconstrained actuator outputs. The active system with constrained control force outputs is shown to be more effective at the resonance frequencies of the supporting plate. However, in the frequency range in which rigid body modes are present, the control strategies employed using constrained actuator outputs can only achieve 5-10 dB power transmission reduction, while at off-resonance frequencies, little or no power transmission reduction can be obtained with realistic control forces. Analysis of the wave effects in the passive mounts is also presented.

Medical resource utilization for administration of trastuzumab in a New Zealand oncology outpatient setting: a time and motion study

PubMed Central

North, Richard T; Harvey, Vernon J; Cox, Levonne C; Ryan, Stuart N

2015-01-01

Background In New Zealand, trastuzumab is standard therapy for human epidermal growth factor receptor-2 (HER2)-positive early and metastatic breast cancer. Given the requirement for ongoing adjuvant or maintenance treatment and intravenous (IV) delivery, such a regimen consumes considerable health care resources. The development of a subcutaneous (SC) trastuzumab formulation with a short administration time offers the potential to reduce hospital expenditure. The aim of this study was to determine medical resource utilization associated with administration of trastuzumab SC injection via handheld syringe vs trastuzumab IV infusion in patients with HER2-positive breast cancer in New Zealand. Methods This noninterventional, descriptive study was conducted at the outpatient oncology centers at Auckland City and Tauranga Hospitals. Trained observers recorded times associated with health care professional (HCP) tasks and consumables use associated with preparation and administration of trastuzumab IV or SC in women with early or metastatic breast cancer. The cost for each formulation was calculated as the mean cost of HCP time (based on Pharmaceutical Management Agency hourly rates) plus the mean cost of consumables used. Results Use of trastuzumab SC vs IV reduced mean chair time by 36.95 minutes and total nurse time by 6.12 minutes; there was a 20.45-minute reduction in pharmacist time when the SC formulation was used. After adding consumable costs, the overall estimated saving with trastuzumab SC vs IV was $76.94 (New Zealand dollars) per patient per cycle. Conclusions Compared with trastuzumab IV infusion, administration of trastuzumab via SC injection reduced time spent in the clinic and decreased HCP resources and consumables needed to administer treatment. These reductions could contribute to a decrease in health care costs and an improvement in the efficiency of HER2-positive breast cancer treatment delivery. PMID:26251623

A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka

PubMed Central

Häsler, Barbara; Hiby, Elly; Gilbert, Will; Obeyesekere, Nalinika; Bennani, Houda; Rushton, Jonathan

2014-01-01

Background One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management. Methodology/Principal Findings A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate. Conclusions The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control. PMID:25340771

A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)—a study protocol

PubMed Central

Harris, Ian, A; Naylor, Justine, M; Buchbinder, Rachelle; Ivers, Rebecca; Balogh, Zsolt; Smith, Paul; Mittal, Rajat; Xuan, Wei; Howard, Kirsten; Vafa, Arezoo; Yates, Piers; Rieger, Bertram; Smith, Geoff; Elkinson, Ilia; Kim, Woosung; Chehade, Mellick; Sungaran, Jai; Latendresse, Kim; Wong, James; Viswanathan, Sameer; Richardson, Martin; Shrestha, Kush; Drobetz, Herwig; Tran, Phong; Loveridge, Jeremy; Page, Richard; Hau, Raphael; Bingham, Roger; Mulford, Jonathan; Incoll, Ian

2017-01-01

Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. Methods and analysis This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. Ethics and dissemination CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. Registration CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460). PMID:28645976

A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)-a study protocol.

PubMed

Harris, Ian A; Naylor, Justine M; Lawson, Andrew; Buchbinder, Rachelle; Ivers, Rebecca; Balogh, Zsolt; Smith, Paul; Mittal, Rajat; Xuan, Wei; Howard, Kirsten; Vafa, Arezoo; Yates, Piers; Rieger, Bertram; Smith, Geoff; Elkinson, Ilia; Kim, Woosung; Chehade, Mellick; Sungaran, Jai; Latendresse, Kim; Wong, James; Viswanathan, Sameer; Richardson, Martin; Shrestha, Kush; Drobetz, Herwig; Tran, Phong; Loveridge, Jeremy; Page, Richard; Hau, Raphael; Bingham, Roger; Mulford, Jonathan; Incoll, Ian

2017-06-23

Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460). © 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.

rpe v5: an emulator for reduced floating-point precision in large numerical simulations

NASA Astrophysics Data System (ADS)

Dawson, Andrew; Düben, Peter D.

2017-06-01

This paper describes the rpe (reduced-precision emulator) library which has the capability to emulate the use of arbitrary reduced floating-point precision within large numerical models written in Fortran. The rpe software allows model developers to test how reduced floating-point precision affects the result of their simulations without having to make extensive code changes or port the model onto specialized hardware. The software can be used to identify parts of a program that are problematic for numerical precision and to guide changes to the program to allow a stronger reduction in precision.The development of rpe was motivated by the strong demand for more computing power. If numerical precision can be reduced for an application under consideration while still achieving results of acceptable quality, computational cost can be reduced, since a reduction in numerical precision may allow an increase in performance or a reduction in power consumption. For simulations with weather and climate models, savings due to a reduction in precision could be reinvested to allow model simulations at higher spatial resolution or complexity, or to increase the number of ensemble members to improve predictions. rpe was developed with a particular focus on the community of weather and climate modelling, but the software could be used with numerical simulations from other domains.

Arsenic remediation from drinking water using Fenton's reagent with slow sand filter.

PubMed

Jasudkar, Dipali; Rakhunde, Rupali; Deshpande, Leena; Labhasetwar, Pawan; Juneja, H D

2012-12-01

This paper describes the development of a remediation approach based on the pre-oxidation using Fenton's reagent and the subsequent removal of arsenic (As) through sand filtration from drinking water. The efficiency of the process was carried out including As(III) and As(V) with various concentration ratios up to 3,000 ppb. Efficient removal of As was observed within WHO guideline value of 10 ppb. The recoveries of samples were found to be 98 % ± 2.5 %. The process was applied to field samples, where results show considerable reduction in As concentrations. This process is cost effective for treatment of drinking water with high concentration of As.

Immersion Cooling of Electronics in DoD Installations

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

Coles, Henry; Herrlin, Magnus

A considerable amount of energy is consumed to cool electronic equipment in data centers. A method for substantially reducing the energy needed for this cooling was demonstrated. The method involves immersing electronic equipment in a non-conductive liquid that changes phase from a liquid to a gas. The liquid used was 3M Novec 649. Two-phase immersion cooling using this liquid is not viable at this time. The primary obstacles are IT equipment failures and costs. However, the demonstrated technology met the performance objectives for energy efficiency and greenhouse gas reduction. Before commercialization of this technology can occur, a root cause analysismore » of the failures should be completed, and the design changes proven.« less

On the Path to SunShot. The Role of Advancements in Solar Photovoltaic Efficiency, Reliability, and Costs

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

Woodhouse, Michael; Jones-Albertus, Rebecca; Feldman, David

2016-05-01

This report examines the remaining challenges to achieving the competitive photovoltaic (PV) costs and large-scale deployment envisioned under the U.S. Department of Energy's SunShot Initiative. Solar-energy cost reductions can be realized through lower PV module and balance-of-system (BOS) costs as well as improved system efficiency and reliability. Numerous combinations of PV improvements could help achieve the levelized cost of electricity (LCOE) goals because of the tradeoffs among key metrics like module price, efficiency, and degradation rate as well as system price and lifetime. Using LCOE modeling based on bottom-up cost analysis, two specific pathways are mapped to exemplify the manymore » possible approaches to module cost reductions of 29%-38% between 2015 and 2020. BOS hardware and soft cost reductions, ranging from 54%-77% of total cost reductions, are also modeled. The residential sector's high supply-chain costs, labor requirements, and customer-acquisition costs give it the greatest BOS cost-reduction opportunities, followed by the commercial sector, although opportunities are available to the utility-scale sector as well. Finally, a future scenario is considered in which very high PV penetration requires additional costs to facilitate grid integration and increased power-system flexibility--which might necessitate even lower solar LCOEs. The analysis of a pathway to 3-5 cents/kWh PV systems underscores the importance of combining robust improvements in PV module and BOS costs as well as PV system efficiency and reliability if such aggressive long-term targets are to be achieved.« less

48 CFR 52.215-11 - Price Reduction for Defective Certified Cost or Pricing Data-Modifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accordingly and the contract shall be modified to reflect the reduction. This right to a price reduction is... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Price Reduction for... CONTRACT CLAUSES Text of Provisions and Clauses 52.215-11 Price Reduction for Defective Certified Cost or...

Software analyzes feasibility of saw kerf reduction for hardwood mills

Treesearch

Philip H. Steele

2005-01-01

Reductions in saw kerf on head rigs and resaws can dramatically increase lumber recovery in hardwood sawmills. Research has shown that lumber sawing variation reduction will increase lumber recovery above that obtained solely from kerf reduction. Reductions in sawing machine kerf or variation always come at some cost in both capital and variable costs. Determining...

Investigation of Cost and Energy Optimization of Drinking Water Distribution Systems.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Gordon, Matthew; Bunn, Simon; Jacangelo, Joseph G

2015-11-17

Holistic management of water and energy resources through energy and water quality management systems (EWQMSs) have traditionally aimed at energy cost reduction with limited or no emphasis on energy efficiency or greenhouse gas minimization. This study expanded the existing EWQMS framework and determined the impact of different management strategies for energy cost and energy consumption (e.g., carbon footprint) reduction on system performance at two drinking water utilities in California (United States). The results showed that optimizing for cost led to cost reductions of 4% (Utility B, summer) to 48% (Utility A, winter). The energy optimization strategy was successfully able to find the lowest energy use operation and achieved energy usage reductions of 3% (Utility B, summer) to 10% (Utility A, winter). The findings of this study revealed that there may be a trade-off between cost optimization (dollars) and energy use (kilowatt-hours), particularly in the summer, when optimizing the system for the reduction of energy use to a minimum incurred cost increases of 64% and 184% compared with the cost optimization scenario. Water age simulations through hydraulic modeling did not reveal any adverse effects on the water quality in the distribution system or in tanks from pump schedule optimization targeting either cost or energy minimization.

Modelled Cost-Effectiveness of a Package Size Cap and a Kilojoule Reduction Intervention to Reduce Energy Intake from Sugar-Sweetened Beverages in Australia.

PubMed

Crino, Michelle; Herrera, Ana Maria Mantilla; Ananthapavan, Jaithri; Wu, Jason H Y; Neal, Bruce; Lee, Yong Yi; Zheng, Miaobing; Lal, Anita; Sacks, Gary

2017-09-06

Interventions targeting portion size and energy density of food and beverage products have been identified as a promising approach for obesity prevention. This study modelled the potential cost-effectiveness of: a package size cap on single-serve sugar sweetened beverages (SSBs) >375 mL ( package size cap ), and product reformulation to reduce energy content of packaged SSBs ( energy reduction ). The cost-effectiveness of each intervention was modelled for the 2010 Australia population using a multi-state life table Markov model with a lifetime time horizon. Long-term health outcomes were modelled from calculated changes in body mass index to their impact on Health-Adjusted Life Years (HALYs). Intervention costs were estimated from a limited societal perspective. Cost and health outcomes were discounted at 3%. Total intervention costs estimated in AUD 2010 were AUD 210 million. Both interventions resulted in reduced mean body weight ( package size cap : 0.12 kg; energy reduction : 0.23 kg); and HALYs gained ( package size cap : 73,883; energy reduction : 144,621). Cost offsets were estimated at AUD 750.8 million ( package size cap ) and AUD 1.4 billion ( energy reduction ). Cost-effectiveness analyses showed that both interventions were "dominant", and likely to result in long term cost savings and health benefits. A package size cap and kJ reduction of SSBs are likely to offer excellent "value for money" as obesity prevention measures in Australia.

Modelled Cost-Effectiveness of a Package Size Cap and a Kilojoule Reduction Intervention to Reduce Energy Intake from Sugar-Sweetened Beverages in Australia

PubMed Central

Mantilla Herrera, Ana Maria; Neal, Bruce; Zheng, Miaobing; Lal, Anita; Sacks, Gary

2017-01-01

Interventions targeting portion size and energy density of food and beverage products have been identified as a promising approach for obesity prevention. This study modelled the potential cost-effectiveness of: a package size cap on single-serve sugar sweetened beverages (SSBs) >375 mL (package size cap), and product reformulation to reduce energy content of packaged SSBs (energy reduction). The cost-effectiveness of each intervention was modelled for the 2010 Australia population using a multi-state life table Markov model with a lifetime time horizon. Long-term health outcomes were modelled from calculated changes in body mass index to their impact on Health-Adjusted Life Years (HALYs). Intervention costs were estimated from a limited societal perspective. Cost and health outcomes were discounted at 3%. Total intervention costs estimated in AUD 2010 were AUD 210 million. Both interventions resulted in reduced mean body weight (package size cap: 0.12 kg; energy reduction: 0.23 kg); and HALYs gained (package size cap: 73,883; energy reduction: 144,621). Cost offsets were estimated at AUD 750.8 million (package size cap) and AUD 1.4 billion (energy reduction). Cost-effectiveness analyses showed that both interventions were “dominant”, and likely to result in long term cost savings and health benefits. A package size cap and kJ reduction of SSBs are likely to offer excellent “value for money” as obesity prevention measures in Australia. PMID:28878175

Identification of Flights for Cost-Efficient Climate Impact Reduction

NASA Technical Reports Server (NTRS)

Chen, Neil Y.; Kirschen, Philippe G.; Sridhar, Banavar; Ng, Hok K.

2014-01-01

The aircraft-induced climate impact has drawn attention in recent years. Aviation operations affect the environment mainly through the release of carbon-dioxide, nitrogen-oxides, and by the formation of contrails. Recent research has shown that altering trajectories can reduce aviation environmental cost by reducing Absolute Global Temperature Change Potential, a climate assessment metric that adapts a linear system for modeling the global temperature response to aviation emissions and contrails. However, these methods will increase fuel consumption that leads to higher fuel costs imposed on airlines. The goal of this work is to identify ights for which the environmental cost of climate impact reduction outweighs the increase in operational cost on an individual aircraft basis. Environmental cost is quanti ed using the monetary social cost of carbon. The increase in operational cost is considering cost of additional fuel usage only. For this paper, an algorithm has been developed that modi es the trajectories of ights to evaluate the e ect of environ- mental cost and operational cost of ights in the United States National Airspace System. The algorithm identi es ights for which the environmental cost of climate impact can be reduced and modi es their trajectories to achieve maximum environmental net bene t, which is the di erence between reduction in environmental cost and additional operational cost. The result shows on a selected day, 16% of the ights among eight major airlines, or 2,043 ights, can achieve environmental net bene t using weather forecast data, resulting in net bene t of around $500,000. The result also suggests that the long-haul ights would be better candidates for cost-ecient climate impact reduction than the short haul ights. The algorithm will help to identify the characteristics of ights that are capable of applying cost-ecient climate impact reduction strategy.

Designing for Cost

NASA Technical Reports Server (NTRS)

Dean, Edwin B.; Unal, Resit

1991-01-01

Designing for cost is a state of mind. Of course, a lot of technical knowledge is required and the use of appropriate tools will improve the process. Unfortunately, the extensive use of weight based cost estimating relationships has generated a perception in the aerospace community that the primary way to reduce cost is to reduce weight. Wrong! Based upon an approximation of an industry accepted formula, the PRICE H (tm) production-production equation, Dean demonstrated theoretically that the optimal trajectory for cost reduction is predominantly in the direction of system complexity reduction, not system weight reduction. Thus the phrase "keep it simple" is a primary state of mind required for reducing cost throughout the design process.

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

PubMed

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

2016-12-01

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

Launcher Systems Development Cost: Behavior, Uncertainty, Influences, Barriers and Strategies for Reduction

NASA Technical Reports Server (NTRS)

Shaw, Eric J.

2001-01-01

This paper will report on the activities of the IAA Launcher Systems Economics Working Group in preparations for its Launcher Systems Development Cost Behavior Study. The Study goals include: improve launcher system and other space system parametric cost analysis accuracy; improve launcher system and other space system cost analysis credibility; and provide launcher system and technology development program managers and other decisionmakers with useful information on development cost impacts of their decisions. The Working Group plans to explore at least the following five areas in the Study: define and explain development cost behavior terms and concepts for use in the Study; identify and quantify sources of development cost and cost estimating uncertainty; identify and quantify significant influences on development cost behavior; identify common barriers to development cost understanding and reduction; and recommend practical, realistic strategies to accomplish reductions in launcher system development cost.

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

PubMed

Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

2017-12-01

Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (<2 years) and "older" (2-18 years) subgroups. Utilization included all cardiology visits, tests, and procedures. Standardized costs were applied to each unit of utilization. There were 100 historical and 63 SCAMP patients in the younger subgroup, and 163 historical and 165 SCAMP patients in the older subgroup. In the younger subgroup, the SCAMP had a 28% reduction in outpatient clinic visits (P < .001), a 52% reduction in chest radiographs (P < .001), a 21% reduction in electrocardiograms (P < .001), and a 30% total reduction in costs. In the older subgroup, the SCAMP had a 21% reduction in outpatient clinic visits (P < .001), a 20% reduction in chest radiographs (P = .05), a 10% reduction in echocardiograms (P = .05), a 25% reduction in exercise stress tests (P = .01), and a 14% total reduction in costs. The total cost savings of the ASO SCAMP was $216 649 in the first 6 years of the SCAMP. There was no difference in clinical outcomes between the historical and SCAMP cohorts. SCAMPs can improve resource utilization and reduce costs after the ASO operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

48 CFR 970.5215-4 - Cost reduction.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost reduction. 970.5215-4 Section 970.5215-4 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY.... Development cost is the Contractor cost of up-front planning, engineering, prototyping, and testing of a...

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa

PubMed Central

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S.; Firnhaber, Cindy

2015-01-01

Background South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Methods Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. Results VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Conclusions Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression. PMID:26569487

Costs and Cost Effectiveness of Three Approaches for Cervical Cancer Screening among HIV-Positive Women in Johannesburg, South Africa.

PubMed

Lince-Deroche, Naomi; Phiri, Jane; Michelow, Pam; Smith, Jennifer S; Firnhaber, Cindy

2015-01-01

South Africa has high rates of HIV and HPV and high incidence and mortality from cervical cancer. However, cervical cancer is largely preventable when early screening and treatment are available. We estimate the costs and cost-effectiveness of conventional cytology (Pap), visual inspection with acetic acid (VIA) and HPV DNA testing for detecting cases of CIN2+ among HIV-infected women currently taking antiretroviral treatment at a public HIV clinic in Johannesburg, South Africa. Method effectiveness was derived from a validation study completed at the clinic. Costs were estimated from the provider perspective using micro-costing between June 2013-April 2014. Capital costs were annualized using a discount rate of 3%. Two different service volume scenarios were considered. Threshold analysis was used to explore the potential for reducing the cost of HPV DNA testing. VIA was least costly in both scenarios. In the higher volume scenario, the average cost per procedure was US$ 3.67 for VIA, US$ 8.17 for Pap and US$ 54.34 for HPV DNA. Colposcopic biopsies cost on average US$ 67.71 per procedure. VIA was least sensitive but most cost-effective at US$ 17.05 per true CIN2+ case detected. The cost per case detected for Pap testing was US$ 130.63 using a conventional definition for positive results and US$ 187.52 using a more conservative definition. HPV DNA testing was US$ 320.09 per case detected. Colposcopic biopsy costs largely drove the total and per case costs. A 71% reduction in HPV DNA screening costs would make it competitive with the conservative Pap definition. Women need access to services which meet their needs and address the burden of cervical dysplasia and cancer in this region. Although most cost-effective, VIA may require more frequent screening due to low sensitivity, an important consideration for an HIV-positive population with increased risk for disease progression.

The economic cost of using restraint and the value added by restraint reduction or elimination.

PubMed

Lebel, Janice; Goldstein, Robert

2005-09-01

The purpose of this study was to calculate the economic cost of using restraint on one adolescent inpatient service and to examine the effect of an initiative to reduce or eliminate the use of restraint after it was implemented. A detailed process-task analysis of mechanical, physical, and medication-based restraint was conducted in accordance with state and federal restraint requirements. Facility restraint data were collected, verified, and analyzed. A model was developed to determine the cost and duration of an average episode for each type of restraint. Staff time allocated to restraint activities and medication costs were computed. Calculation of the cost of restraint was restricted to staff and medication costs. Aggregate costs of restraint use and staff-related costs for one full year before the restraint reduction initiative (FY 2000) and one full year after the initiative (FY 2003) were calculated. Outcome, discharge, and recidivism data were analyzed. A comparison of the FY 2000 data with the FY 2003 data showed that the adolescent inpatient service's aggregate use of restraint decreased from 3,991 episodes to 373 episodes (91 percent), which was associated with a reduction in the cost of restraint from $1,446,740 to $117,036 (a 92 percent reduction). In addition, sick time, staff turnover and replacement costs, workers' compensation, injuries to adolescents and staff, and recidivism decreased. Adolescent Global Assessment of Functioning scores at discharge significantly improved. Implementation of a restraint reduction initiative was associated with a reduction in the use of restraint, staff time devoted to restraint, and staff-related costs. This shift appears to have contributed to better outcomes for adolescents, fewer injuries to adolescents and staff, and lower staff turnover. The initiative may have enhanced adolescent treatment and work conditions for staff.

The costs and benefits of reducing racial-ethnic disparities in mental health care.

PubMed

Cook, Benjamin Lê; Liu, Zimin; Lessios, Anna Sophia; Loder, Stephen; McGuire, Thomas

2015-04-01

Previous studies have found that timely mental health treatment can result in savings in both mental health and general medical care expenditures. This study examined whether reducing racial-ethnic disparities in mental health care offsets costs of care. Data were from a subsample of 6,206 individuals with probable mental illness from the 2004-2010 Medical Expenditure Panel Survey (MEPS). First, disparities in mental health treatment were analyzed. Second, two-year panel data were used to determine the offset of year 1 mental health outpatient and pharmacy treatment on year 2 mental and general medical expenditures. Third, savings were estimated by combining results from steps 1 and 2. Compared with whites, blacks and Latinos with year 1 outpatient mental health care spent less on inpatient and emergency general medical care in year 2. Latinos receiving mental health care in year 1 spent less than others on inpatient general medical care in year 2. Latinos taking psychotropic drugs in year 1 showed reductions in inpatient general medical care. Reducing racial-ethnic disparities in mental health care and in psychotropic drug use led to savings in acute medical care expenditures. Savings in acute care expenditures resulting from eliminating disparities in racial-ethnic mental health care access were greater than costs in some but not all areas of acute mental health and general medical care. For blacks and Latinos, the potential savings from eliminating disparities in inpatient general medical expenditures are substantial (as much as $1 billion nationwide), suggesting that financial and equity considerations can be aligned when planning disparity reduction programs.

Estimating unbiased economies of scale of HIV prevention projects: a case study of Avahan.

PubMed

Lépine, Aurélia; Vassall, Anna; Chandrashekar, Sudha; Blanc, Elodie; Le Nestour, Alexis

2015-04-01

Governments and donors are investing considerable resources on HIV prevention in order to scale up these services rapidly. Given the current economic climate, providers of HIV prevention services increasingly need to demonstrate that these investments offer good 'value for money'. One of the primary routes to achieve efficiency is to take advantage of economies of scale (a reduction in the average cost of a health service as provision scales-up), yet empirical evidence on economies of scale is scarce. Methodologically, the estimation of economies of scale is hampered by several statistical issues preventing causal inference and thus making the estimation of economies of scale complex. In order to estimate unbiased economies of scale when scaling up HIV prevention services, we apply our analysis to one of the few HIV prevention programmes globally delivered at a large scale: the Indian Avahan initiative. We costed the project by collecting data from the 138 Avahan NGOs and the supporting partners in the first four years of its scale-up, between 2004 and 2007. We develop a parsimonious empirical model and apply a system Generalized Method of Moments (GMM) and fixed-effects Instrumental Variable (IV) estimators to estimate unbiased economies of scale. At the programme level, we find that, after controlling for the endogeneity of scale, the scale-up of Avahan has generated high economies of scale. Our findings suggest that average cost reductions per person reached are achievable when scaling-up HIV prevention in low and middle income countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

Operating room waste reduction in plastic and hand surgery.

PubMed

Albert, Mark G; Rothkopf, Douglas M

2015-01-01

Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap. Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors' institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year. OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material. Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.

Integration options for high energy efficiency and improved economics in a wood-to-ethanol process.

PubMed

Sassner, Per; Zacchi, Guido

2008-04-15

There is currently a steady increase in the use of wood-based fuels for heat and power production in Sweden. A major proportion of these fuels could serve as feedstock for ethanol production. In this study various options for the utilization of the solid residue formed during ethanol production from spruce, such as the production of pellets, electricity and heat for district heating, were compared in terms of overall energy efficiency and production cost. The effects of changes in the process performance, such as variations in the ethanol yield and/or the energy demand, were also studied. The process was based on SO2-catalysed steam pretreatment, which was followed by simultaneous saccharification and fermentation. A model including all the major process steps was implemented in the commercial flow-sheeting program Aspen Plus, the model input was based on data recently obtained on lab scale or in a process development unit. For the five base case scenarios presented in the paper the overall energy efficiency ranged from 53 to 92%, based on the lower heating values, and a minimum ethanol selling price from 3.87 to 4.73 Swedish kronor per litre (0.41-0.50 EUR/L); however, ethanol production was performed in essentially the same way in each base case scenario. (Highly realistic) improvements in the ethanol yield and reductions in the energy demand resulted in significantly lower production costs for all scenarios. Although ethanol was shown to be the main product, i.e. yielding the major part of the income, the co-product revenue had a considerable effect on the process economics and the importance of good utilization of the entire feedstock was clearly shown. With the assumed prices of the co-products, utilization of the excess solid residue for heat and power production was highly economically favourable. The study also showed that improvements in the ethanol yield and reductions in the energy demand resulted in significant production cost reductions almost independently of each other.

Structural Considerations of a 20MW Multi-Rotor Wind Energy System

NASA Astrophysics Data System (ADS)

Jamieson, P.; Branney, M.

2014-12-01

The drive to upscale offshore wind turbines relates especially to possiblereductions in O&M and electrical interconnection costs per MW of installed capacity.Even with best current technologies, designs with rated capacity above about 3 MW are less cost effective exfactory per rated MW(turbine system costs) than smaller machines.Very large offshore wind turbines are thereforejustifiedprimarily by overall offshore project economics. Furthermore, continuing progress in materials and structures has been essential to avoid severe penalties in the power/mass ratio of large multi-MW machines.The multi-rotor concept employs many small rotors to maximise energy capture area withminimum systemvolume. Previous work has indicated that this can enablea very large reduction in the total weight and cost of rotors and drive trains compared to an equivalent large single rotor system.Thus the multi rotor concept may enable rated capacities of 20 MW or more at a single maintenancesite. Establishing the cost benefit of a multi rotor system requires examination of solutions for the support structure and yawing, ensuring aerodynamic losses from rotor interaction are not significant and that overall logistics, with much increased part count (more reliable components) and less consequence of single failuresare favourable. This paper addresses the viability of a support structure in respect of structural concept and likely weight as one necessary step in exploring the potential of the multi rotor concept.

Shared responsibility for managing electronic waste: A case study of Maine, USA

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

Wagner, Travis P., E-mail: twagner@usm.maine.ed

2009-12-15

Based on high disposal and low recycling rates of electronic waste (e-waste) and continued exportation to developing countries, reliance on municipal responsibility for e-waste management has been unsuccessful in the United States. This case study examines Maine's program, which was the first US state to mandate producer responsibility for recycling household e-waste. Maine's program established a shared cost responsibility among producers, municipalities, and consumers. The study found that Maine's program resulted in a significant reduction in disposal and a corresponding increase in environmentally sound recycling. In the first 3 years of the program, 6.406 million kg of household e-waste wasmore » collected and recycled for a population of 1.32 million. The new program, implemented in 2006, increased the number of e-waste items collected and recycled by 108% in the first year, 170% in the second year, and 221% in the third year. The program decreased direct economic costs to municipalities and households because of the shared cost approach and for the first time established costs for producers. There was no empirical evidence indicating that producers have or will improve the recyclability of electronic products to reduce recycling costs. While other weaknesses were that found potentially limit the adoption of Maine's program, its positive aspects warrant consideration by other governments.« less

Reference Pricing Changes The 'Choice Architecture' Of Health Care For Consumers.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher

2017-03-01

Reference pricing in health insurance creates incentives for patients to select for nonemergency services providers that charge relatively low prices and still offer high quality of care. It changes the "choice architecture" by offering standard coverage if the patient chooses cost-effective providers but requires considerable consumer cost sharing if more expensive alternatives are selected. The short-term impact of reference pricing has been to shift patient volumes from hospital-based to freestanding surgical, diagnostic, imaging, and laboratory facilities. This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers. The impact on consumer cost sharing is mixed, with some studies finding higher copayments and some lower. We conclude with a discussion of the incentives created for providers to redesign their clinical processes and for efficient providers to expand into price-sensitive markets. Over time, reference pricing may increase pressures for price competition and lead to further cost-reducing innovations in health care products and processes. Project HOPE—The People-to-People Health Foundation, Inc.

Radiation Hardness Assurance (RHA): Challenges and New Considerations

NASA Technical Reports Server (NTRS)

Campola, Michael J.

2017-01-01

Use of commercial-off-the-shelf (COTS) components and emerging technologies often require space flight missions to accept elevated risk. The Radiation Hardness Assurance (RHA) flow includes environment definition, hazard evaluation, requirements definition, evaluation of design, and design trades to accommodate and mitigate the risk a project or program takes. Depending on the mission profile and environment, different missions may not necessarily benefit from the same risk reduction efforts or cost reduction attempts. While this poses challenges for the radiation engineer, it also presents opportunities to tailor the RHA flow to minimize risk based on the environment or design criticality while remaining within budget. This presentation will focus on an approach to RHA amidst the present challenges, using the same RHA flow as in the past, with examples from recent radiation test results. The current challenges and the types of risk will be identified. How these risks drive requirements development and realization will be explained with examples of device results and data for single event effects (SEE) and in one case total ionizing dose (TID).

Production of furfural from pentosan-rich biomass: analysis of process parameters during simultaneous furfural stripping.

PubMed

Agirrezabal-Telleria, I; Gandarias, I; Arias, P L

2013-09-01

Among the furan-based compounds, furfural (FUR) shows interesting properties as building-block or industrial solvent. It is produced from pentosan-rich biomass via xylose cyclodehydration. The current FUR production makes use of homogeneous catalysts and excessive amounts of steam. The development of greener furfural production and separation techniques implies the use of heterogeneous catalysts and innovative separation processes. This work deals with the conversion of corncobs as xylose source to be dehydrated to furfural. The results reveal differences between the use of direct corncob hydrolysis and dehydration to furfural and the prehydrolysis and dehydration procedures. Moreover, this work focuses on an economical analysis of the main process parameters during N2-stripping and its economical comparison to the current steam-stripping process. The results show a considerable reduction of the annual utility costs due to use of recyclable nitrogen and the reduction of the furfural purification stages. Copyright © 2013 Elsevier Ltd. All rights reserved.

Model reduction of multiscale chemical langevin equations: a numerical case study.

PubMed

Sotiropoulos, Vassilios; Contou-Carrere, Marie-Nathalie; Daoutidis, Prodromos; Kaznessis, Yiannis N

2009-01-01

Two very important characteristics of biological reaction networks need to be considered carefully when modeling these systems. First, models must account for the inherent probabilistic nature of systems far from the thermodynamic limit. Often, biological systems cannot be modeled with traditional continuous-deterministic models. Second, models must take into consideration the disparate spectrum of time scales observed in biological phenomena, such as slow transcription events and fast dimerization reactions. In the last decade, significant efforts have been expended on the development of stochastic chemical kinetics models to capture the dynamics of biomolecular systems, and on the development of robust multiscale algorithms, able to handle stiffness. In this paper, the focus is on the dynamics of reaction sets governed by stiff chemical Langevin equations, i.e., stiff stochastic differential equations. These are particularly challenging systems to model, requiring prohibitively small integration step sizes. We describe and illustrate the application of a semianalytical reduction framework for chemical Langevin equations that results in significant gains in computational cost.

What doesn't kill you makes you poorer: Adult wages and early-life mortality in India.

PubMed

Lawson, Nicholas; Spears, Dean

2016-05-01

A growing literature indicates that effects of early-life health on adult economic outcomes could be substantial in developing countries, but the magnitude of this effect is debated. We document a robust gradient between the early-life mortality environment to which men in India were locally exposed in their district and year of birth and the wages that they earn as adults. A 1 percentage point reduction in infant mortality (or 10 point reduction in IMR) in an infant's district and year of birth is associated with an approximately 2 percent increase in his subsequent adult wages. Consistent with theories and evidence in the literature, we find that the level of schooling chosen for a child does not mediate this association. Because of its consequences for subsequent wages, early-life health could also have considerable fiscal externalities; if so, public health investments could come at very low net present cost. Copyright © 2015 Elsevier B.V. All rights reserved.

Applications of ethylene vinyl acetate as an encapsulation material for terrestrial photovoltaic modules

NASA Technical Reports Server (NTRS)

Cuddihy, E. F.; Coulbert, C. D.; Liang, R. H.; Gupta, A.; Willis, P.; Baum, B.

1983-01-01

Terrestrial photovoltaic modules must undergo substantial reductions in cost in order to become economically attractive as practical devices for large scale production of electricity. Part of the cost reductions must be realized by the encapsulation materials that are used to package, protect, and support the solar cells, electrical interconnects, and other ancillary components. As many of the encapsulation materials are polymeric, cost reductions necessitate the use of low cost polymers. The performance and status of ethylene vinyl acetate, a low cost polymer that is being investigated as an encapsulation material for terrestrial photovoltaic modules, are described.

Monitoring and control requirement definition study for Dispersed Storage and Generation (DSG). Volume 5, appendix D: Cost-benefit considerations for providing dispersed storage and generation for electric utilities

NASA Technical Reports Server (NTRS)

1980-01-01

Cost benefit considerations are extremely important in obtaining the acceptance of dispersed storage and generation (DSG) by the electric utilities. These considerations involved somewhat different economic analyses depending on whether the generation is utility, customer, or combined ownership. It is necessary to get acceptance of more easily understood methods for evaluating the economics of DSG because much of the benefits of DSG may accrue in the generation and transmission portions of the utility system while the costs tend to be centered in the distribution portion of that system. The influence of factors, such as reliability, capital costs, and other economic measures were also investigated.

Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

NASA Astrophysics Data System (ADS)

Chukalla, Abebe D.; Krol, Maarten S.; Hoekstra, Arjen Y.

2017-07-01

Reducing the water footprint (WF) of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs) that rank management packages according to their cost-effectiveness to reduce the WF need to support the decision making. MCCs enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a given WF permit (expressed in m3  ha-1 per season) or to a certain WF benchmark (expressed in m3  t-1 of crop). This paper aims to develop MCCs for WF reduction for a range of selected cases. AquaCrop, a soil-water-balance and crop-growth model, is used to estimate the effect of different management packages on evapotranspiration and crop yield and thus the WF of crop production. A management package is defined as a specific combination of management practices: irrigation technique (furrow, sprinkler, drip or subsurface drip); irrigation strategy (full or deficit irrigation); and mulching practice (no, organic or synthetic mulching). The annual average cost for each management package is estimated as the annualized capital cost plus the annual costs of maintenance and operations (i.e. costs of water, energy and labour). Different cases are considered, including three crops (maize, tomato and potato); four types of environment (humid in UK, sub-humid in Italy, semi-arid in Spain and arid in Israel); three hydrologic years (wet, normal and dry years) and three soil types (loam, silty clay loam and sandy loam). For each crop, alternative WF reduction pathways were developed, after which the most cost-effective pathway was selected to develop the MCC for WF reduction. When aiming at WF reduction one can best improve the irrigation strategy first, next the mulching practice and finally the irrigation technique. Moving from a full to deficit irrigation strategy is found to be a no-regret measure: it reduces the WF by reducing water consumption at negligible yield reduction while reducing the cost for irrigation water and the associated costs for energy and labour. Next, moving from no to organic mulching has a high cost-effectiveness, reducing the WF significantly at low cost. Finally, changing from sprinkler or furrow to drip or subsurface drip irrigation reduces the WF, but at a significant cost.

Evaluation of costs associated with tolvaptan-mediated length-of-stay reduction among heart failure patients with hyponatremia in the US, based on the EVEREST trial.

PubMed

Chiong, Jun R; Kim, Sonnie; Lin, Jay; Christian, Rudell; Dasta, Joseph F

2012-01-01

The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial showed that tolvaptan use improved heart failure (HF) signs and symptoms without serious adverse events. To evaluate the potential cost savings associated with tolvaptan usage among hospitalized hyponatremic HF patients. The Healthcare Cost and Utilization Project (HCUP) 2008 Nationwide Inpatient Sample (NIS) database was used to estimate hospital cost and length of stay (LOS), for diagnosis-related group (DRG) hospitalizations of adult (age ≥18 years) HF patients with complications and comorbidities or major complications and comorbidities. EVEREST trial data for patients with hyponatremia were used to estimate tolvaptan-associated LOS reductions. A cost offset model was constructed to evaluate the impact of tolvaptan on hospital cost and LOS, with univariate and multivariate Monte Carlo sensitivity analyses. Tolvaptan use among hyponatremic EVEREST trial HF patients was associated with shorter hospital LOS than placebo patients (9.72 vs 11.44 days, respectively); 688,336 hospitalizations for HF DRGs were identified from the HCUP NIS database, with a mean LOS of 5.4 days and mean total hospital costs of $8415. Using an inpatient tolvaptan treatment duration of 4 days with a wholesale acquisition cost of $250 per day, the cost offset model estimated a LOS reduction among HF hospitalizations of 0.81 days and an estimated total cost saving of $265 per admission. Univariate and multivariate sensitivity analysis demonstrated that cost reduction associated with tolvaptan usage is consistent among variations of model variables. The estimated LOS reduction and cost savings projected by the cost offset model suggest a clinical and economic benefit to tolvaptan use in hyponatremic HF patients. The EVEREST trial data may not generalize well to the US population. Clinical trial patient profiles and relative LOS reductions may not be applicable to real-world patient populations.

Computational circular dichroism estimation for point-of-care diagnostics via vortex half-wave retarders

NASA Astrophysics Data System (ADS)

Haider, Shahid A.; Tran, Megan Y.; Wong, Alexander

2018-02-01

Observing the circular dichroism (CD) caused by organic molecules in biological fluids can provide powerful indicators of patient health and provide diagnostic clues for treatment. Methods for this kind of analysis involve tabletop devices that weigh tens of kilograms with costs on the order of tens of thousands of dollars, making them prohibitive in point-of-care diagnostic applications. In an e ort to reduce the size, cost, and complexity of CD estimation systems for point-of-care diagnostics, we propose a novel method for CD estimation that leverages a vortex half-wave retarder in between two linear polarizers and a two-dimensional photodetector array to provide an overall complexity reduction in the system. This enables the measurement of polarization variations across multiple polarizations after they interact with a biological sample, simultaneously, without the need for mechanical actuation. We further discuss design considerations of this methodology in the context of practical applications to point-of-care diagnostics.

Additional reductions in Medicare spending growth will likely require shifting costs to beneficiaries.

PubMed

Chernew, Michael E

2013-05-01

Policy makers have considerable interest in reducing Medicare spending growth. Clarity in the debate on reducing Medicare spending growth requires recognition of three important distinctions: the difference between public and total spending on health, the difference between the level of health spending and rate of health spending growth, and the difference between growth per beneficiary and growth in the number of beneficiaries in Medicare. The primary policy issue facing the US health care system is the rate of spending growth in public programs, and solving that problem will probably require reforms to the entire health care sector. The Affordable Care Act created a projected trajectory for Medicare spending per beneficiary that is lower than historical growth rates. Although opportunities for one-time savings exist, any long-term savings from Medicare, beyond those already forecast, will probably require a shift in spending from taxpayers to beneficiaries via higher beneficiary premium contributions (overall or via means testing), changes in eligibility, or greater cost sharing at the point of service.

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

Bolan, N.A.; Hansen-Murray, C.S.; Haynes, R.W.

Implications of the interim comprehensive strategy for improved Pacific salmon and steelhead habitat management (PACFISH) were estimated for those Bureau of Land Management (BLM) districts and National Forest System (NFS) lands west of the Rocky Mountains that have anadromous fish. The physical impacts and associated mitigation costs from implementing the PACFISH strategy over the next decade in Pacific Northwest, Intermountain, Northern, Pacific Southwest, and Alaska Region National Forest and BLM district recreation, range, and timber programs were analyzed with the actual current output as the base. Economic considerations were added to evaluate any change in the perceived ranking of severitymore » among the impacts. Two cases were considered in the analyses: a derived worst case, where a total reduction of the actual current output of the programs in anadromous fishbearing drainages occurs (giving a minimum value for the programs in those drainages), and a mitigated case where all or part of the loss is mitigated and the cost of doing so is evaluated with two phases, one without economics and the other with it.« less

Industry's tireless eyes

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

Not Available

1987-08-01

This article reports that there are literally hundreds of machine vision systems from which to choose. They range in cost from $10,000 to $1,000,000. Most have been designed for specific applications; the same systems if used for a different application may fail dismally. How can you avoid wasting money on inferior, useless, or nonexpandable systems. A good reference is the Automated Vision Association in Ann Arbor, Mich., a trade group comprised of North American machine vision manufacturers. Reputable suppliers caution users to do their homework before making an investment. Important considerations include comprehensive details on the objects to be viewed-thatmore » is, quantity, shape, dimension, size, and configuration details; lighting characteristics and variations; component orientation details. Then, what do you expect the system to do-inspect, locate components, aid in robotic vision. Other criteria include system speed and related accuracy and reliability. What are the projected benefits and system paybacks.. Examine primarily paybacks associated with scrap and rework reduction as well as reduced warranty costs.« less

Supply support of NASA tracking networks

NASA Technical Reports Server (NTRS)

1973-01-01

The extent which supply support for Jet Propulsion Laboratory's Deep Space Network and Goddard Space Flight Center's Space Flight Tracking and Data Network should be consolidated is considered along with the Identification of opportunities for improvements in each of the supply systems without regard to consolidation. There is a considerable amount of commonality between the items in the stock catalogs at the two network depots, 58% for federal stock number items and 30% overall. The workload at the DSIF Supply Depot (DSD) is small (less than 20%) compared to the Network Logistics Depot (NLD). A number of important benefits in supply support would result from a consolidation of DSD into NLD. LMI found that a consolidation as is, without any changes in inventory management techniques, would reduce annual operating costs by from $208,000 to $358,000. However, if the consolidation were coupled with a change to use of economic order quantities, the annual operating cost reduction would range from $930,000 to $1,078,000.

Active capping technology: a new environmental remediation of contaminated sediment.

PubMed

Zhang, Chang; Zhu, Meng-Ying; Zeng, Guang-Ming; Yu, Zhi-Gang; Cui, Fang; Yang, Zhong-Zhu; Shen, Liu-Qing

2016-03-01

The management and treatment of contaminated sediment is a worldwide problem and poses major technical and economic challenges. Nowadays, various attempts have been committed to investigating a cost-effective way in contaminated sediment restoration. Among the remediation options, in situ capping turns out to be a less expensive, less disruptive, and more durable approach. However, by using the low adsorption capacity materials, traditional caps do not always fulfill the reduction of risks that can be destructive for human health, ecosystem, and even natural resources. Active caps, therefore, are designed to employ active materials (activated carbon, apatite, zeolite, organoclay, etc.) to strengthen their adsorption and degradation capacity. The active capping technology promises to be a permanent and cost-efficient solution to contaminated sediments. This paper provides a review on the types of active materials and the ways of these active materials employed in recent active capping studies. Cap design considerations including site-specific conditions, diffusion/advection, erosive forces, and active material selection that should be noticed in an eligible remediation project are also presented.

iStent trabecular micro-bypass stent for open-angle glaucoma

PubMed Central

Le, Kim; Saheb, Hady

2014-01-01

Trabecular micro-bypass stents, commonly known as iStents, are micro-invasive glaucoma surgery (MIGS) devices used to treat open-angle glaucoma. Like other MIGS procedures that enhance trabecular outflow, the iStent lowers intraocular pressure (IOP) by creating a direct channel between the anterior chamber and Schlemm’s canal. iStents are typically implanted at the time of phacoemulsification for patients with open-angle glaucoma and visually significant cataracts. This review summarizes the published data regarding the efficacy, safety, and cost considerations of trabecular micro-bypass stents. Most studies found statistically significant reductions in mean IOP and ocular medication use after combined phacoemulsification with single or double iStent implantation. The devices were found to be very safe, with a safety profile similar to that of cataract surgery. Complications were infrequent, with the most common complications being temporary stent obstruction or malposition, which resolved with observation or secondary procedures. Future studies are needed to evaluate long-term outcomes, patient satisfaction, cost effectiveness, and expanded indications. PMID:25284980

Analysis of usage and associated cost of external fixators at an urban level 1 trauma centre.

PubMed

Chaus, George W; Dukes, Chase; Hak, David J; Mauffrey, Cyril; Mark Hammerberg, E

2014-10-01

To determine the usage, indication, duration, and cost associated with external fixation usage. Additionally, to show the significant cost associated with external fixator use and reinvigorate discussions on external fixator reuse. A retrospective review of a prospectively gathered trauma database was undertaken to identify all patients treated with external fixation frames for pelvic and lower extremity injuries between September 2007 and July 2010. We noted the indications for frame use, and we determined the average duration of external fixation for each indication. The cost of each frame was calculated from implant records. 341 lower extremity and pelvic fractures were treated with external fixation frames during the study period. Of these, 92% were used as temporary external fixation. The average duration of temporary external fixation was 10.5 days. The cost of external fixation frame components was $670,805 per year. The average cost per external fixation frame was $5900. The majority of external fixators are intended as temporary frames, in place for a limited period of time prior to definitive fixation of skeletal injuries. As such, most frames are not intended to withstand physiologic loads, nor are they expected provide a precise maintenance of reduction. Given the considerable expense associated with external fixation frame components, the practice of purchasing external fixation frame components as disposable "single-use" items appears to be somewhat wasteful. Level II. Copyright © 2014 Elsevier Ltd. All rights reserved.

Principles of cost-benefit analysis for ERTS experiments, volumes 1 and 2

NASA Technical Reports Server (NTRS)

1973-01-01

The basic elements of a cost-benefit study are discussed along with special considerations for ERTS experiments. Elements required for a complete economic analysis of ERTS are considered to be: statement of objectives, specification of assumptions, enumeration of system alternatives, benefit analysis, cost analysis nonefficiency considerations, and final system selection. A hypothetical cost-benefit example is presented with the assumed objective of an increase in remote sensing surveys of grazing lands to better utilize available forage to lower meat prices.

Sensitivities of projected 1980 photovoltaic system costs to major system cost drivers

NASA Technical Reports Server (NTRS)

Zimmerman, L. W.; Smith, J. L.

1984-01-01

The sensitivity of projected 1990 photovoltaic (PV) system costs to major system cost drivers was examined. It includes: (1) module costs and module efficiencies; (2) area related balance of system (BOS) costs; (3) inverter costs and efficiencies; and (4) module marketing and distribution markups and system integration fees. Recent PV system cost experiences and the high costs of electricity from the systems are reviewed. The 1990 system costs are projected for five classes of PV systems, including four ground mounted 5-MWp systems and one residential 5-kWp system. System cost projections are derived by first projecting costs and efficiencies for all subsystems and components. Sensitivity analyses reveal that reductions in module cost and engineering and system integration fees seem to have the greatest potential for contributing to system cost reduction. Although module cost is clearly the prime candidate for fruitful PV research and development activities, engineering and system integration fees seem to be more amenable to reduction through appropriate choice of system size and market strategy. Increases in inverter and module efficiency yield significant benefits, especially for systems with high area related costs.

Evaluation of Contrail Reduction Strategies Based on Environmental and Operational Costs

NASA Technical Reports Server (NTRS)

Chen, Neil Y.; Sridhar, Banavar; Ng, Hok K.; Li, Jinhua

2013-01-01

This paper evaluates a set of contrail reduction strategies based on environmental and operational costs. A linear climate model was first used to convert climate effects of carbon dioxide emissions and aircraft contrails to changes in Absolute Global Temperature Potential, a metric that measures the mean surface temperature change due to aircraft emissions and persistent contrail formations. The concept of social cost of carbon and the carbon auction price from recent California's cap-and-trade system were then used to relate the carbon dioxide emissions and contrail formations to an environmental cost index. The strategy for contrail reduction is based on minimizing contrail formations by altering the aircraft's cruising altitude. The strategy uses a user-defined factor to trade off between contrail reduction and additional fuel burn and carbon dioxide emissions. A higher value of tradeoff factor results in more contrail reduction but also more fuel burn and carbon emissions. The strategy is considered favorable when the net environmental cost benefit exceeds the operational cost. The results show how the net environmental benefit varies with different decision-making time-horizon and different carbon cost. The cost models provide a guidance to select the trade-off factor that will result in the most net environmental benefit.

Sludge reduction in a small wastewater treatment plant by electro-kinetic disintegration.

PubMed

Chiavola, Agostina; Ridolfi, Alessandra; D'Amato, Emilio; Bongirolami, Simona; Cima, Ennio; Sirini, Piero; Gavasci, Renato

2015-01-01

Sludge reduction in a wastewater treatment plant (WWTP) has recently become a key issue for the managing companies, due to the increasing constraints on the disposal alternatives. Therefore, all the solutions proposed with the aim of minimizing sludge production are receiving increasing attention and are tested either at laboratory or full-scale to evaluate their real effectiveness. In the present paper, electro-kinetic disintegration has been applied at full-scale in the recycle loop of the sludge drawn from the secondary settlement tank of a small WWTP for domestic sewage. After the disintegration stage, the treated sludge was returned to the biological reactor. Three different percentages (50, 75 and 100%) of the return sludge flow rate were subjected to disintegration and the effects on the sludge production and the WWTP operation efficiency evaluated. The long-term observations showed that the electro-kinetic disintegration was able to drastically reduce the amount of biological sludge produced by the plant, without affecting its treatment efficiency. The highest reduction was achieved when 100% return sludge flow rate was subjected to the disintegration process. The reduced sludge production gave rise to a considerable net cost saving for the company which manages the plant.

Optimizing Eco-Efficiency Across the Procurement Portfolio.

PubMed

Pelton, Rylie E O; Li, Mo; Smith, Timothy M; Lyon, Thomas P

2016-06-07

Manufacturing organizations' environmental impacts are often attributable to processes in the firm's upstream supply chain. Environmentally preferable procurement (EPP) and the establishment of environmental purchasing criteria can potentially reduce these indirect impacts. Life-cycle assessment (LCA) can help identify the purchasing criteria that are most effective in reducing environmental impacts. However, the high costs of LCA and the problems associated with the comparability of results have limited efforts to integrate procurement performance with quantitative organizational environmental performance targets. Moreover, environmental purchasing criteria, when implemented, are often established on a product-by-product basis without consideration of other products in the procurement portfolio. We develop an approach that utilizes streamlined LCA methods, together with linear programming, to determine optimal portfolios of product impact-reduction opportunities under budget constraints. The approach is illustrated through a simulated breakfast cereal manufacturing firm procuring grain, containerboard boxes, plastic packaging, electricity, and industrial cleaning solutions. Results suggest that extending EPP decisions and resources to the portfolio level, recently made feasible through the methods illustrated herein, can provide substantially greater CO2e and water-depletion reductions per dollar spend than a product-by-product approach, creating opportunities for procurement organizations to participate in firm-wide environmental impact reduction targets.

Cost decomposition of linear systems with application to model reduction

NASA Technical Reports Server (NTRS)

Skelton, R. E.

1980-01-01

A means is provided to assess the value or 'cst' of each component of a large scale system, when the total cost is a quadratic function. Such a 'cost decomposition' of the system has several important uses. When the components represent physical subsystems which can fail, the 'component cost' is useful in failure mode analysis. When the components represent mathematical equations which may be truncated, the 'component cost' becomes a criterion for model truncation. In this latter event component costs provide a mechanism by which the specific control objectives dictate which components should be retained in the model reduction process. This information can be valuable in model reduction and decentralized control problems.

Relative costs of transporting low-level waste according to four postulated regional-management cases

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

Wilmot, E.L.; Shirley, C.G.

1982-01-01

Results presented in this paper show that almost any compact binding states into cooperating regions for disposal of LLW will reduce nationwide transportation costs markedly. As a corollary, the reduction of costs may reflect a two- to four-fold reduction of transportation distances with consequent reduction of risk to the public since risk generally decreases directly as transport distances decrease.

48 CFR 52.214-27 - Price Reduction for Defective Certified Cost or Pricing Data-Modifications-Sealed Bidding.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Price Reduction for... PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 52.214-27 Price Reduction for Defective... following clause: Price Reduction for Defective Certified Cost or Pricing Data—Modifications—Sealed Bidding...

Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short‐Acting β‐Agonist Formulations

PubMed Central

Zeng, Yaohui; Singh, Sachinkumar; Wang, Kai

2017-01-01

Abstract Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3‐by‐1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration–recommended 3‐by‐1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3‐by‐1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90‐μg test dose and a 720‐μg reference dose (42% cost reduction). Combining a 180‐μg test dose and a 720‐μg reference dose produced an estimated 36% cost reduction. PMID:29281130

Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction.

PubMed

Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Vijayakumar, Sathya; Padia, Reema; Peters, Matthew; Champagne, Trevor; Meier, Jeremy D

2016-10-01

Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short-term complications. An observational cohort study was performed in a multifacility network using a standardized cost-accounting system to determine costs associated with adult STR from January 1, 2008 to July 31, 2015. A total of 4007 cases, performed at 21 facilities, by 72 different surgeons were included in the study. Total costs, variable costs, operating room (OR) time, and 30-day complications (eg, epistaxis) were compared among surgeons, facilities, and specialties. Total procedure cost: (mean ± standard deviation [SD]) $2503 ± $790 (range, $852 to $10,559). Mean total variable cost: $1147 ± $423 (range, $400 to $5,081). Intersurgeon and interfacility variability was significant for total cost (p < 0.0001) and OR time (p < 0.0001). Intersurgeon OR supply cost variability was also significant (p < 0.0001). Otolaryngologists had less total cost (p < 0.0001), OR time/cost (p < 0.0001), and complications (p = 0.0164), but greater supply cost (p < 0.0001), than other specialties. There is wide variation in cost associated with STR. Significant variance in OR time and supply cost between surgeons suggests these are potential areas for cost reduction. Although no increased 30-day complications were seen with faster and less costly surgeries, further research is needed to evaluate how time and cost relate to quality of care. © 2016 ARS-AAOA, LLC.

The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China.

PubMed

Tang, Liyang

2012-09-14

Patient's satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient's life satisfaction in China's health delivery system/in various kinds of hospitals.The aim of this study was to test whether and to what extent patient's satisfaction with medical service delivery/patient's assessments of various major aspects of medical service/various major aspects of patient's trust in health delivery system influenced patient's life satisfaction in China's health delivery system/in various kinds of hospitals. This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. The key considerations in generating patient's life satisfaction involved patient's overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient's life satisfaction were different among low level public hospital, high level public hospital, and private hospital. The promotion of patient's overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient's trust in prescription, the promotion of patient's trust in doctor, and the promotion of patient's trust in recommended medical examination could all help promote patient's life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital.

Assessment of the potential REDD+ as a new international support measure for GHG reduction

NASA Astrophysics Data System (ADS)

Kim, Y.; Ahn, J.; Kim, H.

2016-12-01

As part of the Paris Agreement, the mechanism for reducing emissions from deforestation and forest degradation in developing countries (REDD+) has high potential to simultaneously contribute to greenhouse gas (GHG) mitigation through forest conservation and poverty alleviation. Some of 162 Intended Nationally Determined Contributions (INDCs) submitted by 189 countries representing approximately 98.8% of global GHG emissions include not only unconditional mitigation goals but also conditional goals based on the condition of the provision of international support such as finance, technology transfer and capacity building. Considering REDD+ as one of the main mechanisms to support such work, this study selected ten countries from among Korea's 24 ODA priority partners, taking into consideration their conditional INDC targets alongside sectoral quantified targets such as land use, land-use change and forestry (LULUCF). The ten selected countries are Indonesia, Cambodia, Vietnam, Bangladesh, Sri Lanka, Ghana, Senegal, Colombia, Peru and Paraguay. Of these countries, most REDD+ projects have been conducted in Indonesia mainly due to the fact that 85% of the country's total GHG emissions are caused by forest conversion and peatland degradation. Therefore, GHG reduction rates and associated projected costs of the Indonesia's REDD+ projects were analyzed in order to offer guidance on the potential of REDD+ to contribute to other INDCs' conditional goals. The result showed that about 0.9 t CO2 ha-1 could be reduced at a cost of USD 23 per year. Applying this estimation to the Cambodian case, which has submitted a conditional INDC target of increasing its forest coverage by 60% (currently 57%) by 2030, suggests that financial support of USD 12.8 million would reduce CO2 emissions by about 5.1 million tones by increasing forest coverage. As there is currently no consideration of LULUCF in Cambodia's INDC, this result represents the opportunity for an additional contribution to achieving the country's conditional mitigation goals.

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

Eichman, Josh; Flores-Espino, Francisco

Flexible operation of electrolysis systems represents an opportunity to reduce the cost of hydrogen for a variety of end-uses while also supporting grid operations and thereby enabling greater renewable penetration. California is an ideal location to realize that value on account of growing renewable capacity and markets for hydrogen as a fuel cell electric vehicle (FCEV) fuel, refineries, and other end-uses. Shifting the production of hydrogen to avoid high cost electricity and participation in utility and system operator markets along with installing renewable generation to avoid utility charges and increase revenue from the Low Carbon Fuel Standard (LCFS) program canmore » result in around $2.5/kg (21%) reduction in the production and delivery cost of hydrogen from electrolysis. This reduction can be achieved without impacting the consumers of hydrogen. Additionally, future strategies for reducing hydrogen cost were explored and include lower cost of capital, participation in the Renewable Fuel Standard program, capital cost reduction, and increased LCFS value. Each must be achieved independently and could each contribute to further reductions. Using the assumptions in this study found a 29% reduction in cost if all future strategies are realized. Flexible hydrogen production can simultaneously improve the performance and decarbonize multiple energy sectors. The lessons learned from this study should be used to understand near-term cost drivers and to support longer-term research activities to further improve cost effectiveness of grid integrated electrolysis systems.« less

An interprovincial cooperative game model for air pollution control in China.

PubMed

Xue, Jian; Zhao, Laijun; Fan, Longzhen; Qian, Ying

2015-07-01

The noncooperative air pollution reduction model (NCRM) that is currently adopted in China to manage air pollution reduction of each individual province has inherent drawbacks. In this paper, we propose a cooperative air pollution reduction game model (CRM) that consists of two parts: (1) an optimization model that calculates the optimal pollution reduction quantity for each participating province to meet the joint pollution reduction goal; and (2) a model that distribute the economic benefit of the cooperation (i.e., pollution reduction cost saving) among the provinces in the cooperation based on the Shapley value method. We applied the CRM to the case of SO2 reduction in the Beijing-Tianjin-Hebei region in China. The results, based on the data from 2003-2009, show that cooperation helps lower the overall SO2 pollution reduction cost from 4.58% to 11.29%. Distributed across the participating provinces, such a cost saving from interprovincial cooperation brings significant benefits to each local government and stimulates them for further cooperation in pollution reduction. Finally, sensitivity analysis is performed using the year 2009 data to test the parameters' effects on the pollution reduction cost savings. China is increasingly facing unprecedented pressure for immediate air pollution control. The current air pollution reduction policy does not allow cooperation and is less efficient. In this paper we developed a cooperative air pollution reduction game model that consists of two parts: (1) an optimization model that calculates the optimal pollution reduction quantity for each participating province to meet the joint pollution reduction goal; and (2) a model that distributes the cooperation gains (i.e., cost reduction) among the provinces in the cooperation based on the Shapley value method. The empirical case shows that such a model can help improve efficiency in air pollution reduction. The result of the model can serve as a reference for Chinese government pollution reduction policy design.

Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

ERIC Educational Resources Information Center

Yeh, Stuart S.

2009-01-01

The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

Averting HIV Infections in New York City: A Modeling Approach Estimating the Future Impact of Additional Behavioral and Biomedical HIV Prevention Strategies

PubMed Central

Kessler, Jason; Myers, Julie E.; Nucifora, Kimberly A.; Mensah, Nana; Kowalski, Alexis; Sweeney, Monica; Toohey, Christopher; Khademi, Amin; Shepard, Colin; Cutler, Blayne; Braithwaite, R. Scott

2013-01-01

Background New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically. Methods A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC. Results Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average). Conclusions Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs. PMID:24058465

The cost of treatment failure: resource use and costs incurred by hepatitis C virus genotype 1-infected patients who do or do not achieve sustained virological response to therapy.

PubMed

Backx, M; Lewszuk, A; White, J R; Cole, J; Sreedharan, A; van Sanden, S; Diels, J; Lawson, A; Neal, K R; Wiselka, M J; Ito, T; Irving, W L

2014-03-01

Chronic hepatitis C virus (HCV) infection places a considerable economic burden on health services. Cost-effectiveness analyses of antiviral treatment for patients with chronic HCV infection are dependent on assumptions about cost reductions following sustained virological response (SVR) to therapy. This study quantified the medium-term difference in health resource usage and costs depending on treatment outcome. Retrospective chart review of patients with HCV genotype 1 infection who had received at least 2 months pegylated interferon and ribavirin therapy, with known treatment outcome was conducted. Disease status was categorized as chronic hepatitis, cirrhosis or decompensated liver disease. Health resource use was documented for each patient in each disease state. Unit costs were from the NHS 'Payment by Results' database and the British National Formulary. One hundred and ninety three patients (108 SVR, 85 non-SVR) with mean follow-up of 3.5 (SVR) and 4.9 (non-SVR) years were enrolled. No SVR patient progressed to a more severe liver disease state. Annual transition rates for non-SVR patients were 7.4% (chronic hepatitis to cirrhosis) and 4.9% (cirrhosis to decompensated liver disease). By extrapolation of modelled data over a 5-year post-treatment period, failure of patients with chronic hepatitis to achieve SVR was associated with a 13-fold increase (roughly £2300) in costs, whilst for patients who were retreated, the increase was 56-fold, equating to more than £10 000. Achievement of an SVR has significant effects on health service usage and costs. This work provides real-life data for future cost-effectiveness analyses related to the treatment for chronic HCV infection. © 2013 John Wiley & Sons Ltd.

A Comprehensive Algorithm for Approval of Health Technologies With, Without, or Only in Research: The Key Principles for Informing Coverage Decisions.

PubMed

Claxton, Karl; Palmer, Stephen; Longworth, Louise; Bojke, Laura; Griffin, Susan; Soares, Marta; Spackman, Eldon; Rothery, Claire

The value of evidence about the performance of a technology and the value of access to a technology are central to policy decisions regarding coverage with, without, or only in research and managed entry (or risk-sharing) agreements. We aim to outline the key principles of what assessments are needed to inform "only in research" (OIR) or "approval with research" (AWR) recommendations, in addition to approval or rejection. We developed a comprehensive algorithm to inform the sequence of assessments and judgments that lead to different types of guidance: OIR, AWR, Approve, or Reject. This algorithm identifies the order in which assessments might be made, how similar guidance might be arrived at through different combinations of considerations, and when guidance might change. The key principles are whether the technology is expected to be cost-effective; whether the technology has significant irrecoverable costs; whether additional research is needed; whether research is possible with approval and whether there are opportunity costs that once committed by approval cannot be recovered; and whether there are effective price reductions. Determining expected cost-effectiveness is only a first step. In addition to AWR for technologies expected to be cost-effective and OIR for those not expected to be cost-effective, there are other important circumstances when OIR should be considered. These principles demonstrate that cost-effectiveness is a necessary but not sufficient condition for approval. Even when research is possible with approval, OIR may be appropriate when a technology is expected to be cost-effective due to significant irrecoverable costs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: economic outcomes.

PubMed

Barrett, Barbara; Waheed, Waquas; Farrelly, Simone; Birchwood, Max; Dunn, Graham; Flach, Clare; Henderson, Claire; Leese, Morven; Lester, Helen; Marshall, Max; Rose, Diana; Sutherby, Kim; Szmukler, George; Thornicroft, Graham; Byford, Sarah

2013-01-01

Compulsory admission to psychiatric hospitals may be distressing, disruptive to patients and families, and associated with considerable cost to the health service. Improved patient experience and cost reductions could be realised by providing cost-effective crisis planning services. Economic evaluation within a multi-centre randomised controlled trial comparing Joint Crisis Plans (JCP) plus treatment as usual (TAU) to TAU alone for patients aged over 16, with at least one psychiatric hospital admission in the previous two years and on the Enhanced Care Programme Approach register. JCPs, containing the patient's treatment preferences for any future psychiatric emergency, are a form of crisis intervention that aim to mitigate the negative consequences of relapse, including hospital admission and use of coercion. Data were collected at baseline and 18-months after randomisation. The primary outcome was admission to hospital under the Mental Health Act. The economic evaluation took a service perspective (health, social care and criminal justice services) and a societal perspective (additionally including criminal activity and productivity losses). The addition of JCPs to TAU had no significant effect on compulsory admissions or total societal cost per participant over 18-months follow-up. From the service cost perspective, however, evidence suggests a higher probability (80%) of JCPs being the more cost-effective option. Exploration by ethnic group highlights distinct patterns of costs and effects. Whilst the evidence does not support the cost-effectiveness of JCPs for White or Asian ethnic groups, there is at least a 90% probability of the JCP intervention being the more cost-effective option in the Black ethnic group. The results by ethnic group are sufficiently striking to warrant further investigation into the potential for patient gain from JCPs among black patient groups. Current Controlled Trials ISRCTN11501328.

Economic impact of medication error: a systematic review.

PubMed

Walsh, Elaine K; Hansen, Christina Raae; Sahm, Laura J; Kearney, Patricia M; Doherty, Edel; Bradley, Colin P

2017-05-01

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

PEM Electrolyzer Incorporating an Advanced Low-Cost Membrane

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

Hamdan, Monjid

The Department of Energy (DOE) has identified hydrogen production by electrolysis of water at forecourt stations as a critical technology for transition to the hydrogen economy; however, the cost of hydrogen produced by present commercially available electrolysis systems is considerably higher than the DOE 2015 and 2020 cost targets. Analyses of proton-exchange membrane (PEM) electrolyzer systems indicate that reductions in electricity consumption and electrolyzer stack and system capital cost are required to meet the DOE cost targets. The primary objective is to develop and demonstrate a cost-effective energy-based system for electrolytic generation of hydrogen. The goal is to increase PEMmore » electrolyzer efficiency and to reduce electrolyzer stack and system capital cost to meet the DOE cost targets for distributed electrolysis. To accomplish this objective, work was conducted by a team consisting of Giner, Inc. (Giner), Virginia Polytechnic Institute & University (VT), and domnick hunter group, a subsidiary of Parker Hannifin (Parker). The project focused on four (4) key areas: (1) development of a high-efficiency, high-strength membrane; (2) development of a long-life cell-separator; (3) scale-up of cell active area to 290 cm2 (from 160 cm²); and (4) development of a prototype commercial electrolyzer system. In each of the key stack development areas Giner and our team members conducted focused development in laboratory-scale hardware, with analytical support as necessary, followed by life-testing of the most promising candidate materials. Selected components were then scaled up and incorporated into low-cost scaled-up stack hardware. The project culminated in the fabrication and testing of a highly efficient electrolyzer system for production of 0.5 kg/hr hydrogen and validation of the stack and system in testing at the National Renewable Energy Laboratory (NREL).« less

The cost-effectiveness of harm reduction.

PubMed

Wilson, David P; Donald, Braedon; Shattock, Andrew J; Wilson, David; Fraser-Hurt, Nicole

2015-02-01

HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Clinical and health care aspects of respiratory tract disorders in Poland.

PubMed

Kanecki, Krzysztof; Zycinska, Katarzyna; Tyszko, Piotr

2016-01-01

Respiratory diseases constitute a public health priority worldwide. This is related to the increasing exposure to microorganisms, toxic factors, allergens, drugs and smoking, as the most important factors. Increasing costs of health promotion, prevention, diagnosis and treatment of respiratory tract diseases forces the search for effective strategies in the reduction of costs without making a significant impact of these activities on health results. Chronic obstructive pulmonary disease (COPD) is an example of these diseases with increasing incidence, which has few known modifiable factors and absorbs large medical and social costs. The aim of this study is to present the conception of cost driver analysis that could be useful in constructing a good combination of the EBM-based treatment with cost reduction decisions. Analysis of cost drivers was based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and Polish recommendations of COPD diagnosis and treatment. The proposition of cost reduction strategy in COPD treatment was based on identification of cost drivers in value chain conception. An increasing incidence and treatment costs of COPD force the search for methods of costs reduction in health care. Identifying, evaluating and modifying the cost drivers with use of the value chain conception could be an effective method in achieving these objectives.

Sensor and Methodology for Dielectric Analysis of Vegetal Oils Submitted to Thermal Stress

PubMed Central

Stevan, Sergio Luiz; Paiter, Leandro; Ricardo Galvão, José; Vieira Roque, Daniely; Sidinei Chaves, Eduardo

2015-01-01

Vegetable oils used in frying food represent a social problem as its destination. The residual oil can be recycled and returned to the production line, as biodiesel, as soap, or as putty. The state of the residual oil is determined according to their physicochemical characteristics whose values define its economically viable destination. However, the physicochemical analysis requires high costs, time and general cost of transporting. This study presents the use of a capacitive sensor and a quick and inexpensive method to correlate the physicochemical variables to the dielectric constant of the material undergoing oil samples to thermal cycling. The proposed method allows reducing costs in the characterization of residual oil and the reduction in analysis time. In addition, the method allows an assessment of the quality of the vegetable oil during use. The experimental results show the increasing of the dielectric constant with the temperature, which facilitates measurement and classification of the dielectric constant at considerably higher temperatures. The results also confirm a definitive degradation in used oil and a correlation between the dielectric constant of the sample with the results of the physicochemical analysis (iodine value, acid value, viscosity and refractive index). PMID:26501293

Sensor and methodology for dielectric analysis of vegetal oils submitted to thermal stress.

PubMed

Stevan, Sergio Luiz; Paiter, Leandro; Galvão, José Ricardo; Roque, Daniely Vieira; Chaves, Eduardo Sidinei

2015-10-16

Vegetable oils used in frying food represent a social problem as its destination. The residual oil can be recycled and returned to the production line, as biodiesel, as soap, or as putty. The state of the residual oil is determined according to their physicochemical characteristics whose values define its economically viable destination. However, the physicochemical analysis requires high costs, time and general cost of transporting. This study presents the use of a capacitive sensor and a quick and inexpensive method to correlate the physicochemical variables to the dielectric constant of the material undergoing oil samples to thermal cycling. The proposed method allows reducing costs in the characterization of residual oil and the reduction in analysis time. In addition, the method allows an assessment of the quality of the vegetable oil during use. The experimental results show the increasing of the dielectric constant with the temperature, which facilitates measurement and classification of the dielectric constant at considerably higher temperatures. The results also confirm a definitive degradation in used oil and a correlation between the dielectric constant of the sample with the results of the physicochemical analysis (iodine value, acid value, viscosity and refractive index).

[Frequency distribution of dibucaine numbers in 24,830 patients].

PubMed

Pestel, G; Sprenger, H; Rothhammer, A

2003-06-01

Atypical cholinesterase prolongs the duration of neuromuscular blocking drugs such as succinylcholine and mivacurium. Measuring the dibucaine number identifies patients who are at risk. This study shows the frequency distribution of dibucaine numbers routinely measured and discusses avoidable clinical problems and economic implications. Dibucaine numbers were measured on a Hitachi 917-analyzer and all dibucaine numbers recorded over a period of 4 years were taken into consideration. Repeat observations were excluded. A total of 24,830 dibucaine numbers were analysed and numbers below 30 were found in 0.07% ( n=18) giving an incidence of 1:1,400. Dibucaine numbers from 30 to 70 were found in 1.23% ( n=306). On the basis of identification of the Dibucaine numbers we could avoid the administration of succinylcholine or mivacurium resulting in a cost reduction of 12,280 Euro offset against the total laboratory costs amounting to 10,470 Euro. An incidence of 1:1,400 of dibucaine numbers below 30 is higher than documented in the literature. Therefore, routine measurement of dibucaine number is a cost-effective method of identifying patients at increased risk of prolonged neuromuscular blockade due to atypical cholinesterase.

Shared mission operations concept

NASA Technical Reports Server (NTRS)

Spradlin, Gary L.; Rudd, Richard P.; Linick, Susan H.

1994-01-01

Historically, new JPL flight projects have developed a Mission Operations System (MOS) as unique as their spacecraft, and have utilized a mission-dedicated staff to monitor and control the spacecraft through the MOS. NASA budgetary pressures to reduce mission operations costs have led to the development and reliance on multimission ground system capabilities. The use of these multimission capabilities has not eliminated an ongoing requirement for a nucleus of personnel familiar with a given spacecraft and its mission to perform mission-dedicated operations. The high cost of skilled personnel required to support projects with diverse mission objectives has the potential for significant reduction through shared mission operations among mission-compatible projects. Shared mission operations are feasible if: (1) the missions do not conflict with one another in terms of peak activity periods, (2) a unique MOS is not required, and (3) there is sufficient similarity in the mission profiles so that greatly different skills would not be required to support each mission. This paper will further develop this shared mission operations concept. We will illustrate how a Discovery-class mission would enter a 'partner' relationship with the Voyager Project, and can minimize MOS development and operations costs by early and careful consideration of mission operations requirements.

Geographic applications of ERTS-1 imagery to landscape change. [Mississippi River and Great Smoky Mountains of Tennessee and North Carolina

NASA Technical Reports Server (NTRS)

Rehder, J. B. (Principal Investigator)

1973-01-01

The author has identified the following significant results. ERTS-1 has proven to be an effective earth-orbiting monitor of landscape change. Its regional coverage for large areal monitoring has been effective for the detection and mapping of agricultural plowing regions, for general forest cover mapping, for flood mapping, for strip mine mapping, and for short-lived precipitation mapping patterns. Paramount to the entire study has been the temporal coverage provided by ERTS. Without the cyclic coverage on an 18 day basis, temporal coverage would have been inadequate for the detection and mapping of strip mining landscape change, the analysis of agricultural landscape change based on plowing patterns, the analysis of urban-suburban growth changes, and the mapping of the Mississippi River floods. Cost benefits from ERTS are unquestionably superior to aircraft systems in regard to large regional coverage and cyclic temporal parameters. For the analysis of landscape change in large regions such as statewide areas or even areas of 10,000 square miles, ERTS is of cost benefit consideration. Not only does the cost of imagery favor ERTS but the reduction of man-hours using ERTS has been in the magnitude of 1:10.

A preliminary analysis of recent HVAC energy projects

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

Gaddy, P.J.; Haake, C.F.

A typical Government HVAC design over the last 30 years consisted of two oversized (equal tonnage) electric chillers, two oversized (equal NBTU ratings) boilers, an air economizer cycle, a constant air volume system and a central station pneumatic control system. This typical basic layout for plant design has certain advantages such as simplicity and ease to construct throughout the country. The cookie cutter design/build approach suited federal facilities, when utility costs were not a major consideration, in-house maintenance and operations personnel were plentiful and energy conservation was a moral priority and not an economic concern. Those days are history asmore » energy costs have escalated and operating budgets continue to shrink leaving fewer personnel to maintain the same buildings. Advances in HVAC technology and the reduction in costs for energy efficient systems have finally started affecting the Federal Government`s HVAC replacement and new construction designs. This paper is a brief description of three HVAC projects that go outside the traditional government HVAC design parameters. GSA`s Pacific Rim Region, covering the states of Hawaii, California, Nevada, and Arizona, has implemented three HVAC projects utilizing different technologies not normally found in GSA Federal facilities.« less

Economic Impact of Hearing Loss and Reduction of Noise-Induced Hearing Loss in the United States.

PubMed

Neitzel, Richard L; Swinburn, Tracy K; Hammer, Monica S; Eisenberg, Daniel

2017-01-01

Hearing loss (HL) is pervasive and debilitating, and noise-induced HL is preventable by reducing environmental noise. Lack of economic analyses of HL impacts means that prevention and treatment remain a low priority for public health and environmental investment. This article estimates the costs of HL on productivity by building on established estimates for HL prevalence and wage and employment differentials between those with and without HL. We estimate that HL affects more than 13% of the working population. Not all HL can be prevented or treated, but if the 20% of HL resulting from excessive noise exposure were prevented, the economic benefit would be substantial-we estimate a range of $58 billion to $152 billion annually, with a core estimate of $123 billion. We believe this is a conservative estimate, because consideration of additional costs of HL, including health care and special education, would likely further increase the benefits associated with HL prevention. HL is costly and warrants additional emphasis in public and environmental health programs. This study represents an important first step in valuing HL prevention-in particular, prevention of noise-induced HL-where new policies and technologies appear promising.

Reeled pipelay cost reduction using workboat-based installation

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

Hoffman, J.G.; El Laithy, W.F.; Rothberg, R.H.

1995-11-01

Coiled ``tubing`` is a rapidly growing pipeline technology. because this technology is relatively new, cost can vary significantly depending on deployment strategies and installation techniques. Up until recently coiled pipe was used primarily by service companies for coiled tubing workovers. As the technology expanded the industry began using coiled tubing for other applications such as drilling, coring, logging, well cleanout operations and artificial lift. With the recent advent of larger sizes, three and one half inches, it was now possible to consider using coiled tubing as pipelines. The coiled pipe was proving to be a low cost, time saving, economicmore » alternative to conventional welded pipe for flowlines. Coiled pipe applications have been used in 4 to 100 feet of water in the Gulf of Mexico area and the installation techniques have varied significantly. Considerable engineering work has been done in preparation for GUPCO`s first dynamic lay installation for a subsea well tie-in on Ramadan 22. Subsequently GUPCO installed the worlds longest known coiled pipeline on SB 367. This paper will cover the significant findings of that engineering work and present actual field case histories on Egypt`s first two coiled pipeline projects.« less

Capacitated vehicle-routing problem model for scheduled solid waste collection and route optimization using PSO algorithm.

PubMed

Hannan, M A; Akhtar, Mahmuda; Begum, R A; Basri, H; Hussain, A; Scavino, Edgar

2018-01-01

Waste collection widely depends on the route optimization problem that involves a large amount of expenditure in terms of capital, labor, and variable operational costs. Thus, the more waste collection route is optimized, the more reduction in different costs and environmental effect will be. This study proposes a modified particle swarm optimization (PSO) algorithm in a capacitated vehicle-routing problem (CVRP) model to determine the best waste collection and route optimization solutions. In this study, threshold waste level (TWL) and scheduling concepts are applied in the PSO-based CVRP model under different datasets. The obtained results from different datasets show that the proposed algorithmic CVRP model provides the best waste collection and route optimization in terms of travel distance, total waste, waste collection efficiency, and tightness at 70-75% of TWL. The obtained results for 1 week scheduling show that 70% of TWL performs better than all node consideration in terms of collected waste, distance, tightness, efficiency, fuel consumption, and cost. The proposed optimized model can serve as a valuable tool for waste collection and route optimization toward reducing socioeconomic and environmental impacts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Benefit, risk and cost of new oral anticoagulants and warfarin in atrial fibrillation; A multicriteria decision analysis.

PubMed

Mendoza-Sanchez, Jose; Silva, Federico; Rangel, Lady; Jaramillo, Linda; Mendoza, Leidy; Garzon, Jenny; Quiroga, Andrea

2018-01-01

Warfarin and new oral anticoagulants are effective in reducing stroke in atrial fibrillation; however, the benefits and risks rates in clinical trials show heterogeneity for each anticoagulant, and is unknown the cost influence on a model considering most of the treatment consequences. We designed a benefit-risk and cost assessment of oral anticoagulants. We followed the roadmap proposed by IMI-PROTECT and the considerations of emerged good practice to perform Multi-Criteria Decision Analysis (MCDA). The roadmap defines the following steps: (1) planning, (2) evidence gathering and data preparation, (3) analyses, (4) explorations, and (5) conclusions. We defined two reference points (0-100) to allocate numerical values for scores and weights, and used an analogue numeric scale to assess physicians' preferences. As benefits of the anticoagulant therapy, we included reductions in stroke and all-cause mortality; intracranial haemorrhage, gastrointestinal haemorrhage, minor bleeding and myocardial infarction were considered risks. We also made an estimation of the annual drug cost per person. The scores were: Apixaban 33, Dabigatrán 25, warfarin 18 and Rivaroxaban 14 this score reveals the most preferred up to the less preferred option, considering the benefit-risk ratio and drug costs altogether. The relative model weights were: 51.1% for risks, 40.4% for benefits and 8.5% for cost. The sensitivity analysis confirms the model robustness. From this analysis, apixaban should be considered as the preferred anticoagulant option -due to a better benefit-risk balance and a minor cost influence- followed by dabigatran, warfarin and rivaroxaban.

Periodic Application of Stochastic Cost Optimization Methodology to Achieve Remediation Objectives with Minimized Life Cycle Cost

NASA Astrophysics Data System (ADS)

Kim, U.; Parker, J.

2016-12-01

Many dense non-aqueous phase liquid (DNAPL) contaminated sites in the U.S. are reported as "remediation in progress" (RIP). However, the cost to complete (CTC) remediation at these sites is highly uncertain and in many cases, the current remediation plan may need to be modified or replaced to achieve remediation objectives. This study evaluates the effectiveness of iterative stochastic cost optimization that incorporates new field data for periodic parameter recalibration to incrementally reduce prediction uncertainty and implement remediation design modifications as needed to minimize the life cycle cost (i.e., CTC). This systematic approach, using the Stochastic Cost Optimization Toolkit (SCOToolkit), enables early identification and correction of problems to stay on track for completion while minimizing the expected (i.e., probability-weighted average) CTC. This study considers a hypothetical site involving multiple DNAPL sources in an unconfined aquifer using thermal treatment for source reduction and electron donor injection for dissolved plume control. The initial design is based on stochastic optimization using model parameters and their joint uncertainty based on calibration to site characterization data. The model is periodically recalibrated using new monitoring data and performance data for the operating remediation systems. Projected future performance using the current remediation plan is assessed and reoptimization of operational variables for the current system or consideration of alternative designs are considered depending on the assessment results. We compare remediation duration and cost for the stepwise re-optimization approach with single stage optimization as well as with a non-optimized design based on typical engineering practice.

Greenhouse gas emission reduction: A case study of Sri Lanka

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

Meier, P.; Munasinghe, M.

1995-12-31

In this paper we describe a case study for Sri Lanka that explores a wide range of options for reducing greenhouse gas (GHG) emissions. Options range from renewable technologies to carbon taxes and transportation sector initiatives. We find that setting electricity prices to reflect long-run marginal cost has a significant beneficial impact on the environment, and the expected benefits predicted on theoretical grounds are confirmed by the empirical results. Pricing reform also has a much broader impact than physical approaches to demand side management, although several options such as compact fluorescent lighting appear to have great potential. Options to reducemore » GHG emissions are limited as Sri Lanka lacks natural gas, and nuclear power is not practical until the system reaches a much larger size. Building the few remaining large hydro facilities would significantly reduce GHG emissions, but these would require costly resettlement programs. Given the inevitability for fossil-fuel base load generation, both clean coal technologies such as pressurized fluidized bed combustion, as well as steam-cycle residual oil fueled plants merit consideration as alternatives to the conventional pulverized coal-fired plants currently being considered. Transportation sector measures necessary to ameliorate local urban air pollution problems, such as vehicle inspection and maintenance programs, also bring about significant reductions of GHG emissions. 51 refs., 10 figs., 3 tabs.« less

Space program payload costs and their possible reduction

NASA Technical Reports Server (NTRS)

Vanvleck, E. M.; Deerwester, J. M.; Norman, S. M.; Alton, L. R.

1973-01-01

The possible ways by which NASA payload costs might be reduced in the future were studied. The major historical reasons for payload costs being as they were, and if there are technologies (hard and soft), or criteria for technology advances, that could significantly reduce total costs of payloads were examined. Payload costs are placed in historical context. Some historical cost breakdowns for unmanned NASA payloads are presented to suggest where future cost reductions could be most significant. Space programs of NOAA, DoD and COMSAT are then examined to ascertain if payload reductions have been brought about by the operational (as opposed to developmental) nature of such programs, economies of scale, the ability to rely on previously developed technology, or by differing management structures and attitudes. The potential impact was investigated of NASA aircraft-type management on spacecraft program costs, and some examples relating previous costs associated with aircraft costs on the one hand and manned and unmanned costs on the other are included.

Analog VLSI system for active drag reduction

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

Gupta, B.; Goodman, R.; Jiang, F.

1996-10-01

In today`s cost-conscious air transportation industry, fuel costs are a substantial economic concern. Drag reduction is an important way to reduce costs. Even a 5% reduction in drag translates into estimated savings of millions of dollars in fuel costs. Drawing inspiration from the structure of shark skin, the authors are building a system to reduce drag along a surface. Our analog VLSI system interfaces with microfabricated, constant-temperature shear stress sensors. It detects regions of high shear stress and outputs a control signal to activate a microactuator. We are in the process of verifying the actual drag reduction by controlling microactuatorsmore » in wind tunnel experiments. We are encouraged that an approach similar to one that biology employs provides a very useful contribution to the problem of drag reduction. 9 refs., 21 figs.« less

A Method for Scheduling Air Traffic with Uncertain En Route Capacity Constraints

NASA Technical Reports Server (NTRS)

Arneson, Heather; Bloem, Michael

2009-01-01

A method for scheduling ground delay and airborne holding for flights scheduled to fly through airspace with uncertain capacity constraints is presented. The method iteratively solves linear programs for departure rates and airborne holding as new probabilistic information about future airspace constraints becomes available. The objective function is the expected value of the weighted sum of ground and airborne delay. In order to limit operationally costly changes to departure rates, they are updated only when such an update would lead to a significant cost reduction. Simulation results show a 13% cost reduction over a rough approximation of current practices. Comparison between the proposed as needed replanning method and a similar method that uses fixed frequency replanning shows a typical cost reduction of 1% to 2%, and even up to a 20% cost reduction in some cases.

48 CFR 52.215-11 - Price Reduction for Defective Certified Cost or Pricing Data-Modifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Price Reduction for... CONTRACT CLAUSES Text of Provisions and Clauses 52.215-11 Price Reduction for Defective Certified Cost or Pricing Data—Modifications. As prescribed in 15.408(c), insert the following clause: Price Reduction for...

Systems Engineering Techniques for ALS Decision Making

NASA Technical Reports Server (NTRS)

Rodriquez, Luis F.; Drysdale, Alan E.; Jones, Harry; Levri, Julie A.

2004-01-01

The Advanced Life Support (ALS) Metric is the predominant tool for predicting the cost of ALS systems. Metric goals for the ALS Program are daunting, requiring a threefold increase in the ALS Metric by 2010. Confounding the problem, the rate new ALS technologies reach the maturity required for consideration in the ALS Metric and the rate at which new configurations are developed is slow, limiting the search space and potentially giving the perspective of a ALS technology, the ALS Metric may remain elusive. This paper is a sequel to a paper published in the proceedings of the 2003 ICES conference entitled, "Managing to the metric: an approach to optimizing life support costs." The conclusions of that paper state that the largest contributors to the ALS Metric should be targeted by ALS researchers and management for maximum metric reductions. Certainly, these areas potentially offer large potential benefits to future ALS missions; however, the ALS Metric is not the only decision-making tool available to the community. To facilitate decision-making within the ALS community a combination of metrics should be utilized, such as the Equivalent System Mass (ESM)-based ALS metric, but also those available through techniques such as life cycle costing and faithful consideration of the sensitivity of the assumed models and data. Often a lack of data is cited as the reason why these techniques are not considered for utilization. An existing database development effort within the ALS community, known as OPIS, may provide the opportunity to collect the necessary information to enable the proposed systems analyses. A review of these additional analysis techniques is provided, focusing on the data necessary to enable these. The discussion is concluded by proposing how the data may be utilized by analysts in the future.

Managing hazardous pollutants in Chile: arsenic.

PubMed

Sancha, Ana María; O'Ryan, Raul

2008-01-01

Chile is one of the few countries that faces the environmental challenge posed by extensive arsenic pollution, which exists in the northern part of the country. Chile has worked through various options to appropriately address the environmental challenge of arsenic pollution of water and air. Because of cost and other reasons, copying standards used elsewhere in the world was not an option for Chile. Approximately 1.8 million people, representing about 12% of the total population of the country, live in arsenic-contaminated areas. In these regions, air, water, and soil are contaminated with arsenic from both natural and anthropogenic sources. For long periods, water consumed by the population contained arsenic levels that exceeded values recommended by the World Health Organization. Exposure to airborne arsenic also occurred near several large cities, as a consequence of both natural contamination and the intensive mining activity carried out in those areas. In rural areas, indigenous populations, who lack access to treated water, were also exposed to arsenic by consuming foods grown locally in arsenic-contaminated soils. Health effects in children and adults from arsenic exposure first appeared in the 1950s. Such effects included vascular, respiratory, and skin lesions from intake of high arsenic levels in drinking water. Methods to remove arsenic from water were evaluated, developed, and implemented that allowed significant reductions in exposure at a relatively low cost. Construction and operation of treatment plants to remove arsenic from water first began in the 1970s. Beginning in the 1990s, epidemiological studies showed that the rate of lung and bladder cancer in the arsenic-polluted area was considerably higher than mean cancer rates for the country. Cancer incidence was directly related to arsenic exposure. During the 1990s, international pressure and concern by Chile's Health Ministry prompted action to regulate arsenic emissions from copper smelters. A process began in which emission standards appropriate for Chile were set; this process included careful evaluation of risks versus mitigation costs for abatement options. Such options were developed and implemented. More recently, local communities have pressed for more significant reductions of arsenic in air and water. Considerable experience was gained with the arsenic experience on how to manage this type of hazardous pollutant, in a context of trade-offs among production, jobs, income, and health. In this review article, we cover arsenic levels in Chile's air, water, and soils and discuss health impacts and patterns of exposure. We also describe the process followed to set arsenic regulatory standards, as well as abatement options for air and water and the associated costs.

Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada.

PubMed

Joffres, Michel R; Campbell, Norm R C; Manns, Braden; Tu, Karen

2007-05-01

Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations. To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives. Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey. Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure. Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada.

Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada

PubMed Central

Joffres, Michel R; Campbell, Norm RC; Manns, Braden; Tu, Karen

2007-01-01

BACKGROUND: Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations. OBJECTIVES: To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives. METHODS: Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey. RESULTS: Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure. CONCLUSIONS: Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada. PMID:17487286

Marginal cost curves for water footprint reduction in irrigated agriculture: a policy and decision making guide for efficient water use in crop production

NASA Astrophysics Data System (ADS)

Chukalla, Abebe; Krol, Maarten; Hoekstra, Arjen

2016-04-01

Reducing water footprints (WF) in irrigated crop production is an essential element in water management, particularly in water-scarce areas. To achieve this, policy and decision making need to be supported with information on marginal cost curves that rank measures to reduce the WF according to their cost-effectiveness and enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a certain reasonable WF benchmark. This paper aims to develop marginal cost curves (MCC) for WF reduction. The AquaCrop model is used to explore the effect of different measures on evapotranspiration and crop yield and thus WF that is used as input in the MCC. Measures relate to three dimensions of management practices: irrigation techniques (furrow, sprinkler, drip and subsurface drip); irrigation strategies (full and deficit irrigation); and mulching practices (no mulching, organic and synthetic mulching). A WF benchmark per crop is calculated as resulting from the best-available production technology. The marginal cost curve is plotted using the ratios of the marginal cost to WF reduction of the measures as ordinate, ranking with marginal costs rise with the increase of the reduction effort. For each measure, the marginal cost to reduce WF is estimated by comparing the associated WF and net present value (NPV) to the reference case (furrow irrigation, full irrigation, no mulching). The NPV for each measure is based on its capital costs, operation and maintenances costs (O&M) and revenues. A range of cases is considered, including: different crops, soil types and different environments. Key words: marginal cost curve, water footprint benchmark, soil water balance, crop growth, AquaCrop

Idling Reduction for Long-Haul Trucks: An Economic Comparison of On-Board and Wayside Technologies

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

Gaines, Linda; Weikersheimer, Patricia

Reducing the idling of long-haul heavy-duty trucks has long been recognized as a particularly low-hanging fruit of fuel efficiency and emissions reduction. The displacement of about 10 hours of diesel idling every day, for most days of the year, for as many as a million long-haul trucks has very clear benefits. This report considers the costs and return on investment (ROI) for idling reduction (IR) equipment for both truck owners and electrified parking space (EPS) equipment owners. For the truck owners, the key variables examined are idling hours to be displaced (generally 1,000 to 2,000 hours per year) and themore » price of fuel ($0 to $5/gal). The ideal IR option would provide complete services in varied climates in any location and offer the best ROI on trucks that log many idling hours. For trucks that have fewer idling hours, options with a fixed cost per hour (i.e., EPS) might be most attractive if they were available to all, or even most, truck drivers. EPS, however, is particularly cost effective for trucks on prescribed routes with a need for regular, extended stops at terminals. (EPS is also called truck stop electrification, or TSE.) The analysis shows that all IR options save money when fuel costs more than $2/gal. For trucks requiring bunk heat, a simple heater (plug-in or diesel) is almost always the most costeffective way to provide heat, even if the truck is equipped with an auxiliary power unit (APU) or is parked at a single-system EPS location. For trucks requiring bunk air-conditioning, the use of single-system EPS is most cost effective for those logging fewer idling hours. Even for trucks with higher idling hours, the cost of EPS may be about the same as that for on-board air-conditioning. Clearly, trucks’ locations and seasonal factors—and the availability of EPS— are significant in the choice of “best fit” IR equipment for truck owners. This report also considers costs and payback for owners of EPS infrastructure. An industry that 5 years ago had at least five players has been narrowed to two companies—one in single-system EPS (IdleAir) and the other in dual-system EPS (Shorepower Technologies). Use of EPS by truck drivers has not met initial expectations for a variety of reasons. One area where EPS has particular promise, however, is in the cost-effective provision of reliable air-conditioning. This analysis is focused strictly on cost and fuel savings; it does not consider the important benefits of reduced emissions (i.e., greenhouse gases and criteria pollutants). It is important to note that all IR options provide some emissions benefits. Even where an IR option may not have a rapid ROI, the emissions-reduction benefit may be considerable. Finally, as the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) set stricter standards to reduce greenhouse gas emissions and improve the fuel efficiency of medium- and heavy-duty vehicles, the emissions benefits of IR strategies will become increasingly important.« less

Utilization and costs of HIV antiretroviral drugs in Europe during the last ten years: Impact of generic antiretroviral drugs on cost reduction.

PubMed

Rwagitinywa, Joseph; Sommet, Agnès; Palmaro, Aurore; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse

2018-03-01

Simulation studies showed that generic antiretroviral (ARV) drug utilization could lead to significant cost reduction of HIV treatment in developed world. This study aimed to quantify ARV utilization and costs in European countries between 2006 and 2015. We also assessed the impact of generic ARV drug utilization on cost reduction in real-life. ARV drug utilization in 14 European countries (France, Italy, Germany, Denmark, Netherlands, Norway, Sweden, Finland, Iceland, Croatia, Czech Republic, Estonia, Latvia, and Lithuania) were analysed using defined daily dose (DDD)/1000 inhabitants/year. ARV drug cost was estimated in million euro/year and euro/1000 inhabitants/year. The impact of generics on cost reduction was assessed in three countries: France, Denmark, and Czech Republic, using four parameters: expected savings, observed savings, brand price-reduction savings and overall savings. Between 2006 and 2015, median ARV drug utilization increased from 234 DDDs per 1000 inhabitants per year (IQR 124-388) to 385 (229-670). The median cost increased from €3751/1000 inhabitants/year (1109-4681) to €9158 (3269-10,646). Between 2013 and 2015, overall savings of €0.9, €1.6, and €33.7 million were respectively observed in Denmark, Czech Republic, and France. Overall savings observed in real-life from generic ARV drugs in Denmark were related to high rate of low-price generic utilization, contrarily to France and Czech Republic where these were more related to brand price-reduction than generic utilization itself. Copyright © 2018 Elsevier B.V. All rights reserved.

COST OF SELECTIVE CATALYTIC REDUCTION (SCR) APPLICATION FOR NOX CONTROL ON COAL-FIRED BOILERS

EPA Science Inventory

The report provides a methodology for estimating budgetary costs associated with retrofit applications of selective catalytic reduction (SCR) technology on coal-fired boilers. SCR is a postcombustion nitrogen oxides (NOx) control technology capable of providing NOx reductions >90...

Infection risk and cost-effectiveness of commercial bags or glass bottles for total parenteral nutrition.

PubMed

Durand-Zaleski, I; Delaunay, L; Langeron, O; Belda, E; Astier, A; Brun-Buisson, C

1997-03-01

To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections. The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohn's disease and intensive-care unit (ICU) patients. The extra cost of using bags was $20 per day. The total cost of nosocomial bacteremia was estimated at $6,000. The monetary benefits of using TPN bags were $6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio. Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohn's disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from $90,000 to $7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from $180,000 to $14,000 if the infection rate was reduced by one third. The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.

Response of Integrated CO 2 Capture and Storage Systems in Saline Aquifers and Fractured Shale Formations to Changes in CO 2 Capture Costs

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

Langenfeld, Julie K.; Bielicki, Jeffrey M.; Tao, Zhiyuan

Fractured shale formations are new potential target reservoirs for CO 2 capture and storage (CCS) and provide several potential advantages over storage in saline aquifers in terms of storage capacity, leakage risk, and cost savings from brownfield development. Here, we used a geospatial-optimization, engineering-economic model to investigate the sensitivity of integrated CCS networks in Ohio, Pennsylvania, and West Virginia to reductions in CO 2 capture costs. The resulting reductions in CO 2 capture costs were based on hypothetical cases where technological innovation reduced CO 2 capture costs. There were also small differences in the spatial organization of the CCS deploymentmore » when the capture costs were reduced. We also found that the percent reduction in average cost of CCS systems became smaller as the CO 2 capture costs were decreased.« less

Response of Integrated CO 2 Capture and Storage Systems in Saline Aquifers and Fractured Shale Formations to Changes in CO 2 Capture Costs

DOE PAGES

Langenfeld, Julie K.; Bielicki, Jeffrey M.; Tao, Zhiyuan; ...

2017-08-18

Fractured shale formations are new potential target reservoirs for CO 2 capture and storage (CCS) and provide several potential advantages over storage in saline aquifers in terms of storage capacity, leakage risk, and cost savings from brownfield development. Here, we used a geospatial-optimization, engineering-economic model to investigate the sensitivity of integrated CCS networks in Ohio, Pennsylvania, and West Virginia to reductions in CO 2 capture costs. The resulting reductions in CO 2 capture costs were based on hypothetical cases where technological innovation reduced CO 2 capture costs. There were also small differences in the spatial organization of the CCS deploymentmore » when the capture costs were reduced. We also found that the percent reduction in average cost of CCS systems became smaller as the CO 2 capture costs were decreased.« less

Cost/benefit analysis of advanced materials technologies for future aircraft turbine engines

NASA Technical Reports Server (NTRS)

Stephens, G. E.

1980-01-01

The materials technologies studied included thermal barrier coatings for turbine airfoils, turbine disks, cases, turbine vanes and engine and nacelle composite materials. The cost/benefit of each technology was determined in terms of Relative Value defined as change in return on investment times probability of success divided by development cost. A recommended final ranking of technologies was based primarily on consideration of Relative Values with secondary consideration given to changes in other economic parameters. Technologies showing the most promising cost/benefits were thermal barrier coated temperature nacelle/engine system composites.

California-Specific Power-to-Hydrogen and Power-to-Gas Business Case Evaluation

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

Eichman, Joshua D.; Flores-Espino, Francisco

Flexible operation of electrolysis systems represents an opportunity to reduce the cost of hydrogen for a variety of end-uses while also supporting grid operations and thereby enabling greater renewable penetration. California is an ideal location to realize that value on account of growing renewable capacity and markets for hydrogen as a fuel cell electric vehicle (FCEV) fuel, refineries, and other end-uses. Shifting the production of hydrogen to avoid high cost electricity and participation in utility and system operator markets along with installing renewable generation to avoid utility charges and increase revenue from the Low Carbon Fuel Standard (LCFS) program canmore » result in around $2.5/kg (21%) reduction in the production and delivery cost of hydrogen from electrolysis. This reduction can be achieved without impacting the consumers of hydrogen. Additionally, future strategies for reducing hydrogen cost were explored and include lower cost of capital, participation in the Renewable Fuel Standard program, capital cost reduction, and increased LCFS value. Each must be achieved independently and could each contribute to further reductions. Using the assumptions in this study found a 29% reduction in cost if all future strategies are realized. Flexible hydrogen production can simultaneously improve the performance and decarbonize multiple energy sectors. The lessons learned from this study should be used to understand near-term cost drivers and to support longer-term research activities to further improve cost effectiveness of grid integrated electrolysis systems.« less

Study on utilization of advanced composites in fuselage structures of large transports

NASA Technical Reports Server (NTRS)

Johnson, R. W.; Thomson, L. W.; Wilson, R. D.

1985-01-01

The potential for utilizing advanced composites in fuselage structures of large transports was assessed. Six fuselage design concepts were selected and evaluated in terms of structural performance, weight, and manufacturing development and costs. Two concepts were selected that merit further consideration for composite fuselage application. These concepts are: (1) a full depth honeycomb design with no stringers, and (2) an I section stringer stiffened laminate skin design. Weight reductions due to applying composites to the fuselages of commercial and military transports were calculated. The benefits of applying composites to a fleet of military transports were determined. Significant technology issues pertinent to composite fuselage structures were identified and evaluated. Program plans for resolving the technology issues were developed.

Purification of drinking water by low cost method in Ethiopia

NASA Astrophysics Data System (ADS)

Abatneh, Yasabie; Sahu, Omprakash; Yimer, Seid

2014-12-01

Nowadays, water treatment is a big issue in rural areas especially in African country. Due to lack of facilities available in those areas and the treatment are expensive. In this regard's an attempt has been made to find alternative natural way to treat the rural drinking water. The experiment trials were undertaken on the most promising plant extracts, namely: Moringa oleifera, Jatropha curcas and Guar gum. The extracts were used to treat contaminated water obtained from a number of wells. The results showed that the addition of M. oleifera can considerably improve the quality of drinking water. A 100 % improvement both in turbidity and reduction in Escherichia coli was noted for a number of the samples, together with significant improvements in colour.

An effective model for ergonomic optimization applied to a new automotive assembly line

NASA Astrophysics Data System (ADS)

Duraccio, Vincenzo; Elia, Valerio; Forcina, Antonio

2016-06-01

An efficient ergonomic optimization can lead to a significant improvement in production performance and a considerable reduction of costs. In the present paper new model for ergonomic optimization is proposed. The new approach is based on the criteria defined by National Institute of Occupational Safety and Health and, adapted to Italian legislation. The proposed model provides an ergonomic optimization, by analyzing ergonomic relations between manual work in correct conditions. The model includes a schematic and systematic analysis method of the operations, and identifies all possible ergonomic aspects to be evaluated. The proposed approach has been applied to an automotive assembly line, where the operation repeatability makes the optimization fundamental. The proposed application clearly demonstrates the effectiveness of the new approach.

Least-cost control of agricultural nutrient contributions to the Gulf of Mexico hypoxic zone.

PubMed

Rabotyagov, Sergey; Campbell, Todd; Jha, Manoj; Gassman, Philip W; Arnold, Jeffrey; Kurkalova, Lyubov; Secchi, Silvia; Feng, Hongli; Kling, Catherine L

2010-09-01

In 2008, the hypoxic zone in the Gulf of Mexico, measuring 20 720 km2, was one of the two largest reported since measurement of the zone began in 1985. The extent of the hypoxic zone is related to nitrogen and phosphorous loadings originating on agricultural fields in the upper Midwest. This study combines the tools of evolutionary computation with a water quality model and cost data to develop a trade-off frontier for the Upper Mississippi River Basin specifying the least cost of achieving nutrient reductions and the location of the agricultural conservation practices needed. The frontier allows policymakers and stakeholders to explicitly see the trade-offs between cost and nutrient reductions. For example, the cost of reducing annual nitrate-N loadings by 30% is estimated to be US$1.4 billion/year, with a concomitant 36% reduction in P and the cost of reducing annual P loadings by 30% is estimated to be US$370 million/year, with a concomitant 9% reduction in nitrate-N.

Disproportionate-share hospital payment reductions may threaten the financial stability of safety-net hospitals.

PubMed

Neuhausen, Katherine; Davis, Anna C; Needleman, Jack; Brook, Robert H; Zingmond, David; Roby, Dylan H

2014-06-01

Safety-net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid (known as Medicaid shortfalls). The Affordable Care Act (ACA) anticipates that insurance expansion will increase safety-net hospitals' revenues and will reduce DSH payments accordingly. We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. Decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the act's DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation. Taking these three factors into account, we estimate that California public hospitals' total DSH costs will increase from $2.044 billion in 2010 to $2.363-$2.503 billion in 2019, with unmet DSH costs of $1.381-$1.537 billion. Project HOPE—The People-to-People Health Foundation, Inc.

Evaluating the causes of photovoltaics cost reduction: Why is PV different?

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

Trancik, Jessika; McNerney, James; Kavlak, Goksin

The goals of this project were to quantify sources of cost reduction in photovoltaics (PV), improve theories of technological evolution, develop new analytical methods, and formu- late guidelines for continued cost reduction in photovoltaics. A number of explanations have been suggested for why photovoltaics have come down in cost rapidly over time, including increased production rates, significant R&D expenditures, heavy patenting ac- tivity, decreasing material and input costs, scale economies, reduced plant construction costs, and higher conversion efficiencies. We classified these proposed causes into low- level factors and high-level drivers. Low-level factors include technical characteristics, such as module efficiency ormore » wafer area, which are easily posed in terms of variables of a cost equation. High-level factors include scale economies, research and development (R&D), and learning-by-doing.« less

The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States.

PubMed

Barbosa, Carolina; Cowell, Alexander; Dowd, William; Landwehr, Justin; Aldridge, Arnie; Bray, Jeremy

2017-02-01

To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. Ninety patients who received BT and 878 who received BI. Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P < 0.01). BT would be cost-effective if the decision-maker had a willingness to pay of $8.90 for a 1 percentage point reduction in the probability of using any alcohol. For the other five outcomes, BT was less effective and more costly, and BI would be a better use of resources. It might be cost-effective to offer brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources. © 2017 Society for the Study of Addiction.

A UK trial-based cost--utility analysis of transmyocardial laser revascularization compared to continued medical therapy for treatment of refractory angina pectoris.

PubMed

Campbell, H E; Tait, S; Buxton, M J; Sharples, L D; Caine, N; Schofield, P M; Wallwork, J

2001-08-01

Transmyocardial laser revascularization (TMLR) is used to treat patients with refractory angina considered unsuitable for conventional forms of revascularization. Using patient specific data from a single centre UK randomised-controlled trial, we aimed to determine whether, from a UK National Health Service (NHS) perspective, TMLR plus standard medical management is cost-effective when compared with standard medical management alone. One hundred and eighty-eight patients assessed as having refractory angina, and not suitable for conventional forms of revascularization were randomized to receive TMLR and medical management (94) or medical management alone (94). Costs to the UK NHS of TMLR (where appropriate), and all secondary sector health care contacts and cardiac-related medication in the 12 months following randomization, were collected. Patient utility as measured using the EuroQol EQ-5D questionnaire was combined with 12-month survival data to generate quality adjusted life years (QALYs). The mean cost per patient over the year from hospitalization for TMLR was 11,470 pounds sterling and for medical management alone was 2586 pounds sterling, giving a cost difference of 8901 pounds sterling (95% confidence interval (CI) 7502 pounds sterling--10,008 pounds sterling: P < 0.0001). The mean QALY difference, in favour of TMLR was 0.039 (95% CI -0.033 to 0.113: P = 0.268). This gives an incremental cost per QALY of over 228,000 pounds sterling. Analysis of stochastic uncertainty and of sensitivity to gross changes in key parameters consistently produces very high costs per QALY. The policy implications are clear: for such patients TMLR is an inefficient use of UK health service resources. This conclusion would not be changed by considerable improvements in effectiveness or reductions in cost.

A study of low cost approaches to scientific experiment implementation for shuttle launched and serviced automated spacecraft

NASA Technical Reports Server (NTRS)

1975-01-01

Cost reductions that can be obtained in experiment instrumentation by the use of standardized electronics and by the relaxation of instrument reliability requirements are studied. The feasibility of using standardized equipment for experiment instrumentation is assessed and a system design approach that most effectively incorporates standardized equipment is developed. The level and form of modularization that is appropriate for the standardized equipment is determined. Mission assurance aspects of instrument development are examined to determine the cost reductions that might be derived from the relaxation of reliability requirements and to formulate a systematic approach to the optimization of mission assurance cost reductions. The results of the analyses are applied to a representative model HEAO payload in order to provide a concrete example of the cost reductions that can be achieved by a standardized approach to the instrument electronics.

Comparison of automated satellite systems with conventional systems for hydrologic data collection in west-central Florida

USGS Publications Warehouse

Woodham, W.M.

1982-01-01

This report provides results of reliability and cost-effective studies of the goes satellite data-collection system used to operate a small hydrologic data network in west-central Florida. The GOES system, in its present state of development, was found to be about as reliable as conventional methods of data collection. Benefits of using the GOES system include some cost and manpower reduction, improved data accuracy, near real-time data availability, and direct computer storage and analysis of data. The GOES system could allow annual manpower reductions of 19 to 23 percent with reduction in cost for some and increase in cost for other single-parameter sites, such as streamflow, rainfall, and ground-water monitoring stations. Manpower reductions of 46 percent or more appear possible for multiple-parameter sites. Implementation of expected improvements in instrumentation and data handling procedures should further reduce costs. (USGS)

The economic considerations of patients and caregivers in choice of dialysis modality

PubMed Central

Howard, Kirsten; Tong, Allison; Palmer, Suetonia C.; Marshall, Mark R.; Morton, Rachael L.

2016-01-01

Abstract Introduction Broader adoption of home dialysis could lead to considerable cost savings for health services. Globally, however, uptake remains low. The aim of this study was to describe patient and caregiver perspectives of the economic considerations that influence dialysis modality choice, and elicit policy‐relevant recommendations. Methods Semistructured interviews with predialysis or dialysis patients and their caregivers, at three hospitals in New Zealand. Interview transcripts were analyzed thematically. Findings 43 patients and 9 caregivers (total n = 52) participated. The three themes related to economic considerations were: (i) productivity losses associated with changes in employment; (ii) the need for personal subsidization of home dialysis expenses; and (iii) the role of socio‐economic disadvantage as a barrier to home dialysis. Patients weighed the flexibility of home dialysis which allowed them to remain employed, against time required for training and out‐of‐pocket costs. Patients saw the lack of reimbursement of home dialysis costs as unjust and suggested that reimbursement would incentivize home dialysis uptake. Social disadvantage was a barrier to home dialysis as patients’ housing was often unsuitable; they could not afford the additional treatment costs. Home hemodialysis was considered to have the highest out‐of‐pocket costs and was sometimes avoided for this reason. Discussion Our data suggests that economic considerations underpin the choices patients make about dialysis treatments, however these are rarely reported. To promote home dialysis, strategies to improve employment retention and housing, and to minimize out‐of‐pocket costs, need to be addressed directly by healthcare providers and payers. PMID:27196634

COST OF SELECTIVE CATALYTIC REDUCTION (SCR) APPLICATION FOR NOX CONTROL ON COAL-FIRED BOILERS

EPA Science Inventory

The report provides a methodology for estimating budgetary costs associ-ated with retrofit applications of selec-tive catalytic reduction (SCR) technology on coal-fired boilers. SCR is a post-combustion nitrogen oxides (NOX) con-trol technology capable of providing NOX reductions...

Comparative analysis of heat pump and biomass boiler for small detached house heating

NASA Astrophysics Data System (ADS)

Olkowski, Tomasz; Lipiński, Seweryn; Olędzka, Aneta

2017-10-01

The purpose of the work is to answer the question - which of the two selected heat sources is more economically beneficial for small detached house: heat pump or biomass boiler fuelled with wood-pellets? The comparative analysis of these sources was carried out to discuss the issue. First, cost of both, equipment and operation of selected heat systems were analysed. Additionally, CO2 emission levels associated with these heat systems were determined. The comparative analysis of the costs of both considered heat systems showed that equipment cost of heat pump system is considerably bigger than the cost of biomass boiler system. The comparison of annual operation costs showed that heat pump operation cost is slightly lower than operation cost of biomass boiler. The analysis of above results shows that lower operation cost of heat pump in comparison with biomass boiler cost lets qualify heat pump as more economically justified only after 38 years of work. For both analysed devices, CO2 emission levels were determined. The considerations take into account the fact that heat pump consumes electricity. It is mostly generated through combustion of coal in Poland. The results show that in Poland biomass boiler can be described as not only more economically justified system but also as considerably more ecological.

Improving air pollution control policy in China--A perspective based on cost-benefit analysis.

PubMed

Gao, Jinglei; Yuan, Zengwei; Liu, Xuewei; Xia, Xiaoming; Huang, Xianjin; Dong, Zhanfeng

2016-02-01

To mitigate serious air pollution, the State Council of China promulgated the Air Pollution Prevention and Control Action Plan in 2013. To verify the feasibility and validity of industrial energy-saving and emission-reduction policies in the action plan, we conducted a cost-benefit analysis of implementing these policies in 31 provinces for the period of 2013 to 2017. We also completed a scenario analysis in this study to assess the cost-effectiveness of different measures within the energy-saving and the emission-reduction policies individually. The data were derived from field surveys, statistical yearbooks, government documents, and published literatures. The results show that total cost and total benefit are 118.39 and 748.15 billion Yuan, respectively, and the estimated benefit-cost ratio is 6.32 in the S3 scenario. For all the scenarios, these policies are cost-effective and the eastern region has higher satisfactory values. Furthermore, the end-of-pipe scenario has greater emission reduction potential than energy-saving scenario. We also found that gross domestic product and population are significantly correlated with the benefit-cost ratio value through the regression analysis of selected possible influencing factors. The sensitivity analysis demonstrates that benefit-cost ratio value is more sensitive to unit emission-reduction cost, unit subsidy, growth rate of gross domestic product, and discount rate among all the parameters. Compared with other provinces, the benefit-cost ratios of Beijing and Tianjin are more sensitive to changes of unit subsidy than unit emission-reduction cost. These findings may have significant implications for improving China's air pollution prevention policy. Copyright © 2015 Elsevier B.V. All rights reserved.

Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives.

PubMed

Vozzola, Eric; Overcash, Michael; Griffing, Evan

2018-04-11

Isolation gowns serve a critical role in infection control by protecting healthcare workers, visitors, and patients from the transfer of microorganisms and body fluids. The decision of whether to use a reusable or disposable garment system is a selection process based on factors including sustainability, barrier effectiveness, cost, and comfort. Environmental sustainability is increasingly being used in the decision-making process. Life cycle assessment is the most comprehensive and widely used tool used to evaluate environmental performance. The environmental impacts of market-representative reusable and disposable isolation gown systems were compared using standard life cycle assessment procedures. The basis of comparison was 1,000 isolation gown uses in a healthcare setting. The scope included the manufacture, use, and end-of-life stages of the gown systems. At the healthcare facility, compared to the disposable gown system, the reusable gown system showed a 28% reduction in energy consumption, a 30% reduction in greenhouse gas emissions, a 41% reduction in blue water consumption, and a 93% reduction in solid waste generation. Selecting reusable garment systems may result in significant environmental benefits compared to selecting disposable garment systems. By selecting reusable isolation gowns, healthcare facilities can add these quantitative benefits directly to their sustainability scorecards. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Analysis of improved government geological map information for mineral exploration: Incorporating efficiency, productivity, effectiveness, and risk considerations

USGS Publications Warehouse

Bernknopf, R.L.; Wein, A.M.; St-Onge, M. R.; Lucas, S.B.

2007-01-01

This bulletin/professional paper focuses on the value of geoscientific information and knowledge, as provided in published government bedrock geological maps, to the mineral exploration sector. An economic model is developed that uses an attribute- ranking approach to convert geological maps into domains of mineral favourability. Information about known deposits in these (or analogous) favourability domains allow the calculation of exploration search statistics that provide input into measures of exploration efficiency, productivity, effectiveness, risk, and cost stemming from the use of the published geological maps. Two case studies, the Flin Flon Belt (Manitoba and Saskatchewan) and the south Baffin Island area (Nunavut), demonstrate that updated, finer resolution maps can be used to identify more exploration campaign options, and campaigns thats are more efficient, more effective, and less risky than old, coarser resolution maps when used as a guide for mineral exploration. The Flin Flon Belt study illustrates that an updated, coarser resolution bedrock map enables improved mineral exploration efficiency, productivity, and effectiveness by locating 60% more targets and supporting an exploration campaign that is 44% more efficient. Refining the map resolution provides an additional 17% reduction in search effort across all favourable domains and a 55% reduction in search effort in the most favourable domain. The south Baffin Island case study projects a 40% increase in expected targets and a 27% reduction in search effort when the updated, finer resolution map is used in lieu of the old, coarser resolution map. On southern Baffin Island, the economic value of the up dated map ranges from CAN$2.28 million to CAN$15.21 million, which can be compared to the CAN$1.86 million that it cost to produce the map (a multiplier effect of up to eight).

Scaling of economic benefits from Green Roof implementation in Washington, DC.

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

Niu, H.; Clark, C. E.; Zhou, J.

2010-06-01

Green roof technology is recognized for mitigating stormwater runoff and energy consumption. Methods to overcome the cost gap between green roofs and conventional roofs were recently quantified by incorporating air quality benefits. This study investigates the impact of scaling on these benefits at the city-wide scale using Washington, DC as a test bed because of the proposed targets in the 20-20-20 vision (20 million ft{sup 2} by 2020) articulated by Casey Trees, a nonprofit organization. Building-specific stormwater benefits were analyzed assuming two proposed policy scenarios for stormwater fees ranging from 35 to 50% reduction for green roof implementation. Heat fluxmore » calculations were used to estimate building-specific energy savings for commercial buildings. To assess benefits at the city scale, stormwater infrastructure savings were based on operational savings and size reduction due to reduced stormwater volume generation. Scaled energy infrastructure benefits were calculated using two size reductions methods for air conditioners. Avoided carbon dioxide, nitrogen oxide (NOx), and sulfur dioxide emissions were based on reductions in electricity and natural gas consumption. Lastly, experimental and fugacity-based estimates were used to quantify the NOx uptake by green roofs, which was translated to health benefits using U.S. Environmental Protection Agency models. The results of the net present value (NPV) analysis showed that stormwater infrastructure benefits totaled $1.04 million (M), while fee-based stormwater benefits were $0.22-0.32 M/y. Energy savings were $0.87 M/y, while air conditioner resizing benefits were estimated at $0.02 to $0.04 M/y and avoided emissions benefits (based on current emission trading values) were $0.09 M-0.41 M/y. Over the lifetime of the green roof (40 years), the NPV is about 30-40% less than that of conventional roofs (not including green roof maintenance costs). These considerable benefits, in concert with current and emerging policy frameworks, may facilitate future adoption of this technology.« less

Scaling of economic benefits from green roof implementation in Washington, DC.

PubMed

Niu, Hao; Clark, Corrie; Zhou, Jiti; Adriaens, Peter

2010-06-01

Green roof technology is recognized for mitigating stormwater runoff and energy consumption. Methods to overcome the cost gap between green roofs and conventional roofs were recently quantified by incorporating air quality benefits. This study investigates the impact of scaling on these benefits at the city-wide scale using Washington, DC as a test bed because of the proposed targets in the 20-20-20 vision (20 million ft(2) by 2020) articulated by Casey Trees, a nonprofit organization. Building-specific stormwater benefits were analyzed assuming two proposed policy scenarios for stormwater fees ranging from 35 to 50% reduction for green roof implementation. Heat flux calculations were used to estimate building-specific energy savings for commercial buildings. To assess benefits at the city scale, stormwater infrastructure savings were based on operational savings and size reduction due to reduced stormwater volume generation. Scaled energy infrastructure benefits were calculated using two size reductions methods for air conditioners. Avoided carbon dioxide, nitrogen oxide (NO(x)), and sulfur dioxide emissions were based on reductions in electricity and natural gas consumption. Lastly, experimental and fugacity-based estimates were used to quantify the NO(x) uptake by green roofs, which was translated to health benefits using U.S. Environmental Protection Agency models. The results of the net present value (NPV) analysis showed that stormwater infrastructure benefits totaled $1.04 million (M), while fee-based stormwater benefits were $0.22-0.32 M/y. Energy savings were $0.87 M/y, while air conditioner resizing benefits were estimated at $0.02 to $0.04 M/y and avoided emissions benefits (based on current emission trading values) were $0.09 M-0.41 M/y. Over the lifetime of the green roof (40 years), the NPV is about 30-40% less than that of conventional roofs (not including green roof maintenance costs). These considerable benefits, in concert with current and emerging policy frameworks, may facilitate future adoption of this technology.

Wastewater recycling and heat reclamation project: Red Lion Central Laundry, Portland, Oregon

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

Garlick, T.F.; Halverson, M.A.; Ledbetter, M.R.

1997-06-01

This report discusses water, energy, and cost savings that can be achieved in a commercial laundry through the use of a wastewater recycling and heat recovery system. Cost savings are achieved through reductions in water use, reduction in sewage charges (typically based on water use), reductions in water heating energy, and potential reductions in water treatment chemicals because the recycled water has already been treated with soaps and conditioners. A recovery system saves water by recycling wash water that would normally be dumped into the city sewage system. Recycling the wash water produces considerable energy savings because the recycled watermore » has a higher temperature than fresh water. As a result, a hot water heater consumes less energy to heat the recycled water. The demonstration project discussed in this report was based in a large commercial laundry in Portland, Oregon. The laundry serves a large hotel/motel chain and processes an average of 25,000 pounds of laundry per day. A wastewater recovery system using a membrane microfiltration unit (MFU) was installed in the laundry in September 1995. Time series data of the water and energy consumption of the laundry were taken before and after installation of the MFU. Energy savings were measured by performing a thermal energy balance around the washing machines. Water savings were calculated by metering volumetric flow rates. After a period of approximately five months, the MFU has achieved final results of 52 percent savings in water consumption and 44 percent savings in energy to heat water. This five-month period represents a learning curve during which several small technical improvements were made to the MFU and laundry staff adjusted laundry operations to maximize the benefits of the MFU. An economic analysis discusses the impact of capital investment, daily consumption, and local utility rates on the payback period.« less

Effectiveness and Cost-effectiveness of Four Treatment Modalities for Substance Disorders: A Propensity Score Analysis

PubMed Central

Mojtabai, Ramin; Graff Zivin, Joshua

2003-01-01

Objective To assess the effectiveness and cost-effectiveness of four treatment modalities for substance abuse. Data Sources The study used data from the Services Research Outcomes Study (SROS), a survey of 3,047 clients in a random sample of 99 drug treatment facilities across the United States. Detailed sociodemographic, substance use, and clinical data were abstracted from treatment records. Substance abuse outcome and treatment history following discharge from index facilities were assessed using a comprehensive interview with 1,799 of these individuals five years after discharge. Treatment success was defined in two ways: as abstinence and as any reduction in substance use. Study Design Effectiveness and cost-effectiveness of four modalities were compared: inpatient, residential, outpatient detox/methadone, and outpatient drug-free. Clients were stratified based on propensity scores and analyses were conducted within these strata. Sensitivity analyses examined the impact of future substance abuse treatment on effectiveness and cost-effectiveness estimates. Principal Findings Treatment of substance disorders appears to be cost-effective compared to other health interventions. The cost per successfully treated abstinent case in the least costly modality, the outpatient drug-free programs, was $6,300 (95 percent confidence intervals: $5,200–$7,900) in 1990 dollars. There were only minor differences between various modalities of treatment with regard to effectiveness. However, modalities varied considerably with regard to cost-effectiveness. Outpatient drug-free programs were the most cost-effective. There was little evidence that relative effectiveness or cost-effectiveness of programs varied according to factors that were associated with selection into different programs. Conclusions Substance disorders can be treated most cost-effectively in outpatient drug-free settings. Savings from transitioning to the most cost-effective treatment modality may free resources that could be reinvested to improve access to substance abuse treatment for a larger number of individuals in need of such treatment. PMID:12650390

Weather Driven Renewable Energy Analysis, Modeling New Technologies

NASA Astrophysics Data System (ADS)

Paine, J.; Clack, C.; Picciano, P.; Terry, L.

2015-12-01

Carbon emission reduction is essential to hampering anthropogenic climate change. While there are several methods to broach carbon reductions, the National Energy with Weather System (NEWS) model focuses on limiting electrical generation emissions by way of a national high-voltage direct-current transmission that takes advantage of the strengths of different regions in terms of variable sources of energy. Specifically, we focus upon modeling concentrating solar power (CSP) as another source to contribute to the electric grid. Power tower solar fields are optimized taking into account high spatial and temporal resolution, 13km and hourly, numerical weather prediction model data gathered by NOAA from the years of 2006-2008. Importantly, the optimization of these CSP power plants takes into consideration factors that decrease the optical efficiency of the heliostats reflecting solar irradiance. For example, cosine efficiency, atmospheric attenuation, and shadowing are shown here; however, it should be noted that they are not the only limiting factors. While solar photovoltaic plants can be combined for similar efficiency to the power tower and currently at a lower cost, they do not have a cost-effective capability to provide electricity when there are interruptions in solar irradiance. Power towers rely on a heat transfer fluid, which can be used for thermal storage changing the cost efficiency of this energy source. Thermal storage increases the electric stability that many other renewable energy sources lack, and thus, the ability to choose between direct electric conversion and thermal storage is discussed. The figure shown is a test model of a CSP plant made up of heliostats. The colors show the optical efficiency of each heliostat at a single time of the day.

Reductive Degradation: Versatile, Low Cost.

ERIC Educational Resources Information Center

Water and Sewage Works, 1979

1979-01-01

This article discusses the use of reductive degradation as an economical and effective treatment of chlorinated hydrocarbons. Comparisons with activated carbon treatment show lower capital equipment and treatment costs. (CS)

Cost-effectiveness analysis of rotavirus vaccination in China: Projected possibility of scale-up from the current domestic option.

PubMed

Cui, Shuhui; Tobe, Ruoyan Gai; Mo, Xiuting; Liu, Xiaoyan; Xu, Lingzhong; Li, Shixue

2016-11-15

Rotavirus infection causes considerable disease burden of acute gastroenteritis (AGE) hospitalization and death among children less than 5 years in China. Although two rotavirus vaccines (Rotarix and RotaTeq) have been licensed in more than 100 countries in the world, the Lanzhou Lamb rotavirus vaccine (LLR) is the only vaccine licensed in China. This study aims to forecast the potential impacts of the two international vaccines compared to domestic LLR. An economic evaluation was performed using a Markov simulation model. We compared costs at the societal aspect and health impacts with and without a vaccination program by LLR, Rotarix or RotaTeq. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from literature review. The model incorporated the impact of vaccination on reduction of incidence of rotavirus infection and severity of AGE indicated by hospitalization, inpatient visits and deaths. Outcomes are presented in terms of quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio (ICER) compared to status quo. In a hypothetical cohort of 100,000 infants, the two international vaccines showed very good cost-effectiveness, with ICER of Rotateq and Rotarix shifting from LLR of $1715.11/QALY and $2105.66/QALY, respectively. Rotateq and Rotarix had significantly decreased incidence compared to LLR, particularly among infants aged 6 months to 2 years. RotaTeq is expected to introduce in the national routine immunization program to reduce disease burden of rotavirus infection with universal coverage.

Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short-Acting β-Agonist Formulations.

PubMed

Zeng, Yaohui; Singh, Sachinkumar; Wang, Kai; Ahrens, Richard C

2018-04-01

Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3-by-1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration-recommended 3-by-1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3-by-1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90-μg test dose and a 720-μg reference dose (42% cost reduction). Combining a 180-μg test dose and a 720-μg reference dose produced an estimated 36% cost reduction. © 2017, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

Understanding the reductions in US corn ethanol production costs: an experience curve approach

USDA-ARS?s Scientific Manuscript database

The US is currently the world's largest ethanol producer. An increasing percentage is used as transportation fuel, but debates continue on its cost competitiveness and energy balance. In this study, technological development of ethanol production and resulting cost reductions are investigated by usi...

The Cost of Online Learning.

ERIC Educational Resources Information Center

Milshtein, Amy

2001-01-01

Examines development considerations and tips for controlling costs when a university decides to develop an online distance learning service. Use of the interactive Web Site for Determining Costs tool for unveiling hidden costs is highlighted. (GR)

[A full economic evaluation of extensive vaccination against rotavirus with RIX4414 vaccine at National and Regional level in Italy].

PubMed

Vitale, F; Barbieri, M; Dirodi, B; Vitali Rosati, G; Franco, E

2013-01-01

Vaccination of all healthy children against rotavirus (RV) has been recommended, since the availability of vaccines, both in Europe (PIDJ) and Italy (pediatricians). The aims of universal vaccination against RV include the protection of children against moderate/severe gastroenteritis forms by RV (GARV), prevent hospitalizations, reduce the severity and duration of the disease, and reduce morbidity and socioeconomic costs. Payers need to informed regarding the efficacy and the healthcare utilization related to RV vaccination in order to decide in favour of its extensive implementation. The aim of this paper is to assess the clinical and financial impact of the extensive vaccination aganist RV both at National and Regional level. Particular attention, compared to the previous analysis (Standaert et al, 2008) has been given to the influence of herd immunity (HI) on cost-utility results of vaccination against-RV. Methods. The analysis was conducted with the Markovian model previously used by Standaert B et al and updated for comparing costs and benefits associated with a situation of vaccination anti-RV that includes efficacy data due to HI, with a situation without vaccination. For the base case is assumed an annual coverage of 90%, where the effect of HI is present in the population at risk (0-5 years) and extended to children who have not been vaccinated, adding as conservative assumption, a further 10% to the efficacy of the vaccine, compared to 15% determined by several published studies. Two analysis have been made based on this model: a cost-utility analysis that compared vaccination with two doses of RIX441410 administered at 2 and 3 months after birth compared with no vaccination from National Health Service and Society perspective; a budget impact analysis at National and Regional level. The evaluation has as its main element the reduction of cases of infection through universal vaccination and consequent reduction of Garv events and nosocomial infections. Results. From the NHS perspective, in a cohort of 555,791 born in Italy in 2011, the annual number of hospitalizations due to RV infections in the absence of vaccination is estimated to be 14,550 units. Assuming that 90% of newborns receive two doses of the vaccine, and including an additional effect of HI to the efficacy of the vaccine, vaccination would lead to a reduction of 71% of cases of Garv (176,804 cases in less) and a 86% of hospitalizations due to Garv (12,913 fewer cases), with an impact on quality of life and mortality as a consequence of vaccination. The introduction of the vaccine would lead to a gain of 0.0014 QALYs and 0.0022 life-years gained per child compared to a situation without vaccination (assuming a discount rate of 3% on future benefits). The reduction of GARV also would lead to a strong economic impact. The introduction of the vaccine would lead to a saving of € 25.41 per child or a saving of more than € 14 million for the whole population included in the analysis. Cost reduction increase significantly from the perspective of society and introducing the indirect costs due to lost productivity. In this case, the savings due to the introduction of vaccination would increase to € 67,747,654 in the total cohort, or € 121.89 per child. In an alternative scenario, where HI is excluded, RIX4414 remains dominant (0.0013 QALYs gained and € 22.14 per child saved). The budget impact analysis shows that, as early as the second year, the additional cost of the vaccine is more than offset by a reduction in costs of the disease, which leads to savings for the NHS, which increases from year 3. In a time horizon of 5 years (without the discount rate), the savings for the NHS amount to € 34,440,314. These savings would amount to a cost reduction of € 4.64 per child over 5 years (€ 0.93 per year). The savings due to the introduction of the vaccine were mainly due to a reduction in costs associated with hospitalizations. The budget impact analysis at regional level, has taken a vaccine cost of € 30.00 per dose. Cases of diarrhoea before after vaccination are reduced in each region, based on the number of births, ranging from a minimum of 399 cases avoided for Valle d'Aosta to a maximum of 31,116 cases avoided in Lombardy. In a similar way, the number of hospitalizations due to GARV are reduced considerably, from a minimum of 36 cases in Valle d'Aosta to a maximum of 3,096 in Lombardy. Obviously, these reductions are greater in regions with 30,000 or more births per year. Conclusions. This study suggests that a universal vaccination anti-RV with 2 doses of RIX4414 brings significant clinical and economic benefits both at National and Regional level. The indirect effects of the vaccine (HI) could generate protection even in unvaccinated children with health gain and a number of cases by GARV much less than those that would vaccinating small groups of children and with a cost of illness, for NHS, which would be reduced significantly, despite the additional costs of the vaccine as early as the second year of vaccination. Productivity losses due to absence from work of a parent, as well as all other costs included in the model, show that is precisely the society to pay the consequences, from economic and social point of view. Considering the citizen in the role of private payer, we must stress as for him, the savings generated by vaccination, whether universal or with demand for cost-sharing by the health service, prove significant with a major health gain for the population under study.

Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study.

PubMed

Brennan, Alan; Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

2014-09-30

To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Modelling study using the Sheffield Alcohol Policy Model version 2.5. England 2014-15. Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45 p, and 50 p per unit (7.9 g/10 mL) of pure alcohol. Changes in mean consumption in terms of units of alcohol, drinkers' expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45 p minimum unit price. Below cost selling is estimated to reduce harmful drinkers' mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45 p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health-saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45 p minimum unit price is estimated to save 624 deaths and 23,700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40 p and 50 p per unit, is estimated to have an approximately 40-50 times greater effect. © Brennan et al 2014.

Potential benefits of minimum unit pricing for alcohol versus a ban on below cost selling in England 2014: modelling study

PubMed Central

Meng, Yang; Holmes, John; Hill-McManus, Daniel; Meier, Petra S

2014-01-01

Objective To evaluate the potential impact of two alcohol control policies under consideration in England: banning below cost selling of alcohol and minimum unit pricing. Design Modelling study using the Sheffield Alcohol Policy Model version 2.5. Setting England 2014-15. Population Adults and young people aged 16 or more, including subgroups of moderate, hazardous, and harmful drinkers. Interventions Policy to ban below cost selling, which means that the selling price to consumers could not be lower than tax payable on the product, compared with policies of minimum unit pricing at £0.40 (€0.57; $0.75), 45p, and 50p per unit (7.9 g/10 mL) of pure alcohol. Main outcome measures Changes in mean consumption in terms of units of alcohol, drinkers’ expenditure, and reductions in deaths, illnesses, admissions to hospital, and quality adjusted life years. Results The proportion of the market affected is a key driver of impact, with just 0.7% of all units estimated to be sold below the duty plus value added tax threshold implied by a ban on below cost selling, compared with 23.2% of units for a 45p minimum unit price. Below cost selling is estimated to reduce harmful drinkers’ mean annual consumption by just 0.08%, around 3 units per year, compared with 3.7% or 137 units per year for a 45p minimum unit price (an approximately 45 times greater effect). The ban on below cost selling has a small effect on population health—saving an estimated 14 deaths and 500 admissions to hospital per annum. In contrast, a 45p minimum unit price is estimated to save 624 deaths and 23 700 hospital admissions. Most of the harm reductions (for example, 89% of estimated deaths saved per annum) are estimated to occur in the 5.3% of people who are harmful drinkers. Conclusions The ban on below cost selling, implemented in the England in May 2014, is estimated to have small effects on consumption and health harm. The previously announced policy of a minimum unit price, if set at expected levels between 40p and 50p per unit, is estimated to have an approximately 40-50 times greater effect. PMID:25270743

Using discrete choice experiments within a cost-benefit analysis framework: some considerations.

PubMed

McIntosh, Emma

2006-01-01

A great advantage of the stated preference discrete choice experiment (SPDCE) approach to economic evaluation methodology is its immense flexibility within applied cost-benefit analyses (CBAs). However, while the use of SPDCEs in healthcare has increased markedly in recent years there has been a distinct lack of equivalent CBAs in healthcare using such SPDCE-derived valuations. This article outlines specific issues and some practical suggestions for consideration relevant to the development of CBAs using SPDCE-derived benefits. The article shows that SPDCE-derived CBA can adopt recent developments in cost-effectiveness methodology including the cost-effectiveness plane, appropriate consideration of uncertainty, the net-benefit framework and probabilistic sensitivity analysis methods, while maintaining the theoretical advantage of the SPDCE approach. The concept of a cost-benefit plane is no different in principle to the cost-effectiveness plane and can be a useful tool for reporting and presenting the results of CBAs.However, there are many challenging issues to address for the advancement of CBA methodology using SPCDEs within healthcare. Particular areas for development include the importance of accounting for uncertainty in SPDCE-derived willingness-to-pay values, the methodology of SPDCEs in clinical trial settings and economic models, measurement issues pertinent to using SPDCEs specifically in healthcare, and the importance of issues such as consideration of the dynamic nature of healthcare and the resulting impact this has on the validity of attribute definitions and context.

The Impact of Accounting Methods on Cost Reduction Rates in Defense Aerospace Weapons System Programs

DTIC Science & Technology

1988-12-01

and adhered to in U.S. industry, allow some flexibility in accounting. Under GAAP , accounting areas such as depreciation , inventory, investment tax... depreciation , inventory and investment tax credit) in predicting cost reduction rates are studied. Of the three accounting variables, only inventory...RATES .. ................. ........... 5 1. Depreciation ........ ............... 6 2. Capitalizing or Expensing of Costs . . .. 6 3. Material Costs

Benchmarking U.S. Small Wind Costs with the Distributed Wind Taxonomy

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

Orrell, Alice C.; Poehlman, Eric A.

The objective of this report is to benchmark costs for small wind projects installed in the United States using a distributed wind taxonomy. Consequently, this report is a starting point to help expand the U.S. distributed wind market by informing potential areas for small wind cost-reduction opportunities and providing a benchmark to track future small wind cost-reduction progress.

Metabolic Cost of Lateral Stabilization during Walking in People with Incomplete Spinal Cord Injury

PubMed Central

Matsubara, J.H.; Wu, M.; Gordon, K.E.

2015-01-01

People with incomplete spinal cord injury (iSCI) expend considerable energy to walk, which can lead to rapid fatigue and limit community ambulation. Selecting locomotor patterns that enhance lateral stability may contribute to this population’s elevated cost of transport. The goal of the current study was to quantify the metabolic energy demands of maintaining lateral stability during gait in people with iSCI. To quantify this metabolic cost, we observed ten individuals with iSCI walking with and without external lateral stabilization. We hypothesized that with external lateral stabilization, people with iSCI would adapt their gait by decreasing step width, which would correspond with a substantial decrease in cost of transport. Our findings support this hypothesis. Subjects significantly (p < 0.05) decreased step width by 22%, step width variability by 18%, and minimum lateral margin of stability by 25% when they walked with external lateral stabilization compared to unassisted walking. Metabolic cost of transport also decreased significantly (p < 0.05) by 10% with external lateral stabilization. These findings suggest that this population is capable of adapting their gait to meet changing demands placed on balance. The percent reduction in cost of transport when walking with external lateral stabilization was strongly correlated with functional impairment level as assessed by subjects’ scores on the Berg Balance Scale (R = 0.778) and Lower Extremity Motor Score (R = 0.728). These relationships suggest that as functional balance and strength decrease, the amount of metabolic energy used to maintain lateral stability during gait will increase. PMID:25670651

Use of hypofractionated post-mastectomy radiotherapy reduces health costs by over $2000 per patient: An Australian perspective.

PubMed

Mortimer, Joshua W; McLachlan, Craig S; Hansen, Carmen J; Assareh, Hassan; Last, Andrew; McKay, Michael J; Shakespeare, Thomas P

2016-02-01

The most recent clinical practice guidelines released by Cancer Australia draw attention to unanswered questions concerning the health economic considerations associated with hypofractionated radiotherapy. This study aimed to quantify and compare the healthcare costs at a regional Australian radiotherapy institute with respect to conventionally fractionated post-mastectomy radiotherapy (Cf-PMRT) versus hypofractionated post-mastectomy radiotherapy (Hf-PMRT) administration. Medical records of 196 patients treated with post-mastectomy radiotherapy at the NSW North Coast Cancer Institute from February 2008 to June 2014 were retrospectively reviewed. Australian Medicare item numbers billed for patients receiving either Cf-PMRT of 50 Gy in 25 daily fractions or Hf-PMRT of 40.05 Gy in 15 daily fractions were calculated. Decision tree analysis was used to model costs. Independent-samples t-tests and Mann-Whitney U-tests were used to compare crude average costs for Cf-PMRT and Hf-PMRT and determine which treatment components accounted for any differences. Hf-PMRT, with or without irradiation to the regional lymph nodes, was associated with significantly reduced Medicare costs ($5613 AUD per patient for Hf-PMRT vs $8272 AUD per patient for Cf-PMRT; P < 0.001). Savings associated with Hf-PMRT ranged from $1353 (22.1%) for patients receiving no regional irradiation to $2898 (32.0%) for patients receiving both axillary and supraclavicular therapy. Hf-PMRT results in a significant reduction in the financial costs associated with treating breast cancer patients in a regional Australian setting when compared with Cf-PMRT. © 2015 The Royal Australian and New Zealand College of Radiologists.

Gathering Information on Costs of Service: Some Basic Considerations for Implementation of PURPA,

DTIC Science & Technology

1979-10-01

UNCLASSFIED RAND/P-6b22 ML."’ II I I I ll6lllllUi GATHERING INFORMATION ON COSTS OF .SERVICE: SOME BASIC CONSIDERATIONS FOR IMPLEMENTATION OF PURPA ...CONSIDERATIONS FOR IMPLEMENTATION OF PURPA Jan Paul Acton, Frank Camm, Derek McKay P-6422 October 1979 4v, P ,. . • L .... .S -iii- PREFACE In the period following...the passage of the Public Utility Regulatory Policies Act of 1978( PURPA ) the Federal Energy Regulatory Commission was responsible for the generation

Mate guarding in the Seychelles warbler is energetically costly and adjusted to paternity risk.

PubMed

Komdeur, J

2001-10-22

Males may increase their fitness through extra-pair copulations (copulations outside the pair bond) that result in extra-pair fertilizations, but also risk lost paternity when they leave their own mate unguarded. The fitness costs of cuckoldry for Seychelles warblers (Acrocephalus sechellensis) are considerable because warblers have a single-egg clutch and, given the short breeding season, no time for a successful replacement clutch. Neighbouring males are the primary threat to a male's genetic paternity. Males minimize their loss of paternity by guarding their mates to prevent them from having extra-pair copulations during their fertile period. Here, I provide experimental evidence that mate-guarding behaviour is energetically costly and that the expression of this trade-off is adjusted to paternity risk (local male density). Free-living males that were induced to reduce mate guarding spent significantly more time foraging and gained significantly better body condition than control males. The larger the reduction in mate guarding, the more pronounced was the increase in foraging and body condition (accounting for food availability). An experimental increase in paternity risk resulted in an increase in mate-guarding intensity and a decrease in foraging and body condition, and vice versa. This is examined using both cross-sectional and longitudinal data. This study on the Seychelles warbler offers experimental evidence that mate guarding is energetically costly and adjusted to paternity risk.

Efficacy and safety of a conversion from the original tacrolimus and mycophenolate mofetil to the generics Tacpan® and Mowel® after liver transplantation

PubMed Central

Vollmar, Johanna; Bellmann, Maren Christina; Darstein, Felix; Hoppe-Lotichius, Maria; Mittler, Jens; Heise, Michael; Rüttger, Bernd; Weyer, Veronika; Zimmermann, Anca; Lang, Hauke; Galle, Peter R; Zimmermann, Tim

2015-01-01

Background Expensive pharmaceuticals are a major reason for cost intensive health care systems. Long-term immunosuppressive therapy plays a relevant role after organ transplantation. Patents of original drugs have expired and cheaper products are available. Little data are available regarding efficacy and safety of generic immunosuppressive agents. Methods In this prospective study, 25 patients, who were clinically stable for a minimum of 2 years after liver transplantation, were converted from the original formulations of tacrolimus (TAC) and mycophenolate mofetil to the generics Tacpan® (TAP) and Mowel® (MOW). Patients were followed-up for 6 months. Results were compared retrospectively to 25 age- and sex-matched controls treated with the original brands. Results In the matched-pair analysis of TAC trough level/dose ratio, no significant difference was found between TAP/MOW and TAC/mycophenolate mofetil groups. No acute rejection occurred in either group. In total, 17 patients reported mild side effects in the TAP/MOW group. The most common side effects were gastrointestinal symptoms. Intra-individual analysis of costs revealed a considerable cost reduction in the TAP/MOW group (in median 25.03%; P<0.001). Conclusion In summary, the use of the generics TAP/MOW is effective and seems to be safe and cost-efficient in stable liver-transplantation patients. PMID:26604701

Incremental costs of introducing jet injection technology for delivery of routine childhood vaccinations: comparative analysis from Brazil, India, and South Africa.

PubMed

Griffiths, Ulla K; Santos, Andreia C; Nundy, Neeti; Jacoby, Erica; Matthias, Dipika

2011-01-29

Disposable-syringe jet injectors (DSJIs) have the potential to deliver vaccines safely and affordably to millions of children around the world. We estimated the incremental costs of transitioning from needles and syringes to delivering childhood vaccines with DSJIs in Brazil, India, and South Africa. Two scenarios were assessed: (1) DSJI delivery of all vaccines at current dose and depth; (2) a change to intradermal (ID) delivery with DSJIs for hepatitis B and yellow fever vaccines, while the other vaccines are delivered by DSJIs at current dose and depth. The main advantage of ID delivery is that only a small fraction of the standard dose may be needed to obtain an immune response similar to that of subcutaneous or intramuscular injection. Cost categories included were vaccines, injection equipment, waste management, and vaccine transport. Some delivery cost items, such as training and personnel were excluded as were treatment cost savings caused by a reduction in diseases transmitted due to unsafe injections. In the standard dose and depth scenario, the incremental costs of introducing DSJIs per fully vaccinated child amount to US$ 0.57 in Brazil, US$ 0.65 in India and US$ 1.24 in South Africa. In the ID scenario, there are cost savings of US$ 0.11 per child in Brazil, and added costs of US$ 0.45 and US$ 0.76 per child in India and South Africa, respectively. The most important incremental cost item is jet injector disposable syringes. The incremental costs should be evaluated against other vaccine delivery technologies that can deliver the same benefits to patients, health care workers, and the community. DSJIs deserve consideration by global and national decision-makers as a means to expand access to ID delivery and to enhance safety at marginal additional cost. Copyright © 2010 Elsevier Ltd. All rights reserved.

Engineering and Fabrication Considerations for Cost-Effective Space Reactor Shield Development

NASA Astrophysics Data System (ADS)

Berg, Thomas A.; Disney, Richard K.

2004-02-01

Investment in developing nuclear power for space missions cannot be made on the basis of a single mission. Current efforts in the design and fabrication of the reactor module, including the reactor shield, must be cost-effective and take into account scalability and fabricability for planned and future missions. Engineering considerations for the shield need to accommodate passive thermal management, varying radiation levels and effects, and structural/mechanical issues. Considering these challenges, design principles and cost drivers specific to the engineering and fabrication of the reactor shield are presented that contribute to lower recurring mission costs.

Engineering and Fabrication Considerations for Cost-Effective Space Reactor Shield Development

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

Berg, Thomas A.; Disney, Richard K.

Investment in developing nuclear power for space missions cannot be made on the basis of a single mission. Current efforts in the design and fabrication of the reactor module, including the reactor shield, must be cost-effective and take into account scalability and fabricability for planned and future missions. Engineering considerations for the shield need to accommodate passive thermal management, varying radiation levels and effects, and structural/mechanical issues. Considering these challenges, design principles and cost drivers specific to the engineering and fabrication of the reactor shield are presented that contribute to lower recurring mission costs.

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

PubMed

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

2013-07-01

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

Bookending the Opportunity to Lower Wind’s LCOE by Reducing the Uncertainty Surrounding Annual Energy Production

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

Bolinger, Mark

Reducing the performance risk surrounding a wind project can potentially lead to a lower weighted-average cost of capital (WACC), and hence a lower levelized cost of energy (LCOE), through an advantageous shift in capital structure, and possibly also a reduction in the cost of capital. Specifically, a reduction in performance risk will move the 1-year P99 annual energy production (AEP) estimate closer to the P50 AEP estimate, which in turn reduces the minimum debt service coverage ratio (DSCR) required by lenders, thereby allowing the project to be financed with a greater proportion of low-cost debt. In addition, a reduction inmore » performance risk might also reduce the cost of one or more of the three sources of capital that are commonly used to finance wind projects: sponsor or cash equity, tax equity, and/or debt. Preliminary internal LBNL analysis of the maximum possible LCOE reduction attainable from reducing the performance risk of a wind project found a potentially significant opportunity for LCOE reduction of ~$10/MWh, by reducing the P50 DSCR to its theoretical minimum value of 1.0 (Bolinger 2015b, 2014) and by reducing the cost of sponsor equity and debt by one-third to one-half each (Bolinger 2015a, 2015b). However, with FY17 funding from the U.S. Department of Energy’s Atmosphere to Electrons (A2e) Performance Risk, Uncertainty, and Finance (PRUF) initiative, LBNL has been revisiting this “bookending” exercise in more depth, and now believes that its earlier preliminary assessment of the LCOE reduction opportunity was overstated. This reassessment is based on two new-found understandings: (1) Due to ever-present and largely irreducible inter-annual variability (IAV) in the wind resource, the minimum required DSCR cannot possibly fall to 1.0 (on a P50 basis), and (2) A reduction in AEP uncertainty will not necessarily lead to a reduction in the cost of capital, meaning that a shift in capital structure is perhaps the best that can be expected (perhaps along with a modest decline in the cost of cash equity as new investors enter the market).« less

24 CFR 990.165 - Computation of project expense level (PEL).

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Ownership type (profit, non-profit, or limited dividend); and (10) Geographic. (c) Cost adjustments. HUD... ceiling; (3) Application of a four percent reduction for any PEL calculated over $325 PUM, with the reduction limited so that a PEL will not be reduced to less than $325; and (4) The reduction of audit costs...

Economic choice for hardwood sawmill operations (ECHO)

Treesearch

P.H. Steele; Philip A. Araman; C. Boden

2002-01-01

Reductions in sawkerf on headrigs and resaws can dramatically increase lumber recovery. Research has also shown that lumber target size reductions are even more important than kerf reductions in providing increased lumber recovery. Decreases in either sawkerf or lumber size, however, always come at some cost in both capital and variable costs. Determining whether the...

Burden of micronutrient deficiencies by socio-economic strata in children aged 6 months to 5 years in the Philippines.

PubMed

Wieser, Simon; Plessow, Rafael; Eichler, Klaus; Malek, Olivia; Capanzana, Mario V; Agdeppa, Imelda; Bruegger, Urs

2013-12-11

Micronutrient deficiencies (MNDs) are a chronic lack of vitamins and minerals and constitute a huge public health problem. MNDs have severe health consequences and are particularly harmful during early childhood due to their impact on the physical and cognitive development. We estimate the costs of illness due to iron deficiency (IDA), vitamin A deficiency (VAD) and zinc deficiency (ZnD) in 2 age groups (6-23 and 24-59 months) of Filipino children by socio-economic strata in 2008. We build a health economic model simulating the consequences of MNDs in childhood over the entire lifetime. The model is based on a health survey and a nutrition survey carried out in 2008. The sample populations are first structured into 10 socio-economic strata (SES) and 2 age groups. Health consequences of MNDs are modelled based on information extracted from literature. Direct medical costs, production losses and intangible costs are computed and long term costs are discounted to present value. Total lifetime costs of IDA, VAD and ZnD amounted to direct medical costs of 30 million dollars, production losses of 618 million dollars and intangible costs of 122,138 disability adjusted life years (DALYs). These costs can be interpreted as the lifetime costs of a 1-year cohort affected by MNDs between the age of 6-59 months. Direct medical costs are dominated by costs due to ZnD (89% of total), production losses by losses in future lifetime (90% of total) and intangible costs by premature death (47% of total DALY losses) and losses in future lifetime (43%). Costs of MNDs differ considerably between SES as costs in the poorest third of the households are 5 times higher than in the wealthiest third. MNDs lead to substantial costs in 6-59-month-old children in the Philippines. Costs are highly concentrated in the lower SES and in children 6-23 months old. These results may have important implications for the design, evaluation and choice of the most effective and cost-effective policies aimed at the reduction of MNDs.

Burden of micronutrient deficiencies by socio-economic strata in children aged 6 months to 5 years in the Philippines

PubMed Central

2013-01-01

Background Micronutrient deficiencies (MNDs) are a chronic lack of vitamins and minerals and constitute a huge public health problem. MNDs have severe health consequences and are particularly harmful during early childhood due to their impact on the physical and cognitive development. We estimate the costs of illness due to iron deficiency (IDA), vitamin A deficiency (VAD) and zinc deficiency (ZnD) in 2 age groups (6–23 and 24–59 months) of Filipino children by socio-economic strata in 2008. Methods We build a health economic model simulating the consequences of MNDs in childhood over the entire lifetime. The model is based on a health survey and a nutrition survey carried out in 2008. The sample populations are first structured into 10 socio-economic strata (SES) and 2 age groups. Health consequences of MNDs are modelled based on information extracted from literature. Direct medical costs, production losses and intangible costs are computed and long term costs are discounted to present value. Results Total lifetime costs of IDA, VAD and ZnD amounted to direct medical costs of 30 million dollars, production losses of 618 million dollars and intangible costs of 122,138 disability adjusted life years (DALYs). These costs can be interpreted as the lifetime costs of a 1-year cohort affected by MNDs between the age of 6–59 months. Direct medical costs are dominated by costs due to ZnD (89% of total), production losses by losses in future lifetime (90% of total) and intangible costs by premature death (47% of total DALY losses) and losses in future lifetime (43%). Costs of MNDs differ considerably between SES as costs in the poorest third of the households are 5 times higher than in the wealthiest third. Conclusions MNDs lead to substantial costs in 6-59-month-old children in the Philippines. Costs are highly concentrated in the lower SES and in children 6–23 months old. These results may have important implications for the design, evaluation and choice of the most effective and cost-effective policies aimed at the reduction of MNDs. PMID:24330481

How Will the Affordable Care Act's Cost-Sharing Reductions Affect Consumers' Out-of-Pocket Costs in 2016?

PubMed

Collins, Sara R; Gunja, Munira; Beutel, Sophie

2016-03-01

Health insurers selling plans in the Affordable Care Act's market­places are required to reduce cost-sharing in silver plans for low- and moderate-income people earning between 100 percent and 250 percent of the federal pov­erty level. In 2016, as many as 7 million Americans may have plans with these cost-sharing reductions. In the largest markets in the 38 states using the federal website for marketplace enrollment, the cost-sharing reductions substantially lower projected out-of-pocket costs for people who qualify for them. However, the degree to which consumers' out-of-pocket spending will fall varies by plan and how much health care they use. This is because insurers use deductibles, out-of-pocket limits, and copayments in different combinations to lower cost-sharing for eligible enrollees. In 2017, marketplace insurers will have the option of offering standard plans, which may help simplify consumers' choices and lead to more equal cost-sharing.

Comparison between cylindrical and prismatic lithium-ion cell costs using a process based cost model

NASA Astrophysics Data System (ADS)

Ciez, Rebecca E.; Whitacre, J. F.

2017-02-01

The relative size and age of the US electric vehicle market means that a few vehicles are able to drive market-wide trends in the battery chemistries and cell formats on the road today. Three lithium-ion chemistries account for nearly all of the storage capacity, and half of the cells are cylindrical. However, no specific model exists to examine the costs of manufacturing these cylindrical cells. Here we present a process-based cost model tailored to the cylindrical lithium-ion cells currently used in the EV market. We examine the costs for varied cell dimensions, electrode thicknesses, chemistries, and production volumes. Although cost savings are possible from increasing cell dimensions and electrode thicknesses, economies of scale have already been reached, and future cost reductions from increased production volumes are minimal. Prismatic cells, which are able to further capitalize on the cost reduction from larger formats, can offer further reductions than those possible for cylindrical cells.

Multi-criteria analysis for PM10 planning

NASA Astrophysics Data System (ADS)

Pisoni, Enrico; Carnevale, Claudio; Volta, Marialuisa

To implement sound air quality policies, Regulatory Agencies require tools to evaluate outcomes and costs associated to different emission reduction strategies. These tools are even more useful when considering atmospheric PM10 concentrations due to the complex nonlinear processes that affect production and accumulation of the secondary fraction of this pollutant. The approaches presented in the literature (Integrated Assessment Modeling) are mainly cost-benefit and cost-effective analysis. In this work, the formulation of a multi-objective problem to control particulate matter is proposed. The methodology defines: (a) the control objectives (the air quality indicator and the emission reduction cost functions); (b) the decision variables (precursor emission reductions); (c) the problem constraints (maximum feasible technology reductions). The cause-effect relations between air quality indicators and decision variables are identified tuning nonlinear source-receptor models. The multi-objective problem solution provides to the decision maker a set of not-dominated scenarios representing the efficient trade-off between the air quality benefit and the internal costs (emission reduction technology costs). The methodology has been implemented for Northern Italy, often affected by high long-term exposure to PM10. The source-receptor models used in the multi-objective analysis are identified processing long-term simulations of GAMES multiphase modeling system, performed in the framework of CAFE-Citydelta project.

Co-control of urban air pollutants and greenhouse gases in Mexico City.

PubMed

West, J Jason; Osnaya, Patricia; Laguna, Israel; Martínez, Julia; Fernández, Adrián

2004-07-01

This study addresses the synergies of mitigation measures to control urban air pollutant and greenhouse gas (GHG) emissions, in developing integrated "co-control" strategies for Mexico City. First, existing studies of emissions reduction measures--PROAIRE (the air quality plan for Mexico City) and separate GHG studies--are used to construct a harmonized database of options. Second, linear programming (LP) is developed and applied as a decision-support tool to analyze least-cost strategies for meeting co-control targets for multiple pollutants. We estimate that implementing PROAIRE measures as planned will reduce 3.1% of the 2010 metropolitan CO2 emissions, in addition to substantial local air pollutant reductions. Applying the LP, PROAIRE emissions reductions can be met at a 20% lower cost, using only the PROAIRE measures, by adjusting investments toward the more cost-effective measures; lower net costs are possible by including cost-saving GHG mitigation measures, but with increased investment. When CO2 emission reduction targets are added to PROAIRE targets, the most cost-effective solutions use PROAIRE measures for the majority of local pollutant reductions, and GHG measures for additional CO2 control. Because of synergies, the integrated planning of urban-global co-control can be beneficial, but we estimate that for Mexico City these benefits are often small.

Major study reveals EEC gas oil desulfurization costs

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

Waller, G.J.; Conrad, M.C.; Cremer, G.

1985-01-21

The interest of the European Economic Community (EEC) Commission in the issue of acid rain has prompted a Concawe working group to make an independent study of the cost of achieving a reduction of average sulfur levels for gas oils consumed in the EEC. The need for desulfurization of gas oils should be seen in the context of their overall contribution to SO/sub 2/ emissions. The removal of sulfur from gas oil is apparently one of the most costly ways to reduce SO/sub 2/ emissions. The overall effect is apparently the smallest. A reduction of 0.1% sulfur for all gasmore » oil produced in the EEC would result in a reduction of only about 140,000 tons/year of sulfur, corresponding to less than 2% of the present total SO/sub 2/ emissions. The cost of the incremental ton of sulfur removed from the gas oil pool increases significantly for lower sulfur specifications. The overall conclusion is that sulfur reduction between 0.43% and 0.2% is comparable in cost to other methods of reducing SO/sub 2/ emissions. For a reduction below 0.2%, excessive costs can be expected and it would be more economical in most cases to consider another means.« less

Eighty Kilograms Weight Reduction in a Case of Obstructive Sleep Apnea with Several Comorbidities: Did the Conditions Improve?

PubMed

Foroughi, Moein; Malekmohammad, Majid; Adimi, Parisa

2016-05-01

Obstructive sleep apnea (OSA) together with metabolic disorders is common in severely obese patients. Weight reduction is considered as a treatment modality in these cases while few of them can succeed in considerable weight loss. Here, we present a severely obese man with body mass index of 54 suffered from OSA, type 2 diabetes, hypothyroidism, and hypertension. He intentionally lost 80 kilograms weight during the 2-year follow-up. Diabetes and hypertension completely resolved with considerable improvement in OSA syndrome after this huge weight reduction.

Clinical and financial considerations for implementing an ICU telemedicine program.

PubMed

Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

2014-06-01

As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.

Assessing the cost of fuel reduction treatments: a critical review

Treesearch

Bob Rummer

2008-01-01

The basic costs of the operations for implementing fuel reduction treatments are used to evaluate treatment effectiveness, select among alternatives, estimate total project costs, and build national program strategies. However, a review of the literature indicates that there is questionable basis for many of the general estimates used to date. Different approaches to...

COMPARISON OF WEST GERMAN AND U.S. FLUE GAS DESULFURIZATION AND SELECTIVE CATALYTIC REDUCTION COSTS

EPA Science Inventory

The report documents a comparison of the actual cost retrofitting flue gas desulfurization (FGD) and selective catalytic reduction (SCR) on Federal Republic of German (FRG) boilers to cost estimating procedures used in the U.S. to estimate the retrofit of these controls on U.S. b...

Potential means of cost reduction in grade crossing automatic gate systems. volume I : overview and low cost railroad/highway grade crossing gate systems

DOT National Transportation Integrated Search

1977-02-28

This report, Volume I of a two-volume study, examines the potential for reduction of the cost of installing and maintaining automatic gates at railroad-highway grade crossings. It comprises a general overview; a review of current practices, equipment...

Leadership by Fragmented Destruction after a Merger: An Example from a Facility of Acute Psychiatry

PubMed Central

Grimeland, Jorid

2013-01-01

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations. Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust. Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper. PMID:25478133

The pharmacological cost of COPD during Greek economic crisis.

PubMed

Stafyla, Eirini; Kerenidi, Theodora; Gerogianni, Irini; Geitona, Mary; Daniil, Zoe; Gourgoulianis, Konstantinos I

2017-01-01

The economic crisis in Greece has substantially affected patients with COPD. The reduction of disposable income has its consequences on patients' ability to afford their medication. The aim of the study is to evaluate the cost of treatment for patients with COPD and the influence of the financial crisis to the patients. Data were collected from 189 patients (male: 178, mean age: 70.1±8.4) who visited the outpatient department of University Hospital of Larissa in 2014 and 2015. The pharmacological cost of treatment was calculated based on national pharmaceutical formulary prices. COPD patients were classified into four stages according to Global Initiative for Chronic Obstructive Lung Disease (GOLD): 7.4% were in stage I, 43.4% in stage II, 34.4% in stage III, and 14.8% in stage IV. Patients were graded as per GOLD as follows: 18% as grade A, 14.3% as B, 23.3% as C, and 44.4% as D. The annual cost of COPD maintenance treatment per patient was €952.92 (±398.01), of which €239.91 were patients' expenses. The annual treatment cost for stable disease ranged from €615.44 to €1302.03 depending on disease stages (GOLD stages I-IV) and from €715.01 to €1101.05 depending on GOLD grades (grades A-D). The cost of maintenance medication was statistically and significantly higher for patients with advanced disease (GOLD stages III-IV) and for patients at high risk (GOLD grades C-D [ P =0.000]). The pharmacological cost of treatment for COPD patients seems to be considerably high, in all disease stages. As the average income is decreased, patients face difficulties to afford inhaled medication.

Reducing the costs of meeting regional water demand through risk-based transfer agreements.

PubMed

Palmer, Reed N; Characklis, Gregory W

2009-04-01

Transfers of treated water among inter-connected utilities is becoming more common as the cost of developing new supplies grows, and transfer agreements require well developed rules describing when and how much water will be transferred. The nature of the decision rules governing an agreement must also be coordinated with respect to the treatment and conveyance capacity required to execute the transfers. This study explores different combinations of infrastructure and agreement type that define three different transfer programs, describing the frequency and volume of transfers associated with each, as well as their costs. The agreements are described in terms of the type of decision rule employed: Take-or-Pay, where the timing and quantity of transfers is fixed; Days of Supply Remaining (DSR), which uses a static hydrologic indicator to trigger transfers; and Risk-of-Failure, a probability-based decision rule that involves consideration of both supply and demand. This analysis is conducted within the context of the Research Triangle area of North Carolina (USA), a rapidly growing area that is beginning to approach the practical limits of water resource development. The Risk-of-Failure agreement is shown to reduce the average volume of transfers by over 80% compared to a Take-or-Pay agreement and by roughly half relative to the DSR agreement, leading to significant cost reductions. A utility's willingness to accept something less than guaranteed access to a specified quantity of water (i.e. an interruption) also has a significant impact on cost. Interruptions do not necessarily lead to lower reliability, but rather to the purchasing utility acquiring more water during off-peak periods when the seller has excess treatment capacity available. The lowest cost guaranteed agreement is 40-50% more expensive than the lowest cost interruptible contract.

Operation costs and pollutant emissions reduction by definition of new collection scheduling and optimization of MSW collection routes using GIS. The case study of Barreiro, Portugal.

PubMed

Zsigraiova, Zdena; Semiao, Viriato; Beijoco, Filipa

2013-04-01

This work proposes an innovative methodology for the reduction of the operation costs and pollutant emissions involved in the waste collection and transportation. Its innovative feature lies in combining vehicle route optimization with that of waste collection scheduling. The latter uses historical data of the filling rate of each container individually to establish the daily circuits of collection points to be visited, which is more realistic than the usual assumption of a single average fill-up rate common to all the system containers. Moreover, this allows for the ahead planning of the collection scheduling, which permits a better system management. The optimization process of the routes to be travelled makes recourse to Geographical Information Systems (GISs) and uses interchangeably two optimization criteria: total spent time and travelled distance. Furthermore, rather than using average values, the relevant parameters influencing fuel consumption and pollutant emissions, such as vehicle speed in different roads and loading weight, are taken into consideration. The established methodology is applied to the glass-waste collection and transportation system of Amarsul S.A., in Barreiro. Moreover, to isolate the influence of the dynamic load on fuel consumption and pollutant emissions a sensitivity analysis of the vehicle loading process is performed. For that, two hypothetical scenarios are tested: one with the collected volume increasing exponentially along the collection path; the other assuming that the collected volume decreases exponentially along the same path. The results evidence unquestionable beneficial impacts of the optimization on both the operation costs (labor and vehicles maintenance and fuel consumption) and pollutant emissions, regardless the optimization criterion used. Nonetheless, such impact is particularly relevant when optimizing for time yielding substantial improvements to the existing system: potential reductions of 62% for the total spent time, 43% for the fuel consumption and 40% for the emitted pollutants. This results in total cost savings of 57%, labor being the greatest contributor, representing over €11,000 per year for the two vehicles collecting glass-waste. Moreover, it is shown herein that the dynamic loading process of the collection vehicle impacts on both the fuel consumption and on pollutant emissions. Copyright © 2012 Elsevier Ltd. All rights reserved.

GME: at what cost?

PubMed

Young, David W

2003-11-01

Current computing methods impede determining the real cost of graduate medical education. However, a more accurate estimate could be obtained if policy makers would allow for the application of basic cost-accounting principles, including consideration of department-level costs, unbundling of joint costs, and other factors.

Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651].

PubMed

Lambeek, Ludeke C; Anema, Johannes R; van Royen, Barend J; Buijs, Peter C; Wuisman, Paul I; van Tulder, Maurits W; van Mechelen, Willem

2007-09-20

Chronic low back pain (LBP) is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW) is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands). Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6, and 12 months later. All statistical analysis will be performed according to the intension-to-treat principle. Usual care of primary and outpatient health services isn't directly aimed at RTW, therefore it is desirable to look for care which is aimed at RTW. Research shows that several occupational interventions in primary care are aimed at RTW. They have shown a significant reduction of sick leave for employee with LBP. If a comparable reduction of sick leave duration of patients with chronic LBP of who attend an outpatient clinic can be achieved, such reductions will be obviously substantial for the Netherlands and will have a considerable impact.

Incorporating considerations of cost-effectiveness, affordability, and resource implications in guideline development: article 6 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Hill, Suzanne R; Olson, Leslie G; Falck-Ytter, Yngve; Cruz, Alvaro A; Atkins, David; Baumann, Michael; Jaeschke, Roman; Woitalla, Thomas; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are based on the best available research evidence. This is the sixth of a series of 14 articles prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. In this article, we focused on integrating cost and resource information in guideline development and formulating recommendations focusing on four key questions. We addressed the following specific questions. (1) When is it important to incorporate costs, and/or resource implications, and/or cost-effectiveness, and/or affordability considerations in guidelines? (2) Which costs and which resource use should be considered in guidelines? (3)What sources of evidence should be used to estimate costs, resource use, and cost-effectiveness? (4) How can cost-effectiveness, resource implications, and affordability be taken into account explicitly? Our work was based on a prior review on this topic and our conclusions are based on available evidence, consideration of what guideline developers are doing, and workshop discussions. Many authorities suggest that there is a need to include explicit consideration of costs, resource use, and affordability during guideline development. Where drug use is at issue, "explicit consideration" may need to involve only noting whether the price (easily determined and usually the main component of "acquisition cost") of a drug is high or low. Complex interventions such as rehabilitation services are to a greater degree setting- and system-dependent. Resources used, and the costs of those resources, will vary among systems, and formal identification by a guideline group of the resource requirements of a complex intervention is essential. A clinical guideline usually contains multiple recommendations, and in some cases there are hundreds. Defining costs and resource use for all of them-especially for multiple settings-is unlikely to be feasible. At present, disaggregated resource utilization accompanied by some cost information seems to be the most promising approach. The method for assigning values to costs, including external or indirect cost (such as time off work), can have a significant impact on the outcome of any economic evaluation. The perspective that the guideline assumes should be made explicit. Standards for evidence for clinical data are usually good-quality trials reporting a relevant endpoint that should be summarized in a systematic review. Like others, we are therefore proposing that the ideal sources of evidence for cost and resource utilization data for guideline development are systematic reviews of randomized controlled trials that report resource utilization, with direct comparisons between the interventions of interest.

Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract.

PubMed

Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

2018-04-13

Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants' profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants' profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance).

Designing cost efficient buffer zone programs: An application of the FyrisSKZ tool in a Swedish catchment.

PubMed

Collentine, Dennis; Johnsson, Holger; Larsson, Peter; Markensten, Hampus; Persson, Kristian

2015-03-01

Riparian buffer zones are the only measure which has been used extensively in Sweden to reduce phosphorus losses from agricultural land. This paper describes how the FyrisSKZ web tool can be used to evaluate allocation scenarios using data from the Svärta River, an agricultural catchment located in central Sweden. Three scenarios are evaluated: a baseline, a uniform 6-m-wide buffer zone in each sub-catchment, and an allocation of areas of buffer zones to sub-catchments based on the average cost of reduction. The total P reduction increases by 30 % in the second scenario compared to the baseline scenario, and the average reduction per hectare increases by 90 % while total costs of the program fall by 32 %. In the third scenario, the average cost per unit of reduction (163 kg P(-1)) is the lowest of the three scenarios (58 % lower than the baseline) and has the lowest total program costs.

Cost-benefit analysis of a socio-technical intervention in a Brazilian footwear company.

PubMed

Guimarães, L B de M; Ribeiro, J L D; Renner, J S

2012-09-01

This article presents a costs-benefits analysis of a macroergonomic intervention in a Brazilian footwear company. Comparing results of a pilot line (composed by 100 multiskilled workers organized in teams) with eight traditional lines (still working in a one human being/one task model) the intervention showed to be worth pursuing since achieved gains were higher than intervention costs: there was a reduction in human resource costs (80% reduction in industrial accidents, 100% reduction in work-related musculoskeletal disorders or WMSD, medical consultations and turnover, and a 45.65% reduction in absenteeism) and production improvement (productivity increased in 3% and production waste decrease to less than 1%). The net intervention value of the intervention was around U$ 430,000 with a benefit-to-cost ratio of 7.2. Moreover, employees who worked in the pilot line understood that their quality of work life improved, compensating the anxiety brought up by the radical changes implemented. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Performance-based, cost- and time-effective pcb analytical methodology.

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

Alvarado, J. S.

1998-06-11

Laboratory applications for the analysis of PCBs (polychlorinated biphenyls) in environmental matrices such as soil/sediment/sludge and oil/waste oil were evaluated for potential reduction in waste, source reduction, and alternative techniques for final determination. As a consequence, new procedures were studied for solvent substitution, miniaturization of extraction and cleanups, minimization of reagent consumption, reduction of cost per analysis, and reduction of time. These new procedures provide adequate data that meet all the performance requirements for the determination of PCBs. Use of the new procedures reduced costs for all sample preparation techniques. Time and cost were also reduced by combining the newmore » sample preparation procedures with the power of fast gas chromatography. Separation of Aroclor 1254 was achieved in less than 6 min by using DB-1 and SPB-608 columns. With the greatly shortened run times, reproducibility can be tested quickly and consequently with low cost. With performance-based methodology, the applications presented here can be applied now, without waiting for regulatory approval.« less

A Benefit Analysis of Infusing Wireless into Aircraft and Fleet Operations - Report to Seedling Project Efficient Reconfigurable Cockpit Design and Fleet Operations Using Software Intensive, Network Enabled, Wireless Architecture (ECON)

NASA Technical Reports Server (NTRS)

Alexandrov, Natalia; Holmes, Bruce J.; Hahn, Andrew S.

2016-01-01

We report on an examination of potential benefits of infusing wireless technologies into various areas of aircraft and airspace operations. The analysis is done in support of a NASA seedling project Efficient Reconfigurable Cockpit Design and Fleet Operations Using Software Intensive, Network Enabled Wireless Architecture (ECON). The study has two objectives. First, we investigate one of the main benefit hypotheses of the ECON proposal: that the replacement of wired technologies with wireless would lead to significant weight reductions on an aircraft, among other benefits. Second, we advance a list of wireless technology applications and discuss their system benefits. With regard to the primary hypothesis, we conclude that the promise of weight reduction is premature. Specificity of the system domain and aircraft, criticality of components, reliability of wireless technologies, the weight of replacement or augmentation equipment, and the cost of infusion must all be taken into account among other considerations, to produce a reliable estimate of weight savings or increase.

Enhanced high-solids anaerobic digestion of waste activated sludge by the addition of scrap iron.

PubMed

Zhang, Yaobin; Feng, Yinghong; Yu, Qilin; Xu, Zibin; Quan, Xie

2014-05-01

Anaerobic digestion of waste activated sludge usually requires pretreatment procedure to improve the bioavailability of sludge, which involves considerable energy and high expenditures. This study proposes a cost-effective method for enhanced anaerobic digestion of sludge without a pretreatment by directly adding iron into the digester. The results showed that addition of Fe(0) powder could enhance 14.46% methane yield, and Fe scrap (clean scrap) could further enhance methane yield (improving rate 21.28%) because the scrap has better mass transfer efficiency with sludge and liquid than Fe(0) powder. The scrap of Fe with rust (rusty scrap) could induce microbial Fe(III) reduction, which resulted in achieving the highest methane yield (improving rate 29.51%), and the reduction rate of volatile suspended solids (VSS) was also highest (48.27%) among Fe powder, clean scrap and rusty scrap. PCR-DGGE proved that the addition of rusty scrap could enhance diversity of acetobacteria and enrich iron-reducing bacteria to enhance degradation of complex substrates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Post-impact behavior of composite solid rocket motor cases

NASA Technical Reports Server (NTRS)

Highsmith, Alton L.

1992-01-01

In recent years, composite materials have seen increasing use in advanced structural applications because of the significant weight savings they offer when compared to more traditional engineering materials. The higher cost of composites must be offset by the increased performance that results from reduced structural weight if these new materials are to be used effectively. At present, there is considerable interest in fabricating solid rocket motor cases out of composite materials, and capitalizing on the reduced structural weight to increase rocket performance. However, one of the difficulties that arises when composite materials are used is that composites can develop significant amounts of internal damage during low velocity impacts. Such low velocity impacts may be encountered in routine handling of a structural component like a rocket motor case. The ability to assess the reduction in structural integrity of composite motor cases that experience accidental impacts is essential if composite rocket motor cases are to be certified for manned flight. The study described herein was an initial investigation of damage development and reduction of tensile strength in an idealized composite subjected to low velocity impacts.

A retrospective view on the viability of water fluoridation in South Africa to prevent dental caries.

PubMed

Kroon, Jeroen; Van Wyk, Philippus Johannes

2012-10-01

Despite a Commission of Inquiry into water fluoridation recommending the fluoridation of public water supplies to the optimal fluoride concentration of 0.7 ppm, as well as regulations for the introduction of water fluoridation which compel water providers to fluoridate public water supplies, no artificially fluoridated water scheme exists in South Africa. In view of concerns expressed by South African local authorities about cost and reports urging further investigation into the effectiveness of water fluoridation, the aim of this study was to determine whether water fluoridation is still a viable option to reduce dental caries in South Africa. A model based on a cost evaluation of 44 communities in Florida, United States, and applied to South Africa was used as the basis for this study. Twenty-three input variables were used to create a computerized model which was populated with 2006 and 2011 data. Per capita cost, cost-effectiveness ratio and cost-benefit ratio were calculated as economic outputs to facilitate decision making for projected caries reductions of 15%, 30% and 50%. The average per capita cost of water fluoridation for all category water providers combined is US$0.28 in 2006 and US$0.35 in 2011, an increase of 23.2% over this period. The average cost-effectiveness for all water providers combined varies from US$3.32 for a 50% to US$11.08 for a 15% caries reduction. Despite higher cost-effective values for some cities and towns, the cost per person per year to save one Decayed, Missing or Filled Tooth (DMFT) at a projected caries reduction of at least 15% as a result of the introduction of water fluoridation, is at least 48.4% less than the cost of a two surface restoration. The average cost-benefit for all water providers combined varies from 0.1 at a 50% to 0.34 at a 15% caries reduction. For both cost-effectiveness and cost-benefit ratio better results are achieved when the projected caries reduction increases. The results of this study show that water fluoridation is still a viable option to prevent dental caries in communities in South Africa along with the reduction in the prevalence of dental caries and increases in economically driven variables. © 2012 John Wiley & Sons A/S.

The Cost Effectiveness of Nalmefene for Reduction of Alcohol Consumption in Alcohol-Dependent Patients with High or Very High Drinking-Risk Levels from a UK Societal Perspective.

PubMed

Brodtkorb, Thor-Henrik; Bell, Melissa; Irving, Adam H; Laramée, Philippe

2016-02-01

To evaluate costs and health outcomes of nalmefene plus psychosocial support, compared with psychosocial intervention alone, for reducing alcohol consumption in alcohol-dependent patients, specifically focusing on societal costs related to productivity losses and crime. A Markov model was constructed to model costs and health outcomes of the treatments over 5 years. Analyses were conducted for nalmefene's licensed population: adults with both alcohol dependence and high or very high drinking-risk levels (DRLs) who do not require immediate detoxification and who have high or very high DRLs after initial assessment. The main outcome measure was cost per quality-adjusted life-year (QALY) gained as assessed from a UK societal perspective. Alcohol-attributable productivity loss, crime and health events occurring at different levels of alcohol consumption were taken from published risk-relation studies. Health-related and societal costs were drawn from public data and the literature. Data on the treatment effect, as well as baseline characteristics of the modelled population and utilities, came from three pivotal phase 3 trials of nalmefene. Nalmefene plus psychosocial support was dominant compared with psychosocial intervention alone, resulting in QALYs gained and reduced societal costs. Sensitivity analyses showed that this conclusion was robust. Nalmefene plus psychosocial support led to per-patient reduced costs of £3324 and £2483, due to reduced productivity losses and crime events, respectively. Nalmefene is cost effective from a UK societal perspective, resulting in greater QALY gains and lower costs compared with psychosocial support alone. Nalmefene demonstrates considerable public benefits by reducing alcohol-attributable productivity losses and crime events in adults with both alcohol dependence and high or very high DRLs who do not require immediate detoxification and who have high or very high DRLs after initial assessment.

Research and Development Project Summaries, October 1991

DTIC Science & Technology

1991-10-01

delivery methods, training cost reduction, demonstration of technology’ effectiveness, and the reduction of acquisition risk . The majority of the work...demonstrations, risk reduction developments, and cost-effectiveness investigations in simulator and training technologzv. This advanced development program is a...systems. The program is organized around specific demonstration tasks that target critical technical risks that confront future weapons system

Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

PubMed

Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

2015-08-01

Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction

PubMed Central

Warner, Courtney J.; Horvath, Alexander J.; Powell, Richard J.; Columbo, Jesse A.; Walsh, Teri R.; Goodney, Philip P.; Walsh, Daniel B.; Stone, David H.

2017-01-01

Objective Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. Methods All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Results Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Conclusions Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. PMID:25935271

Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.

PubMed

Ramsey, Scott D; Berry, Kristin; Etzioni, Ruth; Kaplan, Robert M; Sullivan, Sean D; Wood, Douglas E

2003-05-22

The National Emphysema Treatment Trial, a randomized clinical trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema, included a prospective economic analysis. After pulmonary rehabilitation, 1218 patients at 17 medical centers were randomly assigned to lung-volume-reduction surgery or continued medical treatment. Costs for the use of medical care, medications, transportation, and time spent receiving treatment were derived from Medicare claims and data from the trial. Cost effectiveness was calculated over the duration of the trial and was estimated for 10 years of follow-up with the use of modeling based on observed trends in survival, cost, and quality of life. Interim analyses identified a group of patients with excess mortality and little chance of improved functional status after surgery. When these patients were excluded, the cost-effectiveness ratio for lung-volume-reduction surgery as compared with medical therapy was 190,000 dollars per quality-adjusted life-year gained at 3 years and 53,000 dollars per quality-adjusted life-year gained at 10 years. Subgroup analyses identified patients with predominantly upper-lobe emphysema and low exercise capacity after pulmonary rehabilitation who had lower mortality and better functional status than patients who received medical therapy. The cost-effectiveness ratio in this subgroup was 98,000 dollars per quality-adjusted life-year gained at 3 years and 21,000 dollars at 10 years. Bootstrap analysis revealed substantial uncertainty for the subgroup and 10-year estimates. Given its cost and benefits over three years of follow-up, lung-volume-reduction surgery is costly relative to medical therapy. Although the predictions are subject to substantial uncertainty, the procedure may be cost effective if benefits can be maintained over time. Copyright 2003 Massachusetts Medical Society

Effects of payment reform in more versus less competitive markets.

PubMed

Sood, Neeraj; Alpert, Abby; Barnes, Kayleigh; Huckfeldt, Peter; Escarce, José J

2017-01-01

Policymakers are increasingly interested in reducing healthcare costs and inefficiencies through innovative payment strategies. These strategies may have heterogeneous impacts across geographic areas, potentially reducing or exacerbating geographic variation in healthcare spending. In this paper, we exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, we find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets. This led to a convergence in spending across geographic areas. We find that much of the reduction in provider costs is driven by greater exit of "high-cost" providers in more competitive markets. Copyright © 2017 Elsevier B.V. All rights reserved.

48 CFR 1615.407-1 - Rate reduction for defective pricing or defective cost or pricing data.

Code of Federal Regulations, 2010 CFR

2010-10-01

... defective pricing or defective cost or pricing data. 1615.407-1 Section 1615.407-1 Federal Acquisition... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1615.407-1 Rate reduction for defective pricing or defective cost or pricing data. The clause set forth in section 1652.215-70...

48 CFR 1615.407-1 - Rate reduction for defective pricing or defective cost or pricing data.

Code of Federal Regulations, 2014 CFR

2014-10-01

... defective pricing or defective cost or pricing data. 1615.407-1 Section 1615.407-1 Federal Acquisition... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1615.407-1 Rate reduction for defective pricing or defective cost or pricing data. The clause set forth in section 1652.215-70...

48 CFR 1615.407-1 - Rate reduction for defective pricing or defective cost or pricing data.

Code of Federal Regulations, 2012 CFR

2012-10-01

... defective pricing or defective cost or pricing data. 1615.407-1 Section 1615.407-1 Federal Acquisition... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1615.407-1 Rate reduction for defective pricing or defective cost or pricing data. The clause set forth in section 1652.215-70...

48 CFR 1615.407-1 - Rate reduction for defective pricing or defective cost or pricing data.

Code of Federal Regulations, 2013 CFR

2013-10-01

... defective pricing or defective cost or pricing data. 1615.407-1 Section 1615.407-1 Federal Acquisition... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1615.407-1 Rate reduction for defective pricing or defective cost or pricing data. The clause set forth in section 1652.215-70...

48 CFR 52.215-10 - Price Reduction for Defective Certified Cost or Pricing Data.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Defective Certified Cost or Pricing Data. 52.215-10 Section 52.215-10 Federal Acquisition Regulations System... Text of Provisions and Clauses 52.215-10 Price Reduction for Defective Certified Cost or Pricing Data... or Pricing Data (OCT 2010) (a) If any price, including profit or fee, negotiated in connection with...

Corrosion/erosion detection of boiler tubes utilizing pulsed infrared imaging

NASA Astrophysics Data System (ADS)

Bales, Maurice J.; Bishop, Chip C.

1995-05-01

This paper discusses a new technique for locating and detecting wall thickness reduction in boiler tubes caused by erosion/corrosion. Traditional means for this type of defect detection utilizes ultrasonics (UT) to perform a point by point measurement at given intervals of the tube length, which requires extensive and costly shutdown or `outage' time to complete the inspection, and has led to thin areas going undetected simply because they were located in between the sampling points. Pulsed infrared imaging (PII) can provide nearly 100% inspection of the tubes in a fraction of the time needed for UT. The IR system and heat source used in this study do not require any special access or fixed scaffolding, and can be remotely operated from a distance of up to 100 feet. This technique has been tried experimentally in a laboratory environment and verified in an actual field application. Since PII is a non-contact technique, considerable time and cost savings should be realized as well as the ability to predict failures rather than repairing them once they have occurred.

Development of a medical information system that minimizes staff workload and secures system safety at a small medical institution

NASA Astrophysics Data System (ADS)

Haneda, Kiyofumi; Koyama, Tadashi

2005-04-01

We developed a secure system that minimizes staff workload and secures safety of a medical information system. In this study, we assess the legal security requirements and risks occurring from the use of digitized data. We then analyze the security measures for ways of reducing these risks. In the analysis, not only safety, but also costs of security measures and ease of operability are taken into consideration. Finally, we assess the effectiveness of security measures by employing our system in small-sized medical institution. As a result of the current study, we developed and implemented several security measures, such as authentications, cryptography, data back-up, and secure sockets layer protocol (SSL) in our system. In conclusion, the cost for the introduction and maintenance of a system is one of the primary difficulties with its employment by a small-sized institution. However, with recent reductions in the price of computers, and certain advantages of small-sized medical institutions, the development of an efficient system configuration has become possible.

Perceived adherence to prescribed or recommended standards of care among adults with diabetes.

PubMed

Jorgensen, Wendy A; Polivka, Barbara J; Lennie, Terry A

2002-01-01

Adults with diabetes were surveyed to determine the extent to which respondents perceived specific preventive regimens (diet, exercise, weight control, and education) had been prescribed or recommended, adhered to their prescribed regimens, and identified barriers to nonadherence. Surveys were mailed to 2 samples of adults diagnosed with diabetes. The clinic sample was from health department clinics (n = 264); the agency sample was from a nonprofit agency serving people with diabetes (n = 111). Of the 4 preventive measures under investigation, diet plans and weight reduction were perceived as most commonly recommended by health professionals; exercise schedules were the least commonly recommended. Diabetes self-management education was reportedly recommended more often among the agency sample. In terms of adherence, approximately half of both samples were able to lose weight. A smaller portion of the clinic sample was able to get needed foods and exercise, and maintain weight loss. The most frequently cited reasons for nonadherence were cost, transportation, and other health conditions. Improvement in the implementation of preventive behaviors is needed, particularly exercise schedules. Barriers to care, such as costs and transportation, may need special consideration.

Algorithms for detecting antibodies to HIV-1: results from a rural Ugandan cohort.

PubMed

Nunn, A J; Biryahwaho, B; Downing, R G; van der Groen, G; Ojwiya, A; Mulder, D W

1993-08-01

To evaluate an algorithm using two enzyme immunoassays (EIA) for anti-HIV-1 antibodies in a rural African population and to assess alternative simplified algorithms. Sera obtained from 7895 individuals in a rural population survey were tested using an algorithm based on two different EIA systems: Recombigen HIV-1 EIA and Wellcozyme HIV-1 Recombinant. Alternative algorithms were assessed using negative or confirmed positive sera. None of the 227 sera classified as unequivocably negative by the two assays were positive by Western blot. Of 192 sera unequivocably positive by both assays, four were seronegative by Western blot. The possibility of technical error cannot be ruled out in three of these. One of the alternative algorithms assessed classified all borderline or discordant assay results as negative had a specificity of 100% and a sensitivity of 98.4%. The cost of this algorithm is one-third that of the conventional algorithm. Our evaluation suggests that high specificity and sensitivity can be obtained without using Western blot and at a considerable reduction in cost.

The view of European experts regarding health economics for medical nutrition in disease-related malnutrition.

PubMed

Freijer, K; Lenoir-Wijnkoop, I; Russell, C A; Koopmanschap, M A; Kruizenga, H M; Lhachimi, S K; Norman, K; Nuijten, M J C; Schols, J M G A

2015-05-01

Health-care systems are currently facing tremendous budget constraints resulting in growing pressure on decision makers and health-care providers to obtain the maximum possible health benefits of the resources available. Choices have to be made, and health economics can help in allocating limited health-care resources among unlimited wants and needs. Attempts to achieve cost reductions often focus on severe pathologies and chronic diseases as they commonly represent high health-care expenditures. In this context, awareness of the considerable financial burden caused by disease-related malnutrition (DRM) is lacking. Possibilities of reducing costs by optimising the management of DRM through medical nutrition will mostly not even be taken into account. During a European expert meeting, the total evaluation of medical nutrition was viewed and discussed. The aim of this meeting was to gain an experts' outline of the key issues relating to the health economic assessment of the use of medical nutrition. This article provides a summary of the observations per discussed item and describes the next steps suggested.

Active damage interrogation system for structural health monitoring

NASA Astrophysics Data System (ADS)

Lichtenwalner, Peter F.; Dunne, James P.; Becker, Ronald S.; Baumann, Erwin W.

1997-05-01

An integrated and automated smart structures approach for in situ damage assessment has been implemented and evaluated in a laboratory environment for health monitoring of a realistic aerospace structural component. This approach, called Active Damage Interrogation (ADI), utilizes an array of piezoelectric transducers attached to or embedded within the structure for both actuation and sensing. The ADI system, which is model independent, actively interrogates the structure through broadband excitation of multiple actuators across the desired frequency range. Statistical analysis of the changes in transfer functions between actuator/sensor pairs is used to detect, localize, and assess the severity of damage in the structure. This paper presents the overall concept of the ADI system and provides experimental results of damage assessment studies conducted for a composite structural component of the MD-900 Explorer helicopter rotor system. The potential advantages of this approach include simplicity (no need for a model), sensitivity, and low cost implementation. The results obtained thus far indicate considerably promise for integrated structural health monitoring of aerospace vehicles, leading to the practice of condition-based maintenance and consequent reduction in life cycle costs.

Cost-effectiveness analysis of risk-reduction measures to reach water safety targets.

PubMed

Lindhe, Andreas; Rosén, Lars; Norberg, Tommy; Bergstedt, Olof; Pettersson, Thomas J R

2011-01-01

Identifying the most suitable risk-reduction measures in drinking water systems requires a thorough analysis of possible alternatives. In addition to the effects on the risk level, also the economic aspects of the risk-reduction alternatives are commonly considered important. Drinking water supplies are complex systems and to avoid sub-optimisation of risk-reduction measures, the entire system from source to tap needs to be considered. There is a lack of methods for quantification of water supply risk reduction in an economic context for entire drinking water systems. The aim of this paper is to present a novel approach for risk assessment in combination with economic analysis to evaluate risk-reduction measures based on a source-to-tap approach. The approach combines a probabilistic and dynamic fault tree method with cost-effectiveness analysis (CEA). The developed approach comprises the following main parts: (1) quantification of risk reduction of alternatives using a probabilistic fault tree model of the entire system; (2) combination of the modelling results with CEA; and (3) evaluation of the alternatives with respect to the risk reduction, the probability of not reaching water safety targets and the cost-effectiveness. The fault tree method and CEA enable comparison of risk-reduction measures in the same quantitative unit and consider costs and uncertainties. The approach provides a structured and thorough analysis of risk-reduction measures that facilitates transparency and long-term planning of drinking water systems in order to avoid sub-optimisation of available resources for risk reduction. Copyright © 2010 Elsevier Ltd. All rights reserved.

A systematic review of economic evaluations of population-based sodium reduction interventions.

PubMed

Hope, Silvia F; Webster, Jacqui; Trieu, Kathy; Pillay, Arti; Ieremia, Merina; Bell, Colin; Snowdon, Wendy; Neal, Bruce; Moodie, Marj

2017-01-01

To summarise evidence describing the cost-effectiveness of population-based interventions targeting sodium reduction. A systematic search of published and grey literature databases and websites was conducted using specified key words. Characteristics of identified economic evaluations were recorded, and included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Twenty studies met the study inclusion criteria and received a full paper review. Fourteen studies were identified as full economic evaluations in that they included both costs and benefits associated with an intervention measured against a comparator. Most studies were modelling exercises based on scenarios for achieving salt reduction and assumed effects on health outcomes. All 14 studies concluded that their specified intervention(s) targeting reductions in population sodium consumption were cost-effective, and in the majority of cases, were cost saving. Just over half the studies (8/14) were assessed as being of 'excellent' reporting quality, five studies fell into the 'very good' quality category and one into the 'good' category. All of the identified evaluations were based on modelling, whereby inputs for all the key parameters including the effect size were either drawn from published datasets, existing literature or based on expert advice. Despite a clear increase in evaluations of salt reduction programs in recent years, this review identified relatively few economic evaluations of population salt reduction interventions. None of the studies were based on actual implementation of intervention(s) and the associated collection of new empirical data. The studies universally showed that population-based salt reduction strategies are likely to be cost effective or cost saving. However, given the reliance on modelling, there is a need for the effectiveness of new interventions to be evaluated in the field using strong study designs and parallel economic evaluations.

French intensive truck garden

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

Edwards, T D

1983-01-01

The French Intensive approach to truck gardening has the potential to provide substantially higher yields and lower per acre costs than do conventional farming techniques. It was the intent of this grant to show that there is the potential to accomplish the gains that the French Intensive method has to offer. It is obvious that locally grown food can greatly reduce transportation energy costs but when there is the consideration of higher efficiencies there will also be energy cost reductions due to lower fertilizer and pesticide useage. As with any farming technique, there is a substantial time interval for completemore » soil recovery after there have been made substantial soil modifications. There were major crop improvements even though there was such a short time since the soil had been greatly disturbed. It was also the intent of this grant to accomplish two other major objectives: first, the garden was managed under organic techniques which meant that there were no chemical fertilizers or synthetic pesticides to be used. Second, the garden was constructed so that a handicapped person in a wheelchair could manage and have a higher degree of self sufficiency with the garden. As an overall result, I would say that the garden has taken the first step of success and each year should become better.« less

Performance, cost and environmental assessment of gasification-based electricity in India: A preliminary analysis

NASA Astrophysics Data System (ADS)

Rani, Abha; Singh, Udayan; Jayant; Singh, Ajay K.; Sankar Mahapatra, Siba

2017-07-01

Coal gasification processes are crucial to decarbonisation in the power sector. While underground coal gasification (UCG) and integrated gasification combined cycle (IGCC) are different in terms of the site of gasification, they have considerable similarities in terms of the types of gasifiers used. Of course, UCG offers some additional advantages such as reduction of the fugitive methane emissions accompanying the coal mining process. Nevertheless, simulation of IGCC plants involving surface coal gasification is likely to give reasonable indication of the 3E (efficiency, economics and emissions) prospects of the gasification pathway towards electricity. This paper will aim at Estimating 3E impacts (efficiency, environment, economics) of gasification processes using simulation carried out in the Integrated Environmental Control Model (IECM) software framework. Key plant level controls which will be studied in this paper will be based on Indian financial regulations and operating costs which are specific to the country. Also, impacts of CO2 capture and storage (CCS) in these plants will be studied. The various parameters that can be studied are plant load factor, impact of coal quality and price, type of CO2 capture process, capital costs etc. It is hoped that relevant insights into electricity generation from gasification may be obtained with this paper.

Skip the trip: air travelers' behavioral responses to pandemic influenza.

PubMed

Fenichel, Eli P; Kuminoff, Nicolai V; Chowell, Gerardo

2013-01-01

Theory suggests that human behavior has implications for disease spread. We examine the hypothesis that individuals engage in voluntary defensive behavior during an epidemic. We estimate the number of passengers missing previously purchased flights as a function of concern for swine flu or A/H1N1 influenza using 1.7 million detailed flight records, Google Trends, and the World Health Organization's FluNet data. We estimate that concern over "swine flu," as measured by Google Trends, accounted for 0.34% of missed flights during the epidemic. The Google Trends data correlates strongly with media attention, but poorly (at times negatively) with reported cases in FluNet. Passengers show no response to reported cases. Passengers skipping their purchased trips forwent at least $50 M in travel related benefits. Responding to actual cases would have cut this estimate in half. Thus, people appear to respond to an epidemic by voluntarily engaging in self-protection behavior, but this behavior may not be responsive to objective measures of risk. Clearer risk communication could substantially reduce epidemic costs. People undertaking costly risk reduction behavior, for example, forgoing nonrefundable flights, suggests they may also make less costly behavior adjustments to avoid infection. Accounting for defensive behaviors may be important for forecasting epidemics, but linking behavior with epidemics likely requires consideration of risk communication.

General Purpose Graphics Processing Unit Based High-Rate Rice Decompression and Reed-Solomon Decoding

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

Loughry, Thomas A.

As the volume of data acquired by space-based sensors increases, mission data compression/decompression and forward error correction code processing performance must likewise scale. This competency development effort was explored using the General Purpose Graphics Processing Unit (GPGPU) to accomplish high-rate Rice Decompression and high-rate Reed-Solomon (RS) decoding at the satellite mission ground station. Each algorithm was implemented and benchmarked on a single GPGPU. Distributed processing across one to four GPGPUs was also investigated. The results show that the GPGPU has considerable potential for performing satellite communication Data Signal Processing, with three times or better performance improvements and up to tenmore » times reduction in cost over custom hardware, at least in the case of Rice Decompression and Reed-Solomon Decoding.« less

An effective model for ergonomic optimization applied to a new automotive assembly line

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

Duraccio, Vincenzo; Elia, Valerio; Forcina, Antonio

2016-06-08

An efficient ergonomic optimization can lead to a significant improvement in production performance and a considerable reduction of costs. In the present paper new model for ergonomic optimization is proposed. The new approach is based on the criteria defined by National Institute of Occupational Safety and Health and, adapted to Italian legislation. The proposed model provides an ergonomic optimization, by analyzing ergonomic relations between manual work in correct conditions. The model includes a schematic and systematic analysis method of the operations, and identifies all possible ergonomic aspects to be evaluated. The proposed approach has been applied to an automotive assemblymore » line, where the operation repeatability makes the optimization fundamental. The proposed application clearly demonstrates the effectiveness of the new approach.« less

NASA technology utilization survey on composite materials

NASA Technical Reports Server (NTRS)

Leeds, M. A.; Schwartz, S.; Holm, G. J.; Krainess, A. M.; Wykes, D. M.; Delzell, M. T.; Veazie, W. H., Jr.

1972-01-01

NASA and NASA-funded contractor contributions to the field of composite materials are surveyed. Existing and potential non-aerospace applications of the newer composite materials are emphasized. Economic factors for selection of a composite for a particular application are weight savings, performance (high strength, high elastic modulus, low coefficient of expansion, heat resistance, corrosion resistance,), longer service life, and reduced maintenance. Applications for composites in agriculture, chemical and petrochemical industries, construction, consumer goods, machinery, power generation and distribution, transportation, biomedicine, and safety are presented. With the continuing trend toward further cost reductions, composites warrant consideration in a wide range of non-aerospace applications. Composite materials discussed include filamentary reinforced materials, laminates, multiphase alloys, solid multiphase lubricants, and multiphase ceramics. New processes developed to aid in fabrication of composites are given.

Metasurface-based anti-reflection coatings at optical frequencies

NASA Astrophysics Data System (ADS)

Monti, Alessio; Alù, Andrea; Toscano, Alessandro; Bilotti, Filiberto

2018-05-01

In this manuscript, we propose a metasurface approach for the reduction of electromagnetic reflection from an arbitrary air‑dielectric interface. The proposed technique exploits the exotic optical response of plasmonic nanoparticles to achieve complete cancellation of the field reflected by a dielectric substrate by means of destructive interference. Differently from other, earlier anti-reflection approaches based on nanoparticles, our design scheme is supported by a simple transmission-line formulation that allows a closed-form characterization of the anti-reflection performance of a nanoparticle array. Furthermore, since the working principle of the proposed devices relies on an average effect that does not critically depend on the array geometry, our approach enables low-cost production and easy scalability to large sizes. Our theoretical considerations are supported by full-wave simulations confirming the effectiveness of this design principle.

Image Guidance in Radiation Therapy: Techniques and Applications

PubMed Central

Kataria, Tejinder

2014-01-01

In modern day radiotherapy, the emphasis on reduction on volume exposed to high radiotherapy doses, improving treatment precision as well as reducing radiation-related normal tissue toxicity has increased, and thus there is greater importance given to accurate position verification and correction before delivering radiotherapy. At present, several techniques that accomplish these goals impeccably have been developed, though all of them have their limitations. There is no single method available that eliminates treatment-related uncertainties without considerably adding to the cost. However, delivering “high precision radiotherapy” without periodic image guidance would do more harm than treating large volumes to compensate for setup errors. In the present review, we discuss the concept of image guidance in radiotherapy, the current techniques available, and their expected benefits and pitfalls. PMID:25587445

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.

Estimation of marginal abatement costs of CO2 in Chinese provinces under 2020 carbon emission rights allocation: 2005-2020.

PubMed

Duan, Fumei; Wang, Yong; Wang, Ying; Zhao, Han

2018-06-16

The calculation of marginal abatement costs of CO 2 plays a vital role in meeting China's 2020 emission reduction targets by providing reference for determining carbon tax and carbon trading pricing. However, most existing researches only used one method to discuss regional and industrial marginal abatement costs, and almost no studies predicted future marginal abatement costs from the perspective of CO 2 emission efficiency. To make up for the gaps, this paper first estimates marginal abatement costs of CO 2 in three major industries of 30 provinces in China from 2005 to 2015 based on three assumptions. Second, based on the principle of fairness and efficiency, China's 2020 emission reduction targets are decomposed by province. Based on the ZSG-C-DDF model, the marginal abatement costs of CO 2 in all provinces in China in 2020 are estimated and compared with the marginal abatement costs of 2005 to 2015. The results show that (1) from 2005 to 2015, marginal abatement costs of CO 2 in all provinces show a fluctuating upward trend; (2) compared with the marginal abatement costs of primary industry or tertiary industry, most provinces have lower marginal abatement costs for secondary industry; and (3) the average marginal abatement costs of CO 2 for China in 2020 are 2766.882 Yuan/tonne for the 40% carbon intensity reduction target and 3334.836 Yuan/tonne for the 45% target, showing that the higher the emission reduction target, the higher the marginal abatement costs of CO 2 . (4) Overall, the average marginal abatement costs of CO 2 in China by 2020 are higher than those in 2005-2015. The empirical analysis in this paper can provide multiple references for environmental policy makers.